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Thread Topic: Charging Office visit at same time of wound repair...
Topic Originator: Ralph Heath
Post Date July 3, 2008 @ 7:34 AM
Charging Office visit at same time of wound repair...


Ralph Heath
July 3, 2008 @ 7:34 AM Reply  |  Email Friend   |  |Print  |  Top

I was curious to know if it is legal to charge an office visit with a wound repair when the only diagnosis is for the wound repair.

Please share your comments....

Steve Verno
July 4, 2008 @ 8:10 PM Reply  |  Email Friend   |  |Print  |  Top

There is NO State or Federal law regarding this issue so whether it is legal or not cannot be answered.  Maybe the question should be, is it ethical to bill an OV and wound repair.  

many carriers deem the repair to be included with an E/M which is contrary to NCCI edits.

SO, here is a question, if the patient came in with an open wound, what justifies the office visit.  The wound repair is supported by the open wound dx.  

I once got into an argument with the medical director of the practice for biling a wound repair and a 99215 with a minor open wound of the toe. When asked about rhe 99215, the medical director said the doctor did a head to toe exam. My response was, was it medically necessary to to a complete system exam with a minor toe wound. I also knew that there was not a comprehensive systems review documented or even asked because i was present for the visit. It was an exam of the toe and then a couple of sutures.  He finally agreed that a 99215 was not necessary or supported by the documentation when i went over the chart with him.  MY insurance denied the 99215, so they were billing me for the charge because they werent contracted with my insurance.  So, be careful.



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