Dear John: Here’s the background to the big Medicare and insurance rip-off that Congress must address.
Without getting too complex, doctors “code” visits so that they get paid for services they’ve provided.
Your first-ever visit to a doctor costs more because they’re going to spend more time with you, getting history, etc. So they’re going to get paid more than for a second visit, a follow-up that is shorter and less complex.
They have codes for these visits. Code 99213 is for office visits with established patients. The 99213 code was the second-most popular for internists in 2014, as it was used for 41.8 percent of visits.
Usually the presenting problems are of low to moderate severity. The reimbursement for that level of care is $73.40.
Then there is code 99214. That code represents the second-highest level of care for established office patients. This was the most frequently used code by internists in 2014, accounting for 47.4 percent of office visits.
The Medicare allowable reimbursement for this service is $108.13. Usually the presenting problems are of moderate to high severity. Visits get coded this way if two of the following three are done: a detailed history, a detailed exam or moderate complexity medical decision-making.
And there is the rub. Guess what can make one visit “low complexity” and another “moderate complexity.”
That’s right. A doctor prescribing a drug for you is the difference between billing $73 and billing $108.
President Trump and House Speaker Paul Ryan: Have you ever wondered why we see so many drug commercials? That’s right — so patients recall them.
How many folks heading into a doctor’s office ask the doctor if XYZ “is right” for them when XYZ treats everyday issues like light anxiety, occasional sleeplessness or, say, constipation?
We’ll guess it is a lot. Bam! A drug is prescribed and, hello — code 99214 and a bigger bill.
How about a one-month follow-up visit for…