There are numerous occasions when a consultant can charge for a follow-up consultation when performing minor surgery.
But it is important to understand which private medical insurance companies will allow such a combination and which won’t.
This is important because you could be missing out on a fee.
Combination Codes
Take CCSD Code W9040 – an injection into soft tissue – as an example.
Insurance company A says a W9040 attracts a fee of £50 and will allow it to be charged alongside a £150 follow-up.
Insurance Company B says a W9040 attracts a fee of £108 but will NOT allow it to be charged alongside a follow-up.
So…
The total charge for W9040 with Insurance Company A = £200
The total charge for W9040 with Insurance Company B = £108
Charges may differ
If the consultant surgeon does not realise Company A will allow a charge for the follow-up as well and only charge the W9040 fee of £50 they will be £150 out of pocket.
Don’t expect the Insurance company to correct your error.
They won’t. Why should they? It’s your job to ensure your invoices are correct.
Curettage of lesions
Another example: CCSD Code S0820 – a curettage of lesions
Company A says an S0820 attracts a fee of £325 but will NOT allow it to be charged alongside a follow-up consultation
Company B says an S0820 attracts a fee of £107 and WILL allow it to be charged alongside a £150 follow-up consultation
So…
The total charge for S0820 with Insurance Company A = £325
The total charge for S0820 with Insurance Company B = £257
Once again, if the consultant surgeon does not charge Company B for the follow-up AND the episode he or she will immediately be £150 out of pocket.
Check the Charges
To further complicate matters, and using the S0820 as the example, note that Company A set the fee for the S0820 only to be £325. Company B set the charge at £257.
If in error, the Consultant Surgeon charges company A with £257 (company B’s fee) then the consultant surgeon will undercharge. They will only be paid £257.
That is what they have asked for and that is what they will be paid.
It is vital if a consultant surgeon is to maximize the revenue generated by his practice that he understands what he or she can and cannot charge for.
He or she must also understand fees can and do differ between insurance companies.
pete@medicalhealthcaremanagement.co.uk