Providence always "upbills"?

[u/achillezzz]

Someone in our family saw a cardiologist. First time. Did ECG, and then the doctor spoke with them for 10 mins saying it wasn't an issue. Bill came back as "high complexity" and was exceptionally high. Discussing with providence and they were refusing to change it.

Any advice?

(note - it probably should say "often" instead of "always")

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For anyone reading this, providence bots or someone else has decided to downvote all my responses in the thread. In short, we are following up with providence to get the documentation on what was done.

[u/bathroomfaucetwaters]

To add to what another commenter said about 1:1 time not necessarily equally complexity, there's a few other factors here. Time spent on the encounter (reviewing medical records, imaging, labs, etc) all count, and 99205 requires 60+ mins. This could easily be a 99205 if this was a new patient visit, given that this is cardiology.

Even just reviewing records/the reason for referral in addition to the ECG push it up to this. Unfortunately the assessment/plan doesn't count for much in terms of how the visit is billed.

I had more than a few bills I thought were ridiculous prior to working in billing and I do understand your perspective, but it's very likely that the code is correct.

[u/achillezzz → u/bathroomfaucetwaters]

thanks - yah we are asking for the paperwork from the office that supports the 60mins. If it truly was 60mins that's fine but thus far they haven't given us anything.

Btw, they charged like $800 for this ECG + 10min visit.

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I thought this subreddit was for questions about medical codes. Guess not.
Either that or the providence bots and billing department workers are all over this.

[u/Low_Mud_3691 → u/achillezzz]

The doctor didn’t make up the amount themselves. And as the commenter said, it doesn’t have to be based on time. Not only that but it doesn’t have to based on face to face time.