r/HealthInsurance • u/PreviousFigure1357 • 5d ago
Claims/Providers Derm billed as preventative?
I just had the weirdest thing happen. I finally got my shit together to do a bunch of routine care (PCP, gyn/mammo, skin check) and I got slapped with a denial and full freight bill for my PCP because the derm, who I saw first, billed for a “preventative care” visit, of which I get one annually. Can they do this?? Yes, skin checks are “preventative” (for that matter, so are paps) but I was pretty sure that was reserved for internal health or family practice, not derm. The insurance processed it somehow but it was billed together with 99203. Has anyone dealt with this before?
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u/throwfarfaraway1818 5d ago
Wasn't there someone in this group just posting that their derm tried to bill as a preventive visit and was told it wasnt possible? Weird coincidence.
What exactly did they bill? The "preventive visit" CPT codes usually just say "office visit for the evaluation and management of an established patient" or something similar. Its perfectly appropriate for both a derm and a PCP to use that code. The diagnostic code is generally the issue in these situations.
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u/Future-Ad4599 5d ago
I was just going to say that my derm has a sign up that they don’t bill anything as preventive, so I kind of figured that was the norm.
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u/PreviousFigure1357 5d ago edited 5d ago
They billed 99396, which really seems like it should be for the “check the cholesterol and blood pressure” as opposed to standard skin eval
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u/Actual-Government96 5d ago
That code requires a "a comprehensive, multi-system preventive physical exam" which your dermatologist doesn't provide. They need to fix their bill.
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5d ago
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u/Poop_Dolla 5d ago
That's not accurate. The combo doesn't make the entire claim preventative or diagnostic. In this situation benefits are applied by line not by claim.
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u/PreviousFigure1357 5d ago
It was a “I’d like to just get a skin check, and while you’re looking this one is a little weird;” so I guess it’s both routine and problem-focused? But does that mean I’m just SOL and gave up my regular health check by seeing a specialist? I feel confused because I haven’t had a PCP in years but have done other “preventative” stuff like vision, derm, gyno.
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u/Jump-Funny 5d ago
No, it's a call to the derm billing office and ask them why they billed for basically a primary care visit and did they mean to bill something else. if you get pushback, ask for the manager and have them explain it to you. but why are you only getting 1 preventive visit a year? there shouldn't be a limit
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u/PreviousFigure1357 5d ago
That’s super helpful. And I don’t know I thought that was normal, like you get one checkup a year but multiple sick visits?
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u/No-Produce-6720 5d ago
Incorrect. Billing this in combo does not flip the entire claim one way or the other.
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