My Doctor Is Coding The Procedure As An Outpatient Surgical Procedure Which Generates A $250 Copay For Me. I Think This Should Be Coded Differently
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Outpatient surgical procedure vs physician office visit with medication administration. There is a big difference in cost to the patient and insurance. Manufacturer lists this as a subcutaneous injection/implantation. It is done with a needle. My doctor is coding as outpatient hospital or surgical center procedure but his office is neither of these. Any advice? I am faced with $250 copay 4x a year. Thx

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Well a Doctor can most certainly perform outpatient surgery and the ICD Codes ever changing are sometimes limited. This was most certainly not a routine doctors visit when you think about it. I'd call your Insurance carrier and see what they say, perhaps they could provide a better code. Also you can always Google ICD codes although good luck!

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Hi Sean,

Looks like quite a predicament going on there between the definition of a surgical procedure and a simple inj. If you could, I would probably encourage you to speak with the front representative at your doctor's office and inform them of the mistake being made before it's too late to have a say in the matter.

Webster's dictionary defines 'surgery' as - "a medical treatment in which a doctor cuts into someone's body in order to repair or remove damaged or diseased parts." However, because this is not the case for your situation, you should be able to dispute the way they interpret it at the office.

Perhaps a second or third opinion from a medical professional will also add validity to your case if necessary.

I hope this helps!

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