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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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Having
blood drawn is a procedure, not an office visit
July 16, 2004
Q:
I
called my doctor to make an appointment for a cholesterol
and triglyceride test. I have this test several times
a year. I saw the nurse and she took my blood. I did
not see the doctor at that time. When I got the EOB
from Medicare it showed that I had the blood test and
an office visit.
I
called the billing clerk at the doctor's office for
an explanation. She said they bill an outpatient office
visit plus the test charges. I don't want to get my
doctor in trouble over this but do doctors bill such
charges just for blood tests? It cost me some money,
but I felt it was cheating Medicare. Medicare has enough
problems already.
A:
This
is a very difficult question to answer. Even though
Medicare has very specific criteria that each office
visit has to meet, it is still somewhat subjective.
The lowest level office visit does not require a physician
to be present. An office visit is an evaluation and
management of the patient's presenting problem. This
office visit usually takes about five minutes to perform
or supervise this service.
The
notes in your chart will verify what was done during
this visit. It could be a simple blood pressure check,
a weight check, or an instructional visit. Some service
must be performed to justify the reason for an office
visit charge.
Medicare
will say that if you went to your doctor's office and
only had your blood drawn, there was no office visit
involved. A blood draw, by itself, is a procedure, not
an office visit. If no evaluation and management service
was provided, then no office visit took place.
Call
the office manager and discuss this situation. You can
also talk to the doctor. Even though it is not a large
amount of money, you are still responsible for the twenty
percent of the office visit that Medicare does not cover.
You need to find out if an office visit was really involved
with your blood draw or not.
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