Saturday, March 21, 2009

Publish The Medicare Billing Codes?

Dear Mr. President,

Could you help us elders fight Medicare fraud by putting the descriptions for billing codes and diagnosis codes up on the internet where we can see them?

I'm being forced to pay for my free PSA screening exam for the second year in a row due to clinic mis-billing. Please give me what I need to fight this.

My latest free PSA screening exam was billed with an obesity diagnosis code.

Medicare rejected it as not medically necessary for obesity. Blue Cross agreed. It took me four days of research online to discover that the correct billing for these PSA annual screenings is
HCPCS screening code G0103 in company with ICD-9 diagnosis code V76.44
My clinic's Medicare billing coder steadfastly refuses to use this V76.44 code. He has now submitted my latest test's billing a third time without it.

He tries instead to use case management diagnosis codes. He sends the bill to the diagnostics service, they then put CPT treatment code 84153 on the billing - their web site has no mention of G0103, but it preaches 84153 - and it fails every time for screenings. Eventually, dunning letters close the box. This is happening here in Hyde Park, Chicago, IL.

To me, maybe to many.

When Medicare rejects a billing, the insurers are freed of obligations, and poor old men have to pay. We cannot fight numeric codes. Can you please set a visible and understandable public standard for these codes?

Can you chisel them on a column?


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