Physicians to Children, Inc.

The patient was scheduled in our office for a routine preventive serviceDuring the course ofthe evaluation the physician addressed additional medical issues which expanded the servicesbilledThe initial service was billed with *** and additional services billed with *** withthe
supporting diagnoses.According to the American Medical Association CPT billing guidelines: "If an abnormality isencountered or a preexisting problem is addressed in the process of performing the preventivemedical evaluation and management service, and if the problem or abnormality is significantenough to require additional work to perform the key components of a problem-orientated E/Mservice, then the appropriate Office/Outpatient code *** should also be reported."The parent feels we should have notified him that there might be additional charges during thevisitSince the additional medical issues were identified during the visit, the physician electedto address those issues rather than asking the parent to return for another visitThe billingcodes are determined based on the service provided not predetermined prior to the visitItshould be noted that the parent who submitted the complaint was not with the patient at the timeof the visit.Our Compliance Plan requires an audit by our Certified Professional Coder (CPC) prior tosubmitting the claimThe documentation was reviewed by our CPC and found to be medicallynecessary and appropriate and the documentation supported the billingWhen we received thecall regarding the billing, the CPC discussed the parent's concerns with the physician who notedthere was additional time spent addressing the medical issuesAfter receiving the letter fromthe Revdex.com advising us of the complaint, we forwarded the chart documentationto an outside consultant who audited the documentationThe consultant reviewed the medicalrecords and determined that there were diagnoses and complaints addressed above andbeyond the service related to the preventive health visitTherefore it was considered appropriate to bill for the established office visit in addition to the preventive visit, since this additional charge focused on separate issues.The services were billed to the subscriber's insurance and contractual adjustments madeWe feel the service was billed appropriately according to AMA CPT coding guidelines and thereforedecline additional adjustments.We value this family's long-standing relationship with our practice and we regret this issue has caused the parent to call into question the appropriateness of the services providedShould theparent wish to transfer to another practice, we will be happy to provide an authorization totransfer records

Love this pediatric office . Dr. Nelson is amazing

Review: My daughter had an appointment for a physical, nothing more. There is no charge on our end for a physical. It is covered by our insurance. We were shocked to receive a bill for $83.01. My wife tried calling them back in December with no success resolving this issue. So I called them a couple of weeks ago asking for them to resolve this issue. They told me that there was extra services done during the physical that created the charge. I asked them what was done to create a $83.01 charge. I was very shocked to say the least at their answer. They said that my daughter had a heart murmur and scoliosis check. Now my wife asked the doctor if she thought it was a possibility that my daughter could have this. All the doctor did was run her finger down her spine and "referred" her to a specialist. Now for the so called heart murmur part. The doctor asked my daughter if she was breathing heavy during exercising, etc. What kind of question is that. Everyone breathes heavy during exercise. Now for this, she had my daughter fill out a sheet with questions about her heart/breathing.....that's it!! All of this was done without an adult in the room as well. My daughter at the time was 13....a minor. The doctor at no point ever told us (adults or the child) that these would be "extra" services or charges. We thought this was what a physical was supposed to do. Ask the doctors questions during a check up. We also thought they were supposed to check/listen to your heart and check your blood pressure. My wife and I have our physicals and are NEVER charged for this stuff. My wife and I both work insurance and we have to by law fully disclose all extra services/coverage's that could increase the premium before completion. I feel this doctor should have disclosed this to us up front before the services were done. Why am I going to pay for a so called service and then have to go to a specialist after that and pay again?? We just received another letter saying that we needed to resolve this with our insurance company. That is not going to happen. The insurance company just sees the codes that the doctors office sends them to bill us. They have no idea what happened or was done during the visit. The doctor can put down any code they feel like and we would have no clue what they are because we don't have access to these codes. Thus causing the surprise of the bill that we received. My children will no longer be going to this office. I have talked with other parents who take their children down here and they also say they have issues with their billing. The lady I spoke to said that the services included have changed somewhat for physicals at their office. Once again this should have been disclosed up front to us (the adults) before any "extra" services were provided or even entertained. A 13 year old child has no clue about billing, etc. I told the lady...who was very rude by the way....that we never received a letter stating physicals have change. Like I said it has to be at this office, because my wife and I were never charged for extra services this year at our physicals and I know I asked numerous questions at mine.Desired Settlement: I want this charge removed. I am not paying this bill as we took my daughter for a "physical"!! I have never heard of being charged $83 for running your finger down a spine and for filling out a piece of paper. That is highway robbery. I do not know how this is even legal to charge/invoice someone for something that was never fully disclosed up front. This is like hidden fees you are not aware of. This place has lost our business period and I will be sure other parents are aware of this as well. Thank you.

Business

Response:

The patient was scheduled in our office for a routine preventive service. During the course ofthe evaluation the physician addressed additional medical issues which expanded the servicesbilled. The initial service was billed with [redacted] and additional services billed with [redacted] withthe supporting diagnoses.According to the American Medical Association CPT billing guidelines: "If an abnormality isencountered or a preexisting problem is addressed in the process of performing the preventivemedical evaluation and management service, and if the problem or abnormality is significantenough to require additional work to perform the key components of a problem-orientated E/Mservice, then the appropriate Office/Outpatient code [redacted] should also be reported."The parent feels we should have notified him that there might be additional charges during thevisit. Since the additional medical issues were identified during the visit, the physician electedto address those issues rather than asking the parent to return for another visit. The billingcodes are determined based on the service provided not predetermined prior to the visit. Itshould be noted that the parent who submitted the complaint was not with the patient at the timeof the visit.Our Compliance Plan requires an audit by our Certified Professional Coder (CPC) prior tosubmitting the claim. The documentation was reviewed by our CPC and found to be medicallynecessary and appropriate and the documentation supported the billing. When we received thecall regarding the billing, the CPC discussed the parent's concerns with the physician who notedthere was additional time spent addressing the medical issues. After receiving the letter fromthe Revdex.com advising us of the complaint, we forwarded the chart documentationto an outside consultant who audited the documentation. The consultant reviewed the medicalrecords and determined that there were diagnoses and complaints addressed above andbeyond the service related to the preventive health visit. Therefore it was considered appropriate to bill for the established office visit in addition to the preventive visit, since this additional charge focused on separate issues.The services were billed to the subscriber's insurance and contractual adjustments made. We feel the service was billed appropriately according to AMA CPT coding guidelines and thereforedecline additional adjustments.We value this family's long-standing relationship with our practice and we regret this issue has caused the parent to call into question the appropriateness of the services provided. Should theparent wish to transfer to another practice, we will be happy to provide an authorization totransfer records.