7/8/09: Don’t Bundle up!!

Evidently the insurance companies never listened to their mothers when they went out to play in the winter. You can’t “bundle procedures…”

So let’s say you have couple skin lesions you are concerned about and you make an appointment with a dermatologist and you say:

Pt.: “I have a couple moles on my back and on my arm, as well as a wart on the bottom of my foot.”

Me: “No problem, I can take care of those. I can do a shave biopsy of the moles, and I can freeze the wart with liquid nitrogen. But not today.”

Pt.: “Why not?!?”

Me: “The insurance companies will pay for a “clinical evaluation,” and they will pay for a “surgical visit,” but will not pay for both if they are on the same day.”

Pt.: “Ok… so I will schedule an appointment tomorrow.”

Me: “Great, which procedure do you want done tomorrow.”

Pt.: “What do you mean ‘which procedure,’ can’t you do them all tomorrow?”

Me: “These are 2 different types of “surgical procedures” and your insurance will only pay for one procedure a day.”

Pt.: “Ok… so I will have you take the moles off tomorrow and then do the wart the next day.”

Me: “Great, which mole do you want taken off tomorrow?”

Pt.: “What!?!” usually staring in disbelief at this point.

Me: “Since the nevi, or ‘moles,’ are the same billing code we can’t do the shave biopsies on multiple body parts on the same day, or the insurance won’t pay for it (sounding like a broken record at this point). We can do all the nevi on your back one day and the ones on your arm another day.”

Pt.: Ok, lets remove the moles on my back tomorrow, the ones on my arm the next day, and the wart the day after.”

Me: “Well… actually we have to wait 2 weeks between doing the shave biopsies on the nevi because they are the same diagnosis codes. We can do the shave biopsy of your back tomorrow, freeze the warts the next day (because it is a different diagnosis code), and do the shave biopsy on your arm in 2 weeks.”

…and so it goes with almost every new patient. If you do have multiple types of clinic visits or procedures in 1 day the insurance company simply picks the least expensive procedure or visit and covers that one but not the other. I think the goal of this scheme is to not allow a provider to do excessive and “unnecessary” procedures in 1 visit. I think the underlying goal is to frustrate the patient so much that they simply do not return for the procedures and then the insurance companies get to keep your money. Either way, all of these hoops that we all have to jump through are designed to keep money in the pockets of the insurance companies.


We as providers aren’t completely in the clear from all of this billing fiasco that our medical system is now deeply entrenched in either…

So lets say you come in to have a spot checked out on your forehead that has been concerning you. I take a look at it and say I’m not sure what it is but it would be a good thing to freeze it off. I can code for the “destruction of a benign lesion” and receive $300 for that procedure. OR… I can code for “destruction of a PRE-CANCEROUS lesion” and receive $700 for doing the exact same thing. If you are a business owner and you can sell an “apple” for $300, or you can sell the same thing as a “golden delicious apple” for $700, which one do you think you would sell??


Pretty soon everyone in healthcare will all be working for the Government in some form or another and we will be able to trade one bucket of issues for a whole new bucket of problems; but at least they will be different problems…