Any medical billing and coding people who can answer a question?
and bump. 
Someone actually sent me a private message that was very helpful. But I’ll always accept sympathy, as this billing fiasco is almost as frustrating as having a kid who decided to swallow a screw
Can't answer about the coding.... if you don't know about them... PM pediatrics is open until midnight most days, the other one in Union is 10pm.
a screw is definitely something I would not wait overnight for....especially not know what kind....some have sharp tips...
Many years ago, a friend was in the car with her daughter when the daughter asked, “Mommy, what would happen if I had a jelly bean up my nose?” To which my friend replied, “Oh, but we would know not to put a jelly bean up our nose, because if that happened, we would probably have to go to the doctor and then...oh, no - you just put a jelly bean up your nose, didn’t you?” (Not helpful at all, I know, but it’s where my thoughts went when I read about your youngest’s “mishap.”)
jmitw said:
Can't answer about the coding.... if you don't know about them... PM pediatrics is open until midnight most days, the other one in Union is 10pm.
a screw is definitely something I would not wait overnight for....especially not know what kind....some have sharp tips...
We’re out in Hunterdon County. Though I told my husband that while the medical care at Hunterdon Medical Center is fine, if at all possible we’re avoiding that place like the plague from now on, and I’ll happily drive to Essex or Union Co. This is not the first billing mishap we’ve had with the ER Physician’s group, and from a local FB page this is apparently common
Formerlyjerseyjack said:
Did the FB people explain how they solved the problem?
Apparently repeatedly calling the billing company and talking to a brick wall
Hunterdon to Springfield might be about 45 minutes....check websites periodically, these places are popping up all over, they are a fairly new concept...different chains are getting in the game. the one in Union is https://kinderpeds.com/
dickf3 said:
What action resolved your problem, spontaneous?
None so far, they’re “looking into it”
What CPT code did the doctor bill? What is the charge?
What CPT code did the facility bill? What were the billed and allowed amounts?
Were you asked if you knew the composition of the screw prior to imaging being performed?
(side notes/drift, more sympathy)
Was this the same young gentleman with the ornament grenades and the ceiling incident? : )
Sorry to say, you may just have to keep pounding away at the insurance thing, just what you were looking forward to. One of ours put his elbow out of joint at an amusement park, but the problem resolved itself while the ER/urgent doc/tech manipulated his arm for x-rays, so the code was for "fall" only. Not sure we ever got reimbursed despite calls calls calls, letters etc. Hope yours goes better! (otoh the incident with the swallowed toll token that didn't show on x-ray was never a problem, everybody must have billed it right...)
Update
Last week I spoke with the billing company who assured me that they would “look into it” even though previous attempts at the same came up with zero results (I’ve lost count of how many times I’ve called them). I asked if the billing and coding person who insists it can’t be changed to anything else had a supervisor (yes) and if THEY could look at the doctors notes and how they were coded to see if the supervisor could see anything different. Considering that they even said the doctor’s notes mentioned my son swallowing a screw, saying it can only be coded as a “routine visit” doesn’t make sense, so they said they would ask the supervisor to take a look. I’m not holding my breath on that though.
I also asked if they could contact the doc to see if he maybe left anything off of the notes that could help. They said they don’t contact the doctors because doctors see so many patients that there is no way they would remember this one and whatever is in his notes is all they have to go by. Period.
The doctor does not have an office, he only works out of the ER. Getting desperate I had sent him a letter explaining what had happened. I missed his phone call, but he actually called me back and left a voicemail, he remembers my son (I’m guessing screw eating 4 year olds aren’t a dime a dozen 
) and that there is no way the visit should have been billed as “routine” because it was anything but. He said his manager is contacting the billing company to straighten this out, and that if I don’t hear back from the billing department in a few days then I should contact him again. I really did not expect an answer, ER doctors are busy under normal circumstances, and now they’re even busier, so I’m very grateful that he took the time to read my letter and is trying to help get this resolved
And yes, this is the same child who put his head through the ceiling, though luckily in that incident the only damage done was to the house 
December we got into a bad car accident, and we all went to the ER as a precaution. His first visit. Late December he swallowed the screw. Second visit. February we were at the bowling alley and when I turned my back for one minute he decided to pick up and walk with a bowling ball, tripped, and smashed his finger so bad that it split open and the bone broke in three places. At that visit I just asked the ER staff if they had any frequent customer cards so that after ten visits I could get the 11th free 
My endocrinologist, who finally opened up and is now seeing patient via telemedicine, was laughing his head off when I told him about it. He said that in the country he grew up in most injuries weren’t treated at an ER, but that he was a super active child and always managed to injure himself severely enough that he was the exception, and that after awhile his mother actually knew all the orderlies by name
My youngest swallowed a screw a few months back. It was after office hours and after urgent care hours, so we took him to the ER like most halfway decent parents would. The screw was not found on the x-ray, the doctor said if it was plastic it wouldn’t show up.
The billing company insists on billing this visit as a “routine visit” which of course the insurance company refuses to pay. The billing company even admits that the doctor’s notes state he came in for swallowing a foreign body, but because his notes also state it wasn’t found on the x-ray that they can only use “routine visit” for the code and refuse to budge
Oddly enough, the hospital’s bill for the SAME visit was paid within 10 days of being submitted, so I’m guessing the hospital’s coders came up with a different code than the doctor’s coders
So anyone in billing and coding, if a child comes into the ER and tells the doctor that they swallowed a screw, but the screw is not found on the x-ray, are they correct that the ONLY code that can be used is “routine visit”? This just doesn’t seem right to me