"Closed treatment" charge for wrist fracture evaluation
My daughter fell when she was playing basketball and her wrist was in pain. We went to pediatric urgent care where they did an X-ray, they said it is a minor wrist fracture and they put a temporary splint. However they referred us to a orthopedic for further evaluation.
We went to the ortho specialist the next week. The provider reviewed the X-ray and touched my child's hand to see if she is in pain. She then confirmed what the urgent care said, and they just gave us a removable brace (not a cast).
My insurance was billed for CPT code 99203 (office-outpatient visit) AND CPT code 25600 (which I see it is a non-surgical procedure – "closed treatment" to the wrist). This CPT 25600 charge alone costs $980 after insurance/deductible (the office visit is another $292).
My main objection is the 25600, since no procedure was done in the visit. I see in the visit notes the doctor wrote "immobilization – closed treatment with an exos brace x 4 weeks". Obviously, the "closed treatment" phrase was interpreted by the billing department as the CPT vode 25600. I contacted billing to dispute this charge, and they said that since "closed treatment" is written in the visit notes, the charge is correct.
What happens in this case? I am trying to contact the doctor who claims she did a "treatment" (she only touched the hand for a few seconds to see if my child has any pain) but what happens if she insists that she did a treatment? Should I go and report her for fraud? What are my options?
submitted by /u/bomberb17
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