Issue with PCP wellness visit coding, possible billing fraud. Is it pragmatic to even continue fighting this?

I went for a wellness visit. They stated the visit was to establish myself with a new PCP and get medication refill. They billed as a 99204 (new patient comprehensive visit). There’s multiple issues.

First, I am already an established patient of the doctor, seeing her last year. The office states since she joined a new practice, I’m a new patient. They stated it’s their office policy to do this. I already read through the CPT guidelines and I know this is improper. Regardless of other information, 99204 is not the appropriate code.

Second: On the claim they sent to my insurance and in the patient summary they provided, they listed several diagnostic codes that they said were discussed. All of these were copied verbatim from my previous visits with the doctor. I have no way to prove we did not address these at time of visit and they already falsified the record to say they did. No notes or tests were included. Based off these falsified records, they can justify this was a diagnostic office visit. How the heck do I fight that?

The only truth is that two repeated prescription refills for two stable chronic conditions were sent to the pharmacy. These were not claimed to my insurance though. From my point of view, this was a wellness visit where they also provided a prescription refill. The refill was not the purpose of the visit.

I know prescription refills aren’t part of a preventive exam, but the CPT guidelines also say it’s not appropriate to report non-significant and trivial things separately. It’s very unclear what is the appropriate billing. Some argue repeated prescription refills for stable chronic condition are insignificant, others say it’s a low level service, others say it’s a moderate level service. Others are saying it’s a moderate level service if the doctor reports evaluation metrics in deciding to refill the medication or the very act of refilling it a prescription constitutes moderate. No discussion of these drugs took place beyond asking me what pharmacy I wanted them sent to, though I have no faith the office won’t just falsify that record too.

So how should I go about fighting this or is it a lost cause? Seems like they have options to rebill this as an established patient preventive exam with the option to use am e/m modifier 25 to also bill for the prescription drug refill. What would the appropriate code be for the prescription drug?

Do I gain anything by getting them to bill as a wellness visit if they’re going to also bill separately for the prescription drug? Or should I just drop the wellness visit argument and pay for a prescription drug visit. I don’t know if e/m modifier with the free preventive visit would be cheaper.

Am I even saving money getting them to re-bill it? I got charged $150 after insurance discount (high deductible). No doubt I got upcharged for the new patient part. However, the 99204 is a moderate 45-60 minute evaluation code. If prescription drug refill is also considered moderate, the only cost savings would be on new vs established, right?

I already talked to my insurance. They don’t care. As far as they’re concerned, the visit was covered and they stated they do not investigate the truthfulness of the claims, they only review what the provider submitted as-is.