Question for those familiar with medical billing: Was I upcoded?
I went to an Orthopedic to get a simple second opinion about neck\back pain and arthritis. I brought him an MRI, the report for the MRI, and X-rays from a chiropractor. I gave the nurse my MRI disc and report and the doctor was in to see in in five minutes. I explained my symptoms and he said I was fine. He put my XRAYS up and told me I was good. He stated my arthritis is very mild and it is normal for about 20% of people my age. He did a 2 minute examination of my reflexes and I pulled on his arms. I asked him about the pain and he suggested exercise, physio, and said that I did not need surgery thank god. He spent a total of 10, maybe 15 minutes (thats pushing it) face to face. The examination was brief. There was no “coordination of care” or “medical history analysis.” I would say the “medical complexity” was straightforward. I was an “in and out” patient. He billed me using code 99203. I feel as if 99202 or 99201 would be more appropriate based on what I’ve been reading about CPT codes. This was a “corporate doctor” and these codes were most likely generated by EMR software. I am a cash patient that was told the bill would be about $80 but was hit with a $120 bill. Was I upcoded?
This question is in the General Section. Responses must be helpful and on-topic.