Hockey, that's why we no longer do PnPs. You pretty much explained why Vicky no longer does them for me, thank you. But we had a nice one the other day. A women went to her gyn for her "well woman exam." Found a breast lump. Did the Gyn refer her to a breast surgeon? NOoooooo! Refered her to a PCP (us) presumbably so she doesn't have to generate the referral and verify that she went to see the surgeon.
We usually get $125 for the Gardisil vaccine, plus the administration fee. I have determined that this is not worth giving. It a total of $133 or so reimbursement this causes "Cash Flow Problems" for the practice. I think we should write a Rx for it, let the patient pick it up, and then only charge for administering it. Vicky likes to give the vaccines so that she can turn the visit into more by asking about some other problems that the patient may have been having. I think its better to skip the vaccine and just have a different patient who is sick come in.
Medicare only pays for one "introduction to Medicare" physical, but since the patient will have a deductible the patient pays for it anyway.
We also code the 99385 and address another issue by using a -25 modifier w/the 99203 or whatever. This is exactly how the CPT book says it should be done and Medicare honors this. But coding by the CPT book seems to required of doctors, while paying by this coding seems to be an "option" for the 3rd party payers. So Aetna, GHI, and HIP of NY will pay this way, while BCBS/Wellpoint, Cigna, UHC, Oxford, and Healthnet won't. HIP and GHI make the patients pay an additional copay as if it was a second visit. And the patients argue about it too. They say "we didnt address that" we say "Huh? I wrote you an Rx and/or referred you to a specialist."
