Procedure Codes

I suppose one way providers can fight back while being paid 20% of their billed rate for services is by skillfully working the procedure codes.  I may be wrong, but I suspect this may be the case.   The thought never occurred to me until yesterday when I got the approval from Healthfirst for the minor surgical procedure I had two weeks ago.

I had diagnosed the tiny cancer cell on my nose myself.  I had only felt that intermittent slightly stabbing pain twice before.   Each other time it had been a basal cell on my nose.   The growth was so tiny that neither the dermatologist nor the surgeon she sent me to could actually see it.   I pointed to a spot on the bridge of my nose under which the basal cell, its visible part about the size of a pinprick (if the pin is very sharp), was slowly growing.  The surgeon told me that since we’d caught it so early there would be no need for a skin graft, just a couple of tiny stitches that would leave no scar.

The surgery was painful, due, according to the red haired surgeon, to the skin sensitivity of people with red or reddish hair (my beard, before turning white, was red).  It turns out the surgeon had made a slit the length of my nose, dug out the basal cell from underneath, and left a line of large black stitches about the size of an eyebrow, from my left tear duct to the top of my left nostril.   When I first changed the bandage I had a bit of a shock at the size of the incision to remove something smaller than the period at the end of this sentence.  Sekhnet, of course, had a theory about why the long cut was the right thing to do.

Tomorrow I go to get the stitches out.  Yesterday I received approval from Healthfirst for the procedure, which they informed me would be good between the two dates indicated (first date about four weeks ago, the second date rapidly approaching).   They approved five separate procedures:

17311  MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS

17312  MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS BY THE SURGEON, AND HISTOPATHOLOGIC PREPARATION INCLUDING ROUTINE STAIN(S) (EG, HEMATOXYL)  

13152  REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM  [1.02362″ TO 2.95276″ –ED]

14060  ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS-ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS NOSE EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS  [3.93701″]  

14061   ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS-ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS NOSE EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0 SQ CM  [3.93701 SQ INCHES TO 11.811 SQ INCHES– ED.]  

Could all be on the up and up, I suppose.  Until they start digging they don’t know if that tiny tumor will be less than an inch across or the size of 30% of my face.  Fair enough.  The rest of that stuff, I’m not sure about.  Maybe it explains why the incision came so close to my left tear duct, where the stitches start.   Maybe I am just so bitter about corporate medicine, and so aware of the psychopathic nature of the corporation, that I just suspect the worst from these “persons”.  As for the humans– I think about the surgeon’s failure to provide me with pain medication after a surgery she acknowledged was painful for me, as it would be for her,  But why be judgmental?

Still, you know, it makes sense, from the point of view of the provider, being squeezed and nickeled and dimed on their bills by powerful insurance companies, to bill for every possible procedure.  The eyelid adjacent stuff may be very lucrative, for all I know.  Who am I, who has never run a successful business, never been an entrepreneur, never had to answer to a room full of very wealthy, pissed off shareholders, to opine about anyone’s business practices?  

Hopefully there will be little pain tomorrow when I get the stitches out, that I won’t find it necessary to ask the surgeon any pointed questions, and that, true to her word, the long line of stitches will leave no scar.   Otherwise I’ll get me an eyepatch, and a parrot, and limp down the street cursing their salty, scurvy wives and unwashed ill-reputed mothers.   Arrrgh.

 

 

 

 

 

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