Removing a wee splinter? Treating a wart? If a doctor does it, it can be billed as surgery.
||| FROM THE WASHINGTON POST |||
Assuming the bill was a mistake, she called the doctor’s office and was told that surgery had indeed occurred — because the skin was broken in the process. Hence surgical CPT Code 17110, “destruction of 1-14 benign lesions.”
But more and more minor interventions have been rebranded and billed as surgery, for profit. These tiny interventions don’t yield huge bills — in the hundreds rather than the thousands of dollars — but cumulatively, they probably add up to tens of millions if not hundreds of millions of dollars for doctors and hospitals annually. The surprise bills often catch patients off guard. And they must pay up if they haven’t met their insurance deductible. Even if they have, “surgery” generally requires a coinsurance payment, while an office visit doesn’t.
“There’s more pressure to make money, and the idea is you can charge more if it’s a surgical procedure,” said Sabrina Corlette, founder and co-director of Georgetown University’s Center on Health Insurance Reforms. “The payer should be reviewing this and saying, ‘This is a run-of-the-mill.’ But there’s not a lot of incentive to do that.”
Corlette surmised that the codes employed in the instances mentioned above were intended for rare, complicated cases where the removal of a splinter or a skin lesion — or 14 of them — required special skills or time. But the codes’ use has ballooned, covering the complicated and the commonplace. The use of Code 17110 billed from doctors’ offices has gone up 62 percent from 2013 (1,739,708) to 2022 (2,817,190).
The blizzard of surgeries-in-name-only is a symptom of a system that has long valued procedures far more than intellectual work in its payments to medical providers. That merits rethinking, and there are some hints that the incoming presidential administration might be interested in doing so.
**If you are reading theOrcasonian for free, thank your fellow islanders. If you would like to support theOrcasonian CLICK HERE to set your modestly-priced, voluntary subscription. Otherwise, no worries; we’re happy to share with you.**
This has happened to me, twice. There is no recourse. Appeals fail. The doctor snipping the skin tag or giving a quick injection could, but doesn’t and is not obligated to, give one warning that a simple, optional procedure taking less than a minute will be cost hundreds of dollars. Why would they? They are paid to generate money for their employers, not to actually give a damn about patients. I am only grateful that most of them actually do care, and actually are extraordinarily skilled. But the System doesn’t care, and its skill is in dollar extraction.