Paying for fills

sheelk · July 21, 2007

My surgery will be on July 30th - HOORAY --

When I saw the doctor I was told that insurance (Medicare) will pay the hospital fee for having fills in the x-ray department, but that there is no insurance code for the doctor's fee for the fill. Therefore, I must pay the doctor his $175 fee for each fill before it is done. Does anyone have any more information about this? Do anyone know if there is an insurance code for the doctor's portion of the fill procedure. What is being done in your part of the country????

Any help will be appreciated.

Thanks

Sheila

DebLPN · July 21, 2007

Wish I could help, but I was a self-pay and all my visits and fills were included in my global fee. I'll ask next Thursday when I go for my doctor visit and see what they do to bill for a fill. banded 1/29/07 Dr Ken Cleveland-CMMC-Jackson, MS

sheelk · July 21, 2007

Deb - thanks for the help.

To clarify the question:

I am told that the fills will always be done in the x-ray department of the hospital and will be paid for by Medicare (because there is a cpt code for the hospital to use.)

What I am being told by my doctor's office is that there is no code for the doctor to use to file his claim with Medicare. It makes no sense to me and I am trying to find out the real story. If your doctor's office has such a code and uses it, could you please find out what it is - or, in the alternative - get me their phone number so I can talk directly to the insurance person in that office.

For your information, someone on another message board posted that they think Medicare is in the process of correcting this, but I don't know if it has done that yet.

It seems very strange to me that Medicare would pay for the entire procedure (hospital, doctors, anesthesia, etc - and require you to stay in the hospital overnight) and then not pay the doctor for doing fills.

Any help you can get me would be greatly appreciated.

Sheila

DebLPN · July 21, 2007

WOW,,it amazes me that he charges that much for a one minute simple procedure. All I do is lay down on a table in the examining room witha a smalll pillow underneath my waist, he palpates my port,,sticks it,,withdraws to check it,,injects a little then withdraws. Takes all of a minute or two. Of course, I dont know what he charges those that have insurance. Yeah,,I worked in the health insurance industry for 24 years bofore going back to school for my LPN. ICD-9 and CPT-4 codes are constantly being up[dated as new procedures come along,,alot of the time they cant keep up with all the new procedures but eventually develope a code. Take a look at this site,,it give s a Medicare HPCPS code for the fill(see page 24 at teh very bottom)

Adjustment of gastric band diameter – use the HCPCS code S2083

ANYWAY,,,,,here is Dr Cleveland's office number, I dont know who does the insurance there:Phone: (601) 376-2474 or 1-877- LIGHT WT (877-544-4898)

Email:lightwt@cmmc.hma-corp.com

Good luck!!

sheelk · July 22, 2007

Hi Deb - thanks for taking the time to research the information for me. I will copy your post and talk to the office staff at my doctor's office regarding the code S2083.

You say: "Take a look at this site,,it give s a Medicare HPCPS code for the fill (see page 24 at teh very bottom)

Adjustment of gastric band diameter – use the HCPCS code S2083" but you did not give me the site. Perhaps if I could copy that page, then I would have more ammunition when I present the info to the doctor's office.

Again, many thanks -- and have a great weekend

Sheila

lyndalafe · August 6, 2007

Saw your conversation on this.............what site do we go to in order to find out this information.

You would think the doctors would know the code and put the right one on the form?

Mine doesn't put any information on it because I pay, of course, for it myself.

DebLPN · August 6, 2007

HCPCS

Codes

Description

S2083

Adjustment of gastric band diameter via subcutaneous port by injection or

aspiration of saline

ICD-9-CM

Diagnosis

Codes

Description

250.00

Diabetes mellitus without mention of complication, type II or unspecified type, not

stated as uncontrolled

250.02

Diabetes mellitus without mention of complication, type II or unspecified type,

uncontrolled

278.01

Morbid obesity

401.0 – 401.9 Essential hypertension

Page 20

Page 20 of 28

Coverage Position Number: 0051

414.01

Coronary atherosclerosis of native coronary artery

416.0

Primary pulmonary hypertension

416.8

Other chronic pulmonary heart diseases

574.00-

574.91

Cholelithiasis

575.10

Cholecystitis, unspecified

997.4

Digestive system complication

V45.3

Intestinal bypass or anastomosis status

V85.35

Body Mass Index 35.0-35.9, adult

V85.36

Body Mass Index 36.0-36.9, adult

V85.37

Body Mass Index 37.0-37.9, adult

V85.38

Body Mass Index 38.0-38.9, adult

V85.39

Body Mass Index 39.0-39.9, adult

V85.4

Body Mass Index 40 and over, adult

Experimental/Investigational/Unproven/Not Covered:

CPT* Codes

Description

43845

Gastric restrictive procedure, with partial gastrectomy, pylorus-preserving

duodenoileostomy (50 to 100 cm common channel) to limit absorption

(biliopancreatic diversion with duodenal switch)

HCPCS

Codes

Description

No specific codes

ICD-9-CM

Diagnosis

Codes

Description

All codes

*Current Procedural Terminology (CPT

®

)

©

2006 American Medical Association: Chicago, IL.

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