It's because she makes money as a plastic surgeon that she can even afford to take on the Medi-Cal patients who chew up days of her time for a total of $83.50. Of course the $83.50 does not include the equally pathetic amount she will be paid for performing the surgery and doing follow-up visits, but the principle is the same: there is no way she can consider caring for Medicare and Medi-Cal patients anything other than charity. The costs of maintaining her office, paying her staff, and paying the staggering amount in malpractice insurance she has to carry also aren't even touched by the money she makes from this charity care.
And what she says in her article about the problems of medical coding is true. She is billing a 99213, an extended visit, for the time she spends telling the patient about breast cancer options. That number implies that she's spending 20-30 minutes with the patient. The truth is she is spending far more time, perhaps an hour or so, and then may have to devote additional time to fielding phone calls from the patient. She should have billed 99215, a CPT-4 code involving much more time, but Medi-Cal would have rejected the claim altogether if she had.
You are either a provider or affiliated. You speak the truth. The "trusted" group of GYNs we use for our patient's just totally redid their services menu, from meet and potatoes to Botox, massage therapy, and pregnancy body molding (WTF?), among other things. Folks will pay cash on the head for these services, but boy, so much as misplace one digit on a ICD9 code and you will generate hours of misery for a patient and practice alike. This is everybody's problem, in the big picture.
They would have rejected it or perhaps even triggered an audit, which even if proven to be billing legitimately would chew up weeks of valuable time that could be spent tending to patient care and records.
The costs this doctor mentions are real. She must do her "a la carte" plastic surgery services to even keep the doors open for poorly paying patients or insurances companies.
A 99213 visit can be a short as 11 minutes if what you are discussing is complex or involves several "diagnosis groups". The surgical consult shouldn't be as low as a 99243 and the surgical follow-up visit shouldn't be a 99213 either. As soon as you invite in the family, you are treating more that just one patient. Unfortunately our system of medical care allows us to only bill for one patient at a time. Doctors must be good counselors as well as well as good clinicians.
"She should have billed 99215..."
And then years down the road face an audit from the insurance company with a request for repayment. Can't win.