09/09/2024    

RESPONSES/COMMENTS (FROM PM's CURRENT ISSUE)

RE: Prior Authorizations (Paul Kesselman, DPM)

From: Jon Purdy, DPM

 

I have felt the recent impact of insurances pouncing on DME dispensing. It would be wonderful if doctors didn’t have to pull money out of their pockets for patients in “hopes” the items will be covered. Too often we find out a new requirement buried layers deep in the initiatives or one of the carrier regulations has changed leaving us holding the bag. Then there is the inadvertent “T” not crossed that hits us in the wallet.

 

I think it would be wonderful if a doctor could submit all paperwork as a prior authorization and a determination be made then and there. However, I have not seen this in reality. With other carriers and Medicare, denials even after prior authorization are all too common. I’ve appealed items to the level of the ALJ, and had actual apologies from the judge after they noted every last requirement had been met from day one.

 

This is no surprise. The system is designed to discourage physicians from helping their patients with appropriate modalities when it takes monies from the program coffers. The public needs to wake up and realize this is their money that was taken from them, and now controlled by an entity that considers it theirs. When physicians no longer take Medicare, tell patients they no longer dispense DME, and the modalities take weeks to approve, maybe it will make a difference in the voting public.

 

Jon Purdy, DPM, New Iberia, LA

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08/25/2015    

RESPONSES/COMMENTS (FROM PM's CURRENT ISSUE)

RE: New and Modified CPT Codes for 2015

From: Marc Jay Pinsky, DPM

 

Dr. Goldsmith correctly points out, in his recent article, the documentation needed to medically justify and bill for the U.S. guided injections into a joint (CPT 20604, 20606). All that they pay you is an approximate additional $30. Is it worth the risk of loss of time needed to get together medical justification and chart info (for a medical claim review) for such a small additional payment?  Not to me – I don’t even list these CPT codes on my office superbill.  

 

I’ll reserve my limited use of U.S. guided injections for deep bursae and cysts and/or neuromas – CPT 76942, where it is worth my time and effort and the medical justification is easily apparent. It is bad enough that they only reimburse a limited U.S. exam -CPT 76882 (.i.e., for plantar fasciitis) at less than $36. Please don’t insult me with less than $30 additional for adding U.S. to a joint injection (– you will get a larger reimbursement for "just looking" at the joint)!

 

Marc Jay Pinsky, DPM, Petersburg, VA