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CPT99283 Dispute

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questionasking

New member
Hello,

I fell and heard a snap on the way down. Even though my knee was not impacted (fell on my butt), I definitely felt acute pain in my knee. Since I couldn't stand then and I was on a sidewalk far from any friends and family, I called an ambulance and got taken into the E.R.

I tore my meniscus over a decade ago because of a football injury in high school. I never had surgery because I wasn't insured back then and it sort of healed itself after a couple months. Ofcoarse my knee was never the same and as I got older, I've had off and on ligamentitis. I've only ever treated these conditions with rest, ice, compression and ibuprofen.

I've never had an MRI or visited an orthopedist before but my primary care physicians made the determination that I had that meniscus tear in high school and that I had ligamentitis more recently.

When I came into the ER, I told the doctor about my history and requested an anti-inflammatory and crutches because I couldn't put pressure on my leg until the inflammation went down. I also told him that rest/ice/compression/elevation would be enough to eventually get me back on my feet.

He insisted on an X-Ray. I rejected the X-Ray because there was never any impact to my knee and I was sure there was only soft tissue damage at best. I knew the "snap" as I called it was because of how my leg twisted awkwardly as I fell down. He kept insisting on the X-Ray so I told him that I was also concerned about the radiation exposure for what I thought was an unnecessary procedure. I also reiterated my request for an anti-inflammatory to settle my pain but he didn't have the assistants provide me with any, seemingly blowing off the request. I finally agreed to the X-ray but only on the condition that we would do an MRI afterwards because that could actually be used to diagnose my issue.

Then when I went to take the X-Ray ... the X-Ray tech insisted on contorting my knee in several different uncomfortable positions so they could get quality scans. In my experience, this period after the injury is the most important time to keep it still so this went against everything I've learned in my history of self treatment with primary care advise. After the X-rays were finished, my pain level went from a 2 to a 7. When I was brought back over the doctor, I requested the MRI. He then told me that they didn't do MRIs in the emergency room and that I would have to get that from my primary care doctor. It's as if all my protests to the x-ray and my conditional agreement had never happened. I really wasn't in the mood to have an argument so I just reiterated my request for an anti-inflammatory, which he finally requested. Then he promptly left.

At this point, the billing agent from the hospital came by and processed my insurance. I advised them that I was covered and employed and intended to pay the full bill but couldn't make any immediate payment because it wasn't good timing with my pay schedule. After she finished up, they told me that the doctor would be sending someone separately to do their billing. However, the doctor never came. Then one of the assistants said never mind because apparently he wasn't going to bill me. I assumed that he was so embarrassed by the whole process that he didn't want to have that conversation. I did however, receive his recommendation in a 4 page document that surprisingly .... said only to rest, ice, compress and elevate.

Then I received the bill with CPT codes 99283 for a level 3 evaluation .... why is this a level 3 evaluation if the doctor came to the conclusion that I suggested when I first spoke with him? This charge was $1,016.

Furthermore, I was billed for CPT code 29505 for a long leg splinting ... but I never received a splint, tape or knee immobilizer of any sort. That would have actually been useful if it was offered but nothing was done to compress my knee. This charge was $492.

Thank you,
 
Last edited:


questionasking

New member
Should I dispute with their billing department, through my insurance or take legal action? I don't know what the best coarse would be to verify that I wasn't overcharged.

I also had to pay for physical therapy for an especially long recovery and wanted to know if it be worthwhile to pursue compensation from them because the positions I put my knee for the x-ray lead to a delayed recovery.
 

Zigner

Senior Member, Non-Attorney
Should I dispute with their billing department, through my insurance or take legal action? I don't know what the best coarse would be to verify that I wasn't overcharged.
Talk to them first.

I also had to pay for physical therapy for an especially long recovery and wanted to know if it be worthwhile to pursue compensation from them because the positions I put my knee for the x-ray lead to a delayed recovery.
Do you have a medical expert who would confirm that the x-ray led to a delayed recovery?
 

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