I had a minor surgery several years ago. A lump developed on my back shoulder blade. It was quite deep. When it appeared to increase in size and the color began to change, I decided to see a dermatologist. The doctor recommended that I have him remove it. While I was in for my exam my physician asked if I had anything else he should look at. He did a quick skin check, examined my eczema and prescribed a steroid cream – all at no extra charge. He told me his office staff would provide me with an estimated price, schedule the surgery and go over instructions if I wanted to go forward. As I recall the cash price for surgery, a post-surgical follow up and a pathology report was about $570. The initial exam was $85. That is how medicine should work. I was quoted a price, given a choice and had a few additional services thrown in, for which I paid cash.
My wife had surgery too. Well, maybe I should explain. She had a dermatologist who loved to freeze off blemishes using liquid nitrogen. The cost was negligible; it was a nominal charge in addition to the office visit. The price included multiple blemishes removed. I recall a few times that she said they didn’t even bother to charge her for freezing blemishes. The cost was so trivial that when I asked her the price for this post, she could not even recall because it was so minor it didn’t even register in her memory. Little did she know that she could have been billed for surgical procedures.
Kaiser Family Foundation Health News (KHN) reports that doctors are increasingly coding simple services like freezing off a blemish as surgery, billed at surgical prices.
When Helene Schilders of Seattle went to her dermatologist for her annual skin check this year, she mentioned her clothing was irritating a skin tag she had. The doctor froze the tag with liquid nitrogen. “It was squirt, squirt. That’s it,” Schilders told me. She was “floored” by an explanation of benefits that said the simple treatment had been billed as $469 for surgery.
When the patient complained she was told that because the nitrogen broke the skin it could be coded as surgery. But it gets worse. Something as simple as removing a splinter, or a sticker can count as surgery. An Oregon man took his toddler to a pediatrician for a checkup. They noticed a small splinter in his hand and the doctor removed it.
The doctor grabbed a pair of forceps — aka tweezers — and pulled out the splinter in “a second,” Lai said. That brief tug was transformed into a surgical billing code: Current Procedural Terminology (CPT) code 10120, “incision and removal of a foreign body, subcutaneous” — at a cost of $414.
My mother used to use a needle to dig out and remove stickers from my feet when I walked outside barefoot as a kid. Little did she know she was performing surgery. Another anecdote reported by KHN was a toddler who had a chemical ointment applied to a wart. That too was surgery since the ointment penetrated the skin.
Most reasonable people think of surgery as a service requiring a skilled surgeon in an operating room with a scalpel, anesthesia, an OR nurse and support staff. Increasingly, minor interventions that barely abrade the skin (or just barely penetrate the epidermis) are being coded and billed as surgery.
KHN reports that the surgical billing codes, like mentioned above, were intended for rare, complicated cases but are increasingly being used to pad bills. The article blames relative value units, a system developed in the 1980s that Medicare uses to reimburse doctors, for the increase in upcoding because it prioritized procedures over advice.
As I’ve often said, the doctor/patient relationship is primary an information exchange, where physicians are paid for their advice. However, advice is not as profitable as procedures – even if those procedures are something you and I could easily do ourselves with no training. It’s a new type of surprise medical bill: you’re not warned ahead of time, and it appears to be a trivial service covered by the office exam fee. However, you discover you’ve been ambushed, or your health plan has. Yet, people wonder why health insurance gets a bad name for denials. Sometimes, the denial is not really the fault of your health plan.
Read more at KFF Health News: Removing a Splinter? Treating a Wart? If a Doctor Does It, It Can Be Billed as Surgery
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