02/26/2016    Timothy P. Shea, DPM

To Bill or Not to Bill?

I see absolutely no ethical or clinical reason
for not billing for this type of encounter. As a
treating healthcare provider, you supplied
exactly what you are trained to do "healthcare."
Congratulations to you and your staff for picking
up the early signs of what appears to be a
vascular incident and, following through with the
appropriate actions in triaging and referral to
the proper setting for treatment.

These type of encounters, although infrequent,
and sometimes hair raising and definitely
disruptive, are also the ones which give the best
sense of satisfaction in the field we practice
in. Clinically and ethically, you acted
completely responsible and professional.

I see no reason why you can't bill for this
event. It was an initial office visit (encounter)
which required a medical work up, physical exam,
paperwork, and some form of treatment. The key
here I believe is TIME and severity of CLINICAL
decision-making. Although not foot specific in
the long run, your expertise in medical decision
making was extensive, the degree of severity was
high and , disposition of the case was complex.

The time factor greatly exceeds any standard
initial visit. So I believe you easily fall into
the elevated 9920X (4-5) codes. Obviously, your
note should document the whole scenario as you
have already done.

The other patient visits that were lost or
detained you are credited for in some other place
in the cosmos. But this patient you have every
right , and should not feel hesitant in billing
for your services.

In over 43 years of practice, I have had my fair
share of these type of encounters and have acted
and billed the same way.

Timothy P. Shea, DPM, Concord, CA

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