Medical billing codes could keep some from Medicare coverage - KTTC Rochester, Austin, Mason City News, Weather and Sports

Medical billing codes could keep some from Medicare coverage

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ROCHESTER, Minn. (KTTC)- It is a burden anyone who goes to a hospital must carry, and that is paying the bill. One Mayo Clinic patient is claiming that a difference in medical codes is keeping Medicare from covering a procedure.

Charles Wannamaker and his wife are used to having certain procedures covered by Medicare, but when a wellness exam was not covered after it was done at Mayo Clinic, they both took a harder look at the numbers.

"It came to be from billing, receiving a billing notice, that was not immediately obvious, we thought that it would be."

An exam at the Mayo Clinic led to two different charges, one covered by Medicare and one not. A similar exam at the University of Iowa led to full Medicare coverage.

But why?

It is all in the numbers.

The University of Iowa gave the exam a code of 99204, with Medicare coverage. Mayo Clinic gave the code of 99384, leading to no coverage and out-of-pocket costs.

"First thirty minutes might be billed to such a code and the last thirty minutes, but I do not believe it is that simple," says Wannamaker. 

In a letter from Mayo Clinic to their patients it says "An annual history and physical examination is the cornerstone of health maintenance. Medicare and some insurance plans consider this service to be 'preventive' or 'routine' in nature and will not cover the service."

Charles knows that the medical care at Mayo is some of the best in the world, but the billing issue for them grows frustrating.

"What's our result? Our result is that if we want that care, we would have to accept that we may or may not be billed and that we do not have the option to choose a particular service."

Mayo Clinic says that if there is a difference between the bills, this isn't really a question of Mayo's billing practices but instead a matter of the different Medicare contractors' decisions.

Charles says that any attempt to contact Mayo about the issue has led them to use a scripted response leading to no resolution.

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