A New Jersey plastic surgeon took the phrase “time is money” to a new height when he charged $200,892 for what should have been a short procedure. After reviewing and repricing this workers’ compensation bill from 2022, we slashed the expense down to just $1,704 – a significant difference that often is the outcome in our work.
The claim in question was so badly coded that it was originally submitted with the wrong operative report. Upon receiving the correct operative report, we quickly discovered that four of five codes being billed were unbundled, a gimmick to bill separately for work that is included in a procedure and thus not separately payable. We also learned that the surgical center billed for a nerve graft, which is not a standard procedure, and which baffled our physician bill reviewers.
Going Sideways
The problem began when a patient cut through his middle finger, resulting in a partial amputation at the tip. Two months later, to help with healing, the surgeon performed a revision partial amputation and closure at the middle finger distal interphalangeal (DIP) joint, which is the level at the joint closest to the fingertip. The surgeon also performed a removal of the remanent nail from the original injury when the nail was mostly lost, and the excision of a radial digital nerve neuroma, which is a painful benign tumor made of nerve tissue that may develop at the end of a nerve where it has been cut.
The entire bill went sideways upon medical review. The surgeon reported the removal of the nail and neuroma after completing the amputation. By doing the amputation and cutting off a portion of the end of the remaining finger to allow for healing, the surgeon would have consequently removed the remaining nail and neuroma.
Additionally, the surgeon performed a procedure that is not standard when he took the nerve and sewed it back to itself, using an expensive nerve graft and an Axoguard nerve wrap in the process. The repair of a nerve occurs when the ends of two cut nerves are sewn back together, so a digital nerve repair wasn’t performed and there is no scientific evidence showing that what he performed works or is in anyway standard care. The neuroma excision is included in the amputation, and thus not billable. The medical billing was ridiculous – as was an unlisted code whose inclusion in the bill is a mystery, if not a money grab meant for unquestioning eyes.
This bill of the month highlights the egregious medical billing that we see weekly. By exposing these practices, we hope to warn payors and patients about the perils of not questioning charges that just don’t add up.
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