I had a routine annual physical exam recently. My personal physician of more than 30 years spent more than an hour doing various tests and chatting while we caught up and discussed a wide range of topics related to my health. Due to my temporary absence from the local area and other life situation oddities, this was my first physical exam with him since implementation of the Affordable Care Act. In fact, this was the first time I’ve used my post-ACA health insurance only for a physical exam. I expected that the charge would be covered under our private insurance. A few weeks later I received a bill from his office saying that $94 was not covered by insurance for code #99214. Looking up information on diagnostic code #99214 online I found:
“Level 4 Established Office Visit (99214)
This code represents the second highest level of care for established office patients. Internists selected this code for 52% of established office patients in 2012. The Medicare allowable reimbursement for this service is approximately $108 and it is worth 1.5 work RVUs. Usually the presenting problems are of moderate to high severity.
The documentation for this encounter requires TWO out of THREE of the following :
1) Detailed History
2) Detailed Exam
3) Moderate Complexity Medical Decision-Making
Or 25 minutes spent face-to-face with the patient if coding based on time. The appropriate documentation must be included.”
So, the bottom line is that in this age of impersonal rushed medical care I am pleased to pay an additional $94 for the amount of time and attention that my physician provides, even if, thank god, my care is not related to medical problems that the government and private insurers deem as worthy of such intense medical attention.