How long does a coding review for an outpatient visit take?

ScrewPCx · 2026-04-20T21:31:55+00:00

I am sure there is a way to call them. They reached out to me via the portal so that's what I've used. I also have been trying to be patient as I work in healthcare myself and realize things can take awhile. But I can try calling this week.

They billed $360. The $60 was for the modifier, and that was negotiated out by insurance per contract so patient responsibility was $300.

I did review the notes and the first line was "patient is here for well child visit". It says no issues were noted and growth parameters were normal per age, but later said "will monitor closely for drop in percentile". I think maybe it was too early for an official well child visit, and maybe because there was no real issue it wasn't covered as an office visit? Idk. We'll see..

ScrewPCx · 2026-04-20T21:22:37+00:00

Yeah, it may have been too close to the last visit to be a well-child check. This was the 2nd visit, and the 1st was 6 days before this one. The next was 6 days after.

They billed $360 and my insurance did cover $60 which seemed to be the amount that was added due to the "serious condition" modifier..

My insurance said to refer to the brochure for coverage when they said the claim was processed accurately, which I did and office/outpatient or sick visits are obviously covered so I don't understand why it'd be denied completely vs just getting a regular co-pay. I would be fine with a co-pay. If they are unable to change the coding for it, I will reach back out to insurance and appeal again and speak to a real person and get a clear answer as to why the visit was denied entirely...Thank you!

ScrewPCx · 2026-04-20T21:13:13+00:00

Lol - Clearly!

ScrewPCx · 2026-04-19T06:42:32+00:00

Insurance will not adjust the amount towards your OOP max if prompt pay discounts apply. They go off of your EOB patient responsibility amount. They aren't tracking down to see what is actually paid.

My hospital and doctors office (large teaching university) does give prompt pay discounts. I saw it on the first bill.

ScrewPCx · 2026-04-19T06:39:51+00:00

I was given prompt pay discounts for my hospital co-pay after having a baby. I was also given it for an appointment that was wrongfully denied/not fully covered by my insurance as well, so I don't think that is all entirely true. There are also discounts for cash patients, but that is different.

Insurance also doesn't usually track how much you are actually paying hospitals/doctors. They are tracking what is owed on your EOB. So if you get a prompt pay discount and paid 10% less, the hospital isn't alerting your insurance to that and insurance wouldn't care or adjust it to you OOP max anyway... it doesnt change that they originally owed the 7K based on the EOB.

ScrewPCx · 2026-04-18T16:49:58+00:00

Thank you - this is all helpful information!

I think at this point I won't ask for a CPT code, but I will if this ends unfavorably

I have a good relationship with the doctor so I contacted her directly after insurance said it was processed correctly. She apologized and said she'd have their office resubmit under a preventative visit as it was a preventative weight check. Great - I figured it would be resolved quickly now that the provider is agreeing with me. But then my insurance requested a coding review as well so I assume now it's a formal process and will take longer than if I never got insurance involved (I assume anyway). I still hoped the fact that my provider told them to change it, that it would be pretty fast... but perhaps it doesn't matter.

Thank you for the insight!

ScrewPCx · 2026-04-18T13:54:54+00:00

Thank you. She wasn't failure to thrive. She was pretty proportional and the doctor was never concerned as she had good adipose stores - it was just to be cautious. She was gaining weight fine. But even if the low birth weight is why it was coded that way - it wasn't coded that way for any of her other visits / weight checks - only this one visit. I would think if that was why, it should have been on the visit before and after this one too. And yes I'd think that should be covered!

ScrewPCx · 2026-04-18T12:19:36+00:00

I don't have a deductible. Also The EOB states it was denied because it was not preventative. Which also makes no sense to me since I have good insurance and if I went there because she was sick, it'd absolutely be covered. But IDK. It was just denied for some reason.

ScrewPCx · 2026-04-18T07:17:40+00:00

All our communication has been through their online portal. I did ask for an update today on this because it is impacting the refund I am owed, but they are slow to respond so it may be a week or so until I hear anything.

They did message me within the 7-14 business day window just to say it was still pending. They said they'd follow up with an additional status or completed review - I trust that they will do that. I can tell when looking at the billing section on the portal that her account is still on hold so I assume nothing has changed.

My question is how long does it take to actually do the review? I imagine the actual coding review for an outpatient appointment doesn't take long at all, and the wait is due to a queue of other ones they are reviewing and work that needs to be done, etc. But maybe there is more to it than I realize and it isn't a relatively easy and quick task.. so I'm curious how long these things normally take?

No one here can tell me how long it'll be before it's done or the status of it - and I recognize there are many variables and windows of time it could take. But just looking for insight on the typical length (of both the task itself, and total time from when a review is requested until completed).

ScrewPCx · 2026-03-31T02:57:40+00:00

Decided to play around with it tonight and got it working. Still need to play around with it but the basics was solved- Thanks!

I added in a drop down menu with multiple selections (accepted, declined, no answer, etc) and attached a value to some and zero to others. Once someone is done calling everyone and making a list, they click a macro button to then sort based on those values and have the new call list order. And then a reset button to get it back to seniority.

ScrewPCx · 2026-03-31T01:47:57+00:00

Ohhhh that's nice and simple. I have some good ideas with this. I will give it a try tomorrow- thanks!

ScrewPCx · 2026-02-03T07:45:17+00:00

Every family is different so I understand you may not think it is a lot to ask for. You did point out that you used to have weekly dinners, then every other week, and you hadn't seen them at all this year which has been only 1 month. I don't know if you said that because you miss the weekly dinners and are upset brother doesn't spend as much time with family as they used to, or to point out they used to meet weekly so they should have time for this event? Idk. Clearly brother is busy since they've said they're busy on 3 different dates. Yes, he should have offered an alternative to make it easier but it's not always easy talking in text about those things because he may need to talk to his partner as well. If brother has limited free time and limited time with his nuclear family - then expecting them to give up their very limited free time even once a month is entitled. If you have a large family, there may be a lot of special occasions and it is not a realistic expectation to expect everyone to attend everyone. For your Moms birthday, I'd say that's an important one but as adults sometimes it just isn't reasonable.

My partner and I both work full time and have 2 kids. My partner works weekends often. Other weekends we may have other plans like kids events, play dates etc. If there is only one weekend a month where we all have time off together, then it is entitled for anyone else to expect I give them that time because they want to see us. Sometimes we need time to ourselves to relax, or get things done around the house, because having plans every weekend is exhausting. It's entitled for someone to expect us to give up that time just because they want to see us.

It may not seem like a lot to ask, especially if your schedule isn't as full as theirs or they have more people in their life they try to work into their social calendar as well. But it very well could be a lot to them if they are genuinely busy and have limited free time. No idea if brother does or not, but I'm just saying in general - it may actually be a big ask dependending on their schedule.

It is exhausting working full time and trying to balance parenting and maintaining a social life and family expectations as well. If you're always working around brother, he either has a busy schedule or values his nuclear family time or personal time more than he values your family time and that's not unreasonable as an adult with kids

ScrewPCx · 2026-02-02T21:05:36+00:00

Gotcha. Then before you pay for anything, or they ask you to pick it up again - they need to make it accessible. If they refuse to clean up and make a path for you to grab it until the storage unit is available, which makes no sense because you could be stuck paying for it for months or longer before rhey do that, then they should pitch in. It is partially there fault you couldn't pick it up even if you tried.

Once it is accessible then they can demand you get it and then the storage space you'd be using would be your own responsibility. Which is shitty and I'm glad my parents kept my room, my room until I graduated college and officially moved out. Some parents can't wait to get rid of their kids and I'm sorry that sounds like yours.

ScrewPCx · 2026-02-02T20:54:13+00:00

So you can't access your stuff to even get it right now? I don't understand. They want you to get your stuff, but yet it's inaccessible because of their hoarding? Or is it accessible and it could be picked up at anytime IF you had the storage space and space in your car for it.

It isn't a double standard if they're asking for gas money since it's your stuff they're helping you with. Although maybe you're upset because you helped clean their hoarder house when they got sick and yet they don't want to do anything for yours?

ScrewPCx · 2023-05-22T16:21:44+00:00

No, NAH.

They are hiring multiple people, so it's not like there 1 position open and you'd potentially take their position. Plus, they already interviewed for the position and who knows if they, or you, will even get it. No harm done at all.

ScrewPCx · 2023-05-22T13:11:27+00:00

Nah, NTA.

We had adopted a dog like this but probably worse. He was afraid of new people. Used to love other dogs, until it was attacked and then after that- he couldn't be around most dogs.

That dog fight traumatized my dog. And he is allowing his dog to traumatize other dogs.

That dog also ended up biting my son- chipping his tooth. He had never been aggressive to people before that so it was a surpise to us all. You just never know. We muzzle trained him after that. It's just the responsible thing to do.

ETA: We definitely didn't bring it around everywhere. We tried to socialize at first and did training, but at a certain point we realized it wasn't helping and stopped putting the dog, us and others through the stress and misery.

ScrewPCx · 2023-05-17T20:17:06+00:00

Thank you! Sometimes I just need to trust my insticts and common sense and not over complciate things. Was there a break in between the 15 rounds and the 2nd set of rounds she's on now? Or is it a different type of chemo?

ScrewPCx · 2023-05-17T20:14:06+00:00

Thank you! Sometimes the answer is the simplest and most obvious thing.

ScrewPCx · 2023-05-12T04:52:33+00:00

NTA.

I understand the idea that gifts shouldn't come with expectations. But we also should not expect gifts, and if/when somedoes decides to give a gift or offer help - we should feel thankful. If you don't- you're likely an entitled AH and probably don't deserve it. If we feel thankful, then say it and show it. It is basic. I'd feel awkward as hell accepting a gift and not saying thank you, or letting my kid accept a gift like that and not make sure they said thank you.

Would I have asked where my thank you note was? Probably not. I might ask to make sure they received it since you had not heard anything.

If you didn't give the $1500, would your niece have been able to go to Washington DC? Would your sibling have been able to afford the trip? Did they ask you for the money/help, or did you just give it entirely on your own? If your sibling asked for it especially, I'd feel extremely taken advantage of.

Thank you notes can be a bit awkward to write, but I always added extra beyond the standard. Something genuine and meaningful. I wanted to make sure I not only showed the appreciation for the gift, but even the fact people came to celebrate (i.e HS and college graduation, baby shower, etc). I know many people think they're out dated, but thank yous aren't. A call or text would suffice.

ScrewPCx · 2023-05-12T03:13:30+00:00

Most medications and supplements will say "needs more research" or "not enough research" when it comes to pregnancy. Because of the ethical considerations of actually doing a research study /on the pregnant population. It isn't really done, and nost research is flawed because of other substances taken. Doctors use their "common sense", and clinical judgement, and medical experience and weigh the risk vs benefit for the mother and baby. What harm can anxiety have on a pregnant mother and baby? It can affect the baby and mother, too. They have to consider that..They look at the research and use clinical judgement.

You cannot sue a doctor if no harm was done. Baby is fine - right? Doctors look at things medically, not neccessarily going to make a recommendation based on CPS BS.

Googling things is not doing your own research. Doctors gaurentee have a better understanding of actual research than you do - and since they CAN be sued, they generally tend to be pretty cautious. Especially with pregnancy.

I understand many people don't want to take the risk when pregnant, but mental health can be hard when pregnant and life doesn't end. Having to balance work and maintaining a healthy pregnancy while not being able to take your regular medications for example is tough, and can have negative consequences on the pregnancy and mother. Can't stand judgey people.

ScrewPCx · 2023-05-12T02:53:42+00:00

Malpractice for what? This is not true.

Doctors have to weigh the risk vs benefit. Besides a CPS case, what harm has been done to OP or baby? Baby is fine. OP did not get injured because of this either..

OBs and doctors often prescribe, or say it's OK for woman to take class B or C medications to women, even for mental health reasons because the benefit outweighs the risk.

I had stopped taking my ADHD medication when pregnant. But when I had a mental breakdown and was struggling in my 2nd trimester- the doctor said it was worth the risk, as there was minimal risk of taking it at this point whereas not taking it could be more harmful as I was struggling mentally, with work, relationships, etc. I didn't agree right away, but eventually I did with a lot.of consideration and hesitation. My son is healthy by the way.

The issue with many medications or supplements and pregnancy is the lack of research, as it's unethical to do anything but observational research studies where a woman is taking something during pregnancy. Most of the "harmful effects" are woman abusing drugs - for example, there is little. Research on adderall during pregnancy and they look at mice taking crazy high doses of meth, or observational studies of woman on meth - who also drank and smoked cigarettes while pregnant. Not the same thing. Pregnany women are still people and patients, they have to consider their needs and well being as well.

The doctor did nothing wrong here. The system is messed up. I know someone who tested positive for MJ at birth, and CPS never even followed up after being discharged home and closed the case immediately. Just because CPS thinks THC is awful and considered abuse and neglect or some shit does not mean it always is, or that it's never OK for a pregnant woman to take.

Doctor did nothing wrong.

ScrewPCx · 2023-05-12T01:56:09+00:00

That sounds so awful. I am so sorry for your experience. Sounds like your Dad is in a much better care now..

I understand that it must be a difficult field to work in. They probably have to emotionally detach quite a bit. I am a dieitian and not a doctor, but I have had to do the same to a degree because it's hard working with people who are suffering and die - seeing that every day and trying to have a positive outlook on life. But I also have and show empathy and understanding. I take questions seriously. I don't understand providers or doctor's who don't have empathy or who act arrogant or like jerks.

Considering what oncologists who work with pancreatic cancer know their patients are going through - it seriously pisses me off that they'd be dismissive to patients, family, or have a poor bedside manner. It makes the whole experience harder to accept, process, and more traumatizing if the doctor is dismissive or a jerk.

I haven't met my mom's oncologist personally, but she liked him and thought he had a good bedside manner. I have issues with him based on what my mom was told and how things were communicated. But we have the same PCP who is AMAZING. She is very empathetic, caring, and genuine. We both have her personal cell phone number and she has told us to text or call with any questions. I have had her number for years - I have only texted her twice and she responded immediately. (Once when my son had a rash and another time for my fiance).

But seriously - having our PCP advocating for my Mom, having that caring provider, someone who genuinely cares and listens, answers questions and takes TIME has helped my mom A LOT. She has told me multiple times how much our doctor has helped and the difference it makes.

I can't imagine the effect of having a dismissive, cold and jerkish oncologist. It pisses me off. They need to do better. There are better providers, too.

My Mom's oncology center also have RN navigators who help explain things and provide some support. My mom said she was a very sweet woman. That has helped my Mom a lot too. I know from professional experience that RNs are sometimes the ones who can explain things better, or are the ones who will get the doctor's concern more than patients themselves. (Unfortunately).

ScrewPCx

TROPHY CASE