Know the Code, Part II

I wrote about my regular annual physical and bloodletting last week.

The family has been concerned about a little bump on my chest although the doc calls it a sebaceous cyst and says not to worry about it. I do worry at it some since it sits right about where I like to scratch.

Regular readers will remember that I am pugnaciously parsimonious (Rufus says that is spelled “c-h-e-a-p   b-a-h-s-t-i-d”) so I also fretted over how much that office surgery might cost.

Benign skin lesions include sebaceous (epidermoid) cysts and a bunch of other big words. Medicare apparently considers removal of benign skin lesions as medically necessary, and not cosmetic, when any of the following is met and is clearly documented in the medical record, operative report, or pathology report:

intense itching, burning, irritation, pain, tenderness, chronic, recurrent or persistent bleeding, physical evidence of inflammation (e.g., purulence, oozing, edema, erythema, etc.)

Do not watch this:

The surgical director of Aurora Clinics shows how to remove an epidermoid or sebaceous cyst.

Really, REALLY do not watch this:

A Do-It-Yourself sebaceous cyst removal. This is one BFF “showing off her skills” with a single edged razor at home on her friend. Do not try this at home.

“Of course I watched them, plus another DIY where they squirt the creamy sebaceous fluid out all over the camera and wall,” Liz Arden told me. “I was eating breakfast at the time — oatmeal. Mmmmm.”

Dermatologists may also use laser treatments to remove sebaceous cysts.

The doc said all my blood tests were good. He made an appointment with a local surgeon to have the cyst removed and gave me a bottle for, well, you know.

I put off the procedure until next month. My Gold Obamacare wants me to meet the deductible and pay a 20% co-pay on diagnostic tests including the x-ray and blood work as well as the outpatient surgery. Medicare has a small deductible and the same 20% co-pay, but the plan I bought pays those.

The catch, of course, is that Medicare has to approve all the procedures.

I rescheduled the appointment with the surgeon. Actually, I rescheduled three appointments with the surgeon.

He plans to do the procedure in the hospital. With a little local anesthetic. Which means I wonder why I have to see him in the office before and again after, let alone go to the hospital and incur those charges. Other than to churn the bill.

I Googled and found very little about the pre- and post-procedures for removing small cysts. Apparently it’s not complex enough to require much of either.

NIH reports that “Excision of sebaceous [or] epidermoid cysts is a common surgical [office] procedure performed by family physicians.”

This is the same surgeon who called me in for an office visit specifically for my preventive colonoscopy last year. He charged extra for that and, of course, all Blue Cross could do was shrug.

I told one of my clients, a local judge, the story. He was aghast. He also has a lot of experience with the local health care providers. He suggested a dermatology practice with a resort-like name in Winooski, about half an hour from here. “They’ll bring you in to their office, swab it, and zip-zip, you’re done,” he said. “They’re good.”

I’ll call them this week.

Still, I’ll bet that original surgeon Knows All the Codes and how much he can bill on each.


6 thoughts on “Know the Code, Part II

  1. The ubiquitous doctor’s office visit that Herr Blogmeister mentions exists because it is allowed by law: ” Medicare apparently considers removal of benign skin lesions as medically necessary, and not cosmetic,” and doctors seem to have free rein to pad that “necessity” to its pad capacity.

    Point is that the removal of these cysts are as common as turds on a duck pond, and “surgeons” consider them a piece of cake. They like them even better if they are slightly or moreso infected because they can get more office visits and a “consultation charge” — as well as a pathology charge for determining if the eventual removal yielded cancerous tissue. It seldom does.

    I know this how? Well, I have a proclivity for clogged sebaceous glands and I’ve had more of them removed than Robert Downey Jr has had DUI charges. I now have a bothersome one on the rim of my lower-left jaw bone that threatens to compromise my well-chiseled profile.

    Fortunately I photograph best from the right.

    Seriously, I’m putting the surgery off because I have a tooth extraction coming up next week and do not want to be pained from within and without on the same side of my face. Fortunately I have a very good Medicare (medical) insurance provider, and it will only cost me about $75 to get the gland removed/lanced or whatever.

    Oh, let me add, Herr Blogmeister, beware of “swab it, zip-zip, you’re done,” dermatology quacks from Winooski. They make a killing each year by circling all your various skin anomalies with a Marks-A-Lot and freezing them one at a time for $30 a pop. It’s a racket.

    — George

  2. USAREUR Germany ’67-’69. Medical Corpsman. Wildflecken Dispensary and Hospital. Sebaceous cysts were common among the EM and treatment was a quick in and out. Dr. Woderer let me do several under his supervision. For large ones: Incise, lavage, pack with collodion gauze if needed, bandage. To load the procedure with more is organized crime.

    Nowadays everyone is a criminal until proven innocent.

  3. Single payer won’t cure any of this PLUS it will introduce additional problems. (You all HAVE been paying attention to the VA fiasco, right? Same thing but with a much smaller population and bureaucracy.)

    So don’t even THINK it, Libruls. Just STFU.

  4. Rufus said: “(… unless, of course, you have something ELSE to offer.)”

    As I mentioned on another forum (with a larger readership), my liberal Sister-In-Law works for a large, “global” health insurance company; and she is on the bubble in fear of being laid off because of ObamaCure. I would tsk tsk my tongue and say I told you so, but I may have to help support her.

    I hate it when that happens.

  5. The ObamaFailToCare system is the largest boon to insurance companies since Medicare, George. I suspect that, if you end up having to support your much younger sister-in-law, it won’t be because her insurance employer had to reduce its employment force.

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