A butcher was rushed to a nearby emergency room after cutting off the tip of his index finger through the joint. The injury occurred at work. A plastic surgeon was consulted to discuss the definitive treatment, which would be replantation or completion of the amputation. Although it was a clean cut and replantation could be possible, factors such as recovery time and the unlikely improvement of functional outcome were discussed. It was decided the butcher’s finger would be amputated at the joint, in the ER under general anesthesia.
Melody, WellRithms bill review system for workers’ compensation, flagged this professional bill for multiple procedures: amputation, nerve repair, nerve graft, and an unlisted code. According to the operative report, a nerve repair, a nerve graft, and an unlisted procedure were never done. Dr. Ira Weintraub, M.D., WellRithms Chief Medical Officer, an orthopedic surgeon of 45 years, commented, “It’s not possible to repair nerves at the end joint of your index finger. Look, this is a simple procedure for a plastic surgeon. The surgeon cleaned up the wound, used a rongeur to trim the bone, cut the nerve back, and sewed it up. It takes at most 30 minutes to perform the surgery. There would be no nerve repair or nerve graft and certainly no reason for a phantom code for 40 thousand dollars”.
WellRithms physician review led to reducing a $200,892 surgeon’s bill to $1704. Now, that’s a lot of fat!
