Simple procedure or ‘surgery’? Questionable medical billing practices cause confusion

Editor's Note

Certain medical bills reclassifying minor procedures as “surgery” are driving up costs and causing confusion among patients, KFF Health News December 13 reports. Cases such as a $414 charge for a splinter removal with tweezers and a $469 charge for freezing a skin tag highlight how CPT codes assigned to complex surgery are being applied to routine interventions.

Medical coding verbiage like “incision and removal of a foreign body, subcutaneous” and “destruction of 1-14 benign lesions” is what allows procedures like the above examples to be billed as surgeries. CPT code 17110, intended for removing multiple lesions, is frequently used for simple skin treatments—its usage increased by 62% from 2013 to 2022, according to the article.

Critics argue this reflects systemic incentives to prioritize procedural payments over intellectual work. “There’s more pressure to make money, and the idea is you can charge more if it’s a surgical procedure,” Sabrina Corlette, founder and co-director of Georgetown University’s Center on Health Insurance Reforms, told the outlet, explaining the incentive is not there to review and say a case was “run-of-the-mill.” These minor interventions might not yield huge bills, but they could “add up to tens if not hundreds of millions of dollars…annually,” the article noted.

The current system originates from the 1980s Resource-Based Relative Value Scale (RBRVS), which assigns higher reimbursement rates to invasive procedures. Critics say this outdated model skews valuation and encourages misclassification. Efforts to reform are limited, though incoming officials like Robert F. Kennedy Jr, the nominee to lead the Department of Health and Human Service, have hinted at exploring alternatives. Without systemic reform, experts warn such billing practices will persist, burdening patients with unnecessary costs.