I recently have a male patient who presented with a lesion on the buttock.
He wanted it removed as it was bothering him.
I recommended excision under local anesthesia.
He had PhilHealth and an HMO coverage.
I did the excision under local anesthesia out-patient basis.
Showing the specimen removed.
Showing the wound closure with sutures.
After the operation, I had a challenge on what to put in the PhilHealth Claim Signature Forms (CSF).
In the PhilHealth Case Rates list, there is no coverage for skin tags, squamous papillomas, acrochordons, or fibroepithelial polyps which are the diagnoses that I am considering for the skin lesion of the patient.
I came across this line –
RVS Code – 11400
Description: Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms
or legs; lesion diameter 0.5 cm or less
Case Rate: 3,640
Professional Fee: 840
Health Care Institution Fee: 2,800
NOTE: there is a phrase “except skin tag” – so I cannot use this category.
I decided to look for another possible diagnosis which has an RVS in the PhilHealth Case Rates list.
I saw “neurofibroma, cutaneous.”
Case Rate: 4788
Description: Excision of neurofibroma or neurolemmoma; cutaneous nerve
Case Rate: 8,020
Professional Fee: 2,520
Health Care Institution Fee: 5,500
So, I used this.
I submitted the specimen for histopath. The pathologist reported: Fibroepithelial Polyp (not in PhilHealth Case Rates list).
The patient’s bill was covered by his HMO.
ROJoson Medical Clinic 