Frequently Asked Questions

 

Do you take my insurance?

We are currently accepting insured patients covered by the following carriers:


Blue Cross Blue Shield

Evergreen Health Partners

FirstChoice

LifeWise

Premera

Regence

Uniform

United HealthCare


We are an “out-of-network” provider for most other carriers, including Medicare and most of the Washington Health Exchange plans, including those plans offered by the above carriers. Please check with your benefits administrator or your health insurance carrier regarding the specifics of your policy and out-of-network benefits.


Do you treat children?

Generally, no, unless the child has an adult type problem (such as nerve compression or joint instability) or is referred by another orthopedic surgeon or hand surgeon.


What should I bring with me to the appointment?
Please bring your insurance information, a picture ID, any previous medical records, radiographs (plane films, or CD/DVD) MRIs, EMG/NCVs, operative notes, consultations and anything else you feel might be relevant to your situation. There is complimentary WiFi internet access, in addition to several courtesy computers in our waiting area. Consider bringing a book or something to read; appointments may be delayed by emergencies and other circumstances beyond our control. 


What about Workman’s Compensation?

This practice is currently closed to new patients treated under workman’s compensation. Under special circumstances, we do occasionally see patients under workman’s compensation whose employers are self-insured, such as Microsoft, the City of Seattle, and Evergreen Hospital, and for maritime injuries covered under the Jones Act. Please note that, in general, if Dr. Ericson is involved in treatment under a workmen’s compensation claim, he will not be the “Attending Physician” unless surgery is indicated, authorized and/or performed, and that this office does not open claims, re-open claims, add-on to claims, file appeals, perform rating exams or Independent Medical Exams (IMEs), or manage chronic disability.


If you have a Field Nurse Case Manager assigned to your case, please ask him or her to call the office. Our role is diagnosis and treatment, specifically technical, surgical/anatomic, and not administrative. Other restrictions apply; please call for details.


I want to see Dr. Ericson, but he is not in my health insurance network and I have no out-of network benefits. Any suggestions?

We do see patients out-of-network, but for common hand problems there are a large number of particularly well-trained hand surgeons in the Seattle are. You can search for a highly qualified board-certified orthopedic hand surgeon at the American Society for Surgery of the Hand website by clicking here.


I want to see Dr. Ericson but it is too long a wait for the next appointment. Who else could I see?

Seattle is fortunate to have a large number of particularly well-trained hand surgeons. You can search for a highly qualified board-certified orthopedic hand surgeon at the American Society for Surgery of the Hand website by clicking here.


I need some forms signed by a doctor...

Please submit the forms to the front desk on arrival, and at least 72 hours before you need them to be submitted.  Prepayment of a nominal fee is required for some forms. Please note that some forms require only confirmation of medical facts and a signature, but others are complicated and can take substantially more time to complete. There is a charge for this service. Also, please note that this office does not manage chronic disability claims.


Where does Dr. Ericson perform surgery?

Dr. Ericson is on Active Staff at Evergreen Hospital Medical Center in Kirkland, WA. Evergreen Hospital has consistently rated among the top 5% of all hospitals nationwide by Healthgrades, and has received the prestigious HealthGrades “Distinguished Hospital for Clinical Excellence Award” each year for the last several years. The hospital was recently rated “The #1 Non-Teaching Hospital” in Washington State by US News and World Report.

















Award-Winning Evergreen Hospital Medical Center


Dr. Ericson operates on Mondays and alternate Wednesdays at the Evergreen Hospital Ambulatory Surgery Center, and also at the Overlake Hospital Ambulatory Surgery Center. Most upper extremity surgery is done on an ‘outpatient’ basis, meaning that patients come from home on the day of surgery, and are discharged to home following the procedure. Someone must drive the patient home, and the patient must also be discharged to the care of a responsible adult. Generally, this includes patients undergoing “in-office” procedures such as needle aponeurotomy.
























Evergreen  Hospital Ambulatory Surgery Center


If I have an operation, who does the actual surgery?

Dr. Ericson performs the actual surgery; there are no students, interns, residents, Physician Assistants (PAs), other physicians, or “physician extenders” involved in your upper extremity care, in the operating room or in the office. After surgery, you will continue to be followed directly by Dr. Ericson, a board-certified orthopedic surgeon with hand fellowship training and board-certified in hand surgery, not a PA or other non-surgeon.


If I have surgery, what type of anesthesia will be used?

The type of anesthesia utilized depends on a number of factors, including the type of surgery being performed, the expected length of time for the procedure, the general health of the patient, and individual preferences. With local, regional, and general anesthesia, there are specific advantages and disadvantages to each technique. Many procedures can be performed under local anesthesia (“WALANT” - wide awake, local anesthesia - no tourniquet) . Please discuss this issue with your surgeon.


Does Dr. Ericson perform “minimally invasive” surgery?

Yes. Dr. Ericson routinely performs endoscopic carpal tunnel release, wrist arthroscopy, needle aponeurotomy and other minimally invasive procedures, when medically appropriate.


If I have surgery, what will the scar look like?

Ask Dr. Ericson. Most incisions are closed with absorbable internal sutures that do not need to be removed. The following are typical scars for common operations:


























Do you have a disclaimer?

This question is not frequently asked, but recent polls demonstrate common concerns among the public:


-Optimal treatment depends not just on having the correct diagnosis, but also on understanding each individual patient’s needs and expectations, and their unique circumstances. Treatment by Dr. Ericson is completely individualized, and may vary from person to person for the same diagnosis. Results may also vary from person to person, and are not possible to guarantee. Surgery is not offered unless the expected benefits far outweigh the accepted risks. Surgery is inherently risky, and should be avoided if possible; it is often the last alternative. However, if you have painful mechanical instability of a joint, or peripheral nerve compression, surgery may be the only realistic option for lasting pain relief.


-Dr. Ericson has no financial interest, or any other conflict of interest, in any health care facility, surgery center, radiology facility, MRI, physical therapy, hand therapy, medical equipment manufacturer, pharmaceutical company, or web link. This office does not solicit or accept gifts or any other inducements from any vendor, and this office does not pay marketing fees. We do not direct satisfied patients to internet physician rating sites. Dr. Ericson has provided consulting services with regard to product design, ergonomics, and expert witness testimony but has no financial interest in any product or service, other than surgery.


Are you subject to any financial incentives to deny or restrict medical care?

No.


What is your cancellation policy?

We are experiencing high demand for services and often have a waiting list for surgical dates as well as office visits. There is no charge for cancellations, but out of courtesy to other patients who may be waiting please give at least 24 hours notice. Patients who consistently miss appointments without calling to cancel will need to seek care elsewhere.


What should I do with unused post-operative pain medication?

Help protect the environment by taking it here.


I have hypermobile joints that are causing medical problems. Can you help?

Probably. A very useful resource written by Brad Tinkle MD, PhD, a geneticist currently in Chicago, IL, can be obtained here. Another resource is the Ehlers-Danlos Foundation.


Have you heard of a newer, safer table saw?

Table saw injuries occur every 9 minutes and are typically unforgiving. SawStop table saws are not new but detect contact with skin and stop blade motion in <0.005 second. This can result in a small laceration instead of an amputation.


My private health insurance carrier won’t pay my medical bills. What should I do?

Contact the Washington State Office of the Insurance Commissioner for advice or to file a formal complaint.


Why did Dr. Ericson leave Massachusetts?

Massachusetts is a difficult place to practice medicine, particularly in the private practice setting. The “Physician Practice Environment Index”, a statistical indicator of the factors that affect physician practices, published annually by the Massachusetts Medical Society, documents and provides a chronology for how the practice environment for physicians in Massachusetts has consistently deteriorated faster than the rest of the country, and, according to the Association of American Physicians and Surgeons, Massachusetts is now tied for last place (with New Jersey) as the least desirable state in the country for the independent practice of medicine.


What about Medicare?

Medicare payment rates to physicians have decreased over the past ten years, while medical practice costs have steadily climbed. Medicare paid about $38 per RVU (Resource Value Unit - representing physician “work” units) 10 years ago; current payment is $34 per RVU. If adjusted for the annual rate of inflation based on the Consumer Price Index, this payment would now be $47 per RVU. In effect, the overall Medicare physician reimbursement rate has been silently cut by almost 1/3 over the past 10 years. The increase in payment for physicians in 2013 was 0%. Medicare has also made further arbitrary cuts in reimbursement for specific services provided by physicians, such as total joint replacement surgery (-65%), rotator cuff repair (-70%), and spinal fusion (-65%). These cuts are driving many physicians into hospital employment and out of patient care, and have led to decreased access to care for aging patients. Further cuts in physician payment are expected under the guise of reducing the federal deficit:




What else about Medicare?

The Medicare bureaucracy is stifling. Doctors are responsible for diagnosing and treating patients; getting paid for this is another matter. Consider the following directions on how to bill Medicare for a typical office visit, copied directly from Medicare guidelines:


“Medicare Global Surgery Rules define the rules for reporting evaluation and management (E&M) services with procedures covered by these rules. This section summarizes some of the rules. All procedures on the Medicare Physician Fee Schedule are assigned a global period of 000, 010, 090, XXX, YYY, ZZZ, or MMM. The global concept does not apply to XXX procedures. The global period for YYY procedures is defined by the Carrier (A/B MACs processing practitioner service claims). All procedures with a global period of ZZZ are related to another procedure, and the applicable global period for the ZZZ code is determined by the related procedure. Procedures with a global period of MMM are maternity procedures.

Since NCCI edits are applied to same day services by the same provider to the same beneficiary, certain Global Surgery Rules are applicable to NCCI. An E&M service is separately reportable on the same date of service as a procedure with a global period of 000, 010, or 090 under limited circumstances. If a procedure has a global period of 090 days, it is defined as a major surgical procedure. If an E&M is performed on the same date of service as a major surgical procedure for the purpose of deciding whether to perform this surgical procedure, the E&M service is separately reportable with modifier 57. Other preoperative E&M services on the same date of service as a major surgical procedure are included in the global payment for the procedure and are not separately reportable. NCCI does not contain edits based on this rule because Medicare Carriers (A/B MACs processing practitioner service claims) have separate edits.

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI does contain some edits based on these principles, but the Medicare Carriers (A/B MACs processing practitioner service claims) have separate edits. Neither the NCCI nor Carriers (A/B MACs processing practitioner service claims) have all possible edits based on these principles.

Example: If a physician determines that a new patient with head trauma requires sutures, confirms the allergy and immunization status, obtains informed consent, and performs the repair, an E&M service is not separately reportable. However, if the physician also performs a medically reasonable and necessary full neurological examination, an E&M service may be separately reportable.

For major and minor surgical procedures, postoperative E&M services related to recovery from the surgical procedure during the postoperative period are included in the global surgical package as are E&M services related to complications of the surgery that do not require additional trips to the operating room. Postoperative visits unrelated to the diagnosis for which the surgical procedure was performed unless related to a complication of surgery may be reported separately on the same day as a surgical procedure with modifier 24 (“Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period”).

Procedures with a global surgery indicator of “XXX” are not covered by these rules. Many of these “XXX” procedures are performed by physicians and have inherent pre-procedure, intra-procedure, and post-procedure work usually performed each time the procedure is completed. This work should never be reported as a separate E&M code. Other “XXX” procedures are not usually performed by a physician and have no physician work relative value units associated with them. A physician should never report a separate E&M code with these procedures for the supervision of others performing the procedure or for the interpretation of the procedure. With most “XXX” procedures, the physician may, however, perform a significant and separately identifiable E&M service on the same date of service which may be reported by appending modifier 25 to the E&M code. This E&M service may be related to the same diagnosis necessitating performance of the “XXX” procedure but cannot include any work inherent in the “XXX” procedure, supervision of others performing the “XXX” procedure, or time for interpreting the result of the “XXX” procedure. Appending modifier 25 to a significant, separately identifiable E&M service when performed on the same date of service as an “XXX” procedure is correct coding.


What else about Medicare?

Currently, if a patient with a simple ankle sprain was evaluated by a physician, the physician would bill the insurer for the office visit using one of the following four ICD-9 diagnosis codes:


845.00 Sprain and strain of ankle unspecified site

845.01 Sprain and strain of ankle, Deltoid ligament/ Internal collateral ligament

845.02 Sprain and strain of ankle, Calcaneofibular (ligament)

845.03 Sprain and strain of ankle, Tibiofibular (ligament) distal


As of 2015, the physician will be instead be required by the federal government to use one of the following sixty ICD-10 diagnosis codes. Wouldn’t the time spent attempting to figure out the correct billing code be better spent helping the patient?:


S93.401A Sprain of unspecified ligament of right ankle – initial encounter

S93.401D Sprain of unspecified ligament of right ankle – subsequent encounter

S93.401S Sprain of unspecified ligament of right ankle – sequel

S93.402A Sprain of unspecified ligament of left ankle – initial encounter

S93.402D Sprain of unspecified ligament of left ankle – subsequent encounter

S93.402S Sprain of unspecified ligament of left ankle – sequel

S93.409A Sprain of unspecified ligament of unspecified ankle – initial encounter

S93.409D Sprain of unspecified ligament of unspecified ankle - subsequent enc.

S93.409S Sprain of unspecified ligament of unspecified ankle – sequel

S93.412A Sprain of calcaneofibular ligament of left ankle – initial encounter

S93.412D Sprain of calcaneofibular ligament of left ankle – subsequent enc.

S93.412S Sprain of calcaneofibular ligament of left ankle – sequela

S93.419A Sprain of calcaneofibular ligament of unspecified ankle – initial enc.

S93.419D Sprain of calcaneofibular ligament of unspecified ankle – subsequent

S93.419S Sprain of calcaneofibular ligament of unspecified ankle

S93.431A Sprain of tibiofibular ligament of right ankle – initial encounter

S93.431D Sprain of tibiofibular ligament of right ankle – subsequent encounter

S93.431S Sprain of tibiofibular ligament of right ankle – sequela

S93.432A Sprain of tibiofibular ligament of left ankle – initial encounter

S93.432D Sprain of tibiofibular ligament of left ankle – subsequent encounter

S93.432S Sprain of tibiofibular ligament of left ankle – sequela

S93.439A Sprain of tibiofibular ligament of unspecified ankle – initial encounter

S93.439D Sprain of tibiofibular ligament of unspecified ankle – subsequent enc.

S93.439S Sprain of tibiofibular ligament of unspecified ankle – sequela

S93.491A Sprain other ligament of right ankle (Internal collateral/ talofibular) initial encounter  

S93.491D Sprain of other ligament of right ankle (Internal collateral/ talofibular) subsequent encounter

S93.491S Sprain of other ligament of right ankle (Internal collateral/ talofibular) sequel

S93.492A Sprain of other ligament of left ankle, initial encounter

S93.492D Sprain of other ligament of left ankle subsequent encounter

S93.492S Sprain of other ligament of left ankle sequel

S93.499A Sprain of other ligament of unspecified ankle initial encounter

S93.499D Sprain of other ligament of unspecified ankle subs encounter

S93.499S Sprain of other ligament of unspecified ankle (Internal collateral/talofibular) sequela

S93.211A Strain of intrinsic muscle and tendon at right ankle and foot level initial encounter

S96.211D Strain of intrinsic muscle and tendon at right ankle and foot level subsequent encounter

S96.211S Strain of intrinsic muscle and tendon at right ankle and foot level sequela

S96.212A Strain of intrinsic muscle and tendon at left ankle and foot level initial encounter

S96.212D Strain of intrinsic muscle and tendon at left ankle and foot level subsequent encounter

S96.212S Strain of intrinsic muscle and tendon at left ankle and foot level sequela

S96.219A Strain of intrinsic muscle and tendon at ankle and foot level, unspecified side initial encounter

S96.219D Strain of intrinsic muscle and tendon at ankle and foot level, unspecified side subs encounter

S96.219S Strain of intrinsic muscle and tendon at ankle and foot level, unspecified side

S96.811A Strain of other muscles and tendons at right ankle and foot level initial encounter

S96.811D Strain of other muscles and tendons at right ankle and foot level subsequent encounter

S96.811S Strain of other muscles and tendons at right ankle and foot level sequela

S96.812A Strain of other muscles and tendons at left ankle and foot level initial encounter

S96.812D Strain of other muscles and tendons at left ankle and foot level subsequent encounter

S96.812S Strain of other muscles and tendons at left ankle and foot level sequel

S96.819A Strain of other muscles and tendons at ankle and foot level, unspecified side initial encounter

S96.819D Strain of other muscles and tendons at ankle and foot level, unspecified side subs encounter

S96.819S Strain of other muscles and tendons at ankle and foot level, unspecified side sequel

S96.911A Strain of unspecified muscle and tendon at right ankle and foot level initial encounter

S96.911D Strain of unspecified muscle and tendon at right ankle and foot level subs encounter

S96.911S Strain of unspecified muscle and tendon at right ankle and foot level sequel

S96.912A Strain of unspecified muscle and tendon at left ankle and foot level initial encounter

S96.912D Strain of unspecified muscle and tendon at left ankle and foot level subs encounter

S96.912S Strain of unspecified muscle and tendon at left ankle and foot level sequela

S96.919A Strain of unspecified muscle and tendon at ankle and foot level, unspec. side initial encounter

S96.919D Strain of unspecified muscle and tendon at ankle and foot level, unspec. side subs encounter

S96.919S Strain of unspecified muscle and tendon at ankle and foot level, unspec. side sequela


What is the government’s plan to improve health care and decrease costs?


























If these issues concern you, please contact your elected Congressional representative:


Contact your US Representative

Contact your US Senator


Who did your website?

Dr. Ericson. Ask him about it! No ads, testimonials, pop-ups, social networking links... just the facts. This website will not display properly on IE 6&7 because of known bugs in IE related to CSS functions Z-Index, Floated Non-Float, and Float Drop. Dr. Ericson will be migrating this website to Wordpress some day.










 
 



ERICSON HAND CENTER

6100  219th Street SW, Suite 540

Mountlake Terrace, WA 98043

425-776-4444, Fax 425-272-2730


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