Recent content by AlaskanCoder

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    Wiki 94660 CPAP Initiation and Management

    This is a professional service code, not a DME supply code.
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    Wiki Billing 94660 with EM

    I know that this is long after the question was asked - but, since no one has responded, I'll just go ahead and answer it. And the proper answer is "No". CPAP managment 94660 is bundled in E&M services and cannot be unbundled with a modifier per CCI.
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    Wiki Psychiatric evaluation over more than one session

    I have just begun billing for a FQHC BH clinic. The clinicians have told me that "often times" they are unable to complete Psychiatric Diagnostic Evaluation (90791) in one session, so it is split over two sessions (on separate dates.) Can we bill for the total time spent in the two sessions...
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    Wiki Massage Therapy

    A little late to the party - but I just wanted give a bit of a warning in billing for massage therapy. Be very careful billing massage as 97110 (Therapeutic exercises) or 97140 (Manual therapy). Since there is code 97124 (massage - including effleurage, petrissage and/or tapotement (stroking...
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    Wiki Billing 99214 with 99396

    Insurances don't tend to pay or deny services based on "RVU" issues like this. If they allow a level 3 visit but not a level level 4 visit with a preventive visit, I would suggest that they doubt that the criteria is being met for both separately. So, they would want proof that the criteria...
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    Wiki Billing 99214 with 99396

    And one other reason that this CPT code is not priced on the MPFS is that preventive services are billed using Level II HCPCS codes and not Level I CPT codes to Medicare. https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html#AWV...
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    Wiki Flu Shot by Pharmacist

    I have not ever done billing for a Pharmacist, but they should be able to bill for them to most payers. And, yes, for both the administration and the supply. The claim would be submitted on CMS-1500 to most payers. For Medicare, the pharmacist would have to be enrolled under Part B. I would...
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    Wiki Cancer coding

    Wondering if any one has thoughts on this. My surgeon was planing a Whipple procedure on a patient with cancer of the pancreatic body C25.1. When he got into resect the pancreas, he discovered that the tumor in the body of the pancreas was infiltrating the superior mesenteric artery and the...
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    Wiki when does a perinatal condition (HIE) cease to be appropriate?

    I agree with your reasoning. Karen Hill, CCS-P, CPC, CPB,CPMA, CPC-I
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    Wiki Help with Dx Code for Enterotomy

    This was a complication, so that is where I start. Next, it was intraoperative, so that is my first subterm. It was an accidental puncture or laceration of the digestive system during a procedure on the digestive system. So that is K91.71. When you go check this in the tabular list, there are...
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    Wiki pregrnancy tests- cpt 81025

    This is something that is specific to your state's Medicaid. Each state's Medicaid has jurisdiction over certain coding requirements separate from CMS. You would need to ask UHC Comm for a list of appropriate modifiers and their requirements for usage. They probably sent out an announcement...
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    Wiki Modifier 26

    Modifier -26 would be used when you are billing for the pathologist's services and the lab's (facility's) services will be billed by a separate entity (using -TC) modifier. If the pathologist is employed by the facility and the global of the lab service is being billed then no modifier would be...
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    Wiki Ametcalf@intermed.com - CPC

    Since most Medicare Advantage plans use Medicare guidelines for coding, you should only bill the G0438 and not the 99397. Of course, the 99213 can only be billed if there is a truly significant and separately identifiable problem-oriented E/M documented (preferably in a separate note) that...
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    Wiki Reduced services AND unusual procedural services (-52 and -22)

    I am in a bit of a quandary. My surgeon performed a total proctectomy abdominoperineal approach on a patient with a new diagnosis of primary rectal CA. There was extensive adhesiolysis required to support the use of modifier -22. Two years ago, this patient had a primary sigmoid CA removed by...
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    Wiki Physical status modifiers

    The first-listed diagnosis should always be the reason for the surgery. It is my understanding that it is not required to have the diagnosis(es) that supports the physical status modifiers, however, I do use them as additional diagnoses when space allows (only 4 ICD-10-CM codes per CPT code.)...
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