ambernic's latest activity

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    ambernic reacted to xXxPARAGONxXx's post in the thread Wiki 14021 w/ mod 50? with Like Like.
    Per CMS Physician Fee Schedule, cannot use laterality modifiers (LT, RT, 50) for 14021. The same applies to most integumentary procedure codes, as the skin is considered a single organ without laterality. If indeed two distinct sites were...
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    ambernic replied to the thread Wiki BCBS NC and modifier 50.
    Hello, What CPT code is modifier 50 being applied to? From my understanding, when appending modifier 50 only 1 unit should be billed. I don't know if this will help you but I did find BSBS of NC reimbursement policy regarding modifier 50 which...
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    ambernic reacted to debradwright's post in the thread Wiki Can we give injections/vaccines to patient when the provider is virtual with Like Like.
    I had a similar situation when I coded for a hospital in Alaska, the providers would be on site and the patients would be at home. The provider would order a UA/lab/vaccine/etc for the patient to be done same day. We had to manually split the...
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    ambernic reacted to Troykall1's post in the thread Wiki Can we give injections/vaccines to patient when the provider is virtual with Like Like.
    Thank you for responding, we are really struggling with this. We did think about just billing them as POS 11 but I reached out to Colorado Medicaid and they said that if the provider is off site then we would have to bill the E/M as POS 2. So we...
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    ambernic replied to the thread Wiki SPLIT THICKNESS GRAFT.
    CPT code 15120 describes split-thickness graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq CM or less. CPT guidelines direct you to bill add on code 15121 for ea. additional 100...
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    ambernic replied to the thread Wiki Workers Compensation.
    Hi, I actually work for a payor that reviews workers' compensation claims. Massachusetts is one of the states we review. We accept the PA/NP being billed as the rendering provider using their NPI in 24J. However, if the physician is billed as...
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    ambernic replied to the thread Wiki 22551 and 63045.
    Hi Alicia, I believe these can be billed together. 63045 represents the additional work required to complete the decompression at the same spinal level that is beyond the preparation of the interspace for the fusion.
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    ambernic replied to the thread Wiki Can we give injections/vaccines to patient when the provider is virtual.
    I'm wondering if you should be billing with POS 11. Per CPT guidelines, administration can be done by physician or qualified health care professional. I believe it is okay to perform the injection when the provider is not in the office as long as...
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    ambernic reacted to CFINDLING's post in the thread Wiki Modifier 25 Use with Like Like.
    Thanks. I guess only the short sentence at the beginning helps when it mentions being able to effectively respond to payment-policy requirements established by other entities. Because I understand the use of Modifier 25 with another procedure...
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    ambernic replied to the thread Wiki 77002.
    Your CPT book provides guidance regarding which codes it can be billed in conjunction with.
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    ambernic replied to the thread Wiki Pneumatic Compression Devices - Outpatient Surgery.
    Hi, If we receive a claim for durable medical equipment with a place of service 24, we deny as included in the ambulatory surgery center rate. However, we received DME claims for pneumatic compression devices/sleeves regularly with a place of...
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    ambernic reacted to nolanspade's post in the thread Wiki E/M Code and Injection Administration Code with Like Like.
    Hello, there are great discussions already posted on this. The best advice I've seen on this is this: When you do any procedure, there is a certain amount of E/M associated with it--as little just making sure the patient still wants to go...
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    ambernic replied to the thread Wiki E/M Code and Injection Administration Code.
    Hello, I work for a payer. We typically deny the E/M code when it is billed with a minor surgical procedure (ie, 20610). Reason being, per CPT guidelines the surgical procedure billed as 20610 includes evaluation and management service. However...
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    ambernic reacted to JesseL's post in the thread Wiki How to bill for injection w/ office visit with Like Like.
    If patient came in for just the injection or scheduled injection, then bill only 96372. If the patient presented with a new problem that needed a thorough exam, prescriptions, etc and also got an injection, I would bill 99213-25 with 96372
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    ambernic replied to the thread Wiki Modifier 25 Use.
    Hi! I've attached an article from the American Medical Associations CPT Assistant (March 2023) that discusses the appropriate use of Modifier 25. Hope it helps :-)
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