Recent content by ambernic

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    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 states, "Modifier 50 designates a bilateral...
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    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 sq cm. That tells me it should only be billed once.
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    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 the rendering provider but the PA/NP signs the...
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    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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    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 the administration of the vaccine is done by a...
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    Wiki 77002

    Your CPT book provides guidance regarding which codes it can be billed in conjunction with.
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    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 service of 12 (patient's home) and we allow it. We do...
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    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, if the submitted documentation addresses another...
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    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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    Wiki Worried I've made a mistake

    Hi Amber, The advice I received as a new coder is to try and get your foot in the door with a company even if you aren't coding. I too struggled to find a coding position as a CPC-A. I looked for companies in my area that offered coding positions (most wanted experience), but I also looked at...
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    Wiki Inspace balloon procedure

    Hi! I've attached a couple resources. Hope it helps a little.
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