Recent content by CBLENNIE

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    Wiki Inpatient foster care placement

    Are you looking for what revenue code to bill for the R&B or are you asking about procedure codes for professional services such as physician visits? Also, what state are you in because if you are assuming the payer is Medicaid at this point it is going to be dependent on what the state's...
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    Wiki Inpatient foster care placement

    Who are you trying to bill for these services? Medicaid or commercial insurance?
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    Wiki Transport of non-critical & critical of neonate questions

    I work for an insurance company so my responses are going to be based on how an insurance company might consider the claim scenarios you posed. 99468 has a note to "code also interfacility critical care transport services by same or different provider, same or different specialty group, same...
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    Question Mod 51 vs 59

    For CPT 24075 the MUEs for an OP facility, which includes an ASC, is 5 units per DOS, 25075 is 6 units per DOS and 25071 is 3 per DOS, regardless of anatomical site. So, on patient 1, I would expect you would have 2 units of 24075 denied as in excess of the MUEs for the DOS. On patient 2, I...
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    Wiki Billing for Record Review

    If the provider never performs an E&M I would say that the provider cannot bill 99358 per the following layperson description of the code: The codes in range 99446-99452 require a request for a consultation from the treating provider, additionally codes 99446-99449 it requires a verbal and...
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    Wiki Board certification for Hand specialty

    I have a few questions about your question. Do both providers have the same taxonomy code, or are they different? If the providers have the same taxonomy code, most payers are going to consider the hand specialist as the same specialty as the referring provider in the same group. If they are...
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    Wiki 97550 Caregiver training

    I don't believe that 97750 would be appropriate for wound care training of a caregiver as the code is defined as: Caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community (eg, activities of daily living [ADLs], instrumental ADLs...
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    Wiki NDC reporting for multiple vials used

    I think you are going need to check with your payers but from my end working for an insurance company, I would say that it should be billed on 2 lines with the number of units of the drug administered listed with each NDC number. That way you are advising the payer we administered X units of...
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    Wiki cpt 95251 requirement confusion- Endocrinology help

    You need to check your payer guidelines on the frequency for which they will allow 95251 to be billed. It appears based on a quick google search that many payers limit coverage of 95251 to 4 times per year. I didn't see anything defining a month as a 30 day period, so in theory you could bill...
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    Wiki No authorization for Physician Services while Patient was Inpatient

    Did the procedures that are being denied require prior authorization themselves? An approved PA for an inpatient admission, assuming that it was not converted from IP to OBS, would only be for the IP admission and doesn't necessarily include all procedures performed.
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    Wiki AMBULANCE BILLING

    There should be at least one additional code to explain the reason for the denial using CARC 96-Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) What other codes are...
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    Wiki Medicare Wellness

    Medicare doesn't cover the preventative care E&M codes in ranges 9938x & 9939x, so your 99397 is not going to be covered. Also, modifier 59 is not appropriate for G0439 as it is a provider visit (technically it isn't an E&M but it is considered the same for modifier 25 & 59 purposes. You...
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    Wiki CS modifier

    What dates of service are you using modifier CS on your claims? Per the description of modifier CS, it was only effective during the Public Health Emergency (PHE). The PHE officially ended on May 11, 2023. There a great issue-brief from KFF titled Timeline of End Dates for Key Health-Related...
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    Wiki How do get patients to tell you they are in a SNF

    What type of provider do you code/bill for? How are the patients referred to your provider(s) and what information are you given about the patient prior to the service and/or at the time of service?
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    Wiki Caregiver Training 97550 - Initial 30 minutes

    You would only report 1 unit of 97550 per DOS per provider for the first 30 minutes of training. For additional units of caregiver training with the same provider, you would report 97751 for each additional 15 minutes of training. Per the CPT section guidelines: Codes 97550, 97551 are used to...
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