Recent content by cnjacobs15

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    Wiki 96372 Therapeutic injections during office visit

    If the provider truly providers e&m services along with the injection you should bill for both. the NCCI edit is because 96372 requires Direct Physician Supervision. So you have to justify and support that the E&M is not being billed simply for the providers supervision of the injection. I mean...
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    Wiki IV hydration

    Would this apply to the following scenario as well? Pregnant patient is dehydrated due to excessive vomiting. Seen for in office hydration. Lactated Ringers (LR) is being administered because the patient is dehydrated. 1000 mLs and is administered over 1 hour total IVPB Zofran (small bags (50cc)...
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    Wiki Can we give injections/vaccines to patient when the provider is virtual

    I apologize for the delay! we do not bill 99211. We bill injection/admin codes only. We have a NCNUR "charge" that comes over but it has a$0 charge and does not go out on the claim and i believe you should be able to bill under the same NP.. the key to this is the separate claims one POS 2 one...
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    Wiki E/M Code and Injection Administration Code

    We have this issue with our local Highmark Blue Cross but with 96372/B12 injections.. most time the patient is being seen for a follow up on multiple chronic conditions and are also due for their B12 injection.. the insurance will almost always automatically deny the office visit as CO97 if...
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    Wiki Can we give injections/vaccines to patient when the provider is virtual

    We have a provider that is completely telehealth and her patients come into the office.. When the provider orders vaccines during the telehealth appointment for the nurse to administer we have the front desk schedule a separate "nurse visit" encounter. They then bill for the vaccines/any other...
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    Wiki Iowa FQHC Midwives Billing

    I have been told at least for Medicaid and MCO's under our FQHC we should be billing for everything as well as if they are self-pay. Most of our patient's have financial assistance so it typically isn't a problem, however when they are just self-pay I wasn't sure if there were certain things you...
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    Wiki Iowa FQHC Midwives Billing

    I do for a large FQHC in Pennsylvania... I can try to help and maybe talk through things! I am still learning a lot as well and am no expert though!
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    Wiki Billing For Midwives

    I was asked this question by one of our CNMs recently.. "I just had a quick question on if a vacuum delivery counts towards our incentive numbers in the hospital? This question came up because I recently had three labors we treated and pushed with for several hours however, ended up with the...
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    Wiki Billing Questions Highmark Speech Therapy Claims Denials

    So for the authorizations. we are submitting them prior to running out. but the authorizations are being denied as the benefit max has been reached. which is correct since they have met their visit limit.. But they want to continue to be seen for therapy.. With the benefit denial authorization...
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    Wiki Billing Questions Highmark Speech Therapy Claims Denials

    So unfortunately the process our local enforces we are required to complete 3 unsuccessful claim investigations on each claim before we can request a claim escalation with the provider rep! Which our hope is they will eventually get tired of it and figure out why it’s happening! The claims add...
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    Wiki Billing Questions Highmark Speech Therapy Claims Denials

    So this is more billing related rather than coding related... But I am at a loss and figured it would not hurt to ask. I work for large FQHC as a Coding and Billing specialist. We bill for Speech and Occupational Therapy.. These kid's are seen multiple times a week and usually exhaust their...
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    Wiki E&M coding

    I am having this issue with our providers... to the point that we have been notified by a few payers that they will be doing their own audits in 2024 due to the amount of over coding... Since i recently took the coding specialist position that was open for 3 years E/M training on the new...
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    Wiki Prevnar PCV20 Aetna Denials for Pediatrics

    oh thank you so much for that!!!
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    Wiki Billing Global OB

    It definitely depends on the plan. UHC requires 13 and is VERY strict on that Anytime i bill a global delivery to them we always get a letter requesting medical records to prove they were seen for at least 13 prenatal appointments. I was taught they need at least 10 prenatal appointments for a...
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    Wiki Prevnar PCV20 Aetna Denials for Pediatrics

    We just received our first denial from Aetna for a pediatric patient received 90677.. I appealed that but have not received a decision yet. and in the meantime my supervisor was going to send the information to our Aetna Provider rep to see if they had any Recommendations. our big issue is with...
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