Recent content by eharloff

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    Wiki E66.01 Criteria

    You're right - I guess I read into it too much and forget ICD-10 doesn't state anything regarding that. Thanks!
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    Wiki E66.01 Criteria

    Hello! I have a question/concern regarding E66.01 listed on some of our patients HCC lists that our ACO gives us for our Medicare Advantage patients. This code is sometimes listed for patients with comorbidities but their BMI is less than 35 - I have always been under the impression that E66.01...
    • eharloff
    • Thread
    • billing coding e66.01 hcc morbid obesity
    • Replies: 3
    • Forum: ICD-10
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    Wiki Adjustment Reason Code 107

    I was initially wondering that at first! It's currently going through reconsideration but will follow-up and see if that's possibly the reason. Appreciate your input!
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    Wiki Adjustment Reason Code 107

    You're a life saver! I couldn't find anything - maybe I was just overlooking it. I will look into those. Appreciate you :)
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    Wiki Adjustment Reason Code 107

    I am so confused on what this ARC means. This was sent back to me by Blue Care Network (part of BCBS of MI)... I billed a TCM (99496) and Medication Reconciliation (1111F). The claim was processed without payment due the following: CO-107: The related or qualifying claim/service was not...
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    Wiki OCP Initiation Visit

    I've been having issues getting claims paid when patients come in for OCP initiation because the Z30.41 gives me an error stating it cannot be a primary diagnosis but what other dx am I supposed to use if the patient has no other concerns? I should add we are primary family practice. TIA!
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    Wiki Excludes1 Guidelines

    Now, looking in the book, I do not see the excludes1 note for either code. Why would it show up on the claim scrubber as an error if it's not in the book? Am I interpreting the scrubber's results too formally?
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    Wiki Excludes1 Guidelines

    I used Codify's real time claim scrubber with the information above and it gave me the results per my attachment. The only exception is if they are unrelated - which, in my opinion they are.
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    Wiki Excludes1 Guidelines

    I'm confused but not confused on these Excludes1 notes, especially when it comes to Z00.00 excludes1 notes. For example, a patient came in today for her CPE and pre-conception counseling was discussed, so the provider coded Z00.00 and z31.69, but I know this is going to get rejected because of...
    • eharloff
    • Thread
    • annual physical excludes1 guidelines icd-10
    • Replies: 3
    • Forum: ICD-10
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    Wiki Help with New PA-C

    How do I find a preclusion list? Thanks! :)
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    Wiki Help with New PA-C

    My office hired in a new grad PA-C (eff. 9/2023). Her first day with us was October 30, 2023 and we've ran into a few bumps in the road. Our biggest concern is: She is not yet credentialed with Medicare. I am not quite sure if since she is not yet credentialed with Medicare, if she's able to...
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    Wiki Excludes1 Denials

    So a patient of ours came in for her CPE and was also due for her depo injection. We used 99395-25 and 96372 Dx code for 99395, Z00.00 Dx code for 96372 Z30.42. The insurance denied it stating they cannot be billed together, even though the patient received her depo injection the same day as...
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    Wiki TCM Confusion

    For TCM, our Care Manager is under the impression that if a patient is seen within 48 hours of their discharge, we do NOT need to make a phone call prior to the TCM since their appointment is within those 2 business days. Is this accurate or does she still need to call the patient for the...
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    Wiki eCW - Posting Reversal of Payments

    Can somebody steer me in the right direction please?😧 So, I was originally trained that when an insurance company takes back money, I need to delete all charges and make sure claim balance is $0 because the insurance company is reprocessing the claim and wait until the next payment comes...
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    Wiki CMS-1500 Question - PA

    For Box 31 on the CMS-1500 Form, if a patient sees a Physician Assistant, does the PA's name go in that box or does it have to be an MD or DO? Any help would be great! Thank you :)
    • eharloff
    • Thread
    • billing billing questions claim form cms-1500 insurance physician assistant
    • Replies: 1
    • Forum: Billing/Reimbursement
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