Recent content by kari2007

  1. K

    Wiki J1815 and J1817

    Insulin is considered a self administered drug and not payable on a part B claim. There is some guidance in the claims processing manual: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1800B3.pdf
  2. K

    Wiki Looking for Direction from an RHC Biller/Coder

    I do coding in a RHC and have some knowledge about claims. Why do they keep getting returned to you? There should be a RTP reason code
  3. K

    Wiki Billing for Hydration in Labor Check and Call

    If you are doing professional billing and the hydration is taking place somewhere other than your clinic, that facility would bill hydration out on the UB.
  4. K

    Wiki ER physician admitting to himself

    This happens at our facility also. What we do is not charge an ED professional level, and instead charge the H&P admit CPT for that doctor
  5. K

    Wiki COSC exam prep help?

    I took it a few years ago so I can only tell you at that time, there was a lot of spine surgeries in the OP notes. Be really strong in that area
  6. K

    Wiki CPT for Depression Screen

    99420 is for a health risk assessment, which has components of depression screening in it. We use 96127 for the PHQ-9 and GAD-7 screening done in our clinics and we get paid for them almost 100% of the time.
  7. K

    Wiki Routine Laboratories

    Can you be more specific in which labs are getting denied? Maybe we can offer more insight that way
  8. K

    Wiki Well Visit/ Well Woman

    When this happens at our clinics, if the pap is being done by the same provider who just seen them for the GYn exam, we do a no charge visit, as long as no other concerns or problems are addressed. this happens infrequently and usually only when the patient is pressed for time or on their...
  9. K

    Wiki Ppd

    This is correct. WHen they come back for the reading of it, this is a nurse only visit so there is no charge for it.
  10. K

    Wiki Vaccination Injection Codes With Office Visit

    I've encountered the same edit in Epic. i checked the CCI edits and it is a new addition this year. It does indicate you can bypass the edit with a modifier. However i have not found anything yet to tell me when it would be appopriate to bypass it.
  11. K

    Wiki Poa

    The only payor that is requring us to do it currently is Medicaid.
  12. K

    Wiki V Code for need for injection

    I guess i would use the reason they are getting the Haldol as the diagnosis code, not a V-code. I have a patient who does this weekly and I use the schizoprenia code and have had no problems with payment from Medicare.
  13. K

    Wiki Hospital Admit

    If the surgery is scheduled, than it is not medically necessary to do a H&P. It is probably in your hospitals bylaws that one needs to be done but unless you can append the 57 modifier, decision for surgery to it, than most payers will not reimburse you and will bundle it into the procedure.
  14. K

    Wiki Medical care for mentally handicapped

    Look at Prolonged services without direct patient contact if the patient has recently been in.
  15. K

    Wiki Coding help

    :confused: Sounds like something you are unlikely to reimbursed for by insurance. Why wouldnt the patient go back to the plastic surgery office to have these expanders done? I think the unlisted code is probably your best bet- there is no other CPT code for this type of situation.
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