Recent content by lizelder

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    Wiki Confirmation of Pregnancy Visits being incl. in Global Charge?

    In the past the confirmation of pregnancy visits we perform have been separate and paybale from the global OB charge. I am being told by an audit team that they are included in the global charge and are not billable. I have been posting these with very obvious confirmation of pregnancy codes...
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    Wiki Going OON with Cigna, do we need to still file any claims to them?

    Our organization is going OON with Cigna, hopefully short term. I have heard that if we see any Cigna patients we can file the claim to Cigna and the patients sometimes get reimbursed, which helps with what they owe our practice? Just curious if anyone has experience with whether or not we...
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    Wiki Incident To Billing

    For a CNM whose credentialing is in process, is it OK for our practice to use Incident -To billing practices if all of the requirements are met for payors which accept this method?
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    Wiki OutPt vs InPt Surgery Claim

    Hello, I have an LAVH converted to a TAH. Surgery was performed on 05/18 and inpatient admission is listed as 05/19. Should this be billed as an inpatient or outpatient claim? And if it is inpatient can I use the date of surgery as the admit date?
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    Wiki Lab and J Code Modifier Changes

    The denials all revolve around the modifiers not matching the CPT codes. I have done further research and it appears the update of the Claims Xtend claims processing tool is what is causing these problems. So thank you for your response but it seems that now I need to find a way to learn all...
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    Wiki Lab and J Code Modifier Changes

    Recently I have been receiving numerous lab and J code denials. BX is saying the denials are correct as they are following CMS/NCCI updated standards. And almost all of the denials reference a modifier is missing. Does anyone know where I can find clarification on which J codes are now...
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    Wiki ESSURE modifer - We are having claims

    We are having claims denied for lack of modifier on our ESSURE claims. We use 58565 and A4264, and one denial specified that the A4264 needs a modifier. We have tried mod 50 but that was denied. Thnx for any suggestions!
    • lizelder
    • Thread
    • a4264 claims denied essure modifier
    • Replies: 1
    • Forum: OB/GYN
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    Wiki ESSURE modifer - IN SC we have recently

    IN SC we have recently had our ESSURE claims being denied for lack of modifier on the A4264 portion. We have tried mod 50 but that did not work. Is 33 the appropriate modifier? Any thoughts would be appreciated!
    • lizelder
    • Thread
    • appreciated denied essure mod modifier
    • Replies: 0
    • Forum: Modifiers
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    Wiki 9 Dx codes

    I am having certain claims where I have 7, 8, or 9 diagnosis codes (esp when I need to use obesity diagnoses) My software only maps four dx codes per procedure charge. Will it suffice to have them appear on the claim, although unmapped? Of course my software company said this would be fine ;)...
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    Wiki CMS 1500 claim form

    Billing manager, CPC After speaking with my tech support people today (because I had the same concern), I found a way for all dx to appear on the claims, but they will be unmapped. I don't know if this will be sufficient specificity to satisfy payers. Does anyone know if it will be enough that...
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