Recent content by notatthebeach@gmail.com

  1. N

    Wiki occupational therapy group vs one-on-one coding

    Here's my situation. I work as the biller and coder at a pediatric speech and occupational therapy clinic. The owner, also an OTR/L, has her own case load and has picked up a few more kids due to a COTA leaving. She started one 45 min session. When it was supposed to end, she went and got...
  2. N

    Wiki Can you bill insurance for having a translator present?

    Can having a translator be present during a speech therapy session be billed to the insurance? If so, what CPT and is there a modifier? Thanks!!
  3. N

    Wiki BC/BS of Alabama ST precert denial

    I have started working at a pediatric OT/ST facility and the All Kids program through BC/BS of Alabama is denying additional speech therapy visits for a patient that is virtually non verbal due to his Downs. He is getting better. He is having OT, too, but they are authorizing additional visits...
  4. N

    Wiki I am looking for guidance billing for laboratory services and modifiers.

    No one is getting back to me from their office. Definitely not a good way of doing business. But, this is my thinking, I don't think that you need a modifier to bill for the charges if the lab that is doing the reading doesn't bill the insurance at all.
  5. N

    Wiki Remote coding companies

    I recently got my CPC and have done billing for over 30 years with billing/coding experience in Cardiology, oncology, lab, radiology, family practice, DME and Public Health. I have also worked on the insurance company side, too. I am looking to go remote. My email is notatthebeach@gmail.com
  6. N

    Wiki Modifier 51

    We no longer have Blue Cross Medi-Cal in Kern County. They left our county about 4 years ago. We have Health Net, Kaiser and Kern Family that handle the Medi-Cal plans here if they aren't straight Medi-Cal. Certain codes do require U modifiers. We mostly use U8 and UD. But I work at the...
  7. N

    Wiki I am looking for guidance billing for laboratory services and modifiers.

    Let me check with a lab that I know of that we have the same sort of arrangement for. I will respond when I can get ahold of their client billing dept.
  8. N

    Wiki Modifier 51

    I have noticed that there are some Medi-Cal plans that pay way over the normal Medi-Cal allowables. But, also remember, that Medi-Cal does what Medi-Cal wants. They seem to be 5 years behind the rest of how the world bills and pays claims. I am fighting with one of my Medi-Cal payors...
  9. N

    Wiki Vaccine administration coding & billing

    True, there should be no modifier on the 90471. I didn't catch that the first time I read it.
  10. N

    Wiki TC modifier

    That was my next step. Thanks!!
  11. N

    Wiki Modifier 51

    Which one of the procedures are they requesting the money back on? That is the one that will need the modifier 51. But, in most cases (at least where I work), the modifier 51 should go on the lesser priced of the two surgical procedures to ensure maximum reimbursement. Molina Medical? Are...
  12. N

    Wiki Vaccine administration coding & billing

    I guess, what I should really be asking, is why are you also billing for a 99213? Also, who are you billing this to? In California, where I am, Medi-Cal (medicaid) never pays for the admin fee (90471). It is not in their fee schedule and is just not covered. But if it's for a private...
  13. N

    Wiki Vaccine administration coding & billing

    You cannot bill for an E/M code and immunizations at the same time UNLESS the E/M code is truly for something else. We bill for immunizations and TB risk assessments all the time, together, using a 99211 for the TB risk assessment. You don't need a modifier 25 for that. If the only thing they...
  14. N

    Wiki modifier 90

    You can bill for a 99000 for sending a specimen to an outside lab. Is it a nasal swab or is it blood that you are sending out? And, only about 30% of insurances will pay on the 99000.
  15. N

    Wiki I am looking for guidance billing for laboratory services and modifiers.

    Who doesn't the other lab bill the patient's insurance themselves?
See more
Top