-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
rachaelwilleford's latest activity
-
Rrachaelwilleford replied to the thread Wiki CPT code 99417 for UHC.UHC has been following Medicare guidelines. Check the Prolonged Services policy with UHC, but I think they accept G2212 instead.
-
Rrachaelwilleford reacted to Tommy@reducear.com's post in the thread Wiki Texas Medicaid J Code Modifier with
Like.
Have you looked into: The use of the JA (ADMINISTERED INTRAVENOUSLY) and JB (ADMINISTERED SUBCUTANEOUSLY) modifiers is required for drugs which have 1 HCPCS Level II (J or Q) code but multiple routes of administration. Drugs that fall under this... -
RThank you for clarifying Rachael. I just realized that it is specific for the Office/Outpatient E/M. It is all over the article. Guess it's one of those days for me!lol. Adding here for everyone's reference :"All medical professionals who can...
-
RG2211 can only be billed for CPT E/Ms 99202 - 99215. Home visits have their own set of E/M codes, so no, this does not include home visits.
-
Rrachaelwilleford replied to the thread Wiki G2211 with PHQ2 and TCM.Has to be an O/O E/M visit and 25 modifier cannot be appended. It's in the MLN article and the 2024 Physician Fee Schedule Final Rule.
-
Rrachaelwilleford replied to the thread Wiki Infusion start/stop times.Start and stop times that are actually performed. Dr could order 2 hours but an adverse reaction occurs and there's additional time, or they stop the infusion, etc. You code what was actually done.
-
Rrachaelwilleford replied to the thread Wiki Immunotherapy Injection with Ultrasound.Definitely going to be an unlisted code. I was looking at intralesional injections last week. I'd have to look at my books at work, but I'd consider unlisted chemotherapy (as chemotherapy also includes complex drug and highly complex biological...
-
Rrachaelwilleford reacted to Cheezum51's post in the thread Wiki Time vs. MDM-Clarification Please with Like.
Fairly recently, CMS stated that its auditors would evaluate the documentation in records where time was used to determine the CPT code level. Also, you have to understand that the auditors will have a general idea of how long a visit should take...
-
Rrachaelwilleford reacted to jkyles's post in the thread Wiki Time vs. MDM-Clarification Please with Like.
Hi there, Unless the auditor can point to a specific payer policy, there's no such thing as matching the MDM to the time for a code (or vice versa). MDM and time are two independent concepts. The CPT editorial group deliberately structured the...
-
RHi there - 1. If you don't have a claims history for how you've reported the fingerstick in the past, check the NCCI edits. 2. Short answer: I think so. Longer answer: Remember that according to the descriptor, the care can be related to a...
-
Rrachaelwilleford replied to the thread Wiki G2211- HELP!.Throwing this one out there too: https://society.asco.org/sites/new-www.asco.org/files/content-files/practice-patients/documents/2024-01-Visit-Complexity-AddOn-Code.pdf
-
Rrachaelwilleford replied to the thread Wiki IV infusion.No admin code for the hydration. It's at the same time.
-
Rrachaelwilleford replied to the thread Wiki Cancer as illness posing a threat to life.CPT Manual definition states "poses a threat to life or bodily function in the near term without treatment".
-
Rrachaelwilleford replied to the thread Wiki Prior Authorization.Check policies on the payer website. Get names, dates, and times if no reference number is available. I used to get the run around from benefits/eligibility. I didn't both with them, because in the end I'd need to check with PA department...
-
Rrachaelwilleford replied to the thread Wiki Denials of high dollar drugs with JW for wastage.If this is a commercial member and not a Medicare Part B member, you can't look at the NCD for Medicare. You have to go to BCBS Michigan's clinical policy for the drug. If you go to the clinical policy for BCBS Michigan, it shows non-small cell...