Recent content by rachaelwilleford

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    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.
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    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.
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    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.
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    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 agents).
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    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
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    Wiki IV infusion

    No admin code for the hydration. It's at the same time.
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    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".
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    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 anyway. I had one tell me no auth was needed, but...
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    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 lung cancer, small cell lung cancer, biliary...
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    Wiki Z08

    I understand why you feel that way. However, there was an update to the guidelines for 2024. "Codes Z08, Encounter for follow-up examination after completed treatment for malignant neoplasm, and Z09, Encounter for follow up examination after completed treatment for conditions other than...
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    Wiki RTM coding

    No.
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    Wiki Prostate cancer with cancer symptoms

    C61 for Prostate cancer with z19.2 for castration resistant hormone status
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    Wiki Prostate cancer with cancer symptoms

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    Wiki prolonged cpt code

    Nope, they need to be documenting actual total time, not just "in excess of". Also 60 minutes won't cut it for Medicare with the way they apply the prolonged service time. Most Medicare Advantage plans use the G codes for prolonged services. It's payer choice as to which set of codes they take...
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    Wiki 99212 denial

    It's not just commercial plans. Medicare, as shown in previous payment rules, can choose to accept AMA guidelines (CPT coding) or make their own. Take prolonged services for example. They didn't like how the time period was applied so they made their own code. Commercial plans can choose to...
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