Recent content by RaeToll

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    Wiki 85660 Units Billed

    For facility billing 9 units for CPT 85660 are billed on the UB04 and 9 units of 86902 and 10 units of 86922. Seven units of CPT 85660 are always denied for missing/incomplete/invalid days or units. I'm aware the MUE for CPT 85660 is 2 units. Should the additional 7 units not be billed, or does...
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    Wiki CPT 76700 billed with 76775-XU

    I have a facility claim denial for CPT code 76775-XU due to invalid modifier. I'm aware procedure code 76776 is considered to be a component of the comprehensive code 76700. However, I'm questioning if CPT 76775 should in fact be billed separately based on documentation. There are TWO SEPARATE...
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    Wiki Please help me understand the requirements for billing TOB 0141

    I have received multiple claim denials from different payors for labs billed on a UB04 under bill type 0141 (Hospital - Laboratory Services Provided to Nonpatients). The claim does not include lab draw charges (36415). For example, one claim has CPT codes 87491, 87591, and 87661 billed under...
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    Wiki Speech Therapy Cpt code 92507

    Every policy is different. You should be able to call the insurance company to confirm the patient has benefits. Most insurance companies require prior authorization for therapy services. Then, once authorized, they limit the number of visits/treatments.
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    Wiki 76700 billed with 76775-XU

    I have a facility claim denial for CPT code 76775-XU due to invalid modifier. I'm aware procedure code 76776 is considered to be a component of the comprehensive code 76700. However, I'm questioning if CPT 76775 should in fact be billed separately based on documentation. There are TWO SEPARATE...
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    Wiki Nuclear Medicine Functional Reporting

    Absolutely! Thank you for responding... EXAM: NM GASTRIC EMPTYING STUDY TECHNIQUE: Solid: Following the oral administration of 1 mCi of Technetium-99m Sulfur colloid in a solid egg and toast meal, immediate, 1h, 2h and 4h delayed images of the abdomen and lower chest were obtained in the...
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    Wiki Nuclear Medicine Functional Reporting

    I have a claim for gastric emptying study (78264) billed with modifiers MG and PO and G1004 (Clinical Decision Support Mechanism). There is also a charge for lab 82962 and contrast agent (A9541). UHC Medicare denied the claim stating CPT code 78264 requires functional reporting. It's my...
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    Wiki Facility Billing G0108

    I have received multiple claims that denied HCPCS G0108 for Diabetes Self-Management with a denial reason of "the procedure code/type of bill was inconsistent with the place of service". HCPCS G0108 is reported on the claim under revenue code 0942 and CPT codes 83036 and 82962 are billed under...
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    Wiki Modifiers LD & LC

    I'm a utilization nurse reviewing a denial for missing modifiers. Procedure codes billed are 92928 x2, 92978 x1, 92979 x1, and 93458-59 x1. I have my CPC, but it was more so I could get some idea of some of the denials I audit. Based off what I'm understanding with the coding and the op report...
    • RaeToll
    • Thread
    • cardiac catheterization procedures pci coding
    • Replies: 1
    • Forum: Cardiology
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    Wiki Medi-Cal Newborn Reimbursement

    I realize this is a long shot but, has anyone billed newborn claims to California Health and Wellness? I've been getting denials as "payment included in allowance for another service". I reviewed the CA Health and Wellness Global Maternity Package policy; however, it does not specify if the...
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    Wiki Can I bill modifier -PI with a cancer Dx?

    Thank you for your help Susan. I truly appreciate you.
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    Wiki Can I bill PI modifier with a cancer diagnosis?

    I received a Medicare claim rejection for CPT code 78816-PIPO (PET/CT whole body) citing inconsistent modifier or required modifier is missing. The primary diagnosis listed on the claim is C61 (malignant neoplasm of prostate). I reviewed the CMS Billing and Coding policy which states, Claims for...
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    Wiki Can I bill modifier -PI with a cancer Dx?

    I received a Medicare claim rejection for CPT code 78816-PIPO (PET/CT whole body) citing inconsistent modifier or required modifier is missing. The primary diagnosis listed on the claim is C61 (malignant neoplasm of prostate). I reviewed the CMS Billing and Coding policy which states, Claims for...
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    Wiki How to bill J0741 CABENUVA

    I figured it out. Billing drug dosage sometimes confuses me. For any one else needing references for this: https://nastad.org/sites/default/files/2022-04/PDF_Cabenuva_ADAP_NASTAD_March%202022.pdf
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    Wiki How to bill J0741 CABENUVA

    I have a denial for HCPCS J0741 where 600 units were billed. Medicare denied stating the information submitted does not support this many/frequency of services. The order is for Cabotegravir/Rilpivirine 600mg/3mL - 900mg/3mL ER injection Suspension Kit 6 mL. The nurse documented a total of 6mL...
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