Recent content by rthomas@impcna.com

  1. rthomas@impcna.com

    Wiki EPIC in Physician-Owned Primary Care Office

    We are a Physician-Owned Internal Medicine & Pediatric Primary Care office. We looking into switching our EHR & PM to EPIC since both of the major hospitals in our area are on EPIC. Looking for input, pros & cons, and advice. I am the billing manager & credentialing specialist. Since I have...
  2. rthomas@impcna.com

    Wiki G0180 equivalent for commercial insurances

    Yes, that is correct.
  3. rthomas@impcna.com

    Wiki G0180 equivalent for commercial insurances

    You can bill CPT 99374, Care Plan Oversight for your commercial patients.
  4. rthomas@impcna.com

    Wiki TOAD status

    Yes, you are correct, these need to be coded every year.
  5. rthomas@impcna.com

    Wiki Physician Assistant

    Make sure the physician assistant been credentialed with Highmark. When our PA sees patients we do not attach a supervising provider.
  6. rthomas@impcna.com

    Wiki G0444

    We use the PHQ9 and the provider has a brief discussion with the patient regarding depression.
  7. rthomas@impcna.com

    Wiki Tricare and G2211

    Tricare for Life isn't even picking up Medicare's deductible or coinsurance for G2211. It would be interesting to know why Tricare is paying on pediatric claims since they state in the news letter that it's on their No Pay list.
  8. rthomas@impcna.com

    Wiki Diagnosis Code for Weight Checks

    Can you query the provider to see why the patient was to come back in a week for weight check and have then amend the note? Our providers are really good at indicating why the want the patient to come back whether is be due to feeding problems or failure to thrive. When we have infants come...
  9. rthomas@impcna.com

    Wiki Wart or Lesion Count

    If you can look at note in see that 5 lesions removed from left forearm, 2 removed from right thigh then it is not necessary to indicate a total of 7 lesions. In our practice when it comes to removing warts/molluscum (17110 & 17111) we do have the providers indicate the total number. It is...
  10. rthomas@impcna.com

    Wiki Wart or Lesion Count

    Procedure documentation needs to indicate location, what was used to perform procedure, how procedure was performed, did the patient tolerate procedure or were there complications?
  11. rthomas@impcna.com

    Wiki 20610 - Different area, same side - Help!

    For line # 4 I would have used modifier 51 to indicate multiple procedures them list 59 to indicate separate site 20610-RT-51-59.
  12. rthomas@impcna.com

    Wiki WHO IS NUMBER ONE?

    Most companies use the birthday rule to determine who is primary when it comes to a child's coverage. Example: Mom's birthday is in June and Dad's birthday is in March. Since dad's birthday falls first in the year his coverage would be primary. As for an adult there are several scenarios...
  13. rthomas@impcna.com

    Wiki E/M & AWV

    Yes, Medicare allows you to bill AWV & E/M same day. You need to make sure that all the AWV requirements are in your note as well as documentation to support E/M. We have a nurse dedicated to doing the AWVs that way the provider can focus on the E/M. This allows us to make sure documentation...
  14. rthomas@impcna.com

    Wiki Medicaid billing & immun administration codes

    Medicaid doesn't reimburse for additional components. 90461 is for any additional components of the vaccine. If the provider is an EPSDT provider and enrolled in the Vaccine For Children program then you can bill for 1 component per vaccine, 90460. When we send claims with vaccines that 90461...
  15. rthomas@impcna.com

    Wiki BCBS Claim Rejections

    We have had this issue before and it was due to the subscriber & relationship being entered incorrectly. Some insurance cards will have the patients name on them and not the subscriber. Example: My husband Anthem BCBS and my daughter in on his policy. She has a card with her name but my...
See more
Top