Recent content by thomas7331

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    Wiki MA Performing Physical Exam via Telehealth

    I think it's valid concern and an important question you're asking here, but I don't think you are going to find much in the way of written guidance in the addressing this in the coding and billing areas. It's understood for telehealth services that the provider is going to have to rely on the...
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    Wiki Patient on phone, representative in office

    As a general rule, you will code the claim based on the location of the individual who is receiving the services. If the patient is the one being evaluated and treated by the physician, then code and bill based on the patient's location. The location of the representative is not relevant if...
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    Wiki Medicare Private Contract

    I'm not an attorney so can't give legal advice, but it's been my understanding the laws would apply to all Medicare beneficiaries, so you would need to have the contract for any patient who is eligible for Medicare, whether or not they are enrolled in an Advantage plan.
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    Wiki T10-11 fracture

    OK, I see what you're saying. But those codes aren't for reporting two fractures - it just happens to be the case that in those other cases the two different vertebrae are reported with the same code. In your case, you have a T10 and a T11 fracture, which are reported with different codes...
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    Wiki Initial or Subsequent Code?

    To start with, your question is rather confusing because it sounds like you're talking about new vs. established, not initial vs. subsequent? Initial and subsequent terminology only applies to hospital visit codes during a given admission. If you're asking if the clinic visit should be new...
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    Wiki T10-11 fracture

    I agree, if there are two fractured bones, you'd use two separate diagnosis codes. Not sure what code range your looking at, but each vertebra has its own codes for traumatic fractures.
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    Wiki Cardiology

    These are two different conditions - neither one is more or less specific than the other. If the documentation indicates that the patient has both, then I would code both.
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    Wiki Hyperlipedemia

    Z13.220 is a screening code, for use with a test done for early detection of disease in a patient without symptoms or a known condition. If the patient is getting the test because they already have a diagnosis of hyperlipidemia, it would not be appropriate to use the screening code.
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    Wiki Internal Med vs Family practice

    These are definitely two different specialties. On the Medicare enrollment forms, the provider would identify one or the other as their primary specialty. Other payers may follow different rules, of course, for example if both providers are fulfilling the role of a primary care physician. But...
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    Wiki ultrasound codes for OB

    The Z3A codes are for additional information, so they would never be used as the primary code since they do not indicate a reason for an encounter. You can list them anywhere else - the order is not important beyond the first diagnosis code which needs to be your condition that is 'chiefly...
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    Wiki Adding new therapist issues

    I would agree, if the therapist is acting independently at that location and it's not under the management of your organization, then it's not a part of your practice and shouldn't be credentialed as one of your locations with your payers.
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    Wiki SELF PAY CT

    Is your provider contracted or not? If yes, then, they cannot do this. If no, then, I believe that it would be OK as long as you get something in writing from the patient in advance. But I’d caution that you are asking a compliance question here that could have legal ramifications for your...
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    Wiki Non DRG inpatient labor and delivery billing

    I think that this is a question that your hospital is going to have to answer for you. Most facilities would charge their drugs separately, but it’s possible that some would already figure the service charge to be including them. Regarding the revenue codes and units you should also follow your...
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    Wiki SELF PAY CT

    It really depends on what insurance the patient has and also whether or not the provider has a contract with that insurance. For example, if the patient has Medicare, the provider can only do this if they have opted out of Medicare and make a contractual agreement with the patient. On the other...
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    Wiki Anesthesia Billing

    No, nerve blocks are only subject to multiple procedure reductions when performed on the same date as another surgical procedure done by the same provider. Anesthesia is not considered a surgical procedure for purposes of calculating reductions.
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