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    Wiki Medicare patient Self-Pay

    If a clinic is participating with Medicare but, is NOT accepting any new Medicare patients can the patient elect to still receive services on a self-pay cash basis? Limiting Charge would apply. With a waiver/ABN obtained prior to services, according to Federal Register Final Rule I would...
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    Wiki Medication management

    If the provider lists all the medication a patient is taking with the name dosage etc & states medications are reviewed and then in the assessment or plan says something like Diabetes & HTN continue current medication . Can that be counted as medication management? I'm questioning because while...
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    G0439 with 90694

    We billed G0439, G0008 & 90694 on the same date of service. Medica Medicare Advantage paid G0439 & G0008 but, states that 90694 is bundled into G0439. Did something change? And why would they deny the "medication" itself and not the administration of the flu shot. Doesn't make sense to me.
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    Wiki Is an in-office injection considered prescription drug management?

    This question was answered directly by Medicare. Q10. I provided a sample prescription drug to the patient. Is this "prescription drug management"? A10. This would be counted as "prescription drug management."
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    Wiki Is an in-office injection considered prescription drug management?

    This answer is directly from Medicare. Q10. I provided a sample prescription drug to the patient. Is this "prescription drug management"? A10. This would be counted as "prescription drug management."
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    Wiki Is an in-office injection considered prescription drug management?

    This answer is directly from Medicare. Q8. Can we always give a moderate level of risk using the example of "prescription drug management" when we order an injection for the patient? A8. Ordering an injection for the patient is not prescription drug management. There can be many different...
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    Wiki E/M Office visit - CPAP

    CPAP is not medication. It is DME (Durable medical equipment) such as oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics. The U.S. Food and Drug Administration classifies medical devices based on their potential risks. CPAP devices are classified as Class II, or...
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    Wiki add on code 99459

    My question doesn't really pertain to 99459 but, is a related topic. Provider only in the room. What code is used for a pelvic exam only with pap for commercial payers? No breast exam is usually done. Typically, it is a patient that has a physical done elsewhere but, is not comfortable with...
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    Wiki CEMC Exam

    Does anyone know if there is a 2024 update to this document? AMA CPT® Evaluation and Management (E/M)Code and Guideline Changes This document includes the following CPT E/M changes, effective January 1, 2023 https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf/
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    Wiki CEMC Exam

    Csperoni how/where did you find this review class? I missed this one but, would be very interested in searching for another one.
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    Wiki Overweight

    For anyone viewing this post and thought about responding . . . Guess I answered my own question. Services January 1, 2021, and after. This collection of inquiries is a collaborative from all Medicare Administrative Contractors (MACs) that have been presented by our provider community. Q2. How...
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    Wiki Overweight

    Hypothyroidism stable - Will refill levothyroxine and will return in August for lab work. Overweight BMI 29 - Will start on phentermine and recheck in a month. Question is: for overweight is that considered acute uncomplicated problem for complexity? Patient has tried many different diets...
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    Wiki 2021 E/M Guidelines - Cat 2 Ordering Unique Tests for labs

    Also from the AMA guidelines. The ordering and actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the levels of E/M services when the professional interpretation of those tests/studies is reported separately by the...
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    Wiki Risk

    Have a provider that recommends, quite often, peptides and supplements. Where do you think this falls for risk? Minimal or low? Or would you say it depends on the peptide &/or supplement & the condition for which the provider recommends taking it? I have been scoring it as low but, this has...
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    Wiki Pap & Pelvic only

    Thank you for your input.
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    Wiki Pap & Pelvic only

    Is it appropriate to bill S0612 for a Pap and Pelvic only? Is a breast exam a mandatory component? I have not been able to find anything that clearly defines what all is included in S0612. S0613 is clinical breast exam w/o pelvic exam so that leads me to believe that a breast exam IS required...
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    Wiki 1 vs 2 stable chronic

    Would this be considered 2 stable chronic or only 1 since the conditions can be related to one another? (one of the causes of ED can be hypogonadism) • Male erectile dysfunction I recommended he continue on his testosterone of xxxmg q. week• Hypogonadism I recommended that he continue on his...
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    Wiki Semaglutide

    While you can purchase generic Semaglutide (Brand names of Ozempic, Wegovy and Rybelsus) at local pharmacies or online, the FDA recommends obtaining it only with a prescription from a licensed medical professional. Can I count as medication management due to FDA recommendation or still NO...
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    Wiki SK removal

    These lesions were shaved horizontally with a razor blade followed by cautery x3. I also used a curette to evacuate the roots of these lesions. I don't code Derm on a regular basis. Is the use of the curette to remove the roots included in the 11300 series of codes? (Provider does list...
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    Wiki Hypogonadism with erectile dysfunction

    Since over time men with hypogonadism can develop erectile dysfunction if a patient has both would this be considered 1 chronic problem as far as leveling the office visit? Medication is prescribed. (cross posted to Diagnosis Forum)
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    Wiki Hypogonadism with Erectile dysfunction

    Since over time men with hypogonadism can develop erectile dysfunction if a patient has both would this be considered 1 chronic problem as far as leveling the office visit? Medication is prescribed. (cross posted to E&M Forum)
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    Wiki Diagnosis Sequencing

    Yes, it helps. Thank you for your feedback. There is another coder/biller that thought the provider should change the note so Zoo.oo was 1st listed in the assessment. I disagreed that the note needed to be changed.
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    Wiki Diagnosis Sequencing

    Years ago I learned that the order the provider lists diagnosis in the office note is not necessarily the order they will appear in on the claim. The Diagnosis that drives the visit will always be listed on the claim as diagnosis #1 even if the provider may have it listed as the 2nd or 3rd or...
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    Wiki Risk for transfer to ED

    Yes, 74 improved to 84.
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    Wiki Risk for transfer to ED

    If a provider makes the decision for transfer to emergency room which level of risk would that be? Additionally, what would be considered severe respiratory distress? Presents w/SOB, coughing sputum, initial O2 sats in 70's, nausea. Neb Tx in office Ipratropium-Albuterol.
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    Wiki Coding diagnosis patient isn't being seen for

    Related question. Years ago I learned that the order the provider lists diagnosis in the office note is not necessarily the order they will appear in on the claim. The Diagnosis that drives the visit will always be listed as diagnosis #1 even if the provider may have it listed as the 2nd or...
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    Wiki IPPE visual acuity

    If a provider missed the visual acuity at the time of the visit can they have the patient come back in and complete that portion amending all documentation? If yes, what would be a reasonable time frame in which to do this?
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    Wiki IPPE Visual Acuity

    If the provider misses the visual acuity screen at the time of the appointment are we able to ask the patient to come back in and and complete that and amend all documentation?
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    Wiki Explaining level selection to patient

    I often, especially with self-pay patients, need to explain the cost/level of their office visit. I have adopted a policy of "less is more" because the more I try to explain all of the criteria that goes into it the less clear it becomes.. I did have someone today who just wasn't getting it...
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    Wiki Modifier 52 vs 53

    If an endometrial biopsy is discontinued due to stenotic external cervical os would modifier 52 or 53 apply?
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    Wiki Telehealth 2 patients same time

    Thanks for your thoughts. That's what I was thinking as well. Just wanted some other opinions. Thanks again.
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    Wiki Telehealth 2 patients same time

    If a Telehealth is done at same time for spouses who are both Covid positive do each get billed? Each has a separate note. HPI, ROS etc are different but, treatments are the same. However, there would have been separate MDM considered for each they just both landed at the same exact...
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    Wiki Transitional Care management

    Lady T, Thank you for your information! Quite helpful. TCM covers 30 days. Can it be thought of like Fracture Care. If we see the patient back within the 30 days for f/u on admit reason is that visit included in the TCM code & we should NOT bill additional E/M? If we see in F/U for unrelated...
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    Wiki Transitional Care Management

    Should one think of Transitional Care Management like Fracture Care? For example, if you bill TCM and within the 30 days the patient is seen in follow up for the TCM problem you can NOT bill an additional E&M. However, if the patient needs to be seen during the 30 days for a different problem...
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    Wiki Transitional Care Management

    We are a family practice office that frequently will see our patients after a hospital stay. We have always billed just a regular E&M but, are wondering if we should be billing transitional care management. In what situations, if any, are we able to do this? For example, we follow Jon Doe for...
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    Wiki Transitional Care management

    We are a family practice office that frequently will see our patients after a hospital stay. We have always billed just a regular E&M but, are wondering if we should be billing transitional care management. In what situations, if any, are we able to do this? For example, we follow Jon Doe for...
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    Wiki Bleeding skin tag

    Correct coding for a clean claim commercial insurance. Provider states in note - skin tag removal...difficulties with irritation and bleeding after intercourse....tried conservative therapy including over-the-counter freezing medication without any improvement. Just wanting to indicate on claim...
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    Wiki Bleeding skin tag

    To accurately document medical necessity for a bleeding skin tag is it appropriate to add R58, hemorrhage NOS? I know hemorrhage is bleeding but, I always associate hemorrhage with severe bleeding. This is not what I would consider severe bleeding. Was advised to use R58 but, I'm not sure I...
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    Wiki Pre-op

    Any pointers/insight on scoring pre-op exams not based upon time? We do labs but, in-house so no credit there. Obviously great exams but, no credit there now either. We are not the surgeon. I've suggested to my providers that pre-ops may be best if they use time but, that isn't always happening.
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    Wiki 2021 E/M Guidelines - Cat 2 Ordering Unique Tests for labs

    So, if we order 4 different labs (we draw and send out) that each have their own CPT code (not part of a panel), that counts as 4 unique tests as long as we are sending them out and not processing them at in-house lab? If we were billing the CPT for the lab no count as we get reimbursed when we...
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    Wiki Injection Administration of non-covered drug

    What if the "drug" is a non-billable, not on a fee schedule product?
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    Wiki Injection Administration of non-covered drug

    If a drug is considered non-covered by the patients insurance. Can the patient pay cash for the drug and the physician bill the insurance for the administration only? (20610, 20552 etc.)
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    Wiki 2021 Time Question

    I found this to be very helpful. https://www.asco.org/practice-policy/policy-issues-statements/asco-in-action/prepare-2021-em-code-changes-free-webinar
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    Wiki 2021 EM CODES

    I found this to be very helpful. https://www.asco.org/practice-policy/policy-issues-statements/asco-in-action/prepare-2021-em-code-changes-free-webinar
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    Wiki 2021 E&M Changes

    I found this very helpful. https://www.asco.org/practice-policy/policy-issues-statements/asco-in-action/prepare-2021-em-code-changes-free-webinar
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    Wiki Depomedrol J1030 and J1040

    If your clinic stocks only 40mg/ml 10ml multi-dose vials and your provider administers a total of 50mg how is that coded?
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    Wiki Partial IUD removal

    This was attempted in the office. * *IUD strings present at OS, IUD strings grasped with polyp forceps, the IUD was removed but one arm was missing. The cervix was then cleansed with betadine and despite multiple attempts at removal with a polyp grasper and a suction curette, the arm could not...
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    Wiki Emergency Department E/M

    Are eye codes 92002-92014 appropriate for use in the Emergency Department?
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    Wiki History

    question deleted by author
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    Wiki Gatt

    Does anyone know the code for GATT (gonioscopy-assisted transluminal trabeculotomy)? 65820 with 92020?
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