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  1. M

    Wiki MIPS for Dermatology

    I'm curious which Quality measures derm offices are reporting. Thanks!
  2. M

    Wiki Office requires social security number

    A doctor's office is requiring a patient provide their social security number, or else the patient agrees to pay for services before they are rendered. The doctor's office is in-network with the patient's insurance. Is this legal? If the office is contracted with the carrier, isn't that part of...
  3. M

    Wiki E/M denials on same day as surgery

    We are beginning to see denials or recoveries from Humana for E/M claims billed on the same day as a procedure, even when billed with a -25. Is anyone else experiencing this? Anthem BCBS GA issued a policy bulletin this year that they will not pay E/M but I can't find one on Humana's site...
  4. M

    Wiki 21235 and 14061 billed together ASC fee

    When I look at the ASC Final Covered procedure list 21235 shows $2176.10 and 14061 shows $797.93. 21235 typically denies when billed with 14061, but on any claims in which it is paid, it is always reduced and not paid as the primary procedure. I must be missing something...
  5. M

    Wiki adding modifiers on ASC claim

    Thank you for your reply. The Aetna contract isn't specific, or at least I cannot find the specifics within that address the grouper/case rates. If you have any other information or resources regarding navigating or negotiating the grouper/case rates, please message me. I am new to ASC. Thanks...
  6. M

    Wiki adding modifiers on ASC claim

    Where would you apply modifiers to these codes in the ASC setting? Only the 13132 paid. This is an Aetna claim. The denial does state the codes denied for the charges included in the contracted and/or case rate so I'm not sure if that's referring to a grouper for the ASC..? 11402 11442 13120...
  7. M

    Wiki multiple procedures-ASC coding question

    Where would you apply modifiers to these codes in the ASC setting? Only the 13132 paid. This is an Aetna claim. The denial does state the codes denied for the charges included in the contracted and/or case rate so I'm not sure if that's referring to a grouper for the ASC..? 11402 11442 13120...
  8. M

    Wiki Denial of primary code when billed with +add on code

    Is anyone experiencing denials for the payment of a primary procedure, but receiving payment on the +add on code. Ex: 14301, 14302? This is Palmetto GBA in GA.
  9. M

    Wiki Collection agency recommendation

    Can anyone recommend a collection/bad debt recovery agency? I am in GA. Please feel free to Private message. Thanks!
  10. M

    Wiki Mohs, repairs, multiple code combo denials

    I'm new to Derm and I'm coming across a lot of denial issues. Examples below. Feedback appreciated! 13132-59 Claim paid 11200 Charge denied Shouldn't both claims pay seeing that the 59 was added for the NCCI edit? 17311-79 17311-79-59 (BSC left mid-jawline and BSC left lateral...
  11. M

    Wiki ASC fee schedules updates

    I've pulled the Addendum for Final ASC Covered Surgical Procedures for CY2019. 14301 is not listed. Does that mean they've deleted and don't consider that a procedure that is covered in ASC setting? It was on the 2018 list. 11402 isn't on the Jan addendum either.
  12. M

    Wiki fee schedule for procedures in ASC

    I've pulled the Addendum for Final ASC Covered Surgical Procedures for CY2019. 14301 is not listed. Does that mean they've deleted and don't consider that a procedure that is covered in ASC setting? It was on the 2018 list. 11402 isn't on the Jan addendum either.
  13. M

    Wiki Insurance refunds for dissolved company

    Are the physicians themselves responsible to refund overpayments to insurance companies requested from a practice under which they owned but is now closed?
  14. M

    Wiki 14301 denied as not med necessary

    That's a great explanation. Thank you!
  15. M

    Wiki 14301 denied as not med necessary

    Patient defect after Mohs was determined by surgeon to require advancement flap 14301. Aetna requested notes on the case 2 times. Notes and photos were sent to support med nec. of 14301. Aetna denied the 14301 as not medically necessary. OrthoNet advised we should have billed complex repair...
    • MichaelGA
    • Thread
    • adjacent tissue transfer advancement flap complex repair
    • Replies: 2
    • Forum: Dermatology
  16. M

    Wiki Complex repair 13132 rejected after billed with 17000 destruction

    Thanks!
  17. M

    Wiki Complex repair 13132 rejected after billed with 17000 destruction

    I'm new to Derm. Patient had Mohs layer 17311 and the following on the same DOS. Patient had complex repair 13132, and the physician also destroyed a lesion- 17000. The Mohs and destruction paid; however, the complex repair was denied- (PTP edits for 13132 to the 17000). Is this a simple fix...
    • MichaelGA
    • Thread
    • complex repair mohs ncci edits ptp edits
    • Replies: 2
    • Forum: Dermatology
  18. M

    Wiki 96401 Administration code and Xolair

    The patient's dose of Xolair is split into 2 separate injection sites. The reimbursement rep from the drug company has told us to bill 96401 with 2 units which have been paying. Shouldn't it be one administration for the one "dose" of Xolair despite the number of sticks?
  19. M

    Wiki Time documentation for Advance Care Plan

    Thank you for the fast response Debra!
  20. M

    Wiki Time documentation for Advance Care Plan

    Since this is a time-based code (first 30 minutes, face to face..), is it appropriate to document "greater than 15 minutes spent with patient", or must the record reflect the specific amount of time provided for the service? I'm trying to find a specific reference to this.
  21. M

    Wiki New End of Life Consultation

    The codes are 99497 and 99498.
  22. M

    Wiki infusion/drug claims

    I was first instructed in billing claims to list charges in order of greatest charge amount. I'm currently working with a group that will list an infusion and drug code in sequential order regardless of the amount being billed on the line item- for example: 96413 J9025 96367 J2405 Should the...
  23. M

    Wiki billing screening mammogram

    The screening and diagnostic mammo LCD from FCSO instructs under the Coverage Guidance section that "...detection of a radiographic abnormality may prompt the interpreting radiologist to order additional views on the same day. When this is the case, the mammography is no longer considered to be...
  24. M

    Wiki Mammogram LCD

    The screening and diagnostic mammo LCD from FCSO instructs under the Coverage Guidance section that "...detection of a radiographic abnormality may prompt the interpreting radiologist to order additional views on the same day. When this is the case, the mammography is no longer considered to be...
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