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  1. 5

    Wiki G0260 Medicare denial to medical necessity

    Is anyone getting code paid by Medicare G0260? We have tried everything and have called Medicare and we are not getting anywhere. We do not know who we need to reach out to get it fix. I think this is a Medicare edit issue. THank you
  2. 5

    Wiki SurGenTec ION facet screw system

    Hello! Does anyone have experience with billing Noridian Medicare 22612 SurGenTec ION facet screw system? This is the code that we were told you use for the procedure but we are concerned that it is not supported. I was not able to find LCD on this code. Thank you! :)
  3. 5

    Wiki Anesthesia billing questions on time / units

    Anesthesia Billing question - We have never added the quanity to our claims for time units. From what I see, the claims have processed at the correct rate. Does anyone know how Medicare or other insurance process anesthesia claims? Do they use the time that we have on the claim to calcuate...
  4. 5

    Wiki T12 thoracic vs L1 lumbar coding

    Hello, How do all you pain management coders code if the procedure was at the T12 - L1 site? Single injections If it is a ESI, would you use the Thoracic code of 62321? If it is a TESI would you use the thoracic code of 64479? What if the TESI was at the T12-L1 and L1-L2? If it is a facet or...
    • 574coding
    • Thread
    • pain management t12-l1 t12-l1 injections thoracic or lumbar
    • Replies: 2
    • Forum: Anesthesia
  5. 5

    Wiki Signature on chart note

    Hello, I am trying to find something that supports what a "complete" document is and the need of a signature prior to billing. In the office, we are in disagreement on sending claims electronically to insurance companies. I say you need the provider to sign off on the report before billing...
  6. 5

    Wiki Local by CRNA during a procedure

    I think the CRNA was used due to safety for the patient. Prone position with risks and the provider doing the procedure felt this was in the best intrest of the patient. Would you bill it as MAC? I read the anesthesia record as "Local with monitored anesthesia care" by the CRNA due to the...
  7. 5

    Wiki Local by CRNA during a procedure

    Hello, I am a bit confused on how to bill this out. Patient had a procdure (62323 LESI) at a ASC. We have a CRNA that works for our company. The CRNA saw the patient in pre op, did a pre anethesia H&P. Went into the OR with the patient and per the anesthesia record monitored the patients EKG...
    • 574coding
    • Thread
    • crna anesthesial local local by crna mac
    • Replies: 3
    • Forum: Anesthesia
  8. 5

    Wiki service facility location information

    Hi, Our provider will lease space from another practice. What information do we put in box 32 of the 1500 claim form? The name of the practice is under my employer, she will not be an employee of the practice already in existence. . She will have her own NPI, TIN and contracts with insurance...
  9. 5

    Wiki UDS 80307 - in office lab

    Hello, I am having a hard time with this code and a provider. They feel they can bill for it. I do not. They want me to find the "professional fee". The way I see it is the provider orders the test, it adds to the MDM on that visit, will bump up the E&M level and the provider does not get...
  10. 5

    Wiki Pain Management anesthesia cross walk codes

    Hello, I do not have my new CPT books yet and I was wondering if these are the anesthesia cross walk codes you are using in 2022 for : MBB range 64490 - 64493 01937 or 01938 RFA range 64633 - 64635 01939 or 01940 TFESI 64479 - 64483 - I would assume we would use 01937 or 01938 depending on...
    • 574coding
    • Thread
    • anesthesia crosswalk esi crosswalk mbb crosswalk rfa crosswalk
    • Replies: 1
    • Forum: Anesthesia
  11. 5

    Wiki Genicular Nerve Radiofrequency Ablation prior to TKR

    Hello, One of our pain management providers has been contacted by an orthopedic surgeon about GNRFA prior to TKR. Does anyone have any sucess with reimbursement on the GNRFA? Do we need to make sure the patient has has prior knee injections by the ortho surgeon or other provider that have been...
    • 574coding
    • Thread
    • genicular nerve gnrfa post op pain management tkr
    • Replies: 3
    • Forum: Orthopaedics
  12. 5

    Wiki Anesthesia with pain procedures

    Hello, How do you handle the medical necessity for anesthesia on a procedure that per the LCD, anesthesia is not routinely necessary for the procedures? I think our office needs to have a form or something that documents the reason anesthesia is required for the procedure. Does any one have...
    • 574coding
    • Thread
    • anesthesia anesthesia and pain mgmt anesthesia crna medical necessity
    • Replies: 3
    • Forum: Anesthesia
  13. 5

    Wiki 27096 VS g0260

    Hello, We code G0260 for our ASC billing and Pro 27096 for all Medicare/Medicare replacements / work comp claims. We are having the BX and BS deny the 27096 on the pro side. Is anyone else having this issue? What have you done to fix this? With the way things are going right now, we have a...
  14. 5

    Wiki Credentialing help

    Hi, Our prior employee that was our credentialing. department, has left. she spent time training the new person, but it was not enough time. Does anyone have any recommendations on what we can do to find out more information on credentialing or any workshops / webinars on credentialing? Thank...
  15. 5

    Wiki Supartz - correct billing question

    Hi, Having an issue with Supartz billing. We have reasearched and can not find the correct way to document the information on the claim form. We were told that we need the NCD, units of measurement qualifier and the NDC quantity (number of NDC unites administered) listed out in the...
  16. 5

    Wiki Implanted Intrathecal Pain Pump refills

    Hi, I work in the billing department of a pain management office. We are having issues with Blue Cross taking back money for J codes that are billed out when we refill the pumps. Does anyone out in our AAPC world have time to let me ask some questions about this? I was told that Morphine...
    • 574coding
    • Thread
    • intrathecal j code pain pain pumps sufenta
    • Replies: 3
    • Forum: Anesthesia
  17. 5

    Wiki Reporting during COVID-19

    Hi, I do not know much at all about MIPS. With that being said, I have been requested to help our clinic review and add measures. It looks like a lot if the measures we are using for our clinic now, are not supported if it was a telehealth visit. What is every one else doing about this or...
  18. 5

    Wiki kyphoplasty ICD-10 DX for a Medicare patient

    So this is where the problem arises for our provider. Is a diagnosis of osteoporosis is necessary for a Percutaneous Vertebral Augmentation / Kyphoplasty? An osteoporotic vertebral compression fracture (VCF) is different than having a diagnosis of osteoporosis in general. This patient has a...
  19. 5

    Wiki Assistant Surgeon claim not paid due to CCI edit with CPT codes

    Thank you. We will look into it further.
  20. 5

    Wiki Assistant Surgeon claim not paid due to CCI edit with CPT codes

    I do not know. We are the billing company.
  21. 5

    Wiki Assistant Surgeon claim not paid due to CCI edit with CPT codes

    Do you only bill out the codes for the assistant that are allowed? Do you omit the other codes that do not support an assistant on the claim?
  22. 5

    Wiki Assistant Surgeon claim not paid due to CCI edit with CPT codes

    Hello, Our provider performed an arthroscopy of the knee and we billed 29873 and 29875-59. The claim was process and paid. Our provider had an assistant surgeon and the charges were billed and both denied. How can you get a code paid that does support an assistant surgeon (29875) , if you...
  23. 5

    Wiki two speicalty providers same tax ID number

    The procedure was provided in a ASC, and a E/M code was not used so I would think modifier 25 is out. Two claims with each provider listed and their NPI with the TIN. CRNA code of 01160 and provider code of 27096. CNRA was processed and paid, but MD claim is denied. This happens to many...
  24. 5

    Wiki two speicalty providers same tax ID number

    Hello Can someone get back to me on how to bill two different specialty under same Tax ID number. I have incidents at the surgery center with when a CRNA and Pain specialty physician both provided services on the same patient on same day and one is getting denied. One is a anesthesia code and...
  25. 5

    Wiki Nerve conduction studies question on how to bill

    Hi, Just want to double check how this should be billed. EMG provided Bilat upper extremities. On the left side tested: Muscle nerve deltoid Axillary Biceps musculocut Triceps Radial Opp Pollicis...
  26. 5

    Wiki SP surgery with 90 day global-follow up visit inpt

    thanks!
  27. 5

    Wiki SP surgery with 90 day global-follow up visit inpt

    question...pt is a inpt, had surgery, was seen in follow up visits for multi days - nothing out of the ordinary, just following up from the surgery. the surgery has a 90 day global. I feel its a 99024, but another coder in our office feels we can bill out a follow up visit. Can someone help...
  28. 5

    Wiki down coding from 99214 to 99213

    Hello, Our provider feels his office visits support a 99214 due to pain management with patients that are being treated with pain meds. The patient has a work comp approved claim. The provider documentation has ROS of 7 systems, pain assessment with location, rating, description of pain...
    • 574coding
    • Thread
    • down coding pain management
    • Replies: 0
    • Forum: E/M
  29. 5

    Wiki office visit with chronic pain management

    Hello, Our provider feels his office visits support a 99214 due to pain management with patients that are being treated with pain meds. The patient has a work comp approved claim. The provider documentation has ROS of 7 systems, pain assessment with location, rating, description of pain...
    • 574coding
    • Thread
    • down coding pain management work comp
    • Replies: 0
    • Forum: Anesthesia
  30. 5

    Wiki Telemedicine

    Hi, Does anyone have a nice resource on telemedicine? We have a provider that is interested, but we need to figure out if we can provide this service per the guidelines. Thank you!
  31. 5

    Wiki X-ray...how to code

    HELLO, WE ARE A BILLING COMPANY AND ONE OF OUR CLIENTS WILL TAKE X-RAYS IN THE OFFICE AND WILL SEND THE FILMS OUT TO BE READ AT A RADIOLOGY CENTER. THE RADIOLOGY CENTER WILL BILL THE CLINIC A FLAT FEE FOR READING THE FILMS. CAN WE CODE AND BILL OUT AS IF WE PROVIDED BOTH PROFESSIONAL AND...
  32. 5

    Wiki post op visits modifier 24

    Hello, I was not able to find any post about post op care so here is my question. I need some help figuring out what we can bill for in the post op care. Most of the surgeries are 90 follow up that we deal with in our billing department. I bill for a group of multi specialty providers with...
    • 574coding
    • Thread
    • global billing global days modifer post op
    • Replies: 0
    • Forum: Anesthesia
  33. 5

    Wiki MIPS and who to report this information

    Thank you! That helps, but one more question about it... so say as an example, we are using "tabacco non user code 1036F" or "BMI is documented paramenters code G8417 - G8420" as measures we are reporting. Right now, we document in the report tabbacco no user or BMI info and we add the codes...
  34. 5

    Wiki MIPS and who to report this information

    HI, I have been asked to help my administrator with MIPS. Right now, we have been reporting the information to only CMS/Medicare. When I was looking at the guidelines for 2019, it looked like it was not payor driven, that we should also report the codes to Aetna, the blues, work comp, all...
  35. 5

    Wiki Measure and dx codes

    Hello, i work for a billing office and one of our clients requested dx codes to match measures. I know nothing about measures. How do you handle this? I feel you could have many different dx codes depending on the exam / report. I really do not feel its as simple of just giving them a dx...
  36. 5

    Wiki PRP coding

    Prp Thank you...Just want to confirm to help support the coding when questioned by providers... (using lumbar injection 62323 as the example code), you would never use 62323 in place of 0232T if it was a PRP injection at the lumbar location and you would code 0232T as a stand alone code due is...
  37. 5

    Wiki PRP coding

    What is the correct way to bill a lumbar epidural PRP injection or a paraspinal nerve PRP injection? What I am really trying to figure out is would we bill out only 0232T or 62323/64493 or 62323/64493 along with 0232T?
  38. 5

    Wiki Right C2, C3 MBB and RiGHT TON Block

    Thanks you!
  39. 5

    Wiki Right C2, C3 MBB and RiGHT TON Block

    Thank you!
  40. 5

    Wiki Pain Pump Replacement???

    Its a programmable pump...correct? I would use 62362-52 Reduced services if same pump was used. if new pump used 62362.
  41. 5

    Wiki Right C2, C3 MBB and RiGHT TON Block

    Hello, Could I get opinion on how to code this? I feel it is 64490-RT C-2 but it has been questioned on if correct or not. Would you code it as 64490-RT C-2...or 64490-RT-22 C-2... or 64490-RT C-2 AND 64450-RT TON? Thank you! After obtaining written consent, the patient was taken back to...
  42. 5

    Wiki Moderate sedation services

    Thank you! Could you give me additional information on this code set ... If the RN, is employed by the facility performed the sedation, do you bill 99152 on the physician who is performing the injections professional claim or would you use 99152 on the facility claim?
  43. 5

    Wiki Moderate sedation services

    Hello, When you bill out codes 99151-99157, you enter this on the professional claim of the provider who performed the service...correct? Lets say, it was during a ESI 62323 and the MD that did the injection, and they had a RN that was administrating the moderate sedation service. We would...
    • 574coding
    • Thread
    • 99152 conscious sedation moderate sedation
    • Replies: 2
    • Forum: Anesthesia
  44. 5

    Wiki RF of the Greaterl, Lesser and Third Occipital nerve

    Thank you Dwaldman!
  45. 5

    Wiki RF of the Greaterl, Lesser and Third Occipital nerve

    Hello, What codes would you use in 2018 for a RF of the Greater Occipital nerve, Lesser Occipital nerve and the Third Occipital nerve? Would you use 64633 or 64640? I am having a hard time figuring out the correct coding for this. Thanks!
    • 574coding
    • Thread
    • greater occipital nerve lesser occipital nerve occipitall radio frequency third occiptial nerve
    • Replies: 2
    • Forum: Anesthesia
  46. 5

    Wiki Diagnosis codes alphabetical order

    Hello, we just received a denial from blue cross that said: We are unable to process the claim: 203 diagnosis codes must be entered in alphabetical order a-l 019 invalid diagnosis code pointer has anyone else had this type of an issue? Thank you!
  47. 5

    Wiki Modifier 76 - supervisor at Tricare

    use of modifier 76 with Tricare Hello, I am back again with this modifier. I have not been using it, and it looks like it was added to the claim and billed out. it was paid, so now they want me to code it. I still feel it is not correct.... What does everyone else do??? We billed out coded...
  48. 5

    Wiki 61070 75809 - what anesthesia code to use?

    Hello, Our provider provided services on a patient using codes 61070 and 75809. This patient needed anesthesia for the service. What would the correct anesthesia cpt code be? Thank you
    • 574coding
    • Thread
    • 61070 75809 anesthesia pumpogram shuntogram
    • Replies: 1
    • Forum: Anesthesia
  49. 5

    Wiki Crna billing medicare

    We bill for the service of the CRNAs that work in our clinic. If we have a new CRNA that has started to work for us, and we are in the process of getting the enrollment approved with Medicare. How would we bill out the services that are being provided? Do we hold the claims until all the...
  50. 5

    Wiki 63655 vs 63664 coding help

    We are looking for help with coding the revision code or initial placement code, in the case where a patient has epidural SCS Leads removed and paddle leads implanted. If they never had paddle leads before and the laminectomy is a new procedure done in order to place the paddle leads, would we...
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