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  1. J

    Wiki Joint Injection Discontinued

    If a patient is receiving a joint injection but procedure is discontinued, how would you bill for the drug? Procedure started but stopped was cpt code 20610 with drug code J3301.
  2. J

    Wiki Allergy Injections Provided in Outpatient Clinic of Hospital

    Hi everyone! Can anyone tell me how an allergy clinic should be handled within the outpatient setting of a critial access hospital? Is it possible to provide allergy injections (allergist outside of organziation sends drug, we are just admin) in an ouptatient setting of the hospital if there...
  3. J

    Wiki Laterality

    If a provider states in the objective "great toe" but then states in the assessment "cellulitus of toe" is it appropriate to ask that they clarify by putting "great toe" in the assessment? Also, if a nurse states in their intake where the cellulitus is located, is it necessary for the provider...
  4. J

    Wiki Billing for Toradol Injection

    Hi everyone, Can anyone tell me how they bill when 30mgs of toradol is given out of a 60mg, one dose, vial? Are the 30mgs just waisted? Thanks, Jennifer
  5. J

    Wiki Billing CPT 36410

    Happy New Year! Can anyone help me with cpt code 36410? Can this code be billed by a CRNA if the nurse requests that it be performed by a CRNA due to the patient being a hard stick? Thanks for any help that you may be able to provide. Jennifer
  6. J

    Wiki EKGs

    Our practice is looking in to performing ekgs but sending it to a cardiologist to be read. Our office would bill for the tracing only (93005)? Thanks for any help that you may be able to provide. Jennifer
  7. J

    Wiki ICD10 Code for Depo Provera

    If a patient comes in every 3 months for the depo injection would the surveillance code be used? Thanks, Jennifer
  8. J

    Wiki ICD10-Depo Provera

    Can anyone tell me what ICD-10 code you would when a patient comes in for a depo provera injection? Thanks, Jennifer
  9. J

    Wiki ICD-10 Depo Provera

    Can anyone tell me what ICD-10 code you would when a patient comes in for a depo provera injection? Thanks, Jennifer
  10. J

    Wiki Modifier 25 on Preventive Visits

    Hi Everyone, We have recently been told by one of our payors that we can add a 25 modifier to a preventive visit code when also billing G0101 and Q0091. Has anyone else ever had this situation? Thanks for any help that you may be able to provide.
  11. J

    Wiki Office Visit and Hospital Visit

    I understand that if a patient is seen in the office and admitted to the hospital the work from the office visit would be counted toward the initial hospital visit. If a patient is admitted but then never seen by our provider because they were transferred to a different facility w/in 4 hours of...
  12. J

    Wiki COB Info

    Can anyone tell me how they handle a patient who has 2 insurances that are both paying as primary. We have contacted the patient several times requesting that the information be updated but this still hasn't been updated? Because of this we are receiving overpayments. Thanks for any advice that...
  13. J

    Wiki Insurance Cards/HIPAA/Consent to treat etc

    Can anyone tell me how long they keep copies of insurance cards/HIPAA/consent to treat form etc in an EHR? Are we allowed to delete after a certain time frame so our system stays clean. Does everyone have new forms signed annually? Thanks in advance for any suggestions that you may be able to...
  14. J

    Wiki 2 DOT Physicals

    Can anyone tell me how they would handle the billing for a repeat DOT physical. Ex. patient comes in and receives full DOT physical but is not re-certified because of elevated BP. The patient returns several weeks later for a re-check of this and the DOT physical is repeated. Would you charge...
  15. J

    Wiki Zostovax Injection

    Has anyone had problems with receiving payment for an administration of a Zostovax injection from UHC or Humana Medicare advantage plans? Currently, our patients pick up the drug from the pharmacy and then bring it to our office so we can give the injection. We are now receiving denials stating...
  16. J

    Wiki CPT Code 11101

    Hi everyone, Our office performed 3 punch bx. We billed 11100, 11101 and 11101. Medicare is denying one of the 11101 stating that this is duplicate billing. They stated that the 11101 should be billed with a quantity of 2. Can anyone tell me where I can find documentation to support this...
  17. J

    Wiki Administration Code

    Hi everyone! Can anyone tell me if there is an admin code for Zofran when it is given orally? Thanks for your help. Jennifer
  18. J

    Wiki CRNAs splitting services

    We have two CRNAs who split services between a patient. One had started the anesthesia and the other stayed with the patient during surgery. Does anyone know how this should be billed? Thanks for any help that you may be able to provide.
  19. J

    Wiki Sports/School/Camp Physicals

    Soon our office will be seeing an increase in requests for sports/school/camp physicals etc.The majority of the time, an actual preventive is not performed but pt's do not understand why it is not a covered service by the insurance company. My thought was for the patient to receive a preventive...
  20. J

    Wiki Pre-operative Visits

    Does anyone know if an office visit is able to be charged by a specialist, if they are referred by a family practice provider, to receive a colonoscopy? We bill for both family practice providers and general surgeons. There are times that we send patients from the family practice to the...
  21. J

    Wiki Rural Health Office Visit and Pt Admitted

    Hi everyone! If a patient is seen in a rural health setting and admitted from the hospital, can an initial hospital visit and e/m be billed on the same day? Our PAs see patients and then admits them to the hospital but they do not do the initial visit at the hospital the physician does...
  22. J

    Wiki Change in hospital status

    Hi everyone! Can anyone tell me how they would handle the following situation: A patient is discharged from the hospital in the morning but then returns to the hospital in the evening and is re-admitted. Can two initial visits be billed on the same day? Thanks! Jennifer
  23. J

    Wiki Procedure done while pt is in swingbed

    Hi everyone! We did a procedure on a patient who was in swingbed status. Would you use the swingbed place of service or would you use the outpatient place of service code? Thanks, Jennifer
  24. J

    Wiki Number of Units

    I understand that anesthesia minutes are calculated by 15 increments. Can anyone tell me if you automatically round up to the next unit if it is 1 minute over the 15 minute increments? Thanks Jennifer
  25. J

    Wiki Coding of Drugs

    Can anyone tell me how you would bill out for 60mgs of depo medrol when 2 40mg vials were used? Thanks for any help that you may be able to provide. Jennifer
  26. J

    Wiki CPT code 58661 and 58100

    We billed out for 58661 and 58100. When looking at the CCI edits I do not see where a modifier needs to be used. Can anyone tell me why an insurance would bundle these together without a modifier. Thanks in advance for any help that you may be able to give. Jennifer
  27. J

    Wiki Strep Test and Cultures - Can anyone tell me

    Can anyone tell me if they have had problems receiving reimbursement on cpt code 87430 when billed in conjunction 87147 and 87081? We are starting to see insurances bundle 87430 with the last two codes. Thanks for any help that you may be able to provide! Jennifer
  28. J

    Wiki Refunds

    Can anyone assist me with the following situation: A patient has both BCBS and HLNK. The patient's primary insurance should be HLNK because that insurance was through her employer. Both are paying as primary for dos back in 2012. The patient no longer has HLNK but will not contact BCBS to...
  29. J

    Wiki Influenza 87804

    Can anyone tell me if they have trouble receiving payment from Medicare for CPT code 87804(influenza) when done twice on the same day? This is done twice on the same day due to test for flu a/b. Currently, we use modifier 91 for this but are having trouble receiving payment. Thanks, Jennifer
  30. J

    Wiki Return to hospital after procedure

    A patient presented to our hospital for a procedure (46614, anoscopy w/ control of bleeding) on 5/15/13. This was an unplanned return to the operating room from procedure that was previously done on 5-7-13. The patient's surgeon followed up with him on the following two days. Medicare is...
  31. J

    Wiki PQRS Measures-for their CRNAs

    Is anyone doing PQRS measures for for their CRNAs? If so, can you tell me what measures you are using? Thanks, Jennifer
  32. J

    Wiki Consult and procedure on same day

    Can anyone tell me if they have trouble receiving payment for a visit and procedure on the same day when done in the hospital? One of our surgeons seen a patient and then decided to perform surgery. We billed 99232-57(subsequent code used in place of consult code) along with the procedure on the...
  33. J

    Wiki Pre-operative labs

    Does anyone have trouble providing pre-operative labs to Medicare patients? This has been a question as to whether or not we should provide pre-operative labs or we should send the patients to the hospital. I do not see a problem with it but was looking for feedback from other offices. Thanks...
  34. J

    Wiki Insertion of Cath

    Can someone explain as to why 36561 and 77001 cannot be billed together in a place of service 22? One of our specialists performed both services in an outpatient setting. Thanks, Jennifer
  35. J

    Wiki Insertion of Catheter and Guidance

    Can someone explain as to why 36561 and 77001 cannot be billed together in a place of service 22? One of our specialists performed both services in an outpatient setting. Thanks, Jennifer
  36. J

    Wiki ABNs

    Can anyone help me with the guidelines for ABNs? We are currently on an EMR and it is requiring an abn for hemoccult slides. Due to this being a screening but covered by Medicare once a year, is this why an ABN is being generated? Thanks for any help that you may be able to provide. Jennifer
  37. J

    Wiki LabDX

    We have some discrepancies in our office in regards to how dx codes should be attached to visits. Currently our providers fill out a lab order sheet and then we have instructed the lab to send out labs with dx provided by the provider. The lab is finding that there are times where a dx is not...
  38. J

    Wiki Blood Draw Fees

    We collected blood on a patient and then sent it on to an outside lab. Medicare is denying the blood draw fee, stating that another provider was already paid for this dos. Upon calling Medicare, I was told that I could a 26 or TC modifier. Has anyone else experienced this? Thanks, Jennifer
  39. J

    Wiki Cash Patients

    Can anyone tell me how they handle cash patients when presenting for surgery? Do you collect a certain amount up front? If so, is it a flat rate or do you base it off of what you believe the physician will be performing? Thanks, Jennifer
  40. J

    Wiki Cash Patients

    Can anyone tell me how they handle cash patients when presenting for surgery? Do you collect a certain amount up front? If so, is it a flat rate or do you base it off of what you believe the physician will be performing? Thanks, Jennifer
  41. J

    Wiki Observation Initial and Discharge

    If a patient is admitted to observation one day but is not seen by the provider until the next day and then discharged how would you bill? Would the provider receive credit for initial and discharge on the same day? Would they only receive credit for the discharge? Thanks for any help that you...
  42. J

    Wiki Consult Codes

    We recently went from being a Family Practice to a multi-specialty practice. When a Medicare patient is in the hospital and a consult (performed by one of our specialists( is requested by one of our family practice physicians, would the specialist bill the appropriate initial inpatient code and...
  43. J

    Wiki ER/Family Practice Provider

    One of our providers is employed by the ER and by our office. If the provider is working in the ER and then the patient comes into our office as a new patient are we allowed to bill a new patient visit? The provider's employment with the ER has no connection to our office. Thanks in advance...
  44. J

    Wiki Seeing patients in ER

    One of our providers is employed by the ER and by our office. If the provider is working in the ER and then the patient comes into our office as a new patient are we allowed to bill a new patient visit? The provider's employment with the ER has no connection to our office. Thanks in advance...
  45. J

    Wiki Collection of Pap Smear and E/M Visit on Same Day

    If a patient comes in for a repeat pap is it appropriate to bill both an e/m visit and collection of specimen (Q0091)? We have billed both and are receiving a denial from the insurance stating that the e/m is being bundled with the Q0091. I know that a 25 modifier will unbundle the service but...
  46. J

    Wiki Level of Visit

    Can someone help me with the following provider note. It is being questioned if this would stand up in an audit. I believe that it would but I would like another opinion. Past Medical Hx HEENT: Alergic Rhinitis Cardio: HTN, Pacemaker,SVT Psychiatric: Depression Past Surgical Hx Cardio...
  47. J

    Wiki Follow up after surgery

    How would you bill Medicare if a patient has surgery by a physician and is then seen by a physician who is not part of that surgeons group? Thanks!
  48. J

    Wiki Nerve Block

    Does an anesthesiologist have to have an order by the physician in order to perform a nerve block? Also, does anyone have a good resource to find more information in regards to post operative pain control done by an anesthesiologist? Thanks, Jennifer
  49. J

    Wiki Unlisted Code

    Can anyone tell me how they determine pricing when using an unlisted code? Thanks! Jennifer
  50. J

    Wiki Anesthesia documentation

    Can anyone tell me what the requirements are for anesthesia documentation? Thanks!
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