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    Wiki help with appropriate modifier

    I've been struggling with a getting a procedure paid. This was done at a family practice. DX L02.415- Abscess of lower right extremity cpt 99213- 25 27301 They've paid office visit but keeps denying 27301 stating "service code inconsistent with reported modifier or required modifier is...
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    Wiki Medicare "G" code for shingrix admin

    Hello all. I bill for a Family Practice. Is the a specific "G" code to bill Medicare plans for the administration of Shingrix- 90750? I know for flu it's G0008 and pnuemoccal G0009.
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    Wiki Diabetic Retinol Eye Exam

    Hello all, I bill for a Family Practice and we're going to start doing Diabetic Retinol eye exams. Does anyone else bill for this at their practice that are not an ophthalmologist? Codes that I have been finding seem to be for specialists. What cpt code range would you use?
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    Wiki X-Ray billing

    Hello all, I bill for Primary care family practice. We are starting to perform X-rays in office, but they are being read out of office. Can anyone clarify the correct way to bill for when X-rays are read outside office. I know to apply the appropriate CPT code for actual X-Ray, but what...
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    Wiki Child wellness or adult annual preventative?

    Hello all, I bill for a family practice. We had a new patient come in for their annual physical along with an immunization. Billed was Z00.00 (patient is 18yrs old) with 99385, also adult Z68.20 (adult BMI). The claim was denied "invalid diagnoses code with patient's age and/or gender."...
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    Wiki Ear lavage and E/M payment

    Hello all, I work for a Family Practice and have been having trouble getting E/M visits as well ear lavage 69209 both paid. I submitted a claim as follows: 1. H61.23 Bilateral Impacted Cerumen 99213-25 Linked to 1 69209- 50 linked to 1 Blue Care Network paid 69209 (a very small amount) but...
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    Wiki Durolane Injection coding

    Hello all, I work for a Family practice and we recently started giving Durolane injections in the knee. We had patient recently have the injection in both knees in one office visit. My question is am I coding this correctly? I recently submitted a claim to Medicare Plus Blue (MI) as follows...
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    Wiki Medicare G0438 and G0444 denial

    I work for Family Practice. I billed G0438 for patient as well G0444 for depression screening. I have seen G0444 on the preventative list for Medicare. G0444 was denied for "combination not compatible with another procedure or procedure/modifier provided on same day according to NCCI". Can...
  9. M

    Wiki Medicare G0402 and EKG

    For a Welcome to Medicare visit G0402, I know and EKG 93000 is allowed. I'm having trouble getting the 93000 paid as Medicare states it's unbundled. Am I coding this incorrectly? Should I be coding G0403 for EKG with G0402 and not 93000? Any insight is appreciated!
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    Wiki Ear lavage 69210

    I bill for a Family Practice. I have recently been having issues getting payment for office visit 99213/14 along with ear lavage 69210. Some insurances have stated that it's global and only pay the ear lavage and not the office visit or vice versa. In the past, I've never had issues with this...
  11. M

    Wiki Modifier 59 usage

    Can someone please advise on the correct usage of a possible use modifier 59? I work at family practice and billed an encounter as follows: This patient had a Kenolog injection as well as Bupivacaine in left shoulder. 99214- 25 C92290 J3301 20610 (injection of admin of major joint) The 20610...
  12. M

    Wiki Covid PCR and Rapid at the same time billing

    Hello all, I work for a Family practice and we recently received rapid test (cpt 87426) in office. We already do PCR (cpt 87635) testing for patients. Our providers want to starting doing PCR as well as the Rapid test. Does anyone know if insurances pay for both that are done at the same time...
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    Wiki Different cpt codes for covid PCR vs Rapid

    I work for a Family practice and we currently do PCR COVID swabs that are sent out to a lab. We use cpt 87635 for billing. We are currently trying to obtain the covid rapid tests, I'm having trouble identifying if there would be a different cpt code used for a rapid vs a pcr. Can anyone advise...
  14. M

    Wiki Care management coding

    Hi all, We are a family practice and at times refer patients to care management. Is there a specific code to use for this like a "Z" code or would it be their diagnoses as to why we're referring them? Or maybe a cpt code to bill? Any input is appreciated.
  15. M

    Wiki Billling annual preventative with pap on different day

    Can anyone please verify the correct way to bill a pap that was part of annual preventative but was done on a different date of service? A patients comes in we bill 99396 with Z00.00, insurance pays visit. Patient decides to come back week later for PAP. We bill 99213. Insurance applies visit to...
  16. M

    Wiki 83036 A1c help with payment

    I work for Primary Care office. Patient came in for A1C check. DX was E11.9. Billed to BC insurance 99213, 83036- QW, 3051F Insurance denied payment of 83036 stating "We cant pay for this service unless billed with primary procedure. If the primary procedure wasn't covered we owe no payment"...
  17. M

    Wiki CLIA/claim rejections

    Can anyone advise on the type of CLIA certificate a family practice needs for rapid tests and in-house urine drug tests. I have been getting rejections on rapid strep test (cpt 87880) and drug urine tests ( cpt 80306), specifically from United Health Care. Stating CLIA does not meet...
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    Wiki Kenalog billing

    Does anyone know the proper way to bill a Kenalog injection? We are a family practice and have a new provider that uses Kenalog. Would the procedure code be 20610 or 96372? What should the units look like on a claim? Any insight would be helpful.
  19. M

    Wiki Billing HME and PAP on separate dates

    A patient came in for her annual preventative visit on one date at her PCP. The visit was billed with appropriate cpt 99396 paired with dx code Z00.00. A PAP was not performed on this date of service. She comes back to PCP three days later to have preventative PAP performed with dx code Z01.419...
  20. M

    Wiki HELP with finding correct icd-10

    A new pediatric patient was in with mother with history of SUSPECTED physical abuse. I am having trouble finding the appropriate icd-10 code for this. I have only found code for history of abuse but not suspected. Does such code exist? any help is greatly appreciated!
  21. M

    Wiki Billing for Health qualification form

    It has been brought to my attention that you can bill for BCN Health Qualification form for reimbursement when a patient has their annual physical. Does anyone know what the cpt code would be? The closest I have found is 99080. I have not found this code on the BCBS/BCN fee schedule. Any...
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    Wiki 83036 A1C denial

    I work for a Family practice and have been getting denials for 83036 A1C from Medicare and Medicare Plus Blue claims. I am aware that it's not medically necessary sooner than every 3 months, and we do use the QW modifier. It is being linked to E11.29 as this was done part of an annual wellness...
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