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  1. M

    Wiki Modifier 52 or 53?

    Patient comes in for an infusion of Actemra. Patient starts not to feel good. Doctor ends the infusion before its complete. I billed 96413 and J3262 with mod 53. Humana denied saying modifier is inconsistent with procedure code or required modifier is missing. So I sent a corrected claim...
  2. M

    Wiki Contracting a new provider Owner wants to do crazy stuff?? HELP!!!

    We have a new doctor joining us (Dr A). She is only contracted with 3 insurances so far. The Head doctor (Dr B) wants her to see more patients than what she is contracted with. DR B came to me today and said that for the insurances that the Dr A is not yet contracted with she wants her to...
  3. M

    Wiki Hard time getting people to work

    We have put ads on multiple websites for job openings in our billing dept. Either we get no response at all, they don't show up for the interviews, or we get resumes that list they are currently working at Taco Bell ( our ads specifically say experience is a must). Is there any other websites...
  4. M

    Wiki Locum Tenens guidance needed

    I have a new doctor ( Dr A) that starting seeing patients before she was fully contracted with some insurances. The owner/top doctor ( Dr B) wants me to bill all of Dr A's claims as locum tenens using Dr B credentials. Some how I don't think this right. I have read the CMS guideline on LT but...
  5. M

    Wiki Need Help with Durolane J7318

    Hello, My doctor used Durolane on a Medicare pt last 10/31/18 (J3490 back then). They only allowed $344.00. My doctor thinks she spent over $700.00 for this drug. I have scoured the internet looking for the allowable on this drug for this year and can't find. Has anyone got paid for this...
  6. M

    Wiki 24 Years Experience, Seeking Remote Coding/Billing Position

    I have been coding/billing for 24 years. I am a certified CPC through the AAPC. I have worked from home for the last 10 years. I find that I am so much more focused and more efficient while I am working in my quite home office. I am a very disciplined worker. I never give up on a claim. My...
  7. M

    Wiki Tricare Address Needed

    Hello Everyone, Our office has a lot of Tricare patients. (West Region) As of 01/01/2018 UnitedHealthCare no longer processes claims for Tricare. Healthnet took Tricare over. I have searched the internet for the new claims address with no luck. I have tried to call them since the first of the...
  8. M

    Wiki IS IT LEGAL? 93880 and 993882

    I work for an Internal Medicine doctor. A lab comes into our office and performs the service of the Duplex scan of extracranial arteries. They also interpret and write the results. They do not send any claims to the insurances nor do they bill patients. My doctor wants to charge an 93880 or...
  9. M

    Wiki Help!! I can't find a code!!

    My doctor has wrote letters, for 2 of his patients , for admission to a nursing homes. He did review these patients charts. He spent around 1/2 hour on each. He is asking me how he can bill Medicare for this. I looked at the Care Plan Oversight codes, and I didn't feel they were quite what I was...
  10. M

    Wiki Annual Physical labs for Medicare patients

    -------------------------------------------------------------------------------- Here is my problem. Medicare patient calls and makes an appt for a physical. They come in a week prior to get their labs done. The lab codes this with V70.0. The day of the Physical the Dr is reading the results...
  11. M

    Wiki Annual PX for Medicare patients

    Here is my problem. Medicare patient calls and makes an appt for a physical. They come in a week prior to get their labs done. The lab codes this with V70.0. The day of the Physical the Dr is reading the results and finds the patient has hypertension, or high cholesterol. The labs have...
  12. M

    Wiki Medicare denying lab and x-rays

    This is a Family Practice. All of the sudden I am getting denials for such codes as 93000 ( EKG)and 71020 ( Chest x-ray). The denial is N265, N286-- Missing or invalid provider #. Up until now my #'s have been correct on my claims. We have changed nothing in our practice. I have called Medicare...
  13. M

    Wiki Medicare denying labs and X-Rays

    This is a Family Practice. All of the sudden I am getting denials for such codes as 93000 ( EKG)and 71020 ( Chest x-ray). The denial is N265, N286-- Missing or invalid provider #. Up until now my #'s have been correct on my claims. We have changed nothing in our practice. I have called...
  14. M

    Wiki Flu shot admin code G0008 getting denied

    I have just taken over billing for a family practitioner. I am finding that Medicare is paying for the flu vaccine G2036, but denying the G0008 saying it is a bundling problem. I have never had this problem before getting these paid. This is in the State of Washington. Help Please..
  15. M

    Wiki What POS should I use??

    This is a radiologist's clinic. All they do is interpret u/s, x-rays ect..., write the reports and send off to the ordering Dr's. What POS do I use for billing? They always bill with modifier 26.
  16. M

    Wiki How do I get paid for 89261, 89254, 89250, 89280?

    I do billing for an infertility clinic. I cannot get Aetna to pay for the following codes 89261, 89254, 89250, 89280. We code these with 58970 ( which they almost always pay for). They give me the denial codes, not medically necessary, and these labs are not reimbursable because we did them...
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