Search results

  1. K

    Wiki MA providing Scribe and MA duties

    I have a question from a compliance stand point regarding the use of a medical assistant as a scribe. I understand that an MA can be used as a scribe, but my question is regarding the use of the MA as a scribe AND MA during the same visit. Meaning- the MA checks the patient in, does the regular...
  2. K

    Wiki 11750 Documentation

    my provider specifically states that it is a matrixectomy in her procedure note
  3. K

    Wiki Routine Foot Care and the LCDs

    The codes on the LCD are the codes they require to be covered. Medicare also requires a modifier to be used on those codes when the patient meets the qualifications- Q7, Q8 or Q9. The modifier is used to indicate that the routine foot care was medically necessary in the absence of a covered...
  4. K

    Wiki Co-management

    I would not recommend doing that- if the optometrist office is doing the postoperative care, then they should be billing and get the reimbursement that way. I am more curious if the billing agency is billing correctly. We do co-management with a few ophthalmologist for cataract surgery and I...
  5. K

    Wiki Coding in EMR...

    Not silly at all! ;) However, I had to re-read your question a couple times to make sure I fully understood your question. If I am understanding your question correctly- the phlebotomist puts a claim in the EMR for the venipuncture and uses a dx that is not the same as indicated in the...
  6. K

    Wiki Pharmacist billing time-based codes

    I work for a Tribal 638 clinic (IHS) and we utilize internal pharmacists for chronic care management services, but these encounters can not be billed higher than a 99211, and have to be done incident to the patients provider. This can be done due to the pharmacist being considered an ancillary...
  7. K

    Wiki Telemedicine Originating Site Billing Q3014

    Using the same DX as the outside provider was my original thought- as it would make sense that we are only hosting the patient for an outside providers visit so you would want the diagnosis to be the same- providing they send us the notes so we can know what they billed. But wanted to make sure...
  8. K

    Wiki In-house lab billing

    I currently work in a facility where we have an in house lab we own- we bill for the labs we perform, not for tests that we send out to our reference lab. My previous employer however had an outside lab that a was embedded in the office and they were responsible for billing their own services...
  9. K

    Wiki Telemedicine Originating Site Billing Q3014

    If our facility is billing for being the originating site for a telemedicine visit, what would you suggest the ICD-10 would be for this charge? Would you want to use the diagnosis associated with the visit that the billing provider would use at the distant site? Or maybe something more along the...
  10. K

    Wiki To bill or not to bill: missing documentation question

    Christine Thank you!!! Sadly, a lot of this has already happened with these particular chronic offenders. I will discuss this further with my Supervisor and CFO. Thank you so much for your response!
  11. K

    Wiki To bill or not to bill: missing documentation question

    This is probably going to sound like a pretty obvious question, but I am really starting to struggle with this after discussions with my coworkers on code assignment. When I was first starting out as a coder, I was taught that when documentation points for a procedure are missing from a note...
  12. K

    Wiki Clarification needed on new E/M changes

    My apologies for my wording in my previous post- to me, the MDM tool the AMA provided for E/M selection starting in January looks like an updated and more organized version of the table of risk.
  13. K

    Wiki Clarification needed on new E/M changes

    Yes, we will have to rely on the new table of risk as the only tool for these codes- they have removed the HPI and Exam as requirements for leveling, but the providers still need to document these items to better fit the reason the patient is being seen rather than to hit a certain number of...
  14. K

    Wiki 2021 E/M Coding Tool

    The AMA has a free one you can use. It is the updated MDM requirements. https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf
  15. K

    Wiki New patient or established after COVID19

    Thank you Chelle-Lynn!
  16. K

    Wiki New patient or established after COVID19

    With the directive that any patient, new or established, coming into the clinic to be swabbed for COVID19 should be billed with a 99211 when the test is done in clinic, how does that affect the coding/billing of any subsequent visit in the clinic. Is the patient considered established now or is...
  17. K

    Wiki Debridement Coding Clarification

    It would depend on the type of debridement and payer, in my opinion. For example for CPT 11042 Medicare is very specific that they require in the documentation the Pre and Post debridement measurements in addition to other documentation. If part of that is missing, then it wouldn't be correct...
  18. K

    Wiki DME

    If the patient is a Medicare patient, the MAC should have documentation requirements that must be met to indicate the need of the DME, as well as the conditions that are an indicator that the DME is medically necessary. You might try there.
  19. K

    Wiki ICD 10 guidelines VS CDC

    This article was very helpful, and explained things in a way that made it more understandable for me.
  20. K

    Wiki Pre-op COVID swab coding

    99211 does not have the same documentation restrictions that the 99212-99215 have. It does not require the HPI, Exam and MDM like the others.
  21. K

    Wiki ICD 10 guidelines VS CDC

    We are adding the code to patients we are testing that have been screened and determined the need to be tested, whether they are symptomatic or asymptomatic. But like I said, if they have been determined to need testing by either the RN or provider. However, we have just started to do testing...
  22. K

    Wiki Antibody Testing E/M Coding

    Thomas your response is exactly how I am feeling about a topic that was brought up recently in the clinic I work for. The question was raised of if we could bill for collecting a COVID19 sample for testing if the reason was strictly for peace of mind. There is no medical necessity for the...
  23. K

    Wiki How to handle confirmation sample collections

    Good Afternoon, I work for a clinic that has done a few confirmation tests on patients who have tested positive for COVID-19. But they are also doing second collections for confirmation the next day. Example: Patient comes in 7/1 to be tested due to symptoms. We bill a 99211 for the nurse...
  24. K

    Wiki Pre-senile cataract removal in adult patient

    Good Afternoon. I am trying to find guidance on how to properly code a pre-senile cataract that was removed for a 21 year old patient. The encounter was for a cataract global transfer of care, and coded as the surgical center coded the procedure. The encounter was billed with the juvenile...
  25. K

    Wiki Intoxicated Patient

    Thank you.
  26. K

    Wiki Intoxicated Patient

    Good Afternoon, I am struggling with the proper coding for the following scenario: with or without intoxication Patient comes in to the clinic intoxicated and is confused about why he is here. He was found in the parking lot confused and inebriated by staff and brought in for immediate...
  27. K

    Wiki Primary DX for Urine Drug Screen-Pain Management

    I agree with you in regards to the order of the codes. You would want to sequence them as the reason for the medication primary, followed by the long term use code. But also remember the payer may have specific guidelines for the test on how they want the claim to look for coverage. There are...
  28. K

    Wiki Telehealth

    I have found some guidance from private payers, but I had to do alot of digging to find the information at first. Once I found the links though it was easy to go back and reference for updates that seem to happen alot for some of the payers. This is all as clear as mud at midnight!
  29. K

    Wiki Telehealth

    I found this today on the AMA website. https://www.ama-assn.org/practice-management/digital/ama-quick-guide-telemedicine-practice It looks like the restriction that telephone encounters are not able to be billed as E/M has been lifted temporarily-which is amazing. (I found that information...
  30. K

    Wiki BMI code for Telehealth/Telemedicine billing?

    Since the BMI is something you report when it is available to use with an Obesity code, I would think you wouldn't need it for a telehealth visit?
  31. K

    Wiki Coding for unstable type 2 diabetes mellitus

    I have been told that in situations like this, E11.9 would be considered appropriate as the patient doesn't have any complications from the high A1C. In fact, they documented that it is improved. If there is no documentation of a complication(s), it seems inappropriate to code the E11.8...
  32. K

    Wiki Behavioral Health Phone only billing

    Generally I have found that "other qualified health care professionals" indicates that these individuals must be a billable provider type with the payers to provide the services. Remember your providers are making "medical decisions" about their patients conditions and care. :) There are CPT's...
  33. K

    Wiki 25 Modifier

    You would put the 25 on the EM 99397 :)
  34. K

    Wiki Pharmacist Options - CHC

    Agreed Thomas. Although, it is completely in the pharmacists scope to provide E/M of a higher degree, payers are still not recognizing them as such. I have heard that Washington may also allow them to bill on their own at a higher level also. What are your thoughts on if a pharmacist performs...
  35. K

    Wiki HIV vs AIDS

    I completely understand the confusion! HIV coding is incredibly difficult. And like you mention the guidelines on this condition are about as clear as mud! However, I think it depends on the documentation you have to code from. If the provider indicated the patient had a history of an...
  36. K

    Wiki Diagnosis missing from assessment but documented in Exam

    I am hoping that someone can help me with an issue I am having. I know that I have found guidance on this type of situation before, but apparently didn't save it for future reference. So any help you can give is greatly appreciated! Q: Can I add a diagnosis code based on findings in the exam...
  37. K

    Wiki Pharmacist Options - CHC

    Unless the provider is actually examining the patient themselves during the encounter, leaving the MDM for the provider to finish wouldn't be appropriate. I work for a Tribal Clinic (similar to the FQHC) and we use pharmacists for chronic care management, anti-coagulation visits and a few other...
  38. K

    Wiki Pessary

    I was always told to bill the 57160 when the Pessary is actually in hand and is dispensed- along with the code for the Pessary itself. I am not sure about any issues with reimbursement for the pessary itself, but it is appropriate to bill for it when it is dispensed to the patient. Hope that...
  39. K

    Wiki How much expierence is needed to be a remote coder?

    When I first got certified, I was able to work from home only because I had worked for the company for 4 years already and they knew my work ethic. I really think it depends on who you get hired by.
  40. K

    Wiki Counting Diagnoses Question

    Personally I would count them as three individual conditions, they may have been treated with the same procedure, but they are three different conditions that he is treating/assessing.
  41. K

    Wiki CMS E/M Services Documentation Guidelines and Burden Reduction Listening Session

    I find this proposal interesting for many reasons, but one that comes to mind a lot is how much of this documentation burden is being blamed on the 95/97 guidelines for E/M that is actually related to the added documentation requirements that are for meaningful use and other EHR issues that were...
  42. K

    Wiki denial for procedure code 20600,advise for alternative

    I would have coded a trigger finger injection with a 20550 instead of a 20600? Not sure if that could be why they denied due to diagnosis not aligning with the procedure done?
  43. K

    Wiki Posting all procedures

    I am not sure if you have had any answers from anyone else on this question, but this is my experience with this. I work for a clinic that has an encounter rate from our state Medicaid. So when the visit is billed to Medicaid, the Primary CPT has the money allocated to it, and all others are...
  44. K

    Wiki Epi Pen Prescription Visit Help

    I am struggling to find guidance on how to properly code a patient encounter for a prescription of an epi-pen. To give a little back ground: PT is coming in before camping to get a RX for an Epi-pen. The PT has never had an anaphylactic experience, only local reaction. Not currently...
  45. K

    Wiki Auditing Experience

    I was wondering if anyone can help me with ways to gain experience in a auditing? I have been googling training's, but what i am really looking for is hands on practice or something to make me get a feel for how it should be done in real life. I am a CPMA, but do not necessarily feel that...
  46. K

    Wiki Chronic Conditions

    Thank you for your response.
  47. K

    Wiki Chronic Conditions

    I have a question that I am struggling finding solid documentation on, so I am hoping someone on here can point me in the right direction, or at least guide me to a solid answer. If a patient is being seen by my provider for only one of the 4 chronic issues the patient has, even if the provider...
  48. K

    Wiki Feeling Defeated

    Chin Up! Deb, I understand your frustration. It is tough to break into the coding field in my opinion because you really need to be in the right area (city, state) to be able to land your first coding job. There are so many physicians offices that have their set coder/billers. I live in a...
  49. K

    Wiki What order do I put the diagnosis?

    I agree with the above statement. Remember if they come to a diagnosis from the symptoms then you do not code them.
  50. K

    Wiki G0299 Home Health or Hospice code question

    I am looking for some help with billing home health services by RN's. This code does not specify that it is ONLY for Hospice, rather it says it is for Home Health OR Hospice services. We are getting denials that this is only for Hospice and that we can not use it. I have been trying to find...
Top