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  1. E

    Wiki CPT 11055 Denial

    The only thing I can think of is if you are appending the Qx (7,8,9) modifier and/or the toe modifier
  2. E

    Wiki Smoking Cessation 99406/99407

    I always add the Z71.6 code in addition to the F17.210 code
  3. E

    Wiki First steps after accepting a coding position

    General terminology first and then anatomy specific to your specialty
  4. E

    Wiki Medicare denial for 83036

    We generally get CO50 errors on our A1c's for two reasons - done too often or unsupported dx (like when the providers insist on getting A1c's for hypertension)
  5. E

    Wiki Q7, Q8 & Q9

    I can verify that JH needs the modifiers for calluses and nails
  6. E

    Wiki Medicare denying all 96372 injection codes!! Please help!

    Check to make sure that the NDC is coded with the J1885
  7. E

    Wiki Why is Medicare rejecting Covid Vaccines? Please help!

    Our facility has for a few months Our facility has for a few months. Very persnickety to start, but seems to be moving smoothly now
  8. E

    Wiki covid testing with rapid influenza A and B

    At our facility, we are using a BinaxNow that is capable of running both tests simultaneously; however, we are not utilizing this feature for "unspecified CLIA reasons" My understanding is that if you perform both tests simultaneously, use 87428-QW. If not simultaneous, use 87426 and 87804 (x2)
  9. E

    Wiki COVID Uninsured Program

    Working from memory here.....modifier -QW, Z20.828 or U07.1 for a dx, POS 11, and don't forget the HRSA number that comes from the portal is only valid for 3 months, so you may have to get a new one for the same patient periodically
  10. E

    Wiki Q modifiers

    We have the same problem here. You just leave the Q modifier off and let your providers/office manager know that you do not have sufficient documentation for billing
  11. E

    Wiki 51 modifier

    What Thomas said. I used to have to use a 51 for a special optometry procedure for Novitas Medicare, but we got a new machine that didn't use one of the codes, so good bye (and good riddance) to 51 for me
  12. E

    Wiki Billing E/M with 25 - Injections

    While I agree with both of you from an academic standpoint, allow me to at least bring up a "devil's advocate" point.... Remember that the first coding passes for a payor are computer-based edits. I do not know for sure, but it's my guess that your claims (and mine, too) are getting denied...
  13. E

    Wiki COVID Uninsured Program

    Our facility uses "COVID19" for a group number, just so we don't leave the field blank
  14. E

    Wiki Help me understand DM w/microalbuminuria

    Because microalbuminuria/proteinuria is considered to be a kidney condition
  15. E

    Wiki Venipuncture with modifier and e/m

    No
  16. E

    Wiki CPT 11055

    Also, Medicare requires Q7/Q8/Q9 modifiers for lesion removals and toe nail cutting (but not for ulcer debridement)
  17. E

    Wiki Z76.0 Encounter for issue of repeat prescription

    Ashley, Are you coding for a tribal 638 clinic?
  18. E

    Wiki 2021 EM CODES

    Is CMS still planning to pay levels 2, 3, and 4 at the same rate in 2021? Have not heard anything on this in a while.
  19. E

    Wiki Primary DX for Urine Drug Screen-Pain Management

    I work for a small outpatient clinic, and we have no problem billing a 80305-QW with Z79.891 as a secondary dx I do think the reason for the pain meds should be primary over the "long-term use" code; the pain is the proximate reason for the encounter, not the actual taking of the pain meds...
  20. E

    Wiki Lesion removal

    No
  21. E

    Wiki Can Modifier 59, XU, XP, XS, XE be added to G0008, G0009, G0010, 90460, 90461, 90470 & 90471.

    Is your Medicare patient under 18? Also, I don't think Medicare pays for meningococcal vaccines. Did you mean pneumococcal?
  22. E

    Wiki Hep B Vaccine

    I don't think I would bill it at all. You can't use the adult code because I don't think the lot numbers would match up in case of a recall or an adverse reaction, and no way are the insurance companies going to deal with billing 2 units of a pediatric shot for an adult
  23. E

    Wiki Telehealth and FQHC

    I just read an MLN from CMS (ICN 901705) which said that substance abuse and co-occurrent mental health issues can be done with home as the originating site. I will soon be getting back into telemed after a 2-year hiatus, so I too would welcome some more feedback
  24. E

    Wiki E\M vs Psychotherapy (90837)

    They should be separately billable. The only thing I can think of is that the insurance company is checking the taxonomies and blocking it that way. Is it every visit? Certain payers? What is/are the denial reasons on the OV code for the psychiatrist?
  25. E

    Wiki Billing 92557 with 92567 and E/M 99213

    I didn't think that 92557 and 92567 needed a 59 between them. I too would like someone more familiar with SLP to weigh in
  26. E

    Wiki Continuous glucose monitoring

    95250 on the date of sensor placement, and 95251 on the date of sensor read (assuming complete documentation of the read)
  27. E

    Wiki Medicare and Chiropractic Billing

    I had to go through a bit of wrangling with Novitas to get it down.... Use an M99.0x code as primary and make sure there is a pain code somewhere as a secondary diagnosis As a Novitas CS rep explained to me, how can it be mod -AT if the patient isn't in any pain? Novitas' LCD is pretty...
  28. E

    Wiki 25 modifier on OV with injections

    Yes
  29. E

    Wiki billing for chiropractic services

    Don't know about PT, but most (if not all) chiro payers need that mod -AT
  30. E

    Wiki E/M with 86580

    What were your diagnoses?
  31. E

    Wiki Medically necessary code for cpt-80061

    We have that problem here, as well. We use a lot of locum FNP's who think that patient-requested annual labs or "just in case" screening labs are perfectly fine to order If the patient has no known problems with lipid metabolism or obesity and they are only in for a well check, then why are we...
  32. E

    Wiki Q3014 billing guidelines

    1. Yes, unless your payer specifically dictates use of another code 2. Yes, back to whatever timely filing restrictions the payer has 3. No modifier (unless you are a CAH), but don't forget to change POS to 02
  33. E

    Wiki CPT 92250 & 2022F

    also, don't forget your 59/XU if done on same day as an eye exam
  34. E

    Wiki Legal Trends and Issues

    Did anyone else have difficulty posting the CEU code for Legal Trends and Issues? I can verify the code with another attendee tomorrow, but in case we have the same code.....
  35. E

    Wiki Family practice

    As a CFPC, I can tell you that my exam hammered E/M coding HARD. Know your AMA CPT rules for what constitutes an E/M level (NOT the Medicare guidelines for "medical necessity is the overarching criteria", etc) and don't go to sleep on all the other codes in the E/M section that aren't OV (e.g...
  36. E

    Wiki Rapid Strep - 87880

    I have never had an issue billing 87880-QW for patients of any age I would be very interested to hear what you find out after you contact BCBS What dx are you using and what was the error code from the EOB?
  37. E

    Wiki CKD stage 2

    Not an exact answer to your question; just passing along what an MD told me about this very same question 5 years ago While eGFR is extremely important re: CKD staging, there are instances when the eGFR can be influenced by other acute conditions on a temporary basis In other words, the MD has...
  38. E

    Wiki Urinalysis not covered by Medicare with E/M code

    Would 81003-QW be a better code for the device/test you are running?
  39. E

    Wiki Urinalysis not covered by Medicare with E/M code

    Just brainstorming here, but the problem may be with the device you are using vs. the code. Is your urinalysis device CLIA-waived or moderate complexity?
  40. E

    Wiki Medicare Diabetes Prevention Program Claims

    Bumping this because I will need to know this soon for our clinic
  41. E

    Wiki CPT 99406/99407 advice

    We don't bill often for smoking cessation, but I've had good success from Medicare by billing 99406 to dx code Z71.6, with a mod -25 on the preceding E/M code I've never had to bill a 99407, but I imagine there's nothing different compared to a 99406
  42. E

    Wiki Preventative visit with an E/M service

    Looks good to me. The only thing I can think of was the shot code-linked to the neck pain or the exam dx?
  43. E

    Wiki 99214 vs 99215

    To use time vs. MDM, the provider must document the total time of the visit, the amount of time spent on counseling/coordination of care (which must be greater than 50% of the total visit time), and some sort of statement as to why the patient had to be counseled/coordinated I've had one...
  44. E

    Wiki Old coding books

    I always save one previous edition. I also have my last ICD-9 - for nostalgia sake, I guess
  45. E

    Wiki Family Medicine offices

    Our clinic does not do Xrays, but we do offer in house lab testing Because we have both our CLIA waiver and our Moderate Complexity certificate, we are able to bill any lab we do in house (either with a -QW modifier or no modifier at all) Because of our special status as a Freestanding 638...
  46. E

    Wiki Medicare reimbursement for the TDAP vaccine

    Our MAC is Novitas, and we have to submit with a modifier -AT. I've only seen a Medicare TDAP for injury reasons twice in 5 years, so I can't remember anything else that is specifically needed
  47. E

    Wiki Medicare Advantage Flu Shot Billing and Modifiers

    Without being familiar with your EHR, try changing the 90471 to a 90472 and see if that clears the edit
  48. E

    Wiki Dreaded a vs d suffix

    If an ER doc codes a broken leg as an A, then the PCP codes the follow-up as a D but refers to an orthopedist for resetting a malunion, that orthopedist is going to switch back to an A
  49. E

    Wiki Dreaded a vs d suffix

    To piggyback on cgaston's answer, it is possible for a condition to move from A to D and back to A and then back to D, depending on what is being done and which provider is performing the service
  50. E

    Wiki Podiatry coding 11721 and 11056

    Are you getting 11721/G0127 mixed up with 11056? Your post is confusing - are you having issues with the debridements or with the nail trimming or with the keratotic lesion removals?
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