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    Wiki Modifier needed for inpatient

    Hi Debellis59,:) I suggest trying these modifiers to define the different clinical providers. Check it in the HCPCS manual Appendix 2. The modifiers you may seeking could be ... AE Register dietician,, AF Specialty Physician , AG Principal physician, AH Clinical Psychologist, AJ Clinical...
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    Wiki Help! NCCI edits

    Stacia 70, Standard treatment programs in acute rehabilitation include occupational, physical, and speech therapies (OT, PT, and ST, respectively). You need to ensure document minutes, have consult plan of treatment, and body area give treatment. Add modifier 96, 97, GO GN GP depending on...
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    Wiki Rookie Questions about getting labs covered in ambulatory setting

    Hi Krauttermedica I use notations for doc's order to guide me but at times the name of the lab is what the physician is looking for. Also if person has complex illness like type of cancer and it is current most labs will coordinate with such serious illness. Also do not forget to code in lab...
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    Wiki 2 visits on one day--what modifiers should be used in ED?

    Hi Nikki I would try using modifier 27 on 2nd visit to ED on same date. I hope this data helps you Lady T
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    Wiki dietitian billing: Hi i need help with some dietitian billing. any experts? what are the proper cpt codes for billing a dietitian visit?

    Hi Dravekar You can bill CPT 99211 not CPT 99212 for this staff person .Add referring physician or provider on claim. Some payers want modifier AE for dieticians. If do phone call can use CPT 96886 series add minutes in documentation and discussion for established patients. I hope this data...
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    Wiki G2211 FQHC Medicare

    Hi Heather Well I got this data from the journal listed. However are the Dx code billed as unspecified diagnosis? Payers not covering unspecific dx as much. Or it could be when billed Z codes as primary dx. Most Z dx codes are not primary dx codes. Years ago I use to work at a FHQC facility...
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    Wiki G2211 FQHC Medicare

    Hi There HGILHAM The HCPCS code G2211 add on code is not to be billed with outpatient and clinic but for a long term care problem and must be complex. Public feedback has not been good on this HCCS code so made modify conditions on it and budget constraints. Try and visit https://www.cms/.goc...
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    Wiki Personal History of Cancer-- Invalid principal diagnosis?

    Hello Toria Some of the Z codes listed above should NOT be first listed or principle Dx. code on claims per the ICD 10 manual These are not first listed dx codes such as: Z34, Z76, Z99, Z40,andZ42.You can use these as secondary or last dx on claims per documentation. As stated in ICD10 manual...
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    Wiki CCM

    Hi VNorman Yes if want to bill have them do the CYB (cover your behind) in completing proper documentation. Lady T
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    Wiki Need some advice on these three codes...., 90833, 90836, & 90838 Thank you!

    Hi Brad Yes can bill these CPT codes add modifier 95 if video or telehealth. Add modifier 93 if phone call. Ensure put amount of minutes on medical documentation for that day of treatment, describe problem, care, meds using and current dx codes. Ensure the patient name Etc on record & ,add...
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    Wiki 95165 UHC Continuous Denials

    Hi Seraphine8519,🐜🦋 I would use another CPT it states it CPT 95165 is for professional service for preparing multiple doses of insect bugs antigen . Maybe should use CPT 95115-95125 linked with problem..allgery on skin or breathing or mold or Etc. Other factors...CPT Codes 95115 and 95117 -...
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    Wiki CCM

    Hi V Norman They should be aware or able to verify patient, mode of treatment listed is video, phone call or face to face, add minutes talk with patient, get list of current vs past medical histories and last time inpatient & problem. Review meds but also about current visit of the assessment...
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    Wiki Testosterone testing

    A total testosterone test CPT 84403measures free testosterone and testosterone that's attached to proteins. This is the most common type of test. A free testosterone test CPT 84402 measures only the "active" form of testosterone. This test is less common, but it may be useful for diagnosing...
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    Wiki incomplete colonoscopy due to blockage

    Hi Shaughnessy Bill the gastro CPT code chosen- 45380 then use definitive dx for Rectum mass, and dx Z12.11 last on claim. If lab results states rectum cancer is positive from results add that on claim first then Z dx code..Please note digital finger exam is bundled in, Provider cleaned out &...
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    Wiki Peripheral Arterial Disease Coding – Lower Limb Thrombosis

    Hi XXXPAragon To read more about the MPFS search tool, go to the MLN® booklet, How to Use The Searchable Medicare Physician Fee Schedule Booklet (PDF) . See reference https://www.cms.gov/medicare/payment/fee-schedules/physician/lookup-tool. You put in CPT code and list dx associated with...
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    Wiki Peripheral Arterial Disease Coding – Lower Limb Thrombosis

    Hi Dchen You can always take any CPT code then see which dx code it links too under the CMS website. I hope this data helps you and the provider. Some dx seem to fit this category of treatment range in dx blocks of I82.4, Z86.718 C47-C49,or I70 Lady T
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    Wiki Prescription management

    Hi Dmdahlgren All data is good listed above but use differ Z codes for prescription renewed dx Z76.00 and management drugs reconciled dx Z51.81 plus use as the last diagnosis on claim not first. I hope helped somewhat on the topic Lady T
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    Wiki Modifier XE

    Hi ECCM Use modifier 91 for repeat lab procedures which is listed under other provider s name. I hope helped you Lady T
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    Wiki Walk-In Clinic Coding

    Hi Shelly :) I think best bet is to use the Eva Mgnt codes pertain to OP clinic visits & proper documentation of HP, nature of complaint, MDM risk and add ancillary charges if warranted of lab xray injections.. I do think you may get patients pop in just want med prescription renewed Z76 or Z51...
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    Wiki Too many DX Codes for Medicare?

    Hi KKorn :) This looks like clean claim none of the Dx.codes are in conflict to because Excludes Rule 1 if occurred. Each area of body mentioned above hip, stiff elbow, foot drop can be affected by dx G35. All dx. are permissible as long as document in medical record for day of treatment. Ah...
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    Wiki Psychiatrist Billing

    Wskgirl here are other modifiers to check are AJ=LCSW and AF specialty physician and AH clinical psychologist. I hope this helps you Lady T
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    Wiki GYN Well Woman and Problem Visit

    Hi Lb6731 This looks fine ...provider has stated the annual OB/GYN and pt has another problem vaginismus. The annual usually checking/screening for cancer of ovary or cervix. I believe you can put the modifier 25 on annual physical 99395. Ensure link dx to proper CPT. I hope helped you just a...
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    Wiki E/M billed with a Xray Denials

    Hi Terry:) Once put dx linked with Eva Mgnt code, and modifier 25 then xray. Is the xray related to where injury is? Also on external accidents the payer wants date of injury, how did it happen (fall car accident tripped on sidewalk Etc) and location see Y92 dx blocks. We do separate claims...
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    Wiki Speech Therapy Cpt code 92507

    Hello WebbSherry Bond007 :) There is modifier with speech therapy of GN, add minutes on record , pre approval required, add referring doctor name and want date if first time vs previous date of speech therapy. Usually related to strork or autistic or neurology diseases. I hope this data helps...
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    Wiki I42.2 vs I42.1

    Hi Bennie:) The auditor was correct..Dx I42.1 is better suited to documentation above. Patient is suffering with obstruction.... the Dx I42.2 has non obstruction. The details are listed in ICD10 manual .Encoders are great but not give you the details like the ICD10 manual does. Also sometimes...
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    Wiki Diagnosing visits

    Hi Morgan Diagnosis or assessment need to be listed not good idea take dx out of chief complaint. Per auditing regs states follow up needs to add rationale on why coming in for follow up..which the one provider did correct. In the findings.... does the provider list RA and finger pain in later...
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    Wiki Smoking cessation counseling 99406 on a pt in the nursing home or skilled nursing facility

    Hi Bridget Why using CPT 99406 does patient smoke or have dietary overweight problem? Yes can use it but must document what counseling for, suggestions to treat, and minutes talk to patient. Ensure link dx to that CPT of diet E66 and Z68 BMI% or smoking dx F17 , add modifier 25 since added to...
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    Wiki 99211

    Hi Camsgram Yes RN can use 99211......but add attending doc who cover patient's care. Lady T
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    Wiki Inpatient Psychiatric coding information

    Hi Wanda Here is some things may want to be aware of follow therapist or MD 's documentation and list dx assessments do not add if not noted 1. Use Z dx HO codes last, if pt has had suicide in past add that Z dx code, 2. Understand =differ in remission vs recurrent in dx block of F32-F33...
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    Wiki Medical Necessity for Medicare Outpatients

    Hi Mhrivero It use to be a form gave Medicare patient in which they signed know which not covered services. But maybe can add a paragraph or phrase on E signed consent if have the Medicare A & B coverage. Or just add electronic statement at end of consent area let them check it off or what...
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    Wiki Psychotherapy less than 16 minutes

    Hello There Mcdream:) If LCSW does phone call use the CPT 98966-98688 and add minutes on the record and discussion. The CPT 98966 is 5 to 10 minutes of phone call. In the office must have at least 16 minutes face to face. Video health CPT use Beh Health Eva Mgt with modifier 95 but do need 16...
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    Wiki H&P

    Hi Jessica Oh I think a specialist would want to know the medical and personal history of the patient treating. If it is relevant to patient s problem it is vital ...tells more details. Insurance payer like more details. This can be added as Z dx code on last part of the claim and documentation...
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    Wiki E66.01 Criteria

    Eharloff If use E66 dx code use the additional code of Z68 per % of BMI listed in record. It is one of the dx codes which need additional dx code. I hope this data helps you Lady T
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    Wiki Diagnosis I51.89 vs I51.3

    Hi Bennie Yes the auditor was right .The better dx. is I51.3. Read the differ definitions in the ICD10 manual. Thrombosis is related to clot. Lady T
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    Wiki Psychiatrist Billing

    CCat78 If LCSW is supervisor then puts statement on ACSW or QHP staff notation as proof reviewed can sign off, date it then bill it. Of course MD can sign off too, but their name listed on bottom of ACSW notes done after treating patient. Most time payers want modifier of HO and list who is...
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    Wiki Using HPI for capturing diagnoses

    Michelle Yes, you need to follow your statement above. Use the dx code from the assessment or dx list given by provider. However if in documentation you get more details for medical coding then use it. For instance provider states patient has Pneumonia listing dx J12.9 but in provider s...
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    Wiki Comprehensive eye examination

    Hello👀 I know you can only bill CPT 92004 for the eye as body set. Not use this CPT code for a left and one for right eye. If CPT 92004 RT eye and 92004 LT eye both billed same claim it will get denied or even if use modifier 50. Just a FYI I hope this helps someone :) Lady T
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    Wiki MOCA Test

    Hi Kobee, I d use the CPT 99483 for MOCA if for the Dementia or elderly patient with such symptoms . See below... CPT Code 99483 provides reimbursement to physicians and other eligible billing practitioners for a comprehensive clinical visit that results in a written care plan. Code 99483...
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    Wiki LCSWs and E/M Codes

    Hi D Ballard 2004, Yes can use those CPT codes above for all QHP and MD if desire as long as document. On the phone calls made by MD vs LCSW are different codes Need to use CPT 98966-98968 for LCSW or NP or Nurse or other QHP plus ensure they put minutes recorded in documentation. Whereas MD...
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    Wiki Smoking Cessation - Nicotine Dependence

    Hi Annamlupp, :) Blacks and mild type of cigar is worse than cigarettes. I d use dx F17.29 since states other tobacco products (cigars) . Ensure proper documentation for tobacco-use cessation counseling should include the total time spent face to face with the patient, and what was discussed...
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    Wiki O-codes in urgent care clinic

    Hi Mary I d use the problem/illness of why pregnant patient is seeking care for such as J01,J45, R07.R15 and then add last dx code Z33.1 incidental pregnant code. If the provider list trimester add that last dx too.... see blocks Z3A . But provider should ask patient which trimester because the...
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    Wiki LCSW

    Hi Tch678:) She or he your LCSW PhD (modifier AH or AJ) can bill on own accord with proper documentation of describe pt. problem assign dx codes, ensure put minutes in on notations too. Only time LCSW may need to check patient after psychiatrist gave /ordered the patient psych meds. Ensure the...
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    Wiki Coding Kennedy Ulcers vs Presssure Ulcers

    Hi Sdelamora, Kennedy Ulcer are likely skin failure as a result of ischemia from the dying process. This is not to say that there KTUs are strictly due to hypoperfusion, as there may be an element of pressure causing the injury. Understand the etiology of the injury, pulling the clinical...
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    Wiki Code 61782

    Hi Shellnerob CO-B15: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered.I Goggled this.. but seems like needs add on code first or modifier or detailed dx code Lady T
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    Wiki 90836 - Psychotherapy

    Hi JL Green:) Yes on the documentation separate the record by stating so many minutes for the psychotherapy by describe current illness. Then for medical portion or chronic condition add minutes then discuss how monitoring this illness. The med coder will link appropriate dx with the proper...
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    Wiki G2211 with PHQ2 and TCM

    Hello Kimoy I would not bill G2211 with trans care mgnt TCM , do not add modifier 25 if done with other Evl Mgn CPT codes. Also do not bill the G2211 with annual preventive visits. Id use the depression eval for depresson96127 but not with G2211. However G2211 is used with chronic ongoing care...
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    Wiki Help finding a beginner coding and/or insurance verification position

    Cate Get invlovfed with AACP chapter in your area. Also apply at ambulance EMS billing, lab, or insurance billing or insurance/payer companies. Or try to apply for hospital clerk on the floor or registration clerk at clinic or urgent care. After while there then apply for coding department in...
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    Wiki 58571?

    Hi Sometimes payers will reject a claim to save funds in their bank a while longer or just want to slow up the process by making you fix the denial.It deems you coded it correctly Lady T
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    Wiki ER Visit

    Hi Kreng No I would not give that visit 99284. First Id talk to management if there is a rule. Or give it the lowest CPT 99282 for atleast person getting vitals done But did they leave after lab or xray or none of that was done either ?Also did you put Z53.8 AMA on the claim if nothing done...
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    Wiki CPT 20561 documentation requirements

    Hello Dry needling CPT 97760 to 97763 ,need add minutes at least 15 to start, body area possible dx M79, M25, M54, R29.6 M53,or X50 dx blocks, laterality if required (modifier 50, LT and RT) and outcomes. Describe pain of chronic, or acute, Etc. Also add referring provider and dates of visit...
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