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    Wiki Preadmission Testing via Telehealth

    Good afternoon, Does anyone know if a provider can bill for preadmission testing via telehealth and if the reimbursement is different? If so, can someone please direct me to the guidelines/supporting documentation? TIA Denise
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    Wiki Principal Care Management Services

    Does anyone know of any payer specific rules for commercial insurances for 99424? I do see per MCD fee schedule, it looks like MCD doesn't cover these services. Any input would be greatly appreciated. Thank you!
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    Wiki Post PHE Attestation

    Can anyone tell me if this is an acceptable and compliant smart phrase attestation for telehealth post PHE? Patient was seen today via Telehealth by agreement and consent in light of the current COVID-19 pandemic. I used the following Telehealth technology: Audio and video capabilities Patient...
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    Wiki Telehealth for DM Treatment

    Good morning, Can anyone tell me if there is a requirement for a dietitian to see a mental health patient face-to-face prior to treating the patient? TIA Denise
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    Wiki AAA Screening

    Good day All! Has anyone seen a scenario where AAA screening is paid by insurance for ages 55 - 65? I know the guidelines specify ages 65 - 75 however, I have a provider asking if there any exceptions and if so, what dx would be used. TIA for your reply. Denise
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    Wiki 87637 - SARS COV2 & INF A&b & RSV

    Is anyone doing these tests in office, in Ohio? If so, can you tell me if you are getting paid enough to cover the cost of the test kits? Thank you :)
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    Wiki Online Digital E/M Services & PBB

    Good morning, I am new to provider-based billing, and I am just learning (self-teaching) about TOB codes, particularly 12x and 13x. Our hospital committee is talking about billing for online digital E/M services, 99421 - 99423 and G2012. I guess since Cleveland Clinic announced they are now...
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    Wiki 55706

    We have a coder telling our provider that he can't bill 55706 unless he includes 3D mapping in his documentation. Based on the information below, using 55706 is already indicating the biopsy sample is mapped in 3D. I can't find any clear guidelines that state yes 3D mapping needs to be...
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    Wiki AWV done in Patient's Home

    Hello AAPC Friends, Are there any compliance issues I should know about prior to a provider performing AWV in a patient's home? Is there any additional credentialing that needs to be done? TIA Denise
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    Wiki Prior Auth for Sleep Study

    Good afternoon! I have a provider's office attempting to prior auth a sleep study and the insurance (MMO) will not approve the prior auth because the provider hasn't diagnosed the patient with Sleep Apnea. The reason for the sleep study is to determine if the patient does indeed have Sleep...
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    Wiki E/M Visit vs. Wellness Visit

    Good day to All! I have a provider who is asking when an E/M visit turns into an AWV. I have been pondering this for a couple of days and can't think of any reason or instance this would happen. I have had instances where an AWV turned into an E/M and we explained to the patient(s) why this...
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    Wiki Return to Birthing Unit for PKU Testing

    Good morning, A question has arisen by one of our providers regarding bringing a discharged newborn back to the OB floor for repeat PKU testing on inconclusive tests. The argument is that there is a compliance issue with bringing a discharged newborn back to the birthing unit and that the...
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    Wiki 3T MRI

    For those of you who do radiology billing and are familiar with 3T vs 1.5T, can we charge a higher fee for 3T MRI? Are there category III codes that specify 3T MRI?
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    Wiki Transcutaneous Bilirubin 88720

    Can anyone tell me if this is billable and reimbursable in an office setting as part of preventive care? Thank you!
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    Wiki Incident To Billing

    If a patient comes in for Electrical Stimulation, 97032, and a nurse or PTA does the stimulation, can this be billed incident to providing the physician is in the office suite? Additional info; the physician saw the patient initially and the electrical stim is based off his dx. Thank you for...
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    Wiki Billing code 90732

    Good afternoon All, I am hoping someone can provide insight to the following question: Based on the information below, can a 97032 be given by a PT, PTA, RN, or LPN provided a physician is in the office/suite? We can't find any clear information on this. Electrical Stimulation Therapy (CPT...
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    Wiki Provider Based Billing

    Good afternoon All, I am new to provider based billing and to the hospital I am now employed. We are provider based however, the provider's TIN's are different from the affiliated hospital. I am being told that if one of our providers sees a patient in office, then sends said patient to the...
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    Wiki Provider Based Billing/Modifiers

    Good afternoon, I have two questions I am hoping to get help with. I am new to provider based billing. I was told that if a patient sees one of our providers in office then goes to the hospital for labs, x-rays, etc., we have to financially combine those accounts on the billing side and send...
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    Wiki Supportive Oncology Services

    Good morning, I have a provider who is billing codes 99358 and 99359 for her supportive Oncology phone calls when she speaks to a patient on the phone after hours. However, she is also using these codes when spending time talking to family members on the phone in an acute setting during visitor...
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    Wiki Incident-To in PBB

    Good day everyone! Can anyone tell me if incident-to billing is permitted in a provider based billing office? I have read numerous articles on incident-to billing and numerous articles on provider based billing. In all of the articles I have read, none of them discuss the combination of the two...
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    Wiki Harvest of autograft bone

    Good afternoon, What differentiates minor vs major, harvest site, amount, or type of graft? TIA
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    Wiki DME Application

    Good morning, I am looking for some information on applying for a DME. I was told by a colleague that I can't apply with our group NPI and that I need to apply for an NPI specifically for the location to which the provider will be working out of. Can anyone confirm this information is correct...
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    Wiki Excision of vaginal cuff granuloma

    Hello my coding friends, Does anyone know of a code for this? Everything I find leads to the unlisted 58999 and I have no idea how I would be able to get this precerted. Any feedback is appreciated! Thanks, Denise
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    Wiki Pulmonology

    Good afternoon, I am new to Pulmonology. Can anyone tell me if insurances will pay for flu vac given in a Pulmonologist's office? I don't see any reason why they wouldn't however, the doctor is questioning because he is a specialist. TIA Denise
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    Wiki Billing Depo injections

    Good afternoon All, Can anyone tell me the correct ICD 10 code to bill for subsequent depo injection? For the initial injection we bill Z30.013. I am thinking we would bill Z30.42, which is Encounter for surveillance of injectable contraceptive. I just don't see any codes that state subsequent...
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    Wiki Umr

    Good afternoon, Is anyone in Ohio having issues with UMR paying for preop exam for sterilization for the dx of Z01.818 being to vague? What other dx would be used? I thought maybe Z30.09 however that is for counseling and advice. Any advice? Thanks, Denise
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    Wiki C-Section

    One of my providers began a c section on his patient, as he delivered the fetal head, he was called to attend to another patient. One of my other providers stepped in and delivered the rest of the fetus, closed the uterus, fascia, and skin. Should I report 59514-80 even though the primary...
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    Wiki Filshie Clip Removal

    Good morning, I am needing to precert a Filshie Clip removal during a diagnostic lap. I am precerting 49320 for the lap however, I can not find a code for removal of filshie clip, or any diagnostic lap that would include removal of such devices. Any help is much appreciated. Thanks, Denise
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    Wiki GYN/Pessary help

    Good afternoon, I have a doctor who is bringing in a 70yo MCR patient for a fitting and insertion of a pessary device. I instructed him to bill 57160 her dx is N99.3. He already did an E & M so he will only be billing the fitting and insertion. My question is; the patient will be returning...
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    Wiki Fee Schedule - We just hired

    Good morning, We just hired an orthopedic surgeon. Do I base his fee schedule off of MCR and increase by a %? This is the way I set my family practice fee schedule. If so, should I use a higher % than I do for the FP? Any help is greatly appreciated :) Thanks Denise
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    Wiki Ob/gyn mcd pt

    MCD patient 21 weeks goes to hospital having contractions. Baby comes out and lived for about two minutes. Being 21 weeks isn't considered a viable pregnancy, what do we bill? It's not a fetal demise since the baby was born alive. :confused: Thanks, Denise
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    Wiki Modifier TH

    I have an office billing a mod TH on every OB visit. My online modifier handbook reads as follows: TH Obstetrical treatment/services, prenatal or postpartum If a provider renders three or fewer antepartum care visits, the provider is required to include modifier TH with the appropriate E&M...
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    Wiki IUD placement

    Good afternoon, We have a Ohio Buckeye patient who had an IUD placement on June 3rd. She came in today stating that the IUD is coming out. Dr. examined her and confirmed this is the case. Any ideas on how to (and if) this can be billed? Thanks, Denise
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    Wiki Arm Slings

    I have a family practice and an urgent care who is handing out arm slings. For me to bill these arm slings, does the practices need a DME license? Thanks for any help with this.
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    Wiki Anesthesiologist/CRNA billing

    :confused: I am billing for a group which consist of one anesthesiologist and 3 CRNA's. For all carriers except MCR, they will only pay the anesthesiologist and deny the CRNA, or sometimes they will deny the anesthesiologist and pay the CRNA. And they are only paying at a reduced rate. I am...
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    Wiki Breast Reduction with Axillary Roll Resection

    My doctor did a breast reduction surgery and he did an Axillary Roll Resection. Normally we would treat that as cosmetic & make pt pay in advance but he said when he did the surgery it would have been a travesty to leave that and so he wants me to bill this to her insurance. Is there a code...
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    Wiki re-exploration nose for control of post op bleeding

    Dr did a surgery in the morning...the patient started bleeding through her nose...surgeon went back in--"re-exploration nose for control of post op bleeding". He has diagnosis...Epistaxis. I can't find a CPT code...I've got a diagnosis. Would I use a 78 mod...return to operation room???
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    Wiki CRNA being denied a duplicate

    I am billing for an Ohio Anesthetist the following: mod QY when the Anesthetist supervises one CRNA mod QK when the Anesthetist supervises two CRNA I am getting denials from MMO, Anthem, Aetna, UHC and MCR sometimes on the CRNA stating it is a duplicate and sometimes they deny the anesthetist...
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    Wiki MCR primary/MCD Seconary

    I have a patient with Ohio MCR primary and Ohio MCD secondary. I am billing a level 99213, 81002 and h1000. MCR is denying the claim because of the h1000 however, MCD requires the h1000. Is my only choice to bill without the h1000?
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    Wiki Lymphedema Therapy

    Does anyone know if a clinic can get reimbursed for "lymphedema therapy". This would be therapy done by a physical therapist in the clinic. I am not sure if this is something that we could paid for doing.
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    Wiki Billing J0559

    I am billing J0559 for Bicillin since J0540 has been deleted. I billed J0540 @ $50 and was getting reimbursed on average $35. I am billing J0559 @ $50 and I am getting between .04 - .07. Should I be billing 480 units?:confused:
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    Wiki Code 22630 with TLIF

    I billed a 22630 with 63047 & 63048 which is bundled. The carrier paid as bundled and the surgeon wants me to appeal because she did a TLIF and states that on the op notes she listed "further decompression was warranted and necessary" I don't find those exact words in her documentation however...
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