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    Wiki New ICD-10 codes starting October 1

    I just heard that there are new ICD-10 codes as of October 1. Do any of these apply to dermatology?
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    Wiki MIPS payments from Medicare Advantage plans

    Do we get MIPS payments from Medicare Advantage plans?
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    Wiki incident to when there is a new diagnosis

    A patient sees the PA for follow-up on a the doctor's diagnosis and plan, but during the visit the PA diagnoses a new, unrelated condition. My understanding is that the visit cannot be billed incident to, but the doctors are giving me a hard time, stating that what matters is the condition the...
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    Wiki If chemical peel is done on more than one body area, do you bill for two?

    If chemical peel 15792 is done on more than one body area, do you bill the code twice, or does one code cover the entire body?
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    Wiki Supervision requirements for mid-level provider

    I cannot find clear information about Medicare "incident to" supervision requirements for telehealth visits. If the doctor is in the office, but the mid-level is working from home (or vice-versa, or they are both working from their own homes) does this mean we cannot bill incident to?
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    Wiki When the secondary pays more than the Medicare allowed amount

    If a patient has Medicare plus a commercial insurance and Medicare is primary, Medicare pays 80% of the allowed amount, and then the secondary pays MORE than the remaining 20% (perhaps because their fee schedule is higher than Medicare's). Can you keep the difference, or do you have to refund...
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    Wiki Deterioration of support at Allscripts

    We used to think Allscripts support department was very responsive and their reps were very knowledgeable. Now response times are spotty, all the old reps seems to be gone, and they are filled with new people who only halfway know what they are talking about. Is anyone else having the same...
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    Wiki Medical assistant seeing the patient

    I have several questions regarding visits at which the patient sees only a medical assistant (for something that is allowed to be performed by auxiliary personnel, such injection or suture removal): 1. Does a licensed provider have to be present in the office? 2. Does a licensed provider have...
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    Wiki Chemical peel for AKs: 17004 or 15788 series?

    Would you code a chemical peel for AKs as 17004 or with a code from the 15788-15793 series?
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    Wiki Who is the provider when an MA gives an injection?

    If an MA gives an injection (96372), since the MA has no NPI, do you put the doctor as the rendering physician (ie: field 24J)?
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    Wiki Medicare Advantage plans: Does 2nd appeal go to CMS's Independent Review Board?

    Medicare states "If a Medicare Advantage (Part C) health plan makes an adverse reconsideration decision (upholds its initial adverse organization determination), the plan must automatically submit the case file and its decision for review by the Part C Independent Review Entity (IRE)." We have...
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    Wiki Provide Patients Electronic Access - what if the patient doesn't have internet?

    What do you we do if we have a large portion of our patient population that doesn't have internet access? Should we just create a username and password for them anyway?
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    Wiki Humana denying claims for "no referral" even though we attached it

    We are constantly getting denials from Humana with reasons N630 and CO 243 ("referral not authorized by attending physician" and "Services not authorized by network/primary care providers"). This is in spite of having a referral which the PCP documented on the Humana website and we attached the...
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    Wiki Diagnosis for aerobic bacterial culture

    The lab (Quest) tells us that they got a denial for aerobic bacterial culture with diagnosis L.089 (skin infection NOS). What else would we use? (It is for a surgical wound with purulent drainage.)
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    Wiki Z00.00 for full skin check

    We have a patient who wants us to use Z00.00 as the diagnosis for her annual skin check. I always thought that this hurts the patient because they can only have one Z00.00 per year and they need to use it for their annual physical with their PCP. Am I correct about this? Apart from that, is...
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    Wiki Covered diagnosis for aerobic bacterial culture

    Quest is telling us that Humana is denying an aerobic bacterial culture for diagnosis L.089 (skin infection NOS). Is there a better code to use? The patient is complaining of erythema at the site of a surgical wound - should we use erythema, or surgical wound complication, or ???
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    Wiki graft and complex repair on same site

    If an excision is closed by performing complex repair on part of the wound and a graft on the other part, can you bill for the complex repair and the graft. The coding specialist at the AAD says no, but the medical direct at Modernizing Medicine says yes. Who's right?
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    Wiki dx code for pre-op PTT for patient on blood thinners

    Is Z01.812 (pre-op labs) generally a covered diagnosis? Would you use this for pre-op PTT ordered because a patient is on blood thinners?
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    Wiki Complex repair plus graft on same site

    If a wound requires a complex repair for one piece of it, plus a graft for the remaining little piece that couldn't be closed with the complex repair, can you bill both?
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    Wiki Benchmarks for how many complex versus intermediate closures

    Is anyone aware of any Medicare benchmarks for the proportion of complex repairs to intermediate repairs (like the way they benchmark the proportion of each E/M visit a provider does)? Thanks!
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    Wiki Are you distributing the MIPS bonus to the providers or the practice owners?

    If your practice earned a MIPS incentive adjustment for 2017, and if you have any employed or contracted providers, are you paying that incentive adjustment to the providers or to the practice owners?
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    Wiki lab work not covered

    Our doctors sometimes send patients for blood work because the patient has itching all over with no obvious cause, and so they want to rule out thyroid, liver, and other systemic diseases. But since the primary diagnosis is "pruritis," these tests are not covered. Does anyone know how we can...
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    Wiki Cigna adjusting off entire charge as CO-45

    Is anyone experiencing Cigna claims in which they are writing off an entire line of a claim as CO-45? This is clearly a mistake, as these are covered services, and the EOB even includes the (correct) allowed amount. For example: Our charge is $100. The "allowed" amount on the EOB is $61.23...
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    Wiki Is Medicare processing claims during the government shut-down

    One of our doctors heard that Medicare is not processing claims because of the shut-down. We have been getting checks, but since they are (so far) for 2018 services, he thinks maybe they will not be processing claims for 2019 services. I think he heard wrong, but can anyone assure me...
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    Wiki clarification of 10140 vs 10060

    This has been a long-standing question here, and I hope someone on the forum has the answer: Since 10060/10061 are specifically for I&D of "abscess," does that mean that if a cyst is not abscessed, you should use 10140 for I&D of cyst?
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    Wiki Does Humana HMO require referrals for Part B drugs?

    Does Humana HMO require referrals for Part B drugs (the J-code), or only for the service provided in conjunction with giving the drug (ie: the injection or infusion service)?
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    Wiki Can light box be performed by a medical assistant when there is no provider on site?

    Can light box be performed by a medical assistant when there is no provider on site to supervise?
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    Wiki Responsibilities of the billing company versus the office

    If you have worked with or for a billing company, can you please advise who should be responsible for the following tasks - the office or the billing company? 1. Researching and correcting patient's insurance when claims are denied due to wrong insurance or incorrect policy number. 2. Finding...
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    Wiki Medical assistant scope of practice

    If a medical assistant sees the patient without a doctor in the room for services that are within her scope (injection, suture removal, bandage change, etc.), how much is she permitted to actually do? ie: Can she perform and document a brief exam of the affected area? Can she perform and...
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    Wiki Insurance coverage for laser treatment of scar

    Has anyone had experience billing insurance for laser destruction of traumatic scars? Is there any chance of this being covered unless the provider can demonstrate a functional impairment caused by the scar?
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    Wiki Medicare primary and we are out-of-network with secondary

    If the secondary payer does not pay because we are out-of-network with them (either they deny the claim or apply it to a large out-of-network deductible), are we allowed to write off the co-insurance since the patient would not have had to pay it if we had been in-network with the secondary?
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    Wiki Definition of "significant" for modifier 25

    What makes an E/M "significant" enough to warrants a claim with modifier 25 the same day as a minor procedure? Humana has informed us that they will only pay an E/M with modifier 25 if the problem was significant enough to require a prescription, lab order, surgery recommendation, or something...
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    Wiki Mohs surgeon billing under the general dermatologist's NPI

    I have always been under the impression that one doctor cannot bill under another doctor's NPI except under a true Locum Tenens situation. But a friend who works in another derm practice says that her doctor brings in a Mohs surgeon once a week and bills insurance under his own name for the...
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    Wiki Which payers allow consult codes?

    Which payers still allow consult codes?
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    Wiki Writing off the Medicare coinsurance if secondary is out-of-network

    If Medicare pays 80% of the allowance and then forwards the claim to the secondary, but the secondary denies due to our not being in network, is it legitimate for us to write off the 20% for this reason, or are we still required to bill the patient?
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    Wiki biopsy diagnosis: blister... abscess...

    Will a biopsy be paid if performed on a blister? What about if performed on an abscess? In both cases, the provider says she must perform the biopsy in order to rule out something else.
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    Wiki Billing patient when referral not obtained

    My understanding (correct me if I'm wrong) is that if our office fails to obtain a required referral, we have to write off the visit; we can't bill the patient. But what about a situation in which the patient requests to be seen right away without waiting for the referral, and states that if...
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    Wiki "Rendering provider" for MA-performed services

    If a service such as light box, photodynamic therapy, IM injection, etc. is performed by a medical assistant (while a doctor is present in the office), whom do you list as the "rendering provider" (field 24J on the CMS-1500)? We always thought it is the doctor (since the MA does not even have...
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    Wiki Is it okay to treat a referring doctor for free?

    If a doctor from another practice frequently refers patients, is it okay to treat him for free, or would this be considered a kickback?
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    Wiki HPI elements as noted by the physician (rather than as stated by the patient)

    I know this is an old question, but I am drawing a blank: Does the HPI have to be strictly what the patient tells the physician, or can it include the provider's observations, as well? For example, in describing a skin lesion, does the patient have to state that the lesion looks red and...
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    Wiki Treating nursing home owner's family for free

    If a provider regularly visits a nursing home to treat patients, and the owner of the facility asks the provider to treat a family member who happens to be there (and, of course, the provider would be uncomfortable billing them since this nursing home provides him with so much business), would...
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    Wiki "moderate in severity" as HPI element

    Can you count this statement (describing a skin lesion) toward the severity level in HPI? "It is moderate in severity." Or does the provider need to be more specific, like stating the size of the lesion, the pain (if any) it is causing, etc. (And if so, how do I know from a statement of the...
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    Wiki registering new place of service with Medicare when opening new office

    We are opening a new office, and the doctors want to start seeing patients - and sending claims - right away. I know that we have to notify Medicare of this new location on an 855B form (or on PECOS). But do we have to wait for the acceptance letter before sending claims, or can we start...
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    Wiki new path DOS rule

    Medicare just changed their rules regarding pathology DOS. They now expect you to use the biopsy date as the DOS of the technical component and the read date as the DOS of the professional component. This means that if you have been billing for the global service, you now have to start...
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    Wiki Change in pathology billing rules

    For those with in-house path labs, we just got an important update from DermCoder (www.dermcoder.com). Medicare now expects you to use the biopsy date as the DOS of the technical component and the read date as the DOS of the professional component. This means that unless your pathologist reads...
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    Wiki Shared Visit: Doctor treats new problem & mid-level treats follow-up problem

    CMS has stated explicitly that if a shared visit is not incident to, it must be billed under the mid-level. But one of my doctors is questioning why we can't bill it under him if the patient has two problems: the mid-level provider only treats follow-up problem, and he (the doctor) evaluates...
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    Wiki 88342 for multiple stains

    My understanding is that 88342 is for one stain only, and any additional stains are billed as 88341. Our local Medicare's allowance for 88342 is $110.92. Here's the dilema: A co-worker had a biopsy done and the lab charged her almost $1200 for 88342 (and almost $650 even after insurance...
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    Wiki Can we bill for an injection patient gives himself in our officeunder our supervision

    If a patient gives himself an injection, but does so in our office under our supervision (because we are teaching him how to do it), can we bill the injection code?
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    Wiki problem found on exam added to the chief complaints

    A patient comes in a Problem A (the "chief complaint"), but during the exam the provider also found problem B. Can problem B be added as a secondary chief complaint? (The reason we want to do this is that our software only gives us an HPI checklist for chief complaints. If a problem is not a...
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    Wiki J code for intralesional saline solution

    On occasion, our doctors inject saline solution into a scar with atrophy. Is there a J code to use for this saline solution? (The only J codes I can find for saline seem to be for infusion bags.)
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