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  1. J

    Wiki Opinions on this article relating to 2021 e&m rules for derm

    You'd think mdedge is a reliable source. But this article is misleading and gives false information to other providers that do not understand coding.
  2. J

    Wiki Opinions on this article relating to 2021 e&m rules for derm

    I just came across this article from Mdedge (see attachment) regarding 2021 new e/m rules for derms. It says " Simplified coding and billing requirements for E/M visits will go into effect Jan. 1, 2021. For dermatology, any visit where a decision to do a minor procedure or prescribe a...
  3. J

    Wiki Acne table of risk category

    I'm still scratching my head with these new e&m rules. Mainly because it's making it seem much easier to bill higher level of e&m like 99204, which is normally almost never billable by derms with current rules. For example, the 2021 rules for 99204 will be met by a patient coming in for a...
  4. J

    Wiki Acne table of risk category

    Wouldn't that 99214 example fall under 99213 under current rules (2 pts for Est. problem worsening and moderate under risk) if not factoring history and exam?
  5. J

    Wiki Billing E/M codes with new MDM guidlines

    I paid for and saw the same workshop and I found that to be an issue too. She gave bad examples because all the examples given included minor procedures. All of the cases she used, we should not bill a e&m separately with those minor procedures. I heard there will be a "modest" rate increase...
  6. J

    Wiki 11310

    11310 is for shave removal but not for skin tags. For removal of skin tags by any method, use codes 11200 and 11201. For the first 15 skin tags removed, use code 11200. For each additional 10 skin tags removed, also report code 11201. For example, if you removed 35 skin tags, then you would...
  7. J

    Wiki Acne table of risk category

    I'm just looking at the 2021 E&M rules. If acne is considered a chronic illness then that means on the 2021 rules, if someone has worsening acne and there was some prescription drug management then that makes the visit a 99214, since 2021 E&M rules will no longer be based on history or exam but...
  8. J

    Wiki Acne table of risk category

    Would you call facial acne that a person had for years self limit minor problem OR a stable chronic illness?
  9. J

    Wiki manual removal of wart

    What exactly do you mean by "manually?"
  10. J

    Wiki Source of Telehealth waiver expiring July 25, 2020

    I've heard that the telehealth waiver will expired for some plans that follow the HHS, and with their set date for when the public health emergency expiring on July 25, 2020, that's when coverage for telehealth for these plans end. Where do I find the direct source of this information? I cant...
  11. J

    Wiki E/M - Dermatalogy

    to my knowledge, 99211 are for nurse visits, generally should not be used for providers. At minimal they should use 99212 for a problem focus exam and straight forward medical decision making. The problem also needs to be unrelated/separate to the surgery done on the same day to bill modifier...
  12. J

    Wiki BILLING 99421 & 99441 same day or day after.

    How do we bill for scenario where provider spoke with patient on the phone and email on the same day? So far insurances have denied the phone and paid the email. They seem to be bundled for being two E&M visits, even though these are not even face to face visits. Also, how would we bill email...
  13. J

    Wiki United Healthcare Audio only

    I'm even more confused now because they're now saying they're covering 99441-99443 under their virtual check-in section. https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-services-virtual-visits.html BUT, their guide...
  14. J

    Wiki United Healthcare Audio only

    Is anyone else confused that United Healthcare is saying to bill E&M codes for audio only visits? They say they're not covering for 99441-99443 because Medicare doesn't cover them (even though Medicare does now as of the beginning of this month) but they wan't us to bill those with regular...
  15. J

    Wiki Telehealth during emergency periods

    Medicare is not covering for 99441-99443 for telephone I think. They are only cover G2012 and G2010
  16. J

    Wiki 99421-99423 billing date

    For the 99421-99423 codes, are we suppose to claim by the start date or end date (the 7th date) on the claim? If possible please provide source of this answer. Thank you.
  17. J

    Wiki Derm TeleMed - Need immediate Help

    You can find CMS fee schedules here https://www.cms.gov/apps/physician-fee-schedule/overview.aspx
  18. J

    Wiki Derm TeleMed - Need immediate Help

    CMS released this today https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
  19. J

    Wiki CPT 17630 Chemical Exfoliation

    I'm not sure if there are codes that are categorized as "cosmetic" only but you can use that code. It's the matter of if insurance will cover it because chemical peels are generally considered cosmetic, especially for acne.. Some insurance will either flat out not cover it because it's...
  20. J

    Wiki Which Dx to use?

    I would use the D04 codes. AK's have the likely possibility of becoming SCC if it does becomes skin cancer and the lesion you described SOUNDS LIKE it's an AK with signs of SCC. It's still a lesion with signs of cancer. Since it's in the "in situ" stage, I would think to use D04 codes. I...
  21. J

    Wiki Simple repair without sutures, chemical cautery only

    I've always thought that using silver nitrate on wound alone to seal a wound is consider simple repair but began second guessing myself. Do we need to use modifier 52 when no suturing is involved and only silver nitrate was for chemically cauterizing/sealing wound? Or is it truly billable as a...
  22. J

    Wiki New york Medicaid billing for Medicare Part C copays/deductible/co-insurances

    Would like to know how everyone in New York is billing Medicaid for Medicare Part C patient responsibilities. Crossing over from our EMR results in medicaid denying the claim, billing through ePaces is a very tedious process. Hoping for a better way to do this.
  23. J

    Wiki diagnosis code question

    We are a dermatology office. We have a patient that has been picking at his own face to the point that he has a hole in his face. He think's he's trying to get out ingrown hairs. Patient presents with a open wound in his face. The note says patient exhibits signs and behaviors of self...
  24. J

    Wiki insect bites

    Is there problems using these two codes together to report multiple insect bites as oppose to coding each and every bite individually? T07.XXXA - Unspecified multiple injuries with W57.XXXA Bitten or stung by nonvenomous insect and other nonvenomous arthropods, initial encounter
  25. J

    Wiki Incision & Drainage on blisters

    A patient with multiple large blisters due to poison IVY, would you bill 10140 for each incision and drainage performed or just a single unit? Not sure why this code is even priced higher than 10060, which makes me reluctant to bill 10140 for even one blister.
  26. J

    Wiki Not accepting patients with in-network with insurance

    Can a doctor not accept a patient with insurance they are contracted with? There's a practice that said they met the quota for seeing commercial patients for this year and no longer accepting new patients with commercial insurance until next year. Is that even allowed?
  27. J

    Wiki MOD 25 usage by dermatologist

    Per some sources, https://www.aap.org/en-us/professional-resources/practice-transformation/getting-paid/Coding-at-the-AAP/Pages/Modifier-25-Primer-Use-It-Dont-Abuse-It.aspx and https://www.medicaleconomics.com/category-47287/everything-doctors-need-know-about-modifier-25 To bill modifier 25...
  28. J

    Wiki too much time spent deciding to perform procedure

    So the story I'm given is patient has a wart. This usually is billed with 17110. Before the procedure, patient called her husband because she can't make her own decisions. Her sister was also in room asking a million questions and driving the doctor insane regarding this treatment. Total...
  29. J

    Wiki punch/incisional biopsy with closure

    If the result of the procedure needed a layered closure, would that mean it was more of an excision that involved deeper skin layers than it was a simple biopsy? That is if what was biopsied was a lesion?
  30. J

    Wiki Same day, billing office visit and procedure on separate claims.

    Thank you for clarifying! But that is what is happening to us right now. Healthfirst is denying all follow up office visits billed with a modifier 25 (or any claim billed with a diagnosis code that has been billed in previous visits) on the same day as a procedure that is UNRELATED to the...
  31. J

    Wiki Same day, billing office visit and procedure on separate claims.

    So you are also saying that if we saw a patient for psoriasis a month ago and then the next time the patient came to follow up on the psoriasis and has a wart, we used liquid nitrogen to destroy wart and also examined the patient's psoriasis, we don't get credit for examining the psoriasis with...
  32. J

    Wiki 11104 and 11103 modif 51 ?

    No, add on codes do not need modifier 51. Add on codes payments are already reduced. Just as 11101 didn't need modifier 51, I don't think 11103 needs one.
  33. J

    Wiki Discounts

    From what I know is if you are in-network with any insurance you have to charge the same rate to all insurances. You can only discount uninsured patients not patient's with out of network benefits from their insurance unless they go through all the paper work of demonstrating financial hardship.
  34. J

    Wiki Same day, billing office visit and procedure on separate claims.

    The e&ms being denied all have different diagnoses from the procedure because they are truly unrelated to the procedure. The e&m are all getting denied with modifier 25 regardless of the diagnosis. I never had a successful appeal with this payer (for the past year) for any reason because they...
  35. J

    Wiki Same day, billing office visit and procedure on separate claims.

    The thing is, talking to the provider rep and phone rep are both like talking to the wall. I'm still trying to get this resolved through our IPA. No matter who I talk to from healthfirst, our provider rep included, gives the following response: "According to our policy, when an Evaluation and...
  36. J

    Wiki insurances not updated with the new biopsy codes

    You can bill 17000 for 1 lesion and 17003 for each additional lesion up to 14. OR You can bill 17004 for 15 or more lesions. I don't know if you meant you're billing all three of those codes on one claim but it will get denied if you do.
  37. J

    Wiki insurances not updated with the new biopsy codes

    So almost all insurance companies except for MEDICARE seems to not have updated their systems to accept the new biopsy codes... Do we continue to use 11100 and 11101 or wait it out?
  38. J

    Wiki Same day, billing office visit and procedure on separate claims.

    Currently, Healthfirst NY is doing something stupid and denying all E&Ms billed with a minor procedure even THOUGH there's a modifier 25 on the E&M. We use modifier 25 appropriately so its not as though we're abusing it. I tried talking to Healthfirst but it's like talking to a wall when...
  39. J

    Wiki Anus lesion excision and intermediate repair

    It seems the code for excision involving the anus is 46922. How would I code intermediate repair for this? I believe 46922 includes simple repair but not intermediate repair.
  40. J

    Wiki Self Pay Candida and treatment

    We can't do this if we're in-network with the insurance though right? What's the standard discount for prompt pay?
  41. J

    Wiki Self Pay Candida and treatment

    This is based on my own research. From what I know, the patient will have to sign a form that states that the patient does not want the insurance to be billed. BUT you have to charge the patient the same rate you charge all insurances for services rendered. The only time you can charge a...
  42. J

    Wiki CPT 10060 with no incision

    What if he used modifier 52?
  43. J

    Wiki Acne Visit with Injections-PA Derm Office

    Depends. If the acne is worsening and the MD prescribed medication for them on top of injecting a pimple I would bill 99213-25 and 11900. If the acne is stable and the MD didn't really do anything other than inject a pimple, I'd bill 11900 only, especially if the problem is only limited to the...
  44. J

    Wiki Modifier 25 for examining a separate but minor problem

    That doesn't seem like a good way of doing it since some people have insurance plans that have deductibles for procedures (surgery deductibles) but does not apply for E&M. IF going by your suggestion, I'd bill just 99213 but 17110 pays way more even though 99213 has a higher RVU..
  45. J

    Wiki Modifier 25 for examining a separate but minor problem

    I had asked this before in the past but want to hear a little more opinion on this. In the scenario for the modifier 25 to be use, the other problem must be significant and separate from the procedure. I've read that in order for the other problem to be considered "significant" "This can be...
  46. J

    Wiki Personal history coding question

    I'm seeing a lot of conflicting information regarding this. If a new patient is being seen and has "hypertension" noted on the history but not treated by the provider, do we code condition (I10) or the history code (Z86.79)? I'm reading that if the condition is active then you should code the...
  47. J

    Wiki Age of consent for medical care

    We had a new front staff that kind of screwed up. We had a patient who was 16 years old and came with her grandmother. The patient signed all the documents such as hipaa and financial responsibility, etc. Her grandmother signed none of those things. I did not find out until I billed her...
  48. J

    Wiki Billing Doxycyline

    I'm not too sure, it could be just 96365 "Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour.' You could try billing J3490 for unclassified drug, and also adding the NDC code. Try referring to this link on page 3...
  49. J

    Wiki 17000 denial

    Just submit a corrected claim with modifier 59 on 17000. Sometimes payers have their own NCCI edit rules. You're just going to have to override it.
  50. J

    Wiki 17000 Location?

    Its very bad practice not to document where it is, especially if its a precancerous lesion.. Cant half ass with the documentation. You never know when something can become a liability. Chart auditors probably won't like it either and payers may start telling you to give them money back for...
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