Search results

  1. P

    Wiki Hospice Care- but seen by MD in office

    Of course, Lab/Diagnostic will not be paid. OB-GYN has a specific set of guidelines. If I have anything I will post it here. Meantime, I recommend you verify the OBGYN-related guidelines.
  2. P

    Wiki Modifier 52 or 53?

    Of course, even if the modifier shows in codify the insurance will not process the claims and deny them. If we verified the FCSO link provided and applied based on those guidelines, the insurance processed the claim without an issue. Also, the CPT 96413 is a time-based code, based on my...
  3. P

    Wiki Modifier 52 or 53?

    Modifier 53 is not applicable to use CPT 96413. Please refer link below to verify the modifier eligible for the respective service. https://medicare.fcso.com/SharedTools/faces/ModifierLookup_en.jspx?lob=Part%20B&state=
  4. P

    Wiki H Pylori Slide Billing under Facility setting

    Is H Pylori slide is billable service when performed in a facility setting for the physician billing? If yes, what is the appropriate CPT code that can be billed? The provider performs EGD with biopsy (43239) and in-patient bedside, the provider bought the pyloplus kit and using with taking the...
  5. P

    Wiki More than one acute uncomplicated illness

    The above question looks old. Please refer to the revised E/M guidelines MDM table.
  6. P

    Wiki Hospice Care- but seen by MD in office

    Recommended to check the hospice care modifier "GW & GV". Also, check the CMS manual under section 40 https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c11.pdf
  7. P

    Wiki blood transfusion(s) during hemodialysis

    Blood transfusion is part of hemodialysis and it should be considered as an inclusive service. "Hemodialysis is a procedure that involves drawing blood via an intra–arterial or intravenous catheter, then sieving it through a semi permeable membrane to remove the impurities and finally...
  8. P

    Wiki Billing a psychotherapy session with an E/M code 90832, 90833, 99212

    Check out the below one and it may help you, HN = the rendering provider has a highest educational attainment of a bachelor’s degree HO= the rendering provider has a highest educational attainment of a master’s degree. HP = the rendering provider has a highest educational attainment of a...
  9. P

    Wiki HO modifier Behavioral Health

    Check out the below one and it may help you, HN = the rendering provider has a highest educational attainment of a bachelor’s degree HO= the rendering provider has a highest educational attainment of a master’s degree. HP = the rendering provider has a highest educational attainment of a...
  10. P

    Wiki 99072 new code for PPE

    "Patient presents to the office, requiring the care of an illness, ongoing treatment care. The encounter occurs during a Public Health Emergency (PHE), as defined by law, due to respiratory- transmitted infectious disease. Apart from evaluation time, additional time spent by clinical staff to...
  11. P

    Wiki 99072 new code for PPE

    We are billing this code and received payment from BCBS, Aetna & Cigna. But the BCBS & UHC guidelines stated as a bundled code not separately reimbursable code. It might get recoup in the future...
  12. P

    Wiki BCBS Modifier 25 Reimbursement Policy Update

  13. P

    Wiki TAVR?

    Yes, 33361 is would be appropriate for this service. Do not forgot use clinical trial number, please refer below mentioned link for more information. 1. http://www.codingahead.com/2019/07/tavr-rules-changed-by-cms.html 2. http://www.codingahead.com/2019/07/tavr-approved-clinical-study.html
  14. P

    Wiki Coding Suggestion Needed

    Code as pelvic exploration service alone
  15. P

    Wiki Category III 0483T-0484T TMVR

    Have you received payment.
  16. P

    Wiki Scoring method of number of diagnosis or Management in MDM

    Yes,kdlberg said correct. If established problem not treated until mentioned as resolved it should be stable, so we can count for each chronic condition. HTN & HLD as chronic condition.
  17. P

    Wiki Scoring method of number of diagnosis or Management in MDM

    Should be considered as 4 points if it stable
  18. P

    Wiki Scoring method of number of diagnosis or Management in MDM

    You can refer the E/M score sheet
  19. P

    Wiki Laprascopic Low Anterior Resection with colostomy without anastomosis, cpt code?

    Can you look at this.
  20. P

    Wiki Laprascopic Low Anterior Resection with colostomy without anastomosis, cpt code?

    44188
  21. P

    Wiki Medicaid & 90792/1

    https://dmhas.dhs.state.nj.us/NJMHAPP/Content/Documents/NJMHAPP_Provider_Program_Manual.pdf?AspxAutoDetectCookieSupport=1
  22. P

    Wiki Scoring method of number of diagnosis or Management in MDM

    The first two diagnosis are examined today, Tramadol prescribed for headache and EGD ordered for Gastroenteritis and all other two conditions are chronic it should be considered as stable. So still you should count. Hope Headache and Gastroenteritis are new problem, if so you can count 4+4 and 2...
  23. P

    Wiki Humana denials

    Please review the attached pdf. May you get some idea
  24. P

    Wiki Aetna E&M Policy

    We are faced the issue as long time, after verified with billing team, they said as both providers are different specialty but the claim was submitted in group NPI instead of Individual NPI#, Please check the same. Because of your group contains with 8 providers may have billed any face to...
  25. P

    Wiki UHC Consultation Policy

    Hope now you understand this.
  26. P

    Wiki UHC Consultation Policy

    If the service rendered at inpatient setting, then we can bill appropriate admit CPT code, based on the level supported in document. Just assume, the service performed inpatient consult and document supports to bill CPT 99254 ( A comprehensive history; A comprehensive examination; and Medical...
  27. P

    Wiki UHC Consultation Policy

    https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2019/network-bulletin/April-2019-Network-Bulletin.pdf
  28. P

    Wiki 0484T Denials

    Have you received payment, The procedure performed two provider, hence we used modifier 62. Like 0484T - 62,Q0 - I34.x & Z00.6 with mentioned above clinical trail number.
  29. P

    Wiki 0484T Denials

    Yes, we have submitted with Clinical Trail #NCT02245763, and Secondary ICD Z00.6. Still we received the same denial. Also we tried with three different clinical trail number however, received the same result for all three patients. Other number we used, NCT02370511, NCT03706833
  30. P

    Wiki 0484T Denials

    I have facing issue with CPT 0484T denied as Missing/Incomplete/Invalid clinical trail number, we had already submitted with appropriate clinical trail number but still the claim denied as the same. Is anyone received payment for CPT 0484T if so can you assist on the same.
  31. P

    Wiki Cardiologists Ever Perform Aftercare for Cardiac Surgery?

    Physicians Who Furnish Part of a Global Surgical Package Where physicians agree on the transfer of care during the global period, the following modifiers are used: • “-54” for surgical care only; or • “-55” for postoperative management only. Both the bill for the surgical care only and...
  32. P

    Wiki EVAR for pseudoaneurysm in aortofemoral vein graft

    Why not 35539
  33. P

    Wiki should i code 92920?

    Append modifier 52 for CPT 92920
  34. P

    Wiki Tavr

    The claim should be submitted with following information for getting payment. Primary ICD I35.x Secondary ICD Z00.6 POS - 21 Clinical Trail #Ref (https://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/TAVR.html) You can verify the document and choose appropriate CT# Modifier...
  35. P

    Wiki Billing smoking cessation counseling with E&M and EKG

    When submitted 99406/99407 with E&M codes, modifier 25 required for E/M service. You can refer in page#38 in 2019 CPT manual. Modifier 59 depending on payer can use for CPT 93000
  36. P

    Wiki E/M Level 99214

    Refill medication service would not be considered for billing level 4, however can bill CPT 99211 if document supports per guidelines.
  37. P

    Wiki NDC Numbers and Medicare

    You can refer the below link https://www.hipaaspace.com/medical_billing/coding/national_drug_code/ndc_number_lookup.aspx
  38. P

    Wiki ***please help with peripheral coding***

    Cpt 92933 - ld
  39. P

    Wiki CPT 78492 denied - To require modifier from BCBS Florida

    This service performed in office (POS-11), so professional component included
  40. P

    Wiki CPT 78492 denied - To require modifier from BCBS Florida

    We called to BCBS insurance and provided the below comments, CPT 78492 is a Cardio imaging procedure and for its need more appropriate modifier should be obtained to indicate the clinical determination. suggested to send corrected claim with valid modifier for the CPT 78492. DOS 02/11/2019...
  41. P

    Wiki Leadless pacemakers

    Refer below link. http://tyrx.com/content/dam/medtronic-com/products/cardiac-rhythm/coding-coverage-reimbursement/documents/micra-reimbursement-health-policy-bulletin.pdf
  42. P

    Wiki 0484T- Transapical transcatheter valve in mitral ring via left thoracotomy

    Hi, Is this the appropriate CPT code for this procedure. 0484T - Transapical transcatheter valve in mitral ring via left thoracotomy. Also require clincial trail number for "29 mm Edwards Sapien 3 transcatheter valve"
  43. P

    Wiki Bundling Issues

    Medicare,may not pay for both 11042 and 29580 when treating the same wound. but not all payers. Check BCBS Availity portal
  44. P

    Wiki Pulmonary Overcirculation

    I27.89, Other Pulmonary hear disease
  45. P

    Wiki Category III 0483T-0484T TMVR

    Try with clinical trail number . https://clinicaltrials.gov/ct2/home Note: The claim must be submitted secondary ICD code , Like Z00.6
  46. P

    Wiki Vascular Catherization Code Needed

    If the radiologist uses ultrasound guidance when accessing a vessel for a catheter placement but doesn't record the images, do not report 76937 because the descriptor tells you this code requires permanent recording.
  47. P

    Wiki Transapical transcatheter valve in mitral ring via left thoracotomy

    0484T -Transapical transcatheter valve in mitral ring via left thoracotomy Hi, Require CPT codes and Clinical Trail for mentioned below procedure. I thought the appropriate CPT code 0484T PROCEDURE PERFORMED: 1. Transapical transcatheter valve in mitral ring via left thoracotomy. 2...
  48. P

    Wiki HEDIS-HCPCS 3014F ,3017F denied by Medicare as non covered

    Hi, 3017F, The code status as "M" that mean Measurement codes. Used for reporting purposes only." 3014F I = Not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services. (Code NOT subject to a 90 day grace period.)
  49. P

    Wiki AV Fistula Creation and Ligation

    Hi Lavanya, Thank you for your reply, CPT 93970 we billed on previous day itself. Hope document also stated it was done previously. Based on the evaluation from venous mapping and provider planned to do the procedure (Left arm brachibasilic AV Fistula)
  50. P

    Wiki AV Fistula Creation and Ligation

    What is the appropriate code for this procedure Patient with end stage renal renal disease who is nearing requiring hemodialysis. She was evaluiated with a venous mapping and was found to be a candidate for a left arm brachibasilic AV Fistula. Patient was explained and consented for the...
Top