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  1. M

    Wiki Question on billing compound drugs

    https://med.noridianmedicare.com/web/jfb/policies/coverage-articles Noridian says to bill J7999, as do MA and Medicaid plans.
  2. M

    Wiki Auditing Cap

    I would count these as 3 errors. I audit internally and our goal is to be helpful internally before it is discovered externally. Any outside payer would likely count these as separate errors also.
  3. M

    Wiki Decision for surgery question

    Because of the way the rules are written, I agree with you and have been coding OD level 4 and MD level 4/5. Thank you!
  4. M

    Wiki Decision for surgery question

    This is a great question! Our OD's triage care that may end up as treatment or surgery for our retina MD, could be same day or within a week. Our OD bills level 4 E&M and retina bills level 4 or 5, depending on the severity, but both providers are in the same practice. Which provider gets...
  5. M

    Wiki DECISION FOR SURGERY

    Agreed, provider does not need to list all the risks/benefits; only document they were discussed.
  6. M

    Wiki Billing 67028 when a sample drug is used

    What if a sample is used because the drug is provided too soon according to FDA guidelines, does anyone bill insurance for the 67028?
  7. M

    Wiki Billing 67028 when a sample drug is used

    Just curious how others are handling CPT 67028 when a sample drug of anti-VEGF is used? Do you bill insurance or not for 67028? Does it depend on the reason a sample is used? Thank you for weighing in.
  8. M

    Wiki ROP Billing

    We bill 99231 - 99233 unless it's a payer that still allows consultation CPT codes. Since we are not the admitting physician, regular inpatient codes are not appropriate to use.
  9. M

    Wiki In office Covid testing

    We are considering the same scenario, pre-surgical Antigen testing using CPT 87426 but doing the test same day in our ASC. Patients are asymptomatic. Lots of CMS articles, no clear answers.
  10. M

    Wiki MIPS payment posting by secondary payers

    When our Medicare claims cross over to Medicaid, Medicaid is not reading the MIPS adjustment code correctly. They are applying the adjustment against the CO-45, creating a patient balance of what Medicare's MIPS amount was. Medicare when primary is processing MIPS correctly and the payments...
  11. M

    Wiki Any 92136 - Opt Biometry - Denials in 2017

    Effective January 1, 2017, per CMS, the Bilateral indicator changed from 3 to 2 on the professional component of 92136 and 76519, which would explain why they want the RT/LT dropped (just like SLT's in 2016)
  12. M

    Wiki 2016 Anesthesia PQRS

    So do any of these measures apply for claims based reporting only? Thank you!! Very confused on this topic!
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