Search results

  1. S

    Wiki DME for LVAD

    Good morning, is anyone familiar with the supplies for LVAD? I'm reviewing claims and Q0508 is being billed daily as a HeartMate per diem charge. But upon inspection of documentation, their supplies have specific HCPCS codes such as Power Module Q0479, etc. I've reviewed the HeartMate website...
  2. S

    Wiki 3 Major joint 20610 in one day

    I have a general question/comment about codes with MAI of 3. For example, a lab code 83520. Has a MUE of 9 with MAI of 3. Is this saying that with appropriate documentation billing 12 units of 83520 (cytokine panel) does NOT need a 59 modifier to show as distinct since there is documentation to...
  3. S

    Wiki Home infusion therapy per diem including supplies?

    Good morning, I'm reviewing claims for a home health agency billing HIT code S9494 per diem billing along side A4223 consistently and daily for a time period. They are also separately billing 99601 nursing services. Not being a specialist in home health billing, I'm finding conflicting info on...
  4. S

    Wiki MUEs for 86317

    I'm confused about how to bill 86317 for a 14 serotype lab test. The MUE for this code is 6, with a MAI indicator of 3 so with documentation to support medical necessity can override. But does that mean that the additional 8 units need a 59 modifier? Or do all the units above 1 need a 59 mod...
  5. S

    Wiki Is it appropriate to change a modifier on a claim if provider has left practice?

    I agree, just needed some other thoughts on the subject! It's definitely a 99396, it's the AT mod that has no business there. It's a family practice, not a chiro. And I also agree, what a bad policy that wouldn't allow for simple errors. Thank you!
  6. S

    Wiki Is it appropriate to change a modifier on a claim if provider has left practice?

    There is an inappropriate modifier attached to a wellness visit causing the claim to not be paid. The NPP left the practice and the billing office is unwilling to make the correction stating they are unable to change the claim since the provider is gone. I think this would be a function of a...
  7. S

    Wiki Residential Detox billing question

    I'm interested in what is carved out of the per diem charge. I'm having trouble knowing what is bundled into that - Encoder and HCPCS don't have much to say about the H codes. Are lab fees and medications included?
  8. S

    Wiki Can someone help me understand the difference between 87798 and 87801

    Hello! I'm not understanding when billing multiple units of 87798 is appropriate versus billing perhaps one unit of 87801. Any guidance is appreciated.
  9. S

    Wiki CPT code for TMJ eminectomy

    Does anyone know the CPT code for TMJ eminectomy? I am not finding anything in any forum or online except a lot of medical journals about the procedure. Should i use 21299 unlisted? Performed with bilateral arthroplasty 21240. Thank you!
  10. S

    Wiki Eminectomy

    Does anyone know the CPT code for eminectomy? I am not finding anything in any forum or online except a lot of medical journals about the procedure. Should i use 21299 unlisted? Thank you!
  11. S

    Wiki Coding for MAC on facility bill

    Hello! I'm working denials and I have a facility bill for MAC for a colonoscopy where the facility billed 01999, rev code 0370. I've reviewed other claims for a similar situation and they have billed without a CPT and only the rev code and it paid correctly. Anesthesiologist is billing 00812-QS...
  12. S

    Wiki Confused about G0339 and 77373 SBRT coding

    Thank you for your help, that answers exactly what I needed. I will look at the facebook group as well. I appreciate you taking time to explain.
  13. S

    Wiki Confused about G0339 and 77373 SBRT coding

    I'm trying to determine if facilities bill 77373 and physicians bill G0339? Per Encoder, G0339 is a professional code and 77373 is technical only. But I've seen a crosswalk from ASTRO that states G0339 crosswalked to 77373 which doesn't make sense to me. But I really just want to know if a...
  14. S

    Wiki When to bill for supplies in facility

    How do I know when supplies are separately billable or when they are included in the procedure code? I'm working appeals and looking at facility billing often unlisted supply codes such as C1889, A4649, L8699 etc. Any assistance is appreciated!
  15. S

    Wiki Help with respiratory labs

    I'm struggling trying to learn lab coding. I haven't found anyplace to learn, no AAPC resources or local chapter help has been available so I'm trying to educate myself. Everything I've seen states to just match up the test to the code, which doesn't seem to be very real world situation. I'm...
  16. S

    Wiki FS Modifier clarification

    I have questions regarding the FS modifier and whether it applicable to outpatient departments POS 19 and 22, that are billing office E/M codes? I tend to think it is not for use here, as office visits are excluded from split shared. Plus reviewing Encoder Pro's acceptable modifiers linked to...
  17. S

    Wiki Billing E1399 for in-office/mobile anesthesia supplies

    I'm reviewing a claim for E1399 from an anesthesia provider for the mobile supplies he brings with him to perform in-office anesthesia for biopsy. He stated specifically it is for Oxygen, Oxygen analyzer, Crash Cart, EKG machine and backup power supply. Is this an acceptable way to bill? I have...
  18. S

    Wiki PVR - Post Void Residual --- Imaging data point?

    Hi, did you end up making a decision on this question about counting the 51798 PVR as an imaging data point? I'm researching whether this particular code should be considered surgery or radiology. I realize the code is in the surgery section of CPT and leaning toward surgery. Thank you!
  19. S

    Wiki Specific consent needed for depression screening during wellness visit?

    Patient is claiming she didn't give express consent for a depression screening to be performed along with her wellness visit. Office is willing to remove the charge, but she's challenging that still it was improper to perform this without consent and didn't realize what she was being asked at...
  20. S

    Wiki Documentation Requirement for Assistant at C/S

    I'm curious about the portion of this statement, the assistant's services being billed under the own NPI. Is that a requirement or just standard practice? In other words, can it be billed on the same claim as the main surgeon's same CPT, only the with the assistant's line item being listed with...
  21. S

    Wiki Code pair edit for 99213 and 0001A vaccine?

    I assume that 99213 would need a 25 modifier as a distinctly separate service, patient came in for thumb pain, and also received covid vaccine. But when this code pair is entered into Encoder Pro, it states 0001A is "not a valid code type" even though of course in Encoder 0001A is listed as the...
  22. S

    Wiki Coding special stains 88312 & 88313

    I am interested in the stain chart if it's still available. Thank you!
  23. S

    Wiki COVID Booster

    I ran across this AMA covid vaccine tracker and decision tree, might help you. Note, there's a differentiation between 3rd dose and booster also. https://www.ama-assn.org/find-covid-19-vaccine-codes. I should note this was in an article about 2022 new codes so please verify all are currently in...
  24. S

    Wiki CPT code for fluidotherapy (dry whirlpool therapy)?

    I've seen articles to use the traditional whirlpool code 97022 and also the unlisted code 97039. Any recommendations? I'm unclear if 97022 is for water only. Thanks!
  25. S

    Wiki What CPT code should I use for Fluidotherapy?

    I've seen recommendations to use the traditional whirlpool code 97022 and also the unlisted code 97039. Any recommendations? Thanks
  26. S

    Wiki Slings as fracture care

    I have this same question - were you able to confirm if 23500 is appropriate for putting a patient in a sling only?
  27. S

    Wiki Air ambulance base rate includes what services?

    In reading about what is included in the ambulance base rate, there is vague reference to "other items and services provided as part of the transport." But then there is unlisted code A0999 for unlisted ambulance service. If everything is included, under what circumstance would A0999 be...
  28. S

    Wiki Is it appropriate to use O03.9 SAB for follow-up visits

    Patient returns over a month for follow up of bleeding and BHCG levels. Do we continue to code O03.9 for those follow-up visits as primary diagnosis? Thanks
  29. S

    Wiki Dumb question: is the 59 modifier required for facility billing

    Example so that IV admin codes don't bundle with CT scans, such as 96365 and 74177 or 96372 and 91275. Any advice and/or source info would be appreciated!
  30. S

    Wiki MAC without sedation

    Anesthesiologist and CRNA performed the monitoring only, with no sedation given to the patient for a colonoscopy at the patient's request. Can they bill 00811?
  31. S

    Wiki Can a non-licensed psychologist bill while working under a supervising practitioner toward earning the required hours for the license?

    We have a Master's degree psychologist (washington dc) who is working towards their required number of hours to become licensed. Can that person bill for their time, or can the supervising provider bill for their time, as in Incident To rules? I'm finding conflicting information, some saying yes...
  32. S

    Wiki Help with Wide Range Achievement Test and 96127

    Provider has performed the Kaufman Brief Intelligence Test, Wide Range Achievement Test, and the SCARED anxiety screening. He's billing 96127, 96127-59, and 96112, 96113 with total time of 80 minutes. I'm unsure if the WRAT is billable as 96127? Any advice is appreciated.
  33. S

    Wiki When to bill Vision insurance v. Medical insurance

    I'm a coding student, but am curious about when ophthalmology and optometry bill a patient's vision insurance and other times bill medical insurance. For instance, if a patient has a medical history (glaucoma, diabetes, strabismus or even just dry eyes), but needs a routine exam -- Is this...
Top