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  1. rthomas@impcna.com

    Wiki EPIC in Physician-Owned Primary Care Office

    We are a Physician-Owned Internal Medicine & Pediatric Primary Care office. We looking into switching our EHR & PM to EPIC since both of the major hospitals in our area are on EPIC. Looking for input, pros & cons, and advice. I am the billing manager & credentialing specialist. Since I have...
  2. rthomas@impcna.com

    Wiki G0180 equivalent for commercial insurances

    Yes, that is correct.
  3. rthomas@impcna.com

    Wiki G0180 equivalent for commercial insurances

    You can bill CPT 99374, Care Plan Oversight for your commercial patients.
  4. rthomas@impcna.com

    Wiki TOAD status

    Yes, you are correct, these need to be coded every year.
  5. rthomas@impcna.com

    Wiki Physician Assistant

    Make sure the physician assistant been credentialed with Highmark. When our PA sees patients we do not attach a supervising provider.
  6. rthomas@impcna.com

    Wiki G0444

    We use the PHQ9 and the provider has a brief discussion with the patient regarding depression.
  7. rthomas@impcna.com

    Wiki Tricare and G2211

    Tricare for Life isn't even picking up Medicare's deductible or coinsurance for G2211. It would be interesting to know why Tricare is paying on pediatric claims since they state in the news letter that it's on their No Pay list.
  8. rthomas@impcna.com

    Wiki Diagnosis Code for Weight Checks

    Can you query the provider to see why the patient was to come back in a week for weight check and have then amend the note? Our providers are really good at indicating why the want the patient to come back whether is be due to feeding problems or failure to thrive. When we have infants come...
  9. rthomas@impcna.com

    Wiki Wart or Lesion Count

    If you can look at note in see that 5 lesions removed from left forearm, 2 removed from right thigh then it is not necessary to indicate a total of 7 lesions. In our practice when it comes to removing warts/molluscum (17110 & 17111) we do have the providers indicate the total number. It is...
  10. rthomas@impcna.com

    Wiki Wart or Lesion Count

    Procedure documentation needs to indicate location, what was used to perform procedure, how procedure was performed, did the patient tolerate procedure or were there complications?
  11. rthomas@impcna.com

    Wiki 20610 - Different area, same side - Help!

    For line # 4 I would have used modifier 51 to indicate multiple procedures them list 59 to indicate separate site 20610-RT-51-59.
  12. rthomas@impcna.com

    Wiki WHO IS NUMBER ONE?

    Most companies use the birthday rule to determine who is primary when it comes to a child's coverage. Example: Mom's birthday is in June and Dad's birthday is in March. Since dad's birthday falls first in the year his coverage would be primary. As for an adult there are several scenarios...
  13. rthomas@impcna.com

    Wiki E/M & AWV

    Yes, Medicare allows you to bill AWV & E/M same day. You need to make sure that all the AWV requirements are in your note as well as documentation to support E/M. We have a nurse dedicated to doing the AWVs that way the provider can focus on the E/M. This allows us to make sure documentation...
  14. rthomas@impcna.com

    Wiki Medicaid billing & immun administration codes

    Medicaid doesn't reimburse for additional components. 90461 is for any additional components of the vaccine. If the provider is an EPSDT provider and enrolled in the Vaccine For Children program then you can bill for 1 component per vaccine, 90460. When we send claims with vaccines that 90461...
  15. rthomas@impcna.com

    Wiki BCBS Claim Rejections

    We have had this issue before and it was due to the subscriber & relationship being entered incorrectly. Some insurance cards will have the patients name on them and not the subscriber. Example: My husband Anthem BCBS and my daughter in on his policy. She has a card with her name but my...
  16. rthomas@impcna.com

    Wiki NDC Codes

    If its not documented then how do you know what NDC # to use on the claim? We have templates in our EHR that the nurse or provider have to complete when they administer meds or vaccines. The have to document name of medicine/vaccine, NDC #, lot #, exp date and site of injection. Some EHRs...
  17. rthomas@impcna.com

    Wiki Credentialing Time - KPI

    I agree with csperoni, 30-40 mins per application. I recently credentialed a physician with 14 payors and it took me about 10 hours but I had everything I needed.
  18. rthomas@impcna.com

    Wiki Credentialing Time - KPI

    Since I have many positions in my practice I usually dedicate myself a full 8 hour day to complete applications. Having all the applications and required information you need before you begin is a huge time saver. To help with this I have a questionnaire and spreadsheet that contains...
  19. rthomas@impcna.com

    Wiki Physician Assistant for Pediatrics E/M coding

    We do not have to use any special modifiers on our PA. We code and bill out claims for our PA just like we would a physician or nurse practitioner. Our PA is credentialed with all major payers like UHC, BCBS, Aetna, Cigna, Medicare, etc. She has been with us for 8 years and never had issues.
  20. rthomas@impcna.com

    Wiki Physician Assistant for Pediatrics E/M coding

    I am with an Internal Medicine & Pediatric Group that bills a physician assistant. As long as the PA is credentialed you shouldn't have any issues. You may want to check the taxonomy code that is being used for your PA. We have some insurances that want us to use 363AM0700X, Physician...
  21. rthomas@impcna.com

    Wiki Child Well Visit with Sick Visit

    Sorry I dont.
  22. rthomas@impcna.com

    Wiki Child Well Visit with Sick Visit

    96161 is for a Maternal Depression screening.
  23. rthomas@impcna.com

    Wiki Child Well Visit with Sick Visit

    In Mississippi, Medicaid we use EP instead of AM I will use your reference on how we would have to submit the claim. Also you may want to question your provider about the use of 99214 for a URI dx. In my practice, Internal Medicine & Pediatrics, when I have reviewed charts, I have never seen a...
  24. rthomas@impcna.com

    Wiki Vaccine Administration Question

    99391 does need modifier 25 since you are also billing for 90460 which is administration of vaccine with counseling done by provider.
  25. rthomas@impcna.com

    Wiki How do you code both upper and lower bilateral extremity venous ultrasound and will I need a modifier?

    Are you coding global or only for technical or professional components?
  26. rthomas@impcna.com

    Wiki Question

    You only code what is addressed and treated. Just because a patient has a chronic condition doesn't mean it gets coded it at every visit. If the patient was seen and final dx was URI then that is all that is coded. Now if the patient came in for URI, BP elevated or needing meds refilled and...
  27. rthomas@impcna.com

    Wiki RPM

    We use POS 11 and are receiving payment. We have been doing RPM for 3yrs.
  28. rthomas@impcna.com

    Wiki FLORIDA MEDICAID VACCINE CODING

    Have you tried billing as units instead of individually? For example: 90696 90707 90716 90460 x 3 90461 x5
  29. rthomas@impcna.com

    Wiki G2211 with PHQ2 and TCM

    I attached the most recent MLN from Medicare. Hope it helps.
  30. rthomas@impcna.com

    Wiki J2405 HCPC changes

    Check your NDC #. If you have NDC #s hard coded to your HCPCS make sure that it has been updated.
  31. rthomas@impcna.com

    Wiki Billing for Nirsevimab (Beyfortus) RSV 200 mg dose

    A lot of the payers we deal with are wanting us to use 96372 for the administration. Here is the link to the Beyfortus website https://pro.campus.sanofi/us/products/beyfortus/cost-and-coverage. It also states that payer policies may require reporting administration CPT code 96372 for...
  32. rthomas@impcna.com

    Wiki FLORIDA MEDICAID VACCINE CODING

    I know all states are different but in Mississippi Medicaid doesn't reimburse additional components (90461) We send it with a 0.00 charge.
  33. rthomas@impcna.com

    Wiki BILLING MEDICAID VACCINES

    Should look like this. You can only bill 90460 & 90461 if the provider did education/counseling about the vaccines. 99214 25 90700 90671 90648 90460 x 3units 90461 x 2units If the provider did NOT do education/counseling about the vaccines. Then it needs to look like this. 99214 25 90700...
  34. rthomas@impcna.com

    Wiki 99401

    This website will help with coding Medicare preventative counseling. It has been a life saver for our practice. https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html
  35. rthomas@impcna.com

    Wiki Depression Screening to Commercial Payers

    If the assessment turns out to be positive then they will address it and use appropriate dx, for example F41.1. If the screening is negative then Z13.31 is used. When it comes to wellness/preventative visits Z codes are sometimes the only codes associated with the visit.
  36. rthomas@impcna.com

    Wiki Medicare and vaccine coverage in General surgery ?

    For the Hep B vaccine 90647 needs admin code G0010. G0008 is for flu shots.
  37. rthomas@impcna.com

    Wiki Depression Screening to Commercial Payers

    There is documentation to support. We utilize the PHQ9 screening assessment which is reviewed, scored and the provider initials the assessment. Depression screening starting at age 11 is recommended by the AAP Bright Futures guidelines. It's also a requirement of Medicaid wellness visits if...
  38. rthomas@impcna.com

    Wiki Well Child Check first year

    It's going to depend on the payers guidelines as to how many wellness visits they allow in the first year. In our practice we do 99391 at 3-5day, 2 weeks and 2month - 12 month. The only time we have patient comes in for weight check only is if there hasn't been weight gain, feeding problems...
  39. rthomas@impcna.com

    Wiki Depression Screening to Commercial Payers

    We are doing them with a wellness visit and these patients do not have a a definitive dx.
  40. rthomas@impcna.com

    Wiki Depression Screening to Commercial Payers

    We do not use G0444 for commercial plans & Medicaid, we use 96160 with dx Z13.31.
  41. rthomas@impcna.com

    Wiki Newbie: Does 96372 also need the Jcode for drug being injected?

    If the patient brings in the medicine to be injected, ie.: B-12, testosterone, then we only charge 96372. The only time we bill 96372 with a J code is if we supplied the meds, ie: decadron, zofran.
  42. rthomas@impcna.com

    Wiki Screenings and Routine Annual Exam

    What screening diagnoses are you referring to? Is the diagnosis for a screening lab?
  43. rthomas@impcna.com

    Wiki Determining how much to set your fee schedule

    This is going to be something your practice needs to decide on and make it a policy. We are a physician owned Internal Medicine & Pediatric practice, our fees are determined by our Blue Cross allowed multiplied by 130%.
  44. rthomas@impcna.com

    Wiki 96110 Developmental Screening Code Requirements

    In order to bill the screening all sections must be completed. We have the same tool built into our EHR, when all areas are completed we bill Medicaid or commercial insurance for it. We have never had an issue with reimbursement. Since you are doing this with a well child check and more than...
  45. rthomas@impcna.com

    Wiki Allergy Diagnosis coding

    We are a PCP office and we have patients that have their allergist send their allergy injection serum for us to administer (95115 or 95117). The allergist that we do this for recommended that we use T78.49XD. We have never had an issue with reimbursement.
  46. rthomas@impcna.com

    Wiki Billing G0296 on a Medicare wellness exam

    Yes, this can be done during an AWV and Medicare will reimburse. I have attached a link to the Medicare Preventive Services Chart. https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html
  47. rthomas@impcna.com

    Wiki E/M - acute uncomplicated vs acute with systemic symptoms

    I attached 2 different documents. One is from AAPC and the other is from AMA. I use the AAPC one as a quick reference but the AMA article goes in detail.
  48. rthomas@impcna.com

    Wiki New Patient Documentation

    Should the documentation of an office note indicate if a patient is new? My established providers document if the patient is new to group in either the Chief Complaint or HPI. ie: Patient present as a new patient for refills on blood pressure medicine but my newer providers do not. I thought I...
  49. rthomas@impcna.com

    Wiki CPT for Parent wanting to meet w/Pediatrician, patient not present?

    We had a parent call interested in scheduling a time to come speak with one of our pediatricians to see if our practice would be a good fit to provide primary care for her 4 children. The parent would be coming alone. All 4 of these children would be new patients. One child has severe special...
  50. rthomas@impcna.com

    Wiki CPT for parent & physician consult?

    We had a parent call interested in scheduling a time to come speak with one of our pediatricians to see if our practice would be a good fit to provide primary care for her 4 children. The parent would be coming alone. All 4 of these children would be new patients. One child has severe special...
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