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  1. L

    Wiki subspecialty

    so- if my rad onc guys are considered separate then my surg onc will also be separate. i suspected that was the case- i just wanted to verify
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    Wiki E/M visit level

    so- for non qualified professional discussions the way you try to get reimbursed for that is to put towards the total time spent on that case for the day. you would then use time as a deciding factor if it's higher than your MDM.
  3. L

    Wiki subspecialty

    i work for a fairly large oncology practice. we currently have med onc & rad onc docs which are considered subspecialties from each other. we have an oncology surgeon starting in a few weeks who will work directly for our practice. my questions is: is surgical oncology considered a separate...
  4. L

    Wiki 99497 & 99498

    i'm trying to locate a reliable source for the time constraints on these codes. specifically i'm looking for the limits on 99498. on CMS's website they do set the limit for 99497 at 16 mins minimum. my issue is that they do not do that for 99498 but i just watched 2 webinars that say you must...
    • luvbuix
    • Thread
    • Replies: 1
    • Forum: E/M
  5. L

    Wiki discharge issues

    no- we are the admitting & the attending in these cases. all the other docs bill for the d/c whether the pt dies or not.
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    Wiki discharge issues

    no- these are pts that are on our service. we are the attending & do the initial visit which we bill for. same as if the pt is d/c'd to home (or wherever) alive. we are only having this issue when the pt dies. our health systems require a d/c note done within 24 hrs by the MD regardless of...
  7. L

    Wiki discharge issues

    these are almost always our pts that are in the hospital under our service. our health systems have a policy that the admitting/attending needs to do the d/c note within 24 hrs of d/c. we have no issues doing the H&P on admission (initial hosp visit) or the d/c when the pt is still alive...
  8. L

    Wiki discharge issues

    i have several docs who are doing d/c summaries when the pt dies in the hosp & then not charging for them. to compound the matter some of these are shared visits. they will either do the note & then a "no charge" or they will let the APPs subseq visit note done that same day stand as the...
  9. L

    Wiki A/P

    although the info is scant i can get a 99214 out of this one. 1 acute illness with systemic & rx drug mgt= 99214
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    Wiki Can a coder choose MDM over documented total time?

    they should put both on their note & choose the level based on whichever component is the highest. the new guidelines help them/and you optimize their coding. we have cancer pts that get 10-15 min office visits- if they are getting chemo obviously the MDM would be what you would code from. we...
  11. L

    Wiki Unique test ordered for MDM

    or could some of these fit into the minor procedures (hopefully with risks/benes) category under risk?
  12. L

    Wiki extended time

    have they adapted to Medicare requirements? for those you need more time beyond the upper number of the range.
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    Wiki Prolonged Visits

    prolonged visits are for extra time spent beyond the time frame of the 99205/99215 codes on the SAME DAY. for medicare that would be 89 mins or more for the 99205 & 69 mins for the 99215. for commercial carriers it would be 75 mins & 55 mins respectively. also- prolonged service is an add on...
  14. L

    Wiki Office Visits via video

    as of today this would be telehealth. you would bill it same as an office visit with the 95 modifier. for out of state providers check state guidelines for the both states & make sure that provider is licensed in both. a good portion of states are part of the new pact which eases licensing...
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    Wiki Duplicate notes for two kids at same appt?

    your provider should listen to what you are saying, do what you tell them, thank you for keeping them out of jail, & give you a raise!! cloning is a great way to get yourself in trouble- & the coder is not the one that will be in trouble either!!
  16. L

    Wiki Semaglutide

    same with omeprazole- my wife's rheumatologist writes her a prescription for it & manages that even though it is available otc- i would consider that as part of the tx plan managed by the provider
  17. L

    Wiki E/M- High Complexity of Problems

    sounds like they are trying to backtrack to keep people from using the guidelines they created!! i work in oncology & we consider our active cancer pts to have severe exacerbation, progression, or side effects of treatment & if that isn't enough- 1 (sometimes more) acute or chronic illness that...
  18. L

    Wiki Low vs. Moderate Risk of Morbidity

    welcome to the wonderful world of coding!!! one of the greyest professions on the planet!! low risk would be no drugs or sx planned, follow up labs and/or imaging, etc. moderate would be non-chemo drugs, non-opioid drugs, procedures with no global days with risk factors, 90 day global...
  19. L

    Wiki New vs. Established Patient

    but there is part of the definition that you left out- the part in bold that says EXACT same specialty AND SUBSPECIALTY. since this provider changed practices AND specialties i would call this a new pt. i worked for uhc for 14 years & they would consider this a new pt also. just my 2 cents!
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    Wiki Incomplete Colonoscopy: Modifier 52 or 53?

    in my experience if the MD thought a blockage was enough of an "extenuating circumstance" then modifier 53 applies to this situation. coding is not black & white- there is alot of room for interpretation. all the training i've ever received on this topic teaches this modifier is used for...
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    Wiki Does anyone else's provider document like this? How to determine appropriate code assignment?

    in order to meet the current guidelines for CPT leveling the provider needs to support MDM which requires number & complexity of problems addressed. i educate my providers to only list the conditions they addressed/reviewed & are formulating a treatment plan for in their assessment. i would...
  22. L

    Wiki BS charging MRI Copays for Echo's

    if you are going to pursue this yourself you need to get a clinical person on the phone or someone who can comment on the clinical aspect of their denial. you could also try a peer to peer review with your doc & one of their docs. i've worked on both sides of this issue & it is ultimately up...
  23. L

    Wiki Anyone else in this situation?

    i would say if the codes can be billed for both & the hosp is not billing for their own space then he could bill globally. if hosp is billing the tech portion (not sure why they would) then he should only bill the pro fee. as for the read only for the other guys that would be pro fee only...
  24. L

    Wiki Which of us is correct? HELP

    devil's advocate here- i do agree that face-to-face is best however, the actual descriptions of 99212-99215 do not say that face-to-face is required. if the NP is reviewing the medical record & doing the MDM portion of the visit or going for time they can bill whatever code they support per the...
  25. L

    Wiki Billing for Physician Assistant service under Supervising Dr

    there are several levels of guidelines you need to wade through according to each setting. there are state scope of practice guidelines, payer guidelines, practice guidelines, & health system/hosp guidelines that all APPs are subject to. if they can make it through all that then you have to...
  26. L

    Wiki Help with coding Omnipaque

    i'm curious as to why the payer is saying it's experimental? what are you using it for??
  27. L

    Wiki New vs. Established Patient

    i disagree- since this is a different practice under a new TID this would be a new pt. the payers track this per TID so they would probably see it as a new pt also.
  28. L

    Wiki Coding Help

    how about something from the 11440-11446 range? of course- if there is a pathology report showing malignant you'd go to the 11640-11646 section
  29. L

    Wiki Discharge Coding - E/M

    this is why it pays to do d/c day of or next day. for 9/25 this MD should have used a sub hosp visit & one of the other 2 codes the day of actual discharge. d/c should be billed day it happens. good luck if your documentation doesn't match!!
  30. L

    Wiki prescription time

    per the new guidelines this can be included in the time spent on a particular visit for that day. the provider would have to determine how long it took for EACH person as you can only count time spent on EACH INDIVIDUAL pt. this might boost the code to the next level. if that's all was done...
  31. L

    Wiki allotted time for surgical CPT

    also- there is modifier 22 if this is a rare occurrence. the MD would need to state in the op report what it was about a particular case that caused the extra work/time and how much longer in his opinion it took than usual. this modifier CANNOT be used just because the MD is slower at...
  32. L

    Wiki using CPT CODE 99211

    dressing changes other than under anesthesia are not separately billable- if there are codes for ostomy procedures they would need to be billed using those codes & under the MD. wound care has it's own codes but a nurse cannot bill under her/his own name for those- they would need to be billed...
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    Wiki Help determining risk level

    it's not about the pt here- it's about the MD's level of risk. you always should follow the highest level of risk according to the treatment plan set forth by the MD. it doesn't matter what the pt decides. keep in mind though that the treatment plan has to be DEFINITIVE. he can't give...
  34. L

    Wiki Documentation compliance

    due to the new guidelines this area gets a little fuzzy! since we only now need either an MDM portion or a time statement to support a service the SOAP format is not required. although most practices still use that format you could actually just do a paragraph & be ok. i wouldn't call the...
  35. L

    Wiki Incident To Billing in Primary Care

    in a nutshell- an APP can have their own caseload if the scope of practice allows in that state & the practice is ok with that. if they maintain their own caseloads incident to would never be an issue unless the MD becomes involved with the treatment plan. for incident to the MD must see the...
  36. L

    Wiki Fraud question

    sounds like you need to educate your providers to be more specific. some payers may have an issue with that if there was ever an audit. if they have smartphrases in their orders try building both CTs in to that.
  37. L

    Wiki Telehealth or Office?? HEELP

    as of today & until the end of this year MOST pandemic telehealth allowances are still in place. that means location is not an issue as they are still being processed as though thy were done in the office with the 95 modifier. best practice for these if your providers insist on doing them is...
  38. L

    Wiki inpt hosp for hospice

    so- if he says "continue on hospice" is that making the decision again?
  39. L

    Wiki inpt hosp for hospice

    we are a moderate size hem/onc practice that sees inpt as well as outpt. my question is: i know when the decision is made to switch the pt to hospice that is a high risk decision making- what about susbsequent hospital visits after the decision has been made? i've been putting those as 99233...
    • luvbuix
    • Thread
    • Replies: 2
    • Forum: E/M
  40. L

    Wiki simulation supervision

    we are a moderate sized oncology practice in an outpt hosp setting. we do verification of simulations the day prior to treatment on occasion but not the actual treatment. my questions are- what is the degree of MD supervision that needs to occur in these circumstances? resources tell us it...
  41. L

    Wiki coding companies

    that has been my experience also. i was just wondering if it was just me or everybody has had that experience. i've also found that some (most) companies are owned or operated by lawyers, CPAs, MBs, & a host of other non coders. those people are great at running a business but when it comes...
  42. L

    Wiki coding companies

    we are a moderate size oncology practice which is hospital based. we are thinking of bringing on a surgical oncologist & will need someone to do our pro fee coding for that person. there are many coding companies out there. has anyone had positive experiences with these companies & if so...
  43. L

    Wiki Time Guidelines

    i know all of the above already- what i need is a reference that says you need to customize your time for EACH pt
  44. L

    Wiki Time Guidelines

    does anyone know of a reference that talks about stating specific time spent on EACH pt? i have a MD that has set up her templates according to time & all her time statements are canned. so- for all new pts her time statement is 60 mins, all her established pts are for 40 mins. i'm trying to...
  45. L

    Wiki split/shared visits

    i work for a moderate sized hospital based oncology practice. they have several APPs & want to start doing split/shared visits in the office. their plan is to have the APP do 20 mins of the appt & the MD 10 mins. the MD will be doing the MDM portion of the visit. according to Medicare's...
    • luvbuix
    • Thread
    • Replies: 1
    • Forum: E/M
  46. L

    Wiki see below- 3rd time trying for an answer

  47. L

    Wiki Isoloc Rectal balloon

    hi all! ? for anybody that does rad onc on a daily basis. we have a rep for the above mentioned item that's telling our rad onc people to bill this device every day under CPTs 77332-77334. from what i can see online this is just a prefab device & is discarded when tx is done. my rad onc people...
  48. L

    Wiki Isoloc Gas Release Rectal Balloon

    hi all! ? for anybody that does rad onc on a daily basis. we have a rep for the above mentioned item that's telling our rad onc people to bill this device every day under CPTs 77332-77334. from what i can see online this is just a prefab device & is discarded when tx is done. my rad onc...
  49. L

    Wiki DC charges

    HELP! i have a doc who does hosp d/c & puts no time down. we have been defaulting to 99238 but i'm wondering if we should default to whatever subseq hosp code fits since 99238 is not supported either? what does everyone else do??
  50. L

    Wiki G0296

    does anybody know if G0296 can be done as a telephone only visit? none of the resources i've seen say whether the pt. should be seen face-to-face or if counseling can be done on the phone. this was not telehealth- telephone only. any suggestions for resources would be helpful- thanks!
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