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    Wiki Transitional Care Management

    Hello, A septic patient is released from the hospital, we make the phone call at day 2- patient presents to the office within 7 days and the sepsis is completely resolved and no other concerns for the visit- are we able to charge the 99496. The physician reviews the hospital notes but there is...
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    Wiki Moderate sedation codes

    Hello- Wondering if anyone is having issues with insurance companies denying the 99152-99153 when being performed with a colonoscopy and or upper GI? GI physician is doing the procedure, medications is being administered and the RN- trained observer is recording the vitals when observing the...
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    Wiki TC/26 modifier

    Hello, looking for some guidance when it comes to billing cardiology testing such as echo and stress echos- we have a cardiologist that is employed by our facility however he is at an off site location from where we perform the tests. In order to bill services, do we have to split the codes...
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    Wiki GI physicians teaching hospitalist physicians to do colonoscopies

    Hello, Looking for some guidance- we have two hospital physicians that are training to do colonoscopies in our endoscopy unit. The GI specialist is in the room doing the supervision of the hospital MD- we are wondering if we are able to bill under the hospitalist because they are doing the...
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    Wiki current vs history of

    We are looking for some clarification on the coding guidelines regarding history of vs current malignancy. The ICD-10 coding guidelines state that if the malignancy is eradicated and no longer receiving treatment, we should be coding the history of. Our question is what if the patient had a...
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    Wiki Dialysis face to face visits

    Hello, I was wondering if someone could help us out or lead us to the information regarding the face to face visits and what is needed to support the 90960- are we required to document a note each time we do a face to face when patient is receiving dialysis or are we able to do one...
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    Wiki Mix and match vaccine

    Looking for some guidance on the booster dose when patient receives J&J initially and then comes in for a Moderna/Pfizer booster- What admin code are you all using in this situation for the booster? Thanks
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    Wiki midpoint

    I was looking for some guidance on the midpoint for 99402- code reads approx. 30 mins. We spent 20 minutes with a patient so would this qualify for the billing of 99402 since we crossed the midpoint of the 30 minutes. Thanks
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    Wiki transabdominal/transvaginal done same day

    Wondering if we are able to bill both the 76830- transvaginal and the 76857 (?59 modifier) limited transabdominal on the same day? The reason for the transabdominal is we are unable to locate the ovaries via the transvaginal ultrasound. Thank you :)
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    Wiki August Healthcare Business Monthly

    I was wondering if someone could clarify some conflicting information that I found in the magazine this month- on page 21 #6 it states that we are able to charge an additional E/M if chronic STABLE conditions are addressed at the preventive visit and on page 45 it states in order to bill an...
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    Wiki Peer to Peer review

    Hello, I was wondering if anyone has some insight on if and how we can bill for peer to peer review with an insurance company to get approval for a service? The physician also spent time reviewing the notes and then speaking with the caregiver to give a plan moving forward. If we can not bill...
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    Wiki preventive elements split

    Hello, Wondering if someone could give guidance when it comes to patients who have their annual physical with a male physician but prefer to have a female do the pap/breast exam on a different day- are we able to bill the Q0091 for the pap smear on the second visit or could we do a 99212? Thanks...
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    Wiki Employee vaccinations

    I was wondering if I could ask a question regarding flu shots for employees? Our facility suggests that everyone get a flu shot yearly. We sign a form stating we either accept or decline the shot. For billing purposes would you: 1. Provide this at no cost to the employee. 2. File insurance to...
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    Wiki Epley maneuver

    Looking for some guidance. If a patient presents for dizziness and the physician diagnosed with BPPV and performs the epley maneuver in the clinic, are we able to bill an E/M (25 modifier) with the 95992? Thanks in advance Steph
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    Wiki HCC/RAF

    Hello, I am really new at the HCC coding and I was wondering if someone could help me out with finding the weight that goes along with the HCC diagnosis code to calculate the RAF score? Example- DM with retinopathy- .123. Is there a table with these numbers listed that I am just overlooking? I...
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    Wiki Mammogram

    Hello, We are questioning if a patient comes in for a screening Mammogram on 12/1/2018 and a mass is discovered, patient is being followed every 6 months to monitor the issue. Would the 12/1/2019 mammogram go back as a screening Mammogram or remain diagnostic? Thanks Steph
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    Wiki Chronic Care Management G0506

    Hello All, Just wondering if someone had guidance regarding the G0506 add on code for the initiating visit? I am wondering what is considered extensive? Is decision to enroll patient, laying the framework for the care plan and the actual referral into the program enough? Any guidance would be...
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    Wiki Depression screen G0444

    Hello, Looking for some clarification on the G0444. Cpt definition places 15 minutes (7.5 midpoint) on the code but when I look at the NCD 210.9 it states up to 15 minutes. Not sure what is needed to correctly bill for this service. Any guidance is appreciated. Thanks
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    Wiki Chronic care management

    Couple of questions regarding Chronic Care Management. 1. Are we able to count the phone call for enrollment toward the time needed to bill CCM? 2. Does the care plan need to be updated 365 days apart or is it calendar year? 3. Can the termination be verbal and documented in patient chart, or...
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    Wiki Depression screen

    Hello, I was wondering if I could get some clarification on the use of G0444? Are you able to bill when you just use the PHQ-2 or does it have to be use of the PHQ-9 when performed with the SAWV? Thanks Steph
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    Wiki e/m utilization tool

    Hello, Can anyone explain why the e/m utilization tool in the resource tab has the title of national Medicare average when the pediatric medicine specialty is selected? Thanks for you help Steph
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    Wiki G0444

    If a patient comes in for a SAWV or any other visit and has been treated for depression in the past, are we able to code the G0444-screen to see who patient is responding to treatment? Is it once the patient is diagnosed with depression, the option of G0444 goes away? Any guidance would be...
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    Wiki Ultrasound

    A patient presents for a Kidney and Bladder ultrasound, when performing the ultrasound the tech finds issues with the ovaries and these are imaged and reported. The diagnosis for the Kidney and Bladder is of urinary tract pathology, so I am able to code the 76770. Am I able to add the limited...
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    Wiki stress echo

    If a stress echo complete with continuous EKG monitoring is done in the clinic by the RDCS, RVT under direct supervision and it is being sent to an outside Cardiologist for interpretation would we bill: 93350-TC + 93017 since the supervising Clinician and the interpreting Clinician are different...
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    Wiki 76770 with PVR

    Hello, I was wondering if I could get some help on whether or not to bill a 51798 PVR with a 76770? We did a real-time grayscale and color flow doppler ultrasound of the bilateral kidneys and the bladder with the pre and post void. Should we be unbundling this or just leave it as being included...
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    Wiki 69210

    Hello- I am unable to locate guidance regarding the ancillary staff performing the 69210 removal of cerumen with instrumentation. Are there any clinics that are letting their ancillary staff do this service or requiring the physicians perform only? Thanks
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    Wiki 96110, 96127, and 96161

    Needing help with locating coding guidelines for the 96110-develpomental screen and the 96127-emotional/behavioral screen. Is there an age range for the 96110? If a 12-18 year old patient comes in for a preventive visit and we do the PHQ-2 for are we able to bill the 96127 or does it have to be...
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    Wiki venipuncture-redraw after error

    Hello All, Looking for some guidance on the legality of the following situation: A patient comes in for lab work and the physician or phlebotomist missed something on the order and the patient has to come back. Do you no charge the venipuncture when the patient comes back as a courtesy because...
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    Wiki Venipuncture

    Hello All, Looking for some guidance on the legality of the following situation: A patient comes in for lab work and the physician or phlebotomist missed something on the order and the patient has to come back. Do you no charge the venipuncture when the patient comes back as a courtesy because...
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    Wiki Preventive and sick same day

    Hello, Wondering if we could get some guidance on billing Preventive and sick visits same day? CPT states that if an abnormality or a pre-exsisting problem is addressed and the problem is significant enough to require additional work, we are able to bill the E/M with a 25 modifier. If the...
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    Wiki Ear Irrigation 69210

    Wondering if anyone could give me a link to get the guidelines that state that the physician needs to be the only one using instrumentation for 69210? Also the nursing staff to do irrigation without instrumentation? Thanks for your help Steph
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    Wiki Ear irrigation

    Hello All, The 69210 is to be done by a physician. I was wondering if the physician chooses to delegate the use of instrumentation to the nurse, are we still able to bill the 69210? Thanks
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    Wiki observation to inpatient same day

    Hello, Wondering if a new H&P needs to be done when a patient goes from observation to inpatient same day or is reference made in inpatient note ok? Thanks Steph Mescher
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    Wiki billing hospital discharge after death

    Hello All, Just wondering if I could get some guidance on billing discharge when an RN pronounces the patient deceased? CMS guidelines state " only the physician who personally performs the pronouncement of death shall bill for the face to face hospital discharge day management service...
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    Wiki 3D mammogram denials for PA/NP

    Hello All, Wondering if you someone could give me some guidance on how to handle Medicare denials of 3D mammograms when ordered by a PA/NP? Medicare will pay the 77067 but deny the 77063. Thanks in advance. Steph Mescher, CPC, CEMA
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