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  1. Pam Warren

    Looking for a Regulatory Billing Auditor at MaineHealth (fully remote)

    I'm looking to hire a Regulatory Billing Auditor at MaineHealth corporate. Fully remote. Qualified candidates please apply online at: https://www.careersatmainehealth.org/jobs/1831267-regulatory-billing-auditor
  2. Pam Warren

    Wiki American living abroad looking for work within US.

    You would apply online just as anyone stateside would apply. Make sure that the companies you apply to will hire off-shore coders.
  3. Pam Warren

    Wiki Stay or Find Something Else?

    Seven months is hardly enough time to consider yourself experienced, and far too soon to become discouraged. If your employer is not giving you a hard time about your productivity or accuracy, I'd hang in there. If after a couple of years (or if your manager has a heart-to-heart with you about...
  4. Pam Warren

    Wiki Can an E&M be billed in place of a sphenocath?

    Absolutely not. First page, first paragraph of CPT instructs you to report the service that most accurately describes what is being performed. If there is no specific surgical/procedural code you'd report an unlisted code, but never an E&M in place of a procedure.
  5. Pam Warren

    Wiki hemoglobin A1C coverage

    https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56686&ver=13 According to the LCA, that Z code is not covered as of 1/1/24.
  6. Pam Warren

    Wiki Well woman exam billed to Medicare but no pelvic exam/pap

    99397 is statutorily excluded from Medicare Coverage, per federal guidelines. As such, no ABN is required and you may balance bill the patient, which should be evident on your remittance advice. A good rule of thumb is to never provide these for Medicare recipients; instead consider Annual...
  7. Pam Warren

    Wiki Well woman exam billed to Medicare but no pelvic exam/pap

    9938x or 9939x. Preventive visits (basically the well exam). E&Ms are only for visits with chief complaints/problems/illnesses/injuries. G0101 and Q0091 are Medicare HCPCS codes for Pap/Breast/Pelvic. Some commercial payers will cover them.
  8. Pam Warren

    Wiki Billing Pharmacist for blood pressure/med checks

    Currently (and this may change) a pharmacist may not bill independently for any type of E&M visit, except a nurse visit; 99211, as long as incident-to criteria are met. Some states allow higher levels of service by pharmacist licensure, and commercial payers vary in their policies. Medicare...
  9. Pam Warren

    Wiki Nurses in Schools

    If your FQHC is being reimbursed by the school to loan them your nurse, then the school would be the one to do the billing (if any). If you were to also bill for the nurse, that would be double dipping. Also, the kids at the school are not necessarily your patients, so you don't have the...
  10. Pam Warren

    Wiki billing for a consult during surgery?

    If you're the coder for the OBGYN, and he/she wrote a consultation note, and there is a request for the consultation in the surgeon's note, you can bill an E&M/consultation for the OBGYN. Otherwise, you wouldn't bill anything.
  11. Pam Warren

    Wiki Co-Surgeons?

    You can be co-surgeons in the same specialty. The question here is whether or not the payer will cover for the same code, same patient, same day. Noridian has language that says that in instances like bilateral knee replacements, you'd bill as co-surgery, with two surgeons operating on...
  12. Pam Warren

    Wiki Non-covered lab charges

    It depends on the payer, but CMS and the commercial payers all have coverage policies. I know they're 'so much to look through', but that's the business of medicine. Overall, though, we should be coding based on the physician's order, and educating him/her on payer requirements. Medicare...
  13. Pam Warren

    Wiki HCC

    The CRC certification gives a broad overview of risk-adjusted coding. Most organizations that hire coders for their MA plans like to see this certification, but sometimes they'll hire without it, and expect you to obtain iitwithin the year. You can learn risk-adjusted coding on the job, and...
  14. Pam Warren

    Wiki Solumedrol 125 mg HCPCS Code

    J2919, (see below from CMS). You'll have to do the math for 125 mg, billing 25 units. J2919 Add Injection, methylprednisolone sodium succinate, 5 mg J2920* Delete Injection, methylprednisolone sodium succinate, up to 40 mg J2930* Delete Injection, methylprednisolone sodium succinate, up to...
  15. Pam Warren

    Wiki Medicaid denying claims with FS modifier...

    Our state Medicaid hates modifiers. We review their benefit policy manual to see if the modifier is required and if not, we leave it off.
  16. Pam Warren

    Wiki Risk Adjustment

    #1, if they're on medication, then the condition is current and you code it, as long as it was addressed at the visit. #2, if there's no evidence of cancer currently, then you'd code 'history of'. Not to be a pain in the a$$, but both of these questions are answered in the instructional...
  17. Pam Warren

    Wiki Outpatient facility E/M

    Well, if you find one, that would be awesome, and I'd owe you dinner. The guidance isn't really out there. I'm assuming that this is with regards to a provider-based situation. Medicare says only that you devise a system and stick with it consistently. Commercial payers don't recognize...
  18. Pam Warren

    Wiki How to search for Medical Coder Jobs in Germany

    Remember that ICD-10 is different in each country. And because Europe has a socialized medicine program, coding is performed more for data collection and not claims submission. They also don't use CPT. Maybe research the healthcare system in Germany to get an understanding of what you might...
  19. Pam Warren

    Wiki AUDITING APPLICATIONS

    Honestly, I have been leading auditing teams since 2005, and I have yet to find an auditing software that I would be excited enough about to buy. I've found that our methodology, tools, resource repository and templates meet our specific needs. Plus, most of these auditing applications are...
  20. Pam Warren

    Wiki Medicare Annual Wellness Visit and Annual Physical Visit

    an ABN is not required for a categorically excluded service such as the annual physical 9939x. It would be patient responsibility. However, we are expected to adjust the amount of the covered service from the amount of the non-covered service and the patient is responsible for the balance...
  21. Pam Warren

    Wiki Pathology Report Discrepancy, help needed please.

    You would code from the pathology report only if the surgeon notes its clinical significance.
  22. Pam Warren

    Wiki Membership dues.

    AAPC doesn't control whether or not your employer requires you to be certified. AAPC doesn't control your salaries AAPC doesn't force you to go to chapter meetings AAPC doesn't direct the chapter meeting content, although there are bylaws and guidelines that the chapter officers should follow...
  23. Pam Warren

    Wiki Who can dictate procedure note?

    The procedure may be billed only under the performing provider. The provider is responsible for the accuracy of the procedure note, so are they comfortable with someone else documenting their work? Check with your hospital's rules/regs....there may be an expectation that they document their...
  24. Pam Warren

    Wiki NURSE PRACTITIONER NEW PATIENT CLAIMS

    CMS does not recognize Nurse Practitioners with different taxonomy codes (like physicians do) based on different specialties that they might work in. From CMS' perspective, an ARNP is an ARNP period. So if a patient sees a nurse practitioner for cardiology and later a NP for pulmonary in the...
  25. Pam Warren

    Wiki Counseling and Co Insurance

    Our admin used to contact the client's insurance company prior to their diagnostic interview to determine the amount of the copayment/co-insurance. They were expected to pay it at the time of visit. This is for two reasons....first because it places a value on the therapeutic relationship...
  26. Pam Warren

    Wiki Level of Service?

    Where's the medical decision making? There's no chief complaint/problem to support an office visit. I'd say bill the flu shot only. Remind her of the requirements for E&M visits (as of 2021). She'll need a level of MDM or time in order to bill an E&M visit, and show medical necessity for...
  27. Pam Warren

    Wiki New coder can't find a job!

    After 35 years in the industry, I've heard more stories and opinions than you can imagine. No offense taken. However, you're mistaken if you think that AAPC or coders in general are blocking opportunities for new coders. Why would AAPC (a for profit company) want to discourage the success of...
  28. Pam Warren

    Wiki Annual Wellness Visits

    Remember that the instructional notes in CPT indicate that we must report the code that most closely represents the service provided. And HCPCS has the same expectation. All CPT and HCPCS codes have descriptions and documentation guidelines specific to what's expected to be performed if you...
  29. Pam Warren

    Wiki HealthCon Vegas Location

    yes, Harrah's is the location for rooms for HealthCon.
  30. Pam Warren

    Wiki Inpatient coding for procedure

    Physician services, whether employed or otherwise, are always billed on the 1500 form, using CPT. (the exception to this might be for critical access hospitals, but that's not the norm). The PCS codes are for facility charges only and are always bulled on the UB. That doesn't cover the...
  31. Pam Warren

    Wiki Wound care and home health, why are my E/Ms being re-couped

    Selective wound debridement is supposed to be provided by the home health agency. If your hospital/practice does that service, the HHA has already been paid for it under consolidated billing, and you need to recoup the money from them. The surgical debridement codes are outside the scope of...
  32. Pam Warren

    Wiki HCPCS Codes not payable by Medicare

    Generally speaking the H codes are reported to Medicare using psychotherapy codes. You'll want to look at the Local and National Coverage determinations and articles to validate how Medicare covers these services. I wouldn't be able to give you a 1:1 crosswalk because it depends on who the...
  33. Pam Warren

    Wiki Professional Advice!

    Network, network, network. To get your name out there, you need to put yourself and your company in front of healthcare business decision makers. Consider being a vendor at the many healthcare conferences that are out there. Join MGMA. Attend your local AAPC Chapter. Speak at conferences...
  34. Pam Warren

    Wiki Proper Coding for fluroscopic guidance and MRI

    23350 is for the injection, and CPT advises that the imaging codes i.e 77002 would also be billed out. If you got the physician's bill, the fluoro will likely come from the radiology department of the hospital.
  35. Pam Warren

    Wiki Criteria for Inpatient/Outpatient facilities

    Where is the patient located? The volume of provider documentation is not going to determine the service location. If the patient is admitted to an inpatient setting, there would need to be an order for that level of care. This is because the payment for the facility varies based on what...
  36. Pam Warren

    Wiki Book for sale?

    Check Amazon. They sell all kinds of used books, even ones that are out of print.
  37. Pam Warren

    Wiki PAs - How to code for First Start in surgeries

    Make sure they're actually assisting, and not just giving the surgeon an 'atta boy'. They must perform duties throughout the operative session that require the skill of a surgeon. Although a separate note isn't critical, the attending surgeon must show in her/his note why the assistant is...
  38. Pam Warren

    Wiki Keytruda as inpatient

    Infused medications are all bundled into the DRG, and they are not paid for through a line item like outpatient or professional services.
  39. Pam Warren

    Wiki Newborn specialty visit / POS

    All newborn admissions are inpatient. Admission date is DOB. The kid will have his/her own chart.
  40. Pam Warren

    Wiki Colonoscopies - surveillance vs. screening

    Surveillance can be a screening, if there's no symptom or condition that's being managed. So if a patient is a high risk for colon cancer because of previous polyps that have been removed (no current symptoms), any further colonoscopies would be screening. IF the patient has a condition (such...
  41. Pam Warren

    Wiki Suggested CPT code for procedure

    Unroofing/deroofing pustules is included in the E&M. So it's not separately reportable. They usually use a needle to do this. It's not a surgical procedure that warrants a code from the 11000 series.
  42. Pam Warren

    Wiki Membership dues.

    I've done years of volunteer work for AAPC. No paychecks have come my way from this organization, as you wrongly have assumed. However, my association with AAPC (BOD, NAB, Education Committee, Local Chapter officer) has provided me with networking opportunities that have significantly...
  43. Pam Warren

    Wiki Provider Based Billing

    She's right. When you bill an outpatient service in a provider based hospital department, the APC rates (and rules) apply. Facility charges do not get reimbursed in the same fee-for-service method as if done in a physician office setting.
  44. Pam Warren

    Wiki Improper Billing Trends Resources

    without a diagnosis on the order, the order is invalid, and you should not provide the service. It's a risk for sure.
  45. Pam Warren

    Wiki Improper Billing Trends Resources

    your local MAC will have a list of TPE (Target, Probe, Educate) letters that they are sending out related to services that they've identified as possibly being reported inappropriately. I use that list as well as the other resources above to create my annual audit work plan.
  46. Pam Warren

    Wiki Coding

    If they're billed under two different providers, even for the same practice, they're going to be on a separate claim form, however E&Ms don't bundle with diagnostic studies. However, 93971 is unilateral and 93970 is bilateral, so they're bundled unless they're separate structures, whereby you...
  47. Pam Warren

    Wiki Need HPI Help for Preemies with ROP!

    This is a screening for retinopathy, with the chief complaint being the prematurity, not necessarily treatment for the ROP, but the documentation surely could use a boost. You have barely enough information for a brief HPI, but since this is a screening, would this be a well-baby check? Did...
  48. Pam Warren

    Wiki E/M billing

    I'm not sure if you mean E&M code or diagnosis code, so I'll comment on both. Is he seeing the patient in the hospital? if so, there's no 'level 5' for an inpatient E&M visit with POS 21. Depending on the situation, (and payer) 99223 or 99233 would be the highest level code you can...
  49. Pam Warren

    Wiki where am I supposed to learn code linking?

    Frankly, I'm not sure what's meant by 'code linking', unless it means that your CPT and diagnosis codes must correspond to show medical necessity. Can you give an example of what they're looking for?
  50. Pam Warren

    Wiki Translator included in 2021 E/M Time?

    Our legal folks recommended that we not code based on time if a translator was used during the encounter.
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