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    Wiki Multiple Specialties in Large Group - New visit

    Can you help clarify the new patient rules related to multiple specialties in the same group practice? If we have different specialties (e.g., Pain Management, Podiatry, Rheumatology, Orthopaedics) can we charge a New Visit code when the patient is seen for the first time by a physician in a...
    • Summer
    • Thread
    • Replies: 1
    • Forum: E/M
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    Wiki Modifier -59

    Hello, Verifying, if a modifier -59 is placed on a cardic cath and billed with a stent placement on the same day, the heart cath will be reimbursed at 50% of the fee schedule and the stent placement will be paid at full fee - correct? Thank you in advance. Summer
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    Wiki Temp Pacemaker-What I'm seeing

    Good morning to all! What I'm seeing is Medicare requesting take backs on CPT 33210 - Temp Pacemaker. We clearly understand the indications for when to use a temporary pacemaker however we may be a bit foggy on when we could bill for it - a recent Q&A posted lead us to believe a temporary...
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    Wiki Consults - Listing of who recognizes them and who does not

    Good afternoon everyone, Does anyone out there have an updated listing of which payers recognize consultation codes and who does not that is willing to share this information with me? Please send to summerbreezels@alo.com. Thank you in advance. Summer
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    Wiki Stress Test -- 2 physicians

    Good morning, A really silly, silly question.....however, there is a difference of opinion than mine which is ok, though we need to do it correctly. If you have 2 physicians for a stress test, one for the stress portion- 93015 and one to read the SPECT 78452 - the radiopharmaceuticals...
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    Wiki PET - 78492 Performed in POS 11

    Good afternoon everyone, Is there anyone out there who is performing PET's in the place of service 11? If so, are you being reimbursed under the OPPS - Non-Facility PAR Fee Schedule? If so, could you please explain to me why Medicare is paying this way for a POS of 11? Any insite would be...
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    Wiki New vs Established Patient visit

    Good afternoon everyone, I have an insurance carrier denying a New Patient visit because a stress test was read by us 5 days prior to the E/M service. This patient is new to us. It was my understanding diagnostic testing was not considered for the purposes of distinguishing between new and...
    • Summer
    • Thread
    • Replies: 1
    • Forum: E/M
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    Wiki Stress Test 5 days prior to an E/M visit

    Good afternoon everyone, I have an insurance carrier denying a New Patient visit because a stress test was read by our physician 5 days prior to the E/M service. The patient has never been seen by us. It was my understanding diagnostic testing was not considered for the purposes of...
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    Wiki 2013 Medicare Fee Schedule

    Good morning, Yesterday Medicare posted an update:noted below. Are you holding your claims for the first 2 weeks of January? Thank you. Attention health professionals: Information regarding the 2013 Medicare physician fee schedule The negative update of 27 percent under current law for the...
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    Wiki Shared/Split and Consults

    Good morning everyone, I read an interesting article where it spoke about shared/split services and consults - I truly understand the guidelines however this tid bit stood out since I've not seen it written as such in anything that I've read until today. Let me share, although the codes have...
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    Wiki Documentation Audit: Prep for I-10

    Good afternoon everyone: Does anyone have a good tool to use to Audit your physician's documentation for ICD-10 - I'm looking for something specific to Cardiology. Thank you, Summer
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    Wiki PET - 78492 and Medicare Part B Fee Sched

    Good afternoon everyone: I'm seeking advice about reimbursement for CPT code 78492 PET (Heart) which is being performed in the physician's office setting. I'm new to a Cardiology practice and noticed their PET scan services having a denial code CO-59 Charges are reduced/denied based on...
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    Wiki Procedures in a Global Period

    Good morning to all, Please advise, when a Right & Left Heart cath and PTCA are performed within the global period of an ICD generator change out would you add the modifier -79 on the Cath and PTCA. I disagree with my counter part since the Cath and PTCA have a "000" post operative period ...
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    Wiki Consult performed at another practice

    Good afternoon everyone, Quick question, can a physician bill for a consult that was performed at another physician's office (this office is not associated with our facility)? Thank you in advance.
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    Wiki Liability Insurance

    An interesting question has come my way and I do not have the statistics for this particular question however the basic principles to protect the business or individual from third-party claims leads me to say a practice should always have liability insurance in case of unwanted things, something...
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    Wiki Replacement of generator and atrial lead

    Question: when a physician replaces a generator (from a dual chamber) and capped an existing atrial lead then inserted a new atrial lead which CPT codes should we be using? Thank you in advance.
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    Wiki Modifier usage: 76 vs 77

    Good morning everyone, Quick question, if you have 10 physicians from the same speciality/same group who are reading EKGs for the hospital and a patient has 3 EKGs done on the same day and 3 different doctors from this same group read each EKG, would you use a modifier -76 to mean several...
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    Wiki EKGs on the same day as a procedure

    Good afternoon everyone, For the following procedures can we bill for an EKG on the same day? 1) Pacemaker implant or repositioning: we were told to bill for all EKGs, correct? With modifier -76 or -77 and a modifier -59. Correct? Which modifier is in the first position? 2)...
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    Wiki Usage of modifier -25 and -59

    Good afternoon everyone, Please advise, should coders be adding a modifier -59 to every procedure when an E/M is being performed on the same day – for Medicare and / or Commercial carriers: Example below: all performed on the same day Hospital or Office E/M with a modifier -25 EKG –...
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    Wiki Interrogation device evaluation(s)

    Good morning everyone, Seeking advice please, for the Interrogation device evaluation(s) in CPT the wording states physician analysis, reveiw(s) and report(s) (pages 485 - 486); I'm interpretating this to mean the physician must review the electronic analysis and physically sign a report as...
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    Wiki Multiple EKGs in the same day

    Good morning to all, A question that seems simple however insurance carriers are denying claims. BCBS particularly seems to deny this service. Question: How are you billing multiple EKGs on the same day? Are you using box 19 to insert the "time" when each EKG was performed on the same day...
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