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  1. M

    Wiki Surgery with Co-surgeons and Assistant

    Thank you so much
  2. M

    Wiki Surgery with Co-surgeons and Assistant

    If anyone has any documentation regarding the following: Two co-surgeons different specialist and Assistant as well. Does anyone know if you can also bill for the Assistant claim as well, as there are two separate claims for the Co-surgeon. thank you
  3. M

    Wiki Orthopedic Surgery Coding Help

    I have attached an Operative Note - What the provider coding and billed: 29827, 29828 and 29823. Any help is greatly appreciated.
  4. M

    Wiki 99214 and G0439

    Medicare (All Jurisdiction) Posted on the websites for Smart Edits: If you review your Medicare Jurisdiction it provides the Smart edit pattern number and the next steps. 1.) Novitas (Texas) https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00275505 a.) In the...
  5. M

    Wiki New vs. Est

    The patient is considered established to all the physicians in the new practice who are of the same specialty and subspecialty. A change in tax id or physical location doesn't change that the patient is established Noridian Jurisdiction F (Medicare Part B) New Patient vs Established Patient New...
  6. M

    Wiki CPT 99483 AND G0439

    Per the NCCI guidelines Code G0439 is a column 2 code for 99483, but you may use a NCCI-associated modifier to override the edit under appropriate circumstances. Modifier 25. You can also refer to your MAC Carrier for Medicare (not sure what state) Billing and Coding: Cognitive Assessment and...
  7. M

    Wiki VACCINES FOR CHILDREN and ADMINISTRATION CODES

    The State of TN has 3 Medicaid MCO plans: If this is for ESPDT/VFC billing each Insurance has the billing guidelines as well as Medicaid of TN. 1.) Medicaid/TennCare a.) VFC billing: https://www.tn.gov/health/cedep/immunization-program/ip/vfc/vfc-provider-guidance.html b.) Vaccines CPT bill with...
  8. M

    Wiki 20610 when done on two separate sites

    If someone can give insight this is mainly with Medicare: 20610 is done on knee and shoulder 1.) Billing 20610 two separate lines with RT or LT with the ICD based on the knee/shoulder a.) the second 20610 was billed with modifier XS b.) Medicare is denying invalid modifier - than changed...
  9. M

    Wiki Aetna denying the New E/M 2023 changes CPT and POS

    99232 POS 22
  10. M

    Wiki Aetna denying the New E/M 2023 changes CPT and POS

    CPT and POS invalid
  11. M

    Wiki Aetna denying the New E/M 2023 changes CPT and POS

    Hi everyone I am trying to find out if anyone else is having the same issue regarding Aetna (all Plans) denying the New E/M changes:
  12. M

    Wiki Home or Residence Services with POS 13 for Assisted Living

    Thank you - I have advise my billing the same
  13. M

    Wiki Home or Residence Services with POS 13 for Assisted Living

    Is any one also have the same issue with Aetna
  14. M

    Wiki Maintaining EOBs, Appeals etc

    Need some help or guidance or recommendation on how long EOBs, Appeals or any documents pertaining to a Claim need to be held/save
  15. M

    Wiki Help with coding, modifier 22 and Unlisted procedure

    I would appreciate any help with the attached Op note: the following is what the provider is actually coding; Provider Correct billing 50715: 50 modifier 58558 52000...
  16. M

    Wiki 99211 Telehealth LPN and RNs

    HI I am looking for any help or to point in the correct directly: 1.) Question is can LPN/RN allowed to bill for a telehealth 99211 under the MD: if the MD is in another location/state. (Outside of the AMA guidelines for COVID) Thank you again
  17. M

    Wiki E/M billing with same day procedures

    Aetna did send out a news letter back in 2020 stating new edits for modifier 25 - the denial means the required the progress note to support the used of the modifier 25
  18. M

    Wiki in stating modifiers, does the level I code have to come first?

    Per the guidelines: If more than one modifier is needed, list the payment modifiers - those that affect reimbursement directly - first: Payment Modifiers included: 22,26,50,51,52,53,54,55,58,78,79,AA,AD, TC, QK, QW and QY In the above Modifier 22 should be 1st and LT should be 2nd Modifier.
  19. M

    Wiki Left auricular composite graft and postauricular full thickness sking graft Coding Help

    The below follow Operative report - CPT codes billed 15240 & 15760 1.) Aetna is denying 15240 stating the below does not support along with reduce services - Any help will be great need a second set of eyes Procedure: 1.) left auricular composite graft 2.0 left postauricular full thickness skin...
  20. M

    Wiki Excision Begin Lesion

    Looking for some guidance regarding the below Procedure: The anterior lesions were removed with elliptical incision with the scalpel. These were a conglomerate lesion of the left areola, which is about 1.2 cm in size, three right chest skin lesions about 1 cm in size, also an anteriorly there...
  21. M

    Wiki NDC Unit vs CPT description

    Thank you 1 more example - J1040 80mg - NDC 70121-1574-05 Patient received bilateral 160mg than it should be 2 ml not 1ml
  22. M

    Wiki NDC Unit vs CPT description

    the patient received 30 mg for the J1885
  23. M

    Wiki NDC Unit vs CPT description

    Great J1885 per 15 mg The NDC for the 2nd - is 70860070104 30mg/ml - so based on the above the NDC UOM would be ML2 and CPT unit = 2
  24. M

    Wiki NDC Unit vs CPT description

    If any one can help, I have been back and forth with this regarding J codes and what information needs to go out for the NDC unit Example: J1040 80mg a.) The NDC number 11 digit 70121157301 - National Drug Unit: and Drug UOM - = ML: The question is the National Drug Unit should this be 80 -...
  25. M

    Wiki J3301 Rejection - I have a claim that is being rejected

    J3301 falls under the Unclassified Drug and Medicare requires the description in the NOC code description - this is why the claim is either denying or rejecting at the clearinghouse (Injection, triamcinolone acetonide, not otherwise specified, 10mg) - Medicare does not accepted HCFA but if...
  26. M

    Wiki Humana PPI Overpayment Dispute

    This just came up as well - here is a link for Humana provider payment integrity policies and process, this link provider how to dispute Humana's overpayment findings. https://www.humana.com/provider/medical-resources/payment-integrity-and-disputes
  27. M

    Wiki Amerigroup and high risk DX

    HI questions were you able to find out the answer to this - I have the same denial patient delivery vag 38 weeks used O80 and Z3A.38 but Amerigroup is stating O80 is incorrect and another icd should be used
  28. M

    Wiki Midlevel's (NPs & PAs) hire as a Locum Tenens

    Thank you - I do wish they make the rule documentation a little more detail in explaining.
  29. M

    Wiki Midlevel's (NPs & PAs) hire as a Locum Tenens

    The question is coming regarding Locum Tenens 1.) Can NPs & PAs be hired (per-Diem) as a Locum Tenens for a MD, DO or Physician Therapist? I have review and read all CMS guidelines and it does not state Locum Tenens have to be a MD, DO or Physical Therapist. Any help is greatly accepted and...
  30. M

    Wiki Need Help - PR B9 denial for 93928 - patient enrolled in Hospice.

    Any CPT that Medicare Part B has denied stating patient enrolled in Hospice the modifier GW or GV can be applied to that CPT, it is not just for E/M codes.
  31. M

    Wiki UHC denying 90460 as a add-on code

    Also having the same issue - just and FYI - I actually received and email from UHP EDI: United Healthcare had a SmartEdit in place on claims containing 90471 and 90460 stating (This service/procedure require qualifying service be received and covered). This are not add on codes, back on July 8...
  32. M

    Wiki United Healthcare denying 20553 Trigger Point Injections

    Untied Healthcare has been denying trigger point injections 20553 stating these should not be reported during a 7 day period. Example: Patient have Trigger Point Injections: 5/21, 5/25, 5/28 & 6/2/2021 I am unable to find any documentation stating there is a time frame in between injections...
  33. M

    Wiki Billing PTA services Medicare

    Per Medicare PTAs are not enrolled. Per Medicare allows therapist assists to provide therapy services in an outpatient private practice setting. as long as services are performed under the direct supervision of a licensed therapist. Which is very clear but the question is with the New...
  34. M

    Wiki Horizon BCBS of NJ - Modifier 24

    Hi am reaching out to see if any one in NJ is having the same issue. The patient are being seen within the 90 day global for post up but in the appointment the provider is addressing new problems unrelated to the post op - The E/M is being billed with the modifier 24 and the diagnosis related to...
  35. M

    Wiki Need some help on Op note

    Thank you. Here is the issue 29826 is an add on code and this has to be with the prime procedure.
  36. M

    Wiki Need some help on Op note

    I have attached the Op note again - this is the whole Op note - this is why I am having trouble with the codes.
  37. M

    Wiki Need some help on Op note

    Based on the Op note: the provider is billing 29823, 29826 and 23430 - Any help would be great: Thank you
  38. M

    Wiki Oklahoma Medicaid/Soonercare

    New to Vision - if anyone has any information on billing and modifiers for Oklahoma Medicaid/SoonerCare when billing CPT codes V2100-V2499, receiving rejections for modifiers LT/RT are invalid or should use modifier 50 . Does the insurance require a modifier per lens. Thank you
  39. M

    Wiki Revison of a Transmetatarsal amputation foot

    Thanks very confusing - what would be the CPT code than for revision
  40. M

    Wiki Revison of a Transmetatarsal amputation foot

    Question on correct CPT for Revision of Transmetatarsal amputation * A transmetatarsal amputation was previously performed and no the provider is removing some more of the foot but not performing a Chopart amputation. I am reviewing CPT 28112 but it defines a procedure for removal of a...
  41. M

    Wiki ASC CMS guidleins

    Thank you Just to clarify - regarding the EMR with ASC - a provider cannot use the same EMR that the ASC is using if the notes are separate in the system - different log in? I have review ASC review...
  42. M

    Wiki ASC CMS guidleins

    I am curious if any one is billing for an ASC- per the CMS guidelines which is The regulatory definition of an ASC does not allow the ASC and another entity, such as an adjacent physician's office, to mix functions and operations in a common space during concurrent or overlapping hours of...
  43. M

    Wiki Telehealth

    Regarding the Telemedicine - I reviewed this from White House if I reading htis correctly they are waving the originating site - “We are providing $2.2 billion in public health funding for prevention, preparedness and response, including nearly a billion dollars specifically to alleviate the...
  44. M

    Wiki IUD

    I am trying to find out how providers are documenting the IUD - J code in the EMR. 1.) Are providers enter the J code in the lot field attached the NDC - even through it falls under Therapeutic injection 2.) Than the provider orders,links lot # and when completed it drops into the progress note...
  45. M

    Wiki Regarding contact dye using "Q9965/Q9966/Q9967" Payments

    The insurance's companies require a 11 digit NDC number - as the NDC number is 10- I have attached a link for you on how to convert NDCs from 10 digits to 11 digits. https://helpme.kareo.com/01_Kareo_PM/05_Codes/08_NDCs_National_Drug_Code/Converting_NDCs_from_10_digits_to_11_digits
  46. M

    Wiki How to bill 93922, 93923, 93924

    Not sure what state you are in but you can look up the LCD policy under Medicare and also your other insurance plans policy and procedure guidelines - these services are bilateral.
  47. M

    Wiki DME Billing to Medicare-HELP!!!!!!

    Dme I am not sure what state you are in - Medicare DME has part B jurisdictions with LCD policy's this will give you the medical necessary needed, modifiers and any other information for documentation.
  48. M

    Wiki Esrd

    Some confusion on CPT 90960 (four or more face to face visit per month) > should this be billed in units: if patient was seen 5 visit - billed 5 units or 1 unit
  49. M

    Wiki NP/PA billing under MD

    Thanks again - I just needed that information confirmed -
  50. M

    Wiki NP/PA billing under MD

    thank you - what I mean is the claims are being billed under the MD for the NP/PA regardless if the NP/PA is credentialed.
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