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  1. 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
  2. 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.
  3. 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...
  4. 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:
  5. 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
  6. 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...
  7. 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
  8. 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...
  9. 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...
  10. 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 -...
  11. 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...
  12. 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...
  13. 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...
  14. 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...
  15. 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
  16. 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
  17. 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...
  18. 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...
  19. 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...
  20. 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
  21. M

    Wiki NP/PA billing under MD

    Looking for help from all different states - I know the incident to guidelines and most commercial insurance may or may not follow Medicares guideline. Here iss the million dollar question - 1.) if the NP/PA is credentialed with Medicare/Medicaid and commercial insurance can you always bill...
  22. M

    Wiki Mulipule Excision- Malignant lesions

    I need some help with the attached op note - this is what the provider billed 11606 11602 - 59 11602 - 59 11603 - 59 11602-59 11602-59 11602-59 11602-59 11606-59 11602-59 11602-59 11602-59 11602-59
  23. M

    Wiki insertion or replacement of cranial neurostimulator pulse

    I have two questions: This is Humana insurance 1.) 61886 - insertion or replacement of cranial neurostimularor pulse with connection to 2 or more electrode arrays - Provider did bilateral - modifier 50 is not allowed unable to find any coding guidlines. a.) coding - 61886 (LT)...
  24. M

    Wiki excisions

    If any one can please help - Incision size 2cm x 8 cm and 1.6 cm x 6 cm respectively (each lesion pretibial obliue, labled 5 and 6 and excised together, other left lesion 0.8 cm labled 4).
  25. M

    Wiki Virtual Visits

    I have not encounter this yet - Provider wants to do virtual visits - for weight management follow up and lifestyle Modification claims for patients who are in school/college and will not be back int he office until thanksgiving or break. The visit will be done by the MD or a registered...
  26. M

    Wiki Mulipule Excision- Malignant lesions

    Need so help with this multiple excision - First time I have encounter this amount of excision's. The physician coder over 30 CPT codes. > diagnosis: 1.) History of metastatic melanoma with unknown primary of the left lower extremity. 2.) Squamous cell...
  27. M

    Wiki NY York State

    Has any one have any information on a flat reimbursement per visit for NY state per speciality?
  28. M

    Wiki Mulipule Excision- Malignant lesions

    Looking for so help - Physician - is billing for 11606 3 times for excision > right hand lesion 6mm, excision 4cm x 1.2cm > Left Pretibial lesion 1cm, excision 2cm x 8cm > Right calf lesion 1 cm, obligue excision of 2cm x 6 cm billing: 11606 11606 (59) 11606(59) per Medicare only allowed 2...
  29. M

    Wiki Ccnsults for CNS in Inpatient Detox

    Question has arised regarding our CNS performing consults in a Detox center at the hosptial, the patient is inpatient. We have been billing consult codes 99255. One isnurance company is now denying claims stating payment included in fac. The CNS is doing a diagnosis treatment, H & P etc...
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