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  1. Evelyn Kim

    Wiki 99203 + 92071?

    Did you include any modifiers on the CPT codes? check out the TMPPM Vision and Hearing Services handbook, November 2022 section 4.3.8.3: "Modifier LT or RT must be included on the claim to identify the eye on which the service was performed". https://www.tmhp.com/resources/provider-manuals/tmppm
  2. Evelyn Kim

    Wiki Use of arrows in hand written documentation

    I am auditing charts for a provider who is still using paper charts. I seem to remember reading that the use of the up & down arrows in not acceptable, because there are multiple meanings for them. I can't recall where I read this. Does anyone else remember this? Your help is greatly...
  3. Evelyn Kim

    Wiki A little lost when no clear history points

    The only other possibility would be associated signs/symptoms since she stated there are no symptoms.
  4. Evelyn Kim

    Wiki Providing Medical Records for an Audit

    I would agree that a compliance officer needs to make the determination if it is a breach. That being said if it was an insurance company requesting the audit, such as for HEDIS, they should not have access to records that are not covered members of their company. In my capacity as manager...
  5. Evelyn Kim

    Wiki Medicaid Secondary and Billing No show Fees

    Generally, Medicaid does not allow billing for no show appointments. If Medicare does not allow the charges Medicaid can not be billed for the no show fee.
  6. Evelyn Kim

    Wiki Patients over Paperwork - audit question

    It is always best practice to be able to see the document being reference. In fact I just discussed this with a client because I had disallowed the AWV because the required personal history form was not attached to the visit, among other findings. In addition the portion documented by...
  7. Evelyn Kim

    Wiki Referral Gifts

    As a fellow coder and a certified fraud examiner I would say be careful in giving gifts for referrals. It is important to avoid even the appearance of impropriety. It might be the better practice to send a thank you note and save the gifts for the holidays, then it is not tied to an activity...
  8. Evelyn Kim

    AAPC Forums: New Look, New Features

    Very pleasing to the eye. I like the report feature, this makes it easier to flag inappropriate behavior on the forums. Looking forward to getting to spend more time checking out more of the new features.
  9. Evelyn Kim

    Wiki How to become a proctor?

    I agree with the other coders, as an officer myself (secretary) our chapter starts a sign up sheet for the new year at our last meeting of the year. Our officers act as primary proctors, but gladly accept volunteers for the second proctor. Attend the next chapter meeting and reach out the the...
  10. Evelyn Kim

    Wiki Pediatric patients attend visits on their own

    I would be concerned that parents are sending children to the doctor with out an adult accompanying them. That being said, if the child is old enough to drive themselves then it is less of a concern than if they just drop the child off. If treatment is required who authorizes it if the child...
  11. Evelyn Kim

    Wiki Provider treated patients- did not complete notes and relocated

    Another physician can not sign the records, only the one who saw the patient can sign them. Unless signature authority has been granted to someone. I would recommend printing the records and mailing them, certified mail, to the NP and follow up with a letter giving a time frame for the records...
  12. Evelyn Kim

    Wiki Looking for guidance on co-worker matter

    I would be very concerned about coding directions being given by a non-coder. You are right the statements are too vague to be of use, remember the coder adage--If it is not documented it was not done. Of course if the person is someone who is a supervisor over you that might be an issue, but...
  13. Evelyn Kim

    Wiki Diagnosis Documentation

    The patient is out of the post-op period so the Z98.1 can not be a first listed DX. Z89.890 (other specified posprocedural states) followed by Z98.1 would be my recommendation since the visit is billable.
  14. Evelyn Kim

    Wiki Code CPT

    I would refer you to the E&M level guidelines. In example #1 this is a new patient, Problem focused history, Problem focused exam, and Straight forward medical decision making equals a level 1 new patient visit. In example # 2 This appears to be a well woman exam. The documentation supplied...
  15. Evelyn Kim

    Wiki changing level of E/M

    From a payer's point of view, this would not be acceptable documentation for changing the level of service. In fact it would raise red flags and could trigger an SIU investigation of the provider which could lead to refunds/recoupments and other sanctions. Addendums can be used by someone...
  16. Evelyn Kim

    Wiki Total Fracture Care

    Hi Grace, the only time a 55 modifier would be needed is if someone else billed the FX care and it is being taken over by your physician. As for documentation a standard note that indicates the location, type and the alpha character to identify active treatment. It is helpful if he documents...
  17. Evelyn Kim

    Wiki Uhc

    Yes it is allowed to request records, even all of them. The reason might vary, but basically the provider has been selected for an audit. The Health Plan can audit records based on a number of criteria such as billing patterns, reports of "suspicious" activity, repeatedly sending in a...
  18. Evelyn Kim

    Wiki Medicaid Incident to?

    To the best of my knowledge, Medicaid follows CMS guidelines unless specified in the Medicaid Providers manual for your state. In Texas it is not specified except the use of the modifier SA, so we go by CMS guidelines.
  19. Evelyn Kim

    Memory

    First Memory I remember when I took my CPC exam. I drove 30 minutes to another town, back then we had only 5 hours to take the exam and if you left the room your time stopped. No one could leave when they finished the exam until everyone had finished. Still can't believe I passed it on the...
  20. Evelyn Kim

    Wiki Help! 76641 billing with 50 or how??

    It is not necessary to use the -59 if you are using -50. The correct way way to bill 76641 would depend on the insurance carrier. Some will accept the -50 modifier and others want the lateralaty modifiers. Either way the -59 would not be appropriate. Consider one of the newer modifiers if...
  21. Evelyn Kim

    Wiki Need 2/3, can exam be thrown out?

    If the documentation supports the higher level with out using time it would be acceptable, remember it is either key components or time but not both.
  22. Evelyn Kim

    Wiki Non Direct Prolonged Services

    The guidelines in the CPT book state that code 99358 & 99359 are used to report he total duration of non-face-to-face time.....on a given dateeven though the time does not need to be continuous. The description states " Prolonged evaluation and management service before and /or after direct...
  23. Evelyn Kim

    Wiki Modifier 25

    I wouldn't unless the docuemtation is very clear. Because it is a prescheduled procedure an office visit is not going to be separately payable.
  24. Evelyn Kim

    Wiki amending another physician documentation

    I would agree that it is not legal. If the provider seeing the patient the next day they can make a note in their docoumentation of any correction the patient mentions, but cannot "change" another provider's note.
  25. Evelyn Kim

    Wiki Incident to Scenario- Please help

    Micki, I would not recommend billing the NP as incident to after the psychologist visit. Is the NPP able to bill on their own in your state? IF so that would be the best option. I recommend checking out the article in the February issue of the Healthcare Business monthly titled " Satisgy...
  26. Evelyn Kim

    Wiki coding PRN medicantions such as Tramadol as dependant

    We are having a discussion in our office about how to properly code drug dependancy. If a provider documents a medication such as Tramadol is being given to be taken PRN for pain, can he then code drug dependany if the patient is on the medicaion long term?
  27. Evelyn Kim

    Wiki Rheumatoid Arthritis

    Suzanne, That was what we were thinking too, but even the instructional note is a bit vague about wheather 714.0 can stand alone. Although not everyone who has RA has myopathy or polyneuropathy. So still not sure. If there are any Orthopaedic coders out there who can shed some light please...
  28. Evelyn Kim

    Wiki Rheumatoid Arthritis

    I need some help with a confusion over the proper coding for Rheumatoid Arthritis that has no manifestations. In the ICD-9-CM manual under 714.0 there is a note to "use additional code to identify manifestation as : myopathy (359.6) or polyneuropathy (357.1)"; We are having a discussion at...
  29. Evelyn Kim

    Wiki Obesity and malnutrition

    Can anyone point me in the direction of information on whether or not you can bill codes 263.8 and 278.01 at the same time? Thanks.
  30. Evelyn Kim

    Wiki labs done in office

    I agree, there are insurance companies that will not allow a provider to do labs in the office, you need to check with the contract and with the provider relations department of the insurance. In some cases there may be specific codes that need to be used to indicate the test was done in house...
  31. Evelyn Kim

    Wiki Coding for Blood Pressure Screen

    if there is no indications in the record that the patient is to come in for a bloos pressure screening I would be hesitant to bill the 99211 unless incident to could be established.
  32. Evelyn Kim

    Wiki Billing a 99211 for an MA

    not to my knowledge. MA is not a provider under medicare guidelines and therefore can not bill.
  33. Evelyn Kim

    Wiki pre op

    then ususally not. Unless there is some problem or new issue that needs to be evaluated prior to the surgery.
  34. Evelyn Kim

    Wiki Modifier 59 for Wound Care

    the lower 2 RVU procedure would get the 59.
  35. Evelyn Kim

    Wiki CPT code for Distal Raduis Fracture

    Look at 25606----percutaneous skeletal fixation of Distal radial fracture or epiphyseal separation. hope this helps.
  36. Evelyn Kim

    Wiki excision of distal fibular nonunion fragment

    I would look at the non-union repair codes.
  37. Evelyn Kim

    Wiki Sequencing-for surgery clearance

    I would put the primary reason for the visit first and then other DX. Remember the rules about V codes and sequencing.
  38. Evelyn Kim

    Wiki cpt 90715 no ABN

    The only way I know of to bill a Medicare pt with no ABN on file is if the service is statutiorly not covered by MC. No ABN is needed in that case.
  39. Evelyn Kim

    Wiki Documentation Issue

    Agree, this is not sufficient documentation for the procedure, it mearly shows where the injections were done, but does not describe why or provide any documentation for diagnosis.
  40. Evelyn Kim

    Wiki g0444 medicare depression screening

    recommend accomplishing the PHQ-9 for the depression screening, or at least the mini 3 question screening in order to bill the G0444. (Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. Copyright © 2005 Pfizer, Inc...
  41. Evelyn Kim

    Wiki Vitals - Do vitals have to be taken

    you seem to be posing 2 questions, for a followup vitals are not rquired, to establish a visit level you only need 2 of 3 elements. For new patients you need 3 of 3 so vitals would be needed. I would not take it from the registration sheet, it needs to be incorperated into the progress note...
  42. Evelyn Kim

    Wiki Question on Modifier TC and 26

    IF the provider owns the equipment then yes you would bill the global code for the Xray. Bill the Xray on the day it is done and the office visit on the day he comes back for the results. Hope this helps
  43. Evelyn Kim

    Wiki Is there an E/M

    agree not an E/M visit. usually recommend the provider visit with the patient and redo the rx during th visit. E/M requires a face to face encounter.
  44. Evelyn Kim

    Wiki Modifier 22 for ASC

    It is my understanding that the 22 is for physician services, i would recommend reviewing the modifiers that are allowed for the ASC. this link should be helpful http://www.cms.gov/MLNMattersArticles/downloads/MM6405.pdf.
  45. Evelyn Kim

    Wiki Modifier 22/increased charge?

    You can increase the amount by 20%.
  46. Evelyn Kim

    Wiki Bone suppression from methotrexate

    you could try 995.29--usnpecified adverse effect of other drug, medicinal and biological substance, plus the E935.6 Antirheumatics to identify the drug causing the adverse reaction.
  47. Evelyn Kim

    Wiki Screening for varices

    You will need to go back to the provider requesting the test for the signs and symptoms.
  48. Evelyn Kim

    Wiki Medicare Risk Adj. Review?

    Is the request coming from a Medicare Advantage plan? If so review the contract regarding reviews. As a general rule MA plans are required by CMS to do an audit of all the members records. This is to gather the necessary information for the MA plan to submit to CMS to establish the risk...
  49. Evelyn Kim

    Wiki help please

    agree only code the 404.90 and the 585.9
  50. Evelyn Kim

    Wiki Employment

    A temp agency may be a good start too. a lot of the time an employer may go through a temp agency to help screen for the position. I have been working with one for a couple of years that has helped find several CPC-A's their first position. As everyone else has said just don't give up.
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