Search results

  1. M

    Wiki CPT II for KED

    Does anyone know if there are CPT II codes for reporting KED when a urine microalbumin test is performed? I thought there were 2, one for a positive result and another for negative result. I can't seem to find this information.
  2. M

    Wiki CPT II codes for KED

    Does anyone know if there are CPT II codes for reporting KED when a urine microalbumin test is performed? I thought there were 2, one for a positive result and another for negative result. I can't seem to find this information.
  3. M

    Wiki albumin cpt clarification

    Can anyone help me clarify the difference between CPT 82043- urine (micro albumin) quantitative and 82044- urine (micoalbumin) semi quantitative (reagent strip assay) Is one meant to be done in house and the other sent to a lab?
  4. M

    Wiki PT re evals

    I started using mod XU on 97164 and get paid every time now.
  5. M

    Wiki 97164

    Hi, we have been using modifier XU and have been getting paid for a couple years now. https://www.cms.gov/files/document/mln1783722-proper-use-modifiers-59-xe-xp-xs-and-xu.pdf
  6. M

    Wiki No fault/Workers Comp guidelines

    I just purchased the New York Workers Comp medical fee schedule and billing guideline book from Optum. Thank you for your response. I’ll be doing some research.
  7. M

    Wiki No fault/Workers Comp guidelines

    Hi all, I’m a coder/biller in NY, recently due to unforeseen circumstances, I have taken on our No Fault and Workers Comp billing. I’m wondering if these specialties follow CMS E/M guidelines or if they have their own. I’ve only billed for our primary care patients and am comfortable leveling...
  8. M

    Wiki Is an in-office injection considered prescription drug management?

    I had listened to a podcast, I believe it was Terry Fletcher, and she mentioned that giving out samples is not considered prescription drug management. I should try to look for it again, I don't remember the reasoning behind it.
  9. M

    Wiki CT of Hip w/o contrast

    That’s what I was thinking too, thanks for sharing!
  10. M

    Wiki CT of Hip w/o contrast

    Hi all, would a CT of the hip w/o contrast be 72192 or 73700?
  11. M

    Wiki Coding clinic pros or cons

    Has/Does anyone use AAPC's coding clinic or any other? I code and bill for a small primary care office and was just wondering if it would be worth it for me to purchase. Can anyone share their experiences, good or bad. Thanks!
  12. M

    Wiki Coding Clinics pros/cons

    Hi all, I do the coding and billing for a small primary care office. I was looking at AAPC's Coding Clinics and was wondering if anyone uses it and can give me some pros or cons of whether they think it's worth it. Thanks!
  13. M

    Wiki exacerbation?

    Thank you, I appreciate you input!
  14. M

    Wiki exacerbation?

    If a patient has a dx of L/S disc degeneration and the come for a visit stating that the pain in their back is aching, stabbing and throbbing, would this be considered exacerbation of pain? Thanks!
  15. M

    Wiki exacerbation?

    If a patient has a dx of L/S disc degeneration and the come for a visit stating that the pain in their back is aching, stabbing and throbbing, would this be considered exacerbation of pain? Thanks!
  16. M

    Wiki QMB Question

    Quick back story. Our office doesn't take many insurances, we take Medicare, Medicaid, Fidelis and WellCare. If a patient, for example, has a Humana dual plan and are a QMB and wants to come to our office knowing we don't except their insurance and are willing to pay a flat fee. Can we have...
  17. M

    Wiki FY 2023 ICD-10-CM guidelines

    Yes please! mnuhfer04@yahoo.com (=
  18. M

    Wiki Problem is present in multiple locations, i.e., bilateral knee osteoarthritis, both sides were addressed, is it considered 1 or 2 chronic illness(es)?

    Do you think this would be the same for C/S and L/S disc degeneration? That these would be 1 problem if treatment is the same for both?
  19. M

    Wiki Office visit denial with B12 injection

    Definitely reach out to the payer. We do B12 shots all the time and apply mod 25 to the E/M visit, I've never had a problem. We are in NY
  20. M

    Wiki CodingIntel.com?

    Hey all, does anyone have a membership to CodingIntel.com? It was brought up as a good resource in a webinar that I watched. Just looking to see if anyone uses it, if they think it is worth it and perhaps what specialty you work for and if you are with a big or small practice. I work in...
  21. M

    Wiki Hep C undetectable

    If the provider say the patients Hep C is undetectable, would I code for the Hep C or history of? Thanks!
  22. M

    Wiki Physical Therapy Re evaluations

    Good morning! For a physical therapy re evals, do the previous measurements need to be in the note, or just the current measurements from that specific date of service? Thanks!
  23. M

    Wiki MVA

    In NY we bill the auto insurance, and if/when benefits become exhausted, we bill their primary insurance (if we are their PCP).
  24. M

    Wiki BCBSGA/Anthem 99214-99215 Denied/Down coded

    I have as well, but with Fidelis (I am in NY). When this happens, I fill out an appeal form, print out the AMA 2021 E/M Guidelines and write a short letter explaining why this date of service meets the criteria for a 99214. I send that, along with the claim form and medical record to the...
  25. M

    Wiki Billing a Medicaid patient?

    Thank you so much for this information! I hadn't had time to look on Medicaids website yet today, so this is very helpful!
  26. M

    Wiki Billing a Medicaid patient?

    I am pretty sure I know the answer already, but I wanted some opinions. Is it ever legal to bill a Medicaid patient? Example: A patient has a Medicaid managed plan through BlueCross. We do not participate with BlueCross, we do with Medicaid. Can the patient sign a waiver to pay cash since we...
  27. M

    Wiki Networking question

    As far as Facebook groups, I like Medical Billing and Coding Forum, Medical Coding Mentors and Medical Coding Buddies
  28. M

    Wiki G0438 and G0439 Initial Without Subsequent

    Your MAC should have this information on their website as well.
  29. M

    Wiki Networking question

    Facebook has many great coding/billing groups. AAPC has one as well, but there are a ton that have been a great resource for me.
  30. M

    Wiki Prescription drug management for MDM

    Good morning! In regards to prescription drug management for MDM, our MAC states that simply stating in the medical record that a prescription is renewed does not meet the risk criteria in MDM. Our providers will state in the medical record: "Continue meds as prescribed, for refills see meds...
  31. M

    Wiki Massage Chair Code

    Hmmm, interesting, we have been using code 97124 for massage chair for quite some time now.
  32. M

    Wiki PT Eval 97161 denying per Molina

    Hi Mandy, I was told by multiple reps that 97161 was not in their fee schedule and to use 97530...doesn't make sense to me since you HAVE to have an eval before being seen, but that's what I was told.
  33. M

    Wiki prescription drug management for MDM leveling

    It does, thank you! I just asked the providers to document in the note which medications they are refilling, they said no problem.
  34. M

    Wiki prescription drug management for MDM leveling

    Thank you Missy, that makes sense, I appreciate your feedback. :)
  35. M

    Wiki prescription drug management for MDM leveling

    Good morning! I work for a primary care office. Our providers will typically document "refill medications per emr" in the patients SOAP note (the do not list each medication in the note). Now I can see each medication that was refilled in the chart. Would this count as "prescription drug...
  36. M

    Wiki Annual Wellness Visits - Adult

    Our medical assistant does the vitals only and then the provider does the rest of the exam. We have not done any welcome to Medicare telehealth visits though.
  37. M

    Wiki PT Re evaluations & Foto

    Hi all! Does anyone know where I can find out how often Medicare requires Re Evaluations and FOTO for physical therapy? I have been looking on the CMS website, but not having any luck. If anyone has a link or can point me in the right direction, I would greatly appreciate it!
  38. M

    Wiki physical therapy re evals and FOTO

    Hi all! Does anyone know where I can find out how often Medicare requires Re Evaluations and FOTO for physical therapy? I have been looking on the CMS website, but not having any luck. If anyone has a link or can point me in the right direction, I would greatly appreciate it!
  39. M

    Wiki Medicare regulations for physical therapy re evals

    Hi all! Does anyone know where I can find out how often Medicare requires Re Evaluations and FOTO for physical therapy? I have been looking on the CMS website, but not having any luck. If anyone has a link or can point me in the right direction, I would greatly appreciate it!
  40. M

    Wiki Not Paid for Injection Codes

    Hi! I just read a similar post, and someone mentioned that they spoke to a Medicare Rep who informed them that they are denying in error and are working on resolving the issue. We have had the same problem, I am going to wait a week and call them.
  41. M

    Wiki PT Eval 97161 denying per Molina

    Hey all, Molina continues to deny every physical therapy eval 97161 w/mod GP. The denials all state "Benefit is excluded from benefit plan". Molina is fairly new to us, so is there something that I am missing? All of our other insurances pay for this service. We are located in Western New...
  42. M

    Wiki 57421 mod?

    Our physician performed a Colposcopy with biopsy, this is a new to me, does this need a modifier? This was the only thing done during the visit.
  43. M

    Wiki Receiving Lab denials from UHC when using Z codes

    I’ve noticed that most insurances that we work with will only pay for labs that have a dx attached to it and will deny for z codes
  44. M

    Wiki Billing Blood draws in PCP office?

    Our PCP office just hired a Phlebotomist, is it considered bundled when our doctor orders the patient to have blood work done and the patient gets it done that day in office? Or can we bill 36415 for venipunture? And would there be a modifier attached to it? Thanks!
  45. M

    Wiki Annual GYN & Annual Physical not being paid

    I will have to check on that. Thank you!
  46. M

    Wiki Annual GYN & Annual Physical not being paid

    Hey all, I've been having some issues with getting paid for a patient who was seen for an annual physical and then a few months later seen for an annual gyn. She has a commercial insurance, not medicare. Am I correct that both these visits use 9939(x). The GYN visit is being denied stating...
  47. M

    Wiki blood draws in office

    Our primary care office recently hired a Phlebotomist to do blood draws. My question is, if a patient comes in say on Monday for a regular visit and the providers orders fasting blood work, the patient comes in the next day to complete the fasting blood work, would that count as part of MDM for...
  48. M

    Wiki Medication Reconciliation After Discharge

    Thank you, that makes more sense!
  49. M

    Wiki Medication Reconciliation After Discharge

    If a patient has recently seen a specialist and the provider documents that a medication reconciliation was done, is it appropriate to report code 1111f? I ask because when I have looked this code up it states "Medication Reconciliation After Discharge", but the patient was not in an inpatient...
  50. M

    Wiki PT re evals

    The insurance is Fidelis (in NY). I will be giving them a call, its so frustrating, thanks your response!
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