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  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 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...
  5. M

    Wiki CT of Hip w/o contrast

    Hi all, would a CT of the hip w/o contrast be 72192 or 73700?
  6. 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!
  7. 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!
  8. 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!
  9. 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!
  10. 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...
  11. 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...
  12. 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!
  13. 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!
  14. 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...
  15. 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...
  16. 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...
  17. 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!
  18. 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!
  19. 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!
  20. 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...
  21. 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.
  22. 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!
  23. 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...
  24. 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...
  25. 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...
  26. M

    Wiki drug management for 2021 MDM

    If the provider states that the patient is to continue meds as directed and to see EMR for refills, would this be considered prescription drug management? (last column in MDM table). Any thoughts would be appreciated. Thanks!
  27. M

    Wiki PT re evals

    Hey all! I used to be able to bill a pt eval 97164 w/mod 59 and then also bill therapeutic exercise (97530) and get paid for both. Recently I have been getting paid only for the 97530 and denied the re eval stating "NCCI Denial for Column1/Column II Procedures with Claim Validation". I've...
  28. M

    Wiki BMI Reporting for MIPS

    Good morning! When reporting BMI, I am a bit confused between G8417 and 3008f. Would someone be able to help me distinguish these codes and if one or both should be reported together? Also, does there have to be a dx along with it, or is reporting the BMI alone enough? Thanks!
  29. M

    Wiki BMI reporting

    Good morning! When reporting BMI, I am a bit confused between G8417 and 3008f. Would someone be able to help me distinguish these codes and if one or both should be reported together? Also, does there have to be a dx along with it, or is reporting the BMI alone enough? Thanks!
  30. M

    Wiki New CKD3 codes

    I'm trying to better understand what the difference is between the new codes N18.31 and N18.32 (stage 3a and 3b). I have looked in the new 2021 book and the guidelines, but I can't find anything. Maybe I'm missing something. Would someone be able to explain this to me? Thanks!
  31. M

    Wiki NEW CKD 3 codes

    I'm trying to better understand what the difference is between the new codes N18.31 and N18.32 (stage 3a and 3b). I have looked in the new 2021 book and the guidelines, but I can't find anything. Maybe I'm missing something. Would someone be able to explain this to me? Thanks!
  32. M

    Wiki Documenting BMI with a Plan

    Some of our providers will want to bill G8417 BMI above normal with plan. But they only document that they encouraged the patient to make diet modifications and reduce weight. Is that sufficient documentation to warrant using the G8417 code?
  33. M

    Wiki billing for 99401

    99401 is being denied by a Medicare Advantage plan. From what I am reading, Medicare does not pay for this as it is preventative. But the patient came in specifically for nutrition (we are a family practice). So should we be billing for an regular office visit with mod 25 and then 99401, or...
  34. M

    Wiki H0049 vs 80305

    Hi! Would someone be able to explain to me the differences between these CPT codes? Typically our office bills 80305, but I came across the H0049 and was curious about the differences. Thanks!
  35. M

    Wiki gyn medicaid plan

    Hi all, I am a new coder/biller for a primary care office who also does GYN services. I'm hoping someone will be able to help me clarify this for me. If a patient has a Medicaid plan through Fidelis, for their annual GYN w/pap visit, are codes G0101 and Q0091 appropriate? thanks!
  36. M

    Wiki Yearly GYN

    Hi all, I am a new coder/biller for a primary care office who also does GYN services. I'm hoping someone will be able to help me clarify this for me. If a patient has a Medicaid plan through Fidelis, for their annual GYN w/pap visit, are codes G0101 and Q0091 appropriate? thanks!
  37. M

    Wiki Sequelae of Covid

    A patient came in who had Covid 19 previously, now has symptoms such as muscle weakness, pins and needles in certain extremities. They were never diagnosed with those symptoms in the past. Dr. says to use code B94.8. Would this be correct, or should we be listing all symptoms?
  38. M

    Wiki Drug screen for medicare

    Hi! Is there a difference between billing 80305 vs. G0477 for a drug screen for Medicare?
  39. M

    Wiki New Vs. Established

    Hi all, so our office does Primary Care, GYN, No Fault and Comp. We have a patient who has been coming for quite some time for a no fault (car accident) case. Now is having her first annual GYN visit with us. Would she be considered a new patient or established? Thanks!
  40. M

    Wiki New Patient vs Established Patient

    Hi all, so our office does Primary Care, GYN, No Fault and Comp. We have a patient who has been coming for quite some time for a no fault (car accident) case. Now is having her first annual GYN visit with us. Would she be considered a new patient or established? Thanks!
  41. M

    Wiki Yearly GYN visits

    Hi all, I am a new coder/biller for a primary care office who also does GYN services. I'm hoping someone will be able to help me clarify this for me. If a patient has a Medicaid plan through Fidelis, for their annual GYN w/pap visit, are codes G0101 and Q0091 appropriate? thanks!
  42. M

    Wiki MIPS for Breast Cancer Screening

    I am new to coding, and MIPS has me a bit confused at times. I code/bill for a primary care physician. We sent a patient out to get a mammogram for breast cancer screening. We now have the report and it was reviewed by one of our physicians. The patient had a Screening Digital Breast...
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