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    Wiki BRAVO Billing in an Ambulatory Surgical Center

    Hi all! I'm just getting back to GI Billing & Coding after a hiatus. The group I now work with is a private GI practice with our own ASC. We are looking into doing BRAVOs at our ASC. Can you remind me how these should be coded & billed? What codes go on the ASC claim and what codes should...
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    Wiki FIBROSCAN

    Hi All! Just wanted to follow up on this thread. I am just getting back into GI. In my previous practice we billed 91200 for Fibroscans. I am now seeing the 76981 should be used, but I have some concerns about using the 76981. That is for imaging elastography. How does the Fibroscan...
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    Wiki Denials for Advanced Care Planning with mod 25

    Hi all! I'm wondering if anyone has figured out if 99497 is allowed to be billed with the 25 modifier. I am seeing claims denied by United Healthcare and when we call to question the denials, we are being told that cpt 99497 with the 25 mod is not covered per medicare. Any written...
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    Wiki Telehealth Billing after PHE and changes to place of service causing lower reimbursement

    I found this article extremely helpful. Telehealth Fact Sheet and E/M Tips for 2024
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    Wiki CPT Codes for POC Tests Needed(POCT TRICHOMONAS, POCT CARDIAC PANEL, POCT D-DIMER, POCT BNP)

    Thank you!
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    Wiki CPT Codes for POC Tests Needed(POCT TRICHOMONAS, POCT CARDIAC PANEL, POCT D-DIMER, POCT BNP)

    Does anyone know what CPT codes we should be using for these point-of-care tests? POCT TRICHOMONAS POCT CARDIAC PANEL POCT D-DIMER POCT BNP Thank you!
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    Wiki Billing for Acupuncture Services rendered in an FQHC

    Can you bill Medicare Part A under the facility for acupuncture services rendered in an FQHC? If so, can you please provide me with your source? If not, do you have a different solution? See below for the question from my biller. I’m trying to get more information on billing acupuncture...
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    Wiki Nurse visit with limited physician time in the room can it be coded higher than a 99211?

    Thank you!
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    Wiki Social Workers Telehealth Direct Supervision Guidance for Incident To Billing

    Our social workers currently bill incident-to the physicians but the rules previous to COVID stated the physicians had to be in the building and available in order to be the billing provider. The question is….how does the change in telehealth affect this once the PHE is over? Since telehealth is...
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    Wiki Nurse visit with limited physician time in the room can it be coded higher than a 99211?

    Can this visit be coded as a 99213? An established patient comes to the office with complaints of urinary burning and frequency. The nurse takes a focused history, reviews the medical record, discusses the situation with the physician and orders a urinalysis. The nurse then presents the...
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    Wiki Timeframe for Screening Colonoscopy following a normal Cologuard

    This is a great question! I came here searching for documentation to a similar question. I have a Medicare patient who was referred to us for a colonoscopy due to a positive ColoGuard. The patient states they were told by Medicare that as long as we code the colonoscopy as a...
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    Wiki -TC Portion Pathology in ASC

    Wondering if you ever got a response to this or figured it out? We are billing Aetna using POS 11 and getting the "treatment has been rendered by the payer to be invalid or inappropriate place of service" but only on some of our claims. I am completely perplexed. Thanks! Christina
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    Wiki How do you bill for use of the Erbejet?

    Just got word that my provider is going to be doing a procedure using the Erbejet tomorrow. I have no idea what code to use or if it's even considered medically necessary (Medicare patient). I called the sales rep and they don't have a reimbursement team. Thinking CPT 43229 or 43270. Any...
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    Wiki colon screening before the 24 month period

    The second one would be diagnostic and billed with CPT codes in the 453XX (last 2 digits depend on what is done i.e. bx, snare, etc.) series with the ICD 10 code for the change in bowel habits.
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    Wiki G0105 Medicare NCD help needed

    Shlyalford is correct, the second one would be diagnostic because the patient is having symptoms so you would use the CPT codes 453XX (last 2 digits depend on what was done, bx, snare, etc.) with the ICD-10 code for the change in bowel habits.
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    Wiki S0285

    We use this code for Anthem (certain plans), Cigna and Connecticare and get paid.
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    Wiki Abdominal Wall Trigger Point Injections

    We have a new Gastroenterologist in our practice who would like to start billing for abdominal wall trigger point injections for musculoskeletal abdominal pain. Are any of you doing this? If so, I'd love to know more about it. Do you have the patients bring their own steroid that you have...
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    Wiki How would you code screen colon done in asc and hemorrhoid banding done in office

    Our MD did a screening colon on a patient in our ASC and found hemorrhoids so brought the patient back to our office to do a hemorrhoid banding on the same day. I HAVE NO IDEA WHY HE DIDN'T BAND THEM AT THE ASC (we have done that many times)!!!! They are different POS (24 and 11). The banding...
    • cedwards
    • Thread
    • banding global period help!! multiple procedures separate pos
    • Replies: 0
    • Forum: Gastroenterology
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    Wiki code for endoscopic mucosal resection

    EMR Code for Medicare Medicare does not recognize the 45390 code right now so if you are billing this for a Medicare patient you must bill CPT code G6021. See page 7 of this link http://gi.org/wp-content/uploads/2014/12/395-005PNQ_14-6-CPT_Coding_Updates_FINAL.pdf
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    Wiki National Government Services (Medicare) coverage for Solesta Injections

    We are currently doing Solesta injections. We are billing the L8605 and 0377T as of 01/01/15. Prior to that we were billing the L8605 and 46999 and being reimbursed with no issues. Since we started using the 0377T code we have not been paid by National Government Services (NGS) our local...
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    Wiki Help with - I work for a GI group

    Mac Our MAC is National Government Services (NGS). Patient was already given the LAR in the hospital which I assume the physician wants to keep the patient on.
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    Wiki Using 45385 with 45381

    Did the guidance to bill 45381 and 45385 change? I have a physician who removed a polyp using the saline lift tequnique and snare so I billed Connecticare 45381 and 45385 and they denied the 45381 stating these cannot be billed together. I appealed it with a letter with all the documentation I...
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    Wiki Help with - I work for a GI group

    I work for a GI group and have never had to deal with Sandostatin coverage before. I am a pro with Remicade, Entyvio, Humira, etc. One of our patients was started on octreotide 100 mcg b.i.d in the hospital. The patient has not had any since because the patient cannot afford the medication...
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    Wiki After Hours Billing

    If a pediatric practice has office hours posted from 8-5 but indicates that they are closed from 12-1 for lunch can they bill 99050 (Services provide in office at times other than regularly scheduled office hours, or days when office is normally closed) for services that are added on during...
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    Wiki Can this be billed as a new patient?

    A patient new to our practice comes in for a vaccine only visit where the nurse gives the vaccine. The vaccine is billed under the MD. The patient is booked to come and see the physician for a Well Child Check tomorrow. Can they be billed as a new patient for the Well Child even though they...
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    Wiki Job Opportunity

    Resumes should be e-mailed to lanzinger@thehealthychild.biz Busy and exciting Pediatric office in Darien, CT looking for Office/Practice Manager. We are seeking a dynamic person that demonstrates leadership skills, can create and maintain a positive work environment which promotes teamwork and...
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    Wiki Denials for Developmental Screening (96110) when billed with Well Child Check

    I am seeing CPT code 96110 deny when billed with a well child check. Anyone else experience this? If so with which payers? Do you have anything that you use to successfully appeal the denials? Thanks! Christina
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    Wiki Billing for topical ointments and other miscellaneous things

    Does anybody out there have any information regarding billing for topical ointments such as bactroban or mupirocin or other miscellaneous things such as Ibprofin? The doc wants to bill for them but I keep telling them things like this shouldn't be billed separately (because they are included in...
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    Wiki RE: Coding books for Pediatrics

    Coding Books I love the AAPC's Coding For Pediatrics. I purchased the 2014 (19th Edition) this year! I find it very helpful! I have not used the Supercoder one.
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    Wiki Pediatrics

    I was taught that visits with parents when the child is not present are billed with evaluation and management codes. Documentation of time must be done.
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    Wiki New code for my practice 99174 input pls!

    We have it as well and bill 99174. Most payers are reimbursing between $20 and $50! For the patients who have plans that do not cover the service we have the parents fill out a waiver and they pay upfront for the service.
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    Wiki HELP Chemocautry

    CPT code 17250 has 0 global days so you can report it again. Question I have is why did you use the 59 modifier on the 01/23/14 visit? I would have billed the Evaluation and Management service 99213 with a 25 modifier on it and billed the 17250 with no modifier that day.
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    Wiki Vaccine Not Carried Out

    I always use the V code for the specific vaccine product first then the vaccine not carried out code second
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    Wiki New Peds coder seeking advice

    Like family practice, pediatrics covers a wide range of codes. I would highly recommend buying the Coding For Pediatrics 2014 book from the AAP. I have used this book in the past and found it very beneficial. I am waiting for my new one to come in! Good luck and happy coding! Christina
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    Wiki I passed!!!

    Congratulations Congratulations!:)
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    Wiki New vs. Established Patient

    Established patient Patient would be considered established...
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    Wiki Billing Medicare Secondary for Screening Colonoscopy

    We are billing the patient's primary insurance 45378 with V76.51 for a screening colonoscopy. The primary made payment but patient still has a coinsurance which we are billing to Medicare. Medicare is secondary and denied the claim These are non-covered services because this is not deemed a...
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    Wiki Screening Colonoscopy Billing to Medicare Secondary

    We are billing the patient's primary insurance 45378 with V76.51 for a screening colonoscopy. The primary made payment but patient still has a coinsurance which we are billing to Medicare. Medicare is secondary and denied the claim These are non-covered services because this is not deemed a...
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    Wiki Looking for Medical Biller/Coder for GI office

    GI Medical Biller/Coder Would you be willing to entertain a remote coding and billing person? I am not located in TN and I am currently employed full time but I am looking for supplemental income. I have 12 years experience in Medical Coding and Billing. 8 of these years dedicated to GI. I...
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    Wiki Billing software

    I recommend Athenahealth http://www.athenahealth.com
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    Wiki Solestra injections for fecal incontinence

    C code only for facility use To my knowledge the C code is only for use in a facility. If you are doing the Solesta injection in your office you can't use the C code. You should use the L8605 and the 46999
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    Wiki Gastroenterology CPT coding

    EGD with APC I would use 43258
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    Wiki BreathTek/Urea Breath Test

    Anyone performing the Urea Breath Tests in their office using the BreathTek machine? If so how is the reimbursement? Any issues/problems/concerns? Does it require authorization? If so what carriers? I know we would have to send our UHC/Oxford patients to the lab. My providers were looking...
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    Wiki Pouchoscopy w/snare polypectomy

    I would use the unlisted code 44799 (change the description to read Endoscopic evaluation of small intestinal (abdominal or pelvic) pouch; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique, put a note in box 19 (pouchoscopy with snare) and include a copy of the operative...
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    Wiki 2012 paracentesis coding question

    49083 denial I am in Connecticut and billed the 49083 (abdominal paracentesis (diagnostic or therapeutic); with imaging to Medicaid-CT and they denied me for the following reasons... 4155 NO REIMBURSEMENT RULE FOR THE ASSOCIATED FACILITY TYPE 4250 NO REIMBURSEMENT RULE FOR THE ASSOCIATED...
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    Wiki 2012 paracentesis coding question

    I'm billing for the gastroenterologist's professional service. Would you use CPT code 49083 in this case? I'm thinking no because the imaging was performed by the radiology tech and not my MD. Operative report reads: The patient was taken to the endoscopy suite where an informed consent was...
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    Wiki Hospital Outpatient billing; new problem

    My understanding is that you would bill an established patient E/M service. The Observatoin codes are only to be used by the supervising pysician. See MLN MM6740
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    Wiki Patency Capsule - know the CPT code

    Does any one billing for and getting paid for the patency capsule? I know the CPT code to use is 91299 and in box 19 I put "PATENCY CAPSULE TO PROVE FUNCTIONAL PATENCY" We are sending along records which include industry literature, the radiology report done after capsule swallowed, colon & EGD...
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    Wiki Can you bill patient when insurance denies inpatient auth

    I work for a private physician group. We provide consultation services to the local hospitals and bill our services through our private practice. We often get denials from carriers as not medically necessary. When the hospitals exhaust all appeals and the denials are upheld can we as a...
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    Wiki Help with Hemoccult Coding

    Can you bill the 82272 X 3 when the pt completes 3 cards at home for diagnostic purposes?
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