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  1. M

    Wiki Needing to know what code to use for a removal of an eyelid weight please.

    Hello! I had one of my providers remove and eyelid weight while the patient was in OBS care. Can someone help me with a CPT code for this procedure please? It is taking me to 67999, Unlisted procedure, eyelids. Thank you in advance for your help!
  2. M

    Wiki Billing G0296 on a Medicare wellness exam

    Has anyone billed the G0296-Screening for lung cancer on an Annual Medicare Wellness visit? We are a Rural Health Clinic and one of my doctors is asking if I would bill this and I am wanting to know if Medicare will pay for this. Thank you!
  3. M

    Wiki PROVIDER SERVICES WITHOUT THE PATIENT PRESENT

    One of our providers had a Telehealth visit with a patient's mom & care team without the patient present. I unable to find how to bill for this? I sat on a webinar in April & it stated that we are unable to bill an E/M & we are unable to bill insurance. So, is there a generic code to use when...
  4. M

    Wiki Billing for CPR

    Has anyone ever billed the 92950 for CPR? One of our doctors pointed this code out to me today and I was just wondering if anyone has ever billed this as a professional code in a RHC?
  5. M

    Wiki Billing critical care on an inpatient

    Can someone tell me if you have ever billed critical care on an Inpatient? We recently had a patient that needed transferred out. The provider is wanting critical care billed. We are a Critical Access Hospital. Can I bill critical care instead of the Acute d/c code?
  6. M

    Wiki Billing for a swing bed stay on a Medicare advantage insurance patient

    Hello! I am just wondering if anyone bills a 99310 for a subsequent day visit on a Skilled swing bed stay? The codes I show to bill are 99307, 99308 & 99309. Thank you in advance for your help!
  7. M

    Wiki Extended time billing

    Hello! I am inquiring about a Medicare ER patient that was taken care of by one of our PA's on 09/15/22. This patient has an LVAD device and needed transferred out to the hospital he had the device put in at. They did not have an available bed until 09/16/22. He ended up being in our ER for...
  8. M

    Wiki BILLING 90847

    I am trying to bill 90847 but Medicare is stating that it is not a stand alone code. I have tried researching this on multiple sites but I am unable to find another code to bill it with? Does anyone else bill this code in a Rural Health Clinic & if so, how do you get it to pay?
  9. M

    Wiki Billing 99495

    Has anyone ever billed the 99495, Transitional Care Management Services to BCBS before? If so, did it pay ok? The patient was in the hospital and seen 4 days after being discharged. I have never billed this before so I am curious as to how this will pay. Thank You in advance!
  10. M

    Wiki Billing when a family member comes in to discuss another family member

    We had a grandmother come in to discuss her grandson to whom she is the guardian. He was not present. From what I have found, we can bill 90846. The questions are can we bill this code to the grandmother's insurance or will it be self pay & where does the documentation go? Does it go in the...
  11. M

    Wiki Billing for Conners 3rd edition packets

    Hello! I am wondering if anyone has a licensed mental health provider that uses the Conners 3rd edition packets for their patients/parents/teachers? If so, do you bill for the packets that they fill out? If so, what CPT code do you use? We have found that each packet is very expensive and...
  12. M

    Wiki 99421 billing

    One of our Dr's has an established patient who's Mother contacted our Dr's nurse about her daughter having pink eye. The nurse contacted the Dr, who was not in the clinic that day, and the Mother sent a picture of her daughter's eye to the Dr and he prescribed an antibiotic after viewing the...
  13. M

    Wiki SUPERVISION OF PICC LINE PLACEMENT

    Are we able to bill (with a modifier) for our NP that is supervising PICC line placements at the hospital? She has been training other staff so I didn't know if this was billable or not? We are a Rural Health Clinic.
  14. M

    Wiki 99406

    We are getting a denial from Aetna Better Health stating that 99406 needs a modifier when billed with 90471 and 90472. What modifier should we use? Thank You!
  15. M

    Wiki Coding for a vaginal delivery of a stillborn baby

    Hello! We had an OB patient come into our ER and deliver a stillborn baby. We do not have OB here at our facility so I am unsure how to bill this correctly. I am going to bill a 59409 for Mom. What do I bill for baby? Thank You!
  16. M

    Wiki Split/Shared services

    I am in a Rural Health Clinic and have a scenario that I am needing help with. One of my PA's saw a patient for shoulder pain. Referred this patient to one of my MD's for an ultrasound guided injection on the same day. If the PA does documentation and puts in a charge as well as the MD for...
  17. M

    Wiki Can I bill in a Rural Health Clinic for one of our providers using his own ultrasound machine?

    I would appreciate any help on this. Does anyone have any problems with getting their claims paid when one of your providers has their own ultrasound machine and use it to do arthrocentesis/injections? Are there any special modifiers that I would need to use? Thank You in advance!
  18. M

    Wiki 1100F-Fall risk assessment

    Hello! I am just needing feedback on if anyone uses this 1100F code on Medicare wellness exams? If so, do you get reimbursed or is it just for data mining?
  19. M

    Wiki Chest x-ray reading on a picc line insertion cpt code

    Hello! Can anyone help me with a CPT code for the provider who reads the chest x-ray on a picc line insertion? The provider did not put the PICC line in, she read the chest x-ray only. Thank You!
  20. M

    Wiki G0442, G0443 Codes

    I am just wondering if anyone uses this G0442 or G0443 code with a Medicare Wellness exam? If so, do you get reimbursed for it? Also, what ICD-10 codes do you use to get them to pay for you? Thank You so much for your help in advance!
  21. M

    Wiki Authorization form

    Does anyone know of a form that providers can sign authorizing, myself, as a CPC to bill a charge for them if they would forget to do it themselves? All of the providers that are in the practice I work for have all told me verbally that they trust my coding and that if anything needs changed or...
  22. M

    Wiki Can you bill 4 days in Observation?

    Hello! I am just wanting to know if I can bill a Kancare/Sunflower (Kansas Assistance Insurance) with a 4 day Observation Hospital stay?
  23. M

    Wiki Biopsy of a raised skin colored lesion off of ear cpt code

    I talked with the Dr. that did the biopsy and how the sample was removed to send to pathology and he stated that the patient had a lesion that was raised and he just "snipped" off a piece of the lesion. The whole lesion was not removed. So I am wondering how to bill this? I did receive the...
  24. M

    Wiki Billing for a family visit.

    I have a patient that is currently in a nursing home. Her primary care provider had a telehealth visit with her family, the patient was not on the call. Can I bill for this? If so, who would I bill?
  25. M

    Wiki BILLING 93010 IN THE ER

    How does everyone bill an EKG (93010) when done in the ER when the patient is admitted? Do you bill the EKG through the ER or do you roll it into the admission? I'm just curious how other people bill these.
  26. M

    Wiki BILLING 36471 WITH J3490

    Does anyone know how to get reimbursement from BCBS when billing 36471 & J3490? I keep getting denials that this is not medically necessary. I also read that you can't bill the med with the procedure code. I have 2 of these that I can't get paid. Any insight would be greatly appreciated!
  27. M

    Wiki Billing question

    When billing 93010 and 31500 together what modifier do I need to get them both paid? Thank You!
  28. M

    Wiki B-12 injections

    Can a Rural Health Clinic bill for a B-12 injection on a Medicare patient that also has an office visit? Thank You!
  29. M

    Wiki Billing the code G0444

    Good Morning! I am looking to see who has billed the G0444 for depression screenings? Are they covered by all insurances? Can you bill it on other than an annual wellness exam? Any comments will be appreciated! Thank You!
  30. M

    Wiki Billing G0008 and 90471 together

    I am just wondering if anyone else has had trouble billing these codes together? We have had denials because insurances recognize them both as primary codes. Any insight would be appreciated!
  31. M

    Wiki Billing prolonged services

    I am just needing to know if I can bill for prolonged services with an ER E&M for a Medicaid patient that also has an office visit on the same date of service? Thank You in advance for your time!
  32. M

    Wiki Billing procedures

    I billed 45338 (flexible sigmoidoscopy with removal of tumor(s), polyp(s) or other lesion(s) by snare technique and 43239 (EGD with biopsy) together with a 59 modifier on the EGD. The patient has United Healthcare insurance and they are denying the EGD. Can anyone help me to understand why?
  33. M

    Wiki Fast Exam/Bedside ultrasound

    Hello! I am inquiring about a locum Doctor that covered our ER for a weekend and brought his own Fast Exam machine (ultrasound). Is there a way that you can bill for that test being done in an ER setting when the machine is owned by the Doctor? I feel like it would be billed on the...
  34. M

    Wiki Unfinished abortion

    One of my providers in the ER had a lady come in who had an abortion 2 weeks prior. The patient still had tissue that needed removed and so my provider did that in the ER setting. Does anyone know if there is a CPT code to use for this procedure or would I bill an E&M?
  35. M

    Wiki (2) Metacarpal fractures on the same hand

    Hello! I have a patient that fractured her 4th and 5th Metacarpal on the same hand. Can I bill the 26600 twice? Thank you for your time!
  36. M

    Wiki Thoracostomy

    On a thoracostomy, our surgeon changed from a Heimlich valve and drainage bag to a bile bag. Can I bill for this?
  37. M

    Wiki Chest tube procedure

    Hello! I have a question on a chest tube removal. Our general surgeon changed from an under water seal vacuum suction system to a heimlich valve. Can I charge for this, if so, what code would you recommend? The pt has BCBS.
  38. M

    Wiki Lesion removals

    I have 5-11402's that I need to bill out but it exceeds the MUE limit. We have tried to bill it a couple different ways and it keeps paying incorrectly. I also have 12-11403's that are doing the same thing. Any suggestions on how to submit these for correct payment? Thank You!
  39. M

    Wiki Needing help with coding Pathology Surgeries

    Hello! I am on Chapter 18 and working in the Practical Application Workbook. I am having a hard time figuring out how to know what cpt code to use on surgeries. Are there key words I need to look for? I am truly lost when it comes to this. Can anyone help please? Thank You!
  40. M

    Wiki Speculum exam

    One of our PA's did a speculum exam on a patient. Any ideas on what CPT code to use for this? There was no pap done, just a speculum exam. Thank You!
  41. M

    Wiki Two intercostal nerve block of the left anterior thorax

    On this procedure, the 5th and 6th costochondral joint areas are injected. On 64420, it states it is an intercostal nerve, single level. Would the 5th and 6th costochondral joint area be a single level or multiple levels and I would need to bill the 64420 and the 64421? Thank You!
  42. M

    Wiki Multiple Metacarpal Fractures

    I have a 2 yr old that has a R Hand injury with fractures of the third, fourth and fifth metacarpals. No manipulations were done, just a clam shell splint and wrapped with an ace wrap. Do I bill 26600 x 1 or do I bill this 3 times?
  43. M

    Wiki Acute distal radial fracture with minor dorsal angulation and a minor distal ulnar buckle fracture

    How would you code both of these fractures? There was no manipulation done and the patient was put in a sugar tong splint. I thought about 25600 but there is no palmar displacement and there is a dorsal angulation. Any suggestions on this? Thank You in advance!
  44. M

    Wiki High Dose Flu Shots

    We are getting an LCD edit for 99602 and we have a Z23 attached to the claim but it is still throwing an edit. Any thoughts on what diagnosis codes we should use? We can't find it on the LCD list.
  45. M

    Wiki Sacral Wound

    Hello! I have a question on how to code a sacral wound that is not an injury. The patient sits all day long and has developed a sacral wound. Is there a different code other than the "S" code that I can use?
  46. M

    Wiki Lesion removal sizing

    I have a question regarding what measurement everyone uses for a lesion removal? I have always coded and billed a lesion by the width (i.e. 2.4 x 1.6 x 0.9) I would code with the measurement of 2.4. My Dr. that removed this lesion said to use the measurement of 1.6 instead. I have never...
  47. M

    Wiki Surgery modifier

    We have recently added a surgeon to our medical staff so I am still learning on the modifier side of things. Can someone help me as far as a "59" modifier goes. Does it need to go on the least expensive procedure or the most expensive?
  48. M

    Wiki Sunburn code

    We are getting an edit stating that L55.1 requires a related causes code but this is a clinic claim. Has anyone experienced this before?
  49. M

    Wiki I&D

    I have a patient that slammed their finger in a door. Provider did an I&D on the nail to express the fluid that was under the nail. How should I bill this?
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