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    Wiki H2015 coverage for Medicare

    Hello. I understand the HCPCS code H2015 is not a covered service for Medicare. We are a Medicare contracted CAH but we have a behavioral health department that is not contracted with Medicare. They have no PTAN for this area. They want to provide services to patients who are on Medicare for...
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    Wiki Billing ophthalmic kit for cataract surgeries

    Hello, We are a CAH and we perform cataract surgeries and bill for the facility portion only. We are billing the Sodium Chondroitin-hyaluronate ophthalmic kit with a 636 revenue code and a J3490 CPT code. Medicare is denying for not being medically necessary. Is this kit charge considered...
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    Wiki Coding from another facilities medical records

    Hello, I have a compliance question. Our CAH hospital has access to the adjacent clinic's medical records. This is not our clinic and is not owned by the hospital at all. Can our coders go out to their records to code for services received at our hospital. To clarify, a patient is sent to...
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    Wiki Billing for Triage and ER fee

    We are a CAH and I would like to know if you can bill for triage and for the ER facility fee or is the triage included in the facility fee if the patient is seen by a provider. In other words, a patient comes into the ER, is triaged by the nursing staff, and then the patient leaves or is sent...
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    Wiki Medicaid Payments for Quad Screens-CPT 81511

    Hello. Has anyone had issues with Medicaid and Medicaid HMO plans not covering Quad Screens-CPT 81511? Thank you in advance.
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    Wiki Hospital Billing for Stillborn Baby Charges

    Hello. I need help with some coding. We had a mom come in who was 38 weeks in her pregnancy. The cord collapsed and they did an emergency C-Section, got the baby out and worked extensively with CPR to revive the baby to no avail. Would this baby be considered an inpatient or ER? What codes...
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    Wiki Outsourcing Billing

    Hello. We are a small, rural, Critical Access Hospital with an off-site RHC. We are looking at possibly outsourcing our billing. I have never been a fan of outsourcing but the changing environment is making it difficult to find, hire, train, and keep employees in a small town. We need a...
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    Wiki Medicare and Observation hours over 48

    We have had providers who are consistently keeping people in observation over 48 hours. That is being dealt with. However, how do we bill these to Medicare. I know they will send an ADR. Then, we still get a denial for all of the observation charges and not just those over 48 hours. Should...
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    Wiki Billing for Surgical Implants

    We are a CAH and we are having issues with billing for implants. One implant we are looking at is HCPCS C1783 and then implants involving ortho surgeries such as bolts, knee implants, etc. If we do not get paid for these separately, do we have to bill for them or can we roll the expense into...
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    Wiki Sensipar (HCPCS J0604) and Dialysis

    Hello. I am looking for further guidance on Sensipar and ESRD. I have read that it is billed with the bill type 721 and is paid as part of the composite rate (i.e., no separate payment). But, then I read that it is still paid separate from the composite. I contacted Amgen and asked how this...
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    Wiki ICU Observation

    Hello. We are a CAH and this is regarding hospital billing, not professional billing. I was asked about billing ICU Observation. I have been told by a couple of consultants that if a patient is ill enough for ICU, then need to be inpatient. The same would hold true for Isolation. Is this...
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    Wiki Ear Tube Codes

    Hello. For a hospital procedure, ear tubes or collar buttons - is there a HCPCS code for these items? Can they even be billed separately or are they billed as part of the procedure? Thank you in advance!
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    Wiki Paracentesis

    When billing for a hospital charge (CAH) for a 49083 - Parecentesis, do you also bill the 76942 Ultrasound guidance or is that inclusive? Thank you
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    Wiki Regional Blocks

    Can you bill a 370 revenue code for regional blocks, epidurals, etc. or is that specifically for general, MAC, TIVA, etc.?
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    Wiki Shoulder Abduction Device after Surgery

    Hello. I need some guidance on billing for the shoulder abduction device after surgery. Basically, is this device billed as a DME product or supply or should it be billed at all as it is part of the procedure? Thank you in advance.
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    Wiki Blood Glucose Monitoring performed by Nursing

    Hello, I am trying to determine if nursing performs blood glucose monitoring, is it billable? I was always under the assumption that blood glucose monitoring is only billable when performed by lab personnel. Is this true? Thank you in advance.
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    Wiki Discontinued Dialysis Treatment

    Hello. If we had a patient who was dialyzing and something happened to the machine or the patient had to discontinue that treatment for another reason, should there be a modifier put on that charge to show the treatment was discontinued for that day? Thank you in advance.
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    Wiki Outsource companies for Dialysis billing

    Hello, we are a CAH in Nebraska with a Dialysis unit. We have a small billing staff and Dialysis billing has become a difficult task. Does anyone know of any companies that handle Dialysis billing if we outsource only that part of our billing? We have between 10-12 patients. Thank you!!
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    Wiki UHC OptumPay

    Hello. Is anyone else as upset about UHC's new OptumPay service as I am? We are a small CAH and cannot absorb the cost of paying for a remittance advice. I actually question if this is even legal. We are in transition to a new EHR and am not at the point of signing up for new 835 files. We...
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    Wiki Admissions Dept. Errors

    Hello. I need some guidance. We are a 25 bed CAH. I am the Revenue Cycle Director and am recently in charge of the Admissions Dept. They make a lot of errors. They do not always check eligibility, they will put in incorrect insurance or old insurance, they will get names wrong and policy...
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    Wiki Billing for Sole Supports in Hospital PT department

    Hello. Our PT department wants to provide customized sole supports for their patients and we are trying to find out if this is a billable item. We are a CAH hospital and PT is one of our outpatient departments. Now, I read on the CMS website that something that is a custom fit product should...
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    Wiki Kits and Trays

    Hello. We are a CAH hospital and I would like to know if you can bill for kits and trays. We were advised that unless you bill for every item in the kit/tray, it is not billable and should be part of the procedure for which it is used. I am referring to kits and trays used in the OR, and...
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    Wiki Charge Master Policy and Procedures

    Does anyone have a good resource for Charge Master Policies and Procedures? I recently took on this role of managing the CM and I keep reading to put this or that in your CM P&P. I do not even know where to start. Thank you!
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    Wiki Billing for outside services

    Hello. I need help understanding when and if we can bill for outside services provided to the hospital. In other words, we perform a surgery and an outside company comes in with the Lithotripsy laser and performs the service. We have been told in the past this is part of the OR room charge...
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    Wiki Outpatient dialysis on an inpatient

    Hello. We are a CAH and have an outpatient dialysis department. One of our patients is now an inpatient (not Covid related) and needs his dialysis. We cannot transfer right now because of Covid and hospital overcrowding. I have always been told that we cannot perform outpatient dialysis on...
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    Wiki Facility Fee Charges for Hospital OP Clinics

    Hello, We are a CAH and we have outpatient specialty clinics who we bill both the professional fee and the facility fee as they are our employed providers. How do you determine the facility fee? For example, the provider providers an knee injection (CPT 20610) in the clinic and we bill the...
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    Wiki Physical Therapy Supply

    We are a CAH with a Physical Therapy Dept. We do not have a DME license. The PT department utilizes items such as sock aides, shoe horns, dressing sticks, etc. and charges them under a 270 revenue code. My opinion is these should only be billed utilizing a GY modifier and need the required...
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    Wiki Pre-surgical Covid Testing

    Hello. I am in Nebraska and I thought I read somewhere that the commercial plans and Medicare are not going to be covering pre-surgical testing for Covid. Has anyone else heard or read this anywhere?
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    Wiki Bladder Scan

    When billing the CPT 51798 for the Bladder Scan, what revenue code is recommended? I have been using 402. Is that correct? Or should it be 761 since it is done in a treatment room?
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    Wiki ER to Observation to Surgery

    We had a patient that came into the ER on the 19th with several issues but mainly Epigastric Pain. The patient was in observation on the 19th, 20th, and on the 21st a Esophagoscopy Flex Biopsy was performed. After the surgery, the patient was moved to inpatient status. My question is can you...
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