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    Wiki 85660 Units Billed

    For facility billing 9 units for CPT 85660 are billed on the UB04 and 9 units of 86902 and 10 units of 86922. Seven units of CPT 85660 are always denied for missing/incomplete/invalid days or units. I'm aware the MUE for CPT 85660 is 2 units. Should the additional 7 units not be billed, or does...
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    Wiki CPT 76700 billed with 76775-XU

    I have a facility claim denial for CPT code 76775-XU due to invalid modifier. I'm aware procedure code 76776 is considered to be a component of the comprehensive code 76700. However, I'm questioning if CPT 76775 should in fact be billed separately based on documentation. There are TWO SEPARATE...
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    Wiki Please help me understand the requirements for billing TOB 0141

    I have received multiple claim denials from different payors for labs billed on a UB04 under bill type 0141 (Hospital - Laboratory Services Provided to Nonpatients). The claim does not include lab draw charges (36415). For example, one claim has CPT codes 87491, 87591, and 87661 billed under...
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    Wiki Speech Therapy Cpt code 92507

    Every policy is different. You should be able to call the insurance company to confirm the patient has benefits. Most insurance companies require prior authorization for therapy services. Then, once authorized, they limit the number of visits/treatments.
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    Wiki 76700 billed with 76775-XU

    I have a facility claim denial for CPT code 76775-XU due to invalid modifier. I'm aware procedure code 76776 is considered to be a component of the comprehensive code 76700. However, I'm questioning if CPT 76775 should in fact be billed separately based on documentation. There are TWO SEPARATE...
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    Wiki Nuclear Medicine Functional Reporting

    Absolutely! Thank you for responding... EXAM: NM GASTRIC EMPTYING STUDY TECHNIQUE: Solid: Following the oral administration of 1 mCi of Technetium-99m Sulfur colloid in a solid egg and toast meal, immediate, 1h, 2h and 4h delayed images of the abdomen and lower chest were obtained in the...
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    Wiki Nuclear Medicine Functional Reporting

    I have a claim for gastric emptying study (78264) billed with modifiers MG and PO and G1004 (Clinical Decision Support Mechanism). There is also a charge for lab 82962 and contrast agent (A9541). UHC Medicare denied the claim stating CPT code 78264 requires functional reporting. It's my...
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    Wiki Facility Billing G0108

    I have received multiple claims that denied HCPCS G0108 for Diabetes Self-Management with a denial reason of "the procedure code/type of bill was inconsistent with the place of service". HCPCS G0108 is reported on the claim under revenue code 0942 and CPT codes 83036 and 82962 are billed under...
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    Wiki Modifiers LD & LC

    I'm a utilization nurse reviewing a denial for missing modifiers. Procedure codes billed are 92928 x2, 92978 x1, 92979 x1, and 93458-59 x1. I have my CPC, but it was more so I could get some idea of some of the denials I audit. Based off what I'm understanding with the coding and the op report...
    • RaeToll
    • Thread
    • cardiac catheterization procedures pci coding
    • Replies: 1
    • Forum: Cardiology
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    Wiki Medi-Cal Newborn Reimbursement

    I realize this is a long shot but, has anyone billed newborn claims to California Health and Wellness? I've been getting denials as "payment included in allowance for another service". I reviewed the CA Health and Wellness Global Maternity Package policy; however, it does not specify if the...
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    Wiki Can I bill modifier -PI with a cancer Dx?

    Thank you for your help Susan. I truly appreciate you.
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    Wiki Can I bill PI modifier with a cancer diagnosis?

    I received a Medicare claim rejection for CPT code 78816-PIPO (PET/CT whole body) citing inconsistent modifier or required modifier is missing. The primary diagnosis listed on the claim is C61 (malignant neoplasm of prostate). I reviewed the CMS Billing and Coding policy which states, Claims for...
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    Wiki Can I bill modifier -PI with a cancer Dx?

    I received a Medicare claim rejection for CPT code 78816-PIPO (PET/CT whole body) citing inconsistent modifier or required modifier is missing. The primary diagnosis listed on the claim is C61 (malignant neoplasm of prostate). I reviewed the CMS Billing and Coding policy which states, Claims for...
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    Wiki How to bill J0741 CABENUVA

    I figured it out. Billing drug dosage sometimes confuses me. For any one else needing references for this: https://nastad.org/sites/default/files/2022-04/PDF_Cabenuva_ADAP_NASTAD_March%202022.pdf
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    Wiki How to bill J0741 CABENUVA

    I have a denial for HCPCS J0741 where 600 units were billed. Medicare denied stating the information submitted does not support this many/frequency of services. The order is for Cabotegravir/Rilpivirine 600mg/3mL - 900mg/3mL ER injection Suspension Kit 6 mL. The nurse documented a total of 6mL...
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    Wiki Medi-Cal Z7514

    How would you bill for observation (facility) that exceeds 24 hours? I have a claim that denied Z7514 x 2 as exceeding the benefit max. The description of the code reads, "room and board less than 24 hours". The patient was admitted to observation at 02:22 and discharged the following day at...
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    Wiki How do you bill postoperative recovery room or observation charges?

    I have a UHC claim denial for revenue code 0710 for missing the associated CPT/HCPCS code. The patient underwent a septoplasty and was admitted to observation overnight, for which revenue code 0710 was billed without a CPT code. I was thinking to remove revenue code 0710 and rebill with...
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    Wiki How do you bill postoperative observation/recovery room?

    I have a UHC claim denial for revenue code 0710 for missing the associated CPT/HCPCS code. I assumed revenue code didn't require a CPT code. The patient underwent a septoplasty and was admitted to observation overnight, for which revenue code 0710 was billed without a CPT code. I was thinking to...
  19. R

    Wiki Psychiatrist under 10 minute phone call

    Not sure which codes you typically bill within your practice. I did manage to locate the following information: https://journal.ahima.org/page/telehealth-coding-and-billing-compliance https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Criteria Telemedicine Phone Calls 99441...
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    Wiki 2023 CPT code changes by specialty

    AAPC posted an article earlier this month that may provide some information on what you're looking for. https://www.aapc.com/blog/86691-get-a-look-at-cpt-2023-code-changes/ Additionally, they offer multiple webinars for 2023 coding updates based on specialty...
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    Wiki telephone only cpt codes

    I located a copy of CMS' Telehealth service codes effective January 2023. I hope this helps. https://www.cms.gov/medicare/medicare-general-information/telehealth/telehealth-codes
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    Wiki HIPPS code

    Not sure specifically about United Healthcare, but I have to following information regarding billing with HIPPS codes. HIPPS Revenue Codes SPARCS Appendix I- Revnue Codes (ny.gov) Understanding HIPPS HIPPS Codes | CMS Coding HIPPS Definition and Uses of Health Insurance Prospective Payment...
  23. R

    Wiki New to ASC Coding

    Here is the link to Medi-Cal Provider Manuals https://files.medi-cal.ca.gov/pubsdoco/manuals_menu.aspx and Medi-Cal Surgery Billing guidelines https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/surgbillub.pdf I hope these links can help. :)
  24. R

    Wiki medi-cal

    I do not bill for Medi-Cal, but I review some of their claim denials for utilization review. Here is a link to their provider manuals that you may be able to reference. https://files.medi-cal.ca.gov/pubsdoco/manuals_menu.aspx I hope this helps :)
  25. R

    Wiki Please Help 77300 MUE

    This makes sense. Thank you for taking the time to explain this.
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    Wiki CPT 82043 Modifier 91

    I think I found my answer: Modifier 91 is not to be used for procedures repeated to verify results or due to equipment failure or specimen inadequacy. While 59 is used for differentiating two procedures while cannot be billed together on same day. Use of Modifier 91: On a repeat lab test...
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    Wiki Please Help 77300 MUE

    I am a UR nurse asked to review a claim denial for medical necessity where CPT 77300 denied as exceeding MUE. MUE is 10 units. What was billed on the UB04 is 77300 x 10 units and 77300-59 x 73 units. Are the units for 77300 referred to as "shots"? I would like to confirm I'm reading the...
  28. R

    Wiki CPT 82043 Modifier 91

    I have a facility claim for CPT code 82043 for Microalbumin, Urine Random and CPT codes 82043-91 and 82570 for Microalbumin Creatinine Urine Ratio denied by Medicare as "number of units not supported". Both orders were placed at the same time from the same provider. If anyone has experience...
  29. R

    Wiki Non Office Blood Draws by MAs

    Did you resolve the issue with billing CPT 36415 and P9603/P9604 for your travel phlebotomist?
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    Wiki FQHC BILLING

    What services are you billing? https://med.noridianmedicare.com/web/jea/provider-types/fqhc/fqhc-billing-guide https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c16.pdf
  31. R

    Wiki 29581 denied for inconsistent modifier use

    United Healthcare denied a claim billed with CPT 29581-GP-RT-XS and 97597-GP and 97598-GP, stating "procedure inconsistent with the modifier used or a required modifier is missing". I have searched United Healthcare billing and coding guidelines as well as their modifier policy and outpatient...
  32. R

    Wiki CPT 29581-GP-RT-XS denied inconsistent modifier

    United Healthcare denied a claim billed with CPT 29581-GP-RT-XS and 97597-GP and 97598-GP, stating "procedure inconsistent with the modifier used or a required modifier is missing". I have searched United Healthcare billing and coding guidelines as well as their modifier policy and outpatient...
  33. R

    Wiki Ambetter procedure codes 97140 and 97110 denials

    20.1 - Discipline Specific Outpatient Rehabilitation Modifiers - All Claims (Rev. 11129, Issued: 11-22-21, Effective: 01-01-22, Implementation: 01-03-22) Modifiers are used to identify therapy services whether or not financial limitations are in effect. When limitations are in effect, the CWF...
  34. R

    Wiki Same Day Admit/Discharge < 8 hours

    The claim is billed on a UB04. This is what the rep in our office provided me, "Claim was denied due to the admit and discharge dates being the same. Payer has stated that we need a corrected claim with a code explaining the same date discharge. We are requesting coding review". I initially...
  35. R

    Wiki Same Day Admit/Discharge < 8 hours

    I have an inpatient claim with TOB 0111, denied requesting a corrected claim with a code explaining the same date discharge. The patient was admitted inpatient status at 14:50 and discharged at 17:35. Per CMS Manual Pub 100-04 Medicare Claims Processing, CPT codes 99234-99236 require a minimum...
  36. R

    Wiki Same Day Admit/Discharge < 8 hours

    I have an inpatient claim with TOB 0111, denied requesting a corrected claim with a code explaining the same date discharge. The patient was admitted inpatient status at 14:50 and discharged at 17:35. Per CMS Manual Pub 100-04 Medicare Claims Processing, CPT codes 99234-99236 require a minimum...
    • RaeToll
    • Thread
    • cpt99221-99223 cpt99234-99236 samedaydischarge
    • Replies: 3
    • Forum: E/M
  37. R

    Wiki Inpatient Medicare Part B

    The patient does not have Part A coverage. I appreciate your input. We will be appealing this denial.
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    Wiki 86923 Denial Help

    I received a denial from Anthem BCBS for CPT code 86923 stating "CPT code 86923 should be billed with the appropriate code for these services". I was unable to find any reference via CMS or Anthem BCBS website. I appreciate any guidance.
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    Wiki Inpatient Medicare Part B

    I appreciate any assistance with billing the secondary payer following Medicare Part B. Primary payer is Medicare Part B Secondary payer is Anthem BCBS Medicare Part B was billed for outpatient services with TOB 0121. Anthem was billed with TOB 0111. Anthem denied payment as the claim amount...
  40. R

    Wiki Coding a Diagnosis Based on a Query

    The payor denied this inpatient claim for the principal diagnosis of sepsis as the condition was not mentioned within the medical record, and only documented in a physician coding query. Can we bill a diagnosis based on indicators and a coding query, even if not mentioned in the medical record...
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    Wiki No entry level job available even after passing CPC

    Change Healthcare usually has openings for remote coding positions. They specifically note they accept CPC-A and will assist in removing the apprentice status.
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