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    Wiki 96372 Therapeutic injections during office visit

    If the provider truly providers e&m services along with the injection you should bill for both. the NCCI edit is because 96372 requires Direct Physician Supervision. So you have to justify and support that the E&M is not being billed simply for the providers supervision of the injection. I mean...
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    Wiki IV hydration

    Would this apply to the following scenario as well? Pregnant patient is dehydrated due to excessive vomiting. Seen for in office hydration. Lactated Ringers (LR) is being administered because the patient is dehydrated. 1000 mLs and is administered over 1 hour total IVPB Zofran (small bags (50cc)...
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    Wiki Can we give injections/vaccines to patient when the provider is virtual

    I apologize for the delay! we do not bill 99211. We bill injection/admin codes only. We have a NCNUR "charge" that comes over but it has a$0 charge and does not go out on the claim and i believe you should be able to bill under the same NP.. the key to this is the separate claims one POS 2 one...
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    Wiki E/M Code and Injection Administration Code

    We have this issue with our local Highmark Blue Cross but with 96372/B12 injections.. most time the patient is being seen for a follow up on multiple chronic conditions and are also due for their B12 injection.. the insurance will almost always automatically deny the office visit as CO97 if...
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    Wiki Can we give injections/vaccines to patient when the provider is virtual

    We have a provider that is completely telehealth and her patients come into the office.. When the provider orders vaccines during the telehealth appointment for the nurse to administer we have the front desk schedule a separate "nurse visit" encounter. They then bill for the vaccines/any other...
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    Wiki Iowa FQHC Midwives Billing

    I have been told at least for Medicaid and MCO's under our FQHC we should be billing for everything as well as if they are self-pay. Most of our patient's have financial assistance so it typically isn't a problem, however when they are just self-pay I wasn't sure if there were certain things you...
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    Wiki Iowa FQHC Midwives Billing

    I do for a large FQHC in Pennsylvania... I can try to help and maybe talk through things! I am still learning a lot as well and am no expert though!
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    Wiki Billing For Midwives

    I was asked this question by one of our CNMs recently.. "I just had a quick question on if a vacuum delivery counts towards our incentive numbers in the hospital? This question came up because I recently had three labors we treated and pushed with for several hours however, ended up with the...
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    Wiki Billing Questions Highmark Speech Therapy Claims Denials

    So for the authorizations. we are submitting them prior to running out. but the authorizations are being denied as the benefit max has been reached. which is correct since they have met their visit limit.. But they want to continue to be seen for therapy.. With the benefit denial authorization...
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    Wiki Billing Questions Highmark Speech Therapy Claims Denials

    So unfortunately the process our local enforces we are required to complete 3 unsuccessful claim investigations on each claim before we can request a claim escalation with the provider rep! Which our hope is they will eventually get tired of it and figure out why it’s happening! The claims add...
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    Wiki Billing Questions Highmark Speech Therapy Claims Denials

    So this is more billing related rather than coding related... But I am at a loss and figured it would not hurt to ask. I work for large FQHC as a Coding and Billing specialist. We bill for Speech and Occupational Therapy.. These kid's are seen multiple times a week and usually exhaust their...
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    Wiki E&M coding

    I am having this issue with our providers... to the point that we have been notified by a few payers that they will be doing their own audits in 2024 due to the amount of over coding... Since i recently took the coding specialist position that was open for 3 years E/M training on the new...
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    Wiki Prevnar PCV20 Aetna Denials for Pediatrics

    oh thank you so much for that!!!
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    Wiki Billing Global OB

    It definitely depends on the plan. UHC requires 13 and is VERY strict on that Anytime i bill a global delivery to them we always get a letter requesting medical records to prove they were seen for at least 13 prenatal appointments. I was taught they need at least 10 prenatal appointments for a...
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    Wiki Prevnar PCV20 Aetna Denials for Pediatrics

    We just received our first denial from Aetna for a pediatric patient received 90677.. I appealed that but have not received a decision yet. and in the meantime my supervisor was going to send the information to our Aetna Provider rep to see if they had any Recommendations. our big issue is with...
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    Wiki New RSV vaccines?

    I may have spoken too soon... Based on the Billing and coding guide that we were given Z23 can be used. but per this article the AAP released last week Z23 should not be used.... and now there are new admin codes! 96380 96381...
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    Wiki New RSV vaccines?

    Pfizer's Abrysvo 90678 and GSK's Arexvy 90679 are both considered vaccines And even though Beyfortus 90380 90381 is not technically a vaccine Z23 is still to be used. Unless a 2-mL dose is adminsited due to a highrisk condition then Z29.11 Encounter for prophylactic immunotherapy for...
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    Wiki New RSV vaccines?

    I have located my first RSV vaccine fee! Aetna added their fee of 90678. $300.08! Slowly but shortly they are adding! p.s Aetna also added their fees for all of the new covid vaccine codes and admin code. they priced the same as medicare. and capital blue added the covid admin code to their...
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    Wiki Mental Health Assessment

    we are running into this same question.. We are also a large FQHC and We have hired a new MD that is bringing a large number of patients with them.. We are trying to figure out the best route to go.. We are leaning towards requiring re-evaluations 90792 for their first appointments because they...
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    Wiki New RSV vaccines?

    I saw yesterday that Highmark of PA released a bulletin on 09/15/23 stating they have added the RSV vaccines to their Preventive Schedule for Infants and Adults. but they already have their proposed fee schedule out that will be effective 10/01/23 for the 4th quarter and none of the codes are on...
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    Wiki New Patient to group but Est. To provider under different tax ID?

    looking for some clarification on this.. as information given by one of our Behavioral health insurances is conflicting. we recently hired a new provider to our group who practiced with another group in the area Same specialty but Different Group NPI and Tax ID This provider will be bringing a...
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    Wiki New RSV vaccines?

    Has anyone had any luck with any insurances adding the new RSV vaccines to their fee schedules yet? I keep checking fee schedules for our major payers but no one has added them yet with a fee... also been trying to stay on top of newsletters and articles but just haven't found anything yet...
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    Wiki Denials for 96372 & same day E/M MULTIPLE CONDITIONS.

    I am having a huge issue with Highmark only paying on the 96372 and B12 injections and denying the E/M even with modifier 25 when there are other conditions being addressed. An example i have a patient who comes in to see the provider for multiple conditions but also due for their B12 injection...
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    Wiki 96110 Developmental Screening Code Requirements

    I have been researching this endlessly with no clear answer.. We use the SWYC as our tool for developmental screening and have a tool build into Epic. If a Patient is seen for a Well Child check and the developmental portion (milestones and POSI) was all that was completed because there were no...
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    Wiki Provider Education/Training advice needed!

    that would be awesome and much appreciated! i sent you a personal message with my email!
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    Wiki Provider Education/Training advice needed!

    Hi everyone! I am really hoping to get some guidance on this topic. I worked for a large FQHC I recently became certified in April just accepted the official coding specialist position last week.. a position that has not been filled for over 2 years.. I have worked at the office level to...
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    Wiki Coding question

    actually i am very glad you said that... i accidentally deleted my comment. anyways i was questioning that today. I still have ALOT to learn and have started to realize there is a larger world of coding out there that i have not been exposed to since i work for a FQHC... and when i first started...
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    Wiki E/M for 2023

    i just took the 2023 CFPC online exam and there were no questions regarding the 95/97 guidelines. which i was worried about.. not sure if that helps you at all.. i guess it depends on the certification you are sitting for.
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