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    Wiki CCM

    Thank you Lady T, All of this should be documented in a note or a care plan, correct?
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    Wiki CCM

    Hello, I have an NP that wants to start billing for CCM services. We want to make sure we document everything correctly. It is my understanding this is not a typical office note, so what is the best way to document the services related to the CCM services? Are you able to help me? Thank you...
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    Wiki CCM Medicare reimbursement update for RHC

    Hi, I was wondering if you might have any information on the required documentation needed to bill for CCM? I have a new NP that treats home bound patients along with patients in assisted living and group homes and he wanted to start billing for CCM. We just want to make sure we have all the...
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    Wiki Chronic Care Management - CCM Billing

    Hello! I am working with a NP in NJ that treats patients in assisted living, group home and home bound patients. He wants to start billing for Chronic Care Management but we are not exactly sure how that has to be documented in a note. Does anyone have any information on CCM documentation...
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    Wiki G0447 POS

    Hello! :) I just took over the billing from an outsourced billing company and have discovered several claims that were denied (Medicare) for G0447 and the place of service. The service was rendered to patients in an assisted living facility and some in their private homes. I have not seen...
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    Wiki Pap Smear without full GYN Well Women Exam

    Thank you all for the information, I thought maybe I was doing something wrong.
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    Wiki Correct coding for annual exam with Pap and pelvic by a family medicine physician

    Our office is having an issue with reimbursement for Q0091. I thought DX code Z12.4 was a medically necessary code but it continues to get denied stating it is inclusive of another service. I have added the -25 to the Wellness Visit or E&M but I still have not luck. Any advise?
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    Wiki Pap Smear without full GYN Well Women Exam

    Our office is having an issue with reimbursement for Q0091. I thought DX code Z12.4 was a medically necessary code but it continues to get denied stating it is inclusive of another service. I have added the -25 to the Wellness Visit or E&M but I still have not luck. Any advise?
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    Wiki DS Confirmation Billing

    Hello. I am working with a practice in MN who has their own lab. They currently perform and bill 80307 & a confirmation (G0480, G0481, or G0482). They are looking at partnering with another clinic where they would just be doing the confirmation on positive screens. I just want to make sure...
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    Wiki Sanexas

    I apologize, I am not getting alerts when someone responds. If you still need assistance please email me at valarie@ano-rcm.com. Thanks
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    Wiki Sanexas

    I apologize, I am not getting alerts when someone responds. If you still need assistance please email me at valarie@ano-rcm.com. Thanks
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    Wiki J3411 & J3415

    :unsure: I am billing for a cocktail of medication for a neuropathy procedure and I am seeing denials come back through for J3411 - Thiamine and J3415 - Pyridoxine from Medicare stating N95 - This provider type/provider specialty may not bill this service. I was unware that these medications /...
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    Wiki Copay on Unauthorized visits

    This is exactly what I have been trying to tell my doctors however they do not like that one of the providers is not doing his job to get the service reauthorized for medical necessity so they want to keep the co-pay. I have tried to explain that there is $0 put to the patient so you can not...
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    Wiki Copay on Unauthorized visits

    I need some assistance, I have been taught that if you bill for services and they were denied due to not obtained pre-authorization that you can not keep the patients co-pay. Due to the services not being authorized it is not the patients responsibility and all services are to be adjusted off...
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    Wiki Code 97016

    Thank you very much for the information. This is what I was thinking also but wanted to confirm. This is just one more reason why I do not like or trust billing companies. They typically do not have a coder on staff and bill just because something will pay.... well that does not make it right!
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    Wiki Sanexas

    We have actually been performing this service since May 2020 and have had great results with our patients. So far the billing aspect has been a bit bumpy but we are getting reimbursed through Medicare and most Medicare replacement plans.
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    Wiki Code 97016

    We are currently using a billing company for some of our services (something I do not agree with) and they are billing code 97016 twice with a modifier of -76 on the second charge. The services we are performing are being performed at the same session and not as a subsequent visit or session...
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    Wiki COVID-19 Testing?

    It is my understanding that code 86328 has been introduced for COVID-19 testing. Does anyone have any information as to what POS needs to be used for this? Also is this a CLIA waived test? Does this test have to be billed from a lab or can it be billed from a providers office? My office has...
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    Wiki Sanexas

    We are also looking into performing this procedure, were you able to obtain any additional information?
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    Wiki Genvisc Coding

    Is anyone using Genvisc instead of the Supartz for Medicare patients? I know the j code for Genvisc is not listed on the Medicare ASP fee schedule so I was wondering if anyone is having issues being reimbursed? Also does anyone have any pointers on the coding for the new J code? Units...
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    Wiki Sanexas?

    Our office is looking at starting to perform a procedure call Sanexas - I have heard that the coding for this may be a bit difficult and we are being directed to a billing company to have THEM do the billing for this procedure. I would prefer to keep this in house. Does anyone have any...
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    Wiki Mid Level Billing

    First were they seen at another practice or a different location for the same practice? If you are billing under the same TIN, it would be the same practice. How long ago was the patient seen? If the patient was being seen at a different location and they are moving to a different location...
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    Wiki workers comp

    You should be able to bill code 99366 - Nurse Case Manager Conference per 15 mins at $60 per 15 mins. That is what our charge is for Florida. Hope that helps. Valarie D. Norman, CPC, CPCO, CPB, CPPM
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    Wiki Workers Comp???

    Thank you but it really does not help as each state is different and the federal does not apply for each code. The code for the drug screen 80100 has been removed for the CPT book for 2016 and I am not sure what we can use now moving forward and I can not seem to get any assistance as a...
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    Wiki Workers Comp???

    I understand each state is different and has their own unique fee schedule and guidelines. I live in Florida and they recently updated to the 2016 codes, this now means the code for a post accident drug screen that was used 80100 is no longer valid and I can not seem to find another code that...
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    Wiki Foreign Body Removal

    Thank you, thats what I thought.
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    Wiki Foreign Body Removal

    There seems to be some conflict in my billing department regarding the number of FB removals you can bill. We had a patient that came in to our Occupations Medicine practice who shot himself with a nail gun, the ONE nail went through his index and middle finger. The way I understand the...
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    Wiki Injection

    Is it correct to bill code 20610 twice if the doctor has to perform an aspiration of fluid from the joint for one diagnosis then perform an injection of medication for a separate diagnosis? To my understanding these are 2 separate procedures performed for different reasons. Is this correct?
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    Wiki Nurse Services

    So IF I understand this correctly.. we are a 'Group Practice' and we are rendering Designated Health Services (DHS) such as diagnostic imaging within one of our practice locations while our physician is NOT in the office we are okay to bill under our group using the referring provider as the...
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    Wiki Nurse Services

    Debra, Do you happen to know where I can find this information? As some diagnostic testing is listed as 'General Supervision' (the procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required. However, the training of non-physician...
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    Wiki Nurse Services

    Thank you. I guess I am still a little confused as I am finding some conflicting information regarding some services... Must a supervising physician be physically present when flu shots, EKGs, laboratory tests, or X-rays are performed in an office setting in order to be billed as ‘incident...
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    Wiki Nurse Services

    Just so I can clarify it for my clinic staff. This is regardless of what insurance the patient has correct? Medicare, BCBS, UHC, Aetna... it does not matter.
  33. V

    Wiki Nurse Services

    That is what I thought and I have been telling them, however they continue to do some services and wonder why I continue to no charge them. I can NOT bill for them, but somehow this has not gotten through. Thank you!
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    Wiki Nurse Services

    Hello all, What services are allowed to be billed when a nurse / MA performs then and a doctor is not in the office? I continue to receive push back from our clinical director on what can be performed and billed. :( Please help! Thank you, Valarie, CPC, CPPM
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    Wiki Incident to services in an ASC

    Does anyone know how the 'Incident to' applies to the professional services performed by a PA out of an ASC? I know that when services are performed in the clinic setting the Physician has to be on site. Does the same apply with the service is performed in an ASC? Any help would be great, I...
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    Wiki Echo Pelvic Limited vs Office Visit

    The practice I work for is Urology based, however we perform most of our own CT Scans, X-rays, and Ultrasounds. We have noticed an increase in Office Visit denials from Medicare when an Echo Pelvic Limited (76857) is billed at the same time. As code 76857 is not a "Procedure" I am very...
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    Wiki Meaningful Use??

    :confused: Does anyone have information on the Medicare Meaningful Use for EHR? I know that there was an incentive program for it and there will be a reduction in payment for 2015 if the Meaningful Use is not used but I have heard different information on what codes will be effected and what...
  38. V

    Wiki Chest X-ray

    What if BOTH physicians work for the same group?
  39. V

    Wiki Chest X-ray

    I seem to be getting conflicting information and was hoping for some help. When billing for a chest x-ray do you use the physician in house when the x-ray is performed or the radiologist that reads the film? OR can you bill it either way? :confused: Any help would be greatly appreciated...
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    Wiki Penile Dopplers

    Thank you Nancy. So you do not bill for an Ultrasound of an extremity?
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    Wiki Penile Dopplers

    Is anyone out there doing Penile Dopplers in the office? We just started doing these and I am not sure I am getting all the information or capturing all the codes. We are coding the Corpora Injection (54235) and Penile Doppler (93980). We are thinking we should also be coding for an...
  42. V

    Wiki Node Excision

    Thanks appreciate the help. :D
  43. V

    Wiki Node Excision

    One of our physicians has performed a Sentinel Node Excision. I am having some difficulty finding the correct code for this procedure. When I reviewed the information I thought it should be code 38500 however my physician disagrees. He thinks it should be in the 50000 series and I can not...
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    Wiki Bx Site?

    Thanks for the help! :D
  45. V

    Wiki Bx Site?

    :confused: I seem to be at a loss... one of my providers performed a procedure and the way he has it written has me confused. He has it written as a 'Excisional Bx - SP site' What it appears to be is - removal of the Suprapubic catherter and then excision of the redundate tissue, which was...
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    Wiki Penile Prosthesis

    Kristina, Thanks, I was thinking the same thing but wanted to make sure I did not miss something. Thanks, Valarie Norman, CPC
  47. V

    Wiki Penile Prosthesis

    One of our physicians performed an Inflatable Penile Prosthesis in the hospital and he is asking me about a code for "Modeling" (reshaping for Pyeronies). I have never heard of this and can not locate anything for coding on this. I reviewed the OP notes and it just says "Intraoperative...
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    Wiki Radiology Billing - ordering physician

    TJ, Please keep me updated with the progress of this if you dont mind. I will be very interested in the out come. I dont want to start billing under the referring as I just dont feel it is the proper way to bill. Thanks so much! Valarie
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    Wiki Radiology Billing - ordering physician

    :confused: Our group has been in negotiations with a radiologist for coverage and over reads. He currently works for other places as well and I have found that the other clinics do not bill using the radiologist as the rendering for any of the radiology services. They bill these services...
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    Wiki Hospital Charges / Payments?

    I have been given the task of finding out how much a procedure will be reimbursed if it was performed in an outpatient Hospital setting vs it being performed in our ASC. I am having a very difficult time trying to find a Hospital Outpatient Fee Schedule, can anyone help? I have even found...
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