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    Wiki UHC Denials

    Hi Tiffany, I am wish I could assist with the above. Can you please provide the CPT code you're using? I am having a slightly different problem with UHC and injectibles, particularly with J1100 and J3301. UHC has denied mutliple claims for injectables (paired with 20550 and 64455), that are 2...
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    Wiki CPT 11042 - 11044

    Has anyone seen an increase in Medicare medical necessity denials for CPT 11042 - 11044? If so, do you know why? Thank you in advance!
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    Wiki Post Op Wound

    Hi Lily, I was advised by AAPC, modifier -58 can be used for therapeutic debridement. There are some wound care services, that typically take several therapeutic debridements to promote healing. If there is advanced knowledge that additional debridements will need to be performed, just make...
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    Wiki Diagnosis without X-ray

    Hello, Can a MD diagnois a non-displaced fracture of a hand, or toe without an x-ray? I'm coordinating with a another and I advised I don't think you can. However, would love your expertise. Just in case this is helpful. Billed as CPT 28510-T8, Dx S92.344A and M79.671. Thank you!
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    Wiki Complex Closure

    In your first example it would be 15 mm, unless your provider added in the margins (for example - 15mm + 2 mm margins would total 19mm. Margins are 2 sides). If margins aren't listed, then I would query the provider.
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    Wiki Complexity of data

    I'm reading the note next to IH in parentheses. It sounds like you consider IH as a category 2, if it comes out independant or limited, however, you count as a category 1 for Moderate or high. Please correct me if I'm wrong.
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    Wiki Complexity of data

    Two in catagory 1, equals moderate.
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    Wiki Complex Closure

    Add them together, because it is in the same anatomical area.
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    Wiki Complexity of data

    Yes, 2 (ordering a test and IH) in category one, equals a moderate level of complexity of data reviewed.
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    Wiki Modifier 76 on repeat pain blocks

    Is this for CPT 64450 or CPT 64493?
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    Wiki Credentialing

    Hi Pam, A claim will always go out with the Individual Provider NPI as the Rendering Provider and the Group NPI and TIN will be under Box 33 for payment. Yes, the provider needs to be credentialed, or the claim will not be paid. Warmly, H
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    Wiki Addended record

    Hi Ginger, An addedndum, can simply state, updated Dx to E11.40, and the providers name/date/time. However, a good EMR automatically time stamp. If it's not set up, you may want to contact the EMR IT to find out how to turn that feature on. Hope that helps!
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    Wiki E&M Medical Decision Making

    fmshero1 - That is a toughie. My recommendation is to bill with Dx T88.9XXA "Complication of surgical and medical care, unspecified." I believe you may have a case of billing an office visit using modifier -57 if it's a major procedure (90 day global.) Can you share the Dx's of the E/M? That may...
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    Wiki E&M Medical Decision Making

    Esmeralda929 - It sounds like options were discussed, however, no plan was put in place. I also agree with "csperoni" above.
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    Wiki 29950 Global ?

    Per Codify, CPT 29550, does not have a global period. It sounds like they need to update their claims system. While this is a technically a surgery code, it has 0 global days and therefore, no reason to deny office visits. I'm not certain how many payers have Provider Reps left. Maybe you can...
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    Wiki CPT 28297 Clarification

    Hello, Does CPT 28297 capture (CPT 28740 & 28298) or (CPT 28740 & 28292) when performed on the same side? From my understanding, CPT 28297, is the most appropriate code for the fusion and McBride. Please correct me if I'm wrong :) However, seeking more clarity specifically for an Lapdis...
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    Wiki CPT 11055-11057 Med Adv denials

    Hello, As of 1/1/2023, Providence Med Advantage plans have a new foot care policy (see attached.) All of our CPT 11055-11057 are being denied as not covered patient responsibility. I called the health plan and was told that can't be billed with L84 as the primary Dx. The secondary Dx is E11.40...
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    Wiki Providence Med Advantage CPT 11055 denials

    Hello, As of 1/1/2023, Providence Med Advantage plans have a new foot care policy (see attached.) All of our CPT 11055-11057 are being denied as not covered patient responsibility. I called the health plan and was told that can't be billed with L84 as the primary Dx. The secondary Dx is E11.40...
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    Wiki Seeking advice - CMS 1500 to 837P

    Hello. Office Ally is relatively cheap to use. I believe it around $20.00 per month. I support CBLENNIE recommendation, however, it that doesn't work, then I would try Office Ally.
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    Wiki DME code - L3000

    Hi Lexi, Thank you so much for keeping me in the loop! We are in difference DME Jurisdiction D, however, we can get L3260/L3260 paid for patients who have diabetes, for the prevention or treatment of diabetic foot ulcers. If that this is the case, then I append a KX modifier. The L4360/L4361...
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    Wiki CPT 28292/28298

    Thank you for the link to the forums. The information I found didn't specially address the two codes 28292 & 28298 billed together in the same visit. I can't find any reference to them being coded together. Maybe that should tell me something. Still looking for some insight :)
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    Wiki CPT 28292/28298

    Hi there, I'm new to DPM specialty and my provider likes to bill CPT 28292 (Dx M21.612) modified McBride and CPT 28298 Akin procedure (M20.12) during the same visit. Is this unbundling? Insurance companies, seem to like to bundle the CPT 28292, even with a modifier -59 (claims not submitted by...
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    Wiki DME code - L3000

    Please see my response :)
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    Wiki DME code - L3000

    Hello, I started seeing denials like this from Noridian Medicare. They are cracking down the the usage of KX. To append KX you are attesting that the insert is an integral part of the leg brace. What they are looking for in Box 19, is the HCPCS code of the leg brace and the date of purchase. I...
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