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    Wiki Home care certification diagnosis incorrect

    Good morning. We have received a denial on G0180 for a home health certification for missing/incomplete/invalid diagnosis. Generally when we bill these, we just copy the diagnoses directly from the plan of care document sent to us by the HHC provider. However, on this particular form, the top...
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    Wiki Repeat x-ray performed by different provider and facility

    Hello. A patient came into the office following a fall and had an x-ray of the facial bones. We billed and E/M and 70510. We received a denial because the same procedure had also been performed by another facility not affiliated with our group. I am not sure if the patient had this x-ray done...
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    Wiki Sepsis in outpatient

    Patient was hospitalized following a fall and was determined to have sepsis. She is now being seen by primary care for a hospital follow-up. Pt is still on antibiotics for the sepsis. Would the sepsis be coded as still active or would this be considered as historical at this point? Can a sepsis...
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    Wiki Code from context in HPI

    Provider only lists morbid obesity in the A&P. however, in the HPI he lists hypothyroidism, sleep deprivation, and heavy alcohol consumption as context for obesity. (This is the extent to which he mentions these in this encounter.) Is this sufficient to report any of these as additional...
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    Wiki Remote physiological monitoring 99457 during global period

    Our provider billed for 99457 eight days after a minor procedure performed in office so we added modifier 24 to 99457. However the payer is rejecting this upfront due to invalid/missing modifier. Is anyone here able to shed some light on what the issue might be? An E/M was also billed on the...
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    Wiki GHP 80050 components with both medical and preventive dx

    One of my providers ordered a 85025, 80053, and 84443 separately on a patient with commercial insurance. 80053 and 84443 were ordered under a preventive dx, while 85025 was ordered for monitoring of anemia. Since the payer requires these to be bundled as 80050, would we be able to bill the 80050...
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    Wiki Pull diagnosis from patient portal message?

    Hello. I am wondering if we are allowed to pull a diagnosis from a patient portal message? The provider has ordered an MRI based on a portal message in which patient reports new and worsening symptoms. The symptoms in question had not been assessed at a previous encounter. Would I be able to use...
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