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  1. K

    Wiki J1815 and J1817

    Insulin is considered a self administered drug and not payable on a part B claim. There is some guidance in the claims processing manual: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1800B3.pdf
  2. K

    Wiki Looking for Direction from an RHC Biller/Coder

    I do coding in a RHC and have some knowledge about claims. Why do they keep getting returned to you? There should be a RTP reason code
  3. K

    Wiki Billing for Hydration in Labor Check and Call

    If you are doing professional billing and the hydration is taking place somewhere other than your clinic, that facility would bill hydration out on the UB.
  4. K

    Wiki ER physician admitting to himself

    This happens at our facility also. What we do is not charge an ED professional level, and instead charge the H&P admit CPT for that doctor
  5. K

    Wiki COSC exam prep help?

    I took it a few years ago so I can only tell you at that time, there was a lot of spine surgeries in the OP notes. Be really strong in that area
  6. K

    Wiki CPT for Depression Screen

    99420 is for a health risk assessment, which has components of depression screening in it. We use 96127 for the PHQ-9 and GAD-7 screening done in our clinics and we get paid for them almost 100% of the time.
  7. K

    Wiki Routine Laboratories

    Can you be more specific in which labs are getting denied? Maybe we can offer more insight that way
  8. K

    Wiki Well Visit/ Well Woman

    When this happens at our clinics, if the pap is being done by the same provider who just seen them for the GYn exam, we do a no charge visit, as long as no other concerns or problems are addressed. this happens infrequently and usually only when the patient is pressed for time or on their...
  9. K

    Wiki Ppd

    This is correct. WHen they come back for the reading of it, this is a nurse only visit so there is no charge for it.
  10. K

    Wiki Vaccination Injection Codes With Office Visit

    I've encountered the same edit in Epic. i checked the CCI edits and it is a new addition this year. It does indicate you can bypass the edit with a modifier. However i have not found anything yet to tell me when it would be appopriate to bypass it.
  11. K

    Wiki Poa

    The only payor that is requring us to do it currently is Medicaid.
  12. K

    Wiki V Code for need for injection

    I guess i would use the reason they are getting the Haldol as the diagnosis code, not a V-code. I have a patient who does this weekly and I use the schizoprenia code and have had no problems with payment from Medicare.
  13. K

    Wiki Hospital Admit

    If the surgery is scheduled, than it is not medically necessary to do a H&P. It is probably in your hospitals bylaws that one needs to be done but unless you can append the 57 modifier, decision for surgery to it, than most payers will not reimburse you and will bundle it into the procedure.
  14. K

    Wiki Medical care for mentally handicapped

    Look at Prolonged services without direct patient contact if the patient has recently been in.
  15. K

    Wiki Coding help

    :confused: Sounds like something you are unlikely to reimbursed for by insurance. Why wouldnt the patient go back to the plastic surgery office to have these expanders done? I think the unlisted code is probably your best bet- there is no other CPT code for this type of situation.
  16. K

    Wiki Lab Coding Question

    85610 is what we use for Protime/INR tests
  17. K

    Wiki Fracture Care - with a cpt code

    Try CPT 25645
  18. K

    Wiki Pre op visits

    My understanding is if your doc is doing surgery on them and it was already determined before this pre-op visit, you cant charge for the pre-op. It's part of the global package.
  19. K

    Wiki Vaccine counseling

    Sounds like its part of the E&m service then.
  20. K

    Wiki outside lab/late charges

    Do you hold your bills then until you know for sure that the specimen is done being cultured? Or how do you avoid late charges?
  21. K

    Wiki outside lab/late charges

    Does anybody out there send their pathology to a different hospital? if so how are you charging the lab that comes back to you? We are getting slammed with late charges because we send stuff out and then it takes 10, 20 days to grow a specimen and we have no idea in the billing office that that...
  22. K

    Wiki DNR non-covered services from

    WPS medicare only lets us use the G0008 if it is a flu shot only. If there is an office visit, we use the 90471 instead
  23. K

    Wiki PICC line and ER facility level

    Can anybody tell if you can can code a PICC line flush and an ER facility level? Or is this double-dipping? THanks!
  24. K

    Wiki b 12 injections

    In Minnesota there are guidelines so you must have a payable diagnosis. The only other thing is if you are provider based. They will not pay 90772 on the physician side, only facility. (hopefully you arent provider based!!)
  25. K

    Wiki video capsule endoscopy

    :) Cpt 91110 Or 91111
  26. K

    Wiki Demo on how to use inhaler and one touch diabetic meter

    94664 is for demonstrating how to use an inhaler. not sure about the diabetic meter
  27. K

    Wiki Qualifier 99100

    I am wondering why you cant bill 99100 to Medicare? I have been searching the database and cant come up with anything saying you cant? Also our facility is not charging 99140 in emergencies either. Are there any rules on that for Medicare? Thanks :(
  28. K

    Wiki Replacement of Vaginal Estrogen Ring

    i agree that it is included in the office visit.
  29. K

    Wiki Platelet rich plasma injection

    Thanks I found the thread. I printed off margies reference but there are no CPT codes linked to this policy. Are you still using 36513 yourself?
  30. K

    Wiki Platelet rich plasma injection

    :confused: I need some help on this. Our orthopedic doc is doing platelet rich plasma injections were they take the patients own blood from the elbow (because he does this for tennis elbow) and spins it in a centrifuge to get all the plasma. Then he injects the plasma back into the elbow. We are...
  31. K

    Wiki CPT codes 20985-20987

    Thanks! Is there a appendix or a list of approved primary procedures for this or do I need to check the CCI edits each time? I too will need to have the docs tell me if it was image or image-less
  32. K

    Wiki CPT codes 20985-20987

    I am for examples on when to use these codes. Our ortho doc uses a mini c-arm during surgery. Are these codes used to report that? Thanks
  33. K

    Wiki Immigration Physical

    We do immigration physicals at our clinic and we code them as new or established preventative exams. Usually the patient doesnt have any insurance, so we collect the fee for the physical and the lab work and any other charges that same day. If they have insurance, we send it to them with the...
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