Recent content by Billing500

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    Office-Based Anesthesia Billing

    Hello! I have a few anesthesiologists who provide services in an office environment (no facility claim being submitted). Our understanding is that we may submit additional CPTs (aside from the base + time) codes for consideration. Who is billing the following and what are you including /...
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    New York Workers Comp Billing for Anesthesia

    Hi, Our office typically bills anesthesia (provided in ASCs) in the State of NJ. We're now providing services in NY state, and I understand that are some caveats to billing workers comp carriers. I've been told that we cannot bill U&C, but instead we must bill based on the fee schedule...
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    Out of Network Appeals for ERISA plans

    Simple. Because our office advocates on behalf of our patients on poorly paid claims.
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    NJ Workers Comp Appeals

    As many of you know, many NJ Workers Comp insurers pay poorly. There is no fee schedule in place, which is a good thing...but, has anyone found a means of leveraging a higher reimbursement? Though we're sometimes successful by submitting redacted comparable EOBs to these payers, most of the...
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    Out of Network Appeals for ERISA plans

    Does anyone have an effective appeal letter which addresses inadequate reimbursement for OON self-funded plans? We have a solid assignment of benefits form, however, we could use some direction with the context of our actual appeal. I understand we have quite a bit of rights under ERISA. If...
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    PT Coding Question

    Hi! We're billing the following PT codes: 97163 97014 97010 97140 97535 All are affixed with a GP modifier for Medicare, however is a -59 needed? All of our notes seem to indicate that it's only required if billing CPT 97164 (Re-Eval). Can someone please confirm? Also, for Medicare, please...
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    59 Modifier with PT Billing 97140

    That's what I was thinking. If CMT was done on the same day, it would be accurate to -59 the 97140, yes? On account of 97140 + 98941 being billed together.
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    59 Modifier with PT Billing 97140

    Hi! My PT biller is out this week and I've noticed she's been billing the following the following for a single PT visit: 97140-59 97110 97026 97014 97010 According to CCI, however, I cannot find evidence of why -59 is being affixed to the 99140. Am I missing something? I know if it's done on...
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    Post-op care for 0191T iStent with Cataract

    We are attempting to bill post-op care for a cataract/iStent insertion using a 55 modifier. Medicare has denied our submission of 0191T-55. Can the 55 modifier ONLY be used with the actual cataract code, 66984? Any input is appreciated!
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    Medicare Primary, Medicaid Secondary

    I have a question regarding a providers ability to balance bill. The provider is in-network with Medicare, but does not accept (and is not in-network with Medicaid). Can the provider balance bill the patient the 20% coinsurance which Medicare does not cover, despite the patient being enrolled...
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    Pain Management Coder/Billing in NJ

    We are offering a position for a medical billing and coding specialist to join our team. Our office is a multi-specialty billing & practice management company located in Bergen County, NJ. Specialties serviced include: chiropractic, acupuncture, physical therapy, anesthesia, and pain management...
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    Appeal techniques for OON claims

    One of our providers recently decided to go out-of-network with major insurance companies. I'm looking for some tips on what to include in our appeal letters to these payers for increased reimbursement. We are mentioning: FAIR Health rates for our geographical area Relevant aspects of the...
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    Medicare denying Ultrasound Guidance used with Regional Block Placement

    The nerve block is placed before the patient is induced for purposes of post-operative pain control. This is ordered by the surgeon and we have an entire page of our medical notes dedicated to Regional Nerve Blocks (including the name of the ordering surgeon, ultrasound guidance picture, and...
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    Opt-Out of Medicare and Secondary Insurance

    One of our providers is debating opting out of Medicare entirely. Many of her patients have secondary insurance in the for of supplemental and true "commercial" secondary. Though I've contacted many insurance companies, about this, none of my reps have responded with a definitive answer... If...
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    Medicare denying Ultrasound Guidance used with Regional Block Placement

    Since January, CMS has been denying about 85% of our claims for ultrasound guidance 76942-26. Our anesthesiologists use ultrasound guidance when placing nerve blocks for post-operative pain control (sciatic/femoral/etc). Some of our appeals have resulted in the claim being reprocessed, but...
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