Recent content by CBaer

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    E/M 97 Guidelines

    brisk cap refill I would give credit in extremities. They are testing for PVD. Query the provider is always best so you have it from them. Make a chew at sheet and keep it for future use.
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    99211 for cancelled facet joint injection

    The procedure needs to be started (anesthesia administration) in order to discontinue a procedure. Payment for discontinued procedures is based on percentage of service completed. If the physician had a face to face with the patient then nothing less then a 99212 should be billed. Select the...
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    E&M new pt. vs established

    E&M New pt vs est pt To determine if they are considered to be the same specialty, you will need to check the taxonomy of the specialty, then the providers must be credentialed with that particular payer with the different taxonomy. Psychotherapist and psychologist do have different...
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    Immunization inj and Medicare

    I believe for the flu vaccine it is once per flu season. Therefore a person could receive theflu vaccine in Jan or Feb 2014 and receive it again in Sept- Dec 2014. Separate flu seasons. Pub 100-4, chpt 18, section 10.1.2. Quick Reference Chart for Immunization...
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    Fracture Care, Mods 54/55, Medicare Patient

    Mod 54/55 I would not bill for a consultation 1. Medicare does not accept consultations codes. 2. There is no request for your physician's opinion or advice. It is a transfer of care. I would bill according to the WPS guidelines using the closed fracture date from the ED and indicate the...
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    Medicare Adminstration Code for Tetanus

    Administration Code for Tetanus It is my understanding that Medicare does not reimburse for routine vaccination with the exception of Flu, Pnuemonia & Hep B. Per Novitas Solutions, Bulletin: Tetanus Vaccine 03/21/2013 Vaccinations or inoculations are excluded as immunizations unless they...
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    New vs Established

    New vs Est Your physician would be correct, as long as the subspecialties has a different taxonomy code. But most important is that the provider was credential with the subspecialty taxonomy. 20 Physician/Orthopedic Surgery 207X00000X - Allopathic & Osteopathic Physicians/Orthopaedic Surgery...
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    Consult code MCR is sec ins

    Consult Code MCR sec ins Check out MLN SE1010 - Questions and Answers on Reporting Physician Consultation Services origingal date 01/04/10 revised on 11/08/11 and 08/27/12. Q. Will Medicare contractors accept the CPT consultation codes when Medicare is the secondary payer? A. Medicare will...
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    Determining Level of Service

    Mdm Medical Necessity Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service...
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    E/M Audit - Denver - Need an audit done

    Coding Audit Sarah, I believe I maybe able to assist you. We do remote auditing, education and all aspects of HealthCare. Here is my email if you would like to give me a little more specifics I will see what we can do. Cheryl clbaer@zetter.com www.zetter.com
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    Tetanus Help

    Don't forget to use the modifier "AT" acute treatment Tetanus Vaccine (Novitas Solutions Bulletin) Issued: March 21, 2013 To report the tetanus vaccine administered for the treatment of an injury or direct exposure to a disease or condition, append modifier AT (acute treatment) to the code...
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    Hospitalist and Modifier 25

    Hospitalist No, if they are different specialties no modifier is needed. However, if the hospitalist is an NPP and you recieve a denial from Medicare this would be because Medicare does not link a specialty to the NPPs. You will need to show that the NPP is working in a different specialty...
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    Asking for help with Billing MSP claims

    Billing MSP claims If you can provide us with the CPT and ICD 9 code combination used along with the adjustment code, someone may be able to assist or point you in the correct direction.
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    ED visit with Psych problems

    ED visit with Psych Problem 90791 and/or 90792 cannot be billed with an EM on the same day by the same provider. Therefore 90791 and/or 90792 cannot be billed on the same day as an EM by the same provider.
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    GI certification

    CPC is on the coding as a whole. The GI is going to go into great detail specifically on GI. Therefore you will encounter a lot more of the difference types of encounters as well as procedures. You may want to show your manager exactly what the GI certification test you on. If they are a...
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