Recent content by hollomanh

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    New IVUS codes 37252

    Did anybody find any magical primary codes for the noncoronary IVUS yet? We are still having issues :(
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    Medicare denying 37252

    I'm curious if your noncoronary IVUS 37252 was ever paid. Since this code began in 2016, we have had problems with our local MAC not accepting selectives as the primary procedure. I've emailed their provider rep to see if they'd consider letting us know what they consider valid since it seems...
  3. H

    Billing CPT Code 90714

    Because 90714 has the d/a/p portion along with the tetanus, Medicare will consider it for payment when given for an appropriate open wound or such (see above NCD listing), but it will not pass thru their edits and pay even if you have a perfectly valid wound or laceration DX code. In order to...
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    POS for 57410-Pelvic examination under anesthesia

    Propofol and Toradol by a CRNA. And the CRNA billed his services as 00940. The service are bundled when performed by the same provider, but it was a CRNA that came in for the anesthesia portion. I started researching this further and found another case they did in the office where the...
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    POS for 57410-Pelvic examination under anesthesia

    I have a question about valid places of service for CPT 57410. Our OB performed this in the office. This was the only procedure done on this date, so there isn't a bundling issue. Tricare is informing us that the claim was rejected due to an invalid POS and states it's an AMA rule. However...
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    Cardiac Ablation Add On Code CPT 93623 Infusion Guidelines

    I might be wrong but I think the statement no induction of arrhythmia means that the isuprel couldn't reproduce the arrhythmia which is what they hope for after they've done the ablation. The administer the medication in hopes to see that they can't reproduce it. If they can reproduce it, they...
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    Ncd 190.31

    Looks like the update to the NCD file will no occur until January or April 2017 per the CMS website. The new ICDs will be backdated to their effective date, 10/1/16, but they sure make it a pain in the mean time. "Please note that due to this being the first regular ICD-10 code update since...
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    Medicare and Medicaid Preventive visit

    Our Medicaid when secondary to Medicare does not pay for services when the primary (Medicare) denies them as a PR-204. Not to mention our Medicaid does not pay for CPEs (99381-99397) beyond the age of 21 anyways.
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    Modifier 26

    You are correct. Upon reviewing mod 26 guidelines for these codes on the MPFSDB, they come up with an indicator of 0 which means the PC/TC applications are not applicable. Professional/Technical Component: 0 x About "Professional/Technical Component (Modifier 26 and HCPCS Modifier TC)" This...
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    billing/coding physical & sick visit together

    I know I'm late here, but we have providers on both ends of the spectrum so am researching: some state (and are quite adamant) the time and effort it takes to review and manage chronic conditions is 100% separate from an AWV, and some of them say they wouldn't bill the extra E&M because it's...
  11. H

    Help Please IVUS 37252

    Were you ever successful in getting any thru? We are having the same problem with this new code and our MAC won't publish what they think is acceptable as primary codes. Granted, the same procedures were done last year prior to the CPT change and they paid just fine. I've got one out to our...
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    Non-Coronary IVUS 37252

    Every single one we've billed to Medicare so far this year has denied for this bogus denial of needing a valid primary CPT. It's part of a TAVR workup for us as well. The codes it's being billed with are no different than when done in 2015. But something changed with this new code. Per CMS...
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    MDM- Risk Table

    I myself would be careful assessing the moderate MDM for otitis media. For our local MAC, there are certain conditions that no matter how high we might get on the table of risk, they will never allow a moderate selection b/c the nature of the visit did not require it. Otitis media is one of...
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    NP/PA charging new patient visits-Medicare specialty code

    When an NP or PA is credentialed with Medicare, they are assigned one specialty type, that specific to NP or PA, not one that would correlate with the actual specialty they are working in. We are a multispecialty group. We have NPs and PAs that will see new patients as state guidelines permit...
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    Denial code m16

    The M16 should've been just a remark code. There should be other codes on the remit, especially if it was Medicare, like a CO or PR or OA code as well that should give the actual claim denial reason.
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