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  • I apologize for posting this as a visitor message. I was hoping to be able to respond via PM, however your PM Box is full and not allowing me to do so.

    Debra -
    Thank you for your prompt reply. I did read your original response and questioned you again because I have not met many coders who have been coding in every single field at once. I was not trying to suggest you did not have experience, and it was not my intent for you to feel demeaned in any way. I was merely trying to understand your background, as the specifics of your hematology/oncology experience are not listed anywhere in your profile, or the bio's that exist in the coding world for you.
    Perhaps we will never agree on every point we make, which is what makes the world an interesting place & is completely reasonable. I appreciate the information you have shared with me & I wish you the best in the future.
    Sincerely,
    Helene Roberts, CPC, CMIS, CHOC
    Remember the surgeon does not WANT to share the reimbursement with another physician but when he has requested that you participte in the global event with preop services then this is the correct way to bill. Due to the issue of preop days, some states are stating to legislate the number of preop days in their state, when this has happened Medicare has matched their definition of the prop timeframe. Let me know if I have helped in any way. my e-mail is debraawm@yahoo.com, my PM box is full!!!
    I am sorry for taking so long to get back to you but I have been out for my daughters Wedding and just got back. The problem with the 56 modifier is several things. Probably the biggest issue is that most people do not understand the modifier nor how to apply it. Remember HIPAA says all carriers recognize all codes and modifiers. Now the other part of the issue is the preoperative time period. This is payer defined. It can be a little as 1 day prior to the surgery or 7 days prior to surgery or any time in between or even longer. There are even some payers assign 0 preop days to some surgeries. This information you can get from each payer. Medicare in most regions assigns 1 day but even that is not always the case. I am sorry to say that the information from the other presentor is not correct, there is no ryle/law/statute limiting the use of the 56 modifier by specialty.
    PART 2: We have googled and researched to some extent, and would really like some backing for the information you gave us. We do not want to be billing things incorrectly, and really don't want Medicare knocking on our door if we are doing something wrong.
    We have been wracking our brains.....Totally confused...the recent info I found this morning was saying that the preoperative part of global begins the day before the day of major surgery....and the day of for minor... And from what I remember from the seminar, the whole point of us billing with the 56 mod was to get a portion of that global pay out... Can you PLEASE help clarify? Getting different answers from what we originally learned..
    Please and Thank you!!
    Oh boy did I have to go to great lengths to try and find you!! :) And I can't private message you....
    I attended one of the seminars for Insurance Coding & Billing for the Medical Office put on by Cross Country Education beginning of this year. We are a PCP in the state of Florida.
    During that seminar, we learned from you that we could bill differently for Pre-operative visits; by getting the surgical code and appending a mod 56 to it. We started doing this after learning this from your seminar, and have gotten paid on several claims.
    We went to a seminar last night put on by Lorraine Molinari and was told that we are NOT supposed to be billing Pre-ops this way. She said this is only applicable to optometrists & opthamologists in the State of Florida. We called CMS and they are saying they don't have a Modifier 56 in their Chapter 12. So we are completely confused.
    Debra,

    I hate to be a bother but you seem to be one of the most knowledgeable posters in these forums. I was wondering if you could give some insight into coding diagnoses, including chronic conditions, listed in PMH when there is nothing in the note addressing said DXs. I have been trying to pull up info on this but have not been able to find any substantial information. I have always been under the impression that, if there is nothing addressing the dx, they should not be coded from history. I've been told this from numerous sources but I can't seem to pull up anything supporting or contradicting this. Below is the post in question, if you could possibly take a look. Again, sorry if I'm being a bother.

    http://www.aapc.com/memberarea/forums/showthread.php?t=42234

    Also, thanks for being such a great source of information to all us posters in the aapc forums.
    Hi Debra-hope you can help me!!
    I was doing research about a surgeon billing for code 88305 and the lab also billing for it. I KNOW I came across several threads about this and you were very knowledgeable about this issue, but for love or $$ I cannot find those threads again!! I know if the surgeon has an arrangement with the lab, he can bill the global for this code and then reimburse the lab after he gets paid. What if he doesn't have an arrangement with the lab? He can't bill this on his own can he? He would bill the surgery or excision code and the lab would bill for the pathology-correct? I have a doc who is insiting he can bill these path codes even though he does not have an arrangement with a lab. Is there some documentation you can guide me to to clarify this issue? Again, thanks-I always enjoy reading your posts-I learn something everytime!!
    Debra, Below is your answer to a question about when to use the V68.1. My question is can you provide me with Medicare's guideline in writing when they EXPECT to see the V68.1 coupled with the CPT 99211? Thank you in advance!
    ________________________________________
    I am sticking with what was the reason for the encounter. If it truely is to just get a med refil then the V68.1 code is appropriate and Medicare may not pay the visit. Also FYI Medicare does expect this to be coupled with a 99211.
    __________________

    Debra A. Mitchell, MSPH, CPC-H
    I'm looking for clarification regarding tooth extraction. Several teeth are extracted via a mucoperiosteal flap. When the flap was raised the teeth were then luxated using a straight elevator. The teeth were then either removed using the elevator or forceps to extract the remaining teeth. Removal of bone and or sectioning of the tooth was not necessary. Would this be considered simple (D7140) or surgical (D7120) extraction?
    In the ED, if a foley is inserted and an EKG or infusion is done, i get the following edits. Is it appropriate to use a modifier -59 on these to clear the edit? See below: You have coded 51702 in addition to the following code(s):
    (93000, 93005, 93010, 93040--93042, 93318, 94002, 94200, 94250, 94680, 94681, 94690, 94770, 95812, 95813, 95816, 95819, 95822, 95829, 95955, 96360, 96365, 96372, 96374--96376, 99148--99150).The Medicare NCC edits consider this separate reporting of codes that are components of the comprehensive procedure if billed for services provided to the same beneficiary by the same physician on the same day. These codes will be rebundled by your Medicare payor and payment will be based on code 51702 only. * If these codes represent a different session, surgery, site, lesion, or injury, then use of an appropriate modifier on the excluded code will differentiate the services provided and will notify the payor to bypass this edit.
    Sorry about intercepting this conversation, but I am new at posting threads, and I can't seem to find how you post a new thread? I posted a question, but it end up being in the privacy question area??. Then had no special person to address it too??
    Picked your name for it looked like you had something to do with urology?
    Sorry, for just rooting in, but can anyone help,for I have a urgent question.
    Thanks for your help. He even sent me a PM trying to "teach" me about consults so I wouldn't have to be embarrassed in public! I ignored it. LMAO!
    Wow! I was teaching all day so I did not get a chance to view the forums. Miss a day miss a lot! I cannot see the other persons point at all. You are 100% correct and the other post is misleading people and probably confusing everyone. I will respond with a post to support you so maybe it will help Thanks for the heads up.
    Well, that is what I thought but then I found an article that says : per section 1128(b) (6) of the Social Security Act, a provider may not bill a non-medicare patient less than a medicare patient. However (!!!!) it is also appropriate for a provider to have another fee schedule for the uninsured that is lower than both the private and medicare fee schedule because it applies to a specific type of patient, the uninsured. I'm confused as to what is correct.
    I deleted my calculations since you felt that they were incorrect....I trust your integrity here...J.
    Can you help with some surgery questions?

    Can snare forceps be charged? The O.R. dept thinks yes, I think no since you can't do the procedure without them.

    Can anesthesia machines be charged?

    If the surgeon orders Iv LR at 125/hr postop, is this billable? No complications present, just his routine order.

    Thanks again for your input.
    thank you fr your help , sometimes i get confused because of the term sub-, thanks for your help, tj , new orleans
    Debra,

    Below is the comment from our consultant after i forwarded your response to her. Can you help? Thx. Maudy

    "Could you point me to those guidelines. I’m obviously not looking at coding correctly since I’m still going by guidelines that the primary diagnosis is the reason the patient was seen and then using the 648.93 as a secondary. Is the car insurance covering the injury when the injury code isn’t primary? I really appreciate your communication when you find these things. I can really see that I need to get busy and do some studying. Thanks, Sheila"
    Debra, I have a question for you. I am the biller for 24 hospitalist in Texas. If a people we are treating lets say for a week and now we transfer them to hospice but we are still the primary doctor, can we bill another H&P? or just a hospital subsequent visit. Another one, same situation but we transfer care to another hospitalist's care, can the new doctor bill an new H&P or just subsequent visit?

    Thank you so much for you advice. Randi:)
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