Recent content by RDK720

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    Question New vs est

    Hi. You are correct. The patient is established. It looks like you are a Family Practice group which means you're billing under the same Group Tax/NPI ID and Taxonomy. It is not appropriate to bill a new patient.
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    Question Neuro Question

    Hi. This might help. https://www.nuvasive.com/wp-content/uploads/2019/03/SI-1485-2019-IOM-Reimbursement-Guide_9511447-A.pdf
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    Question 93642-26 and 93282-26 both performed on SDOS

    Hi. 93642 includes programming after using the generator to induce arrhythmia. Did your provider do an EP eval or just reviewed a print out?
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    Question Legal liability for physician coders

    If that is their company policy, ask them to put it in writing on the company letterhead. It is fraudulent to bill for non rendered procedures. The procedure done should be reported even if it differs from the authorization received. It is the responsibility of the provider to select, at the...
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    Question coding for 7 days holter

    Hi. Traditional 7 day Holter is 0296T for start date and 0298T for interpretation/sign by provider date. If you dont outsource parts of the components, you just bill 0295T to cover start date, transmission, interp, and provider interp and signature.
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    Question Trigger point inj denials

    Hi. You are correct. “Dry needling” trigger point stimulation is considered not medically necessary. TPI is only covered if it is reported with a drug. I have attached BCBS policy for your ref. https://www.anthem.com/medicalpolicies/guidelines/gl_pw_a051157.htm
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    Signature

    Hello. No. The submitted claim must be supported by the documentation. If the report is not signed, the claim is not billable. The supporting documentation must be signed and finalized prior to payer submission.
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    What changes can a Billing Specialist/Biller (not CPC) make?

    Hi. Link below and hope it helps :) https://med.noridianmedicare.com/web/jeb/cert-reviews/mr/documentation-guidelines-for-amended-records
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    Question Highmark BS and CPT 69210 denials

    Hi. Regular Cerumen Removal is considered incidental to the E&M. The medical record needs to include "Impacted" and "Removed with Tools/Forceps" for 69210 or "Impacted" "Lavage/Irrigated" for 69209.
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    IPA denying inpatient claims

    We had similar denials. On one where it was not authorized, we were successful in appealing whenever the encounter originated in the ER. We had to review the coverage and benefits of the IPA though and if it has Emergent/UR care services covered, we appeal. On the off chance that the IPA wont...
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    IPA denying inpatient claims

    Hi. It must be their coverage benefits, but you can just tell the IPA that this was an ER to IP Admit. Some IPA have a time frame that starts on the admit date to get an auth, but if its an emergency, they should cover the services unless they stated that the patient needed to be transferred to...
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    Question Documentation Requirements for Dermatology

    Hi. Does anyone have a good free resource on what needs to documented for minor Dermatology Procedures like 17000, 17003, 11102, 11403 and so forth? Any info would be greatly appreciated. Thank you!
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    Question Observation Discharge Day After Elective (Pre-Scheduled) Outpatient Procedure/Surgery

    Hi. This link might help. Unless there was a complication or another new/separate issue that needed to be addressed, the overnight stay is considered part of the recovery and should not be billed. https://www.racmonitor.com/observing-the-rules-for-observation-after-outpatient-surgery
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    ROS is this acceptable?

    Hi. The lack of components are only important for Consults or New patients. You can also use three chronic or inactive conditions to substitute for 4 elements of the HPI. I agree with Pathos in regards to MDM to correctly level the encounter.
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    What changes can a Billing Specialist/Biller (not CPC) make?

    Hi. This is from Noridian. Another point, if the provider is requesting to change or changes the EHR AFTER submission of the claim, this would constitute fraud. Documentation Guidelines for Amended Medical Records Elements of a Complete Medical Record When records are requested, it is...
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