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    Billing Medicare for Patient Lift system repairs

    What is the proper way to bill for repairs for E0640. Would we bill the E0640 with a modifier RB or do you use K0739? I can't find an answer on the Medicare website, I have found that they do pay for it but no explanation as to how to bill. Thanks for any help
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    New York Medicaid

    Can anyone familiar with New York Medicaid help me with this denial reason? "The CPT codes are not assigned to a product of ambulatory surgery (PAS) group and or the facility does not have an established rate for the PAS group." We are an out of state hospital and billed 77002, 73222, 23550...
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    Medicare payment calculations

    Our Workers Compensation follows the Medicare OPPS guidelines and status indicators for payment. At this time I need to manually calculate the payments. Reading the OPPS guidelines 10.4.1 Combinations of Packaged Services of Different types that are furnished on the same date of service, when...
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    Multiple Q1 Status Indicators

    When there are multiple Q1 status indicators on a UB with no other services that these would be packaged into, is only one paid regardless of the APC assignment. For example, if a Q1 lab is billed on the same UB as a Q1 xray would only one get paid? Any help would be appreciated, I am...
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    How Many bullets?

    Using the 1997 Musculosckeletal Exam how many bullets would you count this as? Motor Exam: Tone and bulk Intact. Strength is 5/5 throughout Gait: Intact Thoracic/Cervical: Range of motion preserved. Some paraspinal tenderness to palpation. No pain to percussion. No anatomic step-off Lumbar...
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    Psychologist/Psychiatrist

    Would this hold true with a LCSW or a LPC? If the patient is established in counselling with the LCSW and then is referred to the psychiatrist for medication.
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    coding for E/R visits

    We use LCSWs in the E/R for crisis intervention. After being cleared by the E/R doctor the patient is seen by our LCSW for evaluation (mostly suicidal ideation). In most cases the patient is kept overnight and reevaluated the next morning and then discharged. We bill 90801 for the evaluation is...
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    LCSWs performing crisis intervention in ER

    How would we bill for a LCSW who sees a patient in observation. Here is the scenario, The patient presents to the ER and the LCSW does the crisis intervention we bill a 90801. The patient is going to be admitted however we have no beds so the patient is placed in observation (could be for 2 or...
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    Behavior Health Audit Tool

    Please send me a copy also Thank You Denise dlsmith@lmhosp.org
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    MDM question - auditing cardiology

    I am new to auditing cardiology visits and I am looking for some clarification on the table of risk. 1. What types of tests are included in the cardiovasular imaging studies with contrast with identified risk factors? 2. What types of tests fall under cardiac electophysiological tests? I...
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    table of risk questions

    I am new to auditing cardiology visits and I am looking for some clarification on the table of risk. 1. What types of tests are included in the cardiovasular imaging studies with contrast with identified risk factors? 2. What types of tests fall under cardiac electophysiological tests? I...
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    Documentation Help

    Thank You, Denise Smith CPC, CEMC
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    Documentation Help

    I am auditing a surgeons dictated Consultation note. At this visit it was decided to perform surgery the format that this doctor uses is designed to not have to redo the consultation at the time of surgery. In the header she dictates an admin date. During the plan she states that the surgery is...
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    Newsletter has gone out

    Could you please add me as well. dlsmith@lmhosp.org
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    discharge from inpatient psych to medical floor

    Can I bill a discharge from an inpatient psychiatic floor on one day and then bill a subsequent hospital visit the next day, if the patient is discharged from the psychiatric unit and transferred to the medical floor within the same hospital? the patient was admitted to the inpatient...
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    ear piercing

    Does anyone do earpiercing in your office and if so do you have the parents sign a waiver? We are looking into this service and I was wondering how other offices handle it. Thanks for any input. Denise Smith CPC, CEMC
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    help with MDM

    How would you determine medical decision making on this encounter? I am doing some audits for our physcians and would love a second opinion and your rationale. It was a detaild history and comprehensive exam the impressions and plans are Elevated lead level plan - level < 3 Chapped...
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    icd-9 code for penile adhesions

    What CPT code We perfom this same procedure code 54450 states that this if for uncircumsized can we use this also on a circumsized child? And is this documented somewhere so I can show it to our doctors? Thank You Denise Smith CPC, CEMC
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    documentation for nurses

    I would like to do an inservice for our nursing staff on how to properly document the services that they are performing. Does anyone know where I can go to get guidelines on this? Thanks for any help Denise Smith CPC, CEMC
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    vaccine counselling

    Sorry, I don't think that I explained the scenario correctly. What I was wondering is what admin codes would I bill when the patient returned. The 90460/90461 because we counselled at the time of the visit or 90471/90472? Thanks Denise Smith CPC, CEMC
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    vaccine counselling

    If the doctor counsels about vaccines at a physical and the parents decide to not have the vaccines done, then they schedule a nurse visit to have the vaccines done a week later can I bill the 90460/90461? Thanks for any help Denise Smith CPC, CEMC
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    Pre-Op Clearance

    Could you please explain what you mean by the timing difference? This has been a thorn at our office lately. And where can I reference this information to show our doctors? Thanks for any help Denise Smith CPC, CEMC
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    concussions

    We treat and evaluate kids with concussions in our office. Our doctors use the SCAT form to help evaluate the patients. Can we use 99420 to bill for these forms? Denise Smith CPC, CEMC
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    E/M with 96372 - Would I need to use a modifier

    Would I need to use a modifier on an E/M service when billing the 96372 injection code? Here is the scenario, A child comes in and the doctor dx otitis media the doctor then decides to give the patient an injection of rocephin we are billing the 99213 the j code for the rocephin and the 96372...
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    preoperative and preprocdural clearances

    Our doctors perform preoperative and preprocedural clearances for dental work and MRI's. This is done when the child needs to be sedated mainly because they are uncooperative. How would we bill this? Can I bill an office visit with the correct v code? Thanks for any help Denise Smith CPC, CEMC
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    preoperative exams

    When billing for preoperative exams, we are using the surgery code with the modifier 56. How would I bill when we do a preoperative exam for dental work? Thanks for any help. Denise Smith CPC, CEMC
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    preoperative visits

    I am curious as how other offices are billing for preoperative visits. I was reading that we should be billing the surgical code with modifier 56. Does anyone have experience with this? Do you have difficulty getting the codes for the surgeons office? Denise Smith CPC, CEMC
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    documentation guidelines for 94664

    I am auditing charts and wondering what needs to be written in the chart to support billing code 94664? Any help would be greatly appreciated. Thanks Denise Smith CPC, CEMC
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    Modifier 59 attached to E/M?

    Aetna changed there policy for the VEP 95930. They now consider it experimental, there is only four instances that this would be considered medically necessary. We had to stop doing the VEPs for anyone with Aetna insurance. The policy is on their website. Denise Smith CPC, CEMC
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    bulb syringes

    Is anyone billing for bulb syringes? I do have a HCPCS code but I was curious as to what other practices are doing. Denise Smith CPC-A, CEMC
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    where can I turn for help

    I have told our doctors that we cannot bill the initial hospital visit on the day that we admit the patient from the office, if we did not go to the hospital. At a recent seminar the instructor said that if the doctors are dictating the admit note and then faxing it to the hospital so that when...
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    foreing body removal of the hand

    Thank You, I wasn't sure because there is a seperate code for foreign body removal of the foot subcutaneous. Denise Smith CPC-A, CEMC
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    foreing body removal of the hand

    I am trying to locate a cpt code for foreign body removal of the hand. Under code 26320 it states for removal of foreign body in hand or finger, see 20520, 20525. 20520 states removal of foreign body in muscle or tendon sheath; simple. Can anyone help with more information on 20520? I am looking...
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    HPI documentation question

    When the nurse puts the patient in to the exam room for the doctor she will ask questions relating to the illness or the injury and write in the chart. My question is if the doctor writes that he reviewed and agrees can he count this as HPI? I am auditing a doctors notes and the nurse wrote a...
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    inpatient charges

    What would be the correct place of service for this scenario? The patient is seen in the office and the decision is made to admit the patient. The doctor documents the admission from the office based on the services in the office and faxes it to the hospital. The patient is then directly...
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    Has anyone billed new Prevnar 13?

    When billing for the prevnar 13, what ICD-9 code are you using? We billed with V03.82 and BCBS is denying the claims stating that this is not the correct dx. Thanks for any help Denise Smith CPC-A, CEMC
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    lysis of penile adhesions

    I have another question that has just come up with code. Can this code be used on a child who has had a circumcision? Thanks for any help Denise Smith CPC-A, CEMC
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    Code 95930 and Supply codes

    We currently use the VEP and we do bill for the supplies. Some carriers will pay and some leave it to patient balance. As for the test itself Oxford and the Connecticut Husky Community Health Network are the only insurances that do not cover the test, however, alot of the insurances put the test...
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    Hpi

    I am trying to find where it states that the physician must be the one to document the HPI in order for it to count in the E/M level. Our nurses will take a brief history when putting the patient in the room. The doctors will review what the nurses wrote and then add to it. However, some of the...
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    HPI help

    I still haven't found anything, but what is happening in our office is the nurse is taking a brief history before the doctor goes in to see the patient. The doctor reviews what the nurse has written with the patient but does not write their own history because it is already written down. I need...
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    HPI help

    I know that the physician must document the HPI but can someone direct me to where I can find that in writing. I have looked in the 95 guidelines but I can't find anything that specifically states this. Any help is greatly appreciated. Denise Smith CPC-A, CEMC
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    MDM advice

    I have been reviewing office notes for the doctors that I work for, and I am looking for some advice on the MDM portion. If I follow the coding guidelines a patient comes in with conjuctivitis, it is a new problem for this physician with no work up and the MD prescibes an antibiotioc it is a...
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    MDM question

    The provider did a detailed history and a detailed exam. The assessment and plan was written as flat feet/ podiatry referral. Thank You Denise Smith
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    MDM question

    How would you credit medical decision when the plan is to refer the patient to a specialist? this is a new problem and the only plan is to refer the patient to a specialist. Denise Smith
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    need CPT code - Patient had an incision and drainage

    Patient had an incision and drainage of an abscess at the hospital, then came to the primary care physician and had the packing removed, the wound cleaned and then new packing put in. Is there a code for this or does it fall under the E/M codes? Thanks for any help Denise Smith CPC-A, CEMC
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    Admit questions

    I have a couple of questions on admits. The doctor admits a patient directly from the office and the patient is not seen in the hospital by this doctor until the next day, how would you code the level of the admit? All I have is the office notes so would I code based on those notes only? What...
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    illegible records

    I am not an auditor but occasionally will audit our doctors charts to check on the level of their E/M services. We have 2 doctors whose handwriting in illegible, being an employee I can figure what most of it says and ask the doctors to fill in the blanks. My question is if an auditor came into...
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    Global Period - primary care physician

    Thanks for your help. I thought that was the correct way. Is it written somewhere so that I can show it to my coworker? Denise Smith CPC-A
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    Global Period - primary care physician

    If a patient is seen in the E/R by the ER Doctor for an I&D of an abscess, and then comes in to see their primary care physician for a follow up does this fall under the global period? Thanks for any help Denise Smith CPC-A
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    Mdm

    Thank You, I thought that was the right way, but I wanted to make sure. Denise Smith CPC-A
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