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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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    Resource for Psych coding

    Try looking at the following website: APA and AACPA, they have a lot of information as well as some free on-the-demand webinars. Also another good resource is The National Council. You can always submit your questions here. Let me know if I can help. Cheryl
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    Mass confusion!

    Mass Confusion We all can understand. Let us know exactly how we can help you. Although CMS has not come out with any additional information on the new BH codes, the only thing you have to go by is AMA. However, there have been about three MAC that have put out LCDs on the new codes and for...
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    Help with 90801

    Michele is correct. The two new codes that replaced 90801 can be bill in the office as well as the facility (facility includes 51). Have a great day. Cheryl
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    individual psychotherapy

    IP Telehealth Yes, CMS have a guide on telehealth also MM7900 shows the adding of the 2013 CPT Codes to the telehealth list. Hope this helps. Cheryl
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    Signatures on Progress Notes

    supervision signature Who's name are the claims being billed under? If the claims are being billed under the supervisor...than they are ultimately responsible for what is on the claim. If there is an audit it is the name on the claim that is listed in the audit. When the carrier finds out...
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    Behavior Health Audit Tool

    Originally Posted by smdumpert Nope don't mind at all. I have some training material that we used to train our staff that really helped. I'll try to get it up loaded. If not send me an email address and I'll send it that way. I too would like a copy if possible. I am trying to educate...
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    Let's start a pysch coding email group!

    This is a great Idea! Please add me to the list. clbaer@zetter.com Cheryl :)
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    MDM - review/order of test in medicine section (9xxxx) of CPT

    Based on the documentation guidelines it states: diagnostic service (test or procedure) I consider infusion a procedure therefore i would give credit. AMOUNT AND/OR COMPLEXITY OF DATA TO BE REVIEWED The amount and complexity of data to be reviewed is based on the types of diagnostic testing...
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    PFSH Question

    I agree, the physician needs to provide a little documentation to get credit. Either since last visit, Discharge notes from hospitalization (name of hospital and date of discharge) It is always good to have your reference available when informing a provider you need some additional...
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    PFSH Question

    Pfsh To add to Sullivak - Consultations - Initial Hospital Care - Initial Observation Care - Initial NF - Require all three, Past, Family and Social history to be documented for a comprehensive history
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    Help with Self Auditing?

    Self auditing I see this alot where the providers mix and match the ROS and PFSH. The ROS is a series of questions and are as a rule of thumb symptoms. What you have list are all illness therefore they would all go in the past medical history. If you take a look at the 1997 DG for GU...
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    non face-to-face code

    None face to face Take a look at 99358 - Prolong E/M; before and/or after direct patient care; first hour. The info preceeding indicates Prolonged service of less that 30 minutes total duration on a given date is not separately reported. I do not have the CPT Assistants at hand they may have...
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    compliance auditing

    I am not sure if this is what you are looking. How about listing each finding or observation then the recommendation falling it. Findings (observation): Recommendation: Findings (observation) Recommendations If you have the book Medical Record Auditing by Deborah Grider there are...
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    E/M MDM points

    E/M Data Points I agree with F Tessa. Billing for the EKG has a PC/TC therefore the PC is the reimbursement for the interpretation. Therefore 1 pt. Hope this helps. Cheryl
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    Novitas Solutions 1995 Documentation Worksheet

    For those who have not noticed and have Novitas Solutions, Inc. and your contracted Medicare Carrier. They have updated the 1995 Documentation Worksheet, Here are the changes I noticed to the form other than the name on page 1 1. Section 1 History • Removed consultations from the...
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    AWV initial or subsequent

    AWV initial vs Subs I agree with Herbie Lorona, as for the AWV, the Initial can be performed anytime after the first 12 months a patient is on Medicare. 12 months after the Initial AWV the patient is eligible for the Subs AWV (it may be an elapse time of 11 months that will need to be...
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    WPS - Status of 3 Chronic Condition changing standing

    Just sent in an eMews from WPS WPS Medicare Part B Legacy and MAC eNews for Thursday, March 22, 2012 ******************************************************************** Status of Three Chronic or Inactive Conditions in the History of Present Illness (HPI) Effective for dates of service April...
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    E&M based on time w/no exam?

    New ptn based on time Depending on what the counseling is...it could be 99401- 99429. Keeping in mind not all carriers reimburse for these codes. Have a great day Cheryl
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    Expanded PF vs detailed exam

    Exp Prob Focus vs Detailed exam You really need to question your carriers. As for Medicare CMS has left this up to the contracted mac's to determine. Highmark Medicare Services (soon to be "Novitas Solutions, Inc") has a 4X4 rule, however keeping in mind clinical judgement may override this...
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    ABN needed or not?

    ABN or not In your situation you should not need one unless the patient is new, then you do not know if she has already had a high risk yearly GYN within the pass year. Here is where you can find information you may want on ABNs CMS IOM Pub 104 - Medicare's Claim Processing Manual 40.3 -...
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    Another Modifier 50 Question!

    Billing Mod 50 It really depends on the carrier. You really should check with your particular carriers, with that said if it is Medicare you would always bill with one unit and ensure the fee is doubled. Cheryl
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    CPT Codes relating to DRGs

    I realize that DRGs are diagnosis driven. However, I am trying to find a listing of CPT codes the may correspond to some specific CV DRGs. Does anyone know of any such listings? Thanks Cheryl
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    RT and LT

    mod 50 vs RT/LT You need to determine 1st if the procedure can be billed bilaterally. Typically I would check the Medicare Physician Fee Schedule to see what the ruling there is for bil. If it can be the next step is to check with the specific carrier how they want it. some want mod 50, one...
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    Help - my CPC exam

    job searching Don't forget to go to your local staffing agnecies. Alot of employers post with them...you can usually get into a position that is temp to hire there you can show them what you know. That is how I got my first real coding job. At the end of the 90 days they offered me a the...
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    Dx for tests/procedures

    Dx coding for test Based on the ICD 9 Coding Guidelines (found in the front of your ICD 9 manuals or http://www.cdc.gov/nchs/data/icd9/icd9cm_guidelines_2011.pdf) you will find if the definitive dx is know at time of billing you should be coding the test with the definitive not Signs and...
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    Which coding software do you use?

    Software Ingenix has Encoder Pro Contexo has Code it right AMA has Code Manager
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    chief complaint in ehr world

    Documentation of CC The CC is to be documented by the provider rendering and billing for the service. If you look at the documentation guidelines, under the "General Principles of Medical Record Documentation" it state, "the amount of physician work". If you read the actual guidelines it...
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    E&M coding refresher/HELP!

    EM 1995 Documentation Guidelines I agree with skembretson EM University is a good place to start. They also have a case of the week (Coding Rounds) which you code select the LOS you feel is appropriate then he tells you the answer and goes through the steps to get the answer...
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    NCCI Edits, what does 0, 1, 9 mean?

    "Modifier 0=not allowed 1=allowed 9=not applicable" Hope this helps. If you go into the column 1/column 2 at the very top it will show this. Cheryl
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    Need help quickly

    Medicare and PA reimbursement When a claim is submitted under a non-physician practitioner or PA NPI, Medicare reibursement will be at 85% of the medicare allowed amount where a physician is reimbursed at 100%. It is the rendering physician listed in block 31 on the claim form You can find...
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    Holter Moniter

    DOS on Holter services You can find your answer here This is directly from CMS and it tells you what date to use for billing the different components of the Holter. http://www.cms.gov/medicare-coverage-database/lcd_attachments/29584_13/L29584_CV016_CBG_040111.pdf Happy Holidays. Cheryl
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    Icd-10 - I recently became a new coder

    I find other than a couple additional chapters and the "X" place holder, and knowing that some codes will have RT or LT, Initial, subsequent or sequela already in the codes, looking up the codes isn't the issue. The issue still remains with the providers documenting enough to select the code to...
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    New Patient

    No, there is no face to face with a provider. All new ptn visits require a face to face with a provider. I don't recommend billing 99211 as incident-to (a pre established plan from a provider is not made) are not met. Any way if you were to bill 99211, you would forego a new ptn EM code the...
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    skilled nursing facility coding

    This came from a Medicare Report July 2011 from Highmark Medicare Services. Check and see if your answer is in one of these areas: Remember communication between the ambulance provider and the SNF is essential. You'll find additional documentation on ambulance services including a list of...
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    give me a chance you won't regret it

    Keep applying. I do want to say, try an employment agencies they can help the only downside is that the position are usually temp to hire and you don't begin tenure until your employed by the company. I started my medical career as a receptionist first (1995), the person doing the billing...
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