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  1. S

    Telehealth Consult vs New Patient OV?

    I joined a MFM specialty that bills out consults for new patients 99241-99245 and the services are provided via telemedicine. In looking at the medicare covered telhealth services, these CPTs are not covered. Am I thinking correctly that hese visits should be coded as new patient 99201-99205?
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    Methlypredisolone Injections

    The vials come in 40mg and our provider orders 60mg to be injected. Do we bill J1030, J1020, J1020 JW or J1030 1.5 units and J1030- JW .5 units?
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    Telehealth requirments

    I have read the information provided by CMS on telehealth services but still have questions on billing this. We are providing the originating site for patients to see dermatology. How is this billed with just the Q3014? What provider is it billed under and what are the documentation...
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    March 2014 CPT Assistant??????

    This sentence is in the March 2014 CPT Assistant: ?Code 94640 should not be reported when the nebulization is performed for therapeutic purposes.? So, should we not be billing the nebulizer treatment when used on a patient presenting with asthma problems, etc?
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    Billing Anesthesia in units based on time???

    I do not bill for anesthesia but have been asked a question about our dental anesthesia claims. I have now found out that we should bill 00170, but how do I bill the units based on time? Or do I for 94 minutes? Any information is greatly appreciated!!
  6. S

    Non Display Fetal Doppler

    I am not in OB but one of our physicians want to start doing fetal doppler on her pregnant patients after she gives, for example, breathing treatments for their asthma just as a precautionary measure. Is this something that we can bill for in addition to their visit and what would the CPT code...
  7. S

    ov level?

    I need another opinion on this... Can you get a detailed history, comprehensive exam, and moderate mdm? I appreciate any advise and expertise on this. Vital Signs: Time: 03:04 PM Weight: 170 lbs Height: 65" BMI: 28.29 BSA: 1.88 Temperature: 98.0 F (Oral) BP: 158/68(Right...
  8. S

    Procedure or part of E/M

    Is there a procedure code that should be reported for this? Foreign body removal: EAR: INDICATIONS: left lobe patient has an inbedded ear ring back. POSITION: Seated. REMOVAL TECHNIQUE: Grasping foreign body with forceps: Moved the otoscope lens to one side and introduced bayonet forceps or...
  9. S

    MDM and referring to specialist

    When referring a patient out to a specialist does the note get extra points for MDM, or is this included in addtl work up planned, but where would it count then if it was an established problem?
  10. S

    HPI Elements or Conditions???

    How would this HPI be audited, using elements or status of conditions? HPI: Patient presents with his mother. 1 year 1 month age old patient is here for following up from hospitalization for pneumonia and hepatitis. Mom reports that he is breathing much better, eating much better, and is much...
  11. S

    Foreign Body Removal CPT Code?

    What is the difference in 10120 and 28190? Our provider removed a thorn from a patients heel. Which code is more appropriate?
  12. S

    Nurse Practitioners and Specialty Copays

    Has anyone else come across insurance companies processing nurse practitioner claims with a specialty copay? About 6 months ago we saw our first one with an Anthem plan out of New Mexico and now this week we have 2 other companies processing nurse practitioner claims with the patient copay for...
  13. S

    Another Opinion on E/M Level

    No one in the office here does chart audits so I would greatly appreciate the advice/input from others. For this note I came up with History- Detailed, Exam- PF, MDM-Moderate but I am questioning myself on the level 4. Can anyone else review this and let me know what you have come up with in...
  14. S

    Obesity dx 278.00

    when patients present to the office for weight loss options, etc. Is it appropriate to only use dx 278.xx?
  15. S

    MDM- Amount and/or complexity of Data Reviewed

    If a patient is seen for an ED follow up do I assume the doctor reviewed the ER notes and count this as a point under the reviewed data or do they specifically need to document the review of ER record?
  16. S

    Hpi-EPF or Detailed

    What should this HPI come out to? EPF or Detailed? Patient presents with his wife. 76 year 10 month age old patient is here for Here for follow up for depression- is feeling well, but has been taking one whole pill. Would like to have his dose changed to 20mg daily. Here for ED. Has been...
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    UA during Preventive Exam bundled?

    We are getting denials for 81003 when claimed with a preventive exam and when I talked to one of our reps she said they just had the claim edit put in place. Is this new for the UA to be bundled with the PM visit? Where can I find this information?
  18. S

    99214 vs 99215 ?

    Can anyone offer advice on this note? I am coming up with a 214 but it seems like the provider had quite the extensive visit with the patient and has chosen a 215 for this. Patient came to office for an office visit. Nursing Staff: Patient assisted by. Previsit Planning completed by...
  19. S

    Secondary Claims to Managed Care Companies

    Do we have to file secondary claims to our medicaid managed care companies if the primary insurance paid more than the secondary insurance allowable amount? It seems like we are wasting time and money on these claims since we know they are not going to make payment and the amount will be...
  20. S

    HPI Documentation - review of ultrasound

    Shouldn't this HPI have more detail? HPI: 75 year 4 month old patient is here for follow-up visit for review of ultrasound.
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    Billing Providers

    For our mid level practitioners we bill under their supervising physician for the commercial insurances that do not credential NPs. There is now a question if the Doctors have to sign off on the notes that are billed under their name? Can anyone help with this?
  22. S

    office visit coding help

    How should the following note be billed? The psychiatrist wants to report the med managment (code 90863 and of course Q3014 for telehealth) but what is the primary procedure? Do we report an E/M code with this? Any and all advise most appreciated!! Patient came to the office for a...
  23. S

    Cpt 99455

    Our office uses this code when DOT physicals are done, but when I read this code I see work related disability evaluations. Am I missing something?
  24. S

    Questions Regarding 2013 CPT Code Changes

    90792- The medical services defined are provided by the psychologist/psychiatrist not a medical provider in the same practice? Add on codes 90833, 90836, 90838 to E/M- again these are E/M services provided the same day as the psychotherapy services by the psychologist/psychiatrist and not a...
  25. S

    82947 vs 82962

    Can someone help me in identifying what kind of tests are out there that our clinic can use for fasting glucose to correctly report cpt code 82947 to insurance companies? Currently we are using 82962 and the test is done with the strip from an Accu Check monitoring device. I am so confused.
  26. S

    Exam- Expanded Problem Focused or Detailed

    I took this exam as expanded problem focused, but the provider thinks this should be detailed because of the multiple organ systems evaluated. Should this be detailed? General Appearance: The child appears well, comfortable, cooperative, in good state of nutrition. Appears playful. Skin &...
  27. S

    new to auditing and would appreciate a second opinion on visit note

    I have come up with an Expanded Problem Focused History, Comprehensive Examination, and Low Complexity Medical Decision Making for a 213. If anyone could review and let me know if this is correct I would greatly appreciate any and all expertise. Vital Signs: Time: 01:44 PM Weight: 331 lbs...
  28. S

    Educations Codes?

    Currently we having 'dummy' CPT codes set up in our EMR to track education for one of our incentive programs and our old Medical Director told us that with ICD-10 there are dx codes to report the education rather than using the 'dummy' CPT codes setup in our EMR. Has anyone else heard anything...
  29. S


    Can anyone direct me to documentation for the appropriate method for making an addendum to a visit note?
  30. S

    HPI elements- help

    Can anyone offer their expertise on this? I come up with 2 elements for this HPI. HPI: Patient here for a hospital follow up for leaned over into trash can and when he stood up, he collapsed to the ground. Did not lose consciousness. Evaluated and sent for heart test when patient reports was...
  31. S

    Drug Testing Code?

    We are getting a rapid drug test that tests urine for the following drugs: THC,COC,PCP,MDMA,BZO.BAR,MTD,OXY,OPI,MET,AMP is the correct code for this 80100?
  32. S

    Patient Refunds??

    We are just wondering how other offices handle patient credits that are under $10.00? Do you send out refund checks to the patients?
  33. S

    Mycobacterium avium

    Can anyone help with a diagnosis code for history of mycobacterium avium? Any help would be most appreciated :D
  34. S

    Billing of Flu Shot Clinics to Insurance??

    Our Site Manager wants to bill the children's insurance companies when our nurses go to the schools for the flu shot clinics. My thought is we cannot bill insurance for this, the service is not being provided in the office? Can anyone help with this?
  35. S

    split s1

    Is 427.89 the appropriate dx for this, I cannot find a more specific code?
  36. S

    hypertestosterone dx help

    what is the appropriate code for hypertestosteronism for a female?
  37. S

    dx documentation for uncontrolled diabetes

    I am having an issue with dx 250.02, the notes do not state the diabetes is uncontrolled so I have been confirming with the providers it is uncontrolled and if so to state that in the note. I am getting some resistance on them stating 'uncontrolled' if they ran labs that came back abnormal...
  38. S


    :confused: Is this something that we can even bill for? The patient doesn't have a chief complaint? Vital Signs: Time: 04:26 PM Weight: 212 lbs Height: 62" BMI: 38.77 Temperature: 98.0 F (Oral) Waist Circumference: 46 inches BP: 118/60(Left Arm)(Sitting) Pulse: 100 Oxygen: 97...
  39. S

    Preventive and E/M Resource

    I am trying to find a good resource to share with our providers that gives 'direction' of when it is acceptable to bill and E/M with a PM visit. Can anyone help with this?
  40. S

    patient charges for preventive care

    A self pay patient came in for her a general physical and had lab work done etc. Then in two weeks she came in requesting a WWE. Is it appropriate to charge her the full amount of two preventive visits?
  41. S

    dx for breast feeding

    Our providers want to report if a patient is breast feeding, is there a dx that just shows the status of a mother breast feeding with no problems? Would V24.1 work if the provider is not providing supervision?
  42. S

    dx for breast feeding

    our providers want to report if a patient is breast feeding, is there a dx that just shows the status of a mother breast feeding with no problems? Would V24.1 work if the provider is not providing supervision?
  43. S

    Auditing HPI- help

    :confused: I am pretty new to auditing charts and need some expertise on the auditing of a chart HPI. The HPI states: Patient is here in the office for review of labs. Endocrine: Patient is here for follow up of diabetes. Goal for this visit is : Establish care in diabetes. She has type 2...
  44. S

    2 E/M same day by same provider

    I am a little confused on how to do the billing for these visits, the visits were unrelated to each other so they should be billed two separate ovs correct? do I use a modifier on these or send in the notes with claim to show visits were unrelated? Any help is much appreciated.
  45. S

    help with dx code - the provider wants dx for recto-vaginal

    the provider wants dx for recto-vaginal fistula but the note states possible. What would the appropriate diagnosis for this be? Vaginal Examination reveals: discharge present and is brown, stool . and malodorous . No radiation changes note; possible recto-vaginal fistula present. Any advise...
  46. S

    Influenza Like Illness - help

    Our providers want to give the dx 487.1 to patients that have flu like symptoms but have negative tests. The description of 487.1 is influenza with other respiratory manifestations so we would be reporting cases of the flu that are not actually positive cases. Am I thinking correct here? So...
  47. S

    Filing Denials

    We have heard both answers to this but would like any feedback... Are we supposed to file a claim to any insurance company that we know is not covered and will be denied. a couple of examples: filing visits with dental dx to Medicare? filing sick visits to Medicaid when the patient is only...
  48. S

    Documentation Question

    For the examination our providers have added the notation 'unchanged from the previous visit' to the templates. Don't they have to document the examination again?
  49. S

    Resource for E/M coding

    What is the best resource to use for an internal audit of charts for E/M level? I have heard of charts and wheels?
  50. S

    aorta graft dx help

    our provider wants a dx that reflects the patient has had a aorta iliac femoral bypass. the only thing we were able to come up with is V45.81 but he does not like that. Can anyone help with this?