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    Office-Based Anesthesia Billing

    Hello! I have a few anesthesiologists who provide services in an office environment (no facility claim being submitted). Our understanding is that we may submit additional CPTs (aside from the base + time) codes for consideration. Who is billing the following and what are you including /...
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    New York Workers Comp Billing for Anesthesia

    Hi, Our office typically bills anesthesia (provided in ASCs) in the State of NJ. We're now providing services in NY state, and I understand that are some caveats to billing workers comp carriers. I've been told that we cannot bill U&C, but instead we must bill based on the fee schedule...
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    NJ Workers Comp Appeals

    As many of you know, many NJ Workers Comp insurers pay poorly. There is no fee schedule in place, which is a good thing...but, has anyone found a means of leveraging a higher reimbursement? Though we're sometimes successful by submitting redacted comparable EOBs to these payers, most of the...
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    Out of Network Appeals for ERISA plans

    Does anyone have an effective appeal letter which addresses inadequate reimbursement for OON self-funded plans? We have a solid assignment of benefits form, however, we could use some direction with the context of our actual appeal. I understand we have quite a bit of rights under ERISA. If...
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    PT Coding Question

    Hi! We're billing the following PT codes: 97163 97014 97010 97140 97535 All are affixed with a GP modifier for Medicare, however is a -59 needed? All of our notes seem to indicate that it's only required if billing CPT 97164 (Re-Eval). Can someone please confirm? Also, for Medicare, please...
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    59 Modifier with PT Billing 97140

    Hi! My PT biller is out this week and I've noticed she's been billing the following the following for a single PT visit: 97140-59 97110 97026 97014 97010 According to CCI, however, I cannot find evidence of why -59 is being affixed to the 99140. Am I missing something? I know if it's done on...
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    Post-op care for 0191T iStent with Cataract

    We are attempting to bill post-op care for a cataract/iStent insertion using a 55 modifier. Medicare has denied our submission of 0191T-55. Can the 55 modifier ONLY be used with the actual cataract code, 66984? Any input is appreciated!
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    Medicare Primary, Medicaid Secondary

    I have a question regarding a providers ability to balance bill. The provider is in-network with Medicare, but does not accept (and is not in-network with Medicaid). Can the provider balance bill the patient the 20% coinsurance which Medicare does not cover, despite the patient being enrolled...
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    Pain Management Coder/Billing in NJ

    We are offering a position for a medical billing and coding specialist to join our team. Our office is a multi-specialty billing & practice management company located in Bergen County, NJ. Specialties serviced include: chiropractic, acupuncture, physical therapy, anesthesia, and pain management...
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    Appeal techniques for OON claims

    One of our providers recently decided to go out-of-network with major insurance companies. I'm looking for some tips on what to include in our appeal letters to these payers for increased reimbursement. We are mentioning: FAIR Health rates for our geographical area Relevant aspects of the...
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    Opt-Out of Medicare and Secondary Insurance

    One of our providers is debating opting out of Medicare entirely. Many of her patients have secondary insurance in the for of supplemental and true "commercial" secondary. Though I've contacted many insurance companies, about this, none of my reps have responded with a definitive answer... If...
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    Medicare denying Ultrasound Guidance used with Regional Block Placement

    Since January, CMS has been denying about 85% of our claims for ultrasound guidance 76942-26. Our anesthesiologists use ultrasound guidance when placing nerve blocks for post-operative pain control (sciatic/femoral/etc). Some of our appeals have resulted in the claim being reprocessed, but...
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    OMT by DO and Manual Therapy

    Hi, My provider is a DO and wants to bill for OMT, 1-2 body parts using code 98925. He also listed 97110 (Therapeutic Exercises) and 97140 (Manual Therapy). I know I can't bill all, but can you please confirm if I CAN bill: 98925 and 97110 together? I don't see any CCI edits prohibiting...
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    97140 and 98925 Bundled?

    I'm billing for an anesthesiologist for the following CPT codes: 97140 - Manual therapy on thoracic region 98925 - OMT to cervical and thoracic regions Are these separately reimbursable? Should a -59 modifier be placed on the 97140? or Should we only bill 98925 Thank you!
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    LAC vs LPC Billing

    Hi, We are currently enrolled as a FACILITY with Value Options. I have both LPCs and LACs licensed in the state of NJ. Will LACs be reimbursed or do payers only reimburse LPCs? I cannot get a straight answer from Value Options. Thanks!
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    PQRS Incentive Payment

    Hi! I received a payment from Medicare marked "Levy" today for virtually all of our providers. When I called Novitas/Medicare, they only indicated that this payment relates to PQRS and that no other information would be available. When I called the QualityNet Hep Desk, they indicated that a...
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    Medicaid Billing Question

    One of my providers has chosen not to see Medicaid patients any longer due to the low reimbursement (he's still enrolled as a provider). If a nursing facility is willing to pay for his services upfront (without billing Medicaid), is there any issue with that arrangement? It's a simple...
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    Modifier PT for Colonoscopy being denied by CMS

    All of our anesthesia claims are being denied by Medicare when billing: 00810 AA QS PT The 33's are being paid correctly. The "senior CMS rep" has directed me to a January 2015 Release - Part B document which only calls for modifier 33 to be used for anesthesia associated with screening...
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    PreOp care for Extracapsular Cataract Sx 66984

    Hi, We recently submitted a few claims to NJ Medicare for Preoperative Care for extracapsular cataract surgery. The patient intends on having the surgery with another physician. We billed: 66984 with Modifiers: 56RT, Diagnosis was 366.15 Medicare's response is: Procedure code modifiers for...
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    Sternum procedure coding

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    Reporting 58661 vs. 44005

    Hi AAPCers, My provider performed: D&C (58559) Right salpingo-oophorectomy (58661) Laparoscopic Enterolysis [separate procedure] (44005) The D&C is a straight shot. However since the Enterolysis code has a higher work RVU, should it be billed instead of 58661? Alternatively, I've read that...
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    D&C Coding Question

    Can someone assist our office in coding the following? Our coder is away and we'd like to submit these claims. Any help is greatly appreciated. Case# 1 D&C 58558 Laparoscopic Enterolysis 44005 (as a separate procedure) Diagnostic Laparoscopy Pt was diagnosed as follows: Irregular Menses...
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