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  1. L

    Hcpcs j7611-j7614

    I am trying to find out if these J codes can be billed in a physicians setting when we give a nebulizer treatment in the office? Thank you. L~
  2. L

    Proctoring

    Thank you, Chelle. Can I ask you some credentialing/contracting questions?
  3. L

    Proctoring

    A new gastroenterologist in our practice is being proctored by another physician. Do we bill under the new physician? Seems like a stupid question. I just want to be sure. Thank you.
  4. L

    Contracting and credentialing/Places of service

    How do I add a new place of service to our insurances? Does this place of service have to be a part of our contract? Do I just add it to CAQH? I've never done this so I don't know what to do? Thank you.
  5. L

    NCCI Edits

    Hi, I hope someone can help with this question. I am trying to bill 45380 with 45381. The NCCI edits do not have the codes in the column 2. If you look for 45380 in column 1 or 45381 in column 1. Does that mean I can bill them together without a modifier? What does it mean? Thank you for the help.
  6. L

    Need Dx Code...

    What Dx code would you use for "post-polypectomy scar in the proximal ascending colon". It was treated with APC. Thank you!
  7. L

    Food Impaction Dx

    My doc removed food impaction in the ER. The consult did not state there was any difficulty breathing, only difficulty swallowing. I don't really want to use T18.120A because it states "causing compression of trachea". What dx code would you use? Thanks.
  8. L

    Medicare Billing for an ASC

    Thank you so much for the clarification! You don't know how helpful this is!
  9. L

    Medicare Billing for an ASC

    I am having the most difficult time with my clearinghouse trying to setup billing for our new ASC. The commercial payers are fine. They are setup on UB-04s. From what I have read on CMS.gov, for an ASC Medicare and Medicaid claims need to be sent in a HCFA format. They problem I am having is...
  10. L

    -TC Portion Pathology in ASC

    I'm new to both pathology and ASC billing. I have billed our -TC portion of the pathology that was done in our ASC. I billed 88305-TC with a POS of 24. I am being denied with Cigna for inconsistent modifier use and an Aetna denial because "treatment has been rendered by the payer to be...
  11. L

    hot vs cold biopsy forceps

    My two docs disagree on a coding issue. Can you gurus help? Polypectomy done with a cold biopsy forcep. 45384 or 45380 ? Their logic...One says 45384 can be done hot or cold regardless of what the CPT book states because it is a "removal of a polyp by biopsy forceps". One says no. The CPT...
  12. L

    New Gastro ASC

    Thanks!
  13. L

    Need ICD-10 help

    Thanks!
  14. L

    CMS Base Units

    I am new to billing Anesthesia. I am trying to figure the anesthesia allowable for Medicare in my area. Does anyone know the base units for 2015? I found the conversion factors for 2015 and the base units for my codes for 2014. And I know how to calculate it. I just want to make sure I am...
  15. L

    Need ICD-10 help

    My report states "An esophago-gastric anastomosis with an ulcerated stricture was found in the upper third of the esophagus. One superficial esophageal ulcer with stricture with oozing blood and no stigmata of recent bleeding was found 20 cm from the incisiors a the anastomotic site." Any...
  16. L

    New Gastro ASC

    Hello. I am new to billing for an ASC. Our gastro practice is opening an ASC soon. Do I bill facility charges on a UB04 forms for all payers for the ASC? So if I have a procedure 45378 I will bill my physicians services on a CMS-1500 with my practice tax id and 45378 for the facility on UB04...
  17. L

    Coding GI procedures that are bundled

    We are having the same discussion at our practice. I would love to see what some opinions are... Lori
  18. L

    45380, 45384

    I have a physician who removes polyps by COLD BIOPSY FORCEPS. We are having a discussion as to using 45380 which is a biopsy, but not a removal or 45384 which is a removal, but with HOT biopsy forceps. Which CPT code would you use? Thanks!
  19. L

    Documentation question

    I have a colonoscopy report that states in the description of the procedure that polyps were removed from the rectum by cold biopsy. This is not mentioned in the impression. Should I have the physician make an addendum to the report? Thank you.
  20. L

    Labs that are Client Billed

    Previous post How do I delete a previous post?
  21. L

    43255 EGD w/ control of bleeding question

    Thank you so much!:)
  22. L

    endoclip during Colonoscopy

    Endoclip I had this question the other day. Did you ever find an answer? Please post if you do! Lori Isner CMA, CPC
  23. L

    43255 EGD w/ control of bleeding question

    My physician was doing an EGD. He removed a polyp and had to use a hemoclip to control bleeding due to removal of polyp. Can I bill 43239 AND 43255? I always thought 43255 was for control of bleeding in another area or a post-op bleeding that was returned to the op room. For example, doing...
  24. L

    MCR Screening Guideline

    My physician and I are interpreting a Medicare guideline differently and I would like to know your thoughts. We have a patient that had a polyp removed 11 years ago. He did not follow-up for another colonoscopy during that time. I coded this as a screening colonoscopy and my physician says it...
  25. L

    Nutritional Therapy for Medicare Patients

    I would like to have your interpretation on the ADA guidelines for Medicare patients. Under their 2003 article for Medicare Part B it states: 1) Must bill Medicare Part B with thier own PIN 2) Medicare should only be billed for Medical Nutritional Therapy that is appropirately provided to...
  26. L

    Weekend code

    Can I use 99050 as an add on code to endoscopy procedures done in our office suite on Saturdays? I know I can add it to office visits, but for some reason I thought I could not add it to procedures. Thanks! :)
  27. L

    Elevated Vitamin B12 level

    Can anyone tell me the ICD-9 code that would be used for an Elevated B12 level? I have a patient who has a B12 over 1000 and doc has documented "elevated B12 serum level". I can find deficiency all day long, but not sure about elevated. Thanks for the input. Lori
  28. L

    No Nonspecific codes after Oct 1, 2013?

    Never mind...
  29. L

    PPD Administration prior to biologics

    We have patients that will be going on biologic medications and need to have a tuberculosis screening prior to starting. I am using the CPT code 86580 and an administration code 90772 and a nurse visit for the return reading 99211, but what diagnosis code would I use? Am I coding this...
  30. L

    Office Visit Prior to Screening Colon

    Thanks Thanks for all the thoughts and interpretations on this thread. I have found out through the AGA website that if a Medicare patient has a condition that needs to be followed carefully due to risk (i.e. Coumadin Therapy) and it is documented and justifiable, an office visit can be...
  31. L

    Office Visit Prior to Screening Colon

    Hi, everyone. I have docs that want to charge a new patient visit for a patient who is seeing them for an asymptomatic screening colonoscopy (patient over 50) when the patient has a commercial insurance. For Medicare patients, we do not charge an office visit prior. My physicians argue that...
  32. L

    Chg for Office Visit before colon screen

    I have a physician who states that I can bill an office visit (new patient) if the patient has come in for a visit prior to their screening colonoscopy and in the exam he finds GERD. He says since it is a dx in a different part of the system, I should code a NP office visit and use dx GERD...
  33. L

    Payer guideline pole

    I realize this post was a couple months ago, but I am having this problem with a patient right now. I recently attended a GI seminar by a well known GI guru. She stated the same thing scorrado posted. With the current patient, I may have billed it incorrectly though...She has a medicare...
  34. L

    MCR Replacement coding for screenings...

    Should I be using the G codes for screenings on Medicare Replacement Plans like Humana Medicare products?
  35. L

    Anesthesia Codes for colon, egd

    We are planning on having a CRNA to administer MAC anesthesia for IN office colonoscopies and EGDs. Yes. This is new in the GI world. Not an ASC...IN office suite for endoscopies. Would someone guide me through which codes would be used? Thanks.
  36. L

    43239/43248-51

    I am new to GI coding. I have heard and read that modifier 51 is not necessary. I am trying to code an EGD w/ biopsy 43239 and EGD guidewire followed by dilation 43248. Should I add a 51 modifier to 43248? I have read the threads in the modifier section regarding modifiers 51 and 59. I...
  37. L

    80101 bluecross

    I don't understand BCBS rationale. If you have a 9 panel test, you should be able to charge 9 units. Medicare guidelines require you to only submit one unit, I believe. I would like to know if you received an answer.
  38. L

    Influenza A/B billing modifiers

    Thank you, Dawson. I appreciate the reference, too. :)
  39. L

    Influenza A/B billing modifiers

    Will you share some insight on how you bill your Influenza A/B labs? 87804. Since they are two seperate tests, do you add a modifier -59 to one? Someone said a QW and 76 for medicare, but I don't agree. -76 modifier means a repeat and it's not a repeat test. It's a seperate test. Any thoughts?
  40. L

    injections and medication billing

    I am in a new office and I am questioning how they bill their injections and medications. For medications that are covered at a below cost amount at reimbursement through insurance companies (like rocephin, decadron, toradol) this office is not filing the J-code and just charging the patient a...
  41. L

    audiologic Function Tests + 69210 and G0268

    Hi, Suzanne, In our practice, we bill the E/M with 25 modifier, auditory testing and G0268 together and do receive reimbursement. It is helpful if there is a different diagnosis available as primary for the E/M visit and then code the G0268 with cerumen impaction. A 69210-59 will generally...
  42. L

    Diagnosis for Audiology Testing

    What diagnosis do you use if the doctor wants comprehensive hearing tests and tympanometry to rule out a disease and the tests results comeback within normal limits? My research shows V72.19. Is that good to use as a primary code for these tests? Also, if a patient comes in and takes the...
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