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    Frequency for AWV

    Medicare AWV We have the patient back for AWVs after 12 months have elapsed.
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    Advanced Care Planning Diagnosis - claims denied for medical necessity

    Advance Care Planning I contacted Novitas who does not, at this time, have an LCD for the ACP codes. there is no list of allowable ICD-10 codes for the CPT codes.
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    Tobacco Cessation Codes

    Tobacco Cessation codes Our providers do not document in the smoking cessation counseling note how smoking affects their chronic problems. They document what they advised the patient, if they prescribed anything for tobacco cessation, and the amount of time spent counseling, which determines...
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    Wiki Diag codes to be used with 99497 and 99498

    Acp I looked around quite a bit yesterday for guidance on these codes, but found none. There is no guidance as to whether 99497 has to be 30 minutes or up to 30 minutes, and not one article addresses the ICD10 coding for this service. The "feeling" I got was that since Medicare is just...
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    Wiki Coding for sore throat/pharyngitis

    strep throat If the strep test is positive the correct code is J02.0. I do remove the pharyngitis code from the encounter, and it still gets paid.
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    preventative office visit

    preventative visit Did the provider bill the preventative code on the first visit? If so, you cannot bill it again. You could bill a 99211 with the vaccines because you have the ROS, etc on the follow up, but then you could not bill the 90471 with the vaccine codes.
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    Review of Systems based on HPI

    I have a note that states HPI: 1)Here to talk about Viagra, 2) feels depression for about a year. ROS: see above. How would this count in the History section?
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    Med Mngmt during global

    Global If the provider addressed the other problems and provided refills for them, besides the global issue, you may use the modifier on the E/M code and bill for the medication management of the separate issues
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    Physical, Medicare AWV, and office visit

    AWV and OV We normally bill a 99213/25 with the AWV code. The dx for the AWV is V70.0. We only bill a 99213 because so much of the HPI is covered under the AWV. It helps to pull in a separate note for one of the medical conditions in the EMR. Medicare and the Advantage plans all pay on this.:)
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    New patient wellness and OV

    Can a new patient office visit be charged with a new patient wellness? The patient was new to the clinic and the provider, and was scheduled for a wellness visit. The patient also has chronic comorbid medical conditions which were discussed and prescriptions provided. My billing office is...
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    We give a lot of 120mg of DepoMedrol injections. We use 80mg multidose vials. My billing office is telling me I cannot use J1030 because we do not have 40mg vials in the office. I disagree because it is a multidose vial and the only way to bill 120mg is with the two different codes. suggestions?
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    Have a question for Family practice coders

    Where to look for information Two good websites are Mayo Clinic and The Cleveland Clinic
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    Zostovax Injection

    Zostavax We have the Medicare and Medicare Advantage patients sign an ABN for Zostavax injection with patients own meds. It is not a covered service for Medicare. Our providers sometimes recommend the patient receive the injection at the pharmacy the get the med from, if the pharmacy does...
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    Labs included in preventive care visit?

    wellness labs Different insurers allow different wellness labs, but generally we bill a CMP, CBC and Lipid profile for adult wellness and get paid. Some insurers will also cover TSH (expecially for female patients) and a UA.
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    Irrigation code 69210

    69210 The description of 69210 in the CPT book states instrumentation is required. An ear wash using irrigation only would require an E/M code.
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    Annual Medicare Visit with a problem visit on same date of service

    Medicare Annual Wellness visits I printed off the information on MAW visits from Medlearn and presented them to our docs. I also explained that since the guidelines did not allow for an actual physical exam, they could charge for the physical exam and review of labs using 99212-99214, but not...
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    Which modifier during global

    Sorry, this is a duplicate entry. Please disregard!
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    Which modifier during global

    A patient was in for her Medicare AWV and the physician cryoed a plantars wart on her foot. She came back a week later and had another plantars wart cryoed, same foot, different location. What modifier would I attach to the second 17110 done one week after the first?
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    Billing 96372 twice

    Is it possible to bill 96372 twice? A patient comes in and has two separate medications of their own that need to be injected. I don't think a modifier would be appropriate because 96372 is not considered a "medical service." Any suggestions?
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    G0250 - aloowable dx codes

    Can anyone help me with billing G0250? I can find the aloowable dx codes, and everyone I ask says they never get paid, but I cannot find any guidance on exactly how it should be billed. I know the tests have to be done one week apart and you can only bill every 29 days, but how do you indicate...
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    Code for No history of Chickenpox

    Thanks, we did get an ABN, but i am going to call her secondary tomorrow and give them the possible codes. Hopefully, they will pay.
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    Code for No history of Chickenpox

    I have a patient who is hesitant to receive the Zostavax vaccine. she belives she may have never had the chicken pox. We could draw a titre to see if she has, but Medicare will not pay for it. Her secondary, which is through a retirement plan, said they would cover the titre if it was coded...
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    Coders: Annual Wellness Visit--Read the Guidelines!!

    Awv That sounds correct. Our doctors, after I gave them the guidelines, have adhered very well to covering and documenting everything required by the AWV guidelines. I did have to reiterate that if they bill for an E/M at the same time, they cannot use a combined ROS, vitals, etc for both...
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    Tuition Reimbursement

    Reimbursement I work in a clinic within a hospital system. I am reimbursed for the charge for attending seminars, and am allowed 16 paid education hours a year. My annual AAPC dues are not reimbursed, although they did pay for me to take the test. For attending school, the class(es) must be job...
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    Modifier with G0438

    My doc saw a patient for several issues (99214-25) and also did the Medicare Wellness (G0438). In addition he did a trigger point injection (20550) and tobacco cessation counseling (99406). I know the modifier -25 is necessary, but the edit on my sofware is telling me there is another modifier...
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    what modifier??

    I would think the 99396 needs a modifier -25 also.
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    CPT help

    teaching meter use If the patient comes in separately from a regular visit, you can code a nursing visit, 99211, for the service. If it is being done at the time of a physician exam, you cannot bill separately for the teaching.
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    Screening Question

    Coding for labs If the labs are being drawn in conjunction with the patient's annual wellness or preventative care exam, I code them to the wellness code. If they are drawn at other times of the year to keep up with the patient's disease process i would use the diagnosis codes for the disease.
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    Cortisteroid Injection

    Trigger point and joint injections I bill for the medications used. They are not included in the procedure code.
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    Coding for reading EKGs

    My doctors read EKGs at the hospital both for in and outpatients. Should the reading for the EKG be billed with the POS as inpatient, outpatient or ER? This would be as opposed to billing them as being read in the office, which they do not.
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    Coding for reading EKGs

    My doctors read EKGs at the hospital both for in and outpatients. Should the reading for the EKG be billed with the POS as inpatient, outpatient or ER? This would be as opposed to billing them as being read in the office, which they do not.
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    Lab Orders... am I totally wrong here?

    If the doctor has signed a standing order for the lab, it is good for one year. Although it would be "good medicine" if the doctor mentioned the PTs in the OV notes, it is not necessary. It is necessary for him to sign off on each PT result in the patient's chart.
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    NCD/LCD for 17000

    In Arkansas there is an LCD for the use of 17000 & 17003 for 702.0(actinic keratoses). However, I have never had this CPT and ICD combination denied by Medicare. Recently I had a Medicaire Advantage plan deny a claim with these codes based on the LCD. i asked my providers to have ABNs signed...
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    Which modifier for primary service?

    A punch biopsy(11100) and cryo(17000/59) were done on Medicare patient. The punch biopsy was denied as bundled. Any suggestions?
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    Coders and Billers outdated?

    EMRs We are going to EMRs in September. I am in a 5 provider family practice. I will be reviewing the records from the previous day to make sure all the codes, both CPT and ICD are correct, and that all charges are captured. I doubt my docs could learn coding before I am old enough to retire...
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    My best tool for auditing is from Family Practice Management, called the Pocket Guide to the Documentation Guidlines. It was revised in 1998, and I have used it for several years, but you might be able to contact them and see if it is still available. The Medicare Learning network has an...
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    Icd 9 for

    Tobacco/alcohol dependance I would use the V codes for these if the doctor states they have quit.
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    Lab Screening

    Wellness labs I use V72.62. I have had some issues with ins companies not recognizing the code because it is new, but if the patient is in for a wellness exam, and the labs are ordered as part of that wellness, the labs should be coded to V72.62.
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    malignan/benign lesion removal

    A doctor excises a skin lesion which the pathology determines is malignant and close to the borders. He brings the patient back in for a wider excision to be sure the malignancy is completely removed. The path report of the second excision comes back completely benign. Do you code a malignant...
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    Number of Doctors

    audits I audit for 3 family practice physicians and 2 APNs. If I have the whole chart, not just the note, I can usually audit one note in a few minutes. I can do it quickly because I am very used to the audit tool I have. These are family practice office visits, and occasionally a minor...
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    36415 and Medicare

    36415 I believe Medicare does allow for 36415 if there is no E/M, however, very few 3rd party payers will allow 36415 anymore and bundles them into the lab service. If something other than blood is being collected you may not use 36415. Medicaid does not allow the 36415 either
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    Medicaid H1N1 coding

    H1N1 coding In Arkansas we use G9141 for the administration. it is accepted by Medicaid. There is no charge for the medication, because it was all provided by the Federal Government. Medicaid may require the NDC code for the medication when the administration fee is used. The diagnosis of...
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    ABN Use and Co-Insurance/Co-Pay Collection

    Medicare Advantage Plans If no contracts are in place for the Medicare Advantage Plans, and you are only accepting the PFFS plans, there should be no need for an ABN, and you can collect whatever that company advises you the patient will be responsible for.
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    2010 e-Prescribe G code

    e prescribing We use Allscripts and use G8553 if an e-rx was done.
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    DIagnosis code for heavy vaginal bleeding

    heavy bleeding Was it documented that she had a positive pregnancy test before she took the "abortion pill," or was she taking it because she had unprotected sex and wanted to avoid pregnancy. That makes a difference in how you code the heavy bleeding. With no documentation of positive...
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    Neoplasm/ uncertain vs. unspecified

    if the path comes back inconclusive you may use the uncertain. Unspecified is just that, i.e. a puch biopsy charge that is billed before the path report comes back.
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    destruction of molluscum contagiosem to the neck

    destruction of molluscum contagiosum I believe you would use 17110, destruction of benign lesions other than skin tags, up to 14 lesions
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    Radiology code for knee/3 foot standin

    X-ray of thigh to ankle Perhaps you should use 76100. Other than using three different codes for the femur, knee and tib/fib, there aren't many options
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    CMS-1500 Questions

    If the service you are billing for -EKG- was performed in another location and your doctor is reading it, you would bill the professional component only of the EKG. If you are performing and reading the EKG, you bill for the whole thing.
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    Using codes from the Neoplasm Table for beningn lesions

    How do I convince another CPC that I do audits with that it is okay to use benign codes from the neoplasm table if the lesion is benign? She insists that the code has to be 709.9 if a benign lesion is treated, biopsied or removed.