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  1. R

    IDC-10 payment information

    Hello, I was hoping someone could lead me in the right direction. I am looking for a way to find out if certain diagnosis codes are covered/reimbursed by certain payers in our area. I am a coder/auditor/risk adjustment coder, but a lot of providers always ask me if certain dx codes are actually...
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    96127 vs 96160

    Thank you! That is the information I found as well, I was just hoping someone could elaborate on that and if in fact the 96127 is used to bill for the PHQ9
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    96127 vs 96160

    Hello, I need some clarification on 96127 vs 96160. My previous employer always billed the 96160 for depression screen questionnaire PHQ-9, and I just want to make sure that is correct, because when you research online it states the PHQ-9 should be 96127. Can anyone give me some insight on the...
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    Risk Adjustment - Medication List

    Hello, I have a question in regards to using a medication list in order to validate diagnoses reported within the record. If a patient has for example COPD in the PMH/PL list and it is not validated anywhere else in the note, but in the current med list, the medication Ventolin is documented...
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    Medication List / Risk Adjustment

    Hello, I have a question in regards to using a medication list in order to validate diagnoses reported within the record. If a patient has for example COPD in the PMH/PL list and it is not validated anywhere else in the note, but in the current med list, the medication Ventolin is documented...
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    CMS 2019 proposed changes

    Hello, is there a link where I can subscribe or frequently check for updates to the 2019 proposed changes by CMS. I read that they are supposed to make a decision on the their proposed 2019 changes included all the E/M changes and, I want to make sure i get the information as soon as its posted...
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    New Patient OV with a procedure

    Thank you, your response was very helpful. My reason for asking was that we recently had an outside audit by insurance company and the biggest issues were E/M with procedures and the fact that a separate E/M was not warranted. Those have since been corrected, but then we were "advised" that...
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    New Patient OV with a procedure

    Hello, here is my scenario. A provider sees a new patient, the reason for the visit is to remove a wart and there is nothing else wrong with the patient in order to warrant a separate E/M to be billed with the procedure. The new patient E/M (99203 for example) has a higher RVU than the wart...
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    Long Term Use of Aspirin

    Thank you so much, that what I was thinking as well.
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    Long Term Use of Aspirin

    Thank you , yes that was the point I was trying to get across, was that it should be linked to some sort of condition if we are to report as long term use, otherwise we shouldn't be capturing long term use of aspiring for every patient that has this on their med list. Thanks for your response!!
  11. R

    Long Term Use of Aspirin

    Thank you, I wasn't just referring to Medicare HCC's, there are other risk adjustment models such as DxCG in which long term use of aspirin does risk adjust, that's why I was asking. Thanks!
  12. R

    Long Term Use of Aspirin

    Hello, I have a question in regards to Risk Adjustment coding. When extracting codes from documentation, If Aspirin is in the current medication list, would you automatically code for Long Term Use of Aspirin? Have a debate in regards to this and I wanted other opinions/thoughts on this.. My...
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    Risk Adjustment Coding Information

    Hello, i was wondering if anyone has any specific websites, or newsletters in regards to HCC's and Risk Adjustment Coding information that they subscribe to, that sends out periodic updates etc. If so can you please provide the link or info. I like to stay current with any and all changes and...
  14. R

    Coding BMI without associated DX

    I am a risk adjustment coder, and I don't think the question is being understood correctly. I have spoke with several other risk coders and everyone says it depends on the project and assignment. My question is not who can document. I know that anyone can basically document the BMI, but that the...
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    Coding BMI without associated DX

    Hello, I need some clarification, if you will on something. As it pertains to Risk Adjustment Coding, is the coder allowed to extract just the BMI code if documented, without any associated dx also being documented, such as obesity, morbid obesity, overweight? I understand that the BMI codes are...
  16. R

    DxCG Medicaid Risk Model

    Does anyone have a list of the diagnosis codes that are on the DxCG Medicaid Risk model? I cannot seem to find them anywhere and they are not posted like the dx codes for the HCC risk models. Thank you
  17. R

    Massachusetts Medicaid ACO

    Any have any updates or feedback?
  18. R

    Coding for Diabetes with A1C results

    Thank you so much Pam. Those were my thoughts as well, but I needed some back up in order to prove my point here with the rest of the coding staff lol.. :D
  19. R

    Coding for Diabetes with A1C results

    Hello, I have a question in regards to HCC codes. If a patient comes in and the provider states the patient is there to follow up on the DMII, and the provider documented that the patients' A1c levels are @ a 7.1, can the coder then documented Diabetes Type 2 with Hyperglycemia, or does the...
  20. R

    Gestation diabetes during post partum period

    I am not really familiar with OBGYN, but I have a provider who is coding O24.415 - Gestational diabetes mellitus in pregnancy, controlled by oral hypoglycemic drugs. My issue is that this patient is 7 month postpartum, therefore I believe that this MD should not longer be using the O - code...
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    Massachusetts Medicaid ACO

    Hello, does anyone know if there is a list of approved diagnosis codes for the Massachusetts Medicaid ACO. I know they have states that as of right now they are not providing the specific dx codes like CMS and HHS do with the HCC's, and that they are just providing "categories", but I have found...
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    ED visit for rabies vaccines

    Can the ED physicians bill 99281 if the patient is coming back to the ED just for the rabies vaccine series? Example: Patient comes in to the ED for raccoon bite, appropriate history, exam and MDM are documented and pt is give then first rabies vaccine and instruction to return for the next...
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    Documenting Drug Waste

    Hello, I understand that if you are billing for drug waste, that CMS clearly states that you need to document the exact dosage of the drug injected and exact amount and reason for waste. My question is, if you are NOT billing for the waste is there still a requirement to document for it? Any...
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    Office Procedure Documenation

    When a provider is performing a procedure in the office, should the provider be documenting a description of the procedure performed, i.e. how patient tolerates, any complications etc, or is simply stating "Anoscopy done today" enough to bill for that procedure.. P.S. im pretty sure i know the...
  25. R

    procedure documentation requirements

    I have a provider who when doing a procedure will only document the procedure and the findings as a result of that procedure, but does not document or describe what was done during the procedure. Example is when doing an a 46600 (Anoscopy) the provider only documents for the procedure; Anoscopy...
  26. R

    Procedure description documentation

    I have a provider who when doing a procedure will only document the procedure and the findings as a result of that procedure, but does not document or describe what was done during the procedure. Example is when doing an a 46600 (Anoscopy) the provider only documents for the procedure; Anoscopy...
  27. R

    Assessment and Plan not documented

    Awesome! He did put a diagnosis but did not state anything as far as a plan of care or any follow-up or anything so i did not feel comfortable even giving it a 99212 which is what History and Exam supports but MDM is our driving force and without a plan i was not comfortable moving forward with...
  28. R

    Assessment and Plan not documented

    Also if anyone has any references/resources to any guidelines that state if a plan is required to be documented in order to bill the charge would be appreciated. Thank you
  29. R

    Assessment and Plan not documented

    Hello, if a provider see's a patient and provider a diagnosis for the patient but ultimately does not document a plan of care at all, or document any follow-up or meds or anything, would this still be a billable service? I am torn since the MD does diagnose the patient but then does not document...
  30. R

    ED coding profee vs facility

    thank you all for your help, I really appreciate it!
  31. R

    ED coding profee vs facility

    Thank you so much, that is what i thought, but i needed confirmation. Do you know where i could find any resources or articles that state that? Thanks again!
  32. R

    ED coding profee vs facility

    I have a question, when billing for an ED E/M would you bill for any vaccines or medications given in the ED or would that be billed under the facility side? What about vaccine administration code i.e.90471, 96372, would those be billed through the facility side or would the provider also bill...
  33. R

    Emergency Department Professional Billing

    That is great info. Do you have any references for that information. I just like to provide back-up whenever i educate on a certain topic. Thank you
  34. R

    Emergency Department Professional Billing

    Hello, does anyone have any info or resources on the professional side of ED billing/coding. I am wondering what providers can and cant bill for in the ED. A question came up this week if the providers can bill for vaccine and intramuscular meds given in the ED along with the E/M or if its...
  35. R

    Documentation requirements for performing provider of a procedure

    If an ER physician see's a patient and does a procedure while the patient is in the ER and documents a separate procedure note, does the procedure note need to clearly indicate who the performing provider is, or is the signature of the entire note enough.. I see that within the note they are...
  36. R

    ER visit with procedure late on same day

    A patient comes into the ER for a visit in the morning and then is sent home. Later in the day they call the patient to return to the ER because X-ray shows there is a fracture and they need to cast it. Patient returns to ER later in the day and gets a cast. I know we cannot bill for 2 services...
  37. R

    Yearly physical done by one provider and Pelvic and Pap done by another on same day

    Hello, I have a question. If a provider is doing a yearly CPE and during the CPE calls in another provider within the group to do the Pelvic and Pap because the patient required a female provider to do so, can we bill the provider who did the CPE for the year physical and the other provider just...
  38. R

    Modifier 53 with medicaid

    If Medicaid does not accept a 53 modifier, then how do we indicate that a procedure was discontinued? Thanks :)
  39. R

    Otoacoustic emissions test

    I have a question regarding this. Our office owns and read the report for 92587 but Medicaid will not pay unless we provide a TC or 26 modifier. Confused on which on to put?
  40. R

    92587 documentation

    pediatric provider billing code 92587. Dont they need to indicate in documentation whether one or both ears were tested, and if they was done as routine or because of failed hearing test?
  41. R

    Minute clinic vs office visit

    The minute clinic is a separate office from us, so they would bill under a different NPI. In that case would we still get paid?
  42. R

    Minute clinic vs office visit

    I'm pretty sure I know the answer to this question, I just want to make sure!! If a patient is seen at a minute clinic in the morning and then comes into the pediatricians office later that afternoon for a sick visit, only one provider will be paid for that day correct?
  43. R

    New patient/ no established care but wants vaccines

    so the doctor would have to establish care, meaning seeing the patient for an OV or PE before the nurse could administer vaccines correct?
  44. R

    New patient/ no established care but wants vaccines

    If a patient wants to come in for a meet and greet and is not yet an established patient but they want vaccines on the day they come in for their meet and greet? The nurse would be the once giving the vaccines?
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