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    Medicare wrap around payments

    Newbie I have been tasked to file wrap payments for the first time in this FQ. I am curious how exactly you submit your claims, do you create a new claim within your pm to send out? I appreciate any and all information you have, thank you
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    Telemedicine Services

    oh goodness I don't know where my head is, thank you!
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    Telemedicine Services

    other service I know that we can charge the q3014 and bill to medicare. What do we do with the OV charge for the psychiatrist? any additional information would be extremely helpful. Thanks
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    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!!
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    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...
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    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...
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    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...
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    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?
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    HPI Elements or Conditions???

    I am having a hard time pulling any HPI elements out of this also.
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    Auditing Medical Decision Making

    Is this information still available? I would love a copy if possible. shobbs@katyhealth.org
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    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...
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    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?
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    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...
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    Chief Complaint - I have a couple questions

    When the ancillary staff record the chief complaint should it be documented this information was obtained by the nurse? One of our providers do not want to make the Chief Complaint "busy" by adding this information.
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    Another Opinion on E/M Level

    I am going to take this back to the provider, I do not think any of the PFSH should be counted even though it states it was reviewed nothing had changed nor was pertinent to the presenting problem. So that will get the history to EPF and I believe agreeable with the provider. As far as the...
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    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...
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    Obesity dx 278.00

    Right, that is my concern because the commercial payers are not covering the 278.xx dx. The patients are coming in for help and trying to become healthier but their insurance is not covering the visits so it deters them from returning. If we prescribe medication or counseling are there more...
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    Obesity dx 278.00

    when patients present to the office for weight loss options, etc. Is it appropriate to only use dx 278.xx?
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    Dx code for "well child"

    What about dx V65.5?
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    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?
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    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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    IPPE exams with new requlations for 2009

    I am a little bit confused on what is actually required for the end of life planning. Do the providers just need documentation if the patient has an advance directive in place and if so if the provider agrees to follow this? If not, do they determine the patients ability to develop their...
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    99214 vs 99215 ?

    I agree with the exam, but was told I could look at the last visit examination because it was the same. Personally, I don't agree with that how can they be sure the same systems were checked and everything was the same.
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    99214 vs 99215 ?

    I see where we have a problem with the CC now, this information is documented by the nursing staff but not recorded that the nurse took the information. So, there is a disconnect in what the patient has told nursing vs. the provider. I am working the clinic manager to have it documented that...
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    UA during Preventive Exam bundled?

    I could not find it either. It is one of our Medicaid managed care companies in MO that said they recently recieved information that the only E/Ms the UAs would be allowed with are 99201-99215 and 99241-99245. So I figured if it was new and we would start seeing it with medicaid and the rest of...
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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?
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    Secondary Claims to Managed Care Companies

    How do you handle that in your practice management system, write off code for COB?
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    Newsletter has gone out

    Please add me to your list shobbs@katyhealth.org
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    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...
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    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...
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    office visit coding help

    The patient came to our office to see the psychiatrist via telehealth. Are we not supposed to report Q3014 as the originating site? Thank you for your help Claudia.
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    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?
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    Anyone billing their BH claims under FQHC to Medicare???

    I bill at an FQHC and the BH claims are not split up for billing. You are using the 0900 revenue code? What kind of rejections are you receiving back?
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    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...
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    new to auditing and would appreciate a second opinion on visit note

    I had thought the same thing and was not comfortable with taking it up to a 99214 so kept at 213. Thanks!
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    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?
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    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...
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    Let's start a pysch coding email group!

    I think this is a great idea, I am very new to psych coding please add me to your list. I have a few questions about the new CPT code changes for 2013. shobbs@katyhealth.org
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    new to auditing and would appreciate a second opinion on visit note

    Can you help me understand why the dermatitis with new problem get 3 points?
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    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.
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    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 &...
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    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...
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    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...
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    Addendums..?

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