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    Question 99221-99223 denials

    Our office is also getting these. We are a cardiac surgeons office and a lot of our patients are TAVR's and are required to have a cardiologist and a cardiac surgeon sometimes this happens on the same day. Whomever gets the claim out first they pay. This just started happening
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    Question MODIFIER HELP!! 24 AND 25

    We do this with LVAD interrogation codes and e&m. Medicare pays we never have an issue.
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    Question Horizon denying E&M for valid Dx codes

    We have gotten some on surgeries. AVR 33405 with Aortic stenosis I35.0. Incorrect DX code. NO payment. Will bill hundreds of cases a year with that and to them. This was a first!
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    Aetna E&M Policy

    No we are a small office. Only 8 physicians on 1 tax ID. They are denying off physicians our office has nothing to do with. We are cardiac surgeons. The denials keep coming! It just started about 3 months ago.
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    Aetna E&M Policy

    There is a long article in Provider Communications 2018 No Policy # But in Claim Payment and Coding Policies it's listed unter Evaluation and Management E&M Services Payment Policy
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    Aetna E&M Policy

    Yes we have and they state it is their policy no matter whom bills the code that they will only pay ONE per day! How are we supposed to know that and if our billing is behind theirs we lose the money! Its been happening for a couple months now. On ALL Aetna plans
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    Aetna E&M Policy

    Message 005 "We were previously billed by and paid another provider for this service" D40
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    Aetna E&M Policy

    No we are a cardiac surgeons office. We are being denied off other offices under diff NPI's and Diff specialties. To us these are NEW patients. Their new policy states FOR ALL PLANS "We allow 1 of this group of codes per patient per day across all providers based on CMS guidelines." CPT codes...
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    Aetna E&M Policy

    Our office started to get denials for E&M stating this was partially or fully furnished by another provider. This is for a NEW PATIENT! 99204 Their new policy states FOR ALL PLANS "We allow 1 of this group of codes per patient per day across all providers based on CMS guidelines." CPT codes...
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    Medicare Denial: MA130-CLM IS UNPROCSSBLE, SBMT NEW CLM/

    I would look into Modifier XS or 59. And don't forget 51 for multiple procedures.
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    Little Frustrated

    I would just like to voice opinion if anyone at AAPC is listening. Member ship fees bit pricey. And last year when renewing my membership I was offered 12 months of webinars for $150 this year it went up to $215. And the CEU's went from 2 per webinar down to 1. Just wanted to put that out there.
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    TAVR denials

    No they do not. We use I35.0 and Z95.2
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    CAD with other angina

    I25.118 CAD with Exertional Angina 125.119 CAD with Stable Angina I25.110 CAD with Unstable Angina I25.10 CAD without Angina I tend to agree with the coder. Our Physicians are not always that specific but it helps us get to a better DX for the patient when they are.
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    Cardiac mass/lipoma coding dilemma

    D15.1 D17.4 Those are what come to mind.
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    Additional Reimbursement for Modifier 22

    I do not know where to find the info for this on CMS but I use modifier 22 quite a bit Medicare will almost alway pay more when this modifier is attached. Records must be sent for them to determine. I could be related to time, patients complex anatomy. A physician here used to dictate in the op...
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    Please read! Too complicated to title, thank you!

    Since you will be billing for the flaps and that is a procedure that has a global. I do not think you can charges subsequent visits.
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    Please help aaa

    34716 may work
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    Please help aaa

    33860 33866 35626 35626 - 59 36625 - 59 - Femoral Cut Down 37799 - Axillary Conduit Creation
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    Category III 0483T-0484T TMVR

    We are having trouble with them too. Some are getting paid and some are not. (Have only billed them with Medicare) Documentation does need to be sent. But it's a toss up at the moment if they will get paid.
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    TAVR two consultations required

    We have Julie Panter coming to our office next week. This question has been brought up I will get confirmation from her and get back to you.
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    TAVR two consultations required

    Yes two consults are required. If the patient is seen by two physicians in one day only one may be billed. We are the surgeons office. All our TAVR patients that are seen have 2 consults. Both billable if done on different days
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    TAVR- Subclavian percutaneous access

    In our office I use 33363 Q0,62 for subclavian open or percutaneous. We send the documentation also and they are being paid.
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    Supercoder - Does anyone use Supercoder

    I use the AAPC coder. Does anyone have a comparison of this to others. I feel that it leaves out a lot of information that it says it has. For example CMS documents linked to the code changes. Says non available for code. At times this is very untrue and makes me have to pull the information...
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    Lesser of billed provision

    This actually happened to me on a personal medical claim. For three hours all I ever got was this was processed correctly. No reason why.
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    Modifier -22 Medicare insurance

    I work in cardiac surgery. We have only used the 22 modifier with Medicare. I submit charges. Then two days later we get the ICN number and fax in the operative note. From there they decide if they should pay the additional amount. 9 times out of 10 they pay. (we don't use it often)We always use...
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    TAVR Denials from Aetna

    No all of the procedures are billed with the same code every time. They are specifically denied due to the 62 modifier.
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    Tavr

    Do you know what ins company is denying them? I have been billing TAVR's for about a year now. And we are now just getting denials from Aetna
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    TAVR Denials from Aetna

    Is anyone experiencing Aetna Denials for Transcatheter Aortic Valve Replacement Codes 33361 due to Services of an Assist Surgeon, Co Surgeon, or Surgical Team are not covered. Per NCD Guidelines 33361 must always be billed with modifier 62 because a cardiac surgeon and interventional...
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    Aetna Plan TAVR Denials

    Is anyone experiencing Aetna Denials for Transcatheter Aortic Valve Replacement Codes 33361 due to Services of an Assist Surgeon, Co Surgeon, or Surgical Team are not covered. Per NCD Guidelines 33361 must always be billed with modifier 62 because a cardiac surgeon and interventional...
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    Radiopaque Markers during CABG

    Our physician has started to place Radiopaque Markers around the aortocoronary anastomosis during CABG procedures. Does anyone have or currently bill this for the thoracic surgeon? I am looking for a CPT code. Thank you
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    thoracic aortic aneurysm

    The aortic aneurysm codes that I would use for this op-note 33860 & 33870,52,59 (XS)
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    Left atrial appendage removal

    Our office uses code 33257-52 when only the LAA is performed with open cardiac surgery. Documentation may need to be provided for use of the 52 modifier with some ins companies.
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    Aortic stenosis after tavr?

    If they are still an inpatient I would use the I35.0 and Z95.2
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    Cardiac Pacemaker Placement

    Our practice uses the 996.01 and V45.01 for pacemaker end of life. Check dictation to see if DX codes can be used. If the payer is Medicare use the KX modifier. If the pacemaker was placed within the global of another procedure make sure the 78 is also attached.
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    Novitasphere Portal

    May anyone please give me some reviews on using this service. We do use a clearing house. Will they send the revised EOB still by paper or we only see changes electronically? Any Pros/ Cons would be helpful. Thank you
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    TAVR denials

    If you are to google the device then Facility and Physician Billing Guide it helps you better (in my eyes understand what everybody is looking for) This is just one example for the TAVR from Edwards. Look into all the notes sections...
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    Same Dx During Global

    It was 424.0
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    Same Dx During Global

    Any help appreciated. I am coding for the surgeon. He performed a 90 day global procedure. 1 month in the repair has failed and the original DX is now again symptomatic. (Stated they left the OR with none of the DX and his immediate postoperative course was unremarkable) in the office setting...
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    Critical Care in global of CABG

    I have seen this question being asked many times and answers are not specific to our specialty so I will just start with examples of my questions. If our surgeon performs the procedure then monitors his care while he is in the hospital. Procedures ranging from CABG, Aortic Valve replacement...
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    2 Office Consults in Same day

    Well my issue was the first documented a lower visit. Then the second documented a higher and the pt is very high risk. If I were to combine them both yes i would have to go over again but most likely it will be level five for this patient is already established. This is very helpful. Thank you
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    2 Office Consults in Same day

    This patient is already established. (Coming in for a routine review) 99212 Our one physician has been following him for his condition. And now he feels that another physician in the same practice may be a better fit because his condition has now worsened. And so now on the same day he did a...
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    2 Office Consults in Same day

    We have an established patient that came into the office to see our physician for his follow up on a condition. But suggested that another physician in our practice take a look at it because he specialized in it. They are both in the same group both happend on the same day. One would qualify as...
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    Medical Non Comliance

    Thank you for the response. That helps.
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    Medical Non Comliance

    I am new to coding E/M and was coming across medical non compliance in a HPI. We have very ill patients most of the time and all 4 slots can be taken. Should V15.81 be looked into more often if needed? Any feed back would be appreciated.
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    Modifier 22 - We had a surgeon that performed

    We had a surgeon that performed a complex procedure that took place in the OR from 8:30am till 5:00pm. There was a total of six procedures done by our surgeon. The pt had a carotid subclaian bypass bilaterally. By the 1st assist two days prior to the surgery. The patient was very high...
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    Billing Primary when Secondary is Medicare

    Yes BC/BS say Pays 100$ on the E&M for the Primanry ins. 99254 and since their secondary ins is Medicare and Medicare does not reconize that code. It will deny. So it kicks back and asks for the correct code. So if we were to now send it WITH the ammount that the primay insurance has already...
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    DN, DK and DQ Qualifier/Indicator Reporting

    This conversation just came up in my office yesterday. We are a surgical office. Patients get reffered to us DN, Then we can send them to get more tests, DK, Or we supervise their care. DQ (aneurysms) So will this change every time we send out a claim? For E/M or Surgery?
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    Billing Primary when Secondary is Medicare

    If you bill the consult code if you have commercial insurance as your primary and your secondary is medicare. Is it illegal? Example Pt has BC/BS and we send out claim Hospital consult inpatient. And Medicare is secondary. Are we Still supposed to follow medicare guidelines. We bill 99222...
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