1. D

    Wiki Billing for a APRN

    Just wondering if we can bill for a APRN that does not have her RNFA? in Louisiana.
  2. U

    Wiki Bcg

    We have a patient who cannot tolerate the full dosage of bcg. If we give him only 1/3 of the dose can we bill for the waste? He is a medicare patient. Thank you
  3. K

    Wiki are visits for complications for 10060 fall under the global or can we bill for them?

    I know that 10060 has a 10-day global but what exactly does that cover? We saw a pt 5 times within the 10 day period after the procedure for infection and repacking. Can we bill these out and if so what are the codes? Any help would be appreciated.
  4. N

    Wiki Federally Qualified Healthcare Centers

    Since FQHC's don't always bill a traditional CPT code, do they still have to follow the CPT guidelines when obtaining HPI? Example: FQHC's will bill Medi-Cal an "01", this is an office visit. They do not use a 99211-99215 as most traditional offices. So, when it comes to meeting all the of...
  5. M

    Wiki Billing 93306 & 93880 In Office

    Hello just a little confused as how to bill these codes. I work for an Interventional Cardiologist. He contracted a tech to come out and bring the u/s machine to do these procedures in our office. Is there any modifier I should be adding since he doesn't actually own the equipment? Or is...
  6. A

    Wiki Home health POS question

    Hello Does anyone have an CMS information that states physicians cannot bill E/M codes 99211-99215 with POS 12 (home). I have seen some doctors bill with this POS and E/M codes and I am not sure if CMS will allow the location to bill with office/outpatient. thanks
  7. J

    Wiki Genicular Nerve Rhizotomy

    I have a Medicare patient and verifying 64640 billed once or 3 times??? (superomedial, inferomedial and superolateral) Per AMA 11/15 regarding just the block 64450 bill one time only Thanks for any updated info! Jamie
  8. V

    Wiki Appropriate code for billing UDS - BCBS and AETNA

    Hi all, Recently we are receiving denials from AETNA for 2016 claims as " Need to bill with appropriate HCPCS" , currently we are billing 8-series codes for confirmatory tests. The same issue for BCBS. Please help on the above cases as we need to bill HCPCS/CPT code for BCBS and AETNA...
  9. T

    Wiki Pre-Op Visit for Screening Colonoscopy

    My director wants to bill for preop visit for patients who are coming in for screening colonoscopies. Instead of the nurse doing the H&P over the phone, the patient would come in and see the nurse practitioner. Could we bill a low level E&M code for this?
  10. D

    Wiki E/M with a procedure

    Question...I know that to bill a E/M with a procedure the visit has to be distinct from procedure. But I question this........New pt come in to see GYN with irregular bleeding. Provider does COMPLETE work up and gives pt options. One of those options being a endo bx. Pt chooses endo bx. and it...
  11. C

    Wiki observation codes for cardiologists

    We are a cardiology practice that is called for services provided in the hospital. I am having quite the issue understanding exactly how to bill observation codes. When our group is consulted to see the patient what code should we be billing if the patient is already admitted to observation...
  12. H

    Wiki Pap Only

    I have a question. If one of our Providers see a patient for a pap only, no blood work was done she had her annual already but the pap was not done. They are using the diagnosis Z01.419. The research I have done is stating you should only bill the pap and not an E/M, is this correct? I need...
  13. C

    Wiki Sports physicals

    Is it common practice to bill sports physicals with em codes (99201-99215)?
  14. A

    Wiki Can a Health Coach bill under a provider?????

    Help!!! We have a non-licensed health coach starting & my provider thinks he can bill an OV whenever the health coach sees a patient & he steps in for part of the visit. These visits would be strictly for diabetes prevention, weight management, etc. Any information is greatly appreciated!!!
  15. J

    Wiki OB visits for medicaid patients

    what do you bill for a OB visit for a patient with no complications. do you use the ACOG prenatal flowsheet? Currently we bill a 99213 but I am questioning the MDM if the patient is having no complications?
  16. J

    Wiki Two consults for the same NPI, admission to the hopsital and transfer to rehab

    Can someone clarify this for me: The patient is admitted to the hospital and we bill for the cardiology consult. Five days later the patient is transferred to the rehab floor in the same hospital and we see the patient again there due to a hematoma and he is on Coumadin. Do we bill both...
  17. Y

    Wiki Collecting an specimen to send to outside lab

    Hi: Is correct to bill 99000 for any specimen that goes to outside lab? We only bill it once per day per patient even if more than one specimen. Our outside lab provides supplies and picks up specimens. Our staff does "handle" the specimen and prepare it for transport. Which code can we use to...
  18. K

    Wiki The suture holding a patient's percutaneous drain

    The suture holding a patient's percutaneous drain came loose and my doctor placed a new suture. Do we simply bill for an office visit?
  19. M

    Wiki HELP -- billing for adminsitration of intranasal narcan

    Hello, I am working on a claim where one of our Walk-In clinics administered narcan to a heroin overdose victim. I am not able to find any help in how were are to bill for this. HCPCS code J2310 is for injection method, but our patient received it via intranasal. I reached out to our HIM...
  20. J

    Wiki Home Health

    Can anyone help me with this? If a patient is being treated with Home Healthcare and the referring physician authorizes and or signs the Plan of Care but it is not filed to insurance and is not timely filing, can we A) still bill for denial or B) can we file for the re-certification even thought...
  21. M

    Wiki cryoblation in CT

    is there a way to bundle for supplies used in CT or is it better to bill all supplies separate?
  22. H

    Wiki Cerumen Removal - Does a physician have to remov

    Does a physician have to remove cerumen to bill 69210 or 69209 or can a nurse remove it and still bill? Has anyone billed the 69209 and what is the reimbursement for it?
  23. C

    Wiki Abdominal US/Thoracentesis

    Good Morning All, I have a radiology department charging for an Abdominal US when they cannont complete a Thoracentesis. I am new to this group, and when I questioned an edit for an Abdominal US with diagnosis of Neoplasm of the lung and pleural effusion, I was informed that they practice...
  24. J

    Wiki question regarding hysteroscopy and iud removal

    Can you bill 58558 and 58301 together?
  25. O

    Wiki Durable Medical Supplies

    Our small clinic is looking to offer DME (splints, braces, crutches etc.) for our patients to walk out of the office with. Is it legal to bill different insurance carriers, different prices based on their reimbursement? Thanks you.
  26. S

    Wiki Radiation Treatment Planning

    My Neurosurgeon did therapeutic radiology treatment planning with a Radiation Oncologist (different tax ID's). He won't be doing Stereotactic Radiosurgery. Can I bill CPT 77263 for his treatment planning? I'm very new at this and would appreciate any suggestions.
  27. S

    Wiki Bill established then bill new patient code?

    Is there any documentation that addresses whether you can bill an established code prior to billing a new patient code? This seems counter intuitive however, we have a situation where we have an Immediate Care clinic that is modeled after an Urgent Care (without the Urgent Care designation.)...
  28. T

    Wiki modifer help Please

    We have a new computer system. We are running into a problem I haven't had before. A patient comes in for either a physical or AHA (G4038/G0439). If they have other problems we bill a E/M (99213)code also. Then if they have eg: 17000,20600,17110 etc. done I usually bill as follows. 99396/G0439...
  29. K

    Wiki Sports Trainer-Therapeutic exercise coding

    We are a PCP practice investigating to hire a Certified Sports Trainer to provide therapeutic exercises to patients. Would a Sports Trainer be able to bill for these services since the practice is not OT/PT?
  30. C

    Wiki Assistant coding out patient / hospital setting E/M code

    Sometimes the providers do the H&P on OB patients who are seen in the labor and delivery floor. However, it states patient are seen as out patient. Do you bill an out patient e/M code or do you bill observation codes? It doesn't mentioned patient is on observation status... I would like to say...
  31. N

    Wiki Billing Software

    My employer is looking to get a new billing software. Please tell me what you use and pros and cons. I will mainly be using it to bill for home visits, nursing home , and inpatient. Thank you in advance. It may matter that we are in Michigan.
  32. S

    Wiki Fracture with external fixation with internal fixation at a later date.

    In general, the physician debrides fx site, aligns fractures, and uses external fixation to stabilize with plans for internal fixation in 2 weeks because of the damage to soft tissues. Would you only bill the debridement and application of external fixation for the first surgery? Application...
  33. M

    Wiki Coding of Locum Tenem in the Emergency Setting

    I have always been under the impression that when a Locum is working that we are to put the Q6 modifier on anything that they do. Am I correct in my thinking? Where I work they now after 3 years of putting the Q6 on the codes that they have always overridden the Q6 to bill to the doctor that is...
  34. M

    Wiki Physician coding

    2 questions: 1. Patient is seen in office and physician decides to admit to hospital, sends orders with patient, I am to bill and office visit and NOT an initial hosptal correct? 2. Same patient had an EGD on day 2 of hospital was kept for a few hours then discharged to home, can I bill a...
  35. C

    Wiki OB Anesthesia Coding for Epidural with No Delivery

    Our anesthesiologist notes the following scenario: "How should we submit the bill for a patient in labor who had an epidural placed for 20 hours after which they decide to stop her induction of labor for a later time. So she had 20 hours of anesthesia for labor but no delivery." I am inclined...
  36. O

    Wiki OB case

    Hi everyone! Case: pt is 39 weeks pregnant admitted for L/D the Epidural was not done because the patient had to push/deliver What ICD-10 would be used in a case like this? Do I bill for a E/M service based off of the eval? Thank you for your help! Sherri, CPC
  37. L

    Wiki Critical care

    How much critical care time would you bill in this situation. Provider initiates care 02:30 he signs his note at 03:43. Never says critical care time spent anywhere in his note. Patient was seen in the PICU - which I know doesn't necessarily mean critical care. He does an addendum starting @...
  38. P

    Wiki 97610

    Anyone know if you can bill 97610 per wound or is it a code you can only bill once per day no matter how many wounds it is used on?
  39. J

    Wiki Manipulation of previous fracture and re-casting in the office

    My Ortho billed the global codes for fracture care without manipulation for a patient who had a tib-fib fracture. The patient presented to the office for a follow-up visit with a complaint that the cast was too tight and bothering her. He removed the cast and x-rays show that the fracture site...
  40. B

    Wiki Global EKG date of service

    I'm hoping I can get some opinions and perhaps some reference to documentation indicating which scenario is appropriate. Patient has an EKG performed on 2/1/16. The physician doesn't perform an official interpretation of this EKG until 2/5/16. Because it's all being done by the same...
  41. T

    Wiki new patient help please

    We have a physician that is seeing a patient for the first time from China attending school here. Blue cross ppo. The patient has no problems she only came in to get a Gardasil shot. The doctor spent time with the patient going over problems/history/family history etc. How can this be billed...
  42. bekka

    Wiki how do i bill for fibin

    I am wondering if any one knows how to bill for the implant tisseel kit, or Fibrin Sealant. I do understand that this may not be payable but I am trying to locate a code for billing, even if it is a temporary code. We are using it in a ASC setting
  43. P

    Wiki Medicaid FFS - Nevada - 51/59 modifiers

    I bill for an OB and am trying to bill 58552 with 57282. These two codes do allow a modifier. Medicaid keeps denying for incorrect modifier. We tried 51 and 59 on the 57282. Any thoughts or is anyone else having this issue with NV Medicaid?
  44. J

    Wiki Can a RN Bill 93922

    Can a RN bill for all ABi testing and Doppler scans for Dm foot care using this code 93922?
  45. D

    Wiki Billing Hospital Consults

    One of our providers (we are a specialist group) did a consultation in the hospital. The patient is on Medicare. Since you can't bill consultations, what CPT code should we use? I know to change the place of service.
  46. D

    Wiki Consult and Procdure question

    One of my doctors asked me the other day if he does a consult on a patient to determine if a procedure is needed can he bill for a consult and a procedure on the same day? I told him that I did not think we could bill for both. Who is correct?
  47. D

    Wiki ED Consult

    One of my physicians did a consult while a patient was in the ED on 01/09/16. Pt was admitted from the ED to IP on 01/10/16. How would I bill for the consult, as an IP or ED?
  48. K

    Wiki Gynecologist want to bill ECG

    My Gynecology Dr want to bill ECG for a patient who suffer from pelvic pain, menorrhagia, in addition to that she has slight chest tightness, So she wanna know whether she can bill ECG? Really need help....please Thanks in advance Sarith kalikkot CPC-A
  49. L

    Wiki Billing Medicare as secondary

    We are Urgent Care and have an Ancillary contract with Cigna,UHC, and Aetna requiring us to bill S9083 at a flat rate regardless of what was done. I have a patient that is Medicare secondary. Cigna applied charges to pt deductible now I need to bill Medicare but they do not take the S codes...
  50. M

    Wiki PEG Insertion Assistant

    When performing in patient PEG placement our MD's regularly use one of the PA's to assist. There are procedure notes from both the MD and the PA. Can I bill both the 43246 and 43246-80? Is it the same for all payers? Thank you, Michelle Loyd, CPC