1. S

    Wiki Billing two injection codes 96372/90471

    Hi All, I am hoping someone can assist me with this coding scenario. I have a patient that received Vitamin B12 shot and zoster vaccine (shingles). Can we bill 96372 for the B12 and 90471 for the vaccine? Or do eat one...if so, which one should be billed in this case? Please help!
  2. L

    Wiki CPT 78299 and CPT 78278

    When Nuc Med Spect CT is used to pinpoint the exact location of a GI Bleed, can unlisted code 78299 be billed? If so can it be billed with 78278?
  3. D

    Wiki Wound Care

    Does anyone know if codes 97605 and 11042 can be billed together for the same dos and same site? Thanks!
  4. N

    Wiki Application of casts and strapping

    We have a situation that has created quite a debate in our office that we could use some advice on. Here's the scenario: a patient presents to the clinic with a fracture. The physician evaluates the patient and stabilizes the fracture with casting or splinting prior to surgery at a local...
  5. J

    Wiki 77003 and 62311/62310

    77003 and Epidural Steroid Injections Can fluoroscopy be billed with epidural injections- 62311 and 62310? I bill for an ASC and BCBS is notifying us that 77003 and 62311 can't be billed together, that fluoroscopy is included in the procedure code. I know contrast dye can't be billed...
  6. J

    Wiki Technical service and professional service of an eye scan not done on same day

    If an eye scan is performed in the office on a Thursday, but the physician does not do the interpretation until Friday (same practice, same office), can it still be billed globally and if so with which date, or does the service need to be split into the component parts and filed with the tewo...
  7. M

    Wiki Most frequently billed Dx codes for Lacerations/ cuts / open wounds??????

    Is there a website of database I would be able to access to find out the top Dx codes billed for Lacerations/ cuts / open wounds currently or in 2015? I am a coder/ biller and have been asked for this information by my boss for planning purposes. This office is new to billing so they do not...
  8. D

    Wiki hospital billing 99283

    I have a question, if the doctor seen the patient in the hospital and they bring all the papers back and there is no referring or attending physician can this be billed without will this get denied?
  9. C

    Wiki Placement of a T tube into colotomy-Help please!

    Hello, I am unsure if this is something that can be billed or not. The physician placed a T-tube into a colotomy to promote healing. The patient has been undergoing serial wound vac changes for a frozen abdomen. The T-tube was cut and placed into the colotomy and brought out through a separate...
  10. K

    Wiki Gastroenterology - I have a claim that Medicare denied procedure

    I have a claim that Medicare denied procedure 97605 when billed together with 20102 stating invalid modifier billed with 97605. The procedures were billed as 20102-78-GC and 97605-59-78-GC. I verified in NCCI and these modifiers are appropriate. Does Medicare not want the modifier 78 on...
  11. D

    Wiki E/M w/ 57 modifier and operative report denial

    We have seen an influx of denials from payer sources (VA, BCBS and work comp) denying the E/M with a 57 modifier because the E/M and operative services weren't billed on same claim. Is anyone else seeing this? Thank you. Deb Knight, CPC, COC Missoula Bone & Joint & Surgery Center
  12. D

    Wiki new to Path question on Icd10 Z codes

    I haven't coded path since ICD10 was implemented. I don't have a ICD10 Lab book. Question: When coding and billing for any drug test for pain management is there a guideline that you have to have an encounter code or Z code billed? To add to that is there any guideline to any other ICD10 code...
  13. K

    Wiki Radiation Oncology Question - 2016 - Simulation at Cone Down

    Can code 77290 be billed during the cone down for freestanding facilities for IMRT in 2016? There are cci edits for the code 77290 with 77301, but during the cone down the code 77301 is not billed out, but can the Simulation be billed? In 2015 the Simulation code, 77290 was bundled during the...
  14. B

    Wiki billable or inclusive

    Hi, all I hope you all are doing well. I am new to OB coding ……. Here one of my OB provider had billed 99213 with O20.0 for a routine antepartum visit. This claim got denied as not payable and stated it will be inclusive within global service (59400 or 59510) .which is going to be billed in...
  15. C

    Wiki Billing units for HyQvia J1575 I need help!!

    Last year I billed for HyQvia using an unlisted J code. When I billed for this my units were "1" and I put the details of what was administered in box 19. Beginning Jan 1 2016, HyQvia has a new billing code, J1575 Injection, immune globulin/hyaluronidase, (Hyqvia) 100mg, immunoglobulin So...
  16. R

    Wiki Transitional care and smoking cessation

    I have billed 99496 transitional care with modifier 25 and 99406 smoking cessation. New 2016 guidelines have stated that transitional care can now be billed on the day of the face to face visit that's why they were billed together on the same day. I received a denial saying the procedure code...
  17. carelitz

    Wiki Billed Date: Date of Service or Date Read?

    Hello! I am billing for a cardiologist that reads ECHO reports in the hospital. Therefore we bill the professional component using (93306, 93308) -26. Should the billed date be the date the ECHO was performed or the date that our doctor read the ECHO? Thanks!
  18. K

    Wiki WCC with UA and Tympanometry

    In our office, we only do UA's during a WCC if a patient is chronic or complaining of symptoms. Does anyone do UA's on all their WCC's? If so, does it pay out when billed with Z00.129/121? Does anyone bill 92567/Tympanometry with their WCC's? Does it pay out when billed with Z01.10/.11...
  19. D

    Wiki Injections and PA or Dr to be rendering

    If Dr. A sees a patient and does the H&P and X-rays and all of the office visit portion and leaves the room then his credentialed Physician Assistant goes in alone and gives the patient an injection in her knee. Dr A’s documentation is for the OV portion and PA’s documentation is for the...
  20. L

    Wiki -TC Portion Pathology in ASC

    I'm new to both pathology and ASC billing. I have billed our -TC portion of the pathology that was done in our ASC. I billed 88305-TC with a POS of 24. I am being denied with Cigna for inconsistent modifier use and an Aetna denial because "treatment has been rendered by the payer to be...
  21. M

    Wiki Avastin for Medi-cal

    I am trying to Bill Medi- Cal for avastin. They are denying my 92134 and J9035 stating that codes are not payable with DX i am using. I am using E10.39 and E11.311, Does anyone know, how it should be billed? I dont have any problem getting paid with any other insurance, but Medi-Cal (of course)...
  22. C

    Wiki insurance change in maternity

    We have a patient who switch insurance first she had 6 visits with first insurance. we billed 59425... with her new insurance she was seen 8 times plus delivery and post partum . can we billed global to her new insurance?
  23. J

    Wiki how to code a second EGD during a post-op period

    The surgeon I work for performed an EGD and Colonoscopy on this particular patient, and about 3 weeks later he does an EGD with placement of percutaneous gastrostomy tube, 5 days later a tracheostomy, now another 3 weeks later he does an EGD should I have billed this EGD with a modifier? The...
  24. D

    Wiki spine coding questin

    dr. billing 22551 23845 22851 20660 20930 77003 - my question is the fluoro code, I don't see where it says it should not be billed, does anyone have any input on this, I am new to spine coding also with a 59 be appropriate for the 77003?
  25. J

    Wiki Secure Horizon Denial

    Procedure that was done...Robotic-assisted laparascopic radical prostatectomy and bilateral pelvic lymphnode dissection What was billed...55812, 38562/59 and 55866 Any help is greatly appreciated.
  26. A

    Wiki Preventative Visit with E/M

    Under which circumstances could a Preventative Visit/Physical (99396) be billed with a encounter visit such as 99213?
  27. J

    Wiki Help!!!! Ortho coding

    I have a patient that was seen in ER on 12/2/15 and then went directly to the office to be seen. The PA saw him and billed 25600 and then on the same day he went back according to the notes and was admitted for outpatient Surgery, The dictated operative report on 12/2/15 by the physician is...
  28. T

    Wiki Anesthesia cpt 99135

    I am researching how many times you would bill CPT 99135 per claim? I see that 5 units are allowed, so would you expect it to be billed out 5 times or only once and reimbursed x5? thank you for your help!
  29. S

    Wiki Outpatient colonoscopy

    Hello everyone. I am a coder but do not code for facilities and I am having a personal issue with the hospital coding. 5 years ago I had 1 polyp that turned out to be tubular adenoma. resection fof 12 in of my intestine. Had a repeat colonoscopy 2 years later. I went in again recently for a...
  30. R

    Wiki Venoplasty Guidlines needed

    Does anyone have any Venoplasty guidelines they could forward me? Is it just one Venoplasty coded per zone? I have a Venoplasty of Iliac, SFA, POP and PT. Can these all be billed separate or included in the one code of 35476? Thanks!
  31. A

    Wiki Billing representative

    Chiropractor billed for his services the same day we billed physical therapy charges. Chiropractor services paid and our charges denied as max benefit met. How can we get paid for our services because we are different specialty. Is there a modifier we could use?
  32. E

    Wiki Urgent Care/Walk-In Clinic Incident-to Billing?

    Question: For a walk-in/urgent care clinic, the rendering provider is a PA and there is a physician on site that is the supervising physician. The claim is billed out under PA rendering and Doc supervising. The supervising doc does electronically sign the note, but the supervising doc is not...
  33. J

    Wiki Humana denying any OV billed with any testing or vaccines at the same visit

    Did anyone else start receiving denials for O.V mid December anytime it was billed with any vaccine or testing ( 87880,86308, ect) ? We are pediatrics...and yes we are billing with the correct modifiers. Its across the board, not even plan specific within Humana. I'm reaching out to my Humana...
  34. M

    Wiki Does new insurance mean new patient??

    I was told by a provider that when a patient obtains a new insurance, they are billed as a new patient (regardless of when they were last seen). The provider agrees that if someone hasn't been seen for three full years that they are a new patient. However, they have also been told that even if...
  35. K

    Wiki Transfer OB with 14 visits

    An OB patient transferred into our practice at 24 weeks. She was seen for a total of 14 visits with us, delivering at 37 weeks. Can we bill 59426 with modifier 22 to account for the large number of visits or should some of the visits be billed separately? She was GDM on insulin and had mild...
  36. K

    Wiki Billing TCM

    Am I reading correct, we no longer have to hold the TCM codes 99495 and 99496 for 29 days after discharge? They can now be billed at time of service? I hope so;) this would make life much easier!!
  37. H

    Wiki Can BMI code Z68.xx be billed with documentation alone?

    Hello, The title pretty much asks the question. BMI is documented in the vitals, but it is not documented in A/P portion of the progress notes. Can the BMI still be billed? Thanks in advance.
  38. C

    Wiki Cardiokey

    Hi... I am billing for a Cardiokey in an office setting, provider questions I am billing correctly. Pt had the Cardiokey on for 14 days. I billed for 93224. Wondering if I add 0295T? 99215-25 and 93224
  39. K

    Wiki Denied for procedure incidental to another procedure

    I billed 32551 and 99255 on the same day and it denied. Should i have billed 99255/25 with 32551 to pay. I am new to hospital in pt billing. Thanks
  40. C

    Wiki Therapy billing

    If an Occupational Therapist is out on vacation and a "PRN" OT is brought in for coverage, how is this billed to the carriers? Thank you.
  41. D

    Wiki Incident to billing - perform acne surgery

    We are a Dermatology office that has PA's and Aesthetician's who are also CMA's. The aesthetician's perform acne surgery (CPT 10040 Dx L70.0) when it is recommended by the physician or PA and gets billed to the insurance under the physician only. Can the aesthetician perform the acne surgery...