billing and coding

  1. A

    How to bill Pre-employment Physical exam?

    Can someone explain how to bill for a pre-employment physical exam? Do any insurance companies cover this? I have a patient who came in for a pre-employment physical exam required for her admission into a nursing program. Is it appropriate to bill using code 99499 with diagnosis code Z02.1?
  2. T

    Wiki Help please....99244 billed with circumcision performed on same visit.

    Hi All- I am new to pediatric urology billing and need help understanding this encounter. The provider is billing 99244 with modifier -25 , the patient was referred to him for a consultation for the evaluation of nb circumcision. He performed the circumcision in the same consult visit. He also...
  3. P

    Wiki IONM billing questions

    Hi. I am in need of billing advice. I am looking to bill for a Lt. Craniotomy for tumor resection. I haven't had this one before. Any suggestions on the diagnosis code to use for this? My provider does not know and I am not a coder. HELP please!!!! Thanking you in advance
  4. K

    Wiki Billing for OCT's

    Hello all! Just trying to figure out if you can bill 92132 and 92133 on the same date of service? If they are not billable, is there any modifier that can be used to bill them together? Thank you!
  5. morganscott

    Wiki Occurrence Codes

    On the UB-04 claim form, who is typically responsible for attaching occurrence, condition, and value codes? Billers or Coders?
  6. M

    Wiki Molina is automatically downcoding office visits without requesting medical records.

    I do billing for an internal medicine physician who specializes in weight management. Most of his visits are coded as 99214 or 99215 + 99401 or 99402. We do not have a lot of Molina patients, but of the ones we do have, every single claim gets downcoded from 99214 to 99213. We do not receive a...
  7. M

    Wiki Help with TB coding

    Hello coders! Need help coding this scenario: TB nurse visit patient presents for labs and complains of orange urine and yellow eyes. Payers are Medicaid and Medicare. Any and all feedback is greatly appreciated. Thanks!!
  8. M

    Wiki 99211 on same day as injection and pregnancy test

    Hello coders! Please help clarify so I can settle the dispute with the NP and WHNP in my office. A patient came in and was seen by the CMA for pregnancy test and depo injection. The pregnancy was negative. Can we bill a 99211 with the depo injection and the pregnancy test? Please explain...
  9. M

    Wiki Help!! 99211 and Lab Only

    Hello coders! Can anyone please advise and clarify how and when to use and bill a 99211 for lab only services. We generally use 99211 for nurse f/u and lab visits on established patients. The RN's are doing STD exams and coding only the 99211. The CMA is doing the collection. Some of our...
  10. S

    Wiki Any providers or practices in need of billing services?

    This is Suresh with Truline Billing Services LLC. I started this service two years ago, and I am open to any specialty. I am currently rendering my services to couple of providers who are in the dietitians/therapist specialties. We provide medical billing services, practice management support...
  11. A

    Wiki Injectafer billing

    I am new as a coder & biller. I received a denial from magellan complete care with denial code CO_16. Can anybody help me to resolve this & guide me for the same. Which suitable modifier i can use or NDC billing unit for Inj. Injectafer IV with/without outpatient E/M service given. How to bill...
  12. P

    Wiki Question regarding billing an e/m and 96112 same DOS

    Hello, I have a question that was asked by our Developmental Behavioral Pediatrics provider. "Can you give me any information about changes to the 96112 procedure CPT code? Are there any changes to it in the new year? I typically use 96112 with time based E/M codes, are there any new...
  13. R

    Wiki GC Modifier

    Does anyone know if Medicaid accepts the GC modifier? We get denials on these but I cannot find anything on line to support the denial. thanks
  14. F

    Wiki Billing for non-credentialed Nurse Practicioner

    We have a new NP that is not yet credentialed with all payers (only MCR and MCD). The physician wants to bill everything under his NPI. Not all of the encounters meet incident to requirements, some are new patient visits or new chief complaints. Also, not all payers go by MCR guidelines on...
  15. A

    Wiki Should I wait until the pt is discharged from hospital to create and send the claim?

    Hello everyone, I need your help... I am working in a practice that have been doing the hospital billing the same way for the last couple of decades. They are very fortunate to have the same employee for almost 40 years. Now that I involved in the hospital billing I have been informed that they...
  16. M

    Wiki Coding Help for ABA-Autism Billing

    Can anyone help me with a billing/coding question in regards to ABA services, codes 0364T and 0365T? I need to know what the guideline/rules are for billing the secondary code 0365T, as far as the times/rounding up? What is the guideline, for billing the secondary code and rounding up? Does it...
  17. M

    Wiki Confused about Billing-Need Help

    HI, I have a few questions and hope someone here would be a great resource with some help! My first question is about contractual obligations/adjustments. Normally practices/providers have their charged/billed amount as above the medicare allowable. So say they bill 99214, $125 is their...
  18. C

    Wiki Contract Billing and Credentialing from Home

    Certified Coder and experienced billing and credentialing from home. Current knowledge of navigating current, complicated billing procedures and guidelines. Would love to talk to small, independent practice. If in the Dallas area, would be available to meet regularly in the office.
  19. N

    Wiki New at the industry need advice

    Hi! I am a makeup artist and a mom of a smart, vibrant boy. In the search for a better life for my son, I started a medical records certificate. I am three classes away from completing my Medical Records Certificate. I have to admit that now that I can see the end of this journey I am...
  20. M

    Wiki Doctor in the suite documentation

    Our nurse practitioners are seeing patients for more than one doctor during the day. Does it have to be the NP to document which physician is in the suite? Can the ancillary staff documents that the patients doctor is in the suite and available for consultation and the NP review the comment...
  21. H

    Wiki Billing for extended face to face time

    Our office had a woman come in to get her blood drawn for prenatal labs and due to a extreme needle phobia our provider spent over 90 minutes with her. During this time no other consulting or medical services took place. Is there a way to bill for the time our provider took with the patient? I...
  22. C

    Wiki Provider REFUSING to sign documents prior to billing

    I work for a small specialized practice. I have a doctor that refuses to sign her op notes prior to billing, if at all. I have provided references to e-signature requirements and am looking into HCA guidelines for Utah. I have asked for a signed letter stating that she accepts liability of...
  23. B

    Wiki Work Related Injuries going to private health insurance

    I'm hoping to get some information from my fellow coders. We see quite a few patients with work-related injuries (that are not work comp). Many do not inform their employers (in many cases to keep from taking a drug test) or are self-employed. I seem to remember something in my CPB certification...
  24. L

    Wiki Radiation Oncology coding and billing

    Hello! I am new to radiation oncology coding and billing. Does anyone have any resources, cheat sheets or tips they would be willing to share with me? Anything would be greatly appreciated! I am tasked with coding radiation therapy, charge entry and working back end denials that have been...
  25. M

    Wiki Since when does Medicare bundle 76942 with 76872

    For years Medicare has accepted these codes for a prostate ultrasound and biopsy with no bundling issues. This is the order we billed them 76872, 55700, 76972. Since July I have been getting flagged that 76942 is a component of 76872 and a modifier is allowed to differentiate between the...
  26. B

    Wiki Coders charging clients per Chart??

    Would like to ask all coders that are independently doing chart coding if you charge per chart or per hour? If so, how much per chart, per hour? If you prefer to contact me personally, please email me at Thank you! Brenda
  27. E

    Wiki Proficient Medical Biller and Coder with HEDIS Experience

    Elizabeth M. Stone Professional Summary Highly efficient Medical Biller with experience in Cardiology, Gastroenterology, Internal Medicine, Mental Health, Pediatrics, Surgery, and Urology. Excellent multi tasker and demonstrated team player with a...