billing

  1. M

    Wiki CPT CODE QUESTION

    Hi, Our office just added a vascular lab, there are two CPT codes 75726 & 75744 that we are trying to find out if they are globaled or require a modifier when billed with the CPT codes below: 37220 37221 37222 37223 37224 37225 37226 37227 37228 37229 37252 37253 76937 75726 75716 75774
  2. D

    Question Billing Secondary commercial payers

    Hi everyone :) Wondering if anyone could help answer my question in Billing the secondary commercial plan. Just an FYI- Primary is also commercial. Which amounts do we bill the secondary plan? The all amounts that the primary did not cover including denied procedures? Only patient...
  3. J

    NMD billing as MD

    Hello! I have a quick question: Our practice is intending on bringing an NMD (Naturopathic Doctor) into the practice and have them see patients as their service provider, but have the billing provider listed as an MD. [It's basically two doctors seeing a patient in one visit, with the NMD...
  4. M

    Question New to FQHC billing

    Our outpatient medical clinic recently became a FQHC. I have been tasked with figuring out what this means for our billing practices, but I have no idea where to begin because this is something I know nothing about. We have been using the CMS 1500 forms for years, but is there a specific form...
  5. M

    Question Billing for urgent care facility - any advice?

    Hello, I will be billing for a new urgent care facility in the next month so I wanted to see if anyone has any advice or tips on things to watch out for or look into before we get up and running? We have done some research on billing global packages vs billing as a provider's office, S0988 vs...
  6. D

    G0180 and POS 32

    Does anyone have a link on why Medicare of NC is denying G0180 with POS 32? They will pay with POS 31.. I'm so confused and can't get help from a rep. Thank you!!!!
  7. A

    Question How to bill source patient labs to workers compensation insurance?

    I work for an Occupational Health clinic in Illinois and we are trying to figure out how to bill bbp exposure source patient labs to workers comp insurance. These labs were not drawn from the claimant but from the patient whose blood the claimant was exposed to. Does anybody have any information...
  8. M

    Question Nephrology Billing documentation

    My office billers and NP are in a discussion about dialysis unit monthly rounding documentation for billing. We currently use a rounding sheet that has the 3 monthly NP limited visits on one sheet. My NP asked why we could not use the dialysis flow sheet that she reviews makes notes and signs...
  9. B

    Medicaid Denials

    Hello! I keep getting Medicaid denials for claims and the reason is that it says "Missing Billing Provider Taxonomy number". Well this denial just started happening after years of no issues before, also the billing provider and provider taxonomy numbers are the same, anyone else have this issue...
  10. C

    Question Billing Patients Less Than Allowable Amount?

    Are we allowed to bill a patient less than what an insurance company allows? We have a few patients in which a Medicare Advantage insurance has allowed more than they should, and dropped the full allowable amount to the patient, which happens to be their full copayment for an ASC. We have tried...
  11. I

    Question Rotor Study

    My provider is doing a "Rotor Study" (injecting contrast- flouro into the spinal pump to make sure its working properly). I have looked everywhere and still cant find an specific code that would best describe this procedure. Does anyone know if there is a code for this? if not, would the 64999...
  12. M

    Question Weight management billing

    I do billing for a provider who considers himself a weight management specialist. His primary method is a combination of medication and weight management counseling. He also acts as a PCP for his regular patients, but his main priority is weight management. When we bill insurance, we typically...
  13. A

    Ruling: RTM (Remote Therapeutic Monitoring) and Physical Therapy

    Our company is trying to distinguish what are the or are there even parameters to the meaning of "interactive communication with the patient/caregiver." Particularly for codes: CPT code 989X4 — Remote therapeutic monitoring treatment management services, physician/ other qualified health care...
  14. C

    Question All EMGs with NCS for bilateral extremities billing question

    Our new Pain Management provider has just yesterday informed me that he and his staff have always been billing them like this: "Bilateral Upper Extremities: 95911 for 9-10 studies 95886 95886, 76 modifier Bilateral Lower Extremities: 95910 for 7-8 studies 95886 95886, 76 modifiers The lower...
  15. M

    -SA Modifier

    Hi all! We have a scenario where the doctor wants to bill for the NP seeing the patient under his NPI with the -SA modifier even when he is not in the office at the time of the service. I know Medicare clearly states that the doctor must be in the office suite at the time of service but BCBS TX...
  16. M

    Pap Only Visits

    Hello! Please advise....not sure how to code for pap only visits to Medicaid. Our claim denied - service (99212 & 88164) not allowed for this DX (Z12.4). Thank you in advance!
  17. P

    Question EEG Billing and Coding

    I work for a private Neurology practice and just became a certified biller. We offer Amb EEG to many patients with the following codes 95700, 95708, and 95721. We are not getting reimbursed for these or getting reimbursed very little. Does anyone know the best way to code the set up, the...
  18. H

    Question Dental Billing NEED ADVICE - AM I CORRECT OR NOT?

    Hello, I am a dental biller and need some advice about what is the final patient responsibility. I work for an oral surgeon and the patient had wisdom teeth surgery with anesthesia. The patient has medical & dental insurance. We are in network with the medical and out of network with the dental...
  19. E

    Question Account for loss of revenue

    I have a situation where a client was seen for a CDA and through the evaluation the client refused to talk and a diagnosis could not be determined. However, the client was seen after the initial CDA for individual psychotherapy and again for case management. Because there was no diagnosis...
  20. M

    Question billing RPM and CCM services for hospice patients

    Hello I have a few questions in regards to billing RPM and CCM services with patients who are enrolled in hospice; 1) Should patients in hospice be billed for this service at all? 2) If a patient has passed away in the middle of the month, can any of these codes still be billed (99453, 99454...
  21. K

    Question Billing Denied AWV to secondary commerical insurance?

    If a patient's annual wellness visit (G0439) is denied by Medicare because the patient has come in too soon and Medicare puts it to patient responsibility, should you bill it to their commercial secondary given that this is a code that only Medicare uses and covers? This is what they are doing...
  22. L

    Question EMPLOYER VS STUDENT PLANS

    I HAVE SUCH CONFUSION WITH AETNA AND A PATIENT WE HAVE. THE PATIENT IS 28 AND HAS 2 AETNA PLANS. ONE IS AN EMPLOYER PLAN AND ONE IS A STUDENT PLAN. WHICH ONE WOULD BE PRIMARY IF BOTH WERE ACTIVE AT THE SAME TIME, SAME MONTH?
  23. M

    HELP with EPIC Payment Posting!!

    Good morning! Can anyone help me with fixing an error when doing the electronic remittances in EPIC? The Code Error Message: Matching charge not found/HCPCS code not on invoice. Thanks in advance.
  24. A

    Looking for coding, or similar, in Oklahoma

    Hello! I received my CPC-A in June of this year. I am eagerly looking forward to starting a new career path. Any opportunities would be greatly appreciated. I am interested in Risk Adjustment coding, and will begin studying for the CRC within the week. LinkedIn Profile
  25. B

    Assistant surgeon billing

    Hello, I would really appreciate if someone can help me out with billing for an assistant surgeon. I have just started working for a plastic surgeon and he has decided to use an assistant surgeon in one of his surgeries for breast reduction. I would like to know if we have to use different codes...
  26. M

    ICD-10 for Pregnancy NOS

    Hello everyone! Which code to use for Pregnancy NOS Z33.01 or Z34.90 for Texas Medicaid? Thanks everyone!!
  27. M

    Place of Service questions

    Hello! I am a somewhat new biller and got my experience solely from the office I currently work at and through AAPC billing course. I work for an Outpatient Drug and Alcohol treatment center, we also provide co-curring mental health/substance use services. The POS, Place of Service is always a...
  28. J

    UDS help

    We are switching to a new software soon and we normally have our MA's put the UDS and results in a note and sign it then the provider also signs it. Do we have to do this? Or can we just have them put it in as a non billable then when the provider interprets it, he change it to the 80307 and...
  29. morriam91

    Question Visit billed on wrong DOS

    I am currently having an issue where our biller is posting the patient's visits to the wrong date of service. Example: Patient was seen on 5/4/21, but when the charges are entered into the system she by mistake puts the date of service as 5/14/21. I have a handful of claims that have been sent...
  30. N

    Bundled Office Visit w/ -25

    We have been getting denials recently from Humana when billing 99214-25 (I70.233, F17.218, I89.0) 11042 (L97.312, L97.212, T81.31XA) Dx are different for each code. Only thing I can think of is the i70.233 and L97 codes both address the 'right leg' .. BUT we have been getting paid before with...
  31. L

    Question Authorization Denials, Surgery

    Curious- Has anyone had surgery auth denials for final coding not being what was anticipated and auth'd prior to surgery that they've appealed successfully? Example: Surgery paperwork may states "Knee arthroscopy, diagnostic, meniscectomy" CPTs: 29870, 29881 called on/submitted for surgery...
  32. L

    Question Surgery Auths

    Curious- Has anyone had surgery auth denials for final coding not being what was anticipated and auth'd prior to surgery that they've appealed successfully? Example: Surgery paperwork may states "Knee arthroscopy, diagnostic, meniscectomy" CPTs: 29870, 29881 called on/submitted for surgery...
  33. C

    Billing Physician to Psychiatrist Phone Call

    Hi there, I have a question, we have never come across this before. We have a patient that we see, however, that person's psychiatrist wants to sign off on care and transfer care for those medical conditions to our provider, who is the person's primary care doctor. This phone call lasted 20...
  34. M

    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...
  35. C

    Question Physican billing for Car Seat codes 94780

    Are any insurances reimbursing physicians for these Car Seat testing codes? 94780-94781. My Pediatric Hospitalists want to charge and Revenue Dept states they will deny. They are listed on the AAP coding for Newborn decision Tool for 2021 and listed under Medicine/Allergy/Clinical Imm in the...
  36. I

    Question OBL

    Does anyone know where i can find all the procedures that can be done in an OBL (Office Based Labs), Medicare reimbursement for them as well? Any insight would be greatly appreciated.
  37. J

    Question CALCULATING MEDICARE PAYMENT

    Hello Everyone! I am trying to determine if Medicare paid their 80%, but I am having trouble calculating the amounts. I was looking online for the exact formula to follow, but I am getting a lot of info and I was not sure what to use. I know that for a participating provider Medicare will pay...
  38. S

    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...
  39. S

    Pain Management Billing

    We are billing for a bilateral lumbar RFA for 3 levels and are having trouble getting the add on code to pay. It is 64635 Mod 50 and then since the add on code can no longer be coded with a mod 50 we have done 64636 with 4 separate line items (with no modifier) and it has denied. The 2021 CPT...
  40. P

    ESRD coding question

    In Nephrology our providers see patients who are on home dialysis in the dialysis center once for a monthly face to face visit and labs..... We are currently billing with CPT code 90963 based on pts age, billing under facility POS (63). This is what the providers have been told to use prior to...
  41. eharloff

    CMS-1500 Question - PA

    For Box 31 on the CMS-1500 Form, if a patient sees a Physician Assistant, does the PA's name go in that box or does it have to be an MD or DO? Any help would be great! Thank you :)
  42. T

    Question Unbundling

    Can I get some insight on unbundling services? I have a couple of scenarios. 1. 64633-50, 99070, S0020, J3301 ( RF Ablation with use of lidocaine, Marcaine, and Kenalog. 99070 was billed for misc supplies) 2.99203-25 62321, 62323, 99070, J3301, Q9966 (New patient visit where a cervical ESI and a...
  43. KStaten

    Answer What qualifies as a "change" in the plan of care for Outpatient Incident-To Billing Rules?

    Hello Everyone! 🙂 Soo.... Incident-to Billing can be tricky, as even references sometimes vary in their wording/ interpretation of the rules. It has been to my understanding that any time a change is made in the physician's current plan of care, it no longer qualifies as incident-to services...
  44. J

    Question Billing Ensure (Enteral/Nutrition products)

    I work for a company that has started supplying nutritional products, like Ensure, for patients. There are so many different codes that can apply for billing the HCPCS. Can anyone offer me some guidance on which code to bill with? Is there anything notable I should know about billing this?
  45. M

    Question Trying to find a new primary care billing system

    Our clinic is a combined mental health and primary care clinic. The EHR we are currently using (Carelogic) does not work well with the primary care clinic so we are trying to find a system that would make primary care billing easier. Our clinic is small and only has 2 primary care providers. We...
  46. C

    97164

    Hi, This is my post in the forum and newly certified. I’m currently work in a physical therapy office. We were discussing utilizing the re-eval. code 97164. I understand that there are some guidelines when it’s appropriate to use this code. In addition that the modifier 59 would need to be...
  47. S

    Question Covid

    I am new at coding (just started classes... I'm a M.A.) Please forgive my ignorance. We are a family practice in a very small rural town. We see scheduled patients daily. Currently we are overwhelmed with phone calls for covid testing. A nurse takes the call and then triages ... an...
  48. N

    Question MFM Billing for Antepartum Care Only Codes

    My provider is a MFM whom also delivers patients. If my provider delivers the patient, we would bill for the global delivery(antepartum and postpartum). There has been a few instances where the hospitalist will deliver and bill for the delivery. Then the patient will come to our office for...
  49. K

    Question New NP & POS

    I just started working for Primary care and I need some help with the Billing and POS for a New NP in a different location. In the process of hiring a New NP and she will be in a different location 1. New NP A she will use an OBGYN clinic on Wed and Thurs... The OB is closed on Wed...
  50. M

    96127 and UHC

    Hello, we are able to get reimbursement from every major healthcare provider. We are at a loss with United healthcare though. I was wondering if I can get any feedback from somebody on how they get reimbursement for the 96127 CPT code. Not sure if it has something to do with the diagnosis or a...
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