1. P

    CPT 33285

    Can someone please offer some knowledge on this cpt code. 33285. (This is for Professional claims) NY state(NYC) We have been billing Empire BCBS( Mainly mediblue) for this service both inpatient and outpatient. Under BCBS policy the dx that we have been billing Z86.73 or R55 are allowed per...
  2. C

    ILR (implantable loop recorder)

    Can someone please tell me if they have located DX for ILR specifically CPT 33285 or 33286 with in LCD or MCD TIA
  3. S

    Question Commercial and Medicaid Maternity Billing

    Hello, We often have patients that have commercial insurance with Medicaid primary for all of their maternity care. If the patient meets the requirements for a global delivery we will bill the global delivery but in this case the patient doesn't have maternity coverage with her commercial...
  4. H

    Question Locus and telemedicine

    Does anyone have any experience or knowledge on using off site locums tenens provider to bill telemedicine and what requirements I might need to follow or make sure are enforced? Is an offsite locums different than onsite?
  5. K

    Question Starting A Billing Company

    Hello! I was wondering if anyone had any experience starting their own billing company that could give me any advice? I have already completed all legal components (with the exception of the errors and omissions insurance, I am still shopping around for that). Does anyone have any experience...
  6. K

    Billing for a PA in a Teaching University

    Hello Folks, Does anybody have any knowledge/experience doing this? One of my clients ( a PA ) has just joined the University Hospital. The Billing Department is not sure how to bill for her services. Any help/advise would help. Thx a lot Ken Lobo
  7. S

    Kareo vs NueMD

    Hello! I work for a small endocrinology practice and we are currently using Practice Fusion as our EMR and NueMD as our PM system. I am currently looking to change our PM system from NueMD to Kareo. Kareo seems pretty great from what I can tell, but I am not totally sold on the idea yet. I was...
  8. K

    Billing Mental Health/ Billing Medical

    thread deleted
  9. M

    Billing for RN services with no supervising provider in the office

    I work in an outpatient medical and mental health clinic with 2 locations. My location is mainly admin staff and social workers. We do have an ANP and an RN at this location, but the ANP is moving his office to our other location. The problem is that the nurse wants to remain here and continue...
  10. K

    Tobacco counseling billing

    UHC has new issue. They stated that tobacco use counseling covered under optim dx and recommended claim submission to rx. Does anyone already bill 99406 to rx? Thank you
  11. R

    Pacer billing help w/26 & TC mods

    I'm still new to coding and I haven't dealt with pacers before. Our NP does the interrogation then Doc reads the report. Am I supposed to be billing 93288 with 26 under and TC under doc? To me, that is exactly what I should be doing but NP has "built pacer clinic from ground up" and believes...
  12. K

    billing L&I

    I really need some help. The urgent care clinic that I work for uses a national billing company. This company is billing all of our new L&I claims as new patients even if they are established patients with us. When I objected they took it to the person who is the head of their entire billing...
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    Hi, We have a few claims who denied payment because of reason code CO-96 (Non covered charges ) from Primary as well as Secondary insurance. Can we bill this to patient? Please advise. Jay
  14. E

    Modifier 55 NIGHTMARE

    Can anyone please tell me how to get a claim paid when using modifier 55? We had a patient who came in as post operative management care after having ORIF on tibia out of state. According to Medicare guidelines you are to bill the procedure using date of procedure with modifier 55 and place of...
  15. E

    Billing Add On Codes on One Claim that Span Multiple Dates of Services

    Hello, I am a new medical coder and biller, and I am trying to understand if primary codes and add on codes must be billed on the same day when there is a span of dates of services on one claim. Please help. Thank you, Hilliard Emmanuel McDonald
  16. E

    Denial from Primary

    If a patient has two insurances and the primary denies (denial is appealed and upheld), do you have to bill the secondary insurance? A co-worker was told to adjust and to not bill the secondary at all.
  17. A

    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...
  18. J

    billing for delivery DR didn't attend?

    I am at an FQHC Indian Health Facility for general family practice. One of my new providers who will be providing OB care is wanting me to bill for a delivery that she was not present for. I have never done OB coding or billing before but it seems wrong to me. Apparently she is part of a group...
  19. A

    Supervising Physician Requirements with Regards to Billing

    Hello, I am new to the billing/coding world. I've been coding and billing for workers compensation and have some questions. I work for an urgent care in CA with 1 supervising physician and many NP/PA/Locum providers. When billing, the 1500 has the supervising physicians name/NPI in box 17. He...
  20. M

    Icd 10 to cpt cross walk

    What is the best tool to cross a codes CPT's by ICD 10? For example, If I would like to see what procedures can be performed for a condition such as (A63.0)? What is the best tool out there which everyone uses? I appreciate your help.
  21. L

    non-credentials NPs billing under credentialed NPs

    Are there any other organizations billing one NP's service under another NP's name and NPI? We have new mid-level providers who aren't yet credentialed, so the established mid-level providers in the clinic are signing the notes and expecting the claims to go out under their name and NPI...
  22. C

    Cpc_a resume for remote coding position

    Courtney Beth Gainey (Burk) CPC-A 1400 Margina Ave Daytona Beach, FL 32114 Phone: (678)654-7644 E-mail: PROFILE: Highly capable and detail-oriented professional seeking a Medical Coding position to utilize and enhance industry knowledge and coding education...
  23. S

    Bilateral Procedures for ASC

    Can someone please clarify how to bill bilateral procedures for ASC (Ambulatory Surgery Center)? I've heard that it varies between payers, but I just someone just told me that Medicare will not accept modifier -50 for ASC and that we have to bill -LT/-RT on separate line items. Is this correct...
  24. T

    Pathology Coding

    Hi fellow CODERS! I hope this message finds you well. I am in need of some clarification around lab billing. I am not very familiar and would like to get some feedback. our office is billing multiple CPT codes in the Microbiome area. One being 87798, as we know this is an unlisted code...
  25. N


    Does anyone out there use Celerity for their EHR & billing? Also is there anyone that uses it for residential services and office visit professional services? What are your thoughts? Any helpful hints? What issues do you have? What clearinghouse do you use with Celerity?
  26. K

    Billing TCM & G0506 Together

    Hello, Looking for some feedback on billing TCM and CCM code G0506 together. It's been brought to our attention that these are denying when billed together. Wondering if a simple -25 modifier would fix or if this isn't allowed. Can't seem to find any clear documentation in the guidelines. Thanks!
  27. S

    Biller/Coder w/ ASC/SDS Expertise - Looking For FT Work (Remote or NW Houston, TX)

    Hello, I am a certified Medical Biller and Coder with expertise in multi-specialty Ambulatory Surgery Centers/Same Day Surgery looking for full time work either remotely or in Northwest Houston, TX. Willing to do Billing, Coding, or Both. Attached is my resume for your review.
  28. K

    seeing patients without ID

    Where I work we are allowed to check in patients without picture id providing they are cash pay. It concerns me that we are creating medical records and writing prescriptions for these patients. Do I have reason to be concerned or should I just relax?
  29. K

    Carc pr-275

    I have a patient with Providence as primary and BxBs as a secondary payor and the first bxbs payment came through just fine, the patient had some copay, some deductible, and some write off. 2 months later BxBs sent me another EOB saying all of the write off amount has been changed to patient...
  30. J

    Flu Shot by Pharmacist

    When a flu shot is given by a pharmacist, how does that get billed? Can the administration be billed? And would it be submitted under the pharmacist or does a provider need to sign off on it? I am new to flu shots being given by a pharmacist versus given in a clinic by a nurse.
  31. G

    Decision for surgery was made... and then the surgery was cancelled. Can we bill?

    I'm not sure what's correct for this visit: The patient was seen on 8/1 and the decision was made to proceed with a partial mastectomy. Consent forms were signed and surgery was scheduled for the end of the month. The patient was seen again on 8/10 because she had questions about the procedure...
  32. B

    Alabama Billing Position

    Job Purpose: Generates revenue by entering charges, posting remits, working rejections, and reviewing/working accounts receivable; making payment arrangements; collecting accounts; monitoring and pursuing delinquent accounts. Reports to Billing Supervisor Duties: * Enters charges daily. Posts...
  33. U

    Hands on learner, looking for help.

    Good afternoon everyone, I recently graduated from Penn Foster Medical Billing and Coding program and was wondering if their is any hands resources available. I want to start practicing to get certified, but I am more of a hands on learner when it comes to things. I currently work as an...
  34. H

    Physician, Coder Issues

    I am wondering if any one knows where to find a document that you can have your physicians sign, stating that they are liable for any billing issues, such as fraud etc. I was told at a Medicaid conference you can have your physicians sign one. I only want one because I am told alot to just bill...
  35. K

    Can PAs and NPs see a NEW Medicare Patient?

    Hi there, I work in a Dermatology practice and there has been some discussion over billing for PAs and NPs... I'm wondering: Can PAs and NPs see NEW Medicare Patients? Thanks!!
  36. C

    Pain Neurostimulators - Can you bill implants separate on commercial cases?

    Alright alright alright, So far we have only had Medicare neurostimlator cases (63650x2, 63685) and recently we've been asked if we could do a Cigna. Now here's my issue, are we able to bill implants separately with this commercial policy using the various HCPCS codes? The reason for my...
  37. L

    Revenue cycle management

    I am a experienced Revenue Cycle Specialist and I am looking for a remote position in Revenue Cycle Management. Skills: AR, Billing, Payment Posting, Authorizations, Medical Audit Review and Recovery and Refunds
  38. U

    2 billing companies for the same medical group

    Hi, A medical group in LA wants to try a second billing company for Medicare claims, Noridian as MAC and for CCM (chronic care management) related claims only. For the rest of their billing, they want to keep their current biller. What is the exact process that the group, the current biller...
  39. D

    NP seeing patients without physician on site

    Can a nurse practitioner see patients in a family practice office where the collaborating physician does not see patients and is not on site ever? Can the NP bill under the physician's name for those plans that do not recognize NPs? This is in the state of Florida.
  40. O

    NP in Credentialing Process

    Can anyone give me some advice on if we are in compliance by allowing our NP who is in the process of being credentialed(apps already submitted) to see the patients on her own without the provider going in the rooms with her but who is readily available to answer any questions she may have...
  41. E

    Fracture care help

    Could really use some help, My provider saw a new patient for a fracture of distal radius, nondisplaced. She origionally went to an urgent care center and was told she had a fracture and to follow up with ortho. The impression of the office note states "patient was given a brace, follow up in 2...
  42. A

    99090 Analysis of clinical stored data

    Does anyone bill this for reviewing a massive chart before seeing the patient, and if you do, does it get paid? Also what do you bill for it? Thanks in advance!
  43. S

    Over Coding Issue

    Hi Everyone, I've recently started a new position with a family planning clinic and I'm the first coder they've ever had. The previous billing supervisor, who is no longer with the company, put a rule in place that all procedures should be billed with an E/M code & modifier 25. As we all know...
  44. T

    How to simplify ASC Pre-collection process

    Hey there, Ok so I just started working for an ASC in FL, and I was asked today if I had any interest in covering for one of our "pre-collectors" who has just gone out on STD. Here's my issue THIS practice is stuck in 1986 ?, that's right they are still utilizing everything in paper form, ie...
  45. B

    Patient's Refusal to Pay Cost-Share

    Looking for some guidance. In my 7 years in this practice, I have never had a patient refuse to pay an invoice. We've never had to use a collection agency. Patient was billed timely for cost-share of $330. Patient's response to my invoice is that copays should be $12 per visit and not $30. My...
  46. C

    New provider not credentialed with health plans

    Hi there, We have a new provider (an MD - not an NP) who is not quite credentialed with all the health plans our practice participates with. When she sees patients who have an insurance she is not credentialed with, I have been directed to bill those claims under another physician at the...
  47. A

    Routine Eye Exam vs. Medical

    If a patient comes in for a routine eye exam but the provider finds a medical diagnosis, as a coder I am trying to find backup that shows that unless we treat the patient for said medical diagnosis, we must bill to the vision insurance. Example: Patient comes in for yearly routine visit and...
  48. S

    Modifier for Medicare E/M help

    Hi, My colleague and I would be grateful to someone who could advise us on the proper modifier to use for Medicare when the E/M rendered is unrelated to the patient's primary disability plan? Thank you!
  49. C

    Cpc-a iso remote medical coding position

    COURTNEY GAINEY CPC-A 678-654-7644
  50. T

    Billing office structure

    Hello! I am looking for examples of current billing office structures. How many staff you have and what their job descriptions are? Do you have your accounts divided up by last name, payor or by account activities? Any information would be helpful! Thank you! Tara