1. 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 :)
  2. 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...
  3. 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...
  4. M

    CPC, CPB Ready to Break Into Coding Role

    Attached is my formal resume. I am experienced in multiple specialty billing looking to get my break into a coding role. Marissa McClure, CPC, CPB
  5. J

    For hire- associates with Associate/Bachelor Degree in Finance/Accounting

    If you have your degree in Finance and have experience in Healthcare billing/coding, please reach out to be considered for an associate job. CPC-As will be given a great chance to work under CPCs and remove the "A"! Please send your information/resume to
  6. 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?
  7. 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...
  8. C


    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...
  9. 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...
  10. 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...
  11. 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...
  12. 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...
  13. 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...
  14. M

    Therapy Billing

    I recently started billing and coding for a Therapist/Counselor for substance abuse. I am billing all insurance as out of network. My claims are continuously getting denied. How should I be billing out of network for a substance abuse therapist?
  15. M

    Wiki 87426 question

    previously we were billing out 99000 for covid testing. Now between with the 87426 coming out my office is saying that the 87426 is saying its the antigen and not testing someone. I honestly am unsure how to treat it, as there are people saying different things. I thought this 87426 was the...
  16. K

    Contracted with Medicare/other insurances but not Medicaid

    If a practice is contracted with Medicare and other commercial insurances, but not medicaid.. Does the patient legally have to pay their primary insurance co-pay? For example, the patient's primary insurance is United, but their secondary is some type of medicaid plan. If United decides there...
  17. K

    Question Antibody testing

    I need help. I have antibody testing that needs to be billed out but not sure exactly what codes to bill out for IgM, IgG, and IgA test. Do I bill out 3 codes for each one of them? Is it one code? I have found that 86769 is the antibody testing code. Just not sure if I need to bill it out 3...
  18. C

    Ambulance Billing and Coding

    I am posting here to get some insight, references, and general knowledge about ambulance service billing and coding. I have been in my position as the sole biller and coder since December 2018. I've picked up most of my knowledge just by being in the position, but I would really like to learn...
  19. M

    Question Billing for return to work exam/note

    We often get patients who are required to get a work release note in order to go back to work after being sick and I never know how to bill for this. Is it even billable? The patient's symptoms are resolved and the only reason they are here is to get a note to allow them to return to work...
  20. M

    Experienced Medical Coder/Biller

    Magdalene M. Dorsey 616 Gold Sand Road, Louisburg, NC 27549 Home: (919) 853-9000 – Cell: (919) 441-0408 - Education Associate of Applied Science Vance Granville Community College Area of study: Medical Coding Cumulative GPA: 3.773 Graduated: May 2014 High...
  21. M

    Experienced Biller and Coder looking for Coding/Billing Opportunities

    Magdalene M. Dorsey 616 Gold Sand Road, Louisburg, NC 27549 Home: (919) 853-9000 – Cell: (919) 441-0408 - Education Associate of Applied Science Vance Granville Community College Area of study: Medical Coding Cumulative GPA: 3.773 Graduated: May 2014 High...
  22. R

    Question Telehealth interrupted

    What would you code/bill (I'm with an FQHC in AR) a telehealth virtual visit where connection was lost and ended up just being a telephonic visit? Would it depend on the time of each? What about a modifier? (I'm thinking reduced service maybe?) Any help would be appreciated.
  23. J

    Question Inpatient Hospital Billing for Telehealth - HELP

    Can anyone please inform me if any of their MD's are seeing patient's remotely from home and using telehealth/telemedicine charges. If so what are you using to bill to the insurances G0406-G0408? or should they bill NP consult via telemed/health as 99446-99449 Thank You for support guys!!!
  24. B

    Recovery Room charges for IR?

    I'm trying to figure out if we are missing an opportunity for a recovery room charge. I work at a hospital. The patient comes in for an MRI with general anesthesia and goes to PACU for recovery. Should there be a charge under Rev code 710? what if instead the patient recovered in a CVO room (a...
  25. P

    Intra-operative monitoring technical component

    Hello, I work for a small IPA and we are trying to figure out what is correct for the technical component of IOM. I have been denying them because I assumed the technical component was payable to the facility, but I am not sure that is correct, because there is a tech and the neurologist. Does...
  26. M

    Question Billing insurance for titer required by school

    I know that most insurances won't cover things like school physicals and pre employment exams, but are titers covered? We had a patient get Hep B titer done for school. Can we bill the patient's insurance or just bill the patient?
  27. C

    Question Medicare LPC billing

    Hello, Currently, I am coding for three behavioral health providers, one of which is an LPC. Currently, Medicare does not reimburse for any LPC billing. -There is a current bill out to get this updated and get more help for Medicare patients with more provider options within behavioral health.-...
  28. ily620

    CPC w/ Coding, Billing, and Revenue Cycle Exp.

    Hello, I am CPC certified with 15+ years of medical coding, billing, and revenue cycle management experience. I am looking for a remote coding and/or billing opportunity that can be either part time or full time. I have attached my resume for reference of my skill set. Thank you in advance...
  29. 5

    Question two speicalty providers same tax ID number

    Hello Can someone get back to me on how to bill two different specialty under same Tax ID number. I have incidents at the surgery center with when a CRNA and Pain specialty physician both provided services on the same patient on same day and one is getting denied. One is a anesthesia code and...
  30. C

    Question NP DNP

    Hello my fellow AAPC members. I am looking for advice. I have a provider who is a NP DNP and started her own practice in NY. She has worked as an NP under another practice for years treating patients under an MD. She hasn't been with him for over a year now. Her specialty is pain management...
  31. M

    Question TRIBAL FQHC

    I work for a Tribal FQHC and have some questions regarding procedures not associated with a G code under FQHC guidelines. It has been our directive to split out the procedure codes (for example I&D, wart removal, etc) and submit those to Medicare B. However, when I am researching FQHC...
  32. S

    Question Reporting sample drugs

    Hello does anyone report the administration of free sample drugs to the payer with a zero dollar charge along with the administration and an e/m if applicable? thank you in advance. To me it would appear audit worthy to see just the e/m and the administration without a drug of some sort. Jeffrey
  33. 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...
  34. 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
  35. 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...
  36. 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?
  37. 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...
  38. 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
  39. 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...
  40. 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...
  41. 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
  42. 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...
  43. 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...
  44. J


    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
  45. 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...
  46. 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
  47. 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.
  48. 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...
  49. 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...
  50. 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...