billing

  1. H

    Wiki 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...
  2. E

    Wiki 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...
  3. M

    Wiki 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...
    • MagenD
    • Thread
    • billing chronic care management coding hospice remote patient monitoring
    • Replies: 1
    • Forum: Billing/Reimbursement
  4. K

    Wiki 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...
  5. L

    Wiki 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?
  6. M

    Wiki 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.
    • msksmith
    • Thread
    • billing electronic remittance epic payment posting
    • Replies: 0
    • Forum: EMR/EHR Systems
  7. A

    Wiki 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
  8. B

    Wiki 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...
    • bkhattak
    • Thread
    • assistant surgeon billing modifier 80 modifier as plastic surgery plastic surgery coding surgery surgery center
    • Replies: 20
    • Forum: Billing/Reimbursement
  9. M

    Wiki ICD-10 for Pregnancy NOS

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

    Wiki 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...
  11. J

    Wiki 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...
  12. morriam91

    Wiki 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...
  13. N

    Wiki 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...
    • nittamarable
    • Thread
    • 11042 11042/11045 99214 billing debridement e/m e/m with modifier 25 humana modifier 25 office visit
    • Replies: 2
    • Forum: Billing/Reimbursement
  14. L

    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...
  15. L

    Wiki 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...
    • LaurenBrooke
    • Thread
    • appeals authorization billing pre-authorization surgery surgery prior auths
    • Replies: 9
    • Forum: Orthopaedics
  16. C

    Wiki 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...
  17. 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...
    • msksmith
    • Thread
    • 99211 billing billing and coding e/m coding reimbursement
    • Replies: 0
    • Forum: E/M
  18. C

    Wiki 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...
  19. I

    Wiki 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.
  20. J

    Wiki 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...
  21. 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...
  22. S

    Wiki 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...
  23. P

    Wiki 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...
  24. E

    Wiki 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 :)
    • eharloff
    • Thread
    • billing billing questions claim form cms-1500 insurance physician assistant
    • Replies: 1
    • Forum: Billing/Reimbursement
  25. T

    Wiki 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...
  26. KStaten

    Wiki 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...
    • KStaten
    • Thread
    • billing guidlines incident-to medicare outpaient physician assistant plan of care
    • Replies: 1
    • Forum: E/M
  27. J

    Wiki 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?
  28. M

    Wiki 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...
  29. C

    Wiki 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...
  30. S

    Wiki 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...
  31. N

    Wiki 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...
    • Nsolomon87
    • Thread
    • billing billing compliance deliveries maternal fetal medicine mfm coding obgyn coding
    • Replies: 2
    • Forum: OB/GYN
  32. K

    Wiki 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...
    • kjb11
    • Thread
    • billing credentialing different locations nurse practicioner pos 11 supervising provider
    • Replies: 2
    • Forum: Billing/Reimbursement
  33. M

    Wiki 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...
  34. M

    Wiki 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?
  35. M

    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...
  36. K

    Wiki 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...
  37. K

    Wiki 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...
  38. C

    Wiki 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...
  39. M

    Wiki 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...
  40. M

    Wiki 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 - magdalene5836@gmail.com Education Associate of Applied Science Vance Granville Community College Area of study: Medical Coding Cumulative GPA: 3.773 Graduated: May 2014 High...
  41. R

    Wiki 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.
  42. J

    Wiki 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!!!
  43. B

    Wiki 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...
  44. T

    Wiki 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...
  45. M

    Wiki 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?
  46. C

    Wiki 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.-...
  47. ily620

    Wiki 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...
    • ily620
    • Thread
    • biller billing coder coding remote biller remote billing remote billing job remote coder remote coding remote coding job
    • Replies: 0
    • Forum: Resume Postings
  48. 5

    Wiki 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...
  49. C

    Wiki 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...
  50. M

    Wiki 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...
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