1. C

    When all the procedures don't fit on the claim form

    Good morning everyone, I've been an avid reader of the forums for some time and would appreciate some advice on a thorny work situation. The practice I work for has decided to change up some of the lab testing. The problem is what they want to change it to is basically 3 components short of a...
  2. T

    Claim Scrubber Product

    Hello - My company is currently using a Claim Scrubber Product from OPTUM (Claims Manager). We want to review other Claim Scrubber products to determine if we should continue with our current product or find a product that better suits our needs. Our Practice Management product is GE...
  3. M

    Caresource (Medicaid product in OHIO) denying claim due to dx?

    Hi~ I have been told by one of our billers that he was told by a rep from Caresource that a particular claim has denied due to a diagnosis (but of course would not give him the exact 2dx in question). I have researched and could only find the following codes (that state needs additional code)...
  4. R

    CPB billing program - payment plan

    Since AAPC doesn't have a payment plan and you have to pay for the whole program all at once, can you claim this program on your taxes?
  5. C

    0191T with cataract surgey

    Hi, I am new to coding ophthalmology surgeries. My office and I are trying to figure out how to correctly bill an I-stent with a cataract surgery on the institutional claim form. We received some CO97 denials on the claims we have billed with them so far. My questions are: Does the 0191T need a...
  6. S

    ****HUMANA is Fixed ***** denials of well visits with immunizations

    After working the insurance commissioner and Humana all claims processed from 12/12/15 to 01/16/16 should be reprocessed and paid correctly. They stated that there was an internal error where claims with a 25 modifier and 59 modifier were being denied incorrectly. I was able to locate a claim...
  7. K

    Gastroenterology - I have a claim that Medicare denied procedure

    I have a claim that Medicare denied procedure 97605 when billed together with 20102 stating invalid modifier billed with 97605. The procedures were billed as 20102-78-GC and 97605-59-78-GC. I verified in NCCI and these modifiers are appropriate. Does Medicare not want the modifier 78 on...
  8. D

    E/M w/ 57 modifier and operative report denial

    We have seen an influx of denials from payer sources (VA, BCBS and work comp) denying the E/M with a 57 modifier because the E/M and operative services weren't billed on same claim. Is anyone else seeing this? Thank you. Deb Knight, CPC, COC Missoula Bone & Joint & Surgery Center
  9. W

    Billing multiple years on the same claim form

    Can you bill for a DOS in year 2015 on the same claim form as a DOS in 2016?
  10. S

    Inpatient Coding - Could anyone tell me how

    Could anyone tell me how are the codes 31500,36556,92950 and 99291 are to be billed and if a modifier is needed. The clearing house is stating that there is a CCI conflict edit within the claim.
  11. L

    66761-LT denial

    I've received a denial from an insurer for 66761-LT stating it was within the global period of another procedure. Exactly 7 days prior we billed for 66761-RT. Am I correct in thinking the 66761-LT wouldn't be included with 66761-RT since it is a separate procedure done on a different site of...
  12. C

    hospital inpatient treated in physician office

    One of our physicians treated a patient in the office while the patient was an admitted inpatient in a hospital. Medicare denied our Part B claim for inconsistent place of service - CO5 as the hospital also submitted a claim for the same date of service. I was told by a Medicare rep that a Part...
  13. L

    bialteral modifiers with 31297, 31295 and 31255

    Can these codes be used with modifier 50? and on the same claim as 31296?
  14. T

    63047 denying for modifier ....

    Recently Tricare began denying 63047 stating "...INHERENT BILATERAL PROCEDURE WITH UNITS GREATER THAN ONE...." The procedure done was "DECOMPRESSION OF L3 & L4 LAMINECTOMY WITH BILATERAL FORAMINOTOMIES" The original claim was sent with 63047 x1 & 63048 x1 & 69990 x1. According to the CPT...
  15. C

    PAcemaker IMplant denials due to claim having ICd-10 code R55 on claim

    I realize the NCD 20.8.3 for Pacemaker implants CR9078 states the syncope (R55) is not a covered dx for pacemaker implants. It also goes on to state that claim will be denied if R55 is present even with a qualifying covered DX code. I have some concerns regarding this and I am curious if any...
  16. J

    Humana denying any OV billed with any testing or vaccines at the same visit

    Did anyone else start receiving denials for O.V mid December anytime it was billed with any vaccine or testing ( 87880,86308, ect) ? We are pediatrics...and yes we are billing with the correct modifiers. Its across the board, not even plan specific within Humana. I'm reaching out to my Humana...
  17. T

    BCBS Glitches since ICD-10 implementation

    Just a question to see if anyone else is having issues getting paid by BCBS. Starting on 9/25, we have had a multitude of issues. For instance, there are several days in September that our claims were sent to BCBS electronically and accepted by the payer yet BCBS has no record of the claims...
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    Question is anyone having to put an NDC# on claim in order for Medicare to make a pymt?
  19. D

    Coders Direct, LLC ?

    Has anyone ever heard of these guys? They say they will post your contact information and credentials in their database. Then, they'll compare your information to what potential employers are looking for to see if it's a match. They also claim to be a good source for C.E.U.s. I didn't sign...