1. J

    Wiki Claim Denial: Mutually Exclusive Procedures

    Hello, everyone! I am not sure if this is posted yet. But I have a quick question regarding denials and appeals for California. Recently, we have had a denial for mutually exclusive procedures: unbundling for the codes as follows: 17000 - L57.0 AKs 17003 - L57.0 AKs 17110 - B07.00 Plantar...
  2. 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?
  3. 0

    Utilizing MSR on outpatient facility claims

    Hello. I am new to the AAPC so I apologize if I am going about this all wrong. Does anyone have knowledge of a policy that supports the use of MSR (reductions) on outpatient facility claims. This has been a recent hot topic to us locally and I am looking for all the knowledge I can gain...
  4. J

    FQHC Billing Lab Services to Medicare Advantage plans

    Hi, I work for an FQHC in Hawaii and we are having issues with billing PPD tests and other lab services to Medicare Advantage plans like UHC, WellCare, etc. Is there anyone else billing/coding for FQHCs who can share how they are billing labs to Medicare plans? According to the Medicare FQHC...
  5. 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
  6. S

    Wiki Credentialing question

    We have had some issues getting credentialed with Medicare. Our group effective date is 7/31/17, but our provider(we only have 1) is not assigned to the group effective until 10/1/17. Does anyone know of a way to get the claims from 7/31/17 to 9/30/17 processed without the providers name on the...
  7. R

    Experienced professional coder looking for part time (<20h/wk) remote

    I am an experienced CPC with over 15 years' experience. My coding experience ranges from primary care (Fam Med, IM, Peds), to specialties such as ID, OBGYN, and ED. My resume is attached. I am willing to work remotely up to 20 hours per week. My contact information is in the attached resume...
  8. C

    code corrections and modifiers

    Ultimately the physician is responsible for codes, modifiers and diagnosis that are submitted on a claim. I am looking for information on what a certified coder can do vs. a non certified medical biller. Can a medical biller who is not certified add a modifier to a claim or must this be done...
  9. J

    Motor Vehicle Accident Billing ?

    Hello, this has been an ongoing issue in our small orthopedic office for a while... We have an office policy where we do not file personal insurance for MVAs, because when we do, the insurance ends up recouping later on. Therefore, we file no third part companies. So we make patients pay up...
  10. J

    Out of sequence claims

    Can anyone tell me if they know the modifier for Medicare when submitting claims out of sequence.
  11. C

    Denial from BCBS for dx code inconsistent with procedure code

    I work in a Neurology clinic with a physician who specializes in movement disorders. Yesterday we received 3 denials from Blue Cross with the Reason Code CO 11 attached, the diagnosis is inconsistent with the procedure. I coded the visits as follows: G20 (Parkinson's Disease) as the primary...
  12. J

    Number of service lines

    I know this seems like a silly question. I was wondering if anyone knew if you could bill more than 6 lines of service when billing claims electronically?
  13. W


    Is the pick up and drop off location AND the modifiers required on an ambulance claim for Anthem and/or Noridian electronic claims? If so where can I find this documented? like a billing guideline?
  14. H

    ICD10 Global ob billing

    With the new year and so many patient's changing insurance, we have to bill ob visits from 2015 to one insurance, not included in global. We are having trouble with some insurance companies denying our claims even though we are billing semester and weeks gestation as dx code.
  15. L

    ESSURE modifer - We are having claims

    We are having claims denied for lack of modifier on our ESSURE claims. We use 58565 and A4264, and one denial specified that the A4264 needs a modifier. We have tried mod 50 but that was denied. Thnx for any suggestions!
  16. jkyles

    Drug screen claims on hold

    It's not you, it's the edit. "CMS discovered systems errors affecting claims with new drug testing laboratory codes (HCPCS codes G0477 through G0483)...
  17. S

    **** Humana is fixed**** innaproptiate denials of well visits

    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...
  18. 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...
  19. N

    IL medicare xover claims

    Recently our office has experienced claims NOT crossing over from IL Medicare to IL Medicaid. Has anybody else been seeing this happening?
  20. D

    BILIRUBIN Cpt code 88720 changes/updates

    We are having a very difficult time getting Optima to pay for this code. It denies as non covered. After researching the provider rep explained that this code is not covered whether performed in house or with the preferred outside lab. We perform this test on newborns in an office setting...
  21. D

    Need help with diagnosis coding for VNG

    Need some help with Diagnosis Code for VNG testing. At this practice we have always used R42 as diagnosis for this test. Recently UPMC has starting denying the claims because the diagnosis is not medically necessary. Can someone please help me with what code would be medically necessary?
  22. E

    Wiki ICD-10 proficent CPC-A Looking for Billing/Coding Position

    MEEGAN SWEENEY, CPC-A PROFILE Certified Professional Coder, Health Claims Specialist with experience in various areas of bad debt collections and follow-up responsibilities including maintaining accurate patient files and charts. Completed an extensive Health Claims Specialist...
  23. M

    Wiki Medicaid denials per announcement 976

    We are having a problem with Medicaid denying secondary claims per CMS announcement 976 stating that "history of ..." diagnosis codes are not acceptable as primary diagnosis codes. In these cases Medicare has paid the claim with a hx code but Medicaid is denying. I am not sure how to fix them -...
  24. L

    Wiki 59 vs xe

    Hi, We were told by an auditor for a large insurance company that we need to replace the 59 with XE. We code Dermatology and Mohs surgery in a private practice. We have documentation to support the 59 modifier. Does anyone have an opinion on this? None of our claims are being denied. We...
  25. C

    Claims submisison - With Rendering or Without for Urgent care

    We have this big dilemma over Urgent Care claims (CMS 1500). It comes up in other specialties as well. We have some Urgent Care groups stating they don't need to submit a rendering provider and can leave box 24 J blank. We have some that are putting a rendering physician on the claims but are...
  26. J

    Wiki Modifier QW - Does anyone know

    Does anyone know if the new Medicare UDS codes of G0477/G0478 require the CLIA Waived modifier QW? I don't want claims denied for not adding the modifier or vice versa. Thanks!
  27. F

    Remote 1099 Position- Payment posting Chirotouch Experience

    PLEASE ONLY RESPOND IF YOU HAVE CHIROTOUCH EXPERIENCE.- We are growing and have an opening for or a 1099, remote, payment posting/eob review position . Individual must have experience in current version of Chirotouch. This position is responsible for posting insurance payments, working...
  28. C

    Wiki Modifier 59 help

    IBC stopped paying my claims for 2 e/m's (an office visit and preventive visit) and a flu shot . The claims had a 25 modifier on them but now all of a sudden because of NCCI edits I am being told that I have to use a 59 modifier. Is anyone familiar with this modifier - can you tell me if...
  29. S

    PQRS for Hospitalists

    Does anyone have any input on how to meet PQRS guidelines for hospitalists? We deal with the patients that are admitted as inpatient or observation only so we never really have follow ups after they are discharged - I know some hospitals take care of it from them but we are considered a separate...
  30. 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...
  31. B

    Billing software

    I am needing help in choosing the best software for our Diagnostic Radiology business. We have 1 radiologist who reads for 5 hospitals, 3 family practices, 1 orthopedic practice and 2 Mri Imaging centers. We have a ton of work that comes through our office everyday, and we bill about 300 to 400...
  32. O

    Wiki Anyone ever used the CR modifier?! (Catastrophe/disaster-related)

    Hey, y'all. Has anyone ever seen or used this 'CR' modifier?! I'm in Texas and even with our tornado and hurricane disasters, I've never seen this one before. I can find CMS info but would like to hear from someone who has actually used this and what was the result? Catastrophe/disaster...
  33. N

    Wiki Filing Medicare Tertiary Claims (Novitas)

    Does anyone know the secret to getting tertiary claims submitted to Medicare (especially Novitas) successfully? We cannot file them electronically through our clearinghouse. Novitas first told us they would only accept if we did send by paper but put "tertiary claim" in box 19. That worked...
  34. N

    2 providers 1 patient same day DIFF.SPECIALTIES

    What modifier can I use for denied claims when 2 providers see the same patient on the same day? Long term care setting. A NP sees pt then the physiatry doctor sees the patient. Same practice but one provider is a specialist and the other is a physicians assistant or NP... we get denials but I...
  35. K

    DSM to ICD crosswalks

    I've petitioned just about everyone I know on this issue. The APA came out with a crosswalk over three years ago; however, what I'm looking for is information that also goes above and beyond the crosswalk. In the past, I've had to dig out my DSM and point to specific cases of "unbundling" the...