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What is the correct way to bill PA’s and NP’s for E&M codes and Level 1 CPT codes for Workers Compensation in Masshachusetts? When billing PA’s, do we bill them as the rendering provider and have their NPI and Taxonomy code in field 24J on HCFA1500 and use modifier SA ? Will work comp accept...
I have a couple questions and would like the opinion of other coders/clinics.
How many practices are releasing charges without first reviewing the note to make sure the E&M level chosen by the provider matches the documentation?
How many coders are letting the Dr's choose the level of E&M and...
These are the only two categories for which examples are not provided in the MDM table. We have Dermatology providers who regularly choose 99203/99213 for benign skin exams. The MDM notes regularly look like this:
Findings: benign nevi, solar lentigines, cherries
- sun protection/avoidance
-...
This pertains to a surgeon who is a consulting physician (i.e., not the admitting physician), who is asked to see a patient in the ED, who is then admitted by the hospital ED doctor. The surgeon then sees the patient as an inpatient on two subsequent days. Here is the scenario:
Surgeon sees...
Hello. I recently started working for a surgeon. This is my first time coding for a physician that sees patients in a hospital setting. He is on call and sees patients in the ED, ICU, etc..I am often unclear on which place of service to choose for his E/Ms. He mostly does surgery consults...
Hello. I live in AZ and we have state Medicaid (AHCCCS). I have a question regarding dual (or more) insurances and billing E&M codes.
I have patients that have private insurance (i.e. BCBS/UHC/Cigna) as primary and Medicaid as secondary. Do I use the E&M code (i.e. G0108) that I know the...
I am still getting my feet wet on E/M coding/auditing. I am stuck on the following encounter. I feel it is a 99213 for established problem not responding/worsening, only one point for data review (DAT results), and a Moderate MDM with prescription drug management. However, the history...
Diabetes Management Exam:
Foot Exam (with socks and/or shoes not present):
Inspection: MSK/Extremities?
Left foot: normal
Right foot: normal
Nails:
Left foot: normal
Right foot: normal
Sensory-Pinprick/Light touch: Neuro?
Left...
Hello all,
We all know how hard E&M coding can be so I want to clarify what we can or cannot bill. I work in a public health clinic where we see women for their yearly woman's wellness exam. According to our nurses, we have patients who come in for their yearly physical exam. During this exam...
OK...there seems to be some disagreement within my office on Rx Drug Management. The case is: An emergency room provider orders 1 Norco for a patient while he is being assessed in the ED but does not prescribe any long term pain meds on discharge. Some are saying simply ordering the 1 dose is...
Hi coder family:)
I guess my question is can P.A's see new patients in Urgent Care?
I am auditing our P.A.'s who see patients Monday-Sunday in Ortho Urgent Care. My question is, if a new patient comes in to be seen and a P.A. see's them for the first time. Would the P.A. be able to bill...
My physician documented in the assessment part of his note and billed a diagnosis of shoulder pain, however he also diagnosed osteoarthritis in his x-ray results. Since there is a definitive diagnosis, I know this should be replacing shoulder pain. If the note gets audited, will the pain dx be...
We are getting denials from PA's Medicare for CRNAs when billing 99201 for cancelled procedures. Denial when performed/billed by this type of provider. One claim rep said the service is covered under a CRNA but another rep said this was an error. Is anyone getting payment from MC for these? I...
Hello,
Can a psychiatrist bill for a med management visit (99214) for a child, when the psychiatrist only met with the parent? The child was not present at the visit. Are there Medicare guidelines that state that the identified patient must be present?
Thanks,
Abby
If anyone's interested, I've created a simplified lookup table that let's you know exactly which CPT code to use for any E/M subcategory whose codes are based on History, Exam and Medical Decision Making. If you're taking the CPT exam, you can transcribe the table into your book, and I'm sure...
Hello,
Im having trouble understanding E/M services.
Can someone explain how to code an e/m if the time the physician spent with the patient doesn't match the history and/or medical decision making?
Do i code what can be proven with the history noted? or a higher level of E/M due to the...
I am a new Auditor for E&M charges with Hematology Oncology practice. I am looking for any education sites or cheat sheets that anyone finds helpful. My email is tracy_mcpherson@aol.com. Thank you
We have had some difference of opinon on how to bill out the E&M lately with new drs on staff vs drs that have been here for years. Generally patient comes in here for a Full Skin exam which may or may not result in some biopsies but mostly the only other things notes are SK's and maybe Acne or...
Patient had tonsillectomy one day prior to ER Visit. Surgeon met patient in Emergency Room due to N/V with blood. Fluids given and bleeding controlled prior to patient leaving the ER. Since this is within the global period for the surgeon, does this mean that a ED Professional Level can not...
Hi all,
I've been hired as a coder after the clinic I work at updated to a new EMR system, and I've come across issues with coding for nurse visits.
We've established that when patients come in for injections/vaccinations, we code for the injections/vaccinations and the correct admin codes...
Hi,
If I have docs from 3-4 different specialities under the same tax ID performing E&M services on the same patient on the same DOS as part of a multispeciality clinic, do I bill each visit as a separate applicable E&M code? Or something else?
Thanks!
I have a physician who saw a patient in the ER for cholecystitis and removed the patients gallbladder due to the cholecystitis. The patient came in for her post op visit and the pathology revealed she actually had gallbladder consult and he is now treating her for the cancer. Do I still bill...
We did an annual physical on a gentleman, and also addressed his diabetes as not being very compliant. We billed commercial insurance for 99396 with dx z00.00 and 99213 modifier 25 with E11.9
Insurance allowed both charges, paid for the physical and the E&M was applied to his deductible. My...
I code hospital billing and I have a provider who has an intern following him, recently he has allowed the student to document handwritten progress notes and he signs over them correcting/adding/ inputting his own MDM, however the note doesn't have anywhere documented that the intern wrote it...
A patient came in with shoulder pain to see our NP, who did all of the charting for the E&M(99213), then Our physician came in and gave her a trigger point injection(20610) of Kenalog(J3301) How is this coded?
Good Afternoon, I am looking for confirmation of my assumption regarding this scenario more than I am an answer to the question. Is it appropriate to bill a level 5 E&M in addition to the code for an Oral Challenge if the patient does not require physician intervention for anaphylaxis or...
I would like your opinion on this, please.
Pt. walks into the clinic with a laceration due to a fall. Pt. is seen by the doctor for a laceration repair. Doctor also discusses past medical history, patient's current medication--is something off with meds that led to the fall, how is the...
Looking to network with a neurology coding expert! Needing written documentation guidance on billing scheduled EEG's. If the reason for the visit is a scheduled EEG unless separate identifiable E&M is documented the E&M is not billable. Correct? If anyone has any other billing guidance I...
I am struggling to define exactly what all needs to be done in order to bill an EM with 20610. Modifier 25 is a (Significant, separately identifiable E&M service by the same physician on the same day of the procedure), indicates that the patient’s condition required a significant, separately...
If my physician is seeing an established patient and no physical exam is done, can I charge an E&M visit? I have read in a couple places that even though you only have to have 2 of the 3, if an exam is not done, it's not considered a visit. When patient's come back for MRI results, the physician...
I recently to an exam for a coding job and had the following question:
What is the level of HISTORY represented by 4 HPI items, 8 systems on ROS, and 0 PFSH?
I have never been strong in E&M coding.... will some please provide with me with the answer? and explain the answer? By the way I...
A new patient is referred for evaluation and treatment, and based on imaging and medical documentation from the referring the provider performs an epidural steroid injection. Is it appropriate to bill a new patient E&M with modifier -25 in addition to the procedure to establish patient care or...
Hello Friends!
I have recently been asked for some clarification on how we do E&M coding for an inpatient setting. We are an infectious disease specialty clinic and are called in for consultations. Sometimes it is a patient that we have already seen in our clinic, and the consult is for the...
I have a person who was seen and E&M code was 90791 with dx code 296.90. Not sure why this was denied. Could someone maybe have a better insight on this? Thanks!
I have an otolaryngology group that has different subspecialties in it (ear, oncology, etc) and I'm a little confused. They all share the same tax id. I was told I would be able to bill 2 visits to Medicare on the same day for my physicians because the 2 that the pt saw were of different...
Does anyone have a good procedure for coding nurse visits for immunizations and other injections?
I work at an FQHC and there are several people here with different approaches to handling the documentation and coding of such visits...
Thanks for any suggestions you can provide!
I am having some issues with insurance companies denying (saying not seperatly identifiable) an E&M on the same day as chemo. Our docs not only have to verify that the patient is well enough to have the chemo but also wants to schedule a follow-up on the same day so that the already compromised...
Hi
I was wondering if anyone could tell me what elements they would pull from the following HPI.
Pt has a history of bladder cancer, transitional cell, advanced initially treated with Gemzar, carbo, Taxol, and had surgery done and there was residual small cell component. She had four cycles...
LaParsha White: BS, CPC-H
p:239-222-1779
Email:laparsha@aol.com
Southwest Florida Fort Myers, Cape Coral, Naples area seeking full-time employment
Education: Bachelor Of Science Business Administration Hodges University 6/2006
CPC-H American Academy Of Professional Coder 10/2010
AAPC CPC-H...
What level would this be? my coworkers are debating: patient came in to er with cc of headache, the hpi is has the quality, severity, duration and associated symptoms, the ros is complete, the pfsh has 2 areas.
the exam is a 8 system
they gave the patient iv medications and did a xray...
The majority of the patients we code are established patients. I was taught always to use the MDM in the EM selection. However this has brought on somewhat of a confusion.
In all documentation I've researched, I've found the same thing... it only takes one element of risk to qualify for that...
A few weeks back I was doing some research and stumbled across a provider newsletter (bc/bs ??) that indicated that payment for E&M's would be reduced by 50% for the office visit when performed with other procedures. Now I can't find it. Has anyone seen/heard/experienced this yet ? If so can...
In the Edge Blast #123 - Question # 3 I beg to differ:
Answer should be 99213, 99401 as opposed to 99212, 99401.
Assumption
15 minutes of time spent counseling the patient constitutes more than 50% of the E&M and time becomes the key factor. That is, 15 minutes out of 25 minutes (99212...
Can a radiologist perform and E&M Service. The group actually manages the patient care as they are specialists in mammography and carcinoma and will work with the patient by bringing them back for further exams, recommend several surgeons when a carcinoma is discovered, etc.
The radiologist...