facility

  1. T

    Prophylactic Appendectomy performed by a separate provider

    Help! I can't find anything anywhere about this situation. It is my understanding that for facility charges, NCCI editing can be overridden when 2 separate providers are performing procedures that normally unbundle to each other. Is this true when one provider performs a procedure like a...
  2. R

    billing part b for POS 24

    I'm completely lost over how to bill on the CMS1500 for our ASC/facility...to Medicare part B... any help would be lovely. I have rendering physician and ordering physician, even though they're the same. TC also does not work. My EHR doesn't want to let me enter a TOS. So, please...
  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. M

    ER coders/auditors that use a "grid" vs. points to establish E/M level of service.

    ER coders/auditors that use a "grid" vs. points to establish E/M level of service. I would like some thoughts and info on FACILITY coding of ED services using a grid rather than a points based system. How long have you used a grid? How did you go about transitioning to it and how did you set...
  5. B

    anesthesia time calculation for facility on a UB- IP

    Hello I am looking for resources to support what the facility may bill for anesthesia on a UB. I work with auditors who have the belief that the facility may only bill for the technical component therefore this means the OR time and anesthesia time should match most times as the professional...
  6. B

    Revenue Code 200 ICU

    Hello thank you in advance to any response I receive to this question. I am CPC who deals primarily in Professional coding and billing for my daily work. I'm trying to learn a little more about facility coding to aid a friend who had spent some time in the hospital recently. This individual was...
  7. B

    Enterprise income verification form

    In south Florida, facility billing is comprised of reports and payer breakdowns. Now, more and more facilities are requesting an EIV form. I have sent out many of these forms but i never understood how they were calculated. I know from experience the facility usually gives it expected percentage...
  8. R

    United Healthcare PHP is now IP?

    Im finding from VOBs lately that no matter the home plan, UHC is coming back saying PHP is considered Inpatient treatment, and if the facility is licensed as out patient,PHP is not covered. Is anyone else running into this lately?
  9. A

    Facility coding

    I've been thinking of expanding my knowledge into the facility side of coding. I was wondering if anyone had any suggestions for the best books or websites to look at to gain a base understanding of facility coding.
  10. A

    ED vs Urgent Care

    When can you append rev code 450 to an Urgent Care facility instead of rev 516
  11. T

    Bone marrow aspiration for graft

    If my surgeon is performing a surgery and aspirate bone marrow at the facility, can we code for the bone marrow aspiration or is this something the facility will bill for???
  12. P

    Icr

    I Need some input on billing for ICR (Intensive Cardiac Rehab). I am aware of G0422 and G0423 for the physician but is there a facility code that can be used for the facility fee? Any help would be greatly appreciated. Thank you
  13. D

    Help LE Angio's

    I hope this makes sense. My doctor does lower extremity angio's, artherectomy's and stent's. E.g. 37220-37229, at the local hospital. Obviously he gets the payment as service performed in a facility setting. My question is he wants to be a share holder in an outpatient/surgery center and do his...
  14. G

    90670 & 90732

    Can these both be billed (an adult in a nursing facility) ? What is the difference between them? Thank you
  15. P

    Question on ED Facility Level Guidelines - Need Clarifiication - LEVEL 4 or 5

    Working for multiple facilities, every one has their own guide on the facility leveling. A question brought up on whether to charge a level 4 or 5. According to the Level 4 intervention guidelines, preparation for 2 diagnostic tests which would include EKG, LABS or XRAY. Special Imaging such as...
  16. A

    ICD-10 Inpatient facility R/O and H/x

    I work for residential behavioral health facility that serves children and adolescents. I am not sure how to code "rule out" and "history off". For example I have on my summary report history of ADHD or R/O ADHD. Is the F90.9 correct code for both scenarios ? Please help me :)
  17. J

    Physician Orders for Lab/Diagnostic Tests

    Billing for facility: Orders from physician are coming over without a dx or an acceptable 1st listed dx. Facility is providing these services and we cannot code them without clarification. Is it inappropriate or correct coding/billing standards to bill/accept orders for labs/diagnostic tests...
  18. M

    Nursing Facility charges

    I work for an ANP and FNP who occasionally see patients at our local nursing facility. I have used the code 99334 with place of service but am getting denied by Medicare saying that the procedure code is incosistent with the modifier used or a required modifier is missing. When my providers...
  19. L

    Hospital Outpatient facility coding

    Hi everyone --I am looking for some feedback from any coders who work for a hospital and do facility coding. Are you required to code the ICD-10-PCS codes on your accounts or just the CPT codes? I am trying to gather some data to assist in decision making for my organization. Thanks in...
  20. D

    Facility ESI Billing-We have an

    We have an independent CRNA performing ESI's at our facility. The referring provider has been getting precerts and the facility is billing under the referring provider with his precert for facility charges. Should the facility be billing facility charges under the rendering provider which is...
  21. D

    Facility ESI Billing

    Does facility bill under independent CRNA as rendering provider for facility charges or the referring provider who ordered the ESI? Who has to get the precert, at this time the referring provider is getting precert and hospital facility is billing under him not the CRNA who actually provides...
  22. D

    Facility ESI Billing for CRNA

    How does a hospital facility bill for an ESI done by a CRNA? Does the facility bill under the referring provider or the CRNA, this is an independent CRNA we just bill facility codes, however the referring provider is getting the precert for the facility and using the surgeon as the rendering...
  23. J

    IDTF Billing

    I am looking for someone with whom I can discuss billing for an independent diagnostic testing facility. Needed ASAP. Thanks!
  24. M

    sequela or subsequent

    I am really confused thought I had the initial sequela and subsequent down but not so sure now. This patient came into our facility for follow up on foot injury. Provider documented the patients presents today with right foot pain. Seen at a different facility for the initial treatment has a...
  25. T

    Comliance/billing for oncology

    I am new to oncology and questioning if a NPP can supervise chemo tx (96413) when the MD is not in the facility? Could we employee a FP cover this treatment wondering of there are board certification requirements for this treatment? thanks
  26. P

    external cause coding

    I'm having a hard time finding what I'm looking for when doing external cause coding in ICD 10. Has anyone got any tips? We use 3M in our facility. Thanks!
  27. V

    delivery

    Good morning! Has anyone ever had to code for delivery 59409 in the ED?? Our ED delivered baby at 39 wks vaginal delivery and then was transferred to another facility for OB care. No complications etc. Can I bill out 59409?? Do I need to add modifiers?? Thanks for your help! Vicki, CPC
  28. J

    ACDF coding with 77003 radiology code

    Our surgeon specializes in the spine and thinks that we are able to code 77003 for radiology during a ACDF 22551 for his services only and not the facility. So I guess my question is are we able to put the radiology code on the physicians services? Also would you only put it on the facilty...
  29. J

    Premedications before chemotherapy infusion

    Does anyone know if it would be applicable to bill for premedications (benadryl, zofran, etc) given prior to the start of chemotherapy? This would be for facility coding. Please send any references you have and cpt's to bill. Thanks!!
  30. B

    Rental Beds

    A question has come up from my facility. We rent bariatric beds for the larger patients. Received a recent denial. Does Medicare cover bed rental on Inpatients? Thanks
  31. L

    Facility reimbursement for multiple colonoscopies

    Should facilities be paid for multiple colonoscopies performed on the same date for same patient? For example: 45380 & 45385 (billed with mod -59). A Medicare RAC report reported that hospitals should not be paid for more than one colonoscopy per day per patient. However, different facility...
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