hospital billing

  1. aannecchiarico

    Question IUD placement failed in office, moved to OR with anesthesia. Tricare denying. 58300 CPT Code

    Patient was seen in office to have IUD inserted but could not tolerate procedure. Patient was then placed under anesthesia at the hospital on same campus where the IUD was inserted successfully. Tricare is denying claim for "SERVICE ON SAME DAY AS AN EDIT DENIAL WHICH CAUSES ALL OTHER SERVICES...
  2. K

    new to coding/billing swing bed question

    I am going to try and make this make sense because i am so confused. Right now our coders are coding swing beds as 99304-99318 with pos 61, which are being denied for pos, when i called the insurance companies they said the cpt needs to match the cpt and we should be coding it with pos 31 even...
  3. Y

    Wiki Billing as a provider doing surgery at a hospital with a product

    the doctor has surgical privileges at a hospital and performs surgeries there, and this has been fine. she now wants to start using a placental matrix injection during the procedures (mainly for achilles tendinitis and fasciotomies) it seems the hospital orders the product, right? if this is...
  4. M

    Wiki CMS Medicare institutional billing expert CPC certified looking for audit investigating roles.

    Hi folks, Medicare institutional complex billing specialist here specialized in claims investigator audit, research, improper payment validation, RTP return-to-provider, PPS, payment validation, CWF FI system and centralized database proficient looking for remote CMS Medicare expert roles. I...
  5. C

    Wiki E/M Determination between MD and APRN

    We have been having a discussion within our office with different providers and billers to try to determine the outcome of this needed situation. Our office providers routinely go over to the local hospital to round on inpatient and outpatient cardiac patients. Mostly, the APRN or PA does the...
    • ceebugg14
    • Thread
    • aprn doctor vs e/m help! hospital billing
    • Replies: 1
    • Forum: E/M
  6. J

    Wiki Does treatment of COVID-19 with non-EUA drugs disqualify a hospital from receiving CARES Act or ARPA Subsidies

    I'm hearing rumors that hospitals have almost universally stuck with remdesivir to treat COVID-19, in spite of some doctors' preference for other approaches, because they fear losing subsidies if they use something else (e.g., ivermectin). It is my understanding that the CARES Act and ARPA...
  7. B

    Wiki Hospital billing help needed

    Newbie to hospital billing and I have 2 questions from a PCP office: 1. Patient had OP surgery but ended up spending the night (never admitted)....PCP saw her twice in the recovery area (he wasn't the admitting nor surgical doc).....can he bill a 99213 w POS 22 ? Or is another code more...
  8. J

    Wiki Medicare COB Question for IP Stay

    When a member becomes eligible for Medicare Part A in the middle of their Inpatient stay, how is the biller to submit a claim? The patient had Medicaid State SSI as coverage upon admission which fell to secondary payor once the patient was entitled to Medicare Part A. Is SSI responsible for the...
  9. H

    Wiki Physician coding for outpatient procedure

    Can anyone give me suggestions for coding and billing this scenario. My patient has a procedure done in the office every month code 53855 (urethral stent change) . The physician performed a different procedure for another diagnosis/reason in the hospital as an outpatient (22) on this patient...
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