1. A

    Wiki APRN and PA Hospital Billing

    Hi there! I work at a cardiology group that currently has 12 physicians and one APRN and one PA. I was questioned by one of my physicians today on how to go about coding hospital consults and followups when the physician AND the APRN were together physically seeing each patient. How would these...
  2. A

    Wiki Allergy Extract (95165) Made on same day patient was admitted

    Hello, I have a patient that we made allergy extract for (95165) on the same day he was admitted to the hospital for an unrelated condition. Medicare is now denying the Extract because of the admission. Does anyone know of a modifier or what we need to do to have this paid as it is unrelated...
  3. V

    Wiki Medical Decision Making Table (Number of DXs or Treatment options, DATA Reviewed, and Risk table) Examples for Inpatient Hospital Coding 99221-99239?

    Hi, I wanted to ask if someone can provide me with some links or websites or anything really, that may have a list of common illnesses/injuries that are good examples to use for the different levels of the MDM table for Inpatient Hospital Coding (99221-99239) For example, just like on the Risk...
  4. J

    Wiki 99401-99404

    Hi, Can 99401-99404 be used to bill for lactation counseling services provided at an outpatient clinic at the Hospital? Thank you! Julie
  5. K

    Wiki Hospital Billing Confusion..please help?

    My doctors at my clinic take turns doing rounds at our local hospital. These are the scenarios that I am confused about if anyone can help answer I really need to pick someone's brain. 1) pt arrives in ER and our doctor ends up seeing them that day and decides to admit(date 6/18). the hospital...
  6. O

    Wiki Place of Service for Surgery Consults at the Hospital

    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...
  7. A

    Wiki I want to apprentice under hospital coder

    Hi! I live in Orange County, CA. I've really been wanting to become a stronger coder and I would love to sit and learn from a hospital coder. I'd love to work for a hospital but they require so many years under the belt. I'm willing to pick up the workload for free in exchange for an extended...
  8. B

    Wiki Ortho to Hosp Admit

    B][/B]I need some help with an e/m situation. I have a doctor here in our Ortho practice that saw a patient on one day (lets say Monday) and admitted her that day to the hospital. He is also the operating surgeon and saw the patient the next day (lets say Tuesday) in the hospital and then...
  9. T

    Wiki Denial co-89 professional fee removed

    We have a clinic that is connected to the hospital but we do the clinic billing. What does it mean when professional fee removed? Thanks
  10. K

    Wiki Hospital Code for Venipuncture Perfomed in Lab

    Hello, We code for a hospital who has an in-house lab. Occasionally patients will get their venipuncture done at the lab instead of in the clinic. Are we able to code for the 36415 under the ordering physician even if the provider didn't draw the blood? Thank you, Krystal
  11. A

    Wiki Twins: Vaginal birth then C Section. How to bill.

    Hospital billing for a pt that had twins; delivered baby A vaginally and then baby B via C- Section. Which modifier would be most appropriate? :confused: Thank you!
  12. C

    Wiki midwife home birth transferred to hospital

    Home birth with midwife, patient ended up being transferred to hospital for delivery. Midwife is billing 59426 and 59410-52 for the delivery. Should it just be a home visit for monitoring labor until she ended up at the hospital and not the delivery code? She later billed postpartum care...
  13. P

    Wiki Strains, Sprains and Splints in the ED

    Hello All, Just curious what your thoughts are for a patient who is diagnosed with a sprain or strain and given a splint. I am getting different information so I wanted to get some feedback. This is for Emergency Room Visits. Some say we ONLY charge a splint if the patient is diagnosed...
  14. J

    Wiki Goals and A Path

    Hey guys, I'm Joe, new to coding/medical/healthcare field So I took a coding course with Career Step, completed it and I am going for the CPC test this Saturday!!! I was told to look at jobs and even apply now. I am currently working in registration a local hospital near me. I am in MA west...
  15. kathymoon

    Wiki Balloon dilation 31295-31297 and FESS

    I'm very new at ENT coding and I would like some input from those a little more knowledgeable in this area. Out-patient surgery at the hospital. I am coding the professional components. Dr. states that bilateral frontal balloon sinuplasties were performed and irrigated with saline. Next...
  16. J

    Wiki Two consults for the same NPI, admission to the hopsital and transfer to rehab

    Can someone clarify this for me: The patient is admitted to the hospital and we bill for the cardiology consult. Five days later the patient is transferred to the rehab floor in the same hospital and we see the patient again there due to a hematoma and he is on Coumadin. Do we bill both...
  17. D

    Wiki hospital billing 99283

    I have a question, if the doctor seen the patient in the hospital and they bring all the papers back and there is no referring or attending physician can this be billed without will this get denied?
  18. M

    Wiki Physician coding

    2 questions: 1. Patient is seen in office and physician decides to admit to hospital, sends orders with patient, I am to bill and office visit and NOT an initial hosptal correct? 2. Same patient had an EGD on day 2 of hospital was kept for a few hours then discharged to home, can I bill a...
  19. L

    Wiki Echo read at hospital need payable dx

    Our cardiologist reads echos (93306) done at the hospital and many times we are given a diagnosis that is not on the LCD. One question I have is if we cannot get paid for reading the echo with the given diagnosis, can the facility get paid with the same diagnosis just because they are billing...
  20. kathymoon

    Wiki Inpatient in the office?

    I am getting back into coding and billing after doing auditing for the last 6+ years. Also, new to ENT billing. Here's one I've never come across before. The patient is admitted for a sublingual abscess. The patient was seen in consult by the ENT in his office (which is attached to the...
  21. M

    Wiki specialist consult charge in hospital setting

    our specialist did a consult in the are we suppose to code it... I'm confuse, I was told not to charged 99223- range and 99231-range....I thought medicare do not accept consult charge no more.....can anyone please tell where I can get supporting documentation on how to bill...
  22. A

    Wiki When should i be using modifier AI for hospital based coding?

    From my understanding you append a Modifier AI if the physician billing for the charges is the same physician that admitted the patient. Can someone please elaborate on this for me. and provide examples if possible. That would really help me put it into perspective.
  23. D

    Wiki Billing Hospital Consults

    One of our providers (we are a specialist group) did a consultation in the hospital. The patient is on Medicare. Since you can't bill consultations, what CPT code should we use? I know to change the place of service.
  24. R

    Wiki Birth at home then to hospital

    A baby was born at home and then transported to the hospital an hour later. The OB asked the neonatology nurse practitioner to examine the baby. The NNP documented a Provider Delivery Attendance Note but it just states "examination unremarkable and mother wishes to breastfeed after infant has...
  25. D

    Wiki Outpatient Clinic Billing

    We are having a friendly debate on which POS to use for an outpatient client that is owned by an Article 28 hospital. I believe it should be 11 and some of the others believe it should be 22. Please help us.
  26. D

    Wiki 99232 question help

    one of our doctors came into our practice in January and he seen a patient in the hospital for three different days. we are getting a denial that its global pt is in the post op period, we found out that the doctor did surgery on the patient when he was in another practice- not sure how to do...
  27. C

    Wiki 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...
  28. F

    Wiki Long Term Acute Care Hospital Billing

    When a physician performs outpatient services in a Long Term Acute Care Hospital, are the services billed using the NPI of the facility with a POS code of 22 (outpatient)?
  29. O

    Wiki Needing Help Coding Office Visit!!!

    Our physician saw a patient under observation status in the hospital, and then saw him in the clinic for the first time as a new patient. We billed the hospital consult with an e/m office visit code, saw him in the office and did surgery the following day. We used a modifier 57 on this visit...
  30. L

    Wiki 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...
  31. D

    Wiki Facility ESI Billing-how do you

    how do you bill hospital charges for ESI's using independent CRNA's?
  32. D

    Wiki Facility ESI Billing-I need to bill

    How do I need to bill hospital charges for an independent CRNA?
  33. 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...
  34. M

    Wiki dx specificity help

    Hello, Just wondering, if a diagnosis is listed under the p/a as an unspecified code and in the same note under current hospital problems it is written with more specifics, can I code to the higher specificity? see dx *** below. I bill professional services for pts who are seen in the hospital...
  35. D

    Wiki Hospitalist delivery. Can I bill for my OB provider

    Any help anyone could provide would be helpful. Patient arrived at hospital in labor, her OB doctor was called, but it was a precipitous delivery done by the hospitalist. Her provider arrived one minute after the delivery and assumed care (was her OB throughout the pregnancy as well). The...
  36. T

    Wiki E/m level 99221 - 99223 and 99231-99223 initial and subsequent hospital care

    Please help, can we as the hospital charge a e/m level for inpatient for a doc either employed or not by the hospital, even if the doc charges a e/m level through their clinic. We are having a discussion on this issue and of course we all do not agree and need outside advice. Or do you know...
  37. S

    Wiki Outpatient colonoscopy

    Hello everyone. I am a coder but do not code for facilities and I am having a personal issue with the hospital coding. 5 years ago I had 1 polyp that turned out to be tubular adenoma. resection fof 12 in of my intestine. Had a repeat colonoscopy 2 years later. I went in again recently for a...
  38. T

    Wiki New to Outpatient Hospital Coding

    Scenario: A patient is registered in the hospital as outpatient and the physician sees the patient. Do they bill under 99201-99205 or 99211-99215? New versus established rules would apply in this case. Any help is appreciated.
  39. Y

    Wiki Inpatient Hosptial Follow Up with PCP --HELP!!!

    Hello my coding friends, Will some please help me? What is the CPT code do I assign when someone was released from the hospital (inpatient) and the go the PCP for follow up? Is is just a regular established E&M code? Thanks for your support!!!
  40. R

    Wiki POS 19, new for 2016

    Does anyone have insight on when to use place of service 19? The CMS description states "A portion of an off-campus hospital provider based department...". We are private physician practice and are trying to clarify if POS 19 is for hospital employed physicians only. Any input is greatly...
  41. C

    Wiki Inpatient Consult

    If a patient was in the hospital and a consult was requested from a provider and then a month later that same provider was called in to do another consult for a new problem and the patient had been in the hospital the whole time, would you bill a new consult or subsequent visit?
  42. H

    Wiki how to determine new vs est pt in the fac setting

    I have recently started coding for our hospital owned cancer center. The cancer center and the hospital have same tax id. The physicians professional fee billing is done by an outsied source under that companies tax ID and the phy NPI. I was told the facility bills are billed under the...
  43. L

    Wiki Fracture

    Hello, I have one where the patient was seen in the hospital as a consult on 11/3/15 for a distal fibula fracture by our doctor. Then on 11/16/15 the patient comes to the office for a fallow up on that fracture, first time we have seen them in our office. The hospital did not code a...
  44. M

    Wiki Hi I'm Myles, a CPC-A, and I am looking for intern possibilities in Louisville, KY

    This post it is no longer valid This post it is no longer valid :)