1. M

    Help with TB coding

    Hello coders! Need help coding this scenario: TB nurse visit patient presents for labs and complains of orange urine and yellow eyes. Payers are Medicaid and Medicare. Any and all feedback is greatly appreciated. Thanks!!
  2. F

    Lab denial

    So I have 2 separate claims for one patient. They both have 84443 (TSH), They were ordered by separate providers on separate dates but the lab results we're finished on the same date. We got a Medicare denial code 0A-18 ( duplicate claim on the same day). How do I go about billing them so they...
  3. E

    Question 36415 billable with Labs?

    I wondered if someone out there can help me find the guidelines that state the collection of the blood sample (36415) is not separately billable from the labs if they are performed in-house? We frequently have a payer deny 36415 as not separately reimbursable from the lab charges, but other...
  4. K

    Question Pass through billing

    Hello! I am wondering if anyone has any resources that can share that talk about whether it is okay to perform pass through billing, and if yes, is it okay if you make a profit? To give a little background, our office is not pass through billing for all labs in order to be profitable...
  5. H

    Family Medicine offices

    Does anyone do xrays or in house bloodwork in PCP offices? How does it reimburse?
  6. A

    Profee Coding- When to code labs such as 83655 and 85018??

    I have a silly question... I'm doubting myself, I know. When are labs coded. For example, in profee coding for a well child visit, would you code 83655 and 85018 if they are done? I'm not talking about actual blood draws, but the actual labs performed on blood samples. I thought labs were only...
  7. D

    Lab Billing in Doctor Office setting

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  8. Y

    Reference Lab Billing-Admission Source

    Hello, I bill for an OON hospital facility. We just contracted with a reference lab to perform billing for out patient lab services. Lab billing is completely new to me and I'd greatly appreciate any help I can get. I am currently having doubts about the admission source. What admission source...
  9. M

    Yearly Physical Labs

    At my facility, I have a couple providers who like to order their yearly physical labs the week before the physical, so they can review them at the physical. However, there are no diagnoses that would necessarily cover these labs. The patients have no medical issues that I could use and the...
  10. S

    87481 Billed with multiple units HELP!!!! Insurance will only pay 1 unit

    We have been billing code 87481 with 4 units and the insurance companies are only paying for 1 unit. We have billed with and without modifier 91, w/mod 91 we got denial. Multiple Ins. companies are wanting to process only 1 unit. PLEASE HELP ME WITH THIS ISSUE!!!! CPT Code(s): 87481x4...
  11. B

    ER coding help

    hello, Is anyone able to assist in some coding for hospital charges? I work for a physician office, so hospital visits are not my speciality. I'm trying to assist a family member with their bill and want to be sure I'm pulling correct information. The hospital will only provide an itemized...
  12. I

    Billing for Pathology and Labs HELP...

    Example: New PT comes in to practice with chest pain. Problem list is clean, due to PT being new to the practice. Dr. orders a series of blood tests, but has no diagnosis that meet medical necessity. Can the Dr. wait for Lab results to come in, to then assign a diagnosis that does meet medical...
  13. B

    Documentation Requirements

    A patient comes in today for an office visit. At todays office visit the dr order the patient to return at their convenience for fasting labs work. Patient returns 2 weeks later for fasting lab work. What are the documentation requirements for the day that the patient comes back fasting and...
  14. KScoderTN

    DX for labs ordered during preventive visit

    Office discussion: Patient is schedule for their annual well/preventive visit. No abnormal findings. Doctor simply puts Z00.00 on the order for the lab. Do you query the physician to have them specify diagnosis/ICD -10 since Z00.00 is not a covered diagnosis for the specific labs that are...
  15. C

    Routine Laboratories

    Hello, I was really hoping someone can help me obtain the ICD-10 diagnosis code for routine labs? We have several Medicare patients who have had there labs denied because Medicare does not cover routine. What if the patients are healthy and the physician is screening for something that does not...
  16. R


  17. kathymoon

    Coding a 99215

    I have an internist that sees many geriatric patients. As I am reviewing his charts, he is charging a 99215. The patient is coming in for a 6-month or 1 year check up. He documents a comprehensive history and a comprehensive physical exam. He is covering 4 or more chronic conditions that are...
  18. T

    "screening labs" help please

    Our patients are getting bills for labs done as part of their physicals. Mostly for Vitamin D. How are you suppose to code for labs other than the Z00.00. Especially if the patient doesn't end up having any of the problems you are testing for. These tests are expensive, how do you know if...
  19. N

    Moderate Complexity lab tests??

    I was wondering if anyone could tell me (or direct me to the proper documentation) what are moderate complexity labs? :cool:
  20. C

    statutory exclusion labs

    So, I have been doing some research on labs and found most labs' status indicator is X (statutory exclusion-these codes represent an item or service that is not in the statutory definition of "physicians services" for the fee schedule payment purposes. No RVU's or payment amounts are shown for...