1. 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...
  2. T

    Wiki Medicare Denial of 88305 when billed with an unrelated MOHS

    We are a dermatology practice with a doctor that specializes in MOHS (and is a histophathologist). We also employ ARNP's who will occasionally do excisions of skin cancers on the same day a MOHS is performed, which results in an 88305 charge. The pathology is read by our doctor-the...
  3. T

    Wiki Medicare Denial of 88305

    We are a dermatology office whose doctor is a certified dermatopathologist as well. He can perform MOHS. We have come across a new issue with Medicare when billing MOHS and a separate pathology on the same day. Here is an example: Patient comes in and has MOHS done on the arm by the doctor. The...
  4. T

    Wiki Colonoscopy -know this has probably

    I know this has probably come up several times, but here goes again. A pt came in Aug 2011 for colon w/biopsy 45380 at the age of 62 with UHC insurance and dx for diverticulitis. In 2008 he also had 45385 with UHC for dx blood in stool. He is now 67 and has Medicare and has no symptoms. The...
  5. H

    Wiki Incdient II billing and Physical therapy

    I have a question regarding Incident II billing with physical therapy visits for Medicare. My current practice will be merging with another group who has their own PT office. Their PTs are not credentialed with Medicare however the practice that owns them is. The physicians want to bill every PT...
  6. R

    Wiki arthroscopy 29877

    Can somebody please help me out on and ICD 10 issue I am having with Medicare. Whenever I bill out cpt code 29877 w/ chrondromalacia dx/ M22.41 or M22.42, Medicare denies. Any suggestions? I have searched LCD w/ no luck at all. Thanks
  7. N

    Wiki lmft seeing medicare patient

    Does any one have feedback on how to go about the following situation... A severe chronic patient has changed insurance and now has medicare. i know that LMFT can not bill medicare. The patient is in no way stable enough to change providers. is there a way to handle this? the patient is willing...
  8. J

    Wiki Advanced Care Planning Services - Medicare

    Medicare has approved coverage for Advance Care Planning Services for 2016. I know the codes are 99497 and add on code +99498. Has anyone heard what the RVU's and reimbursement rates are? Looking to maximize our revenue by using ACP codes in addition to our usual code set or using prolonged...
  9. H

    Wiki medicare

    does anyone know if medicare is holding back money until they have a clear fee schedule done??
  10. C

    Wiki NC Tracks(NC Medicaid) and assistant to surgery Modifier denial

    Good Morning, Just wondering if anyone else is having trouble getting paid for assistant to surgery for PA's. We are filing with CPT code 37225- 80. Medicare is paying as primary and then medicaid denies stating CPT/modifier combo is invalid. When the AR girls call NC Tracks all they will tell...
  11. D

    Wiki History of Colonic Polyps and E/M Codes

    Hello our physician at our practice used an E/M code of 99397 for a Dx code Z89010, this is a Medicare patient is this coding correct? Will Medicare pay?
  12. A

    Wiki Medicare In patient only list

    Does anyone have a direct link to the Medicare In-patient only list for 2016?
  13. Y

    Wiki HCPCS code modifiers

    Medicare requires modifier w/A4352, A4402-This is new. What modifier should we use?
  14. T

    Wiki Would you use mod 25 or 59

    When reporting codes 99204 and 96103, would you use modifier -25 or -59? for non-medicare and medicare cases...
  15. E

    Wiki Consult with POS ER for Medicare

    I have been coding ER visit codes 99281-5 for the crosswalk for Medicare Consults when the POS is the ER and not crosswalking to OP visit codes new or established for Hospitalist and Orthopaedic consults ;I use those when the POS is Obsrv. Can anyone tell me if I am correct to bill the ER codes...
  16. H

    Wiki 93280 26

    dx is V45.01 medicare having a hard time getting paid any thoughts would help and its dos 7/9/15 thanks a bunch
  17. M

    Wiki Medicaid denials per announcement 976

    We are having a problem with Medicaid denying secondary claims per CMS announcement 976 stating that "history of ..." diagnosis codes are not acceptable as primary diagnosis codes. In these cases Medicare has paid the claim with a hx code but Medicaid is denying. I am not sure how to fix them -...
  18. D

    Wiki Billing DME to Medicare Without Medicare Contract

    After 26 years in working for physicians' offices, I started working for a DME business late last summer. We just became CHAP accredited and are filling out a Medicare Provider application. My question is - If we see a patient who has Medicare primary, can we bill Medicare DMERC (ie., before...
  19. J

    Wiki Billing vaccines for a fqhc

    Our clinic is a FQHC and I'm trying to find out how other clinics bill Medicare for influenza and pneumoccal vaccines. If a patient is seen for an office visit the provider will code a routine office visit (i.e. 99213) along with the codes for the vaccine and its administration code (90670...
  20. T

    Wiki Medicare - government funded

    Can we bill Medicare for the 22 modifier, asking for more money since they are government funded?
  21. H

    Wiki Will Medicaid pay if Medicare denies in NC?

    I am having trouble finding the answer to this question. We have a patient who only has Medicare part A primary and Medicaid secondary. If part A doesn't apply to us, can we file Medicaid and expect payment? If so, would you file the claim as primary or secondary with the information of...
  22. P

    Wiki How to bill when one Provider in practice opts out of Medicare

    I need some advice on how I would bill Medicare for the Nurse Practitioners who still participate in Medicare but the Doctor has opted out of Medicare? And all three are in the same group practice that the Doctor owns. I would appreciate any information I can get...
  23. D

    Wiki Preventative Services and Gastro

    I need some advice one of our physicians keeps coding patients visits with a 99387 (preventative medicine) with use of ICD-10 codes: Z86.010 personal history of polyps, or Z12.11 Encounter screening for malignant neoplasm of colon. My issue is some of our patients are Medicare patients and as...
  24. D

    Wiki Medicare ABN Question

    Can anyone tell me if a Medicare ABN must be signed on the date of service? We give home hemoccult tests that the patient takes home and then brings back or mails back to our office. Can an ABN be signed on the date the test is given to the patient? Or must it be signed on the day the test is...
  25. N

    Wiki "Not payable due to coordination of benefits"

    Please help me to understand this. We bill Medicare and many patients have secondary. My question is below. Example: BlueCross EOB says "This amount is not payable due to coordination of benefits with the member's other carrier. " In this case, can we bill patients (Medicare allowed...
  26. D

    Wiki Cardiac Resynchronization Therapy for treatment of Heart Failure

    I am needing some help with Cardiology practice billing CPT 33249 and 33225 for POS 22 to Medicare Part B J5. The claims are being denied as not medically necessary, decision based on NCD policy online. The policy I found is 20.4 NCD for Implantable Automatic Defibrillators. This policy does not...
  27. H

    Wiki Multiple Medicare Denials for Medical Necessity

    I apologize ahead of time for my ignorance, I am still new to coding/billing and have learned on the job through trial and error. I received 3 pages of denials from Medicare for " these are non-covered services because this is not deemed a "medical necessity" by the payer". But the codes used...
  28. M

    Wiki Medicare denial for 88305 and 88342

    I got denial for 88305 and 88342 from Medicare. According to remittance advice modifier(S) was missing. Do I need to apply modifier 59 to 88305? I am confused I did not know that any modifier needed for those codes.
  29. E

    Wiki Toxicology codes

    I'm confused on the drug screen codes. Medicare deleted g6030-g6058 but they are still in hcpcs book.
  30. P

    Wiki 97610

    Medicare is wanting a Therapy modifier on the 97610. This is performed in the office. Anyone know which modifier it should be?
  31. R

    Wiki MUE of 1 but a bililateral procedure

    If Medicare has a MUE of 1 but the CPT can be billed bilaterally, can you bill this with a 50 modifier and get paid for both sides?
  32. R

    Wiki Medicare and CPT 64561

    Medicare is denying the 2nd 64561 when billed like this? 64561-LT 64561-RT Do I need to add a modifier XS to the 2nd line item? Send reports? The MUE is 1 for this CPT. Any feedback would be appreciated. Thank you!
  33. J

    Wiki G6021 for EMR needs 2 codes

    Can you please help me how to enter the charges in the HCFA form if we have to use those 2 codes like 45378 and G6021 to indicate this is and EMR colonoscopy for medicare patient, how would you enter the $ amount, as we know we cannot bill CPT45390. Medicare will not pay new codes for DOS in...
  34. E

    Wiki medicare auditing for payor

    When coding charts for Medicare audits: If a pcp is coding cancer as current and the specialist is saying the patient is in remission can we change the pcp code to hx of cancer?
  35. B

    Wiki Radiopharm Reimbursement

    We have just started having problems getting our Radiopharm's paid, even with Invoice. They've all gone to Q2 level and are now denying. They (Medicare) will not tell us why, specifically. We've done everything they've asked. Is anyone else having this problem? Any input would be greatly...
  36. T

    Wiki CPT code S0199 help

    Does anybody know anything about the S0199. Medically induced abortion by oral ingestion of medication. This code says all associated services and supplies included (except drug). The Aetna HMO/NAMM says not covered my Medicare so they denied the services. I don't know if there is anything we...
  37. O

    Wiki Anyone ever used the CR modifier?! (Catastrophe/disaster-related)

    Hey, y'all. Has anyone ever seen or used this 'CR' modifier?! I'm in Texas and even with our tornado and hurricane disasters, I've never seen this one before. I can find CMS info but would like to hear from someone who has actually used this and what was the result? Catastrophe/disaster...
  38. A

    Wiki 2016 Medicare Tier Pricing/ Other Insurances

    I am trying to find out what insurances have decided to follow CMS and their Tier Pricing for 2016? I have spent the past few days contacting insurances, however most of them are either clueless, or just tell me that they're not making any changes "as of yet" After a nightmare in 2015 with...
  39. N

    Wiki Filing Medicare Tertiary Claims (Novitas)

    Does anyone know the secret to getting tertiary claims submitted to Medicare (especially Novitas) successfully? We cannot file them electronically through our clearinghouse. Novitas first told us they would only accept if we did send by paper but put "tertiary claim" in box 19. That worked...
  40. T

    Wiki A9555

    Question is anyone having to put an NDC# on claim in order for Medicare to make a pymt?
  41. Z

    Wiki Medicare Coverage for Arterial Duplex -93925/93926

    Hi, have anyone encountered any reimbursement problem with coding Arterial Duplex? I'm having quite a challenge in regards of which diagnosis Medicare accepts. They don't accept pain codes , M79.604 /M79.605 anymore, and same for swelling codes. Has anyone experienced same problem? Need some...
  42. S

    Wiki J codes for interthecal pump refills

    Hi I am new to pain managment billing/coding. The dr I work for has a patient with pain pump (interthecal) and my question is how do you figure out the proper units to bill Example J3010 .1mg how do u convert from micrograms to milligrams? I know that just 1 unit is only paid .70 by Medicare...
  43. C

    Wiki 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...