office visit

  1. P

    Question CPT 59866 Help

    Does anyone have any insight on whether this CPT 59866 can be billed with place of service 11? We've been receiving denials from both Aetna and BCBS stating Invalid POS. I know this code is not an inpatient only code..
  2. N

    Anthem OV Denials

    Hello, we have been having a ton of anthem claims being denied because of 99213 being bundled with Medicare (MIPS) codes. IE, G8427, G9903, G8417. The claims are sent electronic and the values for all of them are 0.00. We have tried getting and answer but no one at Anthem seems to understand...
  3. D

    Can you pick and choose what you bill?

    Hey, Is a physician required to bill for the services that he or she performs? Example: Established patient receives an injection ( 20550 ), an ultrasound (76882). Is it possible to not bill the carrier the 20550 and do a 99213 instead since you cannot bill a OV on the same day you bill a...
  4. N

    Bundled Office Visit w/ -25

    We have been getting denials recently from Humana when billing 99214-25 (I70.233, F17.218, I89.0) 11042 (L97.312, L97.212, T81.31XA) Dx are different for each code. Only thing I can think of is the i70.233 and L97 codes both address the 'right leg' .. BUT we have been getting paid before with...
  5. L

    Question Practicode Cases E/M

    Hello eveyone, hopefully someone can help me with this. I've been mostly experienced with Orthopedic Coding for the past 3 years and im trying to branch out. I wanted to find some training that wasnt expensive, so i purchased an E/M module from AAPC for 50 bucks. It has 20 cases to code, I...
  6. KStaten

    Answer Coding / Billing Audio-Only Telehealth Visits

    Hello Everyone! :) Here's my silly question for the day. (Brace yourselves, as I am sure more are to come. ;) ) As I have interpreted from articles, the accepted Telehealth services have been expanded to include audio-only telephone calls, as well. (Yay!) Now this is the part where I am...
  7. A

    Billing 99213, 11721 & 11055 Humana

    I am having a hard time getting the any office visit code (99212, 99213, 99214) 11721 & 11055 all paid by Humana. I have always had trouble with this insurance bundling these services and only paying for the lower dollar amount item (this example 11055 was the only one paid). This is how I...
  8. L

    Office Visit 2 days in a row same dx-extensive visit

    I need some help we had a new Dr start and she was internal medicine and now a derm so she has a question regarding coding for a patient with an extensive issue that had to come in 2 days in a row. Pt has extensive (over 80%) of the body erythoderma due to psorisis she saw the patient day 1 for...
  9. C

    Consult documentation requirements

    I am looking for clarification. A consultation requires the written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source. The consultant's...
  10. C

    Consult documentation requirements

    I am looking for clarification. A consultation requires the written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source. The consultant's...
  11. J

    99455

    Hello. A patient came in for a rating. So our doctor wants to bill 99455 for the rating but in the dictation it is noted that the patient does not qualify for any permanent or partial disability. The patient doesn't technically have a "rating" because the patient can return to work full-time and...
  12. D

    Documentation Plan of Treatment

    In the assessment, the physician documents DM type II with periph Circ manifestations and peripheral angiopathy in disease and for treatment, he indicates continue with diet and no change. He does not address either in the review of systems or in the PMH, patient is not on meds for either, and...
  13. L

    Lactation consultation with office visit

    Patient comes in for office visit due to fatigue, insomnia, sore nipples, breast pain and needs a Lactation consultation. Provider does Lactation consultation dx Z39.1. This is done in the office, not in the home so 99501 cannot be used. What CPT would you use for the Lactation consultation...
  14. L

    Office visit with a Lactation Consult

    Patient comes in for office visit due to fatigue, insomnia, sore nipples, breast pain and needs a Lactation consultation. Provider does Lactation consultation dx Z39.1. This is done in the office, not in the home so 99501 cannot be used. What CPT would you use for the Lactation consultation...
  15. K

    E/M with a 25 when doing an injection?

    Hello, I am fairly new to orthopedic coding and our docs do a lot of injections! I am struggling with when it is okay to bill an office visit with the 25 modifier. The guidelines that I was told to go by was that we always bill a new patient (99202-99204) with the 25 when an injection is...
  16. C

    Billing E/M Visit and Xray

    I need some help with documentation of some coding guidelines. I work for an orthopedic surgery practice and we are currently setting up our EMR to document E/M visits and have hit some road blocks. I have heard several different places that if you are billing for both the technical and...
  17. D

    Oncology Office Visit then Chemo - mod 25?

    Need help with modifier 25. Here is the scenario: Patient see's the Oncologist to talk about whether its ok to have Chemo that same day. The Oncologist says yes and the patient is sent over to the Chemo Infusion Room. Question: Would the clinician attach modifier 25 to the LOS (i.e. 99214) for...
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