1. C

    Wiki Office Based Procedure Billing

    I work with a surgeon who has started doing minor surgical procedures in his office, some of which require an anesthesiologist. I am trying to verify if the anesthesiologist can bill insurance separately for these, or if the fee that the surgeon receives is all inclusive, in which case he would...
  2. C

    Wiki Temporary POS Due to Flooding

    Help! A physical therapy office I help with experienced massive flooding due to the storms in SoCal. They will be unable to use their office for at lest 3-4 weeks. In the interim, they want to take their patients, who are mostly post-op surgical, to an ASC (where many of the patient's were...
  3. P

    Wiki Advice on transitioning from pediatric coding to remote and/or specialty.

    Currently I work in a very small clinic; one MA, one D.O., and myself. We started from scratch and have grown into a profitable solo practice. I work all the front office duties (secretarial) and back office duties (coding, billing, appeals, authorizations, collections, business research...
  4. B

    Wiki Fracture - regarding this code

    Hello, I am a new biller and have a question regarding this code: 28510. I have a case where we billed this code along with 99203 for the initial office visit. The office visit is getting denied due to the fracture code. I did not think this should be an issue since it is the initial office...
  5. M

    Wiki Billing 93306 & 93880 In Office

    Hello just a little confused as how to bill these codes. I work for an Interventional Cardiologist. He contracted a tech to come out and bring the u/s machine to do these procedures in our office. Is there any modifier I should be adding since he doesn't actually own the equipment? Or is...
  6. M

    Wiki Observation to Admit Status for Medicare Patient

    Previously if a patient was admitted for an observation status which turned into an admit status, an office would bill the admit charge as it was the highest level. However, there are some changes with Medicare and the guidelines of observation and 2 midnight stays? Can someone tell me what...
  7. G

    Wiki Sequencing of CPT codes

    I know it has always been an understood rule that your procedure code or office visit goes first and you go be RVU highest to lowest. I would like to know if there is any documentation stating your office visit E&M should go first. We have a new EHR system and it pulls the office visit to the...
  8. A

    Wiki Please help answer a dispute.

    Me and a co-worker of mine have disputed with each other and the billing office about the code for Mycoplasma Pneumonia. I feel that it should be coded J157 and she says B960. The billing office is saying that code B960 is not being accepted. The coding guidlines state that the underlying...
  9. M

    Wiki 99144 Conscious Sedation in Pain Management Office

    Hello, I was wondering if someone can assist me in how to document for Conscious Sedation in an office setting for Pain Management. We currently just use something like "Per patient request, the patient was then administered 2 mL of 2 mg/2 mL midazolam IM by the nurse." I am received denials...
  10. V

    Wiki Protimes in office setting

    Hello, anyone out there seen any changes on billing Protimes in office setting 85610/QW ..I have researched and also spoke to CMS they are also unaware of any changes.
  11. J

    Wiki Technical service and professional service of an eye scan not done on same day

    If an eye scan is performed in the office on a Thursday, but the physician does not do the interpretation until Friday (same practice, same office), can it still be billed globally and if so with which date, or does the service need to be split into the component parts and filed with the tewo...
  12. L

    Wiki question on remoted job

    Speaking to remote job, I am wondering how you are able to manage your time to do the training, which is in the core office hours time (8-5) "mandatory", while maintain the actual full time job going on?
  13. O

    Wiki Durable Medical Supplies

    Our small clinic is looking to offer DME (splints, braces, crutches etc.) for our patients to walk out of the office with. Is it legal to bill different insurance carriers, different prices based on their reimbursement? Thanks you.
  14. J

    Wiki Home sleep study - I am trying to find out if a doctor's office supplies

    I am trying to find out if a doctor's office supplies home sleep study equipment to a patient to do at home overnight, if the place of service for billing should be office?
  15. M

    Wiki Admit

    Patient was seen in office 2/1 labs drawn office visit and injections billed, lab calls at end of day with critcal lab values and patient is called to told to present to ER for admission, patient waits until 2/2 and comes back to office and JUST picks up admission orders, physician does not see...
  16. 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...
  17. L

    Wiki office visit and consult code

    We had a patient come in for a office visit for constipation. during that visit the provider also did a pre op exam. Can you bill for both the E/M level and a consult code for the Pre-Op? or would you just use a E/M level?
  18. K

    Wiki Office Based Surgery Billing/Reimbursement

    Hello All! Does anyone have any information on office based surgery billing/actually have a surgical suite in your office? We are researching the possibility of opening a suite in office for our pain management/spine doctors to perform level II surgeries. I have a few questions: Do you still...
  19. 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...
  20. L

    Wiki OV by MD & Acupunture in same day

    We recently added an acupuncturist to our practice. I am wondering if we can schedule our patient's for an office visit to see their PCP and also schedule an appointment for the patient to see the acupuncturist on the same day. This is a very common request that our office receives, so...
  21. B

    Wiki Billing Procedure for Sobxone Treatment

    I need assistance with the CPT code(s) that would be used for Drug Addiction Therapy. Our office will shortly begin using Suboxone therapy for treatment of drug addictions. What CPT code would be used for the Assessment which will include an Initial Comprehensive History and Physical, the...
  22. C

    Wiki OB Coding in/out of package

    I have 2 providers in my office that see OB patients and we also work with two other outside physicians in a different office who use the same hospital for services. I know with Mainecare we need to split up the charges by billing each antepartum visit separately, billing for the delivery and...
  23. 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...
  24. M

    Wiki Observation Status

    When a specialist is called in to Consult for a hospital patient kept in Observation status, should I code for OV (99201-99215)? I was denied payment by Novitas (Medicare) for 99220 stating they only pay this code for the admitting doctor and any other physician should code office...
  25. S

    Wiki post op care only

    could someone refresh my memory on how we follow the format for post op care only. My provider is caring for a patient after she had a fx hip surgery done at other facility and is now in our office for fu care.
  26. A

    Wiki Overdrive Pace Termination in the office

    Is there a code that can be used for Overdrive Pace Termination in the office. 93724 has induction that is not being done; however, everything else in that code is being performed.
  27. 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...
  28. E

    Wiki Suture Removal - Different provider, same office

    Hi all, I am sorry if this question has been asked and answered, but I am having trouble finding the answer. I am a new coder, not yet certified. I have a scenario at my new office and was hoping for some help. I've got a person who received sutures by one of our doctors. They came in a few...
  29. N

    Wiki Oral prednisone

    Need some help to see if you can bill for oral prednisone in office setting and if it's covered
  30. K

    Wiki Hipaa violations and state auditors

    Is it a hipaa violation to allow an auditor to use a providers office to work in while they do an audit? I realize that the auditor has the right to request any records they need to complete the audit. However, I am unsure if that is the same as allowing them to be in a messy office with...
  31. A

    Wiki Humana Denial

    Is anyone having trouble with Humana not paying office visits, even with a mod 25 attached? These are all being denied in our office and bundled with lab services or vaccines. Does anyone have any thoughts are how to correct?
  32. K

    Wiki Psychiatry initial in office consultation

    I am new to Psychiatry billing, I have a seasoned Psychiatrist who keeps telling me he has only been billing 90792 for his initial 90min in office consultation. I do not think that is right and am wondering why I am not also billing a 99205. I am guessing at his previous practice his coders were...
  33. T

    Wiki RSV only - ICD10 code

    We recently have received insurance denials when billing RSV (code B97.4) as the only diagnosis. I have not been able to find another ICD10 code for RSV (respiratory syncytial virus). Since we are a pediatrician's office, we have a lot of patients that are seen and treated for this condition...
  34. H

    Wiki Office surgery vs otpt surgery

    Can a physician schedule a surgery in the office (place of service code 11) and take the patient into the ambulatory surgical center (place of service code 24) and bill only the physician portion with place of service code 11? Example: A physician schedules a YAG in the office. Physician takes...
  35. L

    Wiki 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...
  36. L

    Wiki 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...
  37. T

    Wiki surgical aftercare code correct for this?

    Pt is recovering from hospital stay in which liver abscess was drained and was put on antibiotics for 4 weeks. He now presents to office needing 2 more weeks of antibiotics and referral to ID. Prescription is given, referral is made. (No other treatment provided; brief basic exam performed.) Is...
  38. 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...
  39. R

    Wiki Coding Specialist, Senior

    ROZITA POURMOUSSA, CPC, CPC-H E-mail (818) 489-9207 Objective: To obtain a challenging and rewarding position, and to be able to utilize my education, experience as Certified Professional Coder, and Certified Outpatient Coder. Qualification: Certified Professional Coder-...
  40. L

    Wiki Documentation

    Fellow Anesthesia Coders, do you get all you need in your documentation to accurately code for ICD-10? There's been a suggestion in my office to code from the facilities' face sheets. It's been my understanding that we are to only code from our providers' documentation. What do you do when...
  41. I

    Wiki Sitz marker

    How are most of you billing when a patient comes in for an office visit and ingestion of sitz marker? Thanks. Are you billing the office visit along with 99070? Any modifier? Thanks.
  42. C

    Wiki Physician Billing for Drug screens in 2016

    I bill for a pain management office who routinely perform in office (cups) drug screening for patients on RX narcotic meds. We would normally bill G0434-QW for such tests, but now I'm getting rejections for this. I know CMS did away with this code and replaced with several others. I started...
  43. R

    Wiki Screenings..

  44. K

    Wiki o35 material - I know these codes requires

    I know these codes requires any associated maternal condition. If the office doesn't give any code except this one do I assume that there isn't one or do I need to contact the office to get one? The test are for prenatal screenings. Thanks, April
  45. D

    Wiki 80300 - give a prescription

    drug screening, they bill this in the new office I am in before they give a prescription, but its not getting paid, they said they never pay for this does anyone know the facts on this ? thank you
  46. M

    Wiki Procedure Titles

    When a procedure is being done in the office does the procedure note need a title? Example: Nasal Endoscopy. We are having conflicting issues with this, stating the procedure note done does not need a title for a procedure. I believe if you do a procedure you should have some kind of title...
  47. B

    Wiki Radiology Billing

    Please help!!! I am a coder/biller for a new family practice clinic. We are doing x-rays in the office. Here is my question: So we are doing the x-ray in the office, we then send them to an outside radiologist to be read, however will be billing for both the technical and the professional...
  48. 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?
  49. D

    Wiki e/m and xray

    the new office I work in are putting modifier 25 on all office visits with xrays, is that necessary? please help :(
  50. M

    Wiki E/M Level 3 or 4 (Hernia)

    I'm having trouble determining the level for this New Patient. The HX & PE are Comprehensive, but I'm stuck on the MDM. This is the A&P: "I discussed that though he has point tenderness to the area, no obvious fascial defect is palpated in the area. I recommend a CT abd/pelvis to better...