1. B

    49622 IP only code performed OP

    Hello, I have a patient who had a lap para ileostomy hernia repair with mesh done in the outpatient setting (Was discharged same day). Our office billed 49622 but of course that was denied due to it being a status C code for inpatient only. 44346 and 44314 have been considered as alternatives...
  2. C

    Question CMS 99358 (2022)

    Good morning, Do you have any tips on billing this code? Does it have to be on a separate claim to the actual face-to-face encounter? All services were rendered in 2022. Thank you
  3. P

    Question Should I leave my comfortable but monotonous low pay job for something better? What would you do?

    So, I'm a full time risk adjustment medical coder approaching my two-year work anniversary. This is the first job I've been able to keep this long so it feels weird that I'm happily bowing out and not desperate to quit immediately like previous jobs ive held. It's a relatively easy and...
  4. S

    Question Ambulatory detox

    Does anyone have experience billing for Ambulatory detox? This is for an outpatient that regularly bills for PHP & IOP but just recently began trying to seek reimbursements for Ambulatory detox services. I have yet to see any of these claims pay but I am have a particularly difficult time with...
  5. Ceci22coder

    Question Coding radiology Reports in ED Facility Setting

    Hi everyone, I’m in need of some assistance and clarification. There has been different information in my facility on whether we are allowed to pick up radiology diagnoses that’s is reported from the radiology report. For ex from a X-ray, MRI, U/S and or CT in the ED facility setting. Some...
  6. J

    Question Mental Health Prolonged Services

    Anyone have experience with prolonged service codes? We've been billing 90837 with place of service 03-school (we are a school based MH agency) and 99354 for prolonged services. The code description is: Prolonged evaluation and management or psychotherapy services in the office or other...
  7. S

    Question Outpatient or Inpatient E/M

    I have a provider who saw a new patient via telemedicine. This patient was an 'inpatient' at an outside facility for unrelated symptoms. My provider isnt privileged at the patient's hospital. What would be the correct E/M code or location? Thank you.
  8. C

    Question KX MOD in a ASC

    I code for the facility not the professional services. I am being asked to review a claim that denied due to Pt has meet max benefits for the year. The AR rep is stating they were advised that this case scenario may meet the requirements to add the KX modifier. When would it be appropriate to...
  9. C

    POS Question - Senior Center

    Looking for any input please. I have a provider who wants to bill patient visits (minor illness, cough / cold etc.) performed at a Senior Center as POS 11. I don't think this can be done, nor do I know of any pertinent POS. The provider is trying to say it is an "extension of his office" and...
  10. KStaten

    E/M for Biceps Rupture

    Greetings Fellow Coders :) Since the E/M level is now based upon MDM only, I have been noticing that providers are still in the habit of billing with the old guidelines in mind, which in some cases, would result in higher levels of E/M. I would really appreciate if others can help me out by...
  11. KStaten

    "Possible," "Probable," and "Likely" Diagnoses in Outpatient Setting

    Hello Everyone! It has been to my understanding that when physicians use terms like "possible," "probable," "likely," etc when referencing a diagnosis in the outpatient setting, then we cannot code for that dx and must code simply as any other applicable, associated symptom of an undetermined...
  12. 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...
  13. KStaten

    Answer Suspected Diagnoses

    Hello, everyone! :giggle: I have a two-part question. 1) It is has been to my understanding that, in the outpatient setting, a suspected diagnosis cannot be coded, but instead, the symptoms thereof are to be coded until a diagnosis is confirmed. (I consider "suspected" diagnoses to be preceded...
  14. H

    Question Physician coding for outpatient procedure

    Can anyone give me suggestions for coding and billing this scenario. My patient has a procedure done in the office every month code 53855 (urethral stent change) . The physician performed a different procedure for another diagnosis/reason in the hospital as an outpatient (22) on this patient...
  15. stephanieannec

    Question Reliable Coding Resources for FFS???

    Hi! I'm primarily a risk adjustment educator and recently I was asked by my organization to reach out to a provider who also has a large FFS panel to provide general CPT "cheat sheets." I'm really rusty on this aside from E/M and Category II and I'm wondering if there's any reliable material I...
  16. M

    Billing for RN services with no supervising provider in the office

    I work in an outpatient medical and mental health clinic with 2 locations. My location is mainly admin staff and social workers. We do have an ANP and an RN at this location, but the ANP is moving his office to our other location. The problem is that the nurse wants to remain here and continue...
  17. 0

    Utilizing MSR on outpatient facility claims

    Hello. I am new to the AAPC so I apologize if I am going about this all wrong. Does anyone have knowledge of a policy that supports the use of MSR (reductions) on outpatient facility claims. This has been a recent hot topic to us locally and I am looking for all the knowledge I can gain...
  18. C

    CPC outpatient coder 3 yr experience looking for job in NW region or remote position

    Caitlin Cutting EMail:clcutting00@gmail.com Objective Looking for a position where my coding, technology, and organizational skills can be used to help a company to reach their goals. Education Certified Professional Coder Certification AAPC-CPC Aug 2016 CPT, ICD-9, ICD-10, HCPCs...
  19. A

    Outpatient multiple day Injections 96376

    My question is related to multiple injection codes being billed on different DOS at POS 22 outpatient. My example is for the following: DOS 11/22/17 CPT codes 96374. 96375 DOS 11/23/17 CPT codes 96376 Can they bill the 96376 on a different DOS without the initial billed code on the same date??
  20. A

    99401-99404 Medicaid

    Our Doctors and Nurse Practitioners have begun to see patients for weight loss. The dx is usually Morbid Obesity, and they list a diet and exercise plan in the medicine section of the progress note. ( They tend to forget to mark the education sections for this) I am wondering what E/M to use...
  21. C

    Billing H & P for hospital outpatient surgery

    I have APP's that work in the hospital, they do H & P's for surgeons and as of today we have not billed for this service. They do them > 48 hours before surgery and would typically bill a 99213. I have someone from compliance at the hospital telling me that we can't do this. If the surgeon...
  22. C

    Vascular Coder CCC, CIRCC, CCS. 5 years experience

    Interventional vascular outpatient coder seeking new remote opportunity. CIRCC, CCC and CCS credentials. 5 year's experience in outpatient/ambulatory coding. Graduate of a CAHIIM accredited comprehensive coding program. Please see full details and contact information in the attached resume.
  23. L

    Debridement and Unna/Compression CPTs for different wound conditions

    I'm hoping you all can help me find some documentation that I've lost. My research found that if I have a Venous Insufficiency ulcer, I can code Debridement AND Unna/Compression with a -59 modifier because the Debridement is for the ulcer and the Unna is for the separation condition for the...
  24. J

    Outpatient hospital billing under new EAPG payment system

    We bill as an outpatient dept of a local hospital (not an ASC) How are bilateral procedures supposed to be billed? We always billed Medicaid and Medicaid Replacement plans with 2 lines, the first w/ RT modifier and the second w/ LT modifier. They would not accept modifier 50. Now they are...
  25. B

    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...
  26. A

    Home chemo infusion on same day as outpatient chemo?

    Do patients ever receive home chemotherapy (S9330) AND outpatient facility chemotherapy on the same day? I'm auditing some claims and seeing a patient receive both on the same day and it seems very odd.
  27. 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...
  28. C

    Outpatient Provider Based Facility-CCM codes Reimbursement

    I am trying to find out the Part A facility reimbursement methodology for a provider based hospital owned outpatient clinic that is more than 250 yards from this hospital and started billing for services after November 2, 2015. My understanding is that starting in 2017, the above described...
  29. N

    How to prepare for a pre-employment coding test and Interview tips please?? Thanks!!

    Hi, I would like some help/advice re: pre-employment medical coding tests given prior to being hired. Company I'm interested in is a Rehabilitation Facility. Position they are hiring for is an outpatient coder. What do these test typically entail? Are they multiple choice? If the job is...
  30. J

    UB-04 Form - Where does an NDC go?

    Can anyone advise where an NDC would go on a UB-04 form? I have always put in in FL 43 in the revenue description box but I am having a payor push back and they want it in FL 80... has anyone ever put NDC information in that box? Thanks in advance
  31. M

    Seeking part-time remote coding work

    Hello! I am currently seeking a part-time remote coding position, no more than 20 hrs per week. Available all evenings and weekends. Experience in professional fee coding, facility radiology, Emergency Dept, same day surgery, and interventional radiology. Also experienced in cardiac...
  32. G

    Newly Certified CPC-A Seeking Opportunities in the Sacramento?Roseville Area

    Also I am available for remote and in office opportunities at an Entry level.
  33. N

    Unsure e&m

    Hi All, I have a question that I can not seem to find the answer for so this is my last resort. I have a trauma doctor who is trying to bill an inpatient consult (99253) but there's a couple problems, number one the patient is in the ER and hasn't been admitted, YET, second problem is the...
  34. D

    CPC with 5 years experience coding outpatient facility looking for remote position

    I am looking for a remote position coding coding outpatient facility, I have 5years experience coding: ED, Outpatient Surgery, Gastro, Infusion, Hematology, Oncocolgy Darman Clement, CPC 925-956-3767
  35. M

    Observation Codes - Medicaid

    Hello, I am hoping I can get some feedback regarding the coding and billing of Hospital Observation codes for Medicaid patients. According to the HFS Handbook for Practitioners (Observation Section A-220.4) - http://www.hfs.illinois.gov/assets/a200.pdf - "Payment will not be allowed for...
  36. L

    inpatient telehealth question

    hello one of my outpatient MD has been approached to provide telehealth psy services for an inpatient unit. We utilize telehealth with outpatient but I am not familiar with doing inpatent. are any of y'all billing this service if so are you getting paid. thanks lisa
  37. M

    Aviacode is looking for a REMOTE Facility (Inpatient or Outpatient) PT Coder

    Aviacode is looking for a Remote Part-Time coder. Someone who can commit to a minimum of 10 hours per week (more preferably). Type of Work: Ancillary Coding for large hospital (outpatient coding experience required) Reports to: Coding Supervisor Pay: Per chart or Per hour (depending on...
  38. 0

    Outpatient Allergy shots........................

    I have had this question sent to me -- What cpt code do you think is appropriate for an outpatient allergy shot CPT 95115 for one and 95117 for two or CPT code 95120 one shot and 95125 two shot? Actually what is the difference? I’m a little confuse.
  39. U

    Colonoscopy in outpatient setting

    Hello. Wanted to get some clarification. :) Colonoscopy- physician introduced scope through anus and advanced to the terminal ileum, with ID of the appendiceal orifice and IC Valve. The colonoscopy was performed without difficulty. The quality of the bowel preparation was fair to poor. He did...
  40. P

    outpatient hospital code for SI joint using ultrasound

    Can anyone tell me if we are to use G0260 if the SI joint injection is using ultrasound for outpatient facilities and ASC? I understand physicians use 20611 but I can not find anything about the hospitals and ASC's.
  41. V

    Why PCS?

    From my understanding, which is based off of .gov sites like AHIMA, CMS, HIPAA, AAPC, etc., outpatient coders won't have to learn ICD-10-PCS because it is only used in hospitals for inpatient coding. How come there are questions based on PCS coding on the CCA exam, and therefore, how would an...
  42. V

    Is this Case Inpatient or Outpatient?

    A patient is admitted to the hospital with shortness of breath and congestive heart failure. The patient subsequently develops respiratory failure. The patient undergoes intubation with ventilator management. This is just an example of a case that doesn't mention that it is inpatient. This case...
  43. K

    EXPERIENCED Outpatient surgery coders for ASC’s/Both part and full time REMOTE CODING

    Chapter Officers, Do your members need a job? WE ARE HIRING!! Pinpoint Healthcare Consulting, LLC is quickly becoming one of the nation’s leading healthcare vendor consulting companies. We are a member of AAPC and we need help from the members. WE ARE HIRING, PLEASE LET YOUR MEMBERS KNOW. We...
  44. D

    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.
  45. F

    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)?
  46. A

    Free outpatient clinic vist code

    What code would be used for a free visit? The attending did not come in today, and 21 patients were seen by residents only. How could this be coded/billed/documented?
  47. T

    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.
  48. M

    Observation versus ER vist and in or outpatient E/M

    We are a private practice specializing in Orthopedic Surgery, with on call duties at the local hospitals. Recently we hired a new coder, who believes our physicians should be using the observation codes when called into ER or when the patient has been admitted by Hospital Medical Services. We...
  49. F

    Employment Opportunities - Hines, IL

    Edward Hines Jr. Hospital currently has positions open for Inpatient Lead Coder and Outpatient Lead Coder. Salary range is $25.41 to 33.04. We are also looking for Inpatient and Outpatient Coders salary range $14.99 to $29.92 depending on experience. Telework/remote work may be available for...
  50. W

    CPC with in-Facility Experience seeking Remote Position

    Hello, My name is Tatiana and I am desiring to work from home on a part-time or contract basis. I have my CPC and have over three years of in-facility coding experience working with Intermountain Healthcare in Utah. Some of the skills I have been able to develop as a patient service rep/...