1. I

    Question Off the Shelf Back-Braces

    I was wondering, we buy the OTS braces in bulk from a wholesaler and keep them in the office to be dispensed whenever a patients needs it. Can we bill the L codes and the 97760? Since our providers are doing the assessment and we are also the suppliers? Please any advise would be greatly...
  2. KStaten

    Documentation Requirements for Components of E/M

    Hello Everyone! With the new 2021 E/M Documentation changes, there have been questions that have arisen in regards to requirements for the HPI and Exam. Now that these components are deemed "medically appropriate" by the provider, that leads some to think that the extra the flexibility extends...
  3. D

    Billing primary codes/add-on codes on separate claims for same date of service

    Hello- If one provider performed the primary procedure, and a different provider on the same date of service performed the add-on procedure, is it possible to bill these codes on two claims under each individual provider's credentials within the same facility? For example: Dr.A performs...
  4. C

    Provider and place of service for Lab

    I am new to Lab and am trying to resolve some inquiries that I am baffled on. We are going to have a draw station in a separate suite location-not in but near our Medical group office, the specimens will be sent to our hospital lab to perform the tests, and then they are requesting that the...
  5. L

    E/M vs Preventive Visit

    Patient states was only see for annual physical exam provider billed e/m with diagnosis. The CC & HPI both indicate patient was being seen for annual routine exam and the ROS and Exam portion also support this. Is it reasonable to code a routine physical Z00.00 even though the providers...
  6. T

    Help with CPT Code - greatly appreciated

    What would be the best CPT code for debridement of 4 porokeratosis lesions on the plantar aspect of the left foot? I was looking at the 17xxx code range, but I don't see where they support the dx code Q82.8. Any suggestions would be greatly appreciated. The provider used trichloroacetic acid...
  7. A

    Consult code inpatient

    One provider from our group did h&p for admission, brought in cardiologist they consulted pt then requested another provider from our group see pt for consult on the day after can we bill for h&p by the one provder and a consult for the other provider or does it have to be a f/u code. H&p was...
  8. L

    Wiki Coding from Codes

    Hello, I am very curious to know if we can code from codes that the provider has written down. Is there a coding clinic on it? Thank you!
  9. P

    Wiki DVT vs History of DVT/Pulmonary Embolism

    I am a HCC coder and we are having a debate in my office about coding DVTs and pulmonary embolisms. Most of the physician notes we review just say something like "DVT - on Coumadin" I have been told not to code a DVT or Pulmonary Embolism unless the patient is presenting to the hospital or...
  10. M

    Diabetes type 2 with other Complications

    Does anyone know if when a provider chooses "DM 2 with other Complications" E11.49 and the complication listed is Peripheral Vascular Disease, is it appropriate to code the I73.9 code also. I believe I should be picking up all complications that the provider lists, in addition to the E11.49 but...
  11. A

    Cancelled procedure documentation

    There seems to be some debate. In an outpatient/day surgery setting, does a provider need to document the reason why a procedure was cancelled and sign off on it? Or is it sufficient for the nurse to write the reason why in a progress note/nurse note. Specifically if its cancelled due to pt...
  12. C

    observation codes for cardiologists

    We are a cardiology practice that is called for services provided in the hospital. I am having quite the issue understanding exactly how to bill observation codes. When our group is consulted to see the patient what code should we be billing if the patient is already admitted to observation...
  13. D

    Coding for Hospice patient when provider is not the Hospice provider

    We had a patient come in to our office that is a Hospice patient in another location. He was seen for several problems unrelated to his hospice diagnosis. The provider also mentioned his terminal diagnosis in the progress note. Can I bill this with a condition code 07? For treatment of...
  14. M

    ROS acceptable or not----Adivce please

    Hi, Is this acceptable or not? Provider uses a form for the Review of systems that patient fills out. There is only 8 systems listed with the associated symptoms listed with it. The patient is suppose to circle all that applies or has experienced recently; which in this case nothing is...
  15. A

    Can a Health Coach bill under a provider?????

    Help!!! We have a non-licensed health coach starting & my provider thinks he can bill an OV whenever the health coach sees a patient & he steps in for part of the visit. These visits would be strictly for diabetes prevention, weight management, etc. Any information is greatly appreciated!!!
  16. B

    Can we bill 99233 twice on same day

    Hi all, Here I am new to denial management and I need your support on below scenario. As per my documentation, provider A had rendered 99233 service on 030615 & 030715 with the dx sequence 434.91,250.00,585.9 & 780.09 and for the same date of services provider B also rendered 99233 service...
  17. A

    Coding Based on Time

    I have a provider questioning the coding of time. For example a 99213 is 15 minutes and 99214 is 25 minutes. (I realize it has to be greater than these "typical" times with greater than 50% in counseling and coordination). The provider is saying if it is 21 minutes you would round up to the...
  18. M

    Z02.7- Encounter for issue of medical certificate

    Hi all. I work in Family practice so we get a lot of encounters where the provider is completing forms for the patient such as FMLA, jury duty, DMV, SSI etc. I want to indicate that the provider completed a form but if I add this Dx (Z02.7-) it must be first listed. I have decided to look at the...
  19. F

    Billing for services by a Dietician

    I am in need of help on billing for a dieticians services, we have a new NP in our practice and he she as requested consults form our Dietician. Can the services provided by the Dietician be billed to Medicare even though she does not have a provider number? I am looking for instruction on how...
  20. N

    colonic diverticuli

    would colonic diverticuli be coded k5730 this was stated in the CT impression. provider states final diagnosis :diverticulosis
  21. C

    H&P billing after patient delivering the baby in the car

    Can the provider bill the H&P on a patient who actually delivered before arriving to the labor and delivery unit ? Followed the delivery the provider saw the patient ... ? Pls help
  22. C

    Aspiration syndrome

    The patient is an adult and one of the diagnosis is the above. I did a query to the provider as to identify what the patient aspirated on, The provider's response was oral secretions. The patient also had pneumonia as one of the diagnosis listed. I am not sure how to code the aspiration...
  23. T

    Smoking and tobacco use cessation

    Is anyone having a problem getting these codes paid 99406 or 99407. We are using dx F17.210 along with whatever problem the patient came if for and with the proper documentation of the provider counseling the patient. We are also adding a 25 modifier on the office visit. Is there something...
  24. Z

    Is Flat Rate Charging Acceptable?

    Hello, Is a provider allowed to bill the same dollar amount for his office visits? I believe it is reference as "flat rate" billing. Codes 99201-99215 all bill at same amount regardless if have insurance or self pay. Any restrictions with state, federal laws, Medicare, etc.? Note: the...
  25. D

    Wiki Facility ESI Billing-We have an

    We have an independent CRNA performing ESI's at our facility. The referring provider has been getting precerts and the facility is billing under the referring provider with his precert for facility charges. Should the facility be billing facility charges under the rendering provider which is...
  26. D

    Wiki Facility ESI Billing for CRNA

    How does a hospital facility bill for an ESI done by a CRNA? Does the facility bill under the referring provider or the CRNA, this is an independent CRNA we just bill facility codes, however the referring provider is getting the precert for the facility and using the surgeon as the rendering...
  27. N

    "Extended post-viral bronchial hyperresponsiveness"

    I need help. The patient does not have Asthma and I cannot locate anything that resembles this diagnosis! Can any help me? Would the provider code the symptoms only since it's "post"???
  28. J

    Hospital Discharge date-of-service

    A provider does a discharge summary on one day and the patient is not really discharged until the following day, which DOS do we use for the discharge? If we use the DOS for the real discharge day but the discharge summary has the day before’s date on it, do we need an addendum in order to bill...
  29. A

    Modifier TD

    Does anyone use modifier TD for services performed during an RN only visit? For example, patient comes in for a B12 shot which was ordered by the provider. Patient brings in product, the only service to bill is the 96372. Do you add the TD modifier to indicate this was a nursing visit billed...
  30. D

    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...
  31. C

    Glucose screening test / help

    Glucose screening test / help code 82951 ? Is the glucose screening test included in the OB package or can the provider office bill for the actual test ?
  32. B

    N.C. Mediciad Denial for preventive visits on children

    We just recently went to ECW and we cannot get reimbursed for preventive care visits on children. We are using the EP modifier with the CPt codes. our denial reason states attending provider not eligible on service dates. and B7=This provider was not certified/eligible to be paid for this...
  33. M

    Coding for sore throat/pharyngitis

    When a provider orders a strep test and reports dx code R07.0 (pain in throat) and then the strep test comes back positive so the provider also assigns J31.2 (chronic pharyngitis) should the diagnosis R07.0 be removed from the visit note? I know these 2 codes cannot be billed together, however...
  34. D

    Hospitalist delivery. Can I bill for my OB provider

    Any help anyone could provide would be helpful. Patient arrived at hospital in labor, her OB doctor was called, but it was a precipitous delivery done by the hospitalist. Her provider arrived one minute after the delivery and assumed care (was her OB throughout the pregnancy as well). The...
  35. R


  36. C

    Provider signature rules

    Is a provider required to view and sign patient records received form another provider outside of the practice that was simply sent to us as an FYI and is added to our medical record on the patient? Is there any legal liability in the provider being aware of these external records and/or...
  37. M

    Does new insurance mean new patient??

    I was told by a provider that when a patient obtains a new insurance, they are billed as a new patient (regardless of when they were last seen). The provider agrees that if someone hasn't been seen for three full years that they are a new patient. However, they have also been told that even if...
  38. J

    Wiki prolonged service

    We have a pharmacist that provides education on insulin pumps after the provider has seen them. Here is a sample of the dictation: Reason for Appointment 1. Insulin pump start History of Present Illness Care Coordination: Larry and his wife present to the clinic today for an...
  39. B

    Wiki Initial Newborn Coding

    The newborn was fine at birth, but developed problems 3-4 hours later. Our provider wrote his note at age 6 hours and said the baby had respiratory distress. Another provider from the same group saw the baby and wrote her note at age 8 hours, describing critical care treatment. She felt the...
  40. T

    2 surgeons 2 different specialties

    Can 2 surgeons from two different specialties share the TED (15002-15005) for total 250 sq cm if one surgeon only did 25 sq cm and the other surgeon did the remaining 225 sq cm? This is not a CO-surgery. The hand provider came in for an intraoperative consult and decided to debride his part...
  41. C

    Inpatient Consult

    If a patient was in the hospital and a consult was requested from a provider and then a month later that same provider was called in to do another consult for a new problem and the patient had been in the hospital the whole time, would you bill a new consult or subsequent visit?
  42. T

    nailplate reduced

    Diagnosis: Onychodystrophy of toenails. Then provider states "nailplate reduced bilaterally 1." There is no description in his note of how this was done (such as digital block placed, etc.). Is this the same as trimming of nails (G0127)? Or is this avulsion of nailplate (11730, 11732)? Or...
  43. A

    Tobacco Use and J Codes

    I have one provider whom when I ask if it is tobacco use or tobacco dependence he tells me that this should be the CMAs responsibility-he never gives me an answer. When I asked his CMA, she told me that they know he is a tobacco user but have only seen him for quick visits. What templates are...
  44. A

    Nurse Practitioner's and Students

    :eek: Can a Nurse Practitioner act as a supervising provider for medical students? Can an NP act as a supervising provider for NP students? Can anyone give me a link to this in writing either on the CMS website or the Trailblazer Health website (our local Medicare FI). Any help would be...
  45. K


    I am starting a position at a provider who is using Medisoft. I would like to speak to someone who is a user and ask a few questions about the program. Not sure if open discussion is allowed about software but I have a few questions. I can be reached privately at This provider...