1. ronaldgfell

    Need Definitive Answer to when to post procedure

    Hello to those Gastro Coder/billers... I have been coding Gastroenterology claims for EGD's/Colonoscopy's and also Impedance Monitoring, Esophageal Monitoring, Esophageal Function Tests, Antrodudenal Gastric Manometry, Duodenal Manometry, and Colonic Manometry. It seems the coder/biller prior...
  2. H


    Does anyone use Telehealth/telemedicine to provide non face to face visits to patients? If so what are the guidelines you follow and are you reimbursed? Can this service only be provided to rural health professional shortage area?
  3. J

    99053 and on call Orthopedist

    Can anyone tell me if a Hospital employed Orthopedist who is on-call can bill code 99053 for after hours in the ED? Our Orthopedist is insisting that he bill this code (which we have never billed) so that he can get the RVU credits for being pulled out of bed at night for a patient in the ED...
  4. A

    do you need a modifer when using 97032

    I have just received a denial on a claim that I submitted to Tufts. I am working for a chiropractor and I have used 97032 before with no modifier used and now I get the denial CO-182 meaning Payment adjusted because the procedure modifier was invalid on the date of service. This has never...
  5. 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...
  6. J

    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...
  7. M

    Pulse oximetry in ER 94760-94761

    I'm doing a little research to see if this is something we can bill for in the ER. I know Medicare & Medicaid will not pay for this service they consider it to be bundled with the E&M. I'm not sure on our commercial payers though.
  8. L

    Does it need to specify the DOS?

    I'm confused. I thought each sheet of the chart needs to have a DOS on it, and it needs to specify that the date is the DOS, by stating "DOS", "Date of Service", "Date of encounter".... Basically, it can't be a "lone" date on the chart without the words "DOS", "Date of Service", etc...? Is that...
  9. O

    OB case

    Hi everyone! Case: pt is 39 weeks pregnant admitted for L/D the Epidural was not done because the patient had to push/deliver What ICD-10 would be used in a case like this? Do I bill for a E/M service based off of the eval? Thank you for your help! Sherri, CPC
  10. B

    Global EKG date of service

    I'm hoping I can get some opinions and perhaps some reference to documentation indicating which scenario is appropriate. Patient has an EKG performed on 2/1/16. The physician doesn't perform an official interpretation of this EKG until 2/5/16. Because it's all being done by the same...
  11. C

    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...
  12. A

    Reimbursement based on service location or billing location?

    If a service was provided in Brooklyn, NY, but the billing address is listed as NYC, does the payer reimburse based on the servicing address, i.e. Brooklyn, NY or vice versa?
  13. J

    Physician Orders for Lab/Diagnostic Tests

    Billing for facility: Orders from physician are coming over without a dx or an acceptable 1st listed dx. Facility is providing these services and we cannot code them without clarification. Is it inappropriate or correct coding/billing standards to bill/accept orders for labs/diagnostic tests...
  14. 1

    What is considered beyond the usual preop care of 20610

    I am struggling to define exactly what all needs to be done in order to bill an EM with 20610. Modifier 25 is a (Significant, separately identifiable E&M service by the same physician on the same day of the procedure), indicates that the patient’s condition required a significant, separately...
  15. M

    Inpatient vs observation

    I do the insurance appeals for various hospital facilities, I have gotten the following denial several times regarding patients that are originally authorized and admitted as an inpatient but their stay was extended due to continued need for medical treatment. The denial that I will get states...
  16. S

    New Technology Procedures/Services

    Hi, I'm wondering if its appropriate for a provider to offer new technology services and materials to patients on a cash pay basis if codes and fees have not yet been assigned? I know unlisted codes are available but with no set fee you run the risk of insurance reducing reimbursement sometimes...
  17. B

    99401-99404 Preventative medicine counseling and/or risk factor reduction interventio

    Has anyone used these codes 99401-99404? If so, can you please share how the payer reimbursing the service? Is this being counted as Preventative care on the patient's benefit and if patient only has one preventative care service (99391-99394) in a year, how does 99401-99404 affect the...
  18. K

    Billing TCM

    Am I reading correct, we no longer have to hold the TCM codes 99495 and 99496 for 29 days after discharge? They can now be billed at time of service? I hope so;) this would make life much easier!!
  19. P

    Humana not paying for WCC when immunizations billed

    Even though we have modifier 25 on the preventive visit line, lately Humana has been denying it saying, "This procedure code was not reimbursed because the service was included in another service provided at the same time." Any suggestions?
  20. T

    new CPT 69209

    Does anyone have info for this new CPT code for 2016? I have one reference to Wisconsin Medical Society "Practice Vitals". Not sure how legit this website is, so would like to confirm any other info that's out there. Here's the article that was dated 1/05/2016: CPT® code for ear wax removal...
  21. R

    ICD-10 Proficiency Assessment Service Interruption

    Hi, I am currently taking my ICD-10 proficiency assessment and Blackboard stopped working. I am getting a "service interruption" message. Is anyone experiencing the same thing?
  22. R

    ICD-10 Proficiency Assessment Service Interruption

    Hi, I am currently taking my ICD-10 proficiency assessment and Blackboard stopped working. I am getting a "service interruption" message. Is anyone experiencing the same thing?
  23. I

    CPC certified, ICD 10 Proficient looking for permanent full time job

    Hi my name is Alexandra Garcia. I've been working as a Coder at a lab. for over two and a half years. The company was recently sold and will be closing soon. I'm looking to find a company that will continue to grow my skills as a coder. I've attached my resume for review. Alexandra B...