1. A

    Wiki Home visit for dialysis

    Does anyone use this code 99512 HOME VISIT FOR HEMODIALYSIS in addition to the dialysis treatment performed in the home?
  2. P

    Wiki Visit before Cardiac Cath

    We have had a discussion with one of our doctors so trying to find a clarification. For the visit that a catherization is scheduled and they discuss the general risk of procedure do you classify that under Moderate or High Decision Making? For the risk it is determined by the fact whether or...
  3. 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...
  4. M

    Wiki Postop visit w/ strapping change

    Is there any possiblities of biil for paymnet on a postop visit for the strapping only. Patient return to Dr. office within postop days and Dr. changes patients strapping. Billing E&M CPT99024 any possibites of a modifier to the strapping CPT. Thanks of your feed back
  5. 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...
  6. K

    Wiki 99204 and 95970?

    If a Provider does a new patient visit and documents the following under NEUROLOGICAL PHYSICAL EXAMINATION: Integumentary: His incision is well healed without edema, erythema or tenderness. His vagal nerve stimulator was interrogated and did not indicate a low battery Is that sufficient...
  7. F

    Wiki Inpatient Care Conference

    I have been asked to bill a 99213 (inpatient visit) along with 99358 (prolonged service) and 99359 (prolonged add on). The note reflects a hospital visit and 1 1/2 hour care meeting comprised of time with other providers and a one on one with the mother of the child (patient). Is this correct...
  8. L

    Wiki Well Visit/ Well Woman

    Hello! I am wondering, I know the patient can have a preventive visit with her normal pcp and then a well woman with her GYN, but what if a patient comes to her pcp for a well exam (preventive visit) and then comes back few days later to have a routine pap smear; can we bill the pap as...
  9. T

    Wiki Pre-Op Visit for Screening Colonoscopy

    My director wants to bill for preop visit for patients who are coming in for screening colonoscopies. Instead of the nurse doing the H&P over the phone, the patient would come in and see the nurse practitioner. Could we bill a low level E&M code for this?
  10. D

    Wiki E/M with a procedure

    Question...I know that to bill a E/M with a procedure the visit has to be distinct from procedure. But I question this........New pt come in to see GYN with irregular bleeding. Provider does COMPLETE work up and gives pt options. One of those options being a endo bx. Pt chooses endo bx. and it...
  11. L

    Wiki Mutiple Visits - same Tax ID

    Does anyone have any experience or knowledge regarding billing multiple visits on the same date of service under the same tax ID number? I code for a rural family practice clinic and they are wanting patient's to be able to schedule multiple appointments in one day (if needed), like a "one-stop...
  12. B

    Wiki Documentation Requirements

    A patient comes in today for an office visit. At todays office visit the dr order the patient to return at their convenience for fasting labs work. Patient returns 2 weeks later for fasting lab work. What are the documentation requirements for the day that the patient comes back fasting and...
  13. K

    Wiki The suture holding a patient's percutaneous drain

    The suture holding a patient's percutaneous drain came loose and my doctor placed a new suture. Do we simply bill for an office visit?
  14. K

    Wiki Combining Time in a split/shared visit

    Are you able to combine face-to-face time between the patient and the NP and the patient and the Attending in a split/shared visit to determine one time based code? Example: Patient comes in to discuss treatment options for urinary incontinence. The Provider has a face-to-face discussion for 15...
  15. D

    Wiki review of CT/MRI scans

    If a physician has reviewed the CT/MRI with a patient on one visit and then the patient comes back in for another visit and they review the same CT/MRI scan as before can the doctor get credit in their MDM for reviewing it more then once? I was under the impression that once it was reviewed they...
  16. KScoderTN

    Wiki DX for labs ordered during preventive visit

    Office discussion: Patient is schedule for their annual well/preventive visit. No abnormal findings. Doctor simply puts Z00.00 on the order for the lab. Do you query the physician to have them specify diagnosis/ICD -10 since Z00.00 is not a covered diagnosis for the specific labs that are...
  17. D

    Wiki E/m auditing

    When an established patient comes in does the physician have to update their exam or can they just carry it forward from a previous visit? If they change/add one thing to the exam (one section not the whole exam) does this allow them to use the complete exam from the previous visit? On the...
  18. T

    Wiki Needs med to get MRI done

    Pt requests Xanax to have MRI completed. She went twice and got claustrophobic. Dx: Lipoma--pt has huge lipoma on neck. RX for Xanax given. Advised not to drive while taking it. What's the best code for this visit? The reason for the visit is to get medication, not to have the lipoma...
  19. S

    Wiki Fracture Care

    One of my doctor's saw a patient in the office for a suspected fracture. In his note he diagnosed her with a left supracondylar fracture. He decided to treat this nonoperatively and planned to see the patient back in a week. I charged out fracture care for a closed treatment of a supracondylar...
  20. 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?
  21. E

    Wiki Split/Shared IP/OP Hospital Consults

    When a PA Hospitalist performs a IP/OP consult in the hospital without the MD present. Does the MD Hospitalist have to have a face-to -face visit with the patient and also document elements of the visit in addendum to the PA's consult note that they performed personally? -or- Can the MD just...
  22. L

    Wiki Can a registered dietician-nutritionist bill for a home visist

    I have been trying to research whether or not our RD can see a patient in his home for a nutrition visit. He is on a feeding tube and has to come into the office on a a stretcher in an ambulette which is difficult and expensive for him. Is there any code we can use for her time and visit that...
  23. W

    Wiki prolonged services question

    When attempting to determine the appropriate E/M codes to use when an extensive amount of time has been spent with the patient (and documented appropriately :) ), how do you figure out the initial E/M code to use? For example, if you have a 90 minute established patient office visit, do you...
  24. A

    Wiki 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?
  25. H

    Wiki Billing OVs with Medicare injections for Orthopedics

    For Orthopedics, For Visco supplementation injections which occur once a week for 5 weeks with the same diagnosis code, can an OV be billed on each visit? The physician does document a physical exam, but the diagnosis code is osteoarthritis. Thanks
  26. 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...
  27. L

    Wiki Coding History

    Per our physician, he states that on a visit that we can pull diagnoses from medication lists and active problem lists even if he does not assess or document anything to do with those diagnoses. For example, he states to look at a medication and pull down the diagnosis that goes with it as a...
  28. A

    Wiki No exam done, can E&M be billed???

    If my physician is seeing an established patient and no physical exam is done, can I charge an E&M visit? I have read in a couple places that even though you only have to have 2 of the 3, if an exam is not done, it's not considered a visit. When patient's come back for MRI results, the physician...
  29. T

    Wiki Non global package

    We had a patient (she has Molina insurance) seen on 7/15, 8/15, 9/8 and 9/22 and then 4 more times in October. How are we suppose to bill for dates of service before October 1st?? Do we bill as a low office visit. Insurance companies want ICD-9 and ICD-10 codes on different claims. I don't think...
  30. T

    Wiki probable false-positive test

    I'm trying to determine appropriate diagnosis code for this ill visit. Is it simply Z34.82, supervision of other normal pregnancy, since provider states "probable" false-positive? Will insurance accept the Z code as reason for an ill visit? Or is there a more precise code to describe the reason...
  31. K

    Wiki Electrocardiogram

    I work for a Cardiopulmonary Clinic, that is owned by the hospital. I was told that Insurance will not pay for a new PT visit (99204) with ECG (93000 or 93005). Is there a guideline or rule that states why? Where can I find it? Also, is it ok to code 93040 Rhythm ECG with a New PT visit? Thank you!
  32. A

    Wiki 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...
  33. S

    Wiki Ob drop in visit?

    When a OB patient comes in as a drop in and the dx is elevated bp, do we still code it as a subsequent prenatal visit?
  34. A

    Wiki Preventative Visit with E/M

    Under which circumstances could a Preventative Visit/Physical (99396) be billed with a encounter visit such as 99213?
  35. M

    Wiki Coding/Billing for Diagnoses

    My provider wants us to use co-morbid conditions when proving medical necessity for urine drug testing (we work in Pain Management). However, these co-morbid conditions are not always noted on the note for that visit. I am hesitant to use codes that the doctor hasn't documented in the note...
  36. 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.
  37. M

    Wiki 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...
  38. S


    We had a patient scheduled for MVA follow up injury to his back. However, we he was seen he had very high blood pressure which was also treated at visit. Not sure how or to whom to bill. He is scheduled to be seen 3 days from now. Should I bill MVA only?
  39. M

    Wiki sequela or subsequent

    I am really confused thought I had the initial sequela and subsequent down but not so sure now. This patient came into our facility for follow up on foot injury. Provider documented the patients presents today with right foot pain. Seen at a different facility for the initial treatment has a...
  40. C

    Wiki Modifier 59 help

    IBC stopped paying my claims for 2 e/m's (an office visit and preventive visit) and a flu shot . The claims had a 25 modifier on them but now all of a sudden because of NCCI edits I am being told that I have to use a 59 modifier. Is anyone familiar with this modifier - can you tell me if...
  41. T

    Wiki C-section with bladder injury, pt returns for follow-up

    I'm just not sure how to code this postpartum office visit: Subjective: Patient here for incision check Had repeat C-section (date) with incidental cystotomy Bladder injury was repaired in 2 layers with intraoperative retrograde bladder fill with no leak Patient has leg bag and will use for...
  42. A

    Wiki Radiology Professional Charges

    I am getting conflicting information so if someone can answer my question and tell me where to find the rule I would really appreciate it. I code Radiology and Interventional Radiology and with the new ICD-10 some are saying that my coding should only be off of the patients s-ray report or order...
  43. S

    Wiki HUMANA VS Well visits and immunizations

    Help, I have tried speaking with customer service and have now had to send a request to high up contacts. Has anyone noticed that Humana stopped paying for the Well visit when the patients have immunizations. They can give me no information on this. I've ran the codes and they do receive any...
  44. C

    Wiki Postpartum preeclamsia inpatient visit question ( help)

    We have a patient who was admitted several days after her vaginal delivery for postpartum preeclampsia can we bill the inpatient visit and the sub visits? Thanks,
  45. N

    Wiki The new date of service rule for billing transitional care management

    Hello all, I was wondering if anyone had any insight on this new ruling for the TCMS. I am aware that the 30 day wait is no longer and we can bill the TCM on the date of the face to face, however, do we bill the office visit and the TCM? Or do we bill the TCM in place of the face to face? Thank...
  46. T

    Wiki provisional diagnosis of autism

    I'm not sure what diagnosis to assign to this outpatient office visit, mental health department. Provider states: "Provisional diagnosis, F84.0, autism" in his assessment. In looking up definition of provisional, it states "for the present, possibly to be changed later." I'm uncertain if...
  47. L

    Wiki Breastfeeding consult during Postpartum

    If a mother has a visit for breastfeeding consultation/instruction during her 6-8 week postpartum period, can you bill an E/M for the visit or is the visit considered part of the postpartum period?
  48. J

    Wiki 99211

    There is a doctors office that is charging a 99211 for renewing prescriptions due to the new Ct laws CPMRS I feel that is inappropriate- even though a physician is not required, a face-to face visit with a practioner needs to happen and documentation Please chime in on this issue Thanks
  49. C

    Wiki CPT code for Injections When patients bring their own meds

    Hey guys! My practice has been using 96372 for b12 injections when patients bring their own meds. Recently we have been getting denials for "lacking a required modifier" when we have more than one injection. Usually they have a vaccination and also an injection of their own meds. Our office...
  50. O

    Wiki Office visit during the global period

    Please help. I was under the impression, that you can charge an office visit during the post-op period if you treat the pt in the office for infection at the site of surgery. Am I wrong?