a few questions

dsmith06351

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Hi,

I have a few qurestions, that I am hoping someone can help me with.

1. What diagnosis code would you use when the doctor sees child to medically clear them for an immunization?

2. I was told that when billing for CLIA waived tests to use the modifier QW only on medicaid patients, but shouldn't I use it for all insurances?

3. How are other offices billing for lead screenings? We draw the blood but we do not do the test.

Thanks for any help.

Denise Smith CPC-A
 

bhaskins1

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Hi,
I will try to help...

1. Depends on the situation. I would need more info to give you a clear answer. If you can give more details about the visit I can try to help.

2. Using QW for CLIA waived tests is required by Medicaid in my state (NC) but we also use it for all payors. We have yet to get a denial for using it. It is appropriate to use it but I would say this is one of those gray areas that could be carrier specific.

3. We too do lead screenings; we take the sample and send it to the state. So it is inappropriate to code for the lead screening itself since we are only handling the sample. We code 99000 V15.86.


Hope this is helpful... if you supply more info on Question #1 I will try to answer it too.
 

dsmith06351

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Thanks for your help. With question #1 We have babies that are coming in for a synagis injection. The doctor is doing and exam to make sure that the baby is well and can have the shot.

Denise Smith CPC-A
 

bhaskins1

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That can be tricky depending on the insurance carrier.

1. If the child has any medical diagnosis that the Dr. evaluates or counsels the parent on during that e/m you can code that... (feeding issues, sleeping, etc.) Be sure to add Modifier 25 to the office visit.

2. If no other diagnosis is found or discussed we use the diagnosis V04.82. Keep in mind, your doctor may not be reimbursed for the office visit because some carriers will say that it should be bundled with the 90772.

Hope this helps.
 
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Synagis/pt's own med

That can be tricky depending on the insurance carrier.

1. If the child has any medical diagnosis that the Dr. evaluates or counsels the parent on during that e/m you can code that... (feeding issues, sleeping, etc.) Be sure to add Modifier 25 to the office visit.

2. If no other diagnosis is found or discussed we use the diagnosis V04.82. Keep in mind, your doctor may not be reimbursed for the office visit because some carriers will say that it should be bundled with the 90772.

Hope this helps.
Since 90772 has crossed over to 96372, would it still be appropriate to code the 90378 with the 96372?

Also, how would we indicate that the patient brings their own Synagis when coding the 96372?

For example, in the past we've been coding 99212 for the exam prior to administration of Synagis with 90772 (before the admin code changed to 96372) when the patient brought their own med.
 
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