Wiki BEGINNER Billing for Internal Med PROBLEMS

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MandyML

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Hi, I have 8 years billing experience with HHA but this is my first time billing Internal Med, which I am finding out now is a whole different game. I am having issues with Medicare (doesn't everyone) paying on procedures performed in conjunction with E/M.
My first problem I just found out is that the Doc created their own superbills with proc codes they use the most often, problem is that it hasn't been updated. I know I have the wrong codes for Flu vaciness but not sure about the other problems listed below:

1. 93000 am attaching a mod -25 to the E/M but am getting denied due to needing a referring phys and/or ordering phys. The Doc is the primary and doesn't require one (as far as I am aware). Is that the current code for an EKG? and Do I need to add the mod -59 to the 93000?

2. 90658 Seasonal flu inj and 90472 Seasonal flu/Admin. From what I found yesterday 90658 is no longer valid and I must use Q2035-Q2039 with G0008 for the Admin, is that right? Does it matter which one we use, or are those specific to brands? Will I also need mod -59 or any others?

3. Holter Monitor 93224, Doppler arterial 93922, and Bone Density 77080, Mod -59? Are those even the correct up to date codes?

4. Prostate or Yearly women exams? Can I bill WITH E/M? Modifiers?

SO SORRY for all the questions! I am figuring out most of it, but there seems to be a few issues I can't seem to find answers on and would like to get these resolved before they get too much older!

Thank you everyone for the help, it is much appreciated!

:)
 
1. you dont need to add 25 to an e/m service when you perform an ekg during same session neither a 59 to an EKG. this is the right code and it does require ordering/ref physician on block 17a in the cms form from the primary who is the ordering physician
2. yes Q codes are the right codes for flu vaccines, the administration 90741 if you bill medicare the G0008. yes use modifier 59 for the third vaccine you administer, there is 90742 code for the sec vaccine
 
alhmed said:
1. you dont need to add 25 to an e/m service when you perform an ekg during same session neither a 59 to an EKG. this is the right code and it does require ordering/ref physician on block 17a in the cms form from the primary who is the ordering physician
2. yes Q codes are the right codes for flu vaccines, the administration 90741 if you bill medicare the G0008. yes use modifier 59 for the third vaccine you administer, there is 90742 code for the sec vaccine
Click to expand...

Check the current CCi edits as of 1stQ 2011, EKG is bundled into office visits and a 25 will not stop that, a 59 will but the documentation must support that the EKG was not essential to the diagnostic process, but then you would need a reason for the EKG.. I have not checked this quarter CCI edits But I did check 1st and 2 nd Q and it was bundled.
 
MandyML said:
Hi, I have 8 years billing experience with HHA but this is my first time billing Internal Med, which I am finding out now is a whole different game. I am having issues with Medicare (doesn't everyone) paying on procedures performed in conjunction with E/M.
My first problem I just found out is that the Doc created their own superbills with proc codes they use the most often, problem is that it hasn't been updated. I know I have the wrong codes for Flu vaciness but not sure about the other problems listed below:

1. 93000 am attaching a mod -25 to the E/M but am getting denied due to needing a referring phys and/or ordering phys. The Doc is the primary and doesn't require one (as far as I am aware). Is that the current code for an EKG? and Do I need to add the mod -59 to the 93000?

2. 90658 Seasonal flu inj and 90472 Seasonal flu/Admin. From what I found yesterday 90658 is no longer valid and I must use Q2035-Q2039 with G0008 for the Admin, is that right? Does it matter which one we use, or are those specific to brands? Will I also need mod -59 or any others?

3. Holter Monitor 93224, Doppler arterial 93922, and Bone Density 77080, Mod -59? Are those even the correct up to date codes?

4. Prostate or Yearly women exams? Can I bill WITH E/M? Modifiers?

SO SORRY for all the questions! I am figuring out most of it, but there seems to be a few issues I can't seem to find answers on and would like to get these resolved before they get too much older!

Thank you everyone for the help, it is much appreciated!

:)
Click to expand...
As far as are codes up to date you need to check your 2011 CPT book or what ever year corresponds to the visit date. A lot of these codes have changed recently. For modifier questions check your CCI edits that will tell you if a modifier is needed. Are you using preventive for your yearly preventive exams.
 
According to the most recent CCI edits EKGs are not bundled with E/M codes. The CCI edits are updated quarterly, they are currently on version 17.3 with effective date 10/1/11.
 
Can some one explain to me what is the difference between the Q codes (Temporary) and regular CPT codes for non-medicare patients. We are using 90XXX flu vaccine codes for non.medicare patients. How it affects the reimbursement?

Thank you
 
Last edited:
kumeena said:
Can some one explain to me what is the difference between the Q codes (Temporary) and regular CPT codes for non-medicare patients. We are using 90XXX flu vaccine codes for non.medicare patients. How it affects the reimbursement?

Thank you
Click to expand...

The Q codes are generally intended for Medicare patients. Most commercial payers recognize the regular CPT codes for flu vaccine. Reimbursement is dependent on each carrier's policy on paying for flu vaccine.
 
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