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So I’m fairly new to the billing and coding world. I was lucky enough to get hired ant my extern site. Anywho. My questions is, is there a way to check if a CPT code can be billed together with a dx code or several dx code. For example: 99205 F80.2 and H93.25. According to insurance X I can’t bill those 3 together. Where I can cross reference all that. Codify is awesome but I don’t understand it at times when it comes to the crosswalk.
Also in regards to credentialing…besides calling each individual payer, where would the credentialing team go to for getting the appropriate lines of service for the provider?
I dislike the insurance aspect of it all. It’s too many to keep up with. I’ve tried to keep up with in with excel but it’s never ending. And the run around because patient a has insurance won’t of Texas but got seen by MD doe in Vegas well let’s just make her work a little why not lol
 
So I’m fairly new to the billing and coding world. I was lucky enough to get hired ant my extern site. Anywho. My questions is, is there a way to check if a CPT code can be billed together with a dx code or several dx code. For example: 99205 F80.2 and H93.25. According to insurance X I can’t bill those 3 together. Where I can cross reference all that. Codify is awesome but I don’t understand it at times when it comes to the crosswalk.
Also in regards to credentialing…besides calling each individual payer, where would the credentialing team go to for getting the appropriate lines of service for the provider?
I dislike the insurance aspect of it all. It’s too many to keep up with. I’ve tried to keep up with in with excel but it’s never ending. And the run around because patient a has insurance won’t of Texas but got seen by MD doe in Vegas well let’s just make her work a little why not lol

If you look in your ICD-10-CM manual, there's an Excludes1 note for F80.2 and H93.25. (The Excludes notes should show in Codify as well.)

Excludes1 means that the diagnosis codes cannot be billed together.
 
Hi Jbchiquete
Yes every CPT code is linked with certain ICD10 codes. Check the CMS website physician fee schedule. Also you can Google differ medicine services billing information for tips (ie Ortho ,, OB/GYN, Digestive, Medicine Ds.). Also Goggle any medical word or dx meanings or terms you do not understand. Also then compare with the current CPT and HCPCs manual any coding tips get online. But always code according to the documentation given by the provider . You can query him or her to get the why behind it or inform them if get continual insurance denials. Reading the ICD10 manual it gives you more info on dx coding too according to body area, gender, age of child or if adult. Encoders are great tools, but looking in ICD10 manual may clear somethings up. One thing about the Excludes Rule 1 is usually most of those dx codes are repetitious or have same meaning. If a dx code has Excludes 2 rule you can bill together. In your example the dx F80 .2 says Developmental Aphasia and Dysphasia and dx H93.2 is Word Deafness. These 2 dx codes mean just about the same illness so it is why Excludes 1 rule.

Here are some other tips might help...yes docs and provider must be credentialed for each payer. Check out CAQH website and make Excel list of providers, NPI, PIN with payers phone numbers, faxes and web site and little billing tips per payer for you. Are you tracking your denials? Yes many things in healthcare billing & coding changes...it is just this type of business. Does your office have certain staff handling certain payers ?Communication is vital among same team players in billing and coding. Payers have separate departments handle differ processes..credentialing, verfication of pt. benefits, payments and appeals. Get name of who you talk too at insurance payers offices. Check out CPT manual for more info on treatments and modifiers linked for certain settings in specific medical situations.
I hope helped you .
Lady T
 
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