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    TThivierge replied to the thread Coding per insurance- HELP!.
    Hi It depends on the contract from each payer regarding the CPT codes and your company. However,the CMS/Medicare gives a outline how documentation and the dx. codes linked with each CPT should be used. This factor makes the documentation...
  • D
    Does anyone know what the CPT code is for COVID 19 rapid antigen lab that can be performed in the physician office? I am stuck with use of 87426 or U0001. Thanks, Dawn
  • J
    Provider biopsies and brushes the same lesion during bronch. Are both 31625 and 31623 billable since they are the same lesion?
  • T
    thomas7331 replied to the thread Skin cancer removal.
    There are no frequency limitation to the skin excision codes, to my knowledge. There is an MUE edit for a maximum of 2 of any one particular excision code per date of service, but this can be appealed if the documentation supports that a greater...
  • M
    When coding bilateral lumbar facet blocks L3-4, L4-5, and L5-S1 I use 64493-50, 64494, 64494, 64495, 64495. Most insurance companies are denying the 2nd 64494 and 64495 as duplicates or exceeding number this code can be reported. According to the...
  • S
    ShauntaEskridge reacted to thomas7331's post in the thread Price negotiations with Like Like.
    It sounds like you are negotiating pricing of individual claims after the fact and not negotiating contracts with payers. If that's the case, you are in a position of strength because these are services that have already been performed and the...
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    ShauntaEskridge reacted to vhofmeister's post in the thread Price negotiations with Like Like.
    MARS is horrible at negotiating with OON providers. I do not accept less than 80% of Fairhealth prices. You can also go by a percent of total charges. Again, we do not sign for less than 70% of total charges. Our charges are based off FairHealth...
  • J
    No, ear debridement for swimmers ear is considered bundled with the E/M, hence no CPT code. But, when a ear wick is placed you can bill for the microscopy if utilized. Summers ear is the an inflammation and swelling of the canal, the...
  • J
    Yeah, I would say we need the entire operative report to assist in this coding scenerio, I suspect there is more going on here.
  • T
    Does anyone know if you removed a skin cancer ( 11606 ) on a patient how long before you can do another same procedure? Will Medicare deny for "not medically necessary?
  • B
    perfect, thank you, I am following the coding clinic guidelines and wanted confirmation of my thoughts
  • C
    Cheezum51 replied to the thread 92004/92014 vs 99204/99214.
    That clears that up. Meritain is just trying to protect their bottom line by disallowing 9201x codes for medical eye care. In Virginia, for Medicare, the 92012 pays $14 more than the 99213. 92014 pays $18 more than 99214. You add those...
  • C
    We have an RN/IBCLC in our pediatric office who does breast feeding consults. We are currently charging a 99211 under the physician for these visits. Any advice on a way to charge for better reimbursement? Thanks!
  • C
    Anyone?
  • J
    I have a new SR. Management team that wants to change the way we bill out therapy codes based on what the insurance would cover so for instance- Medicare would be billed how we always have been in the past but commercial plans would get a...
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