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Latest activity
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Pam Warren replied to the thread Wiki GLP-1/Weight Management.The preventive counseling codes 99401-99494 are to provide the patient with strategies to prevent disease. From a 'weight' perspective you might counsel a teenager who has a slightly elevated BMI and provide them with strategies to prevent... -
Pam Warren replied to the thread Wiki Billing 96127.You need only -25 on the E&M. I would not recommend using -59. Overuse can cause an audit. -59 is when you have more than one procedure; an E&M is not considered a procedure.
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Pam Warren replied to the thread Wiki Query Providers.Since the ACA in 2009, and the mandate to provide screening services at no cost-share to patients, this issue has been a real PITA. (sorry ..... but I call 'em like I see 'em). That the insurance companies tell patients that this was coded...
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Pam Warren replied to the thread Wiki Claim billing.Bill the insurance first. Then when you get the denial, balance bill the patient. They are responsible for all services that they present for, but you do need to do your due diligence before you drop the claim to the patient. And if you...
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Pam Warren replied to the thread Testosterone injection J1071.J codes are generally reported by the weight of the medication. Milligrams (mg) are measurements of weight..... ml (millileters) are measurements of volume, which only tells you the amount of liquid in which the medication is delivered. Think...
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Cthis is outpatient facility coding. Revenue codes must match to the CPT codes. Certain CPT codes may not be paired with some revenue codes. The revenue codes are standard for every facility. I know the UB-04 manual has a list of revenue codes...
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Pam Warren replied to the thread Wiki Unbundling 59400 Plan 2027.AAPC's Raemarie Jimenez and other AAPC members like Le Church, MD are very involved with the CPT Editorial board. Because these kinds of decisions have a lot of moving parts, and this is not slated until 2027, education will not be forthcoming...
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Jjrienne.belarmino@icloud.com reacted to Pam Warren's post in the thread Wiki BH - Multiple visits within a 12-hour period - MCO with
Like.
I'm assuming that this is an outpatient clinic, these are professional claims, each provider has their own NPI and that the services have been pre-authorized, are medically necessary and a diagnosis is provided. Both CMS and commercial payers... -
Jjrienne.belarmino@icloud.com replied to the thread Wiki BH - Multiple visits within a 12-hour period - MCO.Thank you for confirming. Yes, this is an outpatient clinic, and these are professional claims.
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Pam Warren replied to the thread Wiki audiology code 92543.CPT 92543 was deleted in 2016 (it's probably time for your provider to get you an updated code book), and was replaced by 92537(bithermal) and 92538 (monothermal). You'll need to read the code descriptions and documentation to determine the...
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RI am trying to verify if billing Medicaid behavioral health in Michigan does it go through the Managed Care Plan or directly through the MHWIN/DWIHN PCE portal? I can't seem to get a straight answer from them and the non-profit I bill for has no...
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Pam Warren replied to the thread Wiki G0556 and G0557.I don't have any historical data; these are fairly new codes and we're just now in the process of implementing. What I will say is that there is no clear documentation guidance as to what needs to be in the chart on a monthly basis in order to...
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JHi can you tell me if the above code is deleted and if so, what code replaced it? I am finding conflicting answers Thank you
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Pam Warren replied to the thread Wiki Dx documented in the A/P.He is correct, there is no such requirement. You do not have to mandate the Dx in the assessment and plan; I've seen the diagnosis indicated in the history and/or exam. It's preferred if the Assessment and Plan state the...
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SSelvarani78 replied to the thread MNT for Mental Health.Thanks Pam.