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Latest activity
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AWe are receiving denials from Medicare for vertebral artery stenting (0075T) stating a modifier is missing or invalid. The only applicable modifiers we've found are modifier 26 and the appropriate anatomical modifier. Those are listed on the...
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Vvictorianak posted the thread Global Period - Same Physician, Different Tax IDs in Medical Coding General Discussion.I'm trying to determine how billing for E/M services during the global period works when the physician works for two organizations. Example: Physician works part time for a hospital (Organization A) and part time for a clinic (Organization B)...
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CCynthia Hughes replied to the thread BCBS downcoding E/M services.This is happening a lot. Your physician's medical specialty organizations probably have some advocacy resources and also a state medical society or medical group management organization can help advocate for fair payment consistent with CPT...
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Ff.leffler@brixahealth.com posted the thread Looking for advice (paid) — rheum biologic denials expertise, or a referral? in Rheumatology.Hi all — hoping this group can point me in the right direction. I'm with Brixa Health, a small early-stage company building denial-management and appeal tools for independent rheumatology practices and infusion centers. We're not trying to...
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Lleosailor@icloud.com replied to the thread PRACTICODE.I will make a confession that I use ChatGPT to both check my work and guide me to the right codes. Anyone else use ChatGPT or a similar ai platform like Claude?
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Lleosailor@icloud.com replied to the thread PRACTICODE.I've trying to find any method to that madness myself. I wanted to think it's not random and that there was something about the cases where things like smoking are and aren't coded that I missed, some pattern or detail that I haven't seen yet.
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Lleosailor@icloud.com replied to the thread PRACTICODE.I'm in the same boat. My first instinct is to code everything in the assessment and use the rest of the note for more specificity. I also code things in the problem list and note-body that I believe would likely be coded because they seem like...
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Lleosailor@icloud.com replied to the thread PRACTICODE.I found the Practicode feedback often disappointing and unhelpful. It usually only gives you the index pathways to find the correct codes but does a pretty poor job of justifying the answers. If it did that, it would be an invaluable nugget of...
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Lleosailor@icloud.com posted the thread Practicode support request in Medical Coding General Discussion.Hi, my name is Leo Sailor; I am going through my Practicode cases but I am really struggling in them. I am consistently performing much worse than I feel is acceptable for me. I would really appreciate some mentorship and support to help me with...
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Iiowagirl77 replied to the thread Lipomas.Is that the whole note? The provider should really be stating to what depth they excised in order to correctly code it, such as dermal, subcutaneous, subfascial. I believe lipomas are most commonly seen in the subcutaneous level, but the provider...
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Kknissen replied to the thread UHC Denying all claims as OON but Provider is IN network.Hello, We are having this same issue. We have a ton a claims for Medicare advantage UHC where a patients claims are processing completely fine and then those same patients with the same providers are randomly processing out of network. We have...
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LargoFLSunshine replied to the thread Compliant Provider Query.It is a prospective audit. This is expanding on a query template directly from ACIDS. We are telling the provider we need more MEAT in his future note. -
We are struggling with provider documentation and MEAT. Would this query be considered leading? Documentation Deficiency/ Specificity: During the recent encounter, a diagnosis of CKD3 was documented, but the record lacks the current clinical...
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jkyles replied to the thread 99451/99452 Perioperative dept.Hi there. Based on this scenario there's no consult request from the surgeon to the NPs and it doesn't appear that the NPs are using "specific specialty expertise." Both are required for the consult codes. Preparing a referral for the... -
ANCCI edits indicates that a hernia repair procedure may be inclusive to a laparoscopic sleeve gastrectomy (gastric sleeve surgery) but has a 1 indicator. I have a surgeon that is adamant that we should add a 59 modifier to the hernia repair CPT...