Results 1 to 7 of 7

CT scans included with ED visit??

  1. #1
    Question CT scans included with ED visit??
    Medical Coding Books
    I know this is probably a stupid question but I have to know. We have just started billing for an free standing ER and are getting a lot of denials for the CT scans done saying that they are included with the E/M visit. Is this correct???
    If this is correct, why is that???


  2. #2
    Location
    Columbia, MO
    Posts
    12,924
    Default
    Who is telling you they are included?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    The payor is Scott and White in Texas. Every claim we have submitted to them with CT scans they are being denied as bundled but they will give us not information on why it is bundled which is very frustrating.

  4. #4
    Location
    Columbia, MO
    Posts
    12,924
    Default
    I have not ever had CT scans bundled with a visit. So there are many questions here. Such as is this work comp, or are you an FQHC, or Indian Health.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    This is just a free standing ER and are non contracted with any payers. They do not accept Medicare or Medicaid and dont fall under Indian, or FQHC. These are not Work Comp claims either. I dont get it. We are going to appeal these, but dont know how to proceed.

  6. #6
    Location
    Columbia, MO
    Posts
    12,924
    Default
    Quote Originally Posted by coder2be View Post
    This is just a free standing ER and are non contracted with any payers. They do not accept Medicare or Medicaid and dont fall under Indian, or FQHC. These are not Work Comp claims either. I dont get it. We are going to appeal these, but dont know how to proceed.
    I did billing for a freestanding ER and I remember there was a twist to it. What is the POS you are using? And do you have a trauma designation. Also are billing on a UB or a 1500 form or electronic equivalent.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Milwaukee, WI
    Posts
    61
    Default Modifier?
    Are you appending a modifier 25 on the ED code? I believe there is a CCI edit that bundles the CT scan into the ED code, so a modifier would be required in order to be reimbursed for both.

Similar Threads

  1. Pre-Op visit included in Global?
    By woowooz7 in forum E/M
    Replies: 2
    Last Post: 07-13-2015, 10:44 AM
  2. 90 day post op visit-whats included
    By sara0014 in forum General Surgery
    Replies: 0
    Last Post: 09-30-2013, 10:56 AM
  3. Replies: 3
    Last Post: 06-11-2012, 09:19 AM
  4. Consultation visit included in Global Package
    By sdfrancis324 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 04-29-2010, 06:01 AM
  5. swab included in e/m visit?
    By jifnif in forum E/M
    Replies: 8
    Last Post: 04-21-2010, 01:18 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.