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FQHC Coding/Billing

  1. #1
    Default FQHC Coding/Billing
    Medical Coding Books
    How would coding for an FQHC differ from Coding for a regular family practice. Code selection would be the same wouldn't it? It's the billing of those codes that would change. I work for an FQHC and have been told that we have to implement a whole new way of billing and we will be billing Medicare A. We are a multispecialty clinic serving the underserved. Most of our care is outpatient, why would we bill Medicare A?

    Any insight would be greatly appreciated.
    Heather Winters, CPC, CFPC

  2. Default
    Hi I also work for A FQHC, the billing is done that way because your rate will be higher than a FM . you can email if you have any other questions

  3. #3
    Default FQHC Denial
    I have received a denial for a claim with a 522.5 and 272.4 dx. They stated the reason was because
    claim was denied due to the dental abscess. Dental is an exclusion from Medicare benefits. Once the dental code is on the claim the system will not process ANY items from that claim. You need to re-bill without the dental for the hyperlipidemia only. Since dental services are an exclusion (and not a medical necessity issue) then you may bill the patient for the dental/antibiotics.

    How can this be right? The patient saw us for a mouth abscess and management of hyperlipidemia. We gave him an RX for antibiotics and discussed his lipids ordering labs. I cant just omit the 522.5, Jaw Stiffness (associated with the abscess) was the chief complaint. Does anyone have insight into FQHC coding/billing?
    Heather Winters, CPC, CFPC

  4. #4
    Charleston, WV
    Was this actually a periapical abscess or was it an abscess of the mouth floor or vestibule? If the latter, you can use 528.3. If it was a non-dental abscess of the jaw bone(s), you can use 526.4. Otherwise, due to payer guidelines, you may be able to bill with the dx for the associated symptoms (jaw stiffness) but I would verify that with the payer first. Hope that was some help.

  5. Default FQHC's
    Welcome to the world of FQHC billing. Being a FQHC you should have been billing different all along, your Medicare and Medicaid requires encounter codes and with Medicare you need to bill your office services to Part A. But like the response below if you need any assistance please email me at and I will be happy to offer you any assistance that I can.

  6. #6
    Default icd-9
    Exact DX on assessment was "dental abscess", abnormal exam documents "broken left mandible molar (tender), Left submandible adenopathy.
    Heather Winters, CPC, CFPC

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