Page 2 of 5 FirstFirst 12345 LastLast
Results 11 to 20 of 50

Thread: Please help! Second time posting this question...

  1. #11
    Join Date
    Apr 2007
    Location
    Yuma
    Posts
    405

    Default

    Promo: Code Books
    Also:

    In the office and other outpatient setting, counseling and/or coordination of care must be provided in the presence of the patient if the time spent providing those services is used to determine the level of service reported. Face-to-face time refers to the time with the physician only. Counseling by other staff is not considered to be part of the face-to-face physician/patient encounter time. Therefore, the time spent by the other staff is not considered in selecting the appropriate level of service. The code used depends upon the physician service provided.
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  2. #12
    Join Date
    Apr 2007
    Location
    Athens, Ga.
    Posts
    693

    Default

    That may be CMS's interpretation of the rules, but the patient in this scenario had BCBS. CMS rules do not apply here.
    Last edited by Walker22; 12-23-2009 at 09:32 AM.

  3. #13
    Join Date
    Apr 2007
    Location
    Yuma
    Posts
    405

    Default

    The physician still needs to have 2 of the 3 key components but when determining the level to bill you can use the time as the key or controlling factor to qualify for a particular level of E/M services
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  4. #14
    Join Date
    Apr 2007
    Location
    Athens, Ga.
    Posts
    693

    Default

    Quote Originally Posted by Herbie LoroƱa View Post
    The physician still needs to have 2 of the 3 key components but when determining the level to bill you can use the time as the key or controlling factor to qualify for a particular level of E/M services
    We have that... History and MDM

    I don't really want to argue about this anymore. Our disagreement seems to exist because we are approaching the problem from different perspectives. You seem to be approaching it from a "what will get paid" point of view, and that is perfectly understandable. My approach is from the wording in the CPT book alone. Not every service is covered by all payers. You can code something correctly and still not get paid because of payer interpretation of the guidelines. In the case outlined in the OP, I believe an office visit is the correct code to bill. Whether it will get paid or not is a different question...

    Happy Holidays!

  5. #15
    Join Date
    Apr 2007
    Location
    Yuma
    Posts
    405

    Default

    Well I am not looking at it from a "What will get paid" point of view. Really how do you bill an office visit for a patient who was not in the office. I know the insurances will pay if you submit a bill. You would want to use prolonged services. CPT states in prolonged services that to bill prolonged services "it must relate to a service or patient where direct (face to face) patient care has occurred or will occur and relate to ongoing patient management."
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  6. #16
    Join Date
    Apr 2007
    Location
    Athens, Ga.
    Posts
    693

    Default

    Quote Originally Posted by Herbie LoroƱa View Post
    I know the insurances will pay if you submit a bill.
    Really? You must live on a different planet than I do. Just submitting a bill is not a quarantee of payment. You still have to follow their guidelines.

  7. #17
    Join Date
    Apr 2007
    Location
    Athens, Ga.
    Posts
    693

    Default

    Quote Originally Posted by Herbie LoroƱa View Post
    You would want to use prolonged services. CPT states in prolonged services that to bill prolonged services "it must relate to a service or patient where direct (face to face) patient care has occurred or will occur and relate to ongoing patient management."
    Who said anything about "Prolonged Services"? I was referring to the 99212-99215 codes.

  8. #18
    Join Date
    Apr 2007
    Location
    Athens, Ga.
    Posts
    693

    Default

    Quote Originally Posted by Herbie LoroƱa View Post
    Yeah I am quite aware of that. But with all the fraud going on you can submit bills when the patient was never in the office and get them paid. Basically what you are saying to go ahead and do!
    Excuse me, but I am not, nor will I ever, condone any kind of fraud and I resent the implication that I would. I am merely interpreting the CPT guidelines as written in the CPT book.

  9. #19
    Join Date
    Apr 2007
    Location
    Athens, Ga.
    Posts
    693

    Default

    Quote Originally Posted by Herbie LoroƱa View Post
    Yeah you should be billing prolonged services not E&M
    The prolonged services codes are add-on's for E&M services. You can't bill them without first billing an E&M code, so your statement makes no sense.

  10. #20
    Join Date
    Apr 2007
    Location
    Athens, Ga.
    Posts
    693

    Default

    Quote Originally Posted by Herbie LoroƱa View Post
    So I guess next time I will just go to the Pediatrician without my daughter and just tell him to bill for an office visit!
    I think you are missing the point, but whatever. I'm done with this conversation. Have a nice life.

Page 2 of 5 FirstFirst 12345 LastLast

Similar Threads

  1. 2nd time posting....please help!
    By lisamarhea in forum E/M
    Replies: 3
    Last Post: 09-09-2011, 03:07 PM
  2. please help.. second time posting this question..
    By EverythingCoding in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 04-11-2010, 12:31 AM
  3. need help/ 2nd time posting!
    By chembree in forum Interventional Radiology
    Replies: 1
    Last Post: 02-01-2010, 09:15 PM
  4. 2nd time posting
    By krssy70 in forum E/M
    Replies: 3
    Last Post: 01-20-2010, 09:35 AM
  5. I am posting this a second time, please help
    By Love Coding! in forum E/M
    Replies: 2
    Last Post: 12-30-2009, 11:28 AM

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.