Results 1 to 5 of 5

Medicaid, E/M, and Neb Treatments

  1. #1
    Location
    Overland Park, KS
    Posts
    1,166
    Default Medicaid, E/M, and Neb Treatments
    Medical Coding Books
    Since Pennsylvania Medicaid plans do not reimburse separately for nebulizer treatments administered in the clinics, would a provider be able to count the time required to administer 1+ treatments in addition to the time for the assessment of the sick visit into the overall E/M level for the encounter? Since Medicaid will never reimburse for these, what is the best way for us to be properly reimbursed for the time/money to administer them to Medicaid patients?

    Could we look at a prolonged service code in addtion to the E/M, or am off track here? Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  2. #2
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Anyone out there bill for Medicaid?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  3. #3
    Location
    Columbia, MO
    Posts
    12,527
    Default
    Is it a written policy by Medicaid in PA that you cannot charge the E&M with a neb or just that it has never been paid. You should be able to bill the ov with a 25 modifier and then the neb. However no you cannot count the time of the neb admin with the patient assessment time because the physician is usually not face to face with the patient during the neb and you cannot substitute codes. But I would look into this with Medicaid a little more as I have always been able to bill Medicaid in other states for both and been paid.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks Debra! Mediciad in PA does not pay for nebulizer treatments. We can only bill for the E/M (if it applies).
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  5. #5
    Location
    Columbia, MO
    Posts
    12,527
    Default
    Is there a rationale they provide for this? A nebulizer is a medically necassary treatment! It just boggles the mind that they have a policy like that. But sadly if that is the case there is nothing you can do except send the patients to the ER when they need this kind of treatment, or write it off.

    Debra A. Mitchell, MSPH, CPC-H

Similar Threads

  1. Sufficient documentation for neb treatments
    By KGETGEN in forum Pediatrics
    Replies: 1
    Last Post: 10-28-2015, 10:18 AM
  2. Neb treatment
    By REVELLE in forum Emergency Department
    Replies: 1
    Last Post: 11-30-2011, 11:56 AM
  3. neb treatment help
    By HBULLOCK in forum Pediatrics
    Replies: 3
    Last Post: 11-11-2011, 05:41 PM
  4. initial & subsequent neb treatments
    By bonnie1990 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 03-05-2010, 02:42 PM
  5. How to code for Neb treatment
    By jennipapp in forum Family Practice
    Replies: 2
    Last Post: 02-17-2010, 10:15 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.