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Field Guide to Physician Coding 3rd Edition


Ronald Hirsch
Forum Postings
H & P for nephrology
Fri, Jan/15/2016 11:56AM
If the patient is being admitted as inpatient to the hospital, you can. The bundling only applies to outpatient care.

Observation vs Inpatient
Tue, Nov/10/2015 07:06AM
It depends on the documentation. If the second day the physician documented a full H&P, you can bill an initial inpatient hospital visit. I'd go with low level. If the note is more like a followup, then use 99231-3

Blood in Mouth
Fri, Nov/06/2015 10:50AM

Pre-Op visit
Fri, Nov/06/2015 10:47AM
It is not clear what you are asking but that H&P cannot be billed separately.

Lung Screening
Fri, Nov/06/2015 10:46AM
It's your lucky day! CMS just released their transmittal with all the rules:

Fee for Drawing Blood
Thu, Oct/29/2015 07:28PM
nope- one of those two is the only choice

New patient elements missing
Fri, Sep/11/2015 02:50PM
That seems wrong to get nothing at all. I'd ask that person for a citation that says you can't use established codes for a new patient. Turn it around on them

New patient elements missing
Fri, Sep/11/2015 12:41PM
Well, you got me there- I was "extrapolating" from the guidance on hospital visits. Could they possibly want a doc to use a new patient code when all elements are not met?

New vs Established patient in a Hospital Clinic setting
Fri, Sep/11/2015 12:32PM
Patients registered as an inpatient or outpatient in the prior three years are established patients for the hospital.

Pre-op chest Xray
Fri, Sep/11/2015 12:26PM
No. There must be a medical reason to do it, such as cough, COPD, CAD, etc.

New patient elements missing
Fri, Sep/11/2015 12:25PM

Initial OV & Hospital Admission
Tue, Sep/08/2015 12:25PM
If you are talking about the surgeon, the global period includes the day of surgery so you cannot bill separately for an H&P on the day of surgery. You get the initial office visit to determine the need for surgery then the surgery global payment. No extra for H&P or PAT visit.

an ipatient question
Tue, Sep/08/2015 12:20PM
There must be a separately identifiable reason for the aortogram to be billed separately.

Fecal impaction removal
Tue, Jun/30/2015 04:33PM
E&M based on time.

99211 not being paid
Mon, Jun/08/2015 09:59AM
You cannot "Just have a nurse visit with a venipuncture" just as you cannot have a physician E&M visit with a pre-scheduled procedure. The venipuncture payment is for performing the routine venipuncture by whomever does it, including the doctor if it is a routine venipuncture. So the RN must perform another service that warrants a nurse visit. Now if the RN did a finger stick for a protime, you can charge for a 99211 if the results are reviewed with a provider and patient is questioned.

10060 bundled with 99214
Mon, May/04/2015 05:34PM
I assume linked to the ICD-9 for the 10060 was not linked to the 99214 and there was no dx with the 99214 that could be associated with an abscess?

What is the CPT-4 code for severe congestive heart failure?
Wed, Feb/11/2015 12:31AM
heart failure is a diagnosis- 428.0, CPT® is a procedure code set.

Outpatient procedure
Thu, Jan/29/2015 06:49PM
I'll throw a little wrench in this, but you can ignore it. Waiving a patient charge because of an error may be considered a reportable event. The doctor should contact his/her medical liability carrier and discuss the situation. And hopefully risk management at the hospital was notified.

Implantable Cardioverter-Defibrillator Shocks
Fri, Dec/05/2014 04:47PM
well, if they got shocked, that means they had ventricular tachycardia, so I'd use that code. You can also code the reason for the ICD, such as systolic heart failure. And was their potassium or magnesium abnormal?

Mon, Nov/10/2014 03:05PM
We doctors always think we should be getting paid more than we are...

Preventative Exam
Fri, Nov/07/2014 09:08AM
It is unlikely that a patient who requires a 99215 is stable enough to also have the preventive visit done. Maybe 99215 is upcoding.

Critical care documentation
Fri, Nov/07/2014 09:06AM
MUST say critical care or you'd use the time based coding for E&M. And just because they say critical care does not mean the auditor will agree the patient was critically ill, but that's a separate issue...

billing for OV prior to screening colonoscopy if pt is on coumadin
Fri, Nov/07/2014 09:03AM
The patient may be at high-risk for the screening procedure due to other conditions (i.e., COPD, medications, etc.) that affect the pre-operative instructions given to the patient or how the procedure is performed, however, the consideration given to these risk factors is inclusive in the usual “pre-operative” work associated with the procedure. Reporting an E/M service with a diagnosis code associated with one of the patient’s risk factors implies that the GI physician saw the patient in order to diagnose or manage the illness identified and that is not the case. The GI physician is seeing the patient in order to determine the suitability of the patient for the screening procedure and CMS has stated that these visits are not billable.

The following FAQ was posted on the CMS website: Evaluation and Management Visit prior to Screening Colonoscopy Q. Can a provider bill an E&M visit if a beneficiary is referred for a screening colonoscopy? A. A provider preparing to perform a screening colonoscopy cannot also bill for a pre-procedure visit to determine the suitability of the patient for the colonoscopy. There E/M services, to include consultations, are not separately payable. While the law specifically provides for a screening colonoscopy, it does not also specifically provide a separate screening visit prior to the procedure. Although no separate payment can be made for these visits currently, the fee schedule payment for all procedures, including colonoscopy, contains payment for the usual pre-procedure work associated with it. This reflects the principle that each procedure has an evaluative component.

Two MD's in exam at same time
Fri, Nov/07/2014 09:00AM
If each physician is doing the work to justify the E&M code, there seems to be no reason to not bill it. But be sure each is billing the work they did and not what the other doc did.

Billing both 99211 and 36415 for same date of service
Fri, Nov/07/2014 08:59AM
You should not need the -25. The diagnoses attached to each should be different; be sure the lab is not using the same ICD-9 as the 99211.

nasal spray
Wed, Jun/11/2014 02:30PM
nope. Add to E&M as counseling

Digital fecal disimpaction without anesthesia
Fri, May/16/2014 01:50PM
Use the E&M code for the visit- base coding on time, not volume.

CPT® 92502
Thu, May/15/2014 10:39AM
The ASC should code as they see fit and you code as you see fit. They are under no obligation to use the same code you used.

Mon, May/05/2014 12:46PM
I billed the date I signed it, the diagnosis and place of service- office. Do not send the form or indicate the date range of the home care. Keep a copy of the signed form in the patients chart

medicare pronged inpatient visit
Tue, Apr/29/2014 06:11PM
Medicare certainly does. Be sure the documentation is good and includes the actual time spent and be sure there is also an E&M code

E/M for hospitalists
Tue, Apr/29/2014 06:09PM
Sure- different specialties. But be sure the visit is medically necessary and not just a social visit

Tue, Apr/29/2014 05:56PM
Use the date the form was signed. But be careful-- I signed one when the patient had been readmitted and it was denied since the patient was in the hospital on the "date of service." So I had to lie and put a date prior to readmission; they made me lie...there was no other way to get the claim paid and I performed the service.

Does patient have to be notified while in office of UA results to charge 99211
Mon, Apr/07/2014 10:55PM
I'd say nope. The nurse visit was face to face getting the history and sample as required for 99211.. The test result can be transmitted by phone

Physician signature on medical records
Mon, Apr/07/2014 10:53PM
If it is not authenticated it did not happen.

Is there a limit on units for J1030/J1040
Sun, Mar/16/2014 11:55AM
each unit of J1030 is 40 mg. You are not billing 40 units are you?

How does technical component and professional component each affect the reimbursement from the insurance carrier?
Sun, Mar/16/2014 11:53AM
technical component + professional component = full payment, whether they are billed separately by hospital/clinic and doctor or together by one provider as a single charge.

can i bill 99213 with 99215
Fri, Jan/31/2014 01:55PM
You may want to look at the prolonged services codes; that may meet your needs.

Stretta Procedure 43257
Tue, Jan/14/2014 04:58PM
Here is the LCD- the procedrue code is listed as covered but it depends on the indication. Look at section B on page 3

Screening colonoscopy
Tue, Aug/20/2013 02:17PM
It depends. The time of the previous scope and the findings should dictate when the next one is done. If it was at age 49 and was normal, the next one should not be until 59. Polyps do not know that they cannot grow before the patient hits age 50 so a scope at 49 is ok

Critical Care documentation
Mon, May/27/2013 08:29PM
Critical care is a time based service so the doctor must document time spent. So if the doc documents "spent 60 minutes in critical care of patient" it technically meets the requirement but the patient must be critically ill and so the RN note cannot just say "Dr smith rounded on patient and wrote orders"- it must justify the patient's critical condition

E & M
Fri, May/24/2013 12:43PM
no, the services should be combined into one code- only one E&M per day is allowed. Perhaps prolonged services code can be used

CT scan same day as office visit
Wed, Apr/17/2013 09:41PM
There is no such rule.

POS - Hospital discharge, nursing home admit
Tue, Apr/16/2013 12:51PM
Well that is not kosher. He needs to do the admit at the SNF. That needs to be the place of service. Signing papers is not admitting to a SNF.

E & M codes billed twice on the same day, same specialty within a group
Fri, Apr/12/2013 02:06PM
same specialty, same group--combine all services into one code.

POS - Hospital discharge, nursing home admit
Fri, Apr/12/2013 02:05PM
Are you saying that the SNF is at the same address as the hospital or that the doctor is doing the SNF admit at the hospital and not at the SNF?

Hospital Observation with Prolonged Care.
Fri, Mar/29/2013 04:37PM
Did you read this? CMS does not recognize prolonged services with Observation.

It is clinically unlikely that a patient on Observation needs 1:1 MD care like that. if so, they would be an inpatient.

Fri, Mar/29/2013 04:33PM
Always best to ask the company that supplied the machine. They have all the codes and the proper instructions to bill compliantly

Outside Lab
Fri, Mar/29/2013 04:29PM
It depends on your state laws and the insurer's policies. This is called "pass through billing." Medicare forbids it (except by hospitals), some commercial insurers allow it. If you bill for the test, then obviously the lab cannot bill for it.

Icd code for guinea pig bite
Fri, Mar/29/2013 04:27PM
We had a guinea pig that would bite- the kids named it "Meanie."

Diagnosis code for elevated calcium deposits in heart
Fri, Mar/29/2013 04:26PM
I used 414.01- since the calcium is in the artery (not the heart itself) and that represents atherosclerosis of the artery.

Face to Face Encounter for Home Health
Sun, Feb/10/2013 04:28PM
Nope, it is bundled into other services.

Level 4 visits
Thu, Jan/31/2013 01:09PM

Skilled Nursing Facility Followup from Hospital Stay
Thu, Jan/31/2013 01:08PM
Use the skilled nursing visit codes, bill to Part B, not part A. The SNF is not responsible for any professional fees.

Thu, Jan/31/2013 01:06PM
I don't think you can replace the battery alone; they replace the whole unit.

EKG's and Annual Physicals
Thu, Jan/31/2013 12:59PM
Just to add the medical side of things...the data is clear that there is no benefit to routine EKG's for the "well person" being seen for a annual physical. That does not include those with a chronic stable illness such as diabetes or hypertension who may benefit from one. Of course if you link the EKG to the disease (250.00) then it is not preventative and may affect patient liability.

inpatient procedure billed as outpatient
Mon, Jul/16/2012 06:44PM
Not for a Medicare patient, it is on the CMS Inpatient Only list

Adult Immunizations
Mon, Jul/16/2012 06:42PM
If you are just giving the vaccines, bill for the vaccine and the administration. There is no counseling codes as there are for children.

Fri, Jun/29/2012 11:52PM
or, "reviewed, not pertinent" to document that it was performed as opposed to not even asked

outpatient evaluation and management codes
Mon, Jun/18/2012 12:48PM
more details please to your question

Dr Consulting another Dr about patient
Mon, Jun/11/2012 02:26PM
I would be very careful with that one hour time. No discussion takes one hour. We doctors overestimate the time we spend on all kinds of things. If you are going to use prolonged services code for a hospital patient, be sure the doc specifies in the note the exact time spent such as "11:10 to 12: 15 discussing case with Dr Smith"

Code for adnexal mass
Mon, Jun/11/2012 02:22PM
221.9 or 625.8

immunizations for post transplant pts
Mon, Jun/11/2012 02:19PM
You can check with the patients Medicare part D plan for coverage.

dx code help
Mon, Jun/11/2012 02:17PM
327.41 ????

Medicare Immunizations
Tue, Jun/05/2012 03:55PM
Of course the doctor is wrong. The doctor is referring to the recent FDA approval of administering Adacel/Boostrix to persons age 65 and over. Previously it was approved only for persons under the age of 65.

But of course FDA approval does not equal Medicare or private insurance coverage. And as with the regular tetanus shot, Medicare part B does not cover Adacel/Boostrix.

But...if they have a Medicare part D plan, it may cover it, just as it covers Zostavax. If you are signed up to bill Part D for Zostavax, you can search for coverage for this too. If not, you can sign up your practice here

or refer the patient to the local pharmacy that offers vaccinations.

95075 Ingestion Challenge
Thu, May/31/2012 02:27PM
Why is it a secondary diagnosis? We learn a V code should not be a primary diagnosis but that does not mean it can't be...

interpretation report for diagnostic tests
Wed, May/30/2012 05:08PM
No; there should be a direct interpretation, for example- EKG- A Fib, or CXR- LLL pneumonia

Fri, May/25/2012 10:00AM
look at 910-919 series. Can also add E906.4 if you want to be an awesome coder

no answer to question
Thu, May/24/2012 03:50PM
This is a community driven forum so the question may be difficult to answer so no one knew the answer, poorly written so no one understood it, or posted and missed by everyone. Try again.

MVA after 24 hours?
Thu, May/24/2012 03:48PM
Sure. "I felt fine until I was rear ended two days ago. My neck hurt but I took ibuprofen but it still hurts"

Thu, May/24/2012 03:47PM
no diagnosis for that. Use 626.8

Outpatient consultation resulting in laceration repair
Mon, May/21/2012 05:10PM
The code is therefore an ED visit code, with the -57. There are 5 levels, don't think a laceration would get you to to a level 5.

Outpatient consultation resulting in laceration repair
Mon, May/21/2012 04:58PM

Who consulted you? Was this in the office? New patient to you? Insurance type?

Alternative codes for P9603 & 36415
Sun, May/20/2012 07:44PM
Most Medicaid plans do not pay for venipuncture. Another giveaway. Same also probably applies to P9603. That means there is no other code to use- you are "donating" the services.

New patient encounter to establish care
Sat, May/19/2012 12:58PM
Absolutely bill for this; the doctor reviewed meds for medical appropriateness for the chronic illnesses, examined the patient, formulated a treatment plan.

Not every patient has a "complaint"- 90% of patients feel "fine" and are seen for chronic illness monitoring.

CPT® code list for IP codes only
Sat, May/19/2012 12:56PM
I assume Tricare matches CMS...

Help please, coding well woman exam's
Tue, May/08/2012 08:01PM
v72.31, CPT® is age appropriate wellness exam (?99285- no code book - guessing)

pricing for 99223
Tue, May/08/2012 08:00PM
not allowed to talk about price. try 150% of Medicare allowed

billing nurse visit 99211 with pt/inr
Tue, May/08/2012 07:59PM
Hate to say but I disagree with Nancy. there does not have to be a change in dose to bill 99211. As it says: Alternatively, for patients who have no new clinical concerns, documentation that contemporaneous laboratory values were obtained, reviewed, and used to guide current and/or future therapy documents that a separately payable E/M service has been performed.

We get a set of vitals, review meds, ask about bleeding/ bruising, get the INR, review result with MD and if needed change dose. The MD reviews and signs the note and we bill 99211

25 modifier with and EKG
Mon, May/07/2012 05:40PM
I never use it and I get paid

Glucose coding
Mon, May/07/2012 05:39PM
36416- capillary blood draw

frequent nursing home
Mon, May/07/2012 05:38PM
Nope, the visits must be medically necessary, not based on a family's whim. If the visits are necessary, bill as usual and the documentation should support you.

MRI cost
Mon, May/07/2012 05:37PM
$3-4,000 at a minimum, but no one pays that price

pre-procedure coag studies
Mon, May/07/2012 05:36PM
you can look for the NCD for the INR and see acceptable codes; perhaps the reason for the procedure is there, such as cancer.

Good Laboratory Billing Software
Mon, Apr/23/2012 09:06AM
When you say "better" what are you using now? Our office EMR allows the staff to bill labs; it is no different than billing office visits or surgeries; just a CPT® and an ICD...

Failed all Conservative Care Options
Mon, Apr/09/2012 05:52PM
nope, no code for that, it is a documentation thingie.

Number of Diagnoses or Treatment Option
Wed, Apr/04/2012 11:39AM
an xray is a workup. Yes.

oxygen ?
Wed, Apr/04/2012 11:38AM
no charge for that. If they need it acutely and are really sick/in distress, the doc may be able to bill for critical care services or prolonged services

billing for dr. visits in SFN
Tue, Apr/03/2012 08:42PM
OF course he can bill and should bill. Whether he will get paid is a separate issue. If he provides a service, the patient should pay for it. If they elected not to have part B, then they are responsible.

prostate exams
Fri, Mar/23/2012 11:03AM
But that code is paid if it is the only professional service performed. Any other E&M or wellness visit and it is bundled.

Code for Encounter to discuss tests results
Fri, Mar/23/2012 11:01AM
use "abnormal Mammogram" 793.80 and then E&M based on time

Chief Complaint
Fri, Mar/23/2012 10:59AM
[Is it ok to use follow-up such as follow up colon polyps. ]

Of course! If that is what the patient says

Pathology queestions. A1C
Thu, Mar/15/2012 08:53PM
Just for completeness, a hemoglobin molecule with attached glucose (which is what the HbA1C is measuring) lasts about 3 months. The more there is glucose in the blood, the more hemoglobin molecules get attached glucose hence higher A1C. So if you make a medication change, you really need all the old molecules to be gone and only measuring the new ones. therefore you test no sooner than 3 months to see the complete effect of the medication change. Diabetes is a life-long disease so there really is no rush to test after a month or two rather than 3 months.

Changing medical records.
Wed, Mar/14/2012 11:28AM
every entry in the medical record must be dated and timed. It should reflect the time the procedure was done if the entry is not made contemporaneously. There is no time limit for late entries, except common sense.

Pronouncement of Death
Wed, Mar/14/2012 11:26AM
there is no CPT® for pronouncement of death so you use the discharge codes, as to ICD, use the reason for the illness- pneumonia, MI, heart failure, etc.

diagnosis code
Thu, Mar/08/2012 03:45PM
Why was it done? Tumor? Cancer?

Thu, Mar/08/2012 03:43PM
Wrong code- 99356 for nursing home first 30 minutes

Can I bill a MRA and MRV?
Mon, Mar/05/2012 05:45PM
yes; they are separate tests; you may see a reduction for second test in same setting

Wed, Feb/29/2012 04:32PM
Phlebotomy is the draining of blood for therapeutic purposes (modern day blood letting). Most common for hemochromatosis with iron overload. It is not the same as drawing blood for a lab test-36415

Routine physical with 94010. Help!
Tue, Feb/28/2012 09:03PM
There is no medical reason to do a spirometry as part of a physical. If the patient has a complaint like short of breath, then use that diagnosis to link to the spirometry, and as bilings123 noted you could also bill a 99213-25 with that diagnosis.

Let me add that there also no medical reason to do an ECG with a physical for a patient with no symptoms and no other health conditions. Insurers are a little more liberal in letting that slip through but it is still a waste of all of our money.

Pulse Ox
Sat, Feb/25/2012 09:07AM
I just bought a pulse oximeter at Walmart for $35. Compared it to my $500 office machine and perfectly accurate. As Nancy said, payment is part of E&M code as a vital sign.

Required DX codes
Thu, Feb/23/2012 03:35PM
714.0-714.2 Rheumatoid Arthritis [moderately to severely active in adults] 201 Hodgkins Lymphoma 204.1-204.12 Chronic Lymphocytic Leukemia 200.0-200.08 Non-Hodgkin’s Lymphoma 200.5 Central Nervous System Cancer 446.4 Wegener’s Granulomatosis 446.0 Microscopic Polyangiitis 202.8 B-cell Lymphoma 200.1-200.2 Lymphoblastic lymphoma/Burkitts 203.0 Multiple Myeloma 273.3 Waldenstroms Macroglobulinemia / Lymphoplasmacytic Lymphoma 694.60-694.61 Mucous Membrane Pemphigoid/ (MMP) 447.6 ANC A-associated vasculitis 287.31 Chronic Immune Thrombocytopenia Purpura (ITP) 238.77 Post-Transplant Lymphoproliferative 279.5 Chronic Graft vs. Host Disease

Wed, Feb/15/2012 08:41PM
hospital outpatient for the Obs 99218 , hospital Inpatient for the admit 99223.

hemoccult card diagnosis code
Wed, Feb/15/2012 08:40PM
Now wait a minute- you need to use the code that applies to the reason you did the test! If it was screening for colon ca, use v76.41. Patient has no coverage- too bad. Don't commit fraud! If they had rectal bleeding, use that code, etc.

Wed, Feb/15/2012 08:38PM
why take a chance? Consider it a No and report another one or five more just to be sure.

Wed, Feb/15/2012 08:37PM
Is this Jeopardy? I'm a doctor and can't answer that question. How about something like Leukemia or melanoma?

Weird ICD9- question
Wed, Feb/15/2012 04:03PM
782.5- cyanosis

Medicare Annual Welness Visit
Fri, Feb/10/2012 12:04PM
yep, that's what I use

Preoperative visit for lung replacement
Thu, Feb/09/2012 03:23PM
Who are you? PCP? Surgeon? Adult patient? Child? Insurance?

Nurse visit with unna boot
Thu, Feb/09/2012 03:22PM
I will say..bill 99211. But her documentation should indicate that the wound was inspected, the patient was questioned about symptoms and counseled on continuing care. She should also do vitals and chart that.

email/phone evaluations
Thu, Feb/09/2012 03:21PM
I have not seen any insurers that pay yet. But go ahead and bill for them and keep track of who pays

Thu, Feb/09/2012 03:20PM
no stitch is minor- every stitch can get infected, open up, scar, etc. The risk is there. Bill it based on what was done.

post tussis emesis
Tue, Feb/07/2012 07:06PM
it means you cough so hard you puke. Code it as vomiting.

Nephrology PQRI Measurements
Tue, Feb/07/2012 07:05PM
or go here

scroll to bottom, open second zip file, go in there and open measures specification file, go to page 277

Nephrology PQRI Measurements
Tue, Feb/07/2012 07:04PM
Numerator Quality-Data Coding Options for Reporting Satisfactorily: Most Recent Hemoglobin level > 12.0 g/dL (One Quality-Data code and one CPT® II code [G0908 and 4171F] are required on the claim form to submit this numerator option) G0908: Most Recent Hemoglobin (Hgb) level >12.0 g/dL AND CPT® II 4171F: Patient receiving Erythropoiesis-Stimulating Agents (ESA) therapy OR Hemoglobin Level Measurement not Performed, Reason not Specified (One Quality-Data code and one CPT® II code [G0909 and 4171F] are required on the claim form to submit this numerator option) G0909: Hemoglobin level measurement not documented, reason not otherwise specified AND CPT® II 4171F: Patient receiving Erythropoiesis-Stimulating Agents (ESA) therapy OR Documented Clinicial Reason Patient is not Receiving Erythropoiesis-Stimulating Agent (ESA) Therapy, Patient is not Eligible (One CPT® II code [4172F] is required on the claim form to submit this numerator option) CPT® II 4172F: Patient not receiving Erythropoiesis-Stimulating Agents (ESA) therapy Version 6.2 12/23/2011 CPT® only copyright 2011 American Medical Association. All rights reserved Page 279 of 655 OR Most Recent Hemoglobin Level = 12.0 g/dL (One Quality-Data code and one CPT® II code [G0910 and 4171F] are required on the claim form to submit this numerator option) G0910: Most Recent Hemoglobin Level =12.0 g/dL AND CPT® II 4171F: Patient receiving Erythropoiesis-Stimulating Agents (ESA) therapy

CPT® code 15777
Wed, Feb/01/2012 08:51PM
Use the same diagnosis as that for the primary surgery performed.

Wed, Feb/01/2012 08:47PM
you don't need another code- 250.00 is all you need, ok to order every 3 months.

Dx code?
Wed, Feb/01/2012 08:46PM
Toradol- J1885

Code for sending patient to the hospital
Wed, Feb/01/2012 08:45PM
nope. you either bill for the office visit or the hospital admission for that day. The "craziness" usually means a high level visit- 99215 in the office

Wed, Feb/01/2012 08:44PM
that is a patient whose status is Observation who is on the tele unit. So if you are the primary doc, use the observation codes. If you are consultant, use the outpatient codes.

OV and ER code
Tue, Jan/31/2012 07:47PM
I must reply to this. The patients are free to be angry, but be angry at their insurer or employer, not the doctor. The code was established because there is extra value to being seen the same day; there is increased risk and work for the doctor and the insurer recognizes this and agrees that the service can be charged and should be paid. If they do not like it, they can find another doctor. You get what you pay for...

Tue, Jan/31/2012 07:38PM
I am not sure of your question- ABN requires advance notice so the person must be told before the service is performed.

Thu, Jan/26/2012 03:25PM
Agree, but if the doc cannot tell you the charge there is NO WAY you can know what to charge. So blame the doctor ;-)

Thu, Jan/26/2012 03:23PM
Sure, if the visit met for the 99213. Be sure the note separates the wellness stuff and the sickness stuff and it will be ok

CPT® 20005
Wed, Jan/25/2012 07:58PM
It is a 20605 - aspiration, not an incision and drainage

Neurology Consultation
Wed, Jan/25/2012 07:54PM
So for non-Medicare, if you see a patient in the office as a consult and they are admitted and your doc is consulted, you may bill another consultation.

opthalmology medicaid guidelines
Mon, Jan/23/2012 05:05PM
It is specific to the state and the diagnosis. But the notes should be very clear why the visit frequency is medically indicated. "Just because" and "I am the doctor" will not work.

immunization titres DX Codes
Mon, Jan/23/2012 05:01PM

Family Consultation
Mon, Jan/23/2012 04:55PM
sorry, but that is correct. it was a freebie

Neurology Consultation
Mon, Jan/23/2012 04:49PM
medicare or commercial?

injection - procedure vs minor surgery?
Sun, Jan/22/2012 05:28PM
Are you just billing the injection? If so, no -25. If you are billing a E&M code and the injection, there must be work done to justify the E&M. And if so then -25 is needed on the E&M. So came in for knee injection- no E&M. Came in with knee pain. Full hx and exam done, determined injection appropriate, pt agreed and injection given then E&M-25 and injection.

Free Coding Lists
Thu, Jan/19/2012 07:00PM
Try the AMA site-

try a code you know is not active and see if that works

What is the best way to bill NC Medicaid for an adult physical and a pap smear? I should I use and office visit for the pap smear?
Wed, Jan/18/2012 04:46PM
It is hard to say. Some state medicaid programs cover physicals and some do not. I would bill V72.31 with the proper age associated preventive code. That is what was done so bill it correctly.

medicare offers obestiy counseling
Wed, Jan/18/2012 04:44PM
great question- they don't specify, do they? How about 278.00?

PQRS-Medicare secondary payer
Wed, Jan/18/2012 04:42PM
Bill for PQRS? You mean submit PQRS codes? Sure you can. be sure to indicate that BC paid 100% on the charges. But then again, you do not need to hit 100% so you could skip it and save the money for submitting a zero dollar claim.

medicare offers obestiy counseling
Tue, Jan/17/2012 09:25PM
Ask your fabulous physician Dr Hirsch- he may be able to help you. Here is the long version of the rule:

CPT® code G0447, a 15-minute face-to-face behavioral counseling for obesity, has been assigned total non-facility RVUs of 0.74. The 2011 conversion factor is $33.9764.

Tue, Jan/17/2012 09:16PM
it is not covered by Medicare Part B. It may be covered by the patient's medicare part D plan. You need to register at or send them to the pharmacy to get it

Cerumen Removal or E/M
Tue, Jan/17/2012 09:13PM
69210 if it was me. A significant impaction was found and cleared with a microscope

Physician Visit Coding for Outpatient hosptial Services
Tue, Jan/17/2012 08:58PM
You use the same codes as if seen in office with the place of service outpatient hospital. The doc needs to note if the patient is Inpatient or Observation.

I will add that you may want to audit your charts. If your most common visits are the highest level codes, you may be asking for a government audit. It is also rare for a neurologist to bill for critical care services. Just a word of advice.

As to reimbursement, they should pay since place is outpatient hospital and not office.

Place of service
Mon, Jan/16/2012 05:03PM
people who live forever at the facility and are not using their Medicare A benefit are 32. Those getting skilled care- rehab- are 31.

Does EMR use make upcoding more likely?
Mon, Jan/16/2012 10:32AM
You are not a Luddite.

The EMR has become a tool to allow doctors to get paid what they "deserve" to get paid. We hate counting bullet points, we hate having to document a comprehensive ROS on a patient with an acute MI to get paid a high level H&P (does it really matter if they have nocturia or a funny mole?) so the EMR lets us click to get to that magic number of systems.

When we did not have EMR's these docs wrote "full ROS performed and negative."

The motto is that if you did not document it, you did not do it. So why is the converse not true? If I document it, then I did it. If the insurer is calling me a liar, so be it. But then again if what I document clearly contradicts something else, then I am on my own to defend that.

Billing 99232 along with 78452
Sun, Jan/15/2012 01:19PM
Is your doctor actually interpreting the test and providing an official report, rather than the radiologist? If so, appeal and explain.

Does EMR use make upcoding more likely?
Sun, Jan/15/2012 01:16PM
Not in mine; I document what I do. If I don't ask it, I don't click it. If I use a template as with normal Physicals, I know I examined all the parts that are listed.

I reject the premise- EMR's do not upcode. Doctors use EMR's as a tool for upcoding.

health risk assessment for annual wellness visit-2102
Sun, Jan/15/2012 01:14PM
I keep looking and haven't found one yet...

New reimbursable codes
Sun, Jan/15/2012 01:11PM
I have been searching and have not found it yet...

do I have to do a face to face for billing a discharge
Sun, Jan/15/2012 01:10PM
there must be a visit on that day to bill for it

Late documentation
Thu, Jan/12/2012 08:21PM
After the chart was copied for the auditor and sent away. Or after the doctor forgets what he/she did. Or whenever your lawyer says it is too late.

I can tell you that bad docs routinely don't dictate H&P's, discharge summaries, op reports until they are about to be suspended, usually at 2 months.

So there is no real right answer...but they are doing right by indicting the time and date they entered it and that it was a late entry

Can you bill G0438 along with G0101 by the same physician on the same day.
Thu, Jan/12/2012 08:17PM
Oh, Humana, they can do what they want. They also probably cover the regular Physical codes rather than the annual wellness code

Observation Status Consultations
Thu, Jan/12/2012 08:16PM
For a consult, you bill with the Outpatient visit codes- new or established, 99201-99215, with place of service outpatient hospital. That is for Medicare and probably Medicaid in most states. Only the admitting doc gets to use the Observation codes.

charging for 99217 day after a procedure
Thu, Jan/12/2012 08:14PM
I'll add another potential twist. If the patient had a scheduled outpatient procedure and was kept overnight for "observation" then that is not a real Observation visit. That is an outpatient in a bed and the patient is not discharged from observation, even by the non-surgeon, they are just ending their post-op recovery.

CPT® 11601
Thu, Dec/29/2011 09:13PM
there are not LCD's for all CPT's.

Ordering vs. Supervising Dr for LAbs
Thu, Dec/22/2011 02:56PM
It is the ordering doctor. Why would anyone have to sign off on a blood draw?

Refill diagnoses
Tue, Dec/20/2011 08:49PM
If you are just refilling, then it is not billable as that in itself is not a medically necessary service. The doctor is actually evaluating the problem and making sure the treatment is appropriate so you bill the problem first then if you want add the V58.69.

medical coding and billing
Mon, Dec/12/2011 06:22PM

billing for suture removal, staple removal and or dressings
Mon, Dec/12/2011 06:21PM
Since you did not do the suturing, charge an E&M visit document eval of the wound and treatment, that includes supplies so you are stuck with that cost

nursing home admittance
Sat, Dec/10/2011 12:04PM
99354= it's outpatient, not inpatient

Consultation charge
Fri, Dec/09/2011 09:15AM
And to add, talk to the person who made the appointment; did they ask for a meet the doctor appointment? Most patients specifically ask for that. It is much more common in peds than adult medicine. And ask your docs if they want to accept that type of appt and give away time. It can be done with a new doc in town to help build a practice but if you are a busy practice, they are money losers.

TPN Orders
Thu, Dec/08/2011 11:56AM
I phrased it wrong- that is the code billed by the doctor. You should read the official definition to see the requirements.

Wed, Dec/07/2011 08:42PM
talk to them, do an informal audit of the charts to see what code should be billed; you may find they are undercoding and would want to know that

Wed, Dec/07/2011 08:41PM
it keeps you out of jail.

TPN Orders
Wed, Dec/07/2011 08:40PM
G0181- care plan oversight for the home care company- must be >30 minutes of total time in the month

Long Term Care Medicare Billing
Thu, Dec/01/2011 03:54PM
Medicare does not pay for fingersticks- only venipunctures

99211 E & M: INR POC Visit
Thu, Dec/01/2011 03:48PM
Note that Trailblazer does not require that there be a dosage change. Don't make it more onerous than required.

charging for a discharge
Thu, Dec/01/2011 03:46PM
Only the doc who actually did the discharge can bill for it. in a related area, if a patient dies, only the doctor who declares the patient dead can bill the discharge code

Wed, Nov/23/2011 11:40AM
you really should share what you figured out so we don't have to!

Therapeutic Drug Test
Sun, Nov/20/2011 01:33PM
80162 and 428.1- but are you sure you are allowed to bill for the lab? Are you actually running the assay in the office? If its a medicare patient, the lab must bill it.

Sun, Nov/20/2011 01:29PM
You could use 789.9- unspec abd pain, the visit code is a 99202, 99203, 99204 or 99205, dep on what was documented; the pap gets billed by the lab and I'd link it to v72.31 as a screening test and there is no extra payment for doing the pelvic exam beyond the E&M

Wellness and V70.0
Sun, Nov/20/2011 01:24PM
Check out this table- it has codes and frequencies

Office setup in surgical centre
Fri, Nov/11/2011 07:32PM
Yes, it is correct. The office visits are in the suite he rents and the employees work for him so POS 11 is correct. He does surgeries in a surgicenter that is not owned by him and the surgicenter will bill for the facility fee so you cannot use POS 11.

Supervising Physician
Thu, Nov/10/2011 08:13PM
there is a code for care plan oversight- must be over 30 minutes of work and you need documentation but it only applies to Home Care. For SNF you are out of luck.

Medicare: Well Woman & AWV
Tue, Nov/08/2011 08:14PM
v70.0 with G0438, v72.31 with Q0091 and G0101

preventive care and E/M visit
Sun, Nov/06/2011 06:44PM
-25 goes with the E&M visit. V70.0 with the preventive code, the problem ICD-9's with the E&M.

Fri, Nov/04/2011 09:55PM
Alcohol abuse does not cause the seizure- it is stopping the alcohol and going into withdrawal so I would use alcohol withdrawal 291.81 and seizure 780.39.

Re-validation for physicians
Thu, Nov/03/2011 01:22PM
its just medicare and they are supposed to notify each provider when they want them to revalidate

discharge and readmit with same problems
Tue, Nov/01/2011 07:13PM
subsequent, unfortunately; the hospital will submit bill as one continuous stay too

Mon, Oct/31/2011 10:01AM
J3490, 96372

Mon, Oct/31/2011 09:36AM
Wait a minute; who was the patient? Are you asking about billing in the husband's insurance or the wife's? For her it sounds like situational depression. you can't bill the husband's insurance if he is not present.

hospital admission
Sat, Oct/29/2011 10:54AM
Use the lowest code and scold your provider

Workers' Comp denial
Thu, Oct/27/2011 06:05PM
I know- they know that no doctor in their right mind would charge only a 99212 on a workmans comp patient. The counseling and coordination with the insurer always gets these to 99213 at least. A 99212 is a mole check - you dont even get to touch the patient.

Spirometry and preventative visit
Thu, Oct/27/2011 01:10PM
because there is no indication for doing spirometry as part of a routine physical. You need a diagnosis that fits, not V70.0

blood transfusion ssame day admit medicare
Thu, Oct/27/2011 01:09PM
I will add that Medicare is fairly clear in saying that if anemia was the only reason for admission, they dont cover the stay at all. there is no reason to admit a patient for a blood transfusion.

46221 and 46600
Wed, Oct/26/2011 03:41PM
Doesn't your billing software scrub the claim and bundle them if there is an edit? It should- that is a CCI edit.

medical or mental health?
Wed, Oct/26/2011 03:24PM
Absolutely medical for the DM- the dietician takes into account the patients eating patterns and preferences to counsel so it is not gaming the system to use medical diagnosis.

nurse visit - filling pill boxes
Wed, Oct/26/2011 03:23PM
not a skilled task- sorry, no charge.

What kind of code is it?
Tue, Oct/25/2011 10:29PM
I have seen those used by Home care agencies on their forms. It's the ICD9 procedure code used by hospitals and agencies to bill for services- docs do not use it.

Welcome to Medicare
Sun, Oct/23/2011 07:29PM
v70.0 to the G code, and you are correct with the 99213-25

reg: How do we code for a patient who has ESRD & chronic kidney disease? my doubt is 585.9 is applicable for both chronic kidney disease & chronic kidney failure if we code both 585.6 & 585.9 will insurance is going to validate this? thanks!
Sun, Oct/23/2011 12:06PM
Never use a xxx.9 if you have a more specific code. Patient on dialysis is 585.6

What is meant by "thorough" for a limited ultrasound
Fri, Oct/21/2011 05:21PM
go to the ED experts:

Billing Pap on visit after CPE
Fri, Oct/21/2011 05:19PM
or...bill the first visit with V70.0 and the second with V72.31 and hope their preventive benefit is limited by $ not number of visits.

B.M.I coding
Fri, Oct/21/2011 05:17PM
What codes are you using?

CPT® G0102
Fri, Oct/21/2011 05:16PM
yep, G0102 can only be used if it was the only service provided (and we know guys are lining up asking for prostate exams, especially with the new USPSTF recommendations)

icd 10
Thu, Oct/20/2011 09:36PM
5010- is the new standard for submitting encounter data to insurers ICD10 is International classification of diseases, 10th revision. It puts diagnoses into a form that can be interpreted by computers and shared rather than descriptions of the diseases.

seizure coding
Thu, Oct/20/2011 09:34PM
Absolutely code seizure or alteration of consciousness 780.09. No V code!

Health Insurance
Thu, Oct/20/2011 09:32PM
Ask the doctor what was done and change it. Bill what was done, not what was marked.

Thu, Oct/20/2011 09:31PM
Well, technically an ABN is only for services that Medicare covers in certain circumstances and not others, like a Lipid panel that a patient wants every month or a PSA every 6 months as a screening. You do not have to get an ABN signed for things Medicare never pays for, like liposuction, face lifts, buttock implants. So Medicare never pays for a capillary stick therefore you are free to charge the patient for it without an ABN. As you said there is a CPT® so it is a chargable service. But I think you would be asking for trouble...some crabby old lady is going to call CMS and you'll have an auditor looking at every single charge. And if your doc wants to charge for this, I have a hunch that the E&M coding tends to the overcoding side of things and that's big bucks in an audit. But I hope I am wrong!

Wed, Oct/19/2011 05:29PM
It is an interesting question but that would take some nerve to charge for that.

Injection drug codes
Tue, Oct/18/2011 08:59PM
You mean Toradol?

Vaccines only
Tue, Oct/18/2011 08:37PM

counseling patients to quit smoking
Mon, Oct/17/2011 04:00PM
yes, just document the time, and limit to 2 times a year (I think)

V17.0 - Family History
Mon, Oct/17/2011 03:44PM
I like V17.2 better- hate all psych codes- too much baggage with them.

Diagnosis help
Fri, Oct/14/2011 12:29PM
250.00?? Type II DM

CPT® CODE 77057
Thu, Oct/13/2011 08:54PM
v76.10 is he correct ICD

Office setup in surgical centre
Thu, Oct/13/2011 08:52PM
1- of course 2-not clear your question. You bill place of service as office if he rents the space, employs the staff and owns the equipment. If not, it is outpatient surgery center 3- You should. 4- You must inform them for sure.

Be sure to get place of service right- this is a big audit target with fraud investigators.

Home Health
Thu, Oct/13/2011 08:48PM
11 office

Fee %
Thu, Oct/13/2011 12:15PM
Your fees are set by you at whatever you want to charge. The general rule is to charge at least as much as your best payor. You'd hate to charge $75 for something where X insurance allows payment up to $85. Some use medicare fees and charge 150% of Medicare but regional differences can be huge so you don't want to use a number from us.

Coding lab slips
Tue, Oct/11/2011 08:55PM
If you the lab is billing the insurance of Medicare for the testing, you ABSOLUTELY need a diagnosis from the doctor, either in words or a ICD code. You cannot put in a diagnosis yourself. If you are contracted with the doctor, where their office pays you for the tests he orders, then you don't.

As to covered codes, go here to get the coverage lists for Medicare. V58.61 is ok for protimes.

Help with dx please
Tue, Oct/11/2011 08:52PM
how about gynecomastia?

Help!!! with 99385 and 96372
Tue, Oct/11/2011 08:51PM
How about your diagnosis codes for each CPT®? Did you put a V code on the preventive exam and a problem code on the other one

client billing
Tue, Oct/11/2011 08:50PM
What she really means is states that do not allow pass-thru billing, where the doctor bills for the test that is done by a contracted lab rather than in the doctor's office.

This is never permitted for Medicare or Medicaid and I know of no definitive list by state. It can also vary by insurer. In IL, BC allows it but UHC does not.

Injection Code Billing
Mon, Oct/10/2011 05:01PM
Injection for sure... medication will not get paid on an inpatient, SNF not so sure- kind of expensive to risk it.

But then again there is absolutely no reason to give it to an Inpatient. See them in the office and do it.

icd-9 code
Fri, Oct/07/2011 10:42AM
sounds like 847.0

82270 Occult Blood
Fri, Oct/07/2011 10:40AM
no way!

CPT® code
Fri, Oct/07/2011 10:39AM
Complex enough to be 99215, depends on what is done and how much time spent. Unless you are the surgeon and then it's bundled

Anal paps
Wed, Oct/05/2011 07:13PM
V76.89 is your best bet. I don't think it is USPSTF rated A or B so it probably won't be covered.

Home Health
Wed, Oct/05/2011 07:10PM
Yes if you can justify it.

Medicare wellness, IPPE and annual wellness visits
Tue, Oct/04/2011 09:25PM
Your doc is correct- the wellness visit does not require an exam per se except vitals.

1- Bill wellness visit and 99213-25 with 401.1, 530.81, 715.9x. Be sure the A&P clearly separates the wellness and problem discussions.

2- wellness plus 99212-25 with 465.9, or 99213-25 with 461.9 if antibiotics prescribed. again, be sure A&P is separate

Hallpike vs Epley
Tue, Oct/04/2011 09:22PM
Are you attaching the -25 to the E&M? The Hallpike is probably bundled, the Epley canalith repositioning may get paid- call your carrier.

Setting fees for lab panels
Mon, Oct/03/2011 09:00PM
Want my advice? Send the insurance info to the lab and let them bill for it. These are usually expensive tests and if you take on the billing, it could be a big financial loss. Some things are not worth it. Now if you do a lot of these, it may be worth trying.

Pulse ox
Mon, Oct/03/2011 08:57PM
it is generally recognized as bundled by most insurers. But, you are reporting what services were provided to the patient and if they want to recognize it as a valid service and pay you, then it. This is not the same as unbundling where there are clear guidelines that you are violating. Feel free to send us all a little of the cash!

MCR immunization codes
Fri, Sep/30/2011 11:45AM
yep, use those codes; no need for 90472 for subsequent

Medicaid Patient
Fri, Sep/30/2011 11:03AM
You can't- the G0101 is bundled into the physical CPT® code and the 88142 should be charged by the lab- I am sure you are not doing the actual test. Doctors doing more for less- Medicaid's motto

Flu Shots for Medicare Advantage
Thu, Sep/29/2011 03:04PM
use the medicare codes

Preventive Visit
Thu, Sep/29/2011 03:03PM
absolutely! Use a -25 on the ill visit code and use established code for the ill visit- usually 99213.

How can I bill for an office exam if patient was sent to ER
Wed, Sep/28/2011 05:32PM
No OV bill- the work is included in the H&P payment since the doc will not repeat the full Hx and PE since she just did it.

Dog bite
Wed, Sep/28/2011 08:53AM
That code is correct. Was that your primary diagnosis code? If so, I would suggest using another code as primary- such as contusion arm and the E code as secondary.

Medicare: Yearly Physical
Wed, Sep/28/2011 08:51AM
nope- don't risk it by including that code; and for clarification, it is not a yearly physical- it is a yearly wellness visit. Technically the patient never needs to be touched by the physician- it's all history except vital signs.

Smoking Cessation and Preventive Service
Mon, Sep/26/2011 08:44PM
Absolutely, as long as documentation supports the tobacco cessation counseling and the diagnosis code is an approved one

plasma pheresis
Mon, Sep/26/2011 05:02PM
nope, only order it, like dialysis

Thu, Sep/22/2011 03:30PM
Rocephin injection

CPT® code assistance - skin entrapment/strangulation
Thu, Sep/22/2011 01:49PM
Sorry, insurance does not pay for "undressing" a patient. It's included in the E&M code payment. Were the injections given into the penis? Yeow!

Thu, Sep/22/2011 01:48PM
Who are you billing? The surgeon, the pulmonary doc or the primary? If PCP or pulm billing then it's V72.82, ICD for disease warranting translplant, ICD for other issues. If surgeon, you can't bill.

heart cath
Thu, Sep/22/2011 01:45PM
Sure- the angiogram looks at the arteries, the left heart cath measures the pressures in the blood flowing to and from the heart.

UDS(Urine Drug Screen)
Thu, Sep/22/2011 01:44PM
What brand do you use? I am looking for one for the office. The manufacturer should have billing info- I think it is 80101 x number of tests

What modifier to use for inpatient services?
Tue, Sep/20/2011 09:37PM
Its all about the diagnosis- your doc needs to use a medical diagnosis, not the reason for the surgery

coding for hospital observation
Tue, Sep/20/2011 09:35PM
Yes, you are missing the fact that most insurance people are idiots, and I mean that in the kindest way. The "middle" observation codes are new and probably not in the system.

Pre op physical/consult
Tue, Sep/20/2011 09:34PM
Depends on insurance and the reason for the visit. It's a consult if the surgeon asked for clearance in writing or notated in the docs note and they have medical problems. If it is a 20 yr old healthy person, its a regular office visit. I would not use the 99396 ever for a pre-op

coding a consult performed during patient observation stay
Tue, Sep/20/2011 09:31PM
3 days on Observation? Something wrong there...

Inpatient only surgery list
Mon, Sep/19/2011 09:57PM

and click addendum E

2011-2012 Influenza / H1N1 combo CPT® code
Mon, Sep/12/2011 09:30AM
CPT® is based on the brand of flu shot you give.

Proper coding for Tobacco Cessation Counseling
Sat, Sep/10/2011 05:57PM
Was it Medicare? Your code is wrong

Thu, Sep/08/2011 11:04AM
nope, part of global post-op care, assuming you are not cauterizing an incidental nose bleed.

Wed, Sep/07/2011 04:21PM
You can't- it is trademarked and would cost money. I use Google!

CLIA High Complexity Facility and Waived Tests
Wed, Sep/07/2011 02:33PM
It is test specific, not facility specific. So a rapid strep always has the QW, etc

Cheif Complaint
Wed, Sep/07/2011 02:32PM
no; unintentional omissions are not a crime; systematic cheating is.

Thu, Sep/01/2011 01:24PM
Of course- call the PCP and tell them to send the damn records to you and you will forward them to the insurer and tell the patient to call their insurer and advocate for you.

swallowed a penny
Wed, Aug/31/2011 11:50AM
I would code choking 784.99. There was a complaint. It is wrong to say that because the kid feels fine now that you cannot code it. I do it all the time with chest pain, abdominal pain, headache, blood in stool.

What CPT® Code to use with question below
Wed, Aug/31/2011 09:27AM
no code- you are the surgeon and it is bundled into global surgical fee (It is 90 days, right?)

Wed, Aug/31/2011 09:26AM
just send office notes and testing and op note. They probably want proof surgery was medically necessary. Or was it denied due to lack of precertification?

Emergency Dept & Admission H&P
Mon, Aug/29/2011 06:36PM
Who are you billing for? The primary care doc? If so, you can only bill one service per day for the group.

Pathology Billing
Mon, Aug/29/2011 03:35PM
If the physicians are employed by the hospital the hospital can bill for all of it.

.medical coding and billing
Sun, Aug/28/2011 02:18PM
V58.69, 428.1- what do I win?

OV for depo
Fri, Aug/26/2011 04:44PM
First, most should not be that type of visit. Yearly visits are appropriate. There is no need for a modifier for the visit. But be sure the visit note meets for level 3. IF the doc just asks if there are any problems it's not a real visit.

How do I contact Codapedia?
Fri, Aug/26/2011 04:41PM
Codapedia at codapedia dot com" (we purposely spelled out the email address so the spambots won't find us).

transfer of patient to another facility
Fri, Aug/26/2011 04:39PM
Bill away! As long as your docs are not doing both services, you should be fine

screening diagnosis code for 76770
Fri, Aug/26/2011 03:08PM
Medicare covers a screening Ultrasound of the aorta as part of the Welcome to Medicare benefit. The patient must be at risk, the test must be ordered during the Welcome to Medicare exam, use G0389 as the CPT®. Diagnosis would be V81.2

Billing for associate physicians
Fri, Aug/26/2011 11:47AM
I don't have the reference but you cannot do that!!! The doc must get credentialed with CMS- you cannot bill under another provider

completing precollage immunization forms
Tue, Aug/23/2011 08:40PM
Not really. You can charge a fee for form completion without an office visit or you can charge a V70.3 and do a preventive physical

flu shot and preventative
Tue, Aug/23/2011 08:38PM
Advising to get one is, giving one is not.

V-codes and CXR for medicare
Mon, Aug/22/2011 03:38PM
There is no medical necessity for a CXR for either surgery or a physical, and certainly absolutely no reason for the physicals, so Medicare won't pay, rightly so.

For pre-op CXR, make the hospital do it- it is part of their cost of doing business. The anesthesia docs insist on it. I do the same with CBC and PT/PTT- no medical reason to get those pre-op so if the hospital requires it, they can eat the cost for it.

PPD Reading
Sat, Aug/20/2011 08:48AM
If you placed the PPD, your charge for that includes the reading. If someone else placed it, they should read it. How can you know what they injected?

Medicare denial of 99202-99204 for Not medically necessary
Sat, Aug/20/2011 08:47AM
Polly- what diagnosis are you billing?

Procedure not performed
Fri, Aug/19/2011 10:52AM
Tough call- gotta go with discontinued 53 so when you try again it is not rejected as a "once in a lifetime"-ish procedure.

Place of service for 98966 Telephone Assessment
Wed, Aug/17/2011 03:03PM
I would think it is where the doctor is, not the patient. When I bill Home Care oversight, I bill place of service as office and get paid. The patient is at home when I review the form.

Patient seen in office 2 different times same day
Wed, Aug/17/2011 10:16AM
You submit one bill as if it was one visit with the appropriate modifiers for a procedure on the same day as a visit

Wed, Aug/17/2011 10:13AM
S0630 is for suture removal if you did not place them. Or you can use E&M for the injury

billing for collection of wound cultures
Wed, Aug/17/2011 10:12AM
no, bundled into the E&M. If you charge for the culture, the cost of the culture tube is included in the fee and if the lab charges then they are likely supplying the tube to you for free.

Fri, Aug/12/2011 05:15PM
Anyone trained can do it- my license says "physician and surgeon" Of course I would not do something that I am not skilled in performing or that is not covered under my malpractice insurance. Lots of GI docs do hemorrhoidectomies.

Clinic Setting
Fri, Aug/12/2011 05:12PM
Of course! Unless the patient made the appointment specifically for that procedure, the doctor has to evaluate and determine the procedure is appropriate and get a history to be sure the patient can undergo the procedure.

Rule Out
Thu, Aug/11/2011 10:39AM
I would not use the v code as there is a real complaint so they are not screening an asymptomatic patient.

Rule Out
Tue, Aug/09/2011 03:39PM
how about "altered mental status"? 780.97

Mon, Aug/08/2011 03:36PM
you are correct

cardiac stress test and medicare
Mon, Aug/08/2011 03:35PM
no, there is no code since screening stress test are not a covered benefit for Medicare. If the patient patient wants one, they should sign an ABN. If there is a symptom, use that code, such as CP, SOB

Mon, Aug/08/2011 11:48AM
no- if the visit was specifically for that then no E&M. If the patient came in with a sore foot and and the doc did a history and physical and determined that toe nail removal was needed then an E&M with -25 is indicated.

e/m and pqri
Mon, Aug/08/2011 11:35AM
It depends on the measure you are reporting- most hospital measures look at admission codes, discharge codes or surgery codes. You should look at the measure specifications on the CMS site for the measures you are reporting. then click 2011 specifications manual

Sun, Aug/07/2011 10:58AM
No, I think the difference is that they make an incision rather than a puncture. A needle makes a small hole that could be used to drain an abscess but it is not an incision. I don't know that you can specify the type of tool used- scissors could be used, a scalpel, a cautery tool, etc. It's the incision that counts

finger stick PT/INR and fingerstick glucose, hemoglobin, etc
Thu, Aug/04/2011 03:00PM
Your wording is confusing. You bill for the test itself and for the capillary draw. So you can bill 36416 for hemoglobin, glucose or protime if done by fingerstick. They are all capillary blood specimens. That is not to say that it will be paid...

Thu, Aug/04/2011 02:39PM
I don't think that qualifies as an I&D if all they did was puncture and aspirate. If he made an incision of any length then it would qualify.

Office visit prior to Colonoscopy on Medicare patient
Wed, Aug/03/2011 07:51PM
it's a freebie! No payment. Sorry. Bundled into service

Zometa inj for Hospice Pt in Infusion Center-how to code???
Wed, Aug/03/2011 07:50PM
A hospice patient is likely getting Zometa for bone pain. Call the hospice and talk to their billing people; they are responsible for payment

How to charge for Medicare "SAD" drugs in order to be compensated for injection administration charge?
Wed, Aug/03/2011 07:49PM
what drugs are you talking about?

How to bill G0181
Tue, Aug/02/2011 05:21PM
You need POS office, diagnosis and then use G0181. I think Medicare is the only one that will pay this.

IV CPT® code 90765 gets denials each time we bill
Tue, Aug/02/2011 04:04PM
Why in the world are you giving it IV? I totally agree with insurer- there is no reason in the office to give IV Omeprazole.

Medical necessity denial
Tue, Aug/02/2011 04:02PM
details please. They are saying the test was not medically necessary. Usu the doc has to prove it was by writing a letter

Flu Vaccines during postpartum visit
Tue, Aug/02/2011 04:01PM
99212? That's an office visit- why would you code that for a flu shot? Code the shot and the administraion

Follow Up Appointments for the same diagnosis
Mon, Aug/01/2011 08:31PM
Each note must stand alone; code based on what is documented in that note, no more.

Ask a question
Mon, Aug/01/2011 10:54AM
right here!

Mon, Aug/01/2011 10:14AM
How about billing the patient? You are likely past the timely filing period for Medi-cal and the patient did not properly inform you of her coverage so she is responsible for the costs. There is no modifier for "uninformed patient."

Provider Billing for SNF patient
Mon, Aug/01/2011 08:33AM
no apologies needed. Read Wikipedia- you'll find lots of errors if you look close enough. A community-driven resource can never be 100% accurate. Thanks for contributing!

Provider Billing for SNF patient
Sat, Jul/30/2011 03:12PM
GV is for hospice patient. If it was just the procedure, bill it as usual, place of service SNF. If an E&M also then -25. There is no issue with doctor's professional charges in a SNF. Bill like you do in the office.

Sat, Jul/30/2011 03:10PM
Your EMR may require it but it is silly to do a temp for a patient for a BP check- BP, Pulse, RR are the three we do every time. add height yearly and weight every 3 months.

can you charge a 99211 nursing visit when giving only immunizations
Fri, Jul/29/2011 09:30AM
Oh absolutely not! You are charging an admin fee - that covers nurse's work

Fri, Jul/29/2011 09:01AM
that is the complex test- 85610QW is the office Protime

medicare 83036
Thu, Jul/28/2011 05:24PM
Is your CLIA license on file with CMS? Did you add QW? There is also a frequency edit. DO you do them more than every 3 months?

IVC Filter
Thu, Jul/28/2011 02:34PM

Thu, Jul/28/2011 02:09PM
toenail care is probably considered part of the hospice benefit. Talk to the hospice people about how to bill them for your services. If the patient came to you for DM toe care, etc,, then bill as usual with modifier GV

swing bed
Wed, Jul/27/2011 07:45PM
only as many visits are medically necessary. Daily is fine if there is a reason. Max one per day though...

Wed, Jul/27/2011 03:07PM
what diagnosis? For V76.41 use 82270; if using code for GI bleed or anemia or any other reason, use 82272

exam documentation
Wed, Jul/27/2011 03:05PM
I would hire Betsy Nicoletti to come speak to your doctors at a group meeting. The investment will be paid back in a few days of improved billing and reimbursement. She is a leading expert in this field, and often speaks to surgeons at their national meeting so she understands their way of thinking (and knows she has to talk a little slower with them- just kidding). Google her name for info

Wed, Jul/27/2011 08:47AM

Welcome to Medicare billing EKG
Wed, Jul/27/2011 08:44AM
We bill G0403 linked to v70.0 for the EKG and get paid every time!

consultation for Medicare
Mon, Jul/25/2011 11:21PM
easy- Medicare no longer recognizes consultation codes. This would be an initial hospital visit.

coding for precollege physical
Mon, Jul/25/2011 05:21PM
Medicare - no; commercials- maybe For a Assisted living, I use the regular E&M and use it as a routine maintenance visit. If they are on no meds and perfectly healthy, then you could use this and charge them, but then they would not need the assisted living facility.

Mon, Jul/25/2011 05:09PM
it's a billing term, you have to count bullet points to see what level of care they received. google bullets and E&M and you'll see..

Recording Time In and Time Out for visits
Mon, Jul/25/2011 04:38PM
nope, just minutes spent

coding for precollege physical
Mon, Jul/25/2011 04:37PM
V70.3 with preventive care codes for both school and driver's license (administrative purposes). I personally adjust the charge for the simple ones; I feel bad charging full price for a less than complete preventive visit but that's me. I also take advantage of the visit to talk sex, drugs and life.

Sun, Jul/24/2011 08:09PM
nope- you need 3 vitals to count the bullet so pick your three to use

? about CT scan coding and contrast billing
Sun, Jul/24/2011 08:08PM
Of course it is fantasy No one pays retail but docs and hospitals have to bill a lot for that rare insurer that pays a percent of charges. You have to charge more than your highest reimbursement so as to not leave money on the table. If you have to pay cash, talk to the finance people. Offer to pay Blue Cross or Medicare rate, cash in full. they'll probably take it.

proper way to handle telephone inquiry when patient questions EM level
Sun, Jul/24/2011 08:05PM
often times doctors undercode visits. We had some recent education about proper coding and realized that the previous visits were undercoded, not this current visit overcoded. We wold be happy to go back and adjust up those other visits.

E&M Billed after ER Hospital Visit
Sat, Jul/23/2011 08:56AM
Well, i agree - that makes absolutely no sense, unless patient has some bizarre insurance that makes a global payment for all care related to a problem, but I have never heard of that happening...yet

leaving hosp before work up is completed
Fri, Jul/22/2011 03:01PM
of course! You can only code to the highest specificity available. If it was chest pain and nothing found, then code 786.50

Fri, Jul/22/2011 02:59PM
This is the only established code for care plan oversight of a home care patient. The existence of a code does not mean that the insurer will cover it. The only way to get paid for the service is to either go to the patient home or see the patient in the office and bill for the visit that includes reviewing the plan. If you time coordinating and reviewing exceeds 50%, you can use time based coding.

E&M Billed after ER Hospital Visit
Thu, Jul/21/2011 10:15PM
What happened in the ER? if it was just a consult, then your office visit should be 99214 since patient is established. If you did a surgery in the ER, then there may be a global period.

How acute bronchitis and asthma are coded?
Wed, Jul/20/2011 08:48AM
If it is a patient with chronic asthma who then gets bronchitis, bill both. If a well person gets bronchitis with wheezing, then it's the single code

Denial_Non-Emergency Service_Medical Insurance
Wed, Jul/20/2011 08:47AM
Well, one way to look at it is that the denial from the insurer means the patient is responsible for the charges. You can bill them and see if you get paid.

Review the insurers coverage guidelines; most use a prudent layperson guideline and at a minimum pay for a screening exam. EMTALA allows ED's to tell a person that they do not have an emergency and to seek care elsewhere. In practice no one does that but the consequence is that you don't get paid for the service you provided or you have to collect from the patient.

e scribe code G8443
Tue, Jul/19/2011 08:23PM
That's the old code- G8553 is 2011's code

E-mail communication of PHI with patient
Tue, Jul/19/2011 04:00PM
Nope! Something gets lost or stolen or hacked and that permission slip won't protect you from a HIPAA violation.

preoperative clearance consultation
Tue, Jul/19/2011 04:00PM
Huh? If you were asked to see a patient, you can bill it as a consult if not medicare.

Denial_Non-Emergency Service_Medical Insurance
Tue, Jul/19/2011 03:59PM
For whom are you billing? Hospital? Doctor? Write an appeal; provide medical rationale why patient needed care at that moment and not waiting to see MD in the office

when a woman is pregnant and getting some kind of treatment not related to the pregnancy,is there always be a pregnancy code on the chart
Mon, Jul/18/2011 05:34PM
I'm and internist and I occasionally see my patients for sore throats when they are pregnant and I code the sore throat and do not put any pregnancy code and I get paid. So this probably applies only if you are getting the global OB payment

preop visit to colonoscopy
Sun, Jul/17/2011 08:30PM
Nope- not allowed- staff sets it up, doc meets patient in holding room. If staff elicits any symptoms on that pre-op call, then you can see them and bill

Patient's atty holding our checks.
Sat, Jul/16/2011 11:18PM
Call the patient and explain in a nice way what has transpired- you provided them the service, they owe you the money.

denial on 36415
Sat, Jul/16/2011 11:16PM
Did you do a finger stick INR? that is not a venipuncture. You should link the venipuncture to the ICD for something else.

the national numerical value or relative weight of each ms-drg and each hospitals prospective payment system rate which is referred to as?
Mon, Jul/11/2011 09:29AM
relative weight is the correct term

is this appropriate - 99213 modifier 25 and G0438
Mon, Jul/11/2011 09:28AM
absolutely! You have a great system. The biggest part is to be sure the assessment and plans are clearly separated, which your form could accomplish

Sun, Jul/10/2011 02:02PM
need specifics- are you billing for the medication? You need a diagnosis.

Credentialing PAs
Fri, Jul/08/2011 08:53AM
credentialed by whom? If they are to work at the hospital with the doctor, the hospital will require them to go thru credentialing.

Urine Test
Thu, Jul/07/2011 03:46PM
2 is non-automated, 3 is automated. They won't pay because they make the rules. I think they feel that if you are "just" sticking a piece of paper in a cup and a machine does the work then there is no value to the service and that it is "included" in the payment for the E&M.

Finance charges on Medicare patients
Thu, Jul/07/2011 02:55PM
If you charge interest on anyone you are considered a financial institution. Do you really want to go thru that paperwork? Wasn't red flag rules enough?

Wed, Jul/06/2011 08:14PM
So the INR was done to be sure the leg pain was not related to a hematoma from overanticoagulation with warfarin. So I would link the INR to v58.61 and it should be covered. I still don't see where the Digoxin comes into play but that's ok.

Wed, Jul/06/2011 04:55PM
what is Dignoxin? Did you do an INR? Was the patient on warfarin? Use v58.61

Billing for time
Wed, Jul/06/2011 04:54PM
25 to 39 min is a 99214! I would tell the doc to list total time and ">50% counseling" and not time counseling- as you can see in your example, counseling time is = 50% not >50%. It is a few second difference but some auditor could nail you on it.

EKG interpretation
Mon, Jul/04/2011 06:17PM
93010- interpretation of EKG only. This code is valid only if no other provider billed for the interpretation.

Fri, Jul/01/2011 08:51AM
what are you trying to code? I don't understand the need to find a V code for an ICD

E Prescribe
Wed, Jun/29/2011 09:56PM
One per patient encounter.

ER Consult
Wed, Jun/29/2011 09:56PM
You code an Initial Hospital Care code, assuming the patient was an inpatient. I dont know if you can bill for the neck collar if you mean he literally supplied one to the patient.

Billing denied
Tue, Jun/28/2011 09:26PM
We bill the disease first then V58.61 (not v58.69 for warfarin).

abnormal findig during a annual
Mon, Jun/27/2011 06:40PM
Yes to both; Medicare covers it and most commercial insurers do too. Be sure your documentation is separate in the history, assessment and plan sections

dx codes for annual wellness
Mon, Jun/27/2011 06:38PM
use the V70.0 code for the CPT® that pertains to the wellness, and if you are also addressing problems, link those codes to the 9921x-25.

billing 99214 w/ V70.0
Sat, Jun/25/2011 10:37AM
an E&M visit is by definition the evaluation and management of a medical problem. V70.0 is a preventative visit. You can't prevent a problem that is already present so you cannot bill a E&M code on a preventive visit.

Status Post procedure?
Sat, Jun/25/2011 10:04AM
V15.52 is pretty close since most are caused by trauma

Gamma Injections
Sat, Jun/25/2011 09:46AM

adacel and new patient
Sat, Jun/25/2011 09:43AM
Of course you can! That is a preventive health visit; there are no set requirements for what must be included- if you use the USPSTF recommendations, only a weight and BP are needed fro the exam and I am sure you did that. Talk about exercise, diet, seat belts, guns (except in Florida), helmets, and you are ok to bill 99385 V70.0 for the exam.

Thu, Jun/23/2011 01:37PM
Why hold it for this one? You only need to report on 25 claims in the year- one does not matter.

Documentation and Diagnosis
Thu, Jun/23/2011 01:36PM
What ICD you using? Your reasoning looks good and the CPT's are fine.

coding CAD -coronary artery disease
Thu, Jun/23/2011 01:32PM
I use 414.01 for all patients- to me it is just not worth the hassle to differentiate.

Sat, Jun/11/2011 06:04PM
G8553- link to primary diagnosis, report at least 25 times in 2011 and at least 10 of those prior to July 1st (to avoid 2012 penalty, although that is being revised.)

What ICD code to use for baseline lab testing for liver function tests?
Sat, Jun/11/2011 06:01PM

Lab question
Fri, Jun/10/2011 12:06PM
Since each line of a claim is adjudicated separately against the MUE value for the code on that line, the appropriate use of Current Procedural Terminology (CPT) modifiers to report the same code on separate lines of a claim will enable providers/suppliers to report medically reasonable and necessary units of service in excess of an MUE value. CPT® modifiers such as -76 (repeat procedure by same physician, -77 (repeat procedure by another physician), anatomic modifiers (e.g., RT, LT, F1, F2), -91 (repeat clinical diagnostic laboratory test) and -59 (distinct procedural service) will accomplish this purpose. Modifier -59 should be utilized only if no other modifier describes the service

what ICD 9 is used with CPT® 33211?
Thu, Jun/09/2011 08:55AM
What is the disease? heart block, heart failure, etc??? Your docs need to give you this info- you cannot be guessing!

physicals/preventive visits
Thu, Jun/09/2011 08:54AM
Google "Medicare Preventive services Quick Reference Information" and you will get the 2 pdf's from CMS that explain it all.

Whats the difference between the professional and technical coponents of radiological services
Sun, Jun/05/2011 08:29PM
Technical is the performance of the test, professional is the interpretation of the test

99212 With 99396
Sun, Jun/05/2011 12:26PM
The "exam" we presume to mean a "yearly physical exam" or preventative care visit. So if I see a patient for a physical and "by the way" he asks about sexual dysfunction (always as I am walking out the door, hand on door handle) and I ask more questions and order tests and/or prescribe meds then I bill the physical and a 99213-25 and be sure my A/P section has an area to talk about the PE- weight loss, exercise, seat belts, etc and an area to address the sex issue , outlining impression and plans.

progress notes vs doc orders in in/patient setting
Tue, May/31/2011 07:30PM
Anything documented in the chart is fair game for coding, but I don't think you can meet minimum proof of a visit if there are only orders written and no documentation of actually seeing the patient.

Sat, May/28/2011 10:06AM
I believe medicare will pay for a tetanus vaccine for an injury, use the contusion codes

subsquent visit
Fri, May/27/2011 09:02AM
i think: admitted hospital A on 5/14 by Doctor X on 5/15 seen by Dr X and transfer order to Hospital B written, then prior to transfer Dr Y stops by and adjusts a med. Pt then leaves on 5/16 pt at hospital B and discharged

So, you can only bill once service per day per specialty, so pick the highest paid service.

Vaccine Administration
Thu, May/26/2011 01:00PM
Sorry-- I guess as an internist I don't deserve to get paid to counsel patients on vaccines as my pediatric colleagues.

Vaccine Administration
Wed, May/25/2011 07:48PM
Are they kidding??? It's per shot not per ingredient. People come up with the stragest ways to commit fraud!!!

New Patient Billing
Mon, May/23/2011 07:32PM
Explain more please...what's the situation? I could see a self referred patient with a fracture who 2 years later is referred by his PCP for knee pain to fit here.

Mon, May/23/2011 07:30PM
yes; the service was provided, you can bill for it. Bill for whatever level of service was provided.

Mon, May/23/2011 07:29PM
Resubmit- it is the correct code- the CMS billing systems were just messed up initially (surprise!)

E&M with labs drawn
Mon, May/23/2011 07:28PM
Only if you look good in stripes! That's a big no no!!!

Subsequent visits in an outpatient facility setting
Thu, May/19/2011 01:22PM
What the insurers are missing is that by using for example, 99214 with place 22, they are entitled to pay less than place 11 since you have no office costs associated with the visit. There was just a CERT review that showed 90% of docs performing procedures in hospital outpatient setting were billing it with office place of service and that Medicare overpaid millions because of this and that this was going to be a big audit target.

We can't win with these guys!

Mon, May/16/2011 07:03PM
you are in the wrong forum! We can tell you that if the doctor drew the blood after you missed to use a 96410, but the color of the blood is not a common topic amongst coders. The color has nothing to do with anything- you certainly cannot judge iron content by color. Blood from an artery is reddder than venous blood due to higher oxygen content.

Mon, May/16/2011 07:01PM
I agree with you! Experts? What say you?

When to use a screeing diagnosis for Labs
Wed, May/11/2011 09:03AM
I'll defer to the experts but I will code these as the patient requests. If the insurer tells them they have $xx coverage for wellness and to have the doctor code all labs with V70.0, then I do it. Likewise, if they have little coverage for wellness, I code the exam with V70.0 and the labs with the appropriate diagnosis code.

But at the same time you should not code a visit fraudulently; for example, if the visit is a BP followup and the patient asks you to bill it V70.0, say no.

Malaria prophylactic
Wed, May/11/2011 08:59AM
what injection? I give pills.

One ABN or Separate one for Inpatients?
Wed, May/11/2011 08:57AM
For the hospital with Inpatient, they use a HINN- Hospital issued Notice of Non-coverage. The rules are much more strict so they are rarely used.

For outpatients they also use the ABN.

If you are billing for a doctor, and inquiring about an inpatient stay, then you do not get involved here- just see the patient and bill for the visits- you get paid even if the stay is denied.

Routine Pelvic Exam
Mon, May/09/2011 09:34AM
For Medicare pap/breast exam, G0101 linked to V72.31, Q0091 linked to V72.31 for the "conveyance of pap to lab" and you can bill the colon cancer screening if a stool specimen was collected.

Written Orders for Observation
Mon, May/09/2011 09:28AM
Who ever said that the person who gives the admit/observation order is the only one that can bill for the visit? What if the ED called the on-call doc at 5 am who gave a telephone order for admission and at 8 am the patient's primary doc rounded and did the H&P. They would not bill that H&P? Just plain silly!

compression fractures
Sat, May/07/2011 02:06PM
Depends on the complaint- if they are here for pain, code it 805.4. 733.1x if pathologic fracture. Pathologic fractures means that there is underlying disease in the bone, usually cancer that causes the fracture.

Written Orders for Observation
Sat, May/07/2011 02:02PM
My make my head spin!

It sounds like the moonlighter is not billing for their service and the hospitalist in the am is doing a complete assessment and plan. The hospitalist is entitled to bill the initial observation code 99218-99220. I see no reason the office visit codes would be used at all; there are now codes for subsequent observation visit that are used by the attending physician; only consultants have to use office visit codes for subsequent observation visits.

chief complaint for e/m documentation
Sat, May/07/2011 01:57PM
It works for me. If that is what the patient says, that the chief complaint

Routine Pelvic Exam
Sat, May/07/2011 01:57PM
For commercial, V72.31 as ICD, 9938x for the CPT®. There was not enough service to also bill a 99213 for the HTN

I don't have my medicare cheat sheet with me- stay tuned

ICD Principal Diagnosis selection
Thu, May/05/2011 02:30PM
Oh, then definitely go for DVT first! The DVT caused the PE so coding it first makes sense.

Prescription dates for Therapy
Thu, May/05/2011 02:22PM
the script is for 3 treatments a week for four weeks; that 4 weeks begins at the time of the first visit. But if the patient comes to you 4 months after the date of the prescription, I would send the patient back to the doc to get a recent one since medical necessity is likely no longer present.

Thu, May/05/2011 02:02PM
you can only bill one per year. sorry. 82274

ICD Principal Diagnosis selection
Wed, May/04/2011 03:57PM
I'll give the medical answer- the PE goes first. DVT can be treated as an outpatient, not PE so that is the main reason for admission.

Diagnosis help?
Wed, May/04/2011 03:52PM

BILLING A 99211 WITH A 85610
Wed, May/04/2011 03:47PM
But be sure you can justify the 99211!!!! Big audit target!

Correctly noting ROS
Tue, May/03/2011 08:53PM
yes you can count ROS points from the HPI as long as they do not count in the HPI

Diagnostic PSA versus Screening PSA
Sun, May/01/2011 07:12PM
What a great question! If they are in the midst of cancer treatment and you are looking for a response or relapse, then you use 185. If they are "cured" and not treating you are once again screening so the screening code now applies again.

doctors' orders
Thu, Apr/28/2011 09:45PM
Sorry- I was confusing. You cannot do labs on Medicare patients that are not already cared for in your practice. If they are your patient and a non-affiliated doc orders the labs, you can do them and bill for them but your doc should cosign the order. Medicare is very nebulous on this so it is best to err on the side of caution.

Observation codes vs E/M codes
Thu, Apr/28/2011 09:42PM
But, I can't tell you how many times "Admit" gets misinterpreted. Patients on Observation status are not admitted to the hospital- they are outpatients. The RAC is looking very closely at these orders and taking back lots of money from hospitals.

So while the citation may say that, talk to any Case Management staff person and they will shudder when you say "admit to Observation."

By the way, where did you get that citation?

Observation codes vs E/M codes
Wed, Apr/27/2011 05:13PM
Nancy- Don't say "admit to observation"- the proper phrase is "place on observation."

If the patient was held overnight after an outpatient surgery (commonly called Extended Recovery), the non-surgeon doc would bill a "office visit" code with place of service outpatient hospital.

And BTW, hospital visit codes and Observation codes are all E&M codes too!

Billing a new patient visit prior to a screening colonoscopy
Wed, Apr/27/2011 05:09PM
nope, part of the procedure.

doctors' orders
Wed, Apr/27/2011 05:08PM
Not for Medicare. If you own the lab, you can only do labs on your own patients. If it is your patient, you can run the test and you should incorporate the results in the patient's chart after the patient's doctor in your practice reviews them

Mon, Apr/25/2011 05:33PM
Only if the doctor visits the patient for a meaningful reason, not just to say tolerating Remicade. For example assess joint inflammation, side effects, review course of therapy, review labs, etc

G0246 for Blue Care Network
Mon, Apr/25/2011 09:31AM
use codes 250.60, 250.61, 250.62, 250.63, or 357.2. It is only paid if patient has loss of protective sensation, not on every diabetic patient!

New Patients with out an exam???
Mon, Apr/25/2011 09:29AM
They do get an exam! Vitals are taken (I hope). But I would code this using either the preventive codes or use time as a determinant for the E&M codes and be sure the doc documents time spent. And I would encourage "exam not indicated due to lack of sexual activity" rather than "deferred"

Mon, Apr/25/2011 09:22AM
You are correct- any services not related to the reason patient is on hospice should be paid by the insurance.

BUT...Medicare Advantage plans feel that they can make their own rules. Their behavior is notorious for their purely profit-driven motives.

Appeal, appeal and appeal. If they deny, file a complaint with the state insurance commission.

And ask your doctor to consider not accepting MA plans and posting a sign in the waiting room saying so. Unless we stop accepting their plans, they will continue to treat us like crap.

TPN Therapry
Sun, Apr/24/2011 07:21PM
I would use the underlying diagnosis and then a V code

Wed, Apr/20/2011 08:55AM
Don't tell anyone ....but I'd still bill it and get the doc to fix her documentation- she likely did it but did not write it.

Billing primary and secondary
Mon, Apr/18/2011 09:44AM
Get out of BC!!! Less than Medicare? OMG! Definitely bill the higher fee

G0438 deductible waived?
Sat, Apr/16/2011 10:47AM
oh yeah. All free if you use the right codes for approved screening tests.

Progress Note vs Physician Order
Sat, Apr/16/2011 10:46AM
you are out of luck. Even a subsequent visit needs some documentation of a visit - need 2 of 3 even for level 1 visit or note of time spent

G0245(DM foot check) can be billed with G0438(wellness)?
Fri, Apr/15/2011 12:28PM
it's not part of the wellness check so it should get paid, stressing the "should". The wellness check actually requires no physical exam at all beyond vitals

Chief Complaint
Thu, Apr/14/2011 06:29PM
Anyone can do it. HPI must be provider

Thu, Apr/14/2011 06:29PM
No, there is no code. The first year you had to report that a prescription was not sent electronically. Now they just want to know you have a system for e prescribing. It is separate from PQRI. In 2011 you must report 25 times to get paid the bonus and at least 10 times to avoid getting a payment reduction in 2012. So...just report the code for the next 25 patients for each doc when you send a prescription electronically and you are done (but send at least 30 just in case...)

Certifying Physician
Tue, Apr/12/2011 09:07PM
the attestation is required by the home care company; you don't need to keep it and cannot get paid to sign it- it is included as part of the visit. There is a code for the care plan certification but that is a different document.

Mon, Apr/11/2011 03:45PM

Getting paid for travel vaccines???
Mon, Apr/11/2011 03:43PM
It is a pharmacy benefit, Medicare B only pays Flu, pneumovax, and Hep B. You can enroll at and set up to get paid for travel vaccines if their plan covers them (which is doubtful). Once you are set up, you out in demographics and if their D plan is part of the system then you can see a list of covered vaccines and see the reimbursement. We use it for Zostavax; never tried travel vaccines

icd 9 code for question below
Wed, Apr/06/2011 02:54PM
Sorry about my poor answer- trying my best- a little UTI should not be so hard to code...

icd 9 code for question below
Wed, Apr/06/2011 09:01AM
was this patient admitted, seen in office or other? UTI is 599.0, 041.4 is E coli infection. Not sure the issue here...

Wed, Apr/06/2011 08:59AM
Use the 99304-10 codes but remember if you are called to see the patient by a primary care doc, then the first visit is a consultation if non-Medicare' place of service is skilled nursing facility- 32

E/M payment Issue
Mon, Apr/04/2011 07:37PM
Because in the office you pay for rent, staff and supplies; in an outpatient hospital clinic they supply all those things so you get compensated for your time only.

critical care
Mon, Apr/04/2011 09:12AM
Critical Care codes are for critically ill patient visits- eclampsia with a seizure, not pre-eclampsia, DKA in a coma, not gestational DM. These patients are in the hospital, in a bed, and the doc needs to be at the bedside.

DME Products
Sun, Apr/03/2011 04:18PM
I don't think so, at least for non-Medicare. But in your example, I am assuming the doctor pays the hospital for the brace and then bills the insurer. If he is getting it free, you should not be billing. And watch cost v. reimbursement- insurers often low ball prices to get docs to stop dispensing this kind of thing and instead directing pts to the pharmacy. Medicare is different- perhaps others know.

Hospital Consults
Sun, Apr/03/2011 04:14PM
No consults for Medicare patient. Every new admission where the doc is consulted is billed as Initial hospital visit. There is no new or established as in the office. Same for consults on commercial insurers. First visit is initial consultation, other visits are subsequent visits. If the patient goes home and comes back 2 days later and the same doc is consulted, it is a new Initial visit. But of course most re-consults will say "refer to previous consult" so you should not be seeing high level visits for the second initial visit unless there was a major change on condition.

Thu, Mar/31/2011 07:38PM

Medicare Wellness Visits
Thu, Mar/31/2011 08:56AM
There is no coverage for a urinalysis as a routine. It was long ago shown to be a worthless screening test in a healthy person. Medicare covers USPSTF rated A and B services. Link to HTN or DM if the patient has either of those.

medicare SNF annual assessment 99318
Thu, Mar/31/2011 08:54AM
You can do that- Every visit should not be a 99309- that is the highest level subsequent visit and wold be like coding every office visit an 99215. If you are doing that you better watch for an auditor to come knocking at your door.

Medicare does require an annual assessment and the facility should be tracking that so they can tell you when it is time to do the "annual"

what is the proper way to bill texas healthspring for a physical
Tue, Mar/29/2011 01:18PM
but bill the physical with no modifier and the E&M with -25. That's how 49 other states accept it, assuming the patient has coverage for both services.

PQRI Claims based reporting vs Registry based reporting
Mon, Mar/28/2011 06:29PM
claims based- each visit gets the codes attached to the visit when billed Registry based- you sign up with a company that takes your data and submits it as a batch. you usually pay a fee for that- some EMR's can do this automatically.

Deposition Charges
Mon, Mar/28/2011 06:28PM
$400 per hour, 1 hr minimum, bring check for first hour to deposition

don't want to under bill this
Sat, Mar/26/2011 03:56PM
bill the preventive code with V70.0, the problem with 99213-25. Your HPI and assessment and plan should be clearly separate- they can be in the saeme note but different sections- HPI- PE- needs colonoscopy, mammo UTD, HTN- taking meds, no CP, SOB. A/P- get colon, HTN- cont meds, get labs, EKG

don't want to under bill this
Thu, Mar/24/2011 03:10PM
and link to 790.6 and code for AAA

Thu, Mar/24/2011 03:08PM
but no one will pay it...bill for the hemoccult

pap smear Q0091
Wed, Mar/23/2011 11:47AM
they may be the only one...

Zostavaz - medicare
Wed, Mar/23/2011 11:46AM

Wed, Mar/23/2011 09:54AM
it is a wellness visit for Medicare only, no exam required. Best to use search box and read the articles

if a patient is in snf on private stay can you bill them for ov xray charges even if mcare has been billed and paid their part
Sun, Mar/20/2011 08:44PM
"ov xray charges"? They are responsible for the 20% that Medicare did not pay.

CPT® Codes
Sun, Mar/20/2011 11:33AM
585.4, 285.9, 401.1; that should provide medical necessity for all the labs you noted

Sat, Mar/19/2011 09:46AM
there is more work done than just the test. The nurse should get vitals, inquire about complications such as bleeding or bruising, current dose and instructions for new dose. If all these are charted, then a 99211 can be billed with the test and the capillary blood draw.

Biopsy removal ? Please help me!
Sat, Mar/19/2011 09:44AM
so you need to ask the surgeon the largest diameter of what was cut. the area of the lesion is not used at all.

90658 pos
Fri, Mar/18/2011 11:04AM
give us all the available information in the first post and we can help you. If we saw POS 22, we would know the answer. But of course we should have asked for the details...

Hospitalist Group both IM and FP
Fri, Mar/18/2011 09:17AM
they are serving the same role - as primary care and covering for each other so you cannot bill separately just because one is FP and one is IM

Shingles vaccination
Fri, Mar/18/2011 08:55AM can only bill for the admin fee and you have to either bill the D plan thru or have the patient pay cash (you cannot bill part B for Medicare pts), you cannot be sure the vaccine was kept frozen and you have no idea about how it was handled in the pharmacy.

So we decided it was not worth the liability. If you do not stock it, contact your local pharmacies to see which administer it. You can read more about billing at

Time frame for signature
Fri, Mar/18/2011 08:52AM
but if you get audited and it is unsigned, you get denied.

90658 pos
Wed, Mar/16/2011 04:21PM
flu shot has new codes dep on manufacturer

Wed, Mar/16/2011 04:00PM
if the appt was "remove staple" then no. If for pain or bump then yes. Was the surgeon in your group? that changes things too.

secondary payment
Tue, Mar/15/2011 05:16PM
no, not really. Are you referring to Medicare? The secondary pays the part left over from the approved amount. So you bill $200, Medicare approves $80, they pay $64, your secondary pays $16, you write off $120.

Spirometry and a nursing visit
Tue, Mar/15/2011 12:10PM
unless another service was provided, like teaching MDI use, teaching asthma action plan.

Sun, Mar/13/2011 08:14PM
the doc does not supply the TPN, she can't bill for it. there is no corresponding code as there is for dialysis management. Use a medical diagnosis, wither small bowel obstruction or malnutrition (probably better if there is also a surgeon and GI on the case) and the appropriate E&M visit

Help with diagnosis
Sun, Mar/13/2011 08:09PM
for xrays better to put the symptom and let the radiologist pick the diagnosis- you prefer that to me guessing what you will find. So if I put fracture and there is not one, then you have a harder time coding it. So I put finger injury.

Multiple Records-One E/M visit
Sun, Mar/13/2011 08:07PM
"cloning" is allowed- I can copy and paste the previous Fam Hx, Soc hx, even ROS or HPI into the current note. BUT, and I stress BUT, it must be an active process to bring that part of the note into the current note. So if the EMR automatically copies Soc hx into every note, there is no way to know the doc actually reviewed it. If she has to click a button to import it, that assumes she reviewed the contents and made any appropriate changes. When I see diabetics, I ask the same questions and get the same responses nearly every time so I copy the previous note and then ask the questions again. If there is a new answer, I change that one. But the key is that I do ask the questions and will testify to that in court, therefore it is acceptable

Multiple Records-One E/M visit
Fri, Mar/11/2011 05:02PM
No way, unless the doc writes something like "Fam hx from 2010 reviewed, no change"

Fri, Mar/11/2011 09:17AM
the reason that it is needed, such as short bowel syndrome or crohn's disease, and perhaps malnutrition. But then again , what service are you billing? I am sure you are not supplying and charging for the TPN itself...

nurse practitioners & general surgeons seeing pt's in hospital
Thu, Mar/10/2011 10:54AM
The NP would have to bill with their NPI and get paid less than if the surgeon actively participates in the eval and management. Look for Incident To guidelines

Mon, Mar/07/2011 06:45PM
you should check your state rules- Medicaid marches to its own drummer

Mon, Mar/07/2011 09:20AM
Assuming patient sent home

Medicare- bill ED visit codes Others- bill consult codes

Using V45.89 as a primary diagnosis
Fri, Mar/04/2011 09:04AM
The surgeon could use it if you are in the global period and know there is no reimbursement coming. The problem is that most payors will see that as bundled and not want to pay any provider, even the Primary care doc, if that is all they address.

Time to determine evaluation and management level
Fri, Mar/04/2011 09:01AM
just indicate time and what was discussed

Thu, Mar/03/2011 03:48PM
if you can find them; sepsis also may be a good one to use if that is the cause

Critical Care Time Codes
Thu, Mar/03/2011 09:21AM
if the patient is critically ill, requires over 30 min bedside presence and then dies, the doctor can bill for both. If they do not die (or perhaps get transferred to a tertiary care center), it is unlikely that you would require both services on the same day. Remember being in the ICU does not mean you always bill critical care.

Evaluation & Management services
Thu, Mar/03/2011 09:03AM
You can count "unobtainable" for FH and ROS

"ROS negative except as in HPI" is open to debate- I think most consider it counting for a full ROS since we assume that the doctor did what she documented.

G0431-qw Year 2011
Tue, Mar/01/2011 08:38PM
what are you asking?

When a clinical laboratory that does require a CLIA certificate of waiver performs a qualitative drug screening test for multiple drug classes that does not use chromatographic methods, new test code G0430QW is the appropriate code to bill.

when a clinical laboratory that does not require a CLIA certificate of waiver performs a qualitative drug screening test for multiple drug classes that does not use chromatographic methods, new test code G0430 is the appropriate code to bill.

what code
Tue, Mar/01/2011 08:34PM
is the medicare code for 30+ minutes of oversight of a home care patient. Commercial payers- don't know...

Occult blood screening
Tue, Mar/01/2011 08:31PM

Mon, Feb/28/2011 05:21PM
for injury give dT and link to injury code. There is a new recommendation to give it to over 65 with exposure to infants, but CMS won't pay. If you are set up with you could look it up on that.

Ordering Physician
Mon, Feb/28/2011 12:14PM
there are rules that allow a temporary doctor to bill for services under the original doctor name- that is a locum arrangement. You might find details if you search here for locum- I think there is a limit to time period.

Sat, Feb/26/2011 08:58AM
I would not want an overview 2 years before I have make a change- tell me 2 days before.

Debridement denial for medical necessity
Sat, Feb/26/2011 08:57AM
but honestly I have never heard of debridement for that

Please Help
Fri, Feb/25/2011 11:45AM
use it

Allergic reaction code
Fri, Feb/25/2011 10:49AM
"Did not work" What CPT® did you use? Those are valid ICD's. (Not sure where cough fits with the history you give)

Sleep Study diagnosis
Fri, Feb/25/2011 10:41AM

Please Help
Fri, Feb/25/2011 10:40AM
ignore hx of colonoscopy, V12 series for hx asthma, no reason to code allergy to PCN

coding correctly, using the correct order of codes
Wed, Feb/23/2011 08:54PM
the ICD is the diagnosis and the CPT® is the procedure- on billing forms they go in totally different places. As to order, the primary diagnosis is first then additional diagnoses.

Tue, Feb/22/2011 09:35PM
Medicare approves about $180

screening patient in er setting
Tue, Feb/22/2011 09:29PM
there must have been something- lethargy, fever, pallor, etc. I would also talk to the nursing home about their assessment methods.

Update on the Annual Wellness Visit
Tue, Feb/22/2011 09:28PM
great update. Personally I have a problem with non-licensed providers doing this. My patients come to the doctor to see me. But I understand that financial forces lead many to maximize throughput and optimize physician time, but when that happens and people complain about where our medical system has gone wrong we have no argument besides a financial one and that's not why I went into medicine.

medicare billing and documentation for annual well visit
Mon, Feb/21/2011 04:24PM
an AWV is not a physical - in fact there is no requirement to actually touch the patient except for the BP. If they have a problem, you can also do a 99213 and the physical exam can be counted for both a problem and well visit. The discussion and plan must be separate. If the patient wants a "full physical" then you code a well visit and can charge for a problem visit. The payment on that is complex- I can't explain it

what e/m code would er physician bill if admitted to surgery for observation
Tue, Feb/15/2011 06:16PM
ED docs always use ED codes

ER billing by a Consulting or On Call Physician.
Tue, Feb/15/2011 06:15PM
If yes, then inpatient codes; if sent home, you can use the ER visit codes

T3 testing
Mon, Feb/14/2011 09:23AM
use the same NCD- they are all thyroid tests and if there is an NCD for T3, it would encompass the same codes. As to when it is ordered, that is a nuance best reserved for the ordering doctor. But it is another measure of the level of the hormone in the blood and tissues. Sometimes the TSH can be abnormal but the T3 and T4 normal, or vice versa, or any combination thereof (ok, I don't really understand it completely either)

Prolonged Care Inpatient Setting, CPT® Codes: 99356 and 99357
Thu, Feb/10/2011 02:32PM
it is one loooonnnnnng visit so the codes are the same

denial reson B20 by Medicare
Thu, Feb/10/2011 02:31PM
that you are using the same diagnosis as another doc on the case. So if you and the pulmonary doc both bill pneumonia, only one can get paid. So you cold rebill with another diagnosis and you should ask your docs to be sure not to use the diagnosis if a specialist is treating for that problem

Can I file in the chart?
Fri, Feb/04/2011 12:34PM
It does not concern our charges or billing so we keep it in the chart and we need to refer to it every 3 months to reapply for the patient.

Billing for code 90887
Thu, Feb/03/2011 12:43PM
Behavioral health is really insurance dependent. They set up edits so that only certain providers can bill certain codes, and tis fits that. They do not want a PCP telling a parent- "your kid has ADD" and charging a code that includes specific testing/counseling. So you may need to call your provider reps and get a special dispensation

High medical decision making
Mon, Jan/31/2011 09:26AM
I would; the decision to order plasma exchange is complex and dangerous

OBS to swingbed status
Wed, Jan/26/2011 11:05AM
that is a case management question- doubt anyone here has the expertise in this area, especially with swing bed nuances...sorry

Prostate Screening V76.44
Mon, Jan/24/2011 07:36PM
more than 11 months since the last one? Do you do the blood test yourself? Only things I can think of...although there is talk that the computers are having trouble with preventive codes in 2011.

Prostate Screening V76.44
Mon, Jan/24/2011 03:34PM
what did you bill for CPT®?

Coding for in-office glucose testing for diabetics
Sat, Jan/22/2011 03:02PM
that's what we use, no QW and we get paid...

Sat, Jan/22/2011 11:05AM
Initial visit- pays same at 99204, followup visits- same as 99214

Sat, Jan/22/2011 09:04AM
the realm of V codes is huge- there is no "regular" code that fits?

E/M with urine test
Sat, Jan/22/2011 09:02AM
No reason for a nurse visit - big red flag to get audited! Same with blood tests.

V40.9 DX
Fri, Jan/21/2011 05:57PM
most medicaid plans only pay psych docs for psych diagnoses, and that is pretty darn non-specific code so it may be denied just for being too non-specific

ROS in e/m coding
Wed, Jan/19/2011 08:18PM
Diabetes is not a symptom or sign, don't count it

Billing For Staff Members
Wed, Jan/19/2011 08:17PM
bill for your employees, but not your family. Medicare forbids it but it certainly will be awkward to make your wife pay her copay and 20%. Establish a policy for employee discounts, that is legal.

V codes
Wed, Jan/19/2011 04:32PM
if that was the primary reason for the visit. I bill lots of V70.0, V72.31, etc

what CPT® and ICD codes are used for hospice billing?
Wed, Jan/19/2011 04:31PM
If you are the primary care doc, bill a diagnosis other than the cancer diagnosis and the usual E&M. The cancer care gets billed to the hospice but you should talk to them before billing

Wed, Jan/19/2011 04:30PM
1- You cannot check if they got it or if you submitted enough 2- You will get a lump sum payment in November, 2011 as an entry on your Medicare EOB. If we are lucky, they will then distribute a report of your performance. In past years, we had to go thru 10,000 hoops to get a report. If you have more than one doc, you need the report to see who earned what from that lump sum.

coding Medciare Annual wellness Visit
Tue, Jan/18/2011 08:59PM
there is no requirement for a doctor to do it but you should be on site and review the results

new medicare home certification guidelines
Tue, Jan/18/2011 08:57PM
you are required to fill out a form certifying that you had a face to face visit with the patient- so if you see the patient in the hospital or office for their CVA, you bill the E&M and fill out the form. This is totally different than the Plan of Care billing, G0180, which is billed when you sign the plan of care without a visit.

medicare coverage for shingles (Zostravax) immunization
Tue, Jan/18/2011 02:56PM
Medicare B does not pay for the vaccine or the administration. You may administer it and charge the patient whatever you want and let them apply to their D provider for reimbursement or register at to bill thru them or send them to the pharmacy. Read more here-

E/M code and place of service issue
Mon, Jan/17/2011 04:01PM
I would code this as a home visit. The doc is seeing the patient in their choice of venue.

What is correct in order to bill out correctly
Mon, Jan/17/2011 04:00PM
a screening diagnosis needs a screening visit. You should code 9938x.

ED Consultations
Mon, Jan/17/2011 03:57PM
the patient was seen in the ED and sent home, use the ED codes. No limit to type or number of providers who can bill that as long as separate specialties.

Medicaid Home Healthcare Certification by PCP
Mon, Jan/17/2011 03:56PM
I doubt Medicaid will pay for that- just a fact of Medicaid budgeting. G0180 is the first certification.

SNF- 36415
Mon, Jan/17/2011 11:38AM
your doctor drew the blood in the NH? I am confused. SNF's have contracted labs that do blood work that the doctor orders. If he had to draw it (tech could not get blood or special testing of some type) try 36410- MD blood draw.

Medicare split visit
Mon, Jan/17/2011 10:09AM
that G0102 is bundled into any E&M that is done; you cannot carve it out or bill it separately.

Coumadin Management
Sun, Jan/16/2011 05:59PM
as part of E&M visit

Zostrix immunization
Sat, Jan/15/2011 04:42PM
you cannot bill Medicare B for ZOstavax administration- it is a D benefit!

SNF- 36415
Fri, Jan/14/2011 05:04PM
billing for? Hospital? Doctor? Lab?

Can we bill a patient when Medicare Provider is non-par?
Fri, Jan/14/2011 05:02PM
As a non-participating physician, you probably have an obligation in the hospital to inform patients of their financial liability before initiating services and letting them express an opnion. If you are a specialist and a primary care doc consults you, it is easy to tell te PCP to call another specialist if the patient refuses your payment terms. If you are the primary care doc on call for the ED and the patient is assigned to you as they have no PCP, you have the right to bill the patient if you provided a service.

Medicare Annual Wellness Visit
Fri, Jan/14/2011 04:58PM
I have scoured the literature- CMS has said nothing about the ICD-9 to use. DId you bill just the V70.0 and the G code?

Medicare Wellness and........
Fri, Jan/14/2011 09:35AM
I designed a checklist and a template for my EMR so everything is clearly separate

Medicare Wellness and........
Fri, Jan/14/2011 09:22AM
I’m glad the physician at CMS is on the ball, he pursued things more and contacted me back. He spoke to those that actually wrote the final rule. The proposed rule had language indicating that the AWV + E&M;visit with a modifier would be expected to be an unusual occurrence – and that is what the ACP site indicates. However, there was a lot of feedback and the final ruling removed that phraseology. He said that they will be contacting the ACP to advise them to change their site.

The combined AWV + E&M;can be done without concern about the frequency, as there is no suggestion of a restriction in the final ruling. Two things were noted in my conversation with him (1) if staff members do some or all of the AWV, the documentation should reflect who did the screenings/evaluation (2) the E&M;issues addressed must be clearly separate and distinct in the note so there is no confusion that two separate/combined evaluations were indeed performed.

Fri, Jan/14/2011 08:52AM
it's oral therapy- the patient has to get it at the pharmacy. It's between them and the insurer, although I am sure the manufacturer has a program for patients to help with reimbursement. Do not dispense it in the office- it will be a nightmare of paperwork and you'll never get back your money.

PQRI and Meaningful Use
Thu, Jan/13/2011 02:04PM
that you cannot get paid for eRX and MU, but can get MU and PQRS in 2011

Medicare Wellness and........
Wed, Jan/12/2011 07:19PM
99213-25 attached to 401.1, G001 and Q0091 with v72.31, and G0438 with V70.0; just be sure your documentation is clear in each section

Need help in solving this denial
Wed, Jan/12/2011 11:39AM
Stop taking Medicaid and send them a message about their policies, or if the visit was for an unrelated issue, tell the patient they must return on a different day for the ear wax.

Tue, Jan/11/2011 02:45PM
not since 2009. For 2010 and 2011, you only report G8553 on 25 claims where you sent an eRx. No more of the three choices.

Medicare's Electronic Prescribing Incentive Program
Tue, Jan/11/2011 02:44PM
if you have a certified E prescribing system, you just need to report the G8553 code, linked to the primary diagnosis at least 25 times on claims where you actually sent an electronic prescription for the patient. (I would report it 35 times just to be sure aat least 25 get there.) Then in November, 2012 you will get a bonus check for 1% of your total Medicare billings from 2011.

Can you charge a Self-Pay patient for an assist when CMS doesn't allow an assist?
Sat, Jan/08/2011 12:30PM
if the client wants you to bill the assistant on everything and you know it is wrong, is this the kind of client you want? Will you be indicted for Medicare fraud too? Can you say you were "just" coding what they presented you??? Not to say that this is fraud but docs like this get awfully close to the line sometimes...

Can you charge a Self-Pay patient for an assist when CMS doesn't allow an assist?
Fri, Jan/07/2011 12:00PM
you can do whatever you want...but really? You are going to penalize a cash-paying patient by overcharging them? Insurers do not allow you to bill for assistants because there is no medical reason to have one other than convenience. Make their bill too high and you'll get nothing.

Skin tags
Thu, Jan/06/2011 09:17PM
if they came in for the removal, there is no Evaluation and Management beyond the procedure itself

Pre operative Office Visit
Wed, Jan/05/2011 04:41PM
on the history, physical and medical decision making (actually on 2 of those 3). A patient with one medical problem is probably going to be 99213, 3 or more problems is 99214. A real sickie would be 99215

ICD 9 coding
Wed, Jan/05/2011 02:13PM
in this case. The diagnosis is not as important as the E&M code if you are worried about auditing. The patient is still being treated for a severe exacerbation that has improved so you can still use the severe COPD code. If I document "acute blood loss anemia due to duodenal ulcer with hemorrhage" on the first day to allow the hospital to code that as a CC or MCC (rather than just ulcer and anemia) and on day two I write ulcer and anemia, you can still use the codes since the disease did not change.

If the doc admits this COPD patient who also has diabetes and the doc's notes beyond the H&P never address diabetes then it is not appropriate to carry it forward for subsequent day visits.

hospital admits
Wed, Jan/05/2011 02:06PM
it is just that doctors think that if a patient is sick enough to be in the hospital that they deserve to bill for a level 3 and that no one will catch them if they are wrong.

how do I optimize coding for inpatient admit that conversts to hospice.
Wed, Jan/05/2011 12:05PM
choice 2- you do the work of an admission , discharge and readmission so you deserve to get paid for it

Pre operative Office Visit
Wed, Jan/05/2011 12:02PM
For a preop visit for non-medicare, use the consultation codes if the preop was requested by the surgeon. If Medicare you use the established office visits codes (unless it is a new patient)

Tue, Jan/04/2011 08:21PM
so you can always BUMP your question to the top by posting a "reply" kindly asking for others for help again. We are all volunteers here- I have 4 other jobs so can't check every day and my brain can only hold so much trivial coding information before it starts pushing out important things like the wife's birthday.

Pelvic and Breast Exams on Medicare patients
Tue, Jan/04/2011 08:19PM
The coverage for pap and pelvic remains every 24 months. There is no "rule for annual screening" per se; they just now cover an annual wellness visit to review the recommended services based on age and risk factors.

E/M same day different hospitals
Tue, Jan/04/2011 04:07PM
one "visit" per day. If setting changed, hospital to SNF then yes, two visits

What code do I use for Annual Wellness Visit
Tue, Jan/04/2011 04:05PM
I searched all the CMS literature and no guidance from them on the new Annual Wellness Visit; I am going with V70.0, even though no physical exam is required

Coding Signs, Symptoms, and Abnormal Tests
Mon, Jan/03/2011 10:30AM
what are you coding? What was known at the time of the visit? IS this one visit or multiple visits to follow up on tests?

outpatient obs codes
Mon, Jan/03/2011 10:29AM
the only denial would be if the patient was converted to Inpatient and the hospital bills Inpatient and you bill Outpatient. If "clean" OPO's are denied, you need to look closer

Outpatient observation codes
Sat, Jan/01/2011 06:59PM
my response was the changes for 2011- the admit and discharge were not changed. This of course was warranted since docs were using the subsequent office visit codes for that "middle" visit and that clearly did not make sense

ICD 9 code for bone density test ?
Sat, Jan/01/2011 06:57PM
but it is not on the list

Apligraph use with Simple Mastectomy
Thu, Dec/30/2010 11:55AM
The LCD means it cannot be billed to Medicare- it is not a covered benefit. If you want to use it, the patient should sign an ABN and will have to pay for it. FDA approval does not mean Insurance will cover.

Prolonged service
Wed, Dec/29/2010 03:31PM
you don't use a -25 with the 99214. There is a time element assoc with the 17000 that they may be counting. also there is a debate about whether you can use 99354 with a 99214 or if you must use the highest code 99215 time element and add it to that. We can't get a good answer to that.

Wed, Dec/29/2010 03:27PM
a fall is not a medical problem, it is an action, like a jump or a scream. You describe the injuries or as you did the etiology- ataxia, orthostatic hypotension, syncope, etc.

Screening Schedule for Medicare annual wellness visit
Wed, Dec/29/2010 03:26PM
I have not found one yet- I am debating doing a generic form and using check boxes to indicate which apply to the patient. The whole process for this visit is rather onerous and hardly worth the money

Medical Billing & Coding
Wed, Dec/29/2010 03:24PM
Did Dr Green do the surgery? Is Dr Green the medical doctor? What is the global period on the surgery?

Diagnostic labs ordered
Wed, Dec/29/2010 03:10PM
you just need to have a valid order in your chart

Outpatient observation codes
Wed, Dec/29/2010 03:06PM
there is now a code for subsequent obs visits 99224-6, same standards as subsequent hospital visits

Mon, Dec/27/2010 11:07AM

Billing for 99363, 99364
Sun, Dec/26/2010 12:15PM

code 95165
Thu, Dec/23/2010 01:43PM
but the allergist should- there is a heck of a liability in providing a service to a patient without an established relationship.

Did you know that President Clinton fired the White House doctor because he would not administer the allergy solution that the President brought from his Little Rock doctor?

Trauma Services
Wed, Dec/22/2010 08:56AM
how can you ever bill for something without any documentation????

Skilled nursing facility billing
Mon, Dec/20/2010 05:36PM
use SNF codes, 99304-99310? You may get a denial with the other codes and the place of service not correlating

nursing home admission
Mon, Dec/20/2010 05:34PM
every time they are admitted you can bill the admit code. Your relationship does not count, same as hospital admissions

infected sutures
Wed, Dec/15/2010 03:04PM
The doc can bill an office visit if it addresses a separate diagnosis and it is supported by documentation of the Evaluation and Management (hence the "E&M"). Based on what you presented, probably could bill the pulse oximetry linked to the asthma code but that is all. (And you would have a hard time justifying 3 pulse oximetry checks with no office visit as far as medical necessity.)

flu cpt
Wed, Dec/15/2010 09:01AM
set by manufacturer, not by dosage size or delivery device.

infected sutures
Wed, Dec/15/2010 09:00AM
for the surgery- that is post-op care. Sorry

Wed, Dec/15/2010 08:59AM
hospices are paid a global fee from Medicare/insurers to provide all care related to the diagnosis that warrants hospice. If they bring in doctors- primary care or specialists, they have to pay them from that global fee. So it is reasonable for them to have you sign a contract to codify the agreed-upon fee.

As an alternative, you can bill the patient's insurance for the renal diagnosis (if it is not the same as the hospice-qualifying diagnosis) since doctor care unrelated to the hospice illness is not covered in the capitation. So if they have lung cancer and develop renal failure, you could bill 585.4 and get paid from Medicare directly.

HPV Testing
Wed, Dec/15/2010 08:55AM
I send everything with v72.31- pap, pap with HPV, pap with reflex HPV and I have never been denied by any insurer or asked for additional diagnoses from any lab. so it must work...

what code to use when chlamydia screening is done in the office due to vaginitis
Sun, Dec/12/2010 05:44PM
use the vaginitis ICD; you do not know that the symptoms are not from chlamydia so it is a legitimate diagnosis, as opposed to the screening chlamydia done on females age 25 and under

Sat, Dec/11/2010 02:08PM
it is bundled into the E&M visit, or you can have the patient return after the test to review the results and discuss the use of oxygen and order it at that time.

words catherer
Fri, Dec/10/2010 04:23PM
The I&D for Bartholin's Cyst 56420 includes the placement of a Word Catheter. The supplying of a Word Catheter can be coded a 99070. All as per the 2009 ACOG "Components of Correct Proceedural Coding".

Emergency Deparment
Fri, Dec/10/2010 04:22PM
Coding for- hosptial or doctor? In an ED, the hospital would bill for the hydration, not the doctor. In an office the doctor can bill for it since she is paying for the supplies and labor.

Botulinum toxin A
Fri, Dec/10/2010 12:40PM
A is per unit, B is per 100 units; you can't bill B if you gave A. Different drugs! Appeal

Fri, Dec/10/2010 08:59AM
no one will pay it except workmans comp. You have two choices- have the patient make an appt and sit in the room as the doctor fills it out and charge E&M by time or charge the patient cash for filling out forms $20 or so is the most common fee.

ICD-9 Code
Fri, Dec/10/2010 08:56AM
there are no ICD's for the individual cerebral arteries.

Medical records documentation
Thu, Dec/09/2010 04:16PM
but I would not send a bill until the documentation is done. If they request the record, your are dead in the water if the chart is blank.

Thu, Dec/09/2010 02:16PM
Split personality patient?

billing medicare
Thu, Dec/09/2010 12:01PM
if medically indicated treatment. If you are giving B12 shot for fatigue, no, not indicated or paid. need more details

Medical records documentation
Thu, Dec/09/2010 12:00PM
Time frame by whose standard? Insurer, Medicare, Lawyer?

Tue, Dec/07/2010 04:04PM
It is still a Medicare D benefit as far as I know , but I'd love B to start paying!

Sun, Dec/05/2010 06:53PM
relative value unit- the "value" of the service relative to other services, taking into account complexity, cost, time, risk, overhead, etc. So a RVU of 2 gets paid double an RVU of 1. There is an RVU Panel somewhere that meets and determines the value of new procedures- it is heavily specialist-loaded and they undervalue primary care services to protect their incomes.

normal pap, hpv positive?
Sat, Dec/04/2010 04:44PM
795.05- that is high risk HPV positive

Fri, Dec/03/2010 12:07PM
I suspect that the insurance has special arrangements for psychiatric diseases and in their infinite wisdom insurance companies do not think that primary care docs can treat ADD or depression for these patients. So read the back of the card and refer to the patient to the insurer to appeal the denial. There is no reason for a kid to go to a mental health professional to treat ADD.

Flu Vaccine
Fri, Dec/03/2010 10:25AM
Those are brand names. Look at the vials that your staff is using- you have to pick by what brand you bought. And if you are family practice, it may be different for adults and kids

2011 CPT® Codes Effective for Use
Thu, Dec/02/2010 02:02PM
Medicare just published a Med Matters about the new flu CPT® codes and it states:

For dates of service on or after October 1, 2010, HCPCS codes Q2035, Q2036, Q2037, Q2038 and Q2039 (as listed in the table above) will replace the CPT® code 90658 for Medicare payment purposes during the 2010 – 2011 influenza season. However, these HCPCS codes will not be recognized by the Medicare claims processing systems until January 1, 2011, when CPT® code 90658 will no longer be recognized.

How is that for double talk- the codes are replaced Oct 1st but not valid until Jan 1st. New codes are generally effective October 1st

Thu, Dec/02/2010 10:24AM
the modifier is only if you are billing a portion of it- technical or professional. If you bill the whole thing, no modifier. You probably should separately bill the FDG, knowing you will get denied, so that you are consisent in always billing contrast on scans, unless you can be sure no others are slipping thru unbilled.

Medical Necessity
Mon, Nov/29/2010 05:00PM
but if the doc will sign, it has a little more weight and if the doc is the one not getting paid, she should be willing to sign it to get paid, even if you wrote it. And who better than the doc to know the indications for the surgery? And be sure the info is pertinent- I have seen form letters from offices that have fill in the blanks that carry no weight at all...

E/M Code Bundled with Radiology Code
Mon, Nov/29/2010 04:35PM
adding a -25 to the E&M?

Medical Necessity
Mon, Nov/29/2010 04:23PM
I review charts for an insurance company and I review whatever is sent- patient appeals (usually not much help since it is a passionate appeal, not a scientific one), physician letters, PA, letters, therapist letters, etc. The best is whoever can give the best rationale for the procedure/equipment. References help. Of course for most decisions I look at national standards, guidelines, etc to make a determination. Unusual things belong at universities where there can be controlled trials to prove efficacy.

Long Term Care Coding Guidelines
Sat, Nov/27/2010 05:48PM
Use the Look It Up box- try SNF

PQRI-30 patients
Sat, Nov/27/2010 05:47PM
I had my staff enter the PQRI information in the billing system and keep a list so we knew how many we entered. For eRx, it is easy, just enter it 25 times when you e Prescribe. I did 35 just to be sure that I hit 25 clean entries For PQRI, I assume you are doing the 30 consecutive. You better have a fool-proof method for watching it because if one slips in the middle without codes, you are out. So start on a Monday and keep going until you hit 27 or 28 and finish out whatever day you hit that number and tell your billing staff to get all the charges entered and transmit them since you don't know the order the billing software will send them.

Osteopathy specialty
Wed, Nov/24/2010 02:34PM
it is not a specialty, it is a degree designation. What was she trained to do in residency/fellowship? Orthopedics? Then she is an orthopedist.

Mon, Nov/22/2010 06:44PM
Q0091 is for pap collection

gyn annual exam & sick visit
Fri, Nov/19/2010 11:07AM
but that does not mean the insurer will recognize that and pay it. As noted, the note should separate the medical decision making into preventative and problem and address separately.

SNF visits for skilled nursing home patients
Fri, Nov/19/2010 10:25AM
as medically necessary. Your documentation should support the need for the visits- there are no guidelines for maximum visits

Templetes for Primary Care Physicians
Thu, Nov/18/2010 03:12PM
Really, that is not a snide answer- every doctor is a little different, let them customize to their habits. They survive audits better that way. We counsel differently, examine differently, prescribe differently.

And tell your docs not to depend on them too much- if every exam reads the same, that means they really did not do the exam to an auditor

Nurse visit denial
Thu, Nov/18/2010 03:10PM
for suture removal if your doc did not place them. if you billed to place them then you cannot bill to remove them.

diagnosis codes for lab work ordered
Thu, Nov/18/2010 02:28PM
most print a NCD for lab tests; you can also go to and search

billing 99051
Thu, Nov/18/2010 02:27PM
is a stand alone code, so no -25. Second it is for regularly scheduled after 5 pm and weekend patients. Any some insurers do not pay it so those get written off

Prescriptions for colostomy supplies
Fri, Nov/12/2010 10:43PM
CMS is starting to audit these things (DME fraud is rampant) and at the very least you need a chart in the office and a note that the doc is ordering the supplies. And the doc continues to have liability for the patient. Did he have an interval colonoscopy, does he have scar carcinoma, is the ostomy developing a stenosis? Lots of things that the doc could be sued for. Have the patient make an appt; don't give away services.

BTW it is refreshing to read a posting of a doc who does NOT want to charge a patient for a service.

Fri, Nov/12/2010 01:49PM
and one that I have struggled to understand the logic of CMS. Even if the ED doc comes and pronounces a patient dead, it is the attending/hosptialist who is responsible for the paperwork and should be compensated for that. By this guidance, if the doctor did not see the patient at all that day, then it is a freebie. If there was a pre-death face to face visit, then the time spent on the discharge summary, if done the same time and on the unit, could be added to the visit time to increase the visit level.

Fri, Nov/12/2010 11:47AM
only 99211 does not require a physician or NPP.

Medicare & RHC shot visits
Thu, Nov/11/2010 06:26PM
what vaccine admin are they denying?

Modifier 57
Thu, Nov/11/2010 06:25PM
I told you Nancy would come through!!!!

Medicare’s Internet Only Manual, section 40.2, instructs carriers, “Pay for an E/M service on the day of or on the day before a procedure with a 90-day global surgical period if the physician uses CPT® modifier 57 to indicate that the service was for the decision to perform the procedure.”

I love Nancy and Editor ;-). When I come up with off the cuff answers, they throw out the citation to back me up.

Surgical dx
Thu, Nov/11/2010 03:50PM
If I order a CXR in a patient with cough and I write "Cough" on the requisition, and the xray shows pneumonia, the radiologist codes the bill as pneumonia, not cough.

Modifier 57
Thu, Nov/11/2010 02:48PM
Come on ladies, how can you help? Nancy has a HUGE repository of information and Editor knows everything...

Modifier 57
Thu, Nov/11/2010 01:57PM
The AMA and CMS would publish an advisory saying that you should carve out the fee if that was the case but they are not going to publish an article saying that you do not carve out the fees. Why would they? They can't publish a list of everything we should not do, especially when it we do it they save money.

Your reasoning is correct- the doc is doing a full evaluation for the first time. It just happens to be the day prior to the procedure and they deserve the full fee. If they saw the patient last week, decided to do surgery and brought them back to the office the day prior to do the H&P, then they do not deserve a full E&M visit- they already had the information and that visit is more administrative so bundling it into the surgical global is reasonable.

Modifier 57
Thu, Nov/11/2010 01:19PM
You are correct, of course. There is no carve-out- I have only heard that done when you are doing a Medicare physical (which is not covered) and an E&M visit which is covered.

You won't find a reference that says there is no carve out but here is the CMS explanation of -57 and another great explanation.

Venipuncture / Lab Draw
Thu, Nov/11/2010 11:52AM
if they are established with you as a patient. The doc whose name goes on the claim should review the labs for critical values since they are accepting some liability by billing.

Online PECOS Enrollment
Wed, Nov/10/2010 07:03PM
If you have updated any info in the Medicare system in the last 5 years, you are likely in PECOS- go here to find out

critical care
Wed, Nov/10/2010 03:59PM
for that patient if the doc was flushing blood out of the NG, ordering transfusion stat, titrating pressors minute by minute for hypotension, then it is critical care.

critical care
Wed, Nov/10/2010 03:57PM
That visit is probably 10 minutes- "how ya doin?" wiggle your toes, stick out your tongue" etc. then looking at the CT scan and writing a note. (that is a gross underestimation but you get the point). If the doc was adjusting the intracranial monitor, flushing the port, doing a bedside burr hole, that would be critical care.

MA plans pros and cons
Wed, Nov/10/2010 03:52PM
There is no "contracting" - if you see a MA patient, you are contracted for that one patient. You can elect to see these patients or not, even on a visit to visit basis. If you see one, your are not obligated to take any more or you can pick and choose.

But on the other hand, we have huge problems getting paid; they also are constantly asking for copies of records (at our cost); you have to go thru their precertification process for xrays, surgeries, etc and you get paid the same as traditional Medicare. We avoid the plans and in fact just kicked out every patient (many were with me for 10+ years) that has Today's Options since they seemed to be the worst and paid no bills at all.

professional audit letter sample
Tue, Nov/09/2010 07:59PM
Have you received RAC denial letters? I have not heard of any RAC requests to physicians for E&M services. I need details! What state, what specialty, what did the letter say?

Consultation for Nursing Home visit
Tue, Nov/09/2010 05:54PM
same codes as outpatient but with place of service as SNF

breast implants and screening and diag mammograms
Mon, Nov/08/2010 09:48PM
unless there are symptoms. If you need extra views, use 996.54

Mon, Nov/08/2010 03:41PM
use the Units box. If you are doing a knee replacement and appendectomy, you use -59

Colonoscopy and Prostate
Mon, Nov/08/2010 09:53AM

critical care
Mon, Nov/08/2010 09:37AM
At a recent conference, our loyal editor was asked by a plastic surgeon about billing for critical care time for a consult he saw in the ICU- the patient was critically ill and on a ventilator and pressors but he was seeing the patient for a bedsore. That does not qualify as critical care by the plastic surgeon.

In your case, a concussion is not critical care. The patient is in ICU for nursing neuro checks only. If the patient developed a seizure and pupils suddenly changed, then it would be critical care when the doc goes to evaluate and order a new scan and start seizure meds. If the patient had a gaping head wound and brain matter dribbling out thru the doctor's fingers, and all the doctor did was stand there and hold it in so the surgeon could get ready for surgery then it would be critical care.

Weber Exam for hearing loss
Mon, Nov/08/2010 09:32AM
it requires 30 seconds and a $10 tuning fork- it is bundled into the E&M.

Wed, Nov/03/2010 08:56AM
the tax ID is the number the IRS uses to track money; the NPI is an ID number issued to physicians and others that provide medical services. The NPI just assures that your credentials are legitimate. As with our Soc Sec number, many use it for things other than the intended use.

Administration code for vaccination
Wed, Nov/03/2010 08:51AM
Medicaid in Illinois furnishes the vaccine and syringes and needles so they feel they do not have to pay for the admin. The G codes are Medicare only. Two choices- suck it up or refer Medicaid patients to the health dept for vaccines.

Second opion consult
Tue, Nov/02/2010 03:35PM
if they are not medicare- there are no consults for Medicare. But if the tax ID and group NPI are different, no problem billing as a new patient.

Mon, Nov/01/2010 12:14PM
10 days -I&D abscess

Authorization denial from BCBS for secondary claim
Mon, Nov/01/2010 12:10PM
so my question to you is: is the Blue cross a Medicare supplement or a commercial plan - if supplement then you are correct that they should not deny it; if it is a commercial plan (usually a retiree of a union) then I believe they can require pre-cert.

Authorization denial from BCBS for secondary claim
Mon, Nov/01/2010 09:44AM
Most commercial insurers require pre-cert for vein work to be sure it is not cosmetic. They may allow a retro review since Medicare primary.

Peak Flow
Sat, Oct/30/2010 09:08AM
S8110? If so, feel lucky you got paid at all.

Billing for BRAVO
Sat, Oct/30/2010 09:03AM
you bill the EGD the day it was done and the BRAVO the day it was interpreted. They are different procedures and days so it will get paid.

CPT® codebilling for in office accucheck,
Sat, Oct/30/2010 08:59AM

CPT® codebilling for in office accucheck,
Sat, Oct/30/2010 08:59AM

CPT® code
Wed, Oct/27/2010 06:55PM
please- where was the shot given?

Code P33 on EOB
Wed, Oct/27/2010 04:19PM
If you are contracted with the insurer, you are stuck with the bill (Stuck-- get it?? haha) Unfortunately more and more insurers are not paying for venipuncture. You have the option of sending the patient to the lab to get blood drawn if your doc is not happy, but then your patient will be not happy. Most reimburse $3 so it is not like losing a payment for an EKG or a procedure, although every $ counts. Ask your doc what to do.

Routine Annual Physical
Wed, Oct/27/2010 03:39PM
you may not have been exposed to the past practice of docs billing physicals as ill visits to get them covered. if the patient says they have chest pain, the physical becomes an E&M for 786.50.

Bundled Procedures
Wed, Oct/27/2010 10:21AM
it depends on your ICD code. Ear cleaning is generally bundled into an office visit, often even when the visit is for hypertension, diabetes etc. The best way is to be sure that the E&M is linked to the medical codes with -25 as you did and the ear stuff is linked to hearing loss or ear pain or impacted cerumen or all of them and then cross your fingers that the insurer does not bundle. If they do, it is probably in a contract somewhere that you signed that lets them do it.

Bundled Procedures
Wed, Oct/27/2010 10:17AM

Controlled RX
Wed, Oct/27/2010 10:07AM
no office visit, no bill. You are allowed to give 3 1-month prescriptions with the extra two stating "do not fill until" to the due date for filling per DEA regulations.

92526 in alf
Mon, Oct/25/2010 10:11AM
they treat that as a home and home care services like speech therapy should be arranged by a Home Care provider and billed by the Home Care company, not the individual therapists.

Prolinged service
Mon, Oct/25/2010 09:16AM
as long as it is face-to-face time. So if it is an asthmatic that you try to treat in the office with continuous nebs, and you stay with the patient, it counts. I would record the actual times and be sure your schedule does not have 4 other patients scheduled and seen in that time period.

Consult code
Mon, Oct/25/2010 09:13AM
1- Submit the consult to the commercial insurer and when the EOB comes back, change the code to the appropriate non-consult visit code (by reanalyzing the documentation to see what code fits) to submit to CMS. 2- Bill the whole thing with a non-consult code to both insurers.

Claim submission statute of limitiations
Mon, Oct/25/2010 09:11AM
depends on the insurer. Medicare is one year. As an aside, PQRI codes must be submitted at the same time as the E&M code is submitted; you cannot go back and submit those codes at a later date.

Hospice Patient
Fri, Oct/22/2010 04:18PM
if you are the patient's primary care doc, you can bill with GV modifier and get paid. If you ar the oncologist and are signng the hospice paperwork, you can also use GV. If you are the oncologist and the patient has a primary and his hospice diagnosis is cancer, you are out of luck.

e-Rx Penalty
Thu, Oct/21/2010 01:09PM
starting in 2012 it is a 1% reduction in Medicare reimbursement, 1.5% in 2013 and 2% after that

Two visits same day
Thu, Oct/21/2010 11:24AM
combine the services into one code

CPT code 94760
Wed, Oct/20/2010 04:43PM
have the patient come in to the office only for the pulse ox reading. No other visit, no other service. Then of course you would have to establish medical necessity. Consider the purchase of the pulse ox machine as just another fixed office expense, like buying a new BP cuff or scale.

99211 with Tdap?
Wed, Oct/20/2010 03:56PM
Medicare will not pay for the admin or the vaccine, (and tdap is not indicated for 65 and over). Using a 99211 is not allowed- there was no nurse activity beyond the admin of the vaccine. You should have them sign an ABN (just to cover yourself) and charge them.

Blood Transfusion
Tue, Oct/19/2010 08:35PM
It's a hospital code to cover the cost of blood and supplies, not a physician supervision code. What are the circumstances?

Tue, Oct/19/2010 08:30PM
but I figured it was a typo as the person appears to be a lay person (or maybe it was not wax - ewww).

average charges for 99201-99204
Tue, Oct/19/2010 03:33PM
One can charge as much as one wants to charge. No one pays retail price in medicine. Prices are set by insurers in a basically one-sided process unless you are a large group with sizable market share. And we are not allowed to share charges as that is considered price fixing and a federal crime.

Tue, Oct/19/2010 12:42PM
In short anything that is "done" to a patient is called surgery; the other choice is what we call an E&M visit- evaluation and management. You may want to ask the physician about changing the code to an E&M code. If you presented with "hearing loss" then the doctor did do an evaluation and it could be billed that way. If you presented with "ear clogged by wax" then the surgery code is correct.

inpatient consults
Mon, Oct/18/2010 03:42PM
if the documentation supports the visit and the procedure. A -25 to the EM would be appropriate. I don't think that is considered surgery so the "decision for surgery" -57 is probably not right.

Hospitalist monitoring a Nuclear Stress Test
Mon, Oct/18/2010 02:39PM
there is no code for this- in fact the cardiologist who reads the EKG portion and bills for that service is responsible for the patient and should be supervising it.

E&M visit same day as Bone Marrow Biopsy/Aspiration
Mon, Oct/18/2010 09:04AM
the general guideline is that if an appt is made to perform a procedure then you do not bill an E&M. The consent process is included in the procedure's RVU. If this patient has already been seen by the doctor, no E&M. If the patient was referred by a primary care doc for a hematologic abnormality and the doctor obtains a full History, performs physical, does medical decision making and decides to do bone marrow on the same day, then an E&M is ok.

history of polyps vs. screening colonoscopy
Fri, Oct/15/2010 04:00PM
the recommendation for colonoscopy is every 10 years if normal and every 5 years if polyps found. If the test is done after 5 years and the screening code is again used, will CMS flag those doctors as overutilizers? There must be some way to designate that the testing interavl is medically indicated....

94640, 94664, modifier 59 and 76
Fri, Oct/15/2010 02:11PM
94060 is pre and post bronchodilator so you can only bill once. 94664 is for teaching MDI use. Pulse oximetry does not get reimbursed if any other code is billed.

Abdominal wall mass
Fri, Oct/15/2010 02:07PM
49203-5? That is an endometrioma

minor surgery dermatology
Fri, Oct/15/2010 12:36PM
the diagnosis is established and the patient was sent specifically for the removal, not for an evaluation and recommendation

Signs/symptoms vs definitive diagnosis coding
Thu, Oct/14/2010 09:10PM
Who says you have to use only one? For the IV fluids, I would put dehydration as #1 but phenergan can be linked to either migraine or nausea with migraine.

Influenza Billing-incident to?
Wed, Oct/13/2010 03:28PM
If Walgreens can give and bill Medicare for a flu shot then you don't need the doctor

Wed, Oct/13/2010 03:27PM
or 10121

What is the appropriate ICD for heel pain?
Wed, Oct/13/2010 02:09PM
Use any of those codes- why the worry? The relative complexity of each code is equal so you are not going to trigger an audit if you pick the "wrong" one. If it hurts, it must have been injured/damaged/inflamed even if they do not recall the specific injury.

Rehab in a nursing facility
Tue, Oct/12/2010 03:42PM
If so, then use the SNF codes as you said- initial/subsequent.

CPT for Doc running a Code
Tue, Oct/12/2010 03:39PM
92950 if she ran the code. If the patient died, the doc could also use the discharge code 99238 since only the doctor declaring the patient dead can (and is the only one allowed to) charge the discharge day service even if they are not the one responsible for the discharge summary.

self administered drugs
Tue, Oct/12/2010 12:58PM
are you talking about hospital observation patients?

coordination of care
Mon, Oct/11/2010 03:28PM
but I can tell you I have never seen two doctors talking together for 25 minutes and if they did talk that long it was to trade stock tips, not to talk about a patient.

coordination of care
Mon, Oct/11/2010 02:36PM
But...if he is not seeing the patient for counseling, then he must be spending the time coordinating the care. So I would expect an auditor would want evidence of that- spoke to oncologist, reviewed scan with radiologist, etc. Developing a plan of care by looking at results and typing a note is not coordination of care.

Fri, Oct/08/2010 04:24PM
maybe. 309.24=Depression and anxiety that develop in response to an identifiable stressor that is beyond what is normally expected. So it depends on your definition of "simply stressed out."

H & P and Time frame question
Fri, Oct/08/2010 04:20PM
can't quite tell what you are asking.

If the facility requires an H&P by a primary doctor prior to a procedure and the patient has no medical problems, I bill the reason for the procedure and V72.84 with a consultation CPT code for commercial insurance. Medicare will not cover these exams but if forced to do it I bill 99213 and the same ICD codes.

The facility rules and JC determine the time frames. 30 days is usual and the doctor performing the procedure must sign that H&P just prior to the procedure stating there is no change in condition.

Local Anesthesia
Thu, Oct/07/2010 08:34PM
If so, never. If you mean the administration of the anesthetic, then also never. It is part of the procedure, unless you are treating pain and the anesthetic is the reason for the treatment.

What is the appropriate ICD for heel pain?
Thu, Oct/07/2010 08:31PM
plantar fasciitis since that is the most common cause of heel pain. 728.71; or you could use a pain in joint 719.4x code since the pain technically is from a joint not the heel itself

increase reimbursement rates
Thu, Oct/07/2010 08:28PM
Most reimbursements are determine by contracted rates. The biggest mistake I have seen is setting fees as a percent of Medicare across the board. Unless you pick a really high number you may be leaving money on the table. For example, you see a patient with Green Star/Green Shield Insurance. You do a mole removal and bill your usual $200 fee. They pay you $160 (80/20% plan) with $40 due by patient. Well, you just got paid 100% of your charge. What if you charged $220? $250? At some point they would adjust your fee down to the usual and customary for that plan and indicate a writeoff for you. So you want to set your fees so that every charge gets a writeoff amount. Remember that retail prices are only paid by self-pay patients (and there are ways to give hardship discounts to self pay.) So you can charge $500 for an office visit and a few eyebrows may raise but at least you'll get the maximal reimbursement every time.

stress test with contrast
Thu, Oct/07/2010 03:48PM
use it with the 93351 and the Q code

Discharge summary time
Thu, Oct/07/2010 03:44PM
to EMR's tracking times is that doctors overestimate the time spent doing things. I would bet that if we audit the times that most docs who report 99239 do not spend over 30 minutes on the unit doing the discharge- 10 min with the patient, 10 min on the unit dictating, reconciling meds, etc. Same as our use if time in the office- how can a doc seeing 40 patients a day spend 40 minutes with one patient???

Well Exams
Thu, Oct/07/2010 09:13AM
If whatever you use is causing trouble, use something else ;-)

I link the basic labs to the V70.0 except PSA to v76.44 and hemoccult to v76.41 and pap to v72.31. if it is a well exam and they are diabetic and hypertensive, I link the Hba1c to 250.00 and the urine protein to 401.1 since these are not normally part of a well exam. Payment depends on the insurer benefit- there may be a price limit so they pay up to $500, or a CPT limit where they only pay the 99395. And the biggest issue I have seen is insurers that only pay for labs performed on the day of the exam so if you have you patients come in a week early and get labs in preparation, you'll get denied. It's a guessing game really.

Discharge summary time
Thu, Oct/07/2010 09:08AM
please note that hospital discharge day management codes 99238 (30 minutes or less) and 99239 (more than 30 minutes) are time based so it is imperative that the medical documentation reflect the total time spent by a physician during the discharge of a patient.

I would interpret "reflect the total time" as meaning that it must say 35 minutes, 32 minutes, 45 minutes, etc.

elevated liver functions
Wed, Oct/06/2010 08:49PM
[794.8 says liver scan. I have been using 790.4 for elevated lab tests, is this incorrect/]

Abnormal liver function studies or scan. I use it all the time for all kinds of tests

Tue, Oct/05/2010 08:22PM
Because Xolair® is a monoclonal antibody, the use of CPT code 96401 is permitted.

assigning evaluation and management codes to the following
Mon, Oct/04/2010 01:51PM
I gave the 99211 to the foot dressing change. The lab test one got the venipuncture code only, no E&M.

assigning evaluation and management codes to the following
Mon, Oct/04/2010 09:03AM
with the details you give as representing the complete note:

99391, 99211 (I am not sure if the checkup means the doctor saw the patient), 36415, 99213

inpatient reimbursement
Mon, Oct/04/2010 09:00AM
If the CXR was done in your office on your equipment, you should get paid. If you sent the patient to the hospital for the xray and they bill for it, it will be bundled into the Inpatient payment as it is the same diagnosis.

entering multi diagnosis'
Fri, Oct/01/2010 12:29PM
Our system allows 8 codes; I bill 4 for the visit then the other four can be used to link to vaccines, labs, procedures. I have heard that the insurers only look at the first 2 codes for medical necessity and justification for the visit level that you charge but that's a rumor...

Fri, Oct/01/2010 08:58AM
The G8553 started January 1, 2010. You only need to report it 25 times on patients that eRx's were sent. (I'd report 30 just to be sure). The Feds figured out that f you are using eRx, you are using eRx and they don't need to see it on every claim. No more G4553 at all. If you used it in 2009, you should see a check soon - we just got our PQRI check.

Residents and Immunizations
Thu, Sep/30/2010 08:20PM
There is no E&M code for a vaccine- you bill 90471 and the code for the vaccine. Incident to applies only to visits. Now if you are asking about the order being cosigned, that depends on policy but residents are licensed doctors so they can order without a cosignature.

CPT 99217 (observation discharge code)
Thu, Sep/30/2010 08:18PM
[What if you're doctor is covering for another doctor who is out of town? Say Doctor A admitted the patient to observation on Monday, then went out of town that evening. Doctor B is covering for Doctor A. Doctor B sees the patient on Tuesday and discharges patient.

Doctor B will only bill for the discharge. Doctor A will only bill for the admit.

I know that wasn't really the question, but it is a possible circumstance. ]

What is the issue here? A bills Admit to Obs, B bills discharge from Obs. Two different days, two different docs, two different codes, no reason to worry. Now if Doc A admits in the am and Doc B discharges that same day, only one can bill the admit/discharge same day code.

device checks in the global period
Thu, Sep/30/2010 02:45PM
The global period applies to the doctor. If it is an outpatient, the facility may bill the code for the device check.

CPT 99217 (observation discharge code)
Thu, Sep/30/2010 02:43PM
I just heard Betsy speak- if there was only one visit with the patient then you would only bill the admit to Observation code and no discharge code. Admit and discharge wold only apply if the patient was seen twice in the same day.

CPT 99217 (observation discharge code)
Thu, Sep/30/2010 08:49AM
If the patient was discharged then they must have been admitted! The only circumstance is when a patient comes in late in the evening and your doc sees them in the morning and sends them home. IMHO that is an admit and discharge same day 99234-6 since I am doing the work of both the admission and the discharge.

Thu, Sep/30/2010 08:46AM
794.31 abnormal EKG will satisfy most needs- perhaps ICD-10 will be more specific

speed up reimbursement question
Wed, Sep/29/2010 07:43PM
What insurer? What specialty? In network?

Tue, Sep/28/2010 04:35PM
he can have one if there are indications for it. I would add the code to explain why it is being done under age 50- family hx CA, personal hx CA, etc in addition to the screening code.

New patient Physical w/ Problem
Mon, Sep/27/2010 04:37PM
New physical, established 99212 or 99213-25 for problem. We get rejected on the problem code if we try to use 99201-5. Also be careful with high level 99214 or 99215- that is an audit trigger since most of the work was done thru the physical.

New requirement documenting vitals?
Fri, Sep/24/2010 06:49PM
Height Weight BP and calculate BMI are all required to get paid for meaningful use. That is the latest "requirement standard" that I have heard. Who "informed" you? Perhaps that person can give you a reference if not meaningful use.

Documentation of chief complaint?
Fri, Sep/24/2010 04:47PM
anyone can document the Chief Complaint, only the provider can document the HPI. Is there really no HPI on some charts?

return visit to review abnormal lab
Thu, Sep/23/2010 07:22PM
I could see them bundling the result review office visit into the initial office visit but that is pretty brutal. What CPT codes did you use?

Wed, Sep/22/2010 04:09PM
Commentary- preaching to the choir- What difference does it make if there is a modifier or not? Tell the computers that it should pay 90471 and 90472 any time they are linked to a vaccine code. Done- simple-no questions asked!

Wed, Sep/22/2010 03:02PM
that is vaccine administration! If they don't want to pay, ask the patients with that insurance to bring their own needle and nurse and you'll hand them the vial!

Amylase & Lipase
Sat, Sep/18/2010 03:28PM
there are no LCD's for these tests. Not every test has a LCD.

Try here_ bookmark this one!! Try various tests- B12 has an LCD, CBC does, amylase does not

cpt code updates
Fri, Sep/17/2010 09:37PM

cpt code updates
Fri, Sep/17/2010 06:50PM
Is this a bet? CPT and ICD codes come from the AMA and are not federal regulations so the Federal Register has nothing to do with it.

Fri, Sep/17/2010 06:49PM
In fact, "non-contributory" itself cannot be used. You must actually review the items. "NC" = no bullet

Confused on low, moderate, high cpt
Thu, Sep/16/2010 09:01AM
Save me- quote the rules on medical decision making! I left my booklet at home.

when patient sees 2 physicians
Thu, Sep/16/2010 09:00AM
he should get better twice as fast!

If same group and same specialty, combine services and one visit code. If different specialties, can each bill for their service.

Critical Care with family meeting..
Thu, Sep/16/2010 08:53AM
[All of the patient in the ICU are critical ill, once they are no longer critical ill they are transfer to a regular the critical time for all patient that are critical ill is correct..]

This is not correct! I am sorry to be the bearer of bad news. There are many patients in the ICU who are not critically ill- the COPD patient stable on the vent, the acute MI post-stent being watched 24 hrs post-cath, the 3 day post-CABG patient, the post-colectomy whose surgeon wants him watched closely, the post-carotid stent, the GI bleeder who is no longer bleeding, etc. I would refer you to this notice which states "the presence in an ICU or the use of a ventilator is not sufficient to bill critical care services."

Critical Care with family meeting..
Wed, Sep/15/2010 12:40PM
First, I hope you are not implying that you bill the critical care code for every visit of a patient in the ICU. That is wrong.

Second, if the patient is not present, you can bill for hospital visits "time spent on the hospital floor and unit" but that cannot count to the critical care time- it is not critical care but routine hospital care.

So, really, you should bill 99231-99233 based on time spent for each of these days, documenting time in the chart, and if a patient is critically ill and gets "critical care" then bill the critical care code and not the other code.

Denial from MediCal
Wed, Sep/15/2010 12:34PM
Do you actually perform each test separately and not as a panel? If it is Medicaid/MediCal I would look closely at reimbursement to be sure you are covering your cost. I think they are seeing that a CMP would include the liver test, Glu and sodium so they bundle, the other two are not part of a panel so should be paid separately.

oto tech
Wed, Sep/15/2010 09:37AM
Incident rules do not apply to a tech performing tests. Incident rules apply when performing an evaluation/management. So the tech is doing the test but the doctor is interpreting the test.

CPT codes 45378 & 45380
Wed, Sep/15/2010 09:10AM

It's in the database and may answer your question and more!

Tue, Sep/14/2010 03:11PM
Can you drip in 5 ml over 20 min? Don't know why you'd do that- if it is to enhance revenue, don't do it. If it is a side effect issue, slower push.

Confused on low, moderate, high cpt
Tue, Sep/14/2010 03:06PM
if you let the docs decide. A surgeon called to see a 20 yr old patient with appendicitis is low level. A 90 year old with heart failure, on warfarin and home oxygen would get you complex. But again it depends on documentation in many cases. If all the surgeon writes is "Called to see pt- take to OR" as a consult, no matter what the history, its low level.

The CPT book used to have examples in the front for various visit levels- don't know if it is still there.

Trauma pt. case
Mon, Sep/13/2010 02:40PM
the ED doc consulted the Trauma surgeon to evaluate and admit the patient. It's an initial hosptial visit. She's the admitting/attending on the case. The orthopedist who is called by the surgeon gets to bill a consultation as does the internist. The trauma doc could have billed the ED consultation if the patient went home. If the patient is admitted, even with commercial insurance, no one bills an ED consultation.

ER cpt 99285
Mon, Sep/13/2010 02:36PM
it is the severity of the presenting problem that determines the level of visit. Any good EMR can generate a level 5 visit with a few clicks. So I agree with Nancy that shortness of breath could be a level 5 visit if a CT angio is done, cardiac workup is done and the patient goes home if all is normal, but that is the exception.

elevated liver functions
Mon, Sep/13/2010 02:33PM
Now I'll take ICD codes for $200 Alex

Comprehensive or Detailed History
Sat, Sep/11/2010 03:56PM
it counts. It would be better to indicate the date of the last one or add "no change" to the "reviewed" but I'm gonna side with the doctor here.

What say you Editor, coding audit queen?

Blood testing done for routine general physical exam
Fri, Sep/10/2010 01:48PM
you could use it for labs done prior to a visit for a V70.0 physical. The only reason I could see to use it is that it would allow the insurer to know that it was a visit for just a lab and not an exam (although the CPT should tell them that.) I have seen insurers that cover preventive at 100% but only one visit per year, so hopefuly the V72.62 will not count as that visit.

Pain management physician coverage
Fri, Sep/10/2010 11:21AM
Your internist is a licensed physician and surgeon and can bill for any service that is medically necessary and that he or she actually performed that met the standards of coding and documentation. But if the visit is within a global period and is for followup for the procedure then it would be fraud to bill for that visit.

bone density
Fri, Sep/10/2010 10:29AM
Are you saying that he writes 627.2 and you want him to write "menopause 627.2" on the order?

36415-MC denied as duplicate...
Fri, Sep/10/2010 08:59AM
if they denied it, but you got paid and spent $4 of your time trying to find out how to get $3 for one of your colleagues. So just be sure to get your claims in first and let the other office fight it out.

Was the other office same specialty? That always messes things up.

Medicare reimburesment
Thu, Sep/09/2010 07:08PM
What specialty are you/the other doc? What diagnoses? Office or hospital?

Coding blood work ordered in WWE
Thu, Sep/09/2010 05:20PM
V72.31, same as the pap smear. And I get paid. I guess you could link those labs to V70.0 but most (all) insurers recognize and pay V70.0 and V72.31 the same and consider it preventive care unless your patient is a man.

Thu, Sep/09/2010 02:55PM
giving a nebulizer treatment? That is 94640. The E code is if you are selling them the machine

Spirometry question
Thu, Sep/09/2010 10:00AM
It can be done in both situations- for chronic state measurements and if ill to see degree of airflow restriction. The code is the same for both.

flu shot and allergy shot with administration charge at same visit?
Wed, Sep/08/2010 02:46PM
admin codes are different- flu shot is 90471, allergy is 95115 or 7

Code for combo flu/H1N1 vaccine
Fri, Sep/03/2010 03:41PM
it is coded as a regular flu shot as in all other years since the H1N1 is just another component of the standard vaccine and there is no second shot; the H1N1 code of 2009 is now defunct.

Thu, Sep/02/2010 07:53PM
Don't know the answer but ...did Medicare forward the claim automatically to both secondaries or did you manually do it? And why is the patient paying for two secondaries?

96372 can we bill 2 on the same day?
Thu, Sep/02/2010 03:52PM
did you bill the same code twice or the one code with 2 units?

GYN exam with or/without PAP
Thu, Sep/02/2010 03:47PM
v72.31 and 9939x. That is what you are doing. Payment does not determine what you code, it is what you do that determines the code. Hopefully the other doctor codes a V70.0. And payment will depend on two things- benefits for preventive care and the patient's willingness to fulfill their obligation to you to actually paying the bill.

ear wash
Wed, Sep/01/2010 08:54PM
anyone can do it- I do my own flushes but my partners have their nurses do it and they get paid. But really that does not mean it is legal...

Biopsy after Heart transplants
Wed, Sep/01/2010 08:53PM
the coronary angiogram is the process of injecting dye in the coronary arteries to get pictures of the arteries. A myocardial biopsy is the process of taking a piece of the heart muscle for analysis. Both are done by cardiac catheterization, the process of advancing a catheter from a peripheral artery through the aorta to the heart. In the case of coronary angiogram, they catheter stops at the origin of the aorta where the coronary arteries originate. The catheter can be advanced into the left ventricle to obtain the biopsy. It's all semantics...

Wed, Sep/01/2010 04:15PM
if he is healthy and feels fine and calcium and magnesium is normal then the best answer is "don't test for it" If there are symptoms, then see an endocrinologist. It's too uncommon for a family doctor.

Wed, Sep/01/2010 09:52AM
Modifier -57 It is only used on procedures with a 90 day global period, per CMS, although this is not a CPT® rule. It is only used the day of or before a major surgical procedure. (For a minor surgical procedure, with 0 or 10 global days, no modifier is needed the day before the service, and a 25 modifier is needed the day of the service, if the E/M service was a distinct, separate procedure.)

Clearly an anoscopy at the time of a visit for rectal bleeding requires a 25 and not a 57.

PR codes
Tue, Aug/31/2010 08:12PM
Codes that are never covered by insurance and always patient responsibility? There is no such list- every insurer has different benefits, within each insurer there can be hundreds of plans depending on employer, etc.

Public Health Nurse
Tue, Aug/31/2010 06:47PM
you can only bill for the supplies- flu shot, glucose test strip, capillary blood draw, etc

Refiling a paid claim
Tue, Aug/31/2010 04:22PM
I am bumping it to the top to see if anyone can answer it- come on billers- someone out there must have refiled a paid claim to get more money!

Lipoprotein (a)
Tue, Aug/31/2010 04:20PM
Lipoprotein A is not widely accepted as a proven test therefore reimbursement may be sketchy. You certainly need a 272.x diagnosis to order it. I would get a signed ABN from the first few Medicare patients and see if it gets paid. I have not seen an LCD or NCD on it.

CPT Code 99051
Tue, Aug/31/2010 11:54AM
it is for regularly scheduled hours, not regularly scheduled appointments! Use it!

Mon, Aug/30/2010 08:51PM
it is a very rare problem where cells cannot properly incorporate carbohydrate. If your doc chose it, it was in error, perhaps 272.9

abnormal pap
Mon, Aug/30/2010 04:20PM
the first ICD for the CIN

Sinus Cocktail
Mon, Aug/30/2010 09:09AM
Is this injected? Sniffed? Squirted? Done in the office or is it a compounded med they use at home?

Family Practice
Wed, Aug/25/2010 08:53AM
if the resident was in OB rotation then it is an E&M with a modifier 57 that the decision to take to surgery was made at the time of the visit, assuming the attending's note meets the rules for supervising physician. If it was a FP resident that referred the patient to an OB then the FP resident codes the visit as an E&M and the OB codes a consult and 57 and the D&C.

Patient Medical Record Request
Wed, Aug/25/2010 08:51AM
You "own" the chart. The patient "owns" the information in the chart. She can access it but you should never give away the actual chart. If she wants to "see" the actual chart, you should have someone sit with her while she views it.

Welcome to Medicare
Tue, Aug/24/2010 03:36PM
that was 2009. Now it's G0402 and G0403- and it is 12 months!

Mon, Aug/23/2010 09:14AM
If your doc is signing the 485, you should keep a copy of the signed and dated form in the chart in case of audit. Signing the form implies that the doctor reviewed all the information contained within and agrees or made modifications. You should use date of service as the date it was signed (even though care has been ongoing prior to that date) and place of service Office. (Although I got one in the mail to sign and the patient had been readmitted to the hospital so the date I signed it was also a day he was in the hospital so I got denied. Don't know the official guidance on how to bill in that situation.)

Modifier 25 and 59 Questions..
Fri, Aug/20/2010 09:14AM
There are a lot of 99215 codes on that list. Are they really high complexity visits? Contraceptive counseling and abnormal pap do not seem to justify 99215 at face value... As to the modifier, for the 81000- no modifier, 96372-no modifier, 88143- no modifier.

I'll leave the surgical procedures to someone more knowledgeable.

Medicaid Coding question..???
Fri, Aug/20/2010 09:09AM
This is a screening test and a lifestyle issue and not appropriate to be performed with Medicaid/medicare coverage which does not cover infertility. There is no "test" for fertility. If she is amenorrheic and wants to know if she is in menopause then use 626.0 but asking her if her periods stopped would be a heck of a lot easier. And remind her that even 53 yr olds can get STD's and HIV so barrier protection is always a good idea if she is not in a monogamous relationship.

Thu, Aug/19/2010 07:55PM
but I suspect others will say no. And the differentiation is not the skimpy note but rather the intent of the visit. With the knee example, it could be a tear, could be OA, could be infection-all evaluated and treated differently. With a skin lesion, the plan is almost always "cut it out." So I still think there is an evaluation process and the doc has to decide on biopsy, excision, Mohs, etc. So if the note is " mole on face" and then the procedure, then no E&M. If "mole on face, irreg with growth, bleeds at times, poss BCC, discussed Mohs v. excision and repeat if margins pos" then an E&M is appropriate, IMHO.

G0431 QW
Thu, Aug/19/2010 10:25AM
the best answer is to use the Look It Up box to the left and put in the code. There are several previous discussions about this and easier for you to read those than to retype the responses.

Thu, Aug/19/2010 10:21AM
the referral- "eval and treat" or "please inject knee with steroid". I doubt a PCP would tell the doc what to do so it is more likely a referral for evaluation and if a procedure is performed then it can be billed. I would attach -25 to E&M.

May we get paid for cpt 99173 with any modifier.
Thu, Aug/19/2010 10:19AM
Kind of like charging separately for a blood pressure with a visit for Hypertension. The visual acuity test is an integral part of a visit for a sports Physical, eye complaint, etc. and is not paid separately. The equipment costs are minor and the time required is minor so IMHO it is not unreasonable.

CPT changed by insurance company
Tue, Aug/17/2010 03:09PM
includes payment for direct physician counseling to the parent about the vaccine. I would guess that they noted that most docs counsel during an office visit so it is included in the E&M payment and the patient is not seen by the doctor when they come in just for a flu shot. So if a parent wants to talk to the doctor about the vaccine and there is no other reason for the visit, you should schedule a regualr appt, bill a 99212 with documentation from the physician about counseling and time spent.

Medicare Wellness Exams
Tue, Aug/17/2010 09:13AM
At least 50% of my Medicare patients have 3 or more problems so no reason to use this code if I am getting reimbursed the same and doing more work. I will be anxious to see if I can bill this new type of visit and a 99214-25 visit on the same day if I address the medical problems and their "wellness."

Mon, Aug/16/2010 06:45PM
stick with the medical issue and tendonitis fits the bill. If you start trying to find a code for excessive video playing, you will end up with OCD or some psych illness and then the kid is labeled for life.

Sticky Situation!
Mon, Aug/16/2010 03:39PM
means one charge only. Depending on the problem and documentation, code a New Patient visit. You can count both doctor's notes. And divide the income as they want.

I don't keep patients who throw fits. Not "clicking" with a doctor s one thing; making a spectacle of it is another. If this was my practice, the second doctor would never have gone in; there would be no charge and the patient told that we cannot meet their needs and to kindly find another doctor/group. There will inevitably be a time when doc #1 is covering on a weekend/vacation and then the patient will start making unreasonable demands for another doctor, or worse get a lawyer.

Potassium Chloride Vs K-Rider
Fri, Aug/13/2010 08:49AM
unless they order K phos- when we write K rider is is almost always KCl (potassium Chloride) (Don't ask why potassium is abbreviated K)

Medicare Wellness Exams
Thu, Aug/12/2010 12:43PM
CMS is very good about putting out notices. You can google "CMS preventive examination" once in a while to see if anything new.

Coding of ESRD
Wed, Aug/11/2010 09:18PM
do you need to code it? Use all the other diagnoses- I am sure that the patient has many other illnesses

ICD9 for baseline testing prior to PE tube removal
Wed, Aug/11/2010 09:15PM
I would use the original diagnosis- Otitis, etc. that warranted the tube

soap note format
Tue, Aug/10/2010 06:51PM
you can take data from any part documented by the doctor to count ROS, assessment, plan. It is clear that fatigue is a subjective not objective. You can count it as a complaint

Nonphysician telephone services
Tue, Aug/10/2010 06:48PM
and no one will pay

Heart Failure?
Tue, Aug/10/2010 06:46PM

Diagnosis code
Tue, Aug/10/2010 06:44PM
is use the diagnosis of the disease- HTN, Diabetes, etc. For followup use v58.69

gyn exam
Fri, Jul/30/2010 05:06PM
that is the code I attach to the paps I send to Labcorp and they get paid. It is also the code that CMS advises to use when you perform a screening pap.

RN documenting the H1N1 vaccination
Thu, Jul/29/2010 11:01PM
be sure you give the VIS before the shot is given so they can opt out. The label from the syringe usually has lot, exp date on it so RN initials and location of shot are all you need. I think that a signed consent is not necessary- definitely not for adults, kids I'm not so sure.

Consultation-Non Medicare pt
Thu, Jul/29/2010 10:58PM
To quote Woody Allen- Take the money and run! Jut be sure the consult is not "see my previous consult"

Medicaid Denial
Thu, Jul/29/2010 03:48PM
who eliminated consultation codes? You can try initial hospital code 99222-3.

wart removal
Thu, Jul/29/2010 03:46PM
If the physician destroys fifteen or more warts (or molluscum), then use code 17111. Even if the physician destroys thirty-five warts, it is appropriate to only use the code 17111 a single time.

Out of network question
Thu, Jul/29/2010 03:43PM
since you are not in the insurance, you can draft anything you want. It might be better to work with the primary care docs to figure this out; the waiver is just going to create confusion and patients will not want to pay even if they sign. If there is a small volume, just eat the charge- it is only cognitive time you are giving up- no supplies. if you are giving away a lot of services then either join the network or ask the primary care docs to send those patients to the hospital for their ECHO's.

Out of network question
Thu, Jul/29/2010 01:48PM
It is not clear what "group" you read for. I assume you are cardiologists and a physician group contracts with you to read the ECHOs. They must bill for the technical component and you bill for the professional component. In that case the best situation is to both be contracted with the same insurers so you are both in network for the patients (or both be out of network so patients know they are responsible).

The problem you are having is that the patient's doctor is in, for example, Aetna, but you are not. The ECHO is done, the technical component charge is paid in network at 90% since it comes from their office with no deductible but your bill is charged to the deductible and the patient calls and complains (or just tears up the bill). It is up to your docs to decide how to handle this- in some cases the docs choose to collect what the insurance pays as an out of network provider and forget the rest (even if that means getting nothing) and realize it probably balances with the insurances that pay out of network docs at 100% of charges. Or you can try to collect from the patient and decide how hard to try. if they pay, great; if not then write it off. Last thing you want is to get the docs who send you the business to be mad at you for strong-arming their patients because you'll lose the ECHO business and the caths/ stress tests, etc.

Hope that helps.

ICD 9 code
Thu, Jul/22/2010 08:55PM
she is a carrier of the gene-the polymorphism is a genetic mutation, not a disease. For example, trisomy 21 is a genetic mutation- the disease is down syndrome. This really is just semantics but I stand by my code.

ICD 9 code
Thu, Jul/22/2010 02:41PM

Thu, Jul/22/2010 02:31PM
bill it! but some insurers will bundle it

billing for annual well woman visit
Tue, Jul/20/2010 08:43AM
If it is just a well exam, then V72.31 with the age appropriate CPT code 9938x to 9939x. As to billing for labs, if you are allowed to bill the insurer directly, then go ahead and bill for them and you pay the lab charage, You cannot do that with Medicare and many other nsurers forbid pass-thru billing. With Medicare you can bill a G0101 and a Q0091 but you can't charge the 9938x without a signed ABN.

If they also have a problem, like menorrhagia, that is addressed, add a 9921x code and -25 linked to that diagnosis.

Mon, Jul/19/2010 09:26AM
Or the primary care doc doing the pre-op clearance?

coding guidelines
Thu, Jul/15/2010 10:23AM
Sequencing what? Are you coding for doctors E&M or procedures or hospital?

documentation amendment
Wed, Jul/14/2010 04:35PM
I don't think it is in writing anywhere but the lawyers will tell you to tell the truth. If you omit something, add it at the end and reference where it belongs with a notation about being left out of the original note. Your plan makes perfect sense.

Welcome to Medicare Physical
Mon, Jul/12/2010 03:29PM

Can you bill two E/M visits same day same visit?
Mon, Jul/12/2010 03:24PM
both are E&M visits so you bundle them together. If the time spent face to face was significant, you can use prolonged services codes.

Are the Surgeon required to do an H&P?
Thu, Jul/08/2010 05:50PM
The surgeon is not required to do it. But let's talk more specifically. Joint Commission requires a H&P prior to a patient having surgery. That could be the surgeon doing an H&P or the surgeon requesting that another doctor do the H&P. But if a surgeon asks the patient's Primary care doc to do the H&P, then he is really asking for a consultation on the appropriateness of proceeding with surgery. But Medicare no longer recognizes consults so if it is a Medicare patient then we bill it as a subsequent visit. The global period does not include the primary care doctor's H&P/consult. So, a pre-op H&P serves several purposes- to document the need for surgery and the risk/benefit discussion (done by the surgeon), to document the ability of the patient to survive the surgery (from the primary care doctor) and to meet the JC and the hospital bylaws (done by either one.)

Can you bill two E/M visits same day same visit?
Thu, Jul/08/2010 01:56PM
if the visit was a for a routine physical and a problem. There you can bill the Preventive service (99391-7) and the E&M (99212-5) with a -25.

When we bill cpt 51729 along with 51700, the 51700 rejects as inclusive. Do you know what steps I should take to dispute denail?
Tue, Jul/06/2010 08:28PM
the bladder irrigation is an integral part of measuring the pressures. If your doc is doing it for another reason totally unrelated to the reason for the cystometrogram then bill with -59 but expect a denial and send records for the appeal.

Flut test
Tue, Jul/06/2010 12:09PM
it's a different CPT.

subsequent hospital visits 99231-99233
Tue, Jul/06/2010 12:08PM
[If the child is on a vent, wouldn't you be using the neonatal or pediatric critical care codes?]

Editor: A patient can be on a vent and not critically ill. The critical care codes, at least for adults, require a critical situation, not a critical setting.

Flut test
Fri, Jul/02/2010 04:07PM
not 91- you are correct! Search on influenza in the Look it up box to see previous discussions about this.

Credit for Independent Visualization
Fri, Jul/02/2010 04:05PM
At least they have interest in optimizing coding!

Thu, Jul/01/2010 04:02PM
on your workflow. Most docs do not have the desire to learn the proper modifiers so the billing staff assists. You can ask the doc if the E&M was separate from the procedure and warrants a -25. You should develop a working relationship with your MD's-we don't bite.

H&P prior to admission date
Thu, Jul/01/2010 12:20PM
The date and time of admission is the date and time that the admission order was written by the doctor and the hospital should be using this date and time. If they are using the time that the patient arrives on the floor then they are wrong (and losing money since a day starting at 11 pm is reimbursed the same as a day starting at 1 am).

You should talk to the hospital billing dept about this.

I am surprised that the clearinghouse knows what date the hospital submitted to the insurer as the admit date.

nursing home admissions
Wed, Jun/30/2010 02:54PM
they could be readmitted every 20 days and get a new initial visit. The yearly SNF H&P code can only be once yearly.

Wed, Jun/30/2010 02:52PM
Part of doing business. Be prepared to take heat from the doc but remind him that a violation is punishable by big fines or jail, especially if it is a sign language interpreter.

can cpt 99213E&M Low and 99396 est patient phys (preventive) both on one visit
Mon, Jun/28/2010 04:12PM
you can bill it and many insurers pay if the doc fixes her documentation to reflect the work she actually did. Like a diabetic, hypertensive patient in for a yearly physical has a BP of 160/100 and a glucose of 200. You are addressing the health maint issues but also doing significant work on the 401.1 and 250.02. If you document the separation in the HPI and the MDM sections, and link the codes properly you can bill for both.

Drainage Bartholin's Cyst
Mon, Jun/28/2010 03:40PM
The I&D for Bartholin's Cyst 56420 includes the placement of a Word Catheter. The supplying of a Word Catheter can be coded a 99070. All as per the 2009 ACOG "Components of Correct Proceedural Coding".

Pulse Oximetry
Mon, Jun/28/2010 11:40AM
bundled into the procedure. For a four hour recovery I would assume anesthesia was used so all monitoring is included. Pulse ox only covered if nothing else is done at all except the pulse ox check.

wound packing and draining
Mon, Jun/28/2010 09:00AM
in the E&M. The coding experts will have to address the issue of global periods. Since the ED doc billed for the I&D, she is subject to the 10 day global period. If you bill an E&M with the same diagnosis code you should be paid but I could see an insurer deny it saying that they paid the surgeon for the post-op care (and I am sure she did not use the modifier for surgery only). And daily visits may raise an eyebrow so be sure the notes justify the frequency.

Discharge from hosp, admit to SNF
Sat, Jun/26/2010 03:53PM
the requirements on that link are for SNF payment, not physician payment. For physician billing, you could consult the documentation requirements for the level coded by the doc. It is common for docs to use the hospital H&P and write an addendum to update the history and physical. That would be the lowest level SNF admit code. That being said, the SNF may require more by their own rules.

Vision and hearing
Wed, Jun/23/2010 03:25PM
so if the only way to get the visit paid is to not include the codes, then don't include them. But keep fighting with the insurer to fix their edits.

Vision and hearing
Wed, Jun/23/2010 11:46AM
Crap like this makes practicing medicine a pain! Coding a service even if not paid allows us to track it, run reports on those without it to call and schedule, etc. Denying the whole claim is outrageous! I would bet it is a Medicaid plan- they are the worst with making up their own rules. Talk to your provider rep.

is 90736 covered
Tue, Jun/22/2010 09:45PM

Simplicity probe
Tue, Jun/22/2010 12:14PM
I'll assume you are a pain clinc and do your own procedures in office and are not talking about the physician doing the procedure at the hospital (where the hospital bills for the supplies.) In general the parts are covered with the procedure. If you want to use something special that you definitelty know is not covered by the insurance, you need to look at your contract to see if you can bill the patient for non-covered services and if so I would get a signed letter from the patient that they agree to pay. For Medicare you need to use the official ABN form if this is a non-covered Medicare service.

critical care and cardiac cath
Mon, Jun/21/2010 07:20PM
Unless the patient had a cardiac arrest in the cath lab and required resuscitation that was unrelated to the cath (like if he coded when moved from the gurney to the table) but if it was a complex cath it is included. A cardiac cath requires "constant bedside presence" so you cant bill separately for this.

inpatient post op then d/c home
Wed, Jun/16/2010 03:43PM
need to see global period. Are you billing for surgeon? If still in the global, you cannot bill 99238 if you are the surgeon

Cpt 99051
Tue, Jun/15/2010 04:26PM
we bill it without modifier and my billing staff has not told me to add one.

Denial from CMS (MN) on CPT 92611 Fluoroscopic Swallow Study for Dysphagia
Tue, Jun/15/2010 02:08PM
Includes OT/PT/Speech/skilled nursing so the home care company should have provided the service. If you did a swallow study in radiology. that can be billed to Medicare.

Tue, Jun/15/2010 02:04PM
If so the Trauma doc uses the Initial Hospital codes; if sent home they use the ED codes.

Place of serivce code
Tue, Jun/15/2010 10:07AM
[You may need to change the procedure code. In the state where I am from, Medicaid follows Medicare guidlines. If that is true in the state you are in,the out patient codes to be used would be 99201-99205(new patient) and 99211-99215(established).]

With Medicare, those outpatient codes would be used by the Consultants who are asked to see an Observation patient. The attending uses the Observation codes.

Place of serivce code
Tue, Jun/15/2010 10:06AM
Medicaid follows its own rules, and it changes them whenever it wants, even on a daily basis.

I was denied for an Initial H&P on a patient in hemorrhagic shock from a GI bleed who was admitted to the ICU and died 18 hours later, on a ventilator. Bet you already know the denial "Hospital stay under 24 hours should have been Observation."

is it appropriate to charge an office visit(99211) when patients come in for protime checks?
Mon, Jun/14/2010 05:46PM
we always ask about bleeding and brusing and document answers and do vitals

Fri, Jun/11/2010 08:54AM
the ICD determines why it was done- so you can use 82272 linked to Rectal bleeding 569.3 or to screening V76.41 depending on the purpose. The take home kit is usually for screening V76.41 as is 82274.

Fri, Jun/11/2010 08:51AM
82272 for one specimen done using the card during an exam, 82270 for the take home kit where the patient collects 3 specimens on the card and sends it in; 82274 is for a immune hemoccult test- it's often a little vial with a stick. It also detects occult blood but with a newer technology and fewer false positives (also costs more but reimburses more)

Correct ICD-9 code
Thu, Jun/10/2010 02:51PM
787.6- incontinence of feces, as that is the result of decreased anal tone

Preventive and Sick visit
Thu, Jun/10/2010 02:49PM
new code for preventive visit, est code for sick part of visit with -25

Testosterone and Vitamin D
Thu, Jun/10/2010 12:02PM
For Vitamin D I use almost every diagnosis and get no denials- V70.0, 401.1, 250.00, etc. It apparently is the most ordered test in the country now!

For testosterone, you need a symptom- fatigue, impotence, sleep disorder associated with low testosterone levels for billing.

2 Visits in one day
Tue, Jun/08/2010 12:15PM
the second visit was just to schedule the D&E at the front desk or did she meet with the doctor and discuss the findings and the plans? If so then the two visits could be combined and coded as one visit, assuming the documentation is done.

medicare coverage for lab work
Mon, Jun/07/2010 09:14AM
What diagnosis code was used? The NCD clearly states every 3 months. Could they be short a few days? Is the lab being extra careful and requiring an ABN by all patients (which they should not do)? here is the NCD:

Sun, Jun/06/2010 06:48PM
What kind of infusion were you doing? Do you normally give medications intravenously? What specialty? Are you looking for J codes, or general guidelines?

medicare coverage for lab work
Sat, Jun/05/2010 04:20PM
I do it every 3 months on most diabetics and get no problems from the lab on denials.

Accident or injury diagnosis.
Tue, Jun/01/2010 07:17PM
Accident involving spacecraft- my favorite!

employed by Assisted Living Facility as a consultant
Tue, Jun/01/2010 07:12PM
Hospice medical directors cannot though

Prostate Specific Antigen (PSA)
Sun, May/30/2010 09:23PM
it is no longer a screening test- it is being done in response to an abnormal result- use 790.93 linked to the free PSA.

Prolonged services and Critical care
Thu, May/27/2010 11:49AM

it lists the codes that are eligible for using prolonged sevices

Prolonged services and Critical care
Thu, May/27/2010 11:34AM
can't be done- use the add on code for critical care- cannot link prolonged to critical care services- I'll look for the citation

Diagnosis coding
Wed, May/26/2010 07:54PM
the insurers look to match the diagnosis and CPT to see if they are "compatible". So a 99215 - level 5 established pt office visit with a 462 - sore throat - would raise a flag and could lead to an audit.

Tue, May/25/2010 09:45PM
20500 is bundled into 10060

Admission to the hospital
Mon, May/24/2010 03:39PM
The answer I think she was looking for is that the dictation should say "dictating for Dr X who has seen the patient and formulated the diagnostic plan" So if the patient was seen in the office by Dr Smith and he admitted the patient then use his name. If the patient came in thru the ED and Dr Jones was the doc covering the hospital patients, then use her name.

Fri, May/21/2010 04:46PM
In California the insurer must pay for the translator- you are very lucky. As to this patient, you are only required to use what the insurance provides; if the patient wants more, they pay. Of course the interpreter is going to tell you why you should pay for them and not trust Medi-cal.

Is 96365 a physician code or hospital code?
Fri, May/21/2010 10:05AM
The hospital charged $475-IV only, total bill was ~$1600 there was no breakdown of what was in the IV- maybe potassium. The insurance adjustment was down to $600 or so for the whole visit- my kid is worth that so I paid, and how can I complain when I work at a hospital that charges similar rates?

But I am going to fight the doctor bill- first of all the flu is not a level 4 ED visit and they should not be charging for the IV therapy- maybe this is my chance for a qui tam lawsuit.

Allergy, Asthma and spirometry
Thu, May/20/2010 01:39PM
She still has asthma so it is valid to use that diagnosis. The patient who controls their diabetes with diet still has diabetes.

Chemotherapy treatment rescheduled.....billing for drugs?
Thu, May/20/2010 01:35PM
this is outside coding but... who paid for the drug? I imagine the patient's insurance did if they got it from the pharmacy so they need to be notified that the drug they paid for was not going to be used. Especially if the next dose will therefore be coming up sooner than expected and that dose could be denied. how safe is it? Depending on how it was presented to you (packaging/seals/protections), is it safe to give this med to another patient? What about stability? Did the patient store it properly? Do you want to risk that?

One of the White House doctors was fired when Clinton came into office. The doc would not administer Clinton's allergy shots that he brought from Little Rock since he had no idea what was really in the vial, even though Clinton told him what it was and where it came from. The doc stuck by his standard that if he did not order it and mix it, he could not guarantee the safety and he would not give it.

And how can you bill for something you did not pay for? Urologists got in trouble for taking free samples of Lupron and charging patient's insurance for that med. That's is Medicare fraud- do not go there.

Chemo teach (98960)
Wed, May/19/2010 09:07PM
If you get audited and can show a schedule with one patient every 60 minutes and the documentation and diagnosis fits then you will be ok. If your doc's schedule for the day has 30 patients, they will know it is physically impossible to see a lot of 75 minute patients. The best documentation would include actual time "pt visit from 9:15 to 10:30 AM"

Chemo teach (98960)
Wed, May/19/2010 02:45PM
that code is for self-management teaching. You can use the prolonged services codes 99354 added to 99215 for 40 min plus 30 min.

Coordination of care code
Wed, May/19/2010 02:41PM
unless you have the patient in the office. I do my own auths while i am sitting with the patient (most are online these days) and if it takes a long time, I use time based coding with a note "took 25 min to get thru ins for MRI auth". It also shows the patient what a PITA it is to get them their needed tests.

Present on Admission status -- from a student working towards CPC
Mon, May/17/2010 04:33PM
what you mean by "retain the guidelines". I don't know coding lingo.

documentation guideline for refilling prescriptions
Mon, May/17/2010 04:07PM
That is up to the doctor. But there must be medical justification for the visit such as BP check, DM check, etc, not just refill med. There are some basic standards set by specialty societies such as TSH every year, DM checks every 3 to 6 months, etc. If refill visits are more frequent than that then there should be a good justification, such as a followup after a dosage change, or a known side effect that requires monitoring. There may be reason to see some patients monthly but that is the exception.

On the other side, if a patient will not come in for refills as the doctor requests, such as yearly, the doctor should discharge the patient from the practice.

Present on Admission status -- from a student working towards CPC
Mon, May/17/2010 03:53PM
You need to read the doctor's notes. If they did not document it then you cannot call it POA. Your hospital should be educating the docs on this and a system should be in place to cue the docs when a patient comes in with a foley or a bed sore to document it.

Atrophic vaginitis
Wed, May/12/2010 09:19AM
what's wrong with 616.11?

Atrophic vaginitis
Mon, May/10/2010 03:55PM
616.11? That will get your claim paid- if the insurer really wants to know the type they can request records.

difficult surgery
Fri, May/07/2010 04:38PM
-22? I would assume that a difficult surgery means it took a long time so prolonged service modifier would apply. You will likely need to send the op note to justify the service.

Fri, May/07/2010 04:28PM
I always struggle with that- I use 709.9- and have never been denied. You can't know if it is malignant or benign to better classify it.

Fri, May/07/2010 04:23PM
[How completely unprofessional this comment was.The patient asked for this test. No reason to blame the Doctor for everything. There was no symtons just routine. Is their a DX code for routine RPR?]

I am sorry if you were offended. As your clarification says, it was NOT a routine test as you first stated. The patient asked for it- they requested screening for a sexually transmitted disease. A routine test is a blood pressure, pulse, weight, BMI- something done routinely. That little bit of information would have allowed me to give you a better answer like V74.5 screening for Venereal disease or any of terri's codes, depending on the history.

Fri, May/07/2010 11:09AM
I'd be pissed if my doctor ordered an RPR as a routine test. (Do I look that sleazy?) There must have been a symptom or complaint to order that!

Voiding trials in a global period.
Fri, May/07/2010 09:33AM
the visit for the voiding trial is part of the global (and I don't think a doctor can get paid for letting a patient go pee- there is no modifier for multiple flushes, is there? ) but can they bill if they reinsert a foley catheter 51702 with the diagnosis of urinary retention?

cpt 99291 vs. 99281-99284 ERcpt
Thu, May/06/2010 02:49PM
bill critical care for all kinds of silly things- asthma, chest pain, CHF exacerbation, etc. They claim the rules do not require constant bedside presence as they do with Inpatient and the time they spend calling the specialists, reviewing tests, etc qualify and that they truly spend 60-90 min on each patient and that these patients are critically ill. I have no faith that they are billing correctly...but they are independent practitioners so it's their career on the line.

99214 AND 94640
Thu, May/06/2010 02:44PM
If the diagnosis has anything to do with breathing it should get paid (although the med may get bundled into the nebulizer treatment code)

rapid strep screen
Wed, May/05/2010 02:52PM
462- sore throat since a negative test means no strep and no 034.0, and I do not get denied.

Wed, May/05/2010 01:17PM
You can bill the E&M (perhaps a level 3) with -25 linked to the diagnoses that required eval and mgmt time, so perhaps acne would fit there. Documentation must show work done besides "Pt has acne- will do surgery," perhaps including developing a careplan, recommending skin products, prescribing medications. For the keratoses, in general the eval and mgmt service is bundled into the surgery fee since it is a simple evaluation.

electronic signature
Wed, May/05/2010 01:12PM
CMS is aware that electronic signatures are authentic and acceptable- your inclusion of the statement makes it double ok!

RN/MA documenting Exam/MDM
Wed, May/05/2010 11:25AM
there is a difference between performing and recording. Some physicians employ scribes to document the questions and answers and record their physical exam findings- this is allowed.

Coumadin Management
Tue, May/04/2010 02:43PM
the telephone management codes require a certain number of protimes every 90 days and most of my patients are on q4 week cycles so I can't bill it- the service is considered "bundled" into the E&M for the visits when you do see the patient.

So that is why you should buy your own machine and do protimes in the office! You also do not lose patients to followup- they walk out the door with their next appointment. I just had a guy who used a hospital lab for his protimes "disappear" for 6 months- he was great about testing then poof-gone. Ends up he lost his insurance and could not afford the hospital bill so he stopped going without telling us. If he had clotted off his valve or bled, we would have been liable for losing track of him. So now it's in my office or at a coumadin clinic or find another doc!

ABN forms
Sun, May/02/2010 12:34PM
[Can you use an ABN for a procedure/test being done that is not covered by an insurance company and the patient does not have Medicare?]

You should read the contract to be sure you can bill the patient; you do not need to use an ABN but it certainly is nice proof if the patient decides not to pay.

Home Health Care Oversight
Sun, May/02/2010 12:32PM
that the primary care doc can bill it since the surgeon billed the surgery! In my area, the surgeons don't sign the home care forms- they leave that to us. (finally they dump something on us that can be paid.)

Postobstructive Pneumonia
Fri, Apr/30/2010 06:57PM
there is such an ICD even though it is a common term. I would code bacterial pneumonia due to x bacteria/virus or whatever else they found on bronch. Or 482.9- it is specific enough for my needs...

follow up and admission
Wed, Apr/28/2010 08:16PM
Inpatient at one hospital then Observation at the next one? Not possible. The hospitals have to share to inpatient DRG - the second hospital should be Inpatient too. As to your question, one visit per day per doc in all settings.

ambulatory dysfunction
Wed, Apr/28/2010 09:45AM
Never heard the term...

Medicare consultation for pre-surgical evaluation "Clearance"
Tue, Apr/27/2010 08:33PM
1- Bill like this- V72.84, ICD for reason for surgery, ICD#1 of chronic illness #1, ICD#2 of chronic illness #2. So for a hypertensive, diabetic having a cataract surgery, 366.9, V72.84, 401.1, 250.00

2- yes, if the documentation supports 99214.

3- No, they do not

ABN forms
Tue, Apr/27/2010 02:56PM
you need a price- your lab should give you a price list. If they refuse to sign, don't do the test. They have to agree to pay. If you walk in a restaurant and tell them you are not paying, you don't get fed. An ABN lab test is no different. Remember the ABN is only for a test that Medicare is unlikely to pay for, not for every test.

Wound Vac
Mon, Apr/26/2010 05:36PM
the wound vac is rented or owned by the hospital. Placement of a wound vac is covered by the global for the surgery or as an E&M if no surgery performed.

Technical component/Professional Component
Mon, Apr/26/2010 03:32PM
If not, do what you want. if you see Medicare patients, get a lawyer- really. I am serious. Get a lawyer. Nancy's link shows you how complex this is and if you read that and did not get your answer, then get a lawyer. No one here will tell you to go ahead. Really- get a lawyer!

-25 modifier
Sun, Apr/25/2010 07:23PM
First, you saw the patient for a painful breast or a lump or a red spot; if you saw her for an abscess, then the diagnosis was already known and there is no justification for an E&M, you just bill the procedure. Some even argue that with obvious things like abscesses or thrombosed hemorrhoids you cannot justify an E&M (but disagree with them.)

So assuming you document the E&M properly with a history, PE, and plan then do a procedure, you do not need to have a separate note, just a clear delineation in the note of the procedure with the usual "Procedure: I &D- after informed consent, the area was cleaned..."

G0431-QW Unbundling/Billing
Thu, Apr/22/2010 08:54AM
is a one-time code for a test that tests multiple drug classes at once. I interpret that to mean one strip has 5 or 10 or 11 little boxes that detect that many drugs. This is opposed to the previously discussed G0431 which is one drug class per test strip so you have to dip 11 different strips in the urine and can be billed out 5 or 10 or 11 times. It seems to boil down to supplies- G0430 if you use one test strip, G0431 billed x times if you use x number of unique strips. (Of course I am just a doctor and could be totally wrong)

Wed, Apr/21/2010 04:23PM
but if the patient has commercial primary insurance, then bill a consult code and rebill Medicare as secondary with the appropriate new patient code.

DX coding...
Wed, Apr/21/2010 11:54AM
It depends if the cancer diagnosis was considered by the doctor in their thought process. If the cancer was 3 years ago and you are doing surveillance visits and the patient comes in with food poisoning, i would not list the cancer as a diagnosis. If they came in 2 days after chemo or with bone pain and blood in urine, then the cancer is a pertinent diagnosis and should be listed

G0431-QW Unbundling/Billing
Wed, Apr/21/2010 10:23AM
G0431 – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class

seems to suggest that each drug class gets a "point" so if you have 5 classes then bill 5 units

Technical component/Professional Component
Wed, Apr/21/2010 10:06AM
This is tricky stuff! The relationship between you and the radiologist must be clearly defined to allow you to bill for her services. This is a Medicare Stark issue and cannot be answered here. We do not have the resources to visit you in prison if we give the wrong answer.

leaving hospital against medical advice
Mon, Apr/19/2010 12:37PM
The status should be based on the intent at the time of admission, not the fact that the patient left after a day. The hospital can choose to fight it but if the hospital wants to bill Observation, you should do the same- the payment is equal.

What to do with a 5 year old child in coding
Mon, Apr/19/2010 12:28PM
The doctor's note should state "referred to me by Dr X for eval of heart murmur." You can also call the Primary doc and ask for a copy of the note or send them a form to fill out. I am not sure what the second part means....are you working on a psychology PhD?

Sat, Apr/17/2010 04:29PM
Stop showing off and stealing the medical questions!!!!! ;-)

Fri, Apr/16/2010 03:44PM
and that must be a bad thing if they will not even give it a code! Perhaps you should have the patient sign an ABN

pre hospital billing
Thu, Apr/15/2010 03:20PM
first the guy had an MI- that's not trauma; second I cannot see a trauma surgeon riding around like that without some sort of compensation for his time. It is also an issue of malpractice- who is the employer at the time of service? Now once he steps out of the ambulance and into the ED, it is different. I would suggest you consult your specialty society on this one.

Thu, Apr/15/2010 03:16PM
we do a T- transglutamase antibody IgA blood test and if that is positive they go to GI for an endoscopy. What are you ordering?

leaving hospital against medical advice
Wed, Apr/14/2010 04:41PM
and you should get paid. No special designation for AMA on the claim. But I hope the doc wasn't the first one to find her gone. If the insurer denies the claim, bill the patient! (You won't get anything except the satisfaction of billing someone with Medicaid but that is priceless)

J code
Mon, Apr/12/2010 12:02PM
this is for oral drugs? The dosing mentioned seems to be IV doses.

blood work
Sun, Apr/11/2010 07:32PM
if you build up too much. It is a measure of the kidney's ability to filter. As the kidney fails, the creatinine rises. It can also be elevated from many other causes, including dehydration and some medications.

G0402/medicare preventive
Sat, Apr/10/2010 08:38AM
(Ignore the warning that pops up- it is safe)

medicare claim
Fri, Apr/09/2010 09:45AM
I can see a 75 yr old diabetic, hypertensive, hyperlipidiemic patient with leg pain and chest pain warranting a 99215, but I probably would not throw her up in stirrups for her pelvic at that visit.

injections for medicare patients
Thu, Apr/08/2010 02:30PM
We get $4.22 as the allowed amount from Medicare. It's April - sure it was not applied to deductible?

36415 GLOBAL?
Thu, Apr/08/2010 01:48PM
1- If you are billing for the labs and making money, consider the write-off as the cost of doing business. 2- Complain to the insurer, if you can actually get a human on the phone that cares at all about you. 3- If the lab is billing for the tests, then you have nothing to gain by drawing the blood besides decreasing our productivity. So for those patients, hand them a list of the draw sites for the lab and a prescription to have the labs done and a letter telling them that their insurer no longer pays for them to have their blood drawn at the office and give a number to call at the insurance company to complain.

BRAC testing
Wed, Apr/07/2010 10:22AM
There are two choices- you can bill it out as you are doing or let Myriad bill it out. The test is $3,500 and if the insurance denies it you are at risk for the cost if you bill it. I would not risk it- I would bill the E&M for the counseling and let the lab bill it out. The other option is to refer to a genetic counselor for the counseling and testing. That is actually the best option as they are trained to interpret the test and explain the results and counsel on who needs to be notified- family, etc as there is a liability involved with this test.

Tue, Apr/06/2010 03:34PM
I would use the place of dispensing- the office

medicare claim
Tue, Apr/06/2010 03:33PM
you do not for Medicare

Chemotherapy infusion done in a facility setting
Mon, Apr/05/2010 06:56PM
there are no rules at all about that- the physician does not have to be anywhere near the facility; the facility just needs a valid order for the infusion. I order Reclast, blood, antibiotics without being there.

Mon, Apr/05/2010 03:52PM
Medicare does not cover routine urinalysis, nor is there a medical indication to obtain one "routinely". If the patient has HTN, or Diabetes then link to that diagnosis

Sat, Apr/03/2010 10:30PM
Medicare is a national insurance- the bills may be paid by different entities depending on state but you always send the bill to the intermediary for your state and they will figure out who pays it. The snow birds who have a permanent address in the north but have doctors in Florida and Arizona for winter have no issues with their bills. Providers are contracted with Medicare nationally- all or none.

Code for lacunar stroke
Fri, Mar/26/2010 11:22AM
Nancy, Why would they deny a valid 5 digit code?

CPT CODE for td shot
Thu, Mar/25/2010 08:42PM
and the admin code 90471

Deaf pt
Thu, Mar/25/2010 08:53AM
We do not give away communication for free! That is all I get paid for- I am a cognitist. I think and I advise. The modifier 22 is for procedures that are extended like a simpl ehernia repair that ends up not so simple. Time based coding is used all the time- a patient with new cancer, an newly diagnosed HIV patient, a diabetic starting insulin, etc. I never use a 22 and all I am doing is communicating!

preop exams
Thu, Mar/25/2010 08:48AM
I should have said that the other option is to bill the surgical diagnosis then the V72.84, such as cholelithiasis 574.21, V72.84.

preop exams
Wed, Mar/24/2010 08:44PM
All you can code is v72.84- preop examination and link it to the office visit and the EKG. You can code the office visit as a consultation (if not Medicare) if the patient was sent by the surgeon to you for pre-op clearance. If it is hospital policy and no request from the surgeon, then use the regular office visit codes. Hopefully the insurer will cover this without a medical diagnosis-some see the V code and consider it a screening visit and don't pay and then you have to bill the patient. These are frustrating since as internists we know there is little (or no) value to pre-op exams on well patients and the hospital's pre-op questions will discover any potential troubles. Pre-op exams on cataract patients really bother me- I document "the patient has a heartbeat therefore he is eligible to undergo cataract extraction."

2 consults on same day
Wed, Mar/24/2010 03:13PM
as long as they are different specialists as recognized by the insurer. If not, Mayo Clinic would not exist.

Deaf pt
Wed, Mar/24/2010 09:41AM
Why can't a doctor use the prolonged service code if the service is prolonged? If you document the time and meet the standards then you can bill for it. But if the reply was saying that just because you had to pay for a sign language interpreter you are entitled to use these codes, then I agree- No.

Percutaneous procedure in OR
Tue, Mar/23/2010 08:00PM
I have never heard of an OR "Staff" asking for a guarantee of payment. Aren't they paid by the hospital? The anesthesiologist can file his own professional charges for the services rendered. Now if the "hospital" is asking for a guarantee then they should contact the insurer to get pre-certification.

That being said, a kidney biopsy is generally a semi-elective procedure and if the patient is on observation status it is most likely for another reason than to get the get the biopsy performed. Also it is unusual to have an Observation patient in an ICU- ICU's are usually for sick patients and Observation is to determine if a patient is sick enough to be in the hospital at all. And while it is convenient for the physician to do elective things while a patient is in the hospital, it hurts the hospital financially since they are usually paid per day or per admission, no matter what is done. So if they did elective kidney biopsies in every kid in the hospital for asthma then the OR costs, path fees, longer LOS, risk of complication would eat up any potential profits. We in case management call this the "While you are here" phenomenon.

Make sense?

Sun, Mar/21/2010 05:30PM
I am sure the surgeon saw the patient in the office prior to the surgery so that is the consultation. On Post-op days, the surgeon or surgical residents cannot bill for visits as they are part of the global, but an internist or endocrinologist could bill for visits. The first visit would be a consultation with the outpatient codes and the subsequent visits would be subsequent outpatient visits. Thyroidectomy is not an "Inpatient Only" surgery if done by the standard approach so if the patient was kept for patient/surgeon convenience then the hospital cannot bill for Observation or Inpatient care. I assume that is what your SPU is for-outpatients kept overnight- we call it Extended Recovery. If the patient was still in the hospital on post-op day 2, then perhaps Inpatient care is warranted when the patient's condition changed and an order for such should have been writen- perhaps they developed hypocalcemia.

Fri, Mar/19/2010 11:47AM
Don't know that abbreviation...and what insurance? is your doc the surgeon? What do you mean second post-op day? what was procedure?

Two E/M Visits/ Two Specialties/ Same disgnosis and Date of Service
Tue, Mar/16/2010 05:17PM
They both should get paid for the initial visit even if on the same day. Now you may get a rejection on subsequent visits as there is no medical necessity for two docs to treat the same condition.

initial visit
Mon, Mar/15/2010 06:13PM
I thought the reciprocal stuff was for locums doctors who are "hired" to see patients for a fixed period, not weekend visits.

Ooops- that's a Q6- found it.

But you are making this way complex- why not just bill for who you see???

93580 FDA Approved?
Mon, Mar/15/2010 05:53PM

Common Medication Listing
Sun, Mar/14/2010 02:37PM
I think your best bet is to Google "Ton 10 prescriptions" unless you are looking for a specific type of medication. Here is Blue Cross' list-

Electrocardiogram and office visit
Sat, Mar/13/2010 08:45AM
We have never had trouble getting both paid. Are you linking to proper diagnoses (or "medically necessary" in Nancy's terminology)? The bone density cannot be linked to HTN or DM or whatever, and it must be 1 yr 11 months since the last one. Likewise EKG's need appropriate diagnoses- HTN, CAD, etc...

E/M visit and office procedure - same day
Thu, Mar/11/2010 03:30PM
1- document to prove you did it for auditing and document to prove to a lawyer you explained risks and benefits and did it right. 2-The same page is fine as long as there is a clear separation of the E&M and procedure. I have done ear washes and in the Exam I write "wax occluding canal. Ear lavage with warm water performed with syringe and great difficulty and large amount cerumen removed. TM now visible and normal" and I bill for E&M and lavage.

Who is authorized to change patient status?
Thu, Mar/11/2010 03:25PM
First, this applies to Medicare only- commercial insurers are separate. It always needs a physician order to change status. Any doctor on the case can change the status. Going from Observation to admission just requires an order "Admit as Inpatient." If the patient is admitted as Inpatient and should be Observation then a physician member of the UR committee must make a determination that the status is wrong and the attending physician must be notified of the change. If the attending agrees, then the status is changed and Condition 44 is invoked with notification of the patient that they are now Observation. If the attending does not agree then a second member of the UR committee is called and if they agree then the patient is changed to Outpatient, with the hospital unable to bill for observation hours but can bill for the other services provided.

Clear as mud? (You all probably didn't know I am also a case management expert!)

Medical Management of a post op pt
Wed, Mar/10/2010 04:47PM
I should add that you never want to use the diagnosis code that applies to the surgery (OA hip, cholecystitis, colon cancer, etc) - that is sure to generate a denial as the surgeon is getting paid a global fee for that diagnosis.

coding for ANA and Mono
Fri, Mar/05/2010 06:15PM
usually code the symptoms- fever, lymphadenopathy, or mono. For ANA again the symptoms- joint pain, rash, etc. or of course Lupus. Need the numbers?

discharge doding
Fri, Mar/05/2010 03:59PM
[ The answer is: tell them to do their own discharge services]

Or tell the hospitalists to code that day on time 99233- dictating summary is actually quicker than writing a long note and legible, easier to code for the coders at the hospital to capture all comorbidities, more complete for post-hospital caregivers thereby preventing readmissions, able to be sent to the primary care doc therefore pleasing your customer and can end with "25 minutes spent on care at bedside and unit."

coding for ANA and Mono
Fri, Mar/05/2010 03:56PM
We order a serum mono test 86308; There is a waived rapid mono test too - just add QW. As to ANA, what is in your "panel"? ANA is 86038.

Thu, Mar/04/2010 05:31PM
It is a new code to me- insurers do not publicize this code (surprise!) and my quick search finds mixed results to coverage so go for it and report back on your luck in getting paid.

Hospital observation
Thu, Mar/04/2010 01:05PM
I am waiting for the uproar when the Medicare Contractors start to compare the hospital billing to physician billing and start rejecting physician billing for wrong place of service or visit type. I would bet most doctor offices do not code consultations on Observation patients correctly, and certainly not since the new elimination of consult codes.

Catheter removal in ED
Wed, Mar/03/2010 07:02PM
but I would code the diagnosis as the reason for the catheter and code an ED visit based on the usual MDM standards; there is no code for removal of foley catheter (not should there be one- it is simple)

new / established patient
Wed, Mar/03/2010 05:07PM
[ CMS did clarify that if the initial hospital service done by a consultant did not meet the criteria for a 99221, bill with subsequent hospital visits, even if the initial was not billed by that MD. ]

Do you have that in writing?

new / established patient
Wed, Mar/03/2010 03:51PM
[The initial hospital services codes can be used as often as the patient is admitted: now, by the admitting physician with the AI modifier and by the consultant without a modifier. If a Medicare patient is admitted in June, and cardiology is consulted, bill with 99221--99223 series of codes. If readmitted the following June, and cardiology is asked to see the patient, bill again with 99221--99223 series of codes. New or established is irrelevant, because the initial hospital services are not defined as new or established.]

Editor- Are you sure about that 221-223 receommendation? What about the low level visits??? I thought you were suggesting the use of the subsequent codes for initial visits that don't meet for 99221 ;-) Any word from CMS?

clinical trials
Tue, Mar/02/2010 10:37PM
thankfully but why would you be legally obligated to notify them? If you do not charge the patient for any service you do not have to notify the insurer- they are there to pay medically necessary bills not to provide medical oversight to the patient. They are not guardians for their patients. But do not bill for services provided in conjunction with the clinical trial and keep very clear separate records if the patient is in a trial and concurrently treated for non-trial related conditions that do get billed to the insurer.

Tue, Mar/02/2010 05:39PM
the diagnosis code of the illness that caused them to miss work since you are reevaluating to assess the resolution of that illness. I don't use a V code.

Tue, Mar/02/2010 03:53PM
in that when RVU's are set, it takes into account the resources needed, the costs of the supplies, the expertise, etc. If your techs are fast and crank them out, you can do more per hour and make more money but if your techs are slow then you cannot add a modifier to get paid more per test to account for that.

Pulse Ox 94760
Mon, Mar/01/2010 05:22PM
is only paid if nothing else is billed the same visit, if at all. It is bundled into every other service

diagnosis coding from Medical History
Thu, Feb/25/2010 01:41PM
if they are addressed. Just listing does not count- so "reactive airway- mild intermittent" is ambiguous; it would be fine if it said "reactive airway-now mild, intermittent"

diagnostic vs screening colonoscopy
Wed, Feb/24/2010 04:11PM
is she screening for colon cancer or evaluating for a cause of the constipation? Or base it on what the patient asked for- that way if there is variable insurance coverage (one gets covered better than the other) you can fall back on "but that's what you wanted us to do"

chronic gastritis
Tue, Feb/23/2010 02:18PM
Atrophic gastritis is a specific entity and not common. 535.40 is for the garden variety gastritis they find on almost every EGD these days (is it our lovely American habits?)

G0101 and Q0091
Mon, Feb/22/2010 04:50PM
No need to use it for either code

can anyone comment on the way to correctly Medicare secondary for a consult with BCBS being primary?
Mon, Feb/22/2010 09:09AM
Bill a consultation for Blue Cross then recode the visit to an appropriate level for Medicare (inpatient-3 choices of codes or outpatient-new/est- 9 choices of codes) and send the bill to them. Unfortunately you cannot crosswalk from a consult level x to Outpatient level x or y so technically you have to go to your chart and count bullets, etc. In reality I would say most are going to just guess.

CAB surgery golbal billing
Thu, Feb/18/2010 01:01PM
that critical care billing requires an acutely critically ill patient, and a post-op CABG patient is certainly ill but does not meet the standard for critical care services- unless things go bad. So let's say Dr A did surgery and Dr B rounds the next day, adjusts drips, examines patient, orders blood products- that is a service in the global period. If Dr B is called in and the patient is hypotensive with desaturations on the ventilator, spiking a fever, requiring Dr B to stay in the unit and supervise treatments minute by minute, that is a critical care service.

Thu, Feb/18/2010 12:54PM
I might do a fingerstick 82962 and when it is an unexpected result then confirm it with a venipuncture obtained blood glucose 82947. A modifier sounds like a good idea to me.

Arthrogram coding
Wed, Feb/17/2010 02:58PM
I think by my source for injection itself

modifier -25
Mon, Feb/15/2010 05:49PM
cause no one pays for pulse ox- you may jeopardize your payment for the office visit by billing the pulse ox- the insurer may pay the pulse ox and write off the visit!

Initial Preventive Physical Exam
Mon, Feb/15/2010 04:51PM
The only new thing is that the EKG is no longer mandatory as it was in the past. G0403 is the EKG code

seizure vs epilepsy
Mon, Feb/15/2010 01:35PM
a seizure can be an isolated event from head trauma, alcohol withdrawl, medication interaction, a vagal response (people pass out with blood draws and start twitching) etc. and may never recur. Epilepsy is a chronic illness of recurrent seizures, even if many years apart, that requires monitoring and usually medication. Medicolegally a big difference.

Newest crosswalk for MCR consult codes
Mon, Feb/15/2010 01:26PM
Where did you read that about 99251 fromCMS?

2ndary, tertiary insurance pmts
Mon, Feb/15/2010 01:23PM
You'll need money to buy cigarettes in prison. From your question, it sounds like the full balance due was paid by Primary and secondary. So the tertiary should not have owed anything. I would return it ASAP.

Outpatient Referrals/Authorization
Fri, Feb/12/2010 09:22AM
It is assumed that the coordination was part of the visit that discovered the need for infusion, transfusion, etc. So if the doc spends 30 min on the phone setting up the admit, writing orders, etc while the patient is there, code the visit by time

2010 Consults - NON Medicare
Thu, Feb/11/2010 02:11PM
Your posting is exactly why CMS is eliminating Consultation codes- no one really understands when a consultation is a consultation and not a referral to assume care. The commercial insurers will follow soon so don't kill yourself trying to figure it out.

But if you must, type Consultation into the Look It Up! box and browse the articles.

Home visits and Assisted Living Facility urodynamics and PFR
Thu, Feb/11/2010 10:55AM
If you own the machine and there is a code for global service, you can use it. If there is also a visit to address other issues, put a -25 on the visit and link to the proper diagnosis. I am assuming this is not a SNF where the facility is responsible for all non-MD services.

Modifier 90 on Hospital lab send out
Tue, Feb/09/2010 03:18PM
-90 is for a lab to use when it sends a specimen to another lab for a test they do not do. It is not for a doctor office.

Two doctors on the same day
Mon, Feb/08/2010 06:21PM
Appeal these- you were consulted and deserve to be paid. Once again, this is a situation where "it has always been done this way" no longer makes sense in our current health care crisis. Think about it as a taxpayer since we all pay for Medicare- do you want your taxes going to two doctors to treat the same illness? As the specialist, if this continues to happen your doc should give you the referring doc name and you need to coordinate your billing with their billing. Once they call you, they relinquish the right to use that code.

Two doctors on the same day
Mon, Feb/08/2010 03:32PM
It is what I said- you are both billing the same diagnosis. I did two things to prevent denials- 1- Get my bill in FAST and be the first to use a diagnosis (let the rich specialist get the denial) and -2-if I called a consultant, I did not use their diagnosis. So for the stroke patient, I would bill their hypertension, diabetes, other things I was actively managing to avoid an overlap of diagnoses.

Mon, Feb/08/2010 10:18AM
It depends. Was the lab ordered for routine monitoring as with a lipid panel or to evaluate a new problem like a fever or pain? The first is not a workup, the second is.

Billing MSP
Sat, Feb/06/2010 06:09PM
You describe it perfectly; I have no idea what a commercial insurer would do with an -AI but why take the chance? Remember that Medicare will process claims without the -AI since they really can't know who is the primary doc, and that there is no direct crossover from consult codes (5 choices) to Initial codes (3 choices) so you have to either guess or go thru the note and see what the documentation justifies when you make the switch.

Billing Medicare For Clia Waived Labs -- AMCC Panel Payment Algorithm
Fri, Feb/05/2010 06:35PM
call the Piccolo rep

Billing Medicare For Clia Waived Labs -- AMCC Panel Payment Algorithm
Fri, Feb/05/2010 08:53AM

Billing for Medical Director for Cardiac Rehab
Fri, Feb/05/2010 08:48AM
The doctor should be getting a stipend for serving as medical director or have it as part of her employment contract. She certainly cannot bill the patient's insurance plans for this. The only stand-by coding I know of is for pediatricians for high risk deliveries. If your doc teaches a group class, there are ways to code for "group visits" but I don't know details.

Two doctors on the same day
Thu, Feb/04/2010 05:49PM
Who are the docs? Same specialty? Same group? Billing with the same diagnosis? If you were denied, call the other docs and find out what ICD they billed.

Years ago when Gail Wilensky was head of CMS a memo came out that only one doctor should be billing per diagnosis in a day. So if the primary consults endocrine for diabetes, the internist should not bill for Diabetes.

coding hepatitis diagnosis
Thu, Feb/04/2010 03:28PM
Elevated LFT's? 794.8--- or chronic hepatitis on the biopsy? 571.49

Can you bill for supplies used for office procedures? I'm wondering about ear tubes and also a septal button. Do insurances pay for code 99070?
Thu, Feb/04/2010 03:23PM
and if they pay then you win. if not, write it off.

Billing for Medical Director for Cardiac Rehab
Thu, Feb/04/2010 09:00AM
Can you bill for what? His teaching the class? What is the class? Who are the students?

90470 and 94071/90472/90473/90474
Tue, Feb/02/2010 09:52AM
H1N1- 90470 seasonal flu- 90471 pneumovax- 90472 (as the first add on to 90471)

pap dmear on post hyster patient
Mon, Feb/01/2010 12:06PM
skip the V88.01- the V76.47 code is in the CMS list of approved codes for paps so there is no reason to dirty the water with the other code.

88305 and Modifier 90
Mon, Feb/01/2010 09:00AM
It depends on California's rules on pass through billing. Some states clearly say this is not permitted; California is pretty progressive so I would think they have addressed this somewhere. Ask your medical society. But -90 is reported by labs when they outsource the test to another lab.

Other ins using Medicare Guidelines for Consultations
Sun, Jan/31/2010 09:22PM
The certificate is bad but then again so is UHC. I get the same error and clicked thru it and I am still alive and my computer works.

Here is the pertinent paragraph; For UnitedHealthcare Medicare Solutions, including SecureHorizons®, AARP® MedicareComplete®, Evercare®, and AmeriChoice® Medicare Advantage benefit plans, these plans will follow CMS regulations and implement the change, effective January 1, 2010. The change also includes the revalued relative-value units (RVUs) for E&M CPT codes and a new coding edit, consistent with CMS, to deny the CPT consult code as a non-payable service.

Other ins using Medicare Guidelines for Consultations
Sun, Jan/31/2010 11:57AM
the link below is United Health's memo about it. They will continue to honor for commercial plans but follow CMS for Medicare HMO's. I think the ithers are also obligated to follow the CMS directive.

Recertification for Home Health Services
Fri, Jan/29/2010 12:16PM
Go figure....many commercial insurers do not pay this. Even though the patient is on home care does not mean they cannot come in to the office for a visit that can be charged.

Thu, Jan/28/2010 08:39PM
[ we all know that the breasts are not a part of the pelvic area. ]

You haven't seen the women on the website - there are some breasts that get awfully close to the pelvic area!

Consult code
Wed, Jan/27/2010 07:30PM
Outpatient New/established patient visit 99201-5 or 99212-5, POS 22

Wed, Jan/27/2010 07:28PM
that breast exam is part of the list and it says at least 7 of the elements but it also says "Medicare’s covered pelvic examination includes a complete physical examination of a woman’s external and internal reproductive organs by a physician or qualified non-physician practitioner. In addition, the pelvic examination includes a clinical breast examination, which aids in helping to detect and find breast cancer or other abnormalities."

I do it- the 10 seconds it takes is worth it to guarantee I pass an audit.

I should add that there is no data that clinical breast examination actually finds cancer and is worthless.

Torisel Coding
Wed, Jan/27/2010 11:03AM
the chemotherapy code although the drug does kill cancer thru immune regulation (hence the question of which code to use)

Audiologist doing hearing test from a referring Dr.
Tue, Jan/26/2010 11:49AM
I tried to get my car dealer to bill my tune up to my Blue Cross but it was not approved. So pre-certify the service. If they have benefits, do the test. If not, you can decide if there is a medical indication to see your doc or inform the patient that they must pay for the service.

How would you code Muir-Torre Syndrome?
Mon, Jan/25/2010 06:08PM
but not this syndrome- i would code the manifestations- cancer or cysts as apply to the patient. Perhaps ICD 10 will be of more help.

Whitecoat HTN
Mon, Jan/25/2010 04:19PM

reimbursement for 99215
Mon, Jan/25/2010 03:57PM
if your documentation justifies it.

new code for consultation inp.
Mon, Jan/25/2010 03:57PM
Initial inpatient visit

ICD-9 code needed
Mon, Jan/25/2010 10:11AM
782.2- localized swelling? There is no code for a normal finding like that so the complaint is the next best choice

initial visits
Sat, Jan/23/2010 03:29PM
You are assuming care from a like specialty so your visits are subsequent visits, but you certainly can use time as a factor to get a higher level visit but be sure your note documents the time spent. For hospital care it is face to face plus interactions with nursing, radiology, chart review, families, etc.

Hyperbaric Oxygen therapy
Sat, Jan/23/2010 12:32PM
Intermediary payment is allowed for HBO therapy for diabetic wounds of the lower extremities when performed as a physician service in a hospital outpatient setting and for inpatients. Payment is allowed for claims with valid diagnostic ICD-9 codes as shown above with dates of service on or after April 1, 2003. Those claims with invalid codes should be denied as not medically necessary.

Medicare Inpt Consults - 99251 and 99252
Sat, Jan/23/2010 09:07AM
Read previous posts- I say no way- CMS says the first visit is an initial visit but others including the MACs are saying bill the first visit if it is a low level visit as a subsequent visit or use the unlisted code. Reportedly CMS is going to say something official on this soon.

PQRI measure 110
Thu, Jan/21/2010 01:18PM
You found a confusing one to report! If the patient got his flu shot in November, 2009 and you see them now, in January, 2010 for HTN, you can report that the patient had the flu shot. You are now done reporting on that patient for 2010. And when they return in November, 2010 for their next flu shot, you do nothing.

Or you could not report on them now and wait until flu season returns to start reporting but you would risk missing the 80% mark so I would discourage this option.

Vit B12 inj. in the office
Thu, Jan/21/2010 01:12PM
be sure the injection is linked to an appropriate ICD code to justify its use and not to the office visit for HTN or DM.

Thu, Jan/21/2010 01:09PM
is close enough

Consultations - Medicare
Thu, Jan/21/2010 01:08PM
The two month delay was for the 21% fee cut. The codes do not go away, Medicare will just no longer pay them. Commercial insurers will continue to honor them. Remember the AMA owns the CPT codes and insurers and CMS license the right to use them.

Code G0365
Wed, Jan/20/2010 06:53PM
A new G-code, G0365 (vessel mapping of vessels for hemodialysis access, services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow), was created for use when patients have not had a prior hemodialysis access prosthetic graft or autogenous fistula. Reporting of this code is limited to two times per year and CMS will not permit separate payment for CPT® code 93971 when this G-code is billed, unless CPT® code 93971 is being performed for a separately identifiable indication in a different anatomic region. In addition, other imaging studies may not be billed for the same site on the same date of service unless an appropriate "KO" modifier, indicating the reason or need for the second imaging study, is provided on the claim form.

Ambulance Transfer
Wed, Jan/20/2010 11:54AM
I wold call the transport company and get it sorted out first. There is no medical necessity so Medicare is out...

"Establish Care"
Tue, Jan/19/2010 07:49PM
Bill the both as Physical exam 99381-7- there are no definitive requirements for documentation as with E&M visits.

the first patient must have come in for a reason- a check up?- then it is a physical. If it was to get refills on meds for a chronic problem (that's the HPI)? Then it fits E&M.

Research/Study patients
Mon, Jan/18/2010 07:28PM
No, you do not if the service is totally unrelated, like HTN treatment or DM treatment o if these diseases were present and unrelated to the disease under study. These are not "Routine Services" that are used for the direct management of the patient in the study. So a CMP required every 4 weeks for the study would require the code, a CMP for HTN done when a test is not mandated by the study would not.

Your last paragraph makes no sense to me...

Diagnosis help
Mon, Jan/18/2010 05:27PM
is my guess

Mon, Jan/18/2010 03:20PM
you pick a category in the 30 consecutive patient choices, let's say Diabetes. Then whenever you are ready, start reporting on every Medicare diabetic with the ICD from the list that you see (don't forget Medicare secondary), report the starting code on Patient#1 and keep a list. Report on every code they list. When you hit 30, you can stop and you are done for the year for PQRI. Just don't miss a patient, don't miss a code. I'd report on 32 or 33 just to be sure. use cheat sheets and lists to be sure you hit 100% on the 30 and be sure if you add in a sick patient for a day of visit that is diabetic that the doctor either reports on the measures or does not list the diabetic code on the claim.

NP/PA visit in the hospital setting
Fri, Jan/15/2010 08:58AM
I would use the outpatient E&M codes 99212-5 with place of service hospital (like billing an observation visit) and bill with the NPI of whomever did the service- PA or MD.

Editor will address the admission H&P and billing with joint work with MD and PA

Observation code
Fri, Jan/15/2010 08:53AM
I talked to WPS- our CMS MAC and they say the doctor should bill 99234-6- admit and discharge from observation on same calendar day since the physician service occurred on the same day irrespective of the hospital day of admit and discharge.

PRP injections/Prolotherapy
Thu, Jan/14/2010 03:21PM
Just in JAMA not effective for achilles tendonitis. No better than saline injection. You should just code the injection procedure but I have no idea how to code the fluid. Also M0076 is a Medicare code that may apply but will not get paid.

Medicare routine foot care
Thu, Jan/14/2010 12:46PM
a case where more is not better? If routine foot care is not covered, don't include codes for it. Bill for the procedure and 703.0.

99251 and 99252
Thu, Jan/14/2010 11:17AM
Inpatient overcoding is rampant but no one ever gets audited so docs really care.

I really think that CMS's intent is that the INITIAL visit, no matter how simple or how little documentation is done, gets coded with an INITIAL visit code. And the lowest code is 99221. And that is what I will teach my docs and I'll go to court to defend them on it.

99251 and 99252
Thu, Jan/14/2010 09:34AM
CMS says "All physicians who provide an initial visit to a patient during hospital care shall report an initial hospital care code (99221-99223). The principal physician of record shall append modifier “-AI”, Principal Physician of Record, to the claim with the initial hospital care code. This modifier will identify the physician who oversees the patient’s care from all other physicians who may be furnishing specialty care."

and they say "In the inpatient hospital setting and the nursing facility setting all physicians (and qualified nonphysician practitioners where permitted) who perform an initial evaluation may bill the initial hospital care codes (99221 – 99223) or nursing facility care codes (99304 – 99306)"


There is no except if the service does not meet the documentation requirements or any other qualifier. The first quote says SHALL- that is pretty definitive to me.

99251 and 99252
Wed, Jan/13/2010 04:49PM
and I could shoot myself for not keeping it- that CMS said that the first encounter with the patient in the hospital must be billed as an initial hospital visit, which means 99221. I wish I could find that reference...

The closest I could come was which says "When a physician performs a visit that meets the definition of a Level 5 office visit several days prior to an admission and on the day of admission performs less than a comprehensive history and physical, he or she should report the office visit that reflects the services furnished and also report the lowest level initial hospital care code (i.e., code 99221) for the initial hospital admission."

pap smears
Tue, Jan/12/2010 11:29AM
but of course the insurance company may not. I would think they will look at the NPI not the tax ID- many large groups bill with one Tax ID so that can't be the determining factor.

No exam
Tue, Jan/12/2010 11:27AM
ask the doctor to write an addendum with the time spent? As long as the doc dates and times the addendum it is legal. Or she gets paid the lowest level visit.

Hospitalists and Initial Hospital Visit
Tue, Jan/12/2010 11:22AM
Freudian slip; yes, 99221

Hospitalists and Initial Hospital Visit
Mon, Jan/11/2010 05:20PM
you are not crazy- 99211 is the Initial Hospital Visit- it does not matter whether you have an established relationship or saw them the previous day at the office or at home or at the grocery store.

pap smears
Mon, Jan/11/2010 04:09PM
Never heard of that set up!

In the first, I would bill a well visit with the doctor as provider. One visit code 99396 with V72.31. No extra credit for having 2 sets of hands touching the patient.

In the second case, the first visit is a V70.0- routine exam with physician and the second visit to the PA is a V72.31 well gyne exam under their NPI; both visits get the same code- 99396. Many insurers cover well care up to a certain dollar amount no mater how many providers are seen.

Follow-up visits 99212-99215
Mon, Jan/11/2010 04:04PM
that the "Complexity of the presenting problem is the overriding factor in determining the level of care"- this has been repeated by CMS in several places (none of which I have available) but it is clear that with an EMR you can make every level a 5 with the 2 of 3 rule. Common sense rules again!

Coding separate E & m visits on same day
Mon, Jan/11/2010 04:01PM
from WPS: We received confirmation from CMS on this question. When the physician is performing the assessment for the admission to the SNF or NF at the hospital, the physician may bill this using POS 31 - SNF or 32 - NF. If the patient is discharged from the hospital and admitted to the SNF or NF on the same day, both services may be approved by Medicare when the physician provides both services. There are requirements as to the time-frame for the assessment and plan of care for the patient in a SNF. You can find more information in the CMS IOM Publication 100-04, Chapter 12, Section 30.6.13.

Critical care discharge
Fri, Jan/08/2010 07:41PM
But are you sure that it truly was critical care and not just routine care in the critical care unit? I guess anaphylactic shock can be pretty scary and then clear up enough for a discharge...

94750 CPT
Fri, Jan/08/2010 11:40AM
I have never heard of recording mouth pressure in common medical practice. I am sure there is utility but it is certainly not widely done. It also is probably like Peak flow measurements that are considered bundled into the E&M or considered part of a full pulmonary function test.

Office visit & ER
Fri, Jan/08/2010 10:00AM
of course, unless the doctor also went to the ER and saw the patient there.

cpt 99385
Thu, Jan/07/2010 05:34PM
you should add the modifier -25 to the other code 99213, etc. Perhaps one of the experts can explain why the problem code gets the modifier and not the PE, perhaps because the primary reason for the visit is the PE and the problem is the secondary reason.

inital admission billed as critical care
Thu, Jan/07/2010 11:52AM
An orthopedist electively admits a patient for knee replacement. The hospitalist is called to see the patient and manage diabetes. Here the ortho gets paid in her global surgery payment for everything and does not report an initial hospital visit. The internist does report an initial visit but he is not the managing physician so he does not report the -AI. Hence, no -AI at all for this patient.

Hospital Consults
Wed, Jan/06/2010 12:33PM
This is Medicare only; commercial insurers should still honor Consultation codes, for now. And to be clear- the doctors are still performing a consultation they are just billing it differently.

Discharge day management
Wed, Jan/06/2010 11:24AM
If the patient was kept as a convenience, the next day should not be billed at all. If the patient had a change in condition and the discharge was cancelled then the first doc should change to a subsequent visit code and the next day the doc should bill for the discharge since the change in condition would warrant re-evaluation of the meds, followup plans, and a new summary.

DRX9000 Spinal Decompression table
Tue, Jan/05/2010 12:16PM

Tue, Jan/05/2010 12:00PM
Acc'd to WPS

Mon, Jan/04/2010 06:21PM
The MAC's are reporting that the 2010 fee schedule is not yet available- it is part of the mess of the reversal of the 20% cut.

Gen Surg Coding Help
Wed, Dec/30/2009 04:09PM
44143 - a hartman's procedure????

Multiple problems
Wed, Dec/30/2009 10:06AM
Link the problem coce to an E&M (probably 99213 or 99214) code with -25 and the 99395 to V72.31. Be sure documentation discusses two issues separately.

need dx code
Wed, Dec/30/2009 09:02AM
Ask the doc for manifestations- hypercalcemia, ataxia, etc

Tue, Dec/29/2009 02:06PM
There is no change from 2009 to 2010 except adding and deleting codes, just make sure you are not using a retired code. And of course the e rescribing code has changed but that is not technically PQRI...

Wed, Dec/23/2009 04:39PM
Ask the company that makes the machine? Manufacturers are a great resource for things like this.

HCG for pregnancy
Wed, Dec/23/2009 04:07PM
amenorrhea 626.0- that is the complaint and the condition

Waiving Copays
Tue, Dec/22/2009 08:36PM
you are allowed to give discounts to employees, right? Our hospital offers a 25% discount off of amount due for services provided to employees and physicians and they are VERY conservative with compliance issues and would not do it if it was not approved by legal.

So the questioner could adopt a policy offering a discount and that would provide the same benefit.

HIB Vaccine
Tue, Dec/22/2009 05:47PM
worked for me in an adult- pre-splenectomy. No modifier but did charge for admin, of course

Observation code
Tue, Dec/22/2009 03:36PM
this happens all the time; docs round in the morning, get a new patient in the afternoon or evening placed on Observation and give orders over the phone, do not go see them until the next morning when they are better (ruled out for MI, rehydrated, asthma better) and do the "H&P" and discharge them. In 17 years I have never been asked for records and I used 99234-6 for the one visit. Perhaps a CMS representative is reading this and can get us a formal answer...we are big enough and influential enough to get CMS' attention.

Observation code
Tue, Dec/22/2009 01:12PM
when I saw the patient I performed a full initial evaluation and then reviewed tests and determined the patient could be sent home. I cannot discharge a patient from Observation that I did not admit to Observation....

Medicare 2010
Tue, Dec/22/2009 01:08PM
the 21% cut is on hold as mentioned above. The president of the AMA held a press conference yest supporting the health care reform bill. This was done as part of a back room deal with Reid to get Congress to permanently fix the Medicare payment system by Feb 28th. Stay tuned.

Observation code
Mon, Dec/21/2009 06:13PM
I post enough responses to at least get your opinion on this one. Or admit it's not clear and I'll stick with 99234.

Mon, Dec/21/2009 04:43PM
Ask the doctor for another diagnosis- gait disorder, myopathy, etc. And use the underlying illness- CVA, aspiration pneumonia, etc.

Observation in PCP Office
Mon, Dec/21/2009 04:41PM
face to face with the doctor- time she actually spent IN THE ROOM. If you bill this be prepared to back it up with time documentation, especially if you bill 2.5 hours. You may need to recreate "Pt in room 9:15 to 10:10am, 10:30 to 10:45 am" etc.

consults crosswalk
Mon, Dec/21/2009 04:32PM
If it is "x code now replaced by Y code" then there is no crosswalk. BUT... there are 5 consult codes and 5 new patient codes so you probably could cross those for outpatient but inpatient is 3 codes so the crosswalk leads to a dead end. Read the cms transmittal for details :

Care Plan Oversight
Mon, Dec/21/2009 03:41PM
if provided in the home under the guidance of a home health provider, then yes. If you are talking about signing those "continue PT for x visits" from outpatient PT places, then no.

Mon, Dec/21/2009 09:38AM

I don't know if you can bill both the 90 day review and the tests in your office but financially you are better off with the 99211 with each visit.

Fri, Dec/18/2009 10:05AM
just use 782.7 spontaneous ecchymosis

Not amenable
Fri, Dec/18/2009 09:49AM
that for whatever reason the preferred procedure could not be done. The description says- ablation of tumor or lesion not amenable to removal. Optimally you want to remove a tumor/lesion to send for pathology but if it cannot be removed (perhaps due to location , size, other characteristics) then if the doctor chooses to ablate (destroy) it you use that code.

cpt code 82523
Thu, Dec/17/2009 06:06PM
then we can tell you if it may be reimbursed.

Consults (non-Medicare) requirements
Thu, Dec/17/2009 06:04PM
Every time the doc is asked to see the patient, it is a consult in the hospital (only limit is once per admission) even if they are also seen in the office as an established patient.

? cardiac diagnosis code
Thu, Dec/17/2009 12:22PM
No code for akinesis; and LV ejection fraction is a measurement not a diagnosis. If it is low then go to 428.xx for heart failure.

Thu, Dec/17/2009 12:10PM
that code is for monitoring patients that home test.

If the patient is in the office for the teaching the use the E&M codes and document time. For a test, bill the test and 99211 and document properly.

And BTW, there is a new warfarin-like med coming out that may make warfarin nearly obsolete- hope you got a good deal on the machine!

PPD testing
Wed, Dec/16/2009 08:35PM
no charge for the reading. You get paid for placing it. If it is positive then the patient should see the doctor and there will be decision -making that would qualify for an E&M.

2010 physician fee schedule
Wed, Dec/16/2009 08:33PM
So far there has been no fix to the pay cut. The House just today passed a defense bill with an amendment blocking the cuts and the Senate acts later this week on the bill. is for only a two month delay in cuts. So the battle continues

breast/Pelvic and Obtaining Pap
Wed, Dec/16/2009 02:50PM
is bill everyone with the codes and write off those that do not pay. Commercial carriers are great at following Medicare fee cuts but slow to add codes that require higher payments.

Medicare 2010
Wed, Dec/16/2009 02:48PM
contact your senator.

Keep reading this forum, even if you don't have questions. 2 of those three points would be old news to you if you were a loyal follower.

As to the deductible, that hurts seniors more than doctors. If the 21% cut actually goes into effect, there will be a mass exodus of doctors out of Medicare and then they'll fix it real quick!

2010 consult crosswalk
Wed, Dec/16/2009 10:20AM
If seen in ED and sent home, use the ED codes, if placed on Obs the attending uses the Obs codes and consultants use outpatient new/established pt codes. If admitted use initial hospital codes. Read the CMS transmittal for details- the Observation visits with "consultant" docs is explained

pre op consults for medicare patients
Wed, Dec/16/2009 10:16AM
It's back to using established codes- old things are new again

Sundowner's Syndrome
Tue, Dec/15/2009 08:56PM
It is technically delirium with acute onset, reversible mental status change. 293.0

CMS transmittal on the new consult rules
Tue, Dec/15/2009 08:54PM
This document is a must-read for any coders who handle hospital care. Lots of examples, lots of clarification on Observation. Take the time and read it and save it.

finger stick protimes
Tue, Dec/15/2009 10:50AM
99211 if you document properly

Standing orders
Fri, Dec/11/2009 09:01AM
I often write "DM, HTN, OA stable, check labs and call pt" and then order a bunch of stuff. As long as you link the labs to an appropriate diagnosis there should be no problem.

That being said, documentation for esoteric/expensive tests like Genetic screening for BRCA or other genetic diseases should be more complete both to prove informed consent and in case of insurance audit. Also if you are performing a test more frequently than the standard, such as getting a BMP daily if you just started a diuretic.

prostate bx
Thu, Dec/10/2009 03:14PM
there is no code for "per core"- it is one procedure if they take 6 or 16.

E/M coding questions
Thu, Dec/10/2009 01:32PM
I think the distinction is going to be hard to find in writing. As I see it, if I am treating a patient for a disease and my partner sees the patient in my absence, it is not a new problem- it is a followup of an existing problem (that could be stable, worsening or uncontrolled). If I see a new patient to my practice who has never seen anyone in my group, with an established disease, it is a new problem. If I refer the patient to a partner that is of a different specialty for a problem that I have been treating, like the hypertensive patient to my cardiologist partner (I am Int med) then it is a new problem to him for his visit.

A1C and Blood Sugar Test
Thu, Dec/10/2009 01:25PM
the 82948 is obsolete- that was the days of visual glucose testing- blood drop on the strip, compare colors to the side of the bottle. Use 82962 for a fingerstick glucose. Don't use the V codes!

help on level 5
Wed, Dec/09/2009 08:10PM
Time the doctor in the room and see if she is in there long enough to justify time-based coding. If it is 40 minutes then she can code level 5 as I am sure over 50% was counseling.

I can see a patient with DM, HTN, High Chol, OA and gout and cancer and review all issues and review vaccines and screening needs and order labs and refill meds and finish my EMR note in 12 minutes--level 4

I can see a patient with chest pain, get an EKG that shows an acute MI, get the history and ask the ROS and call 911 and be done in 4 minutes--level 5.

As LL said, it's really all about risk. We may not like it but who makes the rules?? Someone else!

E/M coding questions
Wed, Dec/09/2009 04:31PM
It is an established problem, especially with doctors within the same group

coding lab test dx in ICD 9
Wed, Dec/09/2009 02:17PM
code the complaint or diagnosis not the abnormal lab if possible. Was the patient short of breath or had leg swelling? This is not a routine lab like glucose

A1C and Blood Sugar Test
Wed, Dec/09/2009 02:07PM
They are two different tests- are you sure you are not being denied the "blood letting" codes? You can only get paid for a venipuncture or a finger stick on the same day so if you do a HbA1c from a venipuncture and a finger stick glucose, you can bill both tests but only venipuncture.

modifier 25
Wed, Dec/09/2009 10:08AM
The lubricant probably contributed to that $35 slipping out of your fingers.

99211 for PPD reading
Tue, Dec/08/2009 07:35PM
We consider the reading part of the "global period" for the payment for the placement. Others may disagree but I see no real work in reading a PPD as negative. If it is positive then it becomes a doctor visit.

"No Charge" for Outpatient vs 99201
Tue, Dec/08/2009 07:33PM
99201 is for a new patient visit. It is used for a simple visit with low complexity and little history, like... patient-"I have a mole." doctor-"That's a skin tag. Ignore it."

Family Counseling without patient present.
Mon, Dec/07/2009 07:30PM
You need the patient to be present for Medicare, even if just to get vitals and that's it- then send them to the waiting room and talk to the family (if it is ethically appropriate). Bill on total time, not just face to face with patient. Peds is not paid by Medicare so you can do what you want and cross your fingers

facility modifier
Sun, Dec/06/2009 01:30PM
Bill the procedure and the ICD code with location office.

Injection Code for Tetanus Vaccine?
Sun, Dec/06/2009 01:27PM
it is an immunization

Sun, Dec/06/2009 01:24PM
You still get paid, just a bit less. If it is the same day as surgery and visit was to determine need for surgery then use the modifier.

mod for G0101 & Q0091
Sun, Dec/06/2009 01:21PM
but you don't need to - they clear without the modifier as long as they are linked to a proper diagnosis like V76.2. You may (will) get denied if you link to V70.0

Thu, Dec/03/2009 01:18PM
So Medicare rules do not apply. Go ahead and bill the visit based on time. Be sure the documentation is clear that it was a counseling/coordination of care session

OV with scheduled colonoscopy
Thu, Dec/03/2009 09:57AM
See the patient in the office, gather a history and physical, bill as consult (until Dec 31 if referred by another doc) or new patient then schedule the colonoscopy. Prepping for a colonoscopy is not without risks and not a lot of fun so the determination that the test is appropriate should be made at the time of a visit not over the phone before the patient/doctor relationship is established. What if you order a prep on a patient whose pain is from acute diverticulitis and they perforate? What if they have CHF and your prep sends them into heart failure? What if their pain is in the RUQ and they really needed an ultrasound?

OV with scheduled colonoscopy
Wed, Dec/02/2009 06:26PM
If this is a screening exam then the "meet and greet" is part of the global fee. If the patient has pain/bleeding, etc then you could do a visit and the procedure with a -57 (although since the patient is already prepped the decision was already made.)

Consult vs. Transfer of Care
Tue, Dec/01/2009 07:23PM
Because although the codes are valid CMS said they will not honor them. It's all new patient/existing patient/initial hospital visit/subsequent hospital visit. We expect all other insurers to follow suit.

Nursing home patients -who do you bill?
Mon, Nov/30/2009 12:34PM
If the patient still has Medicare Part B then the doctor bill should be paid by Medicare. If there is some special program like a Medicare Advantage plan where the patient relinquishes their A and B then arrangements could be different. I assume these visits are medically necessary and not just done because the facility requires the visit. Did you review your HCFA? Correct site of service, correct CPT code, correct diagnosis?

Coding from Emergency Room Documentation
Mon, Nov/30/2009 11:07AM
I suppose you could argue that the ED docs do not have privileges to care for patients in the hospital (although they do run codes and respond to emergencies) so their documentation does not count but something is wrong if the ED docs are documenting conditions that the attending and specialists omit!

Mon, Nov/30/2009 09:34AM
It is not incidental; just be sure documentation is present that patient was counseled and not just asked if they smoked. You don't need a lot of details, Medicare pays, other insurers vary.

hosice biling
Wed, Nov/25/2009 10:35AM
skilled nursing facility codes- 99304-9; I don't think this should be considered a domicile

PCP and Psychotherapy
Tue, Nov/24/2009 06:09PM
Use the E&M visits for depression treatment and time-based coding. I would contend that you can use the prolonged service code 99354 with a 99213 or 99214 if the time spent exceeds by 30 minutes the time assigned to 99213/4 (15 /25 min). You should clearly document start and stop times to be ready for an audit.

Just to preempt a rebuttal by the Editor, I reviewed my Medicare payments and in fact have been paid billing a 99214 and 99354 on a visit.

Nursing home patients -who do you bill?
Tue, Nov/24/2009 06:00PM
Why would the facility pay the doctor bill (unless they have some special arrangement)? If your doc sees the patient and does an EMG, you would bill the visit and the professional fee for the EMG to Medicare and the technical component to the nursing home. Billing the EMG as a single code with both prof and technical risks denial

Intraoperative neurophysiology testing
Mon, Nov/23/2009 03:13PM
see page 4

Medicare always seems to round from the half-way point so 30 round down, 31 round up.

attending physician charges in outpatient clinics
Mon, Nov/23/2009 02:22PM
If a resident (or fellow) participates in a service furnished in a teaching setting, a Part B payment will be allowed only if the teaching physician is present to perform or observe the resident perform, the "key" portion of any service or procedure for which payment is sought. Each individual physician may determine the "key" portion of any service or procedure furnished. The "key" portion for a visit or consultation service is defined in CPT as including the activities of history, physical exam and medical decision-making. The "key" portion for a surgical or diagnostic procedure is self-defined by the physician.


Dual insurance
Mon, Nov/23/2009 01:49PM
1- "The mother has dual insurance" - assuming the patient is a child and both parents have insurance, there are guidelines. The parent with the earliest birthday is primary for the kids in married couples. Google "Coordination of Benefits"

2- If the mom was the primary insurer and her policy changed form BC to Aetna in the middle of the hospitalization, then it's a little trickier. I think the easiest thing to do is call the hospital billing office and see who paid them. They have the resources and expertise to be able to figure out messes like this.

Anesthesia question
Mon, Nov/23/2009 09:03AM
Don't know what number it is but I read about it in reference to once in a lifetime procedures like hysterectomies when a surgery is stopped prematurely due to a complication and then gets done again on a different day. The RAC audits will see 2 hysterectomies on the same patient if the modifer is not there.

Found it--- -73 or 74 -- these applies to surgeries so I don't know if they completely apply...

Sun, Nov/22/2009 03:26PM
I am guessing no charge for the H&P- the patient was established and it was not a new problem.

physician billing
Sat, Nov/21/2009 03:32PM
use the search box and try incident to and physician assistant and nurse practitioner

New Medicare coding for inpatient
Sat, Nov/21/2009 03:31PM
the visits are "initial visit" and "Subsequent visit"- nothing to do with new or established

No More Consults
Sat, Nov/21/2009 03:10PM
I would not put the modifier on your doc- he did a "consult" and was not responsible for the H&P. I assume CMS will get no one billing for the "H&P" in this case.

Sat, Nov/21/2009 03:08PM
or you can bill for $0.01. The vaccine is provided free so you can charge the admin fee 90470 with V04.81 Attach a -25 to 99213 (if you want )assuming the patient was seen by the doc for another reason

Fri, Nov/20/2009 11:14AM
Has the surgeon seen the patient in the past for the issue and now needs to do the H&P for the hospital (it is bundled in the surgery) or is the patient seen for the first time in the ER or hospital for an acute problem and the decision to go to the OR is made at that time (not bundled and can be billed as a consultation [until 1-1-10 then with initial visit code] with a modifier to indicate decision to take to OR)

Modifier 90
Fri, Nov/20/2009 08:56AM
If you can do it depends on state law (some states do not allow pass-thru billing) and on your insurer (UHC/Cigna/Aetna do not allow it) and finally some do not require the modifier except on pathology.

Inpatient Infusion adminstration
Thu, Nov/19/2009 12:32PM
Billing for hospital services is a whole different ballgame with rules and codes that will make you dizzy. Perhaps Editor knows where hospital coders hang out...

Inpatient Infusion adminstration
Wed, Nov/18/2009 02:53PM
is that this will be like blood transfusions- you can bill one unit per day. For blood transfusion, it is an approved Medicare RAC target for audit. Google RAC blood transfusion for resources

Specimen collection
Wed, Nov/18/2009 10:07AM
but you could use 99000- conveyance of specimen to lab- and hope you get paid.

Admit/discharge same day
Mon, Nov/16/2009 03:25PM
99234 IMHO

Diagnosis Please
Mon, Nov/16/2009 03:25PM
so use that code- malignant neoplasm endometrium. I see not value in trying to find a more specific code

Fri, Nov/13/2009 08:56PM
I could write on and on about PQRI but I picked the 4 easiest measures I could find and used those. In 2008 I picked challenging ones and got frustrated that I was reporting a lot of "Poor diabetes control" due to patient adherence, medication costs, etc so 2009 got ""asked about smoking", administration of pneumovax, Aspirin for CAD and urine testing in DM.

So the effort was filling out a cheat sheet on each Medicare patient and my receptionist entering the codes on the billing screen of our EMR. The payoff was $1,600. Good return I'd say! And if I spent less time on codapedia and doing administrative work and saw more patients or was a specialist it would have been a bigger check.

I also reported the use of e-prescribing in 2009 so that doubles my bonus!

And finally remember it is pay for reporting NOT pay for performance. Why not participate????

colonoscopy and medicare
Fri, Nov/13/2009 08:48PM
but I would not use the screening code for each one. And Be sure the Op note clearly indicates why it is being done sooner than 5-10 years.

CPT 45915
Thu, Nov/12/2009 06:35PM
Isn't that what nurses are for? (OK, start throwing tomatoes!)

office visit & hospital admit /same day
Thu, Nov/12/2009 03:51PM
bill a high level office visit on the first day and document a complete office note and then perform, document and bill the H&P on the next day. There is no modifier that will get both paid on one day.

Thu, Nov/12/2009 10:24AM
But we just got the 2008 payment for PQRI so expect the 2009 payment in October/November 2010.

Cryo documentation
Wed, Nov/11/2009 05:09PM
as long as billing is not based on size.

Can We Bill the Patient Only?
Wed, Nov/11/2009 05:05PM
You must submit and take the contracted amount for Medicare and Medicaid. And likely for all your contracted insurers. You should have an ABN signed for all of those (but I don't know what BIOZ is) since Medicare can cover them in some circumstances. But you can choose to NOT offer these to Medicare etc and only offer to good payors.

Templates for ROS and exams- please help asap : )
Wed, Nov/11/2009 03:08PM
if you did not document it then you did not do it, you must also assume that if I document it then I did it. We do the same things over and over in an exam and if I click a template and then add the unique features of the patient (mole on arm, tinea of feet, scar in RUQ) then that is what I examined!

Your templates though look way too complex- be sure that the docs examine all those elements

Electronic Signature is this acceptable for Assignment of Benefits
Tue, Nov/10/2009 08:43PM
If so it is ok. You need to be able to show what the patient read when they signed.

basic diagnosis coding
Tue, Nov/10/2009 06:50PM
042 first then 047.9

H1N1 diagnosis code
Tue, Nov/10/2009 06:12PM
is the code for the disease- H1N1- we use it for pts who clinically have the flu even if rapid test negative since so far all the flu is H1N1 and no seasonal flu so far

CMS Eliminating Consults?
Mon, Nov/09/2009 02:51PM
discussed previously with references. see "Consults 2010"

Two dose pediatric influenza vaccine
Mon, Nov/09/2009 02:51PM
They draw up 0.25 ml- that is one split dose

Two dose pediatric influenza vaccine
Sun, Nov/08/2009 04:39PM
90656 for over 3, 90657 under 3 yrs old per shot with admin charge of course

Prostate saturation biopsies--Pathology question
Sun, Nov/08/2009 04:36PM
the surgeon did not report the correct procedure code 55706 but rather the routine biopsy so that is the rejection.

want to see how this works
Sun, Nov/08/2009 04:28PM
585.5 and 404.12

Rh factor
Fri, Nov/06/2009 07:21PM
might work but that might require a sex of F. or try v78.8

cash only (not billed to insurance) selling patient supplies (such as foley bags) to patients direct cash only w/no mark-up by box at cost-is allowed?
Fri, Nov/06/2009 07:13PM
to charge the same amount you charge Medicare and Blue Cross and then give a cash discount to patients who pay at the time of service.

Anesthesia Complications?
Fri, Nov/06/2009 04:52PM
code it psychogenic- it could label her for life and haunt the doctor in a lawsuit

medical billing for MDs
Wed, Nov/04/2009 09:01PM
In person, most medical meetings have sessions- try Pri-Med meetings. On line, try

No clue where you learn about HCC's

Link between ICD-9 and clinical diagnoses ?
Wed, Nov/04/2009 02:55PM
The "sicker" the diagnosis, the higher the visit level can justify. So stable CHF 428.0 is less in intensity than acute exacerbation of systolic heart failure 428.21. So if Cigna has a program that compares the visit level to the diagnosis to see who to audit or reject then we want to be sure to code to the highest specificity.

But I do not know of a resource that can give you that info. Sorry

Workers comp visit code
Wed, Nov/04/2009 11:02AM
692.4- the codes don't change with workman's comp, just the address and the hassle factor.

sensory testing code
Mon, Nov/02/2009 06:28PM
the monofilament test (which takes 5 seconds and costs nothing in supplies once you get a free monofilament from Novartis or Novo Nordisk) is bundled as part of E&M but there are codes for formal foot exams in diabetics with loss of protective sensation that include this- G0245

2010 Fee Schedule for Medicare
Mon, Nov/02/2009 03:55PM
we are hoping there is a last minute fix- if fees are cut 21.2% there will be a mass exodus out of Medicare by doctors.

Mon, Nov/02/2009 03:52PM
That is really an attempt at humor since the code is for "counseling not specified." Seriously, where do you want to use it? Psychiatric counseling? Medical condition counseling? Many here know my opinion on most V codes- avoidance if at all possible.

CMS will stop paying for consults Jan 1!
Fri, Oct/30/2009 06:36PM
says to use the initial hospital visit codes 99221-99223 for that first "consultation" visit

CMS will stop paying for consults Jan 1!
Fri, Oct/30/2009 05:25PM
What does a consultant bill for the first visit in the hospital? Can't be an H&P, can't be a subsequent...

CMS will stop paying for consults Jan 1!
Fri, Oct/30/2009 05:21PM
the 21.2% reduction in physican payments? We sure got lucky with that one- it was going to be 21.5% reduction (I say with sarcasm)

Aseptic Meningitis due to AIDS
Fri, Oct/30/2009 09:08AM
Wouldn't Meningitis be the primary diagnosis? That is the primary illness. From a DRG viewpoint you want the cause of the hospitalization not the etiology of the illness

Snellen eye exam
Thu, Oct/29/2009 10:58AM
Wonder why there is a health care crisis and loss of confidence in the medical profession? Perhaps because some doctors try to charge for such simple things like a Snellen acuity test. What is next? An extra charge for each vital sign taken?

Billing L1810 to DME
Wed, Oct/28/2009 02:48PM
That is why they have this wording. The good guys have to jump through hoops so the criminals can be caught. Organized crime is making millions on Medicare fraud and DME is an easy money maker.

Wed, Oct/28/2009 02:45PM
bill with -26? the equipment is usually owned by the hospital so your doc is just doing the professional component.

inpatient colonoscopy
Wed, Oct/28/2009 02:38PM
of course you can if the admit status was Inpatient. Be sure it was not Observation as often rectal bleeding with stable vitals is Observation.

A better question is can you bill the colonoscopy and an E&M on the same day for Day 2.

Liver Functin Test
Tue, Oct/27/2009 04:22PM
or whatever code your lab gives you

Private Pay Patients
Tue, Oct/27/2009 04:21PM
If they are ill, see them that day, hand them a letter terminating care in 30 days and send their account to collections.

If it is a routine appointment and you are CERTAIN they are not sick, you could turn them away and terminate care in 30 days.

icd-9 code
Tue, Oct/27/2009 04:18PM

Integumentary and Musculoskeletal questions
Mon, Oct/26/2009 03:00PM
how about you give your answers and we tell you if we think they are correct. You can't learn if we give the answers!

Balance Billing
Thu, Oct/22/2009 09:59PM
the law of common sense? You could probably post this at "" to get a reference in contract law that says if you sign a contract you are obligated to honor it, unless you are a major league sports star in which case your agent can authorize you to sit out a season to get your contract renegotiated.

Balance Billing
Thu, Oct/22/2009 03:25PM
If you are contracted with the insurance then you must accept their contracted amount for the service. be sure there is no copay or deductible applied on the EOB that the patient owes. Also be sure you charged admin fee (sometimes practices waive the fee for self-pay)

And look closely to see if the cost of the vaccine is less than reimbursement. If so stop giving it, at least to that insurance company's patients.

rapid flu test
Thu, Oct/22/2009 02:43PM
Yes to medicare, maybe to all others; someone posted that one of their insurers did not pay for it. You'll be ok with the big boys- blue cross, UHC, Cigna as long as you have a CLIA waived license. If you have a capitated HMO plan they might bundle the payment into your cap.

Changing an observation charge to a full admit charge
Thu, Oct/22/2009 01:14PM
keep the Obs level 3 and On day 2 you should bill for an admission H&P level 1 and indicate that patient now inpatient since the hospital will bill day one as Obs and day 2 as inpatient and you want them to match

Surgeon productivity
Wed, Oct/21/2009 03:53PM
my dermatologist saw 30 different patients with one mole each.

Stick to RVU's- your pediatric surgeon data should be reviewed.

Modifier 90
Wed, Oct/21/2009 03:51PM
for that 24 page reference ;-) I'll read it right away

Modifier 90
Wed, Oct/21/2009 02:40PM
IMHO the -90 modifier is only for Medicare labs, you do not need to use it for commercial insurers. We never do and Blue Cross knows we do not run the labs ourselves. Hospitals use the -90 when docs order esoteric tests and the hospital has to send it to a special lab. They are allowed to bill Medicare even though they did not do the test

Consult -vs- new pt office visit
Wed, Oct/21/2009 12:23PM
so your best information is found by using the Look it Up box to the left and type in Consultation. The keys are proof of referral by another doc, giving advice and communicating back to referring doc.

surgery for rectal prolapse
Wed, Oct/21/2009 09:13AM
The AMA makes about $30 million a year on licensing fees from the CPT codes! And they threaten to sue anyone that tries to use it without paying- watch out Editor!

Surgeon productivity
Mon, Oct/19/2009 06:35PM
Your dermatologist cuts off 30 moles in a day and gets 30 case points. Your CV surgeon does one major CABG with double valve on a 90 year old and is in the OR 12 hours and gets 1 case point. Doesn't sound like a good way to determine productivity.

Bicillin C-R
Mon, Oct/19/2009 11:00AM
I am curious (and concerned)

vitamin d testing indications
Sat, Oct/17/2009 01:34PM
Indirectly i do not think there is a list of diagnoses. I get notes from Labcorp if I order a TSH or lipid and forget a good diagnosis but have ordered Vit D with 401.1, 250.00, 633.01, 729.1 and have never gotten asked for another diagnosis. But it cold be that the lab is just eating the cost and not contacting me when they are denied. Aren't there labs that CMS just pays without question, like a CMP or BMP ?

CPT 87804 A&B
Thu, Oct/15/2009 02:10PM
87804QW with 2 units (if your rapid test reports both A & B) and link to the diagnosis your doctor gives you- fever, influenza, sore throat etc.

rapid flu test -
Thu, Oct/15/2009 11:46AM
As long as you have a CLIA waived license on file with the insurance and Medicare

? code for admin of "swine flu"
Wed, Oct/14/2009 08:10PM
90470- non-Medicare admin and 90663 for the vaccine itself G9141- Medicare admin and use G9142 for the vaccine itself

medicare pap smears
Wed, Oct/14/2009 05:14PM
Refer to this chart for CMS coverage of paps and applicable codes

missing family history
Tue, Oct/13/2009 06:32PM
Bill a subsequent hospital visit instead of a lower level inpatient consultation?

new pt physical code/E&M code
Tue, Oct/13/2009 06:31PM
new patient preventative based on age, E&M- established based on complexity. be sure documentation separates the two especially in the impresssion and plans

Mon, Oct/12/2009 09:41PM
Sarah Palin- almost-lame duck ex-Governor c/o Fringe Right Republican Headquarters Glacier in the middle of Alaska with secessionist husband USA that is visible from Russia

There is no code for counseling on end of life issues; it can be included in your general counseling and coordination of care time. And Editor can be more specific but I believe it is considered "high intensity" medical decision making.

(excuse my political commentary- hope I did not offend anyone)

Mon, Oct/12/2009 04:44PM
It is rare that a rheum patient referred from a primary care doctor has something simple. Lupus, RA, even fibromyalgia are complex and counseling alone will get them to level 4. So those are likely to be level 4 and 5. Self referred patients with aches and pains may be lower levels. Don't forget the income potential from infusions for the Rheumatoid arthritis patients

unpaid copay fees
Mon, Oct/12/2009 04:25PM
Be careful who you turn away. Send out a patient without being seen and if things go bad you are liable. For a routine follow up I occasionally turn them away, especially the Medicaid patients who have a $2 copay (who does not have $2???). Other option is to hand them an envelope with our address on it (no stamp) and tell them to mail the copay within 24 hrs. I don't like the ATM idea- their appt was at 10 am; at 10:30 when they get back I am busy with other patients

Test: Ask a Question
Sun, Oct/11/2009 05:26PM
we shall endeavor to answer

Fri, Oct/09/2009 09:01AM
Refer to this chart for CMS coverage of paps and applicable codes

code for organ donor consult
Fri, Oct/09/2009 08:52AM
This falls under the infamous "death panel" provision of the health care reform bill. There is no code or reimbursement for discussing end of life issues. Don't like it? Talk to Sarah Palin- she turned a rational issue into a fiasco.

e/m after colonoscopy
Thu, Oct/08/2009 01:24PM
I would guess Zero, so you can have an office visit after the procedure if medically indicated. I would not bill a visit to tell someone their test was normal or they had a benign polyp and need a test in 5 years but if cancer was found a face-to-face visit is appropriate and billable.

Flu Vaccines -- Not H1N1
Thu, Oct/08/2009 01:17PM
1- there is no E&M with a visit for a flu shot only, not even a 99211. If the patient is seen for other issues then you can bill the E&M appropriate for those issues.

2- link v04.81 to flu shot and 90471 and V03.82 to 90472 and pneumovax (or 90471 to pneumovax and 90472 to flu - it does not matter)

3- Ignore V06.6- just risks a denial IMHO. Never used it, never needed it.

ICD Help
Wed, Oct/07/2009 09:15PM
If a patient had that complaint I would probable code either 443.9 Peripheral vascular disease or 337.21 Reflex sympathetic dystrophy, both of which can cause a cold extremity

E/M visit and flu shot same day.. modifier 25?
Wed, Oct/07/2009 02:35PM
we never use it

Question re: Tritium exposure
Wed, Oct/07/2009 10:00AM
Is there any advantage to finding the exact code? I doubt the AMA had interest in creating codes for exposure to every substance on earth (or in earth) so there should be no problem using general toxic exposure code.

Influenza A
Tue, Oct/06/2009 06:18PM
there is currently no seasonal flu activity in the US so a positive flu test now is H1N1 by default

Home Health Certificate
Tue, Oct/06/2009 06:17PM
denials when I billed the day I got the form and signed it (which was 2 weeks after admission to home care) and it just so happened that the patient was readmitted to the hospital after being home a week so the date I used corresponded in their system to an inpatient day so they denied it. I rebilled with the first home care day and got paid.

Initial ob visit
Mon, Oct/05/2009 05:31PM
And should be paid. The professional fees (and possibly ultrasounds) are all that should be included in the global.

fat biopsy
Mon, Oct/05/2009 04:43PM
12031? Depends on your closure. Or use 11100 and then the modifier for prolonged surgery and send your op note and a letter.

Can I bill a consult
Fri, Oct/02/2009 12:05PM
I have never seen a doctor on the phone for 30 minutes with another doctor!

Perhaps Editor can comment - if the phone call was really 30 minutes AND on the same day as the visit, does it count? So for example, Dr X calls me to discuss Mrs. P who I will see in the afternoon. We go over her hx and previous tests and what the other doc plans and then I see her, review this info and do my own decision making. 30 min with doc, 20 min with patient- does it all count?

Cash-only H1NI vaccination
Fri, Oct/02/2009 12:01PM
with insurers so you would be in breach of contract if you make patients pay cash.

Can I bill a consult
Fri, Oct/02/2009 09:03AM
I see nothing to indicate that pt was referred by another doc or that notes sent to referring doc. With better documentation "Referred by Dr X for allergies and warts" and a discussion of history, physical and advice for allergies, I could see a consult for allergies with -25 linked to 477.9 and the wart diagnosis and destruction code to cover the wart destruction with no associated office visit. But oh boy does the doc need to document better!

billing for deposition time
Fri, Oct/02/2009 08:58AM
Deposition charges get paid by the lawyer requesting the deposition, not by any insurance company. I have heard of specialists charging $1,000 an hour, primary care docs about half that. ALWAYS tell them to bring either a blank check or at least the first hour and get it in your hands prior to the start. Be bold and ask for it. If they don't have it, don't proceed. I have seen docs who never get paid for giving auto accident depositions when the lawyer just ignores the bills.

colonoscopy consult charge when colonoscopy cancelled
Mon, Sep/28/2009 03:04PM
the doc did see the patient and discussed the procedure face to face- counseling at a minimum.

asked for re-consult.
Sun, Sep/27/2009 09:35PM
One consult per hospitalization per doctor. Bill another consultation!

AV Fistula
Sat, Sep/26/2009 07:34PM
A fistula is created by sewing together an artery and a vein side by side. The high flow in the artery lead to the vein getting progressively bigger and bigger and once "mature" it is big enough for the dialysis nurses to stick those giant needles into it to do dialysis. When first created the vein is tiny, like the veins on your hand and so it takes time to mature. A graft is a synthetic tube inserted between an artery and vein to allow dialysis. Since it is full size to start it can be used right away. But it has a higher risk of infection and clotting since it is a foreign body, hence fistulas are preferred.

colonoscopy consult charge when colonoscopy cancelled
Fri, Sep/25/2009 12:19PM
Since you did not do the scope, there is no bundling of the visit into the procedure charge. I would send the referring doc a letter "thanks for referring Mr Smith to consider the risks and benefits of screening for cancer. I advised screening. After his visit and our discussion, he elected not to be screened." You saw the patient, rendered an opinion and sent the info back to the primary doc.

colonoscopy consult charge when colonoscopy cancelled
Fri, Sep/25/2009 08:52AM
Was this an appt for a screening colonoscopy arranged over the phone? (No visit, no charge) Was it an established patient? (You could charge them a cancellation fee if that is your policy) Did the doctor actually see the patient in the holding room, discuss the test and then the patient said "no"? (This is the one instance that you could charge a visit IMHO)

Observation status to acute care
Thu, Sep/24/2009 10:23AM
First day 99218-99220, then second day as outpatient subsequent visit then you should bill the day of switch to Inpatient as a low level H&P but no bill discharge from Observation since the patient is not being discharged

Office visit.
Wed, Sep/23/2009 06:22PM
Perhaps they saw no request for consult or no evidence report sent to requesting doctor

preventive codes
Wed, Sep/23/2009 04:05PM
9938x and Q0091, V72.31

flu shots
Wed, Sep/23/2009 10:02AM
but that does not make it right- will you visit me in prison if I am wrong?

can new office visit/consult be billed if there is no exam?
Wed, Sep/23/2009 10:01AM
I had a patient I had seen for diabetes, heart disease, high cholesterol for years and years. She is 85 yrs old. I see her every 3 months. On one visit I did not examine her but we addressed her meds, labs, etc. As I walked out she said "aren't you going to listen to my heart?" I was absolutely sure that her heart was beating and did not need to be auscultated. But to her it was a crucial part of the visit. Now in this case, I am amazed a surgeon would not examine a woman's breast before a procedure to look for deformities, synchronous lesions, etc, or examine the abdomen prior to a surgery to look for hernias, etc.

removal of a mass
Mon, Sep/21/2009 03:27PM
you don't

Cpt 82306
Mon, Sep/21/2009 11:34AM
Vitamin D deficiency is rampant in the US. We stress sun protection, rightly so, and as a result we do not convert Vitamin D to its active form. There are studies relating deficiency to cancer, heart disease, aches and pains and of course osteoporosis. I test for it often and get no rejections, even from Medicare when linked to HTN, DM, CAD. On a personal note, ask your doctor to test your vitamin D level (25-OH vitamin D is the correct test) or just take 1,000 to 2,000 units a day. There is not enough Vitamin D in multivitamin or calcium/D supplements to meet daily needs. Although it is a fat soluble vitamin, you would need to take 50,000 units daily for a year to get toxic (we treat deficiency with 50,000 units twice a week).

Discharge summary dictated day prior to discharge
Thu, Sep/17/2009 08:23PM
If the physician did the work on the day prior, you bill that day. That assumes the patient was not seen on the discharge day. If the summary was dictated the previous day but the patient was seen and sent home on the next day, bill that day as discharge. The work includes reconciling meds, writing prescriptions, counseling patient, etc.

Reporting Unpaid Debt
Thu, Sep/17/2009 07:38PM
And our consent to treatment states "any unpaid balances will be transferred to a collection agency with a 23% additional fee." The 23% covers the charge the agency charges us on balances that they collect. You could ask local docs for recommendations of agencies in your area and their success rate. There are a million out there including some that use strong arm techniques and your reputation is on the line (even with deadbeats) so pick carefully.

Tick bite
Thu, Sep/17/2009 01:52PM
the past history of Lyme has no influence on the current risk of Lyme from another bite. Coding the past history of Lyme with the V code may help you justify a higher office visit, with the extra counseling to allay the patient's fears but does not change the justification for the lab test at all.

Tick bite
Thu, Sep/17/2009 09:20AM
Your code for non-venomous insect bite is specific enough. There is no reason to get down to the species of insect, is there?

Wed, Sep/16/2009 03:51PM
We use 88142- for billing for the lab interpretation of the pap smear to those insurance companies that let us bill for labs. 99394 is the E&M code for the visit itself. It looks like G0124 is the same as our 88142. As to whether you bill or the lab bills for that service is a contracting issue. I would go ahead and bill it and see what they pay and compare that to what the lab charges you for the service. If you are paid more than you are charged, then go ahead and bill it. If not, let the lab bill it.

How is "Activated Charcoal" Coded, it's a procedure for suicide or vomiting of overdose?
Wed, Sep/16/2009 02:36PM
Activated charcoal is given orally, hemoperfusion involves filtering the blood, as the name implies. There is no CPT for activated charcoal administration just as there is no CPT for administering a tylenol tablet.

Incident To
Mon, Sep/14/2009 04:38PM
they are on the hook. Lawyers bring everyone into the mix. The doctor is ultimately responsible. In court they could say that the pharmacist used an approved protocol and she was only supervising but she'll still get sued. But we can help with coding, not real legal advice so don't take this as gospel.

finger stick for PT/INR
Mon, Sep/14/2009 04:36PM
then you can use the code. Rarely insurance considers this bundled as does Medicare.

Workers Comp Finger Splint
Mon, Sep/14/2009 03:36PM
[ Any suggestions? Aliza]

Stop seeing workman's comp cases? That's the best suggestion I can give as an internist who does not take WC after getting burned too many times on bills. I know that's not practical, but it does bump your question to the top of the list so perhaps you can get a real answer to your coding problem.

ENMT System
Mon, Sep/14/2009 03:32PM
but don't you need 2 bullets in the ENMT system to get credit? The external ear includes the visible ear and the external auditory canal (which does require an otoscope to examine) so you could argue that the "external ear" is examination of ear -the visible part -bullet 1 and otoscopic exam of ear canals - bullet 2. I don't see anywhere that you need to examine NM or T to get credit.

finger stick for PT/INR
Mon, Sep/14/2009 03:20PM
is capillary blood draw

Worker's Comp
Sat, Sep/12/2009 09:55AM
they do not understand why you need an echocardiogram for a workman's comp case? I sure don't

H1N1 Flue clinics
Fri, Sep/11/2009 10:18AM


which has a list of several others.

severe protein malnutrition
Fri, Sep/11/2009 10:03AM
Kwashiorkor or picturing the little african babies with big bellies for protein malnutrition; "normal" severe malnutrition would be the end stage cancer or AIDS patient with generalized wasting. Is that your question - the medical difference?

2nd Question r/e Emergency room CPT coding
Thu, Sep/10/2009 01:07PM
As long as the patient is not admitted, the primary care doc or on call can code an ED visit. It should not be used for convenience visits (meet me at the ER to look at that sore throat) but rather patients who self-refer to the ED and the non-ED doc sees the patient for the initial eval and treatment.

how to code post-menopausal patient is having a bone density test to evaluate for osteoporosis
Thu, Sep/10/2009 09:14AM
just 627.2. When I do a CBC for abd pain, I code 789.01; I do not code for screening for cancer, ulcer disease, etc. even though that's what is banging around in my brain. I use the most specific diagnosis at the time of the testing. I am doing a bone density because the patient has menopause.

H1N1 Flue clinics
Wed, Sep/09/2009 05:56PM
but why not just use your URI template? The patients will be presenting with an undiagnosed febrile illness, not with already diagnosed H1N1. So you still will be seeing strep patients, seasonal flu patients, bronchitis, colds, etc. Your best prep is to vaccinate your staff, have lots of masks and hand gel available and hope for a mild season.

General Billing questions
Wed, Sep/09/2009 05:00PM
If you see a patient that is ill and send for admit, you can bill the office visit! Your assessment should include send to hospital for evaluation. The hospitalist or PCP will bill the H&P and if you are consulted then you can bill an inpatient consult too.

how to code post-menopausal patient is having a bone density test to evaluate for osteoporosis
Wed, Sep/09/2009 03:53PM
627.2 (menopause) and always get paid.

Posting Charges
Sat, Sep/05/2009 01:22PM
in each case the diagnosis code must make sense for the test/procedure. 790.6 (abnormal chemistry) does not really justify an EKG; 401.1 or 428.1 or 786.50 do make sense. 790.6 makes sense for an office visit but not for a mole removal or stool hemoccult test.

Consultation Coding?
Sat, Sep/05/2009 01:18PM
I occasionally get requests from specialists to write a "referral request" for a patient where the patient made the appointment and whom I had not seen them in months/years or even had seen recently but never discussed the problem warranting the specialist visit. I take offense to these requests- I am not a conduit to allow the specialists to make more money. I have also seen specialists send me letters "thank you for referring Mr X for..." and when I review the chart I find the patient was not seen for months/years and certainly never had that problem in my visits. In these cases I am tempted to call CMS (Qui Tam pays well). On the other hand, I occasionally casually suggest a patient see a specialist for an issue "you may want to see a dermatologist for that acne" but do not fax a referral request. In those cases I gladly comply. In your case (and I am guessing) if it was an obese diabetic patient who I told to lose weight (as if that ever works..) and you saw the patient after a lap band seminar, I would be happy to send a referral request.

Wed, Sep/02/2009 06:38PM
by providing the diagnoses that you linked to each code.

Wed, Sep/02/2009 12:01PM
You cannot charge for giving out supplies- the code is for "occult blood TESTING" (my emphasis), not for "provision of supplies for occult blood testing."

4011 vs 4019
Wed, Sep/02/2009 11:57AM
[Guess what though, the payers can't be choicy with ICD-10 because there will be only one ICD-10 code, namely I10, and that code crosswalks to represent 401.0 401.1 and 401.9. ]

How dare they simplify things!!!!! Make three codes into one? That makes way too much sense to be true.

Gardisil and zoster vaccines
Mon, Aug/31/2009 04:03PM
Zostavax is the first routine vaccine that Medicare has deemed to be not a Part B covered vaccine. Neither the vaccine nor the administratio can be charged to Medicare. Rather than rehash my feelings, go here and you can see my writings on the topic. It is a must-read for any physician office that gives Zostavax

Answers to questions
Mon, Aug/31/2009 03:56PM
Put the key words into the Look It Up Box and see if it has been discussed before- we have had almost 700 topics- and if not then Click Ask a Question and ask away! Then check back to see if an answer has posted, and while you are visiting you can answer the other questions or get into a discussion over some controversial topic like Pre Op Exams or GI Cocktails.

ICD9 292.0
Mon, Aug/31/2009 10:32AM
looking at the other definitions of this code it includes cocaine withdrawal and insurers do funny things with their data, like ruin people's lives. Perhaps you can code a symptom...

GI Cocktail
Sun, Aug/30/2009 07:09PM
Others have tried t get a definitive answer on this and no one here knows. If you search in the Look It Up box you can see the threads on GI Cocktail. Sorry :-(

having difficulties locating an ICD-9 dx. code for history of shingles
Fri, Aug/28/2009 09:56PM
But why would you want to code that at all? Once it is gone, it is gone; if you have residual pain then it is 053.19 post-herpetic neuralgia

Fri, Aug/28/2009 09:52PM
should do the trick, or 607.84 impotence

Fri, Aug/28/2009 09:50PM
Pt in ED, placed OPO in hospital, doc sees pt, sends home->99235. Next day pt back in ED, again put in hospital OPO, doc sees pt, sends home again->99235. Just be sure the second document is complete and does not just say "see prev H&P for details." The MAC will compare these codes the the hospital bill and see that they make sense.

Pre-op and consultation coding questions
Fri, Aug/28/2009 09:53AM
[Wow talk about creating a welcoming atmosphere!!]

I sincerely apologize if I came off rude; it just makes more sense to refer to the previous posting than to retype all the arguments and discussions and contribute to my carpal tunnel syndrome. And the easiest way to get there is the Look It Up Box. Sorry again

Prothrombin Test/INR Monitoring
Thu, Aug/27/2009 07:40PM
We bill 99211 and the code for the protime. Diagnosis is V58.61 and the dx for the disease, such as 427.31. Our documentation includes vital signs, questioning on dosage, asking about bruising and bleeding, the test result and the doctor's decision on the next dose to take. This CLEARLY is Medical Decision Making. It is not the same as a BP check or drawing blood for a lipid panel and warrants a 99211 code. Be sure your doc signs every note and you clearly indicate "the results were discussed with the doctor and she recommends x mg daily and test next in x weeks."

Pre-op and consultation coding questions
Wed, Aug/26/2009 10:45PM
We have beat this horse to death. Put "Pre op exam" in the search box and "Look it up" to read our Bobby Flay Throwdown on coding preop visits.

2 part question on must nurses sign note that is part of the visit with MD
Wed, Aug/26/2009 04:27PM
I have my MA put her initials after the Chief Complaint that she collects and documents in our EMR. You are right, I cannot prove she did the medication reconciliation or even the vitals. (If the nurse is doing the ROS, PFSH , etc the doctor better indicate that she reviewed the entries- an auditor could get you on that if they figure out how to see who entered what info in the EMR.)You win. But I'll stick by my answers on a paper chart- initial entries.

HCPCS Fee Determination
Wed, Aug/26/2009 04:06PM
is that you can charge what you want. The ugly side of capitalism is that the insurance company can pay you what it wants. In reality most set fees at a multiplier of Medicare rates- 140-170% and go from there. Watch your EOB's closely and if any insurer pays you 100% of charge then quickly raise your fee. You always want to charge more than what your best payor pays so you are not leaving money on the table.

2 part question on must nurses sign note that is part of the visit with MD
Wed, Aug/26/2009 11:38AM
if that will make the doctor happy. But the malpractice insurer will reinforce that every entry in a medical record should be authenticated by the person performing the service.

Tue, Aug/25/2009 01:01PM
No one else has responded so I'll try. Eval each part by the documentation and code and bill appropriately. They can share the exam obviously. So the back pain needs to be addressed in HPI, ROS and in Assessment and Plan; the diabetes and HTN need to be in HPI, ROS and Assessment and Plan. Count the points in each and code appropriately. The better the documentation is separated the easier it will be to defend an audit. I don't know if there is a rule that reduces the Medicare payment by the amount paid by another insurer for an unrelated treatment.

mrsa screening
Tue, Aug/25/2009 12:53PM
Does the patient have a carbuncle currently that was being treated (at a prior visit) and the doctor wanted a nasal swab for MRSA to see if the patient was a carrier? if so then I say no 99211-it was just a collection of a specimen with no MDM involved. If the patient had a carbuncle and got antibiotics (no global surgery period involved with no I&D) then a wound check with a nasal swab would be 99211 (although the documentation provided does not support a wound check). Finally I have to add that after a MRSA carbuncle there is no recommendation to do nasal swabs to look for MRSA carriage- it is now ubiquitous in our environment and treating colonization does not lessen risk of future infection. The primary treatment is I&D (or antibiotics).

H1N1 help
Tue, Aug/25/2009 12:45PM
There is no vaccine available. Second, the current "talk" is that the vaccine will be supplied to providers for free by the Feds so you cannot charge for the vaccine itself. You cannot buy this vaccine from the normal suppliers. Third, there has been no word on whether you can charge an administration fee (chances are yes) and whether the vaccine will be supplied with syringes and needles to keep down costs to the providers. There is no word on how we choose who to vaccinate, whether we can limit it to current patients or must accept any person that wants the vaccine, how medical providers can get vaccinated if their employer does not offer the vaccine, how we prevent riots when word gets out we have a vaccine, how we educate about the vaccine, and so on...

In Illinois, they surveyed providers about their current flu vaccine numbers and willingness to vaccinate with H1N1 and will be coming out with more information "soon."

Billing with out a CLIA #
Thu, Aug/20/2009 09:02PM
you need a CLIA waived certificate and number to legally perform the test, so you should not bill without it, certainly not to Medicare unless you want men in suites knocking at your door and ruining your week.

Mon, Aug/17/2009 09:55PM
if the HPI requires 2 items and ROS one item, you cannot count nausea and vomiting as 2 HPI and count nausea as one ROS.

age requirements to arrive at office alone
Mon, Aug/17/2009 10:22AM
but here is California's courtesy of Google

New Bariatric Rose Procedure Coding
Sun, Aug/16/2009 05:26PM
BUT, you would never bill this without explicit pre-authorization from the insurer and they can tell you what to bill and how much they will pay (but don't hold your breath for payment from an insurance company!) If it cash deal then use the unlisted codes (Nancy?) for the paperwork.

Bone Mass Measurement ICD-9 Coding
Sat, Aug/15/2009 10:55AM
I can't imagine you have both machines - as far as I know there is no machine that does both tests. So you bill based on whether you are imaging the hand/heel/finger or spine/hip. As to intent (establishing baseline) that does not change your CPT but may change the ICD-9 code you choose. I agree with your occasional need to do both tests- knew there was an explanation!

Bone Mass Measurement ICD-9 Coding
Thu, Aug/13/2009 08:53PM
You either test axial 77080 or appendicular 77081 depending on your machine. Doing both is double dipping, and a disservice to the patient and provides no useful additional information (unless you have more information that you are not sharing)

Code of Federal Regulation help
Thu, Aug/13/2009 08:11PM
but Federal Regulations only govern Medicare/Medicaid. So no one but your contract will tell you what to do for each insurer. That being said, teaching docs to bill differently for different insurers is nearly impossible (unless you are teaching me) so sometimes it is better to bill all and write off those that do not pay. It also allows the charge to show up on the patient's EOB and see the insurer pay nothing and you get sympathy from the patient (at least in a perfect world where patients actually care about their bills and actually pay them.)

Medicare vaccine administration
Thu, Aug/13/2009 01:09PM
Tetanus vaccination is not a Medicare covered benefit unless there is an injury so get an ABN signed if it is a routine vaccination. If it is an injury and given at the same time as a visit to assess the injury then link the vaccine to the V code and the injury code.

physician signature requirements
Thu, Aug/13/2009 10:54AM
Are you billing an E&M, like a nurse visit- 99211? If so, then the doc better document her medical decision making and authenticate her note. If just a venipuncture or BP check with no "thinking" then no need to be signed.

finger stick
Wed, Aug/12/2009 06:23PM
Capillary blood draw 36416. Medicare does not pay, commercial insurers sometimes pay. Don't bill a capillary and a venipuncture draw (for example a protime and a chemistry panel are ordered)- you can only get paid for one or the other.

question on medical decision making and auditing
Wed, Aug/12/2009 06:18PM
If the NP is using their own NPI then collaboration could count; if the doc's NPI is used then he is "doing the work" so it does not count.

Wed, Aug/12/2009 06:14PM
If the patient was admitted then Inpatient; if sent home, outpatient.

Actually location is ED, you meant which code range to use.

CPT 96101-96125
Wed, Aug/12/2009 03:09PM
Part A is for hospital and SNF charges, not medical providers. A medical service provided while the patient is in the hospital is still billed to Part B. The hospital will bill to part A.

Interpreter Services
Wed, Aug/12/2009 12:23PM
I have never heard of anyone paying for this. I would calculate their yearly pay, benefits, etc and calculate an hourly rate and use that number. No one will be able to calculate the wage from that number with all the various taxes, etc stuck in it. Or you can eat the cost if you are worried.

Who is allowed to submit codes to insurance companies?
Wed, Aug/12/2009 12:20PM
but whether they pay is a contract matter. In the good old days patients paid the doctor and sent the receipt to the insurer. So if they have coverage for the medical equipment, they can send in the receipt and get reimbursed.

D.O.T. Exam
Wed, Aug/12/2009 10:51AM
You pay for the cup and the test strip- you deserve to get paid. 99455 is the correct code. Read the article in LOOK IT UP at the left- put in DOT and viola!

Wed, Aug/12/2009 10:23AM
She charges $40 for the visit and if they establish then the money gets credited to their account to cover copays, deductibles, etc.

Wheel Chair Bound
Tue, Aug/11/2009 09:51PM
Using a V code won't get you more money and takes away one of the 4 slots to tell the insurer how sick the patient really is. Technically you could use time since getting the patient out and into the chair is "coordination of care."

Nurse Practitioner billing for lipid consultation
Tue, Aug/11/2009 09:41PM
that the consultation codes are appropriate with time based coding with a letter to the primary physician outlining recommendations. "Thanks for referring Mr Smith, I recommend xxx diet and xxx medication with follow up after xx months for labs, etc. I have discussed the diet concepts in depth with the patient spending 50 minutes in counseling." This is not preventive- it is treatment of an established disease in the 272 series.

Prolonged service billing
Mon, Aug/10/2009 04:17PM
It is so confusing- their table lists prolonged services times for 99201-205 and 99212-99215 yet they also say you should not use the prolonged codes until you get to the highest level code 99215 or 99205. Do Editor or Nancy have any connections to get an answer from CMS or an intermediary? Perhaps a few concrete examples...

Modifier 25
Mon, Aug/10/2009 04:09PM
Link the E&M to acne with the -25 and link the biopsy procedure code to the lesion diagnosis- wait til the path comes back so you can code it properly- benign v. malignant.

G-Codes and Medicare as secondary
Mon, Aug/10/2009 04:08PM
Are you talking about PQRI codes or vaccination administration? Mot insurers recognize the G codes for vaccines and the PQRI codes will screw up their systems (revenge finally)

Coding guidelines
Mon, Aug/10/2009 09:40AM
It is not like them to use email for official communications about an audit or targeted review. Did they ask for your social security number? ;-)

72 hour rule for medicare
Mon, Aug/10/2009 08:57AM
As we often see here, the misunderstanding relates to who is billing- the doctor or the hospital. Hospitals have to bundle any services provided to a patient prior to an admit into the DRG for the admission (don't know the hour guideline). For physicians, the bundling is only for surgery, not for admissions. If I see a patient in the office and admit him, I can either charge an office visit or an H&P. For surgeons, the pre-op H&P is bundled into the payment but they can use modifier -57 to indicate the visit was to determine the need for surgery and get paid. That would apply to a patient with appendicitis when the surgeon is called to the ED.

Principal diagnosis
Sun, Aug/09/2009 04:55PM
These questions are confusing when it is not clear if we are talking about how the hospital is going to select their principal diagnosis/DRG or how the physician is going to code their H&P/consult. Which are you asking about?

Procedure 77432
Thu, Aug/06/2009 01:53PM
But here is CMS guidelines on billing

Pacemaker Interrogation
Thu, Aug/06/2009 01:51PM
Medtronic has some good info on their site on reimbursement. Go to the right side "Followup Guidelines" from this page

Tetanus CODES
Thu, Aug/06/2009 11:32AM
preventive vaccination against tetanus/diptheria V06.5. For CPT- for dT it is 90714, for Adacel or Boostrix it is 90715. Both get a 90471- admin of vaccine. If it is an injury use the ICD for the injury and the V code.

E&M and the Emergency Room
Thu, Aug/06/2009 08:53AM
that the MAC computers will see a patient with an Inpatient hospital claim and an Outpatient MD claim for the same date and reject the claim as inconsistent. I favor billing the ED consult on a patient that is subsequently admitted as an inpatient consult.

Wed, Aug/05/2009 04:38PM
V25.09 for counseling- 99201-5 or 99212-5, depending on time spent counseling

PT/OT in Nursing Facility
Wed, Aug/05/2009 03:27PM
I do not think there is a rule about "how often" the doc must see the patient. Therapy must be ordered by a physician (and a written order should be kept on file) and medically indicated for the condition and should continue only if progress is made towards goals. Therapy to maintain an level of functioning is not not covered.

Appeal help
Wed, Aug/05/2009 12:00PM
Read here: and search for 15420- not covered

Travel Medicine
Wed, Aug/05/2009 11:57AM
I guess is how to code. I would code a 99213 based on time counseling and document the time spent discussing travel precautions, etc.

Cell Saver
Wed, Aug/05/2009 11:55AM
just as they cannot bill for counting sponges (which they monitor), or iv fluids given (which they order and monitor). It is amazing how docs will try to sqeeze water out of a rock.

Pap with abnormal circumstance
Tue, Aug/04/2009 09:31PM
the new guidelines say that for females 30 yrs and better if you do a pap with an HPV screening and both are normal that you can go three years between pelvic exams. There are some gynes who are reluctant to adopt this practice but in this case it would certainly make a happy patient. (Another tidbit- women who have had hysterectomies do not need pelvic exams or pap smears. Their cervix is resting in a jar in the pathology department and cannot develop cancer there. There is no other proven benefit to pelvic exams except to screen for cervical cancer.)

84443-TSH lab has been rejected by an insurance carrier. Any idea what the new number is?
Mon, Aug/03/2009 03:41PM
Try again- they are hoping you won't resubmit.

Mon, Aug/03/2009 03:40PM
ask your lab or reagent supplier if the CPT has changed

bill balance
Mon, Aug/03/2009 03:38PM
if you never want to see them again. I would drop them a note that an error was made and you are forgiving the balance. That way you may actually gain business with new referrals to the doctor office that is not all about money.

diagnostic test reading
Mon, Aug/03/2009 03:34PM
no matter when it was read

Hospital status
Mon, Aug/03/2009 09:25AM
that the hospital will submit an inpatient claim for the stay and your bill should match theirs, but I only know that doctor's bills for E&M need to match the hospital and don't know if same applies to your bills.

General Surgery
Sat, Aug/01/2009 10:53PM
Does that have to do with the warning you get at the end of Viagra commercials...if you have an erection lasting more than 4 hours contact your physician?

How to counteract bundling of E & M with spirometry codes
Sat, Aug/01/2009 08:19PM
One of our local HMO's bundles EKG and spirometry into our capitation payments. It OBVIOUSLY makes no sense, but they do it anyways. Their argument is that the supply cost is minimal and the work of interpretation is an integral part of primary care medicine. The IPA that controls the fee schedule is physician-governed so I can only be mad at my colleagues, not at the insurance company.

coding for self-pay
Sat, Aug/01/2009 04:52PM
It is not wrong to down code- it is my business, I own it, I can charge what I want to someone who has no contract with me that sets fees. Medicare has no right to access charts of patients that are not covered by medicare and if they want to raid me and audit my charts from the last 18 years to find the 10 self pay patients, let 'em! If I was a clinic with lots of self-pay then a policy, a procedure and documentation might be reasonable but I am not spending $5,000 on a lawyer to set up a system to be a nice person. I'm drawing the line!!!!!!!!!!!!!

Fri, Jul/31/2009 05:25PM
Is microscopic exam of vaginal secretions CPT Q0111 (I assume this is Medicare pt since you are using Q0091), you may bill it if you have a CLIA waived certificate for office based procedures

Pronoucing death
Fri, Jul/31/2009 11:50AM
use the discharge codes for CPT and the underlying illness as the ICD. The physician declaring death is the only doctor that can bill the discharge day services code.

diabetic training
Thu, Jul/30/2009 09:31PM
then it's a 99211. If the doc does it, then use time-based E&M

Billing for Labs performed in Office
Thu, Jul/30/2009 10:28AM
In Illinois, pass-thru billing is allowed, and some insurers allow it, some do not. Pass-thru billing is when the doctor office draws the blood, sends the specimen to the lab and the lab sends the results to the doctor. The doctor then sends the bill for the lab processing to the insurance company and the lab sends a bill to the doctor's office for the lab processing. The risk is that the patient may not pay the doctor's bill and then you eat the cost. Depending on your rate with the insurer, if you get paid more than you pay the lab then you make money. You cannot pass-thru bill Medicare or Medicaid.

coding for self-pay
Thu, Jul/30/2009 09:55AM
is bill a level 2 visit. I can justify underbilling to level 2 ("that coding system is so complicated!") but not level 1 (since this is a nurse visit). Then you can apply your cash discount policy and get your money. It is a shame we have to go thru such a hassle to be nice guys!

Reimbursment for G0101
Wed, Jul/29/2009 04:34PM
It is bundled into the preventive visit payment for all but Medicare. best solution- do not do a pap on the same day as an E&M visit, or bill the preventive visit and an E&M with -25; UHC may pay that, jst be sure your note addresses both preventive counseling and problem-oriented treatment.

Wed, Jul/29/2009 04:30PM
You cannot bill the test to Medicare if you do not do it! Only the lab actually performing the test can bill. For PPO you may be able to do pass-thru billing but check your contract.

Prolonged service billing
Tue, Jul/28/2009 07:42PM
this is so confusing!! As I should have done earlier, I read the whole article and you are correct. do you do a 99213 and have face-to-face of 45 min that is not counseling? I guess diabetic teaching is not technically counseling. Reviewing chemotherapy options with use of risk charts and side effects, etc could be considered care planning and not counseling. I WELCOME input from coders out there!!!!

Medical Record Fee
Tue, Jul/28/2009 05:21PM
Illinois lawyers got a bill passed that regulates copying fees. $22.28 handling charge for processing the request for copies $0.84 cents per page for the first through 25th pages $0.56 cents per page for the 26th through 50th pages $0.28 cents per page for all pages in excess of 50

You can see other state fees at:

CPT 80101-QW Drug screening.
Tue, Jul/28/2009 05:19PM
talk to your insurance rep and get them to pay. Just because a test is waived and can be done in the office does not mean an insurer will pay for it. I would present that this is like a strep test- the results are needed at the time of visit, not two days later. The tests DIRECTLY impact what will be done for the patient that day. If their screen is negative then they may be diverting drugs; if it shows other substances then they are in violation of their pain contract.

Prolonged service billing
Mon, Jul/27/2009 03:25PM
Your logic makes great sense BUT CMS says I'm right :-) Look at page 9 on this document and you will see the table. I use the complexity of the presenting problem to guide my code choice and then add the prolonged services code if over 30 min extra. So a mole is 99212, hypertension is 99213, diabetes and hypertension is 99214 and metastatic cancer warrants 99214-5. Any other opinions?

CPT coding
Mon, Jul/27/2009 12:16PM
Herpes is not spread by needle stick- it is not a routine test to obtain after a needle stick. Hepatitis B and HIV are the standards for testing. There are specific protocols after needles sticks especially with risk of HIV transmission and the CDC should be consulted for guidelines. Extenuating circumstances may be present in this case

Removal of central line for IV access
Fri, Jul/24/2009 10:18PM
If it is removal of a tunneled catheter like a Mediport or Groshong (if they even use those any more) then there probably is a code. For yanking out a regular old central line, that is a nursing duty and not billable.

Fri, Jul/24/2009 01:43PM
Not into my TMJ! 3 drugs and into the muscle???? Out of curiosity and to further my knowledge base, what is the diagnosis?

Prolonged service billing
Fri, Jul/24/2009 01:38PM
You don't tell us the medical problem; I could envision a 99213 with a prolonged service code. Take diabetes; a very thorough discussion with teaching could take 45 minutes. The diabetes meets level 3 with no tests ordered, one established diagnosis. Why use a 99214 or 99215 based on time when 99213 and 99354 is more appropriate and pays better?

hospital observation
Thu, Jul/23/2009 01:41PM
that middle day would rarely be a high level visit (use office visit codes not hospital codes as Nancy pointed out) since this is a patient who is unlikely to require high level decision making when they are being observed for response to therapy. And since you are held to outpatient standards, it is unlikely the doc will record the full 9 ROS or the full PE. So a 99214 would be the highest code I could envision.

Billing for Pap Smears - PCP vs OBGYN
Wed, Jul/22/2009 07:56PM
I see no reason to bill with modifier 25. Did you use V72.31 as ICD-9? 99395 is a well visit and 88142 is the lab charge for the pap so those make sense. By any chance is it an insurance that makes the patients see a gyne for well women care? Some HMO's capitate their gynes for this service.

Is this a consultation??
Tue, Jul/21/2009 06:43PM
Yes, every doctor in America would bill a consultation for A fib, and No, Medicare would say that your doc is taking over the care of that issue from the surgeon who never treats A fib so it is not a consultation.

pre op testing
Mon, Jul/20/2009 07:34PM
Was the patient referred for clearance by the surgeon or self-referred? What is the medical problem? What is the surgical problem?

Mon, Jul/20/2009 03:25PM
That sounds like a turf battle just waiting to happen- ENT v. GI. Glad they are not doing those at my hospital!

Mon, Jul/20/2009 12:48PM

Influenza A&B QuickVue
Thu, Jul/16/2009 08:01PM
Our rapid Flu test gives one line if either A or B is positive. So we bill bill only one unit. Be sure your test has two positive lines- one for A and one for B.

Non-hodgkins lymphoma
Tue, Jul/14/2009 06:31PM
If it is recent diagnosis and the doc is following up for the cancer, I would use the 202 range, possibly 202.9 range. NHL is a broad group of cancers so it is hard to get more specific...

joint aspiration followed by joint injection same visit
Tue, Jul/14/2009 06:17PM
I would not charge for the injection and the aspiration, just the aspiration and the med used. I leave the needle in place and change the syringe after aspiration so it is not a second procedure, in my simple mind.

Welcome to Medicare Physical
Mon, Jul/13/2009 05:28PM
You can do all that other stuff but you must have a valid diagnosis- COPD, HTN, etc. The Welcome to Medicare exam is the history, the exam, the EKG, an AAA screening ultrasound and advice to get a colonoscopy. Here is Medicare's quick reference sheet- 2 pages of help:

insurance company changing code
Mon, Jul/13/2009 09:18AM
It is hard to imagine that they pay better to drop a vial in a bag and print a lag form than to actually analyse the specimen and determine if cancer is present. What a backwards system we have! Why do we let insurance companies control our health care system? Nationalize health care and get them out of the system. We will all be healthier.

insurance company changing code
Fri, Jul/10/2009 06:36PM
The Q0091 is for conveyance of the pap to the lab; 88142 is for the interpretation of the pap. If you are billing for the interpretation of the pap (pass-thru billing) then the Q0091 should be bundled into the 88142. If the lab bills for the interpretation and the insurer changes your Q0091 to 88142 the lab is going to be denied when they submit their bill. So you need to sort out what you are billing for and then go to the insurer to fight this.

Nursing Visit
Fri, Jul/10/2009 06:30PM
Blood draws cannot be billed with a nurse visit. A protime check and warfarin adjustment with proper documentation can be billed with a nurse visit. We gave up on 99000- no one pays.

Nephrology and hospital care
Wed, Jul/08/2009 07:26PM
to report management of dialysis that is not an E&M, like the code for management of ventilator?

benign neoplasm of colon
Tue, Jul/07/2009 07:40PM
don't code it since it was just mentioned, BUT if she says "colonoscopy due this year" then it is a Management and I would put it in my diagnosis list. I would probably use 211.3 not the V code since it is an active "problem".

pre op eaxm
Tue, Jul/07/2009 07:34PM
Billing for Preoperative Examinations

List the appropriate ICD-9 code for the preoperative examination (V72.81 through V72.84). List in item 21 position 1. This is your primary diagnosis. If available, list the ICD-9 codes for the condition(s) that prompted surgery and for conditions that prompted the preoperative medical evaluation (if any). List in item 21 position 2-4. The ICD-9 code referenced in item 24e must be the primary reason for the preoperative examination.


benign neoplasm of colon
Mon, Jul/06/2009 03:37PM
here's a rough version what the writer is asking- The doc writes a note- here for HTN. Had adenoma excised at colonoscopy. Exam- normal, bp 120/80 plan- cont BP med. The question is - do you include benign noplasm of colon as a diagnosis attached to 99213 along with 401.1?

discharge doding
Thu, Jul/02/2009 01:26PM
I always dictated the summary on my post-op patients because I wanted a useful summary of events; the surgeons said "patient had surgery and went home." And I billed for discharge day services and got paid. I also made out the discharge papers, wrote the prescriptions, etc. so in my mind I earned the right to bill for the discharge. The hospitalist could probably code based on time spent and get an equal payment if they fear denial.

diabetic foot care
Thu, Jul/02/2009 08:52AM
Clarification- The codes I posted can be billed by any physician who examines a diabetic foot who has loss of protective sensation and documents it properly; it does not apply to routine podiatry foot care.

Alert - CMS 2010 proposal!!
Wed, Jul/01/2009 05:34PM
As a primary care, I'll take the added E&M payment.

preventative vs. E/M visits
Wed, Jul/01/2009 12:36PM
Be sure the note clearly separates the problem eval and management from the preventative counseling in case of audit. When you have a gyne problem and gyne counseling "they" may try to bundle the two together.

diabetic foot care
Tue, Jun/30/2009 07:15PM
G0426 and G0427 are the codes, look up the documentation requirements

pre op eaxm
Tue, Jun/30/2009 03:53PM
We need a Bobbie Flay Smackdown on how you code a pre-op consultation. I have heard lots of options.

Take a cataract patient sent to primary care for clearance who has Diabetes and hypertension. Do you code in which order? 366.10, V72.84, 250.00, 401.1 OR V72.84, 366.10, 250.00, 401.1 OR 250.00, 401.1 366.10 V72.84

behaviorl health billing
Tue, Jun/30/2009 03:46PM
is to first- read the back of the card then if that fails- second- go online to the provider listing and look under psychiatry and see if there are listings for the doctors and any notation about pre-cert.

You will never get a definitive list- Aetna has 20 plans, Blue Cross 200 plans, etc and each plan has their own rules.

If you are a psych office, I would think the effort to call the insurer before starting services would be well worth your time and effort.

Modifier 25 use with ov
Tue, Jun/30/2009 03:41PM
This is a more likely scenario where an insurer might deny an E&M with a -25.

An established patient comes in with the complaint of a red bump. On exam they have a big abscess. I perform an I&D. Can I bill a 99213-25 and the CPT for I&D? Is the E&M justified here since I had to evaluate the bump, examine the patient and then decide on the best treatment?

medical necessity
Tue, Jun/30/2009 03:38PM
that the visit level should reflect the complexity of the presenting problem.

So if a new patient presented with toenail fungus but the doc took a thorough history, the patient filled out a form with PMH, Soc hx, fam hx, surg hx and the exam was comprehensive so all areas justify a level 4 by documentation, you can rightfully say that "it doesn't feel right" because toenail fungus in a healhty patient is not that complex a problem.

On the other hand, a diabetic, hypertensive, hyperlipidemic on meds for all of those comes in for a 3 month visit with no new complaints is a level 4 visit no matter how simple it may sound because 3 chronic problems is actually a complex situation with medication interactions, interpretation of labs, etc.

Nursing home charges on same day patien is admitted in the hospital
Mon, Jun/29/2009 09:17PM
This happened a lot in my practice. The doc who saw the patient in the nursing home should send the patient to the hospital with admit orders and call the hospital-covering doc and sign out the patient, telling the doc to do the H&P the next morning, within 24 hrs of arrival in the hospital. Of course if the patient is critically ill or unstable then they have to see the patient on arrival but that was infrequent. And in that case the nursing home doc did not bill for the visit and left the order writing and evaluation to the hospital doc (the level 3 H&P is better reimbursement than the SNF visit)

What is required documentation for Wellness Exam?
Mon, Jun/29/2009 07:11PM
Mark this down in history- no government requirements- we actually get to do what we think is appropriate!!!! One small victory for doctors.

Billing E/M in an outpatient facility
Fri, Jun/26/2009 11:06AM
when the patient is placed in the hospital as an outpatient. Does this also apply to outpatient clinic visits like an outpatient oncology clinic or a sleep center where docs can see patients like in their office?

Pro fee coding for Hospitalists
Fri, Jun/26/2009 10:54AM
How can you need help with outpatient coding for hospitalists? They work in the inpatient setting. I don't understand CCS or CPC so maybe it is my ignorance...

Billing E/M in an outpatient facility
Fri, Jun/26/2009 09:00AM
How does the hospital report an E&M? What code do they use? Do they guess what code the doc will report and use that? Do they have their own codes or use our 99xxx? If they report one code and the doc reports a higher level code, does it create an audit target?

Billing E/M in an outpatient facility
Thu, Jun/25/2009 06:46PM
They cannot charge the E&M! E&M billing requires both an E and an M. Vitals are part of the E but there is no M involved. I am sure there is miscommunication- they charge a facility fee and the doc charges the E&M. Talk to the billing dept to get it straight. And if they insist on billing the E&M, call CMS Fraud hotline and save my tax dollars.

pre op eaxm
Thu, Jun/25/2009 09:03AM
"Dr Y referred Mr. X for pre-op eval" and "thank you for referring patient; copy of this report sent to Dr Y"

Treatment for Iron Defiency Anemia
Wed, Jun/24/2009 02:56PM
I heard stories about B12 shots for fatigue- the old people loved it! Perhaps it is the needle that does it- it hurts so it must help. Red KoolAid in a syringe would produce the same outcome.

Medicare admin questions
Wed, Jun/24/2009 11:07AM
And was everything linked correctly? We routinely get paid for the pneumovax using 90732/V03.82/G0009.

Treatment for Iron Defiency Anemia
Tue, Jun/23/2009 07:08PM
the patient is iron deficient and needs iron. B12 treats a totally different type of anemia. I do not give iron IV but the hospital infusion center and the local oncologists give it so it is reimbursed. If you are asking about the injectible erythopoietin stimulating agents, like Procrit or Aranesp, they are used to treat the anemia of chronic disease that accompanies chronic kidney disease and cancer and not iron deficiency anemia. As to alternative treatment options for iron deficiency, oral iron is still the best, most cost-effective way to restore iron. I have found giving liquid iron, Fer-in-sol liquid is available OTC and works great.

billing a CT & CTA together
Mon, Jun/22/2009 02:59PM
Nothing is needed except a proper diagnosis for each test. The CT is for organ disease and the CTA for vascular disease so there should be very different diagnoses to justify both. I can't comment on modifiers for billing the technical component.

margins vs length of excision
Fri, Jun/19/2009 11:01AM
Margin is the distance between the edge of the lesion and the edge of the excision. There are guidelines for cancer excision that certain margins are needed to minimize the risk of recurrence. You code and report by total excision size. A 2 cm lesion with a 1 cm margin (remember that it is 1 cm on each side- think of a small circle in a large circle) is a 4 cm excision.

workers comp pre op clearence
Thu, Jun/18/2009 08:51PM
If the patient was referred to the FP doc for medical clearance for medical reasons by the surgeon (not just a quid pro quo) then bill as above.

RN vs MA for Coumidan Clinic
Thu, Jun/18/2009 03:41PM
If you are a private practice, anyone can do the test and the physician makes the dosing decisions. There is a lot of literature about billing 99211 with a protime check (since that is where the profit is)- be sure to read up and document very well!

bilateral elevator palsy
Thu, Jun/18/2009 03:36PM
Vertical strabismus includes dissociated deviations, cyclovertical muscle anomalies and restrictive conditions (e.g., Brown's syndrome) as well as rarities such as double elevator palsy (Royal College of Ophthalmologists, 2000).

I'm not emailing you- you need to come back here and get the response (and help others with their questions). And please note that you got your answer here faster than at AAPC. Touche!

workers comp pre op clearence
Thu, Jun/18/2009 03:32PM
Who is Dr yes? If you were referred for clearance you must be some type of medical doctor- cardiologist, internist, etc....

workers comp pre op clearence
Thu, Jun/18/2009 10:32AM
Are you the medical doctor? Was the patient referred by the surgeon for "clearance"?Bill an outpatient consult with V72.84 and the injury as Dx #2 and any medical problems as #3 and 4.

pre op appointment
Thu, Jun/18/2009 09:01AM
If the patient was referred from the surgeon back to the primary doc for medical evaluation prior to surgery then use the outpatient consultation codes 99241-5. Be sure the note says "referred by Dr X for pre-op eval" and "copy to Dr X of this report". If the patient was not referred but the parent made the appt on their own or at your request, then it is a standard office visit.

Home Visit vs Office Visit
Wed, Jun/17/2009 09:13PM
Regarding independent living patients seen in the on-site clinic, I would probably use a code in the 99201-99215 series, which covers services in the physician's office "or in an outpatient or other ambulatory facility." For those seen in their apartments, I believe you can code a home visit (99341-99345 and 99347-99350). The home services codes are for services provided "in a private residence," and the independent living apartments seem to fit that definition. I believe you are correct in coding visits with assisted living residents as "domiciliary or rest home" visits (99321-99323 or 99331-99333). According to CPT, these codes are for E/M services in "a facility which provides room, board, and other personal assistance services, generally on a long-term basis. The facility's services do not include a medical component." An assisted living facility would seem to fit that description.

monitoring for adverse drug reaction
Wed, Jun/17/2009 07:06PM
I usually use the reason for the med (272.4, 427.31, etc) then a V code. warfarin v58.61; not warfarin V58.69

diaphragm in addition to insertion code 57170?
Wed, Jun/17/2009 05:11PM
If yes, then bill or ask the patient to pay; if they are free starters from the company, then no, that's fraud.

Site of Service - payment reduction
Tue, Jun/16/2009 10:04PM
the difference is the expenses incurred by the provider. If I see a patient in the office, I pay rent, staff, supplies. If I work in an Urgent care that charges a facility fee, I have no costs being there since the facility furnishes everything so I should get paid only for my cognitive services.

Mon, Jun/15/2009 04:27PM
Your message is a little unclear. Did you send it out or do it in house as a CLIA waived test? Use 80101 or 80100 QW if waived test, and 80101 if sent out. And be sure insurer has you CLIA waived number on file.

Mon, Jun/15/2009 04:23PM
80101 is the general CPT for screening and then it depends how many drugs you test. if you do confirmations then there are more specific codes.

medicare vs AMA
Mon, Jun/15/2009 04:20PM

Mon, Jun/15/2009 02:47PM

OB/GYN Coding Question
Mon, Jun/15/2009 02:41PM
It is always worth the 2 day wait to see the actual path- a malignant excision pays a lot better than a benign excision, even with the same procedure (at least in derm that applies).

ICD9 Help
Mon, Jun/15/2009 02:40PM
What rash is not pruritic? 698.x That should cover the CBC and sed rate (I think- no Lab book handy)

Mon, Jun/15/2009 02:38PM
Are you refering to Medicare patients? Children? School physicals?

Can a physician bill a consult on the same day as the EMG is being done?
Mon, Jun/15/2009 08:51AM
if the doctor did the EMG and found neuropathy and prescribed a medication at the same visit, would the visit still qualify as a consultation or does the treatment make it a New Patient visit??

Internal Medicine
Fri, Jun/12/2009 10:45PM
We are having good luck getting paid on Physicals and E&M together with the -25 on the E&M. We are being sure to separate the assessment and plan for each part to clearly differentiate the work involved with the physical and the work with the E&M problem. So...PE- wear seat belt, exercise, lose weight. HTN- Check EKG, start Lisinopril, low salt diet, return 1 month

Fri, Jun/12/2009 04:33PM

Fri, Jun/12/2009 04:27PM
It is the decision to make a patient DNR (or even the documented discussion that DNR was discussed and Full Code chosen) that makes it High Risk. The next day you start from scratch and can't count DNR again (unless the patient changes their mind and you re-address the issue)

New Patient vs Consultation
Fri, Jun/12/2009 12:22PM
the experts- Nancy? Betsy? Anyone?

New Patient vs Consultation
Fri, Jun/12/2009 08:47AM
This is one of the most confusing areas and I would bet that 90% of billed "consultations" are actually "new patients."

Read this from our CMS intermediary.

(Of course when I bill a consultation I KNOW it is correct- the one clearly correct use is when a surgeon refers a patient back to their primary care doc for pre-op evaluation and "clearance." CMS says that should be billed as a consult. {Finally a win for the primary care docs!})

medicare vs AMA
Thu, Jun/11/2009 08:51PM
but it's the truth. We all know it- no patient, no payment.

Nurse Practitioner
Wed, Jun/10/2009 06:11PM
I don't understand your situation- who works for whom but nonetheless you can bill for phone calls any time but you will likely not get paid. First OB is usually a global package and second most payors don't pay for them. And certainly your first contact must be face-to-face to establish a relationship before you can bill a phone call

lab billing
Wed, Jun/10/2009 06:08PM
The GHP (general health panel) applies to commercial insurers. They almost always bundle the CBC, CMP and TSH into the one GHP code and pay that, EVEN if each one is linked to a different diagnosis. Again, it may not be right but they make their own twisted rules.

Nurse Practitioner
Tue, Jun/09/2009 01:48PM
Is the NP in another practice as the patient's OB? If she is providing OB care along with the doc, it is not a consult. Who is "referring" for the consult? If the patient self-refers, it is not a consult. If another practice is "referring" the patient for advice on DM management, then it is a consult.

Tue, Jun/09/2009 01:44PM
so you can get a high level Medical Decision Making (if you are talking DNR the patient likely has high level problem points) and if you meet the other levels, you can get a high level visit

Tue, Jun/09/2009 01:40PM
That rule has not changed...yet

Tue, Jun/09/2009 01:39PM
read this article on Modifier 25, the code to use when you do something in addition to the E&M:

Help with HCPC
Mon, Jun/08/2009 05:13PM
but I doubt you paid for it. You probably gave a sample pill or a return from another patient and to charge for that would be fraud. Ask the docs who got busted charging for Lupron that they got as samples.

Palliative Care Consultations
Sun, Jun/07/2009 01:20PM
It should be a financial decision. What pays more- level 1 consult on day 1 and high level subsequent visit on day 2 or high level consult day 1 and low or medium level visit on day 2. As to documenting, I have not seen anything special for your specialty (or any specialty besides single system exams) so you are bound by usual E&M rules.

Screening Colonoscopy Dx
Fri, Jun/05/2009 04:45PM
if the insurer asks you to use another code to get paid, use that code. Getting paid is more important than being right...sometimes.

Fri, Jun/05/2009 11:57AM
A scribe in an office can be anyone-no one is going to regulate that- the physician is responsible for the content of the note. A scribe never touches a patient but you should give them OSHA training and hep B vaccine and influenza shots.

Thu, Jun/04/2009 09:01PM
and then go to page 9 in this document from one Medicare intermediary

Thu, Jun/04/2009 08:54AM
Both these services are reimbursable at the same visit if the patient presented with a problem that required evaluation and then the acupuncture was administered either for that problem or related to another problem. If the visit was a followup just for acupuncture then the office visit should not be billed.

t-PA administration-Neurology Question
Wed, Jun/03/2009 05:06PM

It looks like the insurers just don't pay the code. Why would you bill a 99215? That is an office code! I would bill critical care and/or prolonged services codes since the doc stands there and watches to see if they get better or bleed.

Wed, Jun/03/2009 10:26AM
but getting paid is another issue ;-) You would probably want to do the review with the patient present in the office; many insurers balk at paying for document review and completion if the patient is not in the office.

Tue, Jun/02/2009 05:15PM
The only consult I bill is the pre-op eval and that is clearly allowed by CMS as long as I say "sent by" and "send copy of report to".

I am going to look for some orthopedists and see how they code- it can't get much more straightforward than a patient with a torn meniscus/fractured arm/hip fracture referred for care.

Mon, Jun/01/2009 08:55AM
I can't wait to hear the answers about those cases! It sounds like they are actually not consultations since you are assuming care for the problem (performing the surgery) and not just rendering an opinion.

Sun, May/31/2009 07:35PM
you can have multiple consultations on the same patient if the problems are different and there is time between problems. So, a patient is admitted with abdominal pain and a rash. Derm is consulted for eval and recommends some cream and sees the patient once. Three weeks later the patient is post-op day 17, in the ICU, on a vent and develops a bed sore. Derm can be re-consulted to evaluate this new problem and can bill both as consultations.

Likewise a nursing home pt can have a rash one month and a new mole 2 months later=2 consults.

Am I wrong?

Postpartum cardiomyopathy
Fri, May/29/2009 01:56PM
If gthe disease is still present then the code still applies. If the history is noted but the patient is pregnant and the disease is no longer present then you could use a high risk code (if such a thing exists) for the current pregnancy to justify increased surveillance.

medical necessity and decision making
Wed, May/27/2009 10:41PM
[Of course we want the CMS citation from your other computer, but don't tell your staff why you're slipping out! Tell them you have to go review an image for a patient you're going to see so they don't get mad at us.....:)]

Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed. Documentation should support the level of service reported. The service should be documented during, or as soon as practicable after it is provided in order to maintain an accurate medical record


ASD, developmental testing and preventive, prolonged services
Wed, May/27/2009 01:29PM
96116 would be the code; payment probably depends on the insurer. I could see this payment being denied if submitted by a pediatrician but paid if submitted by a psychologist or psychiatrist, but that's my internist view of the situation.

Wed, May/27/2009 12:39PM
So when you patients come every year, they should get an ABN and told that they must pay for their exam as Medicare covers it every 2 years.

Billing for loupes
Wed, May/27/2009 12:35PM
Doctors are looking for every way to get more income and rumors like this start when one doc submits a bill and it gets paid. Using loupes is not separately billable, it is not a microscope. You can bill for it but I'd reserve the money and more to pay out the refund and the penalty for Medicare fraud.

Wed, May/27/2009 12:30PM
CMS pays out once a year- they wait 3 months for late claims to be submitted and then 3-4 months to process them. Then it will show up on your Medicare payment list. In 2008 it was very onerous to get the actual data; they claim in 2009 it will be easier to get this info. (Of course you only need the data if you do not get a payment to see where you messed up.)

Obstetrical Ultrasounds with Consultation
Wed, May/27/2009 10:31AM
The requirements for consultation billing are much more onerous than for the office visit. I could see a note " spent 30 min discussing ultrasound results with pt and spouse" as proper coding for an office visit (if there was a little bit of history) but that would never fly for a consultation.

medical necessity and decision making
Wed, May/27/2009 09:28AM
CMS added a clarification about medical complexity because of EMR's. With a few clicks you can document a comprehensive Hx, ROS and PE on a patient with a mole and that would meet the 2 of 3 categories for a level V followup visit but we all know that a mole is not a level V problem. So CMS came out and said that the complexity of the presenting problem is the key in determining the level of visit. I have the exact reference on another computer if you need it.

Gastroenterology ICD-9 coding for screenings
Fri, May/22/2009 05:11PM
It is never appropriate to use v70.0 for a screening colonoscopy...unless the payor tells you to use it to get paid. Every day we are faced with rules that make no sense but we must follow them to get paid- another example- the use of Observation status in the hospital for normal post-op recovery. Medicare calls that fraud, Blue Cross says you have to bill Observation or they won't pay for the surgery. So make up a grid with the payors and their preferred codes and use that, and don't try to argue their logic- it's not worth the effort.

skin wide excisions
Thu, May/21/2009 02:55PM
The difference in the codes appears to be by location and skin is in 88305, not 88307. BUT melanoma is not a skin cancer- it is a cancer of melanocytes and has a huge metastatic potential unlike skin cnacer, so you would have to argue that the work involved fits better in a more complex category than that for a simple skin cancer.

Ischemic White Matter Disease
Thu, May/21/2009 02:34PM
Why do you need a better code? This one is fine. It's another example of the nuances of medicine- we learn terms that have no classification or code but which explain more than the code we are forced to choose if we want to get paid.

Prolonged care
Thu, May/21/2009 12:56PM
I don't think you'll get paid for an admission and a subsequent care in the same calendar date by doctors in the same group. (Are you sure the H&P did not start at 111:59 pm the previous calendar day?)

Hospital Visits Same Day But by Different Physicians In a hospital inpatient situation involving one physician covering for another, if physician A sees the patient in the morning and physician B, who is covering for A, sees the same patient in the evening, Medicare Services will not pay physician B for the second visit. T he hospital visit descriptors include the phrase “per day” meaning care for the day. If the physicians are each responsible for a different aspect of the patient’s care, Medicare Services will pay both visits if the physicians are in different specialties and the visits are billed with different diagnoses.

So I think the first doctor should bill the H&P and prolonged services codes. Let's see what Betsy thinks

Thu, May/21/2009 10:59AM
The 2007 PQRI payments were paid out in July, 2008, so expect the same timeline for the 2009 e-prescribing payments.

No authorization on an inpatient hospital stay
Wed, May/20/2009 08:43PM
and don't blame the hospital staff- the doctor is supposed to notify the insurer- read the contracts- it's there.

No authorization on an inpatient hospital stay
Wed, May/20/2009 08:42PM
I am sure the hospital appealed the denial. If it was a medically necessary stay then the insurer is likely to pay it. But if the hospital appeals and gets approved for the stay, they most likely won't call you to tell you to rebill. So you may want to do the appeal yourself. Then again, if your doc is the primary care doc who was supposed to precertify the stay and she did not then you may be out of luck. And if the stay was determined to be not medically necessary then you are also out of luck. You cannot make the patient pay- that would breach your contract.

does this count for physical examination?
Wed, May/20/2009 08:55AM
You can still examine a sleeping, paralyzed, unchanged patient and get significant findings. The doc can also document- Neuro- limited due to sedation or gait- unable to be tested, etc to get all the bullet points for a comprehensive exam. Consults require all three elements- Hx, Px, MDM and these fail the Px. Give 'em a level 1-3- remember you don't make the rules just enforce them, and that is better than CMS knocking on the door in a year asking for the money back.

Mon, May/18/2009 06:00PM
Do you mean Medicaid? if so, there is no rhyme or reason to their system. Good luck getting anything from them!

t-PA administration-Neurology Question
Mon, May/18/2009 05:20PM
What code are you billing for the t-PA admin? Don't think there is a code for it since it happens in the ED but that is a critical care situation and should be billed for the consultation and the critical care code if the doc was in the ED the whole time.

comprehensive neurological examination in a child
Mon, May/18/2009 05:18PM
The exam should be as comprehensive as possible- if the child cannot do the memory test, write "memory cannot be assessed due to age"- this will count.

In School For Coding and Billing
Mon, May/18/2009 10:34AM
Money? Benefits? Stability? Vacation time? Coverage for illness? Small office v. hospital? These days insurance drives a lot of job decisions. A hospital will give better benefits; many doc offices can't afford to pay for insurance. Take a look at what you are asked to code- can you read the doctor's writing? Do they make you pick the code and hold you responsible for picking the most profitable code? Are the other employees happy? If you have kids, can you take sick days for a sick child? Can you work from home?

Drainage of Skin Abscess without Incision
Fri, May/15/2009 07:28PM
Squeezing a zit is probably bundled in to the E&M. It is also not an adequate treatment for most abscesses- they really need I&D with or without packing.

Medical Decision Making...
Fri, May/15/2009 03:43PM or hire Betsy to teach you!

Medical Decision Making...
Fri, May/15/2009 12:48PM
The doc reviewed the report so 1 pt- if she did an "independent review of image, tracing or specimen" then she could get 2 points.

Thu, May/14/2009 09:43PM
What CPT (94010?) and diagnosis did you use? It is not paid for a diagnosis unrelated to the respiratory system or as a screening test- I would use asthma or dyspnea or COPD, etc. as they apply to the patient's condition. I have seen no frequency limits but that does not mean they do not exist.

insurance equals payment
Thu, May/14/2009 04:02PM
I am an internist who reads a lot and likes to express his opinions (see post about female rectal exam). I do some case management work at my local hospital so know about the hospital side of stuff. Betsy Nicoletti the coding queen got me onto this site. In between patients I read postings and answer questions (don't tell my staff that's what I am doing- they think I am charting!)

Diagnosis code
Thu, May/14/2009 01:03PM
a tan?

insurance equals payment
Thu, May/14/2009 01:02PM
First you have to differentiate Medicare from commercial- CMS publishes lots of guidance, other insurers do not. Also differentiate routine practice from the occasional forgiveness of a debt. And finally waiving a fee for non-covered services is much different (and totally up to the doctor ) than waiving a copay (routine copay waiver is fraud).

So CMS says this: routine waiver of deductibles and copayments by charge-based providers, practitioners or suppliers is unlawful because it results in (1) false claims, (2) violations of the anti-kickback statute, and (3) excessive utilization of items and services paid for by Medicare. from:

female digital rectal exam
Thu, May/14/2009 11:45AM
A rectal exam is part of the exam! If you do a stool for Occult blood then you can charge a 82270, but there is no charge for the glove or the lubricant or the act of actually inserting the finger. Medicare does not pay extra just because a procedure is unpleasurable to the provider.

new code for laser of hemorroids
Wed, May/13/2009 11:06PM
"Thermal energy" sure sounds scary, like on the season finale of Lost!

Should we accept a LIEN
Wed, May/13/2009 07:23PM
You said the attorney "requested"- sounds like they are asking; I guess you have to ask yourself what would happen if you say "no" and they go to collections. If they file for bankruptcy then you get zero. If you take the lien you may have a chance to get something. I have written off many balances instead of sending patients to collections and sent the patient a note telling them that I understand health care is expensive and the economy sucks so as a gesture of compassion I am writing off the balance. Sometimes doing something nice just plain feels good.

Lab Billing
Wed, May/13/2009 04:12PM
Of course I meant "performed by" - sometimes the fingers move faster than the brain.

Lab Billing
Wed, May/13/2009 04:05PM
You can bill for the technical component as long as your CLIA license allows that level of service. As to the requisition, I would imagine as long as there is a clear "paper" trail of what was done where, you should pass an audit. Can they put on the requisition "specimen prep preformed at XYZ GI office by Tom Jones, cytotechnologist"?

diagnosis codes
Wed, May/13/2009 03:02PM
365.8 other specified idiopathic peripheral neuropathy and 907.5 injury to peripheral nerve of lower limb

Medicare and state law
Tue, May/12/2009 01:03PM
[[I am curious- do you want to share what you billed and why they are asking for a refund?]

We billed an x-ray during post op. Pt was apparently enrolled in a skilled nursing facility at the time, but was seen in our office for after-care.]

As the Editor pointed out, your xray should have been paid by the SNF. The good news though is that you could go back to the SNF and ask for payment now. Your professional fee should have been paid by Medicare- Consolidated billing only applies to non-physician services.

Billing for Medical Supplies
Tue, May/12/2009 09:57AM
Most supply costs are bundled into the payment for the procedure- kits for I&D, suturing supplies, etc. If you are getting paid anything, feel lucky and don't argue, and certainly don't try to collect from the patient!

I know one doc who bills for the EKG electrodes and occasionally gets paid $4 or so- but the denials are plenty and the work involved to clear those ecxceeds the income for those that do pay so I don't do it.

As to splints and braces, others may be able to chime in but if you don't like the reimbursement, the insurnace will tell you to send them to a DME supplier who will happily take the insurer's reimbursement.

Medicare and state law
Mon, May/11/2009 06:23PM
I am curious- do you want to share what you billed and why they are asking for a refund?

Additional Critical Care time CPT 99292
Fri, May/08/2009 09:42AM
when does 99292 kick in? Does 16 minutes qualify? Or does it need to be 29 minutes?

(as an aside, I see critical care very overused. A patient in the ED with chest pain and a normal EKG, no acute MI, will get coded with critical care code. Or an asthmatic who requires nebs but is not near intubation or respiratory failure. I can see the RAC really going after those!)

anti-markup rules
Thu, May/07/2009 04:02PM
I am 99.9% certain that for Medicare you cannot bill for the radiologists if they are not part of your corporation. They must bill for their own services and you bill for the TC only.

Prescription Drug Management
Thu, May/07/2009 03:59PM
since it is only available by prescription.

skin wide excisions
Thu, May/07/2009 10:19AM
Q: A 35-year-old BRCA1 mutation-positive patient presented for removal of her right fallopian tube and ovary. (Her left tube and ovary were removed years ago for an ectopic pregnancy.) The tube and ovary were serially sectioned, examined grossly, and embedded in paraffin. Sections from each paraffin block were examined microscopically. No cancer was found. What CPT code should we use?

A: CPT has code 88307, Level V—Surgical pathology, gross and microscopic examination, ovary with or without tube, neoplastic, for a neoplastic ovary and tube and code 88305, Level IV—Surgical pathology, gross and microscopic examination, ovary with or without tube, non-neoplastic, for a non-neoplastic ovary and tube. There is no code specifically for the gross and microscopic evaluation of tissues from patients with a genetic predisposition to neoplasms.

BRCA mutation-positive ovaries submitted for evaluation may require the pathologist to perform the work consistent with an “ovary with or without tube, neoplastic,” or code 88307. In this case, extensive sectioning was performed and the entire specimen was evaluated microscopically, so code 88307 is appropriate. If the organs were not submitted in their entirety, then it would be more appropriate to use code 88305.

non covered services
Wed, May/06/2009 04:53PM
but your summary makes perfect sense. Of course the doc has to be willing to give up the income.

Correct CPT code use
Wed, May/06/2009 04:51PM
They should provide you with codes for billing; many of these new devices are "squeezed" into existing codes by the manufacturers to get good reimbursement and to sell machines. Then the insurers look again and realize what is happening and take away the good reimbursement by getting a new code that pays less. That is what happened with the Neurometrix automated EMG machine for testing peripheral neuropathy and carpal tunnel- they sold lots of machines then the insurers said it wasn't a true EMG and stopped paying at all! But of course I have never heard of the test to which you are referring so I may be totally off base....

Adult Flu Shots with High Risk Diagnosis
Wed, May/06/2009 02:29PM
more details. ICD is v04.81, the shot is 90658 and the admin code is 90471 for regular ins and G0008 for Medicare.

We don't link to the high risk code for any insurer- most policies either cover it or don't cover it, irrespective of health conditions

non covered services
Wed, May/06/2009 11:54AM
Did patient sign an ABN if Medicare? Did pt agree to pay if not covered? If commercial insurance then go ahead and write it off- the fraud is if you write off a copay or deductible without attempting to collect.

Hospice Patient Modifier
Wed, May/06/2009 11:17AM
what did you bill- CPT and ICD? Perhaps you billed Hospice care plan oversight and did not link to the hospice-qualifying diagnosis.

Third party adminstrator question
Tue, May/05/2009 07:24PM
As we will all learn with the upcoming RAC audits, the RAC companies are allowed to have proprietary software and guidelines and are under no obligation to share it with anyone. It should be based on medical standards of care and guidelines but many ares are so grey that no guidelines exist.

Nuc Med procedure without radiopharm
Tue, May/05/2009 07:21PM
The thyroid scan involves injecting radioactive iodine then scanning the body to see if there is uptake. Like many nuclear procedures there are multiple scans over several days. It is still considered one test. The procedure should be billed on the first day with the test and the nuclear agent; you would not bill each day separately. Use modifier 52 or 53 if you do not complete test.

Screening prior to CT scan
Mon, May/04/2009 06:56PM
and I called my billing people- they are checking on what they do. Some they said that they bill with the diagnosis for the test- headache, abdominal pain. I would think that the BUN and Cr will be paid for most diagnoses that require a CT scan and in the office I have never had one denied when ordered whether I do a CT or not. (In other words, checking kidney function in a patient with abdominal pain or headache is medically appropriate as renal failure can cause pain, headache, etc)

Just be sure you call the referring doc to be sure their office did not do one!

Dental abcess
Mon, May/04/2009 04:09PM

Mon, May/04/2009 11:01AM
I always used to put the illness requiring surgery first then V72.8x then the medical illness but Betsy said to put V72.8x first at her Pri-Med lecture.

Any definitive source for this? It comes up all the time....

Sun, May/03/2009 10:21PM
this is an outpatient consultation- bill the appropriate level. For diagnosis, #1 should be v72.8x, #2 the reason for surgery (like OA knee) and #3 and 4 the medical illnesses like 585.3 and 401.1. Be sure the note indicates"Referred by Dr X for preop evaluation due to presence of x and y diseases to assess suitability for surgery" or something like that and "copy of this report sent to Dr X" to meet CMS guidelines for consultation.

Sat, May/02/2009 08:44AM
What are you asking? Or is this spam?

Progress notes
Fri, May/01/2009 09:47PM
After you added your response that if the doc evaluated an irritated keratosis on one visit and decided it needed excision, then on the next visit she could write the procedure note and do the procedure and code it based on the finding of the previous visit and it would be appropriate. Although an operative note should have the diagnosis but that really applies to hospital procedures and is a hospital rule not a coding rule.

EHR Signatures
Fri, May/01/2009 04:14PM
if the "Signed" refers to an electronic signature by a physician. I can't imagine the EHR does not indicate who signed it. Can you right click on the yes and get details?

Progress notes
Fri, May/01/2009 04:11PM
that says you cannot include a diagnosis code that is not addressed anywhere in the note. At least HTN- CPM, or DM - stable.

Documentation of ROS
Fri, May/01/2009 04:09PM
There is no reason the elements can't be in HPI as long as they are the proper elements. Rationally, if it does not apply to the "Present Illness" then they shouldn't be in the HPI. So a visit for a sore throat should not include abnormal periods in the HPI. If you need a reference, I can get you something.

billing codes
Thu, Apr/30/2009 07:23PM
I thought it was an attempt at irony and humor!

I don't do Workmans Comp but with insurers that send forms or want me to call to precertify a service, I have the patient come in the office and help me fill out the form or listen to the phone call. That serves to let them know what information is being transmitted and I get to bill for the service based on time. I have yet to meet a lawyer that will even receive a fax without charging for it, much less fill it out, so why should I give away my time?

billing codes
Thu, Apr/30/2009 05:56PM
E845.0, because workman's compensation can't possibly be a product of humans.

Thu, Apr/30/2009 03:48PM

What diagnosis code?
Thu, Apr/30/2009 01:50PM
Insurance companies get to make their own rules and the insurers sign a contract agreeing to abide by the rules. If the insurer does not pay for preventative care (V codes in general) then if the patient wants the service, they pay for it. If they want a cholesterol test just to see their number, it is screening. If they are in the office with chest pain, I will link the cholesterol to the 786.50 since it is part of my workup. Likewise with varicella. If they have a rash, link it to the code for chicken pox; if it is screening to see if they are immune, the patient may have to pay.

Of course to complicate things some insurers pay GREAT for preventative care so if you code the test linked to a problem visit, the patient gets upset since it now applies to their deductible.

Completing ROS
Thu, Apr/30/2009 01:40PM
It is OK to double dip! You can use an emement in the HPI to be counted in both HPI and ROS according to abundant references found at They have CMS people saying that you can double dip on elements

Completing ROS
Thu, Apr/30/2009 08:56AM
You can count an element discussed in the HPI as part of the ROS as long as you do not consider it in the counting for the HPI. So if the problem was chest pain, and she talked about the patient's shortness of breath, you could count that as ROS for respiratory if you do not use it in HPI as an associated symptom.

Financial Hardship
Wed, Apr/29/2009 03:10PM
IMHO, having a policy takes away the concept of charity. In private practice we are governed by compassion. But I think the "rule" from CMS is that you make an attempt to collect and then you can write it off. You cannot just waive the fee- that is fraud since Medicare is supposed to pay 80% of the fee and you therefore should get 80% of 80% (if that makes sense).

So for your patient, bill her as with all others then your docs can look at the delinquent list and determine who deserves a compassionate waiver of fees and write those off---and send the rest to a collection agency (with the charge jacked up to cover the collection fee.)

Tue, Apr/28/2009 08:20PM
-Acromioplasty - Arthroscopic removal of bone from the acromion & partial resection of the coracoacromial ligament -Distal Clavicectomy: Arthroscopic removal of the end of the clavicle. The superior AC ligament remains intact so that the joint remains stable

RAC thoughts
Tue, Apr/28/2009 07:41PM
Of course they are going after the automated errors first- easy start up money. But then again if you bill for performing a hysterectomy on a male or doing a colonoscopy on a dead patient, you deserve to be caught.

The hospitals are going to have a much tougher time with their medical appropriateness audits- the "retrospectoscope" shows a much clearer picture than when the patient is actually seen and convincing the auditors of that will be tricky. And if you really, really understand the OPO vs. inpatient rules, you are the only one- even the QIO's do not agree on the rules.

Adding a -25 to all claims sounds like a mandate from a physician- "I am sick of not getting paid- just put a 25 on everything." "Yes, Doctor."

Why bill a 99212? Do you really think they are going to see that and say "Hey look- these guys are undercoding! Let's go give them the bucket of money they really earned!"

Take a seminar and learn to code properly. After a session with Betsy, I increased my 99214's by 10-15%- I was doing the work but not documenting what I thought and did. Without even touching a patient I can get 5-6 bullet points on an exam that I was neglecting (rash, joints, bruising, gait, orientation, edema) and all my counseling is now being "appreciated" by the auditors in my documentation. And love that 99354- prolonged service code!

G Codes
Tue, Apr/28/2009 05:59PM
no, you cannot go back- the code must be reported with the E&M code.

you still have plenty of time to earn the bonus since it requires only 50% of 2009 claims to have the appropriate G code.

What is the difference between CAD 414.00 and ASCVD 429.2
Tue, Apr/28/2009 12:07PM
CAD 414 for the patient with established coronary artery obstruction, either by catheterization or other imaging like CT angiogram. I see ASCVD as more ill-defined to include all the diseases that occur when your arteries start to clog (AtheroSclerosis) and stiffen, and would include hypertension, peripheral vascular disease, carotid artery disease, aortic aneurysm and coronary artery disease.

Personally I have never coded a patient 429.2 as it is too vague.

Billing for phone calls
Mon, Apr/27/2009 10:34AM
We do not yet bill for phone calls; most insurers do not pay for it so I don't want to create the billing mess of a charge that is not paid and then the patient gets a bill then they get mad at me and so on...

There is a company Relay health that sets up portals where patients pay for e mail interaction with their doctor if he/she is signed up for the service. of course they take a cut of the payment...

Mammo to check clip placement
Thu, Apr/23/2009 05:54PM
I would say bill a diagnostic mammogram

New patient VS Consultation
Thu, Apr/23/2009 12:08PM
for specialists. As a primary care doc, 99% of the time I send patients to specialists to fix the patient's problem, not to tell me how to fix them. How am I supposed to set a fracture or do a colonoscopy or perform a cholecystectomy??? So technically that is a New Patient for the specialists not a consultation. But I am sure they bill a consultation. They do document "referred by Dr. X" and they send me a note.

No great answers in figuring this one out from me.

Wed, Apr/22/2009 04:43PM
865.01- hematoma of spleen

care plan oversite
Wed, Apr/22/2009 12:09PM
but it is really up to the state what they cover. I do not think the feds tell the states what to pay. It is always a good idea to submit the charge and get denied. When they decide what to cover, if there were a lot of claims made, they may add that charge to the covered list. And I am sure they will not announce that they are now paying for it so keep billing.

Medical Necessity
Mon, Apr/20/2009 10:12AM
It would help to know if you are billing the CT scan or a physician E&M for the ER visit (or something else).

orthostatic vital signs
Fri, Apr/17/2009 10:29PM
Do you really think you can charge extra for orthostatic vitals? Do you charge extra to call a patient by their first and last name? I know we are underpaid for what we do but this is going way too far!!!

How do you code chf?
Thu, Apr/16/2009 06:15PM

Stacie L. Buck, RHIA, CCS-P, RCC, CIC President/Senior Consultant RadRx ]

You really should NOT use 428.0- the doc needs to be more specific. At least 428.1- CMS said a year or two ago that they would not recognize 428.0- I think they wanted to try to get data on type of heart failure(right, left, diastolic, etc.) But as with many threats they continue to recognize it and pay for it...for now.

Renal Ultrasonography - CPT Code
Thu, Apr/16/2009 04:02PM
76770 or 76775

Diabetes outpatient self management training
Thu, Apr/16/2009 03:51PM
G0108- 30 min of DM training; but I don't think that a doctor who is not specially trained to do DM education can bill for this- you may need to be certified as an diabetes educator. If it is "just" the doctor teaching how to use the monitor, use the E&M codes with time documented and if the nurse is doing the training it is a 99211.


Can we get to know each other?
Wed, Apr/15/2009 05:07PM
I am a general internist and HIV specialist. Our docs all code our own stuff (although primary care is tons easier than surgery) I heard Betsy Nicoletti give an awesome lecture at a conference and thru email she told me about this site. I work as a Medical Director of case Management at my hospital so know some about the billing side of hospital activities. We have an EMR in the office, eClinicalWorks. Hope I can contribute; I know I will learn from all of you. Ron H

Can we get to know each other?
Wed, Apr/15/2009 03:03PM
Is there something special between you and feet? Is this a 302.81?

Handling code
Wed, Apr/15/2009 11:53AM
The handling is bundled into E&M for almost everything except paps with medicare.

Radiation Oncology
Mon, Apr/13/2009 05:23PM
The treating docs can bill for consultation with every admission even if established in practicce.

HELP!! Consult/New Patient question...
Mon, Apr/13/2009 10:40AM
The Editor's answer was a little ambiguous.

The physical does require vitals to be billed, but time-based billing does not require them. And since this is a coding forum I will not comment on lack of exam except to say many oncologists have found abnormal lymph nodes and other signs of cancer that I have missed.

HELP!! Consult/New Patient question...
Mon, Apr/13/2009 09:18AM
Did the doc document time spent in counseling and coordination? If >50% time spent in counseling and coordination the doc can choose a code by total time spent. Time is 15, 30, 40, 60 and 80 minutes.

Multiple Radiology Interpretations
Sun, Apr/12/2009 08:42PM
Are you asking if radiologists can get paid to re-read reports already read and billed by another radiologist?

Or is this a specialist - neurologist or orthopedist for example- who wants to bill for interpreting xrays patients had at another facility that were read by a radiologist?

hospital charge vs. office charge
Sun, Apr/12/2009 08:39PM
If I see someone in the office and I send them for admission, I often write in the chart "Admitted" and I dictate the H&P and write orders and bill for initial hospital care. I submit no charge for the office visit. I do not see the patient that day in the hospital; my first hospital visit is the next day and is billed as subsequent hospital visit. I don't think CMS would object to this- it is less costly than a high level office visit and a hospital admission charge.

I have never read that the patient must be "seen face to face" in the hospital (although that does not mean it is not written somewhere.)

Sun, Apr/12/2009 03:34PM
You are crazy! Is your billing software prepared to handle these codes?

Are your doctors ready to pick new codes?

Is your EMR ready to incorporate these new codes?

Do you think every insurer out here is ready for these codes?

Do you think the state Medicaid program is ready for these codes or has the money to fund the conversion?

This is a nightmare- better start saving up funds- I'll guarantee that cash flow in hospitals and doctor offices all over the country will grind to a halt when this happens.

And finally do you think a single patient will get better care or get cured of their disease because of these new codes?

CT scan supervision
Fri, Apr/10/2009 02:14PM
Ask the radiologists if they would be willing to supervise your stress tests; not read them, just be present. Same thing as your docs supervising their CT scans.

What are the differences between CPT Coding and ICD-9CM
Fri, Apr/10/2009 02:13PM
CPT- Procedure- what was done ICD- disease- what is wrong

CT scan supervision
Thu, Apr/09/2009 10:59PM
A doctor is required to be on site when contrast is administered. There is no code for this or charge; it is the radiologist's responsibility. If someone has a reaction, the doctor responds. Best talk to your malpractice carrier about this. If someone codes or dies, your doctor will be part of the lawsuit.

I have no reference except common sense and personal experience.

Thu, Apr/09/2009 03:54PM
[Dear Sir, I read your article about 99211 and an injection. What do you do if the patient brings her own b-12 medicine. I can't bill an admin code of 96372 when I don't show any injection can I? Could I not bill a 99211 then? sandy]

We use 96372- admin therapeutic injection when the patient supplies their own med and get paid. There is no need to have a J code with it. Link it to the diagnosis for the shot- anemia, b12 deficiency, etc. NO 99211!!!!!

hsCRP testing
Thu, Apr/09/2009 03:47PM
Some commercial insurers never cover it, others always cover it. Medicare considers it medically necessary for 'at risk" patients.

From the medical perspective your best chance of success would be to link to 272.x - hyperlipidemia series.

Just to add a medical note, the data on using crp is still not convincing. Most studies were done by the doctor who owns the patent on the test so he has an interest in getting good results. I use it for the patient with mildly high cholesterol who needs convincing that a cholesterol medication will benefit them.

Thu, Apr/09/2009 02:31PM
Click Edit profile at the top of this page, scroll down on next page to Forum Registration, click that and uncheck the boxes

Thu, Apr/09/2009 10:22AM
A B 12 shot requires the nurse skill to administer but no thought process. Room patient, give shot, pt goes home full of energy and vitality.

A BP check can involve thought process- BP high, doc says increase med. BP too low, cut back dose. Documentation is the key to an appeal. If it is "BP 120/80" then no 99211, if it is "BP 150/100 doc says double lisinopril" then 99211 should pass audit

Facility Fee Billing for outpatient services
Wed, Apr/08/2009 09:56AM
If you are offering E&M physician services 99201-99215 I doubt you can charge for a facility fee. If you are an urgent care there are facility codes although I just read that UHC is going to phase out that fee (but don't quote me.)

Modifier 90
Tue, Apr/07/2009 07:50PM
Mod 90 if a reference lab is running the test

93295 and 93296 Pacemakers/ICD's
Tue, Apr/07/2009 07:49PM

Using Robotics in Colectomies
Tue, Apr/07/2009 07:43PM
Surgical techniques requiring use of robotic surgical system (List separately in addition to code for primary procedure)

Administration Code 90473 Reimbursement
Tue, Apr/07/2009 07:16PM
If you also give a 90471, use 90474 for the oral vaccine. You can't have two "first" vaccine administrations.

NPP and consults
Tue, Apr/07/2009 07:12PM
If I was the Primary care doc, I'd never use that specialist again!!!! I want a doctor's opinion, not a PA!

UHC throat culture/urine culture
Tue, Apr/07/2009 07:11PM
UHC does not allow pass thru billing so the lab should be billing for this. (Plus who has a UTI and strep throat at the same time???)

Non face-to-face proglonged services
Tue, Apr/07/2009 09:55AM
Without the patient present, the service is bundled into the last E&M. You can't go back and add it to the previous visit.

Be sure your docs are aware fo the prolonged services codes 99354 to 99357. For example can code a 99213 and a 99354 if the doc spend 45 minutes with the patient to discuss colon cancer treatment, rather than billing a 99215.

Mon, Apr/06/2009 06:27PM
What services do you offer that require an ABN? I am an internist and never use them. Not worth the hassle- if the service is not covered, it should not be done. Medicare's guidelines are pretty reasonable as to what they considered covered.

Impella Device
Mon, Apr/06/2009 03:27PM
looks like...

ICD 37.68- insertion heart assist device CPT 92970-Cardioassist-method of circulatory assist; internal

Code 44312
Mon, Apr/06/2009 03:08PM
This procedure is not on the CMS Inpatient Only list so it does not warrant hospitalization. The description sounds like it could be done in the office but I am no surgeon- "release of superficial scar" sounds pretty inocuous. Did you send the operative note?

Manual disempaction
Mon, Apr/06/2009 03:01PM
but the medical assistant should get a bonus for assisting and cleaning up.

SED rate
Mon, Apr/06/2009 11:24AM
You can find the applicable codes on page 27 of this source- you lab can also provide a list of codes. It is good to have on hand.

Postoperative visits
Mon, Apr/06/2009 10:04AM
If you systematically schedule post-op visits outside the global period, it is fraud, plan and simple. There may be an opportunity for you to file a qui tam lawsuit and collect a reward if she is found to be defrauding Medicare.

New billing code
Mon, Apr/06/2009 10:02AM
There is a code to report if the patient self-monitors at home that can be reported. 99363 every 90 days it cannot be used for pts who have home care testing them or in nursing homes, etc.

hospital charge vs. office charge
Mon, Apr/06/2009 09:46AM
charge a level V office visit if your office note meets that criteria and see the patient the next morning at the hospital and do a level I admit H&P.

Placement of Mesh Vessel Guard coding
Sat, Apr/04/2009 10:46AM
Looks like it is part of the procedure. he may have to bill for assisting. See Gore reference:

Unfinished chart notes
Sat, Apr/04/2009 06:06AM
7 doc private practice on an EMR.

We have no set rules- every doc knows the consequences of being audited and the auditor finding that the notes do not match the visit level chosen. If they think they will look nice in stripes, they are welcome to leave their notes incomplete.

I personally finish every note after the visit and check them all at the end of the day so I don't face a huge number of notes to complete at the end of the week. It's like your kids and their bedroom; if they keep it clean it's not a problem. If they are asked to clean it every week or month, they throw a tantrum and do a bad job.

Recession and/or relocation
Thu, Apr/02/2009 10:17AM
First sell your house- I know way too many people who are proud owners of two houses and two mortgages. Nothing is selling these days.

Documentation of H&P
Thu, Apr/02/2009 10:08AM
If the dictated document contains all the elements to be a 99223 then the coding is correct. There is no rule that the written note must contain all elements.

But this note is of no use to other providers who are looking at the chart. If your transcription turnover is under 30 minutes then it's ok. if no, the consultants called to see the patient will have no idea why they were called, what the primary doc is thinking, and the nurses will be clueless when the family or patient asks what the doctor said. At least "admitted for chest pain, rule out MI" or "acute renal failure, possibly NSAID, call nephrology, hydrate, check ultrasound."

All the emphasis on coding has led many to forget that the chart is foremost a method of communication between the members of the health care team.

Hospitalists and e-prescribing?
Wed, Apr/01/2009 05:22PM
Only if they are moonlighting in the walk in clinic and using the eligible E&M codes.

The standard codes used in the hospital for H&P, discharge and subsequent visits are not eligible.

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