Prior Authorizations and ABNs for Other Insurances

feeds@yuku.com (mbrown555) — Thu, 05 Nov 2009 15:11:32 GMT

Hello Group!

I have a few questions I am needing some feedback on. I'm hoping you can help me.

How is everyone handling prior authorizations for insurances that require them on CTs, MRI, MRA, etc.? Do you have a "cheat sheet" or form that you use? Is somone looking up the CPTs codes & writing them on a cheat list (the hospital orders don't have CPTs on the forms) Who does the prior authorizations in your office? The nurse, billing, front desk?

...

CMS Policy Changes for Physicians Service to Medicare Pts in 2010

feeds@yuku.com (mbrown555) — Fri, 30 Oct 2009 17:03:22 GMT

...

H1N1 Vaccine & Admin

feeds@yuku.com (mbrown555) — Thu, 17 Sep 2009 10:32:01 GMT

Does anyone know if there is a new 2009 CPT code for the H1N1 vaccine code?

I know the new H1N1 virus Dx is 488.1 (not for prophylactic vaccine). I'm assuming we use the V04.81 for the vaccine code? That's what Medicare is going to use.

Also, I'm trying to figure out how we will charge for commercial insurances. I'm assuming with a 90471 or 90472 CPT code?

Medicare:
•G9141-Influenza A (H1N1) immunization administration (includes the physician...

Office Visit Patient Not Present

feeds@yuku.com (mbrown555) — Mon, 14 Sep 2009 09:39:31 GMT

Q I read that it was OK to bill a family member for appointments to discuss patients. Is it acceptable to bill the family members/caregivers on a cash basis as long as we notify them ahead of time? Would you recommend that we base the fee on the E&M codes? Should the appointment be made under the patient's name? I don't know if this would make a difference if we were to get audited.

A It is acceptable to bill the family member. And it's better with advance notice, as...

Nuclear Stress Test billing

feeds@yuku.com (profastbilling) — Sun, 13 Sep 2009 10:30:48 GMT

I was asked a question by a doctor about their nuclear stress testing. This doctor performs the technical component for nuclear stress tests on his patients. He then has another doctor outside of his practice do the professional interpretation. The doctor who does the professional component holds the license as the radiation safety officer and does interpretations for several doctors in the area.

The doctor who does the technical component was billing global for the procedure and...

Code for urine specimen collection

feeds@yuku.com (ReikiBoy) — Sun, 13 Sep 2009 06:53:08 GMT

Is there a code for urine specimen collection that isn't cath'ed? My employer wants to bill for travel allowance for the phlebotomist to go to the home to get the specimen. We bill, and get paid for, travel allowance for blood draws but P9604 requires a specimen collection code on the claim or else it won't be paid. So while the phlebotomist is out doing blood draws she stops at a house to give a urine cup, the sterile wipes, instructs the patient how to clean, waits for the...

Residence/Nursing home Billing

feeds@yuku.com (DFonseca) — Mon, 07 Sep 2009 09:08:40 GMT

When billing Medicare for Nursing Home visits, in Patient address field do i put Residence/Nursing Home address or their actual home Address?

CPT ISSUE

feeds@yuku.com (sdanner) — Mon, 13 Jul 2009 13:45:02 GMT

Hi all:)
Ok here goes. Dr saw patient in nursing home. Billed 99310 used modifier 21 then billed 99357 medicare MO denied 99357 states related or qualifying claim/services ws not identified on the claim what does this mean? and I thought modifier 21 was no longer used! This is an eob with date of service 03312009. Help! From medicare missouri! cleaning up Ar claims and this one came up!

Coding Correction Form

feeds@yuku.com (sdanner) — Wed, 08 Jul 2009 17:05:39 GMT

Does anyone have a Coding Correction Form. Dr. would like to have one to document she approved change so corrections to claims can be resubmitted electronically.

Trainin Primer - Evaluation and Management Coding

feeds@yuku.com (Steve Verno) — Sun, 21 Jun 2009 11:47:14 GMT

Those without training will find coding a simple office visit to be very complicated. But, it is a very easy process. The key to coding an e/m successfully is to make sure you have true, accurate, complete and legible documentation. Incomplete or illegible documentation can clealy affect your coding. When coding, keep it simple. If it isnt documented, it doesnt exist. When coding you dont do well lets say or suppose.or under normal circumstances, the doctor would do or the patient would...

Patient Not Present for OV

feeds@yuku.com (mbrown555) — Mon, 08 Jun 2009 11:39:47 GMT

Q Can I ever bill an E&M code if I am working with the patient's family and the patient is not present?

A This depends on the payer. The CPT manual states as part of the code description for most of the outpatient visit codes that a certain amount of time is spent face-to-face with the patient and/or family.

This language is intended to reference coding by time. In the inpatient codes the language points to "floor time," and the definitions in the E&M...

Medicare (CA) question regarding sonograms

feeds@yuku.com (Terri in California) — Fri, 05 Jun 2009 11:13:58 GMT

I posted this over at 'radiology' but didn't get any replies, so I wanted to give it a shot in this thread.

We've been having problems with Medicare (CA) paying for a pelvic and endovag studies done on the same day. We always do the pelvic sono first and if something suspicious is found, we sometimes do an endovag for better visualization. We always use modifier TC on the sonos. We have tried adding a 51 and 59 on the endovag and still no go. Any suggestions???...

Medicare denied 10060 - help please

feeds@yuku.com (profastbilling) — Sat, 09 May 2009 14:27:10 GMT

I have a claim with codes 99212 and a 25 modifier that Medicare paid, but denied 10060 saying diagnosis is inconsistent with the procedure. The ICD-9 code used was 706.2. A coder confirmed this as correct. Any suggestions? Thanks.

Callling pt

feeds@yuku.com (antony) — Tue, 05 May 2009 08:47:00 GMT

Hi All,

Is that wise to call a patient for break-ups when the insurance has processed the claim and paid to pt.

Please advice.

Also reach me @ tonycoorg@hotmail.com

Thanks in advance.

Regards

Antony Sequeira

ICD Lookup Tool

feeds@yuku.com (sjain) — Sat, 18 Apr 2009 11:32:00 GMT

We developed a free, easy to use ICD lookup tool. Please feel free to use and share. We welcome constructive feedback. Thanks.

Procedure code for Clonidine

feeds@yuku.com (alpha) — Fri, 27 Mar 2009 09:44:53 GMT

Can anyone help me locate the procedure code for clonidine tablet? I found the injection procedure (J0735). These tables are provided to pts to lower there blood pressure

Billing 95860, 95903 & 95904 for Us Dept. of Labor(New York) WC Insurance

feeds@yuku.com (splenderh) — Fri, 20 Mar 2009 04:52:08 GMT

Hi,

We are receiving the denial for EMG from Us Dept of Labor(NY). Please some suggest me onthis, how do we bill EMG & Nerve Conduction coodes by using modifier.
I use to received payumenearlier , if use 59modifier for 2nd & 3rd codes.

Regards,
Splenderh+

List of All Medicare Websites and Phone#s

feeds@yuku.com (sporty981) — Tue, 03 Mar 2009 05:27:19 GMT

Not sure if I posted this before but it's handy to have from CMS:

http://www.cms.hhs.gov/ML...nterTollNumDirectory.zip

CPT & ICD9 ? for Family Medicine

feeds@yuku.com (alpha) — Thu, 19 Feb 2009 02:56:13 GMT

Provider brings me a superbill with the following codes requesting I bill all the procedures listed can someone help me understand this scenario, especially the Q0091 and do I need a modifier 69200?

Proc. 99214.25 with 477.9 dx
Proc. 87210 with V72.3, 616.10
Proc. Q0091 with V72.3, 616.10
Proc. 81025 with V72.3, 616.10
Proc. 69200 with 388.70, 931

Thank you

Legal Counsel

feeds@yuku.com (jnk) — Wed, 18 Feb 2009 10:00:41 GMT

Hello,
One of our physicians spoke with a deceased patients daughter regarding a legal circumstance. How do we correctly bill her? I know this will be a private pay situation. I was just curious...can we use the deceased patient's account or do we need to set a separate account?

Thanks so much!

Details for: CMS ANNOUNCES PAYMENT, POLICY CHANGES FOR PHYSICIANS SERVICES TO MEDICARE BENEFICIARIES IN 2010

For Immediate Release:	Friday, October 30, 2009

General Medical Coding Forum