Supercoder - Ask an Expert? Forum: Family Practice Coding

Supercoder - Ask an Expert? Forum: Family Practice Coding - Recent Posts http://www.supercoder.com/forum/ Supercoder - Ask an Expert? Forum: Family Practice Coding - Recent Posts en Sun, 12 Feb 2012 12:34:33 +0000 Sanjit Mishra on "DRUG SCREEN 80101 VS G0431 FOR MEDICARE PATIENT" http://www.supercoder.com/forum/topic/drug-screen-80101-vs-g0431-for-medicare-patient#post-11340 Fri, 10 Feb 2012 20:40:11 +0000 Sanjit Mishra 11340@http://www.supercoder.com/forum/ As per my review, the given ICDs don't map to CPT G0431. agnes hajdys on "DRUG SCREEN 80101 VS G0431 FOR MEDICARE PATIENT" http://www.supercoder.com/forum/topic/drug-screen-80101-vs-g0431-for-medicare-patient#post-11306 Thu, 09 Feb 2012 21:29:00 +0000 agnes hajdys 11306@http://www.supercoder.com/forum/ DR PERFORMED A URINE TEST IN OUR OFFICE FOR DRUG SCREEN , MEDICARE PT BILLED WITH CODE 80101 QW MOD. CLAIM DENIED. PLEASE ADVICE IF WE REBILL WITH CODE G0431 WITH ICD CODE C58.69,724.4,719.41 WOULD NOT DENY MY CLAIM? THANKS AGGI Sanjit Mishra on "Newborn visits in physician office" http://www.supercoder.com/forum/topic/newborn-visits-in-physician-office#post-11276 Wed, 08 Feb 2012 21:42:40 +0000 Sanjit Mishra 11276@http://www.supercoder.com/forum/ When the visit is in follow-up to an identified problem such as jaundice, infrequent stools, or infrequent feedings, and the physician, nurse practitioner, or physician assistant provides the service, an office visit (eg, 99212-99215) and problem specific diagnosis codes should be reported. * If no feeding or other health problem has been previously noted, this visit may be the first well child visit when provided by a physician, nurse practitioner or physician assistant. Code 99391 may be reported with diagnosis code V20.2 for this service. This service includes time spent addressing routine feeding issues. However, if significant time beyond that typical of the infant preventive service is spent in counseling, physicians may also report a problem-oriented service (99212-99215) with modifier -25 to indicate the significant and separately identifiable services provided on the same date. Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling and context of counseling. (Codes may be selected based on time spent in counseling and coordination of care when documentation indicates more than 50% of face-to-face time was spent in these activities.) * If a nurse visit is provided (e.g., weight screen only), code 99211 may be reported. If the nurse visit results in a visit with the physician, only the physician services would be reported. Marlene Rolf on "patient receiving oxygen in the physician clinic" http://www.supercoder.com/forum/topic/patient-receiving-oxygen-in-the-physician-clinic#post-11255 Wed, 08 Feb 2012 15:31:34 +0000 Marlene Rolf 11255@http://www.supercoder.com/forum/ We have a patient that received oxygen in the physicians office. 10 liters in 25 minutes. I found that the administration of the oxygen is part ot the E&M visit. But what about the actual oxygen? Is this billable? Any help would be appreciated. Thanks. Cyndi Bartkowiak on "Newborn visits in physician office" http://www.supercoder.com/forum/topic/newborn-visits-in-physician-office#post-11246 Tue, 07 Feb 2012 21:35:48 +0000 Cyndi Bartkowiak 11246@http://www.supercoder.com/forum/ In our doctor's office, a newborn is seen as a quick assessment within a few days of birth at no charge. The mother returns with the baby at 2 weeks for an exam. Should this be an E&M and should it be established or new? Sanjit Mishra on "Can a Patient sent to NP from Dr. in same practice be considered new?" http://www.supercoder.com/forum/topic/can-a-patient-sent-to-np-from-dr-in-same-practice-be-considered-new#post-11189 Mon, 06 Feb 2012 09:08:58 +0000 Sanjit Mishra 11189@http://www.supercoder.com/forum/ When NPs are billing under their own provider number, they can bill as New Patient for first visit of a patient to the office, not seen by a physician eariler. But, what you are saying comes in the concept "Incident-to" services. * The rules for "incident-to" services require that a physician perform the initial service for patients being billed under the physican’s provider number. * * In order to bill services incident-to, the patient must be an established patient of the physician or the physician’s group practice. Conclusion: Should be considered Established Patient. Stephanie Beadle on "Hospital Discharge and Stress Echo" http://www.supercoder.com/forum/topic/hospital-discharge-and-stress-echo#post-11170 Fri, 03 Feb 2012 22:32:51 +0000 Stephanie Beadle 11170@http://www.supercoder.com/forum/ Just checking in to see if you have any additional suggestions or input after my last post. This is not denying due to being billed as global from the Cardiologist but as incidental to the discharge. Tanya Ocampo on "Can a Patient sent to NP from Dr. in same practice be considered new?" http://www.supercoder.com/forum/topic/can-a-patient-sent-to-np-from-dr-in-same-practice-be-considered-new#post-11143 Thu, 02 Feb 2012 21:56:28 +0000 Tanya Ocampo 11143@http://www.supercoder.com/forum/ We have 4 Nps in our clinic, 3 are family pratice and 1 is Cardio. Can a patient be referred by physician in our clinic to one of our NPs for primary care be considered a new patient? Or would they be considered established since they have seen a physician? Stephanie Beadle on "Hospital Discharge and Stress Echo" http://www.supercoder.com/forum/topic/hospital-discharge-and-stress-echo#post-11088 Wed, 01 Feb 2012 18:36:40 +0000 Stephanie Beadle 11088@http://www.supercoder.com/forum/ You are correct in that these are interpreted by a Cardiologist from another hospital (Cardiology is not billing as global). Insurance plan is indicating the charges are incidental to our services from the hospital discharge of 99239. Sanjit Mishra on "Hospital Discharge and Stress Echo" http://www.supercoder.com/forum/topic/hospital-discharge-and-stress-echo#post-11087 Wed, 01 Feb 2012 18:07:50 +0000 Sanjit Mishra 11087@http://www.supercoder.com/forum/ As you bill for the technical component only, then those reports must have been interpreted by a cardiologist which info may not be known to you perhaps. If the said cardiologist has billed it globally, then the denial statement of yours will come as inclusive. So, you need to try to find out other info if any other physician has billed these CPTs without any modifier(Wrongly) for the same DOS. Cyndi Bartkowiak on "Non Medicare Patient presents for a general visit and gets a pap smear" http://www.supercoder.com/forum/topic/non-medicare-patient-presents-for-a-general-visit-and-gets-a-pap-smear#post-11085 Wed, 01 Feb 2012 17:20:40 +0000 Cyndi Bartkowiak 11085@http://www.supercoder.com/forum/ Non medicare patient presents for a general visit and wants a pap smear as well. How do you code to include a general visit and the collection of the pap smear? can this be coded with a G0101 even though it is not Medicare? Stephanie Beadle on "Hospital Discharge and Stress Echo" http://www.supercoder.com/forum/topic/hospital-discharge-and-stress-echo#post-11082 Wed, 01 Feb 2012 16:45:40 +0000 Stephanie Beadle 11082@http://www.supercoder.com/forum/ Patient was initially admitted through ED on 8-24 with dx: 786.51, 411.1. He was discharged on 8-25 with 786.51. After his discharge from the hospital he presented later that same day to the clinic per his hospital discharge summary for a stress echo (we only bill for the technical component) with a dx: 786.50. I hope this helps. Please let me know if any additional information would be helpful. Sanjit Mishra on "Hospital Discharge and Stress Echo" http://www.supercoder.com/forum/topic/hospital-discharge-and-stress-echo#post-11056 Tue, 31 Jan 2012 19:19:37 +0000 Sanjit Mishra 11056@http://www.supercoder.com/forum/ Can you plz elaborate on the other part of the doucmentaton, like: 1. What was the scenrio of discharge and as well as readmission? 2. What was the condition before discharge and condition at the time of readmission? 4. Diagnosis codes used in both the claims. Stephanie Beadle on "Hospital Discharge and Stress Echo" http://www.supercoder.com/forum/topic/hospital-discharge-and-stress-echo#post-11015 Mon, 30 Jan 2012 20:34:03 +0000 Stephanie Beadle 11015@http://www.supercoder.com/forum/ We have a patient who was discharged from the hospital and we billed for a 99239. He immediately presented to the clinic for some additional stress/echo testing-93351/TC, 93320/TC, 93325/TC. We are receiving denials on the stress/echo services indicating they were incidental to 99239. Is this truly the case and the adjustment is ours or is there an appropriate modifier I can use to support these services? I guess I’m wondering if a 59 modifier would be appropriate to use in this case? I should also mention that we have attempted with a 25 modifier on 99239 without success. Sanjit Mishra on "group diabetes education in RHC" http://www.supercoder.com/forum/topic/group-diabetes-education-in-rhc#post-10918 Fri, 27 Jan 2012 12:11:24 +0000 Sanjit Mishra 10918@http://www.supercoder.com/forum/ Plz refer to the below link and revert back if you still have any doubt. <a href="http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/research/Diabetes_Education_Services6-10.pdf" rel="nofollow">http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/research/Diabetes_Education_Services6-10.pdf</a> Christine Mcclure on "group diabetes education in RHC" http://www.supercoder.com/forum/topic/group-diabetes-education-in-rhc#post-10899 Thu, 26 Jan 2012 20:19:42 +0000 Christine Mcclure 10899@http://www.supercoder.com/forum/ what code to use to bill medicaid when a certified diabetic educator who is a NP provide group education session Sanjit Mishra on "CODING QUESTION" http://www.supercoder.com/forum/topic/coding-question-5#post-10864 Wed, 25 Jan 2012 22:46:57 +0000 Sanjit Mishra 10864@http://www.supercoder.com/forum/ In many CPT description, you will find the terms "Separate Procedure" at the end of the description of CPT and within parenthesis. Plz refer to following link for Guideline details: <a href="http://www.entnet.org/Practice/upload/Separate-Procedure-ENT-docRP.pdf" rel="nofollow">http://www.entnet.org/Practice/upload/Separate-Procedure-ENT-docRP.pdf</a> monica drozd on "CODING QUESTION" http://www.supercoder.com/forum/topic/coding-question-5#post-10833 Wed, 25 Jan 2012 16:54:22 +0000 monica drozd 10833@http://www.supercoder.com/forum/ WHERE DO I FIND EXPLANATION OF THE TERM SEPARATE PROCEDURE IN THE CPT? Sanjit Mishra on "How to properly bill a pap smear to non medicare payers" http://www.supercoder.com/forum/topic/how-to-properly-bill-a-pap-smear-to-non-medicare-payers#post-10831 Wed, 25 Jan 2012 16:48:02 +0000 Sanjit Mishra 10831@http://www.supercoder.com/forum/ Non-Medicare Payers: HCPCS Code Q0091 should not be reported to private payers for pap smear collection. The collection of a pap smear is included in the E/M or preventive medicine service. Some private payers do reimburse for the Q0091 code. In such cases, it is strongly recommends obtaining the guidelines for that specific policy in writing. Medicare: Medicare pays for certain screening preventive services, including the collection of screening pap smears. Code Q0091 was developed by CMS for reporting the collection of screening pap smears for Medicare patients. Medicare does not reimburse for the comprehensive preventive services that are reported with CPT-4 codes 99384 – 99397. Collection of a diagnostic pap smear for a Medicare patient (performed due to illness, disease, or symptoms indicating a medically necessary reason) is included in the physical examination portion of a problem-oriented E/M service and is not reported or reimbursed separately. Sanjit Mishra on "MEDICARE G CODE FOR POWER VEHICLE CONSULT" http://www.supercoder.com/forum/topic/medicare-g-code-for-power-vehicle-consult#post-10828 Wed, 25 Jan 2012 14:56:12 +0000 Sanjit Mishra 10828@http://www.supercoder.com/forum/ G0372: Physician service required to establish and document the need for a power mobility device Sanjit Mishra on "groin sprain" http://www.supercoder.com/forum/topic/groin-sprain#post-10798 Tue, 24 Jan 2012 19:01:42 +0000 Sanjit Mishra 10798@http://www.supercoder.com/forum/ Going strictly by coding guidelines, you can code 848.9 If you consider this as part of the region in abdominal wall muscle, then you can code 848.8 Twisting pain from lifting, if pertains to abdominal region, then code 789.09 Cyndi Bartkowiak on "How to properly bill a pap smear to non medicare payers" http://www.supercoder.com/forum/topic/how-to-properly-bill-a-pap-smear-to-non-medicare-payers#post-10794 Tue, 24 Jan 2012 18:04:27 +0000 Cyndi Bartkowiak 10794@http://www.supercoder.com/forum/ There appears to be too many options when billing a pap smear. Please clarify, based on 2012, the proper coding structure for a pap smear for medicare versus non medicare. During a sick visit versus a general physical. Which codes will obtain the best reimbursement and which codes are not acceptable today? This specific client uses a Q0091 (does this represent the optaining of the specimen?)or an 87210 (wet mount) when performing test inhouse. very confused. Cheryl Style on "MEDICARE G CODE FOR POWER VEHICLE CONSULT" http://www.supercoder.com/forum/topic/medicare-g-code-for-power-vehicle-consult#post-10791 Tue, 24 Jan 2012 17:03:17 +0000 Cheryl Style 10791@http://www.supercoder.com/forum/ What is correct G code to submit with Medicare claims when doing evaluation for power-operated vehicle? Victoria Collins on "groin sprain" http://www.supercoder.com/forum/topic/groin-sprain#post-10768 Mon, 23 Jan 2012 22:42:43 +0000 Victoria Collins 10768@http://www.supercoder.com/forum/ What ICD9 is used for groin sprain? Pain in groin goes to abdominal code 789.0x and pain in testicle testis goes to 608.9 unspecified disorder or male genital organs. Twisting pain from lifting. Matthew Woodward on "How to code for Medical Insurance Exam?" http://www.supercoder.com/forum/topic/how-to-code-for-medical-insurance-exam#post-10762 Mon, 23 Jan 2012 20:44:18 +0000 Matthew Woodward 10762@http://www.supercoder.com/forum/ Complete history, exam, and labwork such as CMET, CBC, LIPID, HgA1c, UA... Sanjit Mishra on "How to code for Medical Insurance Exam?" http://www.supercoder.com/forum/topic/how-to-code-for-medical-insurance-exam#post-10757 Mon, 23 Jan 2012 20:23:27 +0000 Sanjit Mishra 10757@http://www.supercoder.com/forum/ Documentation Plz? Matthew Woodward on "How to code for Medical Insurance Exam?" http://www.supercoder.com/forum/topic/how-to-code-for-medical-insurance-exam#post-10730 Mon, 23 Jan 2012 14:36:14 +0000 Matthew Woodward 10730@http://www.supercoder.com/forum/ If a patient presents to the office for an insurance exam how do I code this? I have looked at the Preventive Medicine Services codes and I don't feel that it is a preventative exam since it is being requested by a third party it is more an administrative exam... I have also looked a the Basic Life/ and or Disability Evaluation Servies 99450. However, this code does not say for medical inurance evaluation is is only for Life or Disability Insurance... Any ideas? Sanjit Mishra on "coding IV infusions" http://www.supercoder.com/forum/topic/coding-iv-infusions#post-10724 Mon, 23 Jan 2012 06:07:49 +0000 Sanjit Mishra 10724@http://www.supercoder.com/forum/ You can code additionally both 96360 and 96361 as: When performed in conjunction with chemotherapy, these CPT codes are covered only when infusion is prolonged and done sequentially (done hour(s) before and/or after administration of chemotherapy), and when the volume status of a beneficiary is compromised or will be compromised by side effects of chemotherapy or an illness. Ref: <a href="http://www.trailblazerhealth.com/Publications/Job%20Aid/ChemotherapyAdministrationPartB.pdf" rel="nofollow">http://www.trailblazerhealth.com/Publications/Job%20Aid/ChemotherapyAdministrationPartB.pdf</a> Marlene Rolf on "coding IV infusions" http://www.supercoder.com/forum/topic/coding-iv-infusions#post-10698 Fri, 20 Jan 2012 14:37:17 +0000 Marlene Rolf 10698@http://www.supercoder.com/forum/ A patient in the physician clinic receives IV infusion of Demerol, Protonix, and Reglan, along with Normal Saline. The NS started at 10:00 am, Protonix at 10:20 over 3 min, Reglan at 10:23 over 3 min, and Demerol at 10:27 over 5 min, and the NS was DC'd at 11:30 am with a dx of gastritis with nausea & vomiting. How would you code the infusion? Thinking 96374, 96375 x 2, but not sure about CPT for infusing the NS. Would it be 96361 or is it incidental and not billable since we do not have dx of dehydration. Must you have a Dx of dehydration to use the 96360 as initial infusion. Infusion coding is so confusing. Any help would be appreciated. Thanks Sanjit Mishra on "Need help with Ultrasound coding" http://www.supercoder.com/forum/topic/need-help-with-ultrasound-coding#post-10599 Wed, 18 Jan 2012 07:33:24 +0000 Sanjit Mishra 10599@http://www.supercoder.com/forum/ Code 76700 involves imaging of the liver, gallbladder, common bile duct, pancreas, spleen, kidneys, upper abdominal aorta and inferior vena cava including any demonstrated abdominal abnormality. Anything less than this should be coded as 76705 as in the above case. Liver, gallbladder, and pancreas are not retroperitoneal structures, so not to go for 76775