http://www.supercoder.com/forum/ Supercoder - Ask an Expert? Forum: Part B Insider - Recent Posts en Sun, 12 Feb 2012 10:21:37 +0000 http://www.supercoder.com/forum/topic/nurse-visit-for-unna-boot#post-11299 Thu, 09 Feb 2012 19:32:41 +0000 Lynn Pascoe 11299@http://www.supercoder.com/forum/ <p>Is this a Nurse or a Nurse Practitioner ? </p> http://www.supercoder.com/forum/topic/nurse-visit-for-unna-boot#post-11293 Thu, 09 Feb 2012 16:43:29 +0000 Sanjit Mishra 11293@http://www.supercoder.com/forum/ <p>Just for dressing changes by a nurse can be billed with 99211 </p> http://www.supercoder.com/forum/topic/nurse-visit-for-unna-boot#post-11257 Wed, 08 Feb 2012 15:58:53 +0000 Susan Patch 11257@http://www.supercoder.com/forum/ <p>We have a patient coming in several times a week for unna boot changes. Some of these days only a nurse sees him and changes his dressings. If the physician doesn't see the patient, can we charge '29580' or can we only charge '99211'? </p> http://www.supercoder.com/forum/topic/lymphangiography#post-10963 Sat, 28 Jan 2012 19:58:11 +0000 Sanjit Mishra 10963@http://www.supercoder.com/forum/ <p>38790: Injection procedure; lymphangiography<br /> There is no specific CPT code for cannulation. Therefore, you should report the unlisted code for the specific anatomical system. </p> http://www.supercoder.com/forum/topic/established-patient-detailed-history-and-exam#post-10962 Sat, 28 Jan 2012 19:29:19 +0000 Sanjit Mishra 10962@http://www.supercoder.com/forum/ <p>Date of Admit to Observation: 99218<br /> Date of Discharge from Observation on next day: 99217 </p> http://www.supercoder.com/forum/topic/established-patient-detailed-history-and-exam#post-10774 Tue, 24 Jan 2012 06:55:50 +0000 Norma smith 10774@http://www.supercoder.com/forum/ <p>16. An established patient was seen in her primary physician office. The patient fell at home and came to the office for an exam. Due to the possibility of a concussion, the patient was sent o the hospital to be admitted as an observation patient. A detailed history and exam were performed and the medical decision was low complexity. The patient stayed overnight and was discharge the next afternoon. </p> http://www.supercoder.com/forum/topic/lymphangiography#post-10773 Tue, 24 Jan 2012 02:42:46 +0000 Norma smith 10773@http://www.supercoder.com/forum/ <p>needle is cannulated and a catheter is placed and secured. Additional dye is injected. X-rays are taken by Dr. Tin and then repeated 24 hours later. Dr. Jones then removed the needle and sutured the incision. Select the appropriate code for Dr. Jones's services. </p> http://www.supercoder.com/forum/topic/modifier-for-11720-in-global-for-unrelated-procedure#post-10326 Wed, 11 Jan 2012 06:07:40 +0000 Sanjit Mishra 10326@http://www.supercoder.com/forum/ <p>Modifier 79 doesn't go with 11720, so you can bill without 79 modifier. But, you should bill with appropriate digit modifiers. </p> http://www.supercoder.com/forum/topic/modifier-for-11720-in-global-for-unrelated-procedure#post-10301 Tue, 10 Jan 2012 19:47:48 +0000 Vicki Whitney 10301@http://www.supercoder.com/forum/ <p>What is the appropriate modifier for <code>11720</code>performed in the global for an unrelated procedure? Medicare is primary insurance. </p> http://www.supercoder.com/forum/topic/sequence-of-modifiers#post-10179 Fri, 06 Jan 2012 06:39:21 +0000 Sanjit Mishra 10179@http://www.supercoder.com/forum/ <p>MODIFIERS CATEGORIES:<br /> 1. PRICING modifiers<br /> Example: 21, 22, 26, 50, 52, 53, 60, 62, 80, 82, P1-P6<br /> ...<br /> 2. PAYMENT Eligible Modifier*<br /> Example: 24, 25, 51, 57, 58, 59, 76, 77, 78, 79, 91<br /> (*presence communicates special situation that might otherwise not be paid<br /> without the modifier based on billing/coding principles and global surgery guidelines)<br /> ...<br /> 3. LOCATION Modifiers<br /> Example: E1-E4, FA, F1-F9, LC, LD, LT, RC, RT, TA, T1-T9<br /> ...<br /> ORDER OF REPORTING:</p> <p>- Pricing modifiers before payment modifiers and location modifiers EXCEPT when global surgery package involved, then report payment modifiers before pricing. Example modifier 78 and 62.<br /> - Payment eligible modifiers before location modifiers<br /> - Location modifiers are always last<br /> ...<br /> If you have two pricing modifiers, the most common scenario is likely to involve 26 and another modifier. Always add 26 before any other modifier.<br /> ...<br /> If you have two payment modifiers, a common one is 51 and 59, enter 59 in the first position. If 51 and 78, enter 78 in the first position. </p> http://www.supercoder.com/forum/topic/sequence-of-modifiers#post-10178 Fri, 06 Jan 2012 06:35:52 +0000 Try Super 10178@http://www.supercoder.com/forum/ <p>Wanted to know the concept of sequencing modifiers. </p> http://www.supercoder.com/forum/topic/medicare-rejection-of-j3301#post-8982 Tue, 22 Nov 2011 07:37:39 +0000 Snayhil Rana 8982@http://www.supercoder.com/forum/ <p>J3301 (kenalog) is a componenet of Joint injection (20610). </p> http://www.supercoder.com/forum/topic/what-does-rejection-for-relational-field-erro-mean-for-code-j3301#post-8981 Tue, 22 Nov 2011 07:36:15 +0000 Snayhil Rana 8981@http://www.supercoder.com/forum/ <p>J3301 (kenalog) is a componenet of Joint injection (20610). </p> http://www.supercoder.com/forum/topic/what-does-rejection-for-relational-field-erro-mean-for-code-j3301#post-8975 Mon, 21 Nov 2011 23:10:56 +0000 margaret mclean 8975@http://www.supercoder.com/forum/ <p>i billed '99214'-25 with'20610' 'j2001','j3301' and medicare denied 'j3301'. Why? </p> http://www.supercoder.com/forum/topic/medicare-rejection-of-j3301#post-8974 Mon, 21 Nov 2011 23:03:57 +0000 margaret mclean 8974@http://www.supercoder.com/forum/ <p>rejection for rational field in erro for j3301 when billing a visit '99214-25','20610','j2001','j3301' </p> http://www.supercoder.com/forum/topic/iv-infusion-coding-in-hospitals#post-8678 Mon, 14 Nov 2011 17:30:31 +0000 Sanjit Mishra 8678@http://www.supercoder.com/forum/ <p>Found an interesting site with such a detailed info:<br /> <a href="http://compliance.uclahealth.org/workfiles/PDFs/Drug_Administration_Guidelines_January_2010.pdf" rel="nofollow">http://compliance.uclahealth.org/workfiles/PDFs/Drug_Administration_Guidelines_January_2010.pdf</a><br /> Also for comparison with Office-based ones, you can refer to another site:<br /> <a href="http://www.hcpro.com/HIM-66673-859/Pay-attention-to-hierarchy-of-CPT-codes-when-reporting-IV-infusions-with-IV-push.html" rel="nofollow">http://www.hcpro.com/HIM-66673-859/Pay-attention-to-hierarchy-of-CPT-codes-when-reporting-IV-infusions-with-IV-push.html</a> </p> http://www.supercoder.com/forum/topic/iv-infusion-coding-in-hospitals#post-8677 Mon, 14 Nov 2011 17:29:12 +0000 Andrew Simmons 8677@http://www.supercoder.com/forum/ <p>Want to know IV infusion coding guidelines for hospital.<br /> How it differs with Office-based Infusion coding? </p> http://www.supercoder.com/forum/topic/modifiers-gv-and-gw#post-7689 Thu, 13 Oct 2011 19:19:58 +0000 Sanjit Mishra 7689@http://www.supercoder.com/forum/ <p>Concept on GV modifier with a GW modifier<br /> -----------------------------------------<br /> GV Modifier<br /> The GV modifier is used when a physician is providing a service that is related to the diagnosis for which a patient has been enrolled into hospice. This physician is not associated with the hospice and is providing services as a private physician.<br /> ***<br /> GW Modifier<br /> The GW modifier is used when a physician is providing a service that is not related to the diagnosis for which a patient has been enrolled into hospice. This physician is not associated with the hospice and is providing services as a private physician.<br /> *<br /> When a patient is under hospice there is a certain diagnosis that was indicated at the beginning of care. If the service the physician renders is unrelated to the terminal illnesses that hospice has on record, Medicare will not reimburse for the service unless it is submitted with the modifier GW. The GW modifier cuts through the Medicare edits and will pay. </p> http://www.supercoder.com/forum/topic/modifiers-gv-and-gw#post-7679 Thu, 13 Oct 2011 17:28:46 +0000 Laurie Weiner 7679@http://www.supercoder.com/forum/ <p>A new patient seen in our medical office is in an in-patient rehab center following a brief hospital stay for hip pain. What modifier do I append to the office visit code and I assume I bill the rehab facility? The visit included injections into the bursa/hip. thank you </p> http://www.supercoder.com/forum/topic/g8447-question#post-7497 Thu, 06 Oct 2011 22:00:03 +0000 Sanjit Mishra 7497@http://www.supercoder.com/forum/ <p>Refer to one of the recent AMA article plz:<br /> <a href="http://www.ama-assn.org/resources/doc/hit/faq-cms-incentive-program.pdf" rel="nofollow">http://www.ama-assn.org/resources/doc/hit/faq-cms-incentive-program.pdf</a> </p> http://www.supercoder.com/forum/topic/g8447-question#post-7476 Thu, 06 Oct 2011 16:22:45 +0000 Sue Baker 7476@http://www.supercoder.com/forum/ <p>We continue to bill G8553 for e-scribe and G8447 for use of the EHR but I thought I read somewhere that the G8447 is no longer required (in 2011) if you have met certain PQRI requirements. Could you help me attain some information about this?</p> <p>Thank you. </p> http://www.supercoder.com/forum/topic/appilgraf#post-6926 Thu, 15 Sep 2011 16:38:10 +0000 Sanjit Mishra 6926@http://www.supercoder.com/forum/ <p>KX modifier should be used on 15340/15341 to report that the skin substitute was handled, applied, and immobilized appropriately and according to the manufacturers’ label instructions.<br /> *<br /> JC: Skin substitute used as a graft.<br /> JD: Skin substitute not used as a graft.<br /> *<br /> The JC and JD modifiers should be used when billing for skin substitutes. The difference between them is<br /> whether the skin substitute is used as a graft or as a skin covering. The definition of a skin graft for this<br /> purpose is whether the skin substitute is implanted into the wound to be incorporated in the healing of the<br /> wound. If the skin substitute is used to cover a wound, to protect it from contamination or fluid loss, then it<br /> is not a graft, but a dressing. </p> http://www.supercoder.com/forum/topic/appilgraf#post-6919 Thu, 15 Sep 2011 12:08:51 +0000 Michael Aronson 6919@http://www.supercoder.com/forum/ <p>Is a modifier needed when performing 15340 of 1st 25 sq cm for billing Medicare? </p> http://www.supercoder.com/forum/topic/jones-teno-suspension-lt-first-metatarsal-and-hallux#post-6900 Wed, 14 Sep 2011 19:31:06 +0000 Sanjit Mishra 6900@http://www.supercoder.com/forum/ <p>jones teno suspension procedure code : 28760 </p> http://www.supercoder.com/forum/topic/jones-teno-suspension-lt-first-metatarsal-and-hallux#post-6888 Wed, 14 Sep 2011 14:25:27 +0000 Beth Martin 6888@http://www.supercoder.com/forum/ <p>Fusion IPJ left hallux<br /> Jones teno suspension<br /> plantar fascia release of left foot</p> <p>I cannot find the jones teno suspension procedure code, Help </p> http://www.supercoder.com/forum/topic/medicare-2011-schedule#post-6795 Mon, 12 Sep 2011 09:36:17 +0000 apoorba ganguly 6795@http://www.supercoder.com/forum/ <p>Just to clarify, there is no DME or DMEPOS fee schedule in the SuperCoder site. It has only the MPFS with full details based on National rates. For getting DME / DMEPOS fee schedule for a particular state, you need to contact the respective state's authorioty or visit their website. </p> http://www.supercoder.com/forum/topic/medicare-2011-schedule#post-6790 Mon, 12 Sep 2011 07:24:00 +0000 apoorba ganguly 6790@http://www.supercoder.com/forum/ <p>If you are checking the fee schedule of a code in SuperCoder, do the following:</p> <p>Go to "Code Search" page at "Coding Tools" drop down menu. Under "Data search" or "Index search" tab, look for the code that you want. Once the list page for the code comes, click on the "fee schedule" at that particular code line. You will be automatically redirected to the fee schedule of that code. </p> <p>Let me know your home page, or which specialty subscription you hold in SuperCoder. Also let me know what is your home page in SuperCoder. i can hopefully guide you better. </p> http://www.supercoder.com/forum/topic/medicare-2011-schedule#post-6788 Mon, 12 Sep 2011 07:18:09 +0000 apoorba ganguly 6788@http://www.supercoder.com/forum/ <p>Not all the HCPCS codes are payable by Medicare in non-facility / Physician office set up. Usually costs for various supplies (medicine, injection etc.) are included in Physicians' payment amount that CMS sets for them and this fee schedule is also known as "MPFS - Medicare Physician Fee Schedule". Usually a code's non-facility RVU is higher than its Facility RVU. The RVU decides the final payment amount; more the RVU, higher the payment. Non-facility RVUs are set higher by CMS, since the paymnet includes the costs incurred towards supplies. So for most of the supplies / services representable by HCPCS codes, CMS does not pay separately to a physician. That's why you can see $0.00 for many HCPCS codes, when checked under MPFS. </p> <p>But for certain code sets, there are payment amounts associated, for example, G codes. Here is an example where you can see the $$ amounts associated with a HCPCS code under MPFS. </p> <p>HCPCS code --&gt; G0141 (Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician). Visit the link to find the Fee schedule for this code:</p> <p><a href="http://www.supercoder.com/code-lookup/hcpcs/codes/?code=G0141&amp;code_arg=feesch" rel="nofollow">http://www.supercoder.com/code-lookup/hcpcs/codes/?code=G0141&amp;code_arg=feesch</a> </p> http://www.supercoder.com/forum/topic/medicare-2011-schedule#post-6779 Sat, 10 Sep 2011 09:30:38 +0000 Chen Huang 6779@http://www.supercoder.com/forum/ <p>We are getting ready to bill medicare. But we are befuddled we don't know where to find the latest HCPCs dollar amount. Or does that have something to do with RVU's? Can someone shed a light in this? We are Palmetto GBA J area, but on clicking "fee schedule" so many things pop up I don't even know what I am looking at really!...</p> <p>Thanks!!</p> <p>Chen~ </p> http://www.supercoder.com/forum/topic/medicare-part-a-home-health-code#post-6657 Wed, 07 Sep 2011 07:48:13 +0000 Snayhil Rana 6657@http://www.supercoder.com/forum/ <p>In medical or medicare context CKG mean Cardiokymography. </p>