http://www.supercoder.com/forum/ Supercoder - Ask an Expert? Tag: billing - Recent Posts en Sat, 11 Feb 2012 19:51:41 +0000 http://www.supercoder.com/forum/topic/patient-balance-time-limit#post-10633 Wed, 18 Jan 2012 23:07:03 +0000 Leesa Israel 10633@http://www.supercoder.com/forum/ <p>Wow. That is odd, Tanya.<br /> *<br /> I agree that it makes no sense that the patient has received statements and just because he has refused to pay you in those two years you are forced to write it off. If that loophole existed I would think everyone would just sit on their bills for years! :-)<br /> *<br /> That said, I would suggest you might want to consult your practice's attorney if the patient continues to bring up legal defense. I assume you have records of when statements were sent out and such. Do you use a collections agency? Perhaps they could offer advice specific to your state's laws as well?<br /> *<br /> My one caveat again is that I don't know where you are located and don't know your state specific laws, so there may be some loophole somewhere in your state laws. Again, that's why I'd suggest asking a local attorney. </p> <p>*<br /> Best of luck!<br /> *<br /> ~Leesa<br /> *<br /> Leesa A. Israel, BA, CPC, CUC, CMBS<br /> Executive Editor, The Coding Institute<br /> Manager, TCI Consulting &amp; Revenue Cycle Solutions<br /> Home office: (866) 458-2973<br /> Email: <a href="mailto:leesai@codinginstitute.com">leesai@codinginstitute.com</a><br /> <a href="http://www.codinginstitute.com" rel="nofollow">http://www.codinginstitute.com</a> </p> http://www.supercoder.com/forum/topic/patient-balance-time-limit#post-10630 Wed, 18 Jan 2012 22:26:21 +0000 TANYA PEREZ 10630@http://www.supercoder.com/forum/ <p>Thank you for your response. In this case, it was not the patient's initial receipt of the bill. He has been receiving it for quite some time, and is now fighting back stating he is a lawyer, and since the charges are so old we are legally obligated to adjust this. I did not think this to be right... That would say that a patient can just sit on a bill until the two years are up, which would not make any sense. Why would any patient pay there balance if that be the case? Thank you for confirming my conclusion. You guys rock. </p> http://www.supercoder.com/forum/topic/have-question-on-billing-of-94620#post-10520 Sun, 15 Jan 2012 18:37:44 +0000 Sanjit Mishra 10520@http://www.supercoder.com/forum/ <p>For Assisted living facility place of service code 13. What kind of facility it is where the service is provided. Mostly 94060 is provided in Office setting.<br /> So, please crosscheck the actual setting and where the service was provided. </p> http://www.supercoder.com/forum/topic/have-question-on-billing-of-94620#post-10491 Fri, 13 Jan 2012 20:38:47 +0000 brenda hernandez 10491@http://www.supercoder.com/forum/ <p>pos 13 </p> http://www.supercoder.com/forum/topic/have-question-on-billing-of-94620#post-10490 Fri, 13 Jan 2012 20:07:15 +0000 Sanjit Mishra 10490@http://www.supercoder.com/forum/ <p>What POS code have you used? </p> http://www.supercoder.com/forum/topic/have-question-on-billing-of-94620#post-10488 Fri, 13 Jan 2012 19:37:34 +0000 brenda hernandez 10488@http://www.supercoder.com/forum/ <p>co-5 the procedure code/bill type is inconsistent with the place of service </p> http://www.supercoder.com/forum/topic/have-question-on-billing-of-94620#post-10486 Fri, 13 Jan 2012 19:23:57 +0000 Sanjit Mishra 10486@http://www.supercoder.com/forum/ <p>What is the denial reason(statement in EOB) ? </p> http://www.supercoder.com/forum/topic/have-question-on-billing-of-94620#post-10484 Fri, 13 Jan 2012 18:38:14 +0000 brenda hernandez 10484@http://www.supercoder.com/forum/ <p>I do billing for a provider that see's patient's in facility's he has been doing the 6 min walk stress test on some of the patients and im billing the <code>94620</code> which medicare keeps dening. ok so I get it now you can't use that code for if patient is in a facility so does anyone have any input on what code I should be billing I am at a loss.<br /> thanks for any imput<br /> brenda </p> http://www.supercoder.com/forum/topic/patient-balance-time-limit#post-10388 Thu, 12 Jan 2012 13:25:27 +0000 Leesa Israel 10388@http://www.supercoder.com/forum/ <p>Hi Tanya.<br /> *<br /> I wanted to check with a colleague to be sure my initial thoughts were correct and she confirmed my thinking. The only issue you might run into is if your state has any laws preventing this. You should check on state regs but otherwise, we think you'd be okay to bill the patient at any point.<br /> *<br /> That said, we both agree that if the patient has never been billed for the service before (as in, you're billing them for the first time 2-3 years after the service) that's not the best PR move and you're not likely going to get paid. My colleague agrees. Here's what she said:<br /> *<br /> "BUT if you get a patient really ticked off by billing them for the first time a long time after the service, leaving them to think that they don’t owe you because they had not received a statement since the service, and it had been a long time, to quote the person who asked the question, “Say after two-three years”, you will probably run into a very unhappy EX-patient who tells everyone how bad your office is and who may complain to the state medical board and who may get you investigated for your business practices. I have seen this happen with a doctor who set his fees where he wanted to set them and balance billed patients in a non par situation which he had every right to do, but the amount he expected them to pay was so much more than the insurance allowed amounts for R&amp;C that complaints were made to the state medical board and he was audited and it was found that he made coding errors and then he had legal problems. The doctor is entitled to their money, but it is not fair to the patient to be a lousy business person and they are tempting fate when they bill in this way, IMHO and experience.<br /> *<br /> And an unhappy patient tells 10 people who tells 10 people who tells 10 people, etc. That is not a great marketing plan."<br /> *</p> <p>Thanks,<br /> Leesa<br /> *</p> <p>Leesa A. Israel, BA, CPC, CUC, CMBS<br /> Executive Editor, The Coding Institute<br /> Manager, TCI Consulting &amp; Revenue Cycle Solutions<br /> Home office: (866) 458-2973<br /> Email: <a href="mailto:leesai@codinginstitute.com">leesai@codinginstitute.com</a><br /> <a href="http://www.codinginstitute.com" rel="nofollow">http://www.codinginstitute.com</a> </p> http://www.supercoder.com/forum/topic/patient-balance-time-limit#post-10360 Wed, 11 Jan 2012 19:36:37 +0000 Leesa Israel 10360@http://www.supercoder.com/forum/ <p>Hi Tanya.<br /> *<br /> I am looking into this for you and will get back to you just as soon as I can. I want to do a bit of research before giving an answer.<br /> *<br /> Thanks,<br /> Leesa<br /> *</p> <p>Leesa A. Israel, BA, CPC, CUC, CMBS<br /> Executive Editor, The Coding Institute<br /> Manager, TCI Consulting &amp; Revenue Cycle Solutions<br /> Home office: (866) 458-2973<br /> Email: <a href="mailto:leesai@codinginstitute.com">leesai@codinginstitute.com</a><br /> <a href="http://www.codinginstitute.com" rel="nofollow">http://www.codinginstitute.com</a> </p> http://www.supercoder.com/forum/topic/patient-balance-time-limit#post-10313 Tue, 10 Jan 2012 22:28:18 +0000 TANYA PEREZ 10313@http://www.supercoder.com/forum/ <p>Is there a time frame to be allowed to bill a patient for their balance due after the insurance company processes the claim? Say after two-three years, if the patient still owes a balance(according to insurance's allowed charges) are we be able to still bill the patient? </p> http://www.supercoder.com/forum/topic/skin-substitute-billing#post-10017 Mon, 02 Jan 2012 22:09:30 +0000 Sanjit Mishra 10017@http://www.supercoder.com/forum/ <p>The supply of the skin substitute is reported separately when the services are performed in the office setting. An operative report is required and must be available upon request.</p> <p>Ref:<br /> <a href="http://www.wpsmedicare.com/part_b/policy/active/local/l30135_gsurg052.shtml" rel="nofollow">http://www.wpsmedicare.com/part_b/policy/active/local/l30135_gsurg052.shtml</a> </p> http://www.supercoder.com/forum/topic/skin-substitute-billing#post-10009 Mon, 02 Jan 2012 00:33:25 +0000 hazel joseph 10009@http://www.supercoder.com/forum/ <p>Should a doctor's office bill MEDICARE for the porcine xenograft material for wound coverage as 'C936'; in addition to the professional fee for placement (15271 for example) if it is not a ambulatory surgery center (or hospital).<br /> Thank you for any help you can provide! </p> http://www.supercoder.com/forum/topic/lasix-injection-codes#post-9770 Wed, 21 Dec 2011 03:30:50 +0000 Deepak Ahuja 9770@http://www.supercoder.com/forum/ <p>J1940 &amp; 96365 can be used for Lasix upto 20 mg administration through IV. </p> http://www.supercoder.com/forum/topic/lasix-injection-codes#post-9756 Tue, 20 Dec 2011 21:39:46 +0000 Marita Quint 9756@http://www.supercoder.com/forum/ <p>What codes should i be using to bill for an IV med that the doctor administers. Dr. Quint will administer Lasix ( furosemide ) and i do not know what cpt to bill for administration and to bill for the medication it self. </p> http://www.supercoder.com/forum/topic/swan-ganz-catheter-placement-1#post-8497 Wed, 09 Nov 2011 23:13:40 +0000 Sanjit Mishra 8497@http://www.supercoder.com/forum/ <p>Modifier 26 not to be used. </p> http://www.supercoder.com/forum/topic/swan-ganz-catheter-placement-1#post-8484 Wed, 09 Nov 2011 19:40:10 +0000 Maria Minnick 8484@http://www.supercoder.com/forum/ <p>When coding 93503 for placement of Swan-Ganz catheter, should modifier 26 be appended to the code? </p> http://www.supercoder.com/forum/topic/can-different-physicians-bill-separately-for-their-part-in-a-chf-clinic#post-6027 Mon, 08 Aug 2011 21:54:06 +0000 Sanjit Mishra 6027@http://www.supercoder.com/forum/ <p>I am also sending this question to our Editor and will answer ASAP. </p> http://www.supercoder.com/forum/topic/can-different-physicians-bill-separately-for-their-part-in-a-chf-clinic#post-6026 Mon, 08 Aug 2011 21:40:10 +0000 Sanjit Mishra 6026@http://www.supercoder.com/forum/ <p>Plz refer to point#1,2,&amp;3 relevant to your query. I am still working on this issue and will revert back ASAP:<br /> The Medicare National Coverage Determination requires cardiac rehabilitation programs to be comprehensive and include a medical evaluation, a program to modify cardiac risk factors (eg, nutritional counseling), exercise counseling, and lifestyle education. Some clinics also offer lipid management, blood pressure and stress management, and smoke cessation training.<br /> 1. Congestive heart failure in the absence of other covered conditions is not included as a covered condition of cardiac rehabilitation in the CMS National Coverage Determination Manual, Publication 100-03, Section 20.10.<br /> 2. Evaluation and Management (E/M) services, ECGs and other diagnostic services may be covered on the day of cardiac rehabilitation if these services are separate and distinct from the cardiac rehabilitation program and are medically necessary.<br /> 3. Forms of counseling, such as dietary counseling, psychosocial intervention, lipid management and stress management, are components of the cardiac rehabilitation program and are not separately reimbursed.</p> <p>4. CPT/HCPCS Codes:<br /> 93797 Cardiac rehab<br /> 93798 Cardiac rehab/monitor </p> <p>***<br /> GUIDELINES ON GROUP SERVICES:<br /> •Group I services include:<br /> - Continuous ECG telemetric monitoring during exercise.<br /> - ECG rhythm strip with interpretation and physician’s revision of exercise prescription.<br /> - Limited examination for physician follow-ups to adjust medication or for other treatment changes.<br /> A visit including one or more of the Group I services is considered as one routine cardiac rehabilitation visit. For the visit to be reimbursable, at least one of the Group I services must be performed. The same rate of reimbursement would be allowed for each visit, but not all services need to be performed at each visit.</p> <p>•Group II services include:<br /> - New patient comprehensive evaluation, including history, physical and preparation of initial exercise prescription. One will be allowed at the beginning of the program if not already performed by the patient’s attending physician or if that performed by the patient’s physician is not acceptable to the program’s<br /> director.<br /> - ECG stress test (treadmill or bicycle ergometer) with physician monitoring and report. One will be allowed<br /> at the beginning of the program and one after three months (usually the completion of the program).<br /> - Other physician services, as needed. </p> http://www.supercoder.com/forum/topic/can-different-physicians-bill-separately-for-their-part-in-a-chf-clinic#post-6009 Mon, 08 Aug 2011 13:29:22 +0000 Maria Minnick 6009@http://www.supercoder.com/forum/ <p>I appreciate your help--I will try to make this as clear as possible. This is rather confusing. I've been told that this CHF clinic is going to be set up similar to our Cardiac Rehab in the fact that the patients that come to the CHF clinic will not only be our patients who receive our office and interventional services, but these will be patients from other physicians (ex. cardiothoracic surgeons, other interventionalists, etc.). So, I don't believe global periods will be a concern. The CHF clinic is to be set up as a totally separate entity. Doctors from different specialties will be referring their patients to the "separate" clinic, which will also bill it's own services.</p> <p>Let's try a scenario of how I've been told this is going to work:</p> <p>Ten patients are scheduled to come into the clinic on day "X". Three patients are referred by a cardiothoracic surgeon's office, three are referred by a neurologist's office, and four are referred by an interventional cardiologist's office. A Nurse Practitioner will see and examine each patient and bill for her services. All ten patients are then taken to a conference room where they will are counseled about their condition, given various options regarding their continued care, etc. More than one physician may speak to the group (ex, from cardiology, neurology, etc.). Can each one of those physicians bill separately for his/her services for counseling these patients or would this be more of a community service? And, if they can bill separately for their counseling, would they bill each patient individually? What ICD-9 code(s),(probably the CHF codes)and CPT codes would be billed? My personal opinion is that the conference shouldn't be billed, and should be a complimentary service and be included in the CHF clinic office visit. But that's just my opinion.</p> <p>I hope I've been clear. This is all new to us. It's a wonderful program for the patients,and of course, we want it to run smoothly for them, including the billing.</p> <p>I appreciate any and all input, and look forward to your reply!</p> <p>Thank you,</p> <p>Maria L. Minnick, CCA<br /> Interventional Cardiology/WMHS </p> http://www.supercoder.com/forum/topic/can-different-physicians-bill-separately-for-their-part-in-a-chf-clinic#post-5982 Fri, 05 Aug 2011 17:42:01 +0000 Sanjit Mishra 5982@http://www.supercoder.com/forum/ <p>In most of the cases the E/M documentation that follows after surgery are related to aftercare postop surgery. So, getting reimbursement for those services is difficult as they are often included in the global period of service.<br /> ***<br /> So, it depends on the type of surgery performed, the CPTs billed. If you can provide me the range of CPTs that you normally bill, it will help me to guide you better.<br /> ***<br /> I need some additional time to gather some guidelines for you that can guide you better related to your question for better reimbursement. I will revert back to you on this issue ASAP. </p> http://www.supercoder.com/forum/topic/can-different-physicians-bill-separately-for-their-part-in-a-chf-clinic#post-5959 Thu, 04 Aug 2011 18:54:51 +0000 Maria Minnick 5959@http://www.supercoder.com/forum/ <p>We have an established clinic that is going to be opening up it's offices for a separate CHF clinic. The billing will be separate. I do the coding/billing for our interventional practice, and my doctor has asked me to find out if other doctors can bill for seeing the patients on the same date of service as the Nurse Practioner, or is the Nurse Practioner the only one who can bill for her services. All patients will be seen by the NP one at a time and then, as a group, taken to a conference room to hear various drs counsel them about their condition. How do we bill for this? Thank you! Maria L. Minnick, CCA </p> http://www.supercoder.com/forum/topic/billing-for-multiple-20550-inj#post-4348 Thu, 21 Apr 2011 05:33:25 +0000 Anonymous 4348@http://www.supercoder.com/forum/ <p>I am agree with Judy, but little clarification. 59 modifier could be used under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent. It should be used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. </p> http://www.supercoder.com/forum/topic/billing-for-multiple-20550-inj#post-4341 Wed, 20 Apr 2011 19:03:21 +0000 Judy Kay Sandretto 4341@http://www.supercoder.com/forum/ <p>Since it is 2 different sites, I would bill 2 separate lines on the claim - such as 20550 and 20550-59 with 1 unit each on each claim line. The 59 mod will indicate a separate procedure/site, etc. Billing this way will get the claim processed correctly and no denial (unless there is another problem). When using Mod 50 on 1 line of the claim, the unit field will be 1 as the mod 50 indicates that is bilateral. But then you are paid one lump sum and sometimes you do not know if the claim was paid as a bilateral service or not. BUt when using 2 separate line entries, you see that both procedures are paid (the second usually at a reduced rate based on 2 surgical procedures on same day). I advised two separate line entries. Hope this helps.<br /> I get wordly sometimes, so I hope this is clear. </p> http://www.supercoder.com/forum/topic/billing-for-multiple-20550-inj#post-4335 Wed, 20 Apr 2011 14:58:43 +0000 Rick Shoeling 4335@http://www.supercoder.com/forum/ <p>Perfect! Now, does it make a difference if it is in two different sites, say one in the arm and one in the hip, verses doing bilateral arms? </p> http://www.supercoder.com/forum/topic/billing-for-multiple-20550-inj#post-4334 Wed, 20 Apr 2011 14:53:44 +0000 Anonymous 4334@http://www.supercoder.com/forum/ <p>1)Could you please give more information on which location you have injected the injection?<br /> 2)If you are billing for medicare and if you are injecting on two different sites in the same operative session, then you could use 20550 first line to reimburse full payment and second line 20550-50 to reimburse 50% of the actual payment, other than medicare, you could use 20550x2. Hope this helps. </p> http://www.supercoder.com/forum/topic/billing-for-multiple-20550-inj#post-4333 Wed, 20 Apr 2011 13:47:18 +0000 Rick Shoeling 4333@http://www.supercoder.com/forum/ <p>Im wondering how to bill out for injection code 20550. Whether its bilateral or not, say we do 2 20550's. Do I need to bill each on seperate line items with modifiers? Or do I put 1 on a line item and change the unit to 2? Please help!! </p> http://www.supercoder.com/forum/topic/ncv-coding-and-purchasing-studies-1#post-2624 Tue, 04 Jan 2011 23:00:18 +0000 Julie Tollefson 2624@http://www.supercoder.com/forum/ <p>Thank you for that. Good to have something in writting to prove what I am saying. </p> <p>Any thoughts about the purchasing studies? I'm trying to wrap my head around billing globally if he didn't perform the studies, but he will interpret the studies and pay the testing facilities for the studies.</p> <p>Thanks<br /> Julie Tollefson </p> http://www.supercoder.com/forum/topic/ncv-coding-and-purchasing-studies#post-2615 Tue, 04 Jan 2011 18:56:13 +0000 Sanjit Mishra 2615@http://www.supercoder.com/forum/ <p>Rest assure. You are absolutely right in coding that way. Please refer to:<br /> <a href="http://www.supercoder.com/articles/articles-alerts/pmc/increase-pay-up-for-same-day-multiple-nerve-conduction-studies/" rel="nofollow">http://www.supercoder.com/articles/articles-alerts/pmc/increase-pay-up-for-same-day-multiple-nerve-conduction-studies/</a> </p> http://www.supercoder.com/forum/topic/ncv-coding-and-purchasing-studies-1#post-2614 Tue, 04 Jan 2011 18:55:28 +0000 Sanjit Mishra 2614@http://www.supercoder.com/forum/ <p>Rest assure. You are absolutely right in coding that way. Please refer to:<br /> <a href="http://www.supercoder.com/articles/articles-alerts/pmc/increase-pay-up-for-same-day-multiple-nerve-conduction-studies/" rel="nofollow">http://www.supercoder.com/articles/articles-alerts/pmc/increase-pay-up-for-same-day-multiple-nerve-conduction-studies/</a> </p>