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    Wiki 86800 - Humana diagnosis denials - Need help!

    Hi Vidraj IF the pt has dx of Rheumoid Arthritis M05.69 as first dx or SLE dx M32 or D68.62 or L93 forms of lupus per documented problems. Then follow up last dx Z code such as Z13.0 or Z13.220. I hope this data helps you Lady T
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    Wiki CPT codes 2025

    Ritukap These are usually for pain management. Put G89 dx block first, then area need pain managing. Use modifiers for laterality too if necessary Lady T
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    Wiki Insight on OB Antepartum only billing of 59425 and 59426

    Baskiles I hope NOT putting a Z dx code first? Are the providers describing the pregnant woman's medical problems then selecting correct first definitive dx code? Here are some examples of O99 Preg & Glucose, 026 Pregn with unspe illness, O1O Pregn & has HTN, 026 Preg & Exhausted,Etc. Also...
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    Wiki FQ MODIFIER

    Pkirsch Try modifier 93 for phone linked to CPT code and 95 for video. These can be linked to CPT of Eva. Mgnt . But the CPT codes are CPT 98968 series or CPT 99442 for phone calls & per type of clinician. FQ is that a modifier for mental health community clinic ? Lady T
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    Question Time frame to send a bill to patient after the insurance paid?

    Iris Ahh I thought it was like before 6 months runs out must bill a patient after insurance paid. But I do know most insurance payers give you 90 days or 1 yr to bill a claim from date of service.. However it can vary on hospital policies or state laws. I hope helped you Lady T
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    Wiki G0538 Documentation Requirements?

    KKnope Ahh just read that must be internist or cardio provider and monthly billed. The risk management services code, G0538, would be reimbursable on patients found to have intermediate, medium or high risk for cardiovascular disease as determined by the ASCVD risk assessment and would include...
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    Wiki Hx of Polyps

    TamGi Ahh does the patient have a problem such as K92 Digestive or K64 or K59 or R15 reason for colonoscopy? Or use dx K63.89 Disease of Colon unspecified since checking colon again Then Z68.010 if supported and Z12.11. The dx Z09 is not first listed dx code and Z68.010 as 2nd dx is ok I hope...
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    Wiki Billing 99401 with Z71.85

    Kyody Is this for diet control or smoking or sub abuse counseling for the patient with CPT 99401-99404? See pg 37 in CPT manual for yr 2024. Add minutes on record discuss with patient on risk of vaccines possible or diet control problems dx E66 and Z68 BMI%. Vaccines..... I d not use dx...
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    Wiki Incidental Findings and modifier -25

    Ndebien If a Est or New patient arrives for treatment and they have ongoing issue or news medical problem and provider assigns meds this would be the primary dx code. However on treating the patient something else is discovered maybe a skin problem, UTI, cut on foot, or new medical problem...
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    Question Can we bill no show fee?

    Cameshai I say yes bill no show since BC BS is primary ,plus did not list NO SHOW fees this in consent for treatment? But if Medicaid as primary I d say no Lady T
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    Normal Finding on a Stress Test

    Bevelwis07, Are you speaking of CPT 93015-93552 groups on cardio stress test? Per Medicare CMS guidelines any E10-E11 DM or Heart conditions range from blocks of I25, I50, I42 -I48. But R coded symptoms too. If result reports say abnormal cardio stress test use blocks dx R93.1. Provider should...
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    Wiki Code for "Fracture Fragment"

    Meg This means a loose body in ulnar region so I d add code dx M24.031 or M24.032 depending which side right or left. I hope this helps Lady T
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    Wiki Telehealth visits and modifier for 2025

    Forehandl I heard will keep all telehealth CPT codes till Mar 2025. But also heard telehealth works best for mental health support. We use modifiers 93 and 95 with all Evt Mgnt codes but in the southern part of US. I hope this helps you. Also told to use modifier AI, AH and AJ when certain...
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    Wiki Medicare denial for colonoscopy

    I d put first dx K64, then Z12.11 and Z86.010. K64 is ok rationale for checking see if anything else wrong in near that area. But having Z dx codes first is wrong...reason for denial.ICD10 manual states dx Z86 or Z12 are not first listed x code. I hope this data helps you Lady T
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    Wiki Cesarean scar ectopic pregnancy

    Gozer Check out these DX codes 090.2, S36.33S & L76.34 or T81.33S & 090.0 & L76.34. Mind you may want the date this occurred on claim. So it determines if recent birthing or years ago. I hope helped you. Also the CPT code for a C-section ectopic scar removal, typically referred to as a...
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    Wiki EMG codes 95910 and 95886

    JNeilJil and Purn, For EMG studies performed with an NCS on the same day, one should bill using CPT codes 95885 (limited study), 95886 (complete study), or 95887 (non-extremity study). These are considered “add-on” codes, and may not be billed independent of an NCS code.Bill together but in...
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    Wiki Denial for Z12.11 code

    Again the ICD10 dx Z12.11 states in ICD10 manual it is NOT acceptable as principal first dx code. I do not make the rules but the payer may decide to follow the ICD10 manual in this case. Lady T
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    Wiki OCP Initiation Visit

    Hi Eharloff, Why is the female patient coming in ...just to get BC pills? I d use reason associated in which provider could document such as: Mensuration problems use N92.6 block, N88.8, N95. Post. Men. Bleeding, E28 Ovarian Dysfunction, or Dented Uterus Q91.81 or N94.89. I d selected dx...
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    Wiki 86800 - Humana diagnosis denials - Need help!

    Hi Vidraj Per CPT manual says under CPT 86800 bill CPT 84432 if doing a test (see CPT 80438 or 80439) .If this patient is pregnant did you add pregnancy dx code too such as 099 dx block with E03 dx? I have seen this CPT used for males too. Try E07 DO of Thyroid. I hope helped you Lady T
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    Wiki Telehealth visits and modifier for 2025

    Add the modifier 93 if phone call to Evt mgt CPT codes. Ensure provider list mode of treatment (phone call vs face to face).Naturally if face to face do not add modifier 93
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    Yes the radiologist reads the EKG or doctor then give dx code on outcomes. All this data should...

    Yes the radiologist reads the EKG or doctor then give dx code on outcomes. All this data should be on the EKG final report and provider will mention confirmed results of EKG in treating documenting for the day.
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    Wiki Pre-op Bariatric Psych evals

    If you code E66 and Z68 per % pt weighs in, then dx Z72.4 Using dx Z13 .3 means mental health DO provider needs to document some beh. health dx too. Why not find out if the patient has Depression dx F32 or F33 or R63.2 or F50 Eating DO or block R45 or F41 Anxiety or some type mental health...
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    Wiki Blue Care Network Michigan

    Cbo014 Is the first dx code a Z dx code or unspecific dx code? Or has the patient seen more than 1 provider for same issue in short amount of time? I hope I helped Lady T
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    Wiki Coding Inquiry for Procedure with No Pathology Found

    Hi How about checking dx T81.31 and dx Z48 blocks? I hope this helps you Lady T
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    Wiki Looking for Jobs

    Sandy If big medical employer in your area go send by email app online, then after week physically go to office.Ask did get info online web site by could leave resume and talk to coding manager? Face to face visit them with hard copy resume in hand to give out or mail the old fashion way cover...
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    Wiki Needing guidance on Work Hardening (97545)

    Lauren Yes can bill it for 70 minutes as long as not go over 120 minutes CPT 97545. If treatment over that time use next CPT code 97546..ensure put minutes in documentation for the day. Lady T
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    Wiki Help Please

    TLS, Id let him read the CPT manual for CPT 99215 or 99205 that is high level MDM making. I ve been told true emergency transfer to hospital or ongoing Cancer dx with suffering symptoms or life or death soon. This pt would get 99214 cpt for visit. You might tell provider if he give CPT 99215...
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    Wiki CPT code 97545

    Lauren How hurt back per dx S39.012A? I would add that...lifting, fell at work see dx blocks of W18, W01, W11, W22 & where? . They may deny cause cap dates on WC treatment may need to do another authorization if pt need MORE sessions. Did use SAME dx code for problem WC injury authorized by WC...
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    Wiki G0296 Humana Primary Dx Z87.891

    AWolf I suggest the coders READ the CPT manual and linking the proper dx to CPT codes is vital. Sequencing and modifier placement is important in coding. Sometimes the provider may list wrong CPT down, coder needs to fix it by reading documentation to ensure matches the CPT manual description...
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    Wiki CPT code 97545

    Monica, What was the first dx code or list of dx codes used linked to CPT 97545? Did add right modifiers of GO or GP and 96 or 97 depending on documentation. See list of modifiers in CPT manual. Also did you put referring doctor down or if pt had other phys therapist visit same month or month...
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    Wiki CPT code 97545

    Monica & Lauren, What was the first dx code or list of dx codes used linked to CPT 97545? Did add right modifiers of GO or GP and 96 or 97 depending on documentation. See list of modifiers in CPT manual. Also did you put referring doctor down or if pt had other phys therapist visit same month...
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    Wiki UHC Denials for UTiD

    Prakashkg What is the medical reason or dx code given by provider wanting lab tests? Did you bill it with infection and where found first or just Z dx code first? This info here might help you related to lab codes.... CPT 87556 TB see dx blocks A15, A18 and Z dx appropriate code last CPT...
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    Wiki Medicare denial for Z12.11 and 45380

    Patdow Sequence seems wrong,, first dx D12.7, K64.1 then dx Z12.11 or Z13.811 last. Id use Z13.811 last cause if pt had annual screen already due to age might be reason denying it. However I think it is the sequencing part. Also if pt has had polyps years ago add the Z86.010 last. I hope this...
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    Wiki Obesity class 2025 changes

    Hi Jackie If a baby or newborn see dx blocks of R62, R63, P08, P007 or P92.3 which probably match the Z68 dx code for peds. Anytime do Obesity or Weight dx coding should be 2 dx codes if documentation listed. I hope helped you Lady T
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    Wiki Denial for Z12.11 code

    Patdow It seems like the K57.30 first dx , then dx Q43.8 and last dx Z12.11 or Z13.811 The coding sequence seems incorrect listed above. The ICD10 manual states dx Z12.11 is unacceptable as first dx code. Payers like details and specifics in DX and CPT coding which should match the...
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    Wiki Claim denial based on LRC or SI

    Patdow If pt has gastro problem hopefully provider list this as reason...code this dx and dx Z12.11 last. If the results from colon biopsy taken use D12 blocks from wherever the bx are taken from as first dx code on claim. The colon/intestine has like 5 sections in it....you can use K63.5 but...
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    Wiki CHRONIC CONDITION CODING ER VISITS

    Mbradfrod, I d add chronic conditions (the top 10)or forever disease if related to current injury or illness. Usually the provider should know to list this data. Also think about reason pt is coming to ER visit...run out of meds, lacerated hand, fever, or pt suffering with some type of Cancer...
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    Wiki What strategies do you use to code more efficiently?

    Elund If outpt. record first for look for nature of complain , is it type of session ( Est or new or follow up Etc) visits. Then look at review of system ROS see if mentioned the problem and specify details. Hopefully the provider has given coder/reader description of treatment suggested, meds...
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    Wiki Humana Mcr Diagnosis code issue

    Macyoverstreet If provider is checking stomach problems and not give symptom or just checking I d use dx K31.89 DO of stomach and proper Z code. Whereas if provider checking Esophagus but found nothing Id put K22.89 linked with EGD procedure. Hopefully the provider is giving a symptom to go...
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    Wiki Medicare Final Rule Telehealth

    Wfisher If providers documents CPT 99214 can add the modifier 95 video and 93 phone call. Or use CPT 99441-99443 for phone only ensure pt minutes in documentation and tell if phone or video Hope this data helps Lady T
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    Wiki G0545 Infectious Disease

    KMC, I d probably use that with pts have ongoing infectious ds. problems like dx codes of B20, respiratory ds like J01, pneumonia, Covid U09, or contagious skin infections or Sepsis or ongoing sex disease . I imagine use it the first visit as new patient or when lab results confirm the ds. I...
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    Wiki What strategies do you use to code more efficiently?

    Elund:) If abstracting medical codes for certain specialty learn abbreviations, slang terms, modifiers and Z dx codes related to that specialty such as Orth, OB-GYN, Family Med, Gastro Etc. They need to learn basics and understand READING & coding concepts of the differ areas of ICD10and CPT...
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    Wiki coding sequence?

    Hi Linda Some payers want XS instead of 59 modifier if polyps in different areas of the colon see Dx D12 as example. 33 modifier is for FIRST time colonoscopy ever in life time for usually patients age 45-75. Other data you have seems correct Lady T
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    Wiki Humana Mcr Diagnosis code issue

    Well the provider is checking for disease of gastro area...try these listed digestive ds. below and then dx Z12.11 or dx Z13.811. Look at dx Z12.10-Z12.13 However if provider gives you a pt has detailed problem or symptom list that as first dx when checking the colon or stomach area Here are...
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    Wiki Telehealth 2025

    Shih I heard CPT 99441-99443 for MD DO and NP stop at Jan 1, 2025. Told use the CPT 98966-98968 series or modifiers 95 or 93 with Eval Mgnt codes. Lady T
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    Wiki coding sequence?

    Do you understand how to use modifier XS, 53, 52, PT and 33 regarding colonscopies and EGD?
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    Wiki Sepsis related

    Hi Pariharn Sepsis must be caused by some problem such as blood infection, organ failure, infection from catheters, or toxic in body. Using Sepsis usually needs 2 dx codes or combo codes from proper documentation. Provider also should list type of infection strep, E Coli, anaerobes, Etc. the dx...
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    Wiki Claim denial based on LRC or SI

    If polyps are discovered in the colon which be on lab results and provider should explain this in documentation where pluck bx ...you code them as primary. Then I d use dx Z12.11 cause this is why investigating the colon looking for cancer. If not a polyps use a symptom or definitive dx from...
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    Wiki R91.8 FOR PETSCAN

    Hi B Gallaghar Please let me add if the patient has cancer metastasis we add new area where cancer has spread or grown,then dx C78 and C79 of secondary Cancer growth see dx block .Also add past HO of Cancer see dx block Z85 on whatever type/location cancer it is too. Natural the results show...
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    Wiki Documentation requirements to bill 94010 vs. billing 94375

    Hi Jason :) In the CPT manual year 2024 pg 819 explains the difference and not to mesh with add on code CPT 94375 with CPT 94010. It seems kind of redundant processes it is bundled in. The CPT 94375 is a flow volume loop .That seems to be involved in the CPT 94010 Spirometry test. Well that is...
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