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  1. M

    Wiki Wokers Comp telehealth billing

    I hear that billing telehealth will go back to pre pandemic rules, but I didn’t start billing until the pandemic, so I’m not familiar with the old guidelines. Can you help clarify and/or help me know where to find these guidelines?
  2. M

    Wiki Wokers Comp telehealth billing

    Hey all, I am new to workers comp billing. For audio only visits, are these timed E/M codes or are they office visit codes 99202-99215?
  3. M

    Wiki 99245 consultations for workers comp permanency

    Thank you! I will definitely do some more digging. (=
  4. M

    Wiki 99245 consultations for workers comp permanency

    Our office does workers comp, we are in NY. When an established patient comes in for a Permanency appt, the providers do an extensive amount of work, they document their note as well as filling out a C-4.3 form which they upload into the comp board. We have always billed a 99245 consultation...
  5. M

    Wiki CPT II 40134f

    Hi all, I've asked this before, but have not gotten any feedback, so I am posting again. For 4013F Statin therapy prescribed or currently being taken (CAD). Does the patient have to have a dx of CAD in order to use this code? Or can any dx be used for hyperlipidemia if they are taking a...
  6. M

    Wiki TCM (99495)

    Hi, ED does not count unless they were admitted into observation and stayed in the ED due to lack of rooms elsewhere in the hospital. Discharge from any of the following: Inpatient acute care hospital Long-term acute care hospital Skilled nursing facility/nursing facility Inpatient...
  7. M

    Wiki Out of Country Telehealth visit?

    Mental health is all I've found as well. I am probably going to have to reach out to them directly. I did find a link on the Florida Board of Medicine (this is where our patient will be) that lets outside states apply for, it looks like, a temporary license for telehealth services. I'll do...
  8. M

    Wiki Out of State telehealth services for workers comp/DOL

    I am new to workers comp billing, it sure is a different beast than what I am used to. The scenario I am questioning right now is, we have a department of labor/workers comp patient who is going to Florida for the winter. Our providers want to do telehealth visits while the patient is in...
  9. M

    Wiki Out of Country Telehealth visit?

    This is a scenario that I am dealing with at the moment. We have a patient who goes to Florida for the winter, they are a worker's comp through the Department of Labor in NY. Our provider wants to provide telehealth services while they are in Florida. I was always had the understanding that...
  10. M

    Wiki CKD 4 with Dialysis

    Ell.21, E11.22 (diabetes w/ckd), N18.4, N17.9, Z99.2
  11. M

    Wiki CPT Needed

    Thank you!
  12. M

    Wiki Transitional Care Management

    A brief overview of the codes shows three key requirements: 99495 Transitional care management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of...
  13. M

    Wiki use of Z12.31

    Thank you! I don't ever use it as a first dx code, as it is never the reason for the visit. But when the providers see that it is time for the patient to get an updated mammogram, its documented in the note and a referral is given. I was just a bit confused if I should include Z12.31 on the...
  14. M

    Wiki use of Z12.31

    This was more of a general question, not really related to a particular visit. We are a primary care office and when a patient is due for a mammogram, the providers give a referral. That is never the only reason for the visit.
  15. M

    Wiki use of Z12.31

    Hi all, As a PCP office, I had been told that when the provider gives a referral for a screening mammogram that we are to put Z12.31 on the claim for that visit. But the guidelines state that Z12.31 is to be used with a procedure code. We aren't doing the mammogram in office, just referring...
  16. M

    Wiki CPT Needed

    Ryan, do you know what the (PV) and (PAG) stand mean?
  17. M

    Wiki 99245 consult question

    Thank you so much! I will be looking into this.
  18. M

    Wiki 99245 consult question

    Our provider filled out and filed a C 4.3 form for a comp patient. The patient was not seen that day, but was seen the day before. Typically we bill a 99245 consult, but can we still bill that when the provider wasn't face to face with the patient the day he filled it out? And if not, can we...
  19. M

    Wiki CPT II codes and dx

    Hey all,, I put this out there in another forum, but haven't gotten a response so I thought I would put it here as well. For 4013F Statin therapy prescribed or currently being taken (CAD). Does the patient have to have a dx of CAD in order to use this code? Or can any dx be used, like...
  20. M

    Wiki dx codes for CPT II codes

    Hi all, For 4013F Statin therapy prescribed or currently being taken (CAD). Does the patient have to have a dx of CAD in order to use this code? Or can any dx be used, like hyperlipidemia if they are taking a statin for it?
  21. M

    Wiki CPT II for KED

    Does anyone know if there are CPT II codes for reporting KED when a urine microalbumin test is performed? I thought there were 2, one for a positive result and another for negative result. I can't seem to find this information.
  22. M

    Wiki albumin cpt clarification

    Can anyone help me clarify the difference between CPT 82043- urine (micro albumin) quantitative and 82044- urine (micoalbumin) semi quantitative (reagent strip assay) Is one meant to be done in house and the other sent to a lab?
  23. M

    Wiki PT re evals

    I started using mod XU on 97164 and get paid every time now.
  24. M

    Wiki 97164

    Hi, we have been using modifier XU and have been getting paid for a couple years now. https://www.cms.gov/files/document/mln1783722-proper-use-modifiers-59-xe-xp-xs-and-xu.pdf
  25. M

    Wiki No fault/Workers Comp guidelines

    I just purchased the New York Workers Comp medical fee schedule and billing guideline book from Optum. Thank you for your response. I’ll be doing some research.
  26. M

    Wiki No fault/Workers Comp guidelines

    Hi all, I’m a coder/biller in NY, recently due to unforeseen circumstances, I have taken on our No Fault and Workers Comp billing. I’m wondering if these specialties follow CMS E/M guidelines or if they have their own. I’ve only billed for our primary care patients and am comfortable leveling...
  27. M

    Wiki Is an in-office injection considered prescription drug management?

    I had listened to a podcast, I believe it was Terry Fletcher, and she mentioned that giving out samples is not considered prescription drug management. I should try to look for it again, I don't remember the reasoning behind it.
  28. M

    Wiki CT of Hip w/o contrast

    That’s what I was thinking too, thanks for sharing!
  29. M

    Wiki CT of Hip w/o contrast

    Hi all, would a CT of the hip w/o contrast be 72192 or 73700?
  30. M

    Wiki Coding clinic pros or cons

    Has/Does anyone use AAPC's coding clinic or any other? I code and bill for a small primary care office and was just wondering if it would be worth it for me to purchase. Can anyone share their experiences, good or bad. Thanks!
  31. M

    Wiki Coding Clinics pros/cons

    Hi all, I do the coding and billing for a small primary care office. I was looking at AAPC's Coding Clinics and was wondering if anyone uses it and can give me some pros or cons of whether they think it's worth it. Thanks!
  32. M

    Wiki exacerbation?

    Thank you, I appreciate you input!
  33. M

    Wiki exacerbation?

    If a patient has a dx of L/S disc degeneration and the come for a visit stating that the pain in their back is aching, stabbing and throbbing, would this be considered exacerbation of pain? Thanks!
  34. M

    Wiki exacerbation?

    If a patient has a dx of L/S disc degeneration and the come for a visit stating that the pain in their back is aching, stabbing and throbbing, would this be considered exacerbation of pain? Thanks!
  35. M

    Wiki QMB Question

    Quick back story. Our office doesn't take many insurances, we take Medicare, Medicaid, Fidelis and WellCare. If a patient, for example, has a Humana dual plan and are a QMB and wants to come to our office knowing we don't except their insurance and are willing to pay a flat fee. Can we have...
  36. M

    Wiki FY 2023 ICD-10-CM guidelines

    Yes please! mnuhfer04@yahoo.com (=
  37. M

    Wiki Problem is present in multiple locations, i.e., bilateral knee osteoarthritis, both sides were addressed, is it considered 1 or 2 chronic illness(es)?

    Do you think this would be the same for C/S and L/S disc degeneration? That these would be 1 problem if treatment is the same for both?
  38. M

    Wiki Office visit denial with B12 injection

    Definitely reach out to the payer. We do B12 shots all the time and apply mod 25 to the E/M visit, I've never had a problem. We are in NY
  39. M

    Wiki CodingIntel.com?

    Hey all, does anyone have a membership to CodingIntel.com? It was brought up as a good resource in a webinar that I watched. Just looking to see if anyone uses it, if they think it is worth it and perhaps what specialty you work for and if you are with a big or small practice. I work in...
  40. M

    Wiki Hep C undetectable

    If the provider say the patients Hep C is undetectable, would I code for the Hep C or history of? Thanks!
  41. M

    Wiki Physical Therapy Re evaluations

    Good morning! For a physical therapy re evals, do the previous measurements need to be in the note, or just the current measurements from that specific date of service? Thanks!
  42. M

    Wiki MVA

    In NY we bill the auto insurance, and if/when benefits become exhausted, we bill their primary insurance (if we are their PCP).
  43. M

    Wiki BCBSGA/Anthem 99214-99215 Denied/Down coded

    I have as well, but with Fidelis (I am in NY). When this happens, I fill out an appeal form, print out the AMA 2021 E/M Guidelines and write a short letter explaining why this date of service meets the criteria for a 99214. I send that, along with the claim form and medical record to the...
  44. M

    Wiki Billing a Medicaid patient?

    Thank you so much for this information! I hadn't had time to look on Medicaids website yet today, so this is very helpful!
  45. M

    Wiki Billing a Medicaid patient?

    I am pretty sure I know the answer already, but I wanted some opinions. Is it ever legal to bill a Medicaid patient? Example: A patient has a Medicaid managed plan through BlueCross. We do not participate with BlueCross, we do with Medicaid. Can the patient sign a waiver to pay cash since we...
  46. M

    Wiki Networking question

    As far as Facebook groups, I like Medical Billing and Coding Forum, Medical Coding Mentors and Medical Coding Buddies
  47. M

    Wiki G0438 and G0439 Initial Without Subsequent

    Your MAC should have this information on their website as well.
  48. M

    Wiki Networking question

    Facebook has many great coding/billing groups. AAPC has one as well, but there are a ton that have been a great resource for me.
  49. M

    Wiki Prescription drug management for MDM

    Good morning! In regards to prescription drug management for MDM, our MAC states that simply stating in the medical record that a prescription is renewed does not meet the risk criteria in MDM. Our providers will state in the medical record: "Continue meds as prescribed, for refills see meds...
  50. M

    Wiki Massage Chair Code

    Hmmm, interesting, we have been using code 97124 for massage chair for quite some time now.
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