TThivierge's latest activity

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    TThivierge replied to the thread 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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    TThivierge reacted to surbhidhupar02@gmail.com's post in the thread Wiki Secondary insurance COB adjustment when Primary denied with Like Like.
    Yes, secondary insurance should pay if it's covered in their benefit plan. Sometimes, if the primary insurance denies then we can claim to the secondary insurance if they also denies the benefit then the patient is liable for the payment.
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    TThivierge replied to the thread 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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    TThivierge replied to the thread 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...
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    TThivierge replied to the thread 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...
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    TThivierge replied to the thread 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...
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    TThivierge replied to the thread 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...
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    TThivierge replied to the thread 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...
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    TThivierge replied to the thread 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...
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    TThivierge reacted to tori.a's post in the thread Wiki Telehealth visits and modifier for 2025 with Like Like.
    Audio-only for ESRD and behavioral health only per Dr. John Lin with PRS network. For Medicare.
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    TThivierge replied to the thread 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...
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    TThivierge replied to the thread 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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    TThivierge replied to the thread 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...
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    TThivierge replied to the thread 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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    TThivierge replied to the thread 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...
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