Recent content by TThivierge

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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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