Recent content by csperoni

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    Wiki How do you bill for non-covered services?

    There are a lot of nuances about why a procedure isn't covered. There are also a lot of nuances in your insurance contract about when you cannot bill a patient, and the specific requirements when you do bill a patient. Something that is not covered because insurance includes it in the work of...
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    Wiki ATTN CPC-A

    Yes, that is a great reason to do Practicode, especially if you do not have healthcare related experience to pull from. However, I often see others complaining that Practicode was a waste of time and/or money because they believe it counts as experience. They incorrectly believe they will then...
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    Wiki Preventive care with an E/M

    If all the provider did was say "hey, that mole looks odd - go see a derm", my opinion is that does not meet the requirement to bill a separate E&M with -25.
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    Wiki Other opinions

    Whenever trying to determine an E&M level, you need to determine the level of each component of overall MDM: problem, data and risk. You must have at least 2 of those at a specific level to reach that overall level. Alternately, you may bill base on time. My 2 second review indicates this...
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    Documentation Insurance/Cosmetic

    You should get official compliance or legal advice on this. However, I will weigh in with my opinion. It is typically not "required" to have separate notes. Doing so does make a gray area much more black and white. Let's use an example of a worker's comp patient presents for hitting his...
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    Wiki Medicare Annual Exam

    If no problems are being addressed, and patient is receiving a cervical/breast cancer screening, then G0101 would be appropriate. If they do require a PAP, then also Q0091. If a full preventive visit is performed, then 9938x-9939x are appropriate. Remember that G0101 & Q0091 are covered every...
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    Wiki Inpatient Initial E&M

    Ortho definitely not my wheelhouse, but I would think this is more than low for acute, uncomplicated illness. I would consider a fracture in a younger, healthier patient, or a non-displaced fracture to be acute, uncomplicated. I would likely consider this problem acute, complicated as they...
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    Question iud insert with cervical block

    I am not aware of any carrier that does not consider blocks part of the procedure when performed by the physician providing the primary service. This AAGL article specifies: Anesthesia CPT Codes: All anesthesia, local or regional, is considered integral to the procedure so cannot be billed...
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    Wiki New E/M codes reimbursement

    I know you already came up with an answer, but did want to make you aware that discussion to determine charges is something that is actually prohibited. And allowables (except for Medicare/Medicaid) are determined by your insurance contracts. So my allowable for 98000 by a particular payor is...
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    Wiki Insight on billing 59425 and 59426 codes.

    You can check their policy more carefully than I did, but at a glance I did not see this required. I'm in NY and have zero experience with Wellpoint TN. I know for our carriers, we typically bill out the 59425/59426 with the date of last treatment, not a range.
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    Wiki iud insert and rem same day

    I agree with Corinne. The removal was required for the provider to correct their initial mis-placement. In fact, while looking for a reference on a totally unrelated question, I came across this AAGL article which states: Difficult Insertions/Failed Insertions CPT Codes: Modifier 22 can be used...
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    Billing a Post-Op for a provider that changed Offices

    It doesn't matter who employed the physician at the time. The surgery was paid which has a 90 day global. Any work that is part of the global surgical package was already paid when the surgery was paid. The same guidelines apply to new vs established patient.
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    Wiki Insight on OB Antepartum only billing of 59425 and 59426

    Any questions should be posted only once, in whatever the most appropriate forum is. I answered this in your other post. https://www.aapc.com/discuss/threads/insight-on-billing-59425-and-59426-codes.201672/
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    Wiki Insight on billing 59425 and 59426 codes.

    From my experience, anytime a carrier accepts global maternity billing, it can be a challenge when billing needs to be split. If you provided some/all antepartum care, but did not deliver, then 59425 or 59426 could be appropriate. However, if another provider also billed for global, or a...
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    Wiki BCBS 2025 Telemedicine Policy

    Every carrier makes their own guidelines about whether or not telemedicine is covered and how it should be billed. If they already provided guidance to follow their current policy that is what I would recommend.
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