Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

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CPC Practice Exam and Study Guide Package

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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

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2016 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

United Healthcare and Moderate Sedation

United Healthcare will not separately pay codes 99152 and 99153. I have tried modifier XS, 59, and most recently 51. I, however, cannot find any medical policy stating that it is not separately payable as well. I called UHC and spoke to a representative who told me that they are separately payable, but he could not tell me what modifier they accepted.
Does anyone have any assistance they can give with this? I have been going back and forth with them since July.

Any help is much appreciated, any brainstorming is much appreciated.

Thank you all in advanced.

Alli

Medical Billing and Coding Forum

Billing and updating claims information

I have an urgent question As a biller can you legally update information on a claim on the back end. Due to an import error and an error with EMR format claims were missing information for billing. Can the biller update/enter and or correct this data? My belief is the information should be updated by our software analyst by making the necessary formatting corrections and reimporting the data?

Medical Billing and Coding Forum

Asian Medical Tourism Set For Tremendous Growth

According to our research report Asian Medical Tourism Analysis (2008-2012), Asian medical tourism industry has been growing at a robust pace for the past few years and has become a focal point of attraction for several developing countries. Moreover, the Asian medical tourism industry revenue is projected to grow at a CAGR of around 17% during 2010-2012, on the back of some key factors discussed in our report.

The ongoing analysis identified that, the Asian countries, such as India, Malaysia, Singapore, and Thailand have been pouring investments into their healthcare infrastructure to meet the rising demand for quality-assured medical care through first-class facilities and highly trained medical specialists, including tertiary hospital care. The report has also elaborated current market scenario and key developments in these countries. Moreover, emerging market of spa and wellness sector in each Asian country has been covered, depicting new avenues for growth in industry.

The report has covered sections, such as analysis of various medical procedures, tourism destination, accreditations that elaborates cost of various surgeries and procedures in Asian countries, with respect to other countries in the world. The section provides an analysis of treatments, which have cost differentials between developed and emerging market. Moreover, sections like market drivers and market trends define those factors and avenues that have been boosting the market and providing a further momentum.

Asian Medical Tourism Analysis (2008-2012) covers Asian medical tourism market in a complete perspective providing reliable data and effective presentation of each detail covered. It provides comprehensive research and unbiased analysis of the current market performance and future outlook of key Asian medical tourism markets Thailand, Singapore, India, Malaysia, the Philippines, and South Korea. It acknowledges the fact that the six Asian markets covered in the report have vast differences in terms of cost, infrastructure, human resources, patient perceptions, competencies, and level of government support. Each of the fact has been thoroughly studied in the report. The report provides valuable information to clients planning to venture into these markets and helps them to devise strategies.

For FREE SAMPLE of this report visit: http://www.rncos.com/Report/IM105.htm

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RNCOS specializes in Industry intelligence and creative solutions for contemporary business segments. Our professionals study and analyze the industry and its various components, with comprehensive study of the changing market behavior. Our accuracy and data precision proves beneficial in terms of pricing and time management that assist the consultants in meeting their objectives in a cost-effective and timely manner.

Billing patient when referral not obtained

My understanding (correct me if I’m wrong) is that if our office fails to obtain a required referral, we have to write off the visit; we can’t bill the patient.

But what about a situation in which the patient requests to be seen right away without waiting for the referral, and states that if we don’t get it, he will pay out of pocket?

Medical Billing and Coding Forum

Same specialty for Observation

I have a question regarding Observation services. I understand that only the admitting provider (or other providers under the same TIN and same specialty) should bill the Observation codes. All other providers should bill using the standard E&M code set. In our large group practice, the way the “Wards” schedule is, a patient could be admitted to Observation status by an Internal Medicine physician, and the next day the “doc of the day” for that ward is Family Medicine. Both are different specialties, but both are primary care. Can the physician for day 2 bill Observation due to being primary care, or does s/he have to use E&M codes due to different specialties?

Thanks in advance, Shelly

Medical Billing and Coding Forum

Charleston dentist sentenced to five years in federal prison for health care fraud

A Charleston dentist who falsely billed West Virginia Medicaid for more than $ 700,000 was sentenced today to 5 years in federal prison. Skaff, a dentist, admitted that he falsely inflated his billings (a practice commonly known as upcoding) by falsely claiming reimbursement for procedures involving impacted teeth (typically, only wisdom teeth are impacted). However, Skaff upcoded billings for tooth extractions by falsely informing Medicaid that he performed more complex procedures, such as extractions of impacted teeth, when he had actually performed simple procedures. Because Skaff upcoded these extractions, Medicaid paid $ 172 per tooth, much more than for a simple extraction.

Read the full story here!

The post Charleston dentist sentenced to five years in federal prison for health care fraud appeared first on The Coding Network.

The Coding Network

Get Better Treatment with the Help of Medical Tourism

Getting a rather mammoth amount of patronage from millions and millions of people across the globe, medical tourism is popularity stems from many factors. An extremely convenient way to access quality medical care, it has been known to do magic to various global patients. Elective procedures and urgent ones, no matter what one may be seeking, the hospitals in medical tourism destinations cover an exhaustive list of specialties. That apart, you can even find highly specialized healthcare centers focusing on particular branch of medicine and thereby offering all the more superior service. Seeking the help of a medical tourism facilitator also helps, given the fact that they have the right statistics, comprehensive information and a professional way of doing things. Coming back to the main focus area, medical tourism has many takers from every corner of the world. The West works on an institutionalized way of medical system that just doesn’t go down well with a rather large middle-class society, be it in America, England, Canada or other European nations. And, given the lack of basic medical facilities and infrastructure in African and the Middle Eastern countries, one can clearly see how haute property medical tourism is. But, one asks, why not? Affordable world-class medical services, quality care and excellent post-treatment services, who isn’t entitled to all this? It is a win-win situation for both the parties . To be able to access quality care is every human being’s prerogative and to be able to do so in a financial manner that fits into your pocket comes foremost. The Western medical system is such that many feel it’s of no use to them, especially the middle-class. Meeting up with experts or opting to go for a particular cosmetic surgery may take up to several months to a year, even more, which obviously, isn’t a very agreeable situation. And then, to add to the mounting frustrations, it is the insurance policies that play a spoilt sport. When your policy doesn’t cover you for a particular procedure, you are as good or as bad as the uninsured person. Last, but in no way the least, affordability becomes a big question mark in the face of exorbitant medical treatments and services. Compared to all these, doesn’t it sound simpler to just board a cheap flight to a medical tourism destination and get your preferred treatment under all the privacy and for the fraction of the cost that it commands in your home land? This way you not only get to access the best of doctors, the best of medical practices and the best of hospitals for a figure that suits you, but also enjoy a small vacation on the side. Hospitals in the medical tourism hubs have been giving a stiff competition to those in the West.On the other hand, would you mind getting yourself medically treated in a foreign locale for half the price that the hospitals and procedures in your own country demand? We all know what the answer to that question is. The point is, as mentioned above, you can always do a thorough research about a particular treatment or healthcare center and then go with the chosen one. Welcome a healthy change in your life, banish those frustrating thoughts and sadness caused due to your illness, enjoy a normal life after a stint at a Medical Tourism Destinations, it’ll all be worth it. Equipped with an accreditation from international health governing bodies, the healthcare centers boast of a world-class infrastructure, state-of-the-art medical equipment, excellent accommodation facilities, trained nursing staff, efficient administration to make your stay as comfortable as can be and most importantly, highly qualified and experienced doctors. Don’t you take more time to get that illness treated, make arrangements through a medical tourism facilitator and say hello to a new, improved life again.

Medical Tourism search engine offering users the ability to compare Medical Tourism Destinations That provide Treatment and Procedure cosmetic and medical procedure costs and reputation from.

Same Specialty for Observation

I have a question regarding Observation services. I understand that only the admitting provider (or other providers under the same TIN and same specialty) should bill the Observation codes. All other providers should bill using the standard E&M code set. In our large group practice, the way the “Wards” schedule is, a patient could be admitted to Observation status by an Internal Medicine physician, and the next day the “doc of the day” for that ward is Family Medicine. Both are different specialties, but both are primary care. Can the physician for day 2 bill Observation due to being primary care, or does s/he have to use E&M codes due to different specialties?

Thanks in advance!
Shelly

Medical Billing and Coding Forum

CPT 52356 along with dilation for ureteral stenosis

I’m finding some conflicting information for this procedure whether the dilation would be separately billable.

Procedure: Urethral dilation, cystoscopy, right retrograde pyelogram, right ureteral dilation, right rigid ureteroscopy, right flexible digital ureteral pyeloscopy, laser lithotripsy of ureteral and renal calculi, placement of right double-J stent 6 x 26.

A 22-French cystoscope was then used to evaluate the patient. The patient was noted to have meatal stenosis. He underwent dilation of the fossa navicularis with Van Buren sounds up to 24-French.
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A 22-French cystoscope was then used to evaluate the patient. The anterior urethra was normal in appearance without any evidence of stricture. His urethrovesical anastomosis was intact. Upon entering the bladder, both ureteral orifices were identified, appeared to be in orthotopic position with clear
efflux of urine. Systematic evaluation of the bladder with a 30- and 70-degree angle lens demonstrated no gross intravesical pathology. Specifically, no gross inflammation, tumor, or calculi.
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A right retrograde pyelogram was performed. This demonstrated what appeared to be a stone near the iliac vessels. There was also evidence of calcification in the lower pole of the right kidney. The ureteral orifice was dilated with a Nottingham dilator. The cystoscope was then withdrawn.
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A 6.9-French semi-rigid ureteroscope was then used to evaluate the patient. The distal ureter was normal in appearance up to the iliac vessels. The stone appeared to be proximal to the iliac vessels, but unfortunately, I was unable to navigate the semi-rigid ureteroscope proximal to the iliac vessels. At this point, an additional wire was then placed through the working port of the semi-rigid ureteroscope and the ureteroscope was withdrawn.
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The digital ureteroscope was then advanced over the wire. We were able to identify the stone just proximal to the iliac vessels. Using the holmium laser, the stone was then dusted into multiple small fragments. The ureteroscope was then advanced at this point and a wire was placed through the digital ureteroscope and the ureteroscope was withdrawn. An 11 x 13 x 44 ureteral access sheath was then advanced. I was unable to advance the
ureteral access sheath proximal to the iliac vessels. Given this finding, I did place an additional wire, then advanced the ureteral scope into the right renal pelvis. The patient’s major stone burden was in the lower pole of the right kidney. The stone was then broken up into multiple small fragments. These fragments were too small to engage in a Nitinol basket. Systematic evaluation on remainder of the calyces demonstrated no evidence of any significant residual stone burden. At this point, then a retrograde pyelogram was performed through the scope. There did not appear to be any evidence of extravasation nor residual stone burden. The ureter was then examined as the ureteral scope was withdrawn. A 6 x 26 double-J stent was then placed into the right renal pelvis in a retrograde fashion under fluoroscopic guidance. The bladder was drained. The cystoscope was withdrawn. Please note, there was 1 stone fragment, which was retained, which will be sent for analysis. The patient tolerated the procedure well and was taken to the recovery room postoperatively. We will arrange for patient be discharged home with prescriptions for ciprofloxacin, Norco, and Ditropan. Mid-
level follow up in 1 week with KUB.

Medical Billing and Coding Forum