They are denying as bundled.
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Tag Archives: bill
Type of Bill Codes
I need help!
Trying to figure out the proper Type of Bill Code to submit on a UB-04 claim form for a Sub-Acute Detox/Residential Substance Abuse Rehab Treatment Center (Inpatient).
Currently, our Billing Dept is outsourced. They have been using Code 113.
After receiving a denial on a specific claim I contacted that insurance company. I was told that our Tax ID does not reflect a hospital setting and the first digit for claim type is incorrect and should be replaced with an 8-Specialty Facility. When I contacted the Billing Dept they stated that all those claims were resubmitted with bill type 163.
If we are not a Hospital how are they getting our claims paid as a "Hospital" setting?
Please help!
Decision for surgery was made… and then the surgery was cancelled. Can we bill?
I’m not sure what’s correct for this visit:
The patient was seen on 8/1 and the decision was made to proceed with a partial mastectomy. Consent forms were signed and surgery was scheduled for the end of the month. The patient was seen again on 8/10 because she had questions about the procedure and recovery time. Since the decision for surgery had been made at the 8/1 visit, the 8/10 visit was not charged. (8/10 visit is being considered global since the decision for surgery was already made and the visit was related to the surgery)
The patient has decided to postpone the surgery and it has not been rescheduled. (she’s seeking another opinion) In this case, does the visit on 8/10 now become billable? Or should it be left as a global visit since a surgical plan was in place when the patient was seen on 8/10?
Haven’t had this come up before now, and I’m interested to see how everyone else handles it.
Thanks 
Is an OBGYN specialist eligible to bill 81002 in POS-11?
Is an OBGYN specialist eligible to bill 81002 in POS-11?
Hospitals Improperly Bill Medicare Millions for Radiation Therapy
An OIG review shows Medicare overpaid outpatient hospitals as much as $ 25.8 million for complex simulations billed during audit period. Between 2013 and 2015, Medicare paid 1,193 hospitals $ 109,197,933 in bundled payments for intensity modulated radiation therapy (IMRT) — about $ 25,754,171 more than they should have, according to the Office of Inspector General (OIG). The […]
AAPC Knowledge Center
Pain Neurostimulators – Can you bill implants separate on commercial cases?
Alright alright alright,
So far we have only had Medicare neurostimlator cases (63650×2, 63685) and recently we’ve been asked if we could do a Cigna. Now here’s my issue, are we able to bill implants separately with this commercial policy using the various HCPCS codes?
The reason for my confusion is because under the CPT notes this is listed:
Includes The following are components of a neurostimulator system:
Includes Collection of contacts of which four or more provide the electrical stimulation in the epidural space
Includes Complex and simple neurostimulators
Includes Contacts on a catheter-type lead (array)
Includes Extension
Includes External controller
Includes Implanted neurostimulator
However, I’ve seen an old thread where it was mentioned that they do bill separately and on the company’s website they list out the implant codes that can be billed to commercial policies. But how? Since it specifically states they are included. Am I missing something or misunderstanding?
Any help is appreciated!
can you bill both 27340 & 27360??
I have a Medicare-Novitas patient
cci is stating that 27340 is incl with 27360, but the reason for the surgery was more for the excision of prepatellar bursa excision.
doctor did a partial exostectomy of the superior patellar osetophyte, and I 7 D of the bursa(27301 included though)
cci is stating that 27340 is incl with 27360, but the reason for the surgery was more for the excision of prepatellar bursa excision.
doctor did a partial exostectomy of the superior patellar osetophyte, and I 7 D of the bursa(27301 included though)
**patient’s history was prepatellar bursal swelling & build up of fluid w/ positive staph aureus
I am looking at coding only 27340 – does anyone else agree or disagree
suggests please.
thanks
Barb
Can you bill a repair when you are removing hardware?
I have a patient, that doctor removed painful hardware in the ankle.
two separate incisions so I coded 20680 rt, 20680, 59 ,rt
The note states – prominent hardward was wearing through the deltoid, so when he removed the screw and washer – he repaired the deltoid.
Can I also bill 27698??
thanks in advance for your advice
two separate incisions so I coded 20680 rt, 20680, 59 ,rt
The note states – prominent hardward was wearing through the deltoid, so when he removed the screw and washer – he repaired the deltoid.
Can I also bill 27698??
thanks in advance for your advice
How do you bill a Medicare Advantage plan for Medicaid coinsurance?
We have recently gotten this denial from Medicaid for patients who have a Medicare Advantage plan and Medicaid secondary. 01153 CLIENT IS ENROLLED IN A MEDICARE ADVANTAGE PLAN (MAP). PROVIDER SHOULD CONTACT MAP FOR CO-PAYMENTS, CO-INSURANCE AND/OR
DEDUCTIBLES LIABILITIES. Does anyone know how you would go about billing the MAP for it? I have looked online and cannot find anything.
DEDUCTIBLES LIABILITIES. Does anyone know how you would go about billing the MAP for it? I have looked online and cannot find anything.
In Urgent Care setting, Can a Physcian Assistant bill a new pt using his/her own NPI?
Hi coder family:)
I guess my question is can P.A’s see new patients in Urgent Care?
I am auditing our P.A.’s who see patients Monday-Sunday in Ortho Urgent Care. My question is, if a new patient comes in to be seen and a P.A. see’s them for the first time. Would the P.A. be able to bill under their own NPI or because the patient is new and a treatment plan has not been established, P.A. would need to bill incident to and bill using the Supervising doc’s NPI? I think a P.A has to use their own NPI when supervising doctor has no involvement in patients treatment?
Any help is appreciated and if anyone has reference materials to back it up, that would be awesome. Thanks!