Is anyone experiencing denials for the payment of a primary procedure, but receiving payment on the +add on code. Ex: 14301, 14302? This is Palmetto GBA in GA.
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Tag Archives: Billed
99354 billed to Humana
Hello, has anyone had success with billing prolonged E/M (99354), to Humana? I work for an Internal Med office and Humana has been recouping the payment whenever we bill an OV with modifier 25 and the extended visit. Any help would be greatly appreciated.
G0439 billed by two providers
We got a denial for G0439 since another provider has already billed for it. I’m not hopeful we would be successful in our appeal.
Have you encountered this scenario before and what did you do? Were you successful in having the denial reversed? Could we charge this to the patient?
Thank you!
Is it mandatory for all services to be billed?
Just a curious question.
If a physician reads radiology xrays, EKGs, etc and the biller missed billing the professional component (due to paper shuffle, some may be missed), is that "illegal"?
A biller at our office says that it will harm the patient and it will cause trouble for the practice?
She also says that if insurances didn’t get the code the xray to specificity the patient might get future services denied by insurances? (E.g. arthritic degeneration of knee if not coded, may get denied for knee replacement surgery)
I’m not understanding why insurances would base on codes and not the physician’s notes. Most of these procedures require pre auth.
Thanks for clarifying.
Secondary Office visit Billed with Annual Physical
I have a Physician who regularly bills an Annual Physical (99395-99397) with an Office visit E/M(99212-99215). I have tried telling him the differences as to when and how this should be done and for the most part, he has cut down on billing an office visit(99212-99215) with an Annual Physical(99395-99397).
One scenario that keeps coming up however is when a Patient comes in for an Annual Physical, had bloodwork beforehand, is found to have "Vitamin D Deficiency" and then the doctor bills for the Office visit on top of the physical for treating the Vitamin D Deficiency (same goes for B12).
I don’t necessarily think that this qualifies as a significant, separate service but I’m not sure that I have a good argument against it. This doctor’s argument is pretty much, ‘well it’s a new diagnosis and I wrote a prescription for it.’ While I think about the patient receiving a copay or a deductible bill for this and trying to explain to them why they got a bill for Vitamin D deficiency. I think most people would be upset that they got billed separately for this but I can’t tell if I’m looking at this scenario objectively or not.
Is my doctor right in billing separately for this service along with an Annual Physical or am I right in thinking that there just isn’t enough work involved in diagnosis a Vitamin deficiency to bill separately for it?
22612 and 22633 billed together
We billed 22633 and 22612 out done at the same date of surgery but on different levels. There is a CCI edit in place that is creating these two codes to bundle even w a modifier. We have changed the code 22612 to 22614 but it has a much lower RVU. Has anyone else dealt with this situation and know of a different code or workaround to get the full RVU for the second level? 22899???
Thank you for your help,
Stephanie
Outpatient services billed when a patient is an inpatient
Looking for guidance on what services can be billed as an outpatient service when the patient is an inpatient.
Wellness and office vist billed for routine refills?
If a provider is refilling a Medication for an existing problem during a Wellness visit, for example, a statin for dyslipidemia, may we bill an office visit with Wellness? and if yes, a 99212 or 99213?
thanks
thanks
90791 and 90792 Billed on the Same Day
Can a psychologist bill 90791 and NP bill 90792 on the same, without a modifier? Both providers work for the same group.
Facility billing- Can newborns be billed as inpatient OR outpatient ?
We currently are following the 2 midnight rule in regards to billing the mother’s delivery as either outpatient or inpatient.
Initially we billed all deliveries as Inpatient but some moms leave the next day so we have now applied the 2 midnight rule to determine whether the mom is inpatient or outpatient. My question now is what about the newborn billing?? I feel like the newborn billing should match the mother’s billing, if moms billing is outpatient so should the newborns be. But up to now we have been billing the newborns as inpatient.
Initially we billed all deliveries as Inpatient but some moms leave the next day so we have now applied the 2 midnight rule to determine whether the mom is inpatient or outpatient. My question now is what about the newborn billing?? I feel like the newborn billing should match the mother’s billing, if moms billing is outpatient so should the newborns be. But up to now we have been billing the newborns as inpatient.
Wondering what input anyone has on this facility billing regarding outpatient or inpatient for Deliveries and Newborn admits/discharges.
TIA
KAM