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Tag Archives: Both

Coding both G0439 and 9939- to Medicare during the same year

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We are having an issue with one of our primary care practices. There is a new provider who is part of an IPA and they state that they bill out to Medicare an Annual Wellness Visit under G0438/G0439 with medical diagnosis codes and then at another time during the year the same patient comes in for their Preventative Annual and they bill 9939- using the Z00.00 and that they get paid for both visits.
I have never heard of this and am not sure if this is something that can be done.
Does anyone have any insight into this type of situation?
Thank you in advance.

Medical Billing and Coding Forum

Can you bill both a preventive well check AND an annual wellness visit?

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If I have a patient with primary UHC and secondary Medicare, can I bill a preventive visit (99387) to be paid by UHC AND an AWV G0438 to be paid by Medicare? This would be assuming all aspects of both services are being performed.

Thanks!
Emily

Medical Billing and Coding Forum

Trigger finger/FDS repair both billable ?

Posted on by
I need some guidance – some articles say you can bill both 26055 (59)TFR along with flexor digitorum superficialis repair 26350
The insurance is a medicare advantage – that leads me directly to just 26350, but then maybe I have missed something.
Here is a part of the note: The patient has severe tendinosis with longitudinal tearing & fraying of the fds both proximal, distal and under the A1pulley. Debrided and repaired.
History: the patient had a fall -as a result she also had an orif of the distal radius repaired during the same session.

I am looking at : 26350 – M66.341 and 25609 S52.561A
opinions please
Thanks Barb

Medical Billing and Coding Forum

can you bill both 27340 & 27360??

Posted on by
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)

**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

Medical Billing and Coding Forum

Do we have to bill both insurances?

Posted on by
One of our patients recently got a new insurance – so now he has Blue Cross (plus his old ins UHC). He has told us that he just wants us to bill Blue Cross and forget about UHC. Now we have an active contract with both insurances, and his UHC ins is still showing as active. Would there be any issues with JUST billing Blue Cross because he specifically told us not to bill UHC?

Medical Billing and Coding Forum

WHO SHOULD GET THE REFUND? Both Medicare and Aetna paid as primary

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We have a patient in which both Medicare and Aetna paid for multiple dates of service as primary payers. Our office contacted both insurance companies who assured our office that they were in fact the primary payer.

In turn, we contacted the patient to ask that they contact Medicare and Aetna to update their coordination of benefits. The patient has since expired and we even called the patient’s spouse to ask them to contact the insurance companies regarding COB as well, with no success.

We are left with the question of who or how we should refund the overpayment(s) received. Any advice or input would be much appreciated.

Medical Billing and Coding Forum

69210 VS 69209 when both are performed on the same day

Posted on by
Can anyone help me with the following scenario?

Placed hydrogen peroxide drops in the left ear, letting it soak for app 5 min. Attempted removal of wax with lighted curette, with some success. Flushed ear with lukewarm water to remove the remainder. Confirmed removal of wax with otoscope.

Can the most extensive procedure (69210-REMOVAL OF CERUMEN WITH INSTRUMENTATION) be billed?

Medical Billing and Coding Forum

Question on why a 25 modifier wasn’t needed for both scenarios

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I am new to coding and getting experience working in billing for a trauma surgeons practice. I use the Mckesson Clear Claim Connection through the BCBS website.

When I input 99221-57 and 25600-RT both codes are allowed.

When I input 99221-57 and 28400-50 the 99221 is disallowed unless I add a 25.

I am confused as to why the 25 was only needed in the second scenario.

Any help or clarification would be greatly appreciated!

Medical Billing and Coding Forum