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2018 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

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

New patient E&M when insurance carrier changes

Hello,

I recently had a conversation with a provider who stated that a patient is considered NEW (for coding purposes) when they have been treating under workers comp and then come in to treat for a separate, unrelated visit under their private insurance in under 3 years. (or vice versa). Coding a new patient visit has nothing to do with carrier, correct?

Thank you

Medical Billing and Coding Forum

Z03-ruled out and Z33.3 – pregnancy state, gestational carrier

Hello, I am new to OBGYN coding and will greatly appreciate your help in these particular diagnosis.
1.Should we use Z03- condition ruled out or we should use dx from Indications/reason for the service? The cases we have -pregnant woman comes for an ultrasound for ‘low-lying placenta’ for example. This condition was in Indications but in Conclusions: the low-lying placenta is resolved, or MD can write ‘ placenta is normal." Is Z03 -ruled out appropriate or MD must say ‘ ruled out’?
2. In what cases can we use Z33.3- pregnancy state, gestational carrier? We had a case when a woman, a surrogate, came for an ultrasound and the Indication was: Surrogate state.
Thank you in advance.

Medical Billing and Coding Forum

Carrier audit for billing by time

Hello,

My employer has had an audit of charts and the insurance companies hired auditors have an issue with our billing by time documentation.

Our providers always follow the CMS guidelines and then refer to the assessment and plan or other documentation in the note for the content of counseling. Its pretty obvious what the counseling is about due to treatment options, diagnosis or complications. We are a pediatric practice so parents and caregivers come in and require lots of time for answering questions. We spend a lot of time addressing what the parent/caregiver has seen on the internet too. This seems to be a common way to document the counseling topics. However the large carrier that audited us said that’s not enough but would not give us an example of acceptable documentation for the content of counseling.

My question is has any other practice had a billing by time recoupment from a carrier? If so were you given any examples of acceptable documentation beyond the CMS documentation guidelines?

Thank you,
Louise

Medical Billing and Coding Forum

MI Auto Carrier Paying Less Than Billed Amount

I am looking for information regarding Michigan Auto Claims and how to handle the remaining balance.
Some of our claims are paid less than the billed amount with the carrier stating it is "above the usual and customary" for our area.
We do not have a contract with the auto carrier and feel that they do not have the right to pay less than our fee.
Normally, when dealing with an insurance company that we have no contract with, the unpaid portion is billed to the patient.
The auto carrier is informing me and the patient that we are not allowed to balance bill the patient for the remaining balance.
I would appreciate any input on this issue.
Thank you so much.

Medical Billing and Coding Forum