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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

United Healthcare Commercial Reimbursement Policy Updates effective from Sep 1st, 2019


The modifier “GN, GO or GP” will be required on Always for “Therapy codes” to align with the Centers for Medicare & Medicaid Services (CMS).

According to CMS, certain codes are “Always Therapy” services regardless of who performs them, and always require a therapy modifier — GP, GO or GN — to indicate that they are provided under a physical therapy, occupational therapy or speech language pathology plan of care

“Always Therapy” modifiers are necessary to enable accurate reimbursement for each distinct type of therapy in accordance with member group benefits

Reference: UHC Modifier Updates


Coding Ahead

0479T/0480T What to use for commercial payers?

Our providers are using CO2 laser for burn scar contractures. Many of the commercial payers will not accept the temporary codes 0479T/0480T. Our coders have been using alternate CPT code 17110. However, the surgeons argue that 17106-17108 are more appropriate. CPT Assist from 2017 states to use unlisted. HELP! What is the correct way to report this service?

Medical Billing and Coding Forum

Facility observation coding in ED- commercial payer

Hi all!

My boss says that code 99218 has to be added multiple times to get reimbursement (added once for every 30 min that the patient is observed) So let’s say the patient was observed for 6 hours, according to her it must be added 12x. Makes no sense to me. Shouldn’t the 99218 be coded just once in this case?

This is for facility coding. I have tried to show her the CPT description that says ‘per day’ but she says that’s for physician billing. Do you guys know of any guideline that I could show her in regards to this? PLEASE advise!! Thanks.

Medical Billing and Coding Forum

Midlevel Billing Commercial Payers in Hospital Setting

How does your practice bill for midlevels in the hospital setting for commercial payers that want claims billed under the supervising physician? Since incident-to does not apply to hospital setting, is it appropriate to bill under the supervising physician if split/shared visit is NOT performed and the doctor is not physically present at the hospital? The PAs/NPs are employed by us, not the hospital.

Medical Billing and Coding Forum

OB Experts Read!!Ob care and Delivery. Commercial primary and Medicaid secondary

Hello guys!

Any guidance is highly appreciated. If a patient has commercial insurance as primary and Medicaid secondary. How would you bill their OB care and delivery. Commercial bills global codes but Medicaid does not. Reason I ask is because she has a deductible with her primary but Medicaid will not cover the codes we bill to commercial if we were to forward the claim to Medicaid. Please advise! I am so confused!

Medical Billing and Coding Forum

Billing OB Care and Delivery when Patient has Commercial Primary Medicaid Secondary

Hello everyone!

I have not done OB/GYN specialty for long and having some confusion with this scenario. I have a patient who has Aetna as their commercial but has Medicaid as secondary. She has a deductible to be met on her Aetna policy and I know Medicaid will not pick up the codes that will be billed to Aetna for the global delivery. What is the proper way to bill this? Please advise!

Medical Billing and Coding Forum

submitting claims to primary commercial ins and secondary ins medicaid

I have a co-worker who insists that when 99395 is submitted to the primary commercial ins and denied, that the 99395 code can be changed to a 99214 to submit to the secondary ins medicaid plan first to receive payment. I thought this was illegal but I would like to find some information to print off regarding guidelines on this.
Any help would be appreciated.

Judy in Mobile

Medical Billing and Coding Forum

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! :)

Medical Billing and Coding Forum

Behaivor Health Commercial Codes

Do any of you ladies know what the commercial codes for H0032 and H0001 would be for behaivoral health? This is something new for me that I am helping my work with on there AR and these 2 codes aren’t paying and didn’t know if you guys knew a commercial code I could use to bill for these to process and pay?

Medical Billing and Coding Forum

ASA base units for 00811 and 00812 for commercial payers

Can the ASA base units for 00811 and 00812 be raised to 5 units for commercial payers?

Per Anesthesia Guidelines on pg. xi in the RTV guide states

Any procedure around the head, neck, or shoulder girdle, requiring field avoidance, or any procedure requiring a position other than supine or lithotomy, has a minimum Base Value of 5 regardless of any lesser base value assigned to such procedure in the body of the Relative Value Guide.

Thanks!

Medical Billing and Coding Forum