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

Office visit with Pulmonary Function Testing, same day inpatient consult

I have a patient that was seen in our office, complete PFT done. Later that date admitted to the hospital, and a consult was performed by the same doctor that saw the patient in the office earlier in the day.

I am under the impression that I am not able to bill the office visit, but can I still bill for the PFT?
I’m a little confused and can’t seem to find any information on this.

Thanks

Medical Billing and Coding Forum

Billing Consult or New Pt Visit with EMG Test?

Hi Everyone,
I would just like to get the general consensus from anyone working with Doctor’s who perform EMG/Nerve Conduction tests.

Do you normally bill out a New Patient visit (99202/99203) or a Consultation Code (99242/99243)
along with the EMG/Nerve Conduction CPT codes?

I get conflicting information online as to whether this is allowed or not.
But according to CMS LCD guideline I found it stated,
"Usually an E&M service is included in the exam performed just prior to and during nerve conduction studies and / or electromyography.
If the E&M service is a separate and identifiable service, the medical record must document medical necessity and the CPT code must be billed with a Modifier 25"

Do most of you include an E& M code with a 25 mod and then include your EMG/Nerve Conduction codes with it? Does the Doctor perform an actual exam before he begins the test? Wouldn’t that be required if you were going to bill it out this way?
Plus, adding a 25 mod means there’s a separate identifiable issue unrelated to the services (the EMG test) and I can’t imagine the Doctor would be addressing that when the patient’s primary reason for being there is just to get the test done.

Any advice you could give would be greatly appreciated

Thank you!

Medical Billing and Coding Forum

Attempted Consult

Hello!

My provider was called to do a in patient consult but was not able to finish due to the pt refusing medications and treatment. Can this still be billed and what code should be used? Please see notes below:

History of present illness: this is a 70 year Caucasian man, who was hospitalized 1st at Holmes regional medical center then at kindred hospital, for sepsis, right lower lobe pneumonia, metabolic encephalopathy, end-stage renal disease on peritoneal dialysis, chronic hypo-tension, symptomatic bradycardia, pacemaker implant, right BKA, left ft ulcers. The patient is refusing medications and treatment at this time. I have attempted to evaluate the patient but due to the patient’s explicit refusal the family agreed with not to go forward with the evaluation and I have abandoned to proceed. I understand there is as scheduled family meeting with palliative care for today this afternoon. If I could be of any help please do not hesitate to call me. Unfortunately, at this point I cannot do any further intervention.

Any feedback would be greatly appreciated!

Thanks

Medical Billing and Coding Forum

Wiki Coding CONSULT when pt is a Preop clearance???

Hi y’all,
I am getting mixed answers to a question. If an ESTABLISHED patient comes into their family Dr and has to have a PREOP CLEARANCE is it ok to bill a consult code (99242–99245)??? I was always taught this was not allowed, that they can bill an higher established level. They insist I am wrong. Can someone give me a definitive answer with reasoning why??

THANKS!!!
😀

Medical Billing and Coding Forum

Hospital consult patient refused to give contact information

One of our doctors saw a self pay patient in the hospital for a consult. However, the patient refused to give any contact information to the hospital. I have no way to contact the PT or bill them, if we are not able to send statements or contact the PT are we able to send this patient to collections? This is a first for me and I want to make sure I have the correct information prior to telling the Dr we need to write this amount off. I appreciate any help :)

Medical Billing and Coding Forum

Hospital Consult Billing

A hospital-based NP seeing ortho patients and documenting as orthopaedic consult: My ortho surgeon (not hospital employee) is adding to her note stating he agrees/disagrees and what if anything in the plan is changed. My surgeon said I should be billing for the consult provided by the hospital NP as he is "signing" off on the consult. My initial thought is no-can-do. Does anyone have any information to support either way?

Medical Billing and Coding Forum

Admitted a day after consult

Hello,

Our Doctor saw a patient in the hospital for a stroke evaluation. The evaluation was done on 1/16/18, but admission date is 1/17/18. Our doctor wanted to bill 99222. This is incorrect as the pt was not admitted as of yet. So, we should file as POS 22, with appropriate outpatient E/M code. Correct? We saw the patient on 1/17/18 and 1/18/18, those were filed as 99232.

Thanks!

Medical Billing and Coding Forum