Anyone knows how to bill for Non-face to face crisis intervention? Is there a billable code to use?
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Tag Archives: Coordination
Coordination of Care for Crisis Non-face to face (Crisis Intervention)
Does anyone know if there is a billable cpt code to submit to insurance regarding a coordination of care by phone call between facility, with family, with patient? Hope my question makes sense. Thank you.
Coordination of Benefits
I am new Billing Specialist. Can a patient have 2 insurances on file? I know he will need a COB on file, but which one would be first? His own or wife’s?
Emergency Surgery; coordination of professional vs facility billing
Hello,
I bill for a surgeon who sees patients at 2 different hospitals. I seem to be coming across a problem getting paid for emergency surgeries at one of these facilities. For example;
Patient goes to emergency room with RUQ pain and vomitting, etc. Surgeon is consulted, he performs h&p and decides to take patient to surgery for Laparoscopic Cholecystectomy. Patient is discharged the next day.
I bill this scenario fairly frequently for both hospitals with an outpatient e/m code (99203/4), modifier -57 for decision for surgery, and the surgery code (47562); all with place of service of 22 (outpatient). There is no pre-authorization to report since it is an emergency surgery.
I get paid without any problems for one hospital, but the other seems to always cause problems. The payer comes back saying pre-auth absent. When I call the hospital billing department, they tell me everything is in order, they were paid, and if a pre-auth was needed, it was in place. When I call the payer, they say "if the surgery was outpatient, it needs a pre-auth. If it was emergency it does not." but they don’t offer any additional information on where the hang-up is.
So my question is, what are the triggers in the hospital billing process to show that a surgery was an emergency and a pre-authorization should not be necessary for the performing surgeon? OR, am I billing this scenario properly? Sometimes, I do bill the h&p with the ER e/m code and pos (23), but the surgery is always with an outpatient pos.
What am I missing here? Any insight appreciated.
Thanks, Nancy
Emergency Surgery; coordination of professional vs facility billing
Hello,
I bill for a surgeon who sees patients at 2 different hospitals. I seem to be coming across a problem getting paid for emergency surgeries at one of these facilities. For example;
Patient goes to emergency room with RUQ pain and vomitting, etc. Surgeon is consulted, he performs h&p and decides to take patient to surgery for Laparoscopic Cholecystectomy. Patient is discharged the next day.
I bill this scenario fairly frequently for both hospitals with an outpatient e/m code (99203/4), modifier -57 for decision for surgery, and the surgery code (47562); all with place of service of 22 (outpatient). There is no pre-authorization to report since it is an emergency surgery.
I get paid without any problems for one hospital, but the other seems to always cause problems. The payer comes back saying pre-auth absent. When I call the hospital billing department, they tell me everything is in order, they were paid, and if a pre-auth was needed, it was in place. When I call the payer, they say "if the surgery was outpatient, it needs a pre-auth. If it was emergency it does not." but they don’t offer any additional information on where the hang-up is.
So my question is, what are the triggers in the hospital billing process to show that a surgery was an emergency and a pre-authorization should not be necessary for the performing surgeon? OR, am I billing this scenario properly? Sometimes, I do bill the h&p with the ER e/m code and pos (23), but the surgery is always with an outpatient pos.
What am I missing here? Any insight appreciated.
Thanks, Nancy
Examples of Coordination of Care in the Physician’s office
I need to provide my physician’s with some guidance on time based coding, and I cannot think of any examples to give them of what constitutes "coordination of care" in the office setting. The counselling aspect is self-explanatory, but I would like to give them an example of something done in the office that would qualify as "coordination of care." I know it has to be face to face and that the elements involved in MDM do not count. "Counselling" is self-explanatory, but I’m drawing a blank on "coordination of care".
Thanks!
Coordination of Benefits and Conservative Therapy Question
Hello!
We work in a vein/vascular practice and we have a patient who has UHC primary and Medicare 2ndary. UHC doesn’t require a 90 day conservative therapy trial of compression stockings but Medicare requires conservative therapy if the patient doesn’t meet certain criteria. This patient doesn’t meet that criteria. Which medical policy guidelines do we follow?
Many thanks!
CMS Special Open Door Forum: The IMPACT Act and Improving Care Coordination
Question about Coordination of Benefits between Medical and Vision Insurances
Hello,
I am not extremely familiar with filing vision claims and I have tried to research this topic. Most instances it seems that it depends on why the patient is here as to who to bill to as primary, but my question comes in when the patient has a medical insurance and has either a copay, deductible, or coinsurance amount and if vision acts as a secondary to cover these amounts or if the patient is responsible.
The way it has "always been done" here at the clinic I work for is that when the patient’s medical insurance comes back, they file the remainder to any applicable vision policy. I understand that a refraction would be covered in this instance if not covered by the primary, but they have historically changed the diagnoses on the claim for to all vision codes and taken off all the medical. To me this seems incorrect. If the vision insurance acts as a true secondary on medical, then we should be filing the claim exactly the way we did to the medical insurance and not change any diagnosis codes. If their exam was billed as medical because their reason for visit was medical, then that should follow the claim form to the vision insurance company.
My co-worker who has been filing these claims stated that she called the vision company and explained my concerns and the vision company apparently told her it didn’t matter what diagnosis was on the claim. As long as they had the primary EOB, they would process the claim. Now I don’t trust what she is saying which is obviously why I am posting my question here.
Thanks in advance for helping me with this.
Amber