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Make sure claims and documentation support medical necessity. Healthcare providers have been given the go-ahead to provide an additional dose of the COVID-19 vaccine to certain patients. Here’s what you need to know for Medicare claims. The U.S. Food and Drug Administration (FDA) amended the emergency use authorization for both the Pfizer BioNTech COVID-19 vaccine […]
The post COVID-19 Vaccine Boosters Covered by Medicare appeared first on AAPC Knowledge Center.
Obstructive sleep apnea causes those who suffer from it to sleep poorly and always feel tired. Obstructive sleep apnea is also indicative for heart problems and complications. It is not a good idea to ignore obstructive sleep apnea and the potential problems that it may be causing to one’s body. Inspire Medical System’s Inspire® therapy […]
The post Getting Inspire Therapy for Sleep Apnea Covered appeared first on AAPC Knowledge Center.
My doctor gives Eligard in the office. I billed J9217 with dc C61 for prostate cancer on both the J code and the administration code of 96402. HPHC is denying this code (96402) stating that I need to bill with the primary dx. Is C61 prostate cancer not a proper primary code for 96402?
Thank you,
Rhonda
Our ED physician documented UTI as final dx. I coded N39.0 for UTI and B96.89 for bacteria according to documentation. in addition, I added R10.11, R10.12, R11.0, and R50.9. Patient received 25 min of IV antibiotic for which I charged 96365.
Antem insurance is not covering 96365. According to CCI/LCD edit the diagnosis are not covered.
Can someone help me to figure out what else I can add so the insurance will cover it?
UTI without hematuria, site unspecified. Pt. with kuri symptoms of dysuria and hematuria started on Bactrim on Friday. Today developed bilateral flank pain and nausea. Low fever 38.2.consistent wiith pyelo. Labs are normal. She has a few wbsc in urine along with rbsc, but many epithelial cells. Still 2+ bacteria. Will give rocephin and zofram.
1529-CCI/LCD Edit charge review
-CPT 96365 is not covered. Noncoverd dx. List. N39.0, B96.89, R10.11, R11.12, R10.0, R50.9.
In other example,
final dx. UTI, DYSPNEA.
ED provider documented: no suspicious of ACS or MI, pneumonia. He feels comfortable going home and return if getting worse. His blood pressure stays the same when he stands up.
Urinalysis, microscopic done, blood, EKG, X-RAY. all negative.
Thank you so much for any help,
NIKI
Does anyone know how we can order these tests using diagnosis of what the doctor is trying to rule out, rather than the symptoms?
Thanks!
I require someone assistance. I have reported CPT 3014F, 3017F. insurance denied this CPT as non covered, Could you please suggest any other alternate CPT for the same.
3014F – Screening mammography results documented and reviewed (PV)
3017F – Colorectal cancer screening results documented and reviewed (PV)
Thanks
Subha.P.CPC
Since the wound edges are not approximated and wound not completely closed, I would not bill the 12001. Am I correct in that statement and is there another procedure code this would fit that I’m not finding?
An important update has been made to the Medicare National Coverage Determinations (NCD) Manual regarding coverage of magnetic resonance imaging (MRI) for patients with certain implantable cardiac devices. In a National Coverage Analysis (NCA), the Centers for Medicare & Medicaid Services (CMS) determined there is sufficient evidence to conclude MRI for patients with certain implantable […]
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