One of the surgeons I bill for dispenses L1833 knee braces to some of his outpatient surgery patients. United Healthcare commercial plan used to pay for these braces, but around April 2018, it stopped paying and started denying the braces as part of the global service. I called and spoke to a rep about a policy change. She denied any knowledge of a change in policy and suggested I do a reconsideration. UHC denied the reconsideration stating the claim was paid correctly. Does anyone have any advice they can share? Thank you.
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Tag Archives: Date
ALIF and XLIF – same date, two different incisions.
If my surgeon does an ALIF at L1/2 and an XLIF at L3/4, how do I code the 22558 with the same diagnosis?
22558 and 22558-59 (XS)?
22558 and 22558-59 (XS)?
Same surgery, two different incisions.
Hospital Discharge workup prior to the actual discharge date
Hello,
I need some clarification on the scenario below. Please help!
On 08/02/2018, Ms. G was admitted to the hospital. On 8/04/2018, Dr. X examined the patient and found she was stable and ready to be discharged. Dr. X discussed the discharge to a nursing home with Ms. G and she agreed. Dr. X created the Discharge Summary and coded the encounter as a Discharge. There was a transportation issue with the nursing home and Ms. G ended up staying inpatient for another night.
On 8/05/2018, Dr. K was doing rounds at the hospital and examined Ms. G. She was still stable and agreed to be discharged. Dr. K created a Progress Note and coded a subsequent inpatient code.
Both physicians are Internal Med. specialists.
My questions are:
Can the discharge summary be created prior to the actual discharge date, causing the date of service to be different then the actual discharge date?
Can a subsequent inpatient code (99231-99233) be billed after the discharge code (99238) was billed? If not, what should be billed?
Thank you for your help!
99234-99236 Admit / Discharge Same Date
To calculate time of more than 8 hrs but less than 24 hrs guideline for admit/discharge same date (99234-99236), which of the following should be used?
a. ER/hospital arrival time and discharge
b. inpatient/observation order time and discharge
c. physician’s initial visit and discharge
a. ER/hospital arrival time and discharge
b. inpatient/observation order time and discharge
c. physician’s initial visit and discharge
Date of Service When Services Last More than One Day
In most cases, the appropriate date of service when services last more than one day is the day the service concluded. Radiology services typically have two components: professional and technical. The DOS for the technical component is the date the patient received the service. Professional claims for “reading” are billed the day the physician provided […]
AAPC Knowledge Center
Unprocessed CMS-1500 Claims? Check the Date
Medicare claims that do not meet date format requirements will be rejected. The Centers for Medicare & Medicaid Services (CMS) has released date formatting guidelines for the CMS-1500 claim form, which are effective for claims received on or after July 30. When date formatting requirements are not met, Medicare Administrative Contractors will return claims as “unprocessable” with the following messages: Claim/Service […]
AAPC Knowledge Center
ER Visit 2 differents Physicians same Date
Hi, I have two different physicians seen the same patient. Doctor A received and evaluate the patient in the ER at 1:42 pm the she left and the other physician continue with the care of the patient and discharge at 8:56pm both physicians can bill for her’s service 99281-22985 ?
MIPS 2017 Data Submission Date Moved to April 3
From CMS: If you’re an eligible clinician participating in the Quality Payment Program, you now have until Tuesday, April 3, 2018 at 8 PM EDT to submit your 2017 MIPS performance data. You can submit your 2017 performance data using the new feature on the Quality Payment Program website. Note: For groups that missed the […]
AAPC Knowledge Center
exam date 10/21/17….still waiting results
Anyone test on 10/21/17 that has received results? My status is "received" since last Thursday. I called today and was advised they are behind and it could be up to 3 weeks before I know my score. This is beyond frustrating!
CPT 11056 – Last Seen Date
Hello everyone, hope you could help me to understand this claim validation edits.
A Medicare patient was seen (initial office visit) by our podiatrist and performed trim/removal of corns on right 2nd digit. An foot x-ray was performed for the right foot pain.
Reported E&M/CPT – 99203 (Modifier 25), 73630 (Modifier RT), 11056, with reported Diagnosis – M79671, M2021, M2141, M2142, L84
However, our billing system (CareCloud) rejected with a claim validation edits – DATE LAST SEEN IS REQUIRED FOR THIS PROCEDURE AND THIS PAYER. Claim was not even be able to submit to the payer without this information.
I understand that Medicare does not cover routine foot care which removal of corns and calluses is part of routine foot care, and I am expecting a denial on this procedure only. Patient does not have any metabolic, neurologic, and peripheral vascular disease, so I thought the last seen date by another MD or DO within the last 6 months should not be required for this incident. Therefore, the above claim should be able to submit without the last seen date information. I am confused by this claim edits.
If someone could explain to me this "Last Seen Date" is apply only to specific diagnosis OR this is apply to all routine foot care procedures and doesn’t matter with any diagnosis, OR this is the billing system errors? Besides, what if the patient did not have a recent visit within the last 6 months, like the above patient who had the last visit two years ago, what information I should report for the Last Seen Date?
Thank you very much indeed for any help!