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Tag Archives: First

First level appeal for Medicare

Posted on by
We have a patient with Jr after his name. (e.g. John Smith Jr).

Our billing system would not recognize eligiblity if it is entered as John Smith Jr. but it would read it if it’s typed as John SmithJr.

However, our claims for 2018 keep on being denied by Palmetto GBA (TN MAC) as invalid, and if we rebilled it, it denies as duplicate (even if we have zero payments due to denials).

We have tried every permutation available for the name trying to get it to go through the computer systems.

Is it appropriate the go online for the first level appeal?

Thanks!

Medical Billing and Coding Forum

Pregnancies, First v. subsequent

Posted on by
So. If a patient has been pregnant twice… But the first pregnancy resulted in a miscarriage at say, 10 or 12 weeks…

Is the ‘second’ pregnancy considered a ‘first pregnancy’ (i.e. Z34.01), or a subsequent pregnancy (Z34.81), since the first
one wasn’t a ‘full’ pregnancy that resulted in a birth…

Pure logic would have me believe it’s the second pregnancy, technically, because she’s been pregnant twice, but… Here I’ve gone
and started getting philosophical, so… Anybody have any concrete knowledge on this?

Thanks in advance!

Medical Billing and Coding Forum

Coding Modifiers for First Assist Nurse Practitioner

Posted on by
I am getting Medicare denials for the use of AS when filing claims for a NP that first assists for a Neurosurgeon. Denials state inaccurate or need for different Modifier. I researched and found some info to use AS and 80. This combination also got denied. I have gotten info from other billers that they have no problem getting paid with the use of only AS. Another stated she had to use AS and 81. Any comments from other coders on this?

Medical Billing and Coding Forum

First coding job

Posted on by
Hello, I am currently working on getting my CPC certification, however, I am still unsure how to search or what words I should be using in order to search for my first medical coding job. All the job posting I read on Indeed or Zip recruiter state that they want a minimum requirement of 1-3 years of work experience that I don’t have. How do I search for my first medical coding job in Charlotte?
Thank you for taking the time out to read my post and help me.!

Medical Billing and Coding Forum

Colonoscopy procedure CPT/ICD-10 codes for Medicare (First Coast Service Options) FL

Posted on by
PT presented for screening colonoscopy, procedure turned out normal. Colonoscopy CPT will be billed as G0121 with Dx: Z12.11 or PT with history of colon polyps, procedure turned out normal. Colonoscopy CPT will be billed as G0105 with Dx: Z86.010. Medicare started deny claim " This is a non-covered service because it is a routine/preventative procedure" ??? Anyone have the same denials for Medicare patients in Florida? I checked LCDs for Medicare (First Coast Service Options) in Florida but I don’t find any changes. Please advised, Thank you so much.

Medical Billing and Coding Forum

Getting First Practice Manager position

Posted on by
Hello all,

Hope you can offer some assistance.

I have 20 years of senior level management/leadership, managing 90+ with 12 direct reports and $ 5 million P & L. Last fall I took the CPPM exam. Happily I passed the CPPM exam on the first try.

It’s my hope to transition to Medical Practice Management from my current leadership position.

Here is my question. I’ve had some excellent interviews. However, my lack of experience as Physician Practice Manger (PPM) is getting in the way. How did those of you in PPM get your start? There are 100’s of openings, most stating they want 2, 3 or 5 years experience. Seems there must adequate supply of experienced managers, as it is so often a requirement.

Thoughts??

Thanks!

Medical Billing and Coding Forum