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

Need confirmation on final rule for Outpatient E&M fee schedule for 2019

Can anyone say whether CMS going to follow the Proposed fee schedule for 2019 for Outpatient E&M visits since have seen that different rates has been allowed for Office visits -new and established patients in Medicare fcso fee schedule.Which would be the final rule to be followed for 2019.Any help would be appreciated !!!

Thanks,
Priya,CPC

Medical Billing and Coding Forum

Facility billing- Can newborns be billed as inpatient OR outpatient ?

We currently are following the 2 midnight rule in regards to billing the mother’s delivery as either outpatient or inpatient.
Initially we billed all deliveries as Inpatient but some moms leave the next day so we have now applied the 2 midnight rule to determine whether the mom is inpatient or outpatient. My question now is what about the newborn billing?? I feel like the newborn billing should match the mother’s billing, if moms billing is outpatient so should the newborns be. But up to now we have been billing the newborns as inpatient.

Wondering what input anyone has on this facility billing regarding outpatient or inpatient for Deliveries and Newborn admits/discharges.

TIA
KAM

Medical Billing and Coding Forum

Career Advice and Question about Hospital Outpatient Physician Coding

I’ve been coding surgeries at an Ambulatory Surgery Center for 3.5 years and wanted to know the differences between ASC coding and Hospital Outpatient Physician coding. What type of codes do hospital outpatient use? My assumption is E/M codes and one-day procedures similar to an ASC. I’m CPC certified and recently obtained my COC last month. Bottomline, I wanted to have some re-assurance this is a responsible next step for my career.

Thank you for your time,

Jack

Medical Billing and Coding Forum

CPT 96365 and 96367 in Outpatient Hospital Setting

Hello all. I’m wondering if anyone can help.

I’m auditing an outpatient UB that has 96365 on 10/9/18 and 96367 on 10/10/18. I’m new to Outpatient coding and was wondering if billing these on different dates of service is allowed. The itemized bill does not have times or anything like that attached. If it is or is not allowed, can you please let me know what source you used and possibly the URL? I have to be able to defend my audits.

Thanks!
Yvonne

Medical Billing and Coding Forum

L1833 billing on same date as outpatient surgery

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.

Medical Billing and Coding Forum

Outpatient consultations

Good morning
This is my first time in the Forum, so please accept my apologies if I’m not using the proper guidelines, if there are any. My question is regarding how to select the correct outpatient consultation code. Do I follow the same guidelines as I would in selecting the proper level E/M? Do consults require a certain number of elements for ROS, PFSH, Body areas/organ systems to review? I know it’s time based, but what else is there? I’ve researched this topic and come up with NOTHING!!! Help!!

Medical Billing and Coding Forum

E/M Outpatient Office visit

Good Evening,

Needing just a little help regarding presenting problems. There was insight that I had received stating that a presenting problem that is less than 72 hours with a prescription being prescribed would be a 99203 instead of a 99202. Is this true? The following example I usually would level as a 99202 regardless of time I see the plan of care being straightforward due to the fact the dr did perform a strep to figure out what is going on which came back negative and then he went on to prescribe the medication due to the ear. Can anyone let me know how they would code the following?

Guidelines 1995

CC: Ear pain for 3 days + sore throat
27 year old male, new patient presents with earache ongoing for 3 days. Ear does have slight drainage, tender to touch and sore throat. Pt denies headache, nausea, cough, no discomfort of eyes.

Medical History: Knee surgery 2007
Family: Mother heart disease, hypertension
Social: Occasional alcohol

Constitutional: 100 body temp
Pt looks state age, well groomed
Eyes: clear, bright,
ENMT: ear is tender, some drainage, mildly swollen, red
throat is somewhat sore
Respiratory: breathing is well, no crackles, etc…
Integumentary: skin is warm to touch

Found through examining the ear does have mild drainage, tender and red. For the throat performed a strep test which was negative. Due to the drainage, tenderness and slight swelling of the ear will prescribe ofloxacin. As for the sore throat recommended warm salt water gargles and Chloraseptic. Go to emergency department if symptoms worsen.

Medical Billing and Coding Forum

multiple outpatient procedure billing with Modifiers

I would please appreciate some assistance –

Patient comes to the outpatient clinic for a allergy shot, flu shot and b12 injection – which modifiers would go on which cpt codes? No E/M service.

95115(allergy)

90471 – 59 OR 51 OR NONE
90756 (flu)

96372-59 OR 51 OR NONE
J3420

Thank you!

Medical Billing and Coding Forum

Infusion coding in an outpatient setting

When a patient receives multiple drugs during an infusion session, including both chemotherapy drugs and immunotherapy drugs, do I code Z51.11 and Z51.12 for all drugs or only the corresponding Z code for the corresponding/approriate drug? When looking over old codes, completed by others, I have seen it both ways, and I would like clarification.

Thanks,

Julie

Medical Billing and Coding Forum