I am a Certified Professional Coder (CPC) looking for a remote medical coding position. I have 8 years of billing/coding experience in anesthesia and pain management billing, as well as a certificate in Medical Office Billing and Coding from Arapahoe Community College.
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Tag Archives: Professional
Professional Resume Writer
Hello Everyone,
I just passed a COC exam, and I am looking for someone who can help me to update my resume. Does any of you know a professional resume writer or can refer an trusted website?
I just passed a COC exam, and I am looking for someone who can help me to update my resume. Does any of you know a professional resume writer or can refer an trusted website?
Thank you in advance,
MMelic
Billing professional component of x-ray
This has to be one of the most basic radiology coding questions, but if a physician sends a patient from the office to the hospital (outpatient) for an x-ray and then back to the office where the doctor interprets the film, how is the professional component billed with regard to place of service? Of course, the CPT would need the 26 modifier. Additionally, if the doctor did not actually look at the film until a later date, what would be the date of service?
E/M Professional Codes 99218- 99220 Documentation Requirements
Hello,
I am in search of some guidance on the documentation requirements on the code set above. Can the documentation for the initial observation code be combined by multiple providers? For example, if the MD order is signed on 8/14 at 2.32 pm, and the ordering MD provider documents for that 8/14 DOS- Do I only count that documentation for the E/M code? In this case, another provider documents on the next day 8/15 then discharges the patient on 8/15. Can I combine all of the documentation by both providers even though it crosses into the next day? Or do I only count what was documented on day 1 8/14? This is in the ED setting by the way..
Any feedback would be appreciated.
Susan
Nephrology monthly dialysis billing – professional
I’m reaching out to other nephrology billers to see if anyone knows if amending a monthly dialysis limited note to a comprehensive note is a legal, acceptable, and common practice that you have done or heard of.
For example: A provider does a limited visit earlier in the month. Then, when the provider is at the dialysis unit again later in the month to do a comprehensive visit, the patient is absent. By the end of the month, there is only 1 limited visit captured for that patient – which means we are unable to bill out anything for that month. If the provider that did the original limited visit can justify that the work they have done falls under the guidelines of a comprehensive visit, can that provider go back and amend their note to a comprehensive visit so that we can bill out for that month?
Any feedback on this would be greatly appreciated!
Thanks,
Amanda
SNF and Part B billing for Professional services
I am returning to the billing world after three years in other areas of the medical world. The other day I spoke with Medicare RE: Our office performed a DVT rule out for a SNF patient. Initially, Medicare paid and then took it back. Then the bill was submitted to the SNF, but the denied it as it’s a professional service and as far as we know we do not have a contract with this SNF. So I contacted Medicare to ask how may I bill this out? I was directed to 2018 Part B MAC Update as was also told to place a 26 modifier on 93971. We did get paid, but I was told by another biller that this was very wrong I should have never done this as the SNF needs to pay. I could use any additional guidance on this as the other biller is not willing to help me understand what I did that was so wrong when Medicare told me to do this. I know SNF is Part A and our services are Part B and with out a contract agreement, the SNF is not required to pay (I worked in contracts for two years). Any help would be appreciated!:confused:
Professional CPT billing for CTA TAVI
Hello – I’m looking for CPT guidance on a combo report for a radiology practice.
The doctor calls the procedure "CTA chest/abdomen/pelvis/cardiac TAVI" and it’s being done preop.
Technique states scans obtained of chest abdomen and pelvis from lung apices through lesser trochanters with IV contrast, with 2D & 3D prostprocessing reformatted images at independent workstation.
Findings include median sternotomy, AICD, mediastinal lipoma, main pulmonary artery dilation, prosthetic aortic valve, left effusion, cholelithiasis, cirrhosis, unspecified kidney lesion, subpleural pulmonary node, narrowing of mesenteric artery, atheromatous plaque celiac artery, and detailed aorta, iliac and infrarenal measurements.
I have researched similar claims from the previous billing company – some were billed as 74174 + 71275 + 75574; and some just 74174 + 75574.
On Medicare’s LCD page (medicare.fcso.com/lcd/active/l33282) I found this: Billing 71275 plus one of the following (75571-75574) would attest to the fact that two completely separate procedures were performed in their entirety.
However I’ve checked on some where all 3 were billed and Medicare did pay but added a 51 mod (discount mult procedures)
I’d appreciate any thoughts. Thank you in advance 
Over Ten Years Experience in Surgical and Professional Fee Certified Coder
TRISHA S. MOORE, CPC
3888 Lone Oak Rd SE
Salem, OR 97302
Phone: (503) 999-1895
[email protected]
3888 Lone Oak Rd SE
Salem, OR 97302
Phone: (503) 999-1895
[email protected]
Certifications
Chemeketa Community College:
Medical Coding and Billing Certificate
6/11 Deans List
Health Information Tech. Certificate
6/11 Deans List
Western Oregon University:
Bachelors of Science in Health
Education 2001
Relevant Course:
ICD-10 CM Coding/Reimbursement
CPT-IV Coding/Reimbursement
Advanced CPT- IV Coding
Advanced ICD-10-CM Coding
Medical Terminology
Human Diseases
Health Information Systems
Medical Insurance Billing
Medical Law and Ethics
Selected Accomplishment:
Selected to be a consultant for the ICD-10 change over for October 1, 2015
Medical coding/billing SPECIALIST
Multi-Educated Professional seeking employment in a Remote Medical Office Setting Part-Time
PROFILE
Accomplished, well-rounded coding/billing professional seeking an employment position in Healthcare remote office setting. Self-motivated, innovative, and hard-working individual. Dependable, with a genuine interest for medical coding.
Software:
EPIC, NextGen, Optum, Meditech, Epremis, TruCode, SuperCoder, Healthland, GE Centricity, MS Office (Word, Excel, Outlook, Access, PowerPoint)
Diagnostic Imaging 2016 to present
Medical Coder
Assigned ICD 10, CPT, and HCPC codes to all billable visits (Interventional and Diagnostic Imaging)
Trained and mentored prospective coders to the radiology practice.
Reviewed clinical documentation for completeness and billable to insurance.
Assisted the accounts receivable with claim denials and CCI edits.
Communicated and educated the providers regarding coding rules and documentation issues.
Hope Orthopedics 2014-2016
Coding Specialist
Assigned ICD 10, CPT, and HCPC codes to all billable visits (office visits, ED visits, consults, outpatient procedures, etc.)
Reviewed clinical documentation for completeness and billable to insurance.
Assisted the accounts receivable with claim denials and CCI edits.
Communicated and educated the providers regarding coding rules and documentation issues.
In-house consultant for the orthopedic group for the ICD-10 change-over
Samaritan Health Services 2011-2014
Charge Master HIM Coder/Analyst (CDM)
Monitor unbilled accounts and report for outstanding and/or un-coded discharges to reduce AR days.
Abstracts pertinent information from patient records for coding/billing purposes.
Liaison between Application Coordinators and Medical Records for charge issue database.
Verify requested charge issues, CPT codes, and patient information before submitting to processing.
Assist in all set up and changes to pricing and procedure code tables.
~ Positive Attitude ~ ~ Detail Oriented ~ ~ Organized ~ ~ Problem Solver ~
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