Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

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

Practice Exam

CPC Practice Exam and Study Guide Package

Practice Exam

What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

CPC Exam Review Video

Laureen shows you her proprietary “Bubbling and Highlighting Technique”

Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page

Practice Exam

2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

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

Dental procedures provided in a facility..HELP!!!

Hello, I am trying to figure out how a facility bills/gets reimbursed for dental services provided in an OP surgical setting-by an oral surgeon that is a DMD or DDS. We have typically used 41899 or other 4XXXX range CPT codes and received minimal if any reimbursement. Now with Medicaid using EAPG’s they provide package payments based on dental services and are looking for the D codes. In the CDT book, many of the D codes have a facility RVU assigned and the professional claim all use the CDT codes on them as the surgeons are dental/credentialed (DMD DDS). I have multi-tiered questions here:
1. Is it non-compliant to have the facility claim and the professional be inconsistent? (CDT versus CPT)
2. For dual eligible beneficiaries, shouldn’t the claims be coded with CDT codes to get the correct denial to cross over to Medicaid? (Currently we get a not R&N or med necess denial which does not let the claim go to a secondary payer)
3. For services that would normally be performed in a dental office under conscious sedation or nitrous (such as multiple extractions or massive caries); shouldn’t the services be billed as dental with CDT codes?

CMS has D codes on the hospital OPPS addendum B with status indicators showing blank (not recognized), E (exclusion) or other indicating questionable or possibly payable; so I am thinking the D codes are allowable on a UB?

I know this is a lot and any help is appreciated!!!!

Medical Billing and Coding Forum

non-face-to-face diabetes follow up provided by DM-E

Hello All,

We have a Diabetes Educator (DM-E) on staff who sees any patient that our PCP’s have referred to her for services. Our ops team is looking to have the DM-E call our patients and follow-up on their progress (diet, meds etc.) through a survey after they receive her initial face-to-face services. The coding education team has looked at the CCM codes (99490-99491) and ruled them out since DM is the only thing that the DM-E would be following. (we considered that the PCP would be able to count the survey time toward the CCM codes since they do manage all chronic conditions)

We have looked at 99453-99454, 99457 and 99091. What we found in our research is that 99457 would not qualify since CMS states that it only accounts for professional time (even though it lists staff in the code description) and "therefore cannot be furnished by auxiliary personnel incident to a practitioner’s professional services." 99453-99454 seem to work only if the glucose monitors continually transmit to the MD, but this seems to count out what we are trying to bill for since the educator would not be monitoring the actual information transmitted. She is only going to be calling the patients and asking questions on their progress since their last visit with her.

We are not accredited through Medicare to use G0108 or G0109. We are currently billing her face-to-face services with 99211.
Another thing that the ops team is looking into doing is hiring an NP/PA that will also provide DM education and we were not sure how this would impact the coding either.

We are looking to bill these services as incident to under the ordering provider’s credentials.

If anyone has another perspective on the guidelines or can offer another code for what we are trying to bill, we would very much appreciate it.

Medical Billing and Coding Forum

Diabetic Shoes provided to a patient that is non-diabetic

Here is the scenario:

I have a patient that is non-diabetic. This patient has Medicare and has decided to purchase a pair of shoes from our practice. Once again, he is not a diabetic; however, the shoes that he picked are considered a diabetic equivalent shoe. Would I bill this self-pay patient with HCPCS- L3222 x 2 – RLTL as self-pay (statutorily non-covered code with Medicare) OR would I have to obtain an ABN and bill the shoes as A5500 with the GA modifier?

Basically, I am asking, is it appropriate to code as L3222 since the patient is non-diabetic and this HCPCS is for an extra-depth shoe? The shoe provided to the patient was Dr. Comfort – Ranger style – hiking boot.

Thanks!

Medical Billing and Coding Forum

E/M Documentation Can Be Provided by Students Again

Physicians won’t have to re-document medical students’ notes in evaluation and management (E/M) documentation any longer. CR10412 revises the Medicare Claims Processing Manual to allow the teaching physician to verify in the medical record any student documentation of components of E/M services rather than having to re-document the work. It appears from the change request that some […]
AAPC Knowledge Center

No Double Dipping of Services Provided for Part A Inpatient Stays

In case you were unaware of proper billing of services for Medicare patients in a covered Part A inpatient stay, here is a refresher. Medicare will not pay acute-care hospitals for outpatient services provided to patients in a covered Part A inpatient stay at another facility. This includes Medicare patients who are inpatients of long-term […]
AAPC Knowledge Center

Non Supporting Diagnosis provided after denial received

Is there a compliance requirement that states a denied claim denied due to medical necessity must be resubmitted to insurance if a physician provides another non-supporting diagnosis?

Also, is there a compliance issue related to reaching out to a physician to ask if there is additional information after a claim receives a denial for medical necessity? This correspondence does not ask physician for specific dx information. It is general correspondence.

Medical Billing and Coding Forum

Afford Medical Services Provided by Medical Tourism

The growing number of International health traveler’s points towards one simple fact, that is, medical tourism is here to stay no matter what the skeptics might say. Planning a successful health journey abroad takes into account several factors, and if you are contemplating one yourself, be sure to follow some important steps. There are more than 25 countries catering to the global medical tourist, and these very destinations of health tourism can be reached at through their websites. It’ll help you take a final decision as to which hospital to choose, if you go through their list of services, their accreditation, read testimonials of satisfied patients and check the entire cost involved.
Looking after your medical needs can turn into a highly cumbersome exercise in the face of exorbitant price tags and the ever increasing costs of even basic care. This is especially true for those who fall in the category of middle-class in America or anywhere else in the West, and this group happens to be quite a sizeable one. It is precisely this vast section of the human society in general as well as those who lack access to even basic medical practices in certain parts of places like Africa and the Middle East that is greatly aided by medical tourism. Although you might find innumerable destinations for health tourism popping up every now and then, you can be rest assured that among these many names, India seems to clinch the number one spot for being the most favored and sought after destination for all global medical tourists alike. Catering to urgent needs and elective ones, the several kinds and types of hospitals spread through India have been continually reinforcing the claim of being a pioneer in the field of medical tourism. You can expect all that you expect in your own country, be it America, England or other European countries or Canada, and that too for a very reasonable price. The aspect of affordability has always been and continues to be the main propellant of medical tourism. World-class medical facilities that not only offer excellent care to those who require it but do so with a personal touch certainly makes more happy and satisfied clients that anywhere else. To come think of it, why you wouldn’t come back to a medical tourism destination again, if need be, and experience the benefits of a highly inexpensive yet quality medical care as well as enjoy a vacation on the side? When it comes to thinking of surgery abroad, it isn’t without its fair share of concerns and worries. But, given the backing that the hospitals in India have in the form of accreditation from international health governing bodies, it certainly does take care of all the issues regarding authenticity and reliability. Many urgent surgical procedures can be sought at one-tenth the cost of those in developed countries, and there is absolutely no waiting period for elective surgery as well. While those of you who seek to find rejuvenation and holistic healing through Ayurveda, naturopathy, homeopathy and other alternative ways should be heading towards the southern states of India, especially, Kerala. Promoting the state as a health tourism destination, it abounds in low-cost yet high standard spas, wellness centers and the likes.
Coming back to the main focus area, medical tourism has many takers from every corner of the world. The West works on an institutionalized way of medical system that just doesn’t go down well with a rather large middle-class society, be it in America, England, Canada or other European nations. And, given the lack of basic medical facilities and infrastructure in African and the Middle Eastern countries, one can clearly see how haute property medical tourism is. But, one asks, why not? Afford Medical Services,quality care and excellent post-treatment services, who isn’t entitled to all this? It is a win-win situation for both the parties, global medical tourists and the health tourism destinations. Fuelling the overall economy financially and helping it reach international standards through consistent innovation and technological advancement, the phenomenon of medical tourism spells booming business. On the other hand, would you mind getting yourself medically treated in a foreign locale for half the price that the hospitals and procedures in your own country demand? We all know what the answer to that question is. The point is, as mentioned above, you can always do a thorough research about a particular treatment or healthcare center and then go with the chosen one. Welcome a healthy change in your life, banish those frustrating thoughts and sadness caused due to your illness, enjoy a normal life after a stint at a medical tourism destination, it’ll all be worth it.

Medical Tourism search engine offering users the ability to compare Afford Medical Services That provide Treatment and Procedure cosmetic and medical procedure costs and reputation from.