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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

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

Detox rev code and reimbursement rate

I am currently using 0126 and H0010 for Substance abuse Detoxification for a facility. Does anyone use any other alternative revenue codes for this level of care?

Also, has anyone been experiencing very low reimbursement rates for out of network substance abuse treatment in Washington state through bcbs regence and premera?

Medical Billing and Coding Forum

Reimbursement for Orthognathic surgery from Tricare

Normally we bill dentally for most of our dental procedures. There are the few medical but set fee schedules help determine the over all out of pocket cost for patients. In billing medical for Orthognathic surgery, mainly Tricare, if we have the authorization/approval letter, how do I bill out for the procedure and know it will cover costs even though the fee schedule used for reimbursement for code 21189 is considerably less then what the zip code fee book states as appropriate fees for our area? I know Tricare will only cover $ 2,500. I have approvals for codes 41899, 00170 and 21085. I’m just trying to wrap my head around the main CPT code not covering hardly any costs.

Any input in MUCH appreciated!

:confused:

Medical Billing and Coding Forum

Hospice Billing and Reimbursement Essentials

Avoid misconceptions and clarify guidelines to make end-of-life services less intimidating. Hospice is a Medicare Part A benefit most often provided to terminally-ill patients who wish to remain in their homes. Medicare guidelines for hospice are detailed and can be arduous, however, making billing and reimbursement tricky. An overview of the guidelines and clarification of […]

The post Hospice Billing and Reimbursement Essentials appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

facility claim reimbursement

I’m new to ASC billing so I have read so much I’m confused……

2 claims one for physician and one for facility both cms1500

On the Physician claim do I use rendering NPI and modifier 26 on each cpt?
ON the facility claim do I use no NPI except that of group/entity and then a TC on all CPT?

NEED HELP QUICKLY, please.

Medical Billing and Coding Forum

Post Op Pain Reimbursement – Payment for 76942 (x2) when billed with 64447 & 64448

I have billed Medicare (Novitas) for CPT 64447 WITH 76942 (Ultra Sound Guidance) and CPT 64448 WITH 76942 for POST OP pain after a Total Knee Replacement.
Modifier 26 is added to each CPT 76942 item listed separately on each line.

98% of the time, both 76942 codes are denied; 1 with denial code CO-151 (..excessive amt/frequency of services not supported) and the other with denial code OA-18 (duplicate services).
They are then submitted for reconsideration with the result being that only 1 pays and the other denies as a duplicate.
2 images are submitted for the 2 sites, however, the provider does his dictation for both procedures on the same procedure note.

I am looking for advice on how to get the 76942 codes to pay for both without having to appeal or suggestions for documentation to submit for successful appeal for both USG’s.

Question: What is the correct way to bill for TWO CPT codes 76942 (Ultra Sound Guidance) with 64447 (Adductor canal single shot injection for a pain block) and
64448 (Adductor canal continuous catheter pain block) when performed on a single patient?

Question: Do additional modifiers need to be submitted along with the modifier 26?

Thank you for your assistance.

Medical Billing and Coding Forum