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

Practice Exam

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Practice Exam

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

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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

“Same Physician” May Not Mean What You Think It Does

If you’re a coder, you’ve probably seen the term “same physician” used throughout the CPT® codebook: for example, the descriptor for modifier 25 stipulates, “Significant, separately identifiable evaluation and management service by the same physician or qualified healthcare provider on the same day of the procedure or other service.” But here’s the thing: Under Center’s […]

The post “Same Physician” May Not Mean What You Think It Does appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

2 visits on same day in same office by two different providers

I need advice for this situation. our Nurse Practitioner saw a new patient, he was diagnosed with right elbow bursitis. NP referred him to ortho for aspiration. pt could not get in that same day, so our MD told pt to come back in the afternoon and he would aspirate the bursa.

the Nurse Practitioner charged New Patient E/M for the morning appt, MD wants to charge for Established Patient E/M and the aspiration for the afternoon. my question is can this be done? or should we just bill for the procedure in the afternoon and the Office visit in the morning. can i use modifier 57 for the afternoon E/M?

any advice will be greatly appreciated
thanks

Medical Billing and Coding Forum

Two E/M Services, Same Day at Same Clinic, But Two Providers? What modifier??

Hello! So I work for a clinic, where we have a bunch of different providers who do different things, but they are all under E/M codes. So I just ran into something that I have never seen before. I was entering a 99215 encounter for a provider, and I saw that our EMR system automatically put it on hold because there was a 99214 billed the same day but for a different provider. I cannot use -25 since it is a different provider, and I cannot use -59 since it cannot be attached to an E/M code. I read through every modifier and none will work. In this situation, does the E/M code need a modifier? And if so, which one should I use??
Thank you!!

Medical Billing and Coding Forum

2 Billing entities for same practice billing different rates

This is a new situation for me-
The group I work for is transitioning from their current outsourced biller to billing inhouse. The transition is taking place in phases so as I start billing claims for them, do we need to be billing the same dollar amount as the current biller? For ex, say we both send out a claim today with 11042 on it and she bills $ 500, do I also need to bill $ 500? Reason I’m asking because we want to increase our fee schedule for 2019.

Thanks in advance

Medical Billing and Coding Forum

External Fixator 20693 with 20694 Same Session

Provider makes adjustments to external fixator (under anesthesia) 20693, fixes a separate fracture and at the end of the service he removes the external fixator 20694. I have run NCCI edits and these codes do not bundle. Can’t find a source that states these can’t be billed together in the same session. These appear to me as a family of codes? Would appreciate some feedback and sources to give my provider.

Thanks :) ZDX0764

Medical Billing and Coding Forum

Billing Primary Care E/M and LICSW same day

We are integrating a new LISCW in our Pediatric Practice, and we don’t have any experience in billing for a Behavior Health Specialist. Both provider and LISCW are billed with the same group TIN. I have a pretty good handle on psychotherapy coding in general, however, I do have questions regarding billing when a patient has an office visit with a primary care provider (not psychiatrist), but also has psychotherapy with the LISCW in the same day? I know the add-on codes 90833, 90836, and 90838 are used with E/M, but is this only when a Psychiatrist provides the E/M and psychotherapy? Is there a way to bill for both Primary Care and LISCW?

Medical Billing and Coding Forum

Two E/M visits – Same Day – Same Provider

A patient of ours saw a provider for two unrelated issues (different dx) on the same day. There is separate documentation for both visits. I was going to bill the visits separately with M25 on the second E/M visit but from what I am reading online I might put the practice under scrutiny as it will raise a red flag with the carrier.

Is there anyone out there that has billed for this circumstance before that could give me some advise please?

Medical Billing and Coding Forum

Let’s Get on the Same Page when Coding BMI and Obesity

Different interpretations of ICD-10-CM coding leave you at risk for improper quality scores and payment. Medical record auditors see a wide range of interpretation among coders and medical organizations regarding when and how overweight, obesity, and morbid obesity diagnosis should be abstracted from records, and regarding body mass index (BMI) reporting. These variances can potentially […]

The post Let’s Get on the Same Page when Coding BMI and Obesity appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

HELP! using modifier 62 and 80 on the same claim and getting denials

Can anyone give feedback or help me find documentation on billing co-surgeon and assist on the same claim. In Appendix A of the AMA CPT book, modifier 62 states if a co-surgeon acts as an assistant in the performance of additional procedures, other than those reported with modifier 62, during the same surgical session, those services may be reported using separate procedure codes with modifier 80, as appropriate. If we are asked by another specialty to act as co-surgeon we of course bill with modifier 62 on primary procedures however since modifier 62 cannot be appended to instrumentation codes we bill with 80 on instrumentation. We are getting denials now from Horizon and Medicare on the instrumentation codes stating no qualifying base code is being used due to the the primary procedure being billed with 62 makes the TOS 2 and 80 makes TOS 8.
Example:
22551.62
22845.80
22552.62
20930.80

Thanks in advance.

Medical Billing and Coding Forum