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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

E&M with Allergy Testing Coding

Our Allergists have historically charged their visits in the following way:

1st Visit- Consult or New Patient E&M
2nd Visit- Est E&M w/ mod-25 and Percutaneous Scratch Testing

The day of the testing is what is now being questioned. We are being told that we cannot charge an E&M level with a mod-25 in addition to the testing. However, the E&M level is not solely for the testing. The Doctors do review the results of the testing, but they then spend a lengthy amount of time discussing next steps, options for treatment, making adjustments to medications, etc. Are we able to charge the 2nd visit E&M in this instance?

Thanks!

Medical Billing and Coding Forum

Modifier -59 ophthalmological testing

This was handed down from Corporate, and I plan to dispute this, if I can receive confirmation that the payment modifier usage -59- is in fact erroneous/unnecessary:
claim example:
99214
92134
92275 -59 -Lt

CPT codes 92134 & 92275 are separate diagnostic tests (SCODI, ERG), so why would modifier -59 be necessary? :confused:
Per Encoder Pro, there are no CCI Edits for billing the above codes together…and no modifiers are required.

Your response would be appreciated. I have made our Vice President aware of my post to you out there-as he originally sponsored me for the certification. Please let’s show my corporate how AAPC rallies to their fellow AAPC certified coders! 😎

Medical Billing and Coding Forum

Allergy Testing Question – PLEASE HELP

Hi!

For CPT 95018 Allergy testing, does anyone know or know how to find out what the allowed maximum number of units that CMS accepts? I have a provider that bills 80 units, but BCBSTX denies it stating it’s over the limit (they follow CMS guidelines). Do you happen to know their max allowed number of units or the place where I can find this information?

I welcome any tips or advice!

Thank you!

Medical Billing and Coding Forum

professional biling of Treadmill stress testing

What CPT code could I use for a doctors interpretation and report of an EKG treadmill test for his professional fee?

Would the doctor have to be in the room during the testing or not.

Or is it ok for the radiology technician to actually preform the test and the doctor then do the interpretation and written report for his professional fee?

Medical Billing and Coding Forum

Office visit with Pulmonary Function Testing, same day inpatient consult

I have a patient that was seen in our office, complete PFT done. Later that date admitted to the hospital, and a consult was performed by the same doctor that saw the patient in the office earlier in the day.

I am under the impression that I am not able to bill the office visit, but can I still bill for the PFT?
I’m a little confused and can’t seem to find any information on this.

Thanks

Medical Billing and Coding Forum

Pregnancy Testing as part of unrelated encounter

Patient comes in for sinusitis and provider wants to prescribe Cipro, but wants to screen the patient for pregnancy prior to prescription. No other symptoms. Besides the coding for sinusitis as the primary diagnosis —
Would the z32.00/z32.01/z32.02 coding be appropriate to justify the pregnancy test and would you also add Z01.812 (blood or urine testing prior to "treatment or procedure"?

Medical Billing and Coding Forum

Maximize Providers’ Time and Payment for Urodynamic Testing

Understand split billing, modifier, and copay rules for urodynamics to keep your revenue stream strong and consistent. Urodynamics or URODS (pronounced “yur-odds”) refers to a diagnostic test that evaluates the function of the bladder and urethra. Providers order the test for patients with urinary incontinence, recurrent urinary tract infections (UTIs), incomplete bladder emptying, a slow/weak […]
AAPC Knowledge Center

Vitamin D testing denial for medical necessity

Our local Regence is denying all vitamin D testing, even with the code E55.9 stating it does not meet medical necessity. I have decided to try and appeal those who actually have vitamin D deficiency but what about those who have symptoms necessitating more screening lab like Vitamin D testing? Also, it appears that Regence has the whole charge as a contractual adjustment. Can we really not bill the patient for this lab (some patients request it). We are going to implement an ABN, but if we do not have one, can we still bill the patient? The EOBs are confusing as they list a contractual adjustment amount, and then then they add CO-50 which is the "does not meet medical necessity."

Medical Billing and Coding Forum

Coding for neuropsychological testing

CPT 96118 is for neuropsychological testing performed by the Physician with face-to-face time administering tests to the patient, interpreting these tests and preparing the report, per hour. While CPT 96119 is for the neuropsychological testing administered by the Technician face-to-face, per hour. In our clinic, our Physician bills for 96119 x the number of hours spent by the Technician administering the tests with his (physician’s) interpretation and report. However, we still bill for another 96118×1 for the feedback session with the patient. The tests and interpretation are done within 2 days but only report the last day as the date of service. The last day being the "feedback’ session. My question is if we can bill for 96118 together with 96119. Example: 96119 x 10, 96118 x 1

Thank you,
Stephanie

Medical Billing and Coding Forum