Watch for five claims shortcomings that may hang up claims payment. If the results of an April 2018 Office of Inspector (OIG) audit are any indication, claims for telehealth services are about to receive much closer attention by payers. Physicians and staff can best prepare for a potential claims review through awareness and education. Rising […]
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Tag Archives: under
Help with Screening colonoscopy for Medicare under new LCD updates
I have tried billing hcps code G0121 with modifier PT under DX code Z12.11 as primary, DX K57.30 as secondary and K64.1 as tertiary code. I have received denials from medicare stating "The procedure code is inconsistent with the modifier used or a required modifier is missing. We have attempted several different ways to re-code under medicare LCD updated with no results. Can anyone help or does anyone know of the new changes with medicare and how to bill properly under their new rules.
New Patient E&M under 3-year rule
Per the CPT book, the patient cannot receive any "professional" services from the physician/qualified health care professional of the exact same specialty and subspecialty in the same group practice within the past three years.
If the patient has only received allergy injections in the last 4 years in a specific office would it be appropriate to allow a new patient E&M? Or, are the allergy injections considered a professional service even if provided by a nurse or PA?
77001 coding under pa name
If the PA is performing the central line placement, can the 77001 be billed under his name?
TIA
Medicare’s prior authorization program may continue under GAO recommendation
Billing Under Old Tax ID while being credentialed Under NEW Tax ID
Good Morning Friends,
I’m looking for documentation to give to a provider that backs up the following: billing under his old tax id while he’s being credentialed under his new tax id would be considered fraudulent.
Mohs surgeon billing under the general dermatologist’s NPI
I have always been under the impression that one doctor cannot bill under another doctor’s NPI except under a true Locum Tenens situation. But a friend who works in another derm practice says that her doctor brings in a Mohs surgeon once a week and bills insurance under his own name for the Mohs surgeon’s work. When my friend told him he is not allowed to do this, he replied that he has checked into this and found that it is permitted.
Is there something I don’t know here, or is he committing fraud?
NP Billing Under MD in Hospital?
I skimmed through the threads and didn’t see anything specifically addressing this….
Our MDs are going to temporarily be on-call at 2 hospitals simultaneously (weekends). Because they can not be in 2 places at the same time, they plan to have our NPs help with the local hospital on-call.
2 part question:
1. Can our NPs see patients in the hospital (assuming they are credentialed, and all other legal paperwork is in order) and bill under the MDs, or does it have to be under themselves?
2. If they CAN bill under the MDs, what criteria must be met by both the NP and the MD in each note?
I’ve found some information on-line stating incident-to does not apply to hospital settings, but it was dated 2002. I don’t have my course book on-hand to reference either…
Hoping someone has more recent, and concrete information.
Any help is greatly appreciated. =)
Deliveries under 39 weeks
Starting January of this year, we started receiving denials from Amerigroup, stating that the delivery was not medically indicated when the child was born before 39 weeks. We need a diagnosis to indicate why the baby was delivered before 39 weeks. amerigroup will not tell you what diagnosis to use. There are a few diagnosis that I think could work but just wanted to see if anyone else has had this issue. O75.89 other specified complications of labor and delivery. 075.9 complication of labor and delivery, unspecified. 060.14 Preterm labor third trimester with preterm delivery third trimester (not sure these would be considered pre-term as the weeks of gestation were 37 or 38 weeks) 062.9 Abnormality of forces of labor, unspecified. 042.90 Premature rupture of membranes, unspecified as to length of time between rupture and onset of labor. Any help would be greatly appreciated.
Rose Zeron, CPC