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There’s more than one way to determine your physician’s payment. Medicare fee-for-service payments are calculated based on relative value units (RVUs) assigned to each covered CPT®/HCPCS Level II code. As defined in Medicare’s National Physician Fee Schedule Relative Value File, there are three RVU categories that, when totaled, determine payment. 1. Work RVUs account for […]
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Three credible sources give three different answers, and only one is right. The definition for billing units of allergy serum preparation for patients was recently challenged by a colleague of mine who works in the allergy space. Are their limitations on diluted antigens when counting units for CPT 95165 Professional services for the supervision of […]
The post How Many Units of 95165 Can You Bill, Really? appeared first on AAPC Knowledge Center.
Medicaid Fraud Control Units (MFCUs or Units) research and arraign Medicaid supplier extortion and patient maltreatment or disregard. The Department of Health and Human Services Office of Inspector General is the assigned Federal office that supervises and every year supports Federal financing for MFCUs through a recertification procedure. For this report we dissected the yearly factual information on case results, for example, feelings, common settlements and decisions, and recuperations—that the 50 MFCUs submitted for monetary year 2018.
The post At A Glance: Medicaid Fraud Control Units Fiscal Year 2018 Annual Report appeared first on The Coding Network.
When I was hired at my current job at a hospital many, many years ago I was instructed not to append -59 to multiple counts of the pathology codes [eg. 88300-26 x2]. We have never had any issues…now our billing department is wanting the "X" modifiers appended to them.
My question:
Is it appropriate to code 88300-26-XU for the gross description of two separate specimen? Or any other surgical pathology code with multiple counts of the same code, gross was just an example?
Thanks
When a CPT code is placed in conjunction with the revenue code, for example 43239, it is my understanding that the units billed with with the revenue 360 with the 43239 represents the number of times the 43239 procedure is performed. I was told by another person, that the number of units under a revenue code 360 with or without the CPT code represents the number or hours for the use of the operating room services. Would someone please advise?
When billing to the Palmeto / Medicare Mac, you can put up to 13 units on one line, with no modifier, and all units pay.
First Coast rejects the claim, stating there are billing submission errors. We have tried using modifier 91 and 59, but they only pay for one unit and deny the rest as a duplicate.
Any insight would be greatly appreciated.
Thank you.
When my doctor puts a splint on a patient, our billing department is trying to bill multiple units of supply Q codes to one splint application code for reimbursement.
For example: Dr. places a short leg splint on a patient, we bill CPT 29515, our MA informed us that 5 rolls of material were being used for these splints, therefore we tried to bill Q4045 with 5 units in addition to our one 29515… Is this wrong?
I can’t find any article that states how many units that Medicare (or any insurance company) will pay for supplies…
Is there anyone out there who has more information on this issue?… Is anyone getting paid for more than one unit of their cast/splint supplies?
The code I found to use is 26160 (if you have a better one for gouty tophi then by all means correct me). The doctor performed the excisions on the left index, middle, and ring fingers, and also on the right thumb and index finger. However, the right index finger had 3 separate gouty trophi removed (separate incisions as well).
Since these are all separate structures and incisions, I take it that I can bill them all? Should I report 26160 x7? If so, there is not nearly enough room for all of the finger modifiers. Or should I do a separate line item for each finger and its corresponding anatomic modifier? That seems tedious and I’m not sure if the insurance carrier will accept that…
Thank you for your help!
I work for a medical practice and we have a few patients that receive 2000mcg of B12. I am aware the Medicare only covers 1000mcg but is there a way to bill the claim to Medicare so they will cover 1000mcg and deny the other 1000mcg of B12. Our claims are not making it through to Medicare. I really appreciate the help!
This is how the the claims are billed to Medicare:
J3420/59
J3420/59
96372
96372
How many units to bill for this:
A total of 10cc of the following mixture was injected:
4.5 ml of 1% Lidocaine
4.5 ml of .5% bupivacaine
1ml of kenalog 40mg/ml
This was for 12 trigger point injections in bilat L2 superficial and deep, bilat L3 superficial and deep and T12 bilat superficial and deep.
Tired, can’t think anymore today. Thanks.