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Tag Archives: visits

MAC will Reprocess the claims – Telephone E&M Visits

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The March 30 Interim Final Rule with Comment Period added coverage during the Public Health Emergency for audio-only telephone evaluation and management visits (CPT codes 99441, 99442, and 99443) retroactive to March 1. On April 30, a new Physician Fee Schedule was implemented increasing the payment rate for these codes. Medicare Administrative Contractors (MACs) will reprocess claims for those services that they previously denied and/or paid at the lower rate.

There are also a number of add on services (CPT codes 90785, 90833, 90836, 90838, 96160, 96161, 99354, 99355, and G0506) which Medicare may have denied during this Public Health Emergency. MACs will reprocess those claims for dates of service on or after March 1.

You do not need to do anything

Reference: MAC will Reprocess the claims – E/M


Coding Ahead

CMS Issues Warning Against Cutting Therapy Visits Under PDGM

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Will your utilization data pre- and post-PDGM make you stand out to authorities? As the weeks under the Patient-Driven Groupings Model (PDGM) wear on, more reports of home health agencies (HHAs) cutting therapy visits and staff roll in. Now Medicare officials are telling agencies to cut it out. The Centers for Medicare & Medicaid Services […]

The post CMS Issues Warning Against Cutting Therapy Visits Under PDGM appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Medicare Risk Subsequent visits POS 22

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We are a cardiology practice and are having stuggles with one of our Medicare Risk plans denying 99225 or 99226 visits. We have been instructed by our billing company that this plan has it’s own "rules" and they will only accept one subsequent visit code per day regardless of provider or diagnosis. We have been instructed to change our denied codes to office visit codes 99213 or 99214. I believe this advice to be incorrect. If Medicare Risk plans follow CMS guidelines then it would be inappropriate to change these codes in my opinion. I am curious if any other specialist office is struggling with billing for their services/visits on hospital outpatient/OBS codes? And, am I incorrect in thinking we should continue to bill these codes and appeal these denials? Any thoughts or experiences/suggestions on this topic will be very appreciated!

Medical Billing and Coding Forum

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

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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

Unrelated Procedures or Visits leading up to the “Pre-Operative” Period

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Scenario:
A member is inpt., provider is billing code 99232-24 (DOS 01-28-19) mod. 24 as member is still post-operative of another 90-day procedure…

Now day after (01-29-19) provider billed 99232-24-57 as they are seeing the member in post-op but also made same day decision for another 90-day procedure (61510-58).

How should the 01-28-19 DOS be billed as it is the day prior to decision of the major surgery and provider is indicating unrelated and decision was made the next day/same day 01-29-19?

01-28-19 99232-24 denied because the visit was billed by the same provider within the 61510’s pre-operative period.
01-29-19 99232-24-57
01-29-19 61510-58

Medical Billing and Coding Forum

Pain Management Diagnosis Coding for Office Visits

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I am new to pain medicine and have been coding E/M for this specialty for about a month. I need to meet with our physician soon about CDI, in particular, documenting Chronic or Acute pain. I’ve created a decision tree to try to help him understand how I arrive to the codes I assign. Before I do so, I was hoping there is an experienced pain medicine coder who could review the attached decision tree and let me know whether or not my understanding of the coding conventions for pain is correct.

I would appreciate any input!

Thanks,

Tammy Alton, CPC

Attached Files

Medical Billing and Coding Forum

Global Billing vs Problem Visits

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We have 2 OBGYN Doctors and 2 Family Nurse Practitioners. Our FNPs will see OB patients for sick visits that are unrelated to pregnancy (flu, strep, ear ache, ect)

How exactly does the billing work in this situation? We have tried multiple ways but if we bill the e/m out from the sick visit, after the delivery is billed, the claim is reprocessed and gets denied and when appealing, they still dont get covered.

Does anyone have any insight for this type of situation?

Thank you!

Medical Billing and Coding Forum

Two E/M visits – Same Day – Same Provider

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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

Billing Post op visits to Workmans comp carriers

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I work for a group practice where two of the MDs use a separate billing company. That company bills post op visits (99024) to Workman’s compensation carriers with a charge of $ 250.00 and are getting paid!!! Has anyone heard of this? I want to get on top of this before the other MDs catch wind and want to do the same. I do not feel its proper or even ethical, at that, if they are following the rules of CPT. The treatment after the surgery is included in the surgery code for a certain time frame. Any thoughts?

Medical Billing and Coding Forum