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Medicare denying podiatry E/M codes for home visits

Has anyone been successful in getting paid for podiatry home visits? I keep getting a denial stating that the E/ M code was not reasonable or necessary. The provider’s documentation states the reason for the home visit and why the E/M code is necessary. I’m just curious if anyone else is having the same denials I am?

Medical Billing and Coding Forum

Medicare denying podiatry E/M codes for home visits

Has anyone been successful in getting paid for podiatry home visits? I keep getting a denial stating that the E/ M code was not reasonable or necessary. The provider’s documentation states the reason for the home visit and why the E/M code is necessary. I’m just curious if anyone else is having the same denials I am?

Medical Billing and Coding Forum

Nurse visits and UAs

Our coding dept is being requested to bill out a UA with a 99211. I know as it is an E&M I can add a 25 modifier. I am having trouble with this because of the UA having its own CPT code and by my understanding of E&Ms you can only bill both if there is a separate reason for the E&M service. Is there a documented reason and a coding guideline for not being able to do this? I am just wanting to make sure we are not doing something that would cause red flags or repercussions along the way. I have received one answer from another thread but that did not satisfy my manager. I am hoping for more information.

Thanks so much, in advance

Medical Billing and Coding Forum

99024 Reporting for Post-Op Visits in 2018

In July 2017, the Centers for Medicare & Medicaid Services (CMS) began requiring medical offices with 10 or more practitioners in nine states (Florida, Kentucky, Louisiana, New Jersey, Nevada, North Dakota, Ohio, Oregon, and Rhode Island) to report claims data on post-operative visits furnished during the global period of specified procedures using CPT® 99024 Postoperative […]
AAPC Knowledge Center

Hosp visits with modifier 24 or part of global package? Related vs. unrelated….

The more I think about this, the more I confuse myself…..

4 m/o patient with dx of Hirschprung’s disease (Q43.1) s/p surgery on 10/9/17 for complete proctectomy w/ pull through and anastomosis (45120), returned to hospital on 10/26/17 with dx of enterocolitis (K52.9). The patient is still in 30 day Medicaid global at this time. Would the hospital visits related to the 10/26/17 admission be considered related to the surgery performed on 10/9 or unrelated? The enterocolitis is certainly a complication related to the initial diagnosis as pt’s with Hirschprung’s disease frequently do have enterocolitis but nothing in the notes indicate that the enterocolitis is a complication of the procedure itself. I am torn between making the visits post-op visits and no charge vs. whether it would be appropriate to bill these hospital visits with a 24 modifier as unrelated to the original procedure. According to SC Medicaid manual, “Complications or services rendered for a diagnostic reason unrelated to the surgery may be billed with a separate examination code if the primary diagnosis reflects a different reason for the service. To report postoperative visits unrelated to surgery, submit the visit code(s) with modifier 24 or 25. The medical record must substantiate that a visit(s) was justified outside of the surgical package limitation.”

Any insight would be appreciated!

Samantha

Medical Billing and Coding Forum

Pre-op / Post op visits

Hi there, I need some guidance as to coding for post-op / pre-op E/M visits:

Scenario #1:

s/p tonsillectomy 9/30/14 (initial post op visit on 10/27/14)

Problem #1: PHARYNGITIS, ACUTE, RECURRENT

Problem #2: ECZEMA

**Should I bill a 99024 OR the established CPT code of 99213 with a modifier being the physician address the eczema also?
———————————————————————
Scenario #2:

initial consult with cardiologist for pre-op evaluation (colonoscopy & abnormal EKG)

Problem #1: PRE-OP CARDIAC CLEARANCE
Problem #2: OLD MYOCARDIAL INFARCTION
Problem #3: ABNORMAL EKG

**Based on the guidelines this should be coded as a consultation, correct? and NOT a new patient/established code due to the patient didn’t request the consult?

Thanks so much in advance for any guidance on this

Medical Billing and Coding Forum

MCP and office visits for dialysis patients

I know I have asked this question before but I am still not positive about it. If one of our providers sees a patient in the office (our practice also sees dialysis patients and charges for MCP visits) can this provider (billing everything under the same tax ID number as the MCP charges are billed) charge for the office visit if it is any way related to an access evaluation. We have providers that are doing this and charging the office visit. I am saying this is included in MCP charges because it is related to dialysis. My understanding if it is in any way related to dialysis that it cannot be charged. I have printed the list from CMS that shows what is included in MCP but cannot make it clear to providers that even though they are accessing for infection or non-functioning dialysis access that this is part of MCP. Am I correct in saying this?

Medical Billing and Coding Forum