Pulmonology Coding Alert
Look to Third-Party Payers for Provigil
Question: Can our practice do anything to receive approval from insurance carriers to prescribe Provigil to patients with idiopathic hypersomnia? Now we need to have filed two written appeals before we can even gain a phone conversation, and the whole process takes about three months to get approved by carriers. Answer: Provigil, generic name modafinil, is a wake-promoting agent. This is an agent that physicians prescribe for the treatment of narcolepsy, obstructive sleep apnea and shift-work disorder. This medication is not yet approved for the treatment of idiopathic hypersomnia.
Nebraska Subscriber
Unfortunately, until this drug is approved for the treatment of idiopathic hypersomnia, you cannot avoid an application for payment to the third-party payers.
Pulmonology Coding Alert
- Your Top-3 Polysomnography Questions Answered
Refresh your expertise with our 95808-95811 primer Before you report staged sleep studies (polysomnography), look [...] - NCCI Update:
Pulmonology Practices Escape NCCI 10.3 Edits
October 2004 marks the initiation of the National Correct Coding Initiative version 10.3 edits, but [...] - Clip and Save:
Say Goodbye to Immunotherapy Woes
Use this flowchart to guide yourself through 95165 coding for Medicare and non-Medicare patients
If your [...] - Mastered Critical Care Coding? Review These Crucial Steps First
Time always tells all for 99291 and 99292 If you struggle with reporting critical care, [...] - You Be the Coder:
Stick With Documentation for A+ Billing
Question: After one physician performed a laryngoscopy and bronchoscopy, the physician in our practice dictated [...] - Breathe Easy When You Report 94660
Bundling E/M services into your vent management codes is NOT the cure-all When a pulmonologist [...] - Coding Quiz:
Test Your Critical Care Coding Knowledge
3 scenarios from our coding experts help you improve your 99291 skills No pulmonology practice [...] - Reader Questions:
Drugs May Qualify for Incident-To Billing - or Not
Question: Our practice has billed nebulizer drug codes (i.e., J7618 and J7619) since the beginning [...] - Reader Questions:
Billing for PFTs? You Shouldn't Be
Question: We perform pulmonary function tests (PFTs) on an outpatient basis at the hospital, and [...] - Reader Questions:
Look to Third-Party Payers for Provigil
Question: Can our practice do anything to receive approval from insurance carriers to prescribe Provigil [...] - Reader Questions:
Turn to Individual Carriers for LMRPs
Question: Does CMS provide any information on critical care local medical review policies (LMRP)? Is [...] - Reader Questions:
Don't Ever Rewrite History - Stick With the Elements
Question: The chart that physicians use to select the level of history includes identifiers. For [...] - Reader Questions:
Consider 780.50-780.59 for Sleep Diagnoses
Question: We keep facing denials for our sleep terrors, sleepwalking, and idiopathic hypersomnia codes because [...]
