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    ED visit codes (99281-99285) be claimed more than once per a day if different specialty?

    Can ED visit codes (99281-99285) be claimed more than once per a day if different specialty? Patient saw emergency specialty doctor in ED, then saw a different doctor with different specialty for Pre-op, both in ED setting, same hospital.
    • Akulo
    • Thread
    • Replies: 2
    • Forum: E/M
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    Wiki Opinions on this article relating to 2021 e&m rules for derm

    I just came across this article from Mdedge (see attachment) regarding 2021 new e/m rules for derms. It says " Simplified coding and billing requirements for E/M visits will go into effect Jan. 1, 2021. For dermatology, any visit where a decision to do a minor procedure or prescribe a...
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    Wiki Acne table of risk category

    Would you call facial acne that a person had for years self limit minor problem OR a stable chronic illness?
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    Wiki Source of Telehealth waiver expiring July 25, 2020

    I've heard that the telehealth waiver will expired for some plans that follow the HHS, and with their set date for when the public health emergency expiring on July 25, 2020, that's when coverage for telehealth for these plans end. Where do I find the direct source of this information? I cant...
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    Wiki BILLING 99421 & 99441 same day or day after.

    How do we bill for scenario where provider spoke with patient on the phone and email on the same day? So far insurances have denied the phone and paid the email. They seem to be bundled for being two E&M visits, even though these are not even face to face visits. Also, how would we bill email...
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    Wiki United Healthcare Audio only

    Is anyone else confused that United Healthcare is saying to bill E&M codes for audio only visits? They say they're not covering for 99441-99443 because Medicare doesn't cover them (even though Medicare does now as of the beginning of this month) but they wan't us to bill those with regular...
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    Wiki 99421-99423 billing date

    For the 99421-99423 codes, are we suppose to claim by the start date or end date (the 7th date) on the claim? If possible please provide source of this answer. Thank you.
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    Wiki Simple repair without sutures, chemical cautery only

    I've always thought that using silver nitrate on wound alone to seal a wound is consider simple repair but began second guessing myself. Do we need to use modifier 52 when no suturing is involved and only silver nitrate was for chemically cauterizing/sealing wound? Or is it truly billable as a...
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    Wiki New york Medicaid billing for Medicare Part C copays/deductible/co-insurances

    Would like to know how everyone in New York is billing Medicaid for Medicare Part C patient responsibilities. Crossing over from our EMR results in medicaid denying the claim, billing through ePaces is a very tedious process. Hoping for a better way to do this.
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    Wiki diagnosis code question

    We are a dermatology office. We have a patient that has been picking at his own face to the point that he has a hole in his face. He think's he's trying to get out ingrown hairs. Patient presents with a open wound in his face. The note says patient exhibits signs and behaviors of self...
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    Wiki insect bites

    Is there problems using these two codes together to report multiple insect bites as oppose to coding each and every bite individually? T07.XXXA - Unspecified multiple injuries with W57.XXXA Bitten or stung by nonvenomous insect and other nonvenomous arthropods, initial encounter
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    Wiki Incision & Drainage on blisters

    A patient with multiple large blisters due to poison IVY, would you bill 10140 for each incision and drainage performed or just a single unit? Not sure why this code is even priced higher than 10060, which makes me reluctant to bill 10140 for even one blister.
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    Wiki Not accepting patients with in-network with insurance

    Can a doctor not accept a patient with insurance they are contracted with? There's a practice that said they met the quota for seeing commercial patients for this year and no longer accepting new patients with commercial insurance until next year. Is that even allowed?
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    Wiki too much time spent deciding to perform procedure

    So the story I'm given is patient has a wart. This usually is billed with 17110. Before the procedure, patient called her husband because she can't make her own decisions. Her sister was also in room asking a million questions and driving the doctor insane regarding this treatment. Total...
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    Wiki insurances not updated with the new biopsy codes

    So almost all insurance companies except for MEDICARE seems to not have updated their systems to accept the new biopsy codes... Do we continue to use 11100 and 11101 or wait it out?
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    Wiki Same day, billing office visit and procedure on separate claims.

    Currently, Healthfirst NY is doing something stupid and denying all E&Ms billed with a minor procedure even THOUGH there's a modifier 25 on the E&M. We use modifier 25 appropriately so its not as though we're abusing it. I tried talking to Healthfirst but it's like talking to a wall when...
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    Wiki Anus lesion excision and intermediate repair

    It seems the code for excision involving the anus is 46922. How would I code intermediate repair for this? I believe 46922 includes simple repair but not intermediate repair.
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    Wiki Modifier 25 for examining a separate but minor problem

    I had asked this before in the past but want to hear a little more opinion on this. In the scenario for the modifier 25 to be use, the other problem must be significant and separate from the procedure. I've read that in order for the other problem to be considered "significant" "This can be...
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    Wiki Personal history coding question

    I'm seeing a lot of conflicting information regarding this. If a new patient is being seen and has "hypertension" noted on the history but not treated by the provider, do we code condition (I10) or the history code (Z86.79)? I'm reading that if the condition is active then you should code the...
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    Wiki Age of consent for medical care

    We had a new front staff that kind of screwed up. We had a patient who was 16 years old and came with her grandmother. The patient signed all the documents such as hipaa and financial responsibility, etc. Her grandmother signed none of those things. I did not find out until I billed her...
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    Wiki Better way to bill New York Medicaid.

    I have been struggling to bill medicaid secondary due to it's timely filing. I have no trouble billing medicaid secondary when Medicare is primary because for some reasons they only recognize adjustment codes from Medicare ERA's when done through our EMR, so all I have to do is click submit...
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    Wiki insurance retro terminated coverage

    How do you handle situations where at the time of service, patient had active coverage. After the claim is finalized, you find out the insurance retro-terminated/back dated their coverage. Most patient don't pay when that happens and blames the provider and not sort out their insurance. I had...
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    Wiki PMS recommendations

    My boss is looking to switch PMS for dermatology. I prefer a all-in-one system with scheduling, charting, billing etc. My boss is looking at MODMED.com. I'm a little concerned with that because they use a third party billing system and I have no idea how that will work together. I'm leaning...
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    Wiki EMEDNY (NEW YORK MEDICAID) not covering modifier 25

    So I'm having trouble with New York Medicaid not covering the second CPT code. Ex 99203-25 (paid) 11100 (denied) or 11100 (paid) 99203-25 (denied) They're denying what ever is coded second. I called them and they told me since 07/2016 they're no longer paying for procedures billed...
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    Wiki Aspirating Blister with Syringe

    Would you bill CPT 10160 for drawing fluid from an inflamed blister (non-thermal) due to allergic skin reaction?
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    Wiki Self limited or new problem

    A 80 year old patient came in with Daiper rash, rx prescribed. Would you count this as a self limited minor problem or New problem because of RX given under "presenting problems"? Diaper dermatitis Erythematous, irritated located on left buttock and right buttock Medical Decision Making...
    • Akulo
    • Thread
    • Replies: 1
    • Forum: E/M
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    Wiki Emedny, n.y. Medicaid denying second line items.

    Does anyone else have a problem billing medicaid where it gets denied as below. 99213-25 (Paid) 17110 (denied as bundled) But if billed as below: 17110 (Paid) 99213-25 (denied as bundled) They're apparently ignoring modifier 25s now and only paying the first line item... Medicaid didn't...
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    Wiki Patient refuse to sign financial form

    A new staff checked in a patient with out having the patient sign the financial form. The patient saw the doctor already and refuses to sign the financial form after. The purpose of the financial form is mostly educational about what deductibles, copays, co-insurances are and that if they do...
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    Wiki J9040 bleomycin, billing partial

    Provider injected 0.1 cc of bleomycin to wart. The code J9040 is for 15 units (the whole vial). Do I not bill it at all since the provider didn't use the whole bottle?
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    Wiki Units of Measure?

    One of the insurance companies, fidelis care, posted below that they will "reject any claim submitted with a NDC with an invalid unit of measure." Our PMS only has room for the 11 digit NDC code but no room to enter the valid units of measure. I'm concerned about this because our PMS said we...
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    Wiki delete

    Sorry duplicate thread. Don't know how to delete Sorry duplicate thread. Don't know how to delete
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    Wiki dx code for Positive TB blood test.

    Looking for code to report that patient is TB positive based on tb quantinferion gold test.
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    Wiki Medicare exceed timely filing

    I have a claim that was filed through our PMS. I did not find out until recently that the claim never actually made it to the clearing house and was just stuck on "filed" status. I only found out now because recently a whole bunch of claims I submitted through that PMS were stuck on the...
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    Wiki MDM question

    Is two different type of moles, one on the face and one on the forehead, considered to be "two self limited/minor problem" on the MDM, or just "one self limited/minor problem." Thank you.
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    Wiki NY Medicaid now ignores modifier 25

    So I bill in new york and when I bill Medicaid for patient's Medicare HMO's co-insurances, they now deny the second line item. If I bill 17110 and then 99212-25, they'll deny 99212 and pay 17110. If I bill 99212-25 & 17110, they'll deny 17110. Their explanation is they bundle the two codes...
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    Wiki Modifier 24 ignored

    I've been getting denials from Healthfirst and one from BlueCross/BlueShield. For the BC/BS claim I attempted to appeal this with with doctors notes but they upheld the denial. Basically day one the doctor did 11100, 17110, and 17000. On follow up (within 10 days) the patient followed up on...
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    Wiki patient becomes ill right after excision.

    Doctor excised a lesion, patient gets ill right after DUE TO the excision. Does this warrant a E&M for extra work? and what would be the best diagnosis code to describe the situation? I don't know should I bill 99212-25 with r11.2, r06.4, r53.1, R10.819 which are pretty much all the symptoms...
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    Wiki MODIFIER 25 ON E&M for minor problem

    Modifier 25 I read that for the use of modifier 25, the E/M service must be significant. The problem must warrant physician work that is medically necessary. This can be defined as a problem that requires treatment with a prescription or a problem that would require the patient or family to...
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    Wiki 99211? Patient saw Med assistant but leaves without seeing doctor due to long wait..

    Medicare patient saw Medical Assistant but left because he didn't want to wait for the doctor. The scriber documented as below.. F/u on rash on abdomen and back Symptom: still itchy Duration: for awhile Severity: intermittent Timing: constan Dermatitis, unspecified Patient was check-in and...
    • Akulo
    • Thread
    • Replies: 1
    • Forum: E/M
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    Wiki I&D and E&M, modifier 25 or not?

    Haven't been sure of this for a while and want other opinions. If a patient comes in and has a inflamed cyst for the first time, the provider does a I&D and send the contents to culture and wrote two prescriptions such as antibiotic pills and antibacterial ointment, does the culture and writing...
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    Wiki Biopsy skin of scrotum

    For the scrotum, do we use 11100 for biopsy of skin lesions or 54100 for penis biopsy? I don't think 54100 includes scrotum..
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    Wiki History of hives

    If patient comes in complaints of having history of hives but currently has inactive hives but want's medication for next time he gets Hives since its a reoccurring problem, is it appropriate to code Z87.2 by itself for history of hives, or it needs to be coded with L50.9 for Hives. Thank you.
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    Wiki Billing Medicare secondary

    Patients primary, GHI allows 80, paid 60, copay 20. I submitted the claim to Medicare and the deductible was $124.05 with $64.05 as patient responsibility after deducting the $60 paid by GHI. Does this mean we have to follow medicare's E.O.B. and bill patient for the $64.05 even though we're...
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    Wiki Denial - Principal diagnosis inappropriately coded.

    I have a in-office claim denied as Principal diagnosis inappropriately coded. Claim was billed as below 99213 dx T20.29XS, L81.0, D23.4 I can't figure out what they mean by "Principal diagnosis inappropriately coded."
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    Wiki Selfpay discounts only to uninsured not allowed for insured?

    I do billing in New York. I'd like clarification if it's legal to discount self paying uninsured patients for prompt payment upfront. I seems like it's legal for insured patients from what most people are saying here, (some say it's not) but what about patient's with high deductibles with...
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    Wiki Out of network claims, balance billing.

    If we send a out of network claim and "accept assignment" on box 27. Are we allow to balance bill the patient?
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    Wiki 3 letter rule before collections?

    I was wondering, is there such a rule that we cant send patients to collections unless we send them 3 bills? They all sign a financial form that states unpaid bills will go to collections after 90 days. I'm having too much of a hard time managing who to send additional bills to after the first...
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    Wiki Medicaid not covering full $166 medicare deductible.-Is anyone else

    Is anyone else having issues billing medicaid for the full $166 deductible? New York medicaid is telling me they wont pay for deductible amounts over $150. I'm telling them Medicare's new deductible is $166, they don't know what I'm talking about and insisted the charges are invalid. It's like...
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    Wiki Medicaid not covering full $166 medicare deductible.

    Is anyone else having issues billing medicaid for the full $166 deductible? New York medicaid is telling me they wont pay for deductible amounts over $150. I'm telling them Medicare's new deductible is $166, they don't know what I'm talking about and insisted the charges are invalid. It's...
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    Wiki Opting out of medicare, what about medicare advantage?

    If a provider opt out of Medicare, can they still see Medicare Advantage patients? Getting sick of all these penalties and regulations CMS comes up with. I think the provider could live with not seeing straight Medicare patients but at least keep the patients that participated in a Medicare...
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