claim

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    Wiki G0317 Prolonged Service, how to bill

    Do you have to bill the prolonged service G0317 on the same claim form as your E/M visit, (99306-99310) or can this code be billed separately on it's own?
    • amjamil
    • Thread
    • behavioral health claim claim form e/m nursing facility prolonged psychiatric
    • Replies: 2
    • Forum: Billing/Reimbursement
  2. A

    Wiki Retro Claim Reimbursement

    I have been searching and searching for information on how retroactive claim adjustments should be handled by managed care plans. When Medi-Cal retro's the DME supplies or Radiology codes, the effective date went back over 6 months to a year... Is there any guidance or rules on how MCPs are to...
  3. B

    Wiki Clearinghouse limiting # of Diags on a claim! Help

    Hi all, I am running into an issue with a Practice I work with. They are stating that their Clearinghouse is only allowing 4 ICD10 Diagnosis codes to be submitted on a claim, despite them adding the additional diagnosis on the Medicare form appropriately. Now I know that on the electronic...
  4. K

    Wiki UPT Lab Pre-Procedure

    Patient has Glucose or UPT (pregnancy test) prior to procedure in ASC (POS 24)- Can this be billed on either prof or facility claim for procedure?
    • k8mbee
    • Thread
    • ambulatory surgery center asc claim facility glucose test place of service 24 pre-procedure pregnancy test professional
    • Replies: 0
    • Forum: Billing/Reimbursement
  5. C

    Wiki When all the procedures don't fit on the claim form

    Good morning everyone, I've been an avid reader of the forums for some time and would appreciate some advice on a thorny work situation. The practice I work for has decided to change up some of the lab testing. The problem is what they want to change it to is basically 3 components short of a...
  6. T

    Wiki Claim Scrubber Product

    Hello - My company is currently using a Claim Scrubber Product from OPTUM (Claims Manager). We want to review other Claim Scrubber products to determine if we should continue with our current product or find a product that better suits our needs. Our Practice Management product is GE...
  7. M

    Wiki Caresource (Medicaid product in OHIO) denying claim due to dx?

    Hi~ I have been told by one of our billers that he was told by a rep from Caresource that a particular claim has denied due to a diagnosis (but of course would not give him the exact 2dx in question). I have researched and could only find the following codes (that state needs additional code)...
  8. R

    Wiki CPB billing program - payment plan

    Since AAPC doesn't have a payment plan and you have to pay for the whole program all at once, can you claim this program on your taxes?
  9. C

    Wiki 0191T with cataract surgey

    Hi, I am new to coding ophthalmology surgeries. My office and I are trying to figure out how to correctly bill an I-stent with a cataract surgery on the institutional claim form. We received some CO97 denials on the claims we have billed with them so far. My questions are: Does the 0191T need a...
  10. S

    Wiki ****HUMANA is Fixed ***** denials of well visits with immunizations

    After working the insurance commissioner and Humana all claims processed from 12/12/15 to 01/16/16 should be reprocessed and paid correctly. They stated that there was an internal error where claims with a 25 modifier and 59 modifier were being denied incorrectly. I was able to locate a claim...
  11. K

    Wiki Gastroenterology - I have a claim that Medicare denied procedure

    I have a claim that Medicare denied procedure 97605 when billed together with 20102 stating invalid modifier billed with 97605. The procedures were billed as 20102-78-GC and 97605-59-78-GC. I verified in NCCI and these modifiers are appropriate. Does Medicare not want the modifier 78 on...
  12. D

    Wiki E/M w/ 57 modifier and operative report denial

    We have seen an influx of denials from payer sources (VA, BCBS and work comp) denying the E/M with a 57 modifier because the E/M and operative services weren't billed on same claim. Is anyone else seeing this? Thank you. Deb Knight, CPC, COC Missoula Bone & Joint & Surgery Center
  13. W

    Wiki Billing multiple years on the same claim form

    Can you bill for a DOS in year 2015 on the same claim form as a DOS in 2016?
  14. S

    Wiki Inpatient Coding - Could anyone tell me how

    Could anyone tell me how are the codes 31500,36556,92950 and 99291 are to be billed and if a modifier is needed. The clearing house is stating that there is a CCI conflict edit within the claim.
  15. L

    Wiki 66761-LT denial

    I've received a denial from an insurer for 66761-LT stating it was within the global period of another procedure. Exactly 7 days prior we billed for 66761-RT. Am I correct in thinking the 66761-LT wouldn't be included with 66761-RT since it is a separate procedure done on a different site of...
  16. C

    Wiki hospital inpatient treated in physician office

    One of our physicians treated a patient in the office while the patient was an admitted inpatient in a hospital. Medicare denied our Part B claim for inconsistent place of service - CO5 as the hospital also submitted a claim for the same date of service. I was told by a Medicare rep that a Part...
  17. L

    Wiki bialteral modifiers with 31297, 31295 and 31255

    Can these codes be used with modifier 50? and on the same claim as 31296?
  18. T

    Wiki 63047 denying for modifier ....

    Recently Tricare began denying 63047 stating "...INHERENT BILATERAL PROCEDURE WITH UNITS GREATER THAN ONE...." The procedure done was "DECOMPRESSION OF L3 & L4 LAMINECTOMY WITH BILATERAL FORAMINOTOMIES" The original claim was sent with 63047 x1 & 63048 x1 & 69990 x1. According to the CPT...
  19. C

    Wiki PAcemaker IMplant denials due to claim having ICd-10 code R55 on claim

    I realize the NCD 20.8.3 for Pacemaker implants CR9078 states the syncope (R55) is not a covered dx for pacemaker implants. It also goes on to state that claim will be denied if R55 is present even with a qualifying covered DX code. I have some concerns regarding this and I am curious if any...
  20. J

    Wiki Humana denying any OV billed with any testing or vaccines at the same visit

    Did anyone else start receiving denials for O.V mid December anytime it was billed with any vaccine or testing ( 87880,86308, ect) ? We are pediatrics...and yes we are billing with the correct modifiers. Its across the board, not even plan specific within Humana. I'm reaching out to my Humana...
  21. T

    Wiki BCBS Glitches since ICD-10 implementation

    Just a question to see if anyone else is having issues getting paid by BCBS. Starting on 9/25, we have had a multitude of issues. For instance, there are several days in September that our claims were sent to BCBS electronically and accepted by the payer yet BCBS has no record of the claims...
  22. T

    Wiki A9555

    Question is anyone having to put an NDC# on claim in order for Medicare to make a pymt?
  23. D

    Wiki Coders Direct, LLC ?

    Has anyone ever heard of these guys? They say they will post your contact information and credentials in their database. Then, they'll compare your information to what potential employers are looking for to see if it's a match. They also claim to be a good source for C.E.U.s. I didn't sign...
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