Forum Medical Billing and Coding Forum

Since Bilateral Leg Weakness due to CVA is not found under Sequela of CVA would you code this to I69.365 (other paralytic syndrome following cva bilateral)?

Hi guys, I have a provider who loves to bill CPT 99497, but it keeps getting denied by insurance as being "unbundled" with the E/M codes theyre billed with. These are for Careplus and Humana Medicare Advantage. Does anyone know why they would be denied and how to fix it? The documentation supports the code and I cant find a reason for it to be denied.

Hi everyone, I have a question regarding E29.1 (Testicular hypofunction) and E78.00 (Pure hypercholesterolemia, unspecified) . E78.00 has an Excludes1 note for 5-alpha-reductase deficiency (E29.1) . My question is: If the provider documents E29.1 but describes the condition as hypogonadism or testicular hypofunction , rather than specifically documenting 5-alpha-reductase deficiency , can E29.1 still be reported together with E78.00? In... Read more

Patient was referred to the pulmonologist for SOB. She denied any symptoms at all at the visit and reported no specific complaints. Provider selected a 99203 with a dx code for the SOB. The coder changed the dx to Z00.00 since there was no SOB present. The claim denied for the Z code and E/M (99203) combo. Provider feels the coding of SOB is correct since the patient was referred for evaluation of shortness of breath, which is a valid reason for the encounter. Even though the patient denied... Read more

Hi there, I have been getting denials on 33274. We typically bill 33274 KX with Dx: I49.5 and now getting Modifier denials for Medicare. Are there any new Modifier that would be needed ?

Our hospital gave 4 treatments of radiation and the patient is going to another hospital for the 5th treatment. How would we go about getting reimbursed for the treatments we gave? it is my understanding that it is only billed every 5th treatment. thank you! Shelly Jones CHONC, CCS

I understand that mental health group visits (90853) do not qualify for PPS reimbursement under an FQHC, but are they billable as a separate service under Medicare Part B? This assumes the group visit is supported by the individual patient’s treatment plan, following a PPS-covered intake or assessment. We accidentally submitted one claim, and it processed under Part B - now I'm trying to determine the logic behind this.

What diagnosis codes should be submitted with CHI (G0019) codes? Can a medical diagnosis be used or can these only be billed with SDOH diagnosis codes? diagnosis codes, diagnosis coding

Hi All, I've recently received two denials from Medicaid and I am stumped on what to do. Patients were seen for greater & lesser occipital nerve blocks for occipital neuralgia, cpt codes 64450 & 64405, icd 10 code M54.81. Both codes were submitted for a single encounter date as they were done during the same visit and with only one modifier to indicate laterality as I saw no CCI conflicts when I ran them through Encoder. Medicaid has sent back this response for their denial: "The... Read more diagnosis codes, diagnosis coding

Hello, I am a newly certified CPC looking for new opportunities to begin my professional Medical Coding career. I am located in Wright City, MO which is about an hour west of St. Louis. I am open to in-person, remote, or hybrid positions. Thank you so much for your time! diagnosis codes, diagnosis coding

Good afternoon. I'm on the Education Committee for HealthCon, and we just learned that our Path/Lab speaker cannot attend the conference in Seattle. The topic of the presentation is "Clinical Lab Coding and Billing - How to Stay Compliant While Maximizing Reimbursement". I am hoping that one of you on this forum feels comfortable presenting on this topic (slide deck isn't available, apparently), and that we can provide this presentation. If you're able and interested, please reach out... Read more

Hi All, I need help regarding my CPC certificate. I passed my CPC exam in last year under corporate membership. But my employer is not giving me to my CPC certificate & My member ID. card. So, how can I get my certificate from my employer? (There is no bond between us if I leave the Company then they don't give the certificate) And does CPC certificate require at the time of job? (be'coz they may verify me thro' AAPC site). Also if I want another copy of my certificate then what's the... Read more