Medical Billing and Coding Forum forum

Stephanie Vargason’s path into medical coding began long before she ever opened a CPT book. At 20 years old, Stephanie experienced a catastrophic medical event that left her hospitalized and on ECMO, a heart and lung bypass machine. She survived an experience she says she wasn’t expected to survive, and the providers who cared for her left a lasting impression. One surgeon in particular would eventually help point her career in an entirely new direction. She had already started working in... Read more

My Medicare follow up person keeps getting rejected claims refusing to pay for 63047 as part of a spinal surgery. When she calls and speaks to someone, they tell her that the code is inherently bilateral and we are billing it incorrectly. We are not billing anything bilaterally; we have a charge listed for the surgeon and another one for the assistant. Quantity of one for both providers. Mind you all the surgery codes that allow for an assist are billed for both providers. Medicare told her... Read more

Billing 98943 on the same day as 98940 which modifier is correct?

I WORK FOOR A DME SUPPLY STORE. MEDICARE WILLPAY THEIR PORTION OF THE CLAIM THEN AUTOMATICALLY SEND THE CLAIM TO THE SECONDARY WHICH MOST TIME IS MEDI-CAL. MEDI-CAL DENIES THE FORMULA CODES STATING THEY NEED TO BE BILLED TO MEDI-CAL RX BUT ONLY PHARMACIES CAN SET UP TO BILL THRU MEDI-CAL RX AND WE ARE NOT A PHARMACY WE ARE A DME SUPPLY STORE

As a DME biller, we have quite a few monthly patients for trach, ostomy, enteral nutrition etc. The issue I run across mainly is not getting paid for a crossover claim. I understand that billing cycles cannot run into each other but my question is how to counter that? Do I need to make sure my DOS has an end DOS? Most of our claims go out with the DOS as both beginning and end DOS the same..I am thinking this may be the issue but I cannot find any documentation anywhere suggesting that may... Read more

I work for an ENT and we treat allergy patients. When the patient gets new antigen serum mixed for allergy shots we bill 95165. Recently Aetna and UMR/UHC have been requesting medical records for these claims. Problem is they do not see the Doctor so there are no office notes. The nurse notates their account that new serum was mixed and notates the ledger book. I have tried sending their allergy test results to show why they are getting the shots but they are denying the claims stating... Read more

We have a patient who had recent deviated septum repair and nasal hypertrophy. He came in with nasal obstruction last week. It appears there is a small piece of cartilage that is causing this obstruction. My Doctor wants to do an excision of nasal cartilage remnant. My question is which is the appropriate code 31237 or the unlisted code 30999

Do any nephrology practices bill 90966 with 52 modifier when patient misses their monthly PD clinic visit? If so, what are the valid reasons to include in the note documentation for patient missing their visit?

What is the correct dx for smoldering myeloma? Would it be D47.2 or C90.00?

I could use some help with a qualified, sanctioned source that will support that an Arthroscopically aided ACL repair/reconstruction is coded with 29888 (even though that is the description of the code!) over CPT code 27428. The provider is insisting that since he did a mini-arthrotomy with the arthroscopic portion it should be billed as 27428. I have prepared a full researched response as to why it would be 29888 and not 27428 however I guess this is not good enough they want me to have... Read more

Hello - I am not sure if this would be the right forum, but this code is specifically for folks who have dealt with NC Medicaid in the telehealth setting. We have had a few denials over the correct combination of POS, telehealth vs outpatient codes, and modifiers (-95 vs -GT) any NC folks having luck with telehealth Medicaid? What combinations are you all using? Discussing this with NC Medicaid themselves has unfortunately not been helpful either.

I recently left a practice after 9 years, 5 as their medical biller/coder. The physician has reached out asking if I would be willing to assist with some issues they are experiencing. From what I understand, their clearinghouse rejections (Waystar) have not been worked for approximately 4 months, and there may be a mix of insurance-related and coding-related issues. I am considering offering short-term consulting services to review the rejections, identify root causes, and provide guidance... Read more