Fórum Medical Billing and Coding Forum

I am in South Carolina. I have a patient that has 3 insurances. Medicare as primary, (per medicare) BCBS is secondary, and they cross over the claims, and Aetna as tertiary. Aetna has paid on all claims acting as secondary.I have sent refunds to Aetna, with Medicare and BCBS EOB's, along with letters explaining they are tertiary. I cannot get the patient to answer her phone to make Aetna aware that they are tertiary. Aetna keeps returning my refunds. What do I do with the money they refuse... Read more

We are a Part B provider for cardiology care and we have recently seen an influx of denials for pos for patients who were inpatient, and we billed 93294 and 93296, POS 11, not knowing the patient was inpatient at the time of interrogation. Do we bill 93294-21 and not bill 93296? Can someone help me understand this billing/coding issue?

Hello, So at the start of 2027 i see one aspect of the new guidelines will be charging e/m's for all routine ante visits and my question pertains to all the pregancies that are mid pregnancy at this time.....This will be an interruption of many pregnancy episodes. For example say normal pregnancy etc, my practice charges a 0502F no charge ante for routine visits up until delivery when we charge a global delivery charge. So will we just have to bite the bullet for all the visits that we... Read more

Hey guys! would you guys find this return to the OR after a hysterectomy to be inclusive because it was injury that was basically incidental to the procedure. this person seems to have possibly been virginal status it seems and the reason why hyst was changing gender or would you charge a 56700 or a 57200? thanks for your thoughts! i would think not 56700 because she says the hymenal ring was relatively hemostatic. ADD-ON PROCEDURE: Returned to the operating room on 08/19/2026. In the... Read more

Good Afternoon All, I wanted to see if anyone was familiar with a code that could be billed for when a patient presents for MOCA screening only for primary care. I have looked at CPT 96125 (Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report.) but that seems to be... Read more

Has anyone used code 96125 for MOCA test for providers other than P.T., O.T.,or Speech? Our clearinghouse is requiring a modifier GN, GO or GP; none of these code support our specialty -Family Practice.

Hello, we have multiple payors denying claims stating the procedure code is incorrect for date of service. We are billing for an admit code when a patient is being transferred from an acute inpatient hospital to a rehab hospital. Do you know if this is considered as the same admission and should we be billing for a subsequent visit instead of initial admission? Thank you!

We are an ob/gyn practice and our CNM's see pt's under incident to currently. As of 9/1/26 BCBS/BCN are no requiring a modifier SA to be on our incident to billing claims. The SA modifier is for Nurse practitioners' and there is a modifier SB for CNM's. I believe I should be using SB when CNM is doing the visit and not the SA for nurse practitioner but there is no conversation of this for BCBS/BCN or I am just missing it. Any thoughts would be appreciated.

Hello! I work for a hospital as an audit and education specialist. I'm the one on the team responsible for the majority of the work of putting together in-service presentations. We are currently doing an E/M leveling series, and I am getting some conflicting information on using the same thing across both data and risk. For example, patient is inpatient and sees GI. GI wants to order an ultrasound and a bunch of lab work. Both of these things count towards data. However, per the SOHM they... Read more

Hi, can you assist if 23929 is supported by op report attached please? 23515 + 76000 billed by primary and 23515 + 23929 + 76000 billed by assistant surgeon

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 remanent. My question is which is the appropriate code 31237 or the unlisted code 30999

Coding Specialist (Certified Professional Coder - CPC)​ Full-Time | Orthopedic Practice Elk Grove Village, IL 60007 Our growing Orthopedic Practice is seeking an experienced and detail-oriented Coding Specialist to join our team. The ideal candidate will have a strong understanding of medical coding guidelines, excellent attention to detail, and a commitment to maintaining compliance with all regulatory requirements. Position Summary​ The Coding Specialist is... Read more