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Category Archives: Q & A with RMC
Q&A: Unattended Home Sleep Study
Q. We have submitted unattended sleep study interpretations with code G0399 with Modifier 26 but have received some denials from Medicare and other commercial carriers. Is it appropriate to use one of the following codes 95800, 95801 or 95806 with a … Continue reading
Posted in How-To, Medicare, Noridian, Q & A, Q & A with RMC
Tagged advice, answers, assistance, billing, claim, CMS, coding, compliance, CPT, medicare, noridian, physician, questions, reimbursement
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Q&A: Hospitalist E/M Coding, 2 physicians, different subspecialties
Q. Can a new patient be seen and billed for 2 new patient E/M services when seen by two neurologists in the same group practice, but different subspecialties? A. If you’re following CPT guidelines, the answer is yes. CPT defines a new … Continue reading
Posted in Medicare, Noridian, Q & A, Q & A with RMC
Tagged advice, answers, assistance, auditor, billing, claim, CMS, coding, compliance, CPT, E/M, education, Evaluation and Management, healthcare, hospital, hospitalist, medicare, noridian, physician, reimbursement, services
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HPI Element: Modifying Factor
A modifying factor is something that is being done to help or alleviate the problem. In order to qualify this element, there should be some notation of the patient’s response to that which was done. For example: patient has knee … Continue reading
Posted in How-To, News, Q & A, Q & A with RMC, RMC
Tagged advice, answers, assistance, CMS, coder, codes, coding, compliance, component, CPT, documentation, E/M, education, element, Evaluation and Management, history, HPI, medical coding, medicare, physician, physicians, practice, questions, reimbursement, support
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Exam Finding: Extraocular Movements (EOM)
Normally, the eyes move together in concert: when the left eye moves left, the right eye moves left, too. The brain takes the input from each eye and puts it together to form a single image. This coordinated movement depends … Continue reading
Posted in Medicare, Q & A, Q & A with RMC, RMC
Tagged advice, answers, auditor, CMS, coder, codes, coding, compliance, CPT, documentation, E/M, education, eom, eomi, Evaluation and Management, Exam, examination, extraocular, movement, physical, physician, questions
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Pro Fee Coding Question: Consult Requests
Q. Can a physical therapist initiate a consult to a physician for one of their patients?. A. CPT clarifies that a consultation may be requested by another physician or other “appropriate source.” CPT lists examples of appropriate sources to include physician assistants, … Continue reading
Posted in Q & A, Q & A with RMC, RMC
Tagged advice, answers, assistance, billing, chiropractor, coder, codes, coding, compliance, consult, consultation, documentation, E/M, Evaluation and Management, insurance companies, lawyer, nurse practitioner, occupational therapist, physical therapist, physician, physician assistant, physicians, practice, psychologist, questions, social worker, speech-language pathologist
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Pro Fee Coding Question: Preoperative Exam Diagnosis
Q. Can diagnosis code V72.8 (pre-op exam) be used by a general physician or just a surgeon? If used by a general physician would the secondary diagnosis be the reason for the surgery or the condition the physician is actually … Continue reading
Posted in Q & A, Q & A with RMC
Tagged advice, answers, billing, CMS, coder, codes, coding, compliance, CPT, documentation, E/M, education, Evaluation and Management, medicare, noridian, physician, physicians, questions
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Pro Fee Coding Question: Resolved OM
Q. Patient seen for follow-up Otitis Media – physician indicates diagnosis of resolved otitis media. Is it okay to bill with diagnosis of otitis media? A. Yes. The patient was seen to evaluate the course of illness and response to treatment. At … Continue reading
Posted in Q & A, Q & A with RMC
Tagged advice, answers, billing, coder, codes, coding, compliance, E/M, Evaluation and Management, physician, questions
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CMS Recovery Audit Prepayment Review Demonstration Project
The CMS announced that the Recovery Audit Prepayment Review Demonstration, which was delayed from its initial start date of January 1, 2012, is expected to move forward on or after June 1, 2012. The Recovery Audit Prepayment Review will allow … Continue reading
Posted in Medicare, News, Q & A, Q & A with RMC, RMC
Tagged auditor, claim, claims, CMS, coding, compliance, demonstration, documentation, error, improper, medicaid, medicare, physician, prepayment, RAC, recovery, reimbursement, review
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Modifier 22 – Noridian Administrative Services Processing Change
On January 31, 2012, Noridian Administrative Services (NAS) posted a Medicare Part B News update to Issue 274 dated November 16, 2011. OF NOTE: NAS no longer requests additional documentation on procedure codes when billed with modifier 22. Following the initial … Continue reading
Posted in How-To, Medicare, News, Q & A, Q & A with RMC, RMC
Tagged claim, CPT, documentation, E/M, global, modifier, noridian, operative report, Part B, payment, redetermination, surgical procedure
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D-dimer Test Coding Q&A
Question: “What is the best code for elevated D-dimer test?” Answer: Currently there is no official determination as to the best code for this test. 790.6, other abnormal blood chemistry, relates to chemicals/elements in the blood such as cobalt, copper, … Continue reading
