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Regarding the new PQRS codes, G8440 has been replaced with G8730. Is this code submitted only when a new patient or a new condition/flare-up on an established patient treatment plan begins, or is this code submitted with each visit during the entire treatment plan?
Answer:
Medicare has issued clarification that this quality reporting parameter is to be used for Medicare patients aged 18 years and older, when you document pain assessment through discussion with the patient. You must include the use of a standardized tool(s), such as a Visual Analog Scale, on each visit. The parameter also mandates that documentation is included in the SOAP note that there is a follow-up plan to reassess pain, when the pain is present. This measure is to be reported for each visit occurring during the reporting period for patients under active care, seen during the reporting period.
Does the new ChiroCode Complete & Easy ICD-10-CM Coding for Chiropractic book contain all of the new chiropractic codes which need to be in place by October 1, 2013?
Answer:
Our team has done research and done everything possible to pull together the most complete list of ICD-10-CM codes that could be of value to a Chiropractic office. We have also taken the commonly used ICD-9-CM codes and mapped them to their general equivalent ICD-10 codes to help your office make the transition. You will also find tips and helps on how to make the transition from ICD-9-CM to ICD-10-CM based on what other countries have experienced when they made the switch.
I was reading the description of the CPT code 97530 and it seems like it could fit for massage. Do you have any other information regarding billing 97530 code for massage?
Answer:
The AMA CPT has pretty clear rules as to code selection. See the Instructions for Procedural Coding on page F-5 of your 2012 ChiroCode DeskBook. As you can see it it says to select the code that ACCURATELY identifies the service provided and to not select a code that merely approximates the service. 97530 is for therapeutic activities, use of dynamic activities to improve functional performance. Since 97124 exists and is for massage, the use of 97530 would be incorrect.
It is in the best interest of the coder to avoid any coding practices which could raise red flags trigger an audit. There could be instances where the use of another code may be warranted; however; your justification and documentation would have to constitute its use over the existing "accurate" code.
We processed a Personal Injury case. The insurance claim was sent to the patient's auto policy carrier. They refused payment, so we submitted it to their other insurance. Eventually, both payers paid the claims. The auto carrier paid at full value, and the secondary paid at a reduced rate due to my contract agreement with them. The account now has a credit balance. What do I do with the overpayment? Do I keep it? Is there a formula for refunding it to the insurance carriers?
We are having a problem with a PIP carrier denying 97112 (Therapeutic Procedures). They state that it's not medically necessary. Where did the definition for 97112 in the ChiroCode DeskBook come from?
I have a few insurance companies that are rejecting the pelvis 72170 xray stating it is not part of the spine. Do you have any documents that I can send with my appeal to show them that the 72170 is part of spine and thus should be considered for payment.
When I view the NCCI edits and it states that CPT code 97124 (Massage) is a component code of 97140 (Manual Therapy Techniques). Does this mean I have to bill them together or do I not bill the 97124 code at all?
How do you submit TENS (Transcutaneous Electrical Nerve Stimulation) rentals for reimbursement? I have some insurance companies that pay without question and others that deny this.
My payer just told me that since we are out of network, they pay 70% of Medicare Non-Network reimbursement Rate and the patient pay 30% as coinsurance. What is this Non-Network rate and can I find a related fee schedule from ChiroCode Institute?
We currently have two doctors in our facility and I need know how to bill properly if both perform different procedures on the same date of service. For example, doctor A adjusts the patient and doctor B does acupuncture on the patient. Another example, doctor A adjusts the patient's mid back and doctor B adjusts the patient's neck and/or TMJ. How would I bill appropriately
I have been billing 22505 - Manipulation of spine requiring anesthesia MUA) for the cervical, thoracic and lumbar (three units) for one day or service. Is this correct? My payer is claiming my billing is wrong and that 22505 is considered one unit for the entire spine.
Is it appropriate to use modifier- 76 when doing the same procedure multiple times, for example, 97110 done in 15 minute increments twice by the same physician during same visit? And, do insurance companies generally cover this?
Medicare Advantage coverage through my payer has been paying for maintenace therapy. We were billing a 98940 with no modifier. I have now changed that to 98940-GA. Is that the correct billing for Medicare maintenance if the patient marks Option 1 on the ABN?
We would like to start billing for report of findings using the proper documentation. We would also like to go through the past year or so and bill for all of the previous reports as well. How legal is this and is there an expiration on how far back I can bill?
I would like clarification on offering specials for a patient's first visit. The doctor wants to offer a gift certificate good up to $100 for a new patient's first visit if the patient donates money to a particular charity. I have read and have been told different things over the years regarding giving away services. Are the rules more state specific or do they depend on what insurance company is involved?
When care is no longer "medically necessary" but "clinically appropriate," is it best to code S8990? How does this coding apply to the Medicare patient? Also, if a patient has no insurance and has an acute/active condition is it more appropriate to code as S8990 or 98940?
For box 29 on the 1500 claim form, the directions read that if a dollar amount is added there, "part or all of the payment will be paid directly to the client." If this is where you document a co-pay, why is the provider not getting the payment? I don't understand.
We understand that the total amount of time to the minute for each service must be recorded. In addition, should we record the beginning and ending time of each service? We have a copy of a memo issued by the Department of Health and Human services which says it is advisable to record the beginning and ending time of the treatment.
Can we bill for a brief examination and/or an office visit on each visit with a chiropractic adjustment? I examine the patient before and after an adjustment is done on each visit. How can I be reimbursed for my time and services?
We have a patient who was involved in an auto accident and injured her cervical and upper back region. She also has a low back condition, not related to this injury. Can the doctor treat both conditions on the same day and bill separately for them? We would be sending her PI claim to her auto insurance for payment and her low back condition to her commercial health insurance.
I am considering using inversion traction in the office. Is this something that insurance companies reimburse? Is there a preferable CPT code for this modality?
My payer informed me that they are no longer accepting modifier -25 for a new patient examination for an automobile accident. The 2011 ChiroCode DeskBook states that modifier -25 is to be used. My payer suggested using modifier -59. If this is correct, where is it written in the book?
Our office is having a weight management seminar/class for 8-10 patients. Is the code 99412 appropriate? The seminar is 60 minutes long. Or, would 99078 be more appropriate?
In my state a lot of chiropractors are having to pay back a lot of money for billing code 97140-59, for manual therapy or massage therapy. Is a chiropractor allowed to bill this code? What code should be used?
Because I am non-participating with BC/BS, checks are going to my patients instead of coming to my office. Is there some way of forcing BC/BS to send checks to my office?
I am currently in an Applied Kinesiology program and spending a lot more time doing muscle testing and nutritional evaluation via muscle testing. Is there a proper code to use for this kind of very time consuming service?
How do we correctly bill for 97035 Ultrasound (two) units? I realize ultrasound is a timed therapy and two units represent twice the time. But can it also show one unit for the cervical spine and one unit for the lumbar spine, and how is it shown on the 1500 form?
Is the maintenance code S8990 still in use? We have several patients who claim that they have "wellness" visits under their insurance plan. Should we bill their health insurance with this wellness code, and then transfer the balance to the patient if the insurance doesn't pay?
We are having code 96002 for computerized EMG procedure denied as "per the CPT guidelines, this service is not appropriate in this setting (place of service)." We submitted codes 98941 and 96002-25.
We just received a reimbursement request from managed care payer for a $12.60 "overpayment." What is the legal requirement for us to repay them for their mistakes?
Q. My normal office hours end at 5 pm. Am I able to bill for CPT code 99050 if I provide treatment to a patient after 5 pm in addition to my usual fee for services provided?
Our payer is requesting a modifier code for E0856 (cervical traction device) to clarify a purchase. Should we put anything else also, such as notes, etc.?
What is the proper CPT code to bill for shoe orthotics where a casting is made of the patient's foot and then an insert is made by the supplier? Also, what is the proper CPT code for billing a shoe lift?
We are considering accepting insurance for massage therapy. Is there another code besides 97124 that we could use? Code 97124 states that it is for 15 minutes. I need a code that would cover 30 to 60 minutes. If I have to use 97124 two or four times on a claim, will the insurance deny it?
We are very confused about the use of modifier -59 with code 97112. When is modifier -59 required? We had understood it was NOT required;however, when we do not use it, we receive denials. Can you offer some direction/clarification, please?
We are trying to determine the appropriate way to settle a personal injury case. We are a participating provider with BC/BS and they have already paid their portion. Should we charge the patient the full remaining amount or balance bill them for the BC/BS contracted rate?
I have been having problems getting my re-evalutions paid. The last re-evalution I billed was the code 99211 with the modifier-25 to show it was a distinct procedure separate from my adjustment code. According to my payer, one initial exam is covered and one re-exam per episode is covered. They have informed me the 99211 code is not a valid code and can only be used one time in a 60 day period. The patient is an established patient. Any suggestions?
In regards to code 98943 for extraspinal adjustments, when adjusting more than one extremity per visit, how is that coded? Do I list one code with three units, or as three different diagnoses with one unit each?
How should I bundle and bill these procedures? I need to know how to bill them correctly so I don't have to go through an appeal process. The codes are 98940 for less than two regions, 98943 for TMJ and jaw dislocation, and a code for manual traction 15+ minutes, which I have not yet found. I was going to bill the 98940 with the -AT modifier and the 98943 and the manual traction code when I found one with the -25 modifier, or maybe the -51 modifier. I am unsure of which to use.
We would like to start billing for report of
findings using the proper documentation. We would also like to go through the
past year or so and bill for all of the previous reports as well. How legal is
this and is there an expiration on how far back I can bill?read more...
If an insurance
company requests notes on a patient for a particular visit, may we charge the
insurance company for those notes?Also,
if we need to send the notes for a precertification, such as with Landmark
Healthcare, can we charge them for the notes and processing the forms needed?read more...
We
have been using the code "G0283" for electrical stimulation but want
to make sure that is the correct code. In the past we were using the
"97014". Which one is correct?
What is the appropriate code for a cervical traction unit (roll with weighted water bag) used in conjunction with a chin/ head harness–not over the door but used in a supine position. read more...
I’m confused about what constitutes the 98940 to 98943 codes. Do they describe the number of body regions ADJUSTED or the number of regions that the patient’s complaints encompass? read more...
We bill code 97110 for therapeutic exercises. All but one insurance company pays this code in time units. Can the insurance company refuse to pay for units of time performed for therapeutic exercises? read more...
Our insurance billers are really good at talking to the claims payers. On more than one occasion they have convinced Medicare Representatives to make changes and correct claims. I had never heard of anyone who was able to get a Medicare Representative to do anything without a resubmission or appeal. What is the big secret? read more...
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