April 2, 2020 Question: Can we bill telehealth visits by time alone? Answer: Yes, if indicated by the code billed. Telemedicine visits have the same documentation requirements as any face-to-face visit, according to the code the provider chooses. Of course medical necessity is the overarching criterion for all visits. *This response is based on the...
March 19, 2020 Question: At a recent KZA coding course, you discussed being able to charge an office visit after an allergy test if a plan for immunotherapy treatment was discussed. Insurance companies are denying this even if we are using a 25 modifier. How can I get this paid if I use the allergy...
March 5, 2020 Question: One of our major payors will not pay a 92504. They state that it is included in the office visit. Any suggestions on how we can get this paid? Answer: You could appeal by saying “even Medicare pays for it.” Otherwise, if you are contracted with the payor, then you’ve agreed...
February 20, 2020 Question: I billed 95992 (Epley) and 92532 for the Dix-Hallpike I did. I got paid for 95992 but not 92532. Should I have used a modifier to get paid and should we appeal the denial? Answer: No. CPT 92532 is for positional nystagmus testing without a recording such as what you did...
February 6, 2020 Question: In the past, when I did a total thyroidectomy and I needed to re-implant a parathyroid gland I would also code 60512. I am now being told by my coders that I cannot code 60512 it if I implant a parathyroid gland in the sternocleidomastoid muscle. They say I can only...
January 23, 2020 Question: Our surgeon performed an evaluation of the external ear canal on a pediatric patient, under general anesthesia, because the child would not allow the surgeon to evaluate the ears thoroughly in the office. We cannot find a CPT code for this service. Do we use an unlisted code? Answer: CPT code...
January 9, 2020 Question: I have a question about post op visits for PE tubes (code 69436). As you know, these have a 10 day global period but my group of physicians prefer to see these patients back in 4-6 weeks. They state 10 days is not enough time to verify the tubes are working....
December 19, 2019 Question: We are hiring a scribe for the doctor because it will help improve his documentation. Is there anything we need to know about how to document this? Answer: Yes, absolutely. This situation should be clearly delineated so a third party reviewer can identify the provider who performed the service, and the...
December 5, 2019 Question: Is it ok to code 69641, 69642, and 69643 for procedures performed on the same ear at the same operative session? Answer: Absolutely not. Use only one CPT code – whichever represents the procedure performed. *This response is based on the best information available as of 12/05/19. [/cmsmasters_text][/cmsmasters_column][/cmsmasters_row]
November 14, 2019 Question: I oftentimes bill and E/M code with modifier 25 for an office visit and 92504-50 (1 unit) for the binocular microscopy to Medicare. I get denied on 92504-50 but I am paid on 99212. The denial code is “CO-4 The procedure code is inconsistent with the modifier used or a required...
