May 5, 2022 Question: What code do use when our pain doctor sees a patient in the emergency department for a consultation at the request of the ED physician? Our pain doctor treated the patient and discharged the patient from the ED. Answer: Since the patient was not admitted your physician to the hospital you...
April 7, 2022 Question: My physician billed implanted a neurostimulator into the sacral nerve for urinary incontinence. We billed CPT codes 64562 and 95972 for a Medicare patient. Medicare denied CPT 95972 for the analysis and programming. My physician says it should be paid and we should appeal. Can you provide advice? Answer: Based on...
March 24, 2022 Question: When determining if an illness is chronic versus acute is it based on how long the patient has had the condition or is it based on if the condition is considered a chronic or acute condition? Answer: The AMA defines chronic as: A problem with an expected duration of at least...
March 10, 2022 Question: One of our pain management physicians saw a patient the first time in our office. We billed 99204. The insurance carried denied the service. I contacted the insurance carrier and was told that the patient was an established patient to the practice and should be reported as an established patient. The...
February 24, 2022 Question: If a patient has one stable chronic illness and one acute uncomplicated illness without systemic symptoms, can we “up” the level of Problems Addressed to Moderate? Answer: No, sorry, unfortunately it does not work that way. The problems are no additive or cumulative. One stable chronic illness and one acute uncomplicated...
February 10, 2022 Question: I did an inpatient consultation and coded 99253 (non-Medicare). I did not need to follow the patient, so I signed off. They asked me to re-consult a week later. What is the code for a re-consult? Answer: There are no specific E/M codes for an inpatient re-consultation. You will use the...
January 27, 2022 Question: I heard that Medicare patients don’t have to pay their deductible or coinsurance if they have a telemedicine visit. Is this true? Answer: Medicare is not waiving deductibles or co-insurance. However, they are allowing providers to do so at their discretion without penalty for telemedicine visits. This means the provider will...
December 30, 2021 Question: I am trying to find the diagnosis code for vertebrogenic low back pain. Can you help? Answer: There is a new code that went into effect October 1, 2021, for Vertebrogenic low back pain M54.51. This new code distinguishes vertebrogenic low back pain for non-specific causes of back pain. *This response...
December 16, 2021 Question: We are using the 2021 E/M guidelines in the office and in most cases base the level of service on medical decision making. If I have a patient with a chronic condition that is stable who also has diabetes in which the Internist (nor our specialty) is managing, can I assume...
December 2, 2021 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 record...
