When you are billing a Workers' Comp/PIP Claim, your success cautiondepends in part on whether your office captures all the pertinent information up front. When the patient first walks in and fills out the paperwork related to WC/PIP claim, often times it is incomplete, and/or illegible. Result - Confusion and delay in claims processing. By following these simple tips, you can avoid unnecessary delays in claims processing. 1. Obtaining accurate and complete information is not only vital in … [Read more...]
How to bill Pachymetry of the Cornea?
To bill pachymetry of the cornea, one should use CPT 76514 (cornealPachymetry of the cornea pachymetry, unilateral or bilateral). This code can only be used to report if the procedure is being performed using an Ultrasound technique. Since CPT 76514 is inherently bilateral it should not be reported with any site modifiers (RT or LT). Also it would be inappropriate to use modifier -50 with it. This service includes the interpretation and report, therefore no professional and technical modifiers … [Read more...]
Using Modifiers -GY and -GZ
The Center for Medicare and Medicaid Services (CMS) created two modifiers that allows you to distinguish between services that are statutorily not covered or otherwise not a Medicare benefit because Medicare does not consider them "reasonable and necessary". Modifier -GY: Appending -GY modifier to the CPT code enables one to identify an "item or service is statutorily excluded or the service does not meet the definition of Medicare Benefit". This will automatically create a denial and … [Read more...]
How to Correctly Code and Bill Remicade Injection?
Question: A patient with Rheumatoid Arthritis presents for a Remicade Injection(Infliximab) and receives two pushes, one of Benadryl and one of Solumedral. A recommended dose of Inliximab 200 mg was administered for 3 hrs by means of an intravenous infusion. How would you report these services ? Answer: The correct way to report these services would be: Dx Code: 714.0 (Rheumatoid Arthritis) Pre Medication: 96375 X 2 (Total of 2 pushes); J1200 X 1 unit (Benadryl); J2930 X 1 unit … [Read more...]
How to code for 95920 during spinal surgeries?
Question: How should I code for 95920 during spinal surgeries? Answer: If during a spinal surgery, the only modality you are using is screw stimulation, you should report 95920 only for the time spent to interpret to collect this data. You should not report 95920 for the duration of the surgical procedure (i.e. skin incision to skin closure). You can report 2 units of CPT 95870(Needle EMG; limited study of muscles in one extremity or non-limb (axial) muscles (unilateral or bilateral), other … [Read more...]
Bundle Same-Session Surgery and Intraoperative Neuromonitoring Test
Question: Our Physician performed Intraoperative Neurophysiology Monitoring concurrently while performing a total thyroidectomy. We billed the CPT 60240 and 95920-26 but we have no luck in getting reimbursed for 95920-26. It is constantly getting denied as ‘an integral part of the primary service'. What did we do wrong? Answer: Intraoperative neurophysiology monitoring is a procedure that describes the ongoing electrophysiologic testing and monitoring performed during surgical procedures. It … [Read more...]
How To Code Trigger Point Injections?
Trigger point injections are injections of a tendon sheath, ligament, trigger point(s) or ganglion cyst which consists of an anesthetic agent and/or therapeutic agent injected into the area to relax the intense muscles. In case of TPI's, one must really indicate more specifically the etiology of the pain. Since Medical Necessity is the main criteria for TPI's, it is always advisable to keep your documention in a certain way: Documentation of any evaluation/process of arriving at the … [Read more...]
How To Code An Intravitreal Injection?
When reporting intravitreal injection, one should bill CPT 67028, in addition to the drug used. For Avastin, use HCPCS code J9035(Injection, Bevacizumab,10 mg) and bill 1 unit. If the ophthalmolgist is injecting Avastin after a vitrectomy and the treatment is not an integral part of surgery, append modifier 59(Distinct Procedural services) in column 2 with CPT 60728. For Lucentis, use HCPCS code J2778(Injection, Ranibizumab, 0.1 mg) and bill the no. of units used. Don't forget to put … [Read more...]