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Question for Ask the Biller:
December 4, 2007
Hi
Can you
please tell me how to bill 2 E&M codes on the same day for 2
physicians in the same practice with the same tax ID#, but with different
specialties? I know with the same tax ID, same specialty only, one E/M
code per day will be paid, but I can’t find anything that says how to bill
it with different specialties.
Thanks,
Stephanie
Response from Ask the Biller:
Hi Stephanie,
I personally
haven't come across your situation in the billing I've done but I did a
little research. The only thing I can suggest is to try billing out the
second E&M with a 59 modifier. This modifier indicates that the 2nd
E&M is a distinct procedural service. I’m not sure that all insurance
carriers will honor the 59 modifier and pay for both E&M’s but that is
what I would try. Make sure you have different dx's on each E&M. If
that doesn't work, your only other option is for the patient to schedule
the appointments on separate days. Hope that helps!
Michele
Question for Ask the Biller:
December 4, 2007
When billing for a nebulizer in a
physician's office; is it appropriate to bill for the tubing/mask as well,
or is that bundled or only appropriate if you are a dme vendor?
Bridget
Response from Ask the Biller:
Hi Bridget,
If the tubing
& mask are disposable, you should certainly bill for them. Not all
companies will allow for them separately, but some will. If you need to
bill Medicare for them then you would need to obtain a Medicare DME
supplier number. Hope that helps.
Michele
Question for Ask the Biller:
December 4, 2007
I was wondering if you need to put a
remark on a UB04, where could it go? That is excepted by the insurance
companies
Thanks for your help
MICHELLE B
Response from Ask the Biller:
Hi Michelle,
There is a box
for remarks on the UB04, it is field 80 on the bottom left hand corner. It
has four (short) lines. That is the only spot specifically for remarks.
Thanks
Michele
Question for Ask the Biller:
December 3, 2007
Hi my name is Linda and I am the
billing manager for a pediatric office. When we see a sick child for
wheezing and/or tightness in the chest we usually bill 99213 for office
visit and give them a inhalation breathing treatment under procedure code
94664 but we never get reimbursed for the treatment only the office
visit. How do I get insurance companies to consider procedure 94664
am I billing this correctly?
Linda
Response from Ask the Biller:
Hi Linda,
When you see the
patient for the wheezing/tightness and you do the 94664, I would recommend
trying a 25 modifier on the E&M code indicating that the E&M was a
Significant, Separately Identifiable E&M Service by the Same Physician
on the Same Day of the Procedure or Other Service.
Also, if you have more than one diagnosis and if it
is appropriate to use a different diagnosis for the E&M than you use
for the 94664 that may help. For example, if a child comes in with an
upper respiratory infection, and you give him a breathing treatment for
the wheezing/tightness, then you could bill the 99213 with dx URI and the
94664 with the wheezing/tightness diagnosis.
Hope
that helps.
Michele
Question for Ask the Biller:
November 23, 2007
Hi Alice,
I have a question
in regards to C-Leg repairs …..payment from Medicare…..how are other DME
providers submitting there claims and getting paid….I hope you have some
insite on this matter
Happy Thanksgiving..Thank
you Marilynne
Response from Ask the Biller:
Hi Marilynne,
I’m afraid I
am not familiar with billing for CLeg repairs. I did some research but the
only thing I could find was that if the CLeg was medically necessary the
repairs should be covered. I will post the question on my site and maybe
someone out there will be able to send a response.
Is there anyone reading this
familiar with this problem? We would greatly appreciate your help with
this one.
Sorry I wasn’t able to help.
Michele
We received this email Jan
23, 2008
We billed Medicare for repairs for one
of our patients that has a C-Leg. We billed about $8000 for the repairs
and Medicare only allowed around $600. We appealed the claim all the way
to an ALJ Hearing level. At the hearing level the decision was favorable,
but we are still waiting for payment and the repairs were done over a year
ago. We have found that if the C-Leg is out of warranty it is easier to
get Medicare to pay to replace it then to pay to repair it.
Jane
Thanks Jane
Question for Ask the Biller:
November14, 2007
How do you complete the HCFA 1500 form
when using a Locum Tenen?
Response from Ask the Biller:
Hi,
You should be using the
locum tenen’s individual NPI & legacy numbers in box 24 J, and their
name in box 31. Then the group name address and GROUP npi in box 32 &
33.
Thanks
Michele
Question for Ask the Biller:
November 12, 2007
I am having trouble sending sec electronic claims—I
continue to get two error messages—Please help
1.
Line adjudication date invalid
2.paid amt does not
match service line amt
I use Medisoft v.11 I
submit through Availity's Clearinghouse. Medicare is requiring that I
submit sec claims electronically and I can't get the errors figured out.
Thank you,
Kelly
Response from Ask the Biller:
Hi Kelly,
I had a similar
problem and I use Lytec (very similar to Medisoft). Are you using claim
manager to submit? I think the problem is that when you enter the primary
payment you need to enter it on each line item, not just as one payment on
the entire claim. For example, in Lytec I usually enter payment for the
claim as an IP (insurance payment) on a new line on the claim, but if I am
submitting the claim to Medicare as a 2ndary, then I have to hit F5 on
each line item and enter the payment for each service separately. I’m not
quite sure how to do that on Medisoft, but it is the same error that I
received. But if you are using Claim Manager you can send an email to
support@sendclaim.com and they will help you with all the errors. If you
use something else then you should contact your support. They will be able
to help you.
Thanks and Good Luck!
Michele
Question for Ask the Biller:
November 6, 2007
What procedure code would I use, since
we are not the MCP, but we are following the pt care while they are on
vacation? I have conflicting information one document says to use the
90999 x units, the other says to use the G0327 which states for home
dialysis but pt is @ outpatient dialysis center.
Thank you
Beverly
Response from Ask the Biller:
Hi I wouldn’t recommend using the 90999 since it is
not a reimbursable code. I would use the G0327 with an appropriate place
of service code to indicate outpatient dialysis center and use the
facility address in box 32.
Michele
Question for Ask the Biller:
November 7, 2007
Hi,
If a physician is like
Dr. J. Y. Park, P.C.
does that dr need a group NPI
and an Individual NPI?
She says Medicare has
started denying her claims because she didn't have a group NPI.
She is the only dr in the practice. I have 3 other
drs who are the only dr in their practice they all have one individual
NPI. Are they all going to have this problem?
Cathy
Thanks a lot
Response from Ask the Biller:
Hi Cathy,
If the Dr is a
professional corporation (PC) then yes, she does need a group NPI as well
as an individual NPI even if she is the only dr in the PC.
Thanks
Michele
Question for Ask the Biller:
November 6, 2007
Hi Alice,
We
have reason to believe that the IPA that we are participating with is not
accurately reimbursing our practice.
We believe we
found the Medicare fee schedule for our locality at
http://www.medicarenhic.com/cal_prov/fees/2007revfee2_area18.pdf;
however, the IPA says we are contracted at 100% of the RVRBS fee schedule.
We are wondering if this is the same fee schedule as the Medicare fee
schedule for our locality or not. Where can we find an online copy of the
RVRBS fee schedule to verify our reimbursements?
Thank you again!
Denise
Response from Ask the Biller:
Hi Denise,
I'm not sure what
IPA stands for, but I know that we have local insurance carriers that
calculate their allowed amounts based on a formula that includes the
RVRBS. It is not the exact fee schedule that Medicare allows but it is
calculated based on the Medicare fee schedule. I suspect this is the same
thing. I would suggest asking the IPA exactly how they calculate their
allowed amounts. They should be able to tell you the formula.
I hope that helps.
Michele
Question for Ask the Biller:
November 6, 2007
Hi,
How would I
bill Florida Medicare for ESRD related care for a transient pt visiting
Florida for less than a month? Is the 90999 code still applicable?
Beverly
Response from Ask the Biller:
Hi Beverly,
If the patient is
Medicare eligible, you would just bill for the ESRD the same as you would
any other Medicare patient. It wouldn’t matter if the pt were transient,
or how long the patient was in Florida.
Michele
Question for Ask the Biller:
November 2, 2007
My name is
Julie and I am billing for family practices. How can we bill for a pap
smear to private insurances. The doctor is billing a 99214 and did a pap
and has 2 other diag's for other things but it was not a well exam. I have
used the S0610/12 codes and they were paying then stopped paying. I am
using the V72.31 also. Even if it was a well exam it seems that the Dr.
should get paid for the pap smear because of the time involved.
So just want to know certain codes to bill.
Thanks for your help and I am glad I found your
website, you have great info.
Julie
Response from Ask the Biller:
Hi Julie,
If you are billing
for a pap smear to private insurances you should try billing with cpt code
88164. Whether the dr is doing a well exam or a medical visit, the pap
should be billed out separately.
Thanks
Michele
Question for Ask the Biller:
October 24, 2007
What is the ID
qualifier for other payer name? What is the PIN and ID qualifier in the
Referring Dr Tab, needed to be? Is there a list of these ID Qualifiers I
can print and if so do they explain where they are required to be for
claim processing electronically? I use Medisoft version 12
Sincerely
Nellie
Response from Ask the Biller:
Hi Nellie – Here's a link to my blog where the are
listed. You will find them there. Thanks for subscribing to our
newsletter.
http://solutions-medicalbilling.blogspot.com/2007/10/qualifiers-for-medisoft.html
Alice
Question for Ask the Biller:
October 19, 2007
For Physical
Therapy Home Care to a No-Fault Patient in New York, I was told that the
reimbursement is 50% greater than service in an office setting. Do you
agree with that, and do you have supporting documentation?
Artie
Response from Ask the Biller:
Hi Artie,
I don't have any
supporting documentation, but I do not agree that the reimbursement is 50%
higher. I have billed for some services provided in the home in the past
and the reimbursement is greater, but not by 50%. I will soon be billing
for PT in the home but at this time I'm not. Make sure you indicate that
the services were in the home by using the 12 place of service code and
bill your regular fees so that you are allowed the difference.
Good luck
Michele
Question for Ask the Biller:
October 17, 2007
Dear Biller,
I'm a dermatologist in NYC and I'd like to run a
two-part undercoding question past you: Can you bill for an
office/outpatient surgical excision (11401) and complex closure (11301)
without billing for the office visit (99202); and if so, will the
commercial carrier reimbursement be higher for the above two surgical
procedures (when excluding the office visit)?GC
Response from Ask the Biller:
Hi Gil,
Thanks for the
question. Yes, you can bill for just the 2 surgical procedures without
billing for an office visit. There is no rule that you MUST bill for the
office visit, even if it is the first time you're seeing the patient. In
answer to your second part of the question, not billing the office visit
should not increase the reimbursement for the 2 surgical codes. Each
insurance carrier allows a certain fee for each CPT code. Office Visits do
not change the fee. I would think you would be reimbursed more if you did
bill the office visit code with a 25 modifier. This way they would allow
the fee schedule for the office visit and for the 2 surgical
procedures.
Michele
Thanks for
your quick and helpful response. Your reply confirmed my general thinking
on this subject, and I appreciate your succinct and clear explanation.
With much appreciation,
Gil
Question for Ask the Biller:
August 16, 2007
Hello,
I am a
Cardiologist Recruiter for Alliance Recruiting and have a client in FL who
wants to utilize locum tenens. We have a Cardiologist who is available for
a locum to perm position from Sept 3 – Dec 21. This physician is not
covering for vacancy or vacation. The Cardiology group is recruiting for a
permanent Cardiologist but are going to have the physician start off as
locum tenens to see if it is a good fit for the practice.
The client is concerned that they will not be able
bill Medicare for the locum docs procedures after 60 days. She says FL
Medicare is strict with locum tenens and cannot bill beyond 60 days. Is
this correct? Surely there are other groups/hospitals who have used locums
for MD’s longer than 60 days.
Please let me
know
Thanks,
Jessica
Response from Ask the Biller:
Hi Jessica,
Michele did some
research but she didn't come up with any more than you did. Being that
we’re from NY and this is a Fl rule, we haven’t had any experience with
it. I'll put it up on our “Ask the Biller” page and see if someone else
can help you. It sounds as if the break in assignment would work, but we
really don't know.
Good luck.
Alice
How about it? Has anyone had any experience with
this? Please reply and I'll let Jessica know. Thanks
Question for Ask the Biller:
August 12, 2007
Hello!
I
graduated from Penn Foster School this past November in Electronic Billing
and Coding. I 've been keeping up with coding news by reading AAPC
magazine. Should I be coding now from the ICD-10-CM manual? Why is all the
advertising sells ICD-9-CM still but not the other manual? I'm really
confused.
Also can you help me find somebody
that's actually coding from home?
Thank you!
Walter
Response from Ask the Biller:
Hi Walter,
We've been hearing
about the ICD-10 for a long time, but we haven't seen it yet. We are still
using ICD9s and haven't heard about an actual date for the use of the
ICD-10 yet.
Are you signed up for our newsletter?
In the August issue I just sent out last week, I write about where to find
current ICD9 codes with a link to a website where you can look them up
free of charge. We've had very good luck with that website.
We're in the process of
making our “Ask the Biller” page more interactive so when I put up your
question, I'll ask if anyone who codes from home is willing to contact
you.
If I hear any more about the ICD-10s I'll
contact you.
Alice
So is
there anyone out there who does coding at home and would like to contact
Walter, send me an email and I'll send it on to Walter.
Question for Ask the Biller:
August 5, 2007
Hello,
I did
not understand in what way the SOCIAL WORKERS AND MARRIAGE COUNSELORS are
related to claim a medical bill.
Why they do need
a NPI# ? Please let me know in what way they treat a patient and claim for
reimbursement.
Thanking you
Jagdish
Response from Ask the Biller:
Hi,
Thanks for your
question.
Many social workers and/or marriage
counselors can bill insurance companies for their services. It depends on
the insurance company if they reimburse for the services or not. A
counselor can contact the insurance companies to see if they credential
the type of counselor they are or not. Most insurance companies will
credential LCSW's. Some will credential marriage counselors.
If a social worker, or a marriage counselor bills
insurance companies for their services then they need an NPI number.
Hope that is helpful.
Thanks
Michele
June 27, 2007
Hello Alice,
We
are an ancillary network provider, and we only coordinate the care,
services, and supplies for workman's compensation. Are we required to have
an NPI?
Thank you,
Melinda
Response from Ask the Biller:
Hi Melinda,
This is one of
those gray areas. If you call the NPI enumerator they wouldn’t even be
able to tell you. The law states that all Medical Services Providers must
have one. You don’t get reimbursed by health plans but you may need one to
coordinate the care.
Bottom line, they are free
and you are probably better safe than sorry. If I were you, I would do the
application. Worse case, you will get an NPI number assigned, but never
use it. Doesn’t sound too bad!
Good Luck
Michele
Question for Ask the Biller:
June 18, 2007
Hi Alice,
Would
you know when the UB04 form must be used in place of the UB92?
Thanks, Nancy O.
Response from Ask the Biller:
Hi Nancy,
Good to hear from
you.
Yes – effective May 23, 2007 you should be
submitting the UB04 form. There was no extension granted as far as we
know.
Alice
Question for Ask the Biller:
June 18, 2007
Do you know what is required for fields
32b and 33a on the new 1500 forms for uhc and acm and also Tricare.
thanks
Betty
Response from Ask the Biller:
Hi Betty,
Box 32b should be
the group’s insurance PIN number. If you do not have a group PIN number,
then you should use the rendering provider’s PIN number. Box 33a should be
the group’s NPI number (Type II NPI). If you do not have a group NPI
number, then you should use the rendering provider's NPI number. Bottom
line, for most insurance carriers, payment is going to be made to
whomever's NPI number is in box 33a. These rules should be the same for
UHC, Tricare, and ACM.
Thanks
Michele
Question for Ask the Biller:
June 8, 2007
Hello there,
Quick question. We perform retrospective work for
clients and submit corrected claims on their behalf. Since we review
claims 10 months prior to the May 23rd conversion date of the UB04, do you
know if payer(s) would require us to use the NPI number on older claims
that were originally billed under the UB92?
Thank
you
Jim B
Response from Ask the Biller:
Hi Jim,
Yes, the NPI number
is required on all claims after May 23 even if they have dates of service
prior to the May 23 date. Some companies will not deny these claims as all
are not yet on board with the NPI's. It would be best to be submitting
them with the NPI's now.
Alice
Question for Ask the Biller:
May 16, 2007
Is there a website or resource that you
can purchase guides regarding billing services for certain practices such
as psychiatry? I bill for speech and audiology services and they have an
excellent website I can access for information. I have started doing
medical billing at night as a second income. My daytime job is billing and
insurance for a speech clinic. There may be different specialties I will
be billing for and would love to have something to reference such as a
book or a website.
Thanks,
Stephanie
Response from Ask the Biller:
Hi Stephanie
Not that we are aware of. We will soon be releasing
videos and ebooks of billing for specialties. We’re starting with specific
instructions on completing a CMS 1500 form correctly and completely. Next
we will do specialties starting with mental health, vision, chiropractic,
physical therapy, and family practice. This might be something you would
be interested in. Hope to have the first ready by the beginning of June.
Let me know if you would be interested.
Alice
Guess
What!!
Our Ask the Biller
page got out of control. It's too big. We had to archive some of it. To
read questions and responses from July 25, 2005 to May 15, 2006 go to the
"Ask the Biller Archives".
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billing works in simple terms anyone can understand. For more information.
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Alice and
Michele
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Solutions Medical Billing
Inc. offers a
consultation service
for more involved problems with
medical insurance billing. If you have a problem with
your medical insurance billing you would like us to handle, you can
reach Michele or Alice at
1-800-490-4299.
Call for pricing.
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Solutions
Medical Billing Inc. offers a
consultation
service
for more
involved problems with medical insurance billing. If you
have a problem with your medical insurance billing you would like us
to handle, you can reach Michele or Alice at
1-800-490-4299.
Call for
pricing.
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Solutions Medical Billing Inc. 
