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01/28/2019
Question: Can an ICD-10-CM body mass index (BMI) code be used as a standalone code? If not, what documentation should we look for to justify the use of a BMI code?
01/28/2019
Question: How can I identify a suspended claim? Is there anything that can be done to move a suspended claim forward?
01/14/2019
Question: The orthopedic surgeon performed a total shoulder arthroplasty to treat a fracture (code 23472) and in the same encounter, did an open treatment of a proximal humeral fracture (23615) and a biceps tenodesis (23430). Yet codes 23615 and 23430 are bundled as components of 23472 by National Correct Coding Initiative (CCI) edits.This is leading some at our practice to wonder whether it would be better to just submit the fracture reduction and tenodesis codes and skip billing for the arthrodesis. What is the correct response?
 
01/14/2019
Question: We have a commercial payer that dropped a sudden rate change on us with no notice; we only found out via a paid claim. The payer says it notified us of the change 30 days before the date by which we had to approve it, but we never received any notice at all. How can the payer expect to get away with this? 
10/22/2018

Question: A nurse practitioner told a patient to return after an office visit if his chest pain worsened, and the provider ordered a nuclear stress test to take place the next day. Can my provider count the plan for the stress test in the medical decision-making for the previous encounter, even if the diagnosis isn’t made until eight days after the face-to-face encounter?

10/22/2018

Question: All of a sudden, I am getting denials from everyone for billing 99214-25 with 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). Guidelines say billing the codes together is appropriate unless there is a recent change. Is anyone else seeing denials? Before this month, my claims were going through fine.

10/22/2018

Question: What do you know about payments for Zilretta injections? Anything specific that we need to know about billing?

08/20/2018

Question: I’m having a challenge with same-day billing. Here’s my situation: The doctor performs an injection with fluoroscopy at the hospital in the morning and then the patient comes to the office for a follow-up on the same day. The doctor would like to bill both services, but I feel like I’m double-dipping. Can I report both? Any help would be great!

08/20/2018

Question: A patient who steppad and cut herself on a piece of glass months earlier still complained of pain in the area, though the wound was healed. A CT scan showed increased density in the subcutaneous fat on the plantar aspect. Surgery revealed a large, thick, deep callus extending through the dermis down to the subcutaneous tissue and extensive scar tissue. These were excised but no foreign object was found. We’re using 28192 (Removal of foreign body, foot; deep) but is that correct — seeing as we didn’t actually find a foreign body?

07/09/2018
Question: How do I bill if a patient comes in and asks for help quitting e-cigarettes -- that is, vaping? The patient does not smoke regular cigarettes or any other traditional tobacco products; in fact, he says vaping helped him quit cigarettes.

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