Erica

About

Username
Erica
Joined
Visits
3
Last Active
Roles
Member, Part B
Last Name
Schwalm
Job Title
Coding & Reimbursement Coordinator
First Name
Erica

Comments

  • What CMS guidelines? There are 0 work RVUs. It is fine to bill if performed by an MA.
  • Found my answer. From NGS Medicare: What is the correct way to report critical care when the continuous critical care time crosses midnight into the next calendar date? Example: 120 minutes of critical care, start time 11:00 pm on day 1 and cont…
  • You want to use the subsequent observation codes if you are not the provider who admitted patient to observation. Only the admitting physician can bill initial obs codes (which differs from initial inpatient codes). If it's the rare the payor who…
  • G0372 is the code that I know of. "Physician service required to establish and document the need for a power mobility device" Check into the coverage of this. I don't know if Physical Therapists can bill for this service or not. https://www.c…
  • Disagree about different diagnoses. First, the official ICD-10 coding guidelines state do not code symptoms once a definitive diagnosis is made and second, use of different diagnoses is not required to use modifier -25. “Significant, separately …
  • Okay I think I found my answer — Medicare says that for vaccines direct supervision is not required but does state that State laws vary.. so my interpretation is if the State Scope of Practice Laws require on-site supervision, that supersedes the M…
  • Thanks.. I just found this from UHC. Have you ever used -KP or -KQ modifiers?? https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Claims & Payments/NDC_FAQ_Final_Word.p…
  • What is the name brand of the flu vaccine you purchased? http://www.immunize.org/catg.d/p4072.pdf
    in FLU VAC Comment by Erica March 2017
  • Location - carotid artery Context - found on eval to have bruit, sent for US Severity - 16-49% Assoc. Signs/Symptoms - pt denies....
  • Only if both codes have an indicator of 2 in the mult proc column on the RVU file would the 50% reduction apply.
  • Ah! Okay great thanks... as long as I'm not crazy. Haha I'll keep checking back and if I find it, I will share. Thanks! Erica, At the AMA CPT symposium in November in Chicago they simply stated the affected codes will be on the CMS "soon".…
  • That's prior to the final rule. -----Original Message----- From: Keri Yarbrough [mailto:Keri.Yarbrough@identitymso.com] Sent: Monday, December 19, 2016 11:19 AM To: Multiple recipients of list PARTB-L Subject: RE: RE:[partb-l] Reporting post-op…
  • I do understand the rule, that’s not what I’m asking. I want to know which codes will require the mandatory reporting of 99024. “Reporting will be required only for services related to codes reported annually by more than 100 practitioners and th…
  • Can you please send me a link to the list? I haven't been able to find it. Thanks -----Original Message----- From: Maxine Lewis [mailto:MLewis@scrogginsgrear.com] Sent: Monday, December 19, 2016 10:59 AM To: Multiple recipients of list PARTB-L …
  • The table(s) in the CPT manual ARE CPT guidelines.
  • Ah ha! Yes! Thank you bunches
  • “A frequent question Medicare receives is whether or not an assistant surgeon must sign the operative report. The answer is no. The primary surgeon must document, with specificity, the activities the assistant surgeon performed and that the addition…
  • Yes I agree the MDM is High on this one.
  • I would say moderate unless your physician documented identified risk factor(s) other than those inherent to the procedure. Not all planned surgeries equal high risk. Whether the surgery is scheduled or not is irrelevant in my opinion. It’s th…
  • So that means we need to deal with 3-6 months of denials and then bring them to their attention to reprocess? That seems ridiculous doesn't it? From: Pat Schmitter CPC CPC-I [mailto:pbnjna@sbcglobal.net] Sent: Sunday, October 23, 2016 11:15 …
  • Not yet but their 10.1.16 update to the lab manual did not include this new code. Still has R97.2 listed. That’s not good. Second error I found this week. They never added new code pre-diabetes to the covered list for the A1c. I posted about…
  • Well I found an e-mail address and sent this to CMS; we'll see if they actually respond. From: Erica Schwalm Sent: Thursday, October 20, 2016 3:57 PM To: 'CAG_Lab_NCD@cms.hhs.gov' Subject: Question regarding CPT 83036 Importance: High Dear CMS…
  • Most often it is Z71.89 - other specified counseling. This is used in our travel clinic mainly. Patients traveling overseas are counseled on how to avoid travel associated diarrhea and other infectious diseases. Sometimes the OB/GYN office uses…
  • Yes I’ve been billing preventive counseling for years. I find that most commercial plans cover this. Medicare/MA plans do not and MassHealth (Medicaid) does not.
  • No, these are time based codes so the time spent and nature of counseling must be documented.
  • Medicare will pay with the appropriate code pair. You need one of the primary dx codes for nicotine dependence and a secondary dx code. To get the list, go to the NCD at the link below. In the Revision history, download the zip file called TN 119…
  • MDs also https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1672OTN.pdf