Procedure code 19081, 19083 - Biopsy of Breast
procedure code and description19081 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed,...
View ArticleMonitoring Claims Submission Violations
A. GeneralSection 1848(g)(4) of the Social Security Act requires physicians and suppliers to submit claims to Medicare carriers for services furnished on or after September 1, 1990. It also prohibits...
View ArticleDOS reporting for pre-operative test
Outpatient Hospital RequirementsOutlined below are generally accepted billing guidelines.Submit one bill to Florida Blue for: All services provided on the day or within 72 hours, unless otherwise...
View ArticleBilling CPT 90281 Immune Globulin
Coding for Immune Globulins, Vaccines and ToxoidsCPT-Codes (Current Procedural Terminology) are assigned by the AMA and used to bill for Immune Globulins, Vaccines and Toxoids.• Immune Globulins:...
View ArticleCPT code G0248, G0249, G0250 - Demonstrate use home
HCPCS for CarriersFor services furnished on or after July 1, 2002, and prior to March 19, 2008, the applicable HCPCS codes for this benefit are:G0248: Demonstration, at initial use, of home INR...
View ArticleCPT 43775, 43644 - Laparoscopy Bariatric Surgery
Covered HCPCS Procedure CodesFor services on or after February 21, 2006, the following HCPCS procedure codes are covered for bariatric surgery:43770 - Laparoscopy, surgical, gastric restrictive...
View ArticleSkilled Nursing Facilities - Revenue code 0551, 0552
Revenue Codes• Skilled Nursingo 0551 – visit chargeo 0552 - hourly• Indicate “21X”, “22X” or “23X” in type of bill field, which is field 4 for paper claims.o First digit – Type of facility (2)o Second...
View ArticleCPT CODE 92285 AND COVERED ICD code
Coverage Indications, Limitations, and/or Medical NecessityExternal ocular photography is a non-invasive procedure used to photo-document conditions of the external structures of the eye (e.g.,...
View ArticleInpatient Hospital Requirements - DRG and Per Diem concept
Inpatient services are generally reimbursed based on one of the following:• DRG, or• Per DiemOutlined below are generally accepted billing guidelines. This is intended to be illustrative and is not an...
View ArticleOutpatient Therapy Services for Skilled Nursing - Revenue code 0420, 0430
Outpatient therapy can be billed for occupational, physical and speech therapy rendered within the SNF.• The individual therapist providing physical, occupational or speech therapies may not bill...
View ArticleCPT code Percutaneous transcatheter 92928, 92941 AND c9600
Billing for Intracoronary Stent PlacementSince CY 2003, under the OPPS, we assign coronary stent placement procedures to separate APCs based on the use of nondrug-eluting or drug-eluting stents (APC...
View ArticleCPT units reporting and calculation for timed procedure
Reporting of Service Units With HCPCSA. GeneralEffective with claims submitted on or after April 1, 1998, providers billing on the ASC X12 837 institutional claim format or Form CMS-1450 were required...
View ArticleChronic Illness and Critical Care: WITH example
Examples of patients whose medical condition may not warrant critical care services:1. Daily management of a patient on chronic ventilator therapy does not meet the criteria for critical care unless...
View ArticleCritical Care Services and Full Attention of the Physician
The duration of critical care services to be reported is the time the physician spent evaluating, providing care and managing the critically ill or injured patient's care. That time must be spent at...
View ArticleHours and Days of Critical Care that May Be Billed
Critical care service is a time-based service provided on an hourly or fraction of an hour basis. Payment should not be restricted to a fixed number of hours, a fixed number of physicians, or a fixed...
View ArticleHealthcare provider taxonomy code set update
BackgroundThe Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that covered entities use the standards adopted under this law for lectronically transmitting certain health...
View ArticleMedicaid Vaccine and Immunization CPT code list
Pediatric Flu Vaccine: Special Situations In the event a Medicaid provider does not have VFC pediatric influenza vaccine on hand tovaccinate a high priority VFC eligible Medicaid enrolled child, the...
View ArticlePsychiatric and Substance Abuse Facilities
The information in this section pertains to members with PPO (BlueChoice, BlueMedicare PPO, and BlueOptions) and Traditional coverage.Note: All behavioral health services for HMO members should be...
View ArticleLocum Tenens payment Guidelines with example
Physician Payment Under Locum Tenens Arrangements - Claims Submitted to CarriersA. BackgroundIt is a longstanding and widespread practice for physicians to retain substitute physicians to take over...
View ArticleFunction-related G-codes G8978, g9186 ,g9158
E. Function-related G-codesThere are 42 functional G-codes, 14 sets of three codes each. Six of the G-code sets are generally for PT and OT functional limitations and eight sets of G-codes are for SLP...
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