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Coding / Breast Pumps
« Last post by isanino23 on Today at 01:48:02 PM »
Hello, 

Does anyone have experience with breast pump DME billing/coding?

Thanks,
Ivana
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Coding / Re: billing 2 body parts on the same day
« Last post by PMRNC on April 18, 2018, 02:06:13 PM »
Quote
If it is the NP, I could give you some advise. However, an expert consultancy is still mandatory. Here how it goes. If you are visiting for NP for two different reasons and that too, on the same day; Modifier 25 could be your best shot. You will be asked for NOPs that falls in the same tax ID. Hope this helps.


HUH?  She said PT not NP. Michele had the better advise based on this specialty. I'd just ask that it's best to "inconvenience" the patient once you tell them their insurance may  not cover both on the same day, better to be inconveninced with time rather than a large bill :)
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Coding / Re: billing 2 body parts on the same day
« Last post by BikhamHCare on April 17, 2018, 03:13:29 PM »
If it is the NP, I could give you some advise. However, an expert consultancy is still mandatory. Here how it goes. If you are visiting for NP for two different reasons and that too, on the same day; Modifier 25 could be your best shot. You will be asked for NOPs that falls in the same tax ID. Hope this helps.
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Coding / Re: Medicare Reimbursement for 64555-SG, Surgical procedure
« Last post by BikhamHCare on April 17, 2018, 03:11:32 PM »
What it seems to me, the claim is meant to be processed by your Insurance Company. Even though, standard charges for the procedure fluctuates from State to State – it is advised to better consult your Insurance provider. In majority of the cases received charges are listed along with, “what can be paid and what is to be denied”. Google doesn't seem to help much in providing the prominent solution to your query, it would be advised if you could go look for an offline expert advise for 64555-SG.
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Billing / Re: Is this legal?
« Last post by Christy on April 17, 2018, 01:01:43 PM »
I appreciate your in SIGHT  (ha ha), Linda!  ;D
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Billing / Re: Is this legal?
« Last post by PMRNC on April 16, 2018, 12:33:58 PM »
MY personal knowledge of eye care is only from procesing claims and having been to eye doctors and have separate vision plan myself.

Where I go they don't routinely do the pressure test unless you schecule for it and unless there is suspect for certain conditions like glaucuma. When I schedule my visit they always ask me first. My own plan will pick up the IOP for suspect either on day or another day. So no, I don't think the doc is doing anything wrong UNLESs he's not using the proper E/M and of course the patient's benefits and coverage should be taken into consideration.
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Billing / Re: Is this legal?
« Last post by Christy on April 16, 2018, 11:48:32 AM »
thank you, Michele.

In my case, I get a comprehensive eye exam under my insurance once every 2 years at no charge as a preventative exam.

because the doctor's office seems to be unbundling the eye pressure exam, I have to come back on a separate date which is an inconvenience, and I also will have to pay out of pocket for the service (I have a large deductible.) My feeling is that they should do the entire eye exam on one day and if they don't like the payer policy then consider ending the in network agreement with them.

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NPI Numbers / Re: Unlicensed Clinicians billing under a supervisor
« Last post by Michele on April 16, 2018, 10:07:23 AM »
I work for an EHR for Mental Health provides. There is a lot of confusion in the organization that I work for about NPI's. So I have a few questions.

1. Do you need to be licensed to get an NPI

Not all specialties require a license to obtain an NPI.  However some do.  You didn't mention what types of providers these are (other than mental health).  Are they LPCs, LCSWs, PhDs?

2. If you are unlicensed, can you bill under the supervisors NPI? If so, where does that info go on the claim?

This is not in my scope.  However, I believe that while a provider is still working towards getting their license their services are billed under the supervising provider's NPI.


3. If you are licensed, and billing electronically, you must have your own individual NPI correct? even if you are billing with a group NPI in box 33b?

Thanks!!!!

There must be a rendering provider (individual) NPI showing who performed the services even when billing under a group NPI.


Hope that helps!

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Billing / Re: Is this legal?
« Last post by Michele on April 16, 2018, 09:29:31 AM »
I don't believe they are doing anything illegal.  We actually have providers that have similar scenarios.  When services are not covered separately if performed on the same day the provider can advise the patient that they must come in on separate days.  We have providers that don't like to do this because it is an inconvenience to the patient, but they have no choice.  In many cases (at least what we see) they are two very distinct services, but for whatever reason insurance doesn't allow them separately on the same day.

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NPI Numbers / Unlicensed Clinicians billing under a supervisor
« Last post by Brookeyz on April 13, 2018, 12:58:35 PM »
I work for an EHR for Mental Health provides. There is a lot of confusion in the organization that I work for about NPI's. So I have a few questions.

1. Do you need to be licensed to get an NPI

2. If you are unlicensed, can you bill under the supervisors NPI? If so, where does that info go on the claim?

3. If you are licensed, and billing electronically, you must have your own individual NPI correct? even if you are billing with a group NPI in box 33b?

Thanks!!!!
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