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21
Coding / 90460/90461
« Last post by jenniferp on June 06, 2018, 03:18:32 PM »
Good afternoon all --

I have a question about 90460 & 90461.  If we have a patient that comes in and gets multiple vaccinations (ex. MMR, DTaP, Pneumonia and Hepatitis A), is there a limit on how many times the 90461 can be billed per date of service?

One of our coders is saying to bill the 90460 four (4) times w/necessary modifiers because the description states it's for the first component of a vaccination.  Then bill the 90461 four (4) times for the remaining vaccines.  I'm new to primary care billing and want to be sure.

Possible billing example #1 (in addition to an E/M code)
90460  (measles)
90461-59 (mumps)
90461-59 (rubella)

90460-76  (diphtheria)
90461-59-76 (tetanus)
90461-59-76  (pertussis)

90460-76 (pneumonia)

90460-76 (hepatitis)

I am grateful for ANY input on this.

Thanks!!
Jennifer :)
22
Coding / Re: J3880 admin code
« Last post by Michele on May 31, 2018, 08:26:51 AM »
96413 is a valid covered Medicare procedure code and is for the administration of chemotherapy, intravenous infusion technique.  So if that is what you are doing my next question would be are you getting this denial with any other carriers?   If you are only getting this denial with UHC they may have a separate code that they require is used for reporting this service.  Or the denial may be a mistake on their end.  If UHC is the only carrier denying that code then I would start by contacting them and asking them to explain the denial. 

23
General Questions / Re: CPT 80307
« Last post by Ruthie1972 on May 31, 2018, 07:48:58 AM »
hi Michele,
Thank you so much .I thought it was 80307 as well due to the fact that it can not be read instantly, like a POC cup or dipstick. I appreciate your feedback.
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General Questions / Re: CPT 80307
« Last post by Michele on May 31, 2018, 07:42:05 AM »
80306  -  Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or
procedures, (e.g., immunoassay) read by instrumented assisted direct optical observation (e.g., dipstick, cups, cards,
cartridges) includes sample validation when performed, per date of service (maps to 80300 or G0478).

80307  -  Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or
procedures, by instrument chemistry and analyzers (e.g., utilizing immunoassay [EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]),
chromatography (e.g., GC, HPLC), and mass spectrometry either with or without chromatography, (DAT, DESI, GC-MS,
GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
(maps to 80301, 80302, 80303, 80304 and G0479).

You didn't give any specifics so it would be impossible to tell which code would be appropriate.  When I research hair testing the 80307 seems to come up the most.  You might want to check with the supplier you get your kits from.  They usually can provide information on appropriate cpt codes.
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Coding / Re: Hair testing
« Last post by Michele on May 31, 2018, 07:39:33 AM »
You didn't state any specifics as to what you are testing for or how many things are being tested. 

The cpt code 80307 states "Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or
procedures, by instrument chemistry and analyzers (e.g., utilizing immunoassay [EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]),
chromatography (e.g., GC, HPLC), and mass spectrometry either with or without chromatography, (DAT, DESI, GC-MS,
GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service"

When I research hair testing the 80307 seems to come as the most appropriate code.






26
Coding / J3880 admin code
« Last post by sls on May 30, 2018, 08:17:41 AM »
Does anyone know what the correct admin code for Pa Medicare for procedure J3880.  We used 96413 but that denied stating invalid procedure.  Insurance we billed is United Healthcare Medicare. And can you tell me where or if there is documentation.  Thanks
27
General Questions / CPT 80307
« Last post by Ruthie1972 on May 29, 2018, 09:51:31 AM »
Good Morning,
Is is possible to let me know of the correct CPT code for hair testing, is it 80307 or 80306?
thank you.

Ruth
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Coding / Hair testing
« Last post by Ruthie1972 on May 29, 2018, 08:23:11 AM »
Hello,
Can you please let me know what the CPT code for Hair testing is it 80307.
29
Coding / Re: Delay Suture of Tendon
« Last post by nli on May 24, 2018, 12:50:23 PM »
Thank you for the insight. I am doing some historical work with codes from the practice.

Essentially is there any guidance on how much time is allowed for one to bill "delay suture of tendon" - - does anyone have a reference for this?


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Coding / Re: Delay Suture of Tendon
« Last post by Michele on May 24, 2018, 08:01:38 AM »
The 83.62 seems to be more specific and matches what you have described.  It doesn't mention time of the delay, just "delay suture of tendon"  But I'm confused as to why you are using ICD9, instead of ICD10.
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