Author Topic: Special Services that do not have a procedure code  (Read 1337 times)

maria020984

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Special Services that do not have a procedure code
« on: July 04, 2008, 11:08:57 AM »
Let me first start out off with, I am new to medical billing and I enjoy it, and I love this site!!!
I just started medical billing in our office and found a lot of problems. I was trying to figure out another resource I can have so I may get some feedback fr experience billers. I thought to my self, there has to be a forum about medical billing because it is universal and sometimes can be a pain, I was sure that a lot of people feel the way I do, wanting to find out how to do it right and just learning how to work around insurance.

kuddos to the people that started this web site!!!

my problem:

I'm new and have little guide to medical billing. I did however take a course that taught me the basics.

my doctor specializes in Developmental Optometry (not very popular) and has his own private practice. My doctor helps kids with vision problems, vision therapy services to kids that need it , some medical eye problems and routine vision.  He has not had a real medical Biller.
So there are no guidelines of what codes to use for the services that we provide. and If we should bring patients back for the testing  because he does routine vision exams and does the additional testing (which is often coded with and EM code (99), which we should not be doing . He also uses the same procedure codes for different services with different prices. My goal is to set a standard for our services and bill accordingly to benefit the patient and our office.
This is hard because I do not have alot of resources nor do i know anyone that bills for a developmental optometrist. 
My question is are there such a procedure codes that  can be used that will indicate that some of our services has no procedure code? and if so, how can we help patients get paid on it and how can we avoid insurance writing off our services.
2nd.
accepting assignment vs not accepting assignment.

accepting assignment means that we are accepting insurance allowed amount. we do this when we are providers.

when we do not accept assignment does this mean that payment will go to patient if patient paid us privately?
Do we have to put the amount paid on the cms? Because i was told not to because it confuses the person looking at the cms.

 ???

Michele

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Re: Special Services that do not have a procedure code
« Reply #1 on: July 10, 2008, 09:37:01 AM »
Hi,
   Glad you like the forum.  My mother and I started it for exactly the reason that you went looking for it.  When we started billing, about 15 years ago, we had trouble finding any resources.  Many billing services tend to be competitive, but we feel we can all do well and help each other out along the way. 

Now, to the easy part of your question, accepting assignment.  If you are par with an insurance company then you automatically accept assignment.  If you are not par, you can choose to accept assignment on certain claims.  In most cases, if you are par payment will go directly to you, if you are non par payment goes to the patient.  Some insurance carriers allow you to accept assignment when you are non par and then they will send payment directly to you.  Some still send the payment to the patient. 

If you want to ensure that payment goes to the patient, I would recommend not putting 'signature on file' in box 13.  I also have been told not to include the paid amount on the cms but if you want payment to go to the patient it probably wouldn't hurt you. 

Basically, if you are non par, you don't accept assignment, and you leave box 13 blank, payment should go to the patient.

Now for the harder part of the question, billing for vision therapy.

There is an unlisted code, 92499, but it will always require additional documentation.  Insurance carriers don't pay on unlisted codes without knowing what the service was, and then they usually change it to a 'more appropriate code'. 

I did a little research and found that some drs code vision therapy as cpt 92065.  I'm not sure if that is appropriate for what your dr is doing.  I also noted some bill using 99070, but that is for an unlisted supply.  I would use the 92499 before the 99070.

Is your dr an OD?  I'm not aware of OD's not being allowed to bill the E&M codes (99201-99215). 

Anyway I hope this is helpful.

Thanks and Good Luck
Michele
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