Author Topic: 1 or more sessions Help!  (Read 1270 times)

Michelle1965

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1 or more sessions Help!
« on: September 02, 2014, 07:01:00 PM »
Procedure code 67145 clearly states that it includes 1 or more sessions which also includes separate encounters during a defined treatment period.  My provider is wanting to bill this out again for the same eye with a modifier 76, and I know I can't do that. >:(  I mean the description is pretty self explanatory.  Is there anything else I can give my provider to read that states a modifier can't be used with this if its for the same eye during the global period.  Any suggestions would be greatly appreciated.  :)

PMRNC

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Re: 1 or more sessions Help!
« Reply #1 on: September 03, 2014, 09:47:56 AM »
Quote
Is there anything else I can give my provider to read that states a modifier can't be used with this if its for the same eye during the global period.

A CPT Code book? seriously... I'd give him book, tell him your not billing something you know is wrong.
Linda Walker
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Michelle1965

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Re: 1 or more sessions Help!
« Reply #2 on: September 03, 2014, 06:50:45 PM »
I totally agree with you Linda, and I will not bill it out. I did give her my CPT Book, and an article on this code.  Hopefully the provider will take the time to read everything over again, and realize she is wrong.  I might lose my job now, but at least I know I did the right thing.  I am going to start up my own Billing Company, but right now I'm not comfortable doing so until I have learned everything there is to know about running my own business.   This forum is really helping me learn, so thank you for all the good advice you have given me.  I really do appreciate everyone in this forum, and feel this is a great place for Billers and Coders to help each other Succeed.  :)
« Last Edit: September 03, 2014, 06:52:43 PM by Michelle1965 »

kristin

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Re: 1 or more sessions Help!
« Reply #3 on: September 03, 2014, 08:38:57 PM »
Michelle,

One other thing you might try explaining very nicely to the provider is that whatever money she may make by coding incorrectly and getting payment for those codes is not worth what would happen if there was ever an audit. While she may feel that she is "coding correctly" or "deserves to get paid for her work" or "I have always coded it this way, so why are you questioning it?"....those are all refrains I have heard over the years from different providers I educated, and most of them saw the light once I dropped the word "audit" into the conversation. I dropped it in nicely, and with the utmost concern for the providers and their practices, of course...but was firm about the potential consequences. You are doing the right thing, and not risking your certification, or looking at an orange jumpsuit in your future. That is what matters.