Several sundry questions for relatively new biller

[MedBiller]

Thank you for any assistance you can provide.  I'm employed as a medical biller for a specialist group who keeps their billing in house.  Having no formal training, I was taught on the job by my peers.  It has come to my attention, that there are certain aspects to my training that are lacking in regards to the proper way to bill, hence the following questions.  Please bear with me, for they may be basic or unusual, for as I said, I haven't had any formal education in this industry.

1.  Can you bill any of the "consultation codes" (I know CMS has eliminated their consult codes) when using the following codes 99241-99245 &/or 99201-99205 with a procedure the same day of the consult?  I was taught that if you bill any of the previous codes with a procedure (ex:  injection) that the injection will be paid vs. the E/M code.  If a patient presents for the first time as a consultation for hemochromatosis and it is imperative that this patient has a phlebotomy the same day, we can't bill and get reimbursement for both?

2.  When billing NYS medicaid for an office visit (i.e.  99214) and a chemotherapy infusion (i.e. 96413) is it possible to get paid for both the E/M and chemotherapy infusion?  When I bill commercial insurance companies, I use modifiers 25 and 59, however I was instructed not to use modifiers when billing NYS Medicaid. 

3.  When you have a patient who is "Medicaid Pending" are you allowed to bill said patient? If they are later found to be retroactively eligible for Medicaid, can the provider file for reimbursement with Medicaid then upon receipt of Medicaid reimbursement refund the patient all money paid by the patient for the services covered by Medicaid?

Thank you again for any assistance/insight you could provide. 

[Michele]

1.  There is a modifier that may be appropriate for the situation you are describing.  The 25 modifier when attached to the consult or E&M code indicates that the exam/consult was separate and identifiable from the procedure.  However the biller cannot just attach the modifier to get the services paid.  The provider who performed the services, or a coder reviewing the notes/chart would decide if the modifier was appropriate.

2.  I'm not sure why you were told not to use modifiers when billing NYS Medicaid.  I'm not familiar with billing NYS Medicaid for those two codes, but if the modifiers are needed to describe the services I would include them even when billing NYS medicaid.

3.  If the patient presents with the 'pending' notification, then you can't charge the patient, you must bill Medicaid.  (If you are a Medicaid provider)

Hope that helps.

Michele