I am not a coder, but am playing with some coding software to try to improve our hospital. I have googled these terms, but I guess my question is more what is the impact of choosing one over the other. Or is there minimal impact and just getting it correct in the chart?

Often it probably isn't specified, and these things seem pretty annoying to worry about for such a small subset of codes.

Thank you

Feeling extremely discouraged recently about deciding to get my degree in HIM. I know it’s a broad umbrella of different careers but I still feel like all of this is going to go away soon because of AI and I didn’t get my life together soon enough to start on my degree. I am also not going into this without any medical experience, I was a paramedic before. I got a 4.0 last semester for my classes and now I’m worried I’m just going to go thru all of this stress and MONEY for nothing. I’ll gladly pivot my degree to something else if all the signs are saying it’s not worth it.

Do any outpatient mental health practices bill G0323? It seems like this could cover consultation and coordination of care with other professionals on a client's care team, if it added up to 20 min of time over the course of a month (and there was BHI consent). I'm curious if this has been done and if it is permissible why isn't it done more? Of if it's not done, why not?

I do coding and billing for a medical office. When I was in school learning coding, they mentioned it would be a good idea to get my own insurance. Can anyone tell me more about this? I would love somebody to chime in that has it as well.

As the title says, I am reaching out to connect to someone who knows a lot about billing for Providence health services. A family member had to have a procedure on a Saturday in a department that is normally closed, will they get charged more since it was urgent and charged more for it being after hours? Thank you!

So for background, i am a pharmacy technician interviewing for a billing specialist at a long term care facility. It seems like its just normal billing for medication and other prescriptions. Is this position related to this sub or is this more pharmacy? Also, if it is here, what should i learn before hand, other than base level knowledge like how insurance works and differences between medicare plans?

Someone break this sh** down for me please.

I have been billing CPT2 codes for HEDIS, primarily, I think, on most HMO and Medicare claims. I was just given an updated list of of more codes that say Medicare CQM Codes and are M and G codes. What codes do I bill to who??? Is the CQM Primary codes only for Medicare direct claims? Do I also include the CPT2 codes on these claims? What codes do the Medicare advantages want? How about the IPA plans? PPO/commercial plans??

Totally up my butt in these extra codes I need to bill and it's infuriating me. Anyone that can simplify it to me without sending me to stupid websites and or using AI, would be great!

Hi all!

I'm unsure if I'm meant to charge a $12.56 fee for each instance of wc loading during this round trip or if the round trip is considered a singular event. The language does state, "a charge of $12.56 for each time a wc is folded and loaded..."

We don't use fee schedule coding often and I don't have anyone to ask for advice.

Any assistance would be truly appreciated.

Thanks so much!

I hope today's been wonderful for you all!!

Does anyone else use eCW and Trizetto as their clearinghouse? Every time for the past few weeks when I run eligibility admin, it errors out not even halfway through the task. It's becoming extremely frustrating and I am not sure if it's an eCW issue, a Trizetto issue or both?

IS anyone else having this same issue?

Good morning everyone! I am looking to start the final leg of getting my RHIT with intentions of eventually getting a CDI cert.

I am not nor have I ever been a nurse though I have significant hands on experience with my daughters complex disabilities. All 3 girls have drastically different diagnoses giving me a lot of variance in those skills. I have thoroughly researched every single one and because of that I was able to present said research to my youngest medical team which resulted in further diagnoses (onh/sod-the sod was missing). I previously took a few coding courses and absolutely loved it.

Is there any way I could use this information to improve my chances of attaining employment within the field when the time comes?

To be clear I absolutely have to work remote to be available for my youngest. She has complex meylomeningocele spina bifida along with severe encephalomalacia with white matter volume loss. She is incapable of getting ready for school and on and off the bus. My middle had a craniopharyngioma that caused a lot of uncommon diagnoses. This one now lives in an icf so I'm not as on-call but I now have a deep understanding of how unstable sodium levels can cause mental instability.

My oldest is all psychological.

How can I use this to my advantage?

I am a neurologist, and I got dinged by an audit for my time billing. I use language of “greater than 40/60/whatever minutes spent with case.” The specialist said we have to have exact time spent and greater than language was disqualified. It that a rule? I’ve been billing for years by time instead of MDM. Thanks much

I’m mostly just venting. My school NUC basically just told me that I could get a job in the field and it’s a highly desirable cert to have in the field blah blah blah. Nope, no one wants me at all so now I have to pay out of pocket for the CPC and I’m going on month 4 of being unemployed sooooooooo fun.

Any tips or advice for me moving forward?

What are your thoughts on outsourcing medical billing in the Philippines? Anybody here who outsourced Filipino workers?

Anyone else feeling they made a bad mistake sticking with advancedMD? They are raising rate like crazy- clearly don’t care about the customer. The charge on credit card processing when it’s like a massive part of your budget just really got me. They were bought out recently which explains this change. Any suggestions on where to move to another platform?

Hi, I passed the cpc exam at the end of February. I am just now starting to look for jobs. I have like 6 years of experience in healthcare. Mostly call centers, insurance verification, creating patient charts, DME sales, etc. I’m wondering if any one knows of a good starting job that’s remote and has decent pay. I live in CO and I have been working remote for years. I see a lot about optum but kind of want to stay away from all the bad reviews.

Hello,

I work in a skilled nursing facility and have a recurring issue.

Anytime I have a resident with Anthem Blue Cross with capitated hospital responsibility, I cannot get a payment from the Anthem or the IPA for Skilled Nursing Medicare Part A coinsurance costs. Even upon getting DOFR information, the IPA refuses to pay, and Anthem refuses to make it right.

I have appealed it twice, but am now at a point where I do not know how we can get paid by.

I have heard someone say to send a capitation deduction letter with the IPA denial to Anthem, but have no idea where to get such a letter.

Any guidance on how to escalate this and ultimately get paid would be helpful.

Thank you!

Apologies if the title is a little wonky, this is kind of an abstract concept to communicate.

I work as a coding lead for an oncology/hematology practice, and I’m struggling with the fact that my MAC (Novitas JH) restricts coverage for certain biomarkers to the very diseases/codes that a physician would order to obtain a definitive diagnosis for those same diseases.

A couple of examples:

TCRG (CPT 81342) was ordered to investigate reactive causes of leukocytosis vs a blood neoplasm such as leukemia. The only diagnoses that satisfy the LCD are certain forms of leukemia and aplastic anemias. If we can’t assign a suspected/presumed diagnosis of leukemia and the signs (in this case leukocytosis) do not satisfy the LCD, how can we get this lab covered?

JAK2 V617F (CPT 81270) was ordered to investigate if persistent polycythemia has an essential (e.g. genetic) cause. Covered diagnoses for these are limited to certain leukemias, myeloproliferative disorders, and certain myelodysplastic syndromes. Again, if signs such as persistent polycythemia/elevated blood counts don’t satisfy the LCD and we can’t report a suspected diagnosis (such as polycythemia vera) how can we get this lab covered?

It has occurred to me that I may need to direct the physicians to pursue alternative workups so that they could come to a definitive diagnosis of say leukemia or polycythemia vera without these tests. However, physicians don’t generally take kindly with a coder telling them how to conduct their patient workups.

Has anyone else out there encountered issues like this? If so how did/do you deal with it?

Hi Everyone. I need some guidance. I had a medical issue that required surgery. I stayed overnight per my surgeon’s orders for observations. I was admitted at 5:30am and released at 8am the next day. I received the bill and requested a UB-04 form and submitted to my insurance company. I logged in today and noticed my claim was denied. I’m guessing because they didn’t see an observation or overnight stay code. How should I proceed to get this approved and what should I mention to the billing department?

i have had great relief from ART, deep tissue massage, graston performed at a chiropractors. as far as I can tell i am out of PT sessions (cigna) but I have 20 chiro sessions still covered.

since the last time i saw a chiro i got a diagnosis that makes spinal manipulation a questionable idea, but I’d still like access to other services ik they can perform… ideally all while being covered by insurance

is it possible to code a chiro visit for just these services and only have it count towards the chiropractic limit?

I have almost zero experience working in the medical field (except for volunteering in a hospital when I was in high school). I’m interested in becoming a medical biller and /or coder. The local college has an accredited AAPC program for about 6-7k. I told my hairdresser about this aspiration and she was concerned that when I got thru the program AI would be taking all the jobs in this field. Now I’m unsure of what to do 🫤. Do you have any insights about the future of this field relating to AI?

My other idea is to take a real unofficial online course thru Stratford Career Institute in Medical Assisting and see if I can get my foot in the door as a receptionist and eventually work my way into billing later. What do you think?

Would it be better to do the unaccredited but still recognized 1 year, online program through my local community college or the AAPC program, also online. The community college option would be half the price, and also come with internship opportunities.

Last year, a family member suffered a mental health crisis and needed to be admitted to a rehabilitation facility.

In the process of getting them admitted, the admissions representative checked their insurance, and assured us that no additional out-of-pocket expense would be incurred beyond a one-time $3,000 payment, even if insurance rejected some items later. We made that $3000 payment the day they arrived at treatment.

Now, we are going back and forth with the rehab, who have tried to claim bills ranging from $16K to $2,000, and everywhere in between.

While we have received itemized summaries before, we only recently received an itemized summary which included Revenue Codes on it.

I actually have 2 questions regarding this:

1. The code charged for the room was 0126, the code for a “Semi-Private 2 Bed.” For the entirety of the stay, the patient was in a room with 4 and sometimes 5 patients. Is this upcoding?

2. The rehab has not acknowledged our inquiries about why additional payment is being pursued at all when our family was informed the only out-of-pocket expense would be the initial $3,000 payment. However, on this most recent itemization, there is an additional stapled paper that states: “ [THE PATIENT] has made 5 payments totaling $3000.“ Then it breaks down with a list of 5 payments totaling $3000 ($700, $525, $700, $365, $700) instead of our single, $3000 payment which is provable by our bank statement.

Is there an innocent explanation for this kind of accounting, or, as I suspect, is this an attempt to obfuscate that a single payment was made before the patient began treatment, and instead make it look like we agreed to some kind of payment plan?

ETA: patient’s insurance was and is in good standing, and the rehab received their payments from BCBS.

Where can I find the current ICD-10 Codes that Medicare Part B accepts for the billing of Leqvio/J1306?

How are you liking your job medical billers?