One of our commercial insurers has denied our claims based on a “lack of clinical indicators.” We are assigning diagnostic codes based on the physician’s diagnostic statements. Should we be doing something else?
When is it appropriate to report CPT code 94640?
According to the American Medical Association (AMA), the following code took effect on January 1, 2017: 90682—influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use. However, our MAC has denied claims for this code. Does Medicare not accept this new code?
Does CMS allow modifier 91 with the NCCI PTP edits?
Can you provide an example of a mutually exclusive respiratory procedure?
How does CMS determine payment for a drug that is not listed in the ASP file?
I have read that CMS will be developing “episode groups.” What are these?
What CPT code would you recommend for an ultrasound of the temporal artery for giant-cell arteritis?
One of our cardiologists performed the following: a left heart cath w/ coronaries, then a selective left subclavian angiogram to see whether there was a stenosis in the subclavian, and then a selective left internal mammary artery (LIMA) looking at it for a possible grafting site. How would we code this?
Is there any chance that CMS will change the deadline for reporting the private payer information needed to create the new CLFS?
The facility ordered CPT code 71021, and the radiologist documented a lateral and apical lordotic view only. Would it be appropriate to bill 71010 and 71035 or modify CPT 71021 with a 52?
For the Medicare program, what is the difference between fraud and abuse?
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