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Re: [MedicalBillers] Diagnosis Codes

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  • nicole mezni
    Hi Joktan, Federal, mainly Medicare. Nicole Mezni Biller, Urologic Wellness Center of Vero Beach 321.331.9487-phone 407.507.4064-fax nmezni@cfl.rr.com ...
    Message 1 of 5 , Feb 20, 2008
    • 0 Attachment
      Hi Joktan,
      Federal, mainly Medicare.

      Nicole Mezni
      Biller, Urologic Wellness Center of Vero Beach
      321.331.9487-phone
      407.507.4064-fax
      nmezni@...
      ----- Original Message -----
      From: Joktan Edison
      To: MedicalBillers@yahoogroups.com
      Sent: Wednesday, February 20, 2008 2:38 AM
      Subject: Re: [MedicalBillers] Diagnosis Codes


      Are you trying to bill Federal insurance or comm???

      --- nicole mezni <nmezni@...> wrote:

      > Hello everyone,
      >
      > When I am billing for example 99213 and 81001, and
      > the dx codes are 236.5, 790.93, 257.2, 607.84, is it
      > okay to have ALL 4 dx codes for 81001? Or should I
      > only use 790.93......will denials result in using
      > all 4?
      >
      > Thank you so much!!!
      >
      > Nicole Mezni
      > Biller, Urologic Wellness Center of Vero Beach
      > 321.331.9487-phone
      > 407.507.4064-fax
      > nmezni@...
      >
      > [Non-text portions of this message have been
      > removed]
      >
      >

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    • Melinda
      Nicole, I only use codes that are needed for tests, E/M services, procedures, etc. Why did doc order 81001...what was he looking for, or what were the
      Message 2 of 5 , Feb 21, 2008
      • 0 Attachment
        Nicole,

        I only use codes that are needed for tests, E/M services, procedures,
        etc. Why did doc order 81001...what was he looking for, or what were
        the symptoms?

        Your billing software should be able to only attach the codes you
        wish to each CPT. I don't know that you will get a denial for using
        all codes, but the question remains, is is appropriate to use them
        all? What's the reasoning behind using all 4?

        You wouldn't use all those codes if the doc also did a EKG would you?
        No. Medicare publishes LCDs & NCDs that are certain lists of
        codes/criteria for certain tests.
        http://www.cms.hhs.gov/mcd/indexes.asp?clickon=index

        If you look at the HCFA 1500 instructions that were developed by NUCC
        (the makers of the 1500), then you will see that for Section 21 on
        your HCFA, they request "Relate lines 1, 2, 3, 4 to the lines of
        service in 24E by line number."
        http://www.nucc.org/images/stories/PDF/claim_form_manual_v3-0_7-07.pdf

        Now, granted that electronic claims fields & paper claim fields often
        have different requirements, but the concept is still the same.

        I only attach the appropriate codes to the appropriate services.
        Does anyone else have some imput on this issue?

        Melinda Brown, CMBS
        Ins Biller

        --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@...>
        wrote:
        >
        > Hello everyone,
        >
        > When I am billing for example 99213 and 81001, and the dx codes are
        236.5, 790.93, 257.2, 607.84, is it okay to have ALL 4 dx codes for
        81001? Or should I only use 790.93......will denials result in using
        all 4?
        >
        > Thank you so much!!!
        >
        > Nicole Mezni
        > Biller, Urologic Wellness Center of Vero Beach
        > 321.331.9487-phone
        > 407.507.4064-fax
        > nmezni@...
        >
        > [Non-text portions of this message have been removed]
        >
      • Michelle Uhl
        Melinda.. you are totally correct.. only attach the icd-9 code that is appropriate for the proceedure being done... otherwise.. your coding will not match the
        Message 3 of 5 , Feb 21, 2008
        • 0 Attachment
          Melinda..
          you are totally correct.. only attach the icd-9 code that is appropriate for the proceedure being done... otherwise.. your coding will not match the documentation for that proceedure and under audit from the ins you will have to recoup the monies for any codes that do not match the doctors record. i can not imagine the physician would have all those dx's listed for the 81001

          therefore, even if claims are not being currently denied for this.. it is possible in the future to get a recoup letter for the codes not being appropriate for the proceedure.

          hope this helps!!


          Melinda <melindadocsmith@...> wrote:
          Nicole,

          I only use codes that are needed for tests, E/M services, procedures,
          etc. Why did doc order 81001...what was he looking for, or what were
          the symptoms?

          Your billing software should be able to only attach the codes you
          wish to each CPT. I don't know that you will get a denial for using
          all codes, but the question remains, is is appropriate to use them
          all? What's the reasoning behind using all 4?

          You wouldn't use all those codes if the doc also did a EKG would you?
          No. Medicare publishes LCDs & NCDs that are certain lists of
          codes/criteria for certain tests.
          http://www.cms.hhs.gov/mcd/indexes.asp?clickon=index

          If you look at the HCFA 1500 instructions that were developed by NUCC
          (the makers of the 1500), then you will see that for Section 21 on
          your HCFA, they request "Relate lines 1, 2, 3, 4 to the lines of
          service in 24E by line number."
          http://www.nucc.org/images/stories/PDF/claim_form_manual_v3-0_7-07.pdf

          Now, granted that electronic claims fields & paper claim fields often
          have different requirements, but the concept is still the same.

          I only attach the appropriate codes to the appropriate services.
          Does anyone else have some imput on this issue?

          Melinda Brown, CMBS
          Ins Biller

          --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@...>
          wrote:
          >
          > Hello everyone,
          >
          > When I am billing for example 99213 and 81001, and the dx codes are
          236.5, 790.93, 257.2, 607.84, is it okay to have ALL 4 dx codes for
          81001? Or should I only use 790.93......will denials result in using
          all 4?
          >
          > Thank you so much!!!
          >
          > Nicole Mezni
          > Biller, Urologic Wellness Center of Vero Beach
          > 321.331.9487-phone
          > 407.507.4064-fax
          > nmezni@...
          >
          > [Non-text portions of this message have been removed]
          >






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