Pain billing and coding consultant?

[Ligament]

Who are the top people out there? Need a consultant to help educate my in house biller.

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[ziggyziggy]

Marvel J Hammer RN BS CPC CCS-P ACS-PM CPCO is an accomplished professional with considerable years of experience both in the business and medical fields. She is a coding, billing and compliance consultant and owner of MJH Consulting based in Denver, Colorado.

She provides medical coding and billing education and performs compliance reviews for her clients. Marvel enjoys teaching providers and their staff on correct coding and billing issues and presents on these topics nationwide. Her field of specialties includes Pain Management, Physical Medicine & Rehabilitation, Neurology, and Occupational Medicine.

 

[drusso]

Marvel is good but no one will ever care more about your money than you.

 

[tmvguy03]

Marvel is good but no one will ever care more about your money than you.

Exactly. I view reviewing claims/reimbursement as a second job. I have more than "made" the salary of a coder catching errors, requesting resubmission to insurance etc.... In my system the billers/coders are offsite and couldn't care less and there's not much accountability, but at least when I find something wrong it usually gets fixed.

 

[lonelobo]

Marvel is good but no one will ever care more about your money than you.

Think he is asking for a consultant, not to farm out billing
A couple thousand for a billing consultant would be money well spent down the road

 

[xvaderx]

Who are the top people out there? Need a consultant to help educate my in house biller.

I know this is old, but I'm in the same situation now.

Did you find someone worth recommending?

 

[chudat]

Totally off topic Q:

Per asipp fee schedule for 2021, using genicular as example. For genicular knee ablation under fluoro, who it be appropriate to bill cpt code 64624 (genicular knee radiofrequency) PLUS 76000 (examination under fluoroscopy)? Same with US guided injections and nerve blocks? (i.e. to include additional CPT for US)?

 

[Agast]

Totally off topic Q:

Per asipp fee schedule for 2021, using genicular as example. For genicular knee ablation under fluoro, who it be appropriate to bill cpt code 64624 (genicular knee radiofrequency) PLUS 76000 (examination under fluoroscopy)? Same with US guided injections and nerve blocks? (i.e. to include additional CPT for US)?

You can bill both, you will probably discover it’s bundled for most insurance plans

 

[chudat]

You can bill both, you will probably discover it’s bundled for most insurance plans

So what does a genicular bundled plan include for example?

is it the same as the asipp fee schedule for genicular+flouro exam? Would it more beneficial to NOT take the bundled payment but rather each individual coding?

Also if I use sedation, can I bill genicular rfa + fluoro examination + sedation?

 

[Agast]

Would it more beneficial to NOT take the bundled payment but rather each individual coding?

Also if I use sedation, can I bill genicular rfa + fluoro examination + sedation?

Bundled means the insurance plan considers their payment for the procedure to include any imaging guidance. You bill all the codes you want and find you get paid for only one of them.

You can bill for sedation you supervise separately, just make sure you document why sedation was needed.

 

[Ducttape]

Totally off topic Q:

Per asipp fee schedule for 2021, using genicular as example. For genicular knee ablation under fluoro, who it be appropriate to bill cpt code 64624 (genicular knee radiofrequency) PLUS 76000 (examination under fluoroscopy)? Same with US guided injections and nerve blocks? (i.e. to include additional CPT for US)?

I can try to bill anything I want for genicular ablation, but it has been denied this year by Medicare. most local insurances have followed suit.



certain procedures are bundled - SIJ, TF, ESI for example. if you bill the 77002 or 77003 (or 76000), they are bundled, you have no option, as the primary code covers the 77002/77003. for example, ESI - 62323 is bundled epidural with fluoroscopy. ASIPP says that pays $282.64. if you want, use 62322 - ESI without fluoro - and get $151.79... the 77003-26 will pay if $29. if it doesnt get denied completely - some LCDs will not allow 62322.



btw, you should be using 77002 or 77003 for fluoroscopic imaging with procedure, unless you are producing a separate report documenting the radiologic findings that you obtained from the imaging.

 

[chudat]

^ is there a reason why i shouldnt be producing a separate report? Radiology reports for fluoro usage are basically a report stating the fluoro time; I can do the same thing. Also can I bill like this in this hypothetical situation:

I'm an employee for a multispecialty group who has their own in house fluoro, MRI, and CT. I performed a SI joint injection. I bill for 77002-26, 20610. Can the group, who own the fluoro bill 77002-TC?


- this what i dont understand then. Esi with flouro i understand. It's bundled fee according to asipp. But what about a hip injection for example? Can I bill for the hip + the fluoro since according to asipp, it's two separate billings.

- also, if you guys can explain to a newbie how insurance pre auth work. I was under the impression that for example: I schedule a person for esi after office visit. I ask the biller to send to patient's insurance for a pre auth. If the insurance approves the pre auth, then they agree to pay the amount for the procedure. It's a done deal. Can they deny reimbursement after the fact? Meaning, I do the esi, and now when i try to collect the agreed upon $282, can insurance now say we dont approve.

 

[Ducttape]

now i am not a biller or coder, but for most of these questions, i run them by my practice biller and coder; it pays to confirm with your biller/coder.

Radiology reports for fluoro usage are basically a report stating the fluoro time;

that may be appropriate for 77003, but not from my understanding for your 76000.

an example is how radiologists report CT myelogram.

they put in a detailed procedure note report on how the lumbar puncture and myelogram was done.

there is a completely separate report on the findings of the CT scan and the myelogram.

- this what i dont understand then. Esi with flouro i understand. It's bundled fee according to asipp. But what about a hip injection for example? Can I bill for the hip + the fluoro since according to asipp, it's two separate billings.

yes. bill for the hip injection and bill for the 77002.

- also, if you guys can explain to a newbie how insurance pre auth work. I was under the impression that for example: I schedule a person for esi after office visit. I ask the biller to send to patient's insurance for a pre auth. If the insurance approves the pre auth, then they agree to pay the amount for the procedure. It's a done deal. Can they deny reimbursement after the fact? Meaning, I do the esi, and now when i try to collect the agreed upon $282, can insurance now say we dont approve.

as far as i am aware, yes they could turn around and deny after the fact, but not likely.

 

[strike5858]

Can anyone share any billing /coding “cheat sheets” they may use to simply the billing/ ordering process?

I was thinking about making a sheet with most common E/m , procedure codes/ imaging and misc order codes as well as most common icd 10 codes. This way I can simplify it for my staff to put in charges, request authorizations ect.

Hoping someone has something I can build off of.

 

[callmeanesthesia]

Can anyone share any billing /coding “cheat sheets” they may use to simply the billing/ ordering process?

I was thinking about making a sheet with most common E/m , procedure codes/ imaging and misc order codes as well as most common icd 10 codes. This way I can simplify it for my staff to put in charges, request authorizations ect.

Hoping someone has something I can build off of.

Most EMRs have a frequently used list. That’s a good place to start to pull from.