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New Patient Visit Denied, What Should I Do?
One of our pain management physicians saw a patient the first time in our office. We billed 99204. The insurance carried denied the service. I contacted the insurance carrier and was told that the patient was an established patient to the practice and should be reported as an established patient. The patient did see another pain management physician in our group practice who did an injection a year ago, but it was in another city. Is the insurance carrier correct or should I appeal this?
Billing for a Wound Vac
Can you bill for a wound vac on a surgical incision if the patient has a history of incision infections to help prevent this?
Billing Additional Pre-op Visit
Our surgeon placed a patient on the OR schedule as an inpatient case. The surgery was elective and not an emergency case. The patient’s case was canceled because our hospital limited inpatient elective OR cases due to the spike in COVID 19 cases in our area.
Office Visit & Procedure on Same Day – Using Modifier 25
We frequently do a flexible laryngoscopy (31575) or nasal endoscopy (31231) when we see a patient. We always bill the office visit code with modifier 25. Lately, we seem to be getting more denials and have to send in our note for justification. We don’t always get paid. Can you shed any light on this issue?
Closing the Partial Mastectomy Wound
A patient has a partial mastectomy by a general surgeon. After the surgery, a plastic surgeon comes in to close due to possible reconstruction. The plastic surgeon ends up only doing a layered closure. A layered closure is inclusive the in the partial mastectomy (19301) but is the plastic surgeon still able to get credit for the layered closure (12034) because she is a different specialty?
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