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Insurance denials using wrong Z dx code FIRST and missing modifiers which needed

I have been a medical coder for over 15 year. I was insurance biller years ago before coding .Currently at my job I see lots mistakes others make & cannot say anything or will get dismissed.

Important information about refunds: what a joy

Great episode. As a family practice coder I see this constantly. Can you touch on AWVs with an office visit? We have a lot of providers who do office visits when everything is stable. My argument is the service has to be medically necessary to perform, so if everything is stable, it would not be medically necessary. They'll send a referral for labs or refill stable scripts and charge a level 4. What are your thoughts?

I like this hi Terry.

I am a prior authorization specialist getting doctors to comply with the documentation necessary to establish medical necessity for a service being requested is the most difficult part of my job. It seems that some doctors allow their ego as a medical provider to supersede doing what is necessary to get paid. It is excellent compliance in documentation that affords some doctors to be awarded the gold card. Oftentimes it's the lack of amendments to previous doctor's notes that describe the current changes or new occurrences that result in denials on the first submission. This can lead to peer-to-peer reviews with the Medical Director taking time away from patient care. I have the hardest time getting Nurses and Doctors to understand this.

Your videos are realy helpful in terms of healthcare product. Thank you so much. I wish you can have video in regards with incidental by nature / Incidental by total episode of care denials by the insurance. Like DME 😊

endocrinologist billed this , uses virtual care for max 15 minutes, sees them twice a year, commercial insurance doesn’t cover it. Absurd!!!

Great episode, Terry! On the parent-child scenario you mentioned, I agree on the risk-reduction rationale when the parent(s) is/are helpful, but there may be times when the presence of a parent can complicate the visit, esp during visits dealing w teen preg or gender reassignment considerations. Parents can become very emotional on these topics, which may add a layer of complexity to the visit.

Love Numbers!!!

This is great! What about idiopathic conditions?

Wow!!!I needed to hear this! Thank you for all your hard work!💕💕

So, what exactly does longitudal relationship and “managing” the patients needs means? Would calling their insurance company to make sure the lab the doctor sends a biopsy to is in-network….would that be considered management of the patients condition and paid for by this code?

This is an absurd code!!!! I pay a copay THEN pay just to have a relationship with my doctor!?!??! Ridiculous!!!!

There is a hack to do a Big Mac Casserole in the Instant Pot with tortillas. It is awesome! Just Google it!! I'm on Weight Watchers and have lost 100 pounds!

Thanks!

Thank you Terry! Good information today and Great job on losing 70lbs! I love the Big Mac hack, I'll try it!

Congrats on the weight loss, that's awesome.

This was my Troponin Levels readout approx. 8 hours after I had a STEMI, my Dr. was so amazed he asked if I minded if he showed his colleagues, I'm guessing this is high? (BECK) Troponin I, HS View trends Normal value: <21 ng/L Value 30,849 Instrumentation: Beckman Coulter

Thank you for this info 🙏🏼

*PromoSM* 😭

how do you access the cpt assistant ?

How to receive CEUs

I do not understand how come non-physician can judge what physician done right or wrong? Have you ever heard about peer review?

I do not understand how come no-physician cane judge what physician is done right or wrong? Have you ever heard about peer review? That is the mane problem with medicine in this country.

What about billing for 99358, non-face-to-face prolonged care code?

Heyaa! I came across your video, and I have to say it’s really good! Just wanted to mention that this isn’t a completely random comment. 😊 If you don’t mind, I noticed you’ve posted quite a few videos on your channel. You might consider following a healthy structure to improve your reach. If you’re interested, feel free to drop your email I’d love to chat about it over a free call!

Can you please confirm if documentation in the chart note must state if the visit was done using audio-only or audio-video? I see providers simply document "telehealth" and argue that it is not required for them to specify if it was audio-video or audio-only. If there are CMS guidelines that clearly state this requirement, please guide me to the guidelines. Thank you!

Hi Terry I just happened to come across your youtube channel and it has been very informative. Thank you! I have aquestion regarding membership, is the $1800 broken down monthly, 2 payments, or a one time payment, etc?

Yes I was told I had a 160 troponin level but the EKG, Ultrasound and angiogram so I’m totally confused as to if I even have damage. Very strange. But I have struggled with awful anxiety and panic for over 10 years.

Yesssss! The HIPAA vs HIPPA thing makes me insane! I recently heard a well-known physician say "HIPPA" (spelled as such in their video description) stands for "health information privacy & protective act." ... I think my brain exploded. I was baffled.

Hello, this is a really from informative video and appreciate your work on it. Quick question maybe not exactly related to what you know but I thought it wouldn’t hurt to ask. I’m a home health occupational therapist working as a contractor as well as PRN. In my question is, how can home house occupational therapists use telehealth visits as an adjunct to our standard in person visits, and get reimbursed? There is a ton of research that shows when patients consistently monitor, their heart rate, oxygen, saturation, and blood pressure for example, hospital recidivism rates drop significantly. And for patients that have cognition issues. Having a consistent remindercan also affect improvements in working memory. Thanks so much!

How about incident to billing for an MD to MD

This statement gets me and I think confuses people "Review of all materials from any unique source counts as one element" It says ELEMENT! I think people assume it means that no matter what you review from 1 place it counts as 1 POINT. What do you think?

Thank you for the breakdown of this topic! I have a quick question: The E/M guidelines overview has the following guidance: 'These guidelines are for services that require a face-to-face encounter with the patient and/or family/ caregiver.' Furthermore, the Classification of E/M services section states this: 'The place of service and service type are defined by the location where the face-to-face encounter with the patient and/or family/caregiver occurs.' Why would we not accept these as rationale for billing a visit when the patient is not present? Thank you!

Some services might fall into caregiver codes (e.g., 97550/97551).

I love these great chunks of information!❤

Thank you for info. Good show on HULU is The Great about Russian Queen Catherine the Great..funny life history.

Numbers was a great show!!

Great reminder, Terry 👍🏼

Suits is awesome. Also like Burden of Truth

Sooo i was just in for chest pain and shortness of breath ...panic attack i believe. Mine was 0.156.. ekg was fine.. echo showed good. They released me after 3 days in the hospital...when i left the last test was 0.161... im not overweight and pretty active but have had panic attacks for yrs. Should i be concerned

Great discussion on JZ/JW Modifiers. I have a very 'intriguing' question on it, does MUE play a certain role for billing J-codes with these Modifiers, say A certain J-codes has MUE of 10 per day, (50mg/ml in 10ml single use vial) but the patient requires 60mg - additional 2 units, how do we bill this? Do we report discarded 40 mgs? (50mg from first vial and 10mg from second).

I hear what you're saying, labeling is a bad practice just like psychology does😮

Don’t hold it against me. I’m from buffalo ❤

Hi , I have a doubt regarding modifier 24 and 57... Can we code them together on the same date of service.... If yes How can we code them together? If not , why can't we code them together?

I'm a coder and so confused by this new code. If a primary care provider sees a patient for a routine follow up on three chronic conditions...for example, hypertension, hyperlipidemia, and diabetes...all are stable, plan is to continue meds and follow up in three months, does that sound like it would qualify for the G code?

Agree whole heartily; recently had 2 meetings at work where AI was mentioned as coming to our medical coding department. Upper management stated in their presentation to start looking for other jobs within the organization and we were told we were going to 10 chart audits/monthly starting in January when we only had 1 audit per year. Do you think we will be motivated to give our best to this organization? It only motivates me to look for a job elsewhere and hopefully not in healthcare. We see mistakes all the time with the current CAC codes. Documentation from providers; we have to decipher slang language from the computer scribe. I sincerely hope they slow down in healthcare. This will not save money and only bring headaches to the patient experience having to appeal wrong procedures charged due to AI. I can see health insurance plans denying claims left and right due to wrong dx codes.

Thanks Terry