Are you guys billing the G code consistently and if so, has anyone encountered non payment by either private insurers or managed Medicare? I have had a private insurer deny several and the patients got stuck with a charge. I haven’t heard anything from the MA plans but I wouldn’t be surprised if they push the cost onto the patients. (Source: Student Doctor Network ..read more

I am a soon to be new attending and had some questions regarding the utilization of midlevels. The practice I will be joining requires that I see new patients, however, I will have at least one NP to see patients as well. I am in a bonus based off of collections model, so analyzing these details is obviously important. If the NP sees all of the return visit patients including writing their notes and I am the MD in-house providing oversight - 1. Do I get paid at all for the patients they... Read more (Source: Student Doctor Network ..read more

Oregon Medical Board Accuses Pain Clinic Owner of Defrauding Insurers Dr. Poly Chen’s chain of pain clinics was billing $2,500 per COVID test.​ “Along with patients Chen was testing himself, employees and family members, sometimes dozens of times. The document says Chen “routinely performed two COVID-19 tests for each patient each time the patient entered the clinic.” “The board concluded that Chen not only gave unnecessary tests, but was also involved in setting the... Read more (Source: Student Doctor Network ..read more

I may not be fully up to speed on the new billing code criteria for 2021. My basic understanding is that billing on complexity, the subjective and objective don't matter anymore, it's all about the medical decision making. And basically 2+ diagnoses of chronic conditions is a 99214. My frustration lies in the fact if I see someone with depression, anxiety, and suicidality, I'm dealing with a potentially severe situation. The suicide risk assessment takes time and carries risk, and a... Read more (Source: Student Doctor Network ..read more

Hey everyone, for those of you who are inpatient consultants, not the primary physician, how do you charge for the day of discharge? I have been billing as a follow up however I am helping more with discharge paperwork, DME and coordinating with case management and the patient. This made me wonder if I could charge for a discharge code instead of the follow up. What are the guidelines for this? Thanks! (Source: Student Doctor Network ..read more

Im a very short time fellowship will be over and we will be set free to join the workforce as independent providers. Like in most residences and fellowships, billing is not exactly a topic that gets covered a lot. My fellowship is largely academic so attendings often don't think or worry about RVUs. Currently, I bill mostly 99204/99214, occasionally 99205/99215, G2211, and procedure codes for aspiration/injection. Once I get MSK US certified, I plan on incorporating that into my practice... Read more (Source: Student Doctor Network ..read more

All Pain MD's need to rally around this...Urgent action required NOW. To whom it may concern Subject: StimQ PNS Implant Procedures (Vendor: Stimwave) The American Hospital Association has determined that the appropriate code assignment for StimQ PNS stimulator implant is 64555. Furthermore, they specifically stipulated that it is not appropriate to report CPT code 64590 (Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or... Read more (Source: Student Doctor Network ..read more

I see a lot of variety in critical care billing practices. For example, I see some docs are routinely billing critical care time for anyone in the ICU even if stable and going to floor or home that day or totally hemodynamically stable just there for q1h glucose checks for DKA with insulin gtt. Is it recommended to just err on the side of billing for critical care and if it doesn't meet criteria the coders or insurance company will just change it to non-critical care? If lots of physicians... Read more (Source: Student Doctor Network ..read more

Lets say you do a three-level bilateral lumbar facet injection (L3-4, L4-5, and L5-S1). Is the 50 modifier only applied to the first level (64493) or is it applied to the other two levels (64494 and 64495). I was going over my compensation reports and it looks like my organization is only crediting me for the 50 modifier for the 64493 and not for the 64494 and 64495 meaning that I am not getting the wrvu for doing bilateral for the other two joints. (Source: Student Doctor Network ..read more

I've been seeing a lot of talk recently about SNF/SAR work from PM&R attendings and residents. There's a couple big companies that I've seen offer splits (always majority in our favor like 70% collections we keep) on a 1099 but why not just go to the facility directly and set things up? Does anyone do this? You get your own billing service, malpractice etc. and bill directly which would yield a much better split in our favor. Why allow these middlemen companies to take a cut? I understand... Read more (Source: Student Doctor Network ..read more