Billing

“We performed a heel injection on the right foot for a patient with plantar fasciitis. I used CPT 20550 -RT. UnitedHealthcare denied the claim stating we could not prove we injected a substance on a CPT code that requires it. I discussed this with the “MARS” auditor and that was her comment. Any suggestions on why this was denied and how to correct it?”

If a patient that has Traditional Medicare and a secondary coinsurance, when, if ever, is it appropriate or is it payable to bill for a consultation code such as CPT 99243 or CPT 99244?

Can CPT codes 11730 and 11750 be billed together on the same toe as part of the same procedure?

If a Medicare patient has a secondary, supplemental insurance that our practice does not participate with, how should this be handled?

Level of E/M Service in the Emergency Department

Can you please explain the appeals process for Medicare?

Effective January 1, 2024, there will be changes to the definitions/descriptions of the CPT codes for Correction of Hallux Valgus deformities.

The JZ modifier will show Medicare if providers are using pharmaceuticals efficiently by identifying the amount of unused and discarded drugs from single-dose containers or single-use packages. One way to remember the correct use of these drugs is waste vs zero-waste.

Can you please explain what a “RAC” audit is?

Can a hallux valgus correction CPT code be billed if the medial aspect of the head of the 1st metatarsal is not removed?