Medical Billing

When selecting the level of E/M service based upon medical decision-making, the best source of information is the Level of Medical Decision-Making Table. The table includes the four levels of medical decision making (ie, straightforward, low, moderate, high) and the three elements of medical decision making (ie, “number and complexity of problems addressed,” “amount and/or complexity of data reviewed and analyzed,” “and risk of complications and/or morbidity or mortality of patient management”). To qualify for a particular level of medical decision making, two of the three elements for that level of medical decision making must be met or exceeded. It is under “Number and/or Complexity of Problems Addressed” that the issue of acute versus chronic is addressed. Acute versus chronic is not based upon a “time frame.”

“I have a patient who returns to the office for regular treatment of a hyperkeratotic lesion. Our documentation states “a hyperkeratotic lesion with a punctate keratin core with obliteration of skin tension lines to the sub 5th metatarsal head.” The plan is documented as “Cold spray to the lesion for anesthesia. The lesion was then circumscribed with #15 blade. The keratotic core then excised down to the level of the basement membrane. Bleeding was appreciated, then controlled with compression. No biopsy was performed.” Can I ever bill this as a CPT 11305? with a D23.7? If so, can this be done every 10 weeks?”

“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?

Fractures, Dislocations, Casts, and Splints

What is the most appropriate way(s) to bill for the correction of a hammertoe deformity?

Level of E/M Service in the Emergency Department

Can you please explain the appeals process for Medicare?