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Linda,
First things first.  If you are going to be responsible for Billing in this ofc,
you need to get some foundation.  Call whoever administers for HCFA in your
state, and find out when the next educational classes are and sign up!  Also,
make sure you are getting their publications.  In Florida, BC BS of Florida has
administered Medicare for years, and they have a bi-monthly publication and hold
classes in different areas of the state at least 6 times per year.  They also
sell CPT/ICD9 compatibility publications, which tell you what clinical
indications a patient must have for certain tests.  (In FL you can be a single
digit off on the diagnosis and get denied)  Be careful accepting information
from companies that profess to be "Medicare Experts" and put on seminars
themselves.  I've found that your Medicare Carrier is the best place to get
answers.
Your lab problem may be a CLIA # transmission requirement that HCFA just started
in the end of 1998.  My software vendor, Medical Manager Southeast, put the
number in a comment field, then had us key a % sign in the last digit of each
lab code that required a CLIA number, and it points to the comment line for the
number.  I would give your vendor a call and see what they say.   Good luck,
Ann
ps.  Evaluation and Management codes are referred to as E&M codes.  They are
simply the ofc visit, hospital, nursing home, etc. codes.

pich.004@cwix.com wrote:

> Hi Ann and Mark,
> Thanks for responding to my problems. I am in the State of VA and our
> specially is Family Practice.  We use Medical Manager Software.  I am
> familiar with the correlation of cpt and icd9 coding but I don't know what
> the e/m codes are if you could explain that one.  The denials have no
> consistency to them what works one time doesn't work another.  I now know to
> code to 5th level but sometimes there is no 5th level but it is still denied
> anyway.  Simple approved Clia tests which we used to be paid for are
> suddenly being denied.  One patient who is a diabetic has blood sugar
> testing done and its denied because its not necessary.  Ekg's are being
> denied with patients having heart problems.  Sometimes it takes 3 months to
> have a claim resolved and not always to our benefit.  I acquired this job
> when the biller left and I am learning as I go along but it is impossible to
> call Medicare for info on unpaid claims. So I keep changing codes and
> rebilling if it works I'm happy but I need input on what they are looking
> for.
>
> Thank You
> Linda

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