Any Waystar clearinghouse users?

I'm curious to know what PM system you use and if you have a bi-directional interface? What do you see as pros/cons of your system?

(We use next gen now but not in love at all. I do, however, like waystar.)

* This article was originally published here

VA requiring SSN to submit claims?

Has anyone else recently experienced VA claims bouncing back from their clearing house when the patient's SSN is not used as the member ID number (HCFA box 1a)? We were originally advised to put the VA authorization number in this box for claims going to Optum. However, when we submit them this way they kick back & will only go through if we put the SSN in box 1a, & move the VA auth number to the Prior Authorization Number box (HCFA box 23). Just wanted to reach out to see if this is...

VA requiring SSN to submit claims?

* This article was originally published here

24515 vs 24430

DX: left humerus shaft fracture nonunion ( injury was in 2019)

Procedure: open reduction, internal fixation of left humeral shaft nonunion. Debridement left humeral fracture.

A longitudinal incision was made, just lateral to the biceps muscle. The bovie was used to cauterize any bleeders. The brachialis muscle was then split to visualize the humeral bone. this incision was carried down to the bone to allow better visualization of the fractures and to excise any necrotic soft tissue and...

24515 vs 24430

* This article was originally published here

CPT code for excision of bony fragment, subcutaneous tissue, anterior knee

what would be the best code to use for excision of bony fragment, subcutaneous tissue, anterior knee.

* This article was originally published here

Modifier -59, XE in cardiology

We received a claims analysis letter from Amerigroup, stating that our provider fell outside of average utilization of the ff modifier. -59, XE

I queried our system and found the root cause.

Frequently our provider consults on cases, reads EKGs and echoes, stress test for the same patient, all same day service - so we bill as ff

99223-25
93010-59
93306-26-59
78452-26-XE

Are we overutilizing modifier -59?

What should be the correct way of using modifier -59?

Thanks!

* This article was originally published here

Difference between modifier 59 and modifier XS

Hello, Can you please differentiate between modifier 59 and modifier XS with reference to gastrointestinal endoscopy. Please illustrate with some examples related to EGD, ERCP, Colonoscopy.

* This article was originally published here

Hospital Consults for return Patient in Post Op

My Ortho doctor has had a couple patients that he did surgery on for fractures. The patients have had a fall and were admitted back into the Hospital and our ortho was called to to consult the patients who now are needing a second surgery. Is still possible to bill In Patient visit? It is a new fall but still might be considered related to the initial surgery.

* This article was originally published here