Q: Our clinical trial claims often hit edits for missing drugs or devices when those are supplied by the trial sponsor and we can't bill for them. We've been manually reviewing these edits. Is there a recommended method for handling these types of edits that's more efficient?
Q: We have a patient who received a pancreas transplant for the treatment of diabetes. The patient was later admitted to the hospital for treatment of an unrelated kidney stone. Would I still need to assign the ICD-10-CM code for diabetes as a chronic condition based on the patient’s medical history?
Q: I work for a behavioral health recovery center, and many of our programs fall under 42 CFR Part 2, as we provide substance use services. Sometimes a referring agency follows up to ask if a client has scheduled an appointment. Can we confirm that a patient has made an appointment? Do referral appointments like this fall under PHI?
Q: A physician orders a comprehensive metabolic panel (CPT code 80053) and an additional quantitative blood sample to measure blood glucose level (CPT code 82947). Would the physician report modifier -91 (repeat clinical diagnostic laboratory test) or -59 to indicate that the blood sample was performed separately from the panel?
