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Insurance Billing

I have a client who has massage as part of her CAM benefits. It does not require a doctor referral. I do not have to be a preferred provider to bill her insurance. I am using the CMS1500 form to bill but clearly don't have a diagnosis code since there was no referral.

I called the insurance company to ask what I should do. They offered no help. I've left messages with the benefit coordinator at my client's employer and with another massage therapist who I know has billed this insurance, but I haven't gotten return phone calls.

Has anyone else encountered this? What did you do?

Thanks for any help!

Judy

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Replies to This Discussion

Permalink Reply by Jody C. Hutchinson on February 12, 2013 at 8:32am

Judy,

I have a few clients who use their HSA debit cards for massage sessions. They only need a receipt with the CPT code and date and time of service and the fee they paid. I am not sure if this is your situation. You might try sending a CMS form and see what happens. You may be able to re bill if that doesn't work. Sometimes you have to throw it up against the wall and see if it sticks.

Good Luck.

Jody

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Permalink Reply by Judy McCaul on February 12, 2013 at 1:16pm

Thank you, Jody. I haven't had any problem using the HSA cards. I am going to send the CMS form without the Dx code and see. I appreciate your reply!

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Permalink Reply by Mark Nelson on February 16, 2013 at 10:17am

I might get in touch with ACT they can indicate you up with all the systems they cost a fee to procedure each clause but it's really simple and if you end up doing a lot of insurance coverage statements and want to do the payments yourself and keep the fee you might change.

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Permalink Reply by Angel Bass on February 17, 2013 at 8:14am

I wrk for a chiropractor (10yrs billing experience) I would say look into a CPT/ICD book (google it) it will direct you to either a site or a place to purchase an updated book. If you don't know anyone in a Chiro office that would loan u theirs for a moment email me and I'd be happy to help you! After narrowing down symptoms,location,associated ailments, duration and few other things we could find the most appropriate diag. (Yes a Chiro CPT book will have the right diag!) nevaehmassageangel@gmail.com
Hope this helps! And if u need ANY ins billing help (goes for anyone) Please feel free to email me and if I can help I will!!
Health is happiness,
Angel
PS> some treatment CPT require a separating modifier to designate a separate area/service or they may combine service codes and deny!!!! Happy SUNDAY all!!!

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Permalink Reply by Jody C. Hutchinson on February 18, 2013 at 8:32am

Angel,

I am wondering if is appropriate to locate the DX code by a Massage Therapist. If no diagnosis has been made by a physician, there should not be one on the form. Since the OP states that no diagnosis code is required, why risk everything by putting one on the form?

my 2 cent,

jh

Angel Bass said:

I wrk for a chiropractor (10yrs billing experience) I would say look into a CPT/ICD book (google it) it will direct you to either a site or a place to purchase an updated book. If you don't know anyone in a Chiro office that would loan u theirs for a moment email me and I'd be happy to help you! After narrowing down symptoms,location,associated ailments, duration and few other things we could find the most appropriate diag. (Yes a Chiro CPT book will have the right diag!) nevaehmassageangel@gmail.com
Hope this helps! And if u need ANY ins billing help (goes for anyone) Please feel free to email me and if I can help I will!!
Health is happiness,
Angel
PS> some treatment CPT require a separating modifier to designate a separate area/service or they may combine service codes and deny!!!! Happy SUNDAY all!!!

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Permalink Reply by Judy McCaul on February 18, 2013 at 1:42pm

Thanks everyone for the help. I submitted the CMS 1500 without a Dx code since it's out of my scope. Here's hoping they send me my $$$.

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Permalink Reply by Pete L Blanco II on February 19, 2013 at 5:24pm

You should be fine submitting without the Dx code since the client is able to self-refer.

As for the suggestion of looking up a code that fits your best guess based on the client's symptoms, unless things are different in your neck of the woods, it is pretty much outside the scope of practice for a massage therapist to diagnose a client's condition - and yes, looking up the ICD code qualifies as diagnosing. ALWAYS get the ICD code (when one is needed) from the client's referring physician.