PECOS Internet Based 855 Application System

Cyndee Weston and myself threw a hissy fit (probably among many other people and organizations) over the absurdity of CMS not allowing anyone other than the doctor filling out the PECOS Internet based 855 application. Well due to all of the efforts, and the kind support of the AMA, researching and doing an article on the issue (nothing like having an 800 pound gorilla on your side), we won, getting CMS to change their mind.

AMA Files Class-Action Lawsuit Against Wellpoint, Inc.

Health Buzz: American Medical Association Sues WellPoint and Other Health News

Posted March 26, 2009

AMA Files Class-Action Lawsuit Against WellPoint

GA WC Modifier -TR, -RS Changes; Deletes Modifier -21 4/1/09

Please note that effective April 1, 2009, the GA WC Interpreter modifier (21) is changing to –TR and reimbursement will be 125% of the fee schedule (increased from 10% in 2008). Modifier 21 will no longer be valid for dates of service after 4/1/09.


This was sent to me and I thought you might find it of interest. I feel that this is different than other initiatives in the past as this does not ask our lawmakers to make it illegal to offshore, but asks them to pass a law requiring those who offshore to notify the owners of the NPI (and PII) that their information is being sent offshore and get their permission. This is like an “informed consent” for offshoring a patient’s confidential data.

lab charges

Good Morning! I have a question from my pediatrician's office. He is doing a lead screening when the patient is in the office for an E & M. The lab he uses doesn't bill insurance so he is paying the lab himself. Can we bill the insurance company the 83655 cpt and the 36415? Would there be a modifier to indicate that we didn't actually do the 83655? I sure appreciate any help you can give me. Thank you! Marge Scharp

I need Clinical Trials coding for cardiac stents

Hi folks, I am not a Coding professional, but do work in Clinical Research for a CRO. We get asked about coding all the time, and the latest question, which i am at a loss to understand, is WHY do post-marketing studies require a clinical research coding modifier? Where can i look to find out general information about coding for clinical research in general, devices in particular? If you can point me in the right direction I would be most grateful and would offer an adult beverage in payment. Thanks, Teresa in Boston area

Red Flag Rule

Recently I have discussed with several people how we will deal with pediatrics. We do not ask for id from children. What will we do to protect children from identity theft. I know of several instances in which a mother took a niece in to the doctor under the guise of the niece being her daughter? Any ideas?