Provider did a total of 45 units injected and 5 discarded.
there were multiple muscles injected on one side, but the corrugator supercilli muscle was injected with 2.5 in each side. now if I add mod 50 to 64612 is that implying that all the muscles were injected bilaterally?
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Is it okay to bill 17110 (destruction benign lesion) and 96405 (injection to lesion, chemo agent) together?
I looked at the NCCI edits and there's no conflict. Does that mean the service is billable together even though its all done on one lesion?
I find it odd they bundle if billed with 11900 (for steroidal injections) but not for 96405.
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Thank you for the help.
-Chelsea
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Thank you for the help.
-Chelsea
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Free consultsWe offer a free consult, right now we enter a zero charge and a code of 99499, we want to stop entering this charge, it goes nowhere, never billed out, this is done for all consults. Is this ok to omit. The consults is documented in the chart.
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Appreciate any guidance!
Thanks!
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I need to bill, consistently, for the following type of test:
POC (Point of Care cup)
AMPH, BARB, BENZ, BUP, THC, COCM, ETG, MTD, OPI, OXY, CREAT, PH, GRAV, OXID, PCP, XTC
To my understanding, this would be billed as a 80300, as all of these are listed under Drug Class A.
I also need to bill for K2 Spice testing. To my understanding, this would be billed as 80302 x 1 as it is for one test, under Drug Class B.
The provider also does confirmation. Would that be billed as 80377?
And would I bill all of these codes on one statement if they are all performed on the same date of service?
Am I on the right track? Being new to this type of billing is a bit intimidating. Any advice you could offer would be greatly appreciated.
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Ideas?
Anna Sanders
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Wonder if someone can shed some light on this scenario. The CRNA's will document on the record (could be vitals on hand-off note) the and not sign off but the attending signs off. I am told by my superiors that this is acceptable. I was tought that anyone that documents in the record needs to sign the record. If the CRNA is scribbing doesn't the attending need to state this? Is there anywhere that I can go to and print these guidelines that state the record must be signed by all that document on the record? I need black and white. I was told by my instructor to have a reliable resource.
Thank you
RM
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Nope you wont be able to bill. New patient must have all 3 History, Exam, MDM. If you didn't get past history you are kind of out of luck when it comes to the insurance.
__________________
CPC-A as of 11/17/15 - Now studying for COC, CPC-P & CPB
*15 years health insurance experience: Customer Service, Provider Relations, Reimbursement, Contract /Benefit/Directory Configuration Auditing.
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I am a new coder(gastro) so if my wording seems off, please forgive me, hopefully you will understand what I am trying to ask. 
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W19.XXXA-FallsI have several doctors in nursing homes that have patients that fall down. The staff asks for a examination to be sure the patient is truly fine. A lot of the times the patients can not communicate any aches and pains. There are no contusions, hematoma, or any other reason to be seen. Medicare will not cover this as a primary dx. Any suggestion as to what to use?
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Medical Billing Company seeking CPC-A/remoteHi. We are seeking A CPC-A for a temporary remote posititon for ICD 10 coding. Will be coding from Physician Hospital notes. This is a contract position. Preferrably someone in KY. But if you meet our expectations, we could possibly contract it out to someone in another state. This would be at the most 40 hrs per month. So would be great side job for a CPC-A. Your coding will be randomly audited to ensure proper coding. Good luck! Hope to find the right one for our company . Please fax resume to 1-502-565-0129 with a cover letter for your resume Thanks so much!
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I have been hired by a clinicial psychologist (PhD) whose business offers courses for clients who have been convicted of driving while under the influence of alcohol. These state-mandated courses educate the clients about how much alcohol they can safely drink before driving.
The doctor wants me to tell her what codes to use for her services. I believe I have the correct codes, but I'd feel more comfortable if someone (or several someones) could verify that I've chosen the right ones, and that the "multiples" are formatted correctly.
Here are the courses and services she offers. Notes:
a. She teaches the courses herself, and she is considered a "qualified health professional."
b. These are all face-to-face courses with up to 15 students each.
1) A 10-hour Psycho-Ed Risk Education course consisting of 3-3 hour sessions and 1 1-hour session, all on different days. My codes:
Class 1: 99412 x 3
Class 2: 99412 x 3
Class 3: 99412 x 3
Class 4: 99412
2) A 12-hour Psycho-Ed Early Intervention course consisting of 4-3 hour sessions.
Class 1: 99412 x 3
Class 2: 99412 x 3
Class 3: 99412 x 3
Class 4: 99412 x 3
3) A 20-hour Psycho-Ed Treatment program consisting of 1-2 hour session and 6-3 hour sessions.
Class 1: 99412 x 2
Class 2: 99412 x 3
Class 3: 99412 x 3
Class 4: 99412 x 3
Class 5: 99412 x 3
Class 6: 99412 x 3
Class 7: 99412 x 3
4) Each student in all three courses also receives an initial face-to-face, individual, detailed interview focused on the client's use of alcohol and the client's personal history. This meeting is normally one hour long. Code: 99404
5) Last, each student in all three courses also receives one face-to-face individual progress assessement sometime during the course. The meeting lasts 10-15 minutes. Code: 99401.
So, what do you think? Do these sound right? Or are there better codes for these situations?
Thank you for your assistance!!!
Colleen Kobe
Calumet, Michigan
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PREOP DX:
1. RT knee anterior cruciate ligament avulsion fracture (femoral)
2. Medial retinaculum and medial patellofemoral ligament tears
3. Medial collateral ligament tear
4. Medial meniscocapsular ligament tear
5. Lateral meniscus tear
6. Lateral collateral ligament tear
7. Biceps femoris tendon tear
8. Proximal fibula fracture, displaced
9. Lateral tibial plateau fracture, non-displaced
10. Posterior aspect of comminuted displaced lateral femoral condyle fractures
POSTOP DX: SAME
PROCEDURES:
1. arthroscopic assisted ACL femoral avulsion fracture repair.
2. Arthroscopic partial lateral meniscectomy
3. Arthroscopic multiple loose body removal with osteochondral fracture fragments from posterior aspect of lateral femoral condyle fragments (at least 8 fragments, many of which were 12 to 15 mm in length)
4. Medial collateral ligament repair
5. Medial meniscus and meniscotibial ligament repair
6. Medial retinaculum/ medial patellofemoral ligament repair
7. Lateral collateral ligament repair
8. Biceps femoris tendon repair
9. Arthroscopic patellar chondroplasty
DESCRIPTION OF PROCEDURE: after adequate general anesthesia had been obtained, after receiving pre-op IV antibiotics he was placed in the routine supine position. A well-padded tourniquet was placed on the right upper thigh. A leg positioner was distal to this. Extremities were well padded. Venodyne boot was on the left leg. The right leg was prepped and draped in standard fashion. Limb was exsanguinated. Tourniquet was elevated. Anterolateral and anteromedial working portals were created. The medial portal had to be extended to allow passage of loose bodies. There was hemarthrosis that was evacuated from the knee. There are large clots that were removed from the knee. There were as mentioned above 8 significant loose bodies that were bony and articular cartilage. These were throughout the entire knee in the medial lateral gutters, suprapatellar pouch, anterior notch, and posterior compartment of the knee. These were all very carefully removed in case we could proceed with any type of fixation. These were all held in room temp. saline for the duration of the case. Underside of the patella had an unstable articular cartilage centrally. This area was debrided with motorized shaver, contoured with the arthrocare ablation tool. There was evidence of injury in the medial retinaculum with hemorrhage underlying soft tissues. This would later be repaired. Medial compartment had evidence of a tear in the periphery of the meniscus extending into the capsule. The meniscus however was essentially intact and articular cartilage medially was essentially intact. Laterllay there was a large radial tear of the mid-portion lateral meniscus. There is also complex tear of the posterior horn lateral meniscus. Meniscal tears were debrided back to stable peripheral rim. There was significant cartilage injury to the posterior tibial plateau with anterior-to-posterior line correcsponding with the fracture. There was scuffing of articular cartilage, femoral condyle, and tibial plateau. Unstable cartilage was debrided off the medial part of the lateral tibial plateau anteriorly coursing up towards the tibial spine. Popliteus tendon was inspected palpated with a probe and this was actually taut. The bone fragments were debrided around the tendon. The joint could be opened significantly medially and laterally. In the notch, there was some tearing of the anterior portion of the ACL; however, larger bone attachments to the femoral ACL. This was essentially in entire lateral wall coursing into more posterior fragment that was still attached to ACL. With a probe we could flip these fragments and actually have a decent appearance of a proposed repair of the anterior cruciate ligament tear. It was felt that repair of this ligament one it would hopefully allow the patient have avoidance of another ACL surgery and two will have his own tissue. As approximately 20% of the anterior portion was torn he would have 80% restoration of his ACL this was all healed well. We therefore proceeded with the 2 tunnel technique. As we were addressing the lateral pathology a standard hockey stick curvilinear incision was made laterally. IT band identified. This was split about midway using the approach for a 2 incision ACL. A rear-entry tip was utilized and the right hand retrograde reverse drill guide was utilized. Two Beath pins were passed into the femoral ACL footprint at the fracture site. Arthrex FiberStick suture was passed down one tunnel with two sets. These were then passed through the proximal most portion of the ACL in crisscross fashion and then back up through the second tunnel. We were able to tension and pull the ACL along with the bone nicely. After we did the lateral collateral ligament and biceps femoral portion of the case we then tied the corresponding tears over a polypropylene button laterally with the knee in about 20 degrees of flexion. Prior to tying the ACL over the button laterally we exposed the lateral side. Common peroneal nerve was identified crossing the fibular neck. This was protected and preserved throughout the case. A vertical anterior proximal fibular fracture was noted. A small hematoma was evacuated. The biceps femoris was identified and lateral collateral ligament was identified. A set of FiberTape was passed through lateral collateral ligament fibers and then separately through biceps femoral fibers. A SwiveLock 4.75 anchor was placed to the proximal fibula posterior the fracture line. An additional suture was passed from the internal through the tissues outside. We were able to tie the corresponding pairs affording repair of the bicep femoris and lateral collateral ligament with the knee in flexion and with a valgus stress. We then tied the ACL corresponding pairs and that portion of the case was concluded. The lateral IT band split incision was closed with interrupted figure-eight Vicryl sutures, subcutaneous tissues were closed with buried Vicryl. Skin was closed with staples.
All that was being closed the medial incision was made. We wanted to address medial retinaculum, medial patellofemoral ligament, and medial collateral ligament so we went proximal to the medial epicondyle and under the pes bursa region. Of note the patients leg was extremely large as he is about 300 LBS. this also tied into the posterior aspect of the lateral femoral condyle. We placed the knee in significant flexion and there was still articular cartilage contacting the tibial plateau. We did not proceed with attempted fixation of all the multiple comminuted fragments from the lateral femoral condyle posteriorly. The medial side soft tissues dissected down to the level of the fascia and pes tendons were identified. Proximal L-type incision was made to reflect these such that we could place our retractor. Medial collateral ligament deep fibers were identified. Tissue at the medial joint line was completely torn and flipped and reflected inferiorly and starting to scarring. This tissue mass was ?undone? and then all the meniscal tibial fragments, ligaments, and soft tissues were repaired after we placed the medial internal Arthrex FiberLoop Bridge with a SwiveLock just slightly proximal and posterior to the medial epicondyle and then we did flexion-extension to find the isometric point for the distal insertion of the internal fibertape bridge. This was then tightened holding the knee in slight varus stress at 20 degrees flexion. We incorporated with that suture the fibers of the medial collateral ligament. There was excellent stability to the knee with this. Lachman was also negative. The knee was placed in extension flushed off all small fragments with the arthroscope. Exparel had been infiltrated into the lateral soft tissues before closure and then medial tissues prior to closure of the pes reflected tissues, subcutaneous tissues, and skin with staples. Dry sterile dressing was applied. Knee brace was applied. Ice wrap has been applied. Knee brace is to be held in extension and locked. Of note during the case the tourniquet was up for just over 2 hours. We then released the tourniquet for 50 minutes. We then exsanguinated the limb again elevated the tourniquet as he had significant generalized oozing and bleeding making the visualization somewhat impaired.
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PREOP DX:
1. RT knee anterior cruciate ligament avulsion fracture (femoral)
2. Medial retinaculum and medial patellofemoral ligament tears
3. Medial collateral ligament tear
4. Medial meniscocapsular ligament tear
5. Lateral meniscus tear
6. Lateral collateral ligament tear
7. Biceps femoris tendon tear
8. Proximal fibula fracture, displaced
9. Lateral tibial plateau fracture, non-displaced
10. Posterior aspect of comminuted displaced lateral femoral condyle fractures
POSTOP DX: SAME
PROCEDURES:
1. arthroscopic assisted ACL femoral avulsion fracture repair.
2. Arthroscopic partial lateral meniscectomy
3. Arthroscopic multiple loose body removal with osteochondral fracture fragments from posterior aspect of lateral femoral condyle fragments (at least 8 fragments, many of which were 12 to 15 mm in length)
4. Medial collateral ligament repair
5. Medial meniscus and meniscotibial ligament repair
6. Medial retinaculum/ medial patellofemoral ligament repair
7. Lateral collateral ligament repair
8. Biceps femoris tendon repair
9. Arthroscopic patellar chondroplasty
DESCRIPTION OF PROCEDURE: after adequate general anesthesia had been obtained, after receiving pre-op IV antibiotics he was placed in the routine supine position. A well-padded tourniquet was placed on the right upper thigh. A leg positioner was distal to this. Extremities were well padded. Venodyne boot was on the left leg. The right leg was prepped and draped in standard fashion. Limb was exsanguinated. Tourniquet was elevated. Anterolateral and anteromedial working portals were created. The medial portal had to be extended to allow passage of loose bodies. There was hemarthrosis that was evacuated from the knee. There are large clots that were removed from the knee. There were as mentioned above 8 significant loose bodies that were bony and articular cartilage. These were throughout the entire knee in the medial lateral gutters, suprapatellar pouch, anterior notch, and posterior compartment of the knee. These were all very carefully removed in case we could proceed with any type of fixation. These were all held in room temp. saline for the duration of the case. Underside of the patella had an unstable articular cartilage centrally. This area was debrided with motorized shaver, contoured with the arthrocare ablation tool. There was evidence of injury in the medial retinaculum with hemorrhage underlying soft tissues. This would later be repaired. Medial compartment had evidence of a tear in the periphery of the meniscus extending into the capsule. The meniscus however was essentially intact and articular cartilage medially was essentially intact. Laterllay there was a large radial tear of the mid-portion lateral meniscus. There is also complex tear of the posterior horn lateral meniscus. Meniscal tears were debrided back to stable peripheral rim. There was significant cartilage injury to the posterior tibial plateau with anterior-to-posterior line correcsponding with the fracture. There was scuffing of articular cartilage, femoral condyle, and tibial plateau. Unstable cartilage was debrided off the medial part of the lateral tibial plateau anteriorly coursing up towards the tibial spine. Popliteus tendon was inspected palpated with a probe and this was actually taut. The bone fragments were debrided around the tendon. The joint could be opened significantly medially and laterally. In the notch, there was some tearing of the anterior portion of the ACL; however, larger bone attachments to the femoral ACL. This was essentially in entire lateral wall coursing into more posterior fragment that was still attached to ACL. With a probe we could flip these fragments and actually have a decent appearance of a proposed repair of the anterior cruciate ligament tear. It was felt that repair of this ligament one it would hopefully allow the patient have avoidance of another ACL surgery and two will have his own tissue. As approximately 20% of the anterior portion was torn he would have 80% restoration of his ACL this was all healed well. We therefore proceeded with the 2 tunnel technique. As we were addressing the lateral pathology a standard hockey stick curvilinear incision was made laterally. IT band identified. This was split about midway using the approach for a 2 incision ACL. A rear-entry tip was utilized and the right hand retrograde reverse drill guide was utilized. Two Beath pins were passed into the femoral ACL footprint at the fracture site. Arthrex FiberStick suture was passed down one tunnel with two sets. These were then passed through the proximal most portion of the ACL in crisscross fashion and then back up through the second tunnel. We were able to tension and pull the ACL along with the bone nicely. After we did the lateral collateral ligament and biceps femoral portion of the case we then tied the corresponding tears over a polypropylene button laterally with the knee in about 20 degrees of flexion. Prior to tying the ACL over the button laterally we exposed the lateral side. Common peroneal nerve was identified crossing the fibular neck. This was protected and preserved throughout the case. A vertical anterior proximal fibular fracture was noted. A small hematoma was evacuated. The biceps femoris was identified and lateral collateral ligament was identified. A set of FiberTape was passed through lateral collateral ligament fibers and then separately through biceps femoral fibers. A SwiveLock 4.75 anchor was placed to the proximal fibula posterior the fracture line. An additional suture was passed from the internal through the tissues outside. We were able to tie the corresponding pairs affording repair of the bicep femoris and lateral collateral ligament with the knee in flexion and with a valgus stress. We then tied the ACL corresponding pairs and that portion of the case was concluded. The lateral IT band split incision was closed with interrupted figure-eight Vicryl sutures, subcutaneous tissues were closed with buried Vicryl. Skin was closed with staples.
All that was being closed the medial incision was made. We wanted to address medial retinaculum, medial patellofemoral ligament, and medial collateral ligament so we went proximal to the medial epicondyle and under the pes bursa region. Of note the patients leg was extremely large as he is about 300 LBS. this also tied into the posterior aspect of the lateral femoral condyle. We placed the knee in significant flexion and there was still articular cartilage contacting the tibial plateau. We did not proceed with attempted fixation of all the multiple comminuted fragments from the lateral femoral condyle posteriorly. The medial side soft tissues dissected down to the level of the fascia and pes tendons were identified. Proximal L-type incision was made to reflect these such that we could place our retractor. Medial collateral ligament deep fibers were identified. Tissue at the medial joint line was completely torn and flipped and reflected inferiorly and starting to scarring. This tissue mass was ?undone? and then all the meniscal tibial fragments, ligaments, and soft tissues were repaired after we placed the medial internal Arthrex FiberLoop Bridge with a SwiveLock just slightly proximal and posterior to the medial epicondyle and then we did flexion-extension to find the isometric point for the distal insertion of the internal fibertape bridge. This was then tightened holding the knee in slight varus stress at 20 degrees flexion. We incorporated with that suture the fibers of the medial collateral ligament. There was excellent stability to the knee with this. Lachman was also negative. The knee was placed in extension flushed off all small fragments with the arthroscope. Exparel had been infiltrated into the lateral soft tissues before closure and then medial tissues prior to closure of the pes reflected tissues, subcutaneous tissues, and skin with staples. Dry sterile dressing was applied. Knee brace was applied. Ice wrap has been applied. Knee brace is to be held in extension and locked. Of note during the case the tourniquet was up for just over 2 hours. We then released the tourniquet for 50 minutes. We then exsanguinated the limb again elevated the tourniquet as he had significant generalized oozing and bleeding making the visualization somewhat impaired.
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need help with this operation please
a patient with gastric cancer, had an exploratory laparatomy they found ascites, 6 liter of fluid was drained.
how should i code this?
all peritoneal drainage codes are percutaneous, and the open are for abscess ........
any clue?
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need help with this operation please
a patient with gastric cancer, had an exploratory laparatomy they found ascites, 6 liter of fluid was drained.
how should i code this?
all peritoneal drainage codes are percutaneous, and the open are for abscess ........
any clue?
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Operative Report Procedures performed: 1. Left transfem aortogram 2. RLE r/o 3. Right fem exploration 4. Open thrombectomy 5. Fem-BK popl bp insitu GSV 6. Side branch ligation 7. Completion angio Primary e Pre-procedure diagnosis: ALI Post-procedure diagnosis: ALI Start date: 11/23/15 Start time: 2130 Anesthesia: general anesthesia Estimated blood loss in ml's: 600 Blood products: 2 units pRBC Technique/Procedure:
This is a 51 year male with severe peripheral arterial disease status bilateral femoropopliteal bypasses and stenting. He continues to use tobacco. He presented with 3 days history of right lower extremity pain and coldness. He had preserved motor but with paresthesia. His preoperative duplex demonstrated complete thrombosis of the fem-popl bypass and only monophasic waveforms in the right lower leg. Operative management was discussed including risks, benefits, and alternatives and patient consented to proceed.
Patient was seen in preoperative area with consent and site confirmed. He was taken to the operating room, properly identified and placed supine. General anesthesia was induced and the abdomen and bilateral groins were prepped and draped in the usual sterile fashion. perioperative was started and time out was called.
Page 1 of 3
We began with a left femoral access with a micropuncture kit under ultrasound guidance. This was up sized to a 5F sheath and an Omni catheter was brought up the infrarenal aorta for an aortogram. The catheter was pulled down to the aortic bifurcation for additional pelvic views. The right iliac artery was cannulated and the catheter was parked in the distal external iliac artery for right lower extremity run-off. It was difficult to determine patient's lower leg run off due to poor collaterals. A decision was made to explore the right groin. The is was extremity scared down from prior surgery requiring much more than expected time. The femoral artery and its bifurcation was dissected and controlled. Patient came to the OR on heparin drip and was continued with every hour boluses.
The femoral bypass graftotomy was performed and sequential balloon embolectomy was done with a #3, #4, and #5 Folgarty catheters. This retrieved a large amount of old and new thrombus. We were able to pass our #3 catheter to the tibioperoneal vessels with continuous return of old and new thrombus despite patient being on adequate heparin. Thus heparin products were discontinued and Argatroban was utilized. At this point, very little new thrombi were seen. Given little outflow seen, a decision was made to explore the distal fem-pop bypass. An incision was made through previous above knee operative site and the graft was exposed and controlled. The graftotomy was made and more thrombus with multiple stents were removed. Given how poorly the graft appeared a decision was made to abandon this plan and the graft was thus ligated.
The infrapopliteal artery was explored as a last resort via an infrapopliteal incision. No bleeding in the soft tissue was seen but muscles were viable. We encountered the GSV with adequate calliber. The infrapopliteal artery was freely dissected and controlled. Following this a return to the femoral groin was made to explore the saphenofemoral junction. This was carefully dissected and transected flushed. The GSV stump was suture ligated and divided. The vein was spatulated to fit and anastomosed to the femoral artery in an end-to-side fashion with 6-0 Prolene running suture. The distal GSV was dissected, divided, and a LeMaitre valvulotome was passed retrograde multiple times until pulsatile bleed was obtained. Following this the vein was prepped and the distal end to side anastomosis was created in a standard running fashion with a 6-0 Prolene. Pulsatile flow was established and a completion angiogram demonstrated 1 vessel run-off into the foot. Major side branches were ligated and divided. Once hemostasis was satisfactory the wounds were irrigated and inicions closed in multiple layers and dressings placed. Patient tolerated the procedure well, was kept intubated and taken to the ICU in satisfactory condition. All counts were correct.
Specimens removed/altered: stents Complications: none Drain(s)/tube(s): none Implant(s): Vac dressings x 2 Cultures sent: No Fluids:
Page 2 of 3
4500 Urine output: 800 Operative findings: Hypercoagulable Acute and subacute graft thrombosis Completion angio with 2 vessels r/o to foot
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I'm looking for some thoughts on this. Thanks so much!
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Dear Human Resources Manager:
I am a highly motivated professional with a strong record of performance in the customer service, claims, and data processing environments. As my enclosed resume indicates my most recent position as a senior claims examiner within the healthcare industry of which I also hold a CPC-P coding certification through AAPC. I am currently seeking a position within an organization that offers challenge, responsibility, and an opportunity for growth.
I am conscientious in my personal and professional life and take great pride in my work. I cope well with high-stress situations and can manage a variety of projects simultaneously. My strengths include independent work habits, superior communication skills, and the ability to resolve problems by developing efficient and plausible work solutions.
Would you be willing to meet with me for an in-person interview? I would welcome the chance to discuss career opportunities within your organization and my potential fit. Thank you in advance for your consideration. I look forward to meeting with you in the near future.
Sincerely,
Monica J. Murphy
Monica J. Murphy, CPC-P
Enc: Resume
References provided upon request.
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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.
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Basically if the facility treatment does not require UR/Prior auth, then we will get a medical records request for every claim submitted. I have confirmed that we are not under audit, and when we do have an auth number, we have no problem getting paid. I feel this is a malicious obfuscation of paying claims and a violation of the minimum necessary standard of HIPAA.
We have been complying with the requests, however the records never seem to get attached to the claims, or we are told they are sent to the wrong address. (even though we send to the address on the correspondence) When they do get the records, we are told they are incomplete, or they were not received timely. Sometimes we are told that medical necessity is not met, but we are never given an explanation of what standard is not met and where the records are deficient.
The only answer I hear from the off shore call center is that our per diem rate is too high. I think this is incorrect since we are out of network and do not accept assignment, the vast majority of the claims are sent to Multiplan for repricing.
This is wrong to the point of being criminal, however since all UHC plans are self funded, they hide behind ERISA.
Does anyone have any insight or solution? That would be greatly appreciated.
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Bilateral Knee Pain (R>L)
Now, when I check the ICD 10 book, I see there are individual codes for right and left for the knees (or any other joint). However, when I check online, I can find that the same code (for example M25.561) under ICD 10 Data, states that you can use that code to mean bilaterally. I can't seem to find that in the book, however.
So which is right? Do I need to code both right and left for bilateral pain as the ICD 10 CM book says? Or do I just need to code one side or the other for bilateral pain? I have asked the other coder in my office and she doesn't know either.
Sometimes patients will have 15 diagnoses, so this would help shorten the amount we need to code. Thank you for all your help.
Melannie
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Right lower extremity was sterilely prepped and draped. Portal sites are infiltrated with
about a half mL each 1% lidocaine with epinephrine. Portals are created and survey of the joint is undertaken. Medial
meniscus, femoral condyle and tibial plateau are all in good shape ACL visualized intact. Lateral femoral condyle and
tibial plateau are in good shape. There is a small parrot's beak tear of the lateral meniscus in its midbody with extending of
weakness in the innermost portion of the meniscus, extending to the posterior horn. These areas are d?brided with the
basket and a punch. The gutters are clear of debris. The patellofemoral joint tracks well. There are two small areas of
scuff on the patella and there are d?brided with shaver and there was a suprapatellar veil, which is d?brided with
radiofrequency tissue ablator and shaver. All loose debris and fluid is evacuated from the joint. Portals are closed with 4-
0 black nylon mattress sutures. Wounds are dressed with Xeroform gauze, fluffs 4 x 4's, Kerlix and ACE wrap
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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.
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Sitting for examI was wondering if anyone had tips on this exam (CGSG) I am siting for it VERY soon.
Should I bring a reference book as it says we can? If so do you have suggestions?
A medical dictionary?
I have very basic experience in the surgery field. Mainly anything done in office I have coded.
Any and all help/tips/advice is greatly appreciated!
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E/M with Fracture CareDo you include the initial fracture evaluation with a fracture care code in the office? Example I have is the urgent care physician saw the patient, obtained x-rays and noted wrist fracture. Patient was splinted and sent to ortho and seen within 5 days. Orthopod evaluates, reviews previous x-ray and determines there is a slight displacement and reduces the fracture in the office. Takes additional x-rays and casts pt. Would you allow an E/M to be billed with the fracture care code with manipulation? The patient had already received an initial eval and x-rays identified the fracture so the thought is that the E/M is included.
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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.
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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.
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"Two sessile polyps were found in the ascending colon. The polyps were 2 to 3 mm in size. These polyps were removed with a cold snare assisted by cold forceps. Resection and retrieval were complete. Estimated blood loss: none."
Can I only code and bill for the snare technique: 45385 or can I code both approaches 45385, 45380 59?
Any input would be much appreciated! Thank you!
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Operative Report Procedures performed: 1. Left transfem aortogram 2. RLE r/o 3. Right fem exploration 4. Open thrombectomy 5. Fem-BK popl bp insitu GSV 6. Side branch ligation 7. Completion angio Primary Surgeon: Hue Thai, MD Assistant(s): none Pre-procedure diagnosis: ALI Post-procedure diagnosis: ALI Start date: 11/23/15 Start time: 2130 Anesthesia: general anesthesia Estimated blood loss in ml's: 600 Blood products: 2 units pRBC Technique/Procedure:
This is a 51 year male with severe peripheral arterial disease status bilateral femoropopliteal bypasses and stenting. He continues to use tobacco. He presented with 3 days history of right lower extremity pain and coldness. He had preserved motor but with paresthesia. His preoperative duplex demonstrated complete thrombosis of the fem-popl bypass and only monophasic waveforms in the right lower leg. Operative management was discussed including risks, benefits, and alternatives and patient consented to proceed.
Patient was seen in preoperative area with consent and site confirmed. He was taken to the operating room, properly identified and placed supine. General anesthesia was induced and the abdomen and bilateral groins were prepped and draped in the usual sterile fashion. perioperative was started and time out was called.
Page 1 of 3
We began with a left femoral access with a micropuncture kit under ultrasound guidance. This was up sized to a 5F sheath and an Omni catheter was brought up the infrarenal aorta for an aortogram. The catheter was pulled down to the aortic bifurcation for additional pelvic views. The right iliac artery was cannulated and the catheter was parked in the distal external iliac artery for right lower extremity run-off. It was difficult to determine patient's lower leg run off due to poor collaterals. A decision was made to explore the right groin. The is was extremity scared down from prior surgery requiring much more than expected time. The femoral artery and its bifurcation was dissected and controlled. Patient came to the OR on heparin drip and was continued with every hour boluses.
The femoral bypass graftotomy was performed and sequential balloon embolectomy was done with a #3, #4, and #5 Folgarty catheters. This retrieved a large amount of old and new thrombus. We were able to pass our #3 catheter to the tibioperoneal vessels with continuous return of old and new thrombus despite patient being on adequate heparin. Thus heparin products were discontinued and Argatroban was utilized. At this point, very little new thrombi were seen. Given little outflow seen, a decision was made to explore the distal fem-pop bypass. An incision was made through previous above knee operative site and the graft was exposed and controlled. The graftotomy was made and more thrombus with multiple stents were removed. Given how poorly the graft appeared a decision was made to abandon this plan and the graft was thus ligated.
The infrapopliteal artery was explored as a last resort via an infrapopliteal incision. No bleeding in the soft tissue was seen but muscles were viable. We encountered the GSV with adequate calliber. The infrapopliteal artery was freely dissected and controlled. Following this a return to the femoral groin was made to explore the saphenofemoral junction. This was carefully dissected and transected flushed. The GSV stump was suture ligated and divided. The vein was spatulated to fit and anastomosed to the femoral artery in an end-to-side fashion with 6-0 Prolene running suture. The distal GSV was dissected, divided, and a LeMaitre valvulotome was passed retrograde multiple times until pulsatile bleed was obtained. Following this the vein was prepped and the distal end to side anastomosis was created in a standard running fashion with a 6-0 Prolene. Pulsatile flow was established and a completion angiogram demonstrated 1 vessel run-off into the foot. Major side branches were ligated and divided. Once hemostasis was satisfactory the wounds were irrigated and inicions closed in multiple layers and dressings placed. Patient tolerated the procedure well, was kept intubated and taken to the ICU in satisfactory condition. All counts were correct.
Specimens removed/altered: stents Complications: none Drain(s)/tube(s): none Implant(s): Vac dressings x 2 Cultures sent: No Fluids:
Page 2 of 3
4500 Urine output: 800 Operative findings: Hypercoagulable Acute and subacute graft thrombosis Completion angio with 2 vessels r/o to foot
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Estrogen Receptor (ER)
Positive (percentage of cells with nuclear positivity: 11-20%)
Average intensity of staining: Weak
Progesterone Receptor (PgR)
Negative
Internal controls present and PgR positive (as expected)
Her2 (by immunohistochemistry)
Negative (Score 0)
No staining observed
Percentage of cells with uniform intense complete membrane staining: 0%
Thanks.
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DOS: 1/1/2001 Patient XXX:
HX: Patient returns for bilateral shoulder and knee injections. She stated that Dr. XXXX did not want to do her shoulder arthroplasty until the scratches on her forearms are healed. She has a puppy and thin skin and constantly has open wounds.
IMPRESSION: Bilateral cuff tear arthropathy and bilateral knee arthrosis.
PLAN: Each of the four joints was injected with 40 mg. of Kenalog. I will see her back as needed.
Signed by : Dr. XXXX
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Patient comes in for a preventative exam that turns diagnostic, they want to bill both E/M codes on the same dos same doctor. ?
Please advise.
Thank you
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We have great opportunities for experienced coders to be part of a robust coding team! Grow your skills and career with our Professional and Hospital Coding Departments! We offer ongoing training such as lunch and learn, etc., as well as education and support with a variety of resources and tools. Come join our organization!
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Coding Educator and Trainer - CCS, CIC or RHIA coding professional. You'll train physicians, coders and CDI staff on documentation and coding diagnoses, CPT and HCPCS codes.
HIMS Coder - Full Time opportunity for a Coder 3. Must have knowledge of Medical Terminology, Anatomy and Physiology, Pathophysiology and Pharmacology as well as completion of a Health Information Technology program or Certified Coding program required plus 5 years of coding experience in a healthcare setting. Credentials Required: RHIT, RHIA, CCS, CCS-P, CPC, CPC-H (one credential) required.
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I ask because it doesn't mention it under the I25.110 code .. Thank you.
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