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Medical Coding
lundi 29 février 2016
Home Health Coding from Inpatient Documentation
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Home Health Coding from Inpatient Documentation
pyelonephritis, history of vs current
Pt had pyelonephritis early in pregnancy in first trimester, and continues in third trimester to be on medication to prevent recurrence. Do I code pyelonephritis as a current condition since it is being treated, or do I use a personal history code since provider states "history of"?A/P: "History of pyelonephritis this pregnancy. Continue medication to suppress recurrence."
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pyelonephritis, history of vs current
Resume: April Rosenberger CPC-A
1354 Russ Road Jackson, Ohio 45640
Thomasa3april@aol.com
740-577-7997/ 740-710-2356
Objective
Highly capable, resourceful and detail-oriented person, seeking job opportunities to demonstrate medical administrative strengths. Solid work history showing a track record of efficiency and accuracy. Proven ability to meet deadlines in high-pressure environments with keen attention to detail. Backed by academic qualifications and extensive course work in Medical Billing and Coding procedures. Take pride in keeping a professional appearance and attitude while on the job. Committed to patient confidentiality and satisfaction.
Education
Daymar College
Jackson, Ohio 45640
740-286-1554
Billing and Coding Specialist-Associate of Applied Science
September 2013
Graduated with highest honors-Summa Cum Laude.
Completed 90 hours of internship at Pike CAC-Family Health Center in Billing and Coding.
Certified Professional Coder (CPA-A)
ID: 01373878
Certificate of ICD-10 –CM Proficiency-December 23, 2015
A.B.L.E
Ohio Department of Higher Education
Columbus, Ohio
614-466-6000
G.E.D.
June 2002
Experience
Adena Hospital
October 2014 to January 2015
Chillicothe, Ohio
740-779-7500
40 hours per week
Data Entry:
Pay close attention to detail in assuring correct billing for physicians.
Took proper steps to make sure codes were correct.
Corrected codes of any indiscretions.
Prepared codes that were no longer applicable for supervisor’s discretion.
Assisted with necessary paperwork to be mailed.
Operated fax machine.
Filed codes in proper filing system.
Removed duplicate codes.
Proofread all codes before billing.
Bellisio Foods
January 2014 to July 2014
Jackson, Ohio
740-286-5505
40 hours per week
Line Assembly:
Assuring the products met company standards.
Work at a fast pace to ensure production standards are met while not compromising product quality.
Pay close attention to detail in sanitation of equipment to meet company and health department standards.
Tear down and clean-up work station.
Daymar College
October 2012 to June 2013
Jackson, Ohio
740-286-1554
30 hours per week
Federal Work Study:
Use standard filing practices and procedures to file student financial aid files in an orderly fashion.
Assist the college in various capacities to ensure a positive student experience.
Operated fax machine.
Assisted with necessary paperwork to be mailed.
Helped distribute books to students.
Bellisio Foods
January 2010 to December 2010
Jackson, Ohio
740-286-5505
40 hours per week
Quality Control:
Measuring and assuring the products met company standards.
Work at a fast pace to ensure production standards are met while not compromising product quality.
Pay close attention to detail in sanitation of equipment to meet company and health department standards.
Tear down and clean-up work station.
O’Bleness Memorial Hospital
November 2005 to November 2008
Athens, Ohio
740-592-9285
40 hours per week
Phlebotomist:
Took blood from patients ranging from newborn to the elderly.
Placed orders in the computer.
Filed paper work and completed stat draws when needed.
Stocked drawing room with necessary supplies.
Ensured lab was tidy and up to code.
Answered telephone with courtesy and respect.
Interacted with patients in a professional manner.
Certificate of Completion:
The Privacy Rule and Health Care Practice
October 2011
HIPAA Security Basics for the Health Care Workforce
September 2011
Venipuncturist
2004
Honors List:
Fall 2011
Winter 2012
Spring 2012
Summer 2012
Fall 2012
Winter 2013
Summer 2013
Knowledge of the Following:
Medical Terminology
Anatomy & Physiology 1&2
Health Care Delivery Systems
ICD-9
ICD-10
Medical Office Management
Procedural Coding
Claims Processing-1500
Claims Procesing-UB-92
DME, Modifiers & Chart Analysis
Comprehensive Coding
Pathophysiology
Reference
Eric Womeldorf
Daymar College
Jackson, Ohio 45640
740-286-1554/ 740-988-7432
Career Services Rep/ Adjunct Instructor and Former Supervisor
Denis Haney-Hurley
Daymar College
Jackson, Ohio 45640
740-464-1434
Adjunct Instructor and Former Billing and Coding Instructor
Brad Stewart
Personal Reference of 20 Years
Plant Manager at Southern Ohio Sands
Beaver, Ohio 45613
740-226-1801/ 740-710-9538
Paula Floyd
Personal Reference of 5 Years
240 Florence Ave
Jackson, Ohio 45640
740-979-5413
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Resume: April Rosenberger CPC-A
Help-pcnl coding
I am new to Urology coding and would like some help with this OP report please. I know there are new codes for 2016 as well. Any help with this would be greatly appreciated.
Indication for Surgery 2 large left renal stones
Preoperative Diagnosis Same
Postoperative Diagnosis Same
Operation Cystoscopy, left ureteroscopy with laser lithotripsy Percutaneous nephrostomy tube and left percutaneous nephrolithotomy with placement of nephroureteral stents
Findings No evidence of residual stone fragments by nephroscopy, ureteroscopy or fluoroscopy
Specimen(s) Stone fragments
Complications None
Technique After satisfactory timeout the patient underwent induction of general anesthesia in the supine position and then was placed in the prone position and a superman type position with leg spreaders in place. The patient had a pre-existing left double-J stent. The patient was prepped and draped in the genitalia region and also the left back. Cystoscopy was carried out and the existing double-J stent was brought to the meatus but due to encrustation a guidewire could not be placed through the stent. The stent was eventually removed and with some difficulty related to mucosal edema and a 0.035 sensor wire was placed in the region of the left renal pelvis. An 8/10 dilator was then placed and a second wire placed similarly. A 12/14 ureteral access sheath was placed to about the level of just below the stone. Flexible ureteroscopy was then undertaken but we were unable to manipulate the ureteroscope past the stone to allow the tip of the ureteroscope to be used as a "bull's-eye" for placement of the nephrostomy tract. Because of this a laser was introduced and the stone was partially treated with laser to allow passage of the scope on the medial side of the stone up to the level of the superior pole of the kidney above the very large stone. Various fluoroscopic images were captured throughout this entire process and safe to the PACS unit. The ureteroscope was maneuvered up to a superior lateral calyx which was chosen to have of time as the target. Contrast was utilized through the ureteroscope to make sure this was in the correct position. Various anatomic landmarks were marked with the use of fluoroscope including the ribs and the stone location. Utilizing fluoroscopy and the patient at end expiration an appropriate spot was chosen overlying the tip of the ureteroscope and a trocar needle was passed with a bull's-eye technique with only 1 correction needed to be made until the trocar needle was seen to enter the calyx exactly where we chose it to enter. A 0.035 sensor wire was then placed through the trocar and under vision was brought through the ureteral sheath and used as a through and through safety wire. I used the fascial dilator after the skin had been incised over the existing wire in the flank. The 8/10 ureteral catheter was placed over the existing wire and a second wire was placed. The ureteral access sheath was then removed and reintroduced over one of the wires so that the other wire was outside the sheath to allow room for the ureteroscope. Both ends of that wire were clamped as a through and through wire. After fascial dilatation was completed I passed the ureteral balloon dilating catheter which was again observed entering the kidney under direct vision from the ureteroscope and inflated in a typical fashion to about 7 atm to allow dilatation of the tract. The nephroscope sheath was then placed over the balloon a typical fashion and the balloon removed. The nephroscope was then introduced some clots were removed and the stone was fragmented. Fragments were removed with the Perk-n- Circle device. After sequential fragmentation of the stone with removal of all visible pieces the calyces were inspected from below as well as from above. From below the flexible ureteroscope was used and from above the flexible cystoscope as well as the nephroscope were used and no significant stone fragments were noted. The patient then had the sheath withdrawn and there was no evidence of unusual bleeding from the nephrostomy tract and a nephroureteral stent placed with the use of fluoroscopy and cystoscopy. Nephroureteral stent positioning in both the kidney and bladder were accomplished using fluoroscopy and cystoscopy respectively. Silk sutures were placed over the nephrostomy incision and the nephrostomy tube was secured to the skin and placed to gravity drainage. The patient had some bleeding per bladder and so a larger Foley catheter was placed and may be placed to bladder irrigation once he is evaluated in the recovery room. The patient was awake and transferred to the stretcher and taken the recovery room in stable condition.
Thanks so much!!
Kelly, CPC
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Help-pcnl coding
URI and cough
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URI and cough
State DOL Audit
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State DOL Audit
Removal of articial disc & arthrodesis coding
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Removal of articial disc & arthrodesis coding
obs coding question
Pt came in for a lung bx by my physician on 02/15/16 and discharged by my physician the next day 02/16/16. Can I bill 99217 for the discharge or is it bundled in the procedure charge? I haven't been billing 99217, but if I am missing revenue I want to fix that for future claims.
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obs coding question
Clonidine Conversion
If you are using J0735, the description is "1 mg". 100 mcg = .1 mg. Since you can't bill for "0.1" unit of a drug, you would round up to 1 unit.Originally Posted by celcano
My physician used "1 ml of clonidine 100 mcg/ml" for a injection. How many mgs would I bill? Thank you for any assistance.
Meagan Strauss, CPC, CEMC
Coding Coordinator
The NeuroMedical Center
Baton Rouge, LA
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Clonidine Conversion
Referrals without exam or treatment
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Referrals without exam or treatment
Timely filling on labs
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Timely filling on labs
Cpt 90714
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Cpt 90714
Spirometry
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Spirometry
Need help coding LHC and stenting to diag 1 and diag 2
OP REPORT
1- Selective coronary angiogram of the left main (LM) and right coronary artery (RCA).
2- A left heart catheterization without ventriculogram was performed.
3- Selective angiogram of SVG-RCA and LIMA-LAD
4- Percutaneous coronary intervention of D1 with a 2.25 x 16mm Promus Premier
5- Percutaneous coronary intervention of D2 with a 2.25 x 16mm Promus Premier
4- Right CFA angiogram
5- Right CFA Angioseal
Procedure (Diagnostic):
The procedure was described to the patient including benefits, risks, and alternatives to the procedure. The patient confirmed understanding. The patient signed the informed consent. She was brought into the cath lab. The bilateral groins were prepped in a sterile fashion, and a sterile drape was placed over the patient.
The right common femoral artery (CFA) was palpated and the region above the artery was anesthetized with 2% local lidocaine. Using a 4 Fr Cook needle, with the modified Seldinger technique, vascular access was obtained to the right CFA whereby a 6 French sheath was placed without difficulty.
A 6 Fr diagnostic JL4 catheter was advanced over a J-tipped wire to the ascending aorta. The J wire was removed, the catheter aspirated to ensure no air was in the system and flushed in the usual fashion. The diagnostic catheter engaged the left main coronary artery without difficulty. Pictures of the left coronary system were taken in several various orthogonal angles.
The diagnostic catheter used for the left coronary was subsequently removed over the J wire and a 6 Fr diagnostic JR4 catheter was advanced over a J-tipped wire to the ascending aorta.The J wire was removed, the catheter aspirated to ensure no air was in the system and flushed in the usual fashion. The diagnostic catheter engaged the right coronary artery without difficulty. Pictures of the right coronary system were taken in several various orthogonal angles. The catheter was used to engage the SVG-IM and LIMA-LAD, and angiographic views were obtained. The diagnostic RCA catheter was removed from the descending aorta over a J wire.
A 5 Fr MP catheter was used to engage the SVG-RCA and angiographic views were obtained. A left heart catheterization without ventriculogram was performed. A 5 Fr MP catheter was placed over the wire and guided into the left ventricle. The J wire was removed, the catheter aspirated to ensure no air was in the system and flushed in the usual fashion. Left ventricular pressures were 153 with an LVEDP of 20. The catheter was then pulled back across the aortic valve and there was not a significant gradient across the valve. The pigtail catheter was then removed from the descending aorta over a J wire.
Coronary Angiography Findings:
Left Main
Patent with no significant obstructive CAD
Left Anterior Descending
Diffusely diseased, D1 and D2 with 90% stenoses, competitive flow seen in distal LAD
Left Circumflex
Occluded at the ostium
Right Coronary
Mid RCA occluded
PDA
Mild non-occlusive plaques
LIMA to LAD
Patent
SVG to RCA
Patent
After reviewing the images, coronary intervention was deemed necessary.
Procedure (Intervention):
The 5 Fr. sheath was exchanged out for a 7 Fr. sheath.
Anticoagulation with bivalirudin was initiated. An ACT was performed to ensure administration of the Bivalirdin..
A 6 Fr XB 3.0 guiding catheter was advanced over a J-tipped wire to the ascending aorta. The J-tipped wire was removed and the catheter was aspirated to ensure no air was in the system. The catheter was then flushed in the usual manner. The guiding catheter was then seated into the left main ostium.
A 0.014" Asahi Prowater wire was inserted into the guiding catheter and advanced into the D1 coronary artery and passed through the target lesion. Angiography revealed no significant trauma or complication from wire crossing. A 2.0 x 12 mm Emerge balloon was advanced over the wire to the target lesion and was inflated. The balloon was removed. An Asahi Sion Blue was advanced into D2, and D2 was ballooned using a 2.0 x 12mm Emerge.
Next, we advanced a 2.25 x 16 mm Promus Premier stent over the wire to the D2 target lesion and deployed. The stent balloon was removed. A second 2.25 x 16mm Promus Premier was used to stent D1.
Final angiography revealed adequate stent expansion with no evidence of dissection or distal embolization. There was TIMI III flow distally.
At this point the intervention was deemed successful and the procedure completed. The wire and balloon were removed from the coronary artery. The guiding catheter was disengaged from the coronary artery and removed from the body over the J tipped wire.
Closure:
Angiography of the CFA was performed without evidence of dissection, thrombus or perforation. Therefore the access was deemed acceptable for a closure device. A 8 Fr Angioseal was subsequently deployed without complication. The patient was sent to the holding area in stable condition. The patient was hemodynamically stable throughout the entirety of the procedure.
Stent Implanted:
Location of Stent
2.25 x 16 mm Promus Premier
D1
2.25 x 16 mm Promus Premier
D2
Medicare patient, would this be billed as 93459 (26)(59), 92928 (LD),92928(LD)(59) or
93459 (26)(59),92928 (LD),92929 (LD)(59)
I did some research and have read that mcr does not pay for add on code 92929 any info on this?
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Need help coding LHC and stenting to diag 1 and diag 2
Office cardiac stress test billing
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Office cardiac stress test billing
Laminectomy coding question
My provider is performing L4 and L5 laminectomy and bilateral medial facetectomy at the L4-5 level, bilateral foraminotomies of the L5 and S1 nerve roots bilaterally.
He wants to use codes 63047 & 63048. My constant confusion is what's considered a single vertebral segment and what's considered a single vertebral interspace.
I believe coding should be 63047 & 63048 x 2, since 63047 states a single vertebral segment, and 63048 is each additional segment.
Can someone please help? I'd appreciate anything anyone can give me
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Laminectomy coding question
eustachian tuboplasty
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eustachian tuboplasty
Ckd htn dm type ii
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Ckd htn dm type ii
bone biopsy
A linear incision was carried over the base of fourth metatarsal. A jamshidi needle was used to obtain a bone biopsy from the base of the fourth metatarsal. Through same incision, a jamshidi needle and mallet was used to obtain a bone biopsy from lateral cuneiform. Using same incision, a jamshidi needle was used to obtain a bone biopsy from medial cuneiform.
the code is 20220.
As the physician has taken 3 different biopsies, it should be coded as 20220 x3 or only once as it was taken through same incision.
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bone biopsy
dimanche 28 février 2016
right submandibular mass
postop diagnosis: symptomatic right submandibular mass.
intraoperative findings: A pea-sized cystic lesion.
description of procedure: after prep/drape/general anesthesia using LMA device/time out taken. a 1-cm incision was made along skin lines directly over the palpable lesion. incision was carried down to level of subcu tissue. the lesion was circumferentially dissected out and evaluated and appeared to consistent with cystic lesion and sent to pathology. hemostasis was achieved using bovie cautery. there did not appear to be any nerves or important blood vessels in the immediate area. the wounds were closed in layers. the dermal layer was closed with 4-0 Vicryl in an interrupted manner and skin closed with 5-0 prolene in interrupted manner. the wound was cleaned and a sterile pressure dressing was applied. the patient tolerated the procedure well.
path report: Vascular channel with organizing thrombus.
I have a doubt between CPT 42440 and 21040. For 42440 no gland was involved and 21040 description says as mandibular enucleation or should i code 11441 and 12051 for intermediate repair.
please suggest.
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right submandibular mass
nodule on gums
Pt has a prior history of a mucocele and now presents with a similar lesion on upper left gum, currently small. Occasionally grows very large and pushes his lip out. Denies fevers, chills.
Exam: Left upper mid-lateral gums with nodule approx 0.7 mm.
Dx: Neoplasm of gum (D49.0). Possible mucocele. Will refer to ENT.
From the research I've done on this forum, I understand I can't code as neoplasm of unspecified behavior (the code the provider chose above), or even as benign neoplasm because no study has been performed.
A search under "nodule" on gums (term used in exam) leads to R22.0, localized swelling/mass/lump of head.
A search under "lesion" on gums (term used in HPI) leads to K13.79, which is mucocle, but which provider said was "possible"so I don't know about using that...
but a search under "lesion, oral" also leads to K13.79. And I also see K13.70, unspecified lesions of oral mucosa, as a possibility.
I guess it comes down to what term to search under.
The exam is the objective part, and "nodule" is used there, leading to R22.0 -- but K13.70 seems more precise, and "unspecified" lesion here would refer to not knowing what type it is at this point, correct?
How would you code this?
Thank you in advance!
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nodule on gums
Discography and Fluoroscopic Guidance, 62290 and 77003
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Discography and Fluoroscopic Guidance, 62290 and 77003
Co morbidity requirements for risk level 3
One worker feels that there must be documented comorbidities that are different than the surgical diagnosis (such as htn, dm, etc), to support p3, p4 and to query the physician if these are missing. And that the surgical diagnosis alone even if a severe diagnosis is not enough to support billing p3 p4 as the anesthesia cpt for that specific severe surgical diagnosis already takes into account of the severity in the base units of the code.
Another worker feels that the surgical diagnosis is enough to support p3, p4 and above if it is a severe systemic disease on its own, like heart valve replacement mitral regurgitation, etc.
Thank you.
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Co morbidity requirements for risk level 3
Looking to Sell Small Medical Billing Business
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Looking to Sell Small Medical Billing Business
When to use PCS
a. O65.4, 64479
b. O65.4, O33.0, 01961
c. O65.4, 01967, 01968
d. O65.4, O33.9, 01996, 0TSD0ZZ
This is just an example out of the CCA practice exam. How would I know when to use CPS codes in the real world without multiple choice?
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When to use PCS
samedi 27 février 2016
Code urinary retention or symptoms?
"Drinking water and decreased urine output. States has trouble getting urine out at times.
?urinary retention: Pt cathed and had 200 cc clear urine. Pt states he felt better. I do not feel pt needs indwelling catheter."
"A/P: Urinary retention, R33.9. Unclear if he had this. Pt cathed 200 cc of clear urine. Pt did not feel he needed or wanted a catheter. Advised to go to ER if he cannot urinate in a timely fashion. For now will send UA and culture. Follow up in 2 days."
Would you code retention...
...or use an R code to describe the symptoms? If the latter, which one fits the best?
R39.11, Hesitancy of micturition
R39.12 Poor urinary stream (weak stream)
R39.14 Feeling of incomplete bladder emptying
R39.16 Straining to void
Or is this worth a provider query?
Thanks so much for your help!
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Code urinary retention or symptoms?
Coding Anxiety and Depression
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Coding Anxiety and Depression
admitting diagnosis
Hi, I'm a current student and I'm struggling with admission diagnosis issues. I have a couple of questions I'm hoping someone could help me with please.
1. If a patient is admitted at 40 weeks gestation for induction with no other complications what would you code for the admitting diagnosis?
2. If a patient had SROM on one day, gets admitted later that day, and delivers the next day, what would you code for the admitting diagnosis?Thanks in advance for your help.
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admitting diagnosis
vendredi 26 février 2016
Remote coder providence, ri location
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Remote coder providence, ri location
Cpt code 90846 and 90847
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Cpt code 90846 and 90847
Codes 90846 and 90847
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Codes 90846 and 90847
Injury S code with M code
99214:
S89.92XA Left knee injury, initial encounter
M23.92 Internal derangement of left knee
20610/J3301:
M23.92 Internal derangement of left knee
There is only one injury to the knee. I do not read any specific instructions in either the official ICD10 guidelines or the chapter guidelines that prohibits the two codes but it doesn't seem entirely correct either.
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Injury S code with M code
Modifier 80 & 81
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Modifier 80 & 81
Pqrs
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Pqrs
G0296 Written Order Requirement for LDCT
Written orders for lung cancer LDCT screenings must be appropriately documented in the beneficiary’s medical record, and must contain the following information:
• Date of birth;
• Actual pack–year smoking history (number);
• Current smoking status, and for former smokers, the number of years since quitting smoking;
• A statement that the beneficiary is asymptomatic (no signs or symptoms of lung cancer); and,
• The National Provider Identifier (NPI) of the ordering practitioner.
When the order is placed electronically, does all of that information have to be on the actual order or can the provider fax a copy of the office note (which has all of the information) to the radiology facility separately? The note states that they are ordering the LDCT and all of the required information is in the shared decision making visit so is the requirement for the written order met with just the note? I would think that these are two separate requirements and that the electronic order should also have the information but this requires duplicative work. Any insight is appreciated!
Thank you,
Sue
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G0296 Written Order Requirement for LDCT
Practice Administrator
some help in understanding the differences in the CPT Codes:
(thyroids, lymph nodes, neck & parotid)
We started out using:
76536 for ultrasounds + 38505 if FNA was performed
Now the doctors are using 76536 + 10022 if FNA was performed
When I read the descriptions, I’m not sure which is correct.
Can you help me in any way with this dilemma?
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Practice Administrator
Joint revisions - hip capsule, femoral membrane
Based on Padget's handbook, my thinking is that these types of specimens could be coded as 88305 for soft tissue. I would welcome any comments!
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Joint revisions - hip capsule, femoral membrane
Hep B vaccine CPT 90746
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Hep B vaccine CPT 90746
use of postmortem codes
Sorry, not a fun topic. Of course in our niche, we see a lot of sad stuff, don't we?
thanks for any help
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use of postmortem codes
cant think today.....em with procedure
Chief Complaints:
1. Right knee pain.
HPI:
Appointment type:
Established patient - Established problem Patient returns for her right knee. She continues to be symptomatic. She denies any other specific complaints. .
ROS:
no change from 1-8-16.
Surgical History: foot, c section .
Family History: Non-Contributory
Social History:
tobacco- no
alcohol- yes
married.
Medications: Taking Duloxetine HCl , Discontinued Medrol (Pak) 4 MG Tablet as directed as directed, Medication List reviewed and reconciled with the patient
Allergies: Sulfa.
Objective:
Vitals: Wt 155 lbs, BMI 26.60 Index, Ht 5 ft 4 in.
Examination:
Right knee:
LEG EXAMINATION: Alert and oriented times three, NAD with a normal affect. Exam of the right knee reveals normal alignment. Mild effusion. Good patellar mobility. TTP over medial joint line. No lateral joint line tenderness. ROM is full with pain in deep flexion. The knee is stable to ligamentous exam. Positive McMurray's. 5/5 MMT with quadriceps and hamstrings. Posterolateral corner intact. Pain to palpation anterolaterally just distal to the knee joint Sensation intact, distal pulse 2+. Negative calf tenderness, negative Homan's.Exam of the left knee reveals noraml alignment. Full AROM and strength. Knee is stable to exam. Negative calf tenderness, negative Homan's. Sensation intact, distal pulse 2+..
Assessment:
Assessment:
1. Acute pain of right knee - M25.561 (Primary)
Plan:
1. Acute pain of right knee
Notes: I'll long discussion with the patient. I did describe doing a steroid injection anterolaterally. I would needle this area as well. She was in agreement. 1 cc Kenalog and 1 cc Marcaine was injected under ultrasound guidance. Patient tolerated this well. All questions were answered. We will get her going in physical therapy.
Procedure Codes: 20611 INJECTION JOINT/BURSA/DRAIN W/US, J3301 Inj, triamcinolone acetonide, 40mg
Follow Up: 6 Weeks
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cant think today.....em with procedure
Multiple facility addresses
If a physician were to see patients at a separate location from his main office, what are the billing requirements?
For instance, if the physician were to see patients part-time at a facility owned by another doctor, would that facility address need to be on the claim?
The doctor would see his own patients on a walk-in basis at a facility of a colleague but bill them as his own patients.
I would appreciate links to specific billing guidelines (ie: A CMS billing manual).Thank you for the feedback!
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Multiple facility addresses
what CPT would you use?
Surgeon is coding 26418 and 26525, I am looking at 26418 and 26426, one of my coworkers is saying she doesn't see the 26418 and found info to support 26525 for the volar plate and is suggesting 26426 w/a 52 mod
opinions, help please
Thanks!
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what CPT would you use?
J2795 med coding
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J2795 med coding
Coding different kinds of stenosis - ICD 10
If the report states "neuroforaminal narrowing C3-C4" -- does that offer enough for us to code as M99.71 "disc stenosis of intervertebral foramin"?
Same goes with "narrowing of the neural canal" -- is that enough to presume "intervertebral disc stenosis of the neural canal"
Thanks
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Coding different kinds of stenosis - ICD 10
Medicare Gyn annual exam
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Medicare Gyn annual exam
Injecting Bone Marrow for healing
It sounds like the patient with scoliosis had a mixture of transferred bone and marrow as a autogenous bone graft to facilitate healing of whatever scoliosis procedure she had, but they shouldn’t be using bone marrow transplant codes!!! As to what codes they should be using…I am really not sure
Has anyone came across this before?
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Injecting Bone Marrow for healing
cworkman@stonewallhospital.net CPC-A
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cworkman@stonewallhospital.net CPC-A
Complexity of data and medicine section
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Complexity of data and medicine section
Clavicle plate removal
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Clavicle plate removal
jeudi 25 février 2016
Pulmonary vascular congestion
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Pulmonary vascular congestion
icd-10 vaginal cuff from a recurrent cervical cancer
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icd-10 vaginal cuff from a recurrent cervical cancer
Dx code for 2 hr GTT
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Dx code for 2 hr GTT
Tricare
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Tricare
Connective Tissue Pain?
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Connective Tissue Pain?
ICD10 for antenatal screening labs for Medicare and Dept of Veterans Affairs
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ICD10 for antenatal screening labs for Medicare and Dept of Veterans Affairs
69210 vs 69209
I have a question regarding these two codes. I am not sure what to do in a situation where someone presents for impacted cerumen removal and removal is first attempted by a curette (69210), but is unsuccessful. It is then successfully removed by lavage (69209). The CPT book says clearly to not code these together on the same ear, so I need to pick one. As 69210 is more extensive, so I was thinking of doing 69210-52. Thoughts?
Thank you!
Erin
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69210 vs 69209
Medicare not covering colonoscopy for fam. hx of colon cancer
I am getting a ton of denials from Medicare for colonoscopies performed with the indication Z80.0-Family history of colon cancer. The remark code is: 49- These are non covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. It denies patients that we have not billed an office exam with any routine indications. I called Medicare and the rep just kept saying it was not on their list to support medical necessity. I haven't had this issue until recently. They deny any claim with the code; polyp removal or no polyp removal.Anyone else having this issue or know the fix?
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Medicare not covering colonoscopy for fam. hx of colon cancer
OMT and Biomechanical lesions M99 codes
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OMT and Biomechanical lesions M99 codes
Resume help
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Resume help
Partial Colectomy, partial gastrectomy, PEG placement, Gastrocolic cutaneous fistula
How would you bill this?
PREOPERATIVE DIAGNOSES: Gastrocolic cutaneous fistula with exposed infected hernia mesh.
POSTOPERATIVE DIAGNOSIS: Gastrocolic cutaneous fistula with exposed infected hernia mesh.
NAME OF PROCEDURE:
1. Excision of exposed and infected herniorrhaphy mesh.
2. Partial transverse colectomy with adherent mesh and fistula tract.
3. Partial gastrectomy of adherent hernia mesh and fistula tract.
4. Gastrostomy tube placement with use of percutaneous gastrostomy kit.
5. Side-to-side 80 millimeter GIA colocolostomy anastomosis.
6. Complex abdominal wall closure with posterior Strattice underlay mesh.
7. Placement of small sponge wound VAC to the lower half of abdominal incision.
INDICATIONS: An 89-year-old with a draining fistula tract in the mid abdomen over her prior hernia repair. She was referred for excision.
FINDINGS: The patient had an adherent ventral hernia mesh erosion into the transverse colon as well as the stomach. The mesh was excised in its entirety and resection of the adherent transverse colon and stomach were all divided with GIA staplers and sent as one specimen. No other abnormalities were identified. The stomach was closed with a GIA stapler and oversewn with 2-0 PDS suture. The transverse colon anastomosis was performed with an 80 millimeter GIA stapler and oversewn with 3-0 PDS suture. The fascial defect was supported posteriorly with a 10 x 16 Strattice underlay mesh, which was tacked in position with transfascial #1 Vicryl sutures. The fascia was closed primarily with the exception of a small intentional defect in the mid aspect to allow the wound VAC sponge to evacuate fluid collections beneath the fascia and the mesh.
TECHNIQUE: The patient was brought to the operating room, placed supine on the table. After adequate anesthesia, he was prepped and draped in standard surgical fashion. The abdomen was entered via the incision above and below the palpable hernia mesh and the defect. The mesh was excised from the fascia with electrocautery, which was vast majority of the case, mobilizing and excising the mesh. The mesh was excised from the fascia. After circumferential excision of the mesh, the adherent bowel beneath the mesh was excised and the hernia mesh, and the fistula tracts into the stomach and the colon were clearly identified. On either side of the colon fistula tract, a GIA stapler was used to divide the colon and the mesentery was divided with a LigaSure device. The stomach was opened and at this point using a PEG gastrostomy kit. Angiocath was introduced into the stomach and the wire was fed through the stomach and the opening fistula tract. The PEG tube was fastened to the wire and then the wire was brought through the abdominal wall with the same Angiocath. The PEG was then brought through the fistula tract through the anterior aspect of the stomach and secured to the skin. At this point, the gastrotomy was then closed with an 80 millimeter GIA stapler and a gastrotomy staple line was oversewn with 2-0 PDS suture. The PEG was secured to the posterior fascia with 4 circumferential 3-0 Vicryl sutures. The transverse colon anastomosis was then performed in a side-to-side fashion with an 80 millimeter GIA stapler and closed with the same stapler. All staple lines were oversewn with 3-0 PDS suture. The mesenteric defect within the colon anastomosis was minimal. The abdomen was inspected. Hemostasis was obtained and 10 x16 Strattice mesh was then placed in the posterior aspect of the fascia and tacked with interrupted #1 Vicryl transfascial sutures. After positioning of the mesh, the fascia was then closed primarily with a #1 Vicryl suture and met in the middle, an intentional small defect was left to allow adequate drainage in the space between the mesh and the fascia. The patient was stable throughout the operation, and we sent to the ICU for overnight vent weaning. A wound VAC was placed on the lower aspect of the incision as well using a small sponge.
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Partial Colectomy, partial gastrectomy, PEG placement, Gastrocolic cutaneous fistula
Help with "excision" coding
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Help with "excision" coding
V892xxaPart/Full Time Production Coders and Compliance Auditors Needed
Part time requires 20 hrs per week commitment.
Hiring for all specialties. Surgical coders preferred. CPMA preferred but not required.
5 or more years experience preferred.
If you're tired of working for the rest as a "Contractor" we're what you're looking for!
Please send resume to jmitzel@drsmgmt.com. Please no calls.
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Part/Full Time Production Coders and Compliance Auditors Needed
Humana Denials
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Humana Denials
Osteoarthritis versus polyarthralgia.
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Osteoarthritis versus polyarthralgia.
well checks the first year
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well checks the first year
IVUS Coding guidelines
Our Physicians have started using the Intravascular Ultrasound more and the guidelines that I have found still leave me with questions. Sometimes the physician will use IVUS bilaterally and usually includes the Inferior Vena Cava.
For example the Physician will measure the IVC, Right Common Iliac Vein, Right External Iliac Vein, Left Common Iliac Vein, and Left External Iliac Vein.
Since this is being used to measure each vessel should each vessel be reported? I see that a 50 modifier is not allowed and I do not see an MUE limit posted anywhere.
Would the correct coding be:
37252 (IVC)
37253 (RCIV)
37253 (REIV)
37253 (LCIV)
37253 (LEIV)Any clarification is GREATLY appreciated.
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IVUS Coding guidelines
MediTouch EHR
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MediTouch EHR
UDS screening
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UDS screening
BCBS of NC and denials for Prophylactic
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BCBS of NC and denials for Prophylactic
history of/ healed injury
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history of/ healed injury
Procedure discontinued (bronch) modifier
Pt had bronchscopy started, procedure then discontinued due to worsening hypoxia. Can I still bill this as biopsy was done prior to discontined procedure? Would I use modifier 53. Setting is outpatient hospital. Thank you for all responds.
PROCEDURE:
After informed consent of the patient, the patient had received adequate premedication anesthesia, and oxygen per nasal cannular. The Olympus BF-190 fiber bronchoscope was introduced through the left nares to the level of the vocal cords. Vocal cords were inspected and noted to move normally on phonation. In addition, the piriform sinuses, arytenoid, and epiglottis were inspected and noted to be unremarkable. There was noted to be some moderate bleeding from a nosebleed during this portion of the procedure, but the procedure was continue. Additional 2% Xylocaine was instilled over the area of the vocal cords. The scope was advanced through the vocal cords to the main carina, which appeared sharp without fullness or deviation. Additional 2% Xylocaine was instilled on the right mainstem bronchus, then over the right upper lobe bronchus where the anterior, apical, and posterior segmental bronchi inspected. The scope was
advanced down the bronchus intermedius selecting the middle lobe with the medial and lateral segmental bronchi inspected. The scope was advanced down the right lower lobe bronchus to the superior, anterior basilar, lateral basilar, posterior basilar, and medial basilar segmental bronchi inspected. The scope was then advanced into the right upper lobe bronchus where the anterior, apical, and posterior segmental bronchi were inspected. There was noted to be some nodular changes to the mucosa and the carina between these areas of the bronchi, but it was not a clear friable mass..
The scope was returned to the main carina. Additional 2% Xylocaine was instilled down the left main stem bronchus. Then, over the left upper lobe bronchus in the inferior and superior lingular, apical, posterior and anterior segmental bronchi inspected. The scope was advanced down the left lower lobe bronchus where the superior, anterior and medial basilar, lateral basilar and posterior basilar segmental bronchi inspected. No definite endobronchial lesions were noted in this area.
The scope was returned to the previously described area in the right upper lobe bronchus where ****multiple endobronchial biopsies were performed.***
However, due to persistent nasal bleeding, the scope was removed and a pediatric bite block was placed and the scope was advanced through an oral approach back to this area.
****Further biopsies were attempted; however, due to worsening hypoxemia, the procedure was discontinued.***
Samples obtained from the biopsy were sent for histological evaluation. The patient stabilized and was able to be taken to the recovery area in satisfactory condition. Findings were briefly discussed with the patient and family postprocedure. We did discuss the possibility that, depending on the results, we may need to repeat the bronchoscopy again at some time in the next few weeks for further evaluation of this area.
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Procedure discontinued (bronch) modifier
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