oncology question

Can an oncologist order a low dose CT scan for a patient currently under her care? She has been told in the past that only a PCP can order and be paid for this. This seems odd to me because the results of the scan determine the course of care for her. Ultimately she would be treating him and managing his care if the results show recurrence or there are issues to be addressed.

* This article was originally published here

can someone give me list of all inpatient conditions/ diagnosis which can not be coded in outpatient coding?????

can someone give me list of all inpatient conditions/ diagnosis which can not be coded in outpatient coding?????

* This article was originally published here

RFA Lateral or Medial Bilateral

Can 64640 or 64635 be billed as bilateral procedures? Example: S1,S2,S3 bilateral or medial branch ablation 3 levels bilat.

* This article was originally published here

Sigmoid colectomy and end colostomy creation with ileocecectomy with end ileosto

Patient had massive distention of the entire colon as well as small bowel distention. Both the inferior aspect of the cecum and the terminal ileum approximately 15 cm upstream from the ileocecal valve were involved in a firm inflammatory or malignant mass associated with the sigmoid colon and posterior superior wall of the bladder. An en bloc resection was performed. This did not require a cystectomy as we were able to resect the lesion removing the posterior bladder peritoneum. Both ureters...

Sigmoid colectomy and end colostomy creation with ileocecectomy with end ileosto

* This article was originally published here

ICD-10 code for tight hamstring

Physical Exam: LUMBAR SPINE: Lumbar alignment is unremarkable to visual inspection with no asymmetries in sagittal or coronal plane. Full range of motion is noted with flexion and extension. No masses, step offs or deformities are noted. There is no PSIS, sacroiliac, piriformis or trochanteric tenderness to palpation noted. No midline pain with palpation or percussion noted. NEUROLOGIC EXAM: CN grossly intact. Gait is nonantalgic with well coordinated movements of all 4 extremities. UPPER...

ICD-10 code for tight hamstring

* This article was originally published here

PFSH statements

This might seem like a silly question, but I’m hoping someone might humor me anyways. I have seen records with a statement such as, “The following portions of the patient's history were reviewed and updated as appropriate: allergies, current medications, past family history, past medical history, past social history, past surgical history and problem list.” The record doesn’t list any of these areas separately or have additional documentation about these items. Would there be any credit...

PFSH statements

* This article was originally published here

NST CPT 59025

If a patient presents to the labor and deliver floor with an order to rule out labor, the patient receives a non stress test. From those results, the patient is admitted or discharged to the facility. Can the facility charge 59025 and the physician charge 59025-26? The pregnancy is not preterm and the mother is healthy. Can you offer guidance of when and when not this should not be charged? Also, if a facility has a policy in place, can a NST be a standard test to evaluate the pregnancy...

NST CPT 59025

* This article was originally published here

Coding question covid

I am the billing account manager for a neurologist in Atlanta. He is asking if he can test his church congregation for covid and receive reimbursement. The CPT code is G2023. If so, would it get billed for place of service?

Texas Deliveries

Needing help with our local Medicaid product denying our deliveries prior to 39 gestational weeks. Per the delivery note the patient has a 1st or 2nd degree laceration which is what we use for a diagnosis but it is not listed as a payable dx.
Has anyone else incurred similar challenges? If so how are you appealing these denials?

If you are coding a Pediatric Well visit 99392 and you also do a vision a 3yr old occular vision screen 99174, do you only apply the -59 on 99174?

If we are doing a Pediatric's Wll visit 99392 and we also do a 3yr old ocular vision screen 99174, do you only apply the -59 modifier? Has something changed and you also need to add the -25 modier to the 99392?

* This article was originally published here

BAHA Question

Hello, Is anyone doing two stage BAHA's? According to my MD, some of the younger patients need time for the device to ossify to the bone and 3-6 months after initial surgery, need to go back in to complete. Not sure how this should be billed? 69714-52(first part) and 694714-58(if appropriate)-52 (second part)? Any advice is helpful. Thanks.

Modifier help

Does anyone know if there is a modifier that can be used when billing J0490 with 2 different NDC #'s such as J0490.

TIA

Endarterectomy and Vascular Revascularization

MD coded: 35355, 37221 RT, 37221 LT, 37223 x2, 36200, 36247, 75625, 75710

Myself: 35355, 37221-50, 37223-50, 75625-26

Not too sure about that 50 mod. Any input would help, thank you

Operation

1. Right lower extremity ileal femoral endarterectomy with bovine patch angioplasty
2. Diagnostic aortogram with final catheter placement in the abdominal aorta
3. Placement of a left common iliac 8 mm x 59 mm Omnilink balloon expandable stent
4. Placement of a right common iliac 8 mm x 59 mm...

Endarterectomy and Vascular Revascularization

superior capsule reconstruction with a rotator cuff repair??

I have been researching this subject for a while now and while I have concluded that an ASCR done with Dermal Allograft seems to have many different ways that people think it should be coded. I am under the belief that the ASCR with dermal allograft should probably be coded as an unlisted. What I am having a really hard time with, is the rotator cuff repair with the superior capsule reconstruction. My doc is under the belief he can code for the RTCR and the ASCR together if it is for a...

superior capsule reconstruction with a rotator cuff repair??

Vaccine admin code 90473

Is cpt code 90473 (immunization administered by intranasal or oral route for patients >18 years?

Ob/Gyn visit

If a patient is seen by their primary care and that physicians bills a prevent. Now the patient presents to OB/BYN for the pelvic exam and pap. What should the OB/GYN bill?

How to add new diagnosis codes for the ICD10 manual ?

Hi Everyone,
I wrote a letter to the WHO and AMA agencies a few years ago asking to add a Cough diagnosis for use for children or young teens. Of course I got no reply. However I think the illness symptom of Cough for specifically children would be a great addition. I have some other diagnosis codes I think the WHO and AMA agencies should update the disease manual with the following. such as : support animals for mental behavioral health ill patients set up as Z dx. code, or...

How to add new diagnosis codes for the ICD10 manual ?

TAVR & DRG

I have a provider who just started performing TAVRs and the hospital is questioning the provider, who is now questioning me.

Under procedures performed, the doctor is listing:
1: Left Heart cath
2: Temporary Transvenous pacemaker insertion
3: Transcatheter Aortic Valve Implantation with a 26 mm Edwards Sapien 3 Bioprosthetic
4: Rt Femoral Angiography
5: Perclose deployment x 2 in RFA

Per the documentation, he is using a percutaneous femoral artery approach, and of course he is a...

TAVR & DRG

LAA Ligation and Closure of PFO

Good Morning,

Can you tell me if Ligation of left atrial appendage and a closure of a PFO is included in CABG or MV replacement?

Thank you
Tina

Equine-assisted Psychotherapy help

I have done some research but am seeking real-life Coding experience about Psychotherapy services using horses for a small Florida Non-profit provider hit hard by Covid-19 and a large chunk of their self-pay clients had to drop their services due either from loss of income or due to exposure of their immune-compromised patients. They are now panel providers for United Healthcare and Tricare coverages but generally this type of Therapy is considered experimental so not widely covered or...

Equine-assisted Psychotherapy help

Prescription Billing

Hello Everyone,

Could someone help direct me with Rx billing? Can a physician bill for Rx? Thank you in advance.

Application of Cast After Percutaneous Achilles Tenotomy

Is the application of a long leg moulded club foot cast (CPT 29450) at the end of a percutaneous Achilles tenotomy (CPT 27606) to correct Clubfoot deformity separately billable? There is not an NCCI edit between these two codes but I keep going back to the CPT book - According to CPT guidelines, cast application or strapping (including removal) is only reported as a replacement procedure or when the cast application or strapping is an initial service performed without a restorative treatment...

Application of Cast After Percutaneous Achilles Tenotomy

Scaphoid osteotomy w/ malunion repair using distal radius bone graft

I need help with the above CPT. Dr. gave me 25440 but that is for repair of scaphoid nonunion and diagnosis is scaphoid malunion. I'm looking at 25405.
Thank you,

Dacryocystorhinostomy

Anyone know if 31239 Dacryocystorhinostomy and 68815 Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent can be coded together? I don't see any NCCI edits but wasn't sure if insurance would still consider this bundled.

45381, 45380

Would like some help.
Doc did screening colon, scope to ascending colon due to ulcerated mass. The mass caused a complete obstruction. The report says scope could not traverse the lesion and exam could not be finished. Biopsies taken in the ascending and a India ink injection applied for tattooing. Physicians recommended pt. return in a year.
Would 45380 74 and 45381 74, 59 be correct?

96146

Hello. Is 96146 the new code for 96103? How do we bill cpt code 96146 when 3 tests are completed? Do we use 96146 59 with 3 units or 96146 59 1 unit, 96146 59 1 unit , 96146 59 1 unit? Thank you.

Interactive Contact for Transitional Care Management Services

Appreciate any thoughts or information anyone can provide...

Does anyone have a reference on whether or not the interactive contact can be anything other than telephone, email or face to face can a different technology be used?

Our primary care uses RNs on our team primarily to do the 2 day interactive outreach that is required for the TCM services. Just this spring we launched use of a tool called GetWell (loophttps://www.getwellnetwork.com/getwell-loop/) for our transitioning patients...

Interactive Contact for Transitional Care Management Services

* This article was originally published here

99072 New Code

Good afternoon! New code 99072; does anyone know what charting we need to use this code and get paid for it? Thanks in advance

Telehealth

Hi,
During the Covid-19 PHE can a doctor bill for a call he made to a patient? How about to give test results over the phone? Do the regular rules such as call has to be initiated by patient, not originating from appointment within last 7 days or resulting in appointment within 24 hours or earliest available etc. apply? I have looked around a lot and cannot find it spelled out.

Thank you for your help.

ACL REPAIR OF RIGHT KNEE; GRAFT FROM LEFT KNEE

Patient had a right knee ACL Repair [29888]

Graft was taken from the Left Knee, for which I billed 20924, using a modifier 59 on the claim

This procedure was denied per CCI Edit, stating I cannot override the edit
Even though this was a separate procedure, separate structure, am I able to appeal or is this final?

Thanks Orthos

coding mastoidectomy

How would you code this one?

Indications:

This is a female with a history of left pulsatile tinnitus and a left dehisced sigmoid sinus on CT temporal bone imaging.



Details:

The patient was brought into the operation theater and placed under general endotracheal anesthesia. The bed was turned 180 degrees. Facial nerve monitoring leads were placed in the orbicularis oris, oculi, and the contralateral deltoid area. The postauricular hair was shaved slightly and 1% lidocaine...

coding mastoidectomy

CPC 4 1/2 yr experience looking for part-time opportunity

To whom it may concern:

Please see resume bellow. I am seeking a part-time position in medical coding. I am available to start right away, and can work up to 35 hours a week if needed. I have experience in E/m, injection coding, chronic care, and anesthesia . I have billed for practice owned and provider only services. I have experience in provider communication. I have 4 1/2 years of coding experience. I look forward to hearing from anyone that has an opportunity for me.




Abigail M...

CPC 4 1/2 yr experience looking for part-time opportunity

https://www.aapc.com/discuss/forums/pathology-clinical-laboratory.504/

Hi Victoria,

Thanks for your question.

When your lab uses an immunohistochemistry, you have to know when to report multiple units of CPT 88342. The following expert tips will help you get your 88342 coding right every time.

Tip 1: Heed the code definition and bill per antibody:- The 88342 description says, "each antibody," so you should report multiple units of the code if the lab performs more than one antibody stain on a single specimen. You should list each stain as one unit of...

https://www.aapc.com/discuss/forums/pathology-clinical-laboratory.504/

Blending Administrative Expertise with Medical Coding Skills

Kathleen L. Samborski, MSA, CPC-A Open to new opportunities and contacts. Please reach out via email or LinkedIn message.
Royal Oak, MI 48073
kathleen.samborski@gmail.com
Kathleen's LinkedIn Profile

Effective Healthcare Office Professional Supporting Smooth Business Operations with...

Blending Administrative Expertise with Medical Coding Skills

Wound Packing without I&D by different provider

I have a patient that had an I&D by a different provider, in fact a different health system all together. My doc saw this patient for repacking/dressing change. Anyone have a clue what CPT code I could use for this other than E/M?

PODIATRY CODING BOOKS

I am selling 2 books; 2019 Optum Coding Companion, a comprehensive illustrated guide to coding and reimbursement AND TCI Coder's Specialty Guide Podiatry, 2019. Paid over $300...will sell both for $100.

Podiatry

Any one have any good resources in regards how to under and code debridement of ulcers , routine foot care and trimming of nails. I feel there is so much info and looking for sources to help understand how to code, what to look for etc etc, feel a little loss :/ I would greatly appreciate any feedback or recommendations of books, videos or webinars .. Thank you

Provider based CMS guidance on reimbursment

My organization is considering eliminating our provider based billing practices. Is there documentation showing if the reimbursement would increase on the professional side if this occurred? There is the thought process that by discontinuing the technical facility separate billing and removing ourselves from being provider based the office professional would increase to an extent. I cannot find specific documentation on that.

Stable diabetes mellitus and PVD is assessment and plan

Are we able to assume a relationship between Stable DM and PVD if both are is assessment and plan of providers note?

Laparoscopy Oophorectomy with Biopsies of Peritoneum, Omentum

Hello Coding Community! I would like to confirm that we cannot add -22 or cpt for Biopsies in my scenario below? I feel I might miss extra reimbursement for extra work on biopsies but CCI edits tell me- cannot add them. Do you think I could add modifier -22 at least? Thank you very much for your help in advance.
Code 58661(column 1) has a CCI conflict with code 49321(column 2). A modifier is allowed to override this relationship.

...

Laparoscopy Oophorectomy with Biopsies of Peritoneum, Omentum

Drive by Flu Clinic and POS

My physician practice is planning to delivery flu shots in the parking lot of our administrative headquarters building in light of Covid. An MA will meet patients in their car, they step out, get vaccinated, return to car, and drive off. We do not see patients at this physical location, but it does serve as our central lab. I have heard that POS 11 may be used, but seeking other thoughts on the matter. POS 16? Thank you!

Inflammatory spondylopathy

Looking for some help on this... Do conditions such DDD, DJD, spinal stenosis, facet arthropathy and similar conditions, fall under this category? It has been my understanding that an infectious process had to be at play, for this category to be applicable. The organizational coding guidelines provided, don't comment on this condition specifically, and no one has been able to provide a clear answer. Any clarification is welcome!

Many thanks.

Best positions for administration and coding cross-over?

Hello forum - I've been doing a good bit of research over the past 2 years on how to move my career forward. I would love to blend my administrative skills with my new CPC skills (still an apprentice - resume posted on proper forum) and am seeking suggestions. Does anyone have suggestions regarding roles/job titles to target? Some I have received thus far include denials, audits, HCC coding, HEDIS and claims analyst. Any feedback is appreciated!

Place of service code - administer flu vaccines

My Physicians agreed to work with a local Walmart to administer flu vaccines (just found out). Since this is not being done in our office and the majority of the patients will be medicare, I had contacted Medicare about what if anything would need to be done. I looked at the roster bill sign up for Medicare but it states to use for 3 or more places of service where a central billing office is used. Since it is just the one I doubt it will apply. A call and an email to Medicare has not...

Place of service code - administer flu vaccines

HCPCS Code for Regeneten Bioinductive Patch

Good morning!

What is the HCPCS code for the Regeneten Bioinductive Patch, please? Is it C1762 or C9355? Thanks.

Conscious Sedation documentation

Hello, does anyone know where we can find information on the requirements for physician documentation for 99152?

Part-time remote Coder/Biller

I'm interested in a remote position working 5pm to 10pm weekdays.

Coding for Surgical Implants

I recently received a letter from Anthem BC/BS stating that they are deleting CPT code 99070 for surgical implants. We have a signed contract with them that states we have to bill this code for our surgical implants. They are not telling us what code is replacing 99070. Also with Sagamore we have a signed contract that we are to bill code A4649 as our code for surgical implants, but they are now telling us that this code is not allowed. Is anyone else having issues like this with their...

Coding for Surgical Implants

Staged ACL Revision

Procedure performed
Medal meniscal Repair [29882]

Debridement ACL Graft and Allograft bone grafting and debridement of femoral and tibial tunnels CPT ???

Am unsure of how to code for this debridement and bone grafting for the ACL staged revision
.....ACL graft was debrided with use of shaver. Femoral tunnel addressed first. An 8 spacer was placed in femoral tunnel. Guide pin drilled into bone. Femoral tunnel was drilled up to 10.5 reamer. 10 mm graft placed into femoral tunnel.
Guide...

Staged ACL Revision

CPT for intercostobrachial block ?

I can't find much guidance on how to code an intercostobrachial nerve block. I've seen 64420 which is for "intercostal," and 64450 (other peripheral nerve or branch). Descriptions of intercostal blocks say they are for surgery around the chest and abdominal wall, and the injection is done in the area of the ribs. Intercostobrachial blocks are done on the inner arm near the armpit and are used for upper arm surgery.

I'm leaning towards 64450 since the indications and the location for...

CPT for intercostobrachial block ?

Coding help

Preoperative diagnosis: Ischemic rest pain of the lower extremity. Procedure:　Right iliofemoral endarterectomy, SFA endarterectomy and patch angioplasty​ ​ Postoperative diagnosis: Same. Indications: This is a 65 year-old male who presents with ischemic rest pain of the right lower extremity. The patient was found to have near occlusion of the　Right external iliac and　CFA Description of...​

Coding help

venography

PREOPERATIVE DIAGNOSIS:
Recurrent right DVT.

POSTOPERATIVE DIAGNOSIS:
Bilateral common iliac compression.

PROCEDURE NAME:
1. Pelvic venography.
TECHNIQUE/FINDINGS:

The risks, benefits and alternatives of the procedure were discussed
with the patient, and informed written consent was obtained. The
patient was brought to the angiography suite, and the bilateral groins
were prepped and draped in sterile fashion. All elements of maximal
sterile...

venography

venography

PREOPERATIVE DIAGNOSIS:
Recurrent right DVT.

POSTOPERATIVE DIAGNOSIS:
Bilateral common iliac compression.

PROCEDURE NAME:
1. Pelvic venography.
TECHNIQUE/FINDINGS:

The risks, benefits and alternatives of the procedure were discussed
with the patient, and informed written consent was obtained. The
patient was brought to the angiography suite, and the bilateral groins
were prepped and draped in sterile fashion. All elements of maximal
sterile...

venography

* This article was originally published here

Wound Care

I have a wound care question, I work with a wound care provider twice a week, he has always included a 99214(or applicable OV code) with his wound care codes, he has done wound care for a long time, he is now being told that after the first visit with the patient the only code is the debridement code with of course supplies, what is the rule on this? Thanks in advance for information.

Coding Lisfranc Dislocations by Primary Arthrodesis

Good afternoon,
Our practice has recently had several Lisfranc surgeries and I wanted to seek out advice to ensure we were billing them correctly. Any responses to either of my questions for these types of surgeries would be greatly appreciated!

One of the recent surgeries involved a Lisfranc dislocation of all five of the tarsometatarsal joints as well as one of the midtarsal joints. The surgeon treated these injuries by fusing the first TMT joint, fusing the second TMT joint, fusing the...

Coding Lisfranc Dislocations by Primary Arthrodesis

Neurosurgery Exam

Does anyone have tips on preparing for a Neurosurgery exam?

* This article was originally published here

Neurosurgery Exam

Does anyone have tips on preparing for a Neurosurgery exam?

Signature Stamps

I have been a nurse to close to 20 years and obtained by Paralegal 5 years ago and my CPCO certification last November. It's been awhile but isn't signature stamps illegal. I have found limited references to whether they can be used and with that it was documented that they are used for disabled providers and other vague things but nothing really notable on whether they should or should not be used. My practice that I currently work in utilize them. It makes me very uncomfortable to do so. I...

Signature Stamps

RE: CPCO resources

I am prepping for the 2019 CPCO exam and wonder if anyone who has taken it recently knows exactly what is allowed for the exam? It references OIG regulations under books but does not appear to list coding manuals and it does not say if you may print and bring items from the recommended resource list. I believe this was allowed in the past, but I am trying to determine if that is still allowed. I would appreciate any feedback. Thanks!

Established patients being seen in hospital

I work at a urology office. We get called to come do consults on inpatients/outpatients/patients in the ER often. When this happens, we are seeing established patients that obviously have established problems with us. Are there any rules I should know about this?

99221-99223

Help. I have been told too many things on these codes. If my provider is not the admitting physician can he bill these codes for his consult for his initial visit? I have been told yes without the AI modifier and no you bill the 99231-99233 codes since most insurances do not accept the consult codes anymore. Which one is it??

Incident to requirements

For an Ear, Nose and Throat practice, is it permissible by CMS and other insurance companies to have a Physician's Assistant see and treat a new patient in the office and to have the Physician's assistant be billed as rendering provider? (with and MD as supervisor)

AAPC blackboard anyone know why I can't log in? It says no longer a valid address.

Hi,
I paid for CPC, CPC-P and CPMA classes, good through 2/28/17, and can no longer sign into AAPC blackboard. Has the website changed addresses does anybody know?
Thanks,
Leah Johnson RN

Any surgical coders using "Codify"?

I have used EncoderPro for years. I'm wondering how Codify stacks up against Encoderpro since codify seems to be about half the price.

Right distal tibia Salter-Harris II and distal fibula fracture at ankle closed treatment with manipulation - help with CPT

I am looking at 27752 with both tibia/fibula, I am also looking at 27788 distal fibula & 27825 for the salter harris ii distal tibia. I appreciate any feedback. Thank you in advance.

PREOPERATIVE DIAGNOSIS:
Right distal tibia Salter-Harris II and distal fibula fracture at ankle.

POSTOPERATIVE DIAGNOSIS:
Right distal tibia Salter-Harris II and distal fibula fracture at ankle.

PROCEDURE PERFORMED:
Right distal tibia Salter-Harris II and distal fibula fracture at ankle closed treatment...

Right distal tibia Salter-Harris II and distal fibula fracture at ankle closed treatment with manipulation - help with CPT

Carotid Angiogram

Any help is appreciated! This is new to our practice.

We have: 36222 50 and +36227 50

We are being told to look at 36223 50


PROCEDURES PERFORMED:

• Left heart catheterization, selective coronary angiogram.
• Selective bilateral cervical carotid angiogram.

INDICATIONS FOR THE PROCEDURE: This is a 65-year-old gentleman with a known history of dyslipidemia, hypertension, coronary artery disease with history of previous PCI and carotid disease, who had an ultrasound...

Carotid Angiogram

coding

Can 92937 be submitted multiple times same day for separate vessels RC,LD,LC or use 92928 for additional vessel?
Thanks

aortogram

PROCEDURE: Aortogram, bilateral leg angiogram via left brachial approach.

PREOPERATIVE DIAGNOSIS: Limiting claudication right leg.

POSTOPERATIVE DIAGNOSIS: Limiting claudication right leg.

DESCRIPTION OF PROCEDURE: The patient was brought to Angiogram Suite and prepped and draped
in the usual fashion. After infiltration of 10 mL 1% Lidocaine, using ultrasound guidance,
the left common femoral artery was insinuated but found to be totally occluded. There was a
palpable pulse on the right...

aortogram

87426 Rapid & U0003 Culture Billing

Does anyone know if you can bill for 87426 Rapid Covid and U0003 Culture Covid? We now have some rapid available and occasionally they have done both. Not sure if insurance would reimburse us for both or if only one can be billed.

Thanks,
Dawn

J1050 vs J3490

Hello my coding peeps.
Hello my coding peeps. Have any of you heard of BCBS denying claims for J1050 Depo Provera wanting you to bill J3490 Unlisteed drug because of NDC compatiability. This is what they are citing.

They are citing this source.

RJ Health does not crosswalk the medroxyprogesterone NDCs indicated for contraception to J1050 based on a decision made in 2014. This NDC is indicated for the prevention of pregnancy. The excerpt from the RJ Health newsletter is below. Additionally...

J1050 vs J3490

Billing J1050 to BCN

I need some help. Pt came into office, we provided injection and according to BCN "the claim has to show the correct national drug code, unit of measure and quantity for the item. I have called provider services and have gone on their website to see an example. If somebody could provide me with an example, I would appreciate it. For some reason, they're the only insurance that I'm having issues with. The other insurance companies have paid our claims.

Thank you!!!!!

CPCO Exam? - Anyone here CPCO Certified

Anyone here CPCO Certified? Just curious as to any comments/suggestions you could give me regarding the exam.

My background is,
I have my masters in accounting.
Certified Internal Auditor
And 1 year experience in HealthCare Auditing.

Brachial plexus injuries coding help!!!

Hello! Are there any experienced Plastic Surgery coders on here or anyone who is very familiar with coding for brachial plexus injury codes? I am trying to understand not only how to bill these cases, but how to bill the number of units. I get so many denials for exceeding number of units. Any help is appreciated. Some CPT codes that we use often are:
64861
64856
64901
64902

and usually with multiple units on each.

* This article was originally published here

86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV)

Hi Everyone:

I am having trouble finding any information on what the average reimbursement rate for 86769 would be. I work for a company that will be selling antibody tests soon and I need to present a base rate or national average to my clients. Can anyone help? It would be greatly appreciated. Also, please let me know what source you found your information from. Thank You.

2021 E/M Coding Tool

Does anyone know if the E/M Coding Tool (Wheel) has been updated with the 2021 info and is for sale?
Thanks, Jennifer

31239 and 68815

Anyone know if 31239 Dacryocystorhinostomy and 68815 Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent can be coded together? I don't see any NCCI edits but wasn't sure if insurance would still consider this bundled.

Bil carotid artery stenosis I77.9 vs. I65.23

A provider is asking why I77.9 Disorder of arteries and arterioles, unspecified maps to HCC 108 and I65.23 Occlusion & stenosis bilateral carotid arteries does not map to an HCC. Why is the "unspecified" dx an HCC and the more specific one not?

66984

I am having trouble getting medicare to pay for POS 11 for 66984. My other payers have no problem paying both POS 11 and 24, but I haven't figured out the magic combination to get the professional services paid. Any thoughts?

Are there employers in the coding industry who value accuracy more than productivity?

I recently lost my job as a medical coder because I was unable to meet my employer's productivity standards. I know many of my coworkers were struggling with this as well. I've been coding since 2009. My first job was on-site for a privately-owned clinic and my second job was remote for a large healthcare system. I have two certifications - CPC and CEMC. My strength is accuracy but that affects my productivity. I'm very discouraged and starting to wonder if I'm in the wrong industry. I would...

Are there employers in the coding industry who value accuracy more than productivity?

E/M and injections give by an MA

When leveling an office visit that includes an injection, does the fact that the nurse is giving the injection affect the level of medical decision making? The provider still has to make the decision for the injection.

Denial for Placement of Telehealth Modifier

Hello,

Has anyone had any trouble with billing E&M codes with modifier 25 and 95? Optum just advised me that in order for the claim to process as telehealth, modifier 95 needs to be in the first modifier box on each line item.

Brachial plexus injuries coding help!!!

Hello! Are there any experienced Plastic Surgery coders on here or anyone who is very familiar with coding for brachial plexus injury codes? I am trying to understand not only how to bill these cases, but how to bill the number of units. I get so many denials for exceeding number of units. Any help is appreciated. Some CPT codes that we use often are:
64861
64856
64901
64902

and usually with multiple units on each.

97607 Billing for Multiple Wounds

What is the proper guideline for billing negative pressure 97607 on multiple sites, for example Lt heel and Rt ankle? Can 2 units be billed in one DOS?

Locums

I need help trying to figure out if my practice can bill for locum providers for a provider that is leaving our company while we work to replace the provider? We bills for professional services 99305-99316. I know we can only bill 60 days and use the Q6 modifier but the rest is fuzzy. Anyone have experience with this?

How to handle interview coding questions with no experience?

Hi, all. I've only just completed my billing/coding course so have no practical experience. I may have an interview coming up where I'd be asked coding questions. Any hiring managers or supervisors out there that can give me some tips on how to handle that? Pretty nervous about that aspect and I want to do the best I can. Thanks!

Telehealth What to bill?

Hi,

We had a question come up about telehealth billing. Can someone assist? If a provider is using video and the patient is unable to connect to the video call what code do you bill? Thank you

T1015 and E&M codes

Hi all,

Curious if anyone knows the proper billing guidelines for T1015 and E&Ms? I work with many FQHCs as part of a Medicaid ACO. Many of our health centers seem to have very high usage of T1015 but without an associated E&M. Is there a guideline for billing that someone could point me to? I only have an ICD10 code set book as I am only a CRC.

Thanks!!

Clarification needed on new E/M changes

Good Afternoon,
Have the new changes to office and other outpatient visits combined the separate steps of calculating the diagnosis/management options, type of data and risk into one process? Currently, you will:

• Determine the diagnosis and management options (sored with points)
• Calculate the types and amount of data (scored with points)
• Determine risk based on:
  • Presenting problem
  • Dx procedures ordered
  • Management Options Selected.

These are...

Clarification needed on new E/M changes

Billing new code 99072

Does anyone know whether 99072 requires the dictation to include the actual minutes spent for going over the required information? I know everything keeps saying that it's used to cover the time spent and cannot be used with any other time-based services, however it's not clear whether the time spent is actually required to be noted in the dictation. Also, has anyone tried billing this yet and/or had payment/denials for it? Any feedback is appreciated.

When to report 99024

I understand that any visit within the post op period related to the procedure should be reported with a 99024. My question is who reports the 99024? Only the provider/practice who performed and received reimbursement for the procedure? I have a primary care provider who often sees his patients after they have had a surgery in the hospital (not performed by him or any of our providers) and he is reporting a 99024. Should he be or should he be reporting a regular E&M visit even if he...

When to report 99024

Full thickness vs shave

Hello all,
I would like to get your opinion on the below template language - would you consider the below a full thickness excision or shave? Thanks in advance!

Size of lesion: 1.1-2.0cm
The area of the face right temple was prepped with Hibiclens and anesthetized with 5cc of 1% buffered lidocaine with epi. This was then followed by excision with a #15 blade down to the deep, subcutaneous dermis and light electrocautery to the base. PSO and a bandaid was applied. Estimated blood loss:<25ml...

Full thickness vs shave

In Office & Telehealth

Hello!

I work in a Pediatric office, and we have a visit where the parent of the child came into the office, and then she and the provider did a “televisit” with the patient. He is 17, and they did a meds check over video. Since the parent came into the office, should we code this as an office visit? (Similar to a parent only consult.) Or since the patient was seen via video, should we code this as a Telehealth visit. The only coding difference would be to add the 95 modifier if it’s...

In Office & Telehealth

modifier 25

I am using modifier 25 when I see that procedures are done in ED and with tests that have Status Indicator S, T, Q1-Q3. I would like to know if there are other scenarios when this modifier 25 should be used.

Thank you so much for any help,
Niki

Advanced Care Planning Coding denials 99498

I am getting denials from Medicare when billing 99497, 99498, and 99498. The time documentation is appropriate. Medicare is paying the 99497 and the first 99498, however they are denying the second as a "duplicate." Has anyone ran into this issue?
Would a modifier be appropriate with the second 99498? If so which one?

Billing Secondary Insurance

When billing to secondary insurance, if the CPT code originally billed to primary is not recognized by the secondary can you change the CPT code?

Second surgery denied even with mod 79

HI. I received a issue from a fellow coworker. She has a patient who had a foot amputation done which has a 90 day global period. Paitent had a sig flex done during the global period. That claim was denied by Medicare Part B as part of the global period. A mod 79 was attached. When she call Medicare to state the mod should be valid, they said it is not and we should be billing with another modifier.

Has anyone else seen this? The sig was not part of staged procedure. Any advise or...

Second surgery denied even with mod 79

* This article was originally published here

knee dislocation

Pt has knee dislocation diagnosis and physician bills 27427, 27428 for AL, PCL and MCL tear reconstruction. I think 27558 more appropriate. Or 27429?

Modifier For DME Codes

Hi,

I just started working for a Arizona practice and am having some trouble getting DME codes paid.

For our New York location we use a KX and RT/LT modifier and never had a problem however when I billed it this way for Arizona all the codes denied for CO-4.

I tried searching for a policy but couldn't find one.

Any help would be appreciated.

Thanks in advance.

Fracture care in the ED...

It confuses me… a lot! I’ve done research and sometimes the answers are contradicting on this forum and on the internet. =(

Two questions here-

When the ED doctor preforms reductions, splinting of displaced and non-displaced fractures, etc., I’m not always sure if I code only for the splint or only for the procedure.
Most often, the ED Dr. says the patient needs to f/u with ortho in 3-5 days. Splint vs Procedure?

And then there is this one:

Open displaced comminuted...

Fracture care in the ED...

Inpatient visits for Ortho

Hello,

A patient comes in through the ER and is admitted for a femoral shaft fracture and a physician did surgery on the patient. The next day one of my ortho physicians ended up seeing the patient post op in the hospital several times, are we able to bill for inpatient follow up visits 99231-99233? Patient did have surgery by a provider outside our group so can we technically code for the inpatient visits or is this still considered post op even though we did not do the surgery?

Can...

Inpatient visits for Ortho

Documentation not completed for up to 6 months

I work in a critical access hospital as an inpatient coder and also as a documentation improvement specialist. One of our admitting providers has a very bad habit of not completing his H&Ps or Discharge Summaries in a timely manner; it is not uncommon for him to complete his documentation MONTHS after the patient has left. Obviously this leads to inaccuracies/inconsistencies in his documentation as well as billing delays.

Is this normal? Is this allowed at other hospitals? The...

Documentation not completed for up to 6 months

Billing for drug test & confirmation

I recently began working for a pain management physician's office. Everything is done in-house. 80307 is the CPT code currently billed. Should we bill the 80307 with QW modifier since we have a lab that performs the test & operates under a CLIA cert of waiver? Do we wait 48 hours & bill the collection & confirmation all at once?

Second surgery denied even with mod 79

HI. I received a issue from a fellow coworker. She has a patient who had a foot amputation done which has a 90 day global period. Paitent had a sig flex done during the global period. That claim was denied by Medicare Part B as part of the global period. A mod 79 was attached. When she call Medicare to state the mod should be valid, they said it is not and we should be billing with another modifier.

Has anyone else seen this? The sig was not part of staged procedure. Any advise or...

Second surgery denied even with mod 79

NU MODIFIER

Hi,

Can I use modifier NU for DME codes? I used a ZkX modifier and the claim denied.

Are there any specific guidelines for UHC COMMUNITY PLAN ARIZONA regarding billing DME codes?

Thank you.

CODING UNBUNDLING

ARE (92014) AND (92134) BUNDLED? ANY HELP OUT THERE. WILL NEED DOCUMENTS TO SHOW MY ADMINISTRATORS THE TIME SPENT IN THESE TYPE OF SCENARIOS...

Physical Therapy- billing eval/re-eval on same day as other procedures?

I've been having a really hard time getting my physical therapy evaluations paid when any other form of therapy was provided during the same session, and I'm hoping someone can help.
Examples:
97162 and 97530-59 : only 97530 was paid (Alaska Medicaid). 97162 denied for bundling.
97164, 97140 and 97110 : only 97140 and 97110 were paid (Premera BCBS), eval denied for bundling.

Is it inappropriate to bill for therapeutic codes on same day as eval? The code descriptions seem to allow it, and I...

Physical Therapy- billing eval/re-eval on same day as other procedures?

Fiducial markers Placement and Rectal hydrogel spacers insertion.

Asssistance for coding for Fiducial markers Placement and Rectal hydrogel spacers insertion. Will there be 2 CPT:
Fiducial markers Placement 55876 & Rectal hydrogel spacers insertion.55874.
Thank you for your Input

modifier 27

hello,

I was wondering if someone could let me know how to use modifier 27. I am using this modifier on the second visit on the Facility site when patients are coming to ED twice per day. I did research and I found out that this modifier need to be used on Facility level. However, according to edit by coding program that we use the modifier 27 should be used on Professional site. Per lead coder it should be use on Professional site also. I am confused now.

thank you so much for any help...

modifier 27

Lung Cancer Screening Counseling and Annual Screening for Lung Cancer With Low Dose C

Do any private health insurance companies reimburse for these procedures?

G0296 – Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)
G0297 – Low dose ct scan (ldct) for lung cancer screening

AWVS (annual wellness visit)

Can you code a flu shot with an Annual Wellness Visit?

Medicare Meal Benefit

Hello,
Look for advise on meal benefits for Medicare, as what codes should or could be used. TIA.

WellCare Medicare Adv Primary, Fidelis secondary

I'm brand new to billing. I'm in NY state as a Physical Therapy office biller and I'm having trouble with this particular patient. Wellcare medicare advantage plan primary, then fidelis PICC Long Term is secondary. Question Number 1, Will a Medicaid Managed plan pay after a Medicare advantage plan? Number 2, if secondary will pay, how do I bill it? Wellcare accepts many CPT codes and we don't typically bill 97530 (as accepted by Fidelis), so do I need to go into my system and change each dos...

WellCare Medicare Adv Primary, Fidelis secondary

Hip revision

Provider revised the femoral head, femoral stem and poly liner. 27138 or 27134-52? Appreciate your thoughts!

Adrenal Nodule

Would you use E27.8 or E27.9?

Adrenal Nodule

Would you use E27.8 or E27.9?

* This article was originally published here

64450 with breast reconstruction

My plastic surgeon is performing a bilateral breast recon w/ TE replacement. He wants to bill for bilateral nerve blocks of the pectoralis major. Wouldn't this be included with the primary px? What if the blocks are used for post op pain management and not a supplemental/intraoperative anesthestic, can it then be billed separately?

Open subpectoral decompression

Has anyone charged for an open subpectoral decompression?? I need to give codes for pre-auth. The dx is slap tear.
I've triple-checked with the sx scheduler. She says this is what the dr wrote, but I can't find anything, and I've never seen it before.
I'm thinking unlisted 23929...?
Thanks

New Drug-delivery codes for 2020 20700 - 20705

Good Morning,

I'm an orthopedic coder and for years we were using the 11981 - 11983 codes whenever a antibiotic rod, knee/hip spacer, or beads were used/removed. Now that they've created these new codes the description says nothing about them having to be non-biodegradable. Does anyone know if this is true for the new codes? Also, if the codes listed in the parenthical is fixed then this does NOTHING for our practice. They can no longer report putting in an antibiotic...

New Drug-delivery codes for 2020 20700 - 20705

If you are coding a Pediatric Well visit 99392 and you also do a vision a 3yr old occular vision screen 99174, do you only apply the -59 on 99174?

If we are doing a Pediatric's Wll visit 99392 and we also do a 3yr old ocular vision screen 99174, do you only apply the -59 modifier? Has something changed and you also need to add the -25 modier to the 99392?

99072 new code for PPE

Has anyone heard of this code for additional PPE that can be billed with office visits?
Are insurance companies reimbursing for it?
Are there any additional CPT and/or ICD10 codes to bill during COVID for supplies?
What are the documentation requirements for billing 99072?
Thanks

cms approved credentials

Does any one have a list of the approved credentials for HCC coding?

NEED HELP with Prolong services!!! HELP!!!!

Hi All
I have a PCP that billed on 8/18/20 a 99215 and 99496 (TCM). NOW on 9/8 he sent a list of dates and phone calls made to the patient and her family and one phone call to another physician. He is trying to bill 99358 and 99359 because from 9/1/20 thru 9/8/20 he is stating between the phone calls made he has spent 97 minutes total. He has sent a list of these phone calls with times. My question is the last E/M was 8/18 more than 2 weeks from when he wants to bill these prolonged...

NEED HELP with Prolong services!!! HELP!!!!

Cardiac cath help

93458 by MD
93454 by coworker
I am unsure.


Indication:
1. Angina pectoris functional class 3-4
2. Baseline abnormal EKG suggestive of anterolateral wall ischemia
3. Elevated coronary artery calcium score
4. Hypercholesterolemia and hypertension
5. Dyspnea upon exertion
6. Angina pectoris functional class 4 during recovery time after Lexiscan nuclear test today at this institution, terminating the test to proceed with cardiac catheterization
7. I explained to the patient the...

Cardiac cath help

Contract coding

I will be moving out of state in a few months and regretfully leaving my remote coding job behind. I currently work for a large health system/hospital. After my time is up there I am considering a contract coding job during my transition to a new state while I search for a more permanent job. I am not familiar with any contract coding agencies and looking for suggestions/recommendations. Thank you!

1997 E/M GUDIELINES DOCUMENTING 3 CHRONIC CONDITIONS TO COMPLETE AN EXTENDED HPI

PER THE 1997 GUIDELINES TO GET AN EXTENDED HPI THE NOTE HAS TO HAVE AT LEAST 4 ELEMENTS OF HPI, OR LIST 3 OR MORE CHRONIC CONDITIONS. IF I HAVE A NOTE AND THE PROVIDER LISTS 3 CHRONIC CONDITIONS DOES THIS COVER THE ENTIRE ASPECTS OF HPI? MEANING DOES 3 OR MORE CHRONIC CONDITONS WRAP UP THE ENTIRE HPI,ROS AND PFSH? FOR INSTANCE IF I AM TRYING TO BILL A 99214, DOES THIS AUTOMATICALLY INCLUDE AN EXTENDED ROS AND 1 PERTINENT PFSH?

CPC Entry Level Remote Job?

Hello,
I have 17 years of professional education experience, but no coding experience. I recently passed my CPC exam and also the practicum to remove the "A" from my CPC. I am having a tough time getting anywhere with the jobs I have been applying for. I am looking for a remote coding position and was seeking advice to see if anyone knows companies that hire entry level remote coding positions so I could get my foot in the door?
Thank you so much!
Sarah

Est. Vs New multi specialty clinic

Hello, I am wondering the guidelines for coding new vs est. E/Ms for a multi specialty orthopedic clinic. If a podiatrist saw the pt and then the pt is seen by a PA would the PA charge New? For not being the same specialty?
Pt see’s a family medicine MD and then see’s a PA would that PA again charge new?
Note: the NP/PAs all have different taxonomy than the podiatrist and family medicine dr

Modifier -26 on labs?

I don't do laboratory coding but was shocked that a pathologist charged me for the professional component of lab tests (80053-26, 80061-26, 84439-26, 84443-26, 85025-26). As far as I am aware these codes cannot be reported with modifier -26. The person at the pathologist office told me that they CAN use mod -26 and charge me the professional fee. Someone please tell me - is this truly appropriate?
Thank you!

CPC 4 1/2 yr experience looking for part-time opportunity

To whom it may concern:

Please see resume bellow. I am seeking a part-time position in medical coding. I am available to start right away, and can work up to 35 hours a week if needed. I have experience in E/m, injection coding, chronic care, and anesthesia . I have billed for practice owned and provider only services. I have experience in provider communication. I have 4 1/2 years of coding experience. I look forward to hearing from anyone that has an opportunity for me.




Abigail M...

CPC 4 1/2 yr experience looking for part-time opportunity

EKG for cancer

Hi everyone, does anyone know if ordering an EKG can be part of the cancer workup or follow up care? Or if it will be covered for cancer (ie. breast, colon, stomach etc) if patient is having continuation of care? Any information on this would be greatly appreciated!

* This article was originally published here

What is STO coding?

There is a job posting on Indeed.com that says, "Medical Coder (STO and Inpatient Facility and Profee Fees ONLY)" What is STO?

* This article was originally published here

VCMJR5 Resume0.0001

Vino C. Mody Jr.
Dependable and a strong team player. Extensive Experience and Expertise in Health Administration and Teaching. I always finish my assignments on or before completion schedule.
6154 Black Mallard Place, El Paso, TX 79932

678-427-6511 cell; 915-642-4269 home; vinomodyjr13@gmail.com

Objective
A career in teaching and medical administration - coding, billing, audit, compliance, data management, analysis, and internal training.

Work...​

VCMJR5 Resume0.0001

* This article was originally published here

Billing rules for "Wasted" HCPCS

A patient underwent cardiac catheterization and the provider has billed for 6 stents (as HCPCS codes C1874 & C17874).
While auditing the medical records, It is mentioned in the operative notes, that 2 stents were damaged during the procedure and they failed to be inserted due to tortuosity Of the vessels; hence they were discarded. Was it correct to claim the damaged stents from the insurer?

* This article was originally published here

Billing new code 99072

Does anyone know whether 99072 requires the dictation to include the actual minutes spent for going over the required information? I know everything keeps saying that it's used to cover the time spent and cannot be used with any other time-based services, however it's not clear whether the time spent is actually required to be noted in the dictation. Also, has anyone tried billing this yet and/or had payment/denials for it? Any feedback is appreciated.

* This article was originally published here

Delta Phalanx thumb

Could someone please help with a Cpt code for Corrective osteotomy of delta phalanx and chondrodesis thumb with pin fixation. Osteotomy 26567?

Thanks for the help.

Dr Richichi

Naples, Florida - Group looking for Billing/Coder

- Group is offering a $500 to the person who refers them their hire, payable at their 90-day
- Group adding a $1,000 sign on bonus to the hire

Candidate must have experience in primary care/family medicine, a minimum of one year.

Email: Jason@richichihealth.com
Cell Phone: (843) 749 - 2220

CRPP of radial neck fracture

Hi everyone - I need help with a comparison code for a closed reduction, percutaneous pinning of a radial neck fracture. This is a child and I have been doing some research and this is becoming a popular way of fixating these types of fracture in children. TIA!

Charging for breast feeding consults

We have an RN/IBCLC in our pediatric office who does breast feeding consults. We are currently charging a 99211 under the physician for these visits. Any advice on a way to charge for better reimbursement? Thanks!

Multiple procedures during Bronch

Provider biopsies and brushes the same lesion during bronch. Are both 31625 and 31623 billable since they are the same lesion?

Bilateral lumbar facet blocks

When coding bilateral lumbar facet blocks L3-4, L4-5, and L5-S1 I use 64493-50, 64494, 64494, 64495, 64495. Most insurance companies are denying the 2nd 64494 and 64495 as duplicates or exceeding number this code can be reported. According to the AMA CPT manual page 439 only code 64493 is the only code you can use modifier -50 on. Is anyone else having this same issue? I'm appealing but no luck so far. They still think they are duplicates. I even attach a copy of the CPT code book page to...

Bilateral lumbar facet blocks

Coding direction to take

What is the easiest coding speciality to learn and what coding specialities are in demand in the job market?

Coding per insurance- HELP!

I have a new SR. Management team that wants to change the way we bill out therapy codes based on what the insurance would cover so for instance- Medicare would be billed how we always have been in the past but commercial plans would get a different billing structure due to their high volume of denials on certain codes. I am inclined to think that the coding needs to be consistent across the board. Am I right or is it OK to change how things are coded (the codes still absolutely are supported...

Coding per insurance- HELP!

How do I code an xray of bilateral hips, 1 view?

I do not see a code for 1 view of bilateral hips w/pelvis, 73521 is a minimum of 2 views. Can anyone help me?

Lactation Consultation

Hello! I need help with coding an RN certified in Lactation Education. Lately I have been including her services in the E/M and accounting for time along with the physician's assessment. Is there a code I can use for consults for other than physicians and other qualified healthcare professionals? She is not contracted with any payers, so I would have to bill her services under one of our physicians. Another office said they use 99401 & 99402 for their Lactation Consults, but I don't...

Lactation Consultation

COVID 19 RAPID ANTIGEN

Does anyone know what the CPT code is for COVID 19 rapid antigen lab that can be performed in the physician office?
I am stuck with use of 87426 or U0001.

Thanks, Dawn

Guyon's canal exploration cpt code??

I have a surgery that I am stumped on, and was hoping someone could help me figure this one out.
my doc was planning on removing a mass but after getting closer to the "mass" he realized it was a thrombosed artery. He did not remove anything after finding this out. He just closed the incision. He is calling it a Wrist mass exploration After reading the note, it sounds like a Guyon's canal exploration. I am not finding anything that comes closed to this, so I am thinking this should be an...

Guyon's canal exploration cpt code??

Claim denial modifier assistance

Hoping someone can assist with this. Florida Blue is denying claims with these codes billed stating a modifier is needed. These were performed in the office place of service and have always paid billed as is in the past. Anyone have any thoughts or suggestions?

A9555 2 units
J2785 4 units
78492 1 unit
93015 1 unit
78434 1 unit

Thank you!

I am new to AAPC and AAPC Community

Good Morning Everyone,

My name is Jessenia. I am new to Medical Coding. This is my first post ever to AAPC. First post in my life on AAPC. Hello Hello!
Question: Will I be taking my classes through this website? Or will it be via Blackboard? Also happy 4th of July. That is today's date.

7/4/2020 2:17AM
Best Regards,
Jessenia

PRACTICE MANAGEMENT RESOURCE BOOKS

IS ANYONE INTERESTED IN PRACTICE MANAGEMENT BOOKS? I HAVE SEVERAL THAT I WOULD BE WILLING TO SELL AT A SIGNIFICANT DISCOUNT.

PLEASE help with prior authorization request

Authorization request is for :

T9 to pelvis posterior segmental instrumentation, arthrodesis, deformity correction, and spinal-pelvic fixation with autograft ; L4-5 TLIF - interbody fusion specifically for this portion of the fusion. With several osteotomies



Authorization request is for :



T9 to pelvis posterior segmental instrumentation, arthrodesis, deformity correction, and spinal-pelvic fixation with autograft ; L4-5 TLIF - interbody fusion specifically for this portion of the...

PLEASE help with prior authorization request

Skin cancer removal

Does anyone know if you removed a skin cancer ( 11606 ) on a patient how long before you can do another same procedure? Will Medicare deny for "not medically necessary?

Dx for Posterior Glenohumeral Ligament Tear?

One of our doctors performed an arthroscopic labral repair with capsular repair. He stated that the patient had an acute posterior labral tear and an acute posterior glenohumeral ligament tear. For the acute labral tear, I usually code it with S43.49_A. However, I'm not sure how I should code the ligament tear. Any thoughts?

Coding of chronic conditions question, No "MEAT" Required??

Please confirm that this still applies

the following conditions can be coded from any place in the chart.
1. DM
2. COPD
3. CHF
4. A-Fib
5. MS
6. Hemiplegia
7. RA
8. Parkinsonism

Denied for DX I70.211

Hello everyone,

I have billed 36247 and 75630 26, 59 with DX of I70.211, I70.212, and I70.0. The insurance is Humana Medicare both are being denied for needing additional Diagnosis. I have been researching what additional Diagnosis I need to add. Any suggestions?

Thanks,

Kayla Vogel

Humana and GY modifier

We have a few DME items we dispense that are non-covered by Medicare. I submit the charge to Humana in the same exact format as what I submit to Medicare. However, Humana continually denies them stating that I am coding them incorrectly. Because of the way they deny it (CO4), I am not allowed to bill the patient.

This is what I submit:

L3100 RT or LT, GY POS 12
L3260 RT or LT, GY POS 12
L3000 RT, LT, GY POS 12 (billed on individual lines)

The diagnosis codes are...

Humana and GY modifier

same-day MRI/MRA head

how do you bill for MRI/MRA head done on same-day?
the physician ordered MRI&MRA of head for the medicare patient. the patient encountered once and MRI&MRA are done.
we should report this service with 70551(MRI head) and 70544(MRA head) with modifier 59 to receive payment on both MRI and MRA head according to the CCI Edits.
how do you manage same-day MRI/MRA head in your practice?

Loss of credentials???

Curious.....

If you don't renew your membership, you lose your credentials?? I thought you would lose credentials if you did not keep your CEU's up to date!!! I received an email from the AAPC stating otherwise....

WHAT'S THE DEAL???

* This article was originally published here

Coding ?

Has anyone ever coded out for a carpometacarpal hematoma distraction arthroplasty with trapeziectomy - Need some direction please.

Wound Packing without I&D by different provider

I have a patient that had an I&D by a different provider, in fact a different health system all together. My doc saw this patient for repacking/dressing change. Anyone have a clue what CPT code I could use for this other than E/M?

Inflammatory spondylopathy

Looking for some help on this... Do conditions such DDD, DJD, spinal stenosis, facet arthropathy and similar conditions, fall under this category? It has been my understanding that an infectious process had to be at play, for this category to be applicable. Any clarification is welcome!

Many thanks.

Defining radical in 26145

Hello,

I am looking for help in defining what constitutes a Radical Tenosynovectomy and when to use 26145. Does the surgeon need documentation of pathological tenosynovium for code 26145?

Thank a You in advanced,

Eva Wade
CPC-A

CPT 99291 and 99292

When Billing CPT 99291 and 99292 are we supposed to add the Providers time or the first provider must go over 74 minutes the the second provider billed CPT 99292.

Loss of credentials???

Curious.....

If you don't renew your membership, you lose your credentials?? I thought you would lose credentials if you did not keep your CEU's up to date!!! I received an email from the AAPC stating otherwise....

WHAT'S THE DEAL???

billing thru the clinic to snf

Good Afternoon,
I was hoping I could get assistance on clarification. Our orthopedic office billed x-rays as global as they own the x-ray machine and do both the technical and professional component. I was advised a while back that when a patient is with a skilled nursing facility, that for medicare (no matter what) we would always bill the TC to the SNF and the 26 through the clinic; however, I am unable to locate documentation stating this and as stated above our office does global...

billing thru the clinic to snf

bronchoplasty

My provider performed surgery on a patient. She had bronchoscopy, VATs, Robotic assisted Rt lower lobectomy, and lymphadenectomy. But, prior to closing, "a tear was encountered in the right upper lobe bronchus necessitating bronchoplasty repair" The operative report says that he decided to convert to an open procedure, he "undocked the robot and performed a small posterolateral thoracotomy preserving the serratus anterior muscle and cutting a very atrophic latissimus dorsi...

bronchoplasty

Charging for records sent to providers

Hi - in my role as a privacy officer for a large system, I have encountered multiple complaints about practices charging patients or our providers for records sent to our providers when patients either transfer to our facilities or present to the office/facility for the first time. As a patient, I encountered this - my former physician office was going to charge me 75 cents per page and not send an electronic copy of my record there when I moved to my new location and new provider. This...

Charging for records sent to providers

Social worker documentation and billing

Regarding Licensed Social Workers, can you count the time spent looking for resources and filling out forms towards the level of care? Also, what are the specific documentation requirements? I have found some information on this but I'm looking for additional resources and feedback. Thank you!

Revision AVF aneurysms and artegraft placement

Pt has a bleeding AVF aneurysms. They go in for a revision of AVF( resection aneurysms, and Artegraft placement)

Is this all covered under the revision code or can the AVG placement be additionally coded?

"The AVF was dissected an sharp scissors were used to resect the aneurysmal portion and passed off. Thrombus was found in he AVF and removed with forceps.
6mm /artegraft prepared and anastomosed end-to-end to restore flow to AVF. Scissors were then used to sharply excise an elliptical...

Revision AVF aneurysms and artegraft placement

What modifier to use for inpatient procedure

We have a patient who is inpatient and was seen by our provider on a specific day and we used 99233. Patient also had a procedure that same day with the same provider. I already billed out the 99233. What modifier do I use for the procedure? 59?

remplissage

Hello,

Provider performed a remplissage in addition to a limited debridement and capsulorraphy. He is looking to code it as 29822, 29999 and 23462 (capsulorraphy anterior any type with coracoid process transfer ). I'm wondering if the remplissage is reported separately from the capsulorraphy or perhaps report the 23462 with a modifier 22 to identify the remplissage. Any advice would be great and appreciated. Thank you!!

Diagnostic arthroscopy was performed through standard posterior...

remplissage

Vaccines to Medicare

Is anyone getting denials for vaccines/immunizations to Medicare? It appears Medicare will not reimburse vaccines/immunizations for routine care. What is your office protocol when ordering and billing vaccines? Any feedback is helpful.

Inferior patella ossicle debridement

Can anyone tell me what code to use for a removal of an ossicle ununited to the inferior pole of the patella tendon? My surgeon is saying similar to Osgood Schlatters removal 27360. but that is the distal pole of the patella
Any help would be appreciated

Xofigo documentation requirements

When billing Bone Met Infusion Xofigo, are there specific documentation guidelines required besides the diagnosis, order and the usual for any infusion? This is completely new to me. Any feedback on billing this would be extremely helpful.

Complete Cath

This seems to be a little more than a complete heart cath.
Any help would be appreciated.



Procedures

COMPLETE HEART CATH

Conclusion

SERVICE DATE:09/03/2020 NAME OF PROCEDURE: Right heart catheterization, left heart catheterization, left ventricular angiogram, supravalvular aortogram, aortoiliac femoral angiogram. INDICATIONS: Congestive...

Complete Cath

AWV CMS Target Probe

Has anyone else been targeted by CMS for AWVs with additional EM On same day? We are looking for a best audit tool for IPPE and the AWVs since the audit drilled down to details that we were not capturing - ie, in the HRA, ask the patient if they are able to use the phone. The general CMS guidance documents had not been this specific - we found details in the Federal Register but are wanting to see what others may be experiencing. Also, if any of your EM on same day were denied for lack...

AWV CMS Target Probe

note date not reflecting billed service date

I bill on the physician side. I have a couple of "old school" providers who make notes with paper and pen during the visit. Then at a later date they document the visit in the EMR. Sometime the note is entered weeks later. The issue is the EMR enters the date the note is entered as the note (service) date, not the actual date the patient was seen. Example - patient seen on 8/10 provider enters documentation in the EMR on 8/30. The EMR documentation shows "note date : 8/30/20. I...

note date not reflecting billed service date

Should I unbundle?

Codes: 37229, 36247, 36200, 36140, 75710, 75625, 76937

New to Cardiovascular coding and trying to determine if 36200 and 36140 are distinct from 36247 since it's bundled.





Preoperative Diagnosis

Limb threatening ischemia to the left lower extremity
Diabetic foot infection of the left great toe

Postoperative Diagnosis
Limb threatening ischemia to the left lower extremity
Diabetic foot infection of the left great toe

Operation

1. Ultrasound-guided access of the right common...

Should I unbundle?

99072 new code for PPE

Has anyone heard of this code for additional PPE that can be billed with office visits?
Are insurance companies reimbursing for it?
Are there any additional CPT and/or ICD10 codes to bill during COVID for supplies?
What are the documentation requirements for billing 99072?
Thanks

* This article was originally published here

99072 new code for PPE

Has anyone heard of this code for additional PPE that can be billed with office visits?
Are insurance companies reimbursing for it?
Are there any additional CPT and/or ICD10 codes to bill during COVID for supplies?
What are the documentation requirements for billing 99072?
Thanks

Excision of mass left small finger, left carpal tunnel release

How would you code this? I am reading mucoid degeneration and he keeps extending the incision, but I don't think an actual cyst was removed. The carpal tunnel was not planned, can I bill it with the cyst excision 26160 or should I bill the arthrotomy with exploration 26070-26080?


Preoperative diagnosis: Left small finger mass
Postoperative diagnosis: Same
Operation performed: Excision of mass left small finger, left carpal tunnel release
Anesthesia: Block converted to general

Indications...

Excision of mass left small finger, left carpal tunnel release

Diabetes with Peripheral Neuropathy

If the documentation states the patient has Diabetes with Peripheral Neuropathy, can you assume E11.42 (DM with Polyneuropathy) or do you default to E11.40 (DM with Neuropathy)?

Modifier 78

What is considered an operating room to commercial plans? Do they used the same terms as Medicare?

Post Procedural Sepis

I am looking for some clarification . If this would be coded correctly post procedure sepsis

T80.212A port infection

A49.1 sepsis unspecified
R65.21 severe sepsis with shock
N17.9 acute kidney failure
D61.810 pancytopenia - chemo
C83.10 mantle cell lymphoma

Laparoscopic Ovarian cystectomy

I am a little unsure about this.
A D&C of cervix was done first. After that, a physician used a laparoscope and excised an ovarian cyst at its base then the cyst was also removed and the base was cauterized. Cyst was sent to pathology.
Do I code 57800 and 58661? I am not sure if 58661 is removal of the ovarian cyst, it seems that this code is for the removal of the ovary?
Please help.
thank you
Nina

snf billing

Hi question I'm trying to find the fee scheduled for snf consolidated billing. We don't have a contract in place with SNFs so I'm trying to find out if they are responsible for 80% or 100% of the Medicare allowable? What site do I use to find this information? The code is J0178 and its a claim from 2018.

thanks for your time and help
crystal

xen 45Gel Stent , question

when coding for the xen 45 gel stent in an ASC we coding 0449T. However, for professional services are we to code like we would for ASC or would we use 66183 for the insertion?

Clarification needed on new E/M changes

Good Afternoon,
Have the new changes to office and other outpatient visits combined the separate steps of calculating the diagnosis/management options, type of data and risk into one process? Currently, you will:

• Determine the diagnosis and management options (sored with points)
• Calculate the types and amount of data (scored with points)
• Determine risk based on:
  • Presenting problem
  • Dx procedures ordered
  • Management Options Selected.

These are...

Clarification needed on new E/M changes

EVAR with renal stent

Pt had a typical Aortic-bi-iliac Endograft placed (34705) then angiogram showed Type 1 endoleak.
Then 6 EndoAnchors were deployed ( 34712).
Repeat angio still showed Type I endoleak. At this point, he marked the renal artery and deployed a 34x34x52 cuff creating them 2 to 3 mm above the prior graft and deployed the top cap with the...

EVAR with renal stent

Abdominal aortagraph

Can someone confirm if Im coding right? Or give any feedback. I feel the doctor maybe is not documenting enough? What do you guys think? Is it just me?

Consent was obtain. A 6 french sheath was inserted in the left common femoral artery via micropuncture technique through which left lower extremity angiography was performed. Aortgraphy was performed via a 5 french contra flush cathether. Right lower extremity angiography was performed via 5 french contra 2 cathether. At the end of the case...

Abdominal aortagraph

No auth denials

have providers that work for a partner hospital with an Emergency Dept. They often do trauma surgeries on cases referred to them from the ED but POS is 21. We get denied all the time for no authorization. Sometimes we have auth from the partner hospital but most times not and also sometimes the carrier will not honor the hospital auth since we are billing for the MD.. A lot of these cases are captured Medicaid plans. We tried modifier ET but that didnt work. We appeal with the documentation...

No auth denials

Help with Toe amputation an Flap closure

Procedure:
Left Hallux partial amputation
Myocutaneous flap closure of left hallux amputation site

Elliptical incision around the distal end of the hallux where the initial dorsal injection went across the top of the 5th toe transversely just proximal to the nail plate. Then the incision plantarly was performed distally and plantarly just proximal to the ulcer site. After the initial incision dorsally was performed a disarticulation of the interphalangeal joint was performed by releasing...

Help with Toe amputation an Flap closure

VATS PROCEDURE FOR APICAL BLEBS

Procedure Performed: Right VATs surgery with right apical lung resection and chest tube placement for mechanical pleurodesis.

OPERATIVE COURSE: Patient was taken to the operating room, timeout called, everyone agreed, anesthesia provided. Patient positioned and padded in the left lateral decubitus position with right side up. The old chest tube was removed and the patient was given antibiotics. The trocars placed without issue under direct visualization and the camera placed as well...

VATS PROCEDURE FOR APICAL BLEBS

HZ46 Psycho-education

Hello, Trying to get an accurate code for a provider but I can't find it in the ICD 10 CM book. This is a outpatient counselors office and the provider put the code HZ46 but I can't find it in my book. Can someone help find a better code for outpatient drug abuse counseling?

NO AUTH DENIALS AFTER ED ADMISSION

Hi

I have providers that work for a partner hospital with an Emergency Dept. They often do trauma surgeries on cases referred to them from the ED but POS is 21. We get denied all the time for no authorization. Sometimes we have auth from the partner hospital but most times not and also sometimes the carrier will not honor the hospital auth since we are billing for the MD.. A lot of these cases are captured Medicaid plans. We tried modifier ET but that didnt work. We appeal with the...

NO AUTH DENIALS AFTER ED ADMISSION

Giving up coding

I’ve had my CPC since 2017 and I’ve yet to actually work as a coder for the reason being that a lot of companies want experienced coders. I’ve kept up with my CEU’s and always kept my certification current however I’m having 2nd thoughts of renewing this year in April as I feel like I’m going to waste my time again.
Any similar experiences? What can I do? I really don’t want to give it up but the coding employment doesn’t look promising for me

Dental coding

Good morning! I am working in an ASC and we are starting to do some dental procedures in house. Since this is all new to us, does anyone know of classes that I can take to help me learn how to do the coding correctly for insurance companies to pay?
Thanks!

office visits for an inpatient rehab patient

I have a claimed that denied because the patient was brought for an office visit and is an inpatient rehab patient. What would the place of service be for this office visit? Would I bill for the established E/M code and place of service 61?

Coding sepsis

I'm looking for clarity on coding sepsis post procedure. This is how I think is should be coded.
T80.212A port infection
A41.9 sepsis unspecified
R65.21 severe sepsis
N17.9 acute kidney failure
C83.10 mantle cell lymphoma

cpt codes for glossectomy with excision from floor of mouth and graft from leg

hank you. Procedure title: Partial glossectomy with wide local excision, floor of mouth. AND
Leg split-thickness skin graft, 5cm x 4 cm.

cpt codes for glossectomy with excision from floor of mouth and graft from leg

hank you. Procedure title: Partial glossectomy with wide local excision, floor of mouth. AND
Leg split-thickness skin graft, 5cm x 4 cm.

* This article was originally published here

right anterolateral thoracotomy and decortication

Need help with coding,

Bronchoscopy shows normal bronchial tree with no masses,　moderate to excessive amount of　secretions
the entire right lung was trapped, there were very dense , thick parietal and visceral pleura (fibrotic).


Procedure in detail:

After proper identification, the patient was brought to the operating theater and placed supine on a well-padded operating table where general endotracheal anesthesia was administered. A Bronchoscopy was performed, findings above, a double...

right anterolateral thoracotomy and decortication

Thoughts on Athena EMR System for Orthopedic Practice?

Hello Everyone!

From a coder's/biller's standpoint, what are your thoughts on Athena for an orthopedic/ neurological practice? I have heard mixed reviews. I have no experience with it myself, but my concern is that they combined with GE Centricity-- which I have worked on and have found to be entirely frustrating. Pros and Cons would be very helpful. I posted a similar question a while back, but would appreciate any additional input. (ALSO, any...

Thoughts on Athena EMR System for Orthopedic Practice?

SNF Covid Testing

We are a Skilled Nursing Facility and it has been mandated by the state that we test every staff member weekly for COVID19. What diagnosis code should we be using for the test? We were thinking Z03.818. Our staff does not display any signs or symptoms and we want to make sure we are not suggesting that we feel we have might have a positive staff member. We are trying to bill for the Specimen Collection G2023 and what diagnosis should be giving when submitting to the lab? Thank you.

Sigmoidoscopy

If sigmoidoscopy goes to splenic flexure do I bill colonoscopy w/ 52 modifier or a sigmoidoscopy w 22 modifier?

99211 nurse visit

I would like some clarification on billing for the 99211. I work for a pediatric office and if a patient comes in for flu shot only visit or their 2nd hpv vaccine. Can we bill for the 99211 or is just the vaccine and the admin we bill for? If that is the case when would be a scenario that you would bill the office visit code with the vaccine and admin? Does it have to be they were not able to get vaccines due to an illness and they have since came back and it was resolved, or can you still...

99211 nurse visit

Ear procedure bundled codes?

Can anyone tell me what the rules are for coding excision of cholesteatoma/polyp with an ear procedure such as a myringoplasty? There are no ncci edits with cpt code 69610 and 69540. But since it is happening in the same ear, I wasn't sure if an excision of a polyp would be included in the myringoplasty procedure. And same for when it is a removal for a cholesteatoma (cpt code 69145). Since there are no ncci edits, it is ok to use either 69540 or 69145 with cpt code 69610? or are codes 69540...

Ear procedure bundled codes?

OWCP

Has anyone been able to reach anyone at OWCP since they changed administrators? Every time I call I get a message saying due to call volume they are unable to take my call and I get disconnected. I never had this issue with Conduent. CNSI has been a nightmare. Approvals have stalled, claims aren't being processed, and although I have found some information on the portal its been like beating my head against a brick wall. I don't even know who to go to to try to get some resolution!

How can this be coded?

We had a patient who wrecked on her 4 wheeler. She came in repeatedly to have the wound checked to and on one visit she saw our nurse who has a Masters in Wound Care. She cleaned the wound with normal saline and removed 2 foreign bodies (wood splinters) with tweezers. How can this be coded?

Denial Pet Perfusion Scan-Modifier needed?

Hoping someone can assist with this. Florida Blue is denying claims with these codes billed stating a modifier is needed. These were performed in the office place of service and have always paid billed as is in the past. Anyone have any thoughts or suggestions?

A9555 2 units
J2785 4 units
78492 1 unit
93015 1 unit
78434 1 unit

Thank you!