mardi 30 septembre 2014

B-12 Injection Conundrum

Have a question about billing for B12 injections....

I know that for Medicare patients if the coding is correct then Medicare will pay (albeit, pennies on the dollar). I am getting denials from all other insurance companies. If the patient is only coming in for an injection-regardless of the underlying coding, can the patient be held responsible for the injection? In other words, do I have to bill the patients insurance? Or can I inform the patient that we don't bill B-12 injections to private insurances and they are responsible for 100% of the injection?


Any help would be greatly appreciated!






B-12 Injection Conundrum

Time Based Billing

When the Physician notes that he/she spent 20 minutes with the patient and 15 was spent in counseling and coordination of care (Subsequent IP) --> 99231

Yet the HPI, Exam and MDM = 99233


DO YOU HAVE TO BILL BASED ON TIME, JUST BECAUSE IT'S NOTED? Or can you pick and choose which one is higher RVU ($$)?






Time Based Billing

Coding help, please!

Hi, I need some assistance with coding this op report. I'm thinking the correct CPT code would be 21014 but want to make sure I'm thinking correctly. Please give me some advice on this:

PROCEDURE: Submandibular incision approach to left maxillary mass.


INDICATIONS FOR PROCEDURE: The patient with a mass entering from the left nasal floor. The patient underwent a CT scan of the sinuses revealing a maxillary mass not involving any dental roots but protruding into the nasal floor and into the anterior portion of the maxilla. It did not appear to penetrate the sinus. The patient presents for surgical correction.


FINDINGS: Cystic mass filling the left anterior maxilla just superior to teeth number 22, 23, and 24. The second branch of the fifth cranial nerve was identified and was protected.


OPERATIVE NOTE: After informed consent was obtained, the patient was taken to the Operating Room where she underwent general endotracheal anesthesia and 1% lidocaine with epinephrine was injected into the left sublabial area. The patient was cleaned, prepped and draped in the usual manner. Timeout was performed. A 15-blade was used to make a sublabial incision, approximately 2 cm in length, extending from the midline to the left superior canine. Soft tissue was incised down to a cystic mass which was identified and was circumferentially dissected with meticulous hemostasis using bipolar cautery. The entire mass was removed. It did protrude into the left nasal floor. Upon removal, there was a defect of the left nasal floor mucosa. After removal, the specimen was sent for permanent pathology. The wound was then closed, approximating the deep sublabial incision with an interrupted 3-0 Vicryl and the mucosal incision was closed with a running locked 4-0 Vicryl. The left nasal floor was also approximated with interrupted 4-0 Vicryl in an interrupted fashion. The patient was then transferred back to care of Anesthesia where she was awakened in the Operating Room and transferred to the Recovery Room in stable condition. All counts were correct.


Thanks so much for your help!!


Vicki






Coding help, please!

diabetic retinopathy record review
























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diabetic retinopathy record review

Surgery Coder Needed!
























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Surgery Coder Needed!

Cpc-a






















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Cpc-a

duplex exams with other ultrasounds

Can someone offer some clear guidance of coding duplex exams with other ultrasounds? For example ? If a patient has a transvaginal ultrasound and spectrum analysis and color flow is documented of the ovaries do you code a duplex exam? Or should there be separate orders and medical necessity to code the duplex?

The only information that I can locate is the below from the NCCI manual. Does this apply for any ultrasound?


The NCCI manual states- Abdominal ultrasound examinations (CPT codes 76700-76775) and abdominal duplex examinations (CPT codes 93975, 93976) are generally performed for different clinical scenarios although there are some instances where both types of procedures are medically reasonable and necessary. In the latter case, the abdominal ultrasound procedure CPT code should be reported with an NCCI-associated modifier.






duplex exams with other ultrasounds

Ancillary Billing









When billing for ancillary billing of infusion service, are you required by commercial payers to wait until the "to" date passes to bill your claim? Example: You have a patient that gets 500mg of vanco q 12 and on 8/29/14 you dispense 7 day supply, would you have to wait until 9/8 to release the claim or could you go ahead and release it once it is dispensed and the patient receives it. Also would you span date the bill 9/1/14 to 9/7/14?





















Ancillary Billing

J1561 infusion code
























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J1561 infusion code

27658? ONLY Please help :)

Need some guidance, would you just code 27658?

Thanks in advance,

Melissa Bedford,CCS,CPC


PREOPERATIVE DIAGNOSIS:

1) Peroneal Longus Tendon Rupture Right

2) Peroneal Brevis Tendon Tear Right


POSTOPERATIVE DIAGNOSIS:

Same


PROCEDURE:

1) Primary Repair of Peroneal Brevis - Right

2) Peroneal Anastomosis Peroneal Longus/Brevis Tendon Right


PATHOLOGY:

none


ESTIMATED BLOOD LOSS: less than 5mL


MATERIALS:

2-0 Tycron

2-0 Vicryl

3-0 Nylon


COMPLICATIONS: none


ANESTHESIA: regional

Pre-op Pain Block


HEMOSTASIS:

Pneumatic Ankle Tourniquet at 250 mmHg x 72 min


INJECTABLES:

15 mL 0.5 % Marcaine


SUMMARY OF PROCEDURE:

Patient was brought into the operating room and placed on the table in the supine position. A time-out was performed with myself in the room verifying correct patient, procedure, extremity, materials present and administration of ordered antibiotics.


The right extremity was prepped and draped using standard aseptic technique. A well padded tourniquet was applied to the extremity.


Attention was directed to the lateral aspect of the right ankle. A curvilinear incision was placed posterior to the lateral malleolus overlying the peroneal tendon sheath. The incision was deepened with blunt as well as sharp dissection. Superficial vessels were cauterized. Care was taken to avoid the sural nerve. Peroneal tendon sheath was identified.


The peroneal retinaculum was found to be intact intact. A linear incision was made into the peroneal sheath producing significant amount of fluid. Irrigation was employed. The peroneal tendons were evaluated with partial thickness tear, 7 cm within the peroneal brevis tendon. The peroneal longus tendon had a complete rupture with retraction of the proximal section to the level of the distal fibula. The distal segment was absent, with retraction to the plantar foot. There was a significant amount of tenosynovitis within the area where the longus tendon normally is. This was debrided and flushed. Primary repair of peroneal brevis tendon repairs was performed utilizing 2-0 Tycron. The proximal stump, with the minimal amount of tissue remaining was debrided and a anastomosis to the proximal peroneal brevis tendon was performed with 2-0 Tycron. The area was flushed. The peroneal tendon sheath was reapproximated with 2-0 Vicryl. Peroneal retinaculum was also secured with 2-0 Vicryl. Irrigation was employed. Subcutaneous tissues were also approximated with 3-0 Vicryl. Skin was approximated with 3-0 nylon. A well-padded nonadherent bandage was applied. Tourniquet was released with immediate capillary refill to all toes. Posterior Splint Applied. Patient was awakened and transferred to recovery room with all vital signs stable intact to the foot.






27658? ONLY Please help :)

lundi 29 septembre 2014

Cbc
























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Cbc

Independent contractor
























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Independent contractor

CPT 25115 RT and 64721 59RT

For any of my subject matter experts with regards to the above coding scenario- opinions regarding coding would be greatly appreciated and welcomed:

Preoperative DX: Recurrent carpal tunnel syndrome, right wrist

Post Op DX: Recurrent carpal tunnel syndrome, right wrist

Procedures Performed: Decompression and neurolysis, right median nerve at the wrist


The Op Report indicates the following:


"The median nerve was found to be compressed and erythematous. Extensive neurolysis and synovectomy were carried out as needed"


Would CPT 25115 RT and 64721 RT be appropriate for the above scenario?


I am aware that these codes are bundled when billed in conjunction with one another- therefore my gut is telling me that modifier 59 appended to CPT 64721 is most likely not appropriate. Any direction would be appreciated.


Thanks in advance!






CPT 25115 RT and 64721 59RT

Radiology CPT 76140
























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Radiology CPT 76140

seven elements of effective compliance auditor
























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seven elements of effective compliance auditor

Consolidated Billing - Explain it to me like I'm five

I've read a ton on consolidated billing, but I'm still having trouble grasping it. We regularly get pathology denied due to this.

So...a patient is in a skilled nursing facility...is that the only thing that causes consolidated billing rules to kick in? Are there other reasons such as therapy?


"Under the consolidated billing requirement, the SNF, or nursing home, bills Medicare for the entire package of care that residents receive during a covered Medicare Part A nursing home stay. The SNF also bills Medicare for physical, occupational, and speech therapy services received during a noncovered stay."


So, if we are asking patients, the only thing we should be checking for is skilled nursing right? We shouldn't be asking if they are in assisted living because that isn't the same thing here. I'm trying to understand it better so I can explain it to others better.


We can also bill the professional component of a pathology service, correct? So we would bill out 88305-26. How would the SNF be informed to bill out the technical component, 88305-TC?


I know this is a lot, but thank you for anyone who can help.






Consolidated Billing - Explain it to me like I'm five

denial from on cpt 22830

Hello,

I recently started coding for an orthopedic surgeon who specializes on the spine. Medicare has denied cpt code 22830 for "pre/post operative care payment is included in the allowance for the surgery/procedure. The surgeon performed this procedure three times on three different levels on same date of service. Medicare will not pay on any of the procedures. I billed with the modifier 59 and still receiving denials. I don't know what else to do. Someone please assist me with this.

Thanks






denial from on cpt 22830

Spinal manipulation
























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Spinal manipulation

dimanche 28 septembre 2014

Lost

Hi, I failed the ICD-9-CM assessment exam for the second time, so I need a little advice.

In order to train for ICD-10, do I need to pass the certification exam for ICD-9? If not, is it worth skipping the ICD-9 certification exam to train up for ICD-10 since ICD-9 will be basically useless soon?






Lost

KForce and HIMagine
























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KForce and HIMagine

cpc exam
























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cpc exam

samedi 27 septembre 2014

Resume for job oppurtunities



Skill Highlights

? 7+ years experience in a fast-paced, deadline-driven environment

? Critical thinker, detail-oriented and self motivated

? Energetic and organized

? Excellent communication and computer skills

? Continually striving to reach and exceed quality assurance standards

? Proficient with medical terminology

? Self-starter with professional manner

? Member of the AAPC and active in the local chapter

? Have had classes on the medical billing cycle, medical coding, medical terminology, anatomy and physiology, and insurance


Work History


Dr J Clay Simmers (June 08-Aug 14)

Secretary/Optometric Technician

212 W. Boscawen Street

Winchester VA 22601

Phone (540) 722-0445


Rock Harbor Golf Course (May 07-June 08)

Waitress

365 Limestone Drive

Winchester VA 22602

Phone (540) 722-7111


Floors and More (May 06-May 07)

Secretary/Personal Assistant

1860 Berryville Pike

Winchester VA 22602

Phone (540) 535-1600


Home Depot (Dec 02-May 06)

Customer Service Associate

213 Legge Blvd

Winchester, VA 22601

Phone (540) 723-0619


Education


John Handley High School, Winchester VA. Graduated with Diploma 2002


Lord Fairfax Community College, Middletown VA.

? Finished work on associates degree in Liberal Arts in May 2013

? Finished work on medical coding/billing certificate in August 2014

? Also working on an associate?s degree in Health Information Management. At the end of this degree, I will sit for the state exam to become a Registered Health Information Technician

Certifications

AAPC

? Certified Physician Coder ? August 2014


References


Kari Keller, CCS, CPC, CPMA, CIRCC, CPC-I

11639 Back Road

Toms Brook, VA 22660

Cell: (540) 335-3424

Home: (540) 436-3424

Email: kkeller@lfcc.edu


M. Beth Shanholtzer, MAEd, RHIA

Assistant Professor & Program Director, HIM Program

Lord Fairfax Community College

173 Skirmisher Lane, 137H

Middletown, VA 22645

Office: (540) 868-7236

Fax: (540) 868-4133

Email: bshanholtzer@lfcc.edu


Kathy (KJ) Ware, MCLS, CPC, CPC-I

Associate Professor of Health Information Management

Science & Health Professions Division

Lord Fairfax Community College

173 Skirmisher Lane, 137-I

Middletown, VA 22645

Cell: (540) 607-7544

Email: kware@lfcc.edu


Cheryl Knotts, CPC

Classmate

Phone: (540) 877-4017

Email: clk459@email.vccs.edu


Jennifer Brannon, CPC

Personal Friend and Secretary of Winchester AAPC Chapter

Phone: (540) 877-5211

Email: jbrannon@svwc.org






Resume for job oppurtunities

Job available Medical Coder/Cost Analyst in San Gabriel Valley

Medical Coder/Cost Analyst

Would you like to work for a well established, stable company with full benefits?

Are you extremely organized, detail oriented with impeccable computer skills?

If the answer is yes, then we have a position for you.

We are an established Case Management and Medical/Legal Consulting firm looking for a Medical Coder/Cost Analyst to review medical records and billings, and construct reports.

We have a continuous flow of work and require an exceptional person to help in the review process. Using our proprietary software you will assist in the review/analysis of medical bills.

Our office is located in the San Gabriel Valley.


Qualifications:

Certified Professional Coder

Previous experience in analysis and auditing of medical records

Exceptional Computer Skills, especially relating to Microsoft Office Suite

Detail oriented, able to work in a fast-paced environment and adhere to deadlines

If interested, please email your resume in Word or PDF format to:

cheryld@linc.biz






Job available Medical Coder/Cost Analyst in San Gabriel Valley

Hypogastric Nerve Block









My physician has billed for a bilateral superior hypogastric nerve block (64517-50) which hits an edit in our billing software. From what I could find, modifiers 50, LT and RT are not to be used. Can this be a bilateral procedure?

Thank you for any assistance.





















Hypogastric Nerve Block

Coding help again, please!

Hi,

I need verification on the codes I am thinking would be correct to code the following op note. I am thinking CPT 64721 for the carpal tunnel release & CPT 29999 for the endoscopic cubital tunnel release. Please let me know if you agree this would be the correct way to code this:


SURGICAL PROCEDURE: Right endoscopic cubital tunnel release and right carpal tunnel release.


DESCRIPTION OF PROCEDURE: The patient was brought to the Operative Suite. After armband identification, verification of the side and site of surgery, the left upper extremity was prepped and draped in a standard surgical fashion and the tourniquet was utilized at 250 mmHg for a total of 10 minutes. Incision was made over the ulnar nerve at the medial aspect of the elbow. Dissection was carried out bluntly with tenotomy scissors and retractors. The ulnar nerve was then identified. The Osborne's fascia was incised longitudinally and utilizing a blunt dissection superficially to avoid crossing the antebrachial and brachial nerves. The superficial tissues were dissected proximal-ward and distal-ward. Attention was then turned to the cubital tunnel itself in the Osborne's fascia, utilizing the Integra endoscopic cubital tunnel system an obturator was placed into the cubital tunnel, the arthroscopic guide was then utilized over the top visualization to ensure no crossing vessels or nerves. The push cut knife was then used to endoscopically release the fascia overlying the ulnar nerve distal-ward and proximal-ward. At the completion of this, the tourniquet was let down. Hemostasis was obtained with a bipolar electrocautery. Subcuticular closure with 4-0 Monocryl. Steri-Strips and Angiocath 14-gauge were placed prior to wound closure and 10 mL of Marcaine 0.5% with epinephrine were injected. Soft dressings with an Ace wrap were applied. Sponge, instrument, and needle count were verified and correct x2 at the end of the case.


Incision was made in the thenar crease with a #15 blade scalpel. Dissection was carried out sharply with a #15 blade scalpel. The palmar fascia was incised longitudinally with a #15 blade scalpel. Heiss retractors and Ragnell retractor were utilized for exposure. The transverse carpal ligament was identified and released with a #15 blade scalpel. Median nerve was found to be hyperemic upon release of the transverse carpal ligament. Motor branch was identified and protected throughout the remainder of the case. The proximal dissection was performed utilizing curved Mayo scissors into the volar forearm fascia. Attention was then turned distal and superficial palmar arch was identified and protected and the distal leading edge of the transverse carpal ligament was released utilizing tenotomy scissors. The tourniquet was let down. Hemostasis was obtained. The wound was copiously irrigated. The skin was closed with 4-0 nylon horizontal mattress sutures. Xeroform, 4 x 4 gauze, splint and ace-wrap was applied. Sponge, instrument, and needle counts were verified correct x2 at the end of the case. The patient tolerated the procedure well and transferred to the Post Anesthesia Care Unit and will begin hand therapy in three to five days, and will follow up in the office in two weeks for wound check or sooner as needed.


Thanks so much!!






Coding help again, please!

Collection agency recommendation
























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Collection agency recommendation

Entry Level/Externship in Philadelphia, Pa Area

Angela Zirpoli CPC, CEHRS

3629 Bellaire Place, Philadelphia, PA 19154  angzirpoli@gmail.com  215-205-3375

Medical Records, Billing and Coding [

Highly knowledgeable, reliable, and detail-oriented professional with commitment to accuracy, efficiency, and quality. Thrive in high-pressure, fast-paced environments with exceptional organization, communication, and analytical skills. Advanced computer skills and mastery of MS Excel and MS Word. Talent for readily learning new programs, processes, and procedures. Excel in both team member and independent roles. Strong desire to expand medical administrative abilities and contribute to operational improvements. Demonstrated leadership skills and the ability to mentor a wide range of people with different skill levels.

Document Processing  Records Management  Data Base Management  Staff Support

Medical Terminology  Anatomy & Physiology  ICD-9  CPT  HCPCS

Computer Skills: MS Office Suite, 10 Key, 40 WPM

Education & Professional Credentials

Medical Billing & Coding

Certified Professional Coder and Certified Electronic Records Specialist

Bucks County Community College

Course Highlights: Medical Terminology, Anatomy and Physiology, Disease Process, Surgical Procedures, Lifecycle of an Insurance Claim, Healthcare Settings, Healthcare Payers, Procedures and Diagnosis, Coding from Medical Records, Reimbursement Systems, Facility Billing, Medical Practice Management Systems, ICD-9, CPC, HCPCS

Professional Highlights

 Successfully operated and managed my own internet retail home fragrance business. Developed, implemented, and managed all operating systems and procedures including purchasing, receiving, product development, customer service, sales, marketing, website development, and booking.

 Honed proficiency in improving processes and procedures, scheduling, spreadsheet management, regulation compliance, verbal and communication skills, and customer service skills.

 Proficiently and accurately assigned U.S. Customs tariffs to UPS International Shipments.

 Received numerous accolades over course of career at Marriott Hotel Division, including Employee Service Awards and Certificate of Recognition.

Career Timeline

Court Officer II: First Judicial District of Pennsylvania 2005-2013

Proprietor: Angel?s Essence Inc. 1997-2012

Office Manager: Structured Settlements Investments LLC 2004-2005

Court Clerk I: First Judicial District of Pennsylvania 2003-2004






Entry Level/Externship in Philadelphia, Pa Area

vendredi 26 septembre 2014

Billing for Flu and administration codes
























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Billing for Flu and administration codes

Attending/Ordering Doctor on claim for Medi

Hi-

I am looking for some clarification on the correct information to enter in certain fields for our claim form. We bill on a UB04.


Do we enter the provider who actually saw the client as the Operating Clinician? And the medical director/supervising clinician as the Attending?


I read some info on the Medi-Cal website and it says *not* to enter the doctor who sees the client as the Attending, and rather to enter their info in the remarks section.


Anyone know which is the correct way?


Thank you!






Attending/Ordering Doctor on claim for Medi

Sigmoid Sinus Diverticulum
























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Sigmoid Sinus Diverticulum

Behavioral Health Provider Based Facility









Hello:

I need assistance with Behavioral Health Billing. Specially, I am interested in talking with someone about setting up a 'Provider Based' Behavioral Health Facility. I would like to know what services are reimburseable for a Clinical Psychologist and LPC and which payors. I would appreciate any information you can provide. You may email me or contact me at 803-395-4762.

thank you,

Martha Matheny





















Behavioral Health Provider Based Facility

Nst billing
























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Nst billing

Code 11201 Medically Unlikely Edits 0 Units?









Does anyone have any additional information on this? I found that CMS' rationale for setting the units to '0' as "Clinical: CMS Workgroup" for code 11201, but I haven't been able to find anything else to support why the unit threshold on the practitioner table for this most recent quarter. Any documentation or source info would be great. Thanks!





















Code 11201 Medically Unlikely Edits 0 Units?

Coding of varicose veins
























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Coding of varicose veins

CPT Code 92950 and the Lucas Device
























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CPT Code 92950 and the Lucas Device

need help please with CPT code---Hydrodissection

Hello,

I need help with coding this procedure: Left Achilles tendinosis and calcifications. PRP was performed over the mid portion of the Achilles in the area of the tendinopathy. In addition, some high volume hydrodissection was performed between the undersurface of the Achilles and the fat pad, which was adhered and scarred down. 25 cc of saline mixed with some Marcaine was used.


I only provided a small excerpt of the office note.


I am fine with coding the PRP injection but I need help with coding the hydrodissection procedure. I would appreciate all input.


Thank you in advance!

Michelle






need help please with CPT code---Hydrodissection

Radiation Onc Billing Question

Good morning,

Can anyone help me with the following questions being asked?


1. Can we charge Field in Field breast plan for multiple field treatment or just Lat/Med?


2. Can we charge AP/Lat portal set up film for 3D treatment?


Any help would be appreciated.


Tammy Atkins, CPC






Radiation Onc Billing Question

Left ventricular thrombectomy
























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Left ventricular thrombectomy

jeudi 25 septembre 2014

CPC/CIRCC - Looking for part time remote coding position

Hi! I have 3 years of coding experience for a multi specialty practice. My areas of expertise include cardiology, electrophysiology, diagnostic and interventional radiology, and vascular and (some) cardiothoracic surgery. All of my coding is abstract end from physician documentation. I also have extensive experience in follow up in regard to multi specialty coding denials, general denials, and registration denials so I am very familiar with payer guidelines.

Please let me know if interested!


Thanks,

Jaimy






CPC/CIRCC - Looking for part time remote coding position

MOHS surgery

Hi Need some ideas how would you code this case

"OK, so I took out a melanoma on the nose. With the 0.5cm margins the defect was on the cheek and the nose. I closed the cheek with a rhomboid transposition flap (14040) and the nose with a bilobed transposition flap. So, one defect, 2 closure codes on the melanoma nose icd-9 (173.2) which won't match with 14040 code, only 14060 code."

Give me your ideas. All appreciated






MOHS surgery

Mod. 59 with Add on codes
























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Mod. 59 with Add on codes

93458-26 and 93503-59?

Normally I would not code these together, but please see the report below. Two separate approaches...

PROCEDURE NAME: Right and left heart catheterization with right heart catheterization performed from an internal jugular approach using ultrasound-guided Micropuncture access, left heart catheterization with coronary angiography performed from a right radial approach.


INDICATIONS: The patient is a 69-year-old admitted with advanced right heart failure. She has been diuresed 13 or 14 pounds since admission. Initial brain natriuretic peptide level was 320. She has chronic hypoxemic respiratory failure on high flow oxygen with severe obstruction on prior PFTs. She has chronic atrial fibrillation. Echocardiogram during this admission shows moderate to severe right ventricular enlargement, severe or close to severe right ventricular systolic dysfunction, very severe right atrial enlargement, a dilated IVC and a peak TR velocity of around 4 meters per second suggesting severe pulmonary hypertension. She has a prior history of sarcoidosis. She is a former cigarette smoker. requested bi-catheterization.


PROCEDURE: The patient was taken to the catheterization lab in the fasting state on oxygen therapy. The right neck and the right wrist area were prepared and sterilely draped in the usual fashion. Using ultrasound guidance and a micropuncture catheter technique, access was gained easily to the right internal jugular vein and an 8-French hemostatic sheath positioned. A Swan-Ganz catheter was advanced and pressure was recorded in the right atrium, right ventricle, pulmonary artery and pulmonary capillary wedge positions. Measured O2 consumption on 40% oxygen was acquired. These data may not be accurate. Fick cardiac output was calculated after withdrawing blood from the pulmonary artery for O2 saturation analysis and using the arterial oximetry data. Next, thermodilution cardiac outputs were recorded.

Next, attention was turned to the right wrist and using a Terumo radial artery access skid and a short 6-French slender sheath, access was gained to the radial artery. The 6-French sheath was positioned without difficulty. Four thousand units of heparin were given as an intravenous bolus. Two milligrams of verapamil were given through the radial artery sheath. A 5-French Jacky catheter was advanced over a Rosen wire and the left coronary cannulated. Cineangiography was performed in standard views. Jacky catheter was then manipulated to perform right coronary angiography in standard views. Using a Glidewire, the Jacky catheter was advanced into the left ventricle and pressure recorded. A pullback was recorded across the aortic valve. Closing pressure was recorded. The Jacky catheter was withdrawn using the Rosen wire. A TR band was used to remove the arterial sheath from the right radial artery. Hemostasis was achieved. The Swan-Ganz catheter was withdrawn. The venous sheath was withdrawn using manual pressure. Hemostasis was achieved and the patient was transferred to 3 North in stable condition without complication of the procedure.


RESULTS:

HEMODYNAMICS: On oxygen, saturations hovered around 90%.


Mean right atrial pressure is 13 mmHg. RV pressure 90/13. PA pressure 90/40 with a mean of 60. Pulmonary capillary wedge pressure mean 12 to 15 with respiratory variation. Aortic pressure 125/70. LV pressure 125/15 to 17. Mean LV end-diastolic pressure visually less than 15 mmHg.


Thermodilution cardiac outputs averaged 2.7 L per minute with a cardiac index of 1.35 L per minute. Measured Fick cardiac output with O2 saturation arterial 90% and PA saturation 63% 3.9 L per minute with a cardiac index of 2.0 L per minute. Pulmonary vascular resistance 18 Wood units from thermodilution cardiac output and 12.3 Wood units from Fick cardiac output.


CORONARY CINEANGIOGRAPHY: The left main coronary is free of obstructive narrowing, gives rise to an LAD diagonal system and a circumflex marginal system. There is evidence of left coronary to cameral fistula with calcification of the LV cavity during left coronary injection. There is mild diffuse plaque in the left coronary system without obstructive narrowing in the LAD diagonal system or in the circumflex marginal system. The right coronary is angiographically dominant. There is angiographic evidence of plaque without obstructive narrowing.


FINAL CATHETERIZATION DIAGNOSES:


1. Persistent severe pulmonary hypertension despite high flow oxygen, maintaining O2 saturations during this procedure around 90%. Mean PA pressure 60.


2. Severe elevation in pulmonary vascular resistance (pulmonary hypertension is mostly precapillary).


3. Mild to moderate elevation in systemic venous pressure despite 13 L diuresis consistent with severe RV systolic dysfunction.


4. Upper normal or mild elevation in pulmonary capillary wedge pressure.


5. Low resting cardiac output.


6. Nonobstructive coronary plaque in the left and right coronary system.


7. Coronary cameral fistula with left to left shunting.


COMMENT: The role of pulmonary arterial hypertension drug therapy in a patient with severe pulmonary dysfunction, chronic hypoxemia and difficult to control persistent severe pulmonary hypertension is at best uncertain.






93458-26 and 93503-59?

Diagnosis code for return visit to review lab results
























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Diagnosis code for return visit to review lab results

mercredi 24 septembre 2014

Preventive, Breast Pelvic, and Pap for Medicare Patient

One of our coders made the point that our providers' document a preventive service plus a breast/pelvic exam (G0101) and a pap (Q0091) for Medicare patients. Her experience is that the preventive can still be billed although not payable by Medicare. If the patient has a secondary such as a Medicare Advantage Plan, they often pick up the preventive. Just wondering if others have similar experience/knowledge? From a documentation perspective, I would agree this is correct coding.

Thank you






Preventive, Breast Pelvic, and Pap for Medicare Patient

Immunization Clinic

I was asked to look into the financial aspect of starting an Immunization Clinic. Finding the RVU's for the administration part is easy and finding the prices of the vaccine was easy using the CDC website (http://ift.tt/1xkaTii)

What I am not sure is how to set a price for a vaccine. For example, the first listed DTaP is priced at $25.98.


Is that what practices are supposed to charge? I always assumed we would set our own price, but I am not sure what to base that price on.


Any guidance?



__________________

Christopher J. Halk, CPC

Coding Auditor

Sterling Medical Corporation

Kunsan Air Force Base

Republic of Korea






Immunization Clinic

Why are we getting denials









Hi,

Hopefully someone can help. I work in a pediatrician's office and we bill office visit and the urinalysis CPT code 81000 on the same visit. Apparently Healthchoice insurance denies the CPT code 81000 each time asking for the NPI# and the referring doctor name. I write it in on the corrected paper claim and we go in circles each time. Is there a modifier we need to use or is this just not a payable code?





















Why are we getting denials

Documentation
























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Documentation

Patient "Assessment" question









When one of our doctors removes a lesion that they "FEEL" is going to be Squamous,Basal Cell is it ok to put that diagnosis down in the "assessment"? Or should it be coded 238.2. Unspecfied. When they code it as malig then it turns out to just be AK or SK, the patient chart has a wrong diagnosis in it. We wait to actually bill out for the service until the path comes back so it gets sent to the insurance company correct. So does the assessment make much difference since the path will prove what the lesion was?. Sorry if this was confusing wasn't sure how to say what I wanted. Thank you





















Patient "Assessment" question
[unable to retrieve full-text content]


C/O Itching from burns
























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C/O Itching from burns

Are these services billable









Sometimes my provider will utilize a hand held ultrasound device to ck position of a fetus or when she drains a breast cyst. Is this billable and if so would I use the limited ultrasound procedure code 78615? I'm not sure what code to use for the imaging guidance or if it's even billable. Any help would be great. Thanks

























Are these services billable

Aviacode-GREAT COMPANY
























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All times are GMT -6. The time now is 06:39 AM.








Aviacode-GREAT COMPANY

Balance Billing Past Timely

Hello Fellow Coding Gurus,

So my mom has Medicare/Tricare and recently decided to get a second opinion. She requested records from the PCP (who required a $50 fee to distribute) and interpreted the request as transferring care. They decided to slap her with a $200 bill for a G0439 service that was not paid by Medicare (Though Medicare did pay the 99213 for a same day e and m). The date of service was 5/30/2013 and she is just now getting the bill from the PCP. They are also charging interest. I can not imagine that this is correct billing. Of course, I submitted an appeal but it is past timely filing as we did not know this bill would be on her. Can someone advise me of best action here? I don't think this practice should get away with this kind of patient treatment. I have already discussed my concerns with the practice


Thank you


Sparkles






Balance Billing Past Timely
[unable to retrieve full-text content]


mardi 23 septembre 2014

CPC w/ comprehensive education looking for employment in AZ or remotely

I have included my resume. I have been in the healthcare industry since 2001 and have a passion for it.

Amanda Strous

amandalmt@msn.com

(623) 698-8258

OBJECTIVE

I would like a position in your company where I can adapt my skills and knowledge in medical billing and coding to meet and exceed the requirements and expectations of the job position.

SKILLS

 Inpatient and Outpatient Coding

 ICD-9, CPT, HCPCS

 CMS 1500 and UB-04 Claim Forms

 Healthcare Reimbursement

 Medical Terminology

 Anatomy, Physiology, Pharmacology

 DRG & APC Assignments

 Knowledge of HIPAA and Patient Confidentiality

 Microsoft Office (Word, Excel, Outlook)

 3M Encoder / 3M Reference Software

 Administrative Support

 Customer Service and Organization

 Excellent Verbal and Written Communication

 Managed Care Regulations / Coding Guidelines

 Medicare / Medicaid Reimbursements

 Hospital Information Systems: Chart Assembly, Access, Storage, and Status Tracking

 Clinical Data Analysis and Abstraction

CERTIFICATION

American Academy of Professional Coders (AAPC) August 2014

Certified Professional Coder (CPC)

EDUCATION

Inpatient & Outpatient Medical Coding and Billing (AHIMA Approved) ? Career Step May 2014

Certificate of Graduation

 Coursework included: Medical Terminology, Anatomy, Physiology, Pharmacology, ICD-9, CPT (including E/M) and HCPCS Level II coding.

 Included training in the audit of codes on claim forms, process of managing, appealing, and submitting claims for various third-party payers including Medicaid and Medicare as well as liability and worker?s compensation with claims

 Experience coding over 250 outpatient reports and 75 authentic inpatient records.

 Types of reports including: Consultations, Emergency Room reports, History and Physical reports, Laboratory reports, Operative reports, Physician Orders, Procedure Notes, Progress Notes, Radiology reports, and Pathology reports.

Medical Transcription Editor Program, Career Step (Online) October 2010

Certificate of Graduation

 Transcribed over 900 reports and edited over 400 reports in a wide variety of accents and dialects.

 Report types included: history and physical reports, consultations, discharge summaries, operative reports, etc.

 Proficiency using WAV technology, Benchmark KB, Windows Shorthand, and AnyModal Speech Recognition

Massage Therapy- Educorp Career College September 2001

Massage Therapy 3.85 GPA

EXPERIENCE 07/2010- present

Work at home Mom

o Manage a household taking care of children and performing daily tasks.

Internet Search Engine Assessor 04/2012- 04/2014

Lion Bridge/Remote Position

 Assessing search results for internet search engines. Mainly Google and Bing.

 Researched web pages and was responsible for making sure that the search results were relevant.

Massage Therapist /Chiropractic assistant 12/2006- 7/2010

Arrowhead Health

 Responsibilities included checking in patients, scheduling appointments, intake forms on new patients.

 Filed paper charts and input patient information into e-MDs software.

 Put patients on therapy tables along with applying electrode therapy and heat or ice therapy.

 Multitasked between the different steps of patient flow from start to finish






CPC w/ comprehensive education looking for employment in AZ or remotely

CPC-A certified with comprehensive education looking for employment

Amanda Strous

amandalmt@msn.com

(623) 698-8258

OBJECTIVE

I would like a position in your company where I can adapt my skills and knowledge in medical billing and coding to meet and exceed the requirements and expectations of the job position.

SKILLS

 Inpatient and Outpatient Coding

 ICD-9, CPT, HCPCS

 CMS 1500 and UB-04 Claim Forms

 Healthcare Reimbursement

 Medical Terminology

 Anatomy, Physiology, Pharmacology

 DRG & APC Assignments

 Knowledge of HIPAA and Patient Confidentiality

 Microsoft Office (Word, Excel, Outlook)

 3M Encoder / 3M Reference Software

 Administrative Support

 Customer Service and Organization

 Excellent Verbal and Written Communication

 Managed Care Regulations / Coding Guidelines

 Medicare / Medicaid Reimbursements

 Hospital Information Systems: Chart Assembly, Access, Storage, and Status Tracking

 Clinical Data Analysis and Abstraction

CERTIFICATION

American Academy of Professional Coders (AAPC) August 2014

Certified Professional Coder (CPC)

EDUCATION

Inpatient & Outpatient Medical Coding and Billing (AHIMA Approved) ? Career Step May 2014

Certificate of Graduation

 Coursework included: Medical Terminology, Anatomy, Physiology, Pharmacology, ICD-9, CPT (including E/M) and HCPCS Level II coding.

 Included training in the audit of codes on claim forms, process of managing, appealing, and submitting claims for various third-party payers including Medicaid and Medicare as well as liability and worker?s compensation with claims

 Experience coding over 250 outpatient reports and 75 authentic inpatient records.

 Types of reports including: Consultations, Emergency Room reports, History and Physical reports, Laboratory reports, Operative reports, Physician Orders, Procedure Notes, Progress Notes, Radiology reports, and Pathology reports.

Medical Transcription Editor Program, Career Step (Online) October 2010

Certificate of Graduation

 Transcribed over 900 reports and edited over 400 reports in a wide variety of accents and dialects.

 Report types included: history and physical reports, consultations, discharge summaries, operative reports, etc.

 Proficiency using WAV technology, Benchmark KB, Windows Shorthand, and AnyModal Speech Recognition

Massage Therapy- Educorp Career College September 2001

Massage Therapy 3.85 GPA

EXPERIENCE 07/2010- present

Work at home Mom

o Manage a household taking care of children and performing daily tasks.

Internet Search Engine Assessor 04/2012- 04/2014

Lion Bridge/Remote Position

 Assessing search results for internet search engines. Mainly Google and Bing.

 Researched web pages and was responsible for making sure that the search results were relevant.

Massage Therapist /Chiropractic assistant 12/2006- 7/2010

Arrowhead Health

 Responsibilities included checking in patients, scheduling appointments, intake forms on new patients.

 Filed paper charts and input patient information into e-MDs software.

 Put patients on therapy tables along with applying electrode therapy and heat or ice therapy.

 Multitasked between the different steps of patient flow from start to finish



CPC-A certified with comprehensive education looking for employment

Anesthesia facility coding









I work at a hospital and was wondering if the coders are supposed to code for anesthesia and recovery services for the facility only.

On the bills, there aren't any codes attached them which is probably why Medicaid is denying all of our accounts.

Should we ask the coders to be coding these services?





















Anesthesia facility coding

Beware of Peak Health Solutions









Hello fellow coders,

Just a heads up about Peak Health Solutions.....if you are looking for PT or FT coding.....I have had a VERY BAD experience with this company.....I took two different tests an ED test which I was given by one of their recruiters and passed with a 89.38% and then contacted by another recruiter who stated that I was given the wrong test so had to take another test for Profee..... good for that I am all about proving my experience...it took some time but I did it....to make a long story short I was set up for 2 different interviews NEITHER which I got.... trying to find out what my score was for the 2nd test....I ABSOLUTELY WOULD NOT RECOMMEND PEAK HEALTH SOLUTIONS!!!!! unfortunately I believe it is in the recruiters that they have but this is just a heads up..





















Beware of Peak Health Solutions

Home visit annual physicals
























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Home visit annual physicals

RecordFlow
























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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.


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RecordFlow

Need help w/axillary mass

My doc did a procedure where he excised a mass on the right axillary. I cannot find a cpt code that makes sense. Please help! Notes are below:

PROCEDURES: Right axillary mass excision.


INDICATION FOR PROCEDURE: Ms. Neelysabir is an 18-year-old African-American female with what appears to be a right axillary mass, which has been bothering her, which she wants removed. It was decided that an excision with tissue sent to pathology for evaluation would be undertaken in the operating theater. Informed consent was obtained and all questions were answered according to patient's satisfaction.


DESCRIPTION OF PROCEDURE IN DETAIL: Ms. Neelysabir was brought back to the operating room, placed on the OR table in a supine position. _____ General anesthesia was administered. Patient was then prepped and draped in the usual sterile fashion for the right axilla. Time-out was performed. The large right axillary mass was then sharply incised in a circumferential manner at its base. Then electro Bovie cautery was used in order to remove this mass in its entirety. The removed specimen measured 12 x 9 x 3.5 cm. This will be sent to pathology for evaluation as a permanent section. After the mass was excised, the wound was thoroughly irrigated and the wound bed was inspected for hemostasis. Hemostasis was achieved. We then used a 2-layer closure by running _____ Vicryl in the deep layer and then a 4-0 Monocryl in the dermal layer. The area was then dressed with Dermabond. The patient was then extubated and taken to the PACU in stable condition.






Need help w/axillary mass

Coding Echos









Hey All,

I have a question. My boss wants to do echos but lease out a tech and the machine. The Dr will read and interpret the results. I thought each would bill with the appropriate modifiers, we would bill the Drs portion and the tech would bill his. Someone else told me we would bill both components because we are paying for the tech and machine through a lease. I want to be compliant with this so does anyone have any insight?





















Coding Echos

Procedure

Need a cpt code for placement of vaginal mold

Brief description: Speculum was used to visuaize the anatomy and continued the dissection with blunt pushing in order to restore the patency of the vagina, a vaginal mold was fashioned with kerlex and latex mold, this was inserted in the vagina with Premarin cream.


thanks






Procedure

Cpt c9606









First, I code for a physicians office. Needing to make sure we are doing this correct. PT HAS MEDICARE - we code a acute MI for a stent placement and use 92941. I have read that if pt has Medicare we should use C9606. Or is this for hospital coding? Can someone give me some information on this. Thanks





















Cpt c9606