Home Health Visits

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Home Health Visits

Documentation of hydration

I am having a disagreement with some members of our hospital coding team about the necessary documentation to code hydration (96360-96361) for the facility.

Typically, there is an order by the physician for hydration. There is documentation of start and stop times and the appropriate code and charge for 96361 is entered if there is a push or infusion of another drug (see CPT Assistant May 2010) or 96360 if no other durg is infused and then 96361 for additional hours of hydration. Time documentation is very good, so that is not the issue.

The issue is that the hospital coders are saying that a bolus order of saline or DS5 by the physician is not sufficient documentation for billing the hydration. My though is why not - we have a physician order documented, the time of hydration is documented and if the diagnosis meets medical necessity per LCDs, payor rules, etc, then these hydration services should be coded and billed.

I would love to hear other opinions on this and what other documentation could the hospital coders be looking for. Thank you in advance for any opinions shared.

Documentation of hydration

Ultrasound modifier?

Example bilateral knee injections where US guidance for needle placement was used for each injection site. I am aware of the NCCI edit for 76942 allowing only one unit at a single encounter but the disclaimer states a modifier can be used to override edit:

CPT codes 76942, 77002, 77003, 77012, and 77021 describe radiologic guidance for needle placement by different modalities. CMS payment policy allows one unit of service for any of these codes at a single patient encounter regardless of the number of needle placements performed. The unit of service for these codes is the patient encounter, NOT number of lesions, number of aspirations, number of biopsies, number of injections, or number of localizations.

The CMS instruction is that imaging guidance is billed once per encounter and not per lesion. Society guidelines have always defined imaging guidance as reported per lesion or anatomical area involved.

This edit will allow use of NCCI associated modifiers if 76942 is utilized for a separate procedure unrelated on the same date of service.

***Has anyone been successful in using a modifier on the 2nd 76942 billed? I have some test claims out, but unsure which modifier is appropriate*** What are you using? Need help please,Thanks

Ultrasound modifier?

Needs DIAGNOSIS sssistance

Quote:

Hi, What is the best code for CONFUSION for elderly patients with no Mental disorder is it 298.2? or 780.97? Happy Halloween! IM

I would say 780.97.. if you're referring to symptoms, like he got hit in the head and came to the clinic confused. You would use 298.2 if it's a mental disorder type of confusion i would think since it's categorized under that, like something's not actually right with the patients head.

---

Last edited by JesseL; Today at 01:24 PM.



Needs DIAGNOSIS sssistance

Bone, excision

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Bone, excision

Excision Question

Hi all, hope you can help:

The nurse said an "excision squamous cell carinoma and advancement flap reconstruction" was performed.

They listed CPT 14060 adjacent tissue transfer or rearrangement, eyelids, nose,ears and/or lips, defect 10 sq cm...

Shouldn't there be another code for the excision of the left ear carcinoma?

Excisions/repairs confuse me a bit.

Thanks, K

Excision Question

Burn wound care coding

Hi , Can anyone give answer to my below question

Does CPT code series 16000--16030 qualifies only for fire burn wound care or can it be coded for burns caused other than fire also (ex: rope burn/cosmetics burn etc).

We have an urgent care setting where wound care procedures i.e., dressing of all kind of burn wounds will be performed .So wanted to know if above mentioned CPT series holds good for all kind of burns or do we need to consider non fire burns as inclusive to E/M.Kindly advise

Thanks

Ranjitha .CPC

Burn wound care coding

Ventricle aneurysm repair

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Ventricle aneurysm repair

Modifier 79

Are you in a global period? Mod 79 is unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period.

If you are asking about mod 59 (Distinct procedural services) - according AAPC Coder, there are no bundling issues.

Modifier 79

Billing strapping codes for applying slings

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I have a provider who is telling me that he can bill strapping codes 29200-29280 and 29520-29590 when he uses a sling, wrap and or belt to immobilize the area of injury ( SuperCoder March 2001). The last documentation I can find is APC's Insider, February 25, 2005 states that applying a sling is a first-aid technique and not to code as application. Does anyone have any newer documentation to support this?

Billing strapping codes for applying slings

Tlif

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My physician does TLIF cases often and every case is done with decompression, including transpedicular approach; we code 22633, 63056 and 63047. Per CCI edits 63056 and 63047 needs a 59 mod to bypass bundling. The description for 22633 states it includes lami (other than decompression). I want to make sure I am coding the cases correctlly. Can anyone help me?

Tlif

Medical Nesessity

HI All

What are your thoughts - is giving a prescription drug a prescription drug management? What do you think drives the medical decision making - a presenting problem or giving a prescription adjustment? What are your thoughts when a physician examines 9 body parts for a simple sinusitis?

Thanks!

Medical Nesessity

No Multiple Procedure Reduction? ASC billing

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No Multiple Procedure Reduction? ASC billing

Tracking Accts returned for Med Nec

Our facility keeps a paper record for each account that comes back to a coder for a non-passing diagnosis. The majority of what is returned is for outpatients where departments did not include all passing diagnoses on the order. These get returned to departments for passing diagnoses to be provided on the order.

My question is, does anyone else keep paper record of all accounts that have been returned to coders? We are required to document the account number, CPT being denied, and all diagnoses added to get account to pass. Then a copy of the billing statement is kept attached to the spreadsheet.

It is time consuming, seems like overkill, and not lean at all!

Anyone else keep a record?

Tracking Accts returned for Med Nec

Vascular Coding - Mechanical Thrombectomy

As per the CPT book, mechanical thrombectomy can be coded separately when other percutaneous interventions are performed. I am looking for feedback on this scenario, please.

The question is mechanical thrombectomy. Upon diagnostic testing the patient is found to have CTO; there is known emboli when a patient has CTO so the plan is to go in and perform primary mechanical thrombectomy in the vessels; once in the case the physician is able to cross the lesion and perform additional percutaneous interventions and does so in conjunction with the thrombectomy. The primary planned thrombectomy is for emboli known to exist prior to the case ? not for emboli/thrombus created from performing PTA/atherectomy.

Preoperative Diagnosis: Non-healing ulcer right foot, CTO

Postoperative Diagnosis: Non-healing ulcer right foot, CTO

Procedure:

1. Aortogram with right extremity runoff

2. TurboHawk SSCL arthrectomy, Priority One thrombectomy x 4, SFA, CFA, popliteal, additional vessel and peroneal and PTA with Admiral Extreme 4x80. Star Close device was deployed.

Surgeon:

Fluoroscopy Time: 13 minutes, 17 seconds

Contrast: Optiray-320. 57 seconds

Clinical Data: Mr. ______ has a non-healing right great toe ulcer and known chronic total occlusion. He has had a previous stroke affecting the left side of his body. The right side is very important for his ability to stand and bear weight, etc. and to assist with his ADLs so he presents for arteriogram. He understands the risks and agrees to proceed.

Findings: The patient had normal aorta and iliac vessels bilaterally, normal right SFA. He had single vessel runoff via the peroneal and it was a diseased vessel below the knee. He had partial pedal arch. I was able to get a .014 wire across this and did the atherectomy and then the suction thrombectomy and then the PTA which much improvement in flow. Hopefully this will be enough to heal his ulcer. He will follow-up in the office to see me as scheduled.

Procedure: The patient was taken to the angio suite and placed in a supine position and given IV sedation. Both groins were clipped, prepped and draped sterilely. 1% lidocaine was used to anesthetize the area of the left common femoral. A left common femoral approach was used. Micropuncture needle was used to enter the4 vessel. A 5-French sheath was placed and Omniflush catheter was positioned in the distal aorta and aortogram was performed showing no evidence of aortic or iliac disease.

The up and over technique was used to cannulate the external iliac on the right and with the aid of the Bentsen wire the run was performed showing no proximal disease, but peroneal disease. Therefore at this point I placed a Rosen wire, placed an up and over 7-French sheath and was able to use a Glidewire and get into the peroneal artery and then we placed a catheter and then the .014 wire and then used the atherectomy with the TurboHawk SSCL and was able to atherectomize the entirety of the peroneal where the disease was with the aid of the glow and tell tape to mark it. This was then removed and we placed the Priority One suction thrombectomy as a planned primary thrombectomy in the four vessels as mentioned with an excellent result and removal of debris.

I was also able to PTA this with the Admiral Extreme 4x80 after I had to do a wire exchange and place the Glidewire.

Once this had been completed we performed a final run showing much improvement in flow.

The sheath was then pulled back into the external iliac on the left. The Bentsen was replaced and the Star Close device was deployed with no sign of hematoma. At this point direct pressure was held. He will be monitored for two hours prior to discharge and follow-up in the office to see me in a week.

Codes: 37225

37229

37184

37185

37185

75625-59

75710-59

Should modifiers be applied to the thrombectomy code(s)? Any feedback would be greatly appreciated. Thank you!!

Vascular Coding - Mechanical Thrombectomy

CCS,CPC,ICD 10 Coder Seeking Part Time Work

I have over 11 years of Coding & Revenue Cycle experience. Currently seeking a part time remote opportunity. Experience with Hospital and Physician coding, auditing and billing. HCC Risk Adjustment experience.

Certifications: CCS, CPC, and ICD 10 all current

Software: EPIC, 3M, Allscripts, IDX, STAR, Cytrix, HPF, Athena, Mc Kesson and others.

Proficiency: 96%

Productivity: 8-10 Outpatient Charts/Surgery per hour, 2-3 Inpatient Charts per hour, ED 10-15 Charts per hour

Located in Southern California Pacific Time

Email: pandm2009@att.net

Thank You,

Elizabeth Montelongo, CCS, CPC, ICD 10

CCS,CPC,ICD 10 Coder Seeking Part Time Work

atherectomy for in-stent stenosis

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atherectomy for in-stent stenosis

Help! Billing Medicare HCPCS Code P9603

Hello!

I work at Lab and we send our Phlebotomists to Assisted Living & Nursing homes a few times a week. We are looking into billing to Medicare for the trip the Phlebotomist has to take to the patients and back to the lab. Has anyone billed the HCPCS code P9603 before to Medicare? is this the correct code? Are there any modifiers, etc.? Any help would be greatly appreciated. Thanks

Help! Billing Medicare HCPCS Code P9603

Morbid Obesity

I have a question regarding the coding of Morbid Obesity.

The physician says the patient is obese in the examination portion of the note. The BMI is 45.3 which is listed in the physical examination portion of the note. The actual diagnosis of morbid obesity is only found in the past medical history portion of the note.

Would you code 278.01 and V85.42?

Thanks,

Marilee A. Raker, CPC, CCA

Morbid Obesity

Changing provider charges

I apologize up front because I'm sure this has been covered before, however I can't find the threads.

If a company has a policy that providers do their own codes for billing, and you come across procedures not documented, you then inform the provider to append the note. Provider doesn't, or won't. Now you have a note that doesn't justify the charge. Please tell me that my only choice in this scenario isn't just to resign. I obviously can't send in a claim that isn't warranted, but aren't we somehow protected, legally, in this situation?

Any help is greatly appreciated.



Changing provider charges

HPI Elements

CHEIF COMPLAINT:breaast discomfort since longtime

HISTORY OF PRESENT ILLNESS:LOCATION:Breast , QUALITYiscomfort, SEVERITY:Mild,DURATION:Longtime

Physician Notes :breast pain and discomfort.

Please suggest me How many HPI elements we can take from the above documentation.

Thanks in advance..

HPI Elements

CPC looking for an internship

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CPC looking for an internship

Critical Care Physicians

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I work for a hospital that we have several physicians in same practice that may see the same patient for for different reasons in same day. EX: Pt comes into ER and one of our docs see them for critical care and an hr later another one of our docs are putting in ET tube or CVC line (or both). When I bill I will use 99291 for the 1st physician and give the other doc the ET tube/CVC line. The insurance company is saying same group/specialty won't get paid. Should I be putting modifier 25 on 99291 claim??? I didn't think you would because it is different physicians. HELP!!!

Critical Care Physicians

double coverage

If I am understanding your question, the patient is still employed full-time and carries employer benefits, right?

In this scenario, the full-time employer insurance would be billed primary and the secondary would be the insurance through California. The only other rule for this is the birthday rule. If his wife is covered through a full-time employer plan and her birthday is prior to his, then her insurance would be primary and his insurance would then fall to secondary.

Hope this helps!!!

double coverage

20610-50 with 77002

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20610-50 with 77002

vaxcare/immunizations

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I need some help. Our office is now having a company called vaxcare bill for immunizations. We are still giving all the immunizations. My worry question problem is they bill the vaccinations themself's under there physicians name/tax id number with our location. Is that legal? I'm having a hard time wrapping my head around this. Any help would be appreciated. Thank you.

vaxcare/immunizations

E/M coding

We had a patient that was seen by one of our doctors in the office on 10/28/2014, it was a return visit. Then later that afternoon this same doctor, who was on call, got a consult request for this same patient, but as an in patient. After she had left our office apparently later that day she went to the ER and and the physician that saw her there is the one who admitted her. How do I code these two separate visits and can I code both or do I just code the inpatient visit. Thanks for any help I can get with this.

Kristi

E/M coding

colonoscopy

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colonoscopy

64483, 64484 add-on charges

I work in a general clinic/pain management office, we have an anesthesiologist/pain specialist come in and do facet blocks/ TPI, the charges for the initial first level block, but there are no charges entered into our fee schedule for the add-on 64484, couldn't find a charge for it, pt has private insurance, not Medicaid/medicare. Should I call the insurance OR does anyone here know what the charge is for this procedure.

Still new to coding, any help is appreciated, thank you!

64483, 64484 add-on charges

Ceu's

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Ceu's

Coding for complicated bunion correction

What would be the correct CPT coding for the following please:

A patient has a Lapidus-type procedure done, but the joint is fitted with a lateral plate after being packe with osteoinductive/osteoconductive bone graft with cancellous bone chips. The foot was irrigated, and there was still some deviation at the first matatarsophalangeal joint with sesamoid positions being slightly lateral to central.

The op report then states "an Austin bunionectomy was then performed with an OrthoSorb pin secured in place without incident with Chevron osteotomy being slightly longer."

Wound irrigated incisions reapproximated and dressed.

I'm a little stumped, I can't find any coding that actually matches what was done... Help!

Coding for complicated bunion correction

Modifier 91 Clarification

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Good afternoon. We are a pain management group. We do random drug testing on our patients in our office. If the results are not what we expect to see, we send the sample out to an independent lab for a quantitative analysis.

However, our lab charges are being denied as duplicate services. We have put a -91 modifier on our codes, but our billing software gives us a message "Inappropriate use of repeat modifier with a laboratory procedure". Any assistance on how to appropriate code these so our practice and the lab are reimbursed would be greatly appreciated. Thank you!

Modifier 91 Clarification

Coder documenting

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I have a provider insisting that I add diagnosis to his electronic note by guessing according to medication ordered or by looking a a previous note. I know that I can't do that but need to prove to the provider. Any thoughts as to where I can have it spelled out for the doctor.

Thank you.

__________________

Jennifer Pfister, CPC

Coder documenting

Buddy Strapping

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Buddy Strapping

H..E..L..P well woman DX coding. I'm stuck!!

A female came in for her annual well woman she had an exam, a vaginal pap smear along with an HPV screen & she's had a LAVH so would I code

v72.31 routine gynecological exam, AND

v73.81 since we also did an HVP screen, AND

v76.47 since she had a vaginal pap smear AND

v88.01 since she's has a LAVH??

Need clarification. Thx

H..E..L..P well woman DX coding. I'm stuck!!

Post Surgical ICD 9 Code for Therapy

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Would it be safe to use V57 category (V57.1 PT & V 57.21 OT) as the best ICD as Pdx for patient having therapy post surgical then follow by patient?s underlying or associated condition when they had surgery for the following?

Total knee replacement

Total hip replacement

Rotator cuff repair

Achilles tendon repair

Laminectormy

Thank for all feedback, appreciate.

Post Surgical ICD 9 Code for Therapy

Coding Roundtable

My office would like to start hosting a coding round table, and i have been asked to help out.

Have any of you hosted a coding round table before, and if you have, how did you go about getting is started and what topics were discussed.

We are using our round table mainly for education purposes. i am thinking we will take a medical chart/ op note, etc.. Code it and then discuss why we coded it the way we did.

Any suggestions and input are welcome!!

thank you!

Bridget

Coding Roundtable

vapor smoker/e-cig

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It is still 305.1, most e cigs do contain nicotine which is the addictive substance. The advantage of the e cig is to those around the smoker, cigs emit vapor which is not harmful like second hand smoke from traditional cigarettes.

__________________

Debra A. Mitchell, MSPH, CPC-H

vapor smoker/e-cig

same day multiple same E/M Code

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same day multiple same E/M Code

Billable fistulagram?

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In this case, the correct CPT code to bill for the procedure is 35476. I did see that this was an AV fistula, correct? Also, here is a Tip:

When a venous AV fistula or graft angioplasty was performed, the procedure is reported using the following codes:

35476 (Transluminal balloon angioplasty, percutaneous; venous) for the procedure. 75978, [Transluminal balloon angioplasty, venous (e.g., subclavian stenosis), radiological supervision and interpretation.] for the imaging.

Remember to report only one intervention per segment. According to CPT? guidelines, that means reporting 35476 and 75978 only once per segment, even if the physician uses multiple balloon catheters to open multiple lesions or inflates a balloon multiple times.

The fistulogram is bundled into the procedure as the balloon angioplasty is the hierarchy of the procedures performed. Now, if you work for an ASC or Outpatient Hospital, you would code the fistulogram in the ICD-9-PX codes for facility reimbursement.

Also, if the physician performed more than one puncture of the artery, make sure to code the 36012 (selective catheter placement, venous system, second order, or more selective branch).

Hope this helps!!

Billable fistulagram?

Looking for Remote Billing Position

I am looking for a remote billing position, I have experience with pain management, general surgery, internal medicine and ophthalmology but would be interested in any type of medical billing. If interested please reply or email me at elizabet052506@gmail.com

Thank you!

Looking for Remote Billing Position

Help with Transrectal excision of large rectal polyp

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" First the rigid sigmoidoscopy had been performed. The Dr, could see the polypoid growth in the rectum just above the dentate line. The Dr did a rectal ultrasound, whic confirmed the rectal polyp. After the patient was prepped and drapped, using a bivalve retractor in the rectum, the Dr transrectally removed the rectal polyp down to muscle. The specimen was sent to pathology. Then, Surgicel was placed on top of the wound site. After the procedure, the Dr performed a rigid sigmoidoscopy again, he could not see any remaining polyp"

Do I code the ultrasound 76872, sigmoidoscopy 45300 and excision of rectal tumor 45172?

Help with Transrectal excision of large rectal polyp

Opportunities in Houston

I am a healthcare industry professional interested in networking and exploring potential career opportunities in the Houston area.

I have attached a general description of my industry qualifications and experience.

It would be my pleasure to provide additional information at your request.

Best Regards;

EXPERIENCE HIGHLIGHTS

Department Management & Staff Supervision

Monitor, report, and correct quality issues.

Prepare and deliver corrective actions and performance reviews.

Responsible for the staffing and budgeting of four departments.

Supervision and direction of four managers and 25+ staff members.

Conduct staff meetings, develop and present training material for on going department development.

Adjunct instructor teaching certified medical coding and certified medical insurance specialist.

Health Care Administration

Review and interpretation of medical records for appropriate and thorough coding to the highest specificity.

Thorough understanding of medical claim administration, including case management, subrogation, HIPPA regulations, coordination of benefits, PPO, HMO and indemnity plan language.

Created and prepared special needs reports, analysis, and systematic processes for handling and automating unique contract arrangements with the provider and/or healthplan.

Accountable for the implementation and set up of new system modules, conversion processes, and database table maintenance.

Monitored and reported on amendment, needed rate changes, and renewal processes for over 1200 contracts.

Collaborated with facility CFO?s on the execution and implementation of contracts

Administrative Support

Responsible for billing and collections.

Handle sensitive or involved issues that have escalated above the Customer Services Representative level of skill.

Oversee, coordinate and implement internal and external training programs.

Created training and technical manuals for practice management software end users.

Delivered training and instruction to individuals and large groups up to 75 attendees.

CERTIFICATIONS

Certified Professional Coder (CPC)

Certified Professional Coder-Instructor (CPC-I)

Certified Professional Practice Manager (CPPM)

PROFESSIONAL ASSOCIATIONS

American Academy of Professional Coders (AAPC)

Opportunities in Houston

Renal pelvic Washings

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Renal pelvic Washings

Resident virus PA

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Resident virus PA

J0895 Desferal

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J0895 Desferal

injection on same limb for two separate dx

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It depends completely on the office note and what was documented that was relevant to the presenting issue(s)". A new problem does not guarantee that the note will meet the criteria of significant and separately identifiable.

__________________

Debra A. Mitchell, MSPH, CPC-H

injection on same limb for two separate dx

Modifier SK

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Modifier SK

Welcome to Medicare visit and annual visit

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Welcome to Medicare visit and annual visit

Emergency Contraceptives Question

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Emergency Contraceptives Question

72 hour holter monitor

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72 hour holter monitor

Flu Injection and 95117

When a patient has the code 95117 and a flu injection on the same visit, are the codes 95117, 90686, and 90471 or are the codes 95117, 90686 and 90472. I would appreciate any help I could get and also some documentation to back it up. I am new to Med Allergy and need a lot of help.

Thanks..

Flu Injection and 95117

Simple Vs Extensive Destruction

I'm sure many derm coders came across this.

What makes a destruction Extensive for anal, vulva, or penis lesions.

I thought extensive would mean multiple lesions but then CPT says "lesion(s)" under simple so that implies multiple lesions even if it's a simple destruction?

Can't find any info on the differences anywhere.

Simple Vs Extensive Destruction

Inpt E/M with chemo

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scenario:

pt admitted (4yo) because of facial drooping and fever, recently diagnosed with AML. Like two days recent. pt was due to start chemo that day. Coded a subsequent E/M for each day pt had chemo and LP and payor is denying chemo, paying E/M and LP. Pt was admitted to hospital for a month. He is on a very high dose of chemo and they are treating his AML aggressively.. my question is this: Since this is a high dosing of chemo, can you code chemo with any E/M at all ever? Providers insist they are assessing pt each time with exam and making the determination if pt is stable for that days treatment. I realize if the pt has a separate issue we can code the E/M with a 25, but the days they are seeing the patient before chemo there isn't anything but chemo. The facial drooping and fever were resolved after two days with meds.

Inpt E/M with chemo

[unable to retrieve full-text content]

Looking for a CPPM position

Myra Kinnaird

7284 Butternut Ln.

Mentor, Oh 44060

Poohtig11@gmail.com

This letter is to introduce myself and my interest in becoming a part of your practice. The enclosed resume will furnish you with the information concerning my overall employment background, training education and skills.

I am looking forward to moving to the area of Bonita Springs Florid or Myrtle Beach South Carolina area. To share my knowledge and skills with the health care community. In each of my previous job experiences I have performed my duties with a high degree of skill and professionalism.

I have just recently received my CPPM from AAPC.

My positive attitude and willingness to give 150% makes me a valuable asset to any organization that would employ me. I believe in excellence and have always dedicated myself to assure successful accomplishments of any company goals.

I look forward to hearing from you in the near future and hopefully to schedule an interview in which we can discuss my qualifications and the possibility of joining your practice.

I would like to secure a position before my move. If we can do a phone interview and if both of us are in agreement I will be more than happy to make arrangements to come down for a face to face interview.

Sincerely,

Myra Kinnaird

7284 Butternut Ln

Mentor, Oh 44060

440-221-5627

Poohtig11@ gmail.com

Myra Kinnaird

Objective: To utilize my knowledge and skills in the health care community.

Education: Bryant & Stratton, 1995

Highland Hts., Ohio

Associate Decree Medical Assisting

Lakeland Community College, 1992-1994

Willoughby, Ohio

RN program

Chardon High School, 1980

Chardon, Oh

Skills & Abilities:

I am a dependable person who works well with others I am efficient and capable of working independently with little or no supervision. Physician credentialing,

BP, injections, minor surgery, stitch, staple & cast removal, surgery & patient scheduling, CPT & ICD-9 coding, EKG, transcription, supply ordering, mail correspondence, banking deposits, filing, phones, typing.

Employment: Northeast Surgical Assoc. of Ohio

Maria T. Madden, M.D., F.A.C.S.

13170 Ravenna Rd #108

Chardon, Oh 44024

March 2009-present

Medical Assistant/Office Mgr.

Employment

Continued: Foot & Ankle Specialties

7062 Wayside Dr.

Mentor, Oh 44060

2007-2009

Medical Assistant/Secretary

Universal Therapy Dynamics

35000 Kaiser Ct

Willoughby, Oh 44094

440-951-6677

1998-2007

Home Health Coordinator/Secretary

Edwin Hissa, M.D. Inc.

2785 SOM Center Rd.

Mayfield Hts. Oh 44124

740-395-8494

1994-1998

Medical Assistant/Office Mgr.

Family Physicians

6990 Lindsay Dr.

Mentor, Oh 44060

1990-1994

Medical Assistant/Secretary

References: Available upon request

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Last edited by poohtig11@gmail.com; Today at 03:39 PM.



Looking for a CPPM position

Medical Coding Certificate

I'm currently looking for some coding experience.

I have my Medical Coding Certificate from Mississippi State University continuing education program and will be taking my CPC exam on November 8th. I have worked as a hospital coder with 3 years experience, but that was the year of 1985 - 1988. I currently work for a Global manufacturing company as the Office Coordinator and Customer Service Representative. I work onsite and remote with other company sites. The reason for the career change is, our company was recently purchased. If anyone is interested in an extra hand for experience, please forward an email to mims2869@bellsouth.net. I would love to work from my home office but will work on site and weekends.

Best Regards,



Medical Coding Certificate

medical pt/for pregnancy related svcs

Hello

If someone can advise me, A new pt (pregnant) was seen for pulmonary embolus, she has medical only (insurance) for pregnancy and related medical svcs, Dr is Hem/Onc. we bill medical with ICD-9 673.20; 785.6; and 626.0

for a 99205. RAD code 169 : svcs not payable when billed with this diagnosis.

Thank you.

Rosa.

medical pt/for pregnancy related svcs

Need help with axillary excision (CPT code????)

Procedure: Excision of 3.5 cm left axillary cyst with layered closure.

"A 4 cm incision was made over the site after anesthetizing the site. I carried the excision down to the subcutaneous tissue and remove the cystic nodule. It is probable sebaceous cyst. It was totally removed and sent for pathology. Wound was closed in layers"

Which CPT code applies?

Thanks!

Need help with axillary excision (CPT code????)

CPT 28190 Splinter/FB removal

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CPT 28190 Splinter/FB removal

Two different PA's same DOS same Dr.

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Why was this done at two separate times is a good question, ant the fx follow up should be in the global and not billable? Do you have additional information to share that would help to clarify these encounters?

__________________

Debra A. Mitchell, MSPH, CPC-H

Two different PA's same DOS same Dr.

Evar abdominal aortic aneurysm repair

I have never done CV Surgery before.. so I'm needing some help with a few of these procedures. I'm not sure where to start with this one!

Can someone help me with this?? Thank you!

EVAR ABDOMINAL AORTIC ANEURYSM REPAIR WITH STENT GRAFT , ( x 3 endo-grafts) Right External Iliac Artery Balloon Angioplasty, Left External Iliac Artery Balloon Angioplasty, Bilateral femoral artery exposure and repair, Left Subclavian triple lumen placement, Pelvic Arteriogram with run-off, Abdominal Aortogram, Intravascular Ultrasound,

Evar abdominal aortic aneurysm repair

Injection help

Hello -

I have a provider who wants to bill 20551 and 20526. Per ncci edits this code pair comes up as a 1 so we can use a modifier if it is appropriate. My problem is... I dont know if I should place a 59. Does the wrist have separate compartments that we can use to say ithat s why we used the 59?

Medical states:

1. A corticosteriod injection to the second dorsal compartment in the area of intersection syndrome was provided. Patient tolerated well.

2. A corticosteriod injection was administered to the carpal tunell. Patient tolerated well.

I just dont want to chuck a 59 on the code pair of 20551 20526 so I need to be able to rationalize how they are separate. I am not sure how to do that. Any help?

Thanks!

Injection help

shoulder lysis vs debridement

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I have an MD from Orthonet trying to tell me to bill 29825 for lysis of shoulder adhesions when the op report states "we used an arthroscopic biter to incise the middle glenohumeral ligament & continued the capsular release through the anterior-inferior quadrant." Then they moved the arthroscope anterior & it states "A capsular release was then performed". I don't see the op report supporting any lysis of adhesions- only debridement which was billed as 29823. For 29825 doesn't it actually have to say lysis of adhesions was performed? Maybe 29806 would be more appropriate?

shoulder lysis vs debridement

VAC Removal

Can you charge for the removal of a VAC? If so, please help with CPT? I cannot find any info for just the removal. The only charge I am seeing so far is CPT 15852 for the Dressing change under Anesthesia.

The op report says:

All of the dressings were removed and replaced with a clean sterile dressing. The incisional VAC that was on the anterior aspect of his leg was then removed and iodoform followed by ABD padding was placed over the wound.

Thanks.

VAC Removal

G0461 X 2 - 59 modifier used?

When we have two specimens and an immuno is done on each, we can code G0461 for each specimen. Do you code this as:

G0461 X 2

or

G0461

G0461 -59

I do coding, not billing. I have not been using a 59 modifier on the second G0461 and have not heard of any denials from our billing office. But, the question was raised today which is correct.

Thanks!

G0461 X 2 - 59 modifier used?

Need Help with modifiers Q7,Q8,Q9

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with diabetic foot care codes G0245 and G0246 I am getting denials because I don't have one of the Q7, Q8, or Q9 modifiers attached. I need to know what the Class A, Class B, and Class C findings are so I know which modifier to use. I am unable to find the Class's ....can someone please help me!

Need Help with modifiers Q7,Q8,Q9

E/M 1997 Guidelines

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I needs some input please. I recently found some information for the 1997 E/M guidelines for the Exam part for Musculoskeletal System and what is required for each level of coding. 1, 3 vital signs, 2. general appearance 3, Cardiovascular periph,vasc.by obs & palp 4. Lymphatic Palp, lymph, nodes, any loc. 5. gait and so on. then you count up the elements for the levels. My question is. One of the physicians in our office refuses to do the Lymphatic due to he/she is saying it is a liability. but still want to charge a level 99204 for new patient. This would not cover all 30 elements. Is this right and is it really a liability. Personally never heard or read that. Confused. Help please... Thank you.

E/M 1997 Guidelines

need help pls

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need help pls

Sis

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Sis

92240

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92240

Cpt code?

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Cpt code?

Handling of slides and paper requisitions outside of the lab.

A question came up in our office about the potential biohazard of paper requisitions and the various slide preparations. We discovered that CAP has no accreditation requirements for the handling of these items by non-laboratory personnel such as secretaries, admin, and coders.

Do any of your offices have any internal policies for handling these items? For example, paper requisitions sometimes have dried blood or other fluids on them. Some slides have cover slips and some do not. Does your office have any policies for handling these outside of the lab - such as when gloves are needed or not needed or whether eating/drinking is allowed at your workstation if you handle these types of items?

I would be most appreciative if anyone could share their experience.

Handling of slides and paper requisitions outside of the lab.

Documentation guidelines for billing Doppler/Color Flow with TEE

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Can someone please help me? I bill transesophageal echos and I know that when the provider puts in his documentation the regurg amts, stenosis etc that shows he used color flow and doppler. My question is can I bill for the color flow and doppler with just that info or does the provider have to specifically state color flow and doppler were used in the report? I have looked for CMS guidelines and could not find anything specific and get different answers from people I have asked. Would like to have written documentation if anyone can direct me? Thanks.

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Last edited by parkt3@hotmail.com; Today at 05:17 AM.









Documentation guidelines for billing Doppler/Color Flow with TEE

Billing software

Our billing service is looking to upgrade their current billing software. We work with encounter data for primary care providers that have managed care contracts. We would like the audience input; as to which would be the ideal billing system for our office.

Thanks

Billing software

Seminars for OBGYN

Hello,

I am very new to OBGYN coding and I was wondering if anyone knew of any good OBGYN Seminars that our being offered? What companies are good and which ones to avoid? We are looking for one that specializes in ICD-10, Surgical, Office, OB CPT coding. Any help would be great.

Thanks

Seminars for OBGYN

I passed!!

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I passed!!

Auditing medical records

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Auditing medical records

Infusion Administration

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Many offices are using Medical Assistants to infuse biologics under the direct supervision of a physician. It is very unclear whether or not this is under their scope of practice legally. My question is whether or not an insurance company can take back funds paid on an infusion because it was performed by an MA. If they require a RN or an LPN would they have to have this information somewhere in their policy? Has anyone had funds taken back for this?

Infusion Administration

Documenting on a different provider note

I have a chiro provider who is doing his documentation on a othro provider's documentation.

The ortho provider submits his documentation for medical management to the chiro, the chiro scribbles his documentation on the ortho providers note. Where can I find guidelines about this situtation?

Thanks

Documenting on a different provider note

Kaposi's Sarcoma

Ok I am just baffled by this coding question....I don't think the correct answer is given.

Please code: Kaposi's Sarcoma due to HIV disease.

1) 176.9, V08

2) 042

3) 176.9

4) 176.9, 042

Per the guidelines if you have a person that comes in with an HIV related condition you will code the 042 first, then the condition after that. Well to me that means the answer should be:

042, 176.9 but this is not one of the answer options. Please help.

Kaposi's Sarcoma

Cholangiogram/plasty, biopsy, stone removal

Hi Guys,

Can you please help me with this? It looks like there was a lot going on.

PROCEDURES PERFORMED:

CHOLANGIOGRAM, BRUSH BIOPSY DISTAL COMMON BILE DUCT, STONE EXTRACTION

UTILIZING BASKET AND BALLOON TECHNIQUE, CHOLANGIOPLASTY, REINSERTION OF

BILIARY DRAINAGE CATHETER VIA T-TUBE TRACT

IMAGING MODALITY UTILIZED:

Fluoroscopy

ACCESS SITE:

T-tube tract

CATHETER POSITION:

Common bile duct

CONTRAST UTILIZED: Nonionic contrast utilized.

TECHNIQUE: The indwelling tube was sterilely prepped and draped in standard fashion.

Contrast was injected. There is a large oval filling defect identified in

the distal common bile duct. There are several small rounded filling

defects identified nested at the level of the pigtail catheter within the

common bile duct above the biliary enteric junction. The latter were felt

to likely reflect air bubbles. Catheter removed over a guidewire. An 8

French sheath inserted across the common bile duct. Through this, the

distal common bile duct was subsequently brushed using a standard brush

biopsy technique. Subsequently a standard biliary basket was placed and

attempts were made at engaging the presumed choledocholith in the distal

common bile duct. Multiple attempts were performed at positioning the

choledocholith into the bowel. It was difficult to image the

choledocholith due to the radiolucency of the stone. Followup injections

demonstrate a persistent filling defect which appears smaller, this suggest

possible stone fracture and/or possible displacement of portions of the

stone into the duodenum. Subsequently additional techniques were performed

including balloon push technique across the distal common bile duct

utilizing 8 x 20 and 10 x 20 mm balloons. Finally, completion balloon

cholangioplasty was performed using a 12 mm balloon. Balloon inflations

were for 5 minutes x 3. Completion study demonstrates patency of the

common bile duct. There are filling defects within the common bile duct

however these may be blood, underlying stone is not excluded. The patient

will undergo followup cholangiogram. Over the guidewire the sheath was

removed, and a 12 French Dawson-Mueller was placed in the mid common bile

duct. Dressing applied.

FINDINGS:

Cholangiogram demonstrates oblong filling defect in the distal common bile

duct which likely reflects a retained stone/choledocholith. As described

above, various techniques including basket, push balloon, and

cholangioplasty were utilized to fragment the stone in attempt to displace

the stone into the duodenum. Several small rounded defects were evident

nested at the level of the biliary drainage catheter, the latter felt to

likely reflect gas bubbles. Brush biopsy conducted along the level of the

distal common bile duct narrowing. Drainage catheter reinserted. The

patient will undergo followup diagnostic cholangiography to assess results

and need for further intervention.

I thought these codes would be appropriate, but the 47552 is editing against the 47630. I got: 47530/75984, 47630/74327, 47552, 47505/74305. What do you think? Thanks in advance for any help!!

Cholangiogram/plasty, biopsy, stone removal