Cobg certification

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Cobg certification

Billing for patient positioning OR table

Hey all! Can you please help me with this conundrum? I work for a Neurosurgeon and he wants me to bill for positioning the patient on the OR table along with whatever surgery he is performing whether it's spinal or brain.

Is this even billable? Mind this I live in Michigan and we have no fault auto here so maybe just billable to them since their guidelines aren't as strict as Medicare or Medicaid......

If it is billable what is the code? Google wasn't much help and everything I searched was anesthesiology billing..?!?!?!?
Any help is appreciated!!!
Thanks so much!!

Billing for patient positioning OR table

Coding question

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Need advice. Our pediatric office uses an EHR that does code the visits. When reviewing the claims, if there are any corrections I need, such as a change to a diagnosis code like changing V20.2 to V70.0, I ask the provider to make the correction to the chart note also. I feel it is wrong to change the diagnosis in the claim, but not in the chart note even if the note does support the correct code, the incorrect code is still there. Am I wrong?

Coding question

Emg

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Need help on coding EMG w/o paraspinal did not done before
Dr. did 2 extremity w/o related paraspinal areas no NCV :
& Nerve conduction studies was 9-10 studies
I pull CPT 95861 and CPT 95911
However as I check CPT 95861is components of CPT 95911 , so I cannot use both, now I have no idea what is next. Any assistance will be greatly appreciated.
CC: UE numbness and tingling.
Thank you

Emg

Injured by spacecraft

I came across this little morsel and just had to share.

Injured By a Spacecraft? There?s a Diagnostic Code for That - Health Blog - WSJ

http://ift.tt/1BLbGN2

July 15, 2008, 6:09 PM ET
ByJacob Goldstein

July 15, 2008, 6:09 PM ET
ByJacob Goldstein

So we?ve got this patient here who was injured in this spaceship accident. You know, just a routine, uh, orbital mishap. But how do we account for that? Oh, right, it?s ICD-9 code E845 ? ?Accident involving spacecraft.?

Apropos of nothing in particular, this billing code popped up on a couple of medical blogs last week (KevinMD and Dr. Secretwave101). Intrigued, we did a little reporting.

This extended definition notes that the code includes ?launching pad accident,? but excludes ?effects of weightlessness in spacecraft,? which has its own code (E928.0).

ICD (International Classification of Diseases) codes are the basic international health codes that exist for just about everything (as this spaceship thing suggests). They?re used both for billing purposes and for tracking trends in public health.

A spokesman for the Centers for Medicare and Medicaid, one of the key agencies that deals with the codes in this country, told us that E845 was in the current version of U.S. ICD-9 code when it was first published in 1979. The code was created by the World Health Organization as part of ICD-9, the spokesman said. Other places in the world use ICD-10, we?ve stuck with ICD-9-CM.

A little creative Googling turned up a citation of the same code all the way back in 1966.

Just because a code exists, it doesn?t mean anybody?s ever used it. ?Whether someone was injured [by a spacecraft] or not was immaterial because somebody thought, ?What If?? ? Sheri Poe Bernard, a VP at the American Academy of Professional Coders told us.

It didn?t take much to get Poe talking about all the strange things that have their own codes. Bite of a nonvenomous arthropod. Dog bite. Rat bite. Scorpion sting. ?A centipede has its own code ? E905.4,? she said. ?Accident caused by paintball gun, E922.5 Accident by fireworks, explosion, E923.0″.

If you can think of a way to be killed or injured, there?s a code for it. ?Terrorism has all kinds of codes associated, involving marine weapons, aircraft, explosions, conflagration,? she said. ?Terrorism involving nuclear weapons, E979.5; biological weapons E979.6; chemical weapons E979.7.?

Uh, thanks Sheri. If you need us, we?ll be huddling under our desk, fearing for our lives. What?s the ICD code for that?

Injured by spacecraft

post op pain nerve block placement documentation

I'm in need of some help. I have sent a request to NCCI for help also.

I'm in search of information or a link for proper documentation requirements for the placement of post op pain nerve block. I have a case and all the documentation states is: "Epidural placed per MDA".

From my previous experience this should not be billable for post op pain.

Thanks

post op pain nerve block placement documentation

HCPCS code for Mental Health Re-assessment

I work at a Behavioral Health Clinic. We have been providing Mental Health Assessment by non-physician using HCPCS code H0031. Lately we need to perform bio-annual or reassessment of Mental Health Assessment by non-physician. Can we use the same H0031 code or is there a different code for this reassessment. I understand that H0031 can only be used once per year. Any help is appreciated. Thank you.

SA Milne

HCPCS code for Mental Health Re-assessment

Re: Assist/Cosurgeons

We have two general surgeons in the same office. One took out the gallbladder and the other assisted. During the course of the procedure the primary surgeon decided to turn over the laparoscopic resection of the liver to the other doctor who is in the same office. They both dictated separate operative reports listing each other as the assist to each other. It seems to me as if they are unbundling the surgery, and that the 47563 and the 47100 should not be unbundled between the surgeons. They are also not really co-surgeons since they really each did their own part, and they are in the same specialty. I feel that really the entire procedure should have been done by one surgeon, but it was divided up between two general surgeons. I certainly don't want the patient to have two bills with each code separated into two bills. Any suggestions? I believe it will be difficult to justify co-surgeons on these codes.

Thanks,

Dee

Re: Assist/Cosurgeons

Medicare skill nursing codes for discharge

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Have a question need a answer asap. When a patient is prounced decreased in a skilled nursing facility and the dr does a expiration summary, and the patient has Medicare insurance would I use the code 99315 or 99316 depending on documentation for the discharge in a skilled nursing faculty?

Medicare skill nursing codes for discharge

Two Providers bill 99220 for same dos

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Two Providers bill 99220 for same dos

Reporting an E/M in lieu of minor procedure.

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I am looking for guidance please. Is it the discretion of the provider to report an E/M in lieu of minor procedure. I need something official-like to serve as a solid reference either way.
I am bombarded with information about reporting minor procedure with an e/m when I try to search "in lieu of" but that is not what I need.
If anyone can assist I would greatly appreciate it.

__________________
Stephanie W., CPC

Reporting an E/M in lieu of minor procedure.

Reporting an E/M in lieu of minor procedure.

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I am looking for guidance please. Is it the discretion of the provider to report an E/M in lieu of minor procedure. I need something official-like to serve as a solid reference either way.
I am bombarded with information about reporting minor procedure with an e/m when I try to search "in lieu of" but that is not what I need.
If anyone can assist I would greatly appreciate it.

__________________
Stephanie W., CPC

Reporting an E/M in lieu of minor procedure.

COC, CPC, CCS-P, ICD-10-CM/PCS proficient searching for a medical coding position

VINO C. MODY, JR. COC, CPC, CCS-P__ __________________________________________________ ____________________
3353 Dunbar Lane, Suwanee GA 30024
6154 Black Mallard Place, El Paso, TX 79932
vinomodyjr13@gmail.com, vmody@cp.epcc.edu
678.427.6511

GOAL: MEDICAL CODING AND ADMINISTRATION

Certified professional coder (CPC), Certified outpatient coder (COC), and Certified coding specialist-physician based (CCS-P): Strengths include:

 Medical coding ability using ICD-9-CM, CPT, HCPCS systems
 Medical coding ability using ICD-10-CM
 ICD-10-CM proficient
 ICD-10-CM specialized in ophthalmology and cardiology
 Knowledge of anatomy, physiology, disease processes
 Familiarity with medical coding software
 Adept use of Word, Excel, Internet
 Professional conduct (HIPAA, Joint Commission standards)
 Medical records management
 Teamwork + excellent self-management
 Leadership training
 Mastery of correct grammar, spelling, punctuation
 Medical Research experience
 Training and knowledge of all areas of medicine

EDUCATION AND PROFESSIONAL ORGANIZATIONS

Certified Outpatient Coder (COC), American Academy of Professional Coders (AAPC), Salt Lake City, UT June 2015
Passed COC exam, American Academy of Professional Coders, Salt Lake City, UT June 20, 2015
Completed training, COC, AAPC, Salt Lake City, UT April 2015-June 2015
Certified Professional Coder (CPC), American Academy of Professional Coders (AAPC), Salt Lake City, UT March 2015
Passed CPC exam, American Academy of Professional Coders, Salt Lake City, UT October 2013
Completed training, CPC, AAPC, Salt Lake City, UT April-October 2013
Board-eligible Certified Anesthesia and Pain Management Coder (CANPC), Salt Lake City, UT 2014
Sitting for CANPC exam by September 2015, American Academy of Professional Coders, Salt Lake City, UT
Earned CEUs for webinar Correctly coding nuclear medicine procedures, AAPC, Salt Lake City, UT December 2013
Earned CEUs for webinar Neurovascular interventional coding, AAPC, Salt Lake City, UT March 2014
Earned CEUs for webinar Coding for diabetes: pregnancy and beyond, AAPC, Salt Lake City, UT June 2014
Certified Coding Specialist-Physician based (CCS-P), American Health Information Management Association (AHIMA), Chicago, IL March 2015-May 2015
Passed CCS-P exam, American Health Information Management Association (AHIMA), Chicago, IL May 13, 2015
Completed training, CCS-P, AHIMA, Chicago, IL March-May 2015
Completion of training, Certificate of completion for 1.0 CEU for ICD-10-CM Chapter 7: Diseases of the Eye and Adnexa, AHIMA, Chicago, IL June 13, 2015
Completion of training, Certificate of completion for 1.0 CEU for ICD-10-CM Chapter 9: Diseases of the Circulatory System, AHIMA, Chicago, IL June 23, 2015
Training in Certified coding specialist (CCS) from Ohio Health Information Management Association (OHIMA), Gahanna, Ohio May 2015
Certificate of completion for 16.0 CEUs, ICD-10-PCS code set training for procedural codes, AAPC, Salt Lake City, UT June 2015
Certificate of proficiency for 16.0 CEUs, ICD-10-CM code set training for diagnosis codes, AAPC, Salt Lake City, UT January 2014
NHA Certified Medical Administrative Assistant (CMAA) Paper-Pencil, Leawood, KS February 2015
NHA Certified Billing and Coding Specialist (CBCS), Leawood, KS March 2015
Certificate of Completion, Administrative Medical Specialist with Medical Billing and Coding + Medical Terminology (360 Hours), University of Georgia, Athens, GA February 2015
Graduate, Medical Coding Specialist Course (600 Hours), U.S. Career Institute, Fort Collins, CO 2012-2013

PROFESSIONAL EXPERIENCE

Cardiology coding lecturer, Southwest University, El Paso, TX April 2015-June 2015

Prepared lecture on cardiology coding. Covered topics Coronary artery bypass graft, angiography, valvular disorders, central venous catheter, and abdominal aortic aneurysm. Lecture was successfully presented under the supervision of Yasenia Ceniceros, CPC on June 26, 2015. Earned certificate of appreciation from Southwest University for collaboration as a Guest Speaker with the Presentation ?Medical Coding for Cardiology? on June 26, 2015.

Customer Service Representative, Farooq Givani Agency, Norcross, GA 2013-Present

Handled customer service and policy payment. This work is ongoing.

Medical coding trainee, Practicode CPC-A Practicum, American Academy of Professional Coders, Salt Lake City, UT June 2014-November 2014

Assigned medical codes. Determined medical codes to 600 actual medical records for one year of work experience in a hospital, clinic, doctor?s office, emergency room, operative report, radiology report, or pathology report setting. Developed skills for medical coding involving ICD-9-CM, CPT, and HCPCS II.

SIGNIFICANT ADDITIONAL UNDERGRADUATE, MEDICAL, AND RESEARCH TRAINING
Available upon request

REFERENCES
Available upon request

COC, CPC, CCS-P, ICD-10-CM/PCS proficient searching for a medical coding position

[unable to retrieve full-text content]

CPC-A looking for employment

My name is John Chaney and I am looking for employment providing medical billing services. I am willing to relocate and I can begin work immediately. I have provided my resume below.

John C. Chaney, CPC-A
305 Vistamar Dr.
Wilmington, NC 28405
(910) 617-3817
Mr.JohnChaney@Gmail.com

________________________________________

Summary of qualifications:

AAPC Certified Professional Coder
Previous experience providing medical billing for a local optometrist office.
CFCC Honors list every semester.
Phi Theta Kappa Honor Society member.
Current AAPC member.
Ability to code for the upcoming switch to ICD-10. Certification from AAPC.

________________________________________

Education

May 2015
Cape Fear Community College Wilmington, NC
A.A.S. Medical Office Administration
3.7 GPA

May 2008
East Carolina University Greenville, NC
B.S. Recreation and Park Management

________________________________________

Experience

Aug 2014-Dec 2014
Cape Fear Eye Institute Wilmington, NC
Internship

Filed 15-20 insurance claims per day to CMS and private insurance payers
Prepared charts for next day use
Scheduled patients and entered demographic information in EMR
Checked out patients and processed their encounter form
Posted payments and made adjustments to patient accounts

Jun 2010-Sep 2010
Surf City Parks and Recreation Surf City, NC

Summer Recreation Assistant
Provided maintenance for the city?s recreation center
Responsible for setting up scheduled events
Responsible for the daily and nightly operations of the community center
Handled membership registration and activity registration

Aug 2008-Jul 2009
Mecklenburg County Charlotte, NC
Community Gardens Manager

Handled patron registration and rules enforcement within the program
Created spreadsheets detailing fiscal information about the community gardens
Communicated successes of the community garden program to the local media

---

Last edited by JChaney454; Today at 10:54 AM.

CPC-A looking for employment

Sensilase coding

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Sensilase coding

J-Mammoplasty

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J-Mammoplasty

Looking for Billing/Coding position

Dianna Toliver
2204 SE 1st Street
Cape Coral, FL 33990
(419)-410-4031
diannatoliverbk@gmail.com

OBJECTIVE
A Medical Billing and Coding position in the Southwest FL area, which utilizes my recent degree and extensive work experience in customer service, budgeting, accounting, inventory control, MS Word and industry specific software.

EDUCATION
Medical Billing & Coding Certificate, Cape Coral Tech May 2015
Military Quartermaster Courses, US Army, completed 84 credit hours 1991

WORK EXPERIENCE
Manager, McDonalds, Fort Myers, FL 2012-2013
* Lead manager of a high volume fast food restaurant including hiring and managing staff, inventory, payroll, cash control, customer service and ensured all food safety procedures were followed
* Successfully implemented training procedures to handle customer fluctuations and emergency procedures
* Hired and trained all employees and established a process for seasonal and community events to grow sales

General Manager, Burger King, Bennett Management, Maumee, OH 1998-2012
* Lead manager of a high volume fast food restaurant including hiring and managing staff, inventory, payroll, cash control, customer service and ensured all food safety procedures were followed
* Successfully increased sales year over year and consistently passed state and corporate inspections
* Responsible for all incoming new manager training for entire franchise

Services Supervisor, Sunrise Lodge, Hohenfels, Germany 1996-1998
* Responsible for customer service, supervising staff, all maintenance and ordering and managing inventory
* Successfully lead refurbishment of all guest rooms and reorganized a computer inventory system which integrated all lodging functions.

Area Manager, Army & Air Force Exchange Service, Ft. Belvoir, Virginia & Darmstadt, Germany 1991-1996

* Promoted from various clerical and supervisory positions to manage a Home & Garden center with $3.5mm in sales
* Successfully managed 15 employees directly and was responsible for managing 90 employees as closing manager
* Responsible for maintaining the RPOS 3 computer system for daily receipts and the inventory for 3 departments
* Successfully coordinated the construction and opening of a new Home and Garden Center

Material Control & Accounting Specialist, United States Army 1983-1991

* Manager Tech Supply Unit
- Promoted to manage 14 Tech Supply Units providing maintenance and support of military vehicles and aircraft
- Successfully trained and supervised employees on new computer systems
- Experienced in conducting warehouse inspections and investigated inventory discrepancies
- Assisted in a downsizing consolidation of 14 units into 7 units

* Parts Clerk
- Successfully maintained inventory for 300 products lines and bench stock of 1000 items to repair technical vehicles and systems crucial to defense

Certifications
CPC Certified
HIPPA Certified
Basic Life Support
Dale Carnegie Training

Looking for Billing/Coding position

Can tubi grip be coded as 29580?

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Can tubi grip be coded as 29580?

ALSvsBLS

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ALSvsBLS

Bivent Pacemaker with only 2 active leads

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A patient is noted to have a Biventricular Pacemaker. I can see in the device analysis that the patient has 3 leads; atrial, right ventricular, left ventricular. The atrial is noted to be "off" and the right and left ventricular to be on. Would this change the cpt code? If the patient has 3 leads would I still code a 93281 or should it be coded as 93280 because one lead is not "on"?

Bivent Pacemaker with only 2 active leads

ICD 10 Webinar for clinical Pathology Lab

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ICD 10 Webinar for clinical Pathology Lab

Help with global period!

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Patient had an ESWL in another city by her urologist. 10 days later she ended up in the hospital in our city with obstruction in her ureter from the stone fragments, UTI and sepsis. My urologist admitted her, exchanged her stent the same day and then 3 more progress notes. Even though we did not do the ESWL I did not think we could charge the E/M visits because of the 90 day global for the ESWL. He tells me we can with the appropriate post-op modifier because he didn't do the ESWL so it is not our global package. I think he is thinking modifier 55. I don't know what to do. I don't think she was seen for a separate issue since her obstruction seems as though a result of the ESWL to me. Please help!

Help with global period!

20552 or 64445?

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20552 or 64445?

Primary vs secondary

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I have a claim where the primary ins is united healthcare and the secondary is Medicare. This PT had a colonoscopy and united paid but dropped the majority to the deductible. When we billed Medicare the denied it for an LCD code and nothing is documented in the chart for us to use. Now Medicare would say we need to write-off the bill but UHC is saying the PT still has a deductible responsibility. Is it alright to bill the PT deductible to the PT or do we need to Write-off the remaining balance?

Primary vs secondary

ICD10 hard start

My manager is telling me that the ICD 10 will be a "hard start"

meaning on 10.01.2015 you begin using icd10 codes regardless of what dates of service you are billing.

I will still probs be billing august 2015 dates of service at the 10.01.15 date

Do you know if this is true ? where can I find some info on this ?

thx

ICD10 hard start

commercial modifiers for denied auths

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I am wondering if there are any modifiers available when submitting a claim for payment after the authorization was denied but a waiver was obtained? Are the GA, GX, GY, GZ modifiers specific to Medicare only or can they be used on claims to a commercial payer?
Thanks for your help!

commercial modifiers for denied auths

delivery of fetal demise at 20.5

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delivery of fetal demise at 20.5

Interscalene +

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Provider gives the following for coding: Interscalene Block with catheter, with ultrasound and with nerve stimulator. Suggestions for codes and modifiers....

__________________
IBA_Anes_Billing_(NER*CPC)

Interscalene +

orthognathic surgery

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orthognathic surgery

Billing E/M decision for surgery in global period

A provider posed this question:

If a patient is receiving closed fracture treatment and it is failing can I bill an E/M for a surgery consult in the global period of the fracture care?

My initial thought is no because there is not a new problem present. Thanks for your input.

Billing E/M decision for surgery in global period

tibia operation, desperately need help

Hello everybody,

i desperately need help with this operation:

Operation Name: RT. PROXIMAL TIBIAL TUMOUR RESECTION AND RECONSTRUCTION

Procedures: UNDER GA SUPINE POSITION SCRABBING AND DRABBING OF THE RT. LOWER
LIMB.
SKIN MARKING.
SKIN INCISION ANTERIOR TIBIAL WITH PROXIMAMAL MEDIAL PARAPATELLAR APPROACH.
MAKING OF MEDIAL FLAP WITH DISSECTIONN DOWN TO THE POSTERIOR ASPECT AND
EXPLORATION OF POPLITEAL VESSELS AND TIBIAL NERVE.
IDENTIFICATION OF POPLITEAL ARTERY BUFURCATION EITH LIGATION OF ANTERIOR
TIBIAL ARTERY.
THEN COMPLETION OF THE DISECTION DOWN POSTERIOR AND DISTAL.
. ANTEROLATERAL DISSECTION WITH REMOVAL OF FIBULAR HEAD.
BONE CUT ABOUT 12.5 CM PROM KNEE JOINT.
REMOVAL OF SPICEMEN ENBLOCK.
DISTAL MEDUULAY CNAL MARGIN TAKENAS FROZEN SECTION WAS NEGATIVE.
THE REAMIND AND PREPARATION OF THE TIBIA UP TJ 15.5 MM.
DISTAL FEMUR CUT AND REAMING UP TO 18 MM.
WAHING IRRIGATION . TRIAL DONE . THEN PLACEMENT OF DEFINTIIVE PROSTHEIS WITH
BONE CEMENT.
CHEKING BLOOD VESLES PASTERIOT TIBIAL ARTERY WHICH AUIDABLE AT 30 DEGREE
FLEXION.
THEN RECONSTRUCTION BY USING MEDIAL GASTROCNEMIUS MUSCLE AND SUTURRING OF
THE PATELLAR TENDON.
DRAIN .
CLOSURE IN LAYER AND SKIN.
DRESSING BACK SLAB AT 30 DEGREE FLEXION.
POSTEROR TIBIAL ARTERY AUIDABLE.
AND NO RT FOOT DORSI FLEXION OR PLANTAR FLEXION..

the doctor said these codes will fit:
27645
27665
27690

but we still need a code for:
Reconstruction of right proximal tibia by endoprosthesis..

Any suggestion?

tibia operation, desperately need help

nurse visit and injection

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How do I bill for a nurse visit and 2 injections? Patient presented for a lab visit (Prolia injection for osteoporosis). During her visit, she asked if she could have a Toradol injection because she was getting a migraine headache. The nurse consulted with the physician and the physician directed the nurse to give the patient the Toradol injection, 30 mg. I tried to bill 99211 (with and without a modifier 25), 96372 (for the Prolia injection), J1885 (for the Tordaol) and 96372,59 (for the Toradol injection). The claim will not drop. Does anyone know how to bill for this lab/nurse visit? Thank you for your help, tmassey

nurse visit and injection

Insect Bites for Pediatrics

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Insect Bites for Pediatrics

Fecal impaction 560.32 and Constipation 564.00 what to code

If the medical records contain both the fecal impaction and constipation, can we consider to code both 560.32 followed by 564.00. Or we can consider only 560.32 although both the icd exclude to each other. Please help with any supportive references.

Regards
Dawa

Fecal impaction 560.32 and Constipation 564.00 what to code

Open rotator cuff recon vs repair

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Open rotator cuff recon vs repair

Emds Changing EMR

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We are currently using Emds for our EMR and we are in the process of changing to another EMR system. We are having difficulty with having access to our patient old records once we leave that EMR company. Has anyone had any experience with Emds and the process of accessing your patient information after leaving an EMR company.

__________________
Nickie B, CPC

Emds Changing EMR

SPY Elite- Vascular flow test

Hello,

I have an MD who wants to bill 15860, intravenous injection of agent (eg, flourescein) to test vascular flow in flap or graft. He is performing a robotic LAR. This is his dictation:

"In order to be sure I had adequate perfusion in the proximal colonic segment, immunofluorescent angiographic evaluation of colonic flap was performed. This was done by injection ICG intravenously by the anesthetist. Using fluorescence to confirm I had good blood flow. I had immunofluorescence angiographic evidence of adequate perfusion to the proximal bowel before transecting the bowel and performing anastomosis."

I would like any input in regards to this situation, for one I feel 100% that if he is not injecting then he can't bill, his response was "The anesthetist is giving the medication at my direction. They are not an MD, they are working for me at that moment."

Also, wouldn't this be inclusive. Seems to me that making sure there was good vascular flow would be an inherent part of this surgery. You can't have a successful procedure without making sure there is good vascular flow, correct?

Any input is really appreciated.

SPY Elite- Vascular flow test

Physician refusal to correct coding error in record

I found a coding error in my own medical record. Evidently the physician put 493.21 (chronic obstructive lung disease with status asthmaticus) in rather than 493.00 (extrinsic asthma). There is a huge difference in those two codes and I do not have the one that appears in the records!!
After nearly 20 phone calls the clinic now tells me that I have to have a pulmonary function test to prove the coding error wrong and convince the physician to correct the records. This is of course additional testing and I will have a copay for a test I don't need.

I am going in circles with a diagnosis that is very incorrect and I am getting nowhere with this issue. Is this a compliance issue? Where do I go from here? Help!!

Physician refusal to correct coding error in record

help totally confused

I am not seeing the internal fixation for the dislocations but I feel like I am missing another code???

I have 28270 and 28285

3/4 inch incision was made centered over the second MTP joint. Dissection continued through subcutaneous tissue. Capsulotomy was performed. There was some arthritis and contracture of the articulation. Soft tissue release was used to reduce the pathological dislocation and release the contracture. Base of the proximal phalanx was removed in order to shorten the toe and reduce the contracture and extensor tendon rebalancing was done to afford a new resting balance length. An elliptical incision was made through the skin, tendon, down to bone on the dorsum of the second PIP joint and hammertoe correction was performed as a soft tissue release. The proximal phalangeal head was resected using the micro sagittal saw carefully to release the contracture and to release the pathological dislocation of the PIP joint. At this point , a K wire was driven from the MTP joint out to the tip of across the PIP joint and then ante grade through the MTP joint to affix the toe into its new position.

Any help or suggestions would be appreciated.
Edit/Delete Message

help totally confused

lab coding

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lab coding

can you bill 29806 twice ????

---

Doc did repair two separate repairs: anterior/inferior and posterior. When you plug in 29806 and 29806 into the NCCI edits, there is no conflict. However, when you look at the medically unlikely edits you only get one unit. Can we bill this code twice since two separate parts of the labrum were repaired or can we bill this code only once??? Thanks for your help.

can you bill 29806 twice ????

TEE performed in OFFICE POS 11 setting

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TEE performed in OFFICE POS 11 setting

Preventative CPT'S

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Preventative CPT'S

ICD 10 Help

Hi,
I have come across a scenario while coding ICD 10 and need help for finalising the codes. Kindly review the below scenario and advise.

Scenario-A patient is admitted with an infection of the gastrostomy site. Physician documentation confirms the blood culture result that gastrostomy site growth of Staphylococcal aureus has invaded the bloodstream.

Clarification- For the above scenario which code should we use A41.01 or B95.61 along with K94.22. Kindly advise.

ICD 10 Help

[unable to retrieve full-text content]

COC-H ICD 10 certified

Communication is the first step for success.

Nickie Schmidt
503-884-0637
neschmgmail.com

Employment
Salem Hospital
Salem Oregon
7/11/20000 to current

COC- Outpatient Coder
ICD 10 Certified
23 years of Healthcare
ED
ED Procedures
Ancillary
Facility
Wound Care
Charge Capture
Rehab
Epic
3M
Insurance
monitor denials
Educate Staff
Work closely with our Charge Capture team and Patient Finances
Always looking for ways to improve
Remote Coder

Through my years at Salem Health I started in the ED as a registrar, to medical receptionist, to Charge Capture to Coding. I am a whole picture person. I believe that if you know how the process works you can communicate, comprehend and handle issues with the understanding of where and what to adjust for a favorable outlook. I believe in a team atmosphere and helping others grow. I believe in constantly learning and seeking out information. Not only from books but from senior coders, management and departments.

I am looking for a forward thinking employment that allows the flexibility for me to be an amazing employee and allows me to be able to be there for my family as well. I am a mother of two beautiful girls that keep me on my toes with soccer, robotics,choir, band, girl scouts and 4H.I have been married to my wonderful husband for 23 years and 26 years together. My hobbies are crocheting, knitting, scrap booking and singing in our church choir.
I look forward to hearing from you.

COC-H ICD 10 certified

osteophyte after finger fracture

I've been told to code what the provider gives as a diagnosis, but I've also been told they don't always pick the most appropriate code. Here, the provider states certain terms in the body of the note, but then gives a diagnosis that totally threw me. How would you code this? (New provider who is still learning a lot and patient is new to this provider as well.)

S: Osteophyte, finger. Pt had trauma with laceration 1 year ago. Now has a bone spur protruding from finger and wants orthopedic referral.
O: (Nothing pertinent to finger, interestingly enough!)
A/P: Closed fracture of phalanx, 816.00.

I understand that a bone spur could be the result of an injury, so would I then code for injury of finger? I really don't see the fracture supported here (and no previous visits mention of a fracture).

Or is 726.91 (bone spur NOS) what is shown to be the condition documented in this note? (I hate to question the provider's assessment, but sometimes I just have to! I'm just trying to understand, I guess.)

Thanks in advance!

osteophyte after finger fracture

Need Medicare Code for Biopsy Of Anus

Hi All,

Does anyone have a code I can use for Medicare purposes that crosses from CPT code 46607?
Anoscopy; with high-resolution magnification (HRA) (eg, colposcope, operating microscope) and chemical agent enhancement, with biopsy, single or multiple

I am unable to locate a code for Medicare.

Thanks in advance !

Need Medicare Code for Biopsy Of Anus

help totally confused

I am not seeing the internal fixation for the dislocations but I feel like I am missing another code???

I have 28270 and 28285

3/4 inch incision was made centered over the second MTP joint. Dissection continued through subcutaneous tissue. Capsulotomy was performed. There was some arthritis and contracture of the articulation. Soft tissue release was used to reduce the pathological dislocation and release the contracture. Base of the proximal phalanx was removed in order to shorten the toe and reduce the contracture and extensor tendon rebalancing was done to afford a new resting balance length. An elliptical incision was made through the skin, tendon, down to bone on the dorsum of the second PIP joint and hammertoe correction was performed as a soft tissue release. The proximal phalangeal head was resected using the micro sagittal saw carefully to release the contracture and to release the pathological dislocation of the PIP joint. At this point , a K wire was driven from the MTP joint out to the tip of across the PIP joint and then ante grade through the MTP joint to affix the toe into its new position.

Any help or suggestions would be appreciated.

help totally confused

Former Chef looking for an entry level coding position in the Athens, GA area

Rebecca Wells
2021 Washington Hwy, Union Point, GA 30669 | (706)347-1646 | davidchefbecky@windstream.net

Objective

To obtain a position in Medical Billing and Coding

Education

CERTIFICATES | 2015 | UGA/E LEARNING
Certificate in Medical Terminology
Certificate in Medical Billing & Coding

ASSOCIATES DEGREE | 1998 | JOHNSON & WALES UNIVERSITY
Major: Culinary Arts

Skills & Abilities

CUSTOMER SERVICE
Skilled at anticipating the needs of those around me, including, but not limited to; fellow employees, leadership staff and patients.
Compassionate with excellent listening skills.

ORGANIZATION
Self-starter who is able to prioritize tasks, a team player who can also work well independently.

GENERAL OFFICE SKILLS
Answer the phone in a timely and professional manner
Entry level knowledge of: ICD-9, ICD-10, CPT, and HCPCS
Filing
Data Entry
Inventory control and management

LEADERSHIP
In my 18 year culinary career I have worked hard to move forward into leadership and management positions, I will bring this same drive
and determination to this new career.

Experience

CHEF | THE POTTED GERANIUM TEA PARLOR | SEPTEMBER 2008-MARCH 2015
Developed recipes and standard operating procedures.
Maintained a 100% county sanitation score.

CAKE DECORATOR | PUBLIX SUPER MARKET | JULY 2004- JULY 2008
Became proficient at decorating cakes in volume.

ASSISTANT PASTRY CHEF | THE RITZ CARLTON LODGE AT REYNOLDS PLANTATION | JUNE 2002-JULY 2004

In the span of 18 months, I was promoted from an apprentice position to Assistant Pastry Chef.

Former Chef looking for an entry level coding position in the Athens, GA area

need icd 9 code

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need icd 9 code

Documenting Emergency Room Date of Service

When a patient comes into the Emergency Room at 11:30pm on 1/1/15 and is not seen by the resident/attending until 2am on 1/2, our residents are documenting the date of service on their ED notes as 1/2 which is the date services were rendered. We bill the professional side only and the date of service on the claim is 1/1 but if the documents are requested, they are dated 1/2 so some insurances are denying these as incorrect dos. We have asked our docs to document dos as the date the visit started and they refuse saying that is misrepresenting their services. Has anyone else come across this? and what is the solution?

Thanks!

Documenting Emergency Room Date of Service

Coding nuclear stress test

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Coding nuclear stress test

Need Diagnosis code for ICD 10

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Need Diagnosis code for ICD 10

Use of modifier 26

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Use of modifier 26

Diagnosis based only on patient history

A new patient, 23 years old, presents to clinic needing an "approval letter" to take her dogs on the airplane with her. Her husband accompanies her and states she has "high-functioning autism" and is fearful of flying, so she needs her dogs with her. They bring no documentation, and as this is a new patient, there are no established diagnoses in her chart. Husband does state he could provide documentation of her having autism from high school records, but he doesn't have it with him today. Two dogs also accompany her to the visit.

Patient not examined.

Dx: Autistic disorder by history, 299.00.

Plan: Companion animal letter created for patient. Obtain records from previous PCP.

Would you pick up the provider's stated dx of autism or perhaps phobia, 300.29? Either way, it's based on what the patient says. Is that enough?

I guess my bottom-line question is whether we can code per patient history only when there is no exam or testing done to confirm. And once again, I ask if what the provider states as the diagnosis is what I should go with (rather than coding symptoms).

Thanks for your help!

Diagnosis based only on patient history

Anyone looking for part time coding work?

Our company is currently in need of outpatient surgery coders. Need to have experience in coding for ASCs or at least the surgery codes that physicians would use (CPT and modifiers). Job is remote and you will need your own coding books or online resources.

If interested, reply with your email and I will get you their contact info.

Anyone looking for part time coding work?

post op plus modifier 24

---

I have been given conflicting info. Please help! So I have a patient that came in for a post op visit for knee arthroscopy but also complains of pain the wrist. How do I code this? 1 person tells me to do 99204-24 but the other says i need 99204 for the post op and 99212-24 for the wrist pain. Which way is correct?

post op plus modifier 24

Not sure if BPH dx is supported

A male patient, new to clinic, comes in with nocturia and complaint of weaker, slower stream. No prior dx of BPH. Provider's exam only states well-nourished, well-developed male" and does NOT include a rectal.

Diagnosis: "Nocturia associated with benign prostatic hypertrophy (finding) 600.01."

Plan: Send for UA and PSA. Start Cardura at bedtime.

Addendum: PSA is up. UA had blood. Needs urology referral.

Would I code the nocturia (788.43) or the BPH with LUTS (600.01)? I question because there is no exam to confirm enlarged prostate and no prior history of BPH. I know these are symptoms of BPH, but could they as well be symptoms of another condition and we can't assume BPH unless exam or further testing confirms? Or is the provider's assessment enough? (I also question because my providers often give dx of what they suspect rather than what is confirmed via exam or tests. However, in this note he does not state "suspect" BPH but gives it as the diagnosis.)

Thank you for your help!

Not sure if BPH dx is supported

Question on national and regional conferences

---

Hello all, I am currently in coding school and have recently ( as of friday) joined the AAPC. The question I have is, when my wife goes to her conferences ( she is a respitory therapist} , she is allowed to take me along for a additional fee and I can sit in with her when she attends the lectures ( of course I recieve no CEU's ) Is your spouse allowed to go along with you in these conferences or are they on there own while you attend. Thanks for the info.

Question on national and regional conferences

ICD-10 Online Assessment certification??

---

I passed the online proficiency assessment, I got the score, but how do I get the certificate that I've seen floating around? I need proof on Monday to send to my employer that I passed and I'm certified in it. Does the $60 test not come with one? TIA!

__________________
Elizabeth Jaquier, CPC

ICD-10 Online Assessment certification??

Practicode

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Practicode

Arthroscopic+Open Knee Procedure

Hey everyone!!!

My doctor seems to think that I can bill removal of the cyclops lesion with 29874. He also said (although it is not in the op note and will have to have it fixed) that he did a culture and biopsy. I only see 29881 for meniscectomy and 20680 for deep hardware removal. Does anybody see anything else? Can I bill for the culture and biopsy???

Thanks so much!!

POSTOPERATIVE DIAGNOSIS: Left knee lateral meniscal tearing with
cystic tibial lesion, painful hardware, plus removal of 1.5 cm cyclops
lesion.

PROCEDURE: Left knee arthroscopy, arthroscopic removal of 1.5 cm
cyclops lesion with arthroscopic lateral meniscectomy, arthroscopic
lateral chondroplasty, open removal of tibial screw with irrigation
and debridement of tibial cyst.

INDICATIONS: The patient is a 38-year-old status post ACL
reconstruction complaining of pain over the anterior aspect of his
tibia posteriorly and laterally and also pain. Risks and benefits of
surgery were discussed with the patient and he wished to proceed.

The patient was brought to the operating room, placed supine on the
operating room table. After induction of general anesthetic, his left
leg was examined. He was stable to varus valgus stress. He had a
negative Lachman, anterior and posterior drawer and negative pivot
shift. His left leg was prepped and draped in a standard surgical
fashion. Lateral portal was created. Examination of the joint showed
normal medial articular surfaces with normal meniscus. ACL graft was
intact. There was a 1.5 cm x 1.5 cm cyclops lesion with calcified
tissue within it, which was removed with a duckbill punch and a 3.5 mm
full-radius shaver arthroscopically. Lateral compartment had
significant chondromalacia and softening of the tibial plateau with
flaps of cartilage that were flipping superiorly. A Cloward was used
to feel articular bone deep to the cartilage. A duckbill punch and a
3.5 shaver were used to debride a radial tear of the posterior horn of
the lateral meniscus back to a stable rim. The tears were seen
laterally and anteriorly. The remnant of the tear had a horizontal
component to it superiorly and inferiorly not stable. Patellofemoral
joints had grade 2-3 changes essentially along the trochlea, grade 2
changes on the patella centrally. No loose bodies in the pouch or
gutter.

Attention was then directed to the tibial screw site where an incision
was made over the screw site. Yellow fluid was removed and sent for
culture and pathology with stat Gam stain. Sutures were removed from
the previous ACL site. Fragments of absorbed screw were seen. The
tunnel and cyst were curetted and debrided. There were no other signs
of infection.

After irrigation, the incision was closed with 3-0 PDS, 3-0 nylon. A
dry sterile dressing was applied. The patient tolerated the procedure
well and returned to recovery in stable condition.

Arthroscopic+Open Knee Procedure

Combined posterolateral/posterior fusion...

Hi fellow spine coders - - I am new at this and think that I bombed at my first attempt at coding this surgery - - - I also posted this under neuro.

I will be so grateful for your help!!!

The codes I had in mind:

22633, 22840-50 (do you use a modifier?), 22851, 63047-51 (L5-S1 foraminotomy), 38220-59, 20936

PREOPERATIVE DIAGNOSES:
1. L4-L5 dynamic degenerative spondylolisthesis.
2. L4-5 spinal stenosis and bilateral foraminal narrowing with neurogenic claudication
3. Left L5-S1 foraminal stenosis.

POSTOPERATIVE DIAGNOSES:
1. L4-L5 dynamic degenerative spondylolisthesis.
2. L4-5 spinal stenosis and bilateral foraminal narrowing with neurogenic claudication
3. Left L5-S1 foraminal stenosis.

PROCEDURE PERFORMED:
1. Posterior lumbar interbody fusion, L4-L5.
2. Posterolateral fusion, L4-L5.
3. Decompressive laminectomy with partial facetectomies and bilateral
foraminotomies, L4-L5.
4. Non-segmental pedicle screw instrumentation with Orthofix Phoenix
System, bilateral L4 and L5.
5. Placement of prosthetic interbody device Spine Wave StaXx-D system, 22mm x 9mm x12mm x 8degrees lordotic
mm.
6. Use of bone graft substitute, chronOs.
7. Use of bone marrow aspirate through a separate incision.
8. Use of local bone autograft.
9. Left L5-S1 foraminotomy.

IMPLANTS INSERTED
1. Interbody device Spine Wave StaXx-D system, 22mm x 9mm x12mm x 8degrees lordotic.
2. Orthofix Phoenix Screws 6.5mm x 45 mm bilateral L4 pedicles, 6.5mm x 40mm bilateral L5 pedicles.
The operative level was identified prior to making an incision with the use of biplanar fluoroscopy over the L4-L5 as well as the L5-S1 levels. A central midline incision was performed over the L4 and L5 levels after performing a formal preoperative time-out. The skin was then injected with 30 mL of 0.25% bupivacaine with epinephrine. Dissection was carried down to the lumbosacral fascia using Bovie cauterization. The lumbosacral fascia was incised in line with the skin incision. Subperiosteal dissection was carried down to the spinous processes at the L4-L5 level and carried out laterally past the lamina and facets. The transverse processes of L4 and L5 were then well exposed. Following full exposure, attention was placed towards placement of pedicle screws with fluoroscopic guidance. The pedicle screw starting points were located using fluoroscopy in the lateral view and also anatomical landmarks. The pedicles were prepared for screw insertion using sequentially a burr for a starting hole, pedicle probe, ball-tipped feeler, 5.5 tap, and again a ball tip feeler. No pedicle breach was detected with the feeler, in the prepared pedicles. Pedicle screws were placed in bilateral L4 and L5 pedicles using 6.5 mm screws from the Orthofix Phoenix System. The size of the screws was 6.5 x 45 mm bilateral L4, and 6.5 x 40 mm bilateral L5. The we started with the laminectomy. Using a rongeur, the spinous processes of L4 as well as the superior aspect of L5 were excised. Using Kerrison rongeurs, a complete laminectomy of L4 was performed. The cephalad edge of the L5 lamina was also excised and undercut until there was no more pressure on the dural sac and it was mobile for more than 1.5 cm without any stress. The total extent of the decompression was from the inferior aspect of the L5 pedicles, to the middle of the L4 pedicles, comfirmed with fluroscopy. A partial facetectomy of the bilateral L4-5 facets was performed to fully decompress the lateral recesseses. Then, a 2 mm Kerrison rongeur was used to perform bilateral foraminotomies at the L4-L5 level, decompressing the exiting L4 nerves. The Woodson elevator was able
to be placed freely without any resistance into the foramens. The transversing L5 nerve roots appeared to be completely free in the lateral recess. Next, attention was placed towards the interbody fusion. Beginning at the L4-L5 on the patient's left side, a near complete facetectomy was then performed, gaining access to the disk space. An annulotomy was performed using a 15 blade and a complete and thorough diskectomy was performed using a series of pituitary rongeurs, curettes and Kerrison rongeurs. Satisfied, a complete and thorough diskectomy was performed, this patient was then packed with autograft bone, and chronOs allograft mixed with vancomycin powder. A Spine Wave StaXx-D cage, 22 mm x9 mm x 8 degree lordotic was placed in the disk space and elevated to 12 mm. Fluoroscopic images AP and lateral assured a good position of the cage.

We also did follow the L5 nerve roots bilaterally out through the L5-S1
foramen and we performed a full decompression of the L5-S1 foramen,
especially on the left side, where there was impingement of the left L5
nerve root on the MRI. Again, the Woodson elevator was able to be placed
easily through the foramen of L5-S1 bilaterally without any resistance.

We then completed the posterolateral fusion. A high-speed burr was used to decorticate the posterolateral elements bilaterally from L4 down to L5. Then, a mixture of the chronOs allograft, autograft lamina bone, BMA, and vancomycin was placed in the posterolateral gutters in preparation for the fusion. Prior to placement of the mixture we irrigated with > 2L of NS. The appropriate sized rod, 40 mm, was bent to the appropriate lordosis and then the tulip heads were placed and the set screws and the rod was fixed securely to the tulip heads and screws. They were final tightened in the usual fashion after placing some compression on the screws. At this point, hemostasis was obtained using bipolar cauterization, and Floseal. Final AP and lateral fluoroscopic images were obtained to confirm proper position of all implants.

Combined posterolateral/posterior fusion...

intraductal prostate carcinoma

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intraductal prostate carcinoma

CPC-A seeks entry level position

---

Hello, am rather new in the medical coding field. Graduated online since May 2014 and passed the CPC-A 6 months now... I try getting a medical coder job entry level or any company that is willing to train me!!! I live in the OC/LA basin. Also am a career changer, from IT PC support tech to medical coding. I know it is hard, tough whatever you say but let me tell you "is anything easy to get in this world seriously?" Thanks 4 the tip and thank you all...

---

Last edited by mcbwannabee; Today at 03:55 PM. Reason: more specific

CPC-A seeks entry level position

[unable to retrieve full-text content]

Mobilization of splenic flexure

If a surgeon is does a laparoscopy mobilization of the splenic flexure and then has to convert to open and preforms a partial colectomy. I know you can't bill the lap for the splenic flexure and open for the colectomy.

Would you bill the mobilization of the splenic as open?

Mobilization of splenic flexure

92504 w/ office visit

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92504 w/ office visit

Physical, Medicare AWV, and office visit

Physical, Medicare AWV, and office visit

Physical, Medicare AWV, and office visit If a patient comes in for a physical, plus the doctor does the Medicare AWV, and the patient is also seen for a separate issue, how would I code this? 9939725, G0438, and 99213? Is this allowable?

Pass or Fail

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Pass or Fail

help with finger traumatic amputation

please help with the following scenario

dx traumatic partial amputation of distal phalanx index finger

tx: physician does bone excision at both ends and using rongears and using a k-wire fixes them, but there is no documentation of fx.

please help with correct coding

help with finger traumatic amputation

Sequencng HCPCS and CPT???

I took the CPC recently (didn't pass it but I"m very close!) and there were some questions that I wasn't quite sure how to answer and I'm wondering if someone cuold help me? I never learned how to sequence HCPCs codes along with CPT.

Example from the top of my head: If a patient comes in for a pneumonia vaccine, do I just code the HCPCS, CPT or both? if I do code the both of them, how do I sequence them?

Sequencng HCPCS and CPT???

Physical Therapy Evaluation

Hi All,

we are a physical medicine/pain management clinic that uses in house physical therapy for supervised and unsupervised therapys. For example, we apply hot packs, traction, vasopneumatic therapy. Our Physician writes the orders for the therapy and a PT assistant does the therapy.

Here are my questions: When would the initial therapy evaluation code (97001) be used? Would it be used in place of the E&M? Only the physician is qualified to evaluate and in most cases, the therapy is scheduled for another day. So - if the physician is seeing a patient and the exam results in a referral for in house therapy how should this be coded?

thanks for all input.

Lisa Boylan

Physical Therapy Evaluation

Billing jobs

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Billing jobs

DaVinci Debridement

I code for anesthesia and have the below procedure that is throwing me off.. Any help in this matter would be greatly appreciated.

Below is the procedure that was performed along with a description of the procedure performed. I have not seen this procedure, and the only information I have been able to find is that this a form of endoscopic procedures. I am leaning towards 28120 for the osteomyelitis another coder is saying an arthroscopic debridement. I think what's throwing me off the DaVinci exoscopic assisted approach.

Da Vinci exoscopic-assisted approach for the left foot
debridement, skin, subcutaneous tissue, and bone debridement including the
fascia of the plantar surface of the foot. Wide debridement of a bone cavity
osteomyelitis of calcaneus bone.

DESCRIPTION OF PROCEDURE: The patient under supine position under general anesthesia with endotracheal intubation, the left leg was properly elevated and secured with several blankets. The skin area revealed a wound that had a hypertrophic skin and the measurement of 14 x 12 mm in the center part of the calcaneus, rear portion of the calcaneus. The patient was prepared with Betadine and sterile drapes were applied. Betadine-impregnated Vi-Drape was used. The robotic system, which is the XI DaVinci system was brought from the right side of the patient in an oblique fashion. We used a 0 degree 8 mm scope. As we completed the engagement we used a scalpel blade for the electrocautery on the right and ____ instrumentation on the left. As we positioned the robot in an exoscopic approach, the surgeon went to the console and the treatment was initiated with electrocautery. The area of 7 x 4 mm that was definitely located at the center or target of the anatomical area and we did use a wide margin of at least 20 mm, 10 mm each in a circular fashion to remove the skin and subcutaneous tissue. Initially a very thick portion of the skin, hypertrophic was the one that was excised. We got some subcutaneous tissue underneath and we had a very good dissection of the soft tissue. The dissection was carried on with the robotic system and we had a circumferentially actually a cylindrical shape excision of soft tissue including subcutaneous tissue and fascia. The bone was exposed. We had some hyperactive, sick, and irregular bone. The area of the bone exposes approximately 12 x 14 mm in length and width. We the transferred the surgeon to the standby position and the surgeon with the assistant of the 10 mm 0 degree scope performed the eradication of the bone involvement with the Stryker rotator blade. All this was performed with exoscopic approach under direct vision and at one point the rotator blade from Stryker broke into the cavity and that cavity was probably defending myelitis reaction. The cavity was estimated probably in another 10 x 12 mm in size. There was no pause. The cavity was therefore opened and more bone had to be debrided in order to remove completely that portion of the bone and the cavity. Separate specimens of bone pieces were removed and submitted for culture as the label of the bone. The soft tissue had been already submitted. We washed the wound very carefully with saline bacitracin antibiotic mixture solution and we had a very good blood supply of the tissues and particularly all the bone was cleared. We had digital inspection of the bone cavity. We did remove essentially all the bone that was in contact presumably with the area of the inflammatory process from the skin. As we finished washing the wounds, we then applied amniotic membrane or Epifix, 2 membranes were applied reaching the area of the cavity and the scalenus this cavity and the surface of the bone of the calcaneus. As the Epifix membrane was placed in the cavity was
secured with Adaptic and then pressure dressing with 4 x 4 Kerlix and Kerlix
rolled in a gentle and smooth dressing to protect the area just operated.

DaVinci Debridement

Billing e/m for suture removal after global

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Billing e/m for suture removal after global