Cppm

I recently took my CPPM exam and I failed by 2%. The questions were worded very differently than the class. Is there a study group out there, I am scheduled to retake in September and I will really love to pass. I don't think that 50 practice questions is sufficient enough for a 200 question, no reference material exam.

Cppm

Learning ED Coding

Do anyone have a cheat sheet for ED coding?? Or know of any good resource material for learning ED coding. Also looking for infusion cheat sheet as well.

Learning ED Coding

CPPM Exam Results

To all my fellow CPPMs out there, I wanted to let you know I passed the exam this past Saturday! I'm so happy and excited because I honestly did not know how I did. I studied all I could, then I took the exam and felt there was so much I still didn't know. Anyone who has taken the exam knows what I'm talking about, but I'm sure you also know how excited I am knowing I passed. Good luck to anyone who is planning on taking the exam in the near future.

I realized I initially posted this to the incorrect thread, I guess I was just so excited when I found out!

Rodney

CPPM Exam Results

Electronic Brachytherapy

We are billing 17999 (Electronic Brachytherapy on skin cancer) with correct destruction series code in box 19 on HCFA 1500 as requested by Medicare and modifier is being required for subsequent fractions billed on different dates of service, is it 58 or 76 or both?

Also, when 2 treatments are billed on same day with two different series code how should the two separate 17999 be appended with a modifier?

Electronic Brachytherapy

Medicare Annual Wellness Visits (AWVs)

I am looking for assistance with the Medicare Annual Wellness Visit and clarification on the element of "a list of risk factors" for the final section.

What if the provider documents the risk factors throughout the note (ex. in the history or the assessment)?
Would that fill the requirements or does it have to be an actual list?

Examples:

1.) The provider states that the patient has a risk stratification of 1 and currently is not at risk for anything. How could Medicare dock you if the patient has no risks and you completed everything else to qualify for the AWV?

2.) The provider takes a social history and discovers the patient is heavy smoker, he advises the patient to quit and gives him options for cessation. However, that is only in the history and not anywhere else in the note. Would that qualify for the risk factors requires in the AWV or does it have to be listed somewhere else in the note as well?


Please answer with links and documentation if available.

Thank you,
Amanda K, CPC, COBGC

Medicare Annual Wellness Visits (AWVs)

New Patient from Skilled Nursing Facility

Our provider sees a Skilled Nursing Facility patient in our office. Patient is a new to our service. Per CMS we will use POS 31. Are we allowed to use 99304-99306 (Initial admission) or do we use 99307-99310 (subsequent)? SNFs can be so confusing!

New Patient from Skilled Nursing Facility

ASC question

I have been tossing this back and forth and was wondering if someone could help me figure this information out. We have a free standing asc and I was curious if, to bill the asc fee, we should be billing the cpt code with the SG modifier with an increase charge of the same cpt. Thank you!

ASC question

Seeking Experienced CPC

At least 2-4 years multi specialty, prefer strong gastro coding.

Tampa fl

No Remote coding

experienced coder only please

Seeking Experienced CPC

43250: EGD removal by hot biopsy forceps

New to coding EGD's... physician removed a total of 5 samples by hot biopsy forceps. Do I code 5 units? or only 1? Description in CPT: "EGD with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps"
2 samples were from the duodenal bulb, 2 were from the antrum and 1 was from the distal esophagus.
I'm thinking only 1 should be billed, based on the CPT description, but just double-checking. Thank you!

43250: EGD removal by hot biopsy forceps

Coding/Billing for Psychotherapy services

Hello, I recently signed on a new client who is a Psychotherapist. Does anyone out there have any good tips and resources I can use to get proper coding and billing information. I know the basics of Psych coding/billing but I wanted to hear from people already doing it to get some pointers. Thanks

Coding/Billing for Psychotherapy services

CPPM Exam Results

To all my fellow CPPMs out there, I wanted to let you know I passed the exam this past Saturday! I'm so happy and excited because I honestly did not know how I did. I studied all I could, then I took the exam and felt there was so much I still didn't know. Anyone who has taken the exam knows what I'm talking about, but I'm sure you also know how excited I am knowing I passed. Good luck to anyone who is planning on taking the exam in the near future.

Rodney

CPPM Exam Results

How to code a non-union

I need some help in coding this surgery correctly. All help would be appreciated!

PREOPERATIVE DIAGNOSIS: Left humerus fracture delayed union with soft tissue interposition.

POSTOPERATIVE DIAGNOSIS: Left humerus fracture delayed union with soft tissue interposition.

OPERATION: Left humeral nail intramedullary fixation with open bone grafting
left humeral shaft delayed union with soft tissue interposition.


DESCRIPTION OF PROCEDURE: The patient was brought to the operative theater and placed supine upon the operating table. After satisfactory general endotracheal anesthesia was administered, a time-out was carried out confirming the operative site with the operative consent. The patient was brought to the semi beach chair position and a roll was placed between the shoulders. The C-arm was brought in to visualize the fracture in AP and lateral views. Once this was satisfactory, the left upper extremity was then prepped and draped in the usual meticulous sterile fashion for shoulder and upper extremity exploration. After meticulous sterile prepping and draping, an initial incision was then made obliquely from the anterolateral tip of the acromion approximately 2 cm in length and taken through subcutaneous tissue sharply. The deltoid muscle was split in the anterior middle raphe an the rotator cuff was identified. This was incised and split, allowing access to the proximal humerus, proximal to the greater tuberosity. This was then entered with a T-handled cannulated awl and a beaded-tip guidewire was then passed through the proximal fragment down to the level of the fracture site. At this point, an incision was then made just lateral to the biceps muscle and internervous plane and taken through subcutaneous tissues sharply. The incision was carried proximally to a deltopectoral position and dissection down to the bone was then accomplished using sharp and blunt dissection. The fracture site was significantly scarred with much soft tissue interposition and scarring that had to be taken down with care to protect the radial nerve. The end of the proximal fragment was identified and the beaded-tip guidewire end was utilized to pursue the proximal fragment. The proximal end of the distal fragment was then dissected and the intramedullary canal identified. With the scar tissue having been dissected and elevated, the beaded-tip guidewire was passed through the proximal end of the distal fragment and down to the level of the _______ spread of the humerus. This was then sequentially reamed to 8.5 mm. C-arm fluoroscopy was brought in to evaluate the reaming process to ensure that reaming was not eccentric. With the intramedullary canal having been reamed, a 7 mm x 22.5 cm AOS humeral nail was then brought through the proximal fragment, across the fracture site and distally. Excellent purchase of the distal fragment and the isthmus was noted. The impaction had reduced the fracture to near anatomic position. The wound was irrigated and then, utilizing decalcified cancellous bone graft, croutons were then placed into the fracture site. The wound was then closed with 0 and 2-0 Vicryl for the subcutaneous tissue and the skin reapproximated with subcuticular closure with 3-0 Prolene. Proximal wound was closed with the rotator cuff repaired with 0 Vicryl, the subcutaneous tissue closed with 2-0 Vicryl and the skin closed with subcuticular 3-0 Prolene. The wounds were then dressed with Xeroform and 4 x 4's. Throughout the case the C-arm was utilized to ensure that the fracture reduction was maintained and that no rotation occurred. The alignment of the forearm distal and proximal fragments was maintained throughout the case. The patient was returned to recovery, having tolerated the procedure well. Estimated blood loss was 150 mL.

I am not sure if this should be coded with 24516 or if I need to use the non-union codes of 24430 or 24435. I am confused on these codes since 24430 is without a graft, but he did an allograft and 24435 is with an autograft - not what he did! Is there another code that I am missing, or is it OK to code the ORIF code for a non-union.

I am totally confused and after researching this and not finding an answer, I am even more confused!! :)

Thanks for any help!

How to code a non-union

What to put on resume??

I am updating my resume now that I've been a coder, drawing a complete blank as to what to put, other than apply codes to charts! Help!!

What to put on resume??

Locum Coding Question

Is anyone else having problems with their locum claims being denied? The lady who works my claims says we are getting denials because the Locum doctor doesn't document who he is filling in for but I cannot find anything saying that they must document that? We are appending the modifier Q6.

Locum Coding Question

Physician signature requirements

I have been looking for rules and regulations on physician signatures related to multiple page documents. I'm having an issue with the physicians in my office signing only the first page of the progress note when it is a 2 page document. Is there any resources explaining the rules on pagination and signatures. I've only been able to find information on what the signature requires.

Physician signature requirements

ICD-10 Coding Question

Hi,

My manager has us coding certain charts as an ongoing ICD-10 project.

The ER chart assigned today includes radiology on the knee with the impression noted as: "Degenerative change in noted which is relatively mild. Vascular calcifications are present."

My question is should the vascular calcification be coded and if so with what code.

thanks!

ICD-10 Coding Question

Hiring Certified Remote Coders - All Specialties

My company has just sent yet another email looking for the following certified remote coders.
Inpatient Facility Coders ? PPS hospitals with level 1 trauma

? Critical Access Hospital Coders

? Professional Fee Surgical Coders

? Professional Fee Coders ? Inpatient Physician services

? ED Coders ? Professional & Facility

? Inpatient/Outpatient Facility Coding

This is an excellent company with a full benefits package. They are one of the BEST companies I have ever worked for. If you have your certification and are looking for an excellent opportunity, send me you name and email. I will enter your information into the referral form. You can review the company and or apply for a position directly on the email.

Thanks & have a great day

Hiring Certified Remote Coders - All Specialties

RT lumbar L5 dorsal ramums &S1-3 Sacral Lateral Branch Block injections under Fluoro

NEED HELP CODING THIS!!!
Procedure Right Lumbar L5 dorsal ramums and S1-3 Sacral Lateral Branch Block Injections under Fluoroscopy .
Consent The patient's consent was obtained after the risks, benefits and alternatives of the procedure were explained. The patient expressed understanding of the procedure and willingness to undergo the procedure.
Description of Procedure Time out was taken. Anatomical landmarks were identified and a sterile skin prep and drape was performed using Chloraprep. A skin wheal and underlying soft tissues were anesthetized over the Right L5-S1 region between the superior articular process of L5 and the sacral ala and S1-3 lateral neuroforamens, using 1% lidocaine, 1 mL total at each level, via a 25-gauge 1 1/2-inch needle. A 3.5 -inch spinal needle curved tip, 22 gauge, was used to locate each region. Several views were taken to ascertain the proper locations. There was no cerebrospinal fluid or heme after careful intermittent aspiration, or paresthesias produced by the needle at each site. The dorsal ramus of L5 and S1-3 lateral sacral nerve branch locations were found, 1 mL of 0.5 bupivicaine% was injected at each site about 10mm lateral to each neuroforamen. The needle was withdrawn and a sterile dressing was then immediately applied to the injection sites. Estimated blood loss 0.2ml. No specimens obtained. Vital signs were monitored throughout and after the procedure. Patient tolerated the procedure well.The patient was then taken to the recovery room. The patient was observed for the standard period of time post procedure. With no noted complications from the procedure, detailed verbal and written instructions were given. The patient can call our office should any untoward effects result following this procedure. A pain worksheet was given for the patient to fill out for results after injections..

RT lumbar L5 dorsal ramums &S1-3 Sacral Lateral Branch Block injections under Fluoro

lymphomas

Help!!! I am told to code mets to the brain but the path states LARGE B-CELL
LYMPHOMA
HISTORY OF PRESENT ILLNESS
past medical history of diffuse large
B-cell lymphoma, status post allogeneic transplant in 2014, complicated by
relapse with evidence of intracranial disease.
ASSESSMENT
recurrent diffuse large B-cell
lymphoma, admitted with altered mental status and evidence of intracranial
disease.
Path
DIAGNOSIS:
CEREBROSPINAL FLUID, LUMBAR PUNCTURE, FLOW CYTOMETRY AND CYTOSPIN
- LARGE B-CELL LYMPHOMA (SEE COMMENT)
History:
The patient is a 72 year old woman with history of chronic lymphocytic leukemia, status post allogenic transplant
(2014) and relapse with evidence of intracranial disease.
FINAL DIAGNOSIS
A. CEREBROSPINAL FLUID:
- LARGE CELL LYMPHOMA

lymphomas

Care Improvement Plus

Can someone help with this..I am a little confused. Is care improvement plus a Medicare replacement plan? Or a Medicare supplement plan?

Thanks,

Care Improvement Plus

Colposcopy

our patient has a double cervix and we did a colposcopy on both cervix. How would I bill for this? Any body know?
Thanks

Colposcopy

Medical coding position for Pediatric practice

Essential Job Responsibilities:
1. Assigning ICD-9/10 and CPT codes to professional claims to ensure proper reimbursement
2. Maintains coding data quality and integrity for all coding assignments
3. Provide education and training to providers on coding and documentation issues
4. Maintains knowledge of and complies with established policies and procedures including government, insurance and third-party payer regulations.
5. Attends administrative meetings and participates in committees as requested. Conducts special projects and studies as directed.
Knowledge, Skills and Abilities:
1. Advanced knowledge of ICD-9/ICD-10 and CPT coding principles and rules
2. Ability to function autonomously and use independent sound judgement.
3. Ability to effectively communication both orally and in writing
4. Strong organizational skills and the ability to prioritize and multitask
5. Ability to recognize, evaluate, solve problems, and correct errors.

Submit resume to: careers@dvpeds.com

Medical coding position for Pediatric practice

Remote Inpatient Coding Openings- Sign on Bonuses!

If you are an experienced credentialed Inpatient coder looking for an remote coding opportunity with an amazing company look no more. Sign on bonuses, accuracy incentives, salaried FT positions available. We offer unlimited AHIMA and AAPC CEUS annually and room to advance. Please email me for additional information.

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AHIMA Approved ICD-10-CM/PCS Trainer and Ambassador
jcuster@hccscoding.com

Remote Inpatient Coding Openings- Sign on Bonuses!

HMO Billing Question

A patient came in a while back for an office visit and a 90732. He has United Health Care through CVMG. I know CVMG has a timely of 90 days as well as UHC. The first entity I billed was UHC. They then forwarded claim to CVMG. Two months passed, I had not heard anything so I re-billed to CVMG. I then received a denial for timely. I submitted proof of timely showing this claim was billed first to UHC. They basically are telling me my proof of timely does not matter because it was not billed to them within the 90 day time frame. I always thought as long as you show proof of billing an insurance within the time frame it was satisfactory. Am I mistaken or should I appeal?

Thank you for your help on this matter.

HMO Billing Question

Icd 10

Our practice (of six Orthopaedic Surgeons) is still paper MR. Anybody else out there still not electronic? How are y'all preparing the physician's workflow for the ICD-10 shift in less than three months? Yikes! I'm getting overwhelmed!

Icd 10

Colonoscopy with india ink marking of polyp

Hi,

I have been struggling with a procedure performed by one of our surgeons and I am getting conflicting information and I am hoping someone can help. One of our general surgeons performed a colonoscopy for the purpose of marking a known polyp during a scheduled partial colectomy. The physician inserted the scope and reached the polyp which was just proximal to the hepatic flexure and used india ink to mark the polyp. The physician did not go any farther into the colon. The surgeon then proceeded with a laparscopic right hemicolectomy. Since the colonoscopy was utilized only in order to aid in the identification of the polyp during the hemicolectomy, I don't believe we can charge for this procedure. Is this correct or can we bill for the colonoscopy as a reduced procedure? Incidently, the poyp turned out to be an invasive adenocarcinoma (which was confirmed during surgery) which is why the surgeon converted the surgery ot a right hemicolectomy with primary anastomosis.

Any advice or assitance would be greatly appreciated.

Thank you,
lorri

Colonoscopy with india ink marking of polyp

Nebulizer tx

Can someone help me figure out what J code I should use for the albuterol we use in the office with the neb tx's? I looked up the NDC info and this is what it brings up. There are quite a few different J codes and I'm confused about how to figure out which one is the correct one. I'm guessing J7620 is the right one, but I'm not positive.

0487-9501-03 | Albuterol Sulfate (Albuterol Sulfate) | SOLUTION | 2.5 mg/3mL
Product NDC: 0487-9501
Proprietary Name: Albuterol Sulfate
Non-Proprietary Name: Albuterol Sulfate
Product Type Name: HUMAN PRESCRIPTION DRUG
Market Category Name : ANDA
Application Number: ANDA074880
Route Name: RESPIRATORY (INHALATION)
Substance Name: ALBUTEROL SULFATE
Package Description : 1 POUCH in 1 CARTON (0487-9501-03) > 30 VIAL, SINGLE-DOSE in 1 POUCH > 3 mL in 1 VIAL, SINGLE-DOSE
Pharm Class: N/A
DEA: N/A
Labeler Name: Nephron Pharmaceuticals Corporation
Start date: 09-17-1997 / End date: N/A

Nebulizer tx

question from doctor about critical care, see below

For 99292 - Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service)-

Should we be writing new notes and billing for each additional 30 minutes that we are managing our critical care patients who are awaiting an ICU bed. Typically the average length of stay for these patients waiting is about 4-6 hours in our ED before ICU bed is available. I know we are not continuing to document and code for the each additional 30 minutes of care- but I think we should be doing that. Please let me know what the documentation requirements for this are and we will instruct the physicians.

Any input would be great
Thanks!

question from doctor about critical care, see below

CPT Coding question

Physician performed a direct laryngoscopy, bronchoscopy, excision of laryngotracheal tissue and supraglottoplasty on a 2 month old patient. Would either 31541 or 31588 be appropriate along with 31622?

CPT Coding question

Looking for experienced IP coder - Remote postion

Looking for an experienced IP coder. For a remote position. Must have 2-3yrs experience. Please send resume to: anelson@ecodesolutions.com
Please do not apply if you do not have experience.

Looking for experienced IP coder - Remote postion

CPC-A looking for work or externship

I was certified in June 2014 and have been looking for employment in the coding and billing field. Since then I have been certified in ICD-10 through the AAPC online program and am currently participating in the Practicode training.

I am flexible and willing to work hard to get a foothold in this industry.

CPC-A looking for work or externship

emr hx reviewed by

my doc is stating in her note for new PFSH that "it was reviewed in Epic".....when I go to look for the hx, I can see it has been enterted BUT it has been reviewed /signed by the MA.

Am I correct that I cannot count this ? must be reviewed/signed by DR. ?

thx

emr hx reviewed by

43280 outpt only???

we have a denial for this claim-the procedure was done as inpatient. I know we called prior to surgery for auth-they did tell us surgery needs to be outpatient for payment. Surgeon still wanted to keep as inpatient-looking through notes of inpatient only list-it doesn't look I should appeal this?

any advice-first time scenario here

thanks

43280 outpt only???

December 31st Deadline

I have to say that I really am surprised that we are not given more than 3 months to actually use the ICD-10 codes before we are forced to prove proficiency. When ICD-10 was supposed to become implemented in Oct. 2014I thought at that point we were going to be given until December 2015 to test....giving us a fair amount of time. We need time to actually use the codes in our daily work to be prepared to test out on them. We all worked super hard to achieve our credentials and to run the risk of losing them by being forced to prove proficiency in such a short period is dissapointing.

December 31st Deadline

Medicare Chronic Care Management

My practice is looking into subcontracting this service for other providers who are unable to take it on. We currently have nurse case managers who call the patients and satisfy the requirements of the service. Who would be the Billing and Rendering Provider on these claims? Would the Rendering be the provider who we are performing the service for? Would it be the nurse case manager?

Also, when Medicare says that the service can only be billed one time in a Calendar month what exactly does that mean? For example, if we billed the service on June 25th can we then only schedule the next service for July 25 - 31st? If we performed the service on Aug. 31st would we not be able to bill in Sept?

A little confused. Any assistance would be appreciated!!

Thanks!

Medicare Chronic Care Management

Billing under LICSW, LPCC, and Masters of social work

Hello,

I'm trying to find codes for alcohol and substance abuse interventions, health and behavior assessments, and tobacco related counseling, but not sure whether they will be covered by LICSW, LPCC, and Masters of social work (intern).
some of the codes I've found are 99406-99407 (Tobacco related counseling), 99408-99409 (alcohol & substance abuse), 96150-96151 and 99420 (health & behavioral assessments), and 96152 (behavioral intervention/counseling).

I'd appreciate any advice.
Thank you

Billing under LICSW, LPCC, and Masters of social work

ICD Replacement

:confused::confused:

Need help coding a Bi-Ventricular generator change with a RV lead extraction and replacement. RA and LV existing leads attached to the new generator. The codes all focus on the LV lead being changed not the RV. Please any help would be great.

ICD Replacement

47100 x 2???

Dear All,

i have an operation, with 2 liver wedge biopsies

can we report 47100 twice?

Thank you

47100 x 2???

OB/GYN ICD-10 question

A pregnant patient is being seen in the office who has MTHFR. MTHFR is coded as E72.12 in ICD-10. I know the primary code should be O99.283, but do I also add the E72.12 as a secondary code? I am leaning toward 'yes' so that the MTHFR is documented and not just the 'Endocrine, nutritional and metabolic diseases complicating pregnancy'. Thoughts??

OB/GYN ICD-10 question

Rotator Cuff repair w/allograft patch augmentation

My Dr performed a diagnostic arthroscopy and then performed a open Rotator Cuff revision with allograft patch augmentation and a arthroscopic lysis of adhesions. He wrote the cpt code 29999 which I believe is not correct. I have just about exhausted all reference's I could use for research and can't find anything that would lead me into what code to use...I am hoping that someone can help me with a code that would work for this surgery...thank you in advance..Liz

Rotator Cuff repair w/allograft patch augmentation

Leg sprain

What is the code for a leg sprain in Icd10?

Leg sprain

Hiring an Insurance Poster, CPC-A would

a plus; entry level position. We are a multiple physician practice and growing, located in North Alabama (Muscle Shoals area). Please send a resume with a phone number (all will be kept confidential) to mariebill.spc@gmail.com

Thanks
Beverly Abernathy, CPC, CIMC

Hiring an Insurance Poster, CPC-A would

Need Help

Our doctor says he performed a laser photocoagulation of a lesion on the left leg about 1 cm in size.

says the DX is 739.6

We billed this DX with CPT 17000. Medicare denied as not deemed "medically necessary". This usually means the DX is wrong.

So what DX to use for lesion on left leg?
This was not a skin tag.

Or am I way off base? Your help is greatly appreciated.
Nancy K

Need Help

Nurse Practitioner/PA Assistant Surgeon

What about reimbursement from commercial plans for a nurse practitioner assistant surgeon (modifier AS)? Does anyone expect to be paid by them? Being new to CT Surgery billing, we have several plans who I am told 'do not accept' nurse practitioners, but this seems ridiculous.

Nurse Practitioner/PA Assistant Surgeon

billing office visit but pt left early

HOw would you bill for an office visit if the patient left in the middle of it saying they did not have time. Is there a modifier to use or do I audit visit based on the provider's history and exam?
thanks

billing office visit but pt left early

45990 Exam Under Anesthesia ???

I have always been taught to bill CPT 45990 - EUA, an anoscopy and proctoscopy must be performed. The CPT guidelines state 45990 includes the following elements:
- External perineal exam
- Digital rectal exam
- Pelvic exam (when performed)
- Diagnostic anoscopy
- Diagnostic rigid proctoscopy

One physician said these scopes are hardly ever used in the OR, but they use a Hilferguson for the same thing.

My thought is you have to perform all of the elements except the pelvic exam or the pelvic exam wouldn't be an option. Please post your opinions on this. What must be performed to bill an EUA?

Thank you in advance!

45990 Exam Under Anesthesia ???

Modifier TH

I have an office billing a mod TH on every OB visit. My online modifier handbook reads as follows:

TH Obstetrical treatment/services, prenatal or postpartum If a provider renders three or fewer antepartum care visits, the provider is required to include modifier TH with the appropriate E&M service code (99201-99215 and/or 99341-99350) to indicate that the code is being used for obstetrical treatment/services. If the services are HPSA eligible, the provider should include the HPSA modifier AQ in addition to modifier TH.

The office gets reimbursed more when they use the TH modifier. Am I misunderstanding something here? Is it carrier specific? If the office is correct in billing a TH modifier, can a mod 25 be added for an injection for RH negative mother?

Modifier TH

pessary ?

Hi Everyone,

One of our physicians (urology group) did a pessary fitting for a patient with
the patient coming back for the insertion at another apt - Can the fitting & then
the insertion be billed -ins is Humana Medicare

Thanks, Rebecca

pessary ?

New and confused

Hi!

New to ophthalmology and auditing their visits. I do have the description of comprehensive vs intermediate eye exams but have questions on the components with in those pieces. TIA for answering any part of my questions!
1. What is included in a complete visual exam? Is this the same as the slit lamp exam?
2. What description does a slit lamp exam come under.....external ocular exam?
3. Wording I might see if they've done an adnexal exam?

Thanks again!
Tina

New and confused

Discharge Sumary Documentation Requirement

Hello, I came across documentation stating a discharge exam is not required to be performed as long as documentation of some type of a face to face encounter has occurred, i.e. physician documented he spoke with patient, etc. I would like confirmation this is correct.
Thank you in advance.

Discharge Sumary Documentation Requirement

G0181

Hello,

I'm having a little difficulty with Medicare regarding the G0181--on a few claims that I submitted, one or two came back paid but didn't have the required information that I found out you need on the claim. Does anyone know why some are being paid without the required information? Please help. Thank you.

G0181

Laceration After Care?? I am Stumped...

I am stumped....

Patient is presenting for aftercare therapy following a laceration (injury) that was sutured, but the stitches have already been removed.... patient now has stiffness in the area that is being treated...

So would the V-code for the aftercare be V58.89 - other specified aftercare, or can you use V58.43 - aftercare following surgery for injury and trauma??

Sutures are not considered a surgical procedure, right??

Laceration After Care?? I am Stumped...

Help with A-cell & wound closure

Hi everyone. Hoping I can get some help with this OP note. The A-cell implant always gets me. I believe the 15777 should be used, but I can't figure out what main code to use. Any takers?

Indication for Surgery: Poorly healing abdominal wound
Preoperative Diagnosis Same
Postoperative Diagnosis Same
Operation Evaluation and placement of a cell abdominal wall reconstruction technique.
Anesthesia Gen. endotracheal anesthesia
Estimated Blood Loss Minimal
Urine Output Not applicable
Findings 8 8 x 10 cm abdominal wall defect with biological mesh seen underneath small amount of angiogenesis granulation tissue seen
Specimen(s) None
Complications None
Technique This very delightful woman well-known to the surgical service with multiple operations including abdominal reconstruction with biological mesh secondary to intra-abdominal catastrophe with the breakdown of her anastomosis due to her malnutrition as well as our Roux-en-Y gastric bypass surgery. After full exposure risk and benefits including but not limited to bleeding infection and possibility of multiple operation patient was very eager to proceed. Surgical timeout was done. Perioperative antibiotics were administered. Wound VAC was removed from her abdominal wall very clean healthy tissue on her biological mesh underneath the defect was approximately 8 x 10 cm in size. Using the A cell technique the pocket was then placed on the abdominal wall above the biological mesh and then the mesh was then placed on top of that with Xeroform on top of that and covered with an ABD dressing. Patient's heart procedure well EBL was less than 5 mL sponge count correct ?2. Betadine was used on the wound
Surgical Sweep Complete (Yes/No/Not Applicable) Yes
Disposition PACU
Follow up plan Will need to be admitted to the hospital for continue observation of the abdominal wound as well as nutritional support with TPN.
Signature Line (Verified)


Thanks,

Kelly, CPC-A

Help with A-cell & wound closure

Billing Administration When Drugs Comes From Another Source

We have a Blue Cross patient who got a free chemotherapy drugs from a pharmaceutical company. I know if we attach modifier Q1 for the administration claim to indicate that the service is part of clinical trial. But I was wondering if there is a modifier that would indicate if the drugs comes from another source?

Billing Administration When Drugs Comes From Another Source

hematoma excision

I'm not sure what CPT to bill for the following procedure for hematoma removal. It was thought to be a cyst but ended up being a hematoma:


left lateral leg prepped with betadine. 1% lido with epi for local. ellipse made over cystic structure. dissected over cyst which appearred to be clot in varicosity. able to dissect around area and used 4-0 vicryl to tie off base. removed with scissor. closed skin with 5-0 ethilon
wound care and suture removal in 10 days.

Thanks!

hematoma excision

Re: 99211

If anyone, or everyone, would share a little info with me re: the situation I have in the Free Clinic for which I volunteer a few hours each week about 99211:

This being the code of course used most frequently for the Nursing Staff, it seems to be regarded as not too important. However, from my view, I need it to be correct. Here is the question I need answers for before I set my Volunteer Foot down; I need to know whether 99211 must have a diagnosis code in the chart in order to be coded correctly?

The Nurses have been submitting a Billing Slip with sometimes a diagnosis code on it and sometimes not. I may be able to discern that they did a B/P check, and I know that is 401.9. But when I open the Chart, it reads "no diagnosis."

They have recently decided that I will use V65.8 as the diagnosis code for their activities; however, inside the Chart is continues to read, "no diagnosis."

Can this legally happen?

Thanks to anyone with some information.

Re: 99211

Follow Up Fracture Care of Finger Code??

What is the appropriate anatomical site location when coding a follow up care for fracture of the finger, V54.12 - lower arm or V54.19 other bone?

In some areas in the book, the lower arm includes the hand, which would include the fingers, which would be more specific; however, I cannot find anything to clarify what the "lower arm" includes in regards to follow up fracture care codes.

Thanks!

Follow Up Fracture Care of Finger Code??

Out of Network Facility Reimbursement

I code and bill for an out of network ASC and recently BCBS of Texas plans have been allowing at a rate lower than the Medicare Fee schedule for ASC. In the past they have allowed per the Medicare Fee schedule or slightly higher. Has this been an issue for anyone else? Can they allow at such a low rate? Any input would be greatly appreciated.

Out of Network Facility Reimbursement

Looking for Billing & Coding Instructor in NJ

We are looking to hire an instructor for 20 hours/wk, daytime hours. We're looking for someone that has billing & coding experience as well as teaching/training experience. If you're interested and are in the Camden/Burlington county area of NJ, or within a commutable distance, leave a comment with your email and we'll contact you.

Looking for Billing & Coding Instructor in NJ

Transesophageal echocardiogram

What cpt codes do you use when the cardiologist does a transeophageal echocardiogram in an outpatient setting and the equipment belongs to the hospital.

Transesophageal echocardiogram

2016 cpt coding updates

Will APPC publish CPT codes updates for the year 2016 to AAPC members?

I am aware of the ICD 10 updates.

I would really appreciate if someone can guide me

2016 cpt coding updates

2016 cpt coding updates

Is there anywhere or anyone that can help me find out what will be the new CPT codes updates for the year 2016? I am aware of the ICD 10 updates. But how about CPT codes. Does the AAPC publish the new updates?

I would really appreciate if someone can guide me

2016 cpt coding updates

Need Help with DX Rectal GIST

I am completely stumped and was wondering if anyone could give me guidance. I am trying to get a dx code for an unusual malignancy - Rectal GIST.

Any help would be greatly appreciated !!

Need Help with DX Rectal GIST

Noncompliance codes

What is the specific documentation required in order to use the noncompliance code, Z91.19? MD documented in ER reassessment note that pt did not want splint for 5th metacarpal fracture because he had to work (paint). My thinking is yes, since provider documented... Any thoughts?

Thx,
Shari, CPC-A

Noncompliance codes

Good Day All

Some body please help me with this.

Patient had skin graft on his thumb 12 years back and its black and looking ugly now. Now patient is here for

1.Excision of the old graft
2.New skin graft to replace the old one

Nothing about donor site is mentioned and the size is less than 20sq cm.
What will be the CPT code for this case?
Appreciate all supports...!!

Good Day All

Experience in billing &/or coding wanted

CHERLYNNE KEY-THOMAS
397 Fort Smith Boulevard ▪ Deltona, FL 32738 ▪ 770-896-4842 ▪ cktdux50@gmail.com


Top performing professional who combines strong academic success with valuable customer service experience to illustrate level of competence. Regarded as a loyal employee as evidenced by a dedicated work history.

 Able to work in team-based environments with emphasis on performance, accountability, and customer service.
 Manage strong working relationships with clients to ensure consistent, high-quality work.
 Skilled communicator ? relays critical information to promote fluid business operations.


Volunteer: White Lion Against Domestic Violence (WLADV) / 2015 ? Present

Non Profit Resale Shop that supports the cause of domestic violence
Merchandize and stock inventory, manage cash register, and keep establishment clean and organized.

KEY QUALIFICATIONS

Medical Billing ▪ Medical Coding ▪ ICD-9-CM ▪ HCPCS ▪ CPT ▪ Introduction to ICD-10-CM ▪ Medical Terminology
Electronic Health Records (EHR) ▪ Electronic Medical Records (EMR) ▪ Greenway ▪ HIPAA Compliance ▪ Tricare
Centers for Medicare and Medicaid ▪ CMS 1500 ▪ CMS 1450 (UB-04) ▪ EOBs ▪ Payment Posting ▪ Revenue Cycle
Management ▪ Scheduling ▪ Insurance Verification ▪ Insurance Billing Procedures ▪ Insurance Claim Processing
Reimbursement Methodologies ▪ Fee Schedules ▪ Outpatient / Physician ▪ Inpatient / Facility ▪ Co-Payments
Managed Care (HMO, PPO, and POS) ▪ Government Payers ▪ Third Party Payers ▪ Worker?s Compensation
Practice Management ▪ Medical Office Procedures ▪ Anatomy & Physiology ▪ Deductibles ▪ Superbill

ACADEMIC TRAINING

Ultimate Medical Academy
Medical Billing and Coding Diploma │ 2015
- Earned Academic Honors Recognition -
Certificates of Completion: CMS 1500; Medicare Fraud and Abuse Prevention, Detection and Reporting; World of Medicare and Uniform Billing (UB)-4

The PJA School / Upper Darby, PA Harcum Jr. College / Bryn Mawr, PA
Associate Degree: Law/Accounting (GPA: 4.0) │ 1996 Associates Degree: Fashion/Merchandising │ 1980
Paralegal Certificate │ 1990

PROFESSIONAL EXPERIENCE

Sears Holdings / Norristown, PA
Department Manager/Department Leader │ 2000 ? 2011
 Earned performance-based promotion in recognition of keen ability to bring company objectives to fruition, effectively lead personnel and work across multiple departments.
 Supervised/trained up to 8 cashiers throughout all daily activities, including: Customer service, cash flow, individual position in bottom line and handling/settling registers.
 Effectively assumed previously ignored secondary supervisory position to complete paperwork, explain rules to associates and ensure all duties were enforced.
 Played central role in reorganizing and re-training employees to greatly enhance efficiency and effectiveness.
 Maintained department within budgeted labor hours, ensuring customers were served in proper fashion, while reducing company expenditures.

Making Menagerie / Phoenixville, PA
Owner/Operator │ 1993 ? 2000
 Direct and coordinate organization?s financial and budget activities to fund operations, maximize investments and increase efficiency.
 Oversaw all front- and back-office duties, including financial transactions, advertising initiatives, the hiring, training and terminating of employees and completing all applicable paperwork.

Delaware County Domestic Abuse Project / Media, PA
Court Liaison │ 1991 ? 1996

Experience in billing &/or coding wanted

bladder catheterization what CPT ?

2 month y/o Procedure: bladder catheterization
Indication: evaluate for urinary tract infection
Patient identity was confirmed with 2 patient identifiers.
risks, benefits and alternatives to the procedure were discussed & verbal informed consent was obtained
Patient cleaned and prepped with usual sterile technique.
catheter inserted into urethra without difficulty, clear urine removed from bladder into sterile container. Patient tolerated procedure well..

bladder catheterization what CPT ?

Accepting Resumes from experienced coders

Hi

I'm currently accepting resumes for experienced coders, any specialty accepted. Resumes can be sent to rochelle.elie@ahss.org (coding manager for Florida Hospital Physicians Group)

Thanks
Rochelle

Accepting Resumes from experienced coders

Extraction of infected abd wall mesh

Need help coding:

Procedure(s): Laparoscopic converted to open lysis of adhesion with extraction of infected abdominal wall mesh with resection of mesh appendical fistula with appendectomy with closure of midline ventral hernia

After prepping and draping the patient, a midline incision was made below the umbilicus. This incision was carried down through the fascia. The adhesions were lysed to exposed the peritoneal cavity and a gel port was placed. The laparoscopic instruments were inserted and the density of adhesions made the mobilization of bowel impossible. The gel port was removed and the incision was carried proximally to resect the fistula and open the skin to just above the umbilicus. The incision was from the umbilicus to the pubic bone.

The infected mesh was removed to a point where there was a portion of the bowel entering the mesh this was divided with a GIA staple. This was tagged. Eventually the mesh was completely removed.

With extensive lysis of adhesions the cecum was mobilized and the site of division of the GIA was found to be the appendix. The site was involuted into the cecum with interrupted vicryl sutures.

The remaining area was lyse of adhesion and then the hernia was addressed.

The hernia extended to the xiphoid and was closed with a running looped PDS to the pubic bone.

Extraction of infected abd wall mesh

Non emergency patient transfers

Does anyone know what the code(s) would be for an ambulance transfer from facility to facility? This would be for only non emergency issues.

Thanks in advance!:)

Non emergency patient transfers

Endovascular Revascularization

Hello,

I am hoping someone can help me. I am reviewing some charges and came across a patient that had a successful PTA with Atherectomy of the right popliteral artery and was coded as a 37225 but they added on the abdominal aortogram 75625 I thought all radiological S & I directly related to the intervention was inclusive/bundled?

Is there something I am missing?

any help would be appreciated

TIA

Endovascular Revascularization

Hepatitis C vs Carrier of Hepatitis C

I have a patient with Hepatitis C who has been seen by two providers at the practice. One of the providers is selecting 07054 for Chronic Hepatitis C without mention of Hepatic coma and the other provider is selecting V0262 for Hepatitis C carrier.

Which of these codes is correct? One of the providers is insisting both codes are correct because technically the patient having Hepatitis C "deems them" a carrier.

Can someone shed some light on this?

Thank you.

Hepatitis C vs Carrier of Hepatitis C

Reimbursing for Observation

I have a facility bill that is billing for 90 hours of observation care. The facility was waiting for the pt. to be transferred to a SNF. There is no admit order.
How would medicare pay for this? Since observation can only be for 72 hours, can I just pay for 72 of the 90 hours??
THANKS!

Reimbursing for Observation

Auditing Diagnoses in EHR

I work in a large specialty clinic (spine and neurosurgery), and we have implemented use of EHR within the past year. We are preparing to transition to ICD-10 and are auditing notes for the diagnosis.

Our providers use a combination of Dragon dictation and point and click to document the visit. The HPI is usually dragon dictation (which can sometimes be a real mess) and they usually dictate everything here, whether its the current symptoms, recent diagnostic results, etc. Exam is all point and click. The assessment and plan is point and click and they are choosing a diagnosis with an ICD-9 code that may or may not always be correct and there is NO narrative under the A/P section at all - it is only computer-generated terminology that they have picked from a list. So we end up with diagnoses like 724.02, lumbar stenosis, that they select to add to the A/P, but more times than not, we have no narrative from the doctor regarding the implications/reasoning for this diagnosis.

Here are my questions:
1. If all I have to go on is the diagnosis they picked from the computer-generated list, can I code based on that alone, or would it be better just to code any related signs/symptoms (i.e. low back pain)?
2. Also, if they were to mention the recent MRI (as read by the radiologist) showed L4-5 stenosis somewhere up in the history, can I use that to code 724.02, lumbar stenosis?
3. For auditing purposes for ICD-10 readiness, since we are trying to see if they are documenting to the highest level of specificity, should I code on one single note alone, or can I refer back to previous notes in the chart? (i.e., stenosis documented in the past, but they just carried the diagnosis over to this visit since the patient is in for a followup)

Many thanks for your input. I am still learning to swim the waters of coding/auditing!

Auditing Diagnoses in EHR

lipoma

Does anyone else code cortisone injections into a lipoma?
Or does anyone have a suggestion for a CPT code for the injection?
The note reads:

"Deep subcuticular fatty tumors present at the rear foot dorsal lateral..."
"Injected Kenalog 20 mg... to the lipoma at the dorsal lateral rear foot"

Any thoughts?

lipoma

Exam: Unable to assess

I know if the History cannot be documented due to patients condition, and if the doctor documents it correctly that he/she was unable to obtain a History and why, that we can give credit for a Comprehensive History. However, the exam is the exam, if you cannot document a portion of the exam due to the patient?s condition you cannot receive credit for it, you would have to bill based on time/counseling coordination of care, or on whatever OS/BA you were able to exam.

The guidelines themselves state:
-A notation of ?abnormal? without elaboration is insufficient
-Abnormal or unexpected findings of the exam should be described
-Brief statement or notation indicating ?negative? or ?normal? is sufficient

They are not stating negative or normal, and if it?s not negative or normal you need to give an explanation for the other. I always thought time was used, if you cannot document the proper elements for a given level, then the visit should be based on counseling and coordination of care and be documented as such.

How would they give credit for something that was not performed, not documented not done, correct?

Any guidance on this or information would be so helpful. Thanks in advance!

Exam: Unable to assess

Area of Study (AOS)

Any idea about Area of Study (AOS) offer from AAPC? . Is it a big help to pass the CPC certification exam? Thanks!

Area of Study (AOS)

Using Z09 for hospital f/u w/ PCP???

Is the Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm. Correct for a hospital follow up with PCP?

Thanks
Marcie

Using Z09 for hospital f/u w/ PCP???

Is contraception included in CPT 59855 abortion global?

I know contraception is included in the pregnancy global. With fetal demise requiring induced abortion, is it included in the 90 day global for CPT 59855 too?

Is contraception included in CPT 59855 abortion global?

Chronic Back Pain

report states:

chronic back pain encouraged comfort techniques patient will follow with pcp.

would the codes be:

724.5
338.29

your help is so appreciated!

Chronic Back Pain

TPI vs ESI's

What would you code for the below:

a 1 1/2 inch 22 gauge needle was inserted into the right cervical paraspinous muscles into the region of the nerve root outside the dural membrane at the C4, C5, and C6 levels. A combination of 1cc sterile Sensorcaine 0.25% without epinephrine and 16 mg of Kenalog was injected at each level.

TPI vs ESI's

Nuss procedure

My surgeon sometimes puts two bars in when doing a nuss procedure. He is using the same incision but thinks he should be able to bill CPT 21743 x 2. I would agree with him if he were making two seperate incisions. He is making an incision on both sides of the chest but he would do that when inserting one bar. Also, when he removes two bars he feels he is justified in billing CPT 20680 x2. The stabilizer for one bar is on the right and the stabilizer for the 2nd bar is on the left.

Thank you for any advice you can give.

Nuss procedure

Injection billing

Patients are scheduled to come into the office for a testosterone injection, a BCG instillation or TNS procedure there is a Nurse Practitioner in the office but no physician. Under Medicare guidelines we would bill under the Nurse Practitioner's NPI correct?

Injection billing

CPC-A looking for remote PT work

I am looking for leads on part time remote coding positions. I have 2 years experience with emphasis in family practice/e&m and also auditing E&M and quality compliance data. I have my CPC-A which am now able to get off the A after my submission of records and am sitting for my CPMA test on Saturday (I have completed the course in June). ICD-10 test plans after that. I also have plans on going for CCS after these tests are done. I do currently work PT at a hospital as a clinical data auditor for quality initiatives but am looking to supplement (since I work an hour away). Thank you for your time.

Please email me @ justineyaun@verizon.net so that I may forward you my resume. Thank you for your time.

CPC-A looking for remote PT work

How many times can you code Diabetes?

for instance in the report i see:

Patient has DM II which is somewhat controlled with oral medication and insulin.. after A1C results will decide if insulin will be changed.

Due to the diabetes the patient has peripheral vascular disease, peripheral neuropathy and proliferative retinopathy.

would this be coded like:

250.50
362.02
250.60
357.2
250.70
443.81

please advise, thank you!!

How many times can you code Diabetes?

How to code this surgery?

I am not sure which code to use and was hoping for some help with the following procedure:

PREOPERATIVE DIAGNOSIS: Left proximal femur, periprosthetic femoral fracture.

POSTOPERATIVE DIAGNOSIS: Left proximal femur, periprosthetic femoral fracture.

OPERATION: Open reduction, internal fixation, left periprosthetic femur
fracture with salvage of prosthesis and bone graft.

DESCRIPTION OF PROCEDURE: The patient was brought to the operative theater, placed supine upon the operating room table. After satisfactory general endotracheal anesthesia was administered, the patient was brought to the right lateral decubitus position with an axillary roll placed. A time-out was carried out confirming the operative site with the operative consent, and the left lower extremity was then prepped and draped in the usual meticulous sterile fashion from the iliac crest to the ankle. After meticulous sterile prepping and draping, a longitudinal incision was then made taking it through the previous lateral thigh incision from the tip of the trochanter distally about midway to the lateral thigh. Sharp dissection was carried down to the tensor fascia lata, which was incised in line with the skin incision. Proximally, the iliotibial band was noted to have been scarred down to the vastus lateralis and hip abductor tendon. This was elevated and an Adson-Beckman retractor placed. The lateral aspect of the femur was dissected down to by lifting the vastus lateralis muscle from the lateral aspect of the femur anteriorly. This allowed for entering the fractured hematoma, which was evaluated and evacuated. The fractured fragment proximally was noted to be displaced. The fractured hematoma was organized, was curetted and excised and removed with irrigation and suction. Evaluation of the femoral stem was then carried out. The femoral stem was noted to be in stable position with the calcar. The greater trochanteric fragment with the fragment that occupied about one-third to 40% of the circumference of the femur. This was lifted inferiorly, laterally. Two Dall-Miles cables were then passed about the distal third of the fragment. This required dissection posteriorly where the previous surgeries had allowed for scarring of the tissues about the lesser trochanter. The fragment was then reduced and held in anatomic position utilizing two Dall-Miles cables. The crimps were positioned anteriorly to allow for placement of a lateral stabilizing plate. A Biomet LCP plate was then contoured to the lateral femur. This would allow for fixation proximally with 4.5 cortical screws and midway with additional cerclage wires and distally with bicortical screws and cerclage wires. With the prosthesis now fixed and tightly so, it was now stable. The cabled fixation was then augmented with this lateral 12-hole plate. The plate was fixed proximally with bicortical screws through the greater trochanter and midway with two Dall-Miles cables and distally with two bicortical screws and one proximal 4.5 screw and an additional Dall-Miles cable. Throughout the case, C-arm fluoroscopy was utilized to evaluate the reduction and position of the plate and screw fixation. The wound was then copiously irrigated with Bacitracin ointment, with Neomycin, normal saline and the fracture site was then bone grafted with cancellous bone graft, cancellous crouton decalcified bone graft. Augmented by some local cancellous bone harvested from the femur. This having been carried out satisfactorily, a deep vena vac drain was placed. The deep tissues were closed utilizing #1 Vicryl with the edge of hamstrings and the undersurface of the vastus lateralis being closed. The vastus lateralis was fixed proximally, was then released with #0 Vicryl in interrupted fashion. The subcu was closed with #0 Vicryl in a figure-of-eight fashion. Subcu closed with #2-0 Vicryl in interrupted fashion, and the skin was reapproximated with skin staples. The patient was returned to recovery after the wound was dressed with Xeroform, 4 x 4's and ABD pads. Estimated blood loss was 400 ml. The patient was then taken to the recovery room and tolerated the procedure well without complications.

I am leaning towards 27244, 27170 but then I am not sure if it should be 27236 instead. Or if I should be using 27170 either!

Any help would be greatly appreciated!! :)

Thanks,

How to code this surgery?

appropriate modifier for unrelated condition to SNF

Hi All,

Need help on this one.

The office E/M visit (POS-11) is denied as patient was in SNF. Main compliants for E/M visit is "tremor, cough and urinary symptoms". Need suggestions to make appropriate corrections for this scenario.

Thanks in advance,
TIM.

appropriate modifier for unrelated condition to SNF

11045 denails with multiple units

hi can anyone tell me how to bill 11045 with 16 units i received deanails for 11045

11045 denails with multiple units

Workers Comp and automobile accident

Hello,

Does anyone know if workers comp and automobile accident carriers will be all required to accept icd10 starting October 1?

Thank you!

Workers Comp and automobile accident

New to field

Hello I have been fortunate enough to have been hired by a local gastro office for medical billing and coding. This is my very first job as a CPC and I really would like some more info regarding coding, the use of modifiers, and especially more in-depth knowledge of E/M services in this field considering I will be doing this on a daily basis.
Can anyone suggest any webinars, or articles I can read to further my knowledge? Thanks
Debbie CPC-A in CT

New to field

External Fixator in the OR

Hello!
We have a physician; who is using an external fixator in the OR. It is being applied to reduce the fracture so the physician can apply the internal fixation without an extra set of hands in the extremity. It is then removed and casted and/or braced following surgery. I don't think this is billable; as it is not really being used in the manner an external fixator is devised for; but we have another coder who disagrees.

Do any of you have experience with this? Can you point me in the direction of some documentation. I have come up empty handed at this point.

Thanks in advances for time and assistance!

External Fixator in the OR

Path report: Basaloid neoplasm

I am coding for facility only so only have the path available.

Diagnosis according to the path report is "basaloid neoplasm."

I have no idea as to an ICD-9 code here. Pre-path diagnosis is 238.2, neoplasm of uncertain behavior. Do I have to default to this code as post, also?

Thank you!

Path report: Basaloid neoplasm

E/M submitted to payer on 9/30, labs submitted for payment on 10/2:

In our clinic we are wondering about the following scenario. If one of our providers bills for an office visit on 9/30 but the labs for that visit are not performed and submitted until 10/2 should the labs be submitted with ICD-9 diagnosis codes or ICD-10 diagnosis codes? Thank you, Nan

E/M submitted to payer on 9/30, labs submitted for payment on 10/2:

Retrospective Audits

How often do you look at your providers for a retrospective audit? We are a 700+ facility. We do other types of audits.

Thx

Retrospective Audits

Mentor / Coach for Auditing

I'm starting a new chapter in my life. And I'm becoming an auditor, with that being said I'm looking for someone willing to help me "mentor / coach" in terms of guidance, suggestions and pointers to get me to where I want to be.

Thanks
Michele Russell, CPC

Mentor / Coach for Auditing

Stress Testing (93015) and Injection Codes (96374/75)

I am aware that injection codes (96374/75) are considered to be included in stress testing (93015). CCI Edits do allow the use of the injection codes with stress testing (93015) and nuclear stress tests (78452) with the use of a -59 modifier.

I am curious if anyone out there knows of any scenarios where they have seen legitimate justification of the use of the -59 modifier for injection codes in conjunction with stress testing.

Thank you

Stress Testing (93015) and Injection Codes (96374/75)

Auditor fees

We are interested in getting feedback on the fees charges by certified auditors/coders for a review of 10 office encounters (E/M encounters). In this case, the group consists of primary care/occupational medicine providers in multiple locations. Thanks!

Auditor fees

Holter Monitor billing date

When we bill for the interpretation of the Holter Monitor, are we supposed to put the date the test was read, the date it was put on the patient or the date the holter ended?

Holter Monitor billing date

Mdicare Requiring Toxicology Tests??

OK...my doctor had a question for me. He does prescribe pain meds for some patients.
He also sees elderly patients in nursing homes.

Apparently some other doctor told him he would be required to drug test all his elder patients. That Medicare was going to require it.

I have never heard any such thing...but I HAVE heard of doctors doing unnecessary drug testing on Medicare patients in order to jack up the bill - and they do it in such a way as to stay within the law, but always getting around the intent of the law...and padding their pockets...which also would cause Medicare to start red-flagging you and getting all your claims scrutinized and records requested all the time, which I do not want my doctor to be getting into trouble.

I told my doctor not to do this unless:
A. We get something on Medicare letterhead saying we have to
B. We start getting claims rejected/pended requesting this information
or
C. Doctor has a very good reason to believe the patient is not talking the meds themselves (selling the pills) or is "doctor-shopping" - going to more than one doc to get more pain pills for the purpose of selling them, or feeding an addiction.

Otherwise, no testing.

Did I advise my doctor correctly?

Mdicare Requiring Toxicology Tests??

Seclusion & Restraint policy

Does anyone have one of these they can share? I have an insurance company requesting one from us.
We are a small specialist clinic with 2 doctors. All of the examples I have found online are for hospitals and schools, which are like 20 pages.
Thanks!

Seclusion & Restraint policy

Fractured femur procedure code

I am not sure which code to use and was hoping for some help with the following procedure:

PREOPERATIVE DIAGNOSIS: Left proximal femur, periprosthetic femoral fracture.

POSTOPERATIVE DIAGNOSIS: Left proximal femur, periprosthetic femoral fracture.

OPERATION: Open reduction, internal fixation, left periprosthetic femur
fracture with salvage of prosthesis and bone graft.

DESCRIPTION OF PROCEDURE: The patient was brought to the operative theater, placed supine upon the operating room table. After satisfactory general endotracheal anesthesia was administered, the patient was brought to the right lateral decubitus position with an axillary roll placed. A time-out was carried out confirming the operative site with the operative consent, and the left lower extremity was then prepped and draped in the usual meticulous sterile fashion from the iliac crest to the ankle. After meticulous sterile prepping and draping, a longitudinal incision was then made taking it through the previous lateral thigh incision from the tip of the trochanter distally about midway to the lateral thigh. Sharp dissection was carried down to the tensor fascia lata, which was incised in line with the skin incision. Proximally, the iliotibial band was noted to have been scarred down to the vastus lateralis and hip abductor tendon. This was elevated and an Adson-Beckman retractor placed. The lateral aspect of the femur was dissected down to by lifting the vastus lateralis muscle from the lateral aspect of the femur anteriorly. This allowed for entering the fractured hematoma, which was evaluated and evacuated. The fractured fragment proximally was noted to be displaced. The fractured hematoma was organized, was curetted and excised and removed with irrigation and suction. Evaluation of the femoral stem was then carried out. The femoral stem was noted to be in stable position with the calcar. The greater trochanteric fragment with the fragment that occupied about one-third to 40% of the circumference of the femur. This was lifted inferiorly, laterally. Two Dall-Miles cables were then passed about the distal third of the fragment. This required dissection posteriorly where the previous surgeries had allowed for scarring of the tissues about the lesser trochanter. The fragment was then reduced and held in anatomic position utilizing two Dall-Miles cables. The crimps were positioned anteriorly to allow for placement of a lateral stabilizing plate. A Biomet LCP plate was then contoured to the lateral femur. This would allow for fixation proximally with 4.5 cortical screws and midway with additional cerclage wires and distally with bicortical screws and cerclage wires. With the prosthesis now fixed and tightly so, it was now stable. The cabled fixation was then augmented with this lateral 12-hole plate. The plate was fixed proximally with bicortical screws through the greater trochanter and midway with two Dall-Miles cables and distally with two bicortical screws and one proximal 4.5 screw and an additional Dall-Miles cable. Throughout the case, C-arm fluoroscopy was utilized to evaluate the reduction and position of the plate and screw fixation. The wound was then copiously irrigated with Bacitracin ointment, with Neomycin, normal saline and the fracture site was then bone grafted with cancellous bone graft, cancellous crouton decalcified bone graft. Augmented by some local cancellous bone harvested from the femur. This having been carried out satisfactorily, a deep vena vac drain was placed. The deep tissues were closed utilizing #1 Vicryl with the edge of hamstrings and the undersurface of the vastus lateralis being closed. The vastus lateralis was fixed proximally, was then released with #0 Vicryl in interrupted fashion. The subcu was closed with #0 Vicryl in a figure-of-eight fashion. Subcu closed with #2-0 Vicryl in interrupted fashion, and the skin was reapproximated with skin staples. The patient was returned to recovery after the wound was dressed with Xeroform, 4 x 4's and ABD pads. Estimated blood loss was 400 ml. The patient was then taken to the recovery room and tolerated the procedure well without complications.

I am leaning towards 27244, 27170 but then I am not sure if it should be 27236 instead. Or if I should be using 27170 either!

Any help would be greatly appreciated!! :)

Thanks,

Fractured femur procedure code

20604, 20606, 20611

When billing these codes you wouldn't bill for the ultrasound, correct?

20604, 20606, 20611

Partial Hospital Program or IOP

We have a provider and he wants to use 99221-99223 and 99231-99233 when seeing patient in an IOP or PHP, are these codes acceptable?

Partial Hospital Program or IOP

Placement of ureteral stent

Could anyone tell me what CPT codes to use for "placement" of a nephroureteral catheter through an ileal conduit. I can only find the codes for the replacement of a ureterostomy tube/ureteral stent via ileal conduit (50688 & 75984).

Placement of ureteral stent

10060

When billing the G0439 with the 10060 wouldn't I need a modifier?

10060

DX for boating accident, no injuries

Can you help me with a diagnosis for two new patients (siblings) in a boating accident with no injuries and normal exams?

I'm having trouble assigning an E/M since nothing was diagnosed. Also, what would the ICD-9 diagnosis be? Would this be a "worried well" diagnosis? Provider chooses 959.9 (see note below), but I see no documentation of an injury per se. Here's the note for the first patient:

First note: A 2-year-old is here with mother with concern that family was in a boating accident yesterday. Per mother, they were in a small motor boat when the wake from a larger boat caused their boat to flip over and the child was trapped under the boat for about 1 minute. The boat flipped right-side up spontaneously and the child was still in the boat, wearing a life jacket. The child was responsive. No known LOC, no cyanosis. Mother states she started vomiting water. 911 was called and child evaluated on site. Paramedics said child was well enough to go to ER in private vehicle. Child never went to ER.

Per mom, child acting fine today. Good energy level. Eating & drinking well. No fever. No nausea/vomiting.

Exam: (Provider goes over all systems, and all within normal. No abnormal findings at all.)

Assessment: Submersion or drowning due to boat overturning, occupant of small unpowered boat injured, 959.9

Plan: Send for stat chest x-ray. Supportive care. Reassured mom that child has normal exam today. Follow up in 1 week or sooner if child seems worse.

ALSO, second note for sister. I'm just providing HPI here. Provider did detailed exam, with no abnormal findings:

Sister, 6 years old, also in boat at time. She jumped out before boat flipped and was not trapped. Provider gives same diagnosis as above. Plan for this patient is "close observation, return for well child check as scheduled." What would you assign for this patient? Worried well?

Thanks so much for your help!

DX for boating accident, no injuries

ICD-9 to ICD-10 Fee Ticket Conversation

Any idea what CPCs are charging to "try" and convert a practice current ICD-9 encounter form to ICD-10?

ICD-9 to ICD-10 Fee Ticket Conversation

99211 and Documentation

I apologize if this is answered elsewhere, I have not seen it specifically:

Does the Nurse have requirements to document a Dx Code?

Is the Nurse permitted to see a patient and document in the Chart Body, "No diagnosis" and expect that the Coder will give it a 99211?

I am very confused about this; thanks to anyone with information for me.

99211 and Documentation

Question for CIRCC coders

I'm looking for some advice on how to get training for CIRCC coding. Did you get on-the-job training? Or did you study through an entity such as Dr. Z? I'm currently an inpatient coder with an interest in IR/Cardiovascular coding. Dr. Z seems quite expensive, and I'm wondering if there's a more economical way to get comprehensive training. Thanks!

Question for CIRCC coders

Inital/Subsequent codes

I am at working entering all the ICD-10 codes into our software and I noticed that there are a few initial/subsequent codes. My question is initial is for the first visit and then after that we are suppose to use subsequent codes right? My docs are telling me no you are suppose to stay away from subsequent codes.

Inital/Subsequent codes

AAPC externship

I was just offered an externship through AAPC - does anyone have any experience with this? Just trying to get some feedback on the program.

AAPC externship

Initial office visit diagnosis

I had a patient in a office who came in for initial fertility check up, she was trying to conceive for 2 years. She does not have a confirmed infertility dx yet. DX V26.49 denied by her insurance as she has only diagnostic coverage. I don't have any sign or symptoms to code. How should I code the dx for office visit 99204? Please help?

Thanks

San

Initial office visit diagnosis

Homehealth and ICD 10 coding

Does anyone know if we are going to have to use ICD-10-PCS codes with homehealth coding? When we go in to do PT, OT, ST, and dressing changes on surgery sites, will we be coding PCS or is this just for in-patient?

Thanks
Lisa

Homehealth and ICD 10 coding

coding for cpt 76376, 93975, 76700

The GI doctor wants to code 93975, 76700, 76376. Can these all be billed together? In what order and what modifiers do I use?

coding for cpt 76376, 93975, 76700

Inpatient procedure sequencing question

This ICD-9 example is for a bilateral lung transplant from a cadaver with accompanying cardiopulmonary bypass. The primary code is 33.52 for the transplant. The remaining codes are 39.61 for the bypass and 00.93 for the donor source.

What is the correct sequencing for the latter two? So far, I've seen this same example with two different answers and am not sure which one is right, or if it even matters.

Thanks.

Inpatient procedure sequencing question

Coding Diabetic Retinopathy in Resolved Diabetes

hello fellow coders. :)

I need some input on coding diabetic retinopathy after the diabetes has resolved.

the patient's current a1c is 5.6 and the provider states that the diabetes was resolved due to weight loss, so he is not "controlled on medication", but the retinopathy still exists and is technically "due to diabetes".

can I code it with impaired fasting glucose (790.21), which is what the provider is assessing?
that just doesn't seem correct.

how about coding the retinopathy as background retinopathy, unspecified (362.10)?
I'm not sure that sounds right either, because (as I said above) the retinopathy was really "due to diabetes", but this is where I'm leaning.

I guess the same question goes for other diabetic manifestations, too (diabetic neuropathy, or angiopathy).

any input is greatly appreciated.

thanks.

Coding Diabetic Retinopathy in Resolved Diabetes

Replacement for S8262 that was deleted

First here is the code and description:

S8262

Mandibular orthopedic repositioning device, each

It is deleted as of 06/30/15. Is there another code I can use as a replacement for the device itself?

Thanks.

Replacement for S8262 that was deleted

Treatment of FX cpt 25500

I have some questions on what CPT 25500 covers.

1st Visit: Pt came to clinic with hand pain. DX fracture radius, distal (813.42).
Xray of hand (73130) and xray of wrist (73110) done.
Sugar tong splint and sling applied.
Treatment of fracture radius(25500)
Pt to return in 1 week for recheck xray and long arm cast
Are xray covered in cpt 25500?

2nd visit: Pt came into clinic. Swelling on upper extremity reduced.
DX fracture radius, distal (813.42).
Xray of wrist (73110) done.
Long arm cast applied.
Are xray codes and casting covered in the global of cpt 25500?
What code is used to show that the pt was in the office during the global period for these services?

Thanks for the help,
Jennifer

Treatment of FX cpt 25500

Coding abnormal diagnostic testing

I just want to clear something up that's been a debate. If you are coding from a diagnostic report, and the report indicates a definitive diagnosis (e.g. a carotid u/s was done carotid artery stenosis was found), would it be appropriate to either:

A) report only the carotid stenosis (433.10)

B) report 433.10 AND a code for an abnormal carotid u/s

Any feedback and links to resources would be appreciated :)

Coding abnormal diagnostic testing

National Government Services (Medicare) coverage for Solesta Injections

We are currently doing Solesta injections. We are billing the L8605 and 0377T as of 01/01/15. Prior to that we were billing the L8605 and 46999 and being reimbursed with no issues.

Since we started using the 0377T code we have not been paid by National Government Services (NGS) our local Medicare carrier on the admin 0377T code at all and only some of the claims have payments on the L8605 CPT code.

Does anyone in CT have any recommendations?

Thanks!

Christina

National Government Services (Medicare) coverage for Solesta Injections

Diabetes

We were doing some ICD 10 training/discussion with our providers and they were asking what they do when they have a Diabetic patient that has retinopathy, neurological complications and circulatory complications. Do they code E11.321, E11.40, and E11.51?

Diabetes

Crna tunneled catheter

Can a CRNA insert a tunneled centrally inserted central venous catheter, CPT 36558? CGS Medicare denied our claim billed by a CRNA only stating payment is denied when performed/billed by this type of provider.

Crna tunneled catheter

Smoking Cessation Counseling 99406 bundling with Vaccine Admin - 90471

We have billed a 99213-25, 99406, 90471 and 90732.
The payer has denied 99406 (smoking counseling code) stating that it is bundled to 90471 (vaccine admin code). Stating due to NCCI. I can't locate any NCCI information with regards to smoking cessation, as it is an e/m code perhaps we should have added a 25 modifier to the 99406 as well as the 99213 in order to unbundle?
The DX linkage is correct in that the 99406 is linked to 305.1 - tobacco disorder and 90471 to V03.82 - need for pneumococcal vaccine.

Thanks in advance to anyone who can help.

Paula

Smoking Cessation Counseling 99406 bundling with Vaccine Admin - 90471

Audit question

When auditing an operative report that is produced by software vs a dictation; how much weight is given to the ICD-9 codes the doctor lists at the end vs the written description in the indication and the findings in the body of the report? What about the CPTs given vs the written description of what was performed?

Thanks for your help.

Audit question

nerve block inj.

Help me please
Patient received an injection of medrol 2cc with 1 ccof Xilocaine in the L5-S1 region, in the office the reason left sided sciatica.no imaging guidance
the correct cpt will be 62311 or 20610 + drugs?

nerve block inj.

MRI-ultrasound fusion prostate biopsy

Hi guys,
Does anyone have any experience coding these?
I suggested 55700,76942,76872 but I have someone suggesting I use additional codes 77021 and 76377 but in my research I found that these are codes the radiologist bills not the Urologist. I don't feel comfortable billing those additional codes
Also we are not generating a separate report. - Anybody have any input I would appreciate
Thanks
Vanessa

MRI-ultrasound fusion prostate biopsy

dialysis coding instruction....

I have been asked to begin coding for dialysis and I was wondering if anyone knew of any instructional information specific to this? I now code for both inpatient and outpatient in internal medicine and pulmonology. I was hoping to get a little knowledge before stepping off into it.
Thanks,
Tom W.

dialysis coding instruction....

Auditing

How much are auditors charging? Are they charging per chart or per visit? Thank you.

Auditing

Pathology result

Good morning,
any assistance would be helpful, I coded a path report which had the results of
sinus contents, removal:
A. chronic sinusitis- 473.9
B. septal bone and cartilage:
-benign bone and cartilage I coded it as 213.0
I was told not to code the benign code because it is a normal finding. is this correct and if not is there guidance anywhere that I can find to support my decision

thank you

Pathology result

Endoscopy to esophagus

Could you please help with the coding of a endoscopy that only went thru the oropharynx and esophagus. Do I use a 43239 with a 74 (ambulatory surgery discontinued mod) or a esophagoscopy 43198? or am I totally off on both. Thanks for the input.

Endoscopy to esophagus

Hx of abdominal anuerysm

I'm trying to find the ICD9 code for history of abdominal aneurysm. It was diagnosed & patient had surgery in July, but my Dr is discussing it with him in December & still using Dx 441.4. Is there a Dx for history of?

Hx of abdominal anuerysm

Resume with NO EXPERIENCE

I recently passed my CPC and am looking into Project Xtern to help get real world experience. My problem is this... The current career I am in is not even related to coding. How do I write a resume when Ive been in a different career for the last 13 years and none of the skills relate to coding.
What type of resume should I be writing? Any examples would be great!!!

Thanks!!!

Resume with NO EXPERIENCE

Prescription Drug Management

Hello ,
I believe I have read this, but does the provider need to document the name and dosage of the medication if he says continue taking same medications or continue same regimen? If so can you give me a guideline or a location of this being documented, i need to show support for this. Thanks

Prescription Drug Management

Healing Complex Wound

Can anyone tell me what code to use for a Healing Complex wound?

This patient has come in for a follow up visit and the Diagnosis is Healing Complex Wound, Not sure what V code to use or if I should use the wound code. No surgies were done.

Thank you,
LLR

Healing Complex Wound

ER and IP Coders Needed Remote/Salaried/Benefits

We are looking for experienced, credentialed ED and IP coders for full time salaried positions with amazing company. Exceptional benefits and education.

Please email me if you are interested.

Best Regards,
Jenan


Jenan Custer CCS, CPC | Director of Coding Operations
AHIMA Approved ICD-10-CM/PCS Trainer and Ambassador
jcuster@hccscoding.com

ER and IP Coders Needed Remote/Salaried/Benefits

Hospital E&M codes for pos 61

Hi, does anyone know what E&M codes are appropriate for Comprensive Inpatient rehab? We used hospital inpatient codes and Medicare is stating we should've used Snf codes? dont know if I should fight it or recode. I appreciate your input!

Debi

Hospital E&M codes for pos 61

Remote Cardiology Coding position wanted

Located in Greenville, NC I would be available to code remotely for anyone that needs Cardiology Coding and Billing. Please feel free to email me, Donald Johnson, with your billing needs.

dheels01@yahoo.com

I have 12 years experience in Hospital/Office coding in the following areas in Cardiology: EP, Coronary Angioplasty & Stenting, Peripheral Vascular disease, Nuclear Stress Testing, Stress Echocardiogram/2D Echocardiogram, EKG, & RF Ablations.

Remote Cardiology Coding position wanted

No consent to treat/authorization

If a hospital failed to receive an consent to treatment can we still bill the patient? Busy day and we missed it for lab work.

Blue Cross
Medicare

No consent to treat/authorization

Mandibular advancement orthotics

Does anyone know what code would be used for a polysom to titrate for correct position of a MAD? Is it dependent on the parameters of a regular polysom?

Thanks!

Mandibular advancement orthotics

Gardasil vs. Gardasil-9

Is there a different code we should be using for Gardasil-9?

Gardasil vs. Gardasil-9

Strain Imaging with Echocardiogram

We have been performing echocardiograms with strain imaging and we are wondering if that is a payable service. I've done some research, but cannot find any information on additional reimbursement. Is there anyone performing this in their clinics? If so, are you billing for the additional work?

Strain Imaging with Echocardiogram

E&M codes for Comprehensive Inpatient Rehab

What E&M codes are appropriate for Comprehensive Inpatient Rehab? I believe the pos should be 61. Any help is greatly appreciated. Thank you!

E&M codes for Comprehensive Inpatient Rehab

28510

My provider billed this below and the 28510 was denied. I know the modifier 57 is for an E&M, so would I replace it with the modifier 51, because this is for Medicare, and I thought for Medicare you don't need the 51? I'm confused! :confused: Any help would be greatly appreciated. :)

99202-57
28525-T3-T4
28510-57-T3
13132-51-LT

28510

Preperitoneal Lipoma

Can anyone tell me what CPT code and ICD 9 code to use for an excision of a preperitoneal lipoma?

Thanks in advance!
Jessica

Preperitoneal Lipoma

v16.0

I'm trying to figure out if there are any restrictions on use of Family History codes in regards to how far in the bloodline the family history is?:confused:

v16.0

Coding MRI Sinus

Hello-

Can someone please clarify when an MRI of the brain and an MRI of the sinuses are ordered what code or codes should be used? There has been some debate as to whether it should be 70551 (or 70553) or 70540, 70543, thanks

Coding MRI Sinus

Balloon sinuplasty

Does anyone do ballon sinus surgeries in the office. We started doing them today and will be using the codes 31295, 31296, 31297. I was looking online to see if there are any codes for the local and topical anesthesia we will be using, plus the monitoring of the heart rate, administering the oxygen, and the internal nasal packing. If anyone has done any of these or has any suggestions or pointers that would be awesome! thank you so much!

Balloon sinuplasty

Decision for Surgery within global period

Hello Fellow Coding Professionals

Patient had surgery for greater tuberosity fracture with shoulder dislocation and is in the office during the global surgery. There is a displacement of the greater tuberosity fragment and a decision for ORIF is made. Is this a billable E and M since the diagnosis is slightly different? Or would you stick with 99024?

Thank you

Decision for Surgery within global period

Billing S9090 VAX

Does anyone currently bill S9090 for VAX therapy this to insurance? I know it is not a covered service. Does it have to be billed to insurance or can it just be billed to the patient, if they are notified it is not covered and collect the money from the patient up front?

Billing S9090 VAX

Railroad Medicare Denying G0283

Hello Coders!

I am lost as to why Railroad Medicare has decided to deny all patients G0283 the EOB just says it was not necessary. I cannot go on the website because the physician has to reestablish that we are an active provider. Any ideas would be appreciated.

Confused in MI.

Railroad Medicare Denying G0283

Modifiers

Which modifier would you use on a Ambulance Transport if a patient is being picked up friom an adult daycare? E or S.

Modifiers

re-excision

If a patient had surgery which has a 90 day post op period and the doctor wants to do a re-excision on the same area because of the margins would you just charge a post op visit or would you charge a low level evaluation with the visit prior to the re-excision. thank You

re-excision

re-excision

If a patient had surgery which has a 90 day post op period and the doctor wants to do a re-excision on the same area because of the margins would you just charge a post op visit or would you charge a low level evaluation with the visit prior to the re-excision. thank You

re-excision

Office visit to discuss surgery / treatment after biopsy.

Good morning,

Is it appropiate to bill for an office visit when the patient is found to have cancer and is in need of additional surgery or treatment if it is in the global period of the inital excisional biopsy?

Thank you,

Beth

Office visit to discuss surgery / treatment after biopsy.

Malfunctioning J-tube

Indication: Malfunctioning J-tube
Instrument: Fujinon video gastroscope
Medication: Fentanyl 75mcg IV, Versed 3 mg IV

Description of procedure: After informed consent was obtained, the patient was placed in the left lateral decubitus position. The gastroscope was inserted into the oropharynx under direct vision and advanced through the upper esophageal sphincter. The esophagus was traversed. The squamocolumnar line was well delineated. There was no inflammation, ulceration, stricture, ring or web. The gastroscope was then advanced into the stomach. There was a jejunal tube noted that was tightly twisted on itself within the stomach. It was advanced to the jejunal tube, grasped the suture material at the end of the J-tube, the tube was grasped and then advanced well into the distal duodenum. The patient tolerated the procedure well. There were no immediate complications.

IMPRESSION: Successful replacement of malfunctioning jejunal tube through existing gastrostomy tube.

Recommendations: Resume feedings

MY thoughts: not a new tube but malfunctioned due to twisting. 45451-52 since guidance wasn?t used?

Thanks for the help!!
Pamela

Malfunctioning J-tube

Dilation g tube tract

Our surgeon assisted a gastro dr. Incision along the skin adjacent to the G tube tract was made. Using cervical dilators, the tract was dilated to approx. 30 French. Following this, utilized a chest tube proximal end to dilate it further up to approx 36 - 38 French size. At this point we were able to negotiate the ERCP scope through the tract and into the stomach under direct supervision. At this point the gastro dr took over the ERCP. At end of the case we placed 32 French g-tube in tract and secured it.

I am at a loss on this one. Tried doing this early am or late in the day but my brain is just not comprehending. Please help.:confused:

Dilation g tube tract

Sprains/strains

I have a patient, initially seen and diagnosed with a sprain, returns for follow-up a month later. Physician codes 845.00 and 719.47 at her second visit. First question, is the sprain still acute, or would you code pain first diagnosis and code second late effect of sprain/strain at this point in time? Thank you for your assistance.

Sprains/strains

Pain Management/Physical Medicine

We have a pain management doctor in with our Orthopaedic practice with sane Tax ID, he thinks if he refers patients to one of the orthopaedist they can bill new patient and vice versa, I thought it would have to be established. Does anyone have info on this?

Pain Management/Physical Medicine

Hiring Certified Remote Coders

The company I work for is STILL looking for additional certified remote coders. It is an EXCELLENT company that has awesome benefits, superb training, great team environment and outstanding management. Including a full blown benefits package and employees are owners as we are an ESOP company. If interested, PM me with your name and email, experience and I can provide you the necessary referral information.:)

Hiring Certified Remote Coders

Remote Openings -Experienced PRO Clinic Coders Needed

We are looking for 12-15 FT PRO Clinic experienced, credentialed coders for remote salary positions with exciting benefits, please reach out to me if you are interested!

Jenan Custer
Jcuster@hccscoding.com

Remote Openings -Experienced PRO Clinic Coders Needed

Certificate Not Received

Hello everyone,

I am from India. I have passed my CPC exam in March 2015; it has been 4 months since and I haven't yet received the passing certificate to my mailing address. I have sent many e-mails and have called AAPC multiple times, but they always tell me that it will take time. I don't know why would it take 4 months of time for them to send the certificate. I am not getting any replies to the e-mails either. I just don't know how to proceed about this now, feel helpless . Anyone please help.

Regards,

Majid Ali

Certificate Not Received

Excision of Tissue and closure of Wound, Rt Great Toe

Can anyone please assist me with the coding of this procedure? I need assistance with 1 & 2 please:

Procedure:
1. Irrigation and debridement, rt foot
2. Excision of tissue and closure of wound, rt great toe
3. Right fifth toe and partial fifth ray amputation (CPT 28810)

"The patient was placed on the operating table in supine position. Following successful anesthesia the right lower extremity was prepped and draped in the usual sterile fashion. The great toe would was approximately 1 cm in length and the base was cleaned. An elliptical incision was made and sharp dissection was taken through the wound and the wound was then irrigated and closed directly using nylon sutures." ...Then continues on into the ray amputation....

Dx: 1. Osteomyelitis, right fifth toe and fifth distal metatarsal.
2. Open would, right great toe

History: Pt has history of long-standing diabetes and has had a long standing ulcer about her right foot laterally and she is status post partial amputation of her great toe.

Excision of Tissue and closure of Wound, Rt Great Toe

need J code for Trichophyton antigen

Our provider is injecting Trichophyton Antigen for treatment of warts. She is providing an NDC# 0268-0432-02. Does anyone know the CPT code for this drug?

need J code for Trichophyton antigen

Pacemaker gen change with failed lead replacement

Hello All!
I am stuck on this one: After much manipulation the new lead could not be placed. What I think the codes should be are at the bottom. Thanks for any thoughts!

PROCEDURE PERFORMED:
1. Dual chamber permanent pacemaker generator change.
2. Attempted RV lead placement.
INDICATION FOR PROCEDURES: End of battery life status.
COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: The patient was brought to the Cath Lab after informed and signed consent was obtained. The left subclavian area was draped and prepped in a sterile surgical fashion. The patient received IV antibiotics per protocol. The left subclavian artery was
infiltrated with 2% Xylocaine with epinephrine with careful dissection to avoid any trauma to the exiting leads and existing device, the pocket was opened and the device was removed from the pocket. Vascular access was then obtained with a long introducer sheath to overcome a stenosis in the left subclavian vein. A right ventricular lead was placed despite extensive
mapping in 7 or 8 different positions. We were not able to obtain pacing and sensing thresholds any better than the existing right ventricular lead. After an exhaustive amount of time finding a reasonable pacing sensing site, the decision was made to remove the new lead, connect the device to the old lead and the prior atrial lead, as well. The device was placed
in the pocket after the pocket was extended to accommodate the larger device. The pocket was then closed in a 3-layered fashion, with excellent hemostasis and wound approximation.
MATERIALS USED:
1. The new device implant is a Boston Scientific Accolade DR. Model number is L301, serial number is 703556.
2. The existing right atrial lead is a Biotronik device/lead. The model number is 343081, serial number is 24043972.
3. The right ventricular lead is a Biotronik model number 343081, serial number is 24124853.
INITIAL MEASURED DATA:
1. The right atrial T-wave sensing is 2.6 millivolts with a pacing threshold of 0.7 at 0.4 msec with a lead resistance of 451 ohms at a current of 1.6 milliamps.
2. The right atrial R-wave sensing cannot be obtained due to 100% pacemaker dependent. The pacing threshold was 1.8 volts at 0.4 milliseconds with a lead impedance of 403 ohms.
INITIAL PROGRAM PARAMETERS: The device is programmed in a DDDR mode with a lower rate limit of 70, upper rate limit of 130.
CONCLUSIONS:
1. A dual chamber permanent pacemaker generator change. Note that a right ventricular lead was attempted to be placed but could not find acceptable pacing thresholds that were any better than the existing right ventricular lead. Note the new device which has autocapture. The estimated duration of the battery status on this device will be approximately 7 years.
2. The patient will be admitted to the hospital for further observation and evaluation. I will anticipate discharge to home tomorrow morning.

33233
33234
33208
33225-52

or

33228
33225-52

Jennifer Everett, CPC

Pacemaker gen change with failed lead replacement

seeking remote coding job

I have been coding for 4 years at a CAH and have my CPC credentials and would love to have a remote coding job. I have experience in E&M,outpatient,minor procedures (uppers,colons,joint injections,skin grafts, ect), and also ER. Anybody with suggestions as where to look? Thank you!

seeking remote coding job

Help Keratin Granuloma

I dont know how to code breast Keratin Granuloma with with ruptured epidormis cyst.
Any help with ICD-9 would be appreciated thanks

Help Keratin Granuloma

MOHs need modifier 51?

MOHs Example:

17311
17312
13132

Would I need a modifier 51 on the closure?

Do you have any physical evidence proving why or why not? Such as a link to an article?

MOHs need modifier 51?

Peripheral angiogram and stent

I know that typically we can't bill a catheter placement when a peripheral angiogram is done with a SFA stent, but what if the catheter had to be removed from one leg to the other to do the stent? Here is the report. I used 37226,36247-XS, 75625-26, and 75716-26. Any help would be appreciated.

PERIPHERAL ANGIOGRAM AND STENT REPORT

PROCEDURES: Abdominal aortography, bilateral lower extremity angiography,
left superficial femoral artery stent placement.

INDICATIONS: A 58-year-old man with known peripheral vascular disease, post prior stent placement in left SFA and status post right femoral popliteal
bypass. He has had worsening claudication in his left foot, now to class IV
with pain at rest. There has been no skin breakdown. His noninvasive Doppler
study suggested critical stenosis in the mid portion of the superficial
femoral artery on the left. Peripheral angiography and if anatomy allows, PTA
and stent placement is planned.

ANESTHESIA: Moderate intravenous sedation and local anesthetic.

DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient's right femoral region was prepped, draped and infiltrated with Xylocaine. A 5-French sheath was placed in the right femoral artery via the modified Seldinger technique. Attempts at advancing a Glidewire across the proximal common iliac artery were unsuccessful. Iliac angiography was performed using an angled glide catheter, the angled Glidewire was advanced successfully into the aorta. A pigtail catheter was advanced over that guidewire. Abdominal aortography was performed in the PA view. During attempts at advancing the angled Glidewire into the left leg, the pigtail catheter came back across the proximal right common iliac stenosis. Decision was made to approach the left leg from the left femoral artery in antegrade fashion. Through the right femoral sheath, right leg angiography with distal vessel runoff was performed in the PA view.

Attention was then given to the left femoral artery, which was prepped and
infiltrated with Xylocaine. In antegrade fashion, the common femoral artery
was entered. A 5-French sheath was placed. Left leg angiography with distal
vessel runoff was performed in the PA view.

Heparin 3000 units were given intravenously. Through the 5-French sheath, a
0.014 BMW guidewire was advanced down the left leg into the left and
positioned in the left popliteal segment. A 4 x 18-mm Herculink Elite balloon
expandable stent was positioned in the left SFA stenosis and deployed at
maximal 13 atmospheres. The stent delivery balloon was brought back and angiography was repeated. There was evidence for edge dissection on the
proximal edge. The balloon was exchanged over the guidewire for a 4 x 9-mm
Integrity bare-metal stent. This was deployed in overlapping fashion with the
first stent at maximal 12 atmospheres. The stent was brought back and
angiography was performed and guidewire were removed from the sheath.

Both arterial sheaths were removed and hemostasis was achieved on both sides with StarClose devices. Patient tolerated the procedure well. He was
transferred to his room in good condition.

RESULTS:
PRESSURES:
1. Aorta 130/70.
2. Right common femoral artery 130/70 (no gradient across the right common
iliac stenosis).

ABDOMINAL AORTOGRAPHY: Performed in the PA view, the aorta has mild calcified plaque with 30% narrowing distally. The right kidney arises low in the aorta and has dual arterial supply. The right renal arteries are widely patent. Left renal arises higher and was not opacified.

RIGHT LEG ANGIOGRAPHY: The common iliac artery proximally is narrowed at
least 50%. There is no gradient across this stenosis. The stenosis is very
tortuous and it was difficult getting a guidewire across. Just distal to the
stenosis, the vessel is mildly aneurysmal. The remainder of the common and
external iliac segments are without narrowing. At the common femoral segment,
the vessel is calcified. There is 50% narrowing. Just distal to that, the
femoral to popliteal bypass graft arises. The anastomosis is widely patent.
The native SFA is completely occluded. The graft itself is widely patent with
brisk flow. The distal anastomosis is widely patent with antegrade flow only.
The distal SFA and popliteal segment is widely patent. At the trifurcation,
there is 3-vessel runoff to the left foot, but the Peroneal artery peters out
at mid calf level.

LEFT LEG ANGIOGRAPHY: The origin of the common iliac is narrowed 60%. The
remainder is widely patent. The segment of the external iliac that is imaged
is without narrowing. The common femoral artery is not imaged. The
superficial femoral artery has luminal irregularities, but no significant
stenosis proximally. In the mid portion, there is focal 90% narrowing
proximal to and separate from the previously placed stents. Distal to this
stenosis, there is a long stented segment that is widely patent. Maximal
narrowing is 40% within the stent. The distal SFA and popliteal are widely
patent including the balloon angioplasty site from 8/2014. At the
trifurcation, all 3 vessels are patent. The peroneal artery peters out in the
mid calf level, but the other 2 vessels reach the foot with good flow.

PTA RESULTS: Mid left superficial femoral artery 90% narrowing reduced to 0% residual stenosis following stent placement (4 x 18-mm balloon expandable
stent overlapped proximally with a 4 x 9-mm bare-metal stent). Flow across
the entire SFA is brisk.

CONCLUSIONS:
1. Critical stenosis in the mid left SFA with 90% narrowing.
2. Persistently patent stents in the more distal portion of the left SFA.
3. Widely patent femoral-to-popliteal bypass graft on the right.
4. Three-vessel runoff to both feet.
5. Successful stent placement in the left SFA with 2 overlapping bare-metal
stents.

Peripheral angiogram and stent