Diagnostic OB coding Question

I am jumping back and forth between answers from different coders. First, I understand about using codes v220,v221 and how not to use them with CH 11 codes, that is not an issue. What I am questioning are the resolved issues or prev dx . Okay, so a PT has a hx of DVT in prev preg, not being treated, no other issues at this time, DX opinion? Another, pt had placenta previa in the beginning of preg but has since resolved, should this complication appear on all the claims during the preg? Input would be helpful. Thank you

K
OB/GYN

Diagnostic OB coding Question

CPC-A Looking for a job in Hampton Roads Area, Virginia or Northeast, NC

Hello,

I am looking for a position in a medical facility to get my foot in the door. My goal is to have a medical coding job, but I know that experience is needed. I would like to be given the opportunity to prove myself in a medical setting with the opportunity to grow. I am looking for anything to start out with, patient representative, etc. and am willing to work my way up the ladder. I am a single mom and need an income to sustain my household, which is a challenge when you are starting out in a new career field. However, my years of experience in office work and administration will be an asset.

Thank you for your time.

H Beasley

Attached Files

Heather Beasley Resume 1.pdf (18.1 KB)

CPC-A Looking for a job in Hampton Roads Area, Virginia or Northeast, NC

Z Codes

We are having a differing opinion on the correct usage of the Z codes. If a patient has a non traumatic hip replacement due to DJD and they are continuing to be seen past their 90 global period, should the Z code be used or should the diagnosis code with the appropriate extender be used?

Thank you

Z Codes

Pregnancy of Unknown Location

What would be the most appropriate ICD 9 code be for Pregnancy of Unknown Location (PUL)? Physician cannot say for sure if patient is having an ectopic pregnancy. Is there some other diagnosis code I can or should use?

Pregnancy of Unknown Location

Coding stable conditions

Quick questions. Do you code a stable condition if mentioned in the plan "hypertension: stable"? When that is the only information you are giving, no mention of being on meds or any contributing factors, can that code go out on the claim when nothing (in the note) has been done with it? I know you can use it in your MDM, but I was always taught that you can not code stable unless you are referring to labs, meds, or other tests?!?

Thank you in advance.

Coding stable conditions

Flu Vaccine/Private Insurance

Please provide guidance as to whether Flu Shot administration is generally reimbursable when bill to third party insurance by other than PCP

Flu Vaccine/Private Insurance

Hip Sextant Charges

Hi Everyone,

Im hoping you can shed some light on the below!

I was asked the question when billing a hip sextant (73700), is it
correct to charge for only ONE joint, even though technically other joints
are scanned, (knee) . The radiologist is dictating for both joints.

My thought is we can bill for both joints and put a modifier on the code?

Thoughts, opinions???

Thanks in advance!

Hip Sextant Charges

iStent - coding for the device

Need help with the HCPCS code for iStent when the procedure is done in Minor Procedure Room, I was looking at C1783 , but it is used for ASC or HOPD facilities only, so I am not sure if I can still use C1783 for Minor Procedure room or do I need to use the unlisted code L8699.

appreciate your help
Thank you
umachidam

iStent - coding for the device

abd wound exploration

PROCEDURE: Right lower quadrant exploration with removal of old mesh and closure with new biologic mesh.
INDICATIONS FOR PROCEDURE: The patient is a 56-year-old female who has had previous hernia repair and had a laparoscopic right abdominal hernia repair with mesh in 06/2013. She continues to have a knot in that right lower quadrant that is painful. CT did not show a hernia. She now is to undergo exploration with removal of probably that portion of mesh and probable biologic mesh placement.
DESCRIPTION OF PROCEDURE: In the supine position, the abdomen was prepped and draped in the usual fashion. After anesthetizing with 0.25% Marcaine, the old incision was opened and deep tissues were exposed down to that of the abdominal wall. You could feel this mesh through this. I opened the external oblique, internal oblique and then was able to get in to where this mesh was. There was intense reaction around that, about a 2 cm area. I then freed up this mesh and then removed essentially the majority of that mesh and it did not look infected. After ensuring I removed that completely, I felt I should put a biologic mesh deep and close over top of this. I therefore took the smallest XenMatrix mesh, which was 10 x 15 cm. I then placed a circumferential #1 PDS plus, suturing it to the mesh and to the abdominal wall. It was then rested appropriately and tied down. The muscle was then reapproximated with running #1 PDS incorporating the mesh medially. After ensuring that looked good, deep tissues were closed with running 2-0 Vicryl. Skin edges closed with running 4-0 Monocryl subcuticular stitch. Steri-Strips and a sterile dressing was applied.
ESTIMATED BLOOD LOSS: Minimal.
Sponge and needle counts were correct. She tolerated the procedure and was taken to the recovery room in satisfactory condition.


Any takers????

Thanks

abd wound exploration

New HCPCS C9457 & Echocardiography

Has anyone seen pricing on this code yet? From what I can tell CMS has assigned this contrast its own APC but I don't see any pricing listed yet.

Thanks

New HCPCS C9457 & Echocardiography

99495 help please

We are getting denials for the 99495 saying it cannot be billed alone. Does anybody else have this problem? Or know what should be billed along with it. I wouldn't think you could bill a E/M also if you are already using a 99495 for just the follow up? Thanks
ps Anthem B/C

99495 help please

What constitutes a high risk of breast cancer?

I'm currently working some claims where women younger than 35-years-old have had screening mammograms. As is typical, practically zero payers will reimburse these. However, I've got one payer that states the following in their mammography policy: "Coverage No payment will be made for a screening mammogram provided to a member under 35 years, unless a woman is at a high risk of developing breast cancer and medical necessity is provided. The patient's medical record must clearly document the patient's immediate risk of developing breast cancer at an age less than thirty-five."

So what, exactly, would constitute an immediate risk of developing breast cancer? A lot of the claims I've seen state the patient has a family history of breast cancer, but it tends to be in the extended family (grandmothers, aunts, and cousins) rather than the immediate family (mother, sister, or daughter). The other thing I'm finding is when I review the office visit records, the family history isn't even documented, which gives me even less to try to appeal on.

What constitutes a high risk of breast cancer?

fee for 99497

Hi,
I know Medicare is not paying for the 99497 Advance Care Planning, but has anyone come across any insurances that are? We are just wondering so we can set up a fee for this.
Thanks,
Jes

fee for 99497

Icd-10

Suggestions.....

Starting a new job next week and need to buy my own code books. Should I purchase 2015 or 2016 ICD-10 code book? Hate to buy 2015 for just 3 months if there are not really any differences.

Icd-10

Vasectomy - HELP

How does one bill out a Vasectomy with a patient that has only one testicle. This will be our first experience with this. Is there a modifier for this or does one just bill out the procedure at a reduced fee?

Thank you,

Stacy, CFPC

Vasectomy - HELP

Faliure of dye ?

Hello,

how should i code the failed dye injection for sentinle lymph node biopsy?

Operation Name: LEFT MASTECTOMY , LEFT SLNB proceeded TO LEFT AXILLARY DISSECTION
Intra-Operative Events:
COMPLETION OF SLNB WAS ABORTED DUE TO FALIURE OF DYE OR RADIOACTIVE TRACER TO IDENTIFIED AT AXILLA , SO GO WITH FORMAL AXILLARY DISSECTION

Procedures: IN ASEPTIC Technique
INJECTION OF METHYLEN BLUE AND RADIOACTIVE TRACER DONE SUBCUTANEUOSLY LEFT BREAST RETROAREOLAR AREA, MASSAGE DONE FOR ABOUT 15 MINS, NO SIGNS OF RADIOACTIVE TRACE SEEN.

SCRUBBING AND DRAPPING DONE
ELLIPTICAL INCISION LEFT BREAST, LEFT AXILLA ENTERED
NO SIGNS OF COLOURED LN OR UP TAKE OF RADIONACTIVE TRACER
SLNB DECLEARED FAILURE, TO PROCEED LEFT AXILLARY LYMPH NODE DISSECTION DONE WITH PRESERVATION OF LEFT AXILLARY VEIN , LONG THORACIC NERVE AND THORACODORSAL NERVE SUPERIOR AND INFERIOR BREAST FLAP DONE
BREAST TISSUE EXCISED HEMOSTASIS SECURED 2 DRAINS 18 IN AXILLA AND 16 IN THE CBREAST AREA PALCED IN SKIN COLSED IN 2 LAYERS

Faliure of dye ?

Bi-vi upgrade with Azygous vein coil implant

Physician list this in PROCEDURES

Implantation of a left ventricular lead
Implantation of a new RV lead due to RIATA 7000 lead failure
Implantation of an azygous coil due to high DFT

After detailing a standard upgrade of bi-vi ICD he went to speak about the coil implant.

In the body of the dictation it says this about coil, LV and RV leads.

...This determined that the DFT was >30J with the lead configuration in place we decided then to place an azygous coil.

The pocket was then reopened, and the RV lead was unsutured and removed. Two separate accesses were again done with confirmation of guide wires in the inferior vena cava. The single coil bifurcation lead was then placed into the RV apical septum. The lead had excellent characteristics, therefore the lead was sutured to the floor of the pocket. Through the second wire we placed a long sheath-and found the mouth of the azygous vein using a JR-4 catheter. We injected dye into the azygous vein confirming the location. Then the coronary sinus guiding sheath was placed into the azygous vein. Through this sheath, the transvene lead was placed. There was an excellent posterior position of the lead. We then connected all the leads sequentially to the device, reflushed the pocket , and placed the system in the pocket.



My question is would i code anything other than 33249, 33241, 33225 and 93641?????

Bi-vi upgrade with Azygous vein coil implant

RN Draw for Transfusion service

Hi. I'm a newly hired coder for the Department of Hematology/Oncology and my job function is to code Transfusion service. Anyways when the patient had an RN Draw and the diagnosis listed is V70.7 (examination of participant of a clinical trial). I'm suppose to still bill this RN draw? Thanks for your feedback or input.

Mark

RN Draw for Transfusion service

Western Governor's University RHIA program?

I am researching online RHIA and RHIT programs and am interested in hearing from anyone who has attended, graduated from, employs, or otherwise knows/works with someone who has graduated from the RHIA program offered by Western Governor's University. In particular, is the program respected by those who hire coders? Are the people coming out of this program well-prepared for the job and for the RHIA certification exam? I know the program is listed as CAHIIM accredited, but I've read mixed reviews about the school itself. Most of these reviews have been about other programs they offer, though, and not about the HIM program. Any information or personal experiences would be greatly appreciated.

Western Governor's University RHIA program?

Foreign body sensation, none found

Not sure what ICD-9 code to use for this scenario. I am not finding any symptoms to pick up for the area of concern itself (iris), and no foreign body was found.

S: Pt with left eye problem per chief complaint. FB sensation x1 week. Does not recall anything flying in, but does recall something hitting his eyeball. Feels it on the iris.
O: Focused eye exam. No FB readily visible. There is conjunctival erythema on the lateral side of the left eye, but that is away from the area of concern.

A/P: Vision: Spoke to Dr. X, and he will examine more closely using instrumentation.

I'm considering V65.5 (worried well), but the FB hasn't been completely ruled out--though perhaps it has been for this provider (?). Or how about V41.1, other eye problem?

Thanks in advance for your input!

Foreign body sensation, none found

pharyngocutaneous fistula closure

Hello,

any one knows what the cpt code for pharyngocutaneous fistula closure?

pharyngocutaneous fistula closure

CEU's

Hello,
So I was getting ready to turn in my CEUS and I was going through and making sure that I had all of the certificates in case I get audited. I have two I can't seem to find, but even taking those off, I'll still have enough. Should i just delete them? Or?
Thank you :)

CEU's

CPA-A Resume for Myrtle Beach-Wilmington area

Recently certified CPA-A looking for entry-level position in the Myrtle Beach-Wilmington area.

I have a Bachelors of Arts in Business Technology Administration, customer service experience, and knowledgeable of IT support. I also have Practicode experience.

Attached is my resume.
Email me at SharonMarieWest@gmail.com if you have any questions.

Attached Files

Medical Coder Resume.doc (31.0 KB)

CPA-A Resume for Myrtle Beach-Wilmington area

Need help with vaginal occlusion

I do not have the op note yet as the surgery has just been scheduled.
But the patient has a vaginal occlusion and the doctor will be opening this up.
Has anyone coded this or have an idea which direction I should look?

Need help with vaginal occlusion

Icd9 trouble

I'm embarrassed to say that although I passed my CPC in May, I did not do well on the ICD9 section. I do not know why. I don't know if I had the right codes just sequenced wrong or if I was completely wrong. In addition, this week I received a call for a remote position I applied for. They sent me a test. If I had passed with a 90% I would have had the job. Unfortunately, I did not score high enough. Again, it did not seem hard. It was all diagnosis codes. I reviewed the guidelines as I answered and read and watched for notations in the tabular as well. I do not know what I am doing wrong. Im afraid to apply anywhere else remote or on site for fear I make a fool out of myself. I am worried and don't know quite what to do to figure out what I'm doing wrong. Any suggestions that could help me would be much appreciated. Thank you.

Icd9 trouble

ASC Surgical Assistant

I am new to ASC billing and I think I know the answer to this question, but I am going to ask anyway. We have a physician owned ASC and we perform Stim Implants in the ASC (CPT 63685 and CPT 63650 x 2). We also use a PA as an assistant. We are billing out CPT 63685-AS on the pro fee side and wonder if we can/should be billing it out on the ASC Facility side.

Any direction would be much appreciated.

Thanks

ASC Surgical Assistant

Coding Buddy

Anyone would like to share coding discussions via phone/Email/Face to Face, leave contact information. Outpatient coding (any topic from Cpt Px to Modifiers to specific (excision skin lesions,etc). Live in NE Penna area.

Coding Buddy

Wrong sperm or egg used in infertility procedures

What diagnosis code(s) would you use to describe the situation of either the wrong sperm used to fertilize an egg or the wrong egg implanted in a woman undergoing an infertility procedure?

Wrong sperm or egg used in infertility procedures

Newborn discharged to wrong person

Very unique situation... what diagnosis code would you use to indicate a newborn was discharged to the wrong person?

Newborn discharged to wrong person

Add on Lab Tests

Hello,

If you have an add on Lab test, what date of service should you be billing the add on Lab? The date the blood was drawn and originally sent in or the date the Lab test was ordered?

Thank you!

Add on Lab Tests

Need expert advice

Hi,

I have a question about an incident. If a coder takes an adjustment of $1,000 instead of $10.00 which might be by mistake or by will, does it comes under HIPAA violation or compliance issue. Please suggest and providing documentation to support your view is highly appreciable.

Need expert advice

Prosthetic Billing Resources

I'm looking for resources to learn about prosthetic billing. If anyone knows of online resource or are familiar with prosthetic billing, would like to learn what I can. Any sources would be appreciated.

Thanks.

Prosthetic Billing Resources

ICD-10 proficiency

How long after passing the ICD10 proficiency test does it take to show up in the verification results?

ICD-10 proficiency

Planned return to OR

May we get further clarification on this scenario. Our provider performs surgery with the intent of a planned return to the OR at a later date. It is our understanding the patient visits in our office between those two surgeries are still under the initial Extender for active treatment.

Is this correct?

Thank you

Planned return to OR

CPT code 11750

Can this code be used with E/M code?

CPT code 11750

Cooper Thomas and 1099 employment

Has anyone worked with Cooper Thomas LLC and can you provide me any insight on the company. I have interviewed for a part-time remote position and want to make sure I'm not being scammed in anyway. They say they are new to coding and have a contract with the VA Hospitals.

I was also wondering if any one has any experience working as a 1099 employee. Makes me nervous. Anyone have any advise on this?

Thanks!!!

Cooper Thomas and 1099 employment

DGN for 4week old

Help! What would the admit diagnosis be an infant fell off bed?

DGN for 4week old

COC vs CBC

I have been a CPC for over 17 years. I would like to return to this field. It has been 10 years I am 59 years old and I would like to work remotely I am looking to improve my skills and I am going to study for COC or CBC. In your opinion what is the job outlook and demand for either. Live in Florida.

COC vs CBC

Multi DVT Veins-ICD-10 DX

If a patient has DVT of common femoral, superficial femoral and popliteal veins of LLE is it proper to code for all of them?

Multi DVT Veins-ICD-10 DX

Billing mod -50 in an ASC

Would anyone know how a claim from an ASC should be billed for a procedure code like 69436, where in CPT it states to use -50 to report bilateral procedures? In SE1422 there is a caution note that states:
Providers and suppliers, other than ambulatory surgical centers (ASCs), are reminded that Medicare billing instructions require claims for certain bilateral surgical procedures to be filed using a -50 modifier and one unit of service (UOS).
But if billed as two line items or with a unit of 2 then it hits a MUE edit, with a MAI 2.

ASC billing is not something I am familiar with so any help would be appreciated.

TIA

Billing mod -50 in an ASC

37236 and Remit Code B15

Anyone else have any issues with 37236 paying? Every single one I bill out comes back with: { B15 } - This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. I then appeal with the procedure report and it pays every time. Am I missing something initially?
Thanks!

37236 and Remit Code B15

"Infected laceration repair"

Patient presents to ED with knee pain and swelling, S/P laceration repair 3 days ago.

Clinical Impression is "infected laceration repair, right knee."

From what I'm reading (granted, it is an ICD-9 Coding Clinic), the coder "should assume that the wound is the problem and the source of the infection rather than the surgical technique" IN THE ABSENCE OF ANY DOCUMENTATION TO THE CONTRARY.

Because he clearly says "infected laceration REPAIR," am I okay to code to "Infection following a procedure, initial encounter" (T81.4xxA) with secondary of "local infection of the skin and subcutaneous tissue, unspecified" (L08.9) to identify infection?

Am I interpreting and applying this correctly?

Do I require a code for the active treatment (subsequent encounter?) of the original open wound? Otherwise, you really have no idea WHERE the original wound was. However, definition of "subsequent encounter" states "receiving ROUTINE CARE" during the healing phase. Since it's infected, it would no longer be "routine care," I wouldn't think.

Subsequent encounter (7th character 'D'): Used for encounters after active treatment for the injury has been provided and is receiving routine care during the healing or recovery phase. Examples of subsequent care: ...wound check...and follow up visits following injury treatment.

Thank you!

"Infected laceration repair"

Blocks

I need help on which CPT code to use for continuous adductor canal blocks?
I would normally use 64450, but i don't think that this covers continuous?
Would it be 64449?

Also, for the fascia Iliaca continuous blocks do you use 64448?

Thanks to all those you can respond quickly!!

Blocks

Achilles Rupture ICD10 code

We are getting our systems ready for ICD10 and have not been able to decide what ICD10 code we should use for a traumatic rupture of the Achilles Tendon. I have seen in the book that we are led to a very nonspecific strain code. Does anyone have a better idea? I thought the idea of ICD10 was to get away from these non-specific diagnoses. I appreciate you sharing your thoughts!

Achilles Rupture ICD10 code

Lexicode- Good company to work for?

Hi, I'm just trying to get some information on Lexicode. Are they a good solid company to work for or are they a chaotic mess like other remote coding companies? Do they have enough work to keep their coders busy?

Thanks!:)

Lexicode- Good company to work for?

diagnosis code for screening or diagnostic colonoscopy

I have read most of the posts for screening vs diagnostic colonoscopy coding, but I don't believe I read one with the conundrum that I have. The performing physician's H&P documented the patient's symptoms. No mention in this H&P that a screening was to be performed; just the opposite: Colonoscopy & BX with Assessment of: Constipation and he gave indications on the op note as: #1-Screening; #2 change in bowel habitis. My hospital coded this with the symptoms as the primary dx and as a diagnostic colonoscopy. Now we have received a letter from the performing physician requesting this be changed to a screening colonoscopy as just the colonoscopy was done- nothing needed a biopsy and dx of screening. the physician office also supplied us with the primary care physician's H&P where the patient was seen there earlier that has a late entry stating that"Patient was sent for screening colonoscopy. She denied any symptoms at the time the colonoscopy was ordered." Can anyone give me advice on how you would handle this case? Do you accept the additional documentation and change coding or do you abide by the screening coding guidelines?

diagnosis code for screening or diagnostic colonoscopy

Avn capitellar drilling

We need help trying to code a: CAPITELLAR AVASCULAR NECROSIS DRILLING on the Elbow.

Here is the OP Note:

PREOPERATIVE DIAGNOSIS: Right elbow Panner's disease.
POSTOPERATIVE DIAGNOSIS: Same.

PROCEDURES:

1. Right elbow arthroscopy and debridement.

2. Capitellar AVM drilling.

3. Three views of the elbow, AP and oblique.

ANESTHESIA: General.

INDICATIONS FOR PROCEDURE: The patient is an 11-year-old, otherwise healthy, history of elbow pain, found to have an area of avascular necrosis. Surgery was discussed in detail including risks included but not limited to risk of anesthesia,

infection, nerve injury, loss of motion, loss of function, need for reoperation, failure to relive symptoms, reflex sympathetic dystrophy, failure to relieve symptoms, avascular necrosis, growth arrest and need for revision surgery. The patient is aware of the risks and wished to proceed and mother gave consent for procedure.

INTRAOPERATIVE FINDINGS: Include some significant laxity in the entire elbow joint with some very shallow trochlear notch.

DESCRIPTION OF PROCEDURE: After signing proper consent form by the patient's mother, the patient was taken to the operating room, given IV antibiotics, underwent LMA general anesthesia. The patient was then positioned in the side lying position, padding all bony prominences. Proximal arm tourniquet placed. The hand prepped and draped in usual sterile fashion, Betadine solution, Esmarch exsanguination, inflation of tourniquet to 250 mmHg. Posterior and posterolateral arthroscopic portals were established. Posterior arthroscopy carried out. Joint was free of debris. There was significant laxity in both the medial and lateral joint _____ drive the scope through the ulnohumeral joint. On the posterior lateral joint, there was significant redundant tissue, scar tissue and inflamed tissue. A posterolateral arthroscopic portal was established and shaver brought into the joint. This was debrided free. Next, in the anteromedial joint, arthroscopic portal was established. The anterior joint was evaluated. The radiocapitellar joint was intact. There was definitely some laxity and I did not see any damage to the articular cartilage. Appropriate pictures were taken. Wound was thoroughly irrigated. Skin was closed using a 4-0 nylon.

Next, under fluoroscopic guidance, retrograde drilling of the capitellum was then performed percutaneously to the subchondral surface of the capitellum in the area of the avascular necrosis. This was done using a 0.062 K-wire x4 holes. Appropriate pictures were taken and felt to be appropriately decompressed. The patient tolerated the procedure well and was taken to recovery in stable condition.


I was able to find the Panner's Disease is Little league elbow due to overuse but i cannot locate anything in the coding book referencing the AVN CAPITELLAR DRILLING.

Thank you,
Melanie

Avn capitellar drilling

H&P requirements

We are having a discussion with our providers about the following scenario:

Pt admitted to Observation from ED. Same provider does the ED and writes an H&P for the Observation. Than the next day same provider/or provider from same practice admits the pt to Acute care. Patient is later discharged on a different day.

Question: if the H&P is used as the Observation note for that day, can it also be used for the Acute admit on the following day. Since the H&P has to be done within 24 hours, doesn't the H&P for an Acute stay start with the Acute admit date/time order.

They say the H&P should be allowed to cover the Observation and Acute admit. I am saying that the ED report can be used for the Observation admit but if they do the H&P on the Observation admit day than that day it is tied to that date's note. I say the H&P can't be used for both dates. It's double dipping. Am I wrong?

Thanks
Diann DoBran CPC, COC

H&P requirements

Iol without removal of cataract or lens

Please help one of the Dr.'s I work for tried to do a cataract removal with lens insertion when he started the procedure noticed the lens had fell back so all that was completed was a lens insertion. the op notes say No nucleus present, only white anterior cortex open posterior capsule cortex removed sulcus lens with optic capture

How would you code this.

Iol without removal of cataract or lens

T-Spine pain and T-Spine OA

My understanding is if there is a definitive Dx, but symptoms are also documented in the assessment part of the SOAP report, to ONLY code the definitive Dx.

T-Spine pain and T-Spine OA.

I just want to reaffirm that I'm understanding the guidelines - I should not code T-Spine pain (724.1) with T-Spine OA (721.2), correct?

I'm 99 percent sure that I do not code it, and if I'm correct, then this can just be used as a reference for future inquiries.

Thank you,

Chaim Zeitz, CPC-A

T-Spine pain and T-Spine OA

Tunneled line via superficial vein

How would you code this?
A tunneled line via superficial femoral vein?
PROCEDURE: LEFT FEMORAL DOUBLE LUMEN TUNNELED CENTRAL LINE
PLACEMENT


PROCEDURE: A limited ultrasound of the left groin was performed
to choose a site for insertion of the central line. The left
superficial femoral vein was chosen, and the skin of the left
thigh was prepped and draped in sterile fashion. Using real-time
ultrasound guidance, the left superficial femoral vein was
tunnel punctured with a 21g needle from the mid thigh via a
subcutaneous tunnel into the left superficial femoral vein near
the confluence with the greater saphenous vein at the groin. Once
venous blood was obtained an 0.014" hydrophilic wire was placed
into the vein and advanced to the central inferior vena cava. A
small dermatotomy was made and the 3 Fr peel-away sheath was
advanced into the vein. The distance to the cavo-atrial junction
was measured with fluoroscopy and guidewire subtraction technique
and a 2.6 F double lumen central line was cut to 15 cm. Via the
tunnel, the central line was placed into the vein and advanced
with fluoroscopic guidance until the tip was at the inferior
cavoatrial junction. The catheter was fixed to the skin with a
Stat-Lock device in the mid thigh, affixed to the device with
steri-strips, surgicel, gauze and tegaderms. The catheter
aspirated and flushed easily and was heparinized with 10 U of
heparin from a 1mL:10U dilution preparation in each lumen. The
patient left the IR suite in stable condition. Duskiness of the
left lower extremity was appreciated and pointed out to Dr
, Dr. was present for the entire procedure.

FINDINGS: A limited ultrasound of the left groin showed patent
left superficial femoral and common femoral veins. Fluoroscopic
spot image of the appropriately positioned central line at the
inferior cavoatrial junction was obtained and stored in the PACS
system.

IMPRESSION
Successful placement of a 15 cm, 2.6F double lumen
tunneled central line via the left superficial femoral vein with
tip at the inferior cavoatrial junction.

Tunneled line via superficial vein

ICD-9 code for Downwinders Syndrome

Hi all,

Please help me navigate ICD-9 code for Downwinders Syndrome. :confused:

Thanks,

Girish Dadhich

ICD-9 code for Downwinders Syndrome

ileostomy/colostomy takedown need help!

Hi fellow coders! I am new to General surgery and am in need of some help. This is my first big case and don't want to screw up. Maybe I am over thinking this. Can someone shed some light on this. Thanks in advanced!

Im thinking

44625, 44640, 15734-50.

Am i missing anything? :confused:


Here is the op note:

1. S/P multiple exploratory laparotomies due to perforated sigmoid diverticulitis
2. S/P ileostomy
3. S/P sigmoid colostomy and mucous fistula
4. S/P closure of abd wall with mesh


Operation:
1. Ileostomy takedown with primary end-to-end anastomosis using side to side functional end-to-end stapled anostomoses with GIA 75 stapler.
2. Colostomy takedown
3. Closure of abd wall hernia @ colostomy site measuring 15X10cm. Primary closure using bilateral mobilization of myofascial flaps of the internal oblique and transversus abdominis muscle via component seperation.
4. Excision of an enterocutaneous fistula to the inferior most portion of the midline incision with exsicion of the fistulous tract and the fascia, subquw tissues, and skin.

OPERATIVE PROCEDURE:

We started exploring the abd and the small bowel had to be examined Extensive adhesion were noted in the lowermost portion of the incision. At this point it was detected that there was a fistula arising from the defunctionalized segment of the terminl ileum.

This enterocutaneous fistula was excised and the portion of the terminal ileum where the fascial arose was divided with the GIA stapler. The fistula was excised all the way to the fascia, subq tissue, and the skin. The fistula specimen was passed to pathology. At this point, the small bowel was freed, the ilesotomy was freed from the adb wall and was dropped into the peritoneal cavity. A segment of the ileum was divided in order to reach the point where there is adequate blood supply. At this point, a small bowel continuity was established by performing a side-to-side functional end-to-end stapled enteroenterostomy using GIA stapler. The opening in the small bowel was closed using a 3-0 vicryl stitch and reinforced with interrupted silk. The rent in the mesentery of the ileum was corrected using a running 2-0 vicryl stitch.

Attention was then focused to the descending colon. The patient had a previous sigmoid colectomy. The colostomy was freed from the abdominal wall and dropped into the abd cavity. A large parastomal hernia was noted. The distal stump (hartmann's pouch) was also identified. This was also stuck to the abd wall and there might have been also a fistula between the hartmann's pouch and the abd wall. This portion of the hartmann's pouch was the divided and the specimen was sent to path. The descending colon was divided in half to reach a well vascularized segment. An end-to-end stapled anastomosis using a EEA stapler was performed. This was done in a reverse fashion were by the stapler device was inserted int the proximal and the anvil was placed in the distal end. The anastomosis was completed without any difficulty after it was dilated enough t allow the 25mm stapler. The open end of the descending colon was stapled with GIA stapler. The anastomosis was reinforced with interrupted 3-0 silk sutures. The rent in the mesentery was closed with vicryl running stitch.

At this point, a rigid sigmoidoscopy was performed. The examination was done. There were no intraluminal abnormalities. Air was insuflated into the rectum after clamping the descending colon. The integrity of the of the anastomosis was examined by filling the peritoneal cavity with water and no bubbles were noted from the anastomosis. Air was desufflated. 19 Blake drain placed into the pelvis around the anastomosis.

The attention was then focused to the parastomal hernia in the left lower quadrant. This is a large defect and could not be closed primarily. For this reason, the bilateral myofascial flaps were created by mobilizing both the internal oblique as well as the transverse abdominis fascia and muscle. They were both mobilized in order to allow primary closure of the fascia without any tension. This repair was done after adequate mobilization was performed so that the repair would be done without tension. The fascia was then closed using # 1 interupted figure of 8 suture. The subq tissues was copiously irrigated and the suq tissue above it was approximated with 2-0 vicryl.

Similarly, the ileostomy site defect was closed primarily with sutures. Sub tissue was approximated with 2-0 vicyrl and skin was approximated with staples.

Finally, the abd wall was refreshed, all the previous scar was excised including the portion of the enterocutaneous fistula. Fresh healthy well vascularized edges were encountered, The abd wall was then closed in a single layer using # 1 looped PDS. The subq tissue was irrigated and the skin was approximated with staples.

ileostomy/colostomy takedown need help!

Billing for overflow (SDV)

Anyone can provide a reference that clearly states whether or not an overflow is billable?

Example: The pt receives 46 mg of Taxotere out of 40mg SDV (6mg is an overflow obtained from the same vial).

Thank you

Billing for overflow (SDV)

Question on Discharge

Hi! I would like help in clarifying a situation.

8/17 ? MD sees patient. MD enters discharge order at 19:55. MD dictates discharge summary @ 20:18. This includes a statement under Physical Examination that says ?Relatively unchanged today.? and under FollowUp a statement that says ?The patient is going to long-term acute care at . . . ? The LTAC facility is several hours away and sends their own transfer service to pick the patient up.

8/18 ? Transfer service arrives on site @ 00:47. Patient registration/encounter is closed @ 01:22. The MD did not see the patient at all on this date.

When the discharge summary is transcribed, the admit and discharge dates at the top of the summary are auto-populated through the system with the dates the patient?s registration/encounter was opened and closed. Thus, showing the patient?s discharge date of 8/18 because that is when the patient physically left the facility.

Our coding department says the coding world says they cannot bill the discharge on either date without the MD doing an addendum discharge summary to clarify that he saw and discharged the patient on 8/17.

Your time and consideration in reviewing this case would be very much appreciated!

Thank You!

Question on Discharge

Screening code

i'M CONFUSED. IS THERE A SPECIAL SCREENING CODE TO USE WITH COLONOSCOPY 45378? OR CAN i USE THE V76.51?
THANKS

Screening code

Codes by Specialty

Is there any way resource that breaks down codes by specialty? Thanks.

Codes by Specialty

ICD-10 External causes codes

I have a report that states "MVA; Car fell on patient"... I normally use V89.2XXA for MVA, but is there a code for a car falling on the patient??

Also, can you use more than one V code? Would this possibly be a case where 2 V codes would be used?

Any and all help is appreciated!

ICD-10 External causes codes

Coding 33020 with AVR and CABGX3

Hello!
I code and bill for a group of assistant surgeons who primarily do cardiac procedures. We need to bill the same CPT's as the primary to get paid. Before billing, however, I need to make sure the codes are accurate. The op report states there were extensive intrapericardial adhesions and the primary's coder used 33020 Pericardiotomy for removal of clot or foreign body (primary procedure). I don't believe that would be the proper code for adesiolysis or if it should even be billed separately.

Can someone give me a little help here and possibly steer me in the direction of the proper code, if there is one?

Thank you so very much!!
Jackie

Coding 33020 with AVR and CABGX3

Filshie Clip Question

Hi,

I have a question regarding the occlusion of fallopian tubes by Filshie Clip during a C-section. My concern is that while the code for the occlusion (58615) exists, there is no code for this procedure during a c-section. CPT code 58611 is an add on code for the ligation or transection of fallopian tubes when done at the time of cesarean delivery but I don't believe I can use this code for an occlusion by Filshie clip. Can anyone else offer any advice for this scenario? I was thinking of using modifier 52 (reduced service) with 58615 but I am uncertain. BCBS will not pay for 58615 when the patient is an inpatient (POS 21) they indicate a prior auth is needed.

IS ANYONE ELSE having a problem with this issue?

Please advise.

Thank you,
Lorri

Filshie Clip Question

Coding Manager needed in Portland, ME

Maine Medical Center in beautiful Portland, Maine, is seeking Clinical Coding Manager with solid leadership experience. This is an excellent opportunity to lead a growing team of experienced Coders as we transition our organization to ICD-10.
Job Description:
This position manages HIM?s Clinical Data Section, which is accountable for:
 Coding and abstracting the medical records of inpatients, ambulatory surgery, urgent care, observation and outpatient clinics
 Preparing statistical analysis of medical records data
 Compiling, analyzing and summarizing data from medical records into various formats.
The output of the Clinical Data Section is used for:
 Meeting hospital licensure requirements
 Financial and billing purposes, which includes the identification and determination of appropriate reimbursement under inpatient and outpatient prospective payment systems
 Maintenance of acceptable accounts/receivables and DNB levels
 Compliance with internal and external regulatory agencies, such as Quality Improvement Organizations, the Centers for Medicare & Medicaid Services, and JCAHO.
The position also coordinates hospital DRG activities through chart reviews, DRG validation activities, and provides information and reports to fulfill requests made by members of the medial staff, administration and planning.
Required Qualifications:
 Full working knowledge of: medical information and revenue cycle systems; Grouper and Severity of Illness Systems; medical record systems, medical terminology, anatomy, physiology, pathophysiology, microbiology, and pharmacology; State, Federal and JCAHO requirements pertaining to medical records; DRG prospective payment system.
 Have current coding certifications for ICD-10. Skilled in ICD coding and case mix index management. Experienced with EPIC, HP CDM, claim edit processes, 3M encoder and CDI programs. Prior CAC and Lawson a plus.
 A minimum of four years prior successful supervisory experience. Advanced education which should include communication and mathematical/statistical skills and/or extensive knowledge in organization, research and analysis normally acquired through the completion of Health Record Administration/Science Bachelor?s program with certification as an RHIA and coding credentials (CCS, CPC). Credentials are a job requirement and RHIT may be substituted for RHIA credentials provided held in conjunction with CCS and CPC certifications.
 Demonstrated abilities to: correctly interpret and apply Federal regulations and PRO requirements in the assignment of DRG?s, APCs and in the interpretation of various billing guidelines (i.e., medical necessity, resident supervision policies, correct coding initiative, etc. Ability to direct concurrent and retrospective coding reviews and provide physician education for the roll-out of ICD-10 CM and PCS.
 Effective skills in leadership, communications, coaching, planning, motivation, and establishing effective working relationships with at all levels of staffing in the organization.
Those interested, please contact:
Amber Baxter, Talent Acquisition Partner
P: 207-662-6318 E: abaxter@mainehealth.org

Coding Manager needed in Portland, ME

How do I bill for blood draw for BRCA gene testing?

Pt was seen for an e/m plus the blood draw. How do I bill it?

Aetna Better Health denied all of these:

99214, 25 and 36415
99214,36415
99214,25 and 36415, 59


They said that there should be a modifier next to 36415. I do not know which one to use.

How do I bill for blood draw for BRCA gene testing?

billing MNT with CMS 180.1 edit

I am working on clearing edits for Medical Nutrition Therapy codes that are blocked by an edit: Per LCD or NCD guidelines, procedure code 97802 (97803, 97804) has not met the associated provider specialty relationship criteria for CMS ID(s) 180.1.

Is there a modifier that indicates the number of approved visits has been met and to allow the code to pass the edit?

billing MNT with CMS 180.1 edit

Medicare covered Labs

Does medicare cover for preventative yearly labs? If so what DX do you use.

Medicare covered Labs

UB04 claim form

Does anybody know if the UB04 claim form is changing for the ICD10 code or will the current one take all the digits??

Sheila, CPC

UB04 claim form

Psychiatry Consults in ED

I was hoping someone might know if a clinic-based Psychiatrist is doing consults in an Emergency Department what CPT codes would be appropriate. I have found information stating that the ED E&M codes (99281-99285) could be used. I have also found info stating 90791/90792 can be used. We are currently utilizing outpatient E&M codes 99213-99215 - but it seems that there are other more appropriate codes that would provide more revenue for the extensive work this requires. Thanks in advance for any info you might have!!

Psychiatry Consults in ED

25447 with Tendon Transfers

We are getting denials from 4 insurance carriers when we bill out either 25447/26480 or 25447/25310. They are paying the CMC arthroplasties but denying the tendon transfers. Is anyone else out there experiencing the same problem? We have appealed with evidence that these code pairs are not bundled or inclusive and should be reimbursed. Again, only 4 insurance co's denying who use the same claim scrubber vendor...wondering if that is the issue... Help!

25447 with Tendon Transfers

Hpi and elements

Can you pull and element from PFSH and add it to the HPI to get 4 elements?

Hpi and elements

Testing in Houston

I have had quiet a few requests and inquiries from members in Houston who are trying to get their test in by the end of the year - seats are booking up fast and test locations are full.

I would be willing to proctor and set up additional test dates. I am challenged in finding locations and rooms. I am working on that now. Would anyone have a room that is suitable for a testing situation they would be willing to offer to our members here in the Houston area for a test site?

Thank you for your assistance and help!!!

Testing in Houston

Soap Notes

When the physician has 1 diagnosis under the assessment/diagnosis portion of the note, but list 3 diagnosis codes on the encounter sheet do I bill the 3 as long as he mentions the other 2 in the patients HPI, past medical history, or do I just bill the 1 that's under assessment/diagnosis portion of the note? This confuses me! :confused:

Soap Notes

CPT code for diabetic foot scan and mapping

Hi all,

Please let me know what CPT code to use for foot scan for diabetic patients. We work for UAE hospitals and need this code both in CPT 2011 version and CPT 2015 version.

Thanks for the help.

Regards
Ramya Vincent

CPT code for diabetic foot scan and mapping

Va and GA Medicaid programs

Hello All,

i am with a pain management group in TN. We accept Georgi medicaid in out Chattanooga office and VA medicaid with a few MCO's in our Jihnson City office. ia m having problems with Intotal Health, a medicaid plan. Do they accept the new lab commercial codes or the G codes? If I bill the commercial codes, I will need authorization. if I bill the Gcodes, I will not. There is no specification in the providers manual or the newsletter.

Connie

Va and GA Medicaid programs

Remote Coding No DSL or Cable

I am wondering if anyone knows of any options for coding from home when your area does not have DSL or Cable?

I have just been offered a job but now I'm not sure if they will even keep me on because I cannot find a DSL provider! What a heartbreak!

Remote Coding No DSL or Cable

67917 coding help

Scenario - Physician has turned in these codes for one operative session on left eye (ASC facility):

67917 E1 ($800)
67917 59 E2 ($800)

Question - Can 67917 be coded twice for one operative session on one eye?

Richard Mann, CPC

67917 coding help

Abdominal seroma cavity

Any ideas on a CPT code for excision of a internal abdominal seroma cavity. Patient had plastic surgery and this has become chronic. I am looking at 49000, because it is more involved than CPT 10140. Thanks for any help.

Abdominal seroma cavity

Telemtry

what is the telemtry code when a doc sees a pt in the hospital
thanks so much

Telemtry

Mdm

I am still just a little confused by MDM. When taking into account the # of points that can be given for data to be reviewed when reporting SHC, can labs from the previous day be counted as long as it is documented and is being used to influence treatment decisions? This is when the same data was already included in the inpatient follow up from the previous day.

Mdm

New Gastro ASC

Hello. I am new to billing for an ASC. Our gastro practice is opening an ASC soon. Do I bill facility charges on a UB04 forms for all payers for the ASC? So if I have a procedure 45378 I will bill my physicians services on a CMS-1500 with my practice tax id and 45378 for the facility on UB04 with the ASC tax id?

Thanks for the help.
Lori

New Gastro ASC

Using CodeRyte for ICD-10 coding

Is anyone planning to use CodeRyte computer-assisted coding for help with ICD-10? We have used CodeRyte for years but we are getting NO ICD-10 codes from them at this time with no estimates for when it will be working. :eek:

Using CodeRyte for ICD-10 coding

Virtual interview???

I applied and tested for a remote coding position and now I received an email to complete a digital virtual interview! I've never had an interview like this before, apparently its not a live interview with an actual person. Has anyone had to do this before? Any info at all would be helpful.

Thanks :)

Virtual interview???

Confused w/ modifiers to apply

pls help. im not sure which modifier to apply w/ multiple procedures done.

ex:

J1050
G0101
99213-25
96372

:confused::confused:

Confused w/ modifiers to apply

97 General Multi-System

Question, there is a debate that I've been hearing with the 97 Multi-System Guidelines. To get a Comprehensive Exam you need 2 elements identified by a bullet from each of nine areas/system, right? On the Lymphatic exam there is one bullet (palpitation) with four "sub-bullets" Neck, Groin, Axillae and Other. From one point of view it is viewed as only one element available from the lymphatic area, whereas others view it as four opportunities for elements. Aka, if Lymphatic has Neck and Axillae selected and 8 other areas have two elements selected does that give a comprehensive exam or can Lymphatic only be counted as 1 element thereby making it detailed instead of comprehensive? :eek:

If you have an actual source (CMS or other) please include!!! :D

THANK YOU!!

97 General Multi-System

99307 is this appropriate for billing inpatient

Patient is an inpatient in an SNF wing of the hospital. One hospitalist says we have to bill 99307 and another hospital states we just bill a 99233. Confused as to which must be coded. Please advise and direct me to some concrete diaglog to back up your advise. Thanks.

99307 is this appropriate for billing inpatient

95076 Ingest Challenge

If a duration for this test is over 60 minutes but less than 2 hours based on the threshold for code 95076. What do we code? I know it states per CPT that if the test is less than 60 minutes default to an E/M code but if it's in between duration, what are we to do? I have done a web search and cannot find an answer for this.

Feeling frustrated...:(

95076 Ingest Challenge

ICD10 Urine Drug Screening

I'm trying to make a list of some of the more common nursing diagnosis codes for our clinic. We do a urine drug screening on most of the pregnant women. We are testing for meth, marijuana, etc... I don't know if they have a dependence, even if positive. They may be an occasional user, non-dependent. And if its negative, there is definitely no dependence. We screen urine, not blood. I'm hitting non-truths in every code I find. Any suggestions?

Thanks!!!!

ICD10 Urine Drug Screening

Pt own drug supply-what modifier to use

When pt comes in for any injection with their own supply. what modifier do I use? ex:

J0561
96372

J1055
96372

:confused::eek::cool:

Pt own drug supply-what modifier to use

post op diagnosis codes

do I code a v code for a post op visit after surgery or do I code the dx code for the surgery then the v code?

post op diagnosis codes

Multi-Procedure Discounts

Hello!

I work in an office alone and I need to bounce this conversation off of other professionals.

Background:
My provider is only contracted with Medicare, Medicaid, and BCBS. All other payers are out of network; however, we do still accept and treat patients under their out of network benefits.

The majority of procedures performed are inpatient and non-elective (neurointerventional diagnostic and treatments - angiograms, thrombolysis, embolizations, etc). We also have an incoming referral base of outpatient and elective inpatient procedures.

The debate:
My provider has the opinion that we should not be subjected to the "multi-procedure discount" because we do not have a contract with the payer. The majority of commercial payers, especially those who follow CMS guidelines, do have a multi-procedure discount policy for non-contracted payers. For the payers that we are contracted with, there is not any argument over the discount.

I have tried explaining that even though the provider does not have a direct contract with the payer, the patient we are treating does. And when we agree to accept a patient with a non-contracted payer, we are agreeing to accept the terms and conditions of that patient's policy. Most non-contracted payers do allow for the balance billing of the multi-procedure discount and the provider has instructed me to bill the patient, not with an expectation that the patient will pay, but rather in hopes that the patient will call their insurance and have the claim reprocessed for full payment.

Note: Per our state laws, I do appeal claims that are processed towards the patient's out of network benefits for emergent procedures and request that the claim be reprocessed at the in-network benefit level. I am successful in most of these; however, the multi-procedure discount is still applied.

My Questions:
1) Can non-contracted providers challenge the multi-procedure discount?

2) Is it an efficient and effective policy to bill the patient so that the patient contacts their insurance payer to request a claim review/reconsideration? Why or why not?

3) What are your office policies on balance billing the patient for the multi-procedure discount when you are non-contracted, for both emergent and elective procedures? Do you notify the patient that they will be responsible for the non-covered service or is it your policy to write-off the non-covered service as an insurance adjustment?

4) Is there an alternative way to approach this subject with my provider?

I appreciate your time in reading this as well as for offering your feedback.

Thank you!

Multi-Procedure Discounts

Musculoskeletal Exam bullet points

I have a question about the musculoskeletal exam the Provider wants a 99204 so to qualify for 2 bullet points in 9 systems I was wondering if anyone would think that this would qualify as a bullet point for Musc Exam.
Provider documented:
Normal Range of Motion. She exhibits no edema, the edema would be used for the Cardiovascular System so that's 1 bullet point for musc. She also has Head: Normocephalic and atraumatic - would this qualify as a bullet point for the musculoskeletal system?

Any thoughts would be greatly appreciated.

Musculoskeletal Exam bullet points

Initial hosp. Care e and m

This is going to sound like a beginner question BUT here goes. What is already know.....If a patient as admitted as an inpatient, the admitting physician would bill 99221 thru 99223 depending on the key components....The lowest E & M for an inpatient admission is 99221 which is a detailed or comprehensive history, a detailed or comprehensive exam, and medical decision is strightforward or low..Being :confused:intital hospital care 3 out of 3 key components have to be met....My question is...what if the admitting physician does not meet all the key components for even the lowests Initial Hospital Care E & M...Like say the History was only expanded problem focused. The admitting physician does a expanded problem focused hsitory, a detailed exam, and straightforward medical decision making...they did not meet the criteria for a 99221...would they bill a subsequent 99231, instead of an initial, which they do meet??

Initial hosp. Care e and m

Hipaa

Is it ok to send medical records to an attorney under a NON-Secure website/email? I think this would be a HIPPA violation even if the patient signs a paper stating there medical records can be sent out.. Am I correct. Please help. Thank you

Hipaa

Bilateral Pelvis Orthopaedic coding 72170

Good Morning, Hope all is well with each of you. Does anyone have the guidelines for coding 72170 bilateral, is it one code when there are 3 views? Modifiers? Any insight is very much appreciative!:D
Thanks

Bilateral Pelvis Orthopaedic coding 72170

Help Newbie!

How would you code this?

Abdominal aortogram with bilateral lower extremity runoff. (75630?)
Selective left lower leg arteriogram. (75710?)

Also when would you use the 3,000 codes? :confused:

Help Newbie!

Seeking remote coding position for RN, CPC-A, ICD-10-CM, E/M Auditing and Abstracting

I am an RN with the credentials of CPC-A, ICD-10-CM, E/M Auditing and Abstracting, and currently enrolled in a COC class. I graduated the medical billing and coding classes as the top student. Although I do not have experience yet in medical billing and coding, I have several years of experience in the medical field in front office, back office, and hospitals. I am independently motivated and a very quick learner. Ideally I am seeking a position as a remote coder either part or full time.

Attached Files

Coding resume txt.txt (2.8 KB)

Seeking remote coding position for RN, CPC-A, ICD-10-CM, E/M Auditing and Abstracting

office visits vs outpatient visits

If a pt is seen in the office for a pcp and admits it to the hospital the same day, can a Dr charge an admission?
Thank you ;)

office visits vs outpatient visits

Part Time remote coding wanted

Good evening,

I am pretty new to having my CPC-A and I am struggling to find a job utilizing my coding knowledge since I do not have experience. I would love to work part time to gain that experience 15-20 hours a week working in the evening. If you have any leads I would appreciate it. Email me at courtnie.gonzales@gmail.com.

Thank you in advance
Courtnie

Part Time remote coding wanted

MDM- Risk Table

I was wondering if you could give me your feedback in regards to the MDM - risk table portion.

A patient comes in with an acute complaint of Otitis media and is prescribed meds.

New problem w/ no work up (3 pts)

Data to be reviewed is 0 pts.

But on the risk section - would it be counted as moderate because of the med Rx? or low because it is an acute problem and the medication is included in the treatment of the acute/ uncomplicated problem?

Thank you for your help.

Leslie Pou :confused: :rolleyes:

MDM- Risk Table

displaced vs. non displaced

Patient seen in the ER and displaced fx was reduced.

Told to contact our office, so this is patient's initial visit to us.

The question is now that it is no longer displaced, do we code it as a non displaced fx or displaced, going with the original diagnosis?

Displaced fx's that have been reduced, do often re-displace. It might seem odd to code our initial visit as a non displaced fx...only to have it displace again and then we are back to a displaced dx...which the patient initially received tx for in the ER.

I'd like confirmation it should be a displaced dx at the pt initial visit to us.

Thank you

displaced vs. non displaced

Reimbursement for Translators

I was wondering if there is a code or some way to be reimbursed for our cost of having a translator, specifically a sign language translator, for patients who require one. The cost of the translator is more than the reimbursement we receive for the office visit.

Reimbursement for Translators

Pmi cmc

Hi,
Is anyone here also certified through PMI? I was wondering if they have an ICD10 mandatory test like AAPC does. I was looking at their website, and I didn't see it.
The company I work for has made us all take a CareerStep ICD10 course. I was just wondering if any other coders have had to do this through their company.
Thanks,
Kj

Pmi cmc

Medication Management

Our providers had used the M0064 (Brief Medication Management) in the past before it was deleted. One of our providers has decided to "fast-track" his patients and charge a 99212. He will review the patient's UDS results and the MA's notes of H/P. Can we bill a 99212 for him if he never actually "sees" the patient face to face?

Thanks so much!

Medication Management

billing antepartum charge for Alaska Medicaid

Can anyone who has billed for Alaska Medicaid tell me if there are special codes for billing seperate antepartum charge? We have billed 59425 for one patients antepartum charges which was denied as a non covered code.

I have called Alaska Medicaid and all they tell me is that they can not tell us how to code and I have not been able to find anything on their web site offering information for antepartum billing.

Help Please!

billing antepartum charge for Alaska Medicaid

Modifier GT - Telehealth Services

Medicare just started allowing modifier GT for wellness exams (G0438-G0439) as of 1/1/15. Does anyone know if the commercial insurance companies or state medicaid plans (I'm in Oregon) followed suit and now allow modifier GT on the routine exam codes 99381-99397?

Modifier GT - Telehealth Services

PM&R coding

Would a new patient visit for a knee fracture injury, for rehabilitation or pain management, be considered an active treatment visit? What if the patient was seen 6 weeks or 6 years after the injury occurred?

Thank you,
Sue
suebrock17@gmail.com

PM&R coding

Modifier 33

Can anyone shed some light on Modifier 33? Do use with all insurances and does it go with all vaccines.

Modifier 33

Modifier GT - Telehealth Services

Medicare just started allowing modifier GT for wellness exams (G0438-G0439) as of 1/1/15. Does anyone know if the commercial insurance companies or state medicaid plans (I'm in Oregon) followed suit and now allow modifier GT on the routine exam codes 99381-99397?

Modifier GT - Telehealth Services

OB billing for H&P

I have a question regarding billing for OB care. My doctor delivers babies but doesn't do C/S...so my question is my doctor has a patient that ended up having a c/s but he did the H&P on the same day that she had the c/s. Can he bill for the H&P that was done on that day?

OB billing for H&P

modifier 52

I am trying to find updated information regarding using modifier 52 on the original surgery CPT code when the chest is left open and then a few days later the patient goes back to the OR for sternal closure. Does anyone have anything that is current where it states that the modifier 52 must be used?
Thanks

modifier 52

Directed CRNA with Retrobulbar Blocks

I'm not sure if I'm billing these right. So when our patients have these cataract procedures the anesthesiologist does the eyeblock and the CRNA does the MAC. I've been billing the time for the eyeblocks and not the 67500 code separately since it is inclusive to the MAC. I've been billing the MAC for these procedures using the Q modifiers and for the eyeblock since it is done by the anesthesiologist only with AA:

00142,QX,23,QS (for MAC)
00142,QY,23,QS (for MAC)
00142,AA,23,QS (for the eyeblock time)

I'm not sure if this is correct. Should the time for the eyeblock be included with the 00142,QY,23,QS even though the CRNA is not doing the eyeblock or should it be separate using the 00142,AA,23,QS?
:confused:

Directed CRNA with Retrobulbar Blocks

Trigger Point question

Hello!

We've been having issues getting our trigger points paid by Medicare. They pay one level, but if it's bilateral or an additional level we've been having issues getting them reimbursed. We've tried using the '50' modifier as well as the '59' modifier. Has anyone else come across this issue? If so how did you rectify it? :confused:

Thank you!
Sami

Trigger Point question

CPT code 90460

Staywell Medicaid is denying this code as not being covered because of not being on the fee schedule. Has anyone else had this problem, and where can I find this information, because when I pull it up on the Medicare website it is on the fee schedule?

CPT code 90460

Locums NP/PA

Just wondering if anyone can give me some info on how to handle/bill for Locums NP/PA.....?

Locums NP/PA

Clotted avg help pls

1. Catheterization of the subclavian vein with image.
2. Catheterization of the brachial artery with image.
3. Mechanical thrombectomy of the arteriovenous graft.
4. Angioplasty of the arterial anastomosis in brachial artery.
5. Angioplasty of the vein graft anastomosis with stent placement for stenosis.
35475, 36011, 36215, 37187, 37236
I DON?T THINK 35475 SHOULD BE CODED AS IT IS INCLED IN 37236?
:confused:

Clotted avg help pls

IOP question

Hi,
One of my providers now wants to do IOP in his private practice. I am not sure that a private practice can do IOP in his office? Does he need to credential his facility as an IOP facility instead of office? And what the place of service would be? 22?

IOP question

Resume focused on Ped's

Maureen Radu
10785 Hillsboro Circle
Parker, Colorado 80134
Home: (303) 805-1241
Cell: (303) 349-8985
Email: moemoe@jps.net

Objective
To be a value added contributor of the medical coding staff at an established and reputable medical office.

Certifications
CPC ( Certified Professional Coder from AAPC)
ICD-10 Proficiency Exam

Education
Graduate of the CPC course offered through AAPC March 29, 2009.
Trained in ICD-10-CM, ICD-9CM, CPT, HCPS, medical terminology, anatomy and physiology.

Pasadena City College, Pasadena, California
Major-American History, 1977-1979
GPA 4.0

Work Experience
MoeGems, LLC-Owner (December 2013-present)
I create personal gem and crystal pendents.
Make each order, maintain proper accounting books.
Package and mail each order personally.
Maintain a website and all functions associated with it.
Sell additionally on two other website locations.

Dr. Carol Walker,M.D.
South Pasadena, CA.
Certified Professional Coder (January 2013-June 2014)
Abstract all necessary information and assign proper ICD-9CM
codes.
Review and assign the CPT codes and correct if needed.
Worked remotely with clinical staff and maintained files in
accordance with HIPPA rules and regulations.
Participated in all staff workshops, earned approved ceu's.

2002-2013 Moved to Colorado in late 2004 job transfer for Husband.
From 2009-2013 I have been taking care of aged parent,
Moved twice more for Husband's job and also moved aged
parent.





Weight Watcher's-Center Manager (September 1992-2002)
Customer Service to Members, weighing and processing for
meetings.
Performed opening and closing computer procedures, balancing
receipts and monies.
Maintained Member's records, ordering Center supplies.

California State Bank-Assistant Operations Officer (March 1985-1989)
Maintained staff of 30 employees
Responsible for all customer banking transactions
Maintained Vault cash control
Oversee day to day bank operations
Wrote and conducted employee reviews

Southland Bank-Administrative Assistant (March 1981-1985)
Responsible for ADP payroll, wire transfers, bank investments,
Fed Funds, Fixed Assets and Account Payable.
Maintained all employee files, new hires and processed
insurance claims.
Computer Skills-
Microsoft, Linux, Internet, Email.

Organizations-
Current Member of AAPC

Other interests/Hobbies-
Growing Heirloom tomatoes, reading, follow advancement in
Aviation, Civil War buff, Early American History and earthquakes.
WWW.MoeGems.com
WWW.etsy.com/MoeGems
WWW.USGS.gov
WWW.NTSB.gov

Resume focused on Ped's

ICD-10 Coding questions

Please help! I know it's a lot to ask, but I need answers, I've tried getting them on my own, but need someone's expertise...
1. Does a well exam include vision & screening? Do I use Z01.00 only or what other?

2. For aftercare follow-up (pt. d/c from hosp.), do I use Z09?

3. What code do I use for surgical clearance? Do I code as a well visit with a pre-op diagnosis?

4. With 10, can we bill for nurse visit encounter? If nurse gives immunization, willl I only use Z23?

5. If a procedure billed is linked to 5 or 6 dx. codes, will I have to enter the procedure again on a second line to add the rest of the dx. code units? Since the CM1500 form can only hold 4 digits in the unit section (with zero charge, of course).

6. As a provider once asked me, where is the Pediatric bible for ICD-10-CM & where can I get one? Could this be the AAPC Coding for Pediatrics manual? When will it be available for purchase?

Audit question: With I-10, are auditors looking for something different than I-9? & how can I help my Dr. so we can make every effort possible to not get ding?

I know it's a lot of information but I am currently working with a Pediatrician & this field is completely new to me.

ICD-10 Coding questions

medicare SNF reimbrusement

Hello can someone advise me what SNF reimbursement is for Part B to physicians is it still just 80% the nursing should pay us or is it the full Medicare fee and if you can provide link.

Thank you
Bernadette

medicare SNF reimbrusement

CPT Code for Earwell?

Hi! I am hoping someone might have success in billing for an earwell. We have been using unlisted code 21089, but this is not accurate since an earwell is not a prosthetic, it's an ear mold that is placed temporarily to reshape the external ear. I'm wondering about 69399, another unlisted, but it seems more fitting than the other. Any ideas or suggestions would be appreciated. Thank you!

CPT Code for Earwell?

V84.01 as primary DX

Help... I am looking for a way to bill V84.01 (Genetic susceptibility to malignant neoplasm of breast) as a primary code when it is the only diagnosis given. There is no official dx of breast cancer. Any suggestions.

John Baader, CPC-A

V84.01 as primary DX

Intralesional Injections with MMR

Is anyone doing intralesional injections into warts with the MMR vaccine? If so how are you billing the drug code and do you have any feedback on reimbursement?
Thanks!!

Intralesional Injections with MMR

E&M and colonscopy

Anyone know where I can find documentation on billing and E&M for a screening colonscopy to medicare. I need to show proof. Thanks

E&M and colonscopy

Need ICD9 codes

Hi fellow coders, can anyone help me with ICD 9 codes for the following.

Levator ani syndrome

and

Pelvic Floor tension myalgia

Thank you, Robin

Need ICD9 codes

Help with ICD 9 Code

I am having a hard time finding a good dx code for intramuscular chronic hematoma from previous trauma. Can anyone help with their suggestions?

Help with ICD 9 Code

Physical Therapy HELP!!!!

Hello,
So I am a coder at an office and I do the office visit coding. I've been getting questions from the physical therapy employees and I have no idea what to tell them. I know the codes that they have been using are VERY generic. They're usually symptoms. I'm trying to help them out with preparing for ICD-10. I just wanted to see if anyone could help me understand physical therapy coding. Is it correct to be coding only symptoms since they're treating symptoms? Or are they supposed to be using specific codes like I do when the physician sees the patient? I just need to understand how physical therapy is supposed to be coded so that I can actually help them and know what I'm talking about.
:confused:

Thank you

Physical Therapy HELP!!!!

Repair gluteus maximus tensor fascia lata rupture

Hi!
My doc did an open repair to tensor fascia lata and gluteus maximus, restoring tension and length, performed with multiple interrupted #1 Tycron sutures. Figure of 8 and locking sutures also used. The diagnosis was Gluteus maximus tensor fascia lata rupture. I keep coming back to unlisted code. 27299. Wanted to see if anyone might have any other suggestions on where to look.:eek:
Thanks,
Susan

Repair gluteus maximus tensor fascia lata rupture

AAPC CPC Exam Results?

I took my test on August 15th, It stayed in "In transit to AAPC" until Friday August 21st, Then changed to "Received" and then "grading" around noon on Friday. It is now Monday August 24th and it is still in "grading" does anyone know when my results will post? This is my 3rd time taking it, I am so nervous! :(

AAPC CPC Exam Results?

Billing TC

Does anyone know if you can bill the hospital below the medicare fee schedule for the TC portion?

Billing TC

Radiofrequency ablation of SI joint with Simplicity Probe

Procedure was a Radiofrequency ablation of the SI joint with Simplicity Probe. I am being given cpt 64640, but I am not comfortable with that. New to this field. Will appreciate any help!

Radiofrequency ablation of SI joint with Simplicity Probe

Skin graft

I am preparing an estimate for a patient who is having a large malignant lesion removed. There is the possibility of a skin graft due to size. I am thinking I would only use code 15240 for the facility (outpatient hospital) and not on the physician estimate. Is that correct? Or can both the facility and the physician charge this code for the same procedure?
Thank you for any assistance you can offer. I just began in oncology in February and it is a huge change from an ophthalmic private practice!!

Skin graft

Asymptomatic Bacteriuria

I have been working on dual coding to prepare for ICD-10. I came across a diagnosis of asymptomatic bacteriuria which codes out to 791.9 in ICD-9. When I use my index to look up this diagnosis it takes me to N39.0, UTI. My Encoder comparison does not include this option but goes along the lines of abnormal findings in urine and gives about 6 different options. I agree with R82.99 also because this patient doesn't technically have a UTI. What would be the proper way of handling this as my book says one thing and my encoder says another?

Asymptomatic Bacteriuria

gestation codes?

I wrote it down in a boot camp but that was over 2 years ago. Now I need to rationalize it and can't read it.


When coding for OB, when you do omit the code that shows weeks of gestation? I have someone asking about it in reference to spontaneous AB's. All O-codes say to add them. Should you always have a gestation code until you have a delivery outcome code?

thanks!

gestation codes?

Multiple Vials for Same Drug

:confused:We have a few carriers that require the NDC # for each drug administered in our office. Some drugs require multiple vial sizes combined for the dose, meaning there are more than one NDC # for that drug. I am worried about two line items for one drug denying as duplicates. The clearing house will not allow 2 NDC #s per one line item.

Anyone have any insight on how to bill this?

Multiple Vials for Same Drug

billing crna for medicare

I am needing help in how to bill for our crna in pain management for medicare. We obtained a NPI number for our CRNA in pain management and billed under the NPI to medicare and they are coming back not allowed to bill for that procedure. Please can someone help me or point me in the right direction on how to bill. It would be greatly appreciated. You can also reach me at melina.zyph@yahoo.com

billing crna for medicare

Revenue codes for pathology

Does anyone know the correct revenue codes for the following path codes for a UB:

88305
88313
88312
88342

Thank you!!!!!

Revenue codes for pathology

OrthoAtlanta has 2 coding positions

The positions require the applicant to be CPC or equivalent certified. The positions are for the Austell, Johns Creek and potentially Atlanta areas. OrthoAtlanta over the past year has grown at a rate of over 100% which has presented the need for additional coders. Please contact: Tricia Jones Coding Supervisor for OrthoAtlanta pjones@orthoatlanta.com

OrthoAtlanta has 2 coding positions

how to code for a return Pap smear

A 25-year-old patient presented for a physical exam without a Pap (during menses). I billed for 993XX with DX code V70.0. The patient returned two weeks later for her Pap. I can't use another 993XX code so what CPT code should I use? I know the ICD-9 code is V76.2 but not sure about the CPT code. Please help!

how to code for a return Pap smear

online externships

Does anybody know of online externships, esp in ICD-10 coming up? I need job experience.

online externships

Help coding this surgery

Procedures:
1. Fluorescein cerebrospinal fluid fistulography
2. Right fascia lata graft harvest
3. Transnasal transphenoidal exploration of CSF fistula and repair of defect diaphragma sellae.
4. Bilateral nasal packing

Description for Procedure 3:
...Under microscopic magnification, handheld speculum was placed in to identify the defect in the anterior wall of the sellae. A Hardy speculum was then placed in to provide this same exposure. The necrotic material and swollen mucosa were seen in the opening into the sella. This was debridedwith a small pituitary rongeur and bayonet forceps. Removal of necrotic material was continued until the spnenoid sinus was clean. The opening into the sella was clearly seen posteriorly. There was pulsatile flow of the flurorescein stained cerebrospinal fluid that appeared to orginiate anteriorly and superiorly as expected from the preoperative studies. Suction was used until the sella was relatively dry. What appeared to be remaining pituitary tissue was seen posteriorly and to the left. The portions of the fascia lata graft were then cut approximately 1 cm on each side. these were sen together in the center with a 4-0 Nurolon suture. The 2-layer graft thus created was then placed into the sella with the upper most stamp of fascia lata placed through the defect in the diaphragma sellae although lower one remained inside the sella. While this was held into position, fat and fibrin glue were added below it in the sella. An additional fat graft previously taken was then placed underneath the fascia lata graft. Additional glue was placed over this. Finally, several layers of Surgical and fibrin glue were placed within the sphenoid sinus...

Code for Proce 3: 61618
Code for Proc 1: ??

Pls help with the code for Proc 3 and Proc 1.
thx
ken

Help coding this surgery

Medical Coding Resume

Laura L. Elijah

lauraelijah@outlook.com
248 White?s Station Road
Seymour, IN 47274
(317)412-0939

OBJECTIVE:
Seeking a billing or coding position to utilize my current knowledge, skills, and experience in the medical field in order to help clinics and patients with their medical needs.

EDUCATION:
Medtech College Greenwood, IN
Associate Degree in Medical Billing and Coding

Pennsylvania Culinary Institute Pittsburgh, PA
Associate Degree in Specialized Business, Hotel/Restaurant Management

CERTIFICATIONS:
AAPC CPC December 2011

WORK HISTORY:
 Southern Indiana Orthopedics
o Biller/Coder
o August 2013 - Present
 Facilitate the preparation and processing of all daily office based charges.
 Gather, audit, and work with clinical department in ensure proper CPT, ICD9 and HCPCS coding of all office visit.
 Work with medical staff to resolve inappropriate documentation and associated issues.
 Perform billing audits for E/M services to determine documentation and level of service appropriateness.
 Monitor physician profiling.
 Help with staging and documentation needs for ICD10 codes.

 Comprehensive Foot & Ankle Center
o Biller; Coder; Front Desk
o June 2012 ?August 2013
 Post Charges
 Post patient and insurance payments
 Resolved insurance payment issues
 Verified new patient insurance eligibility and benefits
 Performed opening and closing front desk operations
 Collected patient payments at the front desk
 Checked patients in and out
 Entered clinical patient data in HER
 Entered required data to meet Meaningful Use Attestation

 Franciscan Alliance ABO
o Collector
o February 2012- May 2012
 Resolved no response claims
 Proficient in Availity, Interchange, SIHO, and other Commercial and Government Insurance web sites
 Enhanced knowledge of Epic Software

 Franciscan Alliance ABO
o Externship: Collector
o October 2011-December 2012
 Checked status of open aged claims
 Navigated through NaviNet and Availity web sites
 Gained knowledge of Epic software

Medical Coding Resume

IP consults for psychologist bedside

I am beginning to code for a Psychologist who is providing consults to patients bedside at our hospital which does not have a specified psych ward. He mainly provides therapy for terminal illnesses and mental/behavioral health issues that may arise during the IP stay. Should we code for IP consults 99251- 99255 or can I use the IP psychotherapy codes. The Psychologist documents beautifully the length of time he spends with these patients. I feel as a specialist he should get reimbursed for prolonged service add-on codes with the IP psychotherapy codes. He is providing a mental services not treating medical comorbidities. I have looked at past notes where he has documented over 120 min. of time. Also, does the POS matter when providing mental health services? Any advice is greatly appreciated. Links or any learning tools for coding for a psychologist is also helpful.

Thank you for your time!!
__________________
Ethanzoe

IP consults for psychologist bedside

Level of HPI when more than one problem

I'm unsure what to count/focus on in the HPI when determining the level of E/M when there is more than one problem being addressed. An experienced coder told me to just pick one problem and count the elements for that one problem (location, quality, duration, etc.). Another experienced coder told me to consider all problems and count up all elements. Sometimes I'll get a note where the patient has two or more problems/complaints, but the HPI for each problem alone is somewhat skimpy. If I focus on only one problem to count up the HPI elements, I'll get problem focused, but if I consider both problems, this might bump it into the expanded problem focused level of HPI. This can obviously make a difference in the final E/M level of visit. So, the question is, can I count more than one problem for the HPI?

Thanks in advance!

Level of HPI when more than one problem

Exam under anesthesia ankle

Hi fellow coders,

In the many years I have coded for orthopedics I have never seen this procedure performed. I am wondering if anyone has an experience with examination under anesthesia with stress radiographs to evaluate a right ankle fracture.

Any assistance will be greatly appreciated.

Thank you so much!!!
Denise

INDICATIONS: The patient sustained a
distal fibular fracture. The decision of stress radiographs were
obtained to decide stability of fracture and need for operative
fixation. Risks and benefits of the examination were discussed with
her and she wished to proceed.

DESCRIPTION OF PROCEDURE: The patient was brought to the operating
room, placed supine on the operating room table. After induction of
general anesthetic, her right leg was stressed with a C-arm
fluoroscopy viewing the mortise. There was no change in position of
the fibula, no widening of the mortise.

Exam under anesthesia ankle

Billing Manager or Practice Manager or Independent Biller

I am highly qualified to work as a Medical Practice Manager, Billing Manager with experience in both facility and professional billing, or work as an Independent Biller for your outsource needs.

Attached Files

resume 2015.pdf (146.8 KB)

Billing Manager or Practice Manager or Independent Biller

Spine coding for staged procedure

I am new at spine coding and am wondering if someone could help me code this procedure. I am not sure if you would need the entire operative report or if the list of procedures would suffice. This is a staged procedure and has knocked me off my socks.

If anyone has anytime to work with me via this website coding some surgeries until I get a grasp on it would be greatly appreciated.

Thank you so much!!
Denise

STAGE ONE

PREOPERATIVE DIAGNOSIS:
1. Right L2-L3 foraminal stenosis, with right L2-L3 radiculopathy.
2. Lumbar degenerative scoliosis, with advanced right L2-L3
degenerative disc disease and an asymmetric disk collapse on the
right.

POSTOPERATIVE DIAGNOSIS:
1. Right L2-L3 foraminal stenosis, with right L2-L3 radiculopathy.
2. Lumbar degenerative scoliosis, with advanced right L2-L3
degenerative disc disease and an asymmetric disk collapse on the
right.

PROCEDURE PERFORMED: This is a 2-stage procedure, stage 1 of 2.
1. Anterior interbody fusion through a right lateral approach, L2-L3.
2. Placement of prosthetic interbody device, Choice Spine dolphin
cage, L2-L3, size 45 mm x 17 mm x 6-degree lordotic.
3. Use of bone graft substitute, Vitoss, mixed with cancellous chips.
4. Use of bone marrow aspirate through a separate incision.




STAGE TWO
PREOPERATIVE DIAGNOSES:
1. Right L2-L3 foraminal stenosis, severe with right L2 and L3
radiculopathy.
2. Lumbar degenerative scoliosis with asymmetric disk collapse, right
L2-L3, and severe degenerative changes.

POSTOPERATIVE DIAGNOSES:
1. Right L2-L3 foraminal and lateral recess stenosis with right L2
and L3 radiculopathy.
2. Lumbar degenerative scoliosis with severe degenerative disc
disease at L2-L3 and right L2-L3 severe disc collapse.

PROCEDURE PERFORMED: This is a 2-stage procedure, stage 2 of 2:
1. Posterior lumbar fusion L2-L3.
2. Posterior nonsegmental instrumentation pedicle screws, Stryker
Xia, bilateral L2-L3, size 4.5 mm x 45 mm at both levels.
3. Use of bone graft substitute Vitoss and cancellous chips.
4. Right-sided foraminotomy and facetectomy, L2-L3.

Spine coding for staged procedure

Spine Coding Assistance Please

I am new at spine coding and am wondering if someone could help me code this procedure. I am not sure if you would need the entire operative report or if the list of procedures would suffice. This is a staged procedure and has knocked me off my socks.

Thank you so much!!
Denise

STAGE ONE

PREOPERATIVE DIAGNOSIS:
1. Right L2-L3 foraminal stenosis, with right L2-L3 radiculopathy.
2. Lumbar degenerative scoliosis, with advanced right L2-L3
degenerative disc disease and an asymmetric disk collapse on the
right.

POSTOPERATIVE DIAGNOSIS:
1. Right L2-L3 foraminal stenosis, with right L2-L3 radiculopathy.
2. Lumbar degenerative scoliosis, with advanced right L2-L3
degenerative disc disease and an asymmetric disk collapse on the
right.

PROCEDURE PERFORMED: This is a 2-stage procedure, stage 1 of 2.
1. Anterior interbody fusion through a right lateral approach, L2-L3.
2. Placement of prosthetic interbody device, Choice Spine dolphin
cage, L2-L3, size 45 mm x 17 mm x 6-degree lordotic.
3. Use of bone graft substitute, Vitoss, mixed with cancellous chips.
4. Use of bone marrow aspirate through a separate incision.




STAGE TWO
PREOPERATIVE DIAGNOSES:
1. Right L2-L3 foraminal stenosis, severe with right L2 and L3
radiculopathy.
2. Lumbar degenerative scoliosis with asymmetric disk collapse, right
L2-L3, and severe degenerative changes.

POSTOPERATIVE DIAGNOSES:
1. Right L2-L3 foraminal and lateral recess stenosis with right L2
and L3 radiculopathy.
2. Lumbar degenerative scoliosis with severe degenerative disc
disease at L2-L3 and right L2-L3 severe disc collapse.

PROCEDURE PERFORMED: This is a 2-stage procedure, stage 2 of 2:
1. Posterior lumbar fusion L2-L3.
2. Posterior nonsegmental instrumentation pedicle screws, Stryker
Xia, bilateral L2-L3, size 4.5 mm x 45 mm at both levels.
3. Use of bone graft substitute Vitoss and cancellous chips.
4. Right-sided foraminotomy and facetectomy, L2-L3.

Spine Coding Assistance Please

Need help! Selective stent non lower extremity

Percutaneous accesses obtained utilizing a modified
Seldinger technique with placement of a 7 French sheath.
& AORTIC ARCH STUDY
36140 59
36215
37236....i was thinking....
any assistance is greatly appreciated.

Percutaneous access was then obtained in the left radial artery utilizing
a micropuncture kit with placement of a 5 French sheath.
I then advanced a vertebral catheter retrograde in the radial artery and
up to the left subclavian artery. I advanced a 7 French 90
cm destination sheath over the wire to the ascending aorta. A pigtail
catheter was used to perform aortography and then
selectively engaged the origin of the left subclavian artery with a
mammary catheter. I then performed simultaneous injections
in the subclavian artery through the 2 catheters and image the occlusion.Intervention was performed on the left subclavian artery. Initial
attempts at antegrade wiring of the lesion were unsuccessful
and I therefore performed retrograde wiring of the left subclavian
occlusion utilizing an 014 coronary guidewire. I then
performed angioplasty with a Boston Scientific Apex RX 3.0mmX 20mm
balloon. I was then able to antegrade wire the left
subclavian utilizing a Wholley wire. The lesion was angioplastied with a
Boston Scientific Mustang 135cm 6mmX20mm balloon.
The left subclavian was stented with a Express LD Iliac / Biliary OTW 7F
9mm x 25mm 135cm Stent. Final angiography
demonstrated no residual stenosis with no evidence of perforation,
dissection or distal embolization. Angiography was
performed of the right common femoral artery demonstrated an arteriotomy
suitable for closure device. A 6 French Perclose was
deployed with adequate achieving hemostasis.

Need help! Selective stent non lower extremity

IP consults for Psychologist bedside

I am beginning to code for a Psychologist who is providing consults to patients bedside at our hospital which does not have a specified psych ward. He mainly provides therapy for terminal illnesses and mental/behavioral health issues that may arise during the IP stay. Should we code for IP consults 99251- 99255 or can I use the IP psychotherapy codes. The Psychologist documents beautifully the length of time he spends with these patients. I feel as a specialist he should get reimbursed for prolonged service add-on codes with the IP psychotherapy codes. He is providing a mental services not treating medical comorbidities. I have looked at past notes where he has documented over 120 min. of time. Also, does the POS matter when providing mental health services? Any advice is greatly appreciated. Links or any learning tools for coding for a psychologist is also helpful.

Thank you for your time!!:confused:

IP consults for Psychologist bedside

MEDITECH CoderBiller ASAP near 02452

I have a practice reaching out to me who is still utilizing an ancient office scheduling and billing system - MEDITECH until April 2016 --don't ask -don't offer suggestions--
They need to find someone IMMEDIATELY:
1) Candidate REQUIRED to know or can recall how to use Meditech
2) Candidate needs to know General Surgery CODING
and /or
3) Candidate is extremely proficient in Posting /working appeals +denials- utilizing Meditech
Practice located near Watertown /Waltham
Please send your interest and resume to me ASAP!!
If you do not have a recent updated resume contact me anyway only through marywalshcpc@yahoo.com
No Phone calls please. Only looking for written responses.

MEDITECH CoderBiller ASAP near 02452

pressure ulcer or wound injury

Facility Coding: The physician documents pressure ulcer caused by a body brace being used for a vertebral fracture.

Is this truly a pressure ulcer or an injury caused by a device??? How do you code?

Thank you.

pressure ulcer or wound injury

Risk on initial dos-hospital medicine

Provider orders labetalol IV Q2H PRN on the initial DOS....would you determine HIGH risk?

Provider orders morphine IV Q4H PRN on the inital DOS....would you determine HIGH risk?

I am being told that we can't count PRN medications unless we can prove they were administered. However, our policy states that the intensively monitored and/or parenteral drugs must be ordered or administered to determine risk.....just wanting other opinions

Risk on initial dos-hospital medicine