Just curious as to what anyone might have run across during their job searches. Thanks!
Working part-time remotely
jeudi 30 avril 2015
Working part-time remotely
Just curious as to what anyone might have run across during their job searches. Thanks!
Working part-time remotely
Neulasta Delivery Kit
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Neulasta Delivery Kit
Attempted resection pelvic mass
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Attempted resection pelvic mass
E/M choice for multiple inpatient visits on the same day
When a provider sees a hospital inpatient 2 time sin a given day and has notes for each visit, what is the appropriate was to capture the work? Is it different if they have noted their time during each visit- or only if they note that greater than 50% of the time was spent in counseling and coordination of care?
E/M choice for multiple inpatient visits on the same day
Bilateral Procedure Question
I'm now being told by another employee (who is not a coder) that this is wrong and I have to bill 2 line items for all bilateral procedures and calculate for double payment.
Can anyone shed some light on this for me?
Thanks
Angie
Bilateral Procedure Question
29806 and 29999 vs 29806 only
The doctor stated that he performed a posterior labral repair and capsulorraphy. He wanted it coded 29806 and 29999. I am not sure if there are two codes here.
Can someone please enlighten after reading the operative report as to what I am missing? Thank you so much. Any coding suggestions would be greatly appreciated.
POSTOPERATIVE DIAGNOSES:
1. Left shoulder pain.
2. Left shoulder posterior instability.
3. Left shoulder posterior labral tear.
PROCEDURES PERFORMED:
1. Left shoulder arthroscopy.
2. Left shoulder posterior labral repair with capsulorrhaphy.
Arm was placed in 10 pounds of longitudinal traction and a mark was made 2 fingerbreadths down, 2 fingerbreadths medial from the posterolateral aspect of the acromion. An
18-gauge spinal needle was inserted into the glenohumeral joint. Joint was distended with 60 mL of sterile saline. An #11 blade scalpel was used to incise the skin. Arthroscope was introduced in the posterior aspect of glenohumeral joint and a diagnostic arthroscopy was begun. There was no evidence of chondromalacia over the glenoid or humeral surfaces. There was no evidence of superior labral tear. No evidence of anterior labral tear. Subscapularis tendon was in good condition. Biceps tendon was in good condition. No evidence of rotator cuff tear involving the supraspinatus, infraspinatus or teres minor tendons. There was no evidence of loose bodies in the axillary pouch. No evidence of anterior or posterior haggle lesion. There was a small rent in the posterior capsular structures. An
anterior portal was established using outside-in technique. An 18-gauge spinal needle was inserted above the superior border of the subscapularis muscle. An 11-blade scalpel was used to incise the skin. A 7-0 cannula from Arthrex was introduced in the glenohumeral joint. Superior and anterior labrum were probed and felt to be stable. The posterior labrum was felt to be debrided and it was felt to be unstable and torn. A second anterior portal was established as well as a working portal posteriorly was
established. Reviewing was then performed from the anterior portal. The posterior labrum was probed and felt to be unstable. A periosteal elevator was used to mobilize the labrum. The posterior aspect of the glenoid was decorticated using a shaver as well as a red rasp. Then, through a stab incision 2 Griffin anchors were placed into the posterior aspect of the labrum. These were then passed through the labral and capsular tissue using an ideal suture passer then the knots were tied using SMC knots with
alternating half hitches x 5 with switching of the lateral post for the last 2 half hitches. Once all intraarticular work was complete, arthroscopic instrumentation was removed from the shoulder. Half of 3-0 Prolene was used to approximate skin edges. Sterile dressing was applied. Sling was applied. The patient was awoke from general endotracheal intubation and brought to the PACU in stable condition.
29806 and 29999 vs 29806 only
NP Question Please Help
I am helping with the billing for a Pain Management practice located in Maryland (DC Metro area) At the beginning of the year, they started billing strictly under their nurse practioners for the 20611 (joint injections). Previously in 2014 they billed the 20610 and 76942 together. When billing using the MD for this procedure there was never a problem but since changing to the NP billing they have received a huge amount of denials for CO-170. The J code that is billed along with the 20611 is being paid. Should they be using a modifier to indicate this is being billed by an NP only and if so which one? Medicare has given me 4 different answers and none of the reps have been able to provide me with ANY documentation stating NP's cannot do this procedure. We are getting prepared to do a mass appeal but I still don't feel comfortable with the situation.
I hate to go through all of this work if I am unaware of something that does not allow them to bill for this procedure.
Any and all information is appreciated. I am beyond frustrated.
NP Question Please Help
Delivery
Thnx in advance for any response
Delivery
Epicardial Echocardiogram during CABG
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Epicardial Echocardiogram during CABG
How to code tracheal hemorrhage?
DIAGNOSIS: Tracheal hemorrhage, recent tracheostomy
OPERATION: Reintubation and removal of tracheostomy, exploration of wound and control of bleeding.
FINDINGS: Recent tracheostomy that had bled serval times and did have some oozing in serveral places, but no definitive bleed. I was called to see the patient because they were suctioning a fair amount of blood from the traceostomy lumen and the lungs. At the time of the surgery this appeared to be partially a pulmonary hemorrhage and not necessary aspiration of blood. It was felt that the safest course of action would be to simply keep the patient intubated until the coagulaopathy was controlled.
PROCEDURE: The patient was taken emergently to the operating room and , after being adequately sedated, hd the tracheostomy ties removed. Dr. ___ was ready to reintubat the patient, which was performed without difficulty, observing the tube pass the tracheostomy site. Once this was in position below the tracheostomy, suction was used to remove some clots and blood from the tracheostomy. Multiple spots were bovied with fairly continuous bleeding that was mostly oozing and no specific vessel. Thrombin Gelfoam was then used. It was felt that even with an extended tracheostomy, becuase fo the patient's low saturations, it was safer to keep her intubared and the tracheostomy site was packed. She was tranferred to the intensive care unit in critical condition with all final spong, insturment and needle counts correct.
Aside from the unlisted code of 31899, I have thought about 38500 and 31500 but not sure if those are appropriate - or if there is another code that would be more appropriate.
Any help would be greatly appreciated!!
Thanks,
How to code tracheal hemorrhage?
consults
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consults
Project Xtern
I need opinions please and thank you!!!
Project Xtern
mercredi 29 avril 2015
CPT Code for Wound Drainage
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CPT Code for Wound Drainage
CPC-A in Mesa, AZ
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CPC-A in Mesa, AZ
MRI/CT brain LCD for Medicare
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MRI/CT brain LCD for Medicare
Hospital H&P
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Hospital H&P
Getting BMI on a wheelchair bound patient for AWV
We are having a discussion about the requirement for "Height, weight, body mass index (or waist circumference, if appropriate), and blood pressure" as the clinic the patient was seen in did not have the equipment available to measure for height and weight. We can't come to a consensus on if the waist circumference replaces all 3 components or just BMI. Any input would be helpful, documentation stating one way or another would be great.
Getting BMI on a wheelchair bound patient for AWV
Extensor tendon repair with pinning of IP joint
Any help would be great! Thank you in advance!
Open fracture, left thumb with significant extensor tendon injury.
PROCEDURE PERFORMED WAS:
1.Irrigation and debridement down to bone.
2.Open repair of extensor tendon laceration with pinning of IP joint.
TECHNIQUE: The patient was brought to the operating room where a satisfactory level of local anesthetic was introduced in the usual fashion. He had fairly significant pulsatile bleeding, so we did put up a tourniquet and then we prepped and draped in the usual fashion. We then irrigated thoroughly and we cauterized the digital artery that was bleeding. We then explored the joint and noted that the extensor insertion on the base of the distal phalanx was intact on the far ulnar side, but it was completely absent radial to that. At this point, we elected to place a Mitek suture anchor in the area and then did a extensor tendon repair with 2-0 Ethibond. We then oversewed with further 2-0 Ethibond. We then used a 0.54 K wire to hold the IP joint reduced in extension to protect the repair. We then irrigated thoroughly and repaired the pulp wound with 4-0 nylon in an interrupted fashion.
Extensor tendon repair with pinning of IP joint
Dental coding
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Dental coding
1997 General Multisystem Exam
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1997 General Multisystem Exam
Novitasphere Portal
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Novitasphere Portal
59812 vs 59820
PRE-OP DX- SPONTANEOUS 1ST TRIMEST MISCARRIAGE
POST-OP DX- SAME
PROCEDURE PERFORMED- DIALATION AND EVACUATION
HEAVY WEIGHTED SPECULUM WAS PLACED IN THE POSTERIOR ASPECT OF VAGINA AND SIMS RETRACTOR IN THE ANTERIOR ASPECT OF VAGINA. THE CERVIX WAS GRASPED WITH A SINGLE TOOTH TENACULUM AND THE BLADDER WAS THEN STRAIGHT CATCHED REMOVED APPROX 50 CC OF URINE. THE UTERUS WAS THEN GENTLY SOUNDED TO ABOUT 10CM AND THE CERVIX WAS THEN GENTLY DILATED WITH HEGAR DILATORS UP TO A 15X9 MM CANNULAE EVACUATION. CANNULAE WAS THEN GENTLY PLACED INTO THE UTERUS AND SUCTION WAS APPLIED GENTLY AND EVACUATION WAS PERFORMED WITH PRODUCTS OF CONCEPTION NOTED IN THE COLLECTION BAG. THE EVACUATION COUNT WAS THEN REMOVED AND USING A CURETTAGE THE UTERUS WAS GENTLY CURETTAGE. ONE MORE PASS WITH THE EVACUATOR WAS PERFORMED AND ONE MORE PASS WITH THE CURETTAGE UNTIL THE UTERINE WALL WAS NOTED TO BE GRITTY. THERE WAS MINIMAL BLEEDING. THE SINGLE TOOTH TENACULUM AND INSTRUMENT COUNTS CORRECT AND THE PATIENT WAS TAKEN TO RECOVERY IN STABLE CONDITION.
59812 vs 59820
mardi 28 avril 2015
cerebellar hemangioblastoma
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cerebellar hemangioblastoma
Project Xtern
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Project Xtern
without direct fact to face with patient
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without direct fact to face with patient
Vag myomectomy
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Vag myomectomy
Primary and Secondary insurance, bill patient the difference?
Example:
Patient's PRimary: Allows $300 but applied to deductible.
Patient's Secondary: Allows and pays $100
This leaves a balance of $200
We are in-network with both insurances.
In this case, do we bill the patient the difference of $200 or write off the $200.
Our allowed rate is higher than the secondary, who's fee schedule contract do we have to follow?
Primary and Secondary insurance, bill patient the difference?
HPI Documentation
I just started working as a practice manager for a solo practice specialist who refuses to listen to me. He is making his staff do all chart documentation at intake including doing the HPI for him! Even going so far as to have them select the bullets in the templates for location, severity, timing, etc. I have shown him in black and white the CMS guidelines stating that ancillary staff cannot perform or document the HPI, the physician himself must do this. This is a huge problem for me. His response was do it my way or quit. I guess my question is, has something changed and is ancillary staff now allowed to perform and document the HPI or am I correct and we are headed for huge problems down the road if an audit is to occur? If anyone has any information (more current) either way, I would appreciate it. We have an EMR and I tried to explain that everything is documented as to who performs each action and it is even time stamped. His answer was again, do it my way or quit. That, right now, is not an option.
HPI Documentation
How many units are billable for Q9966
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How many units are billable for Q9966
post op pt w/ hemotoma and heart wall repair
I have a return to the OR for a post op hemorraghe/hemotoma and attempted repair of the AV groove. I am having trouble finding a CPT for this surgery. Pt is post aortic valve replacement with dark bloody output from the chest tube.
She was taken to the OR for mediastinal explaration. Once open the surgeon found well, here is the report.
The sternal wires were removed with a wire cutter and a chest spreader was put in place; significant bloody drainage was evacuated and clot. After its evacuation, the patient had a significant drop in her blood pressure down to the 20s and during this drop to the 20s anesthesia gave the patient some epinephrine and there was a huge swing in blood pressure up to the 200s to 240s. With this, as the heart was being lifted, the left lateral wall in the circumflex distribution, there was a significant dehiscence of the heart and a significant hole in the heart at the atrioventricular groove. With this significant blood loss, the patient was emergently placed on bypass. An Ethibond suture was put in the aorta, the heparin was given, the aortic cannula was placed and hooked up and the patient was placed on sucker bypass once the ACT was appropriate. With sucker bypass, after maintaining some type of control, an Ethibond was placed in the right atrium and a right atrial two-stage venous cannula was put in place; this was put in line and the patient was placed on routine bypass. At this point, the patient had fairly adequate drainage. ...
Now, with the patient on bypass and controlled bypass, the patient was arrested with cardioplegia after crossclamping the aorta in the usual fashion. Now, inspecting the lateral wall, the entire lateral wall was extremely friable and unable to hold sutures adequately. Numerous attempts using 3-0 Prolene suture and felt pledgets were undertaken in addition; this tissue still continued to bleed. Attempts were made to place bovine pericardium and use Dermabond at points to try to build up tissue in the area to allow for adequate suture in order to hold the tissue appropriately. Significant thought was given throughout the case to open the left atriotomy and repair the AV groove dehiscence from the inside. ... at no point was the bleeding adequately controlled. Finally, obtaining some sense of repair at the lateral wall with no significant oozing, the attempt was made to come off the bypass machine. The patient came off the bypass machine appropriately; however, ripped this lateral wall further and bleeding once again continued. Numerous rounds of blood, FFP and platelets were given. Patient at this point, after approximately 8 hours, began to become coagulopathic. Despite attempts and lengthy discussion with the family, attempt was still made to try to wean the patient from bypass after controlling the bleeding at the AV groove. Additional sutures were thrown; this too was unsuccessful. Attempt was made, again, to wean the patient from bypass, patient just could not wean from bypass as ongoing bleeding was barely being kept up with the bypass machine.
What CPT code has I missed or should I go with an unlisted code for this case?
Thank you in advance for your help.
Margaret
post op pt w/ hemotoma and heart wall repair
Laminectomy and microscope
I took a workshop where we were told that it is appropriate to bill a laminectomy(63045-63047) and the microscope(69990). From what I am seeing all payers are denying as bundled. We do use encoder which says it is not seperately billable and no modifier allowed to override the relationship. Any help and info appreciated.
Laminectomy and microscope
Path/lab tests and supporting dx codes
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Path/lab tests and supporting dx codes
Sterile Epidural Kits
I have a steady stream of sales representative come through the office weekly and the latest tread are people trying to persuade my physicians to use "sterile epidural kits". These kits cost about $250 per kit and the reps tell us that they are reimbursed at $600-700 per kit. The code we are being told to use is J3490 which is basically an unlisted code. I am thinking this is not a profitable venture, but I need to convince the doctors of that. Has anyone had any experience with these kits or maybe some documentation about these kits? My other concern is that these kits are not Medicare approved yet, so I am not sure commercial insurances are going to recognize them either.
Sterile Epidural Kits
Coding Neurostimulator Implant
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Coding Neurostimulator Implant
Documentation
If you are looking at documentation for a chart that is not on a Medicare patient, and the guidelines for the insurance company in question do not mention 1995 or 1997 guidelines, is there more room for interpretation of documentation guidelines, or do 1995 and 1997 guidelines apply to all documentation for CPT regardless of the insurance company? Thanks!
Documentation
NVD with Second Degree Perineal tear
One OB/GYN doubt as follows; Patient undergone NVD with episiotomy. The diagnosis is obviously NVD and in addition to this patient has second degree perineal tear. My doubt is if we code NVD we should not code any other complication since NVD (O80) is a stand alone code.Please advise how to code this scenario. This is an IP case the dx is both NVD and Second Degree tear.
Thanks In Advance
Ravi
NVD with Second Degree Perineal tear
lundi 27 avril 2015
Friction burn?
Pt seen in office visit as followup from ER, complaining of burn on right forearm s/p MVA 8 days ago. Burn was sustained due to airbag being deployed. Pt is concerned about infection because area is redder and itchy. No fevers.
Skin exam shows a 4 x 3 cm superficial open healing wound s/p burn. Area erythematous, tender. No discharge from area, no increased heat, no bullae or vesicles present.
DX (per provider): Burn (949.0), with developing secondary infection.
Plan: Continue with Silvadene. Apply polysporin to affected area. Rx for Keflex given.
Would I be correct to code as 913.1, Abrasion or friction burn of forearm, infected...?
I think that covers it, but I want to be sure. Burn codes themselves are for thermal burns from a heat source, correct?
Thanks in advance!
Friction burn?
coding resources for general surgery
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coding resources for general surgery
Simple Anesthesia billing questions
1. For the units on the claim form do I put the time that we used the units that I calculate.
EX: If I have a patient who is a ASA P1 and is coming in for a colonoscopy. Total anesthesia time 60 minutes and they have no other qualifying circumstances.
Would I put on the claim 60 minutes or Would I put the units calculated below?
Colonoscopy base units (00810) = 5 units
P1 status = 0 units
Total time 60 minutes/ 15 = 4 units
TOTAL UNITS = 9 units
2. Do I include these status modifiers (P1, P2...) on the claim?
Thanks!!
Hayley Sutton, CPC-A
Simple Anesthesia billing questions
J7195
Weve been trying to bill Medicare for chemo drug infusion and keep getting rejection errors of 16 - Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. This is a clinic setting and not hospital facility.
J7195 Factor IX recombinant (Benefix) 5,000 IUnits NDC #58394063403
Does anyone else bill these infusion drugs and how?
Thanks for your help!:
Last edited by catharine; Today at 12:29 PM. Reason: punctuation
J7195
Looking for Charge-Master Coordinator (Full-time or Part-time)
This position provides support to NEW Charge-Master Assessments/Engagements, and existing clients Charge-Master Maintenance Functions.
We are looking for someone who has demonstrated experience with Hospital CDM?s. This person will also be responsible for educating staff, and using our Charge-Master software product.
?Minimum of 2 years of experience in CDM maintenance, hospital claims, IP & OP charging and coding, CMS reimbursement knowledge and/or other revenue cycle functions.
? Health Information or related healthcare field required.
?Certification in Coding (CCS/RHIT/RHIA) preferred. Nurses are welcomed who have CDM Charge-Master experience
Please send Resume for consideration to:
Amy Nelson - anelson@e-codesolutions.com
Looking for Charge-Master Coordinator (Full-time or Part-time)
peri-procedural device programming
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peri-procedural device programming
Eeg 95951
Duration: The video EEG?s require the duration and/or start and stop times to be indicated within the documentation. When the EEG is less than 12 hours, indicate the duration, such as 2, 4, 6, 8 hours. For EEG?s that are 12 hours or more the start and stop times need to be indicated. Example: Video/EEG began at 0900 hrs on October 10, 2010 and ended at 0900 hrs on October 11, 2010). This information is vital to the appropriate assignment of CPT codes and modifiers
Eeg 95951
Consults dictated under the allotted times.
Is anyone coding for an inpatient consult where the face-to-face is under the 30 minute mark? The CPT Code book says "typically 30 minutes" and we have never billed them when the doctor dictated face-to-face under that time i.e. 25 minutes. I have recently been told that when it's slightly under (25 min), to code the 30 minutes, which I do not believe is true.
Last edited by lbredl; Today at 07:02 AM. Reason: spelling
Consults dictated under the allotted times.
Closure of PFO and ASD
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Closure of PFO and ASD
dimanche 26 avril 2015
Excision tumor soft tisue
Thank you and i really appreciate it
Julie
Excision tumor soft tisue
Specialty Questions
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Specialty Questions
desultory labor, delivered
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desultory labor, delivered
ICD-10 testing through AAPC?? - sm
I did study ICD-10 through my work and we had to pass an exam through them (an AHIMA course).
I'm just confused as to whether I need to pass any ICD-10 test to keep my CPC.
Thanks.
ICD-10 testing through AAPC?? - sm
Shoulder reduction in ER
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Shoulder reduction in ER
Allergy testing
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Allergy testing
Ros
If a provider has a list of systems and the patient or nurse circles the systems the patient has concerns with that day, but doesn't mark the other systems, and nobody says other systems are negative, can the other systems be counted if the office policy is that they discussed all of the systems and not marking them means they were negative? but in the chart there is not a statement about the other systems, it's just an office policy that if they aren't circled, they were negative.
Ros
samedi 25 avril 2015
compliance & regularity in CPC exam
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compliance & regularity in CPC exam
Experienced E/M Coder
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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.
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Experienced E/M Coder
36000 with modifier 59
Does anybody have more information on how to bill 36000 for infusions and hydration for Commercial insurance. OR does the Medicare guidelines apply for everybody.
this is the was it was being coded
99284 e/m
36000-59
96365
96375
96361
Please help
36000 with modifier 59
Where to go next in my career??
I'm a CPC-A looking for the next step in my career, not sure what to do now. I was looking at the CPMA certification as a possibility. Does anyone have any advice on next steps? Has anyone taken this exam and have info to share? Any help would be great! Thank you!
Where to go next in my career??
vendredi 24 avril 2015
Entry level coding jobs
I am just in the process of completing training for medical coding, billing and transcription. I have been looking for jobs for the past couple weeks but most/ all require experience. Are there any available jobs for newbies? I would really prefer a remote position...I am guessing that will be nearly impossible to find. Anyone have any advise or leads? Thanks for your help!
Entry level coding jobs
Removal of Fat Pad on the Pulmonary Artery
My surgeon operated on a patient intending to do a RCA mobilization (which I also can't find a code for), but ended up only removing a significant fat pad from the pulmonary artery instead. He did a sternotomy, opened the pericardium with the intention of RCA reimplantation. Once he removed the fat pad surrounding the pulmonary artery he had a better view of the RCA and decided that reimplantation would not be necessary, and closed the patient.
I have been wrestling with this one for days and my surgeon is not very helpful. Any ideas?
Removal of Fat Pad on the Pulmonary Artery
HIPPA - Who we can discuss the account with
Thank you.
John M.
CPC-A
HIPPA - Who we can discuss the account with
J7195 Reimbursment
J7195 ? Factor IX recombinant (Benefix) 5,000 IUnits NDC #58394063403
Does anyone else bill these infusion drugs and how?
Thanks for your help!
J7195 Reimbursment
cardiac intervention and then admit
A patient is transferred from another rural health facility to our hospital with an acute MI. Our doc is on call, does the intervention and then admits the patient to inpatient.
Can I bill and get paid for the admit? Or is it bundled to the cardiac intervention? I did not know if the AI modifier made a difference.
Thanks for any insight!
Jenn
cardiac intervention and then admit
Help with Code for Historyof Lumpectomy
I am working on guideline to give providers when patient comes in for Follow-up Examination for history of neoplasm. This particular breast cancer patient did not have a mastectomy, just lumpectomy. I need to capture a hsitory of surgery code , but the breast codes are too specific.
Should I just use Z98.89 Personal history NEC and tell the story with the cose for histoy of radiation and history of chemo, currently on Arimedex, also use the history of breast CA, of course.
Appreciate the advice.
Tricia D
__________________
Tricia Didier, RHIT, CPC, CCS-P, CHONC
Help with Code for Historyof Lumpectomy
HELP! Fibroid embolization and arteriogram
UTERINE FIBROID EMBOLIZATION.RIGHT UTERINE ARTERY DIGITAL SUBTRACTION ARTERIOGRAM.LEFT UTERINE ARTERY
DIGITAL SUBTRACTION ARTERIOGRAM.RIGHT COMMON FEMORAL ARTERY DIGITAL SUBTRACTION ARTERIOGRAM.INDICATI
ON: 42-year-old female with bulky uterine fibroids resulting in significant heavy menstrual bleed and
secondary anemia PROCEDURE:The risks, benefits and alternatives to the procedure were discussed in de
tail in a prior visit by the patient to the outpatient intervention radiology clinic. The risks of va
scular injury necessitating further intervention including surgery, inadvertent nontarget embolizatio
n with possible lower extremity ischemia, endometritis and infection to the uterus necessitating hosp
italization, intravenous antibiotics and remote possibility of hysterectomy, as well as premature men
opause were relayed to the patient. The benefits of a voiding hysterectomy and its complication were
discussed. The alternatives of oral medications, myomectomy and hysterectomy were discussed. Informed
consent was obtained after thorough discussion.The patient`s identity and procedure confirmed.Steril
e technique including hand hygiene, cap, mask, sterile gown, and sterile gloves are used. The patient
was placed in the supine position. The right groin was prepped and draped in a sterile fashion with
2% chlorhexidine and a large sterile sheet. The right common femoral artery was evaluated with real-t
ime ultrasound imaging and found to be patent. A hard copy image was obtained and sent to PACs.The lo
wer end of the right femoral head was identified by fluoroscopy and was marked on the skin using ster
ile marker.Under ultrasound guidance, the right common femoral artery was accessed using 21-gauge nee
dle followed by advancing in 018 mandrel wire into the aorta. The tract was then dilated with a 5 Fre
nch micropuncture sheath. An 035 Bentson wire was then advanced into the aorta over which the tract w
as dilated using a 5 French x 10 cm vascular sheath.The vascular sheath was then attached to a contin
uous pressurized heparinized saline throughout the exam.5 French Omni Flush catheter was then advance
d over the Bentson guidewire into the mid aorta. Next the Bentson guidewire was advanced into the lef
t femoral artery using Omni Flush catheter manipulation under fluoroscopic guidance. The Omni Flush w
as then exchanged for a 5 French uterine Roberts catheter. Using catheter and guidewire manipulation,
the Roberts uterine catheter was advanced into the left uterine artery where a digital subtraction a
rteriogram was performed. Following that Progreat microcatheter and 016 microwire were then advanced
through the Roberts catheter into the distal aspect of the transverse portion of the left uterine art
ery where embolization was performed.Next Roberts catheter was pushed back into the aorta and under f
luoroscopic guidance using catheter and Bentson guidewire manipulation, the catheter was advanced int
o the right uterine artery where a digital subtraction arteriogram was performed. Following that the
Progreat catheter and 016 microwire were advanced under fluoroscopic guidance into the distal aspect
of the transverse portion of the right uterine artery where the artery was embolized.At the completio
n of the embolization, the microcatheter and Roberts catheters were removed. Right common femoral art
ery arteriogram was then performed in the right and left oblique projections to determine the adequac
y of closure device use.FINDINGS:LEFT UTERINE ARTERIOGRAM: The cervicovaginal branch is identified. N
umerous tortuous corkscrew vasculature are seen supplying the enlarged uterus containing numerous fib
roids.RIGHT UTERINE ARTERIOGRAM: The cervicovaginal branch is identified. Numerous tortuous corkscrew
vasculature are seen supplying the enlarged uterus containing numerous fibroids.RIGHT COMMON FEMORAL
ARTERIOGRAM: No atherosclerotic disease is seen. No aneurysmal formation is identified. The puncture
site of the right common femoral arteries approximately 8mm superior to the bifurcation of the right
CFA into the SFA and DFA. The puncture site is favorable for closure device use.LEFT UTERINE ARTERY
EMBOLIZATION: With the Progreat microcatheter placed in the left mid uterine artery distal to the cer
vicovaginal branch, the left uterine artery was embolized using 500-700 microns of Embospheres under
fluoroscopic guidance until complete devascularization of the uterine fibroids. Meticulous technique
was used under fluoroscopic guidance to prevent reflux of embospheres into the branches of the left i
nternal iliac artery or left common iliac artery.RIGHT UTERINE ARTERY EMBOLIZATION: With the Progreat
microcatheter placed in the right mid uterine artery distal to the cervicovaginal branch, the right
uterine artery was embolized using 500-700 microns of Embospheres under fluoroscopic guidance until c
omplete devascularization of the uterine fibroids. Meticulous technique was used under fluoroscopic g
uidance to prevent reflux of embospheres into the branches of the right internal iliac artery or left
common iliac artery.At the completion of the exam, the right common femoral artery vascular sheath w
as removed and hemostasis was achieved using closure device.MEDICATIONS: - Moderate conscious sedatio
n using Versed and fentanyl for 150 minutes under the supervision of radiology nurse. The patient`s c
ardiopulmonary status was observed throughout the exam and remained stable.- Intravenous ketorolac du
ring the procedure for inflammation.- 25 mg of intravenous Benadryl for itching.- 1% lidocaine for lo
cal anesthesia.FLUOROSCOPY: 23 minutes of fluoroscopy was used.CONTRAST: 87 mL of Visipaque 320 admin
istered intra-arteriallyCONCLUSION: Successful bilateral uterine arteries embolization.Bilateral uter
ine and right common femoral arteriogram, as described above.DISPOSITION: The patient tolerated the p
rocedure with no immediate complications. The patient was admitted for overnight observation and pain
control during which the patient was placed on PCA pump and intravenous antiemetic. The patient left
the next day in stable condition.Thank you for this referral.
HELP! Fibroid embolization and arteriogram
procedure ?
plasma coagulation in the ASC. Op note says the spermatocele was identified using cold plasma coagulation. Have never heard of this-wondering if anyone knows if this is something that can be billed for by the physician ??
Appreciate any info
Thanks,Rebecca
Urology Associates
procedure ?
V76.51 for Noridian Medicare
Any help will be appreciated.
V76.51 for Noridian Medicare
Global issue 11301 vs 66984
Hello, we have been billing the medicare replacement plan uhc a lesion charge of 11301 and they are deny stating this is global to 66984 cataract removal but yet these were from 2 separate doctors, has anybody ever had any issues regarding this, we have sent appeal after appeal and they are upholding their decision, we have several patients with this issue, any advise would be greatly appreciated.
Global issue 11301 vs 66984
ICD-10 CM Draft vs Official Version
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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.
All times are GMT -6. The time now is 07:31 AM.
ICD-10 CM Draft vs Official Version
PQRS Measure #193
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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.
All times are GMT -6. The time now is 06:27 AM.
PQRS Measure #193
jeudi 23 avril 2015
Question about 44970
I have a stated surgical procedure of laparoscopic appendectomy (44970) with revision of the abdominal cavity. Would the abdominal cavity revision be considered incidental? If not, what code would be used in addition to 44970? The entire procedure was done laparoscopically.
Question about 44970
IUD Insertion and Removal
We have a patient who came in for IUD placement. The patient has a retroverted uterus, so an ultrasound was done after placement to confirm proper location. The ultrasound showed the positioning to be incorrect, so the IUD was then removed during the same visit and samples of OCP were given...
What is the proper way to bill this? Any help or input is appreciated.
IUD Insertion and Removal
Florida Medicaid HCPCS Codes
Florida Medicaid has provided us with a listing of HCPC codes they accept. I am trying to figure out the documentation requirements as some I can not find the CPT match.
I hope this makes sense as I want our providers to be able to provide proper documentation for the service.
Thanks,
Florida Medicaid HCPCS Codes
90 day global period E & M services
My Oncologist/Gynocologist is insisting that he should be reimbursed for all of his E & M services even when he brings the patient back two weeks post op for discussion and counseling of treatment. I have explained that if the visit is unrelated to the surgery I can bill with a -24 modifer. I have contacted Medicare, BCBS and several other carriers and they have advised that a 90 day global means that all E & M services that are related to the cancer surgery (ie hysterectomy) are included in the global. Any suggestions on what I might be overlooking?
90 day global period E & M services
Cognitive Therapy/OT
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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.
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Cognitive Therapy/OT
What DX codes for pap exam with diagnosis charted by provider other than screening
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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.
All times are GMT -6. The time now is 11:34 AM.
What DX codes for pap exam with diagnosis charted by provider other than screening
Help.. Need help breaking this one down. overwhelmed!
Concerns are the use of covered stents in distal aorta and bilateral iliacs. The use of self expanding stents in iliacs. Mechanical thrombectomy performed in iliacs, external iliacs , femoral arteries and aorta
I have the diagnostic portion. However I question the ability to charge diagnostic portion since this was confirmed by a recent CT as dictated by physician. I am not aware of a recent angio.
SO if I can code diagnostic I a looking at
Brachial approach : 75630 with additional selective angio 75774(36245)
Left femoral access: 36140
After that I am uncertain.
I could use some help..... So here we go!
...known history of systemic hypertension and
peripheral arterial occlusive disease, status post multiple endovascular
aortic and iliac artery stents in the past, who now presents with
debilitating bilateral lower extremity claudication, who was recently
admitted to the hospital with resting claudication. The patient recently
had a CT angiogram of the abdominal aorta and lower extremities, which
revealed a chronic totally occluded infrarenal abdominal aorta as well
as bilateral right and left iliac arteries. She now presents for an
attempt at percutaneous endovascular revascularization.
PROCEDURES
1. Abdominal aortography with bilateral iliofemoral runoff.
2. Selective angiography of the right lower extremity via a left
brachial artery access with the catheter being placed in the proximal
portion of the right superficial femoral artery.
3. Selective angiography of the left iliofemoral system with a catheter
being placed selectively via access from the left common femoral artery.
4. Percutaneous thrombectomy of the infrarenal abdominal aorta.
5. Percutaneous thrombectomy of the right and left common iliac
arteries.
6. Percutaneous thrombectomy of the right external iliac
artery and common femoral artery.
7. Intraarterial thrombolysis.
8. Percutaneous transluminal balloon angioplasty with endovascular
stenting of the infrarenal abdominal aorta using 2 kissing stents.
9. Percutaneous transluminal balloon angioplasty with endovascular
stenting of the right and left common iliac arteries utilizing balloon
expandable covered stents.
10. Percutaneous transluminal balloon angioplasty with endovascular
stenting of the right external iliac artery utilizing a self-expanding
stent.
11. Percutaneous transluminal balloon angioplasty with endovascular
stenting of the left external iliac artery utilizing a self-expanding
stent.
ACCESS
1. The left brachial artery was accessed initially with a micropuncture
system.
2. The left common femoral artery was accessed again with a
micropuncture system.
RESULTS: After applying local anesthesia to the left antecubital fossa,
a 5-French micropuncture system was placed into the left brachial artery
utilizing a modified Seldinger technique. This was followed by the
passage of a 0.035 inch guidewire into the descending thoracic aorta.
Subsequently, a 5-French pigtail catheter was passed over the guidewire
into the abdominal aorta at the level of the renal arteries. Subsequent
abdominal aortography with iliofemoral runoff was performed. This
revealed the right and left renal arteries to be widely patent. The
infrarenal abdominal aorta was completely occluded approximately 10 cm
above the iliac bifurcation. There was evidence of multiple bilateral
stents in the right and left common and right external iliac arteries.
All stents were completely occluded as well as the right and left
external iliac arteries. The right common femoral artery was also
occluded. There was some reconstitution of the left common femoral
artery via collaterals from what appears to be lumbar arteries. There
was some faint collateralization and visualization of the most distal
aspect of the right common femoral artery.
At this point in time, local anesthesia was given to the left groin and
utilizing a micropuncture kit, the left common femoral artery was
accessed followed by the passage of a 5-French introducer catheter.
Contrast was injected through this catheter which revealed the patent
left common femoral artery and subtotal occlusion of the left external
iliac artery and complete occlusion within the stent that was previously
placed in the left common iliac artery. The proximal portions of the
left superficial and deep femoral arteries were all patent. At this
point in time, the 5-French micropuncture dilator was exchanged for a 6-
French introducer sheath followed by the passage of a 0.035 inch
guidewire, which was used to recanalize the completely occluded segments
of the left external and common iliac arteries as well as the infrarenal
abdominal aorta. This was used with the assistance of an 0.035 inch
support catheter that was again passed over the guidewire and positioned
at the abdominal aorta at the level of the renal arteries. The guidewire
was removed and contrast again was injected and abdominal aortography
was performed, which confirmed that the catheter was in the true lumen.
At this point in time, the catheter was removed after placement of a
0.035 inch guidewire into the descending thoracic aorta. Attention was
then given 2 the occluded abdominal aorta from a left brachial approach.
The 5-French pigtail catheter was removed over a 0.035 inch guidewire
and replaced with a 7-French, 90 cm introducer sheath that was passed
over the guidewire into the abdominal aorta just below the renal
arteries. The dilator was removed and a 0.035 inch guidewire was passed
beyond the occluded segment into the right common and external iliac
arteries. The 0.035 inch support catheter was passed over the guidewire
into the right external iliac artery. The guidewire was then further
passed beyond the occluded segment of the right external iliac artery
and common femoral artery and into the right superficial femoral artery.
This was followed by the passage of the support catheter that was
positioned into the proximal third of the right superficial femoral
artery. The guidewire was removed and contrast was injected, and
angiographic evaluation of the right lower extremity was performed which
revealed a widely patent right superficial femoral artery and popliteal
arteries. At the level of the trifurcation, there was evidence of
thrombotic occlusion of the tibioperoneal trunk with faint filling of
the proximal portions of the peroneal and posterior tibial arteries.
There also appeared to be subtotal occlusion of the anterior tibial
artery with flow down to the foot.
At this point in time, 4 mg of TPA was given as a slow continuous
infusion followed by reinsertion of an 0.035 inch guidewire and removal
of the support catheter. Subsequently, a 6-French, 120 cm AngioJet
catheter was passed over the guidewire and passed into the right common
femoral artery and percutaneous thrombectomy began of the entire
occluded segments of the right common femoral artery, external iliac
artery, and right common iliac artery as well as the abdominal aorta.
Upon removal of the thrombectomy catheter, repeat angiography was
performed which revealed marked improvement in antegrade flow throughout
the occluded segment, but there were still multiple areas of high-grade
focal stenosis which was at the right external iliac artery just distal
to the stent as well as the proximal portions of the common iliac artery
and the infrarenal abdominal aorta.
At this point in time, an 8 mm x 8 cm self-expanding stent was passed
over the guidewire and positioned into the stenotic segment of the right
external iliac artery and subsequently deployed. This was followed by
the passage of an 8 mm x 8 cm balloon angioplasty catheter was passed
over the guidewire into the stenotic segment of the left external iliac
artery and inflated to a maximum of 16 atmospheres of pressure. The
balloon catheter was then pulled into the common iliac abdominal aorta
and subsequently dilated to a maximum of 18 atmospheres of pressure. The
balloon catheter was removed and contrast was injected through the 90 cm
sheath which revealed now marked improvement in antegrade flow and no
significant residual stenosis in the right common femoral artery and
external iliac artery. However, there remained again a significant high-
grade stenosis in the abdominal aorta and the right common iliac
artery.
At this point in time, attention was given to the left iliofemoral
system whereby the AngioJet catheter was passed over the 0.035 inch
guidewire and percutaneous thrombectomy of the left external iliac
artery as well as the common iliac artery and abdominal aorta was
performed which revealed limited improvement in overall luminal patency.
At this point in time, it was felt that we were dealing with
predominantly fixed chronic obstructive lesions at this point in time,
and so a 7 mm x 10 cm balloon angioplasty catheter was passed over the
guidewire and subsequently used for dilatation of the left external
iliac artery and eventually the left common iliac artery and abdominal
aorta. After balloon angioplasty there was significant residual stenosis
and actually an intimal dissection flap was noted in the left external
iliac artery.
At this point in time, it was felt the patient would benefit from
endovascular stenting. Consequently, an 8 x 59 mm iCast covered balloon
expandable stent was passed over a 0.035 inch wire from the left
brachial access into the right common iliac artery and a second iCast
stent measuring 7 x 59 mm was passed over the guidewire through the 7-
French sheath that had been previously placed via the left common
femoral artery into the left common iliac artery and subsequently
deployed at 24 atmospheres of pressure. This was followed by deployment
of the right iCast stent at 20 atmospheres of pressure. The balloon
delivery catheter was removed from the left and an 8 mm x 8 cm balloon
angioplasty catheter was passed into the stent and simultaneous
inflation of both 8 mm balloons was subsequently performed. This
resulted in marked improvement, but there continued to be a high-grade
stenosis of the abdominal aorta above the stents, so consequently 2
additional 8 mm x 59 mm iCast stents were placed in a kissing fashion
via the left common femoral artery as well as the left brachial artery
access in an overlapping fashion and subsequent deployed at 20
atmospheres of pressure. The balloon delivery systems were subsequently
removed and the pigtail catheter was placed via the 6-French 90 cm
sheath at the level of the renal arteries and subsequent aortography was
performed. This revealed that the abdominal aorta was now widely patent
with excellent antegrade flow throughout the right iliofemoral system
and markedly improved flow down the left iliofemoral system, but there
was evidence of a high-grade flow limiting dissection in the left
external iliac artery.
At this point in time, a 10 mm x 8 cm self-expanding stent was passed
over a 0.035 inch guidewire through the sheath in the left common
femoral artery and subsequently deployed, followed by post-balloon
inflation with a 7 mm x 10 cm balloon angioplasty catheter. At this
point in time, the final abdominal aortography was performed via the
pigtail catheter that had been placed via the left brachial artery. This
was of excellent result. Both renal arteries remained widely patent. The
infrarenal abdominal aorta now had 0% residual stenosis and excellent
antegrade flow. The right and left common as well as external iliac
arteries were also widely patent with 0% residual stenosis.
COMPLICATIONS: No immediate complications were noted.
Help.. Need help breaking this one down. overwhelmed!
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