http://www.aapc.com/memberarea/forums The American Academy of Professional Coders provides education and certification for the medial coding community. en Wed, 19 Jun 2013 20:16:47 GMT vBulletin 60 http://www.aapc.com/memberarea/forums/images/misc/rss.jpg http://www.aapc.com/memberarea/forums http://www.aapc.com/memberarea/forums/showthread.php?t=94043&goto=newpost Wed, 19 Jun 2013 20:10:29 GMT I have a note from a Seminar that I went to last year that states "Beginning October 1, 2013, nonspecific diagnosis codes will be denied by all payers."

Has anyone else heard this? If so, any documentation?

Thanks.
Lori ]]> Diagnosis Coding lisner1204 http://www.aapc.com/memberarea/forums/showthread.php?t=94043 http://www.aapc.com/memberarea/forums/showthread.php?t=94042&goto=newpost Wed, 19 Jun 2013 20:10:14 GMT Hello, Can someone please explain when 97605 and 15120 can be billed together? These codes are bundled, per cci, but a modifier is allowed.... Hello,
Can someone please explain when 97605 and 15120 can be billed together?
These codes are bundled, per cci, but a modifier is allowed.
Thanks:confused: ]]> Dermatology ndelucia5 http://www.aapc.com/memberarea/forums/showthread.php?t=94042 http://www.aapc.com/memberarea/forums/showthread.php?t=94040&goto=newpost Wed, 19 Jun 2013 19:54:33 GMT Good afternoon fellow Coders, Patient came in for follow up exam 99215 and cpt 69210 removal impacted cerumen Medicare paid 69210 but denying... Good afternoon fellow Coders,

Patient came in for follow up exam 99215 and cpt 69210 removal impacted cerumen Medicare paid 69210 but denying office visit as PAYMENT IS INCLUDED IN THE ALLOWANCE FOR ANOTHER SERVICE/PROCEDURE could I appeal this or would adding modifier 25 to the E/M be sufficient?

Thank you,
TH:confused: ]]> E/M tholcomb http://www.aapc.com/memberarea/forums/showthread.php?t=94040 http://www.aapc.com/memberarea/forums/showthread.php?t=94039&goto=newpost Wed, 19 Jun 2013 19:53:26 GMT Can anyone tell me definitively what cpt code is for the CMC joint injection ? I have been using 20600. One of my doctors is stating 20605. And... Can anyone tell me definitively what cpt code is for the CMC joint injection ? I have been using 20600. One of my doctors is stating 20605. And if you have a source for the information, that you could share with me, it would be wonderful. Thank you

" 0.5cc Lidocaine and 20 mg Kenalog were injected into the left CMC Joint "
Dx is CMC/ST arthritis of the left thumb ]]> Orthopaedics scooter1 http://www.aapc.com/memberarea/forums/showthread.php?t=94039 http://www.aapc.com/memberarea/forums/showthread.php?t=94038&goto=newpost Wed, 19 Jun 2013 19:49:19 GMT Physician is questioning when NP sees patient and documents the visit, the MD then reviews and documents he has discussed case with NP and agrees on... Physician is questioning when NP sees patient and documents the visit, the MD then reviews and documents he has discussed case with NP and agrees on treatment
signs the note, MD bills for service. Is there anything specific the MD needs to
document in the NP note, in order for him to submit the charge under his name?
The NP has documented all elements of e/m code being billed.
Thanks for any help. ]]> Medicare Regulations Bellaboo http://www.aapc.com/memberarea/forums/showthread.php?t=94038 http://www.aapc.com/memberarea/forums/showthread.php?t=94037&goto=newpost Wed, 19 Jun 2013 19:44:58 GMT I have a question as to how to code a hernia repair that is being billed to Medicare and there is an inguinal hernia on both sides and an umbilical... I have a question as to how to code a hernia repair that is being billed to Medicare and there is an inguinal hernia on both sides and an umbilical hernia on the left side. I have it coded as 49650-22-LT and 49650-59-RT. Does anyone agree with this or perhaps not. I was not sure if this would be billable this way or if I should bill it another way. Any thoughts? ]]> Medicare Regulations ksj737@verizon.net http://www.aapc.com/memberarea/forums/showthread.php?t=94037 http://www.aapc.com/memberarea/forums/showthread.php?t=94036&goto=newpost Wed, 19 Jun 2013 18:58:39 GMT Can someone tell me what dx to use for disruption xiphoid process? Can someone tell me what dx to use for disruption xiphoid process? ]]> Diagnosis Coding mamacase1 http://www.aapc.com/memberarea/forums/showthread.php?t=94036 http://www.aapc.com/memberarea/forums/showthread.php?t=94034&goto=newpost Wed, 19 Jun 2013 18:38:58 GMT Procedure performed: Excision of biopsy mass. The patient was taken to the operating room and placed under general anesthesia. The left elbow was... Procedure performed: Excision of biopsy mass.

The patient was taken to the operating room and placed under general anesthesia. The left elbow was prepped and drapped in sterile manner. Transverse skin incision was made over the mass. It was about T-shaped and it was bluish. Soft tissue was raised around the mass, which appeared cystic and vasculitic and it was excised and appeared to have a small vein leading into that was Bovie electrocauteried. No evidence of any neurological issues and it was well contained in the subcutaneous tissue with fascia over the triceps was intact. Wound was irrigated in subcuataneous and vertical mattress nylon sutures. Sterile dressing was placed. He was awakend, extubated, and taken to the recovery room in stable condition with a small compression dressing. The specimen was sent off for pathology for a definitive diagnosis.

Need help with the cpt code... would it be 2 codes... one for the excision and one for the biopsy? ]]> Orthopaedics kellit21 http://www.aapc.com/memberarea/forums/showthread.php?t=94034 http://www.aapc.com/memberarea/forums/showthread.php?t=94032&goto=newpost Wed, 19 Jun 2013 18:11:44 GMT Good morning, We bill for our doctors seeing patients at the SNFs. Do we need to have their notes sent to the clinic so that we can scan into... Good morning,

We bill for our doctors seeing patients at the SNFs.
Do we need to have their notes sent to the clinic so that we can scan into our EMR to support the biling we are doing in our PMS for the SNF visits in case the billing was ever audited?

Thank you,

Janice ]]> General Discussion jvail http://www.aapc.com/memberarea/forums/showthread.php?t=94032 http://www.aapc.com/memberarea/forums/showthread.php?t=94031&goto=newpost Wed, 19 Jun 2013 18:10:11 GMT Abdomen was prepped and draped in the normal sterile fashion. Local anesthesia was infiltrated to the right lower abdomen and an incision was made to... Abdomen was prepped and draped in the normal sterile fashion. Local anesthesia was infiltrated to the right lower abdomen and an incision was made to accomodate a 5 mm port. Under countertraction an optical viewing trocar was placed. Pneumoperitoneum was then established to 14 mmHg. The abdomen was inspected and there was found to be no trocar related injury. At this point, the endoscope was advanced with mild difficulty through the oropharynx. This was however done under direct visualization. The scope was then advanced into the stomach. The stomach wsa then insufflated. Under direct visualization the canulating needle was then palced transabdominally and into the lumen of the stomach. The guidewire was advanced and this was grasped with the snare via the endoscope. The endoscope and wire were then removed from the mough. A 20-French gastrostomy tube was then advanced over the wire. A small incision was then made over the wire site on the anterior abdominal wall. The gastrostomy tube was then pulled though and was found to sit at 4 cm at the skin. The appropriate adapters were then applied. The gastroscope was not readvanced into the stomach as it is difficult to traverse the oropharyynx initially. The stomach was then allowed to decompress through via gastrostomy tube. The gastrostomy tube hub what then secured to the skin with nylon. The right lower quadrant incision site was then closed with a 4-0 Monocryl.


I am looking at 43246 with maybe modifier 22. THe patient has Railroad Medicare. Any input would be much appreciated.

Thanks ]]> General Surgery lindacoder http://www.aapc.com/memberarea/forums/showthread.php?t=94031 http://www.aapc.com/memberarea/forums/showthread.php?t=94030&goto=newpost Wed, 19 Jun 2013 17:57:31 GMT -------------------------------------------------------------------------------- Hi all, I was taught that we should always code dx checking... --------------------------------------------------------------------------------

Hi all,

I was taught that we should always code dx checking the NCD/LCD.

I could see that some of the charges are getting paid even if they dont have a proper dx that is in the LCD/NCD.(Medical Neccessity not met)

Could someone explain me why or how are these paid?

Thanks ]]> General Discussion Cuteyr http://www.aapc.com/memberarea/forums/showthread.php?t=94030 http://www.aapc.com/memberarea/forums/showthread.php?t=94029&goto=newpost Wed, 19 Jun 2013 17:53:44 GMT Hi all, I was taught that we should always code dx checking the NCD/LCD. I could see that some of the charges are getting paid even if they... Hi all,

I was taught that we should always code dx checking the NCD/LCD.

I could see that some of the charges are getting paid even if they dont have a proper dx that is in the LCD/NCD.(Medical Neccessity not met)

Could someone explain me why or how are these paid?

Thanks ]]> Billing/Reimbursement Cuteyr http://www.aapc.com/memberarea/forums/showthread.php?t=94029 http://www.aapc.com/memberarea/forums/showthread.php?t=94028&goto=newpost Wed, 19 Jun 2013 17:52:08 GMT I need some help, I think I have the codes down, not too sure as IR is not great for me, this is the report: PROTOCOL: A 6-French sheath was... I need some help, I think I have the codes down, not too sure as IR is not great for me, this is the report:


PROTOCOL: A 6-French sheath was placed in the right femoral artery.
A Contra catheter was then taken to the descending aorta and
abdominal aortic angiography was done. The iliacs were free of
disease. The Contra catheter was then placed from the right iliac
artery to the left superficial femoral artery using a glide wire.
Angiography demonstrated that the iliacs and the SFAs were clean.
Popliteal artery was normal. Below the knee, the patient had a 1
vessel runoff through the peroneal artery. The anterior tibial
artery occluded proximally and the posterior tibial artery had
multiple collaterals and was occluded in the mid vessel. The
peroneal artery was occluded above the ankle and then gave
collaterals to the anterior tibial artery and the posterior tibial
artery. There was a posterior tibial artery at the ankle. We
attempted to angioplasty this posterior tibial artery.

The Contra catheter was removed over a long Magic Torque wire. A
90-cm destination sheath was placed in the right popliteal artery. A
PT 2 wire was placed in the Quick-Cross catheter and then placed down
the posterior tibial artery; however, there were multiple collaterals
in the posterior tibial artery and we could not move. I was not sure
which was true posterior tibial artery and which was a collateral.
Then we attempted to enter the posterior tibial artery from a
retrograde fashion.


The left foot was prepped and draped sterilely. Lidocaine was
introduced in the posterior tibial artery and we spent a great amou
of time to enter the posterior tibial artery. However, this was no
successful. We used a day ultrasound probe and used a SmartNeedle
and then fluoroscopy and injections through the leg as well. We
could enter the vessel, however, the wire would go onto the
collateral and could not stay in the true lumen of the major vessel
After about 1.5 hours of attempting to enter the posterior tibial

artery, further attempts were aborted. The sheath was removed and
and a Mynx was used. The patient was given Angio-Seal during the
procedure; however, this was stopped at the end of the procedure.

FINDINGS:
1. The bilateral iliacs and superficial femoral arteries are free of
disease.
2. The left popliteal artery is free of disease.
3. There is 1-vessel runoff through the peroneal artery. The
posterior tibial artery and anterior tibial arteries are occluded and
filled by collaterals. Unfortunately, we could not angioplasty the
posterior tibial artery as there were too many collaterals to know
exactly which one was the true lumen from above, and we could not
enter it from retrograde approach. The patient will be continued on
medical therapy.

The codes I come up with for CPT are:

37228-52
75625
93005-59 (EKG showed heart block, done prior to surgery)

Any ideas would be greatly appreciated!

Mary G ]]> Interventional Radiology maryg http://www.aapc.com/memberarea/forums/showthread.php?t=94028 http://www.aapc.com/memberarea/forums/showthread.php?t=94027&goto=newpost Wed, 19 Jun 2013 17:51:48 GMT Can anyone tell me what would be some good tools and tips for the CPC-H exam. I want to take it in September. Thanks Can anyone tell me what would be some good tools and tips for the CPC-H exam. I want to take it in September.

Thanks ]]> General Discussion marty3073 http://www.aapc.com/memberarea/forums/showthread.php?t=94027 http://www.aapc.com/memberarea/forums/showthread.php?t=94025&goto=newpost Wed, 19 Jun 2013 17:46:04 GMT We have a physician on staff (since Nov 2012) that is still not credentialed with any insurance. He signs his records and then the physician that is... We have a physician on staff (since Nov 2012) that is still not credentialed with any insurance. He signs his records and then the physician that is credentialed signs and billing is submitted under the credentialed physician. I recently found out the physician's license, that's not credentialed, is on probation until Oct. 2014. Someone said this is why he is not credentialed.

I am trying to find where in CMS I can find a statement or ruling regarding this practice. Incident to does not apply so I really believe this might be fraud.

Suggesting I ask the billing manager will not get me anywhere because I've asked several times about credentialling and other billing issues I have and all I get is the run around or very vague answers.

Thanks for any assistance. ]]> General Discussion Licorice5 http://www.aapc.com/memberarea/forums/showthread.php?t=94025