Recent content by AthensCoder

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    Question New vs Established Patient Clarification

    Hello Fellow Coders, I have a new provider to our group who saw a patient that he previously saw 2 1/2 years ago at his old practice, which has a different tax-id. The patient has Medicare and received a denial that only one evaluation and management code at this service level is covered...
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    Question Help with possible ERCP?

    Hello All, I'm in need of some help. My research did not pull up anything close to this scenario and I'm at a loss as to how to code this. The lubricated Olympus endoscope was inserted transorally and advanced under direct visualization to the jejunum. There was evidence of previous...
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    Positive Feccal Occult test and pre-screening visit

    In my opinion, the patient is now symptomatic and the need for the colon is to determine the source of the bleeding. Thus this would not be a screening visit,but a diagnostic visit. To qualify as a screening the patient must be asymptomatic with no complaints/issues.
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    S0285

    Hello, I use this code for all my commercial payers when appropriate and have been getting paid.
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    Colonoscopy with balloon dilatation

    Hello fellow coders, I'm in need of your opinions on the coding of the below op report. Optum is denying my claims stating that the services are not supported due to no documentation within the op report that the colonoscope went to the cecum. Per CPT book the definition of a colonoscopy is...
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    OP Note assistance

    Hello all, I'm in need of some assistance withe coding the below report. It has me a little confused due to the scope only went to the duodenum, but the report also states "Papillotome was used for cannulation and a cholangiogram was obtained and showed no filling defects". I'm thinking 43247...
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    Colonoscopy Diagnostic vs Preventative - What's your Opinion

    Hi Christine, The issue I come into is when the patient comes in for the evaluation the docs states rectal bleeding, diarrhea, etc. BUT on the OP note does not list these symptoms. I've explained several times that the patient MUST be symptom free, i.e, no problems.
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    Colonoscopy Diagnostic vs Preventative - What's your Opinion

    Hello Everyone, I wanted to get other's opinions on the much debatable issue of diagnostic versus preventative colonoscopy in my office. I have several providers within my office that like to order "screening" colonoscopies for the below scenarios. 1. Pt says they are here for a screening...
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    Incomplete colonoscopies and procedures

    For our Medicare contractor, Palmetto, they auto deny all claims with modifier 53 or 74 due to needing medical records to support the use of the modifier. Hope this steers you in the right direction.:)
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    CMS ICD10 High Risk Colons Deny

    Colon Screen I'm here in Georgia, and today & rep from Cahaba advised the same & also advised to submit an appeal.
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    Medicaid denials in Georgia

    Medicaid Georgia Medicaid put out a provider bulletin advising that they will not accept unspecified code for any outpatient/office claims. As for the J30.5, I looked it up, & that IS a specified code, so this may be a glitch in their system.
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    Bravo ph monitoring

    Bravo I have a practice who are doing a Bravo's. The dilemma is that they own the equipment and are doing the procedure in an ASC facility. We are getting denials because we are billing global with POS 24. The Bravo Rep is telling us for commercial payer we need to bill it with the date it's...
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    GA Veterans Administration Claims - Help!!

    Hi Everybody, I am being told by the VA that due to a new system implementation that all UB-04 claims have to now come on CMS-1500 forms. Does anyone know if this is true. I have been told two differnet things by two differnt people today and can't get a straight answer.
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    GA Veterans Administration Claims

    Hi Everybody, I am being told by the VA that due to a new system implementation that all UB-04 claims have to now come on CMS-1500 forms. Does anyone know if this is true. I have been told two differnet things by two differnt people today and can't get a straight answer.
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    New to ASC Facility Billing

    Can anyone provide some insight on the difference between ASC facility billing reimbursement and the professional billing reimbursement? Should the facility be reimbursed per procedure as the physicians do? Do you know of any good websites that will be helpful? Thanks for any help.
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