iowagirl77's latest activity

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    iowagirl77 reacted to RyanRaichCPC's post in the thread Question Modifier 25 with Like Like.
    Definitely an excellent point Iowagirl
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    iowagirl77 replied to the thread Question Modifier 25.
    Also of note: modifier 25 is for when a separately identifiable E/M is done same day as a minor procedure (0 or 10 day global), but modifier 57 is for an E/M on same day or day before a major procedure (90 day global). Use of the wrong modifier...
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    According to this article, it may depend on the payer. However, I play it safe and assume everyone goes by Medicare rules on this. https://www.karenzupko.com/multiple-fractures-one-code-multiple/
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    iowagirl77 replied to the thread Question polydactyly.
    I'm trying to make sense of this. 79 modifier would indicate it is in global of another procedure? You shouldn't need any digit/laterality modifier for 11200. Not sure what you mean by level 11 modifier? If it is not in global of another...
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    If the patient is truly a new patient (not been seen by any of the providers within that billing group, then it is considered a new problem. The audit tool I have specifically states 'New problem (to examiner)'. However, if it is a self-limited...
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    iowagirl77 replied to the thread 25332 vs 25447.
    I would actually go with 25447; I've seen this surgery multiple times. I haven't seen one for 25332 before so I had to look that one up. Per the coder's desk reference, 25332 has to do with the carpal and radius/ulnar joints but 25447 has to do...
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    This isn't my specialty, but I'm willing to offer a couple of thoughts on it since no one else has. Although you might consider posting it in the OBGYN area of the forums to find the experts. -Was sepsis due to retained products mentioned? If...
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    iowagirl77 replied to the thread Question 20910 vs 21230.
    Hi Walker, -20910 is for the harvest of the graft alone. If you were doing a procedure that didn't bundle the graft harvest, you could bill 20910 with it. -21230 includes graft harvest as well as the repair/reconstruction with placement of the...
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    iowagirl77 replied to the thread Documentation 28193 depth.
    The dermis is actually above the subcutaneous. 28190 is subcutaneous, 28192 is deeper than subcutaneous tissues. The Coder's Desk Reference is a wonderful guide if you are able to get one. It advises that 28193 may include incision, repair of any...
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    iowagirl77 replied to the thread Psychology/Psychiatry.
    96138 bundles to 96136, but you can add a 59 modifier to 96138 as long as the provider and technician performed different testing. If it still denies, try appealing.
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    iowagirl77 replied to the thread Ribs.
    You would have to review each payer's policy on this to see if this applies to your patient, but I found nearly identical responses for Aetna and Amerigroup that explain the conditions of when it is considered medically necessary. This also...
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    I'd look at 27745 for the cementation and fixation. The excision and biopsy will bundle into this so they cannot be billed. I couldn't find a code for the cryotherapy, but perhaps someone else is familiar with this?
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    You should be able to still bill a new patient visit. I was able to find this information on Noridian: Individual who has not received any professional services, Evaluation and Management (E/M) service or other face-to-face service (e.g...
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    iowagirl77 replied to the thread Question appeal decisions.
    Hopefully an ABN was signed? You might try appealing based on a change in medical condition- see the attached from a DME webinar...
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    I agree there should only be one fee schedule. I'd advise against creating alternate pricing. However I believe most systems allow for a discount function to be applied, so perhaps you can set this up?
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