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    Question 99212 OR 99213 follow up fracture care

    Would like to have this office visit "audited" by another coder on the e/m visit code. CC: Left Elbow Fracture DOI 10-14-2019 HPI: X-rays performed in house No complaints. He is here with his father MEDICAL HISTORY: Denies MEDICATIONS; None ALLERGIES; NKDA VITALS [ALL...
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    Question Physeal Sparing ACL Reconstruction

    Patient had Arthroscopy, and ACL Reconstruction. Dr. did a "physeal sparing" and wants to know if there is a CPT code for this part of the procedure or is it included in the 29888? First time I have come across this, so need some guidance. Thanks CW
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    Question Assist at Surgery Modifer Order

    I am unsure of the correct modifier position on procedure 29826, whether the AS should be first position, or 59 is correct ? This is a PA assisting on the surgery. CPT 23412-AS-LT CPT 29823-AS-LT CPT 29826-59-AS-LT Appreciate any and all responses, CW
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    Bone Grafting tibial and femoral tunnels knee, failed ACL

    Procedures Performed Arthroscopy Debridement ACL Graft Removal Tibial Button Bone Grafting Tibial and Femoral Tunnels knee Portion of op note reads as follows: ACL was completely absent in mid aspect. Remaining soft tissue was debrided along tibia. Tibial tunnel was found to be anterior...
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    Question Proximal Humeral Fracture Dislocation

    Title of Procedure: Attempted Closed, Open Reduction and Internal Fixation Proximal Humeral Fracture Dislocation Post op Diagnosis: Posterior fracture Dislocation, Left Shoulder Looking at CPT 23615 for this surgical case. Operative note extensive, so did not provide. Questions concerning...
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    Metacarpal fractures

    Patient had displaced fifth metacarpal fracture and a third metacarpal fracture. Fifth metacarpal fracture was manipulated in office. Third metacarpal was not manipulated. My posting would be 26605 for the fifth metacarpal fracture. For third metacarpal I will code 26600-59. Am I correct in this...
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    99212 or 99213

    Need a refresher and would like someone to audit this visit for a patient that returns for follow up of her left knee pain and MRI results CC: MRI results of Left Knee HPI: Orthopedics Patient comes in for follow up of the left knee. She has no problems and is fully functional. She is...
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    Knee arthroscopy

    Operation performed arthroscopy right knee, joint debridement with synovectomy, partial medial menisectomy, chondroplasty patellofemoral joint, medial and lateral. Partial lateral menisectomy performed also. Question on procedure coding according to operative note, suprapatella pouch, medial...
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    97760 orthotic training

    We have in our orthopedic office, a company that provides our braces and also does the fitting at the time of the visit, i.e. knee braces, wrist splints, post op shoes, etc. My doctor wants to me to bill 97760 which would represent his time in instruction, training and explanation of orthotic...
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    Revision patellar and tibial components of knee

    Revising patella and tibia components only Would I be correct in using CPT 27487, which is actually revision of femoral and tibia components Or use 27486 x 2
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    Open subscapularis tendon and rotator cuff repair

    Not sure if I am coding these procedures correctly Operation Performed: Arthroscopy, Labral Debridement, Subacromial Decompression with Open Repair of Subscapularis Tendon, Biceps Tenodesis, and rotator cuff repair, right shoulder Post operative diagnosis: Full Tear of subscapularis tendon...
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    Shoulde Surgery Multiple Procedures

    Would like an opinion of the coding on this shoulder surgery OPERATION PERFORED: Arthroscopy left shoulder, joint debridement, labral debridement, acromioplasty, and proximal biceps tenodesis PREOPERATIE DX; Biceps labral dysfunction, rotator cuff dysfunction, impingement shoulder POSTOP DIX...
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    CPT 26160 pr 26111 Mass Finger

    Title of procedure: Incision and drainage of mass, flexor surface, distal portion of right index finger Portion of op note: Patient had mass at flexor surface distal to distal crease. L-shaped incision made with apex at flexor crease on radial side of finger, flexor crease upside. Dissection...
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    Biceps Tenodesis and rotator cuff tear

    Patient had high-grade tear in labrum biceps with a 1.2 cm tear rotator cuff and impingement High lighting portions of operative note that I have questions on coding "Through and through tear of rotator cuff, 1.2 cm. Bursectomy, CA ligament resection and acromioplasty done. Bed of bone...
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    Othovisc Injections for Shoulder

    The doctor wants to start giving Orthovisc injections to shoulder patient on same day as surgery at Hospital. Can these injections be given at the Hospital. They have always been done in the office. We buy and bill the Orthovisc and of course charge for the injection [20610], which I imagine I...
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    Observation Status

    My doctor saw a patient at the Hospital who was admitted for Observation. And as a result, Surgery was performed same date, with Hospital still having patient in Observation Patient has Medicare A only. Can the visit be coded as an outpatient visit [99203-57] Confused as to how to code this...
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    Debridement of lateral retinaculum knee

    Procedures Performed [preop diagnosis was lateral retinacular tear] and scheduled for repair PRP Injection left knee Arthroscopy partial meniscectomy 29881 Debridement lateral retinaculum Need help coding the debridement of the lateral retinaculum. Will highlight that portion of operative...
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    MDM for Fracture care follow up

    Our office generally bills for office visits rather than a one-time global fee for closed fracture treatment. Table of Risk lists closed treatment of a fracture as a moderate decision management option My question is for all follow up visits for which we charge these fracture patients, is the...
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    Greater tuberosity drilling procedure

    Need some coding advice on this surgery Dx: Partial Rotator Cuff Tear, Left Shoulder Adhesive Capsulitis Procedures Performed Arthroscopy, Capsular Release Decompression Drilling Greater Tuberosity These are the codes I have selected for the first 2 procedures CPT...
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    Elbow and wrist surgery

    Need to see if I was correct in billing these procedures together Dx: Lateral epicondylitis with common extensor tendon tear Carpal Tunnel Cubital Tunnel Submitted CPT 24341 for repair of tendon, elbow 64718 Ulnar nerve release at elbow...
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    ACL Repair, with Medial Meniscal Repair, and Lateral Menisectomy

    For this knee surgery, I billed 29888 for the ACL repair 29882 for the Medial Meniscal Repair 29881 for the Lateral Menisectomy The insurance company has paid the 29888 and 29881, but denies the 29882 [meniscal repair] I need to Appeal the denial of the 29882 for the repair of the meniscus...
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    Elbow Surgery

    Patient had Decompression of Ulnar Nerve, billed CPT 64718 for nerve decompression Also had Olecranon Bursitis, Billed 24105 for Excision of the Olecranon Bursa Medicare has denied the 64718 as inclusive to 24105 Do I have an appeal for payment on 64718? Thank you, CW :confused:
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    Osteochondritis Dessicans Surgery

    Checking on CPT code for this procedure Scope, Open Reduction, Internal Fixation OCD left knee DX: Osteochondritis Dessicans left distal femur Had this procedure been done arthroscopically, I would have used CPT 29887 [drilling osteochondritis dissecans with internal fixation Procedure was...
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    Four part fracture humeral head

    Procedure: Shoulder Hemiarthroplasty Should I code CPT 23470 or CPT 23616 Briefly, Humeral Head was placed in. Operative note also states "Repair of lesser tuberosity and greater tuberosity to the prosthesis itself, done with Ethibond through eyelets in the back, and then tuberosities...
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    Arthroscopic and Mini Open Rotator Cuff

    Work Compensation Denied by charges for Arthroscopic procedures performed with mini-open rotator cuff repair [23412] Submitted 29822 for Biceps Tenotomy and Labral Debridement [High grade biceps tear/fraying and labrum fraying Submitted 29826 for Subacromial Decompression and Resection...
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    99212 or 99213

    Would like someone to audit the E/M for this visit SYBJECTIVE CC: MRI Results HPI: Orthopedics: Patient comes in for follow-up of right shoulder. This has been going on for a long time. He has trouble with daily activities and at night. It hurts to reach up and out, and to reach behind him...
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    Orthopaedic Diagnosis Coding Only

    If a patient has a medical condition that would alter or affect the Orthopedic Doctor's plan of treatment, should the diagnosis for the other medical condition [for example, heart disease], be included on the claim submission. Aetna denied one of my claims where I had included a "cardiac...
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    Excision Neurofibromatosis masses , wrist and fingers

    Would like help coding this procedure Dx: Neurofibromatosis masses, wrist and fingers Procedure: Patient had 3 masses, one in dorsum of left wrist, dorsum of middle finger proximal phalanx, one in ulnar aspect middle finger [middle phalanx]. Small incision made over each mass that was...
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    Trapeziectomy of wrist

    WOULD LIKE ANOTHER OPINION ON THE CODING OF THIS PROCEDURE. WILL PROVIDE DESCRIPTION OF PROCEDURE ONLY. DX: Carpometacarpal arthritis left thumb Procedure: Trapeziectomy left wrist Incision made, centered over first dorsal compartment. Dissection carried down until dorsal compartment...
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    Telephone Call Workers Comp Patient

    Concerning a Department of Labor workers compensation claim, and a call to the patient by the doctor Can this phone call be billed to the workers compensation insurance? Waiting to hear, CW
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    Shoulder Surgery Coding

    Would like to see what codes someone else would use on this surgery. Operative note is lengthy, so will try to shorten, but report as much as possible. DX : Slap lesion of superior labrum with high grade partial tear of rotator cuff and impingement Procedures Performed: Arthroscopy of right...
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    Hip xrays denied for codes no longer valid

    All hip xrays that our office is submitting are being denied, stating no longer valid as of 1-1-2016 cpt 73500, 73510, 73520 are there new codes for 2016? Definitely not aware of any of this??? Can someone share their knowledge on this? Thank you cwilson orthopaedics
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    Excision Gouty Tophi Fingers

    Need some help with the CPT code for this procedure Excision of gouty tophi, thumb, index finger and long finger Incision extended from distal to DIP joints, involving dorsal and volar aspects. Thanks to all, Carol
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    Posterior Tibial Tendon Tubularization

    Need Help with CPT code for this procedure: Debridement and tubulariztion of posterior tibial tendon of ankle Procedure Note: The patient was brought into operative theater and placed in supine position. She was given general anesthesia and ancef intravenously. Left ankle was prepped and drped...
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    Physical Therapy Billing Question

    Very new to PT billing and need help with this scenario: Medicare patient, Initial evaluation Therapist billed 97001... I requested G codes and C modifiers that I think is required for Medicare Therapists states: "No functional test [written] performed to determine G-codes. I did an...
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    Physical Therapy Modifiers

    New to physical therapy billing. Still hunting for answers. Does 97001, Medicare, always require C modifiers [Severity level] along with G codes [functional] Therapists have been only using the G functional codes, and not adding the C modifiers. I know GP is used on each procedure. Next...
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    Physical Therapy 97001 Denied by Medicare

    New to physical therapy billing. Need some guidelines when billing Medicare 97001 , PT evaluation and treatment same date, i.e. 97140, 9730, 97710. Am told by my AR person, that Medicare is rejecting/denying 97001. No problem with commercial insurances. Always put GP modifier on these codes...
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    Help with Appeal of CPT 29881

    I need some help on doing an appeal of an arthroscopic menisectomy that was denied as "experimental/investigational] CPT 29881 Patient had MRI which confirmed a complex tear of the posterior aspect of the medial meniscus. There was a displaced meniscal flap tear. The doctor dictates that the...
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    Achilles Debridement CPT

    Patient had MRI left ankle, demonstrating mucoid degenerative changes with respect to Achilles Tendon. No frank tear, no haglund deformity, but with mild retrocalcaneal bursitis. Procedure to be scheduled: Debridement of Achilles Tendon, with PRP injection. What CPT code to use for the...
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    Osteochondral defect knee

    Help, Need Procedure Coding help. Procedure Code: Arthroscopic [not open] Repair of Osteochondral Defects Looking at CPT 29885 through 29887 Thanks to one and all.
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    99203 or 99204

    Would like to have someone audit this exam on a new patient? Patient: Mrs. Ortho DOS: 5-1-2014 CC: Left foot pain HPI: The patient is a 76-year old female who has had ongoing pain in the left foot. She has a history of plantar fasciitis. She has some low back pain that also radiates...
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    Open Repair of Osteochondral Defect

    Need help with CPT code for this procedure: Open Repair of Osteochondral Defect Outpatient DX from MRI: Large, 2.8 cm loose/displaced osteochondral fragment along peripheral anterolateral femoral condyle, donated from lateral femoral trochlea where there is a large osteochondral defect and...
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    Removal polyliner total knee; repair rupture vastus medialis

    Need help coding this surgical case. 1. Removal polyliner, status post total knee replacement 2 months ago [CPT 27486-52-58] ???? 2. Aspiration of joint [joint effusion] ?? 3. Repair ruptured vastus medialis and medial retinaculum ?? Would appreciate any and all replies. CW
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    99213 or 99214 - This is a follow up visit

    This is a follow up visit on a patient who returns for MRI results and surgical scheduling. IH: The patient continues to have instability and pain in the right knee. MRI performed shows ACL tear and some other damage in the knee PLAN: We discussed the treatment options. He has done well...
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    ACL Revision/Meniscal Reapir

    Procedure: Revision ACL Reconstruction with Hamstring Autograft and Medial Meniscal Repair Billing: CPT 29888 [failed ACL reconstruction] CPT 29882 [meniscal repair Can I also bill for removal of the previous screw fixation.:confused: Hamstring Autograft was...
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    Arthroscopic Menisectomy and Chondroplasty

    Correct me if I am wrong on the coding of this procedure: Arthroscopy of knee Chondroplasty of patella Chondroplasty of Femoral Trochlea Chondroplasty of Medical Femoral Condyle Chondroplasty of Lateral Tibial Plateau Partial Medial Menisectomy Platelet Rich Plasma Injection DX: Complex tear...
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    Bilateral xray billing to Virginia Medicaid

    Patient had bilateral knee xrays. I billed 73562-50, which I thought was correct billing procedure to Virginia Medicaid, with only 1 unit Medicaid did not pay for bilateral xrays. Should I have increased the fee to what normally would have been paid for right and left xrays or is there another...
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    Ankle Tendons Surgery Coding

    Need help coding this surgical case. Procedure: Debridement and repair peroneus longus, peroneus brevis tendon, and debridement of peroneus tertius of ankle. Description of Procedure: ...........Incision was made posterior to fibula and lateral malleolus. Care taken to...
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    Help with Elbow Surgery

    Diagnosis: Patial Tear, medial conjoined tendon medial epicondylitis and tendinopathy of lateral conjoined tendon, right elbow; Subluxation of ulnar nerve of elbow Procedure: Debridement and repair of medial conjoined tendon of elbow; Decompression of...