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    Who is ultimately responsible for Correct Coding

    I attended a seminar a couple of years ago; where the speaker cautioned us on changes to definitions in the laws. They specified; these changes allow the OIG to look at BOTH an organization AND the coders involved for fraudulent claims. I have unfortunately misplaced the notes for this. The...
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    Spinal Arthrodesis counting

    Hello! I have a question regarding Posterior Spinal Arthrodesis. Anterior is clearly defined as interspace, Posterior is confusing me a bit. 22630 states Interspace, 22633 states interspace 22600 states single level; and the add on that follows is per segment How would we count the initial...
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    External Fixator in the OR

    That makes sense; because you can bill for an ORIF; and an External Fixator. But the External Fixator is part of the treatment at that point and has a 90 day global period. Sometimes things do not bundle; but you know you should not bill them (IE scouting scopes). Should we really be billing...
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    External Fixator in the OR

    Hello! We have a physician; who is using an external fixator in the OR. It is being applied to reduce the fracture so the physician can apply the internal fixation without an extra set of hands in the extremity. It is then removed and casted and/or braced following surgery. I don't think this...
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    Diabetic Wound Care Diagnoses

    That is awesome advice. Thank you so very much for taking the time to assist me. That sounds like a very informative class!
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    Diabetic Wound Care Diagnoses

    When billing for Diabetic Wound Care; our LMRP suggests the patient need to have co morbidities to support the billing of the Wound Care. Our physician is listing the following in his impression Diabetes Mellitus Ankle Ulcer Peripheral Neuropathy Venous Insufficiency He debrides the wound We...
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    Consultation vs new patient?

    That is the distinction the referral must make. If the patient has a known condition and the referral is simply for treatment of that condition...then a consult will not be billed. Diabetes and asthma are known conditions. If the patient is sent to a specialist because the physician can't manage...
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    Consultation vs new patient?

    In order to bill a formal request for consultation MUST be present in the medical record If a patient comes in because their Dr mentions that they should see an allergist...and they get your name from a friend or carrier...and make an appt. And they do not present with an order for...
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    Consultation vs new patient?

    Only Medicare has said they will not pay for consult codes. This will include your Medicare replacement plans. In some states Medicaid will follow I would check with your carrier. But Commercial Insurances (IE; Aetna,Blue Cross and Blue Shield, Med Mutual, UHC[again unless they are a...
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    Consultation vs new patient?

    I agree with the previous post. If the problem has been diagnosed; and the patient is referred for treatment, a new patient code is appropriate. However, if a patient is referred for "sinus symptoms"; and the physician does a work up and finds it to be allergies; and asks the patient to return...
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    Hernia repairs with Excision of leasion of spermatic cord

    Hello! When billing for an inguinal hernia repair (49505), if a physician performs a spermatic cord lesion removal (55520) Is it ALWAYS separately reported with a 59 modifier. I know there is a CPT assistant (Sept 2000 page 10) that states: AMA Comment: Code 55520, Excision of lesion of...
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    ERCP with Stent exchange; and additional stent placement

    I am looking for clear cut documentation to support coding the following service: A 10FX5cm double pigtail stent was removed via snare. The CBD was cannulated. Retrograde opacification reveals a high grade stricture...A 10FX5cm double pigtail stent was inserted. There was immediate drainage of...
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    post op visit

    Post op applies to the surgeon and tax ID Post Op periods apply to the surgeon and Tax ID, not the state. If a patient is seen by another physician who was not involved in their surgery in another state Post Op will not apply
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    Locum tenens billing

    Locum Tenens indicates their actual hospital priviledges. They can still be employed and be a Locum Tenens-you would still bill with a Q6-Hope this helps!
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    Documentation question (smoking cessation)

    I have a physician who wants to bill for smoking cessation. She did not document it in her progress note-but did in her letter to the referring provider. I do not think it is billable this way, my impression is an auditor would look at the progress note, and for the presence of a return letter...
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    Immunizations & Injections

    For Therapeutic Injections such as B-12 and testosterone you would bill the med and adminstration code 96372 For Vaccines: you would bill the vaccine code and 90471 for the first one, and 90472 for each additional vaccine The Counseling Codes for Children are only valid if the PHYSICIAN...