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    Question tPA admin via EVD catheter

    Hello, My neurosurgeon is doing this and the codes I come up with are: 61120, 61781, and 61645. Can anyone tell me if I'm correct or maybe direct me to the correct codes? Second question would be if tPA is administered on a subsequent days, how do I code them? OP Note: Postoperative...
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    Kyphoplasty and bilateral pedicle screw fixation

    Severe T12 fracture corrected using Kyphoplasty and T11 to L1 pedicle screw fixation, bilateral. I coded 22513 and 22840. Auto insurance is denying. Any suggestions? Any help would be appreciated. Thank you, Tina M Boback, CPC
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    SECOND request**Need help**

    We have 3 new NP's and I've never coded for NP's. 1) When a NP assists my neurosurgeon on a procedure, what is required? 2) Does the NP need to dictate their own note for the procedure? 3) Does the surgeon have to dictate who assisted them and what part of the procedure did they assist? 4)...
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    NP assistant during surgery/procedure

    We have 3 new NP's and I've never coded for NP's. 1) When a NP assists my neurosurgeon on a procedure, what is required? 2) Does the NP need to dictate their own note for the procedure? 3) Does the surgeon have to dictate who assisted them and what part of the procedure did they assist? 4)...
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    3 level total disc arthroplasty (artificial disc)

    My doctor wants to do a 3 level total disc arthroplasty (artificial disc). For the first two levels the codes are 22856 and 22858. What would I use for the third level? Would I have to use 22899 unlisted procedure with modifier XS? Any suggestions? Thank you, Tina
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    billing 0200T & 0201T

    I have billed both of these codes and Medicare has denied as "Procedure/treatment is deemed experimental/investigational by the payer" Claims were appealed with documentation (Op Note and documentation where they have approved these procedures as of July 2009). The DX codes being billed are...
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    Kypho with Facet block?????

    Can Kyphoplasty and Facet block be billed together? CCI edits say they can, but I wanted to see if anyone had this come up before. Op note incase anyone is interested... PROCEDURES: 1. Balloon reduction of compression fracture at T11. 2. Vertebroplasty at T9. 3. Biplanar fluoroscopic guidance...
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    Cranioplasty for skull defect

    I have a new Neurosurgeon starting soon. He asked me what code I would use for a cranioplasty for skull defect when he uses polymethyl methacrylate or PMMA instead of the patients own bone. I think I would use 62146 Cranioplasty with autograft? Can anyone confirm this for me?
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    DBS intra-operative programming

    When my doctor does 61885 for initial placement or batter replacement, he does programming and/or reprogramming. Which is the correct code? 95971 or 95978?
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    Two Phase Spinal Surgery

    Phase 1 was coded: 22558 - Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace; lumbar 22845 - Anterior instrumentation; 2 to 3 vertebral segments 22851 - Application of intervertebral biomechanical cage 20930 - Allograft, morselized, or placement of...
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    Lap repair of perforated ulcer-HELP

    The only code I could find to use for this procedure is 43659 (unlisted laparoscopy procedure, stomach. There is no RVU for this code. Has anyone billed for this? What was the price billed? What was the reimbursement? Here is the op note: PREOPERATIVE DIAGNOSIS: Peritonitis, acute abdomen...
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    Revision & placement of 2nd shunt-HELP

    PROCEDURES PERFORMED: 1. Revision of right ventriculoperitoneal shunt placement. 2. Tandem shunt placement, proximal, no Strata valve shunt, set at 1.0. 3. Shunt placed in tandem more distally, 0.5 setting with anti-siphon device being placed. PREOPERATIVE DIAGNOSIS: Hydrocephalus...
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    Anterior Cervical Discectomy WITH bilateral foraminotomies at C5-6

    PROCEDURE: 1. Arthrodesis anterior interbody technique cervical diskectomy with bilateral foraminotomies at C5-6. Documentation supports the above procedure...so far I have 22554. WHAT CODE SUPPORTS ANTERIOR BILATERAL FORAMINOTOMIES AT C 5-6? Tina
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    Assistant Surgeon**HELP**

    **SECOND TIME POSTING** Sorry, but I need help, Who can qualify as an Assistant Surgeon and what type of documentation is required? Resident and PA-C's are submitting encounters as Assistant Surgeon. They are not dictating their own report. I believe they need to dictate their own report...
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    Assistant Surgeon-Who can qualify

    Who can qualify as an Assistant Surgeon and what type of documentation is required? Resident and PA-C's are submitting encounters as Assistant Surgeon. They are not dictating their own report. I believe they need to dictate their own report. Someone had asked can Residents and PA-C's...
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    Reversal of loop ileostomy, extensive lysis of adhesions and repair of peristomal her

    Need help coding this procedure: PROCEDURE IN DETAIL: The patient was subsequently taken to the OR, placed on OR table in supine position. Bilateral SCDs were placed. Anesthesia was induced. The patient was intubated. Foley catheter was inserted. Abdomen was prepped and draped in sterile...
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    HPI Element "denies N/V"

    I audit E/M visits and I have a re-evaluation from a provider who is using "Denies Nausea/Vomiting" as the Associated Signs and Symtpoms. I believe this is NOT a valid element. Any thoughts or souces that I can use to support this NOT being a valid element?
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    99366-Need some insight

    Need some insight on 99366. We see doctors billing this for when a case manager is at the E/M visit or when they visit a patient at their homes. Both being billed as often as on a weekly basis! Correct me if I'm wrong, but isn't a doctor supposed to use an E/M code for these visits? If...
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    Auditing E/M coding using time

    I have a case where a doctor has been over coding his E/M visits and I have been downcoding them to the proper code. Now he has submitted a new E/M and this time he put at the end "Time spent with patient - 45 minutes." He can say 'well I spent the entire time of 45 minutes with the patient'...
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    95-97 guidelines used by doctors

    I know a doctor change change between using 1995 and 1997 guidelines for E/M. The question is how often can they change between the two? I am doing some auditing and have a doctor told me that he changes between 1995 and 1997 guidelines as he pleases. Sometimes from day to day or...
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    *Help* Surgical post op E/M

    For auditing purposes I need help with this: Scenario ONE (Doctor A Neuro Surgeon/Doctor B Spine Surgeon) Day 1 - Patient has surgery on spine by doctor A Day 10 - Pt has E/M with doctor A (included within surgical package) Day 28 - Pt has E/M with doctor B for refill on Rx Is day 28 payable...
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    Surgical Post Op E/M

    For auditing purposes I need help with this: Scenario ONE (Doctor A surgeon/Doctor B same practice MD/DO) Day 1 - Patient has surgery on spine by doctor A Day 10 - Pt has E/M with doctor A (included within surgical package) Day 28 - Pt has E/M with doctor B for refill on Rx Is day 28 payable...
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    Audit-Surgery Guidelines/Surgical Package

    We have a doctor who performed a surgery with no internal fixation (90 day global). Day 13 he billed E/M (denied) with x-ray (paid) Day 50 he billed E/M (denied) with x-ray (paid) We expect to see more E/M and x-ray services within the 90 day global from this doctor for the same patient...
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    Auditing E/M by time

    Doctor says "Appointment began at 11:15 and ended at 12:45 for 1.5 hours duration." PLAN: "counseling long time today" Would this be enough for code 99215 and 99354? Let me know your thoughts!
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