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  1. Tami_F

    Question Premature Baby and wellness visit

    This dx should be ok. P codes can be used throughout the life of a patient as long as the documentation shows that the condition originated in the perinatal period.
  2. Tami_F

    Billing for Holter Monitor

    How about something like 93272 with modifier 52 for reduced services?
  3. Tami_F

    Question Credentials on a Resume

    I list mine on the top, next to my name. I put them in the same order AAPC does (next to my name on my member profile), which theoretically goes from most general to most specific. At the bottom of my resume, there's a section that shows what they all mean and the dates they were obtained.
  4. Tami_F

    Question Qualifying Use of 96112

    Here's some guidance from the AAP that may be helpful. It is my understanding that the score(s) must be documented in the note in order to bill these codes.
  5. Tami_F

    Question Abrupt status in neurological status

    I agree with your auditor. A known seizure disorder alone is not high risk. I would not qualify that as an "abrupt change in neurological status". A patient that is in status epilepticus or actively seizing would better fit that description. Many antiepileptic medications require monitoring for...
  6. Tami_F

    Question Question

    It seems like most job listings I see for CDI-related positions either prefer or require clinical experience and a current nursing license. You could have a lot of options with your background, if that's something you're interested in.
  7. Tami_F

    Wiki Mental Health & billing for Phone Therapy / Telemedicine calls.

    Here are a couple helpful webinars from earlier this year: What You Need to Know About Telehealth Behavioral Health Documentation Standards This one is coming up next week: Pitfalls to Avoid in Behavioral Health Documentation and Coding
  8. Tami_F

    E/M Help

    I have not heard of this practice. Do you know what the rationale is for coding consults this way? It sounds like downcoding, and is almost certainly costing your practice both revenue and RVUs. The only reason I can think of for billing a sub day instead of an initial day is if the...
  9. Tami_F

    Question E/M coding for physician inpatient charges

    In short: no. 1. The location of the patient at the time of service does not determine the level of care. Just because a patient is in the PICU does not mean that it is appropriate to bill critical care. 2. The pediatric critical care codes should only be billed by the attending...
  10. Tami_F

    Question Observation Discharge Day After Pre-scheduled (Elective) Outpatient Procedure/Surgery

    Agreed. If everything is routine and there are no complications, clearing the patient for discharge is part of the work involved in the scheduled procedure.
  11. Tami_F

    Question New Patient

    Agreed, this sounds like preventive care (CPT 99381-99397). These codes are age-based, and differentiate between new and established patients.
  12. Tami_F

    Diagnosis coding for Consultation

    When coding for suspected autism, I often use F94.8 (Other childhood disorders of social functioning). It depends on the documentation.
  13. Tami_F

    Peritoneal drain placement

    How about 49020 (Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess, open)? Per the lay description in Encoder, this code can include the placement of a drain. There's a Q&A on Super Coder, as well.
  14. Tami_F

    E/M Help

    Perfect, then you can bill the consult :) If the insurance doesn't accept consults, just crosswalk it to 99221-3 like usual.
  15. Tami_F

    Question Subsequent Days - newborns in hospital

    Thank you. Separate guidelines sound wonderful, but I won't hold my breath.
  16. Tami_F

    E/M Help

    No. These intensive (and critical) care codes should only be billed by the attending service. Code to the documentation. Did your urologist perform the procedure? Was it a consult? If your urologist documented providing critical care, use the time based critical care codes (99291-2).
  17. Tami_F

    Question Subsequent Days - newborns in hospital

    Cindy, thanks so much for your ongoing help with this. I will share your advice with my supervisor. Actually, the question in the "Reporting of Neonatologist Services" states in part, "The baby was resuscitated, and transferred to the neonatal intensive care unit (NICU) at the same hospital."...
  18. Tami_F

    Question Subsequent Days - newborns in hospital

    We're still having this conversation (on and off), hooray! We are also getting denials. My supervisor just brought this to my attention, and I'm curious what you think, Cynthia. I'm hesitant to post the full Q & A without consent from the AHA. Personally, I'm not sure this clarifies much...
  19. Tami_F

    BMI

    Keep in mind that BMI for pediatric patients needs to be documented as a percentile to be coded correctly. Pediatric BMI codes Z68.51-4 are for use in patients from 2-20 years of age. Per ICD-10-CM Guidelines:
  20. Tami_F

    Weight used for 99478-99480?

    The CPT definitions of these codes specify "present body weight". Coding for Pediatrics 2018 elaborates: "Codes 99478-99480 are reported once per calendar day of subsequent intensive (but not critical) care for the E/M of the recovering infant weighing 5,000 g or less. Selection of the code...
  21. Tami_F

    Ekg

    These patients are having an EKG to determine whether or not they have a cardiac condition. How is that not a screening?
  22. Tami_F

    Ekg

    Our cardiologists often read EKGs from outside institutions, and therefore don't have the context to provide signs or symptoms of why the test was ordered. We use Z13.6 (Encounter for screening for cardiovascular disorders) for normal EKGs.
  23. Tami_F

    E/M Risk level - history other than pt

    This would count towards the amount and/or complexity of data reviewed, rather than risk, to determine the overall level of MDM. Parents count as historians. We encourage our providers to document the source of the patient's history, whether from a parent, overnight resident or nurse, medical...
  24. Tami_F

    Critical Care VS Consult

    Yes. If he provides critical care to a patient he is consulting on, he should document it appropriately, and it will be billable. If he does not provide critical care, a consult should be billed. Critical care can be provided in any setting, it is not dependent on the physical location of the...
  25. Tami_F

    99215 ?? Feeling very frustrated

    I'm inclined to agree with the provider on this one. Risk is not the only factor in determining the overall level of MDM. I would credit 4 points for dx, 4 points for data, and moderate risk, which is high complexity MDM. For data: 1 point for reviewing labs, 1 point for ordering stat CT, and 2...
  26. Tami_F

    GC Modifier and EKG Interpretation and Report

    Unless the cardiologist attests to having acted in a teaching capacity on the interpretation note, GC wouldn't be applicable.
  27. Tami_F

    Family practice/Medicaid and ADHD patients

    Have you tried using Z51.81 (Encounter for therapeutic drug level monitoring) as the primary code for these kids? That's generally what we do when the pt is primarily being seen for management of ADHD meds.
  28. Tami_F

    69210 and 92587

    I just plunked this into EncoderPro, and it says, "Code 92587 (column 1) has a CCI conflict with code 69210 (column 2). A modifier is not allowed to override this relationship." The reason given is, "Misuse of column two code with column one code."
  29. Tami_F

    Pediatrician coding postpartum depression on child's visit

    I'd just show them the entry in an ICD-10 book. This is a female-only, maternity diagnosis, which means it can only be used on female pts between the ages of 12-55, per ICD-10. What code(s) does the documentation support?
  30. Tami_F

    Newborn coding clarification

    We have been debating this issue here for quite a while now. Welcome to the conversation! Cindy's quote from the Coding Clinic above is correct. When you start working through the CPEDC study guide, you'll find that AAPC wants you to use the Z00 codes from DOL 2 forward. Personally, I think...
  31. Tami_F

    Dx coding help on genetics

    Hi, An enzyme is not a diagnosis. I've been coding genetics for several years and will be happy to try to help once you've gotten clarification from the provider.
  32. Tami_F

    Neonatal Inpatient Codes 99478-99480

    99477 specifies "28 days of age or younger," but the rest of that code set is weight-based rather than age-based. For sub days, as long as the patient's present body weight is within the specified range, a code from 99478-80 can be used. The descriptions of those codes do not specify that the...
  33. Tami_F

    Pediatric Coding Question...

    There's a peds sub-forum, as well :)
  34. Tami_F

    Question Subsequent Days - newborns in hospital

    Check your guidelines. This is from the first page: "The term encounter is used for all settings, including hospital admissions." Thank you!! For reference, the case study is a "pediatrics well newborn inpatient discharge note," and the question asks for the ICD-10 code. The rationale points...
  35. Tami_F

    Wiki Newborn dx needed

    Please don't use a birth injury code if the documentation doesn't support it! If there isn't an appropriate corresponding P code, use the H code.
  36. Tami_F

    Studying for CDEO

    Hooray! Good luck Steph! When will you be taking it? I didn't take an extra reference, just CPT, ICD-10, and HCPCS, and honestly didn't feel like I needed one. I did utilize a lot of the blank pages in my coding books for notes, but didn't end up using those much, either. It wasn't as hard of...
  37. Tami_F

    Cystic Fibrosis testing

    That seems reasonable, since Z13.71 specifies that it's for nonprocreative screening. Z31.430, Encounter of female for testing for genetic disease carrier status for procreative management, seems like a better fit.
  38. Tami_F

    Studying for CDEO

    I took the AAPC course and practice exams. I didn't use much outside information partially because I didn't want to spend time focusing on things that wouldn't be on the exam, and partially because I only had a few weeks to study before taking it.
  39. Tami_F

    Critical Care Coding question

    It depends This article from 2015 looks like a good resource. If Dr 1 and Dr 2 are from different specialties: yes. If Dr 1 and Dr 2 are from the same specialty: no. You mentioned that this is a teaching environment - only the time the attending/supervising physician spends providing...
  40. Tami_F

    Wiki What icd-10 code should be used in Hashimoto's encephalopathy (HE)

    G04.81 is the code for "other encephalitis and encephalomyelitis." Since you are looking for an encephalopathy, G93.49 - other encephalopathy, seems like a better fit.
  41. Tami_F

    NICU consultations based on time

    Sure :)
  42. Tami_F

    NICU consultations based on time

    The consult codes can be billed based on time as long as time is documented correctly. If the time is not documented correctly, an exam would be required to meet the minimum criteria for a consult (3/3 key components). Regardless, if the providers are performing an exam, it should be documented...
  43. Tami_F

    CDEO certified coders

    This is good information, thank you. I'm still on the fence about whether or not to do the whole training program, and you may have swayed me. It is disappointing that it only costs $20 less to buy the training program and practice exams a la carte than to buy the full training package. It...
  44. Tami_F

    Specialist called into NCCU-what code would you use?

    Correct. As long as your ID specialist is providing critical care, then you are correct to bill his time using 99291/99292. CPT is clear about this, but that doesn't help much if your payor refuses to read CPT. I can't comment on whether or not we've had this problem because it wouldn't come...
  45. Tami_F

    CDEO Study Guide

    You/your source was right, Steph! HOORAY. Now, we just have to figure out if we want to pay that much for it ;) ETA: Has anyone here completed one of AAPC's exam preparation courses? Are they worth the expense?
  46. Tami_F

    CDEO Study Guide

    This is a great reference, thank you! Here's hoping your source is right. It will be so nice to move forward with this, whenever it happens.
  47. Tami_F

    Newborn weight check for weight loss after birth

    Happy to help :)
  48. Tami_F

    Newborn weight check for weight loss after birth

    How about P96.89 (Other specified conditions originating in the perinatal period), followed by R63.4 (abnormal weight loss)?
  49. Tami_F

    CDEO Study Guide

    Thank you for coming back to let us know how your exam went. I'm sorry to hear that you failed, and hope you ace your retake. Based on some of the recent responses in this thread, I'm interested to see if any CDEO-related exam prep becomes available on June 1st. If not, that would make a full...
  50. Tami_F

    Thank you Alan Pechacek, M.D.

    100% agreed. I have zero experience in ortho, but your answers to questions are so well thought out and informative that I always make sure to read them because I always learn something. You're an excellent resource - thank you!
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