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  1. E

    Ureter cath during general surgeron

    I don't know what provider you are talking about when you say "the same provider" - Do you mean the Urologist or the general surgeon? If the Uro is only inserting then temporary stent then it is a billable event, if the general surgeon is inserting the temp. stent during the course of a larger...
  2. E

    Diagnostic Ultra Sound

    Not a chance... nope, not at all, no way. In order to bill for a diagnostic US the physician would have to document the diagnostic results of the ultrasound, including but not limited to - prostate density, volume and measurements, seminal vesicles, median lobe size/protrusion, hypoechoic...
  3. E

    Looposcopy & Loopogram

    I would use CPT code 44380, Ileoscopy, through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure). CPT 52000\52005 are inaccurate because they reference urethroscopy and cystoscopy, both of which are not performed. 74425 would still...
  4. E

    Help! Post void residual done without ultrasound?

    Wow..... You were led down the wrong path.... and you should not use 51798 if you are not using a PVR machine. As mentioned previously, the code description states specifically that this is done by ultrasound scanner, and you're not using one so how would this code be appropriate? I'm shocked...
  5. E

    Resection of prostate....Please help

    TURP vs. PVP (52601 vs. 52648) The procedure described in your op note is a TransUrethral Resection of the Prostate (TURP), coded with 52601 (if this is the patient's first TURP) or 52630 (If the patient has had a previous TURP). The key documentation elements to watch when selecting this CPT...
  6. E

    can you bill for urodynamic testing perform by MA or RN, but interpreted by a MD

    Per the American Urologic Association: "Urodynamics can be performed by non-physician practitioners such as physician assistants, nurse, or medical technician. However, billing for these services requires direct supervision, which means that the billing physician must be present in the office...
  7. E

    54235 vs 54200

    He's just doing anesthesia, it doesn't matter how deep he goes into the penis, it is still just anesthesia, which is bundled into the procedure. This would definitely be called "abuse" or upcoding if noticed by an insurance company.
  8. E

    ICD-10 coding

    are we playing "fill in the blank" and I missed something.....or is this supposed to be a request for help? Just saying, if you want help, it might be helpful to actually ask...
  9. E

    Is it 51 or 59?

    To piggyback off what King said, these modifiers are very different and are used for different but sometimes overlapping situations. Modifier 51 is used on all surgery/medicine codes billed in addition to the main procedure. For example, if my doctor performed a lap. radical prostatectomy as...
  10. E

    Modifier 50

    without an op note it is hard to assign the correct CPT code, but the one you selected does allow for Modifier 50 to be used. If the scenario is truly a straight forward bilateral FB removal, then you would be correct to either 1.) add modifier 50 or 2.) bill the same CPT code on two claim lines...
  11. E

    Modifier for HT Revision

    58 is for a staged (planned) return to the OR. Since you had device failure (which I can only assume was not the plan:)) this would not be a planned secondary procedure. 76 is when a physician has to perform the same procedure, during the global period of the original procedure. It sounds like...
  12. E

    MUSE suppository code?! Please help!!

    Muse is supposed to be self administered so, to my knowledge, there is no CPT code for it's insertion. If the physician is performing the insertion to demonstrate this to the pateint, then consider documenting and billing an office visit. If it is performed by a nurse/MA then you may have to...
  13. E

    PCNL with nephrostogram

    Correct on all accounts. Thanks for filling in what I missed JEYCPC!
  14. E

    radical nephrectomy

    Agree with JEYCPC, this is a separate anatomic location for two procedures that are usually not performed in the same operative setting. Since you didn't provide exact CPT code is is hard to give a more exact answer, but I hope you get the answer you're looking for.
  15. E

    Nephrectomy help

    The long, lay description for CPT code 50220 (according to EncoderPro for Payers) states "The physician removes the kidney and upper ureter, but does not remove the adrenal gland, surrounding fatty tissue, or Gerota's fascia.". since your physician removed the kidney "intact within the gerotas...
  16. E

    PCNL with nephrostogram

    Codes 50081, 50693 and 74425 should all be good with the appropriate modifers (RT, 51, etc.). I question if this is the appropriate use for 52000, since the cysto is not an integral part of the PCNL & stent and was done to check/correct the stent placement. The cysto was not performed because of...
  17. E

    Risk Adjustment Coding Forum

    Anyone know of plans for AAPC to have a risk adjustment discussion forum? know of one elsewhere that is accessible?
  18. E

    Ureter cath during general surgeron

    since you did not state the method of approach, I am assuming that this is being done through a cystoscope. In that case you should use 52005, Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;. No...
  19. E

    Wiki E11.628

    Coding vs. Clniical As a coder, it is not our position to question the clinical decision making of the provider. It is our job use our years of coding education and training to to code what is documented and let the provider, with their years of clinical education and training, decide which...
  20. E

    Wiki Major Depressive Disorder - Duration Unspecified

    With ICD-9-CM, when documentation for MDD did not specify single episode or recurrent, the subcategory 296.2x gave the option "single episode or unspecified" in the notes after the subcategory in the tabular. With ICD-10-CM, the unspecified option has been removed. When documentation does not...
  21. E

    obs status changed to inpt in hosp for 4 days

    E/M Code Families If/When an observation stay is converted to an inpatient stay, the admission date should be changed back to the patient's first day in the hospital. Therefore, day 1 should be your inpatient admission code, and days 2-4 should be your subsequent hospital care codes.
  22. E

    Urodynamics performed by a certified nurse practitioner

    State Specific As you are probably aware, each state regulates what services mid-levels can/cannot provide independently. I would research your state specific laws through government websites and professional organizations.
  23. E

    Manipulation of urethral calculus

    52330 is for a ureteral calculus, not a urethral calculus and would therefore be inappropriate to use. There is not a CPT code for manipulation of urethral calculus.
  24. E

    Procedure, Incision and Drainage, dc'd in office at request of patient

    What and how you bill this depends on when the patient elected to cancel the procedure. more than likely you will end up billing an E/M, but I could see certain circumstances where billing the procedure CPT with a 52 would be warranted.
  25. E

    99214 dilemma

    From CMS - Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted...
  26. E

    Use of Modifier -25 Question

    agree with Pamsbill, well said.
  27. E

    Removing bilateral ureteral stents!

    I would bill 52310. There is nothing "complicated" about removing two stents instead of one. The whole procedure takes about 5 minutes instead of 4. I would consider 52315 as upcoding since it is describing a level of difficulty that is not accurate.
  28. E

    how to bill for S0020 in the office

    S0020 (Injection, bupivicaine HCl, 30 ml) Is stated as an injection. I would not bill this with a bladder instillation. If you are using the drug for an instillation, I would find the appropriate J code. If there is not a specific J code for bupivicaine, I would use J3490.
  29. E

    Hospital Consult

    agree with Debra. without a fece-to-face visit, you cannot bill for this E/M service. Your doc should have waited for the patient to return.
  30. E


    you are correct, i typeds 74450 twice instead of 74455 which is the correct code. Thanks for catching the typo!
  31. E

    New practice and existing patients?

    If it's a new practice and a new physician for the patients, there is no reason for these visits to be anytihng other than new pateint visits.
  32. E

    pessary ?

    57160 (Fitting and insertion of pessary or other intravaginal support device) should be billed with a 52 modifier (reduced services) since the fitting was done but not the insertion. Duplicate the coding when the patient returns for the f/u appt to have the pessary inserted.
  33. E


    Two tests done, retrograde UCG and Voiding UCG. you should only charge the injection once, but should charge for the supervision & interpretation (S & I) on both radiological procedures, assuming it is appropriate in this situation for your doctor to charge for the S & &. You may need to bill...
  34. E

    Diagnosis for Positive McMurray's Sign??

    I'd say that is about all you can use until an actual diagnosis has been docuemnted.
  35. E

    coding same procedure different day

    Are the second warts removed in the same location as the first and just wern't removed the first time? Different location? Were the two proceudres planned to take place on separate days or was the second procedure unplanned? There are important circimstances missing that would help provide the...
  36. E

    Bilateral Procedures

    Since there are multiple ways to bill a bilateral procedure and different payers have different rules, there is not a "one-size-fits-all" answer. Short answer though, if you are billing a unilateral code with modifier 50 to note that the procedure was performed bilaterally, you should increase...
  37. E

    Help with a surgery.....

    You are asking about CPT 52353 which is for URETERoscopy with laser lithotripsy. The op report you posted is for calculi in the URETHRA, not the URETER, so 52353 would be inappropriate from an anatomic standpoint. The code you would need is 52317 - Litholapaxy: crushing or fragmentation of...
  38. E

    how to code B-TURP vs. M-TURP

    A TURP is a TURP, regardless of the setup used to perform it.
  39. E

    emr hx reviewed by

    In a perfect world, the doctor should review any part of the note that was done by a nurse or MA and sign off on it. However, I would say that it is still acceptable to take as long as they have signed the completed note, which ultimately means that they attest to the accuracy of ALL of the...
  40. E

    Dilation of bladder neck contracure

    The work done here is the same as what would be done for a urethral dilation. The op note does not make it clear where the dilation is. It notes 3 parts of the urethra (pendulous, membranous, bulbar) and says they are normal, and then says the bladder neck is open and structured. I think you are...
  41. E

    MRI-ultrasound fusion prostate biopsy

    Here's a link from NCBI that will explain this way better than I can.
  42. E

    MRI-ultrasound fusion prostate biopsy

    It's very hard to provide proper CPT guidance without reading an operative report, especially when there is work from more than one provider involved. Please post an example and we would be glad to assist.
  43. E

    Dilation of bladder neck contracure

    how are the performing the dilation of the BNC? The details of this may be important to finding the correct code.
  44. E

    Doctor joining group bringing patients with him

    From the WPS (Medicare MAC) website: Q10. Doctor A is new to our group. If a former patient sees Doctor A under our group, is this patient new or established? If the former patient has a visit with Doctor B, in our group with the same specialty as Doctor A, is the patient new or established...
  45. E


    The J code is J1580, and each unit is 80mg. If you are using more then you should bill for multiple units when documented. In most instances you would bill for the injection/administration with 96372.
  46. E

    Documentation of Encounter

    You are 100% correct. It sounds like there is widespread fraud happening. I would not want to be a part of it and would get out of there as fast as I can. I would also consider reporting this to the proper authorities because this physician's neglect for his patient could very likely be putting...
  47. E

    Use of Modifiers with Add On Codes

    Even more alarming is that your billing company is adding modiiers to ANYTHING! They are being paid to bill what you send to them, correct? If they are coding as well as billing then that is a diferent story (and you can disregard my diatribe below) but if they are only doing your billing then...
  48. E

    need help with this procedure

    I would recommend posting your op note in the orthopedic section. You will get specialty specific help far quicker and probably with more accuracy than in the general discussion board. I am not an ortho coder, but your op note seems very choppy and incomplete to me. Maybe it will make more...
  49. E

    New Physician

    I don't know how you would consider them new patients when they all have an established relationship with the provider. The first question in the new vs. established decision tree is - "Has the patient received any professional service from the provider or another provider in group of same...
  50. E

    Instillation of anticarcinogenic agent with cyto.

    Since the are non-overlapping services, I think you could justify unbundling with an XU modifier.