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  1. primrose1

    Question Patient with dementia

    We had a new patient come into our office from a local nursing home facility without much ppw unfortunately or send the radiographs that they were supposed to send along with her. She has dementia. When our provider tried to examine her, she was not able to communicate any signs or symptoms...
  2. primrose1

    Question Coblation chondroplasty

    Has anyone been successful in coding/billing and receiving payment for this procedure? Wondering what you've used. I've been using 29999 for the warewolf coblation arthroscopic technique. Any advice/suggestions with this?
  3. primrose1

    Question AAOS and AAPC vs CCI edits

    I'm newly employed to an organization that codes strictly to Medicare guidelines/CCI edits regardless of patient insurance coverage (except for work comp and no fault). I've always used information from the Coding Companion books to appeal claims that are denied for modifier 59 usage (i.e...
  4. primrose1

    Help with anesthesia time

    I'm looking for help please. I usually code ortho but I'm helping to cover a gal who is out on disability who codes anesthesia. I've picked up on things fairly well but I need some guidance on labor/delivery time coding. I have the start/end times available but there are a few cases that the...
  5. primrose1

    Open SLAP repair

    Is there a CPT for the open repair or is it unlisted? Thank you!
  6. primrose1

    Z71.2

    Can someone tell me please if Z71.2 is a primary billable code? Can it be used as the only dx on a claim? I know it cannot be used as a primary inpatient code for Medicare, but can we use it in the office, say for MRI results? Thank you! Kris
  7. primrose1

    Need help coding: Stump revision or just I&D?

    I'll try to post a scrubbed up op note. I'm not sure if I should code this with the debridement codes because of the abscesses/ulcers or is this considered a stump revision? I was going to code it a revision but the surgeon did 11044 & 11047. Any help which way I should go? Patient's right...
  8. primrose1

    Retired MD

    A surgeon in our office has retired. His patients are now choosing other surgeons in the practice for procedures. If a decision for surgery was already made prior to his retirement but are now meeting the dr. that will be taking over their care, is that E/M billable since they're seeing them...
  9. primrose1

    NYS billing for RPA's

    Hoping someone here can clarify an issue I'm having as I'm getting conflicting information regarding billing for physician assistants (in NY). Originally I was informed that Medicare does not recognize or will not pay for a physician assistant that is not 'certified' (RPA-C), now I'm being told...
  10. primrose1

    Facility TC component and modifier 25

    I posted this originally on the 'modifier' thread but didn't get a response :(; maybe someone here can advise?? Thank you!!! Hoping someone can clarify for me as I'm confused. I've been billing in a private ortho practice for several years and we recently merged with a local hospital so we're...
  11. primrose1

    Modifier 25 & TC

    Hoping someone can clarify for me as I'm confused. I've been billing in a private ortho practice for several years and we recently merged with a local hospital so we're now technically an outpatient facility. There are several insurance carriers that require split billing. What I'm told from...
  12. primrose1

    Office procedures

    My physician normally does his carpal tunnel releases and trigger finger releases under a local in the OR but is thinking of possibly performing them in the office in the near future. Wondering if anyone here bills for these in-office procedures and if there is an increase in re-imbursement...
  13. primrose1

    Post-op aspiration

    I'd just like confirmation from others on this as there's a debate in my office. I say if a patient comes in post-op from a knee scope with effusion and it's aspirated, that falls under the catagory of being included in the surgery and no charges to the insurance company if it's under the...
  14. primrose1

    code-a-round

    Has anyone tried the ortho code-a-rounds for ceu's?? I purchased my first one last week when they were the hot deal and boy is it tough!!!
  15. primrose1

    ORIF and open reduction w/o fixation

    One of my doctors did an ORIF of a proximal tibia with an open reduction without fixation on the proximal fibula. Having a brain lapse today..........use a combo code or can I code these separately?
  16. primrose1

    CPT for PTT synovectomy

    Looking for a posterior tibialis tendon synovectomy code...........?????? Help!!
  17. primrose1

    What do you do?

    Just wondering how you may do things in this scenario: Patient comes into the office with a bimalleolar fracture. Is treated with a cast/splint the first day but is being scheduled to go to the OR the following week (5-6 days after the office visit) for an ORIF. Do you code the initial...
  18. primrose1

    Aftercare coding - dislocation

    Is there a code for aftercare of a dislocation? Specifically an AC joint? Or is a fracture aftercare code used for these too?
  19. primrose1

    Modifier 59 w/ injections - some injection claims

    I have an insurance company that is denying some injection claims. We billed 20610 for a shoulder injection and patient also had a trigger finger injection during the same visit which was billed 20550 (59). They want reasoning as to why the trigger finger injection should be paid. Is this not...
  20. primrose1

    Modifier 59 w/ injections

    I have an insurance company that is denying some injection claims. We billed 20610 for a shoulder injection and patient also had a trigger finger injection during the same visit which was billed 20550 (59). They want reasoning as to why the trigger finger injection should be paid. Is this not...
  21. primrose1

    CMBS credential

    Just wondering how many have this credential and if you feel it's beneficial to go along with others you may have? Any thoughts/recommendations as to whether or not to pursue this also? Thanks! Kris
  22. primrose1

    CMBS credential

    Just wondering how many have this credential and if you feel it's beneficial to go along with others you may have? Any thoughts/recommendations as to whether or not to pursue this also? Thanks! Kris
  23. primrose1

    self pay patients - ACL reconstruction

    Curious as to how other practices quote prices for surgeries for self pay patients? i.e., if a patient needs an ACL reconstruction......do you set your own price, give them Medicare rates, give them Medicaid rates, work comp rates?????? This would be for physician and physician assistant...
  24. primrose1

    Core decompression

    Core decompression of a femur...unlisted procedure???? Would it be an unlisted code for the hip or more for the knee?
  25. primrose1

    24 and 57?

    We have a patient that had a toe fx charge back in December; he's still under that global period. Came in yesterday with a new wrist fx. Do I put both 24 & 57 on the E/M?? Thanks! Kris
  26. primrose1

    24 and 57?

    We have a patient that had a toe fx charge back in December; he's still under that global period. Came in yesterday with a new wrist fx. Do I put both 24 & 57 on the E/M?? Thanks! Kris
  27. primrose1

    Billing 29826

    A co-worker of mine is resistant to the changes for this code. She's still wanting to bill out the old RVU's as a primary procedure along with the other scope/open codes and wants "to see what happens" as far as who reimburses what (i.e., Medicare, work comp, no-fault, commercial plans, etc)...
  28. primrose1

    CEU's

    I've taken a couple of the on-line CEU exams from The Coding Institute but am having trouble with the December 2011 quiz. I believe I have all the questions correct from reading the articles but still not passing the test. Just wondering if anyone else has tried it? Also, does anyone know...
  29. primrose1

    Need help-Does anyone have

    Does anyone have any experience coding an Ertl procedure/stump revision? I'm looking at CPT 27886. In the explanation it states the physicial surgically cuts the tib/fib individually to complete the re-amputation. My doctor says he would be "trimming the tib/fib about one-quarter inch" so is...
  30. primrose1

    20610 and POS

    One of my doctors performed bilateral knee injections for an inpatient at our local hospital. The insurance company is denying the claims stating the POS does not meet policy requirements for this procedure code per LCD or NCD, CMS ID(s) L25820. I don't remember having trouble with this issue...
  31. primrose1

    Tibial tubercle

    I do not have the operative report back yet, but, any hints on an open excision of tibial tubercle fragments and exostectomy?
  32. primrose1

    Wound vac-experience coding

    Does anyone have any experience coding for a wound vac, 97605?? Wondering if a modifier is necessary as this was placed during a surgery and also reimbursement? There are no set RVU's for this that I've found. Thanks! Kris
  33. primrose1

    Cosc

    Passed my exam! Yeah! :D Just wondering if there are other COSC's in New York and wondering what chapter you may belong to? Kris, COSC
  34. primrose1

    Stats

    Does anyone happen to know if there is a web site to get general certification information in so far as how many certified coders/certified speciality coders are registered by state? Not looking for names of anyone, just certified numbers. Hope that makes sense...............:o Kris, COSC
  35. primrose1

    Bankart procedure

    done via scope..............29806 or 29807? No op report yet.....
  36. primrose1

    practice exam

    Just wondering if the COSC's out there took the on-line practice exam and if it helped you get an idea of where you may have needed to focus more of your studies on before taking the exam..........for myself I'm concerned about the spinal areas as our practice does not do backs or necks and the...
  37. primrose1

    29877

    Back to this code!! One of my doctors did an arthroscopy with tricompartmental debridement w/ adhesiolysis. Would this just be 29877 reported once?
  38. primrose1

    Help needed from 'dbarnes'!

    Can you please email the E/M audit sheet you use with your MD's and residents? You had replied to a post back in October and it went crazy with requests for it. Not sure if the most recent replies/requests are getting to you at this point. It would be much appreciated if you can forward that...
  39. primrose1

    Global Service Data

    Does anyone know if the AAOS Global Service Data books are allowable books for the COSC exam?
  40. primrose1

    Fluoro injections

    My physicians do fluoro-guided hip injections fairly often in the OR with anesthesia. Am I able to bill both the 77003 and the 27095? We've just been billing the 27095 but info I've recently come upon, if I'm reading it correctly, says to bill for both. If that's correct, is there a modifier...
  41. primrose1

    Scalene blocks

    Having difficulty getting paid when one of my providers performs a scalene block during a shoulder procedure. I'm using CPT 64415 - 59 but Medicare is denying. Is this correct? Any advice on getting payments for this code? Thanks!
  42. primrose1

    Cpt 27350

    One of my physician's did a patellectomy via scope. CPT 27350 does not specify in the books I have whether it's arthroscopically or open. Does anyone know? Or does it not matter either way?? Help! Thanks!
  43. primrose1

    COS-C examDo

    What did you use for your optional reference book for your exam? And does the apprentice status apply to the COSC?
  44. primrose1

    Casting

    Some insurances will pay no problem without a modifier on a subsequent cast after the initial application but some deny as global to the initial fracture care. Does anyone add a modifier routinely to the casting codes during the 90-day follow up? Modifier 58? Thanks!
  45. primrose1

    Cos-c

    I'm preparing for my upcoming exam......does the COS-C have an apprentice status? I'm not sure if I need to send in letters from my employers. Or are those only required for the CPC? Thanks!
  46. primrose1

    Can I bill for the E/M?

    Scenario: New patient comes in for shoulder pain and sees a PA. PA orders an MRI for further evaluation. MRI shows rotator cuff tear. The PA calls the patient with the results and recommends surgery. An appointment is set up to meet the physician and also have an H&P on the same day with...
  47. primrose1

    same day visits

    A lot of our patients in our practice see a PA for their initial visit. If necessary, an MRI is ordered. If surgery is indicated, the patient will come back to meet the physician and on the same day see the PA again for their H&P. I know the H&P is not a billable service since it's global in...
  48. primrose1

    E/M with fracture charge?

    I was originally told when I started ortho coding (trained by a co-worker) that if a fracture charge is coded for an initial visit, that an E/M cannot be charged. Whether it's with or without a manipulation, is this correct? Or can an E/M be charged with with a 57 modifier along with the fx...
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