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    Question New vs Established Patient Clarification

    Hello Fellow Coders, I have a new provider to our group who saw a patient that he previously saw 2 1/2 years ago at his old practice, which has a different tax-id. The patient has Medicare and received a denial that only one evaluation and management code at this service level is covered...
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    Question Help with possible ERCP?

    Hello All, I'm in need of some help. My research did not pull up anything close to this scenario and I'm at a loss as to how to code this. The lubricated Olympus endoscope was inserted transorally and advanced under direct visualization to the jejunum. There was evidence of previous...
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    Colonoscopy with balloon dilatation

    Hello fellow coders, I'm in need of your opinions on the coding of the below op report. Optum is denying my claims stating that the services are not supported due to no documentation within the op report that the colonoscope went to the cecum. Per CPT book the definition of a colonoscopy is...
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    OP Note assistance

    Hello all, I'm in need of some assistance withe coding the below report. It has me a little confused due to the scope only went to the duodenum, but the report also states "Papillotome was used for cannulation and a cholangiogram was obtained and showed no filling defects". I'm thinking 43247...
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    Colonoscopy Diagnostic vs Preventative - What's your Opinion

    Hello Everyone, I wanted to get other's opinions on the much debatable issue of diagnostic versus preventative colonoscopy in my office. I have several providers within my office that like to order "screening" colonoscopies for the below scenarios. 1. Pt says they are here for a screening...
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    GA Veterans Administration Claims - Help!!

    Hi Everybody, I am being told by the VA that due to a new system implementation that all UB-04 claims have to now come on CMS-1500 forms. Does anyone know if this is true. I have been told two differnet things by two differnt people today and can't get a straight answer.
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    GA Veterans Administration Claims

    Hi Everybody, I am being told by the VA that due to a new system implementation that all UB-04 claims have to now come on CMS-1500 forms. Does anyone know if this is true. I have been told two differnet things by two differnt people today and can't get a straight answer.
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    New to ASC Facility Billing

    Can anyone provide some insight on the difference between ASC facility billing reimbursement and the professional billing reimbursement? Should the facility be reimbursed per procedure as the physicians do? Do you know of any good websites that will be helpful? Thanks for any help.
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    RAC Audits

    Is anyone getting RAC audits and the reason for the refund on the Medicare remits and Refund request letter are not matching?? If so beware of this issue...I am from the Georgia region and the have talked to several Medicare reps who cannot give me a straight answer for the reason of the...
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    Need Help/Opinions Please

    I need help coding the followign OP report. So far I have the following codes: 43332, 43840, 49440, but I don't have a code for the gastropexy. I am thinking 43999. Preop/post op Dx: Hiatal hernia with gastric outlet obstruction Procedures Performed: 1. Exploratory Laparotomy with reduction...
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    Thyroid Coding....HELP!!!

    :confused:Need help with the CPT codes for following OP report: It is very lengthy,,, I'm thinking 60240 & 38724 59. Pre/Post Op Dx: Metastatic papillary cancer of the thyroid. Procedure: 1. Total thyroidectomy 2. Central node neck dissection 3. Excision of bilateral internal jugular cervical...
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    Need help with the CPT codes for following OP report: It is very lengthy,,, Pre/Post Op Dx: Metastatic papillary cancer of the thyroid. Procedure: 1. Total thyroidectomy 2. Central node neck dissection 3. Excision of bilateral internal jugular cervical nodes A low transverse cervical incision...
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    Blue Cross & Plug Placement

    Hey Everybody, I just wanted some opinions on the following scenario: Blue Cross does not cover plug placement for fistulotomy, all though Medicare does, so I wanted opinions on the best way to bill for this. Would you bill the patient for the whole thing or just the portion that was not...
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    Hospital Discharge

    My general surgeon discharged a patient from the hospital,but I have also ran across another discharge by the PCP. In addition, the patient was admitted by the General Surgeon group. By the way the patient has a Medicare replacemene policy. Who should get reimbursed for the diacharge? Any...
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    Lap Femoral Hernia Repair

    I have billed a Lap Femoral Hernia repair to Humana (Medicare replacement plan) with CPT 49659 as there is no laproscopic code for a femoral hernia repair. They have denied it stating that unlisted codes are non covered by Medicare. I have gotten feedback on how it should be billed. Feedback...
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    Excision of Perianal abscesses x2

    I have gotten a claim denial from the payer advising to sumit claim with a valid code. I could not locate any valid code so the claim was submitted with 46999 (unlisted code) along with the OP report. Pre/post Op diagnosis: recurring perianal abscess, bilateral Procedure: Excision of bilateral...
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    Stitch abscess

    What is the proper way to cade a stich abscess of the abdominal wall? Any help/opinions would be greatly appreciated. OP report reads as follows: Preop Dx: Infected abdominal wall mesh vs stitch abscess PostOp dx: stich abscess, abdominal wall. Procedure Performed: Excision of stitch abscess...
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    Medicare Primary and Othr Ins Secondary

    I just had a question for everyone. Is there a regulation set by medicare that says when they are the primary payer and there is a seconday payer (whos allowable is more) that we can only accept mcare payment minus any coins/ded? Does this make sense to anyone? Example. Mcare Primary Allw'd...
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    2002 Global Days - CPT 44005

    Does anyone know the global days for this procedure or the can provided the link wher I can find the information? Any help would be greatly appreciated. Thanks!
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    Laparoscopy with evacuation of blood

    Need help coding the following OP report: Pre-Op Dx: Postoperative bleed Post-Op Dx: Postoperative bleed Procedure: Laparoscopy with evacuation of blood A Hasson catheter was introduced and the abdominal cavity was insufflated with carbon dioxide gas. A second 5mm triocar was placed in the...
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    Need Help - Evac of Axillary Hematoma w/ Ligation of vessel

    Please help coding the following OP report: PreOp Dx: Rt. Axilarry hematoma w/ active bleeding PostOp Dx: Same Procedure: 1. Evacuatiojn of Rt. axillary hematome w/ ligation o bleeding vessel 2. complex closure Pt is a 69 year old gentleman status post excision of rt axillary...
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    Out of State Medicaid

    I am in Georgia and my surgeon saw two patient's in the hospital with out of state Medicaid (FL & Ill.). I have contacted these two state and have not gotten very far, they will not give you any info; such as claim status or eligibility, and basically told me that we won't get paid unless we...
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    Medicare Secondary Billing

    :confused:Hello Everyone, I just wanted to get some opinions on Medicare secondary billing after billing primary payer a consultation. I wouls like some feedback an how you are doing your Medicare secondary billing when a Consult has been billed to the primary payer. Are you recoding it to...
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    :eek:Pt has Gastic Cancer with periaortic metastases. My physician performed a Lap Choel with resection of periaortic node. OP report reads as follows: There was a palpable node on the antierior aspect of the aorta. The peritoneum was incised, and the node dissected and excised using harmonic...
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    Pelvic Mass Excision

    Help!!!! I am stumped on this one. The patient underwent Abdominal exploration with enterolysis for a small bowel obstruction, apon exploration the surgeon found a pelvic mass. OP report reads as follows: On inspection of the pelvis there was a round fatty mass, approximately 5x7 cm, well...
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    Need the opinions of My Fellow Coders

    I am taking online courses through the University of Phoenix and had an assignment due. Please see below the questions and the attached answer key, (in seperate post)which I believe is incorrect. 1. Initial consultation is performed for a 78-year-old woman with unexplained weight loss...
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    Drainage of Liver Laceration - he patient had more than 2 liters

    OP report reads: The patient had more than 2 liters of hemoperitoneum, which was aspirated. Can not find a code that fits the scenario. Please help.
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    Wedge Resection of Gastric Ulcer?

    Anyone know the CPT codefor this procedure?:confused:
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    Mastectomy Coding

    Does anyone know of any good resources for mastectomy coding?
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    Removal of Lactiferious Ductal System

    Does anyone know what the code is for this procedure?:confused:
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    Exision of Redundant Breast/Axillary Tissue status post Mastectomy

    What would be the proper code for the above mentioned scenario?
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    Neck Exploration

    What would the correct code be for a neck exploration? The surgeon is dissecting the neck, so that another surgeon can conduct a cervical diskectomy. OP report reads: The right thyroid was diseccted free from the strap muscles. This was carried posteriorly. Recurrent laryngeal nerve was...
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    New to Hemorrhoid Coding ??

    I am new to hemorrhoid coding....Can someone explain to me what code 46946 means when it states "2 or more hemorrhoid colums/groups"? What is the colums or groups referring to?
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    Malignant Removal and layerd closure

    The doctor I bill for did a malignant removal of a lesion and did a layered lesion. The doctor is billing the following codes: 11603, 12032 -79 I do not belive that this is the correct modifier, can anyone help. I think maybe a modifier 22.
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    Global Surgical Days

    Does anyone know where on the CMS website I can find the list for the global surgical days??
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    Seeking Medical Coder/Billing Positon in Atlanta, GA area

    I will be relocation to the Atlanta area within 3 weeks and would love to have a position upon my arrival. Please see resume below for work experience. If you would rather have an copy emailed to you, please submit request to 311 REEDWAY • MONROE, GA 30655 PHONE (619)...