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    Question taxonomy code or specialty code?

    Hi, Does Medicare use the different taxonomy codes to determine whether a subspecialist can bill for a second initial visit, or do they only look at the specialty code? We have an ortho practice with multiple orthopedic subspecialties and different taxonomy codes, but the specialty code is the...
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    icd-10-cm code for vaginal cuff dehiscence post hysterectomy

    What's the best diagnosis for a vaginal cuff rupture/dehiscence? This is about 3 months after hysterectomy, op report says "vaginal cuff open approximately 1 inch with bowel present at the cuff edge.". I keep finding N99.3-vaginal vault prolapse after hysterectomy-- but that doesn't sound right...
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    excision of aneurysmal arteriovenous fistula

    Should this be coded as 35206, 37607, 36821? I feel like this might be more of a revision of the old fistula with creation of a new fistula and that 36832, 36821-59 might be better. The physician excised an aneurysmal radiocephalic fistula, then created a new brachiocephalic fistula...
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    broken end of peritoneal dialysis catheter

    Thanks, that's what I thought. This is a doctor who questions everything, so I wanted an outside opinion.
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    broken end of peritoneal dialysis catheter

    Patient was on peritoneal dialysis, got up to walk, and the connector came out of the end of the tubing. Patient tied a knot in the tubing to prevent leakage, and came to the ED. Per the E/M the peritoneal dialysis catheter is intact, except for the end connector which as come off. The...
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    what place of service code to use for in-house credentialed sleep lab?

    Te practice has a credentialed sleep lab in office, and they are performing monitored polysomnography. They are getting many denials for POS when 95810 & 95811 are submitted with POS 11. The lab is not affiliated with a hospital, but it is under the direction and control of a physician. Is...
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    cholecystectomy and ICG immunofluorescence

    I code for a general surgery group, and two of the newer surgeons are using firefly on all their laparoscopic cholecystectomies. I'm having a hard time deciding how--or if--this should be coded. Their reports don't mention intraoperative cholangiography, and they don't explain the procedure...
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    medicare and unlisted codes

    Does anyone know what CMS and Noridian mean when they say 'concise description? Do they have something specific in mind like a cpt short descriptor, or is it okay to say "compare 37799 to 37765-RT, 4 stab incisions made"? (just an example) Also, do you find that it's necessary to send the...
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    is there a diagnosis code for this situation?

    The patient came to ED with right upper extremity pain and numbness. Oatient was found to have a right brachial artery thrombus. Patient has a history of atrial fibrillation and has been taking Eliquis, but stopped one week ago due to a change in insurance. There are codes for intentional and...
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    Stab Phelebectomy

    37765-RT, 37799-LT; compare 37799 to 37765-LT, and give the number of incisions used in the left leg. 37765-50 would not be appropriate unless there were 10-20 stab phlebectomies done per leg. In your second scenario, use 37799, compare it to 37765-50, and give the number of incisions used in...
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    billing 36901 and 36832 together?

    Is this enough to justify billing 36901 as diagnostic? Patient has a non-maturing AVG. there is significant tortuosity of the cephalic vein, as well as a branch point. Both the main cephalic vein and the accessory cephalic vein were tortuous; the main cephalic was also small and atretic higher...
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    modifiers for 19301 & 38525, separate incisions

    My surgeons frequently perform the lumpectomy and SLNB through separate incisions. There are no CCI edits for these two codes. Would you use a -51 or a -59 on 38525? Have you found that different insurances have different requirements? I've been using -59 without issues, and I think I started...
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    use 75630 & 75774 or use 75625 & 75710?

    This physician is new to the group and I'm still adjusting to his dictation. Per the report, these were diagnostic, and he did perform 37226 & 37220 as a result of the findings. He selected codes are 37226, 37220, 75716, 75710, 76937, and G0269. I think 75630 & 75774 since it sounds as if he...
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    35571 with 76998?

    I know that 35571--Bypass graft, with vein; popliteal-tibial, -peroneal artery or other distal vessels--includes saphenous vein harvesting. My doctor used ultrasound to mark the GSV for harvesting. NCCI says 76998 is a component of 35571. I suspect that applies even when it's used indirectly...
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    Mastectomy coding

    Teresa, based on the report, there was no blue dye injected by the surgeon, only the radioactive tracer injected by radiology. The surgeon did use the Gamma probe to map the radioactive tracer. I believe the question is, can 38900 be used when the surgeon only uses a gamma probe for mapping...
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    Seems like double-dipping for any plans that cover the G codes. Medicare does not, the G0378 & G0379 are assigned status X, Statutory Exclusion.
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    80061, 82248, 82977 denied

    The office billed 80053, 82043-QW, 80061, 83036-QW, 82248, 82977. Regence BCBS of Oregon denied 80061, 82248, and 82977 as –M15--Separately billed services/tests have been bundled as they are considered components of that same procedure. Three of us have looked at all these codes, and at the...
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    Can someone help me code this please??

    What was the reason for the surgery in the first place? What reasons were given in the report for each of the procedures performed? I suspect you can only bill for the open adhesiolysis (44005) and the tube jejunostomy (+44015). It seems likely that the enterotomy closure/omental...
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    General Surgery

    Try unlisted code 44799; compare to 44130. Lysis is not separately billable, neither is the repair of the injury.
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    Angioplasty of the aorta???

    37246? Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the...
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    billing 99291 & 99292, provided by different doctors, same specialty, same practice

    billing 99291 & 99292, provided by different doctors, same specialty, same practice A critically ill patient is seen by Dr. A, who is a pulmonologist. The critical care time is 55 minutes. Later in the day the patient decompensates and is seen by Dr. B, a pulmonologist from the same practice...
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    is there a diagnosis code for induced paralysis in the setting of ARDS?

    that's pretty much it--I'm trying to find a code for medically induced temporary paralysis. Apparently muscle paralysis helps improve the outcome in ARDS patients.
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    Vaginoscopy with Cystoscopy Did you see this? This doesn't answer the question, but it's interesting. I also found this, which might or might not be helpful. Maybe try an unlisted code and compare to 57420?
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    Vaginoscopy with Cystoscopy

    what sort of scope are they using then?
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    Failing right ateriovenous fistula with right arm swelling

    Take a look at 37607--ligation or banding of angioaccess AVF--for the right arm, and use 36821 for the left arm. I would consider the ligation of the tethering vein on the left to be a component of the fistula formation and therefore not separately billable. You could try a mod 22 for the...
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    Erythrocytosis vs polycythemia

    D75.1 includes erythrocytosis NOS as a descriptor, so I think you're stuck with secondary polycythemia even if the definitions of the two conditions don't align exactly. The only other option would be R71.8--other abnormality of red blood cells.
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    post op visits to a preceding Procedure

    Your doctor performed a colostomy takedown, then had to take the patient back to surgery 5 days later for an anastomotic leak? The sepsis is due to the leak, which is a complication of the first surgery. Any E/M services during that 5 day period are part of the global package for the colostomy...
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    Cpt 10140

    10140 is an active code with a 10 day global period. Medicare allows around $121 when this is performed in a facility. Non Facility allowance is around $165. There probably isn't a list of covered diagnoses, but it's for the drainage of hematomas, seromas, or other fluid collections.
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    On q painball/ infusion pump placed by anesthesiologist

    The On-Q website used to have billing information. It's been several years since I've billed for pain pumps, but they recommended using the appropriate unlisted code for the body part being treated. I don't believe Medicare will pay for this. On-Q had contracted with a billing company to offer...
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    Graham patch repair of duodenal ulcer

    Another vote for 49905.
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    what POS for doctor supplying Mirena when patient is in facility?

    The patient is in a Comprehensive Inpatient Rehabilitation Center. Insurance paid the provider for the insertion, but denied payment for J7298 for invalid place of service. Should the IUD be submitted with POS 11 since it was supplied by the practice, not by the facility?
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    ICD 10 for non-healing traumatic wound

    The HPI says "About 3 weeks ago, patient fell and hit left leg, causing a wound which has failed to heal despite several rounds of antibiotics and local wound care. The wound is getting larger and the patient is having more pain." Exam says "the patient has a wound on the left anterior shin...
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    Using modifiers -26 and -80 on the same procedure code?

    Can any of you think of any situations in which this might happen (and be payable)? I'm specifically thinking of intraoperative procedures, for example, 76937-26 or 77003-26.
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    Spinal fixation

    22845 and 22853 both billable? I have a related question. I work for the general/vascular surgeon who performs the approach, then stays on to assist. The other surgeon's report says "Annulectomy followed by diskectomy and decompression was performed with resection of posterior annulus and...
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    Multiple Assistants at Surgery

    Reviving this question. I can find documentation from some Medicare Advantage plans, but nothing from CMS.
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    Yes, as long as U/S guidance was used for both joints.
  37. E

    Is a non-invasive arterial study considered diagnostic for NCCI purposes?

    Per the hospital face sheet, the patient was scheduled for "abdominal aortogram, possible PTA stent" for right lower extremity claudication. My physician was the admitting physician. The doctor wants to bill for both the stenting and the angiography. Indications for procedure state that the...