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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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    Positive Feccal Occult test and pre-screening visit

    In my opinion, the patient is now symptomatic and the need for the colon is to determine the source of the bleeding. Thus this would not be a screening visit,but a diagnostic visit. To qualify as a screening the patient must be asymptomatic with no complaints/issues.
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    S0285

    Hello, I use this code for all my commercial payers when appropriate and have been getting paid.
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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

    Hi Christine, The issue I come into is when the patient comes in for the evaluation the docs states rectal bleeding, diarrhea, etc. BUT on the OP note does not list these symptoms. I've explained several times that the patient MUST be symptom free, i.e, no problems.
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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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    Incomplete colonoscopies and procedures

    For our Medicare contractor, Palmetto, they auto deny all claims with modifier 53 or 74 due to needing medical records to support the use of the modifier. Hope this steers you in the right direction.:)
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    CMS ICD10 High Risk Colons Deny

    Colon Screen I'm here in Georgia, and today & rep from Cahaba advised the same & also advised to submit an appeal.
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    Medicaid denials in Georgia

    Medicaid Georgia Medicaid put out a provider bulletin advising that they will not accept unspecified code for any outpatient/office claims. As for the J30.5, I looked it up, & that IS a specified code, so this may be a glitch in their system.
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    Bravo ph monitoring

    Bravo I have a practice who are doing a Bravo's. The dilemma is that they own the equipment and are doing the procedure in an ASC facility. We are getting denials because we are billing global with POS 24. The Bravo Rep is telling us for commercial payer we need to bill it with the date it's...
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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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    Hemorroidectomy

    Depends on the mehtod used. Was the hemorroidectomy done via ligation with rubber bands or another method?
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    Credit Cards

    My office is one that does keep credit cards on file; however the information is kept in a password protected spreadsheet. In addition there are only two people with the password, myself and the office manager. Once the balanc eis paid in full then the information is deleted from the...
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    Anthem BC/BS colonoscopy

    For my local Blue Cross they have advised us that they regonized the modifier PT, which indicates that a colorectal cancer screening test was converted to a diagnostic test, this is from their provider notification letter. In addition, they have indicated that modifier 33 is to be appened to...
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    Laparoscopic paraesophegeal hernia w/ Nissen

    Laura, I am confused on your question; however, I will try and help you to the best of my ability. CPT 43328 is for a esophagogastric fundoplast via a thoroacotomy (this code does NOT include a hernia repair). CPT 43337 would not be the correct code either as this is for a thoracoabdominal...
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    Has anyone had to code Neurogenic Shock?

    This is what I found of the condition: Neurogenic shock is a distributive type of shock resulting in hypotension, occasionally with bradycardia, that is attributed to the disruption of the autonomic pathways within the spinal cord. Hypotension occurs due to decreased systemic vascular resistance...
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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!!!

    I see what you are saying. Thank you for your help. I posted this in another thread and no one out of 98 coders had any answers or opinions, so you help is greatly appreciated.
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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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    Please help me-colonoscopy

    Coding Colonscopies Hi everyone! I'm have the same problem with patients and isurance tell them that it was coded wrong. What I do is I educate the patients and the meaning of a screening colonoscopy; i.e NO PROBLEMS = screening. If they are coming in because of issues; such as, constipation...
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    Help!!!

    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

    I am referring to CPT 46275 (BC covers) and CPT 46707 which is a fistula repair with plug (BC does NOT cover). Is anyone else having problems with getting CPT 46707 paid by BC?
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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

    Thanks for the insighton this issue. I am new to billing for hospital rounds and it was very helpful. Provided a great deal of info I did not know.:)
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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

    Thanks for your help:)
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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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    Wiki How many gained employment with NO experience?

    :oI got hired for a billing/coding position right out of a technical school. I believe the only reason I got the position because it was a A Native American Health Center and I had Native American preference. There is hope. The Office Manager I worked for was not very happy about this at...
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    2002 Global Days - CPT 44005

    Thanks, I thought the same but just wanted to be sure, since that was before I started coding for surgeries.
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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

    Any sugesstions Does Anyone have any sugesstions?? I am think 49322, maybe?
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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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    Refunds / Overpayments

    What i do is determine what they should have paid and them refund them the difference. I send proof of why they overpaid and if the send the payment back then at least I tried, so they can't ask for interest.
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    Need Help - Evac of Axillary Hematoma w/ Ligation of vessel

    Thanks Thanks everyone for your help and advice.:)
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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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    Medicare Secondary Billing

    Thanks Debra, I am with you on that. I keep trying to explain this to my office manager who just does not seem to get it, so I thought I would get some fellow members opinions.
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    Out of State Medicaid

    Thanks! That was my opinion was as well.
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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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    Write off policy

    Financial Policy At the office I work in we send out three statements and follow with a phone call after we send the second letter. After the final letter they have 15 days to send in the balance or make arrangements, after that we write off to colelctions, but the software we have shows the...
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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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    Pelvic Mass Excision

    THanks That was one of the codes I was looking at. Just need some more opionions.
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    Help!!!!

    :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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