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  1. L

    Medical decision making for obstructive sleep apnea

    Medical Decision Making is made up of multiple components - so there is no way to actually answer your question as posted. Number of Diagnosis/Management Options; Amount and/or Complexity of Data Reviewed and Risk of Complications, Morbidity, Mortality (Table of Risk) all need to be taken into...
  2. L

    Need advice regarding E&M upcode

    The provider only needs to meet the requirements for either '95 or '97 guidelines, they do not have to meet both. If provider documentation supports a higher level of service then what "they selected", it is not a bad or wrong thing to correct it appropriately. Under coding is just as bad as...
  3. L

    Need help with Clarix amniotic membrane graft

    I am having a hard time finding a code for the placement of a Clarix amniotic membrane graft. I have two encounters: 1st - Clarix amniotic membrane graft inserted intraarticularly and subcuticulary and first MTP for reduction of inflammation, joint surface tissue formation. 2nd - Clarix...
  4. L

    Help with code for Clarix membrane graft

    I am having a hard time finding a code for the placement of a Clarix amniotic membrane graft. I have two encounters: 1st - Clarix amniotic membrane graft inserted intraarticularly and subcuticulary and first MTP for reduction of inflammation, joint surface tissue formation. 2nd - Clarix...
  5. L

    Infection of Hip hemiarthroplasty

    Look to the 27134 area for the revision, I'm thinking the irrigation and debridement might be included.
  6. L

    Coding Radius/Ulnar FX of differing locations

    :confused:Hope someone can help me with this. The provider performed ORIF of proximal radial fracture and ORIF of midshaft ulnar fracture. My conundrum is the following: Would the fractures be coded out separately as they are in differing areas (813.17, 813.32). Or would I use a Radius with...
  7. L

    Help with CPT for repair nonunion/malunion sacrum fracture

    I am looking for a CPT code to capture the Repair, nonunion or malunion, sacral. All I am finding is for the initial fracture repair. In addition, the provider removed prior fixation device and in my research I am showing that he can charge for the removal of the earlier placed hardware in...
  8. L

    FB in arm

    I would code 729.6 and a V-code. You didn't state that it was a new wound and residual is "something left over". Hope this helps!:)
  9. L

    need help please

    I don't see any reason why the surgeon could not bill an inpatient consultation, as long as the specific criteria regarding consultations is documented properly and the patient is not Medicare. If the patient is Medicare than I would look to the subsequent services 99231-99233.
  10. L

    Can I bill an E&M?

    Where there any issues found with the patients blook work? Where any medications or treatments prescribed?
  11. L

    Help - hospital side

    Don't know if this will help or not but here goes. Per CPT guidance - Do not report 92133 and 92134 at the same patient encounter. Per Encoder Pro - You can bill either 92133 and 92250, or 92134 and 92250 and modifier -59 would be appropriate.
  12. L

    Wiki Hyponatremia-resolved

    The patient is still admitted and the issues have resolved? Would query what else is going on. Are they still monitoring the issues?
  13. L

    Coding blood in stool with GI bleed diagnoses

    Thanks for you input!
  14. L

    Coding blood in stool with GI bleed diagnoses

    :oProvider diagnoses, GI bleed and blood in stool. Would you code both 578.9 and 578.1? Or just 578.9 because 578.1 is a symptom of? I believe the 578.1 helps to give a better description of the issue. Blood in stool is visible, where as say, 792.1 occult blood is not visible and is found...
  15. L

    Coding blood in stool with GI Bleed

    Provider diagnoses, GI bleed and blood in stool. Would you code both 578.9 and 578.1? Or just 578.9 because 578.1 is a symptom of? I believe the 578.1 helps to give a better description of the issue. Blood in stool is visible, where as say, 792.1 occult blood is not visible and is found during...
  16. L

    first interview

    Bring your best smile! Oh, and of course it is best to do a little "do dilligence" in regards to finding out what you can about this office. Fam Practice, OB/Gyn, etc. and to brush up on the code sets that might be utilized. Review CPT for recent code changes. And don't be afraid to talk about...
  17. L

    acute bronchitis with asthma

    I would use 493.90. Index bronchitis, down to asthmatic (acute).
  18. L

    Trigger Point - Trapezius region

    I'm not seeing a valid CPT code 72885. Usually trigger points are coded using 20552-20553. Oops! Sorry, you said diagnosis code. If the main reason for the injection is trigger finger I would use 727.03. If the only sign/symptom is spasm the only code I'm finding is the 728.85. Sorry, I...
  19. L

    HPI and ROS Double Dipping

    You can break it down like this: cc: Chest pain HPI: duration = 2 weeks quality = dull in nature ROS: respiratory = No SOB This way you are not "double dipping" as you put it. ROS can be abstracted/taken from the HPI.
  20. L

    New Patient Visit

    Agree, I do not see a 99203 as that would entail a Detailed history and Detailed exam. I would go with 99202.
  21. L

    need help with a surgery code for repair of cyclodialysis cleft

    You have posted this question incorrectly under Employment, General Discussion. You might want to repost again under the coding forums, broken out by specialty. Scroll down more to look at all the categories. Good luck!:)
  22. L

    E/M Audit

    Can I also get a copy please Brandi? longshot-lori@hotmail.com Greatly appreciate it!:)
  23. L

    cervical lymph nodes

    Wrong category for questions Hi, wanted to let you know that you posted your question under the wrong category. This is for Employment General Discussions. Scroll down a little further in the Forums and you will see specific headings for questions types.:)
  24. L

    Modifier -50 on 92250

    Thanks so much for your input.:D
  25. L

    Modifier -50 on 92250

    Would you use Modifier -50 on 92250 Fundus photography with interpretation and report? Code description: 92250 - Ophthalmoscopy allows a complete view of the back of the eye. The physician or technician aligns the fundus camera, which is attached to an ophthalmoscope, along the patient's...
  26. L

    Injections for alopecia areata

    Would like to know your thoughts on coding the following: Diagnosis: Alopecia Areata, scalp Procedure: Injected total of 1.5cc of 5mg/cc kenalog in 6-7cm patch of smooth alopecia L frontal scalp. I have heard people say they use 11900 and others say 96372. I am leaning towards 96372 myself...
  27. L

    Acute and Chronic conditions

    Oops - boy did I state that wrong - it was tonsillitis Oh my goodness! I'm sorry everyone - it was "recurrent tonsillitis'. I feel so silly now! Correct scenario - provider documents "recurrent tonsillitis", coder coded 474.00. I say it should be 463 because provider didn't state chronic...
  28. L

    Acute and Chronic conditions

    Agree with the definition, however a recurrent problem doesn't necessarily mean it is a chronic condition. How long do you have to have a recurrent problem for it to be considered chronic? Coders do not diagnose patients, physicians do. We can query physicians.
  29. L

    Acute and Chronic conditions

    Performing an Audit and see that provider diagnosed "recurrent sinusitis" and coder coded as "chronic sinusitis". It was my understanding that if the provider didn't state acute or chronic specifically that we as coders could not code it as such. Am I correct in my thinking? I can't find any...
  30. L

    employment listings for coders

    Start with your local chapter Have you checked with your local chapter to see if they have any information regarding an Extern program or requests from other possible employers? Volunteer to code for experience. Is there a large Family Practice, Orthopedic Clinic, Radiology, Lab, Native...
  31. L

    Laceration repair - layered closure

    Laceration repair during delivery is inclusive unless extensive repair necessary, then append -22. My question: Is extensive repair 3rd degree tear or higher? And 2nd degree or less inclusive? How do you know where to break it? Doesn't 2nd degree require layered closure? Is that extensive...
  32. L

    Newsletter has gone out

    newsletter list Can you please add me to your newsletter list too? I tried to private message you but it says your box is full and won't accept anymore. Thanks much! longshot-lori@hotmail.com
  33. L

    I&D and OV with mod 25

    ??-57 Thanks Rebecca, appreciate the additional information!
  34. L

    I&D and OV with mod 25

    -57 Rebecca would you please explain why you feel the -57 is inappropriate? At the bottom of the -25 explanation the note states: This modifier is not used to report an E/M service that resulted in a decisionn to perform surgery. See modifier 57. -57 Decision for surgery: An evaluation and...
  35. L

    I&D and OV with mod 25

    also FYI Just an FYI, if you look at all the headings listed on this website you will see that down lower there is a "Medical Coding" heading and different sub-headings. Posting your questions there according to category will get more readership and possibly more/faster responses to your questions.
  36. L

    I&D and OV with mod 25

    I&D & OV w/-25 I would code an office visit w/-57 and the I&D code, if of course there is supporting documentation.
  37. L

    Icd9 help

    wrong heading for question FYI, you posted your question under the wrong heading. This is for general discussions regarding employment. If you scroll down further when you click on the main forums heading you will see medical coding and it is broken up by categories. This is where you want to...
  38. L

    infusions

    IV Assuming it was one bag with the morphine that ran from 17:10 to 22:45, I would code the following. 96365, 96366x5 17:10-18:10=1hr 18:10-19:10=1hr 19:10-20:10=1hr 20:10-21:10=1hr 21:10-22:10=1hr 22:10-22:45=35min, since it ran for "more than 30min" you can add 96366 again. Hope this helps!
  39. L

    Pay scale Lead Auditor position

    Looking to find/get information on the going rate/pay people are receiving for Lead Auditor positions. Low/High kind of scale. Greatly appreciate any help.:confused:
  40. L

    Lidocaine added to nebulizer treatment

    Have encounter where "combineb w/2.5cc 4% lidocaine" was given. Code only J7620 or both J7620 & J3490? Have the phrase "charge for no "caine", ie marcaine/lidocaine" running through my brain. Don't know why I can't wrap my head around this one this morning. Senior moment I guess. Please...
  41. L

    fetal heart tones

    Thanks Thanks for your input - that was the way I was leaning - just needed someone to finish pushing me that direction. LOL!:)
  42. L

    fetal heart tones

    What is the correct CPT code for "fetal heart tone" when using a hand-held monitor in the ER setting? The codes I have found seem to be more fitting for use in an OB/GYN setting. Any input would be helpful. Thanks much!
  43. L

    re: KForce

    re: KForce Would anyone be willing to share their experience, good or bad, regarding working for KForce? Hear great things about them. Thanks for sharing! :)
  44. L

    ? appropriate dx

    thyroid nodule I would query the provider before deciding on a final diagnosis
  45. L

    Removal of foreign body - ear

    Agree :)I agree that a lavage does not warrant use of 69200 per the definitive description
  46. L

    locum tenens??

    thanks Thank you so much for your help - greatly appreciated!
  47. L

    locum tenens??

    :confused:HELP! I know there is a modifer that can be appended to CPT codes when one physician fills in for another, say while he is on vacation - locum tenens. My brain sure isn't working today. Can anyone help me?
  48. L

    Morgan Lens

    Need help coding for a Morgan lens - used to flush eye out. Looking at 99070, V2797. Am I missing something? Is anyone else coding for these?:confused:
  49. L

    Morgan lens

    Need help coding for a morgan lens apparatus used to flush eye out. Looking at 99070, V2797. However looks like I need another HCPCS code. Is anyone else coding for these?:confused:
  50. L

    Pulse Ox coding

    When do we code for the pulse ox in the Emergency Room? Specifically respiratory and cardio issues?
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