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  1. C


    I would not code Z86.010 for hyperplastic polyps because they are not considered neoplasms. Z86.010 is for personal history of benign neoplasm. I would code Z12.11 instead.
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    Positive Feccal Occult test and pre-screening visit

    I agree with Sonja. The FOBT was the screening, which has already been billed as such. If you try to bill a screening, you should get a denial. Once the patient has a positive finding, he/she is no longer asymptomatic and the colonoscopy is diagnostic. Yes, you can bill the office visit, but not...
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    EGD and pathology results

    Yes you may
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    Question Follow-up Colonoscopy

    This will be a surveillance colonoscopy, but not screening. I would code the polyp that he is following up on as the diagnosis and 45378 or other appropriate CPT code if additional polyps are found. No modifiers since it is not a screening. You can also use Z09-encounter for follow up exam after...
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    Question What documentation do you code from for TC component of abdominal ultrasound?

    I am wondering what documentation does everyone code from when coding abdominal ultrasounds:76700, 76705? We perform the technical component in our office. Do you use the images to verify whether or not it was complete or partial US, or do you code based on the interpretation report, or simply...
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    UHC Consultation Policy

    Thanks for this. I have read this before, but it is not entirely clear. Do you know if this statement means to bill 99222 for hospital visits? "When services are rendered at the request of another physician or appropriate source, care providers should submit an appropriate E/M service in...
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    UHC Consultation Policy

    Now that UHC is no longer accepting consult codes, does anyone know what codes UHC wants you to bill for patients seen in the hospital setting? For example, should you follow CMS and report 99222 for the first time a patient is seen in the hospital setting, or would they require 99232 instead?
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    Aetna E&M Policy

    If your office is part of a larger network, then they will deny based on the same tax id regardless of different specialty.
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    Elevated Bilirubin

    I use R17 since the book leads you to that under elevated liver function test, bilirubin. I've heard guidance to use R74.9 for this, but I don't feel comfortable doing that since the book does not guide you to this code.
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    Doc Requirements for billing -TC Abdominal US 76700 in Office

    We are a specialist office and bill for the techincal component of abdominal ultrasounds in the office. What documentation do you use to support the billing for the technical component of 76700?Does the non-interpreting provider need to sign the images? Would the ordering diagnosis be present on...
  11. C

    Colonoscopy with electrocauter

    I agree with 45388
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    Chronic diarrhea

    I am glad you posted this question here, as I would not have seen it under another topic. To answer your question, I would code chronic diarrhea as K52.9 since the book leads you to that code under "diarrhea, chronic"
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    Endoscopic Placement/Advancement of Capsules

    According to CMS NCCI, the 2 are not billable unless "the EGD is a medically necessary and complete diagnostic procedure." They also say EGD cannot be billed just to place the M2A. It seems like your scenario may fall under placement of the m2a. Perhaps if the EGD was for dysphagia and...
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    Problems with Category K ICD-10 codes

    No, I have not seen that. I would send the payer a photo copy of the K section of the ICD-10 book showing these are valid codes. If your book is marked up like mine, you can print from the cdc's website. They have an electronic copy of the book...
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    Technology-based service G2012: What POS should you use?

    Does anyone know what place of service you should use when billing G2012 (Brief communication technology-based service, e.g.virtual check in)?
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    43270 for treatment of Barretts

    I've seen where carriers are treating it as investigational if the Barretts muscosa is without dysplasia. They will only pay for Barretts with biopsy proven high grade dysplasia. Low grade is covered under certain circumstances. You'll have to check each individual payer's policy regarding this.
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    Midlevel Billing Commercial Payers in Hospital Setting

    How does your practice bill for midlevels in the hospital setting for commercial payers that want claims billed under the supervising physician? Since incident-to does not apply to hospital setting, is it appropriate to bill under the supervising physician if split/shared visit is NOT performed...
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    Observation Admisson/Discharge by Different Drs

    We were called to assume care for a patient admitted to observation by the surgeon (not related to our practice) following a procedure. There is not an H&P for the admission by the surgeon in the chart, however our doctor dictated one. My question is how should we bill for our services? Since...
  19. C

    Cpt 45385 and 45380 bill together

    Try billing with -XS instead of -59
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    H&P Consults done in the hospital for outpatient surgery

    Yes, they are. For outpatient cases you would bill a new or established office visit unless your doctor admitted them to Observation status. In that case you would bill observation codes, but only if he is the ordering physician.
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    H&P Consults done in the hospital for outpatient surgery

    Yes, Medicare requires you to bill 99221-99223 instead of consults. If your dr is the admitting physician then you add modifier -AI.
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    Patency Capsule Coding

    Is anyone billing for Patency Capsules? I have older coding guidance that states to bill 91299, however I can not find any updated clear guidance to say whether or not this code is still appropriate. If you are billing for the patency capsule, what CPT/HCPCS codes are you using?
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    43255 or 43270

    Does the patient have symptoms of previous bleeding such as Iron deficiency anemia or blood in stool? Even if the lesion isn't currently bleeding, if the intention is to prevent future bleeding and it is determined that previous bleeding was due to this lesion, I would be inclined to code 43255.
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    Help with Screening colonoscopy for Medicare under new LCD updates

    If you are billing G0121, PT modifier is not necessary because the HCPCS code G0121 already implies screening in its description. You would use the PT modifier when a polyp is found to show that the original procedure was a screening, but turned diagnostic to remove the polyp. For example, the...
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    Established problem but "New" patient since it has been over 3 years

    If a patient's PCP is referring him back to our office for re-evaluation of a problem treated by us more than 3 years ago, is that worth 2 points (est. problem worsening) or 4 points (new problem, additional workup planned) under # of diagnoses or treatment options in MDM? The patient would be...
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    If only vitals are present, can that count towards consitutional component of exam?

    If only vitals are present, and no other elements are documented, can I count that as meeting the "consitutional" portion of the exam? For example, this is for a new patient visit with no exam, however the vitals are present. Would this qualify as 99201?
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    MD left practice, can Chief Medical Officer sign notes?

    Hi Arrana, Do you happen to still have the direct links from CMS and OIG that you used to support your stance? I am looking for something similar myself. Thanks!
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    Copays for visits denied for timely filing

    If a copay was collected for an office visit but the visit was never billed to insurance or the claim denied for timely filing, is the provider allowed to keep the copay? Technically an allowed amount was never adjudicated by the insurance company, so would it be wrong to keep the copay?
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    Need second opinion Re: LA grade / Esophagitis

    If the note clarifies "LA grade 2 reflux esophagitis," then I will use K21.0. However, since we can't assume, if the only thing stated is "LA esophagitis," I would put K20.8 unless the indication for the note is GERD. In that case, I would code K21.0 since both conditions are present
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    ERCP or EGD?

    Intended procedure was ERCP but note states they were not able to successfully cannulate. However, the note says partial cholangiogram and pancreatogram performed. Which code is more appropriate to bill? 43235 or 43260? "Upon passing into the pylorus, there were two very large periampullary...
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    Fecal Microbiota Transplant (G0455) and Palmetto

    Has anyone had any luck getting Palmetto to pay G0455? They are denying stating it is not medically necessary. We were a part of the transition from Cahaba to Palmetto, and Cahaba always paid. Any advice? I found this link and it does not look like Palmetto covers this code ...
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    Midlevel Billing and Commercial Reimbursement Policies

    Can someone provide me with links to Cigna or Humana regarding the billing of Midlevel providers? I cannot find clear polices on their websites stating whether or not they want services billed under the physician or midlevel. Do they follow CMS incident-to guidelines? Thanks!
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    Aborted Screening Colonoscopy at Sigmoid

    Given the CPT instructions to code a flex sig if the scope does not go past the splenic flexure, how are you all coding screening colonoscopies aborted prior to reaching the splenic flexure? My experience is if I were to bill 45378 with Z12.11 to Medicare for a completed scope, they would deny...
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    Modifier 25 use: E/M on same day as procedure by another provider in same practice?

    Great, thank you! I second guessed myself because of the description "same provider."
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    Modifier 25 use: E/M on same day as procedure by another provider in same practice?

    If provider makes a decision for a same day procedure to be performed by a another provider in the same practice, same subspecialty, ie; same tax id, is it appropriate to append -25 to the E/M service?
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    GI procedures bundling

    Yes, you can bill for both as long as they are on different anatomical sites. I would use -XS (separate structure) modifier in lieu of -59
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    + Cologuard = ? screening

    You are correct. The patient is now diagnositc because they are presenting with an abnormal finding. The cologuard test was the screening and would have been billed as such, utilizing that preventive benefit. Even if you tried to bill as a screening, it should get denied because screening...
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    Need help coding ERCP Stent Exchange

    Thank you for your response! Wouldn't the work for removal of PTC be included in 47537, and if I coded 43276 would that be considered double billing? My thinking is since there are 2 different techniques, that would exclude 43276 with 47537. The placement of the stent was via ERCP (43274) and...
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    Need help coding ERCP Stent Exchange

    Should the appropriate codes be: 43274, 47537 or just 43276? We did not originally place the PTC and the removal of PTC through abdominal wall is what's throwing me off. Indication: Known Pancreatic cancer with malignant common bile duct obstruction. ERCP for exchange of stent/internalization...
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    Need Definitive Answer to when to post procedure

    I agree with you. That's how I would code it.
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    How do you know when to code 45390 vs 45385, 45381

    How do you know when to bill 45385, 45381 over 45390? I understand you’re supposed to look for terms such as “flat polyp,” but what if the note doesn’t say that, it just says: "A single sessile 11 mm polyp was found in the cecum. A piece-meal polypectomy was performed using a hot snare over a...
  42. C

    Positive Occult Test

    The fecal test would have been considered the screening and a positive finding makes the colonoscopy diagnostic. Your indication will be R19.5.
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    help with coding this procedure?

    I would code 43264 (balloon sweep) and 43262 (for the sphincterotomy). 43277 is considered inclusive to 43264 as it applies to dilating, but the sphincterotomy is separately billable. As is fluoroscopic interpretation if no radiologist was present. My codes would be: 43264 43262 74328-26 (if...
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    Colonoscopy for High Risk patient

    It sounds like the colonoscopy is for Z85.038. Therefore, I would code 45378-Z85.038 because that is stating it is for surveillence purposes. If you were doing a screening, which is every 2 years, then you would code G0105-Z85.038. Z12.11 is for average risk screening (G0121) once every 10...
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    Colonscopy- Surveillance vs Preventative

    It depends on the payer guidelines. If the insurance company recognizes Z86.010 as preventive, I would use -33, if its surveillance, then I would leave off -33. Most of the commercial insurance companies I work with do not recognize Z86.010 as preventive only surveillance, with Humana being...
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    ERCP removal of one stent with replacing multiple stents in the same duct

    I would try 43276 for the exchange then 43274-59 for the additional.
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    Repaeat Colonoscopy

    I would use D12.0 for the follow up procedure indication since that is the reason he is coming back in.
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    Screening Colonoscopy discontinued

    I would code G0121-74 if it does not make it to the cecum. The professional charges should be G0121-53. This puts a stop on the time interval so that the repeat procedure is not denied for frequency. I would also place the V64.3 after V76.51 on the claim