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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

    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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    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...
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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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    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...
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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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    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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    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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    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?

    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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    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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    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...
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