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  1. M

    Newly certified can't find job

    Risk Adjustment Coding Hi Katrina, Are you currently doing risk adjustment coding? I have been a coder for many years (facility) and have wanted to apply for HCC coder positions, but all postings require 1-5 years HCC experience (??). In my opinion, if you can review and abstract information...
  2. M

    V1272 vs 211.3

    I know this is an old post, but.......... Tabular list in ICD-9 shows V12.72 as an Unacceptable PDX
  3. M

    Platelet Transfusion

    Your CPT code would be 36430 If for some reason you needed the ICD-9 procedure code, that is 99.05 Hope this helps :)
  4. M

    Polypectomy w/dx of benign colonic mucosa

    If the physician did a biopsy with the Colonoscopy, I would code the biopsy. As for diagnosis, you can only work with what you have. If need be, send supporting documentation to insurance carrier.
  5. M

    Please help with modifier 73

    My understanding of Modifier 73 is that it applies if the procedure is cancelled/ aborted (due to extenuating circumstances or those that threaten the well being of the patient) "after" patient is taken into the O.R., but "before" receiving any anesthesia in the O.R. In other words, if the...
  6. M

    Dx code: Mild mental retardation

    I woukd code as follows: 317 326
  7. M

    Business Manager

    I wouldn't use either of those modifiers in that scenario...... Below is a CPT Assistant that concurs: Surgery: Cardiovascular System Question: If an intra-aortic balloon assist device is placed percutaneously during a cardiac intervention and removed at that session, may both the insertion...
  8. M

    Lauren Rush, CPC

    Below are two CPT Assistants regarding CPT 99000: MISCELLANEOUS SERVICES 99000 Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory For example, a patient collects a 24 hour urine specimen and brings it to the physician's office. The conveyance...
  9. M

    CPT 19380 inconsistent with Dx 611.89 - I am getting denials from Humana

    Often times, revision of reconstructed breast (CPT 19380) is done due to an issue with asymmetry. In the case of a mastectomy with subsequent reconstruction where the physician is documenting asymmetry as the reason for current surgery, dx code would be 612.1 Keep in mind that the patient may...
  10. M

    CO2 Ablation with excision

    Have you considered using modifier "59" on your codes from the 11420-11426 range? If ablation was done on lesions other than the ones excised, you can code these procedures separately.
  11. M

    67924 & 67923

    Medicare bundles these two codes, with 67924 being the code that will be paid. Just wondering....was one procedure done medially, the other one laterally? Would it be possible to provide a copy of the Operative report?
  12. M


    Is there a hospital near you that would possibly allow you to work under an internship? Does the institution where you took your Coding Class offer any type of job assistance?
  13. M

    Depo Provera

    If you do a Forum Search for J1050, there are 2 other threads where this issue is being discussed.
  14. M

    Urinary retention due to foley cath

    I would go with 788.20 only
  15. M

    28820 with 28122

    Please correct me if I am wrong, but it sounds like all of this was done through the same incision.....if that is the case I would lean toward 28820 only.
  16. M

    ?? about new codes & DOS

    You have to utilize codes that are/ were in effect on the date of service for which you are billing.
  17. M

    63030 vs. 63047

    You are welcome. I forgot to mention that Medicare and Medicaid consider CPT 63710 an "Inpatient Only" procedure. And depending on the circumstance (as noted in CPT Assistant below), the dura graft may be included with CPT 63030: To further clarify usage, code 63030 may be reported only when...
  18. M

    Does a 63047 include discectomy??

    No.....CPT 63047 is for procedure in regards to the vertebral segment, not the interspace.
  19. M

    63030 vs. 63047

    Based on my understanding of how these codes read in the CPT book, and the corresponding procedure descriptions in the Coders Desk Reference, 63030 would apply to a "vertebral interspace" while 63047 would apply to a "vertebral segment". Description of CPT 63047 does not reflect any disc...
  20. M

    repair of diastasis of recti muscle

    Per the 3M encoder, CPT code for "Repair, Diastasis Recti" is unlisted code 22999
  21. M

    Periprosthetic Capsulectomy, breast

    CPT 19371 includes removal of the implant. Therefore, it would not be appropriate to code 19328 or 19330 in addition to 19371 unless you are coding the situation noted in the CPT Assistant below: Integumentary System Question In a case when the breast implant has ruptured and the implant...
  22. M

    Piriformis muscle injection

    Hello All...... Just happened to come across this thread while searching for something else...... Please see link below: In the majority of the scenarios I have coded for this injection, the documentation supports...
  23. M

    Vitrectomy / lensectomy

    Hello....... have you looked at 67108?
  24. M

    diagnosis for benign excision

    Thanks Deb........I was about to ask that same question. I also code many Medicare claims for benign lesion excision, and have never heard anything from the billing dept regarding denials or reimbursement issues because I have only coded one diagnosis code for the lesion.
  25. M

    Tissue Expander Question

    I think you may want to use Modiifer "76" or "77" instead........
  26. M

    Ulcer debridement of toe?

    I would not assign 11043 based on the documentation provided..........:)
  27. M

    Simple and Radical Nephrectomy

    Hi...... Without more details about the procedures, I will not attempt to verify your choice of CPT codes. I will suggest modifiers RT (for simple) and LT (for Radical). You have to be careful in your use of Modifier 59. That modifier tends to be over-used, even in cases where there is no need...
  28. M


    Hello...... Pathology is not my coding arena. But.......I am thinking that you should be able to code for each "separate" specimen that is received for evaluation.
  29. M

    How would you code this procedure?

    Based on the Procedure note, depth is definitely deeper than "Integumentary" system. Once you are below fascia, you are heading into the "Soft Tissue", or Musculoskeletal level of a body site. I do disagree with a comment in the last response.......lesion size used to determine the CPT code...
  30. M

    Question regarding reimbursement

    WOW........ I had to read this a few times to make sure that I was really seeing what I was seeing..... I do not do the same type of coding that you do........(I code Hospital Ambulatory Surgery), however I will respond this way....... Downcoding is considered just as fraudulent as...
  31. M

    Tissue Expander Question

    Hello...... Your choice is 19357 (because code descriptor says "Breast Reconstruction,immediate or delayed, with tissue expander") I would not code the removal of the original expander have to take the old one out to put the new one in. Hope this helps..........
  32. M

    Looking for a coding wizard

    Other than 58999 that you note above, only other code that I come up with is 37799 (??)
  33. M

    ICD coding immunosuppressant Infusion post Kidney transplant

    Glad to help..........:)
  34. M


    I would agree with 88307 if the location is soft tissue........ Size is only an issue when coding the excision of the lesion, not when assigning the Pathology code.
  35. M

    ICD coding immunosuppressant Infusion post Kidney transplant

    Hello...... Have you considered: V58.44 V42.0 ?
  36. M

    Diastasis recti

    Hello....... I would say Musculoskeletal........
  37. M

    Coblation of Nasal & Nasopharygeal Papilloma

    Hello....... Have you looked 30117 and 42808?
  38. M

    help please - Hello all

    Hi Jamie...... Unfortunately, this has to be coded as "Unlisted" (42999).... Your suggestion would not be appropriate because the biopsy was done via the scope. Therefore the approach would be the first consideration, and would have to be coded with only one CPT for the procedure. Also, the...
  39. M

    Biopsy of Perianal Lesion

    Unfortunately, if no scope was used to perform this procedure, the only available code is 46999......:)
  40. M

    operative report/path report

    As an Amb. Surg. coder, any time a lesion removal is done I wait for and utilize the Path result.
  41. M

    buttock mass

    This procedure was done on the "buttocks", not in the pelvis/ hip region. The code choices we are given in regards to "excision depth" depend on from where anatomically the lesion is being removed. Does that help?
  42. M

    buttock mass

    report doesn't mention going beyond subcu.........
  43. M

    buttock mass

    what about 11406, with an additional diagnosis of 709.3?
  44. M

    buttock mass

    can you provide details from the Procedure report?
  45. M

    Modifier 58 - Please help

    CPT book answers this question for you. Description of Modifier 78--Unplanned Return to the Operating Room/ Procedure Room by the same physician following initial procedure for a related procedure during the Post-Op period. If you doctor is telling you up front that this procedure will be...
  46. M

    Vag Hyst converted to TAH

    Naturally, your dx code would be the reason they were going to have the original procedure.
  47. M

    Vag Hyst converted to TAH

    Just code the Total Abdominal Hysterectomy
  48. M

    How to code an elective preop for breast augmentation

    If this is totally cosmetic, this should be "Self-Pay" across the board (including Pre-Op exam)
  49. M

    Secondary diagnosis Help!!

    My feeling has always been that a secondary payor should follow suit with the primary payor. However, Medicare and Medicaid seem to want their guidelines followed regardless. Was the primary diagnosis used based directly on the report for the procedure? Was the correct CPT code billed?