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  1. P

    Icd 10 for past history of needle stick?

    Oh, great idea! That should work, thanks so much for the help!
  2. P

    Icd 10 for past history of needle stick?

    Provider documented only: "During her career, she has had needlestick injury. Unsure if she had had Hep B vaccine. Has not been tested for hepatitis C." Provider ordered labs, incl Hep B,C, RPR, and HIV. No documentation that she'd ever actually been exposed to bodily fluids. Tatoos don't...
  3. P

    non-selective debridement done by nursing staff

    Hi, along this same line, I have a provider who insists on billing 97602 to clean and bandage abrasions from falls, and the like; How can I convince this provider that this in inappropriate use of 97602? Thanks!
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    Has anyone here ever been involved in practice start-up?

    Thanks so much, Jon! I appreciate the support I have been shown through this Practice Management Forum! P&P is my biggest challenge, so far. It can be overwhelming, but I am taking another deep breath and "just keep swimming", to quote my friend, Stephanie! I'm breaking it down by sections, and...
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    Has anyone here ever been involved in practice start-up?

    Gotcha! Yup, lots and lots to think about! I just downloaded Reed's New Practice Checklist, and one of the things listed under "Office Operational Issues" is "Prepare Office Policy and Procedures manual". I have read many policy and procedure manuals, as a staff member with many different...
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    Has anyone here ever been involved in practice start-up?

    Thanks so much, Marlene! All really good information. I did not think about the Arizona Medical Association. Was trying to navigate the Az Medical Board website, but it was not helpful at all! Just pulled the AzMA, and already found more pertinent info in 5 minutes than I have in 5 days, lol...
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    Has anyone here ever been involved in practice start-up?

    Thanks so much, Kathleen, I will do that right now! :)
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    Out of Network Insurance and Practice Managers questions

    I am a Practice Manager, and I had the same question about this particular forum, as well. This forum is titled "Practice Management", but looks like the term "General Discussion", as the sub-category, has over-shadowed the actual PM title. I've learned how to use the "Search this forum" for PM...
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    Has anyone here ever been involved in practice start-up?

    Hey, Marlene, thanks for taking time to help me out! I'm struggling with P&P right now. I've been trying to find specific info or guidelines on what is required for a small solo provider practice, and wishing I could find some samples or template to follow, and just not having much luck...
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    Has anyone here ever been involved in practice start-up?

    Looking for some guidance in setting up a new primary care practice. Cannot afford to hire a "start-up consulting firm", just really need some suggestions for resources for policy and procedure templates, and the like. Any suggestions appreciated! Excited to be doing this, but today, feeling a...
  11. P

    Coding Hypothyroidism in Hashimoto's

    In researching Hashimoto's, I came across an article that said not all patients with Hashimoto's develop hypothyroidism. The chart I am coding this morning documents Hashimoto's disease, pt started on Nature-Throid. Do I want to code both the Hashimoto's and Hypothyroid? TY!
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    Wiki DVT Prophylaxis Coding

    You rock, thank you so much!
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    Wiki DVT Prophylaxis Coding

    I've been struggling with this question as well, documentation of a DVT, now on prophylaxis to avoid recurrence. Does that make it "Chronic DVT"?
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    Wiki Coding GERD with Barrett's esophagus

    This seems like a really simple question, but I can't find an answer! When documentation states GERD and Barrett's Esophagus, are they coded separately or does it code to GERD with esophagitis? Thanks for your help!
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    Looking for opinions on how to handle erroneous code selection through EMR

    Nope! That is what is so frustrating. Came across 2 this week that were coded DM due to underlying condition, but no documentation, anywhere, as to what that underlying condition might be. Sent a query on that one. This is a new practice for me, started last month, so looks like provider...
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    Looking for opinions on how to handle erroneous code selection through EMR

    Debra, what about those situations where the providers use the chosen ICD code as their ASSESSMENT, and really do not provide any other type of narrative, other than maybe " Continue current meds.." For example: " Assessment: 1. Bilateral post-traumatic osteoarthritis of knee - M17.2...
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    Looking for opinions on how to handle erroneous code selection through EMR

    Good afternoon; I am just wondering how everyone else handles the issue of providers who choose incorrect diagnosis codes through the EMR system. Perfect example, I just came across in a chart note from October 2015: "Assessment: 1. Neoplasm of uncertain behavior of right...
  18. P

    Heart disease with hypertension

    I am having a problem with documentation for Hypertensive heart disease as well. I often have providers state "HHD", but do not specify the heart disease. Coding Guidelines refers to "Heart conditions (425.8, 429.0-429.3, 429.8, 429.9) are assigned to a code from category 402 when a causal...
  19. P

    Use of modifier 26

    Tyvm!
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    Use of modifier 26

    So which modifiers would I use for my provider(outpatient podiatry clinic) who actually performs the in-house xrays and provides the interpretations?
  21. P

    Colposcopy AND Office Visit??

    I agree with you. If the patient is brought back specifically for the procedure secondary to an abnormal pap, and no other significant, separately identifiable problem is documented, then the use of an E/M code and the -25 modifier would not be appropriate. Additionally, in my mind, the patient...
  22. P

    schizoaffective disorder, bipolar type

    Hi, you may want to consult the DSM V, and/or consult your provider, but there is no combo code for this. We use just the ICD 9 295.70, and leave the "bipolar type" to the provider's documentation.
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    V45.89-I was wondering

    That is very weird that you posted this today, as, yesterday, I was searching for a status code for implanted spinal cord stimulator and couldn't find any posts that were helpful, so I eventually settled on the V45.89. Never did decide if "neuropacemaker" is same as spinal cord stimulator, but...
  24. P

    Diagnosis Codes

    Even though he started her on Vit D supplementation? Thanks for your help as always, you are appreciated!
  25. P

    PFSH in EHRs

    The EHR program we are using does not reflect who actually entered the PFSH in that portion of the chart, even though the provider does it at the new patient visit. In order for PFSH to be "counted" for New Pt E/M, doesn't the provider have to actually document in the note that he/she...
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    EHRs and PFSHx

    The EHR program we are using does not reflect who actually entered the PFSH in that portion of the chart, even though the provider does it at the new patient visit. In order for PFSH to be "counted" for New Pt E/M, doesn't the provider have to actually document in the note that he/she...
  27. P

    Diagnosis Codes

    Along the same lines, my provider documented "Significant clinical obesity, especially abdominal" and "Lab results: ......., Vit. D- 30 mg (30-100) Low Sep.'13" In Assessment, he reported only DM. Because the obesity is documented as clinically significant, and pt is diabetic, and there is a...
  28. P

    polypharmacy

    Are you talking about polysubstance abuse/dependence diagnosis?
  29. P

    Modier 25 and diagnostic test on same day

    This post was 2 years ago, no response ever materialized that I can see. Anyone want to weigh in on this? I would love to have the answer to this question :D
  30. P

    Physician erroneous diagnosis

    When reviewing chart notes to provide dx codes to the lab, I came across a note where physician "A" reported a rule out dx in his chart note. Physician "B" saw the pt in f/u 6 weeks later, as physician A is no longer with our clinic, and documents "Review of the records indicates (pt name) has...
  31. P

    Wiki Discomfort vs Pain

    Thank you, Debra, you just validated my gut instincts!;):):D
  32. P

    Wiki Discomfort vs Pain

    Thank you for your reply! Don't think I can use 791.9, as the "dark frothy urine" is subjective, not an actual examination of the urine (as in urinalysis). Guess my question really is can I code "pain" from the documented "discomfort"? And can I code dysuria because the provider said to...
  33. P

    Wiki Discomfort vs Pain

    Ok, here's a stupid question for a Friday am: Primary Care SOAP note documents subjective "...c/o dark, frothy urine" and "...vague complaint of left testicular discomfort." Physical exam documents "...normal testicles, possible some varicosities on the left..." When queried for more...
  34. P

    Obesity coding with comorbidities

    I think too, that there is a difference between coding the co-morbidities, and billing for them. I would say code them, as pertinent to treatment, but do not bill as they were not directly assessed in this encounter? :)
  35. P

    Obesity coding with comorbidities

    I do not have an answer for you, but I do have an addition to your original premise, and that is I am struggling with the same type question for all types of comorbidities, ie: patients with diabetes, COPD, etc., all these conditions have to be taken into account when considering treatment...
  36. P

    Intent of CPT 90837

    IMO: Family therapy and Group therapy are 2 different things. Group therapy is for a group of individuals with related problems being treated as a group by the provider. You said the provider was paid for 90847; why did the "system configuration" change the code? I came across this from...
  37. P

    DSM vs ICD 9

    Since I am coding for psychiatry, most of all these patients would qualify for the counseling codes, unless the abuse was very recent or actually current. Thank you for your help! :)
  38. P

    withdrawal from Percocet Rx

    Therein is my confusion: 292.0 says for "...mental or behavioral disturbances due to drug withdrawal..." ; my documentation does not support this as there is no mention of any mental or behavioral issues, just the physical symptoms.
  39. P

    withdrawal from Percocet Rx

    The record I am coding this am, reports that the patient is out of his prescribed narcotic pain medication due to changes in PCP and a delay in getting him in to see a pain management specialist. He is experiencing physical symptoms of withdrawal of a drug he has been taking correctly, as...
  40. P

    2nd attempt regarding "double dipping" per Cutting Edge article

    Could be we (me, for one!) just have not read it yet! Now you have my curiosity piqued, I have my assignment for the weekend ;)
  41. P

    PFSH Question-I would like

    Past medical history is only one component of PFSH; if, for instance, a child, it's possible that there is no pertinent past medical history. IMO: this would be acceptable for what it is; are the other 2 components addressed at all? (family medical, social)
  42. P

    final diagnosis coding

    And that is why we review all of our providers notes before sending to billing! :D
  43. P

    99211 for weight cks for anorexic

    I've been researching 99211 for hours now, looking for guidance whether or not to bill 99211 for provider-ordered Nurse Visit weekly weight checks for patient w/ dx of anorexia nervosa. Any thoughts?
  44. P

    DSM vs ICD 9

    I am confused by DSM vs ICD 9 dx codes for child sexual abuse. DSM says to use 995.53 if the patient is the victim and to use V61.21 if patient is the perp. It has always been my understanding that ICD 9 995.53 is for current, recent or active abuse; and V61.21 for history of child abuse...
  45. P

    Coder/Biller vs Biller/Coder

    How does a coder become a biller, as it appears billers are expected to be coders, as well and many more positions are available as such. Coders. per se, do not seem to be much in demand except in in-patient settings :confused:
  46. P

    Child abuse code vs Counseling for Victim of child abuse

    Any thoughts on when to use 995.50 Child abuse vs V61.21 Counseling for victim of child abuse? Is it as simple as: if the patient is 17 yo or younger (per ICD 9 guidelines), then use the 995.50, but even if the abuse occured several years ago? DSM says to use the 995.5x if the patient is the...
  47. P

    Chronic residual limb pain

    Any ideas? Documentation states: "Chronic residual limb pain", not phantom limb pain; pt is Left AKA
  48. P

    ICD-9 code for baseline EKG

    I would use V58.69, with a primary should be 311 Depression. I am a Psych coder and this is how I code labs/EKGs for pts on psych meds that require monitoring. V58.83 is for "therapeutic level" in the blood- good for Depakote, Lithium etc., but not appropriate for EKGs :O)
  49. P

    90791 Question

    Good question! CPT does not really give any specifics except "integrated biopsychosocial assessment, including history, mental status and recommendations." If the documentation supports each one of these, why not? (I can see where it could be possible, especially if it is a patient w/o a long...
  50. P

    New to behavioral health billing

    If the encounter was an assessment of the patient for psych clearance for the pain management treatment, I am not sure about psychotherapy. Psychotherapy is a specific type of therapy such as behavior modification, cognitive behavioral therapy (CBT), insight-oriented, supportive, etc.). Was it...
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