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    Hyperlipidemia (E78.5) and Hyperglycemia (R73.9)

    The reasons you have listed above were pretty much all I could think of, too. It's nice to at least know I wasn't missing something somewhere. You're the best, Debra! Thank you for taking the time to expand. :-)
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    Hyperlipidemia (E78.5) and Hyperglycemia (R73.9)

    Hi Debra, You have been answering a lot of these ICD10 questions. Thank you very much. I truly appreciate your answers. :-) I do understand the Excludes 1 notes, and the fact that you cannot code these 2 together because of the Excludes 1 rule. What I personally was looking for was to see...
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    Hyperlipidemia (E78.5) and Hyperglycemia (R73.9)

    I have that very same question. I'm really hoping someone will have an answer for you soon.... Rebecca Hardin, CPC
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    Hospital H&P

    Not to my knowledge, you don't. The H&P is always available through the hospital's medical records dept if you need it, but there's no reason to hold up surgical billing because you don't have it in your chart. Becky H, CPC
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    Postpartum care after c-section

    Yes, you are correct. If the doctor who did the C-Section is billing for the C-section (which s/he should), then you are left with the antepartum care and the post partum care. Don't forget to bill appropriately for whatever your doc did in the hospital before turning patient over the surgeon...
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    change of insurance

    Most insurances will want you to split the OB care out, billing the old insurance for only the care provided while the patient was eligible, and then billing the remaining antepartum care + delivery/PP codes to the new policy. I have run across a few (very few) policies that let me bill the new...
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    27884 vs 11403

    Op report states, "..the right below-the-knee amputation site was approached and sharply debrided into the subfascial plan removing all necrotic and devitalized tissue to healthy bleeding tissue. The would was then copiously irrigated with sterile saline. Hemostasis was achieved with...
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    27884 vs 11043

    Op report states, "..the right below-the-knee amputation site was approached and sharply debrided into the subfascial plan removing all necrotic and devitalized tissue to healthy bleeding tissue. The would was then copiously irrigated with sterile saline. Hemostasis was achieved with...
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    Neuromonics Device

    Anyone have any experience billing for a Neuromonics Device? What HCPCS do you use (is there a better one than E1399)? If E1399 is the only code choice, what documentation do you submit in order to maximize any insurance benefits the patient may have? Becky, CPC
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    Confused About the Sequencing Here.

    I use LT/RT modifiers instead of -59 when I feel it might get me less flak from the insurance carrier. They basically do the same thing as a -59 by indicating different body parts. I do check CCI edits routinely for bundling issues. If a -59 is allowable, I then have to make sure it's...
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    Laparoscopic Ureterolysis CPT Coding Help

    Lysis work is typically included in the main procedure code and is not billable as a separate procedure. This has been true of pelvic LOA for some time, and CCI edits have recently been updated to include Enterolysis. I suspect Ureterolysis falls under the same bundling edits. If the lysis...
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    Confused About the Sequencing Here.

    The cystectomy RVUs are slightly higher than the SO RVUs. Maybe it takes slightly more work to remove a cyst from the ovary than it does to remove the entire ovary. That's just a guess, though. I also am not getting any CCI bundling edits on these 2 codes, so technically a 59 modifier...
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    57287 vs 57295 with 52 modifier?

    The procedure described in the 57287 & 57295 codes are typically done in a facility setting, not in an office setting. Both codes are also listed under the "repair" heading, and this doesn't sound like a vaginal repair procedure. This sounds closer to a foreign body removal kind of thing, and...
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    Tricky Global Maternity Scenario - HELP!!!

    It's not incorrect to bill a global OB to the new insurance, but I'd recommend contacting the payer first to see how they prefer you to bill out the OB care in this situation. Some will be fine with paying the whole global. Some will want you to separate out the care. If you bill a global...
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    attempted C-section but had to go vaginal

    Now that's an unusual situation. I'd code a 59510-22 (assuming you are billing a global). Try to get extra reimbursement for the extra time, effort, and risk. You might be able to make an argument for one of the VBAC global OB codes if the patient started out as a VBAC, went to C/S, and then...
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    52000 help

    Thank you very much for the article, OCD! I'm saving it for future reference. :-) Becky
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    Billing Well woman with problem visit?

    On order to bill a "separately identifiable" E&M service, you need to make sure the documentation supports a separate E&M code. That is, the elements used for the problem E&M code must be able to stand alone and apart from the WWE elements. No double dipping is allowed. You might want to take...
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    52000 help

    It's my understanding that if a 52000 is done to check the work of the main procedure, e.g. to make sure the surgical procedure caused no injury to the bladder, then you do not bill a 52000 separate from your main procedure. If, however, there is a diagnosis or condition separate from the main...
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    Prom code with 650

    Per ICD-9 notation, 650 "is for use as a single diagnosis code and is not to be used with any other code in the range 630-676."
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    2 degree perineal lacreation during vaginal delivery

    No, you do not use the 650 ICD-9 code if you are also using the ICD-9 code for the tear.
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    2 degree perineal lacreation during vaginal delivery

    I agree, you wouldn't bill separately for the lac repair. But your dx code should reflect the tear.
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    2 degree perineal lacreation during vaginal delivery

    664.12 isn't a valid code. The 5th digit choices for 664.1X are [0, 1, 4] only. The note under 650 states "This code is for use as a single diagnosis code and is not to be used with any other code in the range 630-676." So no, you do NOT code the 650.
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    Cesarean delivery / lysis of pelvic adhesions

    Lysis of Adhesions (LOA) is very often bundled into the primary surgery. In my opinion, you'd be better off reporting the 59510-22 only and trying to get extra money for the extra time and effort doing the LOA part. You could try billing the 58740-22 & 59510, but chances are the 58740 will be...
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    95992 - Audiologist & Incident To Question

    Thank you. That's what I think, too. Unless somebody else rains on my billing parade, I'm taking that answer and running with it. :-)
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    95992 - Audiologist & Incident To Question

    Can a Canalith procedure (95992) performed by an audiologist be billed as incident-to a physician's services if all incident-to guidelines are met? Becky, CPC
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    Well Women CPT codes

    Yes, the G0101 & Q0091 codes are included in the 993xx codes. The G0101 & Q0091 codes are used to "carve out" those pieces/services that Medicare will pay for from the rest of the 993xx bill that Medicare will not allow. You bill all 3 codes to Medicare. Medicare will deny the 993xx code as...
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    Billing Medicaid for prenatal visits

    I've been billing out OB for years, and this is the first time I've ever heard of an auditor not allowing prenatal visits for absence of a CC on the ACOG form. There should be no need for a separate CC column on each line when the reason for the visit is routine prenatal care. The ACOG form...
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    Failed endometrial biopsy

    Here are my thoughts (that anyone else can differ with): My CCI edits source lists both the 64435 and the 57800 as a Column 2 exclusion to the 58100 code. You can't bill either code in conjunction with the 58100 code no matter what. That being said, the endometrial bx was the procedure...
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    97 guidelines for the Musculoskeletal exam

    My thoughts are no. I would want to see a specific statement indicating the provider specifically addressed muscle strength and tone. Something like "muscle strength is 5/5 with normal tone and no abnormal movement." Or simply "muscle strength and tone is normal" would do it for me. But...
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    Need some help, please!!!!

    The 49000 is included in and will bundle with the 58700 (no modifier allowed). There isn't a specific code for the paratubal cystectomy. If I was coding for this procedure alone, I'd use one from the 49203-49205 range, depending on the size, but you can't bill a 49203 with the 58700 - the...
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    31237 - Post Operative Debridement

    That's exactly the expert advice I needed, as well as the answer I expected. Thank you, Candice! :-)
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    NCCI Separate Procedure Guidelines

    There are no CCI edits preventing you from billing both codes together. I ran them through my CCI edits checker, and I got a green light on both, which means you don't even need a 59 modifier. That's all I've got. i couldn't find any CPT Assistant articles that deal with the billing of both...
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    31237 - Post Operative Debridement

    I need the expert advice of an expert ENT coder. Are there any rules for billing or not billing a 31237-58 during the global post op period of a septoplasty procedure? I know I'm OK billing the 31237 when the debridement is releated to the FESS codes, since the FESS codes don't have any global...
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    E/M Bundled into laceration repair procedure

    Thank you Camille! Do you happen to know if the entire 2012 NCCI Policy Manual is available online somewhere for download? Becky, CPC
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    E/M Bundled into laceration repair procedure

    I understand there was a language change to this particular section of the NCCI Policy Manual Chapter 1 effective 1/1/13. Does anyone have a previous version of Chapter 1, or does anyone know where I can find the 1/1/12 version (hopefully free version outside of NTIS)?
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    Degenerated Disc Space

    I'm coding for a radiologist who works for an Ortho group. If he lists degeneration of disc space in his impression without listing any other issue, what dx code range should I look in? It's not enough to use a DDD dx, is it? Becky, CPC
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    twin delivery

    Definitely check your payer guidelines. Some want a 22 modifier. Some want it billed as rharmon notes above. Unless payer states otherwise, I bill as follows: 1 c/s, 1 vag = 59510+59409-59-51 2 vag = 59400+59409-59-51 2 c/s = 59510 (extra work is not significant enough for separate billing of...
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    Non-global Twin C/S Coding

    If your clinic did not provide all prenatal care, and you have to split the billing, then you bill the 59514 or 59515 for the twin C/S delivery. Usually. Most insurance carriers won't pay for delivery of the second babe when both are delivered via C/S. If both are delivered vaginally, or if...
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    Radiology Dx

    I'm not sure "fun" would be my word of choice right now, but it is getting easier, and I'm not using the other words as much any more. ;-) Thank you very much for your answer! :-)
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    Radiology Dx

    I am new to radiology coding, and I'm having trouble making the shift from the cut-and-dried dx coding in chart notes to the not-so-overt diagnoses listed as a radiologist's impressions. I can use an opinion or 2 or 3 from others more experienced than I. Please read the following and let me...
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    What is the correct way to bill an initial OB visit?

    If the OB record is initiated at the time of the encounter, you may not bill for a separate E/M code. It does not matter if the patient is new or established. The chart documentation for that initial 99202 would have to be able to stand alone without crossing components over into the initial...
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    Stll Learning OB/GYN-Billable Prcedures done in the Office

    Same coding rules apply to OBGYNs as to other specialties. As with any other office, you pick out the things that are not included in the E/M code, and hopefully find a CPT code for them. STD counseling is part of your E/M code. Specimen collection is also part of your E/M reimbursement...
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    billing an officd visit for OB px

    You are correct in your CPT book interpretation. The initial pre-natal visit is just that - an initial PRE-NATAL visit & is therefore included in the global OB package. Some people theorize that as long as they don't initiate the pre-natal record, then they can bill for that initial exam...
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    Help! OB Transfer of care patient

    I'd look to your providers for guidance on this one. If it were me, I'd bill for the 1 visit and the delivery, and let the other OB bill for antepartum only. I assume the patient is coming back to your practice for post partum, right? There doesn't have to be an official transfer of care like...
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    LAVH+Cervix

    More info, because your question made me realize I have always assumed you couldn't do a LAVH without taking the cervix, and assuming stuff like that has bit me in the posterior region more than once: http://en.wikipedia.org/wiki/LAVH#Technique LAVH begins with laparoscopy and is completed such...
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    LAVH+Cervix

    58550 includes removal of the cervix. Here's what I found on SuperCoder under the Lay Term heading for 58550: Physician Responsibility What makes this a LAVH is that the physician severs all the upper connections of the uterus via the scope, but the physician severs the lower connections from...
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    Ob visits using v22.0 and v22.1

    Debra is absolutely correct. It does not matter what the outcome of any previous pregnancy was. G1 = V22.0. G2 or more = V22.1. The word "normal" refers to the absence of any complications during the current pregnancy. It does not refer to the first normal pregnancy. Becky, CPC
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    Kidney Stones during Pregnancy

    Thank you very much for your responses, fellow coders!! :-) I have always second-guessed myself on the kidney stone thing, and it's a relief to know I wasn't totally off base. I should have asked for your opinions a long time ago. I did go with the 646.2x & 592.0 for the induction and...
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    Kidney Stones during Pregnancy

    I need opinions on the dx coding for an OB patient admitted for kidney stones. She was subsequently induced "for pain." I would normally use 592.0 + V22.2 for the hospital stay, but I'm not comfortable using that combo to explain the induction & delivery. Would a 646.2x be appropriate (are...
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    Laparotomy,TAH,BSO,Lysis of adhesions,examination under anesthesia

    58150 is the only billable code I can pick out of the op note. A laparoscopy was not done, and the BSO is included in the 58150. The 57410 is going to be bundled into the TAH. If your physician feels s/he spent an extraordinary amount of time on the 58150, you can bill out a 58150-22. The...
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