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  1. M

    Question Not Billing Insurance but accepted patient copay

    The medical record is a legal document. Providers are credentialed with payers/insurance carriers, that involves contractual agreements. See the 1995 & 1997 Documentation Guidelines. If the visit is not documented it is considered incomplete and is non-billable. The copay should be returned...
  2. M

    Question thoracic laminectomy

    Use the same Thoracic Laminectomy CPT code with a Modifier 76 or 77.
  3. M

    Injection need help with ml vs mg how to calculate

    Injections Thank you Thomas. This did help. I was looking at this completely wrong.
  4. M

    Injection need help with ml vs mg how to calculate

    The providers always document ml and the HCPCS mostly has mg. I need to figure out the caluclation to verify the units are correct. example: 1.) 6ml 0.25% Bupivacaine and 2 ml of 4 mg/ml Dexamethasone. 2.) 2ml 0.25% Bupivacaine and 1 ml of 4 mg/ml Dexamethasone Thank you
  5. M

    Family Medicine Provider billing Pathology/Lab series

    Can a Family Medicine Provider bill a CPT from the Pathology/Lab series? Office note: KOH shin prep was negative CPT 87220 DX: R21 rash
  6. M

    87210 Wet Mount vs 87220 Tissue exam by KOH slide

    Can someone please let me know where I can find a better explanation of these two codes. The way I'm interpreting these codes is: 87210 - Smear, Primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps). This would be used for Vaginal Discharge...
  7. M

    Impella VAD

    Thank you all for your responses. Yes, this was a replacement. The 34812 would be great but this was an Axillary cut-down. I spoke to someone from Abio-med. They suggest the 33999 Unlisted procedure.
  8. M

    Impella VAD

    Procedure: Insertion of Impella 5.0, Left ventricular support device with Removal of left Femoral Percutaneous 2.5 Impella. How would I bill a 33990 Insertion of VAD - if it was done as, Cut down/open? Would it be 33990 with a modifier 22? I think the removal of Impella 2.5 is Bundled into...
  9. M

    CABG Arterial or Venous Graft??

    Yes, 33533 IMA to LAD 33518-22 is - (1st)the Saphenous Vein Graft to the Ramus (this does include the Radial Artery attached to the hood of the Saphenous Vein) and (2nd) Saphenous Vein Graft to the RCA. 35600 Harvest of Upper Extremity Artery
  10. M

    CABG Arterial or Venous Graft??

    Ok I will give this a try. I believe this would be a Venous Graft. In the CPT Note: To determine the number of bypass grafts in a coronary artery bypass (CABG), count the number of distal anastomoses (contact points) where the bypass graft artery or vein is sutured to the diseased coronary...
  11. M

    Cabg blunder

    Coding CABG I agree with ER CPC. You can NOT code 33511 & 33533 together. When coding a CABG: check what is done 1- Arterial Graft (33533-33536) 2- Combined Arterial & Venous Graft (33533-33536 and 33517-33523) use one from each code group...
  12. M

    Resection of tricuspid posterior leaflet

    I agree with the Procedure code, but question the Modifier. Was the Valvuloplasty separate from the Myxoma? Look at modifier 59.
  13. M

    VATS - help

    for the procedure done twice within a month, use a modifier. Look at Modifier 76 or 78.
  14. M

    Femoral artery exposure help

    Usually with exposure cases, I bill the same procedure code as the other Surgeon. You would add Modifier 62 to the procedure and make sure the other Surgeon also uses the 62 modifier.
  15. M

    Cardioverter-defibrillator SUBCUTANEOUS LEAD INSERTION

    I don't use the Category III codes, but thank you.
  16. M

    Cardioverter-defibrillator SUBCUTANEOUS LEAD INSERTION

    Need help finding a code for - Revision of AICD , placement of left lateral chest subcutaneous lead insertion. (from op note) An incision was made over the scar of the previous AICD placement on the Rt subclavicular fassa. The skin was divided with the scalpel: the electrocautery was used to...
  17. M

    Chest Exploration post CABG

    Shouldn't code 33511 be used because - SVG to LAD and PDA to RC ?
  18. M

    Right Thoracoscopy. VATS Evacuation of Recurrent Pleural Effusion.

    Look at code 32650 with modifier RT. The diagnostic biopsy of pleura (32609) would be bundled into the surgical pleurdesis.
  19. M

    Open Heart Biopsy

    Does anyone know a code for an OPEN HEART BIOPSY done the day after a Heart Transplant? The chest was packed for coagulopathy. They took the patient back to the OR the next day, removed the packing, did the open heart bx and closed the sternum.
  20. M

    cardioverter Defibrillator

    I haven't needed to use these for awhile but Medicare did have a medical policy that listed the Codes that support medical necessity. I would go to Medicare web-site, under Medical Policy and search "Implantable Cardioverter-Defibrillator." I hope this helps.
  21. M

    EMCO insertion/management

    1 - Is the ECMO management (33960, 33961) considered global to the insertion 36822 with (90 day global) ? 2 - Physician that inserts 36822 ECMO is in the same group as the physician doing the management ( 33960, 33961)
  22. M

    MV Repair then MV Replacement ? Modifier

    I would bill both the repair and the replacement, but use the modifier 59.
  23. M

    AVR w/ Debridement & repair of intra annular abscess

    Aortic Valve Replacement - 33405 ? There was large subannular and intraannular abscess starting approximately in the midpoint of the lt coronary cusp and extending two-thirds toward the noncoronary cusp. This area was very friable and was obviously areas of necrosis and infection. This was...
  24. M

    Wound Vac-Surgeon does

    I think anytime you take the patient to the OR, it is a billable charge. Use the Modifier 58 or modifier 78.
  25. M

    Removal of sternal wires

    For the removal of the sternal wire look at codes 20670, 20680 - and for the debridement look at codes 11042,11043, or 11044. I hope this helps.
  26. M

    ECMO cannula removal

    see thread by GIBBERS dated 1/25/12--- reply post by lisigirl
  27. M

    32505 vs 32500

    For the Lymph node removal you would still use +38746. Look at the note under 38746- report in conjunction with ... - code 32505 is there. I have simular issue but I need the VATS lymphadenectomy +32674 and the note under 32674 report in conjunction with ...- does not include my primary code 32607.
  28. M

    Mediastinotomy for cardiopulm bypass placement

    It sounds like your part of the procedure (mediastinotomy w/placing pt on bypass) is integral component of total procedure. I think you should have coordinated this with the primary surgeon. You should use the codes the primary surgeon uses for excising a rt renal mass with caval thrombosis...
  29. M

    Valve replacements w/ additional reconstruction or repair

    I have two separate patients, both had : Aortic Valve Replacement 33405 & Mirtral Valve Replacement 33430. Each had additional work done. patient #1 had -Patch repair of Aortic Wall and Left Sinus (? cpt code) patient # 2 had -Reconstruction of Mitral and Aortic Valve Annuli (? cpt code) Can...
  30. M

    Code for Repair of Paravalvular Leak?

    See code 33496. You would also bill 33530 for repoeration.
  31. M

    CABG day 1 and return to OR day 2 is it billable?

    procedure code 35820 with modifier 78 and diagnosis 998.11 and v45.81.
  32. M

    Repair of great vessels

    When I am billing for more than one vessel repair, would I use Procedure code 33322 Suture repair of aorta or great vessels w/ cardiopulmonary bypass, only once? Procedure Performed: 1. Mediastinal Exploration 2. Repair of Innominate Artery Laceration...
  33. M

    MV Repair by Thoracotomy

    I have billed this surgery using the 334_ _ series. It was my understanding that the approach doesn't matter.
  34. M

    critical care time

    Be careful with that Critical Care Table. The coding for the 170 minutes would be 99291 and 99292 x 3. 74 min. for the 1 hr 30 min. 30 min. 30 min total 164 minutes.
  35. M

    dx for aortic tear or aortic disection

    See dx 441._ _ Aortic dissection
  36. M

    Cpt 32655

    Yes, these codes can be billed together. You may want to put modifier 59 and/or use separate dx .
  37. M

    Off Pump Coronary Bypass Graft OPCAB

    More info or the op note is needed to code correctly. 33533 is for a single arterial graft and that you mentioned LIMA to Diagional. There is no difference for coding on pump vs. off pump.
  38. M

    Biatrial reduction - CPT?

    Not sure but my quess would be to look at 332_ _ series.
  39. M

    Coding question

    Without seeing the op-note, all I can do is give you some codes to look at 10120 - 10121 or 20100-20103 as appropriate.
  40. M


    I believe the 39400 includes the lymph nodes.
  41. M

    Pqri reporting

    Is anyone reporting PQRI? I am looking for some guidance with reporting PQRI. STS registry reporting - vs - Claim based reporting. Right now I am submitting Claim based PQRI but that is as far as we have gotten. The physician billing group I am with, has not been fully committed to this...
  42. M

    End-life of pulse generator

    Take a look at the 996._ _ series. COMPLICATIONS Mechanical complication or Other complication (due to Presence of any device, implant and graft)
  43. M

    cabg x4 please help

    The above note CABG x4 looks like 33533 Lima to LAD 33519 three vein grafts.
  44. M

    Bill a thoracoscopy when converted to thoracotomy?

    When a VATS turned open, I have been billing both and apply the modifier 59. These codes are not in cci edits / not in mutally ex, but I would say half are rejected as mutally exclusive- included in pmt for other procedure. I do like that dx V64.42. I will try that on my next claim and see if...
  45. M

    Chest wall resection/plastic reconstruction NO tumor

    This is hard to code without the opnote. You should have the Doc look around the Lungs and Pleura, ie: 32504.
  46. M


    Your coding is correct. I would appeal the rejection.
  47. M

    Thoracic lymphadenectomy HELP

    What do you think about using 38500 and then the 38746? Sorry the above falls under a CCI edit. I would just use the 38500.
  48. M

    How would you code ligation of atrial appendage?

    That's a good question. I usually see this when a MAZE procedure 33254 is done and I was told the oversewing is included in the MAZE procedure. There is no billable code when done without maze. See the notes on page 148 of the CPT 2009 Professional Edition - under the Electrophysiologic...
  49. M

    mediastinal explor vs sternal debridement

    I agree with 35820 with modifier 78.
  50. M

    Non-Invasive Cardiac Surgery

    I don't think there is a separate code for robotic procedures. I have tried to bill the procedure w/ modifier 22. I sent the opnote and a letter - example Modifier 22 – Increased procedural service ROBOT-ASSISTED MINIMALLY INVASIVE Please accept this as a request for higher...