Search results

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    Presacral Biopsy

    49180 & 77012 as I would consider this presacral Bx retroperitoneal.
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    71045 and 74018

    The April 2018 NCCI tables have been published on the CMS website; the edit has been deleted effective Jan. 1, 2018. Thanks to the ACR.
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    96372 and 96361

    96372 does not have an initial versus subsequent designation, so it should not be considered the primary code for add on CPT code +96361. The parenthetical note in CPT identifies the possible primary code(s): "(Report 96361 to identify hydration if provided as a secondary or subsequent...
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    IR Resources

    I've been using Dr Z's for a few years now...I prefer the ZHealth Publishing products. The instructions and diagrams are usually very detailed and relatively easy to follow for even the most difficult IRD procedures. I have tried MedLearn, however prefer the content and layout of Dr Z's, it's...
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    facility critical care

    Critical care is coded (facility) when performed in the ER...Hospitals bill critical care for ED cases when the requirements of critical care have been met. Hope this helps,
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    New to Urology

    "temporary" ureteral stent placement during cystourethroscopic diagnostic or therapeutic interventions is an integral component of those endoscopic procedures and would not warrant additional reporting. The insertion of a "temporary" stent refers to those types that are used during the...
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    Cpt 96367

    No mod on 96367.
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    new coder needs help with debridement of burn

    See CPT codes: 16020-16030 Hope this helps,
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    Searching for J code for Sorbitol/Manitol

    J2150 injection Mannitol, 25% in 50ml Osmitrol Hope this helps
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    Help with Angioplasty coding please

    As per NCCI edits CPT codes 37228 and 75710 will generate a "bundling" edit. The guidelines for when the codes can and cannot be reported together are found in the CPT manual page 373, just prior to CPT code 75600. The guideline lists when diagnostic angiography should NOT be used with...
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    Encoders - I am beginning to research encoders for our practice

    3M is an excellent encoder, however you must invest in the optional references for optimal results. CPT Assistants, AHA ICD-9 & HCPCS Coding clinics, Fay Brown, Dr Z's, Abbreviations, etc. Hope this helps,
  13. C

    Non-Stress Echo with Contrast

    TTE/ TEE: See 93306, 93307, 93312 or C8923- C8925... Hope this helps,
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    Dx code help

    I have no reference, however 3M assignes 746.89 Congenital anomoly of the heart. Hope this helps,
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    US CPT Coding

    There is a CPT Assistant, Clinical Example (2001) which indicates that if the pregnancy was "definitely known" based on previous diagnostic studies or physician evaluation and the US does not currently demonstrate an IUP; the Obstetrical US codes should be used as the US was ordered based on the...
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    Diabetic Foot Exams

    NCD for Services Provided for the Diagnosis and Treatment of Diabetic Sensory Neuropathy with Loss of Protective Sensation (aka Diabetic Peripheral Neuropathy) (70.2.1) Publication Number 100-3 Manual Section Number 70.2.1 Version Number 1 Effective Date of this Version 7/1/2002 Implementation...
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    lymh node bx

    19102 is for core biopsy of the breast....your example indicates core bx of axillary lymph node....38505 would be the better choice... 38505 Biopsy of excision of lymph node(s): by needle, superficial (eg cervical ,inguinal, axillary) can be with or without imaging guidance (coded separately)...
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    Bilateral code??

    CPT code 21196 is inherently bilateral. A CPT Assistant indicates that the description was changed from ramus to rami, making the code inherently bilateral. The CPT code is also an Inpatient Only procedure for facilitiesl status indicator C. Additional information indicates that if the...
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    Modifier 74 usage

    If the physician indicated that the procedure was terminated or incomplete due to ".....", appending modifier -74 would appear to be appropriate. For the facility, use of modifier 74 renders full payment for the procedure while modifier -73 renders 50% of the payment (Medicare) for the...
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    heparin flush

    96523 Irrigation of implanted venous access device for drug delivery systems
  21. C


    Correct the edit between the code pair was deleted as of 01/01/1996.
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  23. C

    Tetnus shot with CPT 96372

    The CPT manual provides guidelines for Vaccines & Toxoids which indicates... "Codes 90476-90748 indentify the vaccine product only. To report the administration of a vaccine/toxoid, the vaccine/toxoid product codes 90476-90749 must be used in addition to an immunization administration code(s)...
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    Unsuccessful/failed coronary intervention

    Unsuccessful or discontinued? If Discontinued see modifier -53 (physician) or -73 / -74 (hospital), in addition to ICD-9 V64.__ code.
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    Is this coded correctly?

    CPT Assistant, 2007 indicates the removal of an embedded IUD via hysteroscope, forceps & curette may be reported with 58562. Not sure about the inclusive part...payer specific
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    Hyalgan injection???

    As the descriptor indicates per dose, I would be reluctant to report more than one unit per treatment/injection. Check with your local carrier for additional infor. Here in NYC the carrier is NGS... This is what they have for J7321.... "Hylan G-F 20 (Synvics-One TM) - Effective 02/26/2009...
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    Renal angio; Bilateral - HELP

    Reporting 36245 -50 x 1, indicates a bilateral procedure. It seems inappropriate to report 36245 -50 x 2 for a bilateral renal angiogram; hence the "overpayment". If 36245 -50 x 2 was reported to Medicare on a hospital claim, it would generate a billing edit; OCE 74 Units Greater than one for...
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    Thyroidectomies: Complete vs Total

    Total and complete appear to mean the same thing...removal of the entire thyroid gland.
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    Is 99183 a time based code?

    CMS 's Medically Unlikely Edits (MUE) indicates one unit per day max for CPT 99183
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    Is 99183 a time based code?

    Hospitals that bill under OPPS report C1300 which is time based...each 30 minutes in lieu of 99183.
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    IV meds administered in office

    If IV infused, you would report 96365 (initial, up to 1 hour) drug administration, and J3488 for the Reclast/ Zometa. If IV infused for 15 minutes or less you would report 96374. See full range of drug administration codes to assure that you're appropriately capturing the correct codes based...
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    billing bronchs

    31625 should only be billed once per encounter; CPT assistant '99 indicates bronchoscopy is inherently bilateral, CPT assistant '04 indicates "...code is intended to be reported once, regardless of whether one or more biopsies are performed on a single site or multiple site". CMS has a...
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    Maximum units on 20550

    I do not think that CPT code 20550 is addressed in Medicare's Medically Unlikely edits (as published or non published MUE);there appears to be no maximum allowable units set. The descriptor indicates "Injection(s); single tendon sheath, or ligament, apneurosis It appears that the units should...
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    urinary incont?

    ICD-9 Coding Guidelines (UHDDS) Section III. R Reporting Additional Diagnoses GENERAL RULES FOR OTHER (ADDITIONAL) DIAGNOSES For reporting purposes the definition for “other diagnoses” is interpreted as additional conditions that affect patient care in terms of requiring: clinical evaluation...
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    You can find reimbursement data by CPT/HCPCS code in the Addendum B on CMS 's web-site... Hope this is helpful,
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    Injection - separately from the PPD test

    Although I do not have a reference.... I have only coded the 86850 for PPD's...if you were to code 86850 in conjunction with CPT 96372 for a Medicare patient an edit would be generated indicating 86850 as code 1 and 96372 as code 2. Hope this helps,
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    Stress or Rest

    The documentation appears to lack documentation significant for... "rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress" No indication as to whether or not the patient was stressed via Bruce protocol or via pharmacology (Adenosine...
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    "irritated" seborrheic keratosis

    I agree....702.19. irritable does not clearly indicate inflamed.
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    70486 vs 76380

    There is a CPT Assistant coding communication (July 2007), which refers to a limited CT study of thorax... The article indicates that it would be appropriate to report either the limited CT CPT code 76380 or the anatomical site code with modifier -52. Hope this helps,
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    You should not code both codes for the same injection procedure, there is an NCCI edit between 206XX and the 96372, with 96372 as code 2. If you appended a modifier you would be indicating that 96372 was a separate / distinct procedure which would be inappropriate for the same injection. Hope...
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    92136 ophthalmic biometry

    Interesting.... There is a CPT Assistant (April '02), which indicates that from a coding perspective CPT 92136 is inherently unilateral however Medicare appears to consider the code inherently bilateral. ?
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    Declotting PICC 36593

    I would only code IVP, 96374 for a diagnostic, therapeutic, prophylactic IVP of a drug/substance unrelated to the administration of alteplase/cathflo as CPT 36593 is reported for the administration of the alteplase/cathflo. limited access to references at present time, however would not report...
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    Vascular Coding-My question is Hope this helps,
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    97110 & 97112

    Please see CMS Transmittal 1019, August 3, 2006 The codes initially referenced are included... Hope this helps,
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    97110 & 97112

    Not really my area however if both services are performed it appears appropriate, in addition there is no edit that would require appending modifier -59. 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance,range of...
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    Cms - Is anyone else having difficulties Seems to be ok for me as well
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    radiology coding

    CT of the abdomen and pelvis would be reported with the codes shown...Are they flat out denying payment for the CT of the abdomen or simply indicating that the payment for both are combined into a single payment (i.e. composite APC).... The Medicare LCD (NGS) for CT scans list CT Abd & Pelv...
  48. C

    Billing drugs when less then stated quantity given

    References... “When the dosage amount is greater than the amount indicated for the HCPCS code, the facility rounds up to determine units. When the dosage amount is less than the amount indicated for the HCPCS code, use 1 as the unit of measure.”...
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    Billing drugs when less then stated quantity given

    To my knowledge you would bill for one unit as units are reported in whole cannot report 1/2 a unit on a claim. If the dosage given exceeds the per unit dose (hcpcs descriptor) you would round up... For ex. descriptor indicates per 30 mg....If 40mg were given you'd bill 2 units...