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  1. K

    knee help needed

    Would 29881-59 & 27331 be appropriate? INDICATIONS FOR PROCEDURE: The patient is a 23 year old female who has been having some right knee pain for the past several months. An MRI did not reveal any significant intraarticular damage; however, she had persistent in an area over the lateral aspect...
  2. K

    CPC, COSC...what's next? :)

    I'm looking at adding to my certifications and am trying to decide if I want to pursue the CPCO or the CPMA credential Which do you think will open more doors? I believe the salary study showed that compliance pays better… What are your thoughts?
  3. K

    Code 0232T

    Every insurance I've researched considers PRP (0232T) experimental and does not reimburse. You should get an ABN from the patient so you can bill them after the denial.
  4. K

    New Versus Est Pts

    If you're billing under the same tax ID, then yes, if seen by the other practice in the last 3 years they would be established.
  5. K

    PRP injection 02032T

    I would say you can only bill once since the code description states injection(s).
  6. K

    Perc. repair Achilles tendon w/PRP

    Wikipedia: Barbotage is a medical procedure that involves the repeated injection and aspiration of a fluid. 20605 & 0232T? or 27899 (unlisted procedure, leg or ankle) & 0232T?
  7. K

    Perc. repair Achilles tendon w/PRP

    Which body part are we talking about?
  8. K

    open thumb release

    CCI bundles 26440 into 26145. I would just bill 26145.
  9. K

    22554 with 63075

    I would say they both report 22551 with modifier 62.
  10. K

    knee coding

    Remember, you can only bill for the loose body removal if the loose body is greater than 5 mm.
  11. K

    E/M During Global Period

    I would go ahead and bill with a -24 on the E&M and a -79 on the injection.
  12. K

    Orthopaedic/Fracture Care

    When I was billing for an Urgent Care, we never billed the fracture care codes, just the cast/splint codes. The patients were then referred to a specialist for proper fracture care.
  13. K

    E/M During Global Period

    If the surgery was performed due to the arthritis and the injection was given for the same issue, yes you are correct you can only bill for the injection & drugs. Make sure you add a modifier 58 on the injection since you are within the global period. If this is Medicare, you can only bill the...
  14. K

    Help with shoulder surgery

    I would code as 29807 29820 If you are more comfortable with 29807 & 29822, you need to remove the mod 59. CCI does not bundle these procedures. Hope that helps!
  15. K

    Please help! Scoliosis Segmented Spine Sx

    When coding spine surgeries always look for and code when appropriate the following: Decompression Arthrodesis Instrumentation Bone Graft Possible others: Microdissection (69990) Navigation (61795)
  16. K

    Arthroscopic assisted loose bodieS removal ankle

    I believe you can only code this once per ankle.
  17. K

    Global calender

    Here's an online calculator: http://www.medicarenhic.com/providers/billing/billing_calc_global_period.html
  18. K

    Help Please !

    Sunrise View: - used to image a tangential view of the patella; - the patient is prone with the knee flexed 115 deg; - central beam is directed toward the patella with 15 deg cephalic tilt; http://www.wheelessonline.com/ortho/axilla_view_of_the_knee
  19. K

    question: post op dural leaks

    Medicare has a Units of Practitioner Limit: 1 for 63709.
  20. K

    podiatry-CPT-4 codes needs

    Without seeing the op report, this would be my guess... procedures: 0232T Platelet injection 28899??? Platelet tissue activation with low energy radial shocwave therapy (inclusive) Biopsy 28060 Partial Plantar Faciectomy 76880 Diagnostic musculoskeletal ultrasound
  21. K

    29877 with G0289

    G0289 is not billable with 29877. If all that is done is chondroplasty, then you can only bill 29877 alone. G0289 can be billed with other arthroscopic codes if the chondroplasty was performed in another compartment and doesn't bundle with other codes in that compartment.
  22. K

    resident as second assist

    I have a physician who did spine surgery with his PA as his first assistant. He had a resident as a second assistant. The surgeon dictated this information. For billing purposes would we just bill the PA with the AS modifier as if they were the only assistant? Thanks!
  23. K

    achilles tendon repair?

    I would probably go unlisted and compare to 27652. Here's an article on PRP Matrix grafts - http://www.prolotherapy.com/PPM_JanFeb2008_Crane_PRP.pdf
  24. K

    achilles tendon repair?

    0232T but it probably won't be reimbursed. I haven't found an insurance carrier that will pay for PRP injections.
  25. K

    28575

    My guess would be only once as it looks like they are part of the same joint...
  26. K

    Total Knee Replacement w/Removal of prior Total Knee Prosthesis

    When hardware is removed to put in new, then you can't bill for the removal. It's included in the "reinsertion".
  27. K

    New to PT coding

    You only need modifier GP when billing Medicare.
  28. K

    New to PT coding

    Great thanks!
  29. K

    27784 Fixation included with 27758 Open Treatment?

    Yes, 27758 is open trmt of tibial shaft fx (WITH or without FIBULAR FX). The CPT definition of 27758 includes 27784.
  30. K

    questions regarding 20610?

    If you're giving an injection during the post op period for pain and the carrier follows Medicare's global surgical package, you can only bill for the medications not the injection itself. Medicare includs pain management in their global package. If the carrier follows the CPT global surgical...
  31. K

    New to PT coding

    Debra, Can you point me to documentation for the information you shared? I'd like to share with others in my office. Thanks!
  32. K

    dx help. Synovial bands

    Maybe 727.89 or you might look at all the 727.XX codes to see if one fits better.
  33. K

    ultrasound guidance for injections

    76942 has a MEU of 1 unit and modifier 50 is not allowed on this code. We only bill this code once per session no matter how many injections are given.
  34. K

    Cpt 22856

    Check out LCD L27449: http://www.cms.gov/mcd/viewlcd.asp?lcd_id=27449&lcd_version=20&show=all. This is a non-covered service in your area due to inadequate evidance of efficacy and/or effectiveness. I would print the LCD and give it to your doc. You have no appeal rights in this instance.
  35. K

    Does Splinting fall under fracture care?

    If this is the initial treatment of the fracture you can bill the fracture care code even if a splint was given instead of a cast. You can not bill for the splinting though, it is included in the fracutre care. You can bill for the materials though.
  36. K

    Arthroscopic removal of calcific nodule shoulder?

    I agree with 29823 as long as you don't have any bundling issues with any other procedures performed.
  37. K

    ultrasound guidance for injections

    We've used these codes in our office and have been getting reimbursement. My caution to you would be that there is growing discussion over the medical necessity of using ultrasound for needle placement and these may become bundled into the injection codes.
  38. K

    Cpc exam - coding in an orthopedic

    I had NO experience in the medical field and took the AAPC self study course and passed the CPC exam with no problems. Just remember to code per CPT rules and not what the payors are wanting and you'll be fine.
  39. K

    Hematoma Block

    It depends on the reason for the block. It is inclusive if the block is to numb the hand for the treatment of the fracture. If the block was for a completely separate issue, then you could bill for it with a mod 59.
  40. K

    shoulder coding

    I also got some good advice from Margie Scalley Vaught: You can report a debridement code with modifier 59 if you debrided something that you did not go on to repair. She also mentioned using the same information you stated in your last post in regards to choosing which type of debridment to...
  41. K

    Meniscus Repair to Menisectomy

    Was this done during the same surgery? If so, I would say he can only code for the menisectomy.
  42. K

    64721,64718,64719 - Can all of these be billed at one time

    I don't see any bundling issues per CCI.
  43. K

    shoulder coding

    Okay, I don't know why but shoulder coding drives me crazier than spine coding!! The more I look into the debridement issue the more confused I get. Is the debridement able to be separated by the "regions" or do you have to look at the whole shoulder to decide whether it is 29822 vs 29823? If...
  44. K

    shoulder coding

    I really need help with figuring this one out. Since the AAOS states there are 3 regions of the shoulder (glenohumeral, AC and subacromial) and procedures done in one area don't influence coding in a different area, can you bill for debridement in say the gleohumeral joint when a bundled code...
  45. K

    shoulder coding

    I have a claim with a denial for 29823 (debridement) to 29824 per CCI. My understanding is that if the procedure is performed in another region (glenohumeral vs AC) it is billable. My confusion comes in when there's debridement performed in all 3 regions. Can I bill for the region that doesn't...
  46. K

    Injections

    You may want to look at whether the E/M is really billable. If the patient came in for the purpose of receiving the injection and wasn't evaluated for a different issue, the E/M isn't billable, it's inclusive to the injection. We've gotten denials like the one you described and that ended up...
  47. K

    post op question

    That's a great article. I don't know how I missed when I read through it. Thanks for pointing it out!
  48. K

    post op question

    If they follow CPT (does anybody?) then I wouldn't need a modifier? None of the modifiers seem to fit this issue. It's related to the surgery but is an "un-typical" issue.
  49. K

    post op question

    I'm drawing a blank on this one and any help would be greatly appreciated. If a patient is seen during the post op period and has an exacerbation of the problem we can bill for the E/M correct? And if so, is it modifier 24?
  50. K

    64490 debate - your thoughts?

    Thanks!! Sorry about the level confusion. I just grabbed the first code for this procedure and made up the example without paying attention to the level :rolleyes:. Hopefully my brain will function better today.
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