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  1. primrose1

    Question Patient with dementia

    We had a new patient come into our office from a local nursing home facility without much ppw unfortunately or send the radiographs that they were supposed to send along with her. She has dementia. When our provider tried to examine her, she was not able to communicate any signs or symptoms...
  2. primrose1

    Question Coblation chondroplasty

    Has anyone been successful in coding/billing and receiving payment for this procedure? Wondering what you've used. I've been using 29999 for the warewolf coblation arthroscopic technique. Any advice/suggestions with this?
  3. primrose1

    Question AAOS and AAPC vs CCI edits

    I'm newly employed to an organization that codes strictly to Medicare guidelines/CCI edits regardless of patient insurance coverage (except for work comp and no fault). I've always used information from the Coding Companion books to appeal claims that are denied for modifier 59 usage (i.e...
  4. primrose1

    Help with anesthesia time

    I'm looking for help please. I usually code ortho but I'm helping to cover a gal who is out on disability who codes anesthesia. I've picked up on things fairly well but I need some guidance on labor/delivery time coding. I have the start/end times available but there are a few cases that the...
  5. primrose1

    Open SLAP repair

    I was looking at that along with 23455 but in the description for 23450, it says for arthroscopic refer to 29806; the 23455 does not go back to a scope code......when looking at 29807 (these are all in the Coding Companion), it doesn't say anything about a code for an open type. Am I...
  6. primrose1

    Open SLAP repair

    Is there a CPT for the open repair or is it unlisted? Thank you!
  7. primrose1

    Z71.2

    Can someone tell me please if Z71.2 is a primary billable code? Can it be used as the only dx on a claim? I know it cannot be used as a primary inpatient code for Medicare, but can we use it in the office, say for MRI results? Thank you! Kris
  8. primrose1

    Need help coding: Stump revision or just I&D?

    I'll try to post a scrubbed up op note. I'm not sure if I should code this with the debridement codes because of the abscesses/ulcers or is this considered a stump revision? I was going to code it a revision but the surgeon did 11044 & 11047. Any help which way I should go? Patient's right...
  9. primrose1

    Athroscopic Cyclops Lesion Code

    removal of a Cyclops is 29884
  10. primrose1

    Z47.89 surgery aftercare code with UMR

    We use Z48.89 for post-ops without an issue or denials.
  11. primrose1

    Retired MD

    A surgeon in our office has retired. His patients are now choosing other surgeons in the practice for procedures. If a decision for surgery was already made prior to his retirement but are now meeting the dr. that will be taking over their care, is that E/M billable since they're seeing them...
  12. primrose1

    NYS billing for RPA's

    Hoping someone here can clarify an issue I'm having as I'm getting conflicting information regarding billing for physician assistants (in NY). Originally I was informed that Medicare does not recognize or will not pay for a physician assistant that is not 'certified' (RPA-C), now I'm being told...
  13. primrose1

    Facility TC component and modifier 25

    Thanks Debra for your help!!! I've been seriously debating signing up for the COC training/exam to see if that will clear up a lot of my questions. Do you happen to know if this is information that they would cover as far as E/M's and modifiers and when/what is appropriate??? I'm struggling...
  14. primrose1

    Facility TC component and modifier 25

    Thank you for your help! I received a call from the hospital now that with the insurances that are split billed, if we take a patient to surgery the day they're seen or the next (i.e., for a fractured ankle), rather than putting a 57 modifier on the E/M, for the technical portion they're saying...
  15. primrose1

    Facility TC component and modifier 25

    I posted this originally on the 'modifier' thread but didn't get a response :(; maybe someone here can advise?? Thank you!!! Hoping someone can clarify for me as I'm confused. I've been billing in a private ortho practice for several years and we recently merged with a local hospital so we're...
  16. primrose1

    Modifier 25 & TC

    Hoping someone can clarify for me as I'm confused. I've been billing in a private ortho practice for several years and we recently merged with a local hospital so we're now technically an outpatient facility. There are several insurance carriers that require split billing. What I'm told from...
  17. primrose1

    26432 in office settings

    Trying to find the same info! Nothing coming up for NCD or LCD for CMS. I have an insurance company denying for the POS per CMS guidelines but cannot find anything.
  18. primrose1

    Multiple toe fractures

    Left or right? Kris COSC, CPC, CPB, CMBS
  19. primrose1

    Office procedures

    My physician normally does his carpal tunnel releases and trigger finger releases under a local in the OR but is thinking of possibly performing them in the office in the near future. Wondering if anyone here bills for these in-office procedures and if there is an increase in re-imbursement...
  20. primrose1

    Bone marrow bx/aspiration ? - When billing medicare should

    Hi! I'm not a coder for this speciality but asking for a friend of mine......is an E/M visit allowed (new patient) when a biopsy is performed??? If so, modifier 25? Thanks!!!
  21. primrose1

    Post-op aspiration

    I'd just like confirmation from others on this as there's a debate in my office. I say if a patient comes in post-op from a knee scope with effusion and it's aspirated, that falls under the catagory of being included in the surgery and no charges to the insurance company if it's under the...
  22. primrose1

    Billing Quadricepsplasty with total knee revision????

    I checked the Coding Companion and the Medicare CCI edits and don't see where the two codes are bundled together so you should be able to bill for both!
  23. primrose1

    code-a-round

    Has anyone tried the ortho code-a-rounds for ceu's?? I purchased my first one last week when they were the hot deal and boy is it tough!!!
  24. primrose1

    medial menisectomy w/remove loose body

    Since comp does not follow CMS guidelines, it should be the 29874 for the LB removal.
  25. primrose1

    ORIF and open reduction w/o fixation

    Thank you!!
  26. primrose1

    ORIF and open reduction w/o fixation

    One of my doctors did an ORIF of a proximal tibia with an open reduction without fixation on the proximal fibula. Having a brain lapse today..........use a combo code or can I code these separately?
  27. primrose1

    Coding Dressing Change

    If the patient was taken to the OR due to a traumatic injury, I've been coding their f/u as V58.43 and V58.31 (for dressing change) and then usually one time after that V58.32 for the removal of either staples or sutures.
  28. primrose1

    59 question on 27422 29877 59

    The Coding Companion states that when 27422 is performed with another separately indentifiable procedure, the highest dollar value code is listed as the primary procedure and subsequent procedures are appended with modifier 51. Hope this helps!
  29. primrose1

    Need Help on Splint codes and materials

    For the first visit you gave in your initial question, what was charged? An E/M code or fracture charge?
  30. primrose1

    Coding Edge CEUs

    Hi Katie! Congrats! I also just found out I passed the CPC exam from last week. You can only count the Coding Edge CEU's from this time forward. I believe June's will count though. I became a COSC this past December and I used that month's magazine for a CEU. :D
  31. primrose1

    CPT for PTT synovectomy

    Looking for a posterior tibialis tendon synovectomy code...........?????? Help!!
  32. primrose1

    total knee coding

    We've never billed that separately. In the Coding Companion, the patellectomy is included with the total arthroplasty code.
  33. primrose1

    repeat total hip replacement

    The doctor's office is incorrect. Removal of the hardware (20680) is part of the revision code 27138. They should not be re-imbursed for this code nor should they be billing you for it!!!
  34. primrose1

    E/M with closed fracture treatment

    Your provider is correct. If a procedure has a 90-day f/u period, modifier 57 is added to the E/M code, as is in this case with a fracture. If a cast is applied during the initial visit, you also bill for the supplies. Subsequent cast changes during the global period, bill for the cast...
  35. primrose1

    K wire removal during global

    You can try to bill 20680 with modifier 58 as a staged procedure. Some payers will only pay if done in the OR, some will still pay when done in the office. You'd have to submit the claim and see what that specific payer policy is. Kris
  36. primrose1

    Hip Core Decompression

    Our practice bills an unlisted procedure for the core decompressions.
  37. primrose1

    CR and ORIF on different encounters, Can I charge for both?

    I would also like to find out if there is literature regarding this. I asked the same question a couple of weeks ago and got a couple of different answers.........any other thoughts and/or recommendations???
  38. primrose1

    What do you do?

    Thanks for the reply!! Is there a time limit between the first office visit and going to the OR where it's acceptable to do the staged coding?
  39. primrose1

    What do you do?

    Just wondering how you may do things in this scenario: Patient comes into the office with a bimalleolar fracture. Is treated with a cast/splint the first day but is being scheduled to go to the OR the following week (5-6 days after the office visit) for an ORIF. Do you code the initial...
  40. primrose1

    Long arm casting supplies-VA MDCD

    The Q codes I have for cast supplies are age specific. This code is for 11+ years. Was it a pediatric patient 10 years or younger?? Kris
  41. primrose1

    Removal of hardware from ring finger

    You're probably going to want 20680 since it was an ORIF: 20680: removal of implant, deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) 26320: removal of implant from finger or hand (eg, Silastic implant) If you're able to get Coding Companions for orthopaedics, it may...
  42. primrose1

    Aftercare coding - dislocation

    Is there a code for aftercare of a dislocation? Specifically an AC joint? Or is a fracture aftercare code used for these too?
  43. primrose1

    27096 denials

    This info is from a webinar I sat in on, not sure if it'll help your situation: - 27096 for injection procedure for SI joint, anesthetic/steroid with image guidance (fluoro or CT) including arthrography when performed; - bundled the imaging - states if you did without imaging it is...
  44. primrose1

    Modifier 59 w/ injections - some injection claims

    I have an insurance company that is denying some injection claims. We billed 20610 for a shoulder injection and patient also had a trigger finger injection during the same visit which was billed 20550 (59). They want reasoning as to why the trigger finger injection should be paid. Is this not...
  45. primrose1

    Modifier 59 w/ injections

    I have an insurance company that is denying some injection claims. We billed 20610 for a shoulder injection and patient also had a trigger finger injection during the same visit which was billed 20550 (59). They want reasoning as to why the trigger finger injection should be paid. Is this not...
  46. primrose1

    CMBS credential

    Just wondering how many have this credential and if you feel it's beneficial to go along with others you may have? Any thoughts/recommendations as to whether or not to pursue this also? Thanks! Kris
  47. primrose1

    CMBS credential

    Just wondering how many have this credential and if you feel it's beneficial to go along with others you may have? Any thoughts/recommendations as to whether or not to pursue this also? Thanks! Kris
  48. primrose1

    self pay patients - ACL reconstruction

    Curious as to how other practices quote prices for surgeries for self pay patients? i.e., if a patient needs an ACL reconstruction......do you set your own price, give them Medicare rates, give them Medicaid rates, work comp rates?????? This would be for physician and physician assistant...
  49. primrose1

    Coding help

    The comp patients can be released to go back to work at any E/M visit. We use the 99455 for a scheduled loss of use only which includes any percentage of disability (per our state's Work Comp Board Medical Guidelines) the patient may have from the work-related injury.
  50. primrose1

    Bimalleolar fracture ORIF on medial malleoli only

    Yes, I believe you can bill for both fractures, the one treated operatively and the other non-operatively.
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