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  1. J

    CPT 43240- Is removal of Stent included?

    Hi, I was informed that the removal of stents are included in the code for placement of stent. But for some of the procedure (such as 43276), the describes states remove and replacement or even a guideline to state the removal is included in the procedure. One of our GI providers are removing...
  2. J

    Documentation for Psych Eval

    Hi, I was wondering if anyone has any templates or can help me with information on what common documentation can be added for psych evals. A majority of our Psych notes are being drown grade with level 3 due to the lack of HPI elements. I've been researching for different templates but they...
  3. J

    Negative Response for HPI Elements

    Hi, I know this question has been asked in the forum but I wanted to see if there was any difference in opinion now. Can we use Negative response for HPI elements? Such as negative for trauma or patient hasn't take any medication. If anyone has any guidelines to support, it would be greatly...
  4. J

    Heart Transplant- Donor cardiectomy CPT 33940

    Hello, Does anyone have any information on when to bill Donor cardiectomy (CPT 33940)? My providers are preforming the benchwork and heart transplant and we were recently questioned on why we aren't billing for the Donor cardiectomy. I reviewed some of the op notes and they state harvesting was...
  5. J

    Size of Wound??

    Hi, My provider performed a debridement of necrotic tissue on the muscle. He states in his documentation "The wound was noted to be approximately 50 cm in the caudal cranial direction and 25 cm in the anterior posterior direction; however, there was significant undermining both superiorly and...
  6. J

    Mitral Clip

    Our provider is coding 33418-Transcatheter mitral valve repair.
  7. J

    Mitral Clip

    Hi, Our claim scrubber will not let our claim go without the clinical trail modifier & diagnosis. I reviewed the patient's chart and couldn't locate that the patient was on a clinical trail. Is this a given to add the modifier & diagnosis or is there a website I can check to see if the patient...
  8. J

    Sequencing CPT

    Hi, I'm planing to take my General surgery exam soon and was wondering if there is anyway to know how to sequence the CPT without knowing the RVU? I don't think we're allowed to take fee schedule in the exam with us. If anyone has taken the exam, please provide some insight. Thank You
  9. J

    Supervised CRNA

    Per Attending, Supervised.
  10. J

    Supervised CRNA

    Hi, How should we bill for CRNA that was supervised by the Anesthesiologist for a TEE in 2 Room? It Conscious Sedation (QS) but we also have modifier QK, QX for the CRNA. The Attending is attempting to bill under him but should the CRNA have her name under the service provider and also, what...
  11. J

    Sepsis=Critical Care??

    Hi, I need to understand if sepsis= Critical care. If my provider documents sufficiently, with a time statement can sepsis equal critical care? I have a provider whom seems to think so he writes "Patient was septic, met our code sepsis alert guidelines (similar to a STEMI, stroke alert or...
  12. J

    DX for Pulmonary Hypertension w/CKD

    Hi everyone, I hopefully have an easy question that I just can't find...... If a patient has Pulmonary hypertension with ESRD, do I code I12.0 and N18.6? I was thinking I27.0 and N18.6. I understand that Pulmonary hypertension is different than regular hypertension but one of our Cardiology...
  13. J

    Continuing Intensive Care Service 99477-99480

    Hi, I need some direction with the intensive care code (99477-99480). I've read the guidelines but looking at my provider's notes, it seems like the visits are not meeting them. My question is if the patient is a preterm infant with a low birth weight and the providers are supporting the infants...
  14. J

    Mediastinal Washout & Exploration

    Hi, I'm coding an op note for a patient with an open chest which requires daily washout of the chest. What's the best code for Mediastinal washout and exploration? I was looking at CPT 35820-58 but it seems like it doesn't fit. Should I add modifier 52 for reduce services since there weren't any...
  15. J

    Swan Ganz vs. Central Line

    Hi, I'm new to Anesthesia and was hoping someone can help me...... My first question is: When you code Anesthesia, is the only document you use to code the Anesthesia record? Or do you use the procedure note from the surgeon? Second Question: What document do I need in order to bill for Swan...
  16. J

    Wiki Initial or Recurrent Ventral Hernia

    Hi, I'm reviewing an op note that doesn't state if the hernia is initial or recurrent. My first thought is to code initial but just checking to see if there are any guidelines that state if not documented we must code recurrent. Please help. Thank You
  17. J

    Help with CPT for Abscess

    Hi I need assistance with a procedure note. I'm new to surgery and I'm stuck. I don't know if I'm missing something. I'm looking at 49020 for the below procedure but that seems way off. I was thinking off a regular abscess code 10060. I also coded 49084 for wash and 97606 for VAC. Any thoughts...
  18. J

    Dopamine Challenge

    Hi, I'm covering for our Neurology coder....... One of our providers have asked me how should she bill for a dopamine challenge. I've looked high and low to see if there was anything out there about how other practices are coding this. To my understanding, the patient comes in without taking...
  19. J

    Temp Pacemaker & ICD replacement

    Hi Can I bill for both an Replacement of ICD and an insertion of a tempoary Pacemaker? We were looking at CPT 33210 and 33249 bundle they are bundling. Any thought? Is there another code that includes everything? Thank You.
  20. J

    Critical Care Time

    Hi A question was asked in regards to critical care time in the ED. Several physician asked if they should be including any time that they provided support to Medic prior to patient's arrival in the ED? Has anyone run into this and if so, do you have a documentation that will help assist me...
  21. J

    Cath Coding

    Hi Can someone assist me with CPT code for the following procedure note? I was going with 92928 and 93454 but feels like i'm missing something. Thank You in advance! :confused: RFA and RFV access after modified Seldinger technique by Dr. The RCA was selectively cannulated with a guide...
  22. J

    Not a Pre-op Visit

    Hi A patient is admitted for abdominal pain and the surgeon send the pt for additional study on the initial visit. Day 2 they made the decision to performed surgery on Day 2. We billed an initial visit on day 1 and a subsequent visit on day 2 with modifier 57 and the procedure. But the initial...
  23. J

    HCPCS Code for Inhaler

    Hi Does anyone know if we can bill for albuterol Sulfate Inhaler? It's for 200 metered. Thank You
  24. J

    CPT for Finger reduction

    Hi I need some assist for CPT on Finger reduction. Pt doesn't have a FX or dislocation, Dr thinks its tigger finger. Procedure note below. What do you think should be coded? So stump on this. Thank You "Digital block under aseptic conditions by me using8 cc 1% Lidocaine with no epi and the...
  25. J

    Diagnosis Code-History of Chronic OM

    Hi I need some help with diagnosis code. I have a new patient who was referred to our office for history of chronic OM but no signs of current OM present. The referral was for possible PE tube placement. How should I code the diagnosis? Thank You in advance. :)
  26. J

    Dx Help for Genetic Counseling

    Hi I'm reviewing a few edits for Genetic counseling. They are editing for DX is not a primary code, they are using V84.XX only. Should there be another code? Some pt's may have family/personal history of the disease but again not a primary code. Any Help??
  27. J

    Ultrasound Guidance in ED

    Hi I've been ask to look into CPT codes for ultrasound guidance for IVC size and DVT. I found 93308 Echo but i'm not sure if this is correct. Is this the correct code or is there no ultrasound guidance code for these procedure? Thank You any help will be great!
  28. J

    Diagnosis Code-plaque in the thoracic aorta

    Hi I'm looking for a diagnosis code for "plaque in the thoracic aorta". I looked up Arteriosclerosis but it takes me to Abdominal aorta. I did see 444.1 but that states Emoblism or thrombosis of Aorta and I don't think that's the correct code. Any help please?
  29. J

    Surgical Path CPT for Heart vessel

    Happy Friday! I'm looking for a Surgical path CPT code for Heart Vessel? I was thinking maybe 88305 but I'm not a 100% sure. My physician code 88302 and 88307 but I don't think either is correct. The report states "consists of three yellow-white pieces of vessel measuring 8 x 5.5 x 2.5 cm in...
  30. J

    EKG at Each Yearly visit

    HI, Hope your all have a great day..... Question. Is it normal for peds cardiologisit to perfom an EKG at each yearly visit. Patient is not having any problems. But he was diagnosis with Tetralogy. The same day they did an Echo but i believe the EKG was done prior with the Office visit. Any...
  31. J

    Enteroenterostomy 44130

    That what I was thinking also. Thank you
  32. J

    Enteroenterostomy 44130

    Hi As anyone billed out 44130 twice with modifier 59 attached to the second line? One of our outside coder billed a procedure this way and we recieved a denial for the 2nd line from the insurance stating max number allowed. I asked the coder to review the report again and she says that two...
  33. J

    93000 and 93040

    Hi, Just wondering if you have gotten a response/answer to your posted question. I am now going through the same thing. Please feel free to email me It would be greatly appreciated. Thank You
  34. J

    DX code for atrial septal hypertrophy

    Hello Everyone, Does anyone know the best diagnosis code for lipomatous atrial septal hypertrophy? My physician performed an TEE and states that the patient has severe lipomatous atrial septal hypertrophy. I was thinking maybe 429.3- Cardiac Hypertophy. Any thoughts? Thank You
  35. J

    93325 twin Pregnancy

    They are working on the babies. They are also billing 76825 & 76827 X2 with Modifier 59 on second set.
  36. J

    93325 twin Pregnancy

    Hi. Has anyone billed for CPT 93325 for a twin pregnancy? We billed it twice with Mod 59 attached to the 2nd line but denied as they only pay one per day. I read one article that states that it can't be billed twice with twins but need to confirm. Can anyone provided any additional feedback...
  37. J

    Oberservation in the ER

    Sorry Physician.
  38. J

    Oberservation in the ER

    Only 1 report from start to discharge.
  39. J

    Oberservation in the ER

    Hi I hopeing someone can help me clear a question: When a patient is placed in observation at 10pm and is not released until day 2 at 2am, can we bill 99220 day 1 and 99217 day 2? I've notice some of our outside coder billing this way and I just received a call from a patient stating we are...
  40. J

    New EP codes 93613 with 93656

    Hi I'm on the same boat. Did you find any additional information? I did find a web site, that is stating to bill the two codes but nothing further. I'm still looking so any further info, i will post.
  41. J

    88291 denials

    Hi Has anyone ran into any denials from Medicare for frequency? I looked over our LCD but it doesn't state anything on Frequency for leukemia. Any thoughts?
  42. J


    Hi I have a patient who came back to the ED during her postop period because her rib fracture has not gotten better. Normally, I would code this as a postop but what should I do when her history (comprehensive) is all about the fracture, the physician did perform an comprehensive exam and MDM...
  43. J

    Postop period

    Hi I have a patient who came back to the ED during her postop period because her rib fracture has not gotten better. Normally, I would code this as a postop but what should I do when her history (comprehensive) is all about the fracture, the physician did perform an comprehensive exam and MDM...
  44. J

    ED:New Problem w or w/o additional work up

    Hi I have a pt who came into the ER with Chest Pain. They had workup in the ER and nothing was found. Final diagnosis Chest Pain R/O MI. The ER physician stated he wants the pt to follow up with his PMD in a week. Would you consider this New Problem with additional work up?
  45. J

    To code or not to code: Mild (diagnosis)?

    Hi. I was once told by an "experience" coder to never code a mild condition. Has anyone ever heard of this? I discussed this same issue with another coder and they don't feel that is correct. I haven't seen any guidelines for this topics so I'm trying to confirm with any physical back up. Is...
  46. J

    ED Aduiting

    Can anyone provide point on how to audit ED E/M? My physician seem to always complete a Comphrensive History & Exam but MDM get me loss. For example, if a patient comes in with abdominal pain or fever. I don't believe this should be a level 4. Any suggestions????
  47. J

    ED Level of Service

    Hi.. I need a little help. We have an outside vendor who codes are ED visits and when I audit the notes, at times I get a different level then they do. I see a majority of the time it's between a level 3 and 4. The physician usually have a Comprehensive History and Exam so it fall on the MDM...
  48. J

    Guidelines for Documentation

    HI I need to give a educational seminar to resident/intern on guidelines for documenting procedures. The group are cardiology speciality so they are performing Echo, Cath, Stress Test, etc. No major surgery. Any resources/book that you can suggests will be very helpful? I'm finding very...
  49. J

    Additional Codes??

    HI, I think this is a very simple question but i'm not a 100% sure of the answer. Pt comes into ED because of power failure. He has CP & MR requiring Oxygen. The coder coded V60.89 but this code is not a primary code. Can I also code CP & MR and do they have to be secondary codes?? Thank you....