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    Drug delivery devices

    Hello,, With the introduction of new CPT codes for the insertion and removal of drug delivery devices (20700-20705), has CPT code 11981 (insertion of non-biodegradable drug delivery implant) been deleted? Thank you
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    Question implant removal 20670, 20680

    I am in disagreement with a provider over the reporting of IN-OFFICE removal of implants (20670 OR 20680) during the global period. I am under the impression that when you are performing this service in the office, it is included in the global package. When you perform it in a hospital...
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    Question initial inpatient vs subsequent inpatient

    I need help understanding the proper use of inpatient evaluation and management codes. Are initial inpatient codes (99221-99223) for the initial evaluation of a problem and subsequent codes (99231-99233) for follow up visits for the same problem? For example: patient is inpatient, and seen by...
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    inpatient E&Ms initial vs subsequent

    I need help understanding the proper use of inpatient evaluation and management codes. Are initial inpatient codes (99221-99223) for the initial evaluation of a problem and subsequent codes (99231-99233) for follow up visits for the same problem? For example: patient is inpatient, and seen by...
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    ESI injecction

    Good afternoon, PMR provider performed an ESI injection on the following levels Left L4-5 Right L5-S1 I am not certain how to report this. 64483 bilateral or 64483 and 64484 because its not the same level on both sides. Thank you
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    The role of a PA in the OR

    Hello, I am curious as to what is expected of a PA in the OR when assisting in a surgery. Are they just there for prepping, draping, positioning, and closure? Or do the participate in the procedure itself? I'm asking because our surgeons document the medical necessity of the PA assist, and I...
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    3 part distal radius ORIF WITH tenotomy of brachioradialis

    Our provider is performing a tenotomy of the brachioradialis tendon (CPT 25290) during an ORIF of a distal radius fracture (CPT 25609) He is using the same fracture diagnosis on both the ORIF and the tenotomy. Documentation: "due to the pull of the brachioradialis , it was not possible to...
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    replacement of hip cement spacer with debridement

    Hi, I would appreciate any coding advice you can provide.. Patient seen previously by another provider outside of our practice for a displaced femoral neck fracture. A cemented hemiarthroplasty was performed. He fell and presented with an infection and dislocated spacer. He was taken to the...
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    Missing Gel One and Durolane fee schedule

    Does anyone know why there is no 2019 Medicare fee schedule for Gel One (J7326) and Durolane (J7318)?
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    HELP! femoral fracture coding advice needed

    Patient was treated for an upper femoral fracture 5 weeks ago. Reported with 27245. She fell during the global period, injuring her lower femur. To fix the lower femur, we had to remove the femoral rod and replace it with a smaller one - so I think for that we code S72.142A - 27245 (78) and...
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    HELP! femoral fracture coding advice needed

    Patient was treated for an upper femoral fracture 5 weeks ago. Reported with 27245. She fell during the global period, injuring her lower femur. To fix the lower femur, we had to remove the femoral rod and replace it with a smaller one - so I think for that we code S72.142A - 27245 (78) and...
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    2 E&Ms on the same day

    Can 2 different providers with different specialties (hand & ortho) bill for an E&M on the same day? They are the SAME tax ID. Thank you
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    New patient E&M when insurance carrier changes

    Hello, I recently had a conversation with a provider who stated that a patient is considered NEW (for coding purposes) when they have been treating under workers comp and then come in to treat for a separate, unrelated visit under their private insurance in under 3 years. (or vice versa)...
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    Nurse practitioner billing

    Good morning, Scenario: multi specialty practice, ONE tax ID.. Ortho and PM&R. When a patient sees an ortho, and then sees the PM&R within 3 years, the PM&R can bill a new patient visit because the PM&R is a different specialty, and vice versa. Is a nurse practitioner considered a...
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    Nurse practitioner billing

    Good morning, Scenario: multi specialty practice, ONE tax ID.. Ortho and PM&R. When a patient sees an ortho, and then sees the PM&R within 3 years, the PM&R can bill a new patient visit because the PM&R is a different specialty, and vice versa. Is a nurse practitioner considered a...
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    coding of an unsuccessful fracture reduction

    If a doctor performs an honest attempt at reducing a fracture, and it is unsuccessful, leading to the scheduling of ORIF, is the initial reduction billable? Would it require a modifier? I'm getting different information on the usage of modifier 52 in this scenario. Thank you
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    billing for manipulation and surgery

    Good morning "I saw him at GSH ER and performed a closed reduction under sedation by the anesthesia service. Residual displacement was noted. I recommended office follow-up to discuss surgical intervention. He complains of some ongoing discomfort in the splint. Patient subsequently has...
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    New patient E&M when insurance carrier changes

    A provider sees a patient under private insurance as a new patient (eg 99203), and a year later, the patient presents with a new injury under WC or NF. Can that same provider bill a new patient E&M to the WC/NF carrier? Thank you
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    percutaneous pinning of lesser toe

    Hi Physician performed closed reduction of lesser toe with percutaneous pinning. I can only find a CPT code to report this in the great toe. We tried to authorize an unlisted procedure, but the carrier is telling me that there is a code for what we did. The only code I can find similar is...
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    hematoma block

    Can a hematoma block be billed for the manipulation of a fracture if fracture care is NOT being billed? If so, what would be the appropriate CPT code to report it? Scenario: Dr sees a patient with a displaced fracture of neck right fifth metacarpal fracture. He administers a hematoma block and...
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    Fluoroscopic guided hip arthroscopy

    Is the use of fluoroscopic guidance to assist in a hip arthroscopy payable separately?
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    G0289

    Does code G0289 require the loose body to be over 5mm? I've heard that but cant find a factual reference to support it. Thank you
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    Medical necessity of Viscosupplementation

    There are a number of carriers that will not cover Viscosupplementation for the treatment of osteoarthritis in the knee, as they deem it ineffective. Specific carrier verbage reads: "..... many analyses have not shown a clinical benefit beyond the effect seen with placebo, and evidence from...
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    thumb x-ray coding

    I am looking to code a thumb x-ray but I am finding conflicting information. Some resources state that the thumb is considered a finger and should be coded as such. Others state the finger x-ray code is for digits 2-5, excluding the thumb which is part of the hand and should be coded with the...
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    thumb x-ray coding

    I am looking to code a thumb x-ray but I am finding conflicting information. Some resources state that the thumb is considered a finger and should be coded as such. Others state the finger x-ray code is for digits 2-5, excluding the thumb which is part of the hand and should be coded with the...
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    tibial plateau fracture

    Question from physician: A young woman had a tibial plateau fracture that was fixed out of state. She had a screw which was too long so I performed a procedure to remove the one screw and replace it with a shorter one. Should I just code removal of deep implant? Thank you for your responses...
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    NPP and radiology coding. PLEASE HELP!

    We are currently being denied by Medicare for all x-rays billed under par participating PAs as they are not qualified to perform these services. In researching, I am realizing that they are supposed to be charging for the professional component of the x-ray (modifier 26) and the supervising...
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    NPP and radiology coding. PLEASE HELP!

    We are currently being denied by Medicare for all x-rays billed under par participating PAs as they are not qualified to perform these services. In researching, I am realizing that they are supposed to be charging for the professional component of the x-ray (modifier 26) and the supervising...
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    external fixation with closed reduction

    An orthopedic had to apply an external fixation in order to reduce an ankle fracture. Should he bill for the external fixation only or both the eternal fixation and a closed reduction? The patient will require a second procedure in which ORIF will be performed. Thank you
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    external fixation with closed reduction

    An orthopedic had to apply an external fixation in order to reduce an ankle fracture. Should he bill for the external fixation only or both the eternal fixation and a closed reduction? The patient will require a second procedure in which ORIF will be performed. Thank you
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    place of service by CPT

    Hi, Is there such thing as a list of billable places of service by CPT code? We have one that is denying by some carriers for inappropriate place of service. CPT 26432. We billed it as an in office service. The carrier denied, and stated they are following CMS guidelines but I can't find...
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    what is included in coding for an injection?

    Hello, When performing and billing for an injection (20611, 20610, etc) , I know there is a certain time that is allocated for decision making. Where would I find a reference on this information? (this is not a request for E&M decision making time. I am specifically referring to...
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    in search of a consultant

    We are a large Orthopedic group in downstate NY and we are looking to have consultant come to us for a ICD 10 training for our physicians. There would be a minimum of 30 people attending. Similar to what someone from Karen Zupko does when they hold seminars on ICD 10. Can anyone recommend...
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    magnacare and knee xrays

    We have recently had some denials from Magnacare for CPT/DX mismatch. Here are 2 claims that denied: 73564/S83.8x1A- sprain of other specified parts of right knee and 73562/S83.242A- other tear of medial meniscus,current injury, left knee Both xrays had appropriate RT/LT modifier. I cant...
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    PAs

    Can someone please guide me to the rules and regulations for whether or not a PA can treat patients when they are in a practice setting, but not under the direct supervision of a physician (physician not physically on site). In other words, if they are not practicing "incident to", can they...
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    77071- stress view xray

    Hello, Our physician performed a stress view xray (77071) on an ankle with one view taken. Since there are only ankle xray codes for 2+ views, would it be appropriate to bill for only the stress view? Thanks so much
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    77071- stress view xray

    Hello, Our physician performed a stress view xray (77071) on an ankle with one view taken. Since there are only ankle xray codes for 2+ views, would it be appropriate to bill for only the stress view? Thanks so much
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    77071- stress view xray

    Hello, Our physician performed a stress view xray (77071) on an ankle with one view taken. Since there are only ankle xray codes for 2+ views, would it be appropriate to bill for only the stress view? Thanks so much
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    what is included in an injection (20610)

    20610 global package states this CPT includes: local infiltration of medication(s), anesthetic, or contrast agent before, during, or at the conclusion of the procedure Does that mean that ALL medications we inject are included in the billing of 20610 and we shouldn't be reporting them separately?
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    injection and licocaine

    Good afternoon, Is lidocaine included in an injection (20610) or is it payable separately?
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    2 E&Ms on the same day

    Hello, if I have 2 providers that are 2 different specialties, but under the same tax ID, can they both bill for an E&M on the same day for the same patient? Orthopedic billed E&M for cyst right knee. Physiatrist billed for E&M for lumbar sprain and injection of the knee. Thank you
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