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  1. D


    How does this work? in July of the same year the patient joins the above HMO and clinic scans in his card along with his MDCR card showing that the patient has only Part A coverage. Now his is here for a Medicare Wellness visit. If he does not have Part B, how can he be entitled to the Wellness...
  2. D

    Joining a HMO but having only Part A? how does that work?

    I a patient only has Part A showing on their actual Medicare card how does that work as far as billing annual wellness visits? Don't they have to have Part B to get that? Or is that where the HMO comes it? I am a little confused as pt is coming in for a Wellness visit and to me he should need to...
  3. D

    Is XU appropriate on IM with a push?

    I have not billing an infusion in a while. Patient had an infusion of fluids, a push and an injection. I am billing 96374,96361,96372.59. CCI edit is failing the 96374 and 96372. Is that not the correct modifier?
  4. D

    Radiology Review and the Interpretation

    I am inclined to say the if a provider is getting credit for Interpreting and visualizing an image that he would also have to review that report in order to do it. I credit 2 points. auditor at my clinic gives 3 points , 1 more for review, separately. I think that is a stretch. I found a Novitas...
  5. D

    E/Ms with MDCR wellness

    Our auditor allows providers to bill an E/M with Wellness visits when patient presents without complaints, but get labs done. This has the 'potential', but provider is not giving a status of the condition of the patient with regard to the Problem the lab is being ordered for. To me this is...
  6. D

    Documentation 28193 depth

    Please advise on the depth of the foreign body for this procedure. I see 28190 is subcutaneous. 28192 deep, the layer below that, dermis. Does use of 28193 have to be in the lower level of skin as in nerves, muscle or, as the note says "complicated".If the would is infected and requires...
  7. D

    injection for alopecia areata

    Is 11900 the correct code to use for this service? I have only used it for keloid scar, not this application. The patient has a place on his chin, in his beard. Provider injects 20 mg of triamcinolone. Tricia D
  8. D

    20611 done by CMA

    I am looking at this procedure for the first time, covering for someone. Is this within the Scope of Practice for a CMA? I looked on the CA Board for CMA and only injection is mentioned not ultrasound. I see the report is signed by CMA, not the MD and this has me concerned. Please advise. Tricia
  9. D

    Separately Identiable E/M

    If a patient is coming in for chemo but the provider goes over Pet/CT scan that assesses the response to the chemo would you consider that bundled into the chemo? It shows a positive response so the patient does not have complaint. No change to the Care Plan. I am struggling to decide if the is...
  10. D


    I know that the POS for this type of service Telehealth is 02. but there is more to it. there is a POS Type . Home is 12. I was going to ask this question because most often it is in the office and that would be 11. am I right or ....not. I do not typically get involved in this billing and...
  11. D

    Neuroendocrine Tumor of unknown primary

    Can a Neuroendocrine tumor of an Unknown Primary still be coded with C7A.1 since the code descriptor says any site? we do not know the site, but does that matter in this scenario? It has metastasized and the secondary site is known and can be coded.
  12. D

    Neuroendocrine Tumor of Unknown Origin

    I am trying to code a neuroendocrine tumor of unknown origin. if the code book says that C7A.1 is for any site, can I use that? Do we need to know the site..... Tricia
  13. D

    Can a Time Statement be overriden?

    Must we use the time statement if it is obvious that the provider did not counsel, did not document how this time was spent? I am seeing visits with the correctly stated notation, but it is not apparent what was discussed. I want to challenge it and bill the level based on the HPI, exam and...
  14. D

    Faslodex, two injections

    If this drug is given in two sites, should it be billed 96402, 96402.59? Tricia D
  15. D

    Day of Death Discharge is 100 Minutes

    Is there a way to capture all this time? the provider is billing 99233 with 99356 on day of discharge/death to capture 100 minutes of bedside time caring for his patient and family . but he also is the Physician who is Summarizing the Death , who should bill 99239 with greater than 30 minutes...
  16. D

    Ganglion removal with blade , no sutures

    I am a loss for a CPT code to use for a procedure done to remove a ganglion on finger done with dermablade. The provider used 11421 but she did not excise it. I looked at 26160 but she did not make an incision and excise. no sutures. The cyst is removed at the base with the blade. I looked at...
  17. D

    Inpatient Not Rousable

    If a patient who has dementia is not fully awake can the provider still bill for this visit? would you consider this face-to-face acceptable? Exam is deferred because provider does not to wake her up....I don't think this should be billed. Daughter is there and they discuss her discharge the...
  18. D

    Radiation Mucositis K12.33 Needs External Cause Code from Range W88-W90. Help

    Which Wcode is appropriate to add-on in this scenario? Tricia D
  19. D

    Minor Surgery Package Limits

    In the Urgent Care setting providers often do minor procedures. I am trying to get them out of the habit of charging office visits for these, telling them the initial evaluation for minor surgical procedure is always included in the global package.If an xray is done and interpreted, I still...
  20. D

    Procedure, Incision and Drainage, dc'd in office at request of patient

    The patient changed her mind about this procedure. I can find an appropriate modifier if we were an ASC, 74, to use after anesthesia, but what can I do about in the office?I am aware of diagnosis code V64.2, procedure not carried out because of patient's decision. I guess we could us .52 and...
  21. D

    20610 SI injection

    Can this CPT be used for this anatonical site? I came across an LCD ( 31359) that says it is not appropriate to use this code for SI joint injection, rather use 27096. This code Injection procedure for sacroiliac joint, anesthetic steroid with image guidance (fluoroscopy or CT) including...
  22. D

    Code choice for mesothelioma

    When chosing a diagnosis for biphasic mesothelioma that is in the chest wall, would you just use c45.9, biphasic, or go on down the page to site selection and choose the NEC code C45.7 because you know the site? It is more specific than C45.9. When you look them up in the tabular, there is no...
  23. D

    Radiation Dermatitis

    I code for Oncology and this is a commin situation. Now I need 2 codes and I am unsure about the 2nd one- the one about the source of the radiation. This coding scenario requires two codes l59.8 Radiodermatis unspecified. Use additional code to identify the source of the radiation (W88, W90)...
  24. D

    Labial cyst removal

    When looking up a code for a labial cyst I was taken to 624.8, cyst of vulva. Is it appropriate to code the incision and drainage of this cyst 56501?
  25. D

    Glue only- other providers 17110.

    A young patient came in with his mother because the glue from planter wart procedure done at another facility came off. (do not know why she did not go back there). This provider just re-glued the skin -without the repair. There is not actually a procedure note. He just cleaned the skin and...
  26. D

    new global

    New to this-if a patient comes back within his global for 11200,11201 and the some of the lesions are retreated am I to understand that this starts a new global? " additional course of treatment is not a part of a normal recovery from surgery." Do I need to have one cpt for lesions being...
  27. D

    Med Mngmt during global

    A patient comes in during a 10 day global for medication management for 4 medications- not all related to her procedure- just one. The provider does extend the rx of antibiotic received at her procedure and he looks at her wound too. He was the provider of her minor procedure. Does this rule out...
  28. D

    Global 24

    A patient comes in during a 10 day global for medication management for 4 medications- not all related to her procedure- just one. The provider does extend the rx of antibiotic received at her procedure and he looks at her wound too. He was the provider of her minor procedure. Does this rule out...
  29. D

    Sent to ER after RE eval for swollen wrist

    Patient seen previously for swollen wrist. returns and reevaluted by a different provider who does a thorough exam and consults with ortho, decides he should go to ER, possible sepsis. Should this be billed to patient? Patient disputes . Tricia
  30. D

    Help with Code for Historyof Lumpectomy

    I am working on guideline to give providers when patient comes in for Follow-up Examination for history of neoplasm. This particular breast cancer patient did not have a mastectomy, just lumpectomy. I need to capture a hsitory of surgery code , but the breast codes are too specific. Should I...
  31. D

    20611 Injection with calcium breakdown

    I don't often bill for such injections so I thought I should ask the experts. Procedure: Ultrasound Guided Subacromial Subdeltoid Bursa Injection w/ tenotomy and Percutanious Needlain of Calcification with the Tendon The site was cleaned with chloro perp. An ultrasound transducer was placed...
  32. D

    Confirm a dx Right atrial Epithelioid Hemangioendothlioma (EHE)

    I understand this is a rare tumor. It is a malignant sarcoma, an atrial tumor. If look up sarcoma, hemangioendotheial and epithithelioid cell it directs you to Neoplasm, connective tissue, malignant. But that is where I see that 'Atria' is not on the list and you are told to code to Neoplasm of...
  33. D

    Need DX-pt sent for labs by dentist

    Here is the scenario. The dentist sustained a finger stick while treating the patient. He sent the patient for labs , Hep B, Hep C, HIV. He was seen in urgent care for brief exam and labs ordered. There is medical decision making. Dentist did not order the labs. but I am at a losss for a...
  34. D

    Observation Based on Counseling

    Is an Observation code billable based on counseling/co-ordination of Care? I don't get these very often and I cannot find it addressed. Provider has made a time statement and it is plausable in the scenario due to her diagnosis, however I do not know if it is allowed. He does need meet level...
  35. D

    Need input re code choice for leptomeningeal carcinotmatosis

    The patient has lung cancer. The chart note reads metastatic, (cerebellar-198.3) , now new finding confirming leptomeningeal carcinomatois. I am having a little trouble deciding how to code the carcinomatosis. Specified site NEC -see Neoplasm by site malignant makes this another primary, not a...
  36. D

    Re thrombosed hemorrhoid

    I don't have this scenario often enough to know how to proceed. Provider lanced thrombosed hemorrhoid 46320 one day. the very next day the patient came back in pain , requesting to have it lanced again because it had re-thrombosed overnight. She has had numerous hemorrhoids in the past. This...
  37. D

    tcell lymphoblastic lymphoma, mediastinum

    I am going around in circles. In the code book, do I first go to Tcell , making this 202.12..or lymphoblastic, making this 200.12 Tricia D
  38. D

    Follicular Lymphoma in-situ

    Need a code for this. I found 234.9 for carcinoma in situ NOS ,but technically lymphoma is not a carcinoma. Tricia D
  39. D

    Secondary neuroendocrine lymph node code

    What is the significance of the word 'distant' in the code descriptor for 209.71? Secondary neuroendocrine tumor of distant lymph notes.....I want to use it for any lymph node.....Distant from what??? Tricia D
  40. D

    Gray Zone Lymphoma

    I am curious to know how others are coding this lympoma. I have not had to assign a code for it before. It has features of both Bcell and classic Hodgkins per the path report. Provider has used two codes. Tricia D
  41. D

    Post op Frenotomy

    As I generally code Oncology, I thought I should ask for advice on this from people who are in the know on this topic. MD performed 41010 four days ago. Now mom brings baby in and he wants to charge her an office visit with 24 modifier with dx for 783.41 weight check during this post op period...
  42. D

    Mixed phenotype carcinoid

    How are others coding a goblet cell carcinoid that the path report reads 'adenocarcinoma arising from appendiceal goblet cell carcinoid the provider coded as adenocarcinoma. I am leaning towards the carcinoid. It has metastasized to ovary. I would have NEC 209.29, secondary NEC 209.74 Thanks...
  43. D

    2nd opinion Please metastatic choroidal melanoma

    I like seeing these- the research is fun. I have never come across choroidal melanoma. The book takes me to 190.6. It is metastatic to the shoulder. The instruction for metastasis 'of or from a site not of skin -see Neoplasm, by site, malignant, secondary. That would be 198.89. I checked out...
  44. D

    Secondary Neuro lymph diagnosis

    I am struggling with code choice for metastatic regional lymph involved by neuroendocrine tumor. Provider does not like 209.71 because the verbage in the code book is 'distant lymph nodes'. That is the only choice. What is that supposed to mean? Tricia D, CPC, CHONC
  45. D

    Sebaceous Cyst in Groin

    I am out of my league here. I am an oncology coder, not derm so I need to have your advice about coding for a sebaceous cyst drained lower perineum, 1x1cm. anesthesia yes, but no sutures, just drainage. I could not find a code specific to genital area. Is 10060 appropriate? Appreciate input...
  46. D

    Breast Cancer DX 174.0

    Is it appropriate to use 174.0 areola for a path designation of '2 o'clock subareolar' ? I want to use more specific codes but sometimes I hesitate if the wording is not exact. I don't think it is would be 'central'. That seems like it would be deeper into the body of the breast. Tricia D
  47. D

    162.8 Contiguous sites

    I want to use this code for a upper and lower lobe cancer -the sites are contiguous. But what is meant by the phrase ' whois point o forigin cannot be determined'? Tricia D
  48. D

    203.00 and 198.5

    I have seen the Coding Clinic article from 1992 re lymphomas, but the code range does not include 203.00. I don't think 203.00 should be billed with 198.5 because bone detioration is a symptom of the myeloma. The disease is happening in the marrow. It is not spreading to the bone. I have a...
  49. D

    Nature of Counseling

    I have always thought that a provider could summarize the nature of his counseling in his Assessment and Plan. I should be easily inferred. If he then made a time statement of 25 minutes spent in counseling etc I had no problem accepting it, because I could tell what he and the patient had been...
  50. D

    NPP TIME BASED, Incident to

    I have been searching for information to 'rule out' or 'rule in' the above scenario. Can a NPP bill incident to, and use a time statement? I can find nothing to say this is not do-able. Any input appreciated. Tricia D, RHIT, CPC.CCS-P