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  1. T

    Lymph Node with Melanoma

    Hi, Can someone let me know the correct way to code this. The doctor went deep into the axilla to remove a large mass, in whcih he stated resembled a large lymph node. The path report later confimed "lymph node with melanoma". Myself and another coder was having a discussion as to whether what...
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    Excision Mass Axilla/ Skin Flaps

    Hello, Can someone offer their expertise on the followng sugery, I'm not sure if I should charge for skin flap closure (13120) All he said in the report was marcaine and epinephrine was infiltrated into skin flaps. Please let me know if 19120 as well as 13120 is correct for the following...
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    Debridement bone(sacrum) & I&D (Presacral)

    Hello, Can someone share their expertise and let me know if the following surgery is coded correctly? Also a few of my concerns is: To my knowledge, precaral space is a different site than the sacrum, so I coded the I&D with a 59. One of the dx's is sepsis in which the patient was admitted for...
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    Lap choly with lap appendectomy

    Hello, Can these two be billed together with a mod 59 on the apepndectomy? Is the appendectomy considered incidental? The dx for it is 543.9 dialation. I thought I can, just wanted to make sure. Thanks!:) DESCRIPTION OF PROCEDURE: The patient was transported to the operating room and placed in...
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    Deep axillary lymph nodes, superficial or deep?

    Hello, Does anyone have information regarding what entails deep vs superficial lymph nodes? I ran across some information, the following is what I have been going by, please let me know if that is correct or if you have additional info:38500 (superficial) suggest one or two superficial nodes...
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    Repair of sliding iguinal hernia , Incarcerated?

    Hello, Can someone help with the following surgery? I am trying to figure out if this should be code 49525 or 49507. There is further instructions in CPT under 49525 to see other codes for Incarcerated. The patient is over 5 years old. Also Should I append a modifier 22 as well due to the...
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    599.0 need additional code??

    I was asked the following question, was not sure the answer, maybe someone can provide their expertise? Thanks!:) Do you think it would work ok if we have a 599.0 with 038.9 for UTI with unspecified infection type. Or would 136.9 be better? Thanks
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    Exploration and debridement of wound,breast

    Hi, can someone help me with the following surgery and DX? Thanks in advance :) The opened incision on the left breast was opened for a few millimeters medially, so the area could be probed. There was a tunnel that extended inferiorly for approximately 3 to 4 cm. The skin overlying this area...
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    DX for Foreign Body Giant cell reaction, breast

    Hi, Do anyone have the DX for Foreing Body Giant Cell Reaction of breast? Thanks for your help!:)
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    Invasive carcinoma ?

    Hi, I am trying to figure out if invasive means metastasis( secondary) or primay. The path reports states: INVASIVE squamous cell carcinoma for the RT arm arm, invading 0.5cm, And, Squamous carcinoma left distal arm, invading 0.1cm And, squamous carcinoma, invading 0.1cm, left upper arm...
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    Lt Knee Arthroscopy with chondroplasty patella

    Hi, Can somoene let me know if this surgery is coded correctly? Thanks in advance!:) Name of operation-LT knee arthroscopy with arthroscopic chondroplasty patella post/op DX- Grade 3 chondromalacia of patella It was coded as 29877-LT/717.7 and 733.92 A 30 degree scope, Dandy nerve hook...
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    Wide excision of melanoma/ Complex repair?

    Hi, I am trying to figure out if I coded this surgery correctly. I believe complex repair should be coded, given skin flaps were involved. Also, dictation states he went through skin and sub q tissue all the way to the fascia.I am not sure I am in the right code series, given that he went to the...
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    Debridement and I&D of foot

    Can someone out there provide your expertise on this surgery please?:o Name of Procedure: 1. Debridement skin, subqu tissues and muscle over the the medial aspect of the left foot, over the MTP joint. 2. I&D abscess on the plantar surface of the foot extending between the first and second toes...
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    Critical Care Frustration - subsequent or critical care?

    :confused: One of our biggest confusion and difficulty in coding critical care as well as other E/M's is the fact that, the physician may not include everything he did in the note, it may be documented elsewhere in the chart, and so, we don't know if we should be hunting for this information...
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    Is 49020 bundled with 44143?

    Hello, I am trying to figure out if I should bill these two codes together (44143 and 49020). The CCI book stated 49020 is bundled with 44143, However; when I put it in encoder pro, it stated under CCI, that it was a standared medical practice, I took this as you can not bill it seperately, it...
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    Psychiatric examination 1997 guidelines

    Hello, Can someone clarify the requirement of the shaded and unshaded statement mentioned under comprehensive examination for psychiatry? I just started coding psychiatry on a regular basis and I am confused with the coding tool I am using vs the information in the 1997 guidelines under...
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    94640 with office visit/ modifier 25?

    I have recently had United HealthCare deny an office visit (99213) when it was billed with a breathing treatment (94640) stating the office visit was part of the breathing treatment service. Medicare and other insurances do not deny either when performed in the same day and no modifier is...
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    critical care suspected condition

    Hello, Can we code a suspected condition such as septic shock for critical care? The physician is giving the patient a blood transfusion to optimize oxygen capacity in suspected shock setting. Thanks!
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    multiple hernia with mesh again!

    Hello, Can we bill 49568 twice w/o a modifier 59? The physician did a bilateral ventral hernia repair, I am billing it as follows: 49560 49560-50 ( this code has a status indicator 1, in which the 50 applies, right?) 49568 49568 Is this correct? :cool: Do I always need to send out a paper...
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    cardiac injury and induced hypoxic injury

    Hello, Is the appropriate dx code for cardiac injury 861.00? I was nort sure if there was another appropriate code or not. The physcian stated on the first day of critical care treatment that the patient had cardiac ischemic injury, and on another visit, the physician documented the patient...
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    Cardiac injury

    Hello, I am trying to find out if the DX cardiac injury is sufficient documentation for a critical care. i know in the CPT it states injury. Do anyone know the DX code for cardiac injury? Thanks!:)
  22. T

    BX peritioneum/small bowel BX/feeding JJ tube

    Hello, Can someone please help me code the follwing sx::cool: Not sure of the codes for the BX's. I am looking at these codes: 44110-small bowel Bx 49441 or 44015-JJ tube ( what is the difference in using those codes for the JJ tube?) or 44110,49010 and the JJ tube, which I believe may be...
  23. T

    non oliguric renal insufficiency

    Do anyone know the DX for non oliguric renal insufficiency? I know that non oliguric means 500ml or more urine output and oliguric means less than 500ml. The only thing I am getting from that documentaion is that the patient is having renal insuf with more than 500ml output, so i am thinking...
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    Critical care billing-staus has not changed

    Hello, I have a doctor that bills critical care when a patient is in ICU. He frequently bills this, even when the patient's staus has not changed. Through reading and research, I do understand that the patient's conditon has to be life threatening, has to have one or more organ failure. I do...
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    Incident II billing-NPP billing a laryngoscopy

    We do incident II billing for our nurse practitioner when she sees patients in the office. We had a case today where the patient seen the physician for an office visit but the nurse performed the laryngoscopy, can we bill the office charge under him and a separate charge for the laryngoscopy...
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    47379 vs 47001 with major lap PX

    Hello, There seems to be different answers from the forum. I have read one that says 47001 is used for hundreds of lap procedures including 47562 and 47563, ( I have used the search tool to find the list that was posted, no luck with that, and I've have read others that stated to use 47379. I am...
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    Removal of infected gastric band port

    Hello, Can someone help me code the following report: The physician submitted code 43659:cool: Thanks! TE: 08/29/09 PREOPERATIVE DIAGNOSIS: Infected gastric band port. POSTOPERATIVE DIAGNOSIS: Infected gastric band port. NAME OF OPERATION: Removal of infected gastric band port. ANESTHESIA...
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    Dx code for infection of groshong infection

    :)Hello, does anyone know the DX code for infection for a removal of a groshong cath? i know it would be under complication. Thanks!
  29. T

    Multiple hernia repair vs defect

    Hello, Can someone explain to me when I should code a multiple hernia repair. I am gathering bits and pieces from other responses. This is what I have so far: If the hernias was repaired all through the same incision, you just code it once with a mod 22 and submit the notes with claim or if...
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    2 doctors, same specialty,consult different dates, different DX

    Hello, Can the following be billed: You know I have 3 providers that share same specialty so my question is if one dr see's pt for a consult on 09/11 can I bill another consult for another dr on a different date? Different dx's. yes, right? :cool:
  31. T

    ICD-9 for remote MI

    Hello, Does anyone know the dx for remote MI. Isn't this like a late effect or deficits from prior MI? Is there a code for it? Thanks!:)
  32. T

    ICD_9 for remote MI

    Hello, Does anyone know the dx for remote MI. Isn't this like a late effect or deficits from prior MI? Is there a code for it? Thanks!:)
  33. T

    Transfer of care

    Hello, I have two questions: Can someone tell me what codes I should be using for transfer of care? The patient was transfered from the care of a pysch doctor to the care of a internal medicine physician. The patient has already been admitted in the same hospital as both physicians. 2nd: A...
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    Rule out DX's

    Hello, How do you determine when to code the rule out dx? I usually look at the medical decision making to see if any treatment for it will be done, and what they were reusted to do but if that is the only DX given, I code it. This is pertaining to inpatient consults, I know you can code rule...
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    Modidifier 25 with 0 day globals

    Hello, Can someone tell me if modifier 25 can be used on an E/M on the same day as a 0 day global such as a scope PX 52000 ? I always thought 0 days globals do not get 25. 10 day get 25 and 90 day get 57. I also read that if the 0 day global procedure was performed on the same day as the E/M...
  36. T

    Cholecystectomy, cholangiagram common bile duct exploration

    Hello, Can anyone tell me if the cholangiagram is included in the 47610/47550? He did a open choly with cholangiagrams and exploration of common bile duct. Should I code the cholangiagram separate, and if so woud it be 74300? I was just going to code it as 47610/47550. Please let me know...
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    Laparoscopic assisted sigmoid colon resection

    Hi, I am not sure if these are the correct codes and modifier for the following surgery. Should there be a separate code for the dcompression of ovarian cyst? would the assistant surgery append 80 to his surgery only? I did not think the primary physician that is doing the main PX would get the...
  38. T

    open repair rotator cuff tear

    Hello, Can someone explain the difference between codes 23410 and 23420. Regarding 23420, I was told it is for the repair of all three major muscles and for chronic tears. After reading the report, it syas 1 small tear, so I didin't know if I should ue the 23410, because i was told that is for...
  39. T

    adenocarcinoma pancreatic pseudocyst/Gastric tumor

    Hello, What would be the correct way to code adenomacarcinoma pancreatic pseudocyst and adenocarcinoma gastric tumor? The instructions in the ICD-9 says to see neoplasm by site malignant if not under adenocarcinoma. I have 157.9 and 151.9 Thanks!:)
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    Exploratory/Repair Enterotomies

    please let me know if this is the code to use and if a modifier 52 should be attached. I m a little confused on what PX was terminated. The two enterotomies were repaired. The Exp Lap is included. Thanks for any help!:) 44615 PREOPERATIVE DIAGNOSIS: Small-bowel obstruction secondary to...
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    pleural parenchymal process for thoracentesis

    Hello, Can you tell me what DX you use for pleural parenchymal process? Is this the same as pleural effusion? The doctor did not list a Dx for the thoracentesis. He just wrote RT lower pleural parenchymal process and abnormal chest X-ray. He just stated patient was admitted for the above.I...
  42. T

    observation-99217 and 99218

    Hello, Can you tell me if codes 99217 and 99218-99220 can be used in conjunction. In the CPT guidelines on page 11 whwere it says do not report 99217 with hospital admission, is that referring to 99221-99223? I don't use these very often, so I am trying to understand the difference. The...
  43. T

    Laparoscopic drainage pelvic and subhepatic abscess/placement JJ feeding tube

    Hello, Please help with the following op report::cool: 49441?/49323/49329???:cool: REOPERATIVE DIAGNOSES: 1 Sepsis. 2 Fever. POSTOPERATIVE DIAGNOSIS: Multiple intra-abdominal abscesses. NAME OF OPERATION: 1 Laparoscopic drainage of pelvic and subhepatic abscesses. 2 Placement of...
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    Conversion to laparatomy/lysis adhesions/BX's/Repair enterotomy/Fedding JJ

    Hello, Please assist with the following op report::cool: I know I don't code the Diagnostic Lap. I believe I don't code the laparatomy as it is a component of the main PX, in which I beleve is the massive lysis adhesions. The code I am looking at for Feeding JJ is 49441, and I am not sure about...
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    Conversion to laparatomy/Massive Lysis adhesions/Pancreatic Pseudocyst BX/ stomach BX

    Hello, Please assist with the following op report::cool: I know I don't code the Diagnostic Lap. I believe I don't code the laparatomy as it is a component of the main PX, in which I beleve is the massive lysis adhesions. The code I am looking at for Feeding JJ is 49441, and I am not sure about...
  46. T

    491.21 vs 491.22

    Hi, If the physcian documents COPD/AECB, would the DX be 491.21?, as AECB stands for Acute Exacerbation Chronic Bronchitis. ( I do not see Acute Bronchitis in that abbreviation) I have read the guidelines in the ICD-9, chapter 8 part B, last sentence. So I am trying to understand how would this...
  47. T

    Diagnostic Lap with Graham's patch - duodenal perforatios

    Hello, Please help with the following PX: The physician did a diagnostic Lap with Graham's patch( a surgical techinque that is used to close duodenal perforatios. A piece of omentum is used to cover the perforation). DX: peritonitis secondary to anastomitic leak The patient just had bariatric...
  48. T

    Diagnostic Lap with Graham's patch

    Hello, Please help with the following PX: The physician did a diagnostic Lap with Graham's patch( a surgical techinque that is used to close duodenal perforatios. A piece of omentum is used to cover the perforation). DX: peritonitis secondary to anastomitic leak The patient just had bariatric...
  49. T

    incidental px

    Hello, Can somone please help me to determine the correct code on the following report ( I believe the code is 43771 and I'm not sure if I should code the incidental appendectomy and if not, should I put a 22 on the main px? : Name of procedure: Diagnostic Laparoscopy/ Repair gastric band...
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    Diagnostic laparoscopy/repair gastric band/incidental appendectomy

    Hello, Can somone please help me to determine the correct code on the following report ( I believe the code is 43771 and I'm not sure if I should code the incidental appendectomy and if not, should I put a 22 on the main px? : Name of procedure: Diagnostic Laparoscopy/ Repair gastric band...
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