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    Hypertension with Cardiovascular disease I11.9

    Thank you so much!
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    Hypertension with Cardiovascular disease I11.9

    Hello, I am not strong in cardio :). I am trying understand what constitutes the use of this code. If patient has ASHD, Arteriosclerosis, Cardiomyopathy with hypertension I am thinking that it is possible these can be tied in to the I11.9 if no heart failure. Can they? or not? Do you have...
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    Hypertension with Cardiovascular disease I11.9

    Hello, I am not strong in cardio :). I am trying understand what constitutes the use of this code. If patient has ASHD, Arteriosclerosis, Cardiomyopathy with hypertension I am thinking that it is possible these can be tied in to the I11.9 if no heart failure. Can they? or not? Do you have...
  4. E

    Medicaid Modifier for Aliens (MLA) Florida

    Thank you, no we had not. Is this on the procedure? We had been getting paid but this just started, Is this a new procedure for FL?
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    Medicaid Modifier for Aliens (MLA) Florida

    We are getting denials for Florida Medicaid deliveries for emergency Medicaid for Aliens. They are denying the vaginal deliveries for a required modifier?? I have not seen a modifier for a vaginal delivery? Thanks,
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    TRANSISTIONAL CARE MANAGEMENT w/ E/M service

    Thank you, I do not see a exam component to the TCM code. This is why I am asking.
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    TCM w/Evaluation and Management

    If justified/documented. Can a physician code a TCM code with a E/M. I am looking at CCI and do not see a edit nor do I see a exam component to the TCM. I am thinking yes if necessary but want to double check. Thanks! :confused:
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    TRANSISTIONAL CARE MANAGEMENT w/ E/M service

    If justified/documented. Can a physician code a TCM code with a E/M. I am looking at CCI and do not see a edit nor do I see a exam component to the TCM. I am thinking yes if necessary but want to double check. Thanks! :confused:
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    BH Diagnosis

    I am new to this specialty on top of having to handle how Medicaid prefers to use H codes(I think I have this under control) :) But, we are trying to get a handle on the diagnosis codes as to which codes they are covering. Can anyone give me some insight as Medicaid is very vague and does not...
  10. E

    retroplacental hemorrhage/vaginal bleeding

    Thank you. I did see that but was not sure as it is not post partum. This was the reason for the C-section. I am thinking the option of coding vaginal bleeding as the retroplacental hemorrhage was found when the placenta was removed via the C-section. I do not find any other appropriate code.
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    retroplacental hemorrhage/vaginal bleeding

    Please help! The op report (c-section) indicates: Vaginal Bleeding but the procedure description indicated "some evidence of retroplacental hemorrhage at the time of placental removal" Can you help with coding of the retroplacental hemorrhage? The codes I was looking at was for premature...
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    Retroplacental hemorrhage/vaginal bleeding

    Please help! The op report (c-section) indicates: Vaginal Bleeding but the procedure description indicated "some evidence of retroplacental hemorrhage at the time of placental removal" Can you help with coding of the retroplacental hemorrhage? The codes I was looking at was for premature...
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    OP report/procedure not listed

    Good afternoon, I am trying to code a Operative report, the provider has left off the name of procedure. I know what was performed but is this acceptable? or should I request the provider to addend the report? Thanks,
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    OB Coding in/out of package

    Florida Medicaid is the same with a limited number of visits, so we have to make sure if we track the visits carefully. The visits are coded with a HCPC code H1000. If the patient comes for a unrelated problem then we use E/M codes.
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    H&P billing after patient delivering the baby in the car

    We code 59430 post partum care only.
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    z34 and gestational codes

    Are you talking about the weeks of gestation codes? From what I understand. These only apply to complication of pregnancy or the codes that begin with O. Sine the Z34 code has the trimester as well as no complication it should not be necessary to apply these codes. If you are using a O code...
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    Annual GYN Exam no pap

    If a patient comes in for annual gyn exam not including a pap(just a breast and pelvic exam). Should the preventative medicine code be used? If not what cpt code do we bill? I am thinking the preventative as it is just preventative. The provider is saying no and is concerned that the patients...
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    Robotic Total Lap Hysterectomy/lysis of adhesions

    I need a opinion. The Operative report indicates "began by removing some relatively dense adhesions of rectosigmoid colon to the left tube and ovary into the cul-de-sac as well a the posterior uterus. I think if justified we can code to lysis of adhesions correct? IF so, do you feel it is...
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    Delivery of placenta vs Curretage

    Good Morning, I am a little confused on this one. Patient delivered at home and a attempt to deliver the placenta with out success. The physician brought the patient to the OR to attempt to deliver placenta. He again attempted to deliver placenta without out success and then used a sharp...
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    New v.s. Established

    We consider them as established. I have not found anything regarding this anywhere to clarify this, but the way our company looks it is the patients information was available to the provider and is not new. Taking the information and transferring it a new practice is merely administrative and...
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    Assistant Surgeon dictating note

    Hello, It is appropriate for the Assistant Surgeon to dictate the note rather than the main surgeon? I am not sure if this is a error or not. Thanks
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    Deliveries with lacerations

    Hello, I have not done coding for deliveries for a while and need some help. With Vaginal deliveries not complications it should be coded 650, V27.0. If the patient had a perineal laceration during delivery, should this be coded rather than the 650 Normal delivery? I want to make sure I am...
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    Medicare Review Audit

    Thank you both for your opinions on this. There are only 3 charts out of 40 reviewed which I disagree on. It is not a lot, however we would like to understand the rational for the decision. Screenings (Depression, alcohol, etc.) and Prolia injections but what it looks like was when the...
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    Medicare Review Audit

    Good Morning, Has anyone appealed a Medicare focused review? I have a provider where Medicare did a review and has down coded many of his visits based on Medical necessity. I understand on many of them the justification, but there are several which I am agreeing with the providers coding...
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    E/M level

    Let me ask, If it is a new problem with Prescription drug management, why would the MDM be moderate? I have the same problem with my providers and keep racking my brain on this.
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    Accuracy of coding decline

    Good Afternoon/morning! I do post payment audits to track the accuracy of our physician coding and educate them but for the last few months I have seen a decline in the accuracy of their coding. I am at a loss and was wondering if anyone can make any suggestions of where to start. I generally...
  27. E

    Diagnosis code

    This code can only be used on a mother not a baby and will be rejected by the carrier. Is the child experiencing any symptoms or developmental issues as these can be coded.
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    Florida Medicaid HCPCS Codes

    Good Afternoon, Florida Medicaid has provided us with a listing of HCPC codes they accept. I am trying to figure out the documentation requirements as some I can not find the CPT match. I hope this makes sense as I want our providers to be able to provide proper documentation for the...
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    Hpi

    Thanks for the reassurance. I always second guess myself when a physician is arguing over something. Most of my response is I am just the messenger and don't make the rules, just abide by them :)
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    Hpi

    The document has 2 problems in the HPI, both explained quality for each. I had a physician tell me he can count 2 points for quality. I disagree. I am counted the second problem as a associated sign and symptom and only giving one point for quality. Should 2 points for quality be counted in...
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    Should Edema be coded

    Thanks, I though possibly I was correct, but sometimes I do second guess myself :) :)
  32. E

    Should Edema be coded

    Maybe I am having a brain fart! :) The physician coded edema on the visit. The exam indicates "Extremities without clubbing, cyanosis, or pitting edema. It does document that the last visit he ordered Ted hose for edema but the patient did not comply with treatment. The documentation...
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    Scoring Physicians

    I am not sure if this may be of interest. I do audits for 27 providers in a group. I score based on their % of accuracy per quarter. Each provider has a % as well as the overall average of the group. We compare their % to the group % to see where they are amount the others. The individual...
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    Help! - patient for chest pain

    I would say chest pain. Which is the main reason for you provider to see the patient. I also would indicate the second code as the reason for he was getting chemo. I am not sure if the chemo can be used as a secondary diagnosis in this situation but if you can I would also apply that. Just...
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    Diagnosis coding of Follow Up ER

    Thank you
  36. E

    Diagnosis coding of Follow Up ER

    :confused: We have a record which the provider indicated a fall but does not state injury. We have the documentation from the hospital shows the injury. Can we use this for coding or ? I know we can not just use a E code Thanks,
  37. E

    Dermatopytosis 110.0

    We are primary care
  38. E

    Dermatopytosis 110.0

    Thanks, They are the standard Medicare. The only thing I can think of we are a FQHC but it really should not be a issue.
  39. E

    Dermatopytosis 110.0

    :confused:Hello All, Maybe you can help me. I am sure there is some reference you can refer me to. Medicare is denying this diagnosis code as non covered. I know there is something, I just cannot find it. This is for a office visit, I am trying to find a reference for this. I went to the...
  40. E

    Dermatophytosis 110.0

    :confused:Hello All, Maybe you can help me. I am sure there is some reference you can refer me to. Medicare is denying this diagnosis code as non covered. I know there is something, I just cannot find it. This is for a office visit, I am trying to find a reference for this. I went to the...
  41. E

    Pap only visit

    Thanks, There really is not enough documentation. I am not sure why it was not done at the time of visit. No HPI or ROS, MDM pap done.
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    Pap only visit - preventative med

    A patient came for a preventative med visit. She came back a few days later for the pap. How should the pap visit be coded? It is not a preventative med visit nor a problem focused visit. Any thoughts? TIA
  43. E

    Pap only visit

    A patient came for a preventative med visit. She came back a few days later for the pap. How should the pap visit be coded? It is not a preventative med visit nor a problem focused visit. In the past we coded just a problem focused visit. Any thoughts? TIA
  44. E

    "Appers to be diagnosis"

    Thanks, my thoughts exactly! I just need to convince the provider without "offending" them.
  45. E

    "Appers to be diagnosis"

    Good Morning, I am reviewing a documentation and the provider notes "appears to be seborrheic keratosis" I am saying that this is not a confirmatory diagnosis, and should not be coded as seborrheic keratosis. What are your thoughts? Thanks, :confused:
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    Mycosis

    Thanks, the only thing the documentation says is "fungal lesion on lateral aspect of left ankle" I am unsure how the provider determined it as "fungal" there is no confirmation by lab that it is a "fungal lesion" unless by visual exam? I am not a clinician so I am not sure if this can be...
  47. E

    Mycosis

    Medicare is denying our visits for not medically necessary for 110.9 and 111.9. It does not seem correct as these were office visits and the provider did prescribe treatment. Since I normally do not handle derm maybe the experts can help me :)? Doesn't seem quite right. I did try to see if I...
  48. E

    Dermatophytosis and Dermatomycosis

    Medicare is denying our visits for not medically necessary for 110.9 and 111.9. It does not seem correct as these were office visits and the provider did prescribe treatment. Since I normally do not handle derm maybe the experts can help me :)? Doesn't seem quite right. I did try to see if I...
  49. E

    Signs and symptoms/definitative diagnosis

    Hello All! Base on the guidelines I know if there is a definitive diagnosis you would not code signs and symptoms the are a integral part of the diagnosis or routinely related. So if for example: URI sometimes there is fever but not always, would you code the cough and the URI or just the URI...
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    Diagnosis codes when dr is not managing condition

    Good afternoon, If the doctor is not medically managing a condition or does not address the condition I was told not to code it. Is this correct? The physician has listed this in the list of problems as this is a multispecialty group but he is not addressing it. I am being told I need to...
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