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  1. H

    POS 11 or 81

    Pam, Thanks so much for your reply. For box 24J you say "Supervising provider at lab practice site." Do you mean the provider that does professional services at the same site as the lab equipment? If so, he is in one state (SC) while the specimen was obtained in another state (NC) and he is...
  2. H

    POS 11 or 81

    Any assistance to help with a debate is greatly appreciated. Some of the questions may seem ridiculous, but I'm trying to resolve a debate. Scenario: 20+ locations of a primary/urgent care business crossing state lines. High complexity CLIA certificate at a location in state "X" where high...
  3. H

    Under coding on Urine Drug screens acceptable?

    Suppose G0480 is the only code from G0480-G0483 approved for reimbursement/on the fee schedule for a payer that makes up a considerable part of your payer mix. Suppose the provider is going to prescribe opiates for chronic pain and manage this pain long term. Suppose a new patient comes in to...
  4. H

    Infusion + shots

    We have pt that comes in regularly for Xolair injections and we bill and are paid billing it as follows: 96372-RT 96372-LT 96372-RT/59 This pt recently came in for Reclast infusion on same date as Xolair injections. We billed as follows: J3489 - paid by BCBS 96365 - paid by BCBS 96372-RT -...
  5. H

    Correct use of modifier XE

    modifier XE use Thomas, Thanks! I understood it the exact same way as you, your answer helped resolve a debate. Thanks again! Hunter Smith, CPC
  6. H

    Correct use of modifier XE

    CMS introduced X (E, U, S, P) 1/1/15. I am being told it is correct to use modifier XE in place of 59 in the following situations: 1) Established out patient is seen for a problem visit and has an EKG done. Bill as 9921"x" and 93000-XE (NOTE, the EKG was done during the same encounter, patient...
  7. H

    95803 Actigraphy reimbursement

    I have a billing client that is a sleep specialist that has purchased several actigraphy devices to be worn by patients. The CPT code is 95803. I have not been successful in getting any payer, commercial or CMS, to pay for the testing - even though the testing is done on dates of service other...
  8. H

    Rapid Flu Test A & B

    Flu test Group A and B Like Teresa, I also bill on two lines and use Mod 59 and get paid by all my payers. Hunter Smith, CPC
  9. H

    Quantitative Drug screen codes G0481-G0483

    I have a client that is billing South Carolina Medicaid for G0481, G0482, and G0483 and SC Medicaid only pays for G0480. Can anyone give me any guidance on why Medicaid only pays G0480 and not G0481-G0483? Thanks, Hunter Smith, CPC
  10. H

    code corrections and modifiers

    Certified vs. non-certified Camille, I'm not aware of any regulation that says modifiers must be added by only certified coders. There are probably 20-25 non-certified coders performing coding and billing function in my town alone of 50,00-60,000 population. I would say 5-10% of the charges...
  11. H

    Skilled NF frequency

    I bill for a geriatrician that has "heard" of a physician that performs the initial E&M on a newly admitted patient and then has PA's/NP's that are employed by the physician (not the SNF) that go to the SNF every single day to see patients. 1) it has been our understanding a "billing provider"...
  12. H

    Question on Post Op E&M visits

    post op E&M I would suggest you ask the physician if the follow up dx is related/caused by the surgery. If no, add mod 24. If yes, then it's a post op complication covered in the surgical global package.
  13. H

    Venous ligation code help

    Pt was tender to touch on scalp over "mass" so my surgeon took to the OR to excise the "mass." Following is op note I need help coding. Once she was positioned, the surgical site on the posterior right head measured approximately 2 cm x 2 cm palpated. The surgical site was prepped and draped in...
  14. H

    External Jugular line Placement

    CODE for external jugular line placement Hi, 36555 - If pt is younger than 5 years of age. 36556 - If pt is 5 years of age or older. Hunter Smith, CPC
  15. H

    Help with liver procedure

    Thanks for your help! Hunter Smith, CPC
  16. H

    Help with liver procedure

    Any suggestions on how to code this is greatly appreciated! Summary - Diagnostic laparoscopy, right lobe of liver biopsy of a tumor (laparoscopic), converted to open laparotomy with partial hepatectomy (segment 6). After informed consent.....Following placement of all trocars, the laparoscope...
  17. H

    reilled breat implants

    "The original implants were for cosmetic reasons but then pt was in an accident and needed to have a this restructuring done... " Can you please explain how the restructuring was medically necessary vs. cosmetic?
  18. H

    Removal of two catheters, insert one

    What about unlisted procedure codes and op note vs. billing only one CPT when 3 different procedures were performed?
  19. H

    Removal of two catheters, insert one

    Background: Patient has ESRD with malfunctioning peritoneal dialysis catheter. Presented to ED with fluid overload and my surgeon placed a non-tunneled central venous catheter (36556) Vas-Cath to allow emergent dialysis. Four days later.......the plan is to: 1) remove malfunctioning peritoneal...
  20. H

    replace removed gastrostomy tube

    gastrostomy replacement I'm leaning toward 11005 and 43830, but I'm not sure and would like assurance or someone to tell me a better/more accurate way to code this case. Thanks for any input! Hunter Smith, CPC
  21. H

    replace removed gastrostomy tube

    Please help me code this one!! Thanks for any assistance. Patient had gastrostomy tube placed, increased leakage was noticed, presented to ER and patient admitted to manipulating the gastrostomy tube. Was taken to the ER and below is the Op note: ....Exploration of the former gastrostomy site...
  22. H

    Wound clinic billable during global period?

    My doc did an open cholecystectomy on a diabetic and therefore slow/poor healer. He then saw the patient in the wound clinic as one of the general surgeons rotating through the wound clinic. The wound clinic visit was within the global period of the cholecystectomy. Is the wound clinic billable...
  23. H

    Help please on coding surgery

    what payer paid Ca.brule: yes, mod 78 was used. trinacmt: I billed as follows: 44143 mod 78, 49020 mod 59 and 78, 44140 mod 59 and 78, 44005 mod 59 and 78. UHC is carrier, and they did tell me that on the phone. What they paid was the 44143 and advised "they only pay the primary CPT when a...
  24. H

    Bill for closure on port removal?

    Can you bill for the deep closure on a port removal, 36590, or is it considered included in the procedure of the removal? Thanks for any help, Hunter Smith, CPC
  25. H

    Coding for a inpatient visit the day before a surgery - HELP!

    Marci_ann, I would not necessarily bill 99024 if the visit is for an unrelated reason. If the patient had appendectomy and now they are having knee replacement then I would by all means code the hospital visit at the appropriate E&M Level and append modifier 79. Without more information (what...
  26. H

    Help please on coding surgery

    Below is an op note for a patient that previously had 44140, 44139, and 49585 done 2 weeks prior to presenting to ED as: shocky, diaphoretic, tachycardic, hypotensive and in severe distress. CT showed free air in the abdomen and it was presumed the anastomosis had dehisced from the surgery two...
  27. H

    PT in North Carolina

    I'm about to begin billing physical therapy charges in North Carolina for a doc that has told me his relative doing physical therapy billing in New York told him there is a $50/day global maximum for physical therapy charges in New York. Charges above the $50/day are simply not reimbursed. I'm...
  28. H

    G0439 + e&m?

    g0439 + e&m Cher91600, I agree with OCD_coder. This is a battle I have fought many times. What I explain to my providers/clients is: If it is a simple, quick, easy, non-life threatening issue, then "just do it" and consider it included with the G0439. As OCD_coder pointed out, it's highly...
  29. H

    93352 with a 93306?

    Ok, I've uncovered part of the answer to my question. I can't bill 93352 with anything other than a stress echo per AMA CPT book and other resources I have found. However, does anyone see anything wrong with billing 96374 (IV push) for the administration of contrast (Q9957) when doing a...
  30. H

    93352 with a 93306?

    I know I can bill the add on code 93352 when the physician is doing a stress echo for the use of Q9957 contrast. However, can I bill 93352 or some other code for the administration of contrast for an echo (non-stress echo)? If there is another code to use, what is it? Thanks, Hunter Smith, CPC
  31. H

    ICD-10 Frustration

    Some great ideas, thanks. I really like what you are doing mitchellde, I'd like it even more if the providers themselves were told to code to ICD-10 based on their documentation! Bottom line is what gets providers attention? Money. My fear is that as Jim alluded to, we will not get the...
  32. H

    ICD-10 Frustration

    Getting up on my soapbox, can anyone help me here? It seems 100% of the "focus" on the ICD-10 transition is all about ... drum roll please..."clinical documentation needs to allow coders to code to the appropriate ICD-10 code." It simultaneously seems 100% of the education, seminars, etc. on...
  33. H

    Payers exempt from Oct 1, 2014 deadline?

    Penalty for not converting to ICD-10 I was in a conference with my clearinghouse recently and was told that there most likely will be some payers that are required to convert that are not going to convert by the deadline. As incentive to be ready next October there are financial penalties. My...
  34. H

    Eval for port

    OK, Two scenarios: Scenario 1: My surgeon performs a mastectomy on a patient. Shortly after the patient is referred back to my surgeon (or it was in the plan all along) to put in a port a cath for chemo administration. The referral is to meet with the patient, review anatomy and placement of...
  35. H

    Hospital billing for Surgeon

    I think there are 2 possible explanations: 1) There is a gross misunderstanding and one person (or more) have completely no clue what has actually been said. or 2) The hospital is somehow trying to gain business and their strategy is to gamble on the fact they can tell the Dr. anything and...
  36. H

    can an office visit be billed w/a hysteroscopy that is done in the office?

    I would agree with the above reply, but simply add that you need to append modifier 25 to the E/M if it was "significant, separately identifiable...." Hunter Smith, CPC
  37. H

    Hospital billing for Surgeon

    I am a billing company and also bill for a general surgeon. What was stated above is accurate. Only the person/entity/group that "owns" the facility where services are performed can bill "facility fees." Therefore, the hospital is billing the facility fees now. OR, possibly the hospital billing...
  38. H

    Discontinued procedure leads to admission

    OK, need someone to confirm my thinking on this one. Patient shows up for outpatient lithotripsy (50590). Once procedure was started patient BP began fluctuating dramatically and procedure was discontinued. Patient was admitted and cardiology was consulted to workup the patient. The next day...
  39. H

    Cerumen removal and 99354

    69210 and E&M continued Kristina, Thanks for response. Are you telling me your payers will pay BOTH an E/M and 69210? I've tried with a 25 on the E/M and without. With different DX codes and with same DX (on E/M and 69210) and payers will pay one code or the other but not both. I guess I'm...
  40. H

    Cerumen removal and 99354

    I have a debate going that I would like some feedback on and please provide references whenever possible. Primary care setting, patients with ear pain, problems hearing, etc that upon physical exam have impacted cerumen. Scenario 1: Provider irrigates patient ear/s, uses sucker, whatever...
  41. H

    How to bill Appendectomy?

    44960 Yes, there was abscess. Thanks so much. Hunter Smith, CPC
  42. H

    Lap Hernia and cholecystectomy

    47562 and 49652 Yes, I had this same kind of case and billed 47562 as line 1 and 49652 as line 2 with mod 51 and was paid with no problem. Hunter Smith, CPC
  43. H

    How to bill Appendectomy?

    OK, The doc knew based on CT scan that the appendix was ruptured. But, his op note and list of procedures reads as follows: 1) Diagnostic laparascopy 2) Laparotomy 3) Appendectomy 4) Drainage of abdominal cavity Laparscopy was initiated and then terminated when it was discovered there were...
  44. H

    cpt 36000-When is it proper

    36000 What I can tell you is that I bill it for IV infusion therapy (hydration, therapeutic, and chemo-therapeutic). However, Medicare bundled this code with the infusion codes as included/incidental to the infusion codes effective 1/1/12. I continue to bill it for infusion to all other...
  45. H

    Prostate biopsy

    Possible solution OK, I personally have not billed Blue Medicare, but I was getting denials on the 76872. What I found to get all of them paid was: 55700 dx 790.93 76872 dx 600.10 76942 dx 790.93 And that has gotten all three codes paid when Cigna previously was considering the 76872...
  46. H

    Can I bill for "misadventure"?

    OK, Help me settle the score - conflicting opinions on this. During a reversal of a diverting ileostomy, the following appears in the op note: The small bowel was dissected from itself and its attachments in the pelvis. There was one loop of small bowel that was torn during the dissection...
  47. H

    Resource for E/M coding

    Check out emuniversity.com. Free material as well as subscriptions available from the most coding knowledgeable physician ( a CPC) I've ever met. Not saying much I know, but Dr Jensen knows E&M. Hunter
  48. H

    inpatient visit along with ov

    OV and admit I would ask you this: Do the admitting doc and the OV doc work together? Specifically, do they submit charges with the same tax id? If the OV is done by Doc A with tax id 123 and the admission is done by Doc B with tax id 123, then I would bill the admission only. However, if...
  49. H

    J2175 50 mg, but description is per 100

    The demerol comes in 50 mg ampuls. So, 1 full ampul is used or 2 full ampuls are used. There is apparently no J code for using just one 50 mg single use ampul.
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