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  1. J

    AAPC Forums: New Look, New Features

    LOVE IT!!
  2. J

    Non joint injection for Guyon's Syndrome

    op note? I code a lot of Ortho but I was unfamiliar with this condition. I would like to know the answer as well, as I'm sure if we haven't seen it yet, we probably will in the future. From a little research, it looks like Guyon's Syndrome is like cubital tunnel but a compression of the ulnar...
  3. J

    Reverse total shoulder arthroplasty treatment for complex fracture of proximal humeru

    A reverse is a total It sounds like from reading the description of 23616 that that code only involves repairing or replacing one component, the humeral component. If the patient is truly receiving a Reverse total, that would include replacing the glenoid component as well, regardless of the...
  4. J

    Arthroscopic meniscectomy

    Procedure description for 29881 Hi all. The actual CPT code 29881's description should be all you need in this case. "Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/ shaving of articular cartilage (chondroplasty), same or...
  5. J

    Partial breast excision

    Breast reduction Regardless of the reason, you are performing a breast reduction on that one side. I would look at dx Q838 (with Q798 if the pec muscle is also congenitally missing) and depending on the method utilized, I would look at a CPT in the breast reduction area, possibly 19318 and add...
  6. J

    Fracture and dislocation treatment

    Fractures trump dislocations I think fractures trump dislocations. We code a lot of Lis Franc injuries of the feet at our center and when coding those, they are almost always a mix of fractures and dislocations. In correcting the anatomical positions of the feet in order to fix the fractures...
  7. J

    Spinal neurostim lead adapter revision question CPT 63663

    (I code for a hospital outpatient facility.) I came across a case today and was wondering if anyone else had dealt with this situation? Pt comes in for a neurostim generator change (due to dead battery) but the old leads (that are functioning fine) do not have the same connector that the new...
  8. J

    discontinued colonoscopy

    Check the CPT book I believe if a colonoscopy was the intended procedure, the CPT book indicates that if the instrument makes it to the splenic flexure or any point beyond, it is to be coded as an incomplete colonoscopy. If the splenic flexure is not able to be reached, it goes to sigmoidoscopy.
  9. J

    Surveillance Colonoscopies

    We code both At our center, if a patient presents with a personal history of cancer or a personal history of colon polyps and is presenting for a screening, we code both diagnoses if the provider gives them to us. We list it in the order he or she provides it on the Operative Report. I haven't...
  10. J


    Thanks for the response! I appreciate you taking the time to respond :) We have been told to code the degenerative route unless there is mention of an accident, so we have been doing that and I guess I should have used "rotator cuff tendonopathy" to truly illustrate what I was specifically...
  11. J


    clarification- He will give me "rotator cuff tear" and then "bicipital tendonopathy". I can get the rotator cuff tear but not a disease process for it.
  12. J


    I have a physician that refuses to dictate anything other than "tendonopathy" when he treats a non-traumatic rotator cuff tear. I have addressed the office, and while I was unable to speak directly to the physician, they emailed me that his usage of the term "tendonopathy" is to indicate that...
  13. J

    63047 and 63048

    agreed We code these often and I agree with 63047, 63048 x 2
  14. J

    question on Colonoscopy coding

    you are right That is correct, they are mistaken. 45385 or 45380 can only be coded once per encounter. (But they can be coded together if both methods of removal are used on two distinct and separate lesions at separate locations.)
  15. J

    Active forums-where can I find answers? Not pleased with this forum

    I agree I think there are a lot of unanswered questions as well and it IS frustrating, especially for those of us that don't have another coder handy to ask for help or their opinions. I have gotten so that if I post on here and never get an answer to my question, I come back later and update...
  16. J

    Looking for guidance on co-worker matter

    Same boat here sometimes, directed to do things by people that aren't coders I agree that 20610/20611 can be billed once for each MAJOR joint injected (Major joints being the shoulder, hip, knee joint, or subacromial bursa, as defined by CPT.) I did find this though, a CPT Assistant that is...
  17. J

    Is it appropriate to not code a service because you know it will be denied

    Same question and no good answers I have a very similar situation (with different codes) going on and I feel the same way about it. I am a coder for an outpatient facility. I feel like when I code, the CPTs that I send out should accurately reflect the entire procedure (or procedures)...
  18. J

    Posterior Ethmoidectomy Only... pt had Anterior Eth done at an earlier encounter

    Hi all, I am looking for suggestions on how to code a Posterior Ethmoidectomy ONLY. This patient had an anterior ethmoidectomy done years ago and now is coming back in for recurrent sinus issues and removal of the rest of the ethmoids. At this visit, they are doing a Posterior...
  19. J

    Post-mastoidectomy Thiersch Grafting procedure 69670 vs 15120- 15158 range vs 17999

    Update I did wind up going with 15120. We use the 3M encoder and I consulted with the Nosology service that they offer. The rep I was in contact with couldn't find anything in the CPT guidelines or updates specifically directing us to any code but also felt that after reading the Op Note...
  20. J

    Post-mastoidectomy Thiersch Grafting procedure 69670 vs 15120- 15158 range vs 17999

    Hi all, I code for an outpatient hospital surgery department. We have a new physician that is doing some more involved ENT procedures than we have previously seen. I was wondering if anyone had any information on the correct CPT to cover split-thickness skin grafting from the upper arm to...
  21. J

    Carpal Tunnel Surgery using the Sonex Microknife

    billing a diagnostic US with a needle placement US " I might suggest that if/when your surgeon(s) do this particular procedure in the future that they do take some retained images during the Diagnostic US (and maybe at the end of the procedure), and dictate a separate "US Report" into the...
  22. J

    Baxter's Neuroma EXCISION

    Thanks so much for your response!
  23. J

    Baxter's Neuroma EXCISION

    Hi all, I am coding Outpatient procedures for a multi-specialty hospital facility. I have a podiatry case that has me stumped and I'm hoping someone out there has a better code for me to use for this case. It has been returned to me because insurance didn't like my diagnosis and procedure...
  24. J

    Carpal Tunnel Surgery using the Sonex Microknife

    Thanks so much for your insight, Dr Pechacek. I read and reread 64721's description and I can agree that should cover the release portion, however large or small the incision. (I think that I was getting hung up on the fact that the incision was the size of an arthroscopic entrance but it was...
  25. J

    Carpal Tunnel Surgery using the Sonex Microknife

    The Op Notes are finally arriving "Ultrasound-guided microinvasive right carpal tunnel release and complete diagnostic ultrasound of the volar wrist and carpal tunnel" Wrist is prepped and placed in a slight dorsiflex position. "The sterile ultrasound device was brought onto the field...
  26. J

    Surveillance Colonoscopy vs Screening

    I felt the same way about using the 2 dx codes together when the hospital I work for instructed us to code them together. I had been under the impression that you would drop the screening Z12.11 if ANY other symptom was presented and Z86.10 could be considered a symptom. I looked everywhere...
  27. J

    Carpal Tunnel Surgery using the Sonex Microknife

    Thanks so much for your reply! I did come across 29848 but from what I have gathered online, it isn't really endoscopic. There is a small knife tool that enters the wrist while an external piece performs the ultrasound portion. So the "eyes" are outside the structure. I do like your 76998...
  28. J

    Carpal Tunnel Surgery using the Sonex Microknife

    Has anyone had experience coding CTS done with the Sonex Microknife (including ultrasound guidance)? I code for a hospital outpatient department and have a surgeon that is going to start bringing this procedure to our location. I am familiar with 64721, which is the code we use for the regular...
  29. J

    Remplissage Procedure

    Late to the discussion but I just found this info Per Coding Clinic 4th Q, 2016 page 10, question 2 from the "Ask the Editor" section (In summary) When a patient reports for an arthroscopic anterior capsulolabral repair with arthroscopic remplissage and rotator cuff repair- report code...
  30. J

    Trulicity (dulaglutide) coding

    Hi, I was wondering how everyone was coding the use of Trulicity for type II diabetes patients? It was listed as an injectable drug -but not an insulin product- in my patient's chart. The codes I have found for diabetes meds were : Long term (current) use of insulin- Z97.4 (It...
  31. J

    Does each procedure note need to stand alone???

    I agree completely as long as there was no interruption of sedation between those procedures.
  32. J

    BRCA 1 + ...Z15.01 and Z15.02?

    Hi diagnosis whizzes, I am coding a case of prophylactic ovary removal due to the patient having a personal (remote) history of breast cancer and a newly gained positive BRCA 1 test. The only diagnosis the physician is stating besides the personal history of breast cancer is "BRCA 1+". I...
  33. J

    Are 64721 and 64719 code-able together?

    great, thanks! I am going with source 2, stating that 64721 and 64719 require a separate incision/ approach in order to be coded at the same time.
  34. J

    Are 64721 and 64719 code-able together?

    I have 2 well-versed sources telling me different guidelines to determine whether these two procedures are code-able together or not. Source 1 says that as long as I have a good applicable diagnosis justifying each release, there are legitimately two structures requiring release to cure two...
  35. J

    pathologic shouler labral tears, SLAP and non-SLAP

    What is everyone using for a SLAP tear that they physician dictates as non-traumatic? How about a non-traumatic shoulder labral tear that is not a SLAP? We have looked at and discussed the M24 set and the M75 set and were recently instructed by a higher up (that is very educated) to use the...
  36. J

    OCD of Talus, caused by injury NOT disease

    Can anyone help me find a diagnosis injury code that would identify an OCD lesion of the talus or the right ankle that was caused by an injury? I keep coming up with M codes and I need an S code. :( Thanks!
  37. J

    Cystoscopy with retrograde pyelogram and ureteral stent exchange

    I believe 52332 covers it all.
  38. J

    Questions regarding bundling 46230 and 46221

    I am just looking to clarify a couple of things for myself if anyone has an opinion or info on the topic, I would appreciate any input. If a patient presents and has 5 band (internal) ligations done at the same time as they have 3 exterior tags removed from the anal region, it doesn't seem in...
  39. J

    Please help...Does code 23550 include excision of a portion of the clavicle?

    The link did not work but thanks for trying :) Your effort is appreciated. We had also sent this question to our supervisory team in-house and they returned the same result. No one gave me a specific resource but we are all agreeing now that 63550 alone does NOT include excision of clavicle...
  40. J

    Please help...Does code 23550 include excision of a portion of the clavicle?

    I have a procedure that fits the 23550 code very well except the surgeon actually excises a portion of the clavicle during the procedure. I do not see 23550 and 23120 bundling...are they codable together or does the 23550 cover it all? If you can find any literature on why they can or cannot...
  41. J

    Chelation of Calcuim Band Keratopathy w/ Gunderson pedicle conjunctival graft

    Final answer I have reviewed this one several times with other coders and we have collectively decided that this procedure was best described using codes 65436 and 68362. That is what I am moving forward with.
  42. J

    Chelation of Calcuim Band Keratopathy w/ Gunderson pedicle conjunctival graft

    Hi all, I am looking for more information in coding a procedure the physician is calling "chelation of C++ Band keratopathy" and the use of a "Gunderson pedicle conjunctival graft" both procedures (graft placement and harvest as well) same eye. Abbreviated Op note below- Pt has a history or...
  43. J

    I10 Ultrasound for guidance, previously 76942, for nerve blocks

    -error- -error-
  44. J

    "Colon scrn" with long term diarrhea and fecal incontenence

    I am a relatively new coder for an outpatient facility. YESTERDAY, I had a note returned to me stating that I should have left v76.51 as the primary dx for a patient that presented with multiple digestive symptoms, including long-standing diarrhea and abdominal pain. I was corrected by a more...