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  1. D

    Atypical lymphoid infiltrate, code needed

    I agree with 238.2 - this a an appropriate example of uncertain behavior.
  2. D

    Excision Size vs Lesion size vs path report

    Do not use the size of the elliptical excision You would code this as 1.8 cm - You do not code this as the 3 cm elliptical. The codes are for the lesion plus margins. An elliptical excision is not about margins but about appropriate closure technics. Please see the pictures associated with...
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    Need help with lesions excision guidelinse

    Anyway this CPT assistant could be provided? This contradicts what I have read about coding this scenario. Please note this article by Dr. Janevicius an ASPS representative to the AMA CPT Advisory Committee. This is his comment under the header 'Coding excisions of neoplasms': Many of these...
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    skin lesion removal coding

    lesion plus margins = excision code When a doctor removes a "BCC 9mm lesion on the trunk."however with margins it is 1.5cm. How would that be coded. According to the CPT book, it states "lesion including margins" so would it be 11601 (0.6 to 1.0cm) lesion size only or (11602 1.1 to...
  5. D

    Neoplasm table

    FYI A neoplasm of the skin of the breast is not the same as a neoplasm of the structures of the breast.
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    Clarification 111xx vs. 113xx

    The difference between these two code sets is whether the lesion was removed. If a complete removal then it is not a biopsy. When a lesion is removed by shave technique it is coded with 113xx. 'Does anyone know why some MDs state "Shave Removal" "Shave Biopsy" and always bill same code...
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    Biopsy vs excision

    I agree with Tonya. Follow the original intent which was a biopsy. I discourage providers from changing anything already documented just for better reimbursement.
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    Help with Self Auditing?

    I agree with Cheryl. There is a lot of incorrect cross usage of PFSH into the ROS. CMS specifically states that past medical history can not be used as ROS.
  9. D

    colonoscopy diagnosis coding

    I agree that this would not be a screening. The screening benefit is for colorectal cancer so the doctor must be clear that s/he is performing a screening to evaluate for colorectal cancer on an asymptomatic patient. Keep in mind that there is no cure for Crohn's so there is no 'history'...
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    digital block-If anesthesiologist

    I agree with aaron that the block is normally bundled with the closure. This could be seen as unbundling. I coded for ER for 4+ years and have never heard of anesthesiology involved in a laceration repair.
  11. D

    EMR & Documentation

    I think we agree. Doctors should not be coders-they do not want to code. My point is if the provider is putting a code anywhere in the medical record then they need to agree to changing those codes. Many EMRs record the provider's assignment of CPT and ICD-9 codes directly into the notes...
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    How do I know when I NEED a modifer?

    You do not need a -59 modifier here. The -59 is a misunderstood and overused modifier. This should only be used when you bill two codes that are bundled and there is reason to unbundle the codes. Here are the reasons per CMS: 1) Different sites 2) Different incisions 3) Different encounters...
  13. D

    EMR & Documentation

    The medical record is a legal document. You must be the author of the record in order to change the record. You must have permission to change the codes.
  14. D

    Full Thickness Skin Graft Closure

    What modifiers were used?
  15. D

    Mohs done in global period of ED&C

    No, the global period is on the other provider's procedure and is not a repeat of the same procedure.
  16. D

    Looking for some info

    Degree requirements vary by employer. All will require about 5 years coding experience, some will require auditing experience. You want to have that coding experience to succeed. Passing the test is not a substitution for experience. I believe you can't register for the AAPC test without the...
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    exam documentation

    The cc and HPI must be documented by the provider not the MA. No, I would not accept an exam that doesn't mention the body part examined. Consitutional requires documentation of at least 3 vitals (temp, blood pressure,ht, wt. etc.)
  18. D

    reconstruction of Mohs wound

    A notch? A scar or deformity of the site is not coded with the cancer code at this point (with no evidence of disease). Was something sent to pathology by your doctor?
  19. D

    Large skin tag excision

    Doesn't matter what size it is it is still a skin tag.
  20. D

    Past Medical History-Is it acceptable

    According to CMS, past history can't be used in the ROS. Q: Can I use the patients past history in the review of systems (ROS) or history of present illness (HPI) elements of the E/M score sheet? No. The ROS and HPI elements pertain to the chief complaint and the reason for the patients visit...
  21. D

    Biopsy with C & D

    A biopsy is often performed before another more comprehensive procedure of the same lesion but it is not billable.
  22. D

    Mohs surgery in global days.

    Closures have a variety of global periods Not all closures are 90 day global. Simple closure has a zero global, intermediate and complex have 10 day global. Flaps, grafts and adjacent tissue transfers have 90 days.
  23. D

    Screening vs Diaginostic

    This is still a screening. Please read toward the bottom of the link provided. •Is a surveillance colonoscopy (patient has no current symptoms but a polyp or cancer was identified during a previous procedure) considered a screening? Yes. A surveillance colonoscopy is a high-risk screening...
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    Removals

    You can post these questions to the Dermatology forum here where there are several CPCD certified folks answering questions. (use the search function) 'Inga Ellzey practice group' is a great source. The AAD.org has info about coding and much more. Beware of just using google. Old info is...
  25. D

    Diabetes Education

    Only a doctor or NPP can diagnose (ie. provider working within the scope of their practice to diagnose) What are the credentials of the diabetes educator?
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    chief complaint question

    If all E/Ms billed require a chief complaint then what would you down code to? The chief complaint explains the reason for the provider to see the patient. It is the medical necessity for the visit. A lot of providers believe that the hospital is a running comentary on the visit-maybe...
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    Finally! My first Coding Job-Internal Med-Gastroenterology

    As far as advice goes...read, read, read. If your company has a policy manual start reading there, but don't stop. Know Medicare guidelines. For GI info (coding and more) checkout AGA.org Google is a place to stimulate your thoughts but it is often not a reliable source. Remember, CPT...
  28. D

    Advice!

    Proof is in your book The answer to your question, and therefor the proof, is in the front of your ICD-9. These guidelines answer many questions that are asked in the forums. I highlight the guides that I am checking often or tend to use as explanantion for audits of doctors or coders. Dee...
  29. D

    Takken the CPC exam? How many passed the 1st try?

    I passed the first time with 1 year experience. I went chapter by chapter with a PMCC instructor at work. Dee CPC, CPCO, CPMA, CPCD
  30. D

    13 Visit Rule"

    Leandra is correct. If all else fails, ACOG.org is a great source. Dee CPC, CPMA, CPCD
  31. D

    Seminars-new to ENT coding

    Karen Zupko is a well known source. We are attending a seminar by her group for ENT and ortho June 6-8th. We can't wait. Looks like we will have the doctors there too! Dee CPC, CPMA, CPCD
  32. D

    Curretage with Excision

    As with many posts here, the note is required to make sure the question matches the documentation. I field many questions every day at work and only a few match the note once I read it. My concern is the statement, 'From which size would you add the margins to get the diameter?" You cannot...
  33. D

    Curretage with Excision

    That is odd. I have never seen the same lesion excised after an ED&C. Anyway we could see the note? Is there an explanation of why he/she didn't start with the excision? Same lesion then only one code can be billed. You stated, 'which size would you add the margins to get the diameter?'...
  34. D

    Critical care

    I did audit for hemonc but not inpatient charges so I hesitated to answer. However, I have coded ED so this is what I am thinking: There are serious reactions to chemo drugs including anaphylaxis. A serious allergic reaction is often coded as critical care because the airway may be compromised...
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    Time Coding Example

    The office is face-to-face and it seems that is a missing piece for the doctors. They do not have to state it exactly, '"Total time spent was xx minutes, with >50% of the visit in direct face-to-face counseling and coordination of care with the patient discussing/treating/planning, etc...."...
  36. D

    Billable?

    I don't have my books with me but there is a code for filling out paperwork. It might be 99080. Since it seems that there is no real medical necessity for this visit and the Doc documents the reason for the visit is for the form, I would not code and E/M. Dee CPC, CPMA, CPCD
  37. D

    number of elements

    How is When did the problem start? different from How long have you had this problem? In the example the answer is the same..today. Neither of these are timing. Dee CPC,CPMA, CPCD
  38. D

    Curretage with Excision

    Did the doctor do an ED&C-Electrodesiccation and curettage? With an ED&C the provider may measure then after treatment have to go beyond that original measurement. This is because the cancer below the skin is wider than visibly seen above the skin. I have asked my doctors to do a before and...
  39. D

    Critical care

    No, I am sorry but because the hospital lists a patient as critical does NOT make it okay to bill critical care codes. Critical care codes are for a service that is rendered to stabalize a critically ill or critically injured patient. Being in ICU does not justify critical care. Please read...
  40. D

    pfsh help

    What do you mean ROS-is complete and exam -complete? Is that what the doctor is stating in the note ("I obtained a complete ROS and performed a complete exam"? or are you counting the elements and just stating that it is complete? It would be easier if we could see the actual note -redacted.
  41. D

    Evaluation & Management

    I wouldn't consider chronic a quality. Throbbing, aching, heavy, hot, sharp, dull...all qualities or descriptions of the condition or symptom. Chronic as oppsosed to acute-these are about duration. Dee CPC,CPMA,CPCD
  42. D

    Screening vs Diaginostic

    If a patient has symptoms (ab pain, gas, BRBPR, diarrhea, constipation, etc.) requiring a colonoscopy to look for a cause for the symptom then this is not a screening. Just because the doctor documents “screening colonoscopy" that doesn't make it a screening. A screening colonoscopy is...
  43. D

    psfh

    99203 requires a detailed HPI. A detailed HPI requires 1 PFSH. 99204 and 99205 require 3 PFSH. Here is our CMS guide (colorado) a bit long but detailed: http://www.trailblazerhealth.com/Publications/Job%20Aid/coding%20pocket%20reference.pdf Dee
  44. D

    When do you change a cancer code to personal history code?

    See the coding guidelines at the beginnning of your ICD-9. Page 8 is the beginning of the guidelines for Neoplasms. Read section d. primary malignancy previously excised.
  45. D

    E/M and wart removal

    17000 is for destruction of AKs and 17110 is for benign lesions other than skin tags and vascular proliferative lesions (warts, sk, etc.) Dee CPC,CPCD, CPMA
  46. D

    location

    I usually agree with Inga Elzey but not on this...to me it is one rash. If there was a raised rash on the torso and a weepy rash on the arms then I might consider these as seperate elements. Dee CPC, CPCD, CPMA
  47. D

    Excision of lesion CPT coding

    I agree with Deb. I have worked with a large dermatology group (20+ providers) for years. These docs usually did a biopsy and then had the patient return when necessary. There were times when the assessment stated wart, scar or skintag but path came back as actinic keratosis or cancer. So...
  48. D

    Wart removal-I code in

    I agree with Julia and Mallory, we get paid for canthacur. Dee CPC,CPMA,CPCD
  49. D

    Need help coding this procedure!!

    Skin: Multiple SK's on neck; one on face. Larges t 2 on neck are about 1 cm; one in axilla is about 3 cm Impression & Recommendations: Problem # 1: SKIN LESION (ICD-709.9) 10 small SK's, and 3 large lesions removed with Ellman Unit. SK on face frozen. The lesions were cleansed with...
  50. D

    Neoplasm of uncertain behavior

    I'm sorry, but this is incorrect. Only use 'uncertain behavior' if pathology returns with uncertain morphology. I believe this is explained in the front of the ICD-9. Dee CPC, CPMA, CPCD
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