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  1. H

    Using Locum tenens as rendering

    A locum tenens is filling in for a physician out for surgery. The facility also does urine drug screens for multiple locations of the same company and the rendering (box 24J) has always been listed as the physician there in the location where he sees patients in the building with the urine drug...
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    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...
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    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...
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    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 -...
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    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...
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    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...
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    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
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    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"...
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    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...
  10. 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...
  11. 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...
  12. 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...
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    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...
  14. 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
  15. 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...
  16. 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...
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    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
  18. 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...
  19. 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...
  20. 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...
  21. 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...
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    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...
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    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...
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    Why is J2180 in the HCPCS book?

    It appears Mepergan (J2180), a combo of meperidine (Demerol) and promethazine (Phenergan) injectable has not been manufactured for a couple of years. We noticed a couple years ago the claims were denied and upon investigation found the payers knew the drug was discontinued and therefore stopped...
  25. H

    J2175 50 mg, but description is per 100, J2175 is per 100 in the HCPCS book, but patients routinely get 50 mg (while some do get 100 mg). Since the description is "per 100" vs. "up to 100" how do I bill this? I have done some research and getting very conflicting solutions - what do those that are on here do/suggest...
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    44025 and 44320?

    General surgeon did an exploratory laparotomy, on table decompression of the large bowel loop sigmoid colostomy. Any help to advise best way to bill this is greatly appreciated! Here's the op note once patient was open: The large bowel was noted to be markedly distended to the point where there...
  27. H

    5 procedures, how many can get paid?

    OK, my doc did: exploratory laparotomy, greater than 2.5 hours of lysis of dense adhesions, cholecystectomy, takedown and closure of cholecystoduodenal fistula, and enterotomy with removal of gallstones from the ileum! I have to believe I can get him paid for something other than the lysis of...
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    Help with partial gastrectomy

    OK, any help would be greatly appreciated. Partial gastrectomy but no mention of: gastroduodenostomy, Roux-en-Y reconstruction, or formation of intestinal pouch (43631-43633). OP note after opening via laparatomy: "A hole was noted in the anterior abdominal wall in the area of the mid stomach...
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    Discharge part of post op global?

    Patient is referred to general surgery (seen in office). Patient is diagnosed with colon cancer, is admitted as inpatient, undergoes colectomy by general surgeon, is followed post op, and discharged home. Is the discharge (99238) typically part of global, typically payer specific, or what? I...
  30. H

    Laparatomy,biopsies, resection/anastomosis

    All right, here's another I would appreciate help on. Procedures: Exploratory laparotomy, small bowel resection with side to side anastomosis, and excisional biopsies of small bowel mesenteric nodules X2. I get that exploratory laparatomy includes biopsy/ies. I get that exploratory laparatomy...
  31. H

    Small bowel obstruction?

    Please help - exploratory laparatomy for small bowel obstruction. Lysis of adhesion associated with open cholecystectomy done in 1984. Now, quoting from op note referring to adhesions: "These adhesions were lysed with the Bovie cautery and there was a loop of bowel that was twisted on itself...
  32. H

    Inpatient H&P

    To bill a 99221-99223, does it have to be done on the date of admission or within 24 hours of admission?
  33. H

    Pt home post op visit

    I am billing for a general surgeon that recently left his partner and is out on his own and trying to build up name/reputation in community. So... He has a patient that is post op, needs stitches/staples taken out but has transportation and financial issues. Doc has agreed to go to patient home...
  34. H

    Paraphimosis reduction CPT?

    Doc used manual means in outpatient office to perform a reduction of paraphimosis. Is this an "included" service in the E&M or is there a separate CPT code that should be billed specifically for paraphimosis treatment/reduction? Thanks, Hunter Smith, CPC
  35. H

    Modifier for infusion pump

    I'm getting denials requiring modifiers for infusion pump billing: E0780. Patient comes in, gets infusion of either: hydration, therapeutic, or chemotherapeutic and DME equipment is used in the process. Can I bill E0780 for the use of the pump during the infusion or is it "included" in the...
  36. H

    36000 with 99195?

    Patient with hemochromatosis requires blood to be drawn off for ~30 minutes, 1 time a week for several weeks and then periodically once on mainetenance. 99195 is what I am charging for therapeutic phlebotomy. Doc wants to also charge 36000 for the venous access to do the therapeutic...
  37. H

    E/m on pt/inr

    OK, This ?/issue has been posted several times and several different ways with very conflicting answers and responses. Internal Medicine practice (no PharmD involved). Provider established a guideline of what they deem acceptable PT/INR results to continue current coumadin therapy. If...
  38. H

    Wiki CPT for repacking/dressing change

    Does anyone have a solid answer on how to bill/not bill for a pt being seen for dressing change and repacking? A prior post on this site referred to 99211 example in appendix C, but that example states: "Office visit for an established patient for dressing change on a skin biopsy" (top of pg...
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    CPT for diabetic monofilament testing

    Does anyone know if monofilament testing for diabetic neuropathy is separately billable or if it is considered "included" in the E/M? If it is billable, what is the CPT? Thanks, Hunter Smith, CPC
  40. H

    CPT for botox injection into bladder

    Doc is doing 15-20 injections of botulinum toxin into the tissue of the bladder. Doc is visualizing with a cystoscope, maneuvering around the bladder and injecting the botox. Anyone know of a code for this procedure?
  41. H

    82274 when to bill

    If provider gives patient tubes for specimen collection for fecal occult blood they either: a) obtain specimen and return to office or b) don't bother with specimen collection. My question is: do I bill 82274 based on giving the patient tubes (provider has incurred expense and expense has walked...