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    Fat Graft to face

    Hello! Surgeon is excising a cyst off mandible and will take a piece of mandible as well. He will be harvesting a fat pad from the abdomen to fill space of excision. Is this separately billable or considered part of closure? Looking at 20926 for graft, but not finding anything for placement of...
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    Facility billing with TC/26

    I'm not experienced in outpatient/facility coding but need help with a question. How do you bill for procedures when there is a TC/26 involved? For example, a specialist see's a pt in out outpt clinic and orders an EMG. HE reads the EMG. The hospital billing department needs to bill the...
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    Lap placement of a J-tube

    Anyone know how to bill for this?
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    Lap and Open Procedures

    Pt was diagnosed with gallbladder issues and had a CT where a colon mass was found. She was taken to surgery and had a lap chole, and the doc then mobilized the splenic and hepatic flexures, but the colon mass was too big to resect laparoscopically. He converted to open and took the mass "en...
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    Transfer to another facility - Doctor is transferring an inpatient

    Doctor is transferring an inpatient to another hospital (not related to ours). Will he bill for a discharge or a subsequent inpt code? He will not be involved in care any longer. Thanks
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    Help with Lesions Please

    Ok, skin lesion experts...help me resolve some differences of opinion please! 1. Doctor documents "the elliptical excision was 4x2cm" and doesn't specify much more than that...would you code as 4 cm or 6 cm?? ( and yes, I know, Dr should specify...let's pretend he moved to Antarctica where...
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    Surgeon doing anesthesia?

    We are a small hospital, but we have four gen surgeons. Our hospital currently only staffs one OR at a time. One of my surgeons has certification in some sort of anesthesia using Propofol. They are wondering if one surgeon could operate, and the other administer the propofol and do the related...
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    Help with HPI level

    What level of HPI would you give this? I struggle with these when its not the normal list of symptoms/elements of HPI. :confused: "Pt is new to this clinic. She was seeing Dr.AAA, prior to that was seeind Dr.BBB. She has depression and anxiety, she is worried I am going to change her meds. She...
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    Auditing a Specialist

    I occasionally have to audit visits done by a Rhematologist...a specialty I am not familiar with. This doc tends to favor level 5's and I am just not seeing it. He does have his complete/comprehensive HX and EXAM...but when it comes to the MDM I am not sure. In the table of risk, it does list...
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    Strangulated Umb hernia w/ excision of bowel

    Usually, when doing another procedure, and you close an unbilical hernia, its bundled. But what if the hernia was incarcerated and led you to excise a portion of small bowel? In the CPT book it says to code the repair of the strangulated hernia in addition to the codes for teh excision of the...
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    New patient

    Is there written documentation that states we should follow our intermediaries rules over CMS rules? Not that they are different...but they are being interpreted that way. I've written both CMS and my FI, and am awaiting response. Having an issue with the way they both describe a new patient...
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    Treatment of canal stenosis

    Ok all you ENT coders...a biller brought this to me, and I'm not sure what to do. Pt has canal stenosis, ear ends in a blind sac. Dr coded a 69310. Here is her note: Using 1% Xylocaine with 1:100,000 epinephrine, the area is anesthetized, An incision is made both vertically and horizontially...
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    GA-GY-GZ Modifiers

    Is all this correct??? GZ - an ABN should have been signed, but wasn't. Medicare denies and you cannot bill patient GY - a non-covered (excluded service) that you are submitting for a denial EOB only. (this non-covered can also be charged to patient and you do not have to send claim to...
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    Inpatient Hospital Billing

    Anyone have knowledge of how to bill the HOSPITALS charges for an inpatient? I'm talking the meds/supplies/IV's, etc (the $80 gowns);) I need some help with billing for services that are provided by outside agencies that come in when we call them to de certain things we dont have the staff to...
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    Wound vac replacement w/ washout

    We have a patient who had a hernia repair with mesh. The mesh was rejected and the surgeon on post-op day 3 went back in and removed it and placed a wound vac. Pt left with multiple enterotomies and abdomen left open (with wound vac) The patient has been taken back several times to the OR for a...
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    Standing Orders Expire?

    Are there any written guidelines on how long a standing order can stand? Of course, I know they shouldn't go to long without seeing the physician for a re-eval...but as far as official rules...are there any? Thanks!
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    Mesh Removal with abscesse

    Wow! I have been out of Gen Surg for 7 months, and already getting rusty! Surgeon did a repair of incarcerated ventral hernia with mesh, a few days later, he has to go back in. He removes mesh, and has to I&D several "pockets of fluid,mostly in pelvis" I was thinking (for second...
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    Cci & mod 59

    Ok, cci...you have column one and column two...usually this means column two bundles into column one, and so the 59 would go on column two to keep it from bundling, correct? Question two...what if column two code has a higher rvu value, and should be sequenced first on your claim...can you put...
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    Diagnosis Cheat Sheet

    Does anyone have a Family practice diagnosis code cheat sheet, perhaps in an excel file, that they would be willing to share via email?? Thanks!
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    Drug monitoring for toxicity

    I very recently heard in a teleconference or a webinar that there is a list available of "drugs that require intensive monitoring for toxicity" and that coumadin was NOT on it. Unfortunaltely I can find my note, or remember the source. Does anyone know if such a list truly exists?
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    Repair of mesh s/p hernia repair

    Dr. did a repair of a periumbilical incisional hernia, with mesh. Five days later mesh sutures pulled loose from fascia, and this resulted in a bowel obstruction. Dr. re-opened, reduced bowel, trimmed mesh and re-sutured it. How would I code this repair? 49566? 44050 ? Thanks
  22. L

    RX vs. Sample Meds

    FNP gives sample medication for GERD. Can this still be counted as "prescription drug management"? It is a medication that would require a Rx. Thanks.:D
  23. L

    Chemotherapy services

    I'm trying to learn billing for Chemo, and other injection/infusion services. From what I understand, hydration, when administered with the chemo, is not seperately payable. However you can bill it if it is administered seperately, as a subsequent service...for example if the patient becomes...
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    Out Pt Hospital Coding- need a CPC-H

    I have always worked in physician billing, and coded/billed for the professional services. Ive had a project given to me that involves hospital coding, of which I have no experience. We have a "Specialty Clinic" at the Hospital where the specialists see their patients, they also do...
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    Question on MDM

    Do you count co-existing conditions, that are not treated, but are listed in the dx list? Pt sees a general surgeon for hemorrhoids, exam is problem focused...but surgeon lists all this guys co-existing problems in his assessment list. Do you count these in the "amount of diagnoses" box, or in...
  26. L

    Documenting a consult.

    I know just because a visit is labeled as a consultation, that doesn"t make it one....but here is all I have: Doc writes: Referred by Jackie Scmoooe, FNP Reason for Consult:Possible umbilical hernia and then into the HPI, etc. He also dictates a letter that says " thank you for asking me to...
  27. L

    Hx "unchanged"

    Doctor documents "social history unchanged" and "no recent changes in medical history" I know he should be putting the date of the history he reviewed/compared to...but in an audit can you count this at all?
  28. L

    Wound Vacs

    I've always been with surgeons who refer to wound care centers for post-op wound complications, but I just started on with a group who has a new doc who does this type of wound care in the office. Is the wound vac code, 97605, payable in the post op period? If so, do you bill this code...
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    MDM and "additional workup"

    What constitutes "additional work up planned" when considering for medical decision making? For example...pt has an enlarged lymph node, and dr wants blood work...is ordering a lab test considered a "workup"? Ordering a CT or an Xray?
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    Preventative visits

    Are there any audit tools out there for PREVENTATIVE visits? I see alot of these with great exams...but alot of them lack in documentation of the other components...such as the anticipatory guidance. What is enough, and what isn't...and do any on you ever consider billing a Well visit with an...
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    Consult with colonoscopy

    I just found out a gen surg in our group has been billing a consult with a colonscopy. Situation is pt is set up for colonoscopy via their PCP....surgeon meets pt that day, examines and dictates wht he calls a consult, and then performs the scope. Pt is already scheduled for colonoscopy when he...
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    Coding Software-Our office

    Our office is looking into getting some sort of coding resource this coming year...CPT and ICD-9 coding, CCI and ME edits, global days, RVU....does anyone have any recommendations...either something downloadable, or web based. We have about 10 users here, but would maybe like to make it...
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    HPI elements - had cold symptoms

    When calculating HPI elements, do all "4" have to be on the same complaint? for example, pt came in for cold and shoulder pain.. Pt has had cold symptoms for five days (duration) and has been taking Robitussin with some relief of symptoms (modifying factors). complains of low grade fever...
  34. L

    Roux-en-y gastrojejunostomy

    I'm looking at an op for a Roux-en-y gastrojejunostomy (no gastric resection) with insertion of j-tube. Op in a nut shell describes anastamosis of jejunum to stomach, and then a seperate anastamosis of jejunum to jejunum...then the insertion of j tube at yet another site. I am considering the...
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    95 Exam Requirements

    Does anyone have any clarification on what a detailed exam is? What exactly does "an extended examination of the affected body area(s) and other symptomatic or related organ system(s)." mean? Thanks!
  36. L

    Modified Lothrop

    I am new to ENT, I know the description after some help from Google...but wondering about the code???
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