1. K

    Cervical Polyp Removal GYN Coding HELP! New OBGYN Coder question.

    Hello everyone. A new coder to GYN and have a question about coding for an endocervical polyp removal. The only documentation for this was provided in the physical exam: Genitourinary: General: Normal vulva. Vagina: No vaginal discharge, erythema, bleeding or lesions. Cervix: Lesion...
  2. B

    Question CPT Codes 96132 & 96138

    Hello! I work for a Specialists office that does ADHD testing. However, we do NOT bill as Mental/Behavioral. We have been billing the following codes: 99214 96110-59 96132-59 96138-59 since I have been here, and starting November 2022, they (BCBS of NC and Aetna) are not paying the 3 testing...
  3. xxxZithxxx

    Question Pacemaker/Defib Checks after PM/Defib Insertion/Battery Change

    A patient has a pacemaker/defib inserted or battery/lead changed and 10 days later returns to the office for a routine follow-up visit and pacer/defib check. The follow-up visit would be billed as a post-op 99024, as it is within the 90 day global period. -->But what about the pacer/defib...
  4. J

    Question PDL Coding within Global Period?

    Hello! I am aware that PDL Coding (e.g., 17107~) of any kind has a global period of 90 days. However, I have a provider that bills for PDL every 30 days. With this, I was wondering if there is an appropriate modifier we can use to bill for PDL within the global period to get reimbursed by any...
  5. C

    How many...

    Hi, On a day with no interruptions, no queries and perfect documentation. How many accounts can you code PROPERLY and submit? (Yes, I know this scenario is unrealistic. But, please play along.) Specialty: Years of experience (range) Do you have to add y our own modifiers...
  6. S

    Candid Injection

    One of my providers read on through the AAD that you can bill the unspecified drug injection code J3490 for candid but candid as a specific code 86485 so I'm assuming I need to go with 86485 since its specific?
  7. B

    Question Incomplete Colectomy

    My provider attempted to perform a Lap Partial Colectomy with end colostomy- 44206. They also performed over 90 minutes of adhesion removal and a take-down of the splenic flexure. However, when they went to do the colectomy, the disease was too active and they decided to not do it, and no...
  8. M

    Office visit + preventative counseling for MEDICARE patient

    Hello, I do medical billing for a "weight management" doctor (AKA a primary care physician whose niche is providing weight loss medicines and counseling). As some of you may know, Medicare does not accept the typical weight prevention counseling codes other commercial carriers accept...
  9. A

    Coder review 99212/Provider insist on 99213

    I need feedback from Auditors and fellow coders. Let me start off by stating this provider does handwritten notes, which in itself is an issue. It is not at all helpful in justifying the level of care the provider would like to bill. I have two separate scenarios. Patient A is seen for a skin...
  10. E


    hello all, Can anyone enlighten me on coding in the EPIC system? I am trying to get a contract coding position, and they all want epic experience, but there's not a lot of information out there training wise. currently I've been using Cerner and 3M. Are they similar with charge entry? i'm...
  11. A


    We have been having an issue of getting our pain management injections paid by Optum Lifeprint (ex. ESI, MBB, RFA, Joint, etc). Everytime we bill an injection, we get a denial stating that Optum requires a drug code to be associated with the claim. And here is the kicker: we don't buy the drugs...
  12. K


    Hello, Is bacteremia considered high risk on the table of risk chart? The provider is treating the bacteremia with IV antibiotics.
  13. V

    Question Medical Decision Making Table (Number of DXs or Treatment options, DATA Reviewed, and Risk table) Examples for Inpatient Hospital Coding 99221-99239?

    Hi, I wanted to ask if someone can provide me with some links or websites or anything really, that may have a list of common illnesses/injuries that are good examples to use for the different levels of the MDM table for Inpatient Hospital Coding (99221-99239) For example, just like on the Risk...
  14. S

    Using an SUD specific CPT code with a BH diagnosis

    Hi there, I am trying to do some research about using 99408 which is - Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services and having a BH diagnosis for example F42.9 Obsessive-compulsive disorder, unspecified. Does...
  15. M

    Question Weight management billing

    I do billing for a provider who considers himself a weight management specialist. His primary method is a combination of medication and weight management counseling. He also acts as a PCP for his regular patients, but his main priority is weight management. When we bill insurance, we typically...
  16. A

    Ruling: RTM (Remote Therapeutic Monitoring) and Physical Therapy

    Our company is trying to distinguish what are the or are there even parameters to the meaning of "interactive communication with the patient/caregiver." Particularly for codes: CPT code 989X4 — Remote therapeutic monitoring treatment management services, physician/ other qualified health care...
  17. M

    Pap Only Visits

    Hello! Please advise....not sure how to code for pap only visits to Medicaid. Our claim denied - service (99212 & 88164) not allowed for this DX (Z12.4). Thank you in advance!
  18. C


    I have a patient who came in with bilateral knee pain and right shoulder pain. Doctor Injected 40 MG Kenelog into RT knee, 40 MG Kenelog into LT knee, & 40 MG Kenelog into RT shoulder. How can I code this properly for it to go through with Medicare Primary and BCBS secondary? I tried J3301 -...
  19. J

    Modifier 27 help

    Hi all! I'm looking for resource material regarding the use of Mod-27. I code for an ED with affiliated Primary and Specialty Care offices and Walk-In's. At some point, someone in my organization advised we could not use Mod-27 with ED E/M's when a patient has an additional outpatient visit that...
  20. P

    Question EEG Billing and Coding

    I work for a private Neurology practice and just became a certified biller. We offer Amb EEG to many patients with the following codes 95700, 95708, and 95721. We are not getting reimbursed for these or getting reimbursed very little. Does anyone know the best way to code the set up, the...
  21. M

    Question billing RPM and CCM services for hospice patients

    Hello I have a few questions in regards to billing RPM and CCM services with patients who are enrolled in hospice; 1) Should patients in hospice be billed for this service at all? 2) If a patient has passed away in the middle of the month, can any of these codes still be billed (99453, 99454...
  22. C

    Question Billing/coding for covid vaccine third dose and flu vaccine at same encounter

    Hello - reaching out to see if anyone has found any specific CMS/payer guidance regarding billing for the covid vaccine and flu vaccine at the same encounter. Our practice is having trouble with Anthem processing the traditional administration codes for the flu vaccine- 90471/2 (when billed with...
  23. L

    Orthopedic Surgical Coder (Certified)

    Coding since 2018. Looking for part time or contract work coding trauma, other orthopedic surgeries, or office visits. Please email for inquiries
  24. M

    ICD-10 for Pregnancy NOS

    Hello everyone! Which code to use for Pregnancy NOS Z33.01 or Z34.90 for Texas Medicaid? Thanks everyone!!
  25. M

    Help with TB coding

    Hello coders! Need help coding this scenario: TB nurse visit patient presents for labs and complains of orange urine and yellow eyes. Payers are Medicaid and Medicare. Any and all feedback is greatly appreciated. Thanks!!
  26. M

    99211 on same day as injection and pregnancy test

    Hello coders! Please help clarify so I can settle the dispute with the NP and WHNP in my office. A patient came in and was seen by the CMA for pregnancy test and depo injection. The pregnancy was negative. Can we bill a 99211 with the depo injection and the pregnancy test? Please explain...
  27. M

    Pregnancy Test

    Hello coders! Can anyone confirm if an E/M code is needed when a patient is coming in for a pregnancy test and if so, what code will that be. This will be for commercial and Medicaid payors. Thanks everyone in advance!
  28. M

    CPC-A seeking first job

    Hello! I completed my CPC course in JULY 2020 and I am actively looking for employment! I am located in the St. Louis Missouri area and can also work remotely! Thank you!
  29. S

    Pain Management Billing

    We are billing for a bilateral lumbar RFA for 3 levels and are having trouble getting the add on code to pay. It is 64635 Mod 50 and then since the add on code can no longer be coded with a mod 50 we have done 64636 with 4 separate line items (with no modifier) and it has denied. The 2021 CPT...
  30. KStaten

    New Forum Feature Suggestion- AAPC Expert Interaction in Forum

    Hello, Everyone! :) I have been reviewing some of our posts on here and the thought occurred me to that many times, we are struggling to find solutions to our answers. Many questions either go unresolved, receive contradictive answers, or simply fade into the gray area. Now, that doesn't mean...
  31. C

    Question Coding-adjacent positions available?

    A few months ago, I completed a certificate program at my local community college and got my CPC-A, but it seems that nobody will take on new hires without coding experience. Are there any entry level jobs that would be helpful for getting a coding job? Ideally, it would be something less...
  32. L

    PPE Advice

    Hi everyone! I'm a health information technology student in my last semester in need of assistance. As part of my program, I must complete Professional Practice Experience hours at a facility. Any suggestions or advice on contacting facilities/practices? It's been difficult getting in touch with...
  33. V

    Question Therapeutic Wound Exploration and lysis of lumbar adhesions.

    Our pain management doctor performed a procedure which was authorized under CPT code 11043 - Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less. This is what the doctor documented: The patient was brought back into the...
  34. R

    Question CPT Coding for Urine Albumin Creating Ratio (UACR

    It was my understanding that the codes for UACR would be 82043, 82570. Are these to be both submitted for UACR tests?
  35. G

    Chiropractic Physician, CPC-A, MCS-P (Compliance Specialist)

    I am seeking full time employment in coding, auditing, and compliance work. I have practiced Chiropractic (Family practice, portal of entry) for 23 years, I have been a Compliance Specialist and Officer for my practice for 3 years, and a newly minted CPC-A. lastly, I am a post-graduate...
  36. R

    Question CS MODIFIER

    When a patient presents with COVID-19, as a hospitalist, can we use the CS modifier? Also when the patient is COVID-19 recovered but we are using diagnosis codes Z09 and Z86.19 can you use the CS mod with that as well?
  37. M

    96127 and UHC

    Hello, we are able to get reimbursement from every major healthcare provider. We are at a loss with United healthcare though. I was wondering if I can get any feedback from somebody on how they get reimbursement for the 96127 CPT code. Not sure if it has something to do with the diagnosis or a...
  38. M

    Therapy Billing

    I recently started billing and coding for a Therapist/Counselor for substance abuse. I am billing all insurance as out of network. My claims are continuously getting denied. How should I be billing out of network for a substance abuse therapist?
  39. L

    Question What is STO coding?

    There is a job posting on that says, "Medical Coder (STO and Inpatient Facility and Profee Fees ONLY)" What is STO?
  40. M


    Twin pregnancy, Baby A delivered vaginally, but demised. Baby B, C-section, alive. What CPT codes would you used for delivery? This is global insurance.
  41. K

    Question Antibody testing

    I need help. I have antibody testing that needs to be billed out but not sure exactly what codes to bill out for IgM, IgG, and IgA test. Do I bill out 3 codes for each one of them? Is it one code? I have found that 86769 is the antibody testing code. Just not sure if I need to bill it out 3...
  42. T

    Question Coding Department Structure

    Can anyone share with me the organizational structure of the coding department you work in? I would love as many responses as possible. Feel free to also share feedback, what you like or dislike about the structure, any roles you feel are missing. Really trying to gain a solid perspective of...
  43. C

    Ambulance Billing and Coding

    I am posting here to get some insight, references, and general knowledge about ambulance service billing and coding. I have been in my position as the sole biller and coder since December 2018. I've picked up most of my knowledge just by being in the position, but I would really like to learn...
  44. M

    Experienced Biller and Coder looking for Coding/Billing Opportunities

    Magdalene M. Dorsey 616 Gold Sand Road, Louisburg, NC 27549 Home: (919) 853-9000 – Cell: (919) 441-0408 - Education Associate of Applied Science Vance Granville Community College Area of study: Medical Coding Cumulative GPA: 3.773 Graduated: May 2014 High...
  45. T

    Question 99211 , 96372 coding when patient brings his own Testosterone Medication

    I work for a Urology Practice. The patient brings his own medication for Testosterone. We are questioning coding for 99211 &/or96372. The nurse is injecting medication the patient brings to office. In the Office note signed by the MD it is documented as there is HPI, PQRI, Allergies, Medication...
  46. R

    Question Telehealth interrupted

    What would you code/bill (I'm with an FQHC in AR) a telehealth virtual visit where connection was lost and ended up just being a telephonic visit? Would it depend on the time of each? What about a modifier? (I'm thinking reduced service maybe?) Any help would be appreciated.
  47. V

    Question G8990 - alternative code?

    Good afternoon everyone, Our office has been using HCPCS code G8990 for our grip strength tests and cannot seem to find a similar code in either the HCPCS or CPT book since the code was deleted on January 1, 2020. Does anyone have a suggestion? I would rather not use an unlisted procedure...
  48. G

    Does anyone code for Medicaid of WA RHC?

    We are an RHC and we are having issues getting OB claims processed by MA WA. Biggest issue at this time is MA WA does not accept our billing of high risk DX codes and only wants to pay on normal pg DX codes. ????? Any help or pointing to references that actually can help would be greatly...
  49. ily620

    CPC w/ Coding, Billing, and Revenue Cycle Exp.

    Hello, I am CPC certified with 15+ years of medical coding, billing, and revenue cycle management experience. I am looking for a remote coding and/or billing opportunity that can be either part time or full time. I have attached my resume for reference of my skill set. Thank you in advance...
  50. B

    I changed my career path...earned my CPC on my first looking for a coding opportunity!

    You and I might have something in common. We are both looking for a long term relationship which will benefit each of us. And like many successful relationships, it all starts with a hello. Now, I am not trying to sound pompous but I have many years of experience and skill. But, here’s the...