1. K

    Wiki Too many DX Codes for Medicare?

    I have a physical therapist wanting to submit a claim to Medicare with 6 DX codes for their evaluation (97163 GP & 97110 GP). Their primary diagnosis is G35 (MS) but the provider has also added M21.372, M54.6, M54.59, M25.552, M25.562. I am worried this will lead to a denial. Thoughts?
  2. E

    Wiki E66.01 Criteria

    Hello! I have a question/concern regarding E66.01 listed on some of our patients HCC lists that our ACO gives us for our Medicare Advantage patients. This code is sometimes listed for patients with comorbidities but their BMI is less than 35 - I have always been under the impression that E66.01...
  3. M

    Wiki Electronic source for code books

    Hi, Our clinic is wanting to move away from using the physical code books and would like to get electronic books or coding software, what do you guys recommend? Is Codify any good?
  4. T

    Wiki CEMC Exam

    I was wondering if anyone has any tips on how to study for the CEMC exam. I have failed twice and I am at a loss because I did really well on both the Practice Exam and the Study Guide exam.
  5. S

    Wiki Hysterectomy & Myomectomy

    I am far from an expert and actually very new to OBGYN specialty. I have a surgery that I am unsure of which CPT codes are appropriate and any advice would be appreciated. Case: Pre-procedure diagnosis: 1. Abnormal uterine bleeding 2. Dysmenorrhea 3. Uterine fibroids 4. Pelvic pain...
  6. P

    Wiki What is the scope of practice for a LCSW?

    Can a LCSW bill for the following services? 99457/99458 99449 99424/99425 99441-99443
  7. S

    Wiki Any Recommendations?

    Hey! I'm in a pickle. I'm having so much difficulty understanding how to code. I'm looking for additional practice from websites or anything you guys recommend. Please let me know :)
  8. F

    Wiki CPC-A Earned December 2023

    I am a highly motivated and detail-oriented individual with a strong passion for Medical Coding and Billing. I completed the Outpatient Medical Coding and Billing program at in November 2023 allowing me to earn my CPC-A in December 2023. I gained a comprehensive knowledge and...
  9. R

    Wiki Guidance on coding medications

    Hello! Recently the company I work for opened an imaging center and they are now billing for medications administered and contrast. This is something I am not super familiar with and feel as though I am struggling and cannot find much guidance on. I am wondering if there is any good webinars or...
  10. A

    Wiki APRN and PA Hospital Billing

    Hi there! I work at a cardiology group that currently has 12 physicians and one APRN and one PA. I was questioned by one of my physicians today on how to go about coding hospital consults and followups when the physician AND the APRN were together physically seeing each patient. How would these...
  11. P

    Wiki Remote Patient Monitoring - 99453 / 99454 / 99457 / 99458

    Hi, I am having difficulties finding resources regarding RPM billing and coding. First question, I was hoping to clarify if we could bill 99453/ 99454 for a “software” called Monitair. It’s a software that registers data from CPAP machines. It requires for the providers to set up an account...
  12. L

    Wiki R39.14 vs R33.8

    Here is an example of documentation with some of our providers: They also sometimes say something like: PVR of 68 mL indicating incomplete bladder emptying. Here is the link that I am referring to...
  13. A

    Wiki Difference between Independent Clinic (POS 49) vs Office place of service (POS 11)

    Can someone help me in explaining what is the difference between independent clinic (POS 49) and Office ( POS 11) as well as the scope of practice and types of services offered in both?
  14. A

    Wiki How Many Procedural Cases a Day is the Norm?

    Hi! I was wondering for a medical coder who works at a private practice for cardiology (interventional, general, and EP) and is the only coder for 14 providers what the norm would be for the amount of reports being submitted a day? I only code for hospital procedures. So I am doing all of the...
  15. S

    Wiki 99214 for NEO's

    Does noting a neoplasm and scheduling surgery justify a 99214?
  16. K

    Wiki 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...
  17. xxxZithxxx

    Wiki 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...
  18. J

    Wiki 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...
  19. C

    Wiki 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...
  20. S

    Wiki 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?
  21. B

    Wiki 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...
  22. M

    Wiki 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...
  23. A

    Wiki 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...
  24. E

    Wiki EPIC

    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...
  25. 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...
  26. K

    Wiki Bacteremia

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

    Wiki 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...
  28. S

    Wiki 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...
  29. M

    Wiki 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...
  30. A

    Wiki 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...
  31. M

    Wiki 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!
  32. 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 -...
  33. J

    Wiki 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...
  34. P

    Wiki 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...
  35. M

    Wiki 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...
  36. C

    Wiki 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...
  37. L

    Wiki 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
  38. M

    Wiki ICD-10 for Pregnancy NOS

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

    Wiki 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!!
  40. M

    Wiki 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...
  41. M

    Wiki 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!
  42. M

    Wiki 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!
  43. S

    Wiki 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...
  44. KStaten

    Wiki 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...
  45. C

    Wiki 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...
  46. L

    Wiki 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...
  47. V

    Wiki 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...
  48. R

    Wiki 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?
  49. G

    Wiki 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...
  50. R


    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?