1. K

    Wiki incomplete colonoscopy due to poor prep, with same day complete colonoscopy

    Patient was scheduled for a complete colonoscopy. Due to poor prep, the colonoscopy was halted at the hepatic flexure. (45378-53,33). After several hours and another prep the same day, the patient had a complete colonoscopy, 45378-33. Is the first, same day, incomplete colonoscopy billable? or...
  2. N

    Wiki Application of casts and strapping

    We have a situation that has created quite a debate in our office that we could use some advice on. Here's the scenario: a patient presents to the clinic with a fracture. The physician evaluates the patient and stabilizes the fracture with casting or splinting prior to surgery at a local...
  3. B

    Wiki bundled or billable

    Hi I hope all are doing well... Please share your suggestion on this. As per documentation, patient got admitted in ED with the complaining of abdominal pain then patient found to have gallstones by ED physician (99284). Finally patient got discharged and admitted as inpatient care settings on...
  4. G

    Wiki INPT/OPT admision and discharge same day

    Patient was admitted to the Observation on 1/31/2016. The admitting physician gave the orders over the phone on that day at 5:50pm. He saw the patient the next morning (2/1/2016) and did the H&P. Then, patient was discharged from the Observation on the same day at 4:10pm. How should it be...
  5. L

    Wiki Mutiple Visits - same Tax ID

    Does anyone have any experience or knowledge regarding billing multiple visits on the same date of service under the same tax ID number? I code for a rural family practice clinic and they are wanting patient's to be able to schedule multiple appointments in one day (if needed), like a "one-stop...
  6. M

    Wiki DSMT G0108 and G0109

    I recently was asked about a scenario where a Medicare patient received 30 minutes of individualized training (G0108) and 45 minutes of group training (G0109) both performed on the same day. I am not able to find anything in writing that states if both codes could be reported on the same day...
  7. A

    Wiki 65400 ptk

    My doctor is asking if 65400 RT and LT are allowed to be preformed during the same session. The patient doesn't want to go to the surgery center multiple times, so we are trying to accommodate. Also, will the second eye be paid at a reduced rate because of being done the same day? I've been...
  8. C

    Wiki Post op visits after global periods are eliminated

    Supposedly, CMS is eliminating 10 day post op periods in 2017 and the 90 day post op periods in 2018. Does anyone know how we'll bill for post op visits after the global periods are eliminated? I assume we'd use the appropriate 99xxx code but will there be special modifiers to indicate that...
  9. S

    Wiki Help!

    We recently added a dermatologist to our practice and he insisted that we can bill an office visit 99213 and excision for the same day with the same diagnosis code...I believe that's not right ...Please help
  10. P

    Wiki 97610

    Anyone know if you can bill 97610 per wound or is it a code you can only bill once per day no matter how many wounds it is used on?
  11. R

    Wiki Transitional care and smoking cessation

    I have billed 99496 transitional care with modifier 25 and 99406 smoking cessation. New 2016 guidelines have stated that transitional care can now be billed on the day of the face to face visit that's why they were billed together on the same day. I received a denial saying the procedure code...
  12. D

    Wiki Consult and Procdure question

    One of my doctors asked me the other day if he does a consult on a patient to determine if a procedure is needed can he bill for a consult and a procedure on the same day? I told him that I did not think we could bill for both. Who is correct?
  13. T

    Wiki Medicare Denial of 88305 when billed with an unrelated MOHS

    We are a dermatology practice with a doctor that specializes in MOHS (and is a histophathologist). We also employ ARNP's who will occasionally do excisions of skin cancers on the same day a MOHS is performed, which results in an 88305 charge. The pathology is read by our doctor-the...
  14. V

    Wiki Exploratory lap with lysis of adhesion help

    Hi guys Dr performed exploratory lap with lysis of adhesions but he only temp closed the abdomen with wound vac because he wanted to have a second look in 24 hours. So the next day he brought the patient in again and did another exploratory lap with closure of the abdomen. would I code day one...
  15. L

    Wiki Change in the Global days for Ophthalmology Laser Procedures for 2016

    Two of our surgeons are questioning the decrease in global days from 90days to 10days for all laser eye procedures. Have found nothing to indicate a 10 day global period for codes 67210, 67220, 67228,67145, 66762, and 66821. Have found only two codes which indicate a 10 day Global Period 66761...
  16. C

    Wiki Gazyva

    Has anyone had any experience billing Gazyza? It's a 1,000mg vial-day 1 100mg and day 2 900mg. Trying to find info on CMS site.
  17. K

    Wiki Bx, path and MOHs same day

    My provider is doing a biopsy/path code same day as MOHs surgery. The site is different than where the Mohs was performed. My office manager is telling me that 59 is not appropriate for the Bx and path code? I am new to this speciality and need advise. Thanks.
  18. J

    Wiki Hospital Discharge date-of-service

    A provider does a discharge summary on one day and the patient is not really discharged until the following day, which DOS do we use for the discharge? If we use the DOS for the real discharge day but the discharge summary has the day before’s date on it, do we need an addendum in order to bill...
  19. L

    Wiki Modifier 57 - variety of payers

    Hello, I am seeing a lot of denials by a variety of payers for the E/M code with 57 modifier when a surgery is done the same day or day after. Is anyone else seeing this? We have been appealing with no success. I am not sure what the increase is caused by but we are following CMS guidelines...
  20. E

    Wiki Consult with POS ER for Medicare

    I have been coding ER visit codes 99281-5 for the crosswalk for Medicare Consults when the POS is the ER and not crosswalking to OP visit codes new or established for Hospitalist and Orthopaedic consults ;I use those when the POS is Obsrv. Can anyone tell me if I am correct to bill the ER codes...
  21. J

    Wiki Help!!!! Ortho coding

    I have a patient that was seen in ER on 12/2/15 and then went directly to the office to be seen. The PA saw him and billed 25600 and then on the same day he went back according to the notes and was admitted for outpatient Surgery, The dictated operative report on 12/2/15 by the physician is...
  22. M

    Wiki New cpc-a, looking for employment

    Hello, I am a new CPC-A (11/2015). I am looking to start my career in coding. Does anyone know of a company(ies) that hires CPC-A? Any information you can provide will be greatly appreciated. Have a wonderful day. Thank you,
  23. P

    Wiki Staff using cheat sheets ?

    Does your staff use I-10 cheat sheets ? I am trying to get my admin staff to use I am giving out carpal tunnel I-10 code on the daily...every day sometimes multiple times a day. they do not know how to look up code in Epic. they are not coders. Just want to know if i am being...
  24. D

    Wiki CGSC exam, how to know bundling w/o electronic devices

    Hello! For those who have taken the CGSC exam - how do you know when procedures are bundled, Category 1, Category 2 codes, etc., when you are not allowed to use any electronic devices? In our day to day coding jobs you cannot survive without Encoder, CMS website, etc. So, how did you memorize...
  25. J

    Wiki prolonged service

    We have a pharmacist that provides education on insulin pumps after the provider has seen them. Here is a sample of the dictation: Reason for Appointment 1. Insulin pump start History of Present Illness Care Coordination: Larry and his wife present to the clinic today for an...
  26. D

    Wiki Referrals and MDM - I work for an urgent care

    Good Afternoon, I work for an urgent care organization and we average roughly 60 referrals per day. I reviewed the CMS 2014 E&M guidelines and under the MDM section for "Number of Diagnoses and/or Management Options": If referrals are made, consultations requested, or advice sought, the...
  27. N

    Wiki 2 providers 1 patient same day DIFF.SPECIALTIES

    What modifier can I use for denied claims when 2 providers see the same patient on the same day? Long term care setting. A NP sees pt then the physiatry doctor sees the patient. Same practice but one provider is a specialist and the other is a physicians assistant or NP... we get denials but I...
  28. A

    Wiki Pre op appt

    If a surgeon sees a patient and makes the decision for surgery and schedules the surgery a month out and the pre op appt for 2 weeks out, can you bill for that visit? I have always understood that once the decision for surgery has been made, you can't bill for that office visit regardless of if...
  29. Valdezcg

    Wiki October 12 is State Coders Day In Texas!

    We have 19 chapters in the state of Texas. I propose we hold a 'get together' on "our" state day! Oct. 12, 2007 falls on a friday, but we could do this on the 13th (saturday). This would give us a chance to meet, greet, and network with our peers. Since the state is so big, we could hold it...

    Wiki 93975 vs 93976

    Ok the question of the day here...What is the difference between 93975(complete) and 93976(limited)? Someone please help, I am having a major coding problem here. Thanks so much! :)