1. Q

    Wiki Medicare vs. Medicare Advantage

    Whose coverage guidelines would take precedence between Medicare (MCR) NCD and a Medicare Advantage (MA) clinical policy, where the MA's policy was more restrictive? For example: If MCR guideline allowed for treating a certain condition, but the MA plan's guidelines require additional criteria...
  2. A

    Question E/M with Debridement in Wound Care Clinic

    Hello, Does anyone have further clarification on when it is appropriate to bill an E/M with a debridement performed on the same wound and in office, pos 11. Guidelines state they can be billed if a reasonable and necessary office visit is provided and is separately identifiable from the...
  3. H

    Question Coding pressure ulcer stages, should ICD stage be updated during healing process?

    For wound care, we are asking our providers to updated their ICD-10 codes when a wound changes stages. Example Sacral pressure ulcer stage 4 at initial assessment, but as services are being rendered, after a few visits, the staging is now at a stage 3. ICD should be updated to reflect Sacral...
  4. H

    Question Surgical amputation (can it be coded as traumatic?)

    If the amputation was surgical, can we still report the traumatic amputation codes? Example, S98.11A (Complete traumatic amputation of right great toe initial encounter) since there is no code that specifies complete SURGICAL amputation of right great toe initial encounter. (Coding for wound...
  5. C

    Question Surgery after Inpatient Fall

    I am very new to Inpatient coding and need some help please! We had a patient come to our hospital for a Right Total Knee Arthroplasty. Two days later, during his inpatient stay, he had a fall in the hospital and landed on his knee, splitting open his surgical knee wound. He was brought to the...
  6. K

    CPC-A with strong data entry skills ready to work full-time | Remote | CRC Exam next month

    Hi! I am a newly certified CPC-A that is seeking full-time remote employment. I scored 89% on the CPC exam two weeks ago and am currently scheduled to take the CRC certification exam on July 23. I have exceptional data entry skills from a computer programming degree and strong analytical skills...
  7. KStaten

    Injection Template Documentation Guidelines

    It has been to my understanding that the provider is responsible for documenting the procedure, exam, and plan (unless he/she is assisted by a scribe). IF a provider decides to start using a template (such as for routine joint injections), which has drop-down menus to enter the correct...
  8. A

    Question Medicare ABN

    Good morning all. I am extremely frustrated. Maybe someone can offer some guidance. We are a dentist office that deals with Medical. We are a non-par Medicare DME supplier for medical oral appliances. I have told our staff and provider repeatedly that they cannot have every medicare patient sign...
  9. KStaten

    Question Are Medicare's Guidelines for E/M CPT Codes the same as AMA's?

    Hello, Everyone. :) I would greatly appreciate it if you could please share documentation that shows how "closely" Medicare bases its guidelines in comparison to AMA's rules/ guidelines regarding levels for E/M-- specifically, the MDM table. 😐 It has recently been suggested to me that the rules...
  10. T


    I'm having an issue with this specific Excludes 1 problem: M20.4 (Other hammer toe(s), Acquired) shows Q66 (Congenital deformities of feet) in the Excludes 1; However, Q66 does not have the M20.4 codes in their Excludes 1. Why does a code appear in the Excludes 1 column of one code, but it's...
  11. R

    Question Help! Rule(d) Out Diagnosis Guidance for Inpatient

    Hi, when a diagnosis for inpatient at time of discharge states rule out or ruled out, should the diagnosis still be coded? In the inpatient guidelines it states "still to be ruled out" diagnosis can be coded? I just need clarification.
  12. J

    Wiki Coding Pressure Ulcers in the same area

    I'm need of clarification. When a patient has 2 pressure ulcers in the same area (ie. 2 separate ulcers on the left buttock, stage 2), would the code be used twice since the guidelines states "assign as many codes ... to identify all ..."? Or would coding it once suffice since both ulcers are...
  13. buskeys

    Question Modifier FP

    What situations can you use mod FP in? Guidelines? I am having a hard time finding a straight forward answer.
  14. K

    Premade Template Guidelines

    I've got a provider that has built templates for specific insurances. While templates aren't a bad thing, the way these are built are greatly concerning. The template looks like a complete document with prebuilt HPI, ROS, Exam, Assessments, and Procedures. Essentially, the visit looks complete...
  15. J

    Billing closed treatment of Vertebral Body fractures?

    An orthopedic doctor at my practice is wanting to bill 22310 for vertebral body fractures. This code requires bracing - he is wondering if we can still bill this code if we write the patient a script for a brace instead of doing it in the office ourselves. Note: If we did do it in the office -...
  16. T

    G0446 Intensive Behavioral Therapy Cardiovascular Disease Documentation Requirements

    Good Afternoon, Would anyone have a good resource for documentation requirements on G0446 Intensive Behavioral Therapy for Cardiovascular Disease. Is there a commercial code for this. Thank you in advance. Tammie Womack, MBS, CPC
  17. E

    Wiki Fracture care help

    Could really use some help, My provider saw a new patient for a fracture of distal radius, nondisplaced. She origionally went to an urgent care center and was told she had a fracture and to follow up with ortho. The impression of the office note states "patient was given a brace, follow up in 2...
  18. T

    Nurse visits and UAs

    Our coding dept is being requested to bill out a UA with a 99211. I know as it is an E&M I can add a 25 modifier. I am having trouble with this because of the UA having its own CPT code and by my understanding of E&Ms you can only bill both if there is a separate reason for the E&M service. Is...
  19. G

    HELP!! Radiology/EKG Coding

    I am new to radiology coding and I need some clarification. Here is the scenario: A patient, who is an inpatient, is experiencing shortness of breath. The physician orders a chest x-ray. The radiologist reports in the impression that opacities and pleural effusions are seen. Do we code the...
  20. A

    1995 Exam Elements

    Hello, I've been auditing evaluation & management documentation for a long time and I've noticed something about the 1995 exam guidelines that I could really use some help on from a fellow auditor or coder or whomever can help! I get the overall guidelines are based off of body areas and/or...
  21. C

    Wiki Provider REFUSING to sign documents prior to billing

    I work for a small specialized practice. I have a doctor that refuses to sign her op notes prior to billing, if at all. I have provided references to e-signature requirements and am looking into HCA guidelines for Utah. I have asked for a signed letter stating that she accepts liability of...
  22. J

    Wiki Modifier 25 with X-rays? AAPC practice exam says it is required?

    Maybe I am missing something... I am trying to clarify the issue. I was taking the AAPC module that I purchased: Specialty Practice Exam COSC™ And on Case 20 it goes over a basic office visit for knee pain. All that is done is an e/m and an x-ray, 73562. Question three asks if a modifier...
  23. P

    What are the Requirements to charge for IV Hydration in the ER - Please Help!

    Hello, I have a question as to what is required in order to charge for IV Hydration in the Emergency Room. The CPT books don't really go into depth about either of these questions. It is a 2 part question. 1st Question: We know that we first need a Physician order, Start and Stop Times...
  24. P

    Inpatient Admission and initial contact by admitting physician

    Our coding compliance manager has some of my coworkers and I perplexed. She is stating that if an admission occurs before midnight, let's say at 11:30pm, and the admitting physician sees the patient after midnight, let's say 12:05am, then we cannot bill an initial inpatient admission code...
  25. N

    Federally Qualified Healthcare Centers

    Since FQHC's don't always bill a traditional CPT code, do they still have to follow the CPT guidelines when obtaining HPI? Example: FQHC's will bill Medi-Cal an "01", this is an office visit. They do not use a 99211-99215 as most traditional offices. So, when it comes to meeting all the of...
  26. T

    Question on Level of Service

    For an established patient if the MDM is straight forward does that automatically make the level of E&M a 99212 whether or not you have met the History & Exam? If so can someone please refer me to the guidelines for this to back that up? I was marked off for coding a 99213 where I currently...
  27. V

    Needs assistance pls. - HCPCS

    Hi All, Is there a HCPCS CODE FOR CPT 99173 as per MEDICARE GUIDELINES? Thank you, IM
  28. B

    Wiki Exam documentation - I know that VS can be counted as constitutional

    Hello everyone, I code E/M for ED providers, and I have a question about exam documentation. Occasionally, for whatever reason, the exam portion of our notes will be blank, with the exception of the vital signs. I know that VS can be counted as constitutional, but is that a billable service...
  29. P

    Question on ED Facility Level Guidelines - Need Clarifiication - LEVEL 4 or 5

    Working for multiple facilities, every one has their own guide on the facility leveling. A question brought up on whether to charge a level 4 or 5. According to the Level 4 intervention guidelines, preparation for 2 diagnostic tests which would include EKG, LABS or XRAY. Special Imaging such as...
  30. K

    Wiki Does partnership pay 11719

    Does Partnership EVER pay for 11719? Is it constantly denied because it's considered routine? I keep getting denials with all different DX and I'm new to podiatry so I'm trying to navigate through all the guidelines.....HELP
  31. G

    Coding guidelines ICD 10

    Are there any guidelines in the ICD 10 book stating when to use chronic or acute codes?
  32. L

    ED charges for same drug push and infusion

    Do I charge IV Push of Heparin when they also have Heparin Infusion? Or do I only charge for the infusion? I cannot find any guidelines concerning this situation.
  33. C

    Long Term Acute Care Hospital

    I would appreciate if someone could guide me with the coding and reimbursement guidelines and rules for Long Term Acute Care Hospitals (LTACH). Regards, Chithra
  34. A

    CIS vs. CIN 1

    Please help me understand the logic behind the following coding scenario: Patient has been diagnosed with CIS of the Endocervix (D06.0) and CIN 1 of the Cervix (N87.0). When I checked the "Excludes 1" for each code I found the following: D06. "Exclude 1" CIN 2 and CIN 3. N87. "Exclude 1"...
  35. M

    Need help coding w 1997 guidelines

    Im used to coding using the 1995 guidelines. As well I have been coding surgery for the last 5 years. I need a little boost to get started! ;) Here's a scenario I need help with 1997 guidelines and 1995 so I can see the difference..... A 16 y.o. patient presents to Dermatology Clinic for...
  36. C

    Urgent Care - Can anyone tell me what guidelines

    Can anyone tell me what guidelines or resources I can follow?? I'm assuming it follows Emergency care to some point. But I would like some resource/seminar/book on Urgent Care coding. Thanks Carol