1. S

    Wiki No insurance, EM+ procedure

    Hi, Our practice wants to offer discount rates on office visits and procedures for those patients without insurance. We have a concern on billing correctly. Example: If filing insurance: A procedure is performed (no separately identifiable EM) then only the procedure would be billed to...
  2. S

    Wiki Is documentation of procedures in a separate note from E/M necessary?

    I work for an EHR vendor and we've had some ophthalmology clients complain that payer audits have dinged them for having minor procedures, such as injections, documented within the same encounter as an office visit. According to these clients, the audit results state the procedure has to be...
  3. K

    Wiki E/M and Procedure same day, New patient

    If a patient is referred to us for Epistaxis R04.0 and we have never seen them before, we do the E&M and it is decided that the patient needs a scope. Can we bill a new patient visit and a scope on the same day 99204 with a 25 modifier 31231 Nasal Endoscopy?
  4. C

    Wiki Medicare denying claim for missing procedure modifier

    Last Update: My supervisor says she doesn't want me doing denials. At least, not yet. It was a co-worker who had asked for my help in getting it done. I had wanted to try doing denials anyway, but since I was dropped into the deep end without a float, I felt frustrated and stuck when the...
  5. I

    Wiki OBL

    Does anyone know where i can find all the procedures that can be done in an OBL (Office Based Labs), Medicare reimbursement for them as well? Any insight would be greatly appreciated.
  6. S

    Wiki Coding Query Escalation P&P

    Would anyone happen to have a sample policy & procedure they could share related to Coding Query Escalation and/or Clinical Documentation Improvement Escalation? Thanks! Scott
  7. G

    Wiki Incomplete procedure note

    We are receiving an MUE edit/denial for this visit. Facility side coded: 99253 11043 1unit 11046 32units Clinical (professional fees) side believes this coding is incorrect - no mention of excisional, no mention of instrument used for I&D or debridement (should not be billed/coded without this...
  8. C

    Wiki When all the procedures don't fit on the claim form

    Good morning everyone, I've been an avid reader of the forums for some time and would appreciate some advice on a thorny work situation. The practice I work for has decided to change up some of the lab testing. The problem is what they want to change it to is basically 3 components short of a...
  9. J

    Wiki Surgery Coding Help

    Can someone help me code for this procedure please thank you! PROCEDURE PERFORMED: 1. Re-exploration of lumbar wound. 2. Utilization of intraoperative fluoroscopic imaging. 3. Removal of L4-5 transforaminal lumbar interbody fusion spacer. 4. L4-S1 posterolateral autologous lumbar fusion...
  10. J

    Wiki Billing a new pt visit and excision

    The patient's only reason for the visit was for her mass. I am hesitant to bill the E/M with a 59 as there was nothing else addressed. The doctor coded a 99202 and a 27327 both with the same diagnosis of D17.9 I am new to surgical/procedural billing and coding Do I only bill the excision...
  11. R

    Wiki Global Period Modifier Scenario

    Patient had an eye surgery done that has a 90 day global period. Patient then had a second procedure done on same eye 2 weeks later (modifier 58 was used since it was staged) but this second procedure only has a 10 day global period. Patient is about to have a third procedure done on the same...
  12. S

    Wiki PFO Closure with no PFO

    Hello, Our provider suspected the patient had a PFO and proceeded to do a closure. However, during the procedure, the patient was found not to have a PFO and thus, there was no closure done. The only procedure performed was the intracardiac echocardiography, 93662. Since this is an add...
  13. J

    Wiki Looposcopy with removal of right ureteral stent

    Does anyone know the code for this procedure?
  14. E

    Wiki Wrong procedure code was precerted

    Can someone please clarify this for me. Our front desk employee precerted a pts sx with code 58570...hysterectomy without BSO. After I got the op note in the billing dept I didn't realize the wrong code was precerted so I coded it correctly with 58571 with BSO. So we got the denial from the...
  15. Q

    Wiki laparoscopic bilateral separation component

    Hello need help!!! with this cpt code I see that some are using 15734 but is this is for an open procedure? What about if the operative report indicates laparoscopic Can we use 49999? Any help appreciated
  16. R

    Wiki Any help with coding this procedure would be appreciated.

    PROCEDURE PERFORMED: Right axillary exploration and capsulectomy. OPERATIVE FINDINGS: The patient had a well-defined seroma capsule extending from the lateral border of the pectoralis along the chest wall and up into the apex of the axilla. DETAILS OF PROCEDURE...
  17. C

    Wiki Prp rvus

    My provider has started doing PRP injections in the office. We are aware that the insurances do not cover 0232T and therefore we cannot find any work RVUs. Can anyone share with me what work RVUs your physicians are being assigned for this procedure? Please and thank you.
  18. E

    Wiki Cystoscopy, R stent insertion, bladder stone extraction

    Pre-operative Diagnosis: Obstructing R stone Post-operative Diagnosis: Obstructing R stone Procedure: Cystoscopy, R stent insertion, bladder stone extraction Operative Indications: 61 y.o. male with an obstructing R-sided stone with concern for sepsis. The risks of the procedure...
  19. D

    Wiki E/M with a procedure

    Question...I know that to bill a E/M with a procedure the visit has to be distinct from procedure. But I question this........New pt come in to see GYN with irregular bleeding. Provider does COMPLETE work up and gives pt options. One of those options being a endo bx. Pt chooses endo bx. and it...
  20. A

    Wiki Cancelled procedure documentation

    There seems to be some debate. In an outpatient/day surgery setting, does a provider need to document the reason why a procedure was cancelled and sign off on it? Or is it sufficient for the nurse to write the reason why in a progress note/nurse note. Specifically if its cancelled due to pt...
  21. A

    Wiki Synovectomy and Neurectomy

    I'm currently in the learning process of orthopedics coding and am stuck on a operative procedure. procedure performed: 1. Right radiocarpal and midcarpal joint open synovectomy, complete 2. Right extensor tendon compartment tenosynovectomy 2nd, 3rd, and 4th dorsal extensor tendon...
  22. K

    Wiki Level 5 E&M with Oral Challenge

    Good Afternoon, I am looking for confirmation of my assumption regarding this scenario more than I am an answer to the question. Is it appropriate to bill a level 5 E&M in addition to the code for an Oral Challenge if the patient does not require physician intervention for anaphylaxis or...
  23. E

    Wiki Billing 99211 catheter and vascular line removal

    I struggle with removal of gastrostomy tube removal and temporary vascular line removal. Is it appropriate to bill 99211 in the following instance: Advice is appreciated. Procedure: Temporary triple-lumen catheter removal. Indication: 46-year-old patient from nursing home sent for removal of...
  24. K

    modifier 80 and 78 to medicare - Need help with this

    Need help with this. One of our docs assisted an OUTSIDE doc on CPT 35665 and 37618. I know I need modifier 80. Here is the dilemma ....this procedure takes place within the global period for a DIFFERENT procedure that one of OUR docs did. Do I also need modifier 78 along with the 80 because...
  25. K

    Wiki modifier 80 and 78 to medicare

    Need help with this. One of our docs assisted an OUTSIDE doc on CPT 35665 and 37618. I know I need modifier 80. Here is the dilemma ....this procedure takes place within the global period for a DIFFERENT procedure that one of OUR docs did. Do I also need modifier 78 along with the 80 because...
  26. C

    Wiki Abdominal US/Thoracentesis

    Good Morning All, I have a radiology department charging for an Abdominal US when they cannont complete a Thoracentesis. I am new to this group, and when I questioned an edit for an Abdominal US with diagnosis of Neoplasm of the lung and pleural effusion, I was informed that they practice...
  27. M

    Wiki Global Denial - out of sequence dates of service

    We have a claim that denied as being included in the global period of another procedure, however this was the first surgery we had performed on this patient. When I called Cahaba I was told the claim was billed out of sequence with a subsequent procedure performed 2 weeks after the first...
  28. J

    Wiki Valid Procedure codes can be either ER HC IV or WK

    Invalid Procedure Code Qualifier for Procedure Procedure 2: 37237. Valid Procedure codes can be either ER, HC, IV, or WK.
  29. A

    Wiki Coding Help Needed - deep suctioning

    Our physicians would like to start deep suctioning in the office. Is anyone familiar with the procedure code for this? Can we bill for supplies also?
  30. L

    Wiki Mediccare denial for 65855

    We billed 65855 RT for a trabeculoplasy of the right eye and Medicare has denied stating the procedure modifier is inconsistent with the procedure code or a required modifier is missing. What am I missing? Thanks for any input.
  31. J

    Wiki Chelation of Calcuim Band Keratopathy w/ Gunderson pedicle conjunctival graft

    Hi all, I am looking for more information in coding a procedure the physician is calling "chelation of C++ Band keratopathy" and the use of a "Gunderson pedicle conjunctival graft" both procedures (graft placement and harvest as well) same eye. Abbreviated Op note below- Pt has a history or...
  32. J

    Wiki Denial: Valid Procedure codes can be either ER, HC, IV, or WK.

    We received a denial from Medicare: EDRC-Invalid Procedure Code Qualifier for Procedure Procedure 2: 37237. Valid Procedure codes can be either ER, HC, IV, or WK. Here are the diagnosis and procedure codes we submitted on the claim: I70.219, I65.8 37236-LT, 37237-LT, 35475-59, 75710-26-59...
  33. T

    Wiki CPT Code for nasal swab/brushing for ciliary dyskinesia

    My physician did a nasal swab/brushing for Ciliary Dyskinesia, not a 'culture' swab but a tiny bottle brushing of the nasal turbinate's. Procedure done in the physician's office. We need a procedure code if there is one for this procedure. I am thinking it would be some type of Lab code...
  34. R

    Wiki Removal of Spleen and suture of mesentery

    Can both the removal of the spleen (38100) and suture of the mesentery (44850) be coded??? is a 55-year-old gentleman who underwent pancreaticoduodenectomy (Whipple procedure yesterday 11/05/2015). He initially remained stable, but then developed hypotensive episodes and clinical evidence of...
  35. J

    Wiki 53 modifier after needle placement for facet injections

    If a patient was prepped to receive facet injections, and upon the first needle placement, requested the procedure be discontinued due to her pain, would a 53 modifier be appropriate? The physician documented "Procedure aborted after single needle placed corresponding to L5 dorsal ramus at...
  36. K

    Wiki Low anterior resection, end closure & colostomy. (no anastamosis)

    I have an open procedure to code. A total mesorectal excision (low anterior resection) was done for rectal cancer, this included part of the sigmoid colon. The colon was brought out thru the stoma hole & the colostomy appliance applied. I need help with coding this procedure. The closest code I...
  37. J

    Wiki subchondroplasty for assistant surgeons

    the new Zimmer subchondroplasty procedure that uses an unlisted code 27599 we are having trouble with reimbursement and especially for the assistant surgeon. Has anyone has any experience or recommendations for this procedure? Thanks in advance
  38. 5

    Wiki anesthesia during 64490 or 64493 procedure

    Hello, I know that anesthesia is "typically not required" with 64490 or 64493 but what if you do need anesthesia with this procedure? What code would you use? We have different opinions here in the office. Some think 01992, 01935, 01936 or 00600 or 00630. Does anyone have any information about...
  39. D

    Wiki Mult days in OBS

    If we have a pt in the hosp for OBS for mult days, how would that be billed exactly? Pt admitted to OBS on 01/12 did a consult, 01/13 fu visit, and procedure and discharge on 01/14. Or vice versa, pt has procedure on 01/12, fu 01/13, discharge on 01/14. These always confuse me.
  40. 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?
  41. L

    Wiki 66761-LT denial

    I've received a denial from an insurer for 66761-LT stating it was within the global period of another procedure. Exactly 7 days prior we billed for 66761-RT. Am I correct in thinking the 66761-LT wouldn't be included with 66761-RT since it is a separate procedure done on a different site of...
  42. J

    Wiki Which CPT codes would be used?

    My surgeon did a surgery which appears to be a co-surgery with the GYN. The patient had a large mass that was attached to the colon, as well as the ovary. They both have documented their portions. The following is my surgeon's portion. If someone could look at this and help me with some codes it...
  43. J

    Wiki Help needed for codes for this surgery!!

    My surgeon did a surgery which appears to be a co-surgery with the GYN. The patient had a large mass that was attached to the colon, as well as the ovary. They both have documented their portions. The following is my surgeon's portion. If someone could look at this and help me with some codes...
  44. J

    Wiki I&D Scrotal Abscess

    PROCEDURES IN-OFFICE: SURGEON: Emily White FNP FINDINGS AND PROCEDURE: Patient was placed in a supine position. Patient has a scrotal abscess. The area was prepped and draped. The abscess was incised, purulent material drained, and the cavity was irrigated with sterile water. Incision was...
  45. J

    Wiki J3301 - associated tenderness

    Hello everyone- Im just wondering some input on how you would code this? My main concern is the kenalog. I currently bill at a neurology clinic and me & the other biller do not agree on how to code the J3301. Would love to hear what my fellow members think? Thank-You in advance =) Procedures...
  46. D

    Wiki Pericardial stripping with mechanical pleurodesis

    Hi!! I hope someone can assist me with this :) Pt had what the surgeon called a Pericardial stripping, pt was placed on bypass. I coded 33031. Pt also has Pleural effusion so a mechanical pleurodesis was performed. I am unsure what to code for this procedure since it is a open procedure...
  47. O

    Wiki CPT for bone marrow aspiration and injection for meniscus repair ??

    Physiian repaired the meniscus. After that, he aspirated some bone morrow and injected into the meniscus repair. I have never seen that done before. Is there a code for this procedure? Is it separately reported or part of the meniscus repair? Any ideas ???
  48. T

    Wiki 63047 denying for modifier ....

    Recently Tricare began denying 63047 stating "...INHERENT BILATERAL PROCEDURE WITH UNITS GREATER THAN ONE...." The procedure done was "DECOMPRESSION OF L3 & L4 LAMINECTOMY WITH BILATERAL FORAMINOTOMIES" The original claim was sent with 63047 x1 & 63048 x1 & 69990 x1. According to the CPT...
  49. M

    Wiki Help! - appears all the procedure

    I have two op reports and I am very new to this specialty. First: 32656 with 31622 Second: 32607, 31622, 32674 On both, it appears all the procedure were done however; 31622 is a separate procedure so does that mean I need to not code it? I have never coded these procedures before and I am...
  50. K

    Wiki Reimbursement same or different for same day procedure w/OV?

    I have been told that for a particular procedure billed to an insurance with and without an OV, the reimbursement would be less vs. if they were scheduled separately. If billed together we use with modifiers. Can someone kindly assist? Thank you, Karla