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    arbucklej reacted to rmwinder's post in the thread Wiki Coding for Cataracts with Like Like.
    Since you are asking in the Risk Adjustment area, I'll answer according to that. : ) Under the 'with' guidelines for Diabetes, you would always code the combination code for DM w/ cataracts when they are documented in the same note. Even after...
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    arbucklej reacted to nielynco's post in the thread Wiki Viability Ultrasound and AMA with Like Like.
    Certainly being over 35 may increase a pregnant woman's risk of a possible complication, but it is only about 20% of women in this age range that end up with problems. It is a statement, not an indication that the entire pregnancy would be high...
  • C
    Cynthia Hughes replied to the thread Wiki Post-concussion Syndrome primary Dx.
    If the patient was recently injured (eg, within 1month), the care provided is subsequent care (during healing) and the 7th character D is appropriate. As symptoms vary, it seems appropriate to report symptom codes as well. However, when a cluster...
  • S
    solocoder reacted to jodielonkoski's post in the thread Wiki 00910 / 00918 versus 00862 with Like Like.
    Following up because I emailed the ASA crosswalk asking on this. I specifically had asked in regards to 52332 and 52356 which is why they focused on those in the reply. So sounds like it may not be an alternate for 52332 next year but otherwise...
  • M
    mdnewsome replied to the thread Wiki new 2027 ob guidelines.
    For codes 59425 and 59426--when should we use this code? How will we know which one to use if we do not know how many visits they will have before their delivery? Would we wait until maybe their December visit and then total up how many...
  • S
    syprice replied to the thread Wiki new 2027 ob guidelines.
    Hi, I read that we can count the ob visits and do a billout for those in 2026 ie: 59425 or 59426. I'm not sure if the new guidelines will go into effect Oct of this year, or Jan 2026. Does anyone know for sure when it will go into effect?
  • R
    rmness replied to the thread Wiki What E/M level.
    Yes, I would like an opinion on what the outpatient E/M (99202-99215) would be based off that documentation in addition to where the risk of pt mgmt would be on the MDM table based on the documentation. There was PFSH in the note which I did not...
  • M
    MPELO replied to the thread Wiki Is there a CPT code for smoothing out rough edges of calcaneus?.
    Applicable CPT Codes CPT 28119: Use this code if the surgeon excised a bona fide calcaneal spur, regardless of whether or not a plantar fascial release was also performed. Smoothing the edges with a bone rasp is a standard component of this...
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    AlishaFEC posted the thread ASC Facility Billing Question – CPT 91035 (Bravo) with CPT 43239 in Billing/Reimbursement.
    We recently started performing Bravo pH studies in our ASC and are seeing a consistent denial pattern from commercial and Medicaid payers. Claim setup: ASC facility billing UB-04 for commercial/Medicaid Revenue code 0490 CPT 43239 (EGD with...
  • R
    rmness posted the thread Wiki What E/M level in E/M.
    Two Questions: 1. Where would you place this in the risk column for patient management? 2.What level would you give? The time documented can't be used as the patient was seen in a group setting. HPI HPI The primary purpose of this service...
  • R
    rmness reacted to NRaizman's post in the thread Wiki Level 3 or 4?? with Like Like.
    Level 3. That is basic and clear from the CPT E&M chart. There is no allowance for multiple uncomplicated illnesses to bump you up a level.
  • S
    Shahin7 replied to the thread Wiki Percutaneous screw fixation with partially threaded cannulated cancellous screws X 2.
    27766 orif revision
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    freespririt0806 posted the thread 64450 in ENT/Otolaryngology.
    Is anyone billing 64450 with dx R05.3 for chronic cough and getting paid , we are getting denials
  • F
    freespririt0806 replied to the thread Wiki Revision of right nasal implant.
    was this due to rhinoplasty, septo or nasal valve surgery?
  • kdifelice
    kdifelice reacted to amyjph's post in the thread Wiki CGM 95249 with Like Like.
    There is a lot of info if you search CGM or the codes or continuous glucose monitor here: https://www.cms.gov/medicare-coverage-database/search.aspx AACE https://pro.aace.com/cgm/toolkit/billing-codes Most payers have extensive rules and...
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