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Latest activity
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Ccoding@pprm.org reacted to jkyles's post in the thread Wiki RN Counseling Contribution to Physician E&M Coding with
Like.
That would depend on whether the physician uses that counseling for their medical decision making for that visit. If the counseling just happens to occur on the same day as an E/M visit it would not. -
NNRaizman replied to the thread Wiki Second opinion-periprosthetic fx.No -22 for this. Most supracondylars are bicolumnar and require reduction and fixation of both condyles. You can make an argument that it should be -22 because it's periprosthetic, but the operative report doesn't really describe the additional...
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jkyles replied to the thread Anesthesia Billing from a patient's POV (Need Help) with some references..First: I hope your son is doing well. Second, QX means a CRNA performed the anesthesia under supervision of an anesthesiologist, so if 27705A indicates an an anesthesia service preformed by anesthesiologist, there's a conflict. But yes, you... -
NNRaizman replied to the thread Wiki Fracture Care Help.Need to be more specific here. Did the ER bill the fracture care code with a -54 modifier? Who is the payor? Are the ER docs and ortho part of the same system? What fracture are we talking about? What is the ortho's definitive treatment plan...
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NNRaizman replied to the thread Wiki Polyethylene Liner, Ankle.That is reasonably a revision of one component. 27703 with a -52 modifier
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NNRaizman replied to the thread Wiki Removal Anterior Cervical Osteophytes C2-C4.I think it would be fine to use 22110. There is no CPT or CPT-A guidance that would prohibit it. A corpectomy is removal of the entire vertebral body, or at least a significant majority of it - it is a massive procedure and would require...
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NNRaizman replied to the thread Wiki Arthroscopic wrist coding question.I'd consider that all debridement, but there are no firm guidelines. I think it's risky to go 29999 because of risk of denial and subsequent delayed AR and a lot of effort needed. 29846 is all I would do. Arthroscopic SL debridement takes me...
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jkyles replied to the thread Wiki 2026 Inpatient Only List.Scroll down to the OPPS final rule here https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-ambulatory-surgical-center
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jkyles replied to the thread Wiki To charge or not to charge an e&m.Hi, unless I'm missing something the doctors are documenting work that they did not do and billing for it. If so, while I can't say it is fraud because that requires a finding of criminal guilt, I can say this is improper documentation and coding...
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DWhere can I find the Inpatient Only list for 2026? I have been looking all over. I know they are going to drop 285 codes.
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LIs anyone else having a problem with Aetna/Medicare paying for High Risk Screening colonoscopies? I have had multiple denied in 2025. They are denying stating benefit maximum for time period had been reached. Policy benefits have been...
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ANew code 52597(Transurethral robotic-assisted waterjet resection of prostate, including intraoperative planning, ultrasound guidance, control of postoperative bleeding, complete, including vasectomy, meatotomy, cystourethroscopy, urethral...
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JJim Pawloski replied to the thread Wiki endovascular revascularization.You would code for the most complex code which would include angioplasty. I would code 37273.
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CThis statement does not support a separate E/M code. While we can now select the E/M code based on either MDM or time, documenting time alone is not sufficient, there must be a chief complaint that is evaluated and managed. This service is not...
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BHow do we know what icd10 code to use for a routine post op follow up visit? How do we differentiate between z09, z4889, z48.816? Especially for those who have a hysteroscopy d&c done (58558, 0 day global period) and come into the office 2 weeks...