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bethb

Recent content by bethb

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Wiki Pennsylvania Trustmark HOP (PSERS) secondary claims

Good morning. This question is specific to Pennsylvania providers and Medicare crossover claims. Is anyone finding Medicare primary with crossover to Trustmark (HOP) claims not actually being crossed over to Trustmark? We have quite a backlog of unpaid Trustmark HOP secondary claims that are...
- bethb
- Thread
- Apr 23, 2024
- Replies: 0
- Forum: Billing/Reimbursement
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Wiki EGD with biopsy and scope advanced beyond the second portion of the duodenum to the 4th portion but not including jejunum.

I agree with the provider - 44361 only.
- bethb
- Post #2
- Nov 20, 2023
- Forum: Gastroenterology
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Wiki High Risk Screening Colonoscopy

If the patient presented for a high-risk screening colonoscopy, and is status-post treatment for the condition which justifies the use of Z86.010, I sequence the diagnosis codes as Z12.11 (primary dx); Z09 (secondary dx because the ICD-10-CM Parent Code notes for Z86 state to "code first" any...
- bethb
- Post #2
- Nov 17, 2023
- Forum: Medical Coding General Discussion
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Medicare Screening Colonoscopy LCD's

Which MAC? I do not think there is a specific LCD (at least for Novitas / Pennsylvania) for a high-risk screening colonoscopy. The guidelines for what is considered "high risk" and screening frequencies are given in the Medicare Preventive Services Quick Reference chart. Link - MLN006559 –...
- bethb
- Post #2
- Nov 17, 2023
- Forum: Medical Coding General Discussion
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Wiki Surgical Laparoscopic procedure with diagnostic Sigmoidoscopy

What was the reason for the sigmoidoscopy? If it was done to check the patency of the anastomosis, then it should not be reported separately.
- bethb
- Post #3
- Aug 26, 2022
- Forum: Gastroenterology
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Wiki Colonoscopies - surveillance vs. screening

Yes, this absolutely makes sense - I appreciate your input and thank you. I cannot even find screening guidelines, high risk guidelines, etc, for our local BCBS. It is crazy how there is little transparency and guidance with surveillance regimens. I feel bad for the patients who are...
- bethb
- Post #7
- Aug 26, 2022
- Forum: Gastroenterology
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Wiki Colonoscopy after a positive stool test.

I have many questions about the new guidelines. If we follow what many commercial guidelines tell us, Z12.11 is used in the absence of symptoms or findings. R19.5 is a finding so I do not think Z12.11 would be applicable. However, under the guidelines, a follow up colonoscopy for a positive...
- bethb
- Post #5
- Aug 26, 2022
- Forum: Gastroenterology
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Wiki Colonoscopies - surveillance vs. screening

Hi and thank you for your reply. I'm stuck at past history of polyps.. if a patient presents for a surveillance colonoscopy due to a past history of a polyp, is that previous polyp considered a "finding" which commercial insurances would consider non-screening criteria? Even though the...
- bethb
- Post #5
- Aug 26, 2022
- Forum: Gastroenterology
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Wiki Colonoscopies - surveillance vs. screening

Hello and thank you for your reply and link.
- bethb
- Post #4
- Aug 26, 2022
- Forum: Gastroenterology
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Wiki Colonoscopies - surveillance vs. screening

Hello. To me, coding guidance for surveillance colonoscopies is murky, at best. How are you all coding and billing surveillance colonoscopies for commercial insurances? i.e. repeat colonoscopy for a past finding (polyps) Surveillance colonoscopies are usually done at more frequent intervals...
- bethb
- Thread
- Aug 19, 2022
- Replies: 7
- Forum: Gastroenterology
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Wiki P1-P6 modifiers

I am new to Anesthesiology billing and wondered if anyone can provide guidance about this- Medicare (Novitas) and Medicaid (Pennsylvania) do not make any additional reimbursement for the physical status modifiers or for the qualifying circumstances add-on codes, but should we still be putting...
- bethb
- Thread
- Nov 6, 2020
- Replies: 1
- Forum: Anesthesia
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Wiki Cholecystectomy with wedge portion of liver

Our surgeon performed a laparoscopic cholecystectomy and indicated in the note that he removed a wedge of the liver with the gallbladder because there was no definable plane between the gallbladder and liver. The specimen was sent to pathology. Can a wedge resection of the liver be charged...
- bethb
- Thread
- Jan 31, 2020
- Replies: 1
- Forum: General Surgery
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Hi! Nice to meet you.

Hi! Nice to meet you.
- bethb
- Profile post comment
- Oct 22, 2019
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Wiki Laparoscopic partial cecectomy (no anastomosis) coding

I am on the fence with coding for a laparoscopic partial cecectomy (partial cecum and appendix stump) without anastomosis. Patient is S/P appendectomy, many years ago, and presented with continuous right sided abdominal pain. I have read forums and literature that suggest using CPT code...
- bethb
- Thread
- Oct 22, 2019
- Replies: 1
- Forum: General Surgery
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Wiki Callus shave

Thank you for your help! Beth
- bethb
- Post #3
- Feb 15, 2019
- Forum: Dermatology

bethb