Recent content by cgaston

  1. C

    Wiki Professional Component claim denial

    My guess is that whoever is billing for the technical component did not use a modifier, so they were paid the global fee.
  2. C

    Wiki pt not seen code

    In general, the provider needs to have a face-to-face encounter with the patient in order to bill an E&M service.
  3. C

    Wiki EWSL in urinary bladder

    If the calculus was in the bladder, you might want to look at 52317 or 52318
  4. C

    Wiki Your favorite underrated coding tools

    https://www.cms.gov/medicare/physician-fee-schedule/search I use this daily! You can quickly check RVUs, global periods, whether multiple surgeons, co-surgeons or assistant surgeons are allowed on any code. You can even check list of codes or a range of codes if you want. You can also check...
  5. C

    Wiki vagus nerve stimulator

    Could your patients have any of the contraindications that would cause this to be considered "not medically reasonable and necessary" according to the LCD: Hypoglossal nerve neurostimulation is considered not medically reasonable and necessary when any of the following contraindications are...
  6. C

    Wiki General Surgeon "Fellow"

    Medicare makes payments to teaching hospitals for training residents and fellows in approved training programs. Fellows cannot bill for the services they perform during their training program.
  7. C

    Wiki Is the CODIFY + EBOOKS bundle worth getting?

    I had Codify at my last company and the best part (to me) was the free CEUs
  8. C

    Wiki Billing Telephone Services for Providing Test Results over the Telephone

    This is from the CodingIntel website: The AMA is consistent in this instruction. If you order a diagnostic test, say a CBC at a patient visit, reviewing the results that day, or, a day later, or at the subsequent visit, it is part of the order. When the patient returns to the office two weeks...
  9. C

    Wiki Is face to face required for Subsequent Inpatient?

    It states under the Evaluation and Management section of the CPT "professional services are those face-to-face services rendered by physicians and other qualified health care professionals who may report evaluation and management services". The provider needs to have a face to face encounter...
  10. C

    Wiki Greater occipital nerve block J-codes

    I have found that most carriers want J3490 for compounded drugs. The only two that I encountered so far that want J7999 are Medicare and UHC Medicare plans.
  11. C

    Wiki Spinal Cord Stimulator Electrodes Implant - Anthem denial

    The AANS suggests billing 63650, 63650-59 if a second electrode is placed
  12. C

    Wiki Final Diagnosis

    Being able to determine the correct diagnosis from the note is what we Coders are trained to do!
  13. C

    Wiki Complex Closure or Adjacent Tissue Transfer?

    https://www.aapc.com/blog/45313-complex-repair-vs-tissue-transfer-rearrangement/#:~:text=Undermining%20of%20adjacent%20tissue%20to,close%20a%20wound%20or%20defect This blog post was from 2019 but I like the description of the difference between complex closure vs adjacent tissue transfer...
  14. C

    Wiki 63052 with 22633 Edits

    KZA had an article about this at the end of June: "KZA contacted the relevant specialty societies who. in turn, immediately contacted Medicare's NCCI officials. The outcome? NCCI admits that this edit was published in error and will be rescinded as soon as possible, but likely not until the...
  15. C

    Wiki Do Your Surgeons Select Their Own Surgical Codes (CPT)?

    Also some of them. For the same reasons as Cmama12
See more
Top