Recent content by Cynthia Hughes

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    Wiki 99497 & 99498

    Please see the CMS fact sheet MLN909289. There is a table on page 4 showing that CMS applies the CPT midpoint rule.
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    Wiki G2211 description on patient statements

    I don't work directly with practices and I have not seen any messaging from Medicare to beneficiaries to explain the new charge. The short descriptor from CMS is "Complex e/m visit add on." However, you might consider something like, "Longitudinal care resource add-on" as the term "complex"...
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    Wiki Searching for diagnosis code

    If you look up hair tourniquet, you are directed to constriction, external, by site which leads to external constriction of the clitoris and directs to S30.844A External constriction of vagina and vulva, initial encounter. R10.2 describes pain in the perineum. Hope that helps. Cindy
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    Wiki 31615

    You are correct that 31615 describes a complete bronchoscopy. 31575 appears to be more appropriate. You can see a related question and answer in the December 2020 CPT Assistant newsletter. Hope that helps. Cindy
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    Wiki Annual Physical Exam & renewal of birth control

    See coding advice from ACOG here, https://www.acog.org/education-and-events/publications/larc-quick-coding-guide/em-services-code-only. This is specific to long-acting reversible contraceptive but the same would apply to prescription of other forms of contraception. Hope that helps, Cindy
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    Wiki 69210-RT and 69200-LT

    Ear wax is not a foreign body. Removal of non-impacted cerumen is not separately reported from the service requiring the clearance (eg, office visit). I hope that helps. Cindy
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    Wiki 83036 A1c Denials

    No easy answer on this one. You would need to access the CIGNA plan's policy for A1c testing to see what diagnosis codes (E11.65 should be good.), frequency of testing (usually 90 days), etc. are covered by the plan. If no answers are found there, it may be necessary to contact provider services...
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    Wiki JZ Modifier

    For now, I suggest that you follow any instruction from the individual payer; some are not requiring JZ at all. Some may exempt vaccines based on the Medicare policy that exempts the vaccines covered under Medicare Part B. Medicaid plans will likely issue policies on the appropriate use based on...
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    Wiki RX REFILLS

    This answer from Medicare Part B Administrative Contractor, First Coast Service Options, may state it best. "E/M FAQ -- What constitutes prescription drug management? Q. During an evaluation and management visit, what constitutes "prescription drug management?" A. "Prescription drug management"...
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    Wiki Vaccine Supervision

    To verify that no supervision is required, see the Medicare Claims Processing Manual (cms.gov/manuals online only manuals 100-04, Chapter 12, section 10.1.2) for the following. "Effective for services furnished on or after May 1, 1993, the influenza virus vaccine and its administration is...
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    Wiki Flu shot Medicare

    The list on this page, https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/vaccine-pricing, will give you the codes for the currently recommended vaccine products. As previously answered, report G0008 for the administration of the vaccine. I don't remember for certain but think...
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    Wiki Question 2023 Inpatient/ Observation coding

    If any physician or other qualified health care professional in the same specialty and same group has provided face-to-face care at the hospital, the patient is established when seen in the office. It is not the site of service that matter but whether any professional service has been provided...
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    Wiki P00.82 vs Z20.818

    Code P00.82 (newborn affected by maternal colonization) is reported based on the observation for the suspected condition until it is ruled out (eg, no signs or symptoms at 24 hours) and then code Z05.1 (observation and evaluation of newborn for suspected infectious condition ruled out) would be...
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    Wiki How to code, administration of Survanta (NICU)?

    Hi, look at code 94610 but note that this is bundled into daily critical care. The code is reported per dosing episode. I hope that helps. Cindy
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    Wiki Congenital Diaphragmatic Hernia Non-neonate

    While the congenital diaphragmatic hernia is usually repaired early in the neonatal period, there are codes for the non-traumatic paraesophageal hernia repair (43332-43337 for open approaches) that may describe the procedure performed. I did see a case report of a child who was diagnosed at age 4.
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