Recent content by hsmith67

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    Wiki Weight loss leading up to bariatric surgery

    Patient has 37.4 BMI and presents for bariatric surgery. Sleeve gastrectomy approved by Medicare replacement plan. Patient goes through the nutrition counseling, psych eval, etc. and proceeds to drop BMI to 33.5 just before surgery. BMI is now under the required 35. I can't find where it clearly...
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    Wiki 78,80 modifier usage

    Thanks so much for the feedback!
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    Wiki 78,80 modifier usage

    The previous was a 90 day global and the surgery was done within the global. 78 was applied to both primary and assistant surgeon claims. Patient has Medicare replacement so I think you are correct - it is payer specific not wanting 78 on the assistant. We will resubmit corrected with 80 only on...
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    Wiki 78,80 modifier usage

    Patient had surgery by Dr. X. Dr. X was in a practice with several general surgeons and left the practice during global period. Dr. Y was consulted on a Dr. X patient with post op pain, CT showed free air and intussusception. Dr. Y took patient to OR and requested assistance with Dr. Z. Dr. Y...
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    Wiki UTS guided breast bx

    I'm pretty sure I know the answer - just looking for confirmation. 19083 is percutaneous breast bx with UTS guidance. As UTS guidance is in the definition the reimbursement for UTS technical and professional components are included, correct? In other words, it would be wrong to bill 19083 as...
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    Wiki 92622 new code

    Has anyone billed this new code for BAHA? Are payers paying (commercial and CMS) you? Does anyone have guidance on documentation requirements - specifically regarding time documentation?
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    Wiki Q6 locum tenens in Florida

    Does anyone know which payers (other than Medicare) accept Q6 modifier and which do not in Florida? I'm researching myself now but any help is greatly appreciated. Thanks, Hunter Smith,CPC
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    Wiki New '23 hernia code documentation

    I have some guidance on how to select codes from the new hernia codes from various sources but I'm not able to find anything from CMS. Does anyone have guidance from CMS on how to document the size of the defect? Specifically, in the AMA/CPT book it states "the hernia defect size should be...
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    Wiki General Surgeon "Fellow"

    Thanks so much. Now... it appears the surgeon is post residency and working toward becoming a "Fellow of the ACS", he is not doing a "fellowship in a surgical sub-specialty", he can perform and bill surgeries by himself, is employed by the practice, and is credentialed with the payors. Dr. A is...
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    Wiki General Surgeon "Fellow"

    Surgeon A is primary surgeon, performs left mastectomy. Surgeon B is a Fellow that is acting as an assistant surgeon and performs right mastectomy at same time. Surgeon A is in OR entire time Surgeon B is, Surgeon A dictates note for himself and in the note refers to Surgeon B as the assistant...
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    Wiki 99211 for Home Sleep study

    I definitely would not support billing 95800 when they pick up the machine as there are too many things that could go wrong that lead to this being seen as fraudulent (equipment didn't work, patient did not hook up correctly, patient had to go to ER for something unrelated, etc.). While I can...
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    Wiki Wire localization separately reportable?

    Any assistance on resolving a debate is greatly appreciated. Surgeon is placing wire localization in the OR with ultrasound or stereotactic guidance prior to beginning any other procedure (biopsy, lumpectomy, mastectomy). After completing the wire localization the surgeon then begins and...
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    Wiki Reverse shoulder CPT

    23472 is the code for a total shoulder arthroplasty, whether traditional or reverse, correct?
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    Wiki 99211 for Home Sleep study

    So we have a debate if we can/can't bill a 99211 for the visit when a patient comes in to get their home sleep study equipment. The nurse note: All instructions clearly communicated and demonstrated to patient for home sleep study using the ARES. Placing the ARES on after thoroughly washing...
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    Wiki E&M based on time, what can be included?

    Thanks, but I want to make sure you understand the tests are being reported separately for reimbursement.
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