Recent content by nomie7

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    Wiki Orthopedic Presenting Problem Question

    I am doing some auditing and am questioning whether to count conditions diagnosed at the current encounter as a chronic illness with exacerbation if by the nature of the problem it is a chronic illness but it is just diagnosed and only became noticeable to the patient with the last few months?
    • nomie7
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    • Forum: E/M
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    Wiki Neonatal consult prior to pre-term birth

    Any thoughts on the CPT code level for neonatologist performing consultation for probable preterm delivery?
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    Wiki Perinatal/neonatal counseling

    Given updates to E/M code requirements in 2021 and beyond, what typically would a neonatal consultation be billed as assuming they are not documenting time?
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    Wiki Still need chief complaint with 2021 rules?

    Do you still need to document a chief complaint with new 2021 E/M rules?
    • nomie7
    • Thread
    • Replies: 1
    • Forum: E/M
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    Wiki cystoscopic cyst evacuation

    Could someone please help with coding suggestion for the following case? " PREPROCEDURE DIAGNOSIS: Hematuria POSTPROCEDURE DIAGNOSIS: Bladder tumor. PROCEDURE PERFORMED: Transurethral resection of bladder tumor ( medium). Vaginal exam ANESTHESIA: General. ESTIMATED BLOOD LOSS: Minimal. FLUIDS...
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    Wiki Credit for bullet not performed?

    If a patient refuses a recommended portion of an exam, or the exam cannot be fully completed due to the patient's condition, would the provider still receive credit for that bullet point that could not be carried out?
    • nomie7
    • Thread
    • Replies: 1
    • Forum: E/M
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    Wiki Modifier -25 on E/M when billed w/diagnostic procedure on same DOS

    Thank you for your input. We do cystoscopies in the office setting all of the time. Every once in a while it is done in the OR due to extenuating circumstances.
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    Wiki repair of bladder laceration

    This is the case I am looking at right now. Our urologist was called in to correct a bladder wound made by another surgeon. Can we bill for this since it was our surgery originally? What code would you say to use for robotic bladder repair if so?
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    Wiki Modifier -25 on E/M when billed w/diagnostic procedure on same DOS

    I am in urology specialty. Often times we have a patient come in for a scheduled cystoscopy (diagnostic procedure), and a lesion is discovered, and/or the provider decides to pursue surgery after the cystoscopy for a variety of reasons; sometimes a transurethral resection of prostate. Anyhow, we...
    • nomie7
    • Thread
    • Replies: 3
    • Forum: E/M
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    Wiki One stone, two forms of fragmentation

    I have this same situation. Thoughts on also billing 52332 in addition to 50590?
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    Wiki cystoscopic bladder repair retained stitch

    57320?
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    Wiki Not sure what to code here...

    51040 is my thought; although was urethral catheter instead of cystotomy tube specifically.....
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    Wiki Scoping and dilation of ileal conduit stoma

    I would like coding suggestion for the following excerpt from a chart note. I am kind of at a loss. Thank you. ****************************************************** "Procedure: cystoscopy After informed consent, she was placed in the supine position and prepped and draped in the usual manner...
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    Wiki BCG and urine culture billing

    I was looking for an ICD-9 to be put on the order for the urine culture (87088).
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    Wiki BCG and urine culture billing

    I was hoping someone could help me with the following coding situation. Our office does BCG instillations. It is protocol to have the patient come into the office a week before the scheduled BCG instillation, and submit a urine specimen to be sent to an outside lab for culture. When we are...
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