Recent content by Orthocoderpgu

  1. O

    Wiki Plica, scar tissue procedure

    Code 29877 is for the debridement / shaving of chondral tissue. So code 29877 would not fit plica/scar tissue.
  2. O

    Wiki Consultation Codes

    If the E/M is based off MDM, and your provider can't treat the patient due to the circumstances, I don't see it as a billable visit. If they can't treat the patient, how can they get credit for MDM?
  3. O

    Wiki Dx lap including lysis of adhesions

    You need to code what was performed. Very possible with the adhesions being treated that the patient's symptoms will decrease or go away. Full disclosure I only code ortho surgeries.
  4. O

    Wiki Consultation Codes

    A referral is not a consultation.
  5. O

    Wiki CPT open procedure debridement of biciptal groove

    Code 11043 is in the integumentary system for the debridement of open wounds. Your provider did not debride an open wound, so you can eliminate the codes from the integumentary system. Your provider made an incision to get to the bone, so the code is going to be from the musculoskeletal system...
  6. O

    Wiki Can medical coders make addendums?

    I think you know the answer, just need something in writing. No, coders cannot document. I'm aware of a company that went from charts to an EMR, and the EMR initially allowed the coders to document. The coding manager found out, went to the IT department and changed their access to coders could...
  7. O

    Wiki H&P

    I've been working in an orthopedic clinic for 10+ years. My guess is that your work flow is probably the same. In orthopedics there really is no H&P "per se". The providers initial visit with the patient will usually be used as the "H&P" at the hospital. That initial visit could be at the clinic...
  8. O

    Wiki Excision 11400 or 25075

    I suggest working with your provider on increasing the specificity of the documentation. Code 11400 is for the removal of basically epidural lesions. Code 25075 is for the removal of deeper subcutaneous lesions. In this case lipomas. There's no doubt that this is what the provider did, however...
  9. O

    Wiki Auditing PA assist at surgery

    What was the given reason for the error? Does the surgical procedure allow an assistant? Does the insurance allow PA's to assist? Something had to be incorrect on the surgeon's codes for it to be "dinged". More information is needed.
  10. O

    Wiki J7327 Modifier ?

    I wonder if they are looking for that modifier. I just asked someone in the clinical staff if they had ever not given the entire syringe and she said no. She's been injecting for 8 years. But they might want that modifier !
  11. O

    Wiki 64640 can this cpt be reported more than once on a dos?

    It has an MUE of 5. On the second and third lines you would want to add -59 or -XS to show that it's an additional procedure.
  12. O

    Wiki J7327 Modifier ?

    Just an FYI. H/A products such as Euflexxa and Synvisc do not come in vials that are drawn from. They come in pre-dosed syringes and the entire syringe is injected. Three injections are performed about a week apart to complete the treatment.
  13. O

    Wiki 64718 and 24359

    I'm not sure what your referring to. I would apply the same coding rules with 64718 and 24359 as any other two codes that hits an edit. As your aware using a -59 modifier is never automatic, the codes have to qualify for the -59 modifier.
  14. O

    Wiki 11951

    You have an up-hill battle since this is used for cosmetic purposes and for post breast reduction surgeries which is why it's getting denied the way it is. Most insurance companies have a MD working as a medical director for them. This is probably the person who you need to get a hold of. A...
  15. O

    Wiki Lemaire Procedure

    I have been coding orthopedic surgeries for over ten years now. I have personally not seen this procedure yet which surprises me. However doing a bit of research leads me to believe you. I don't know why your compliance department would not agree. Code 27427 is for an extra-articular...
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