Recent content by smsmith

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    Wiki eRx hardship 2013

    I just received this in our American College of Surgeons email, this might help: REMINDER: ELECTRONIC PRESCRIBING HARDSHIP EXEMPTION DEADLINE IS JUNE 30 The deadline for applying for the 2013 Medicare Electronic Prescribing (eRx) Incentive Program hardship exemption is drawing near. To avoid...
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    Wiki Who has the CGSC credential?

    I have not taken it yet. I did get the study guide, I was pretty easy for me. Our work has been so busy that I have not had a chance to get myself on the schedule for the exam. I do plan on taking it as soon as I can.
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    Wiki Appeal for 11042 vs 97597

    I came upon a Medicare Learning Network issue ICN 006973 from Nov 2011 that talks about Medicare Claim Review Programs, and MUE's specifically. It states you can bill the code that is in excess of the MUE, such as 11045, using a single line item for each one and billing them with -76 modifier...
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    Wiki Appeal for 11042 vs 97597

    I also bill for physicians that work in a wound center. I have sent in multiple appeal letter to our Medicare carrier for the 11045 that they deny above 4 units. I had a few come back unfavorable, but most came back favorable and the additional payment was made. As long as the documentation...
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    Wiki 11046 Add-on, Medicare Limit?

    I was just about to send in my second level appeal when I got in the mail several letters from Medicare in response to my redetermination requests. They ruled fully favorable on a few, partially favorable on one and not favorable on one. I may need to request a second level appeal on the ones...
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    Wiki 11046 Add-on, Medicare Limit?

    I have had the same problem. I came to the conclusion that Medicare is only allowing up to 4 units on 11045. I searched the entire Medicare site and only found out that these codes appear as a MUE, Medically Unlikely Edit. I sent redetermination requests on all the ones they denied. I just...
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    Wiki Ins rejecting 97597 BCBS Not correct code or needs more info??

    I use a variety of different diagnosis codes. They are almost always an ulcer or a non healing surgical wound. I need to pull my old denials from BCBS to get the exact verbage on the denial, but it was something to the effect the code was not allowed in the place of service that was billed...
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    Wiki Ins rejecting 97597 BCBS Not correct code or needs more info??

    I know that Arkansas BCBS does not allow for 97597 and 97598. I have not been able to get anywhere with my provider rep to get this addressed. I do wound center coding and they do lots of selective debridements, along with the excisional ones. I have been just billing the appropriate level...
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    Wiki Help with OP note please

    That is an excellent article! That is exactly what I have been stressing over. The fact that the reimbursement is so high for the 15734, it puts the 49560-49568 as a lesser valued codes, when the primary procedure was the ventral hernia, not the flap. I am going to refer this to the...
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    Wiki Who has the CGSC credential?

    I have been coding general surgery for 20 years and an looking into taking the CGSC exam to add to my CPC. I would appreciate any input from those that have taken that speciality exam. Thanks! Susan Smith, CPC
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    Wiki 2nd request--help!!!hernia w/seroma

    I don't see your original message...what did your op note say?
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    Wiki Help with OP note please

    Unless I missed it, I don't see an ileostomy being created in that note. Instead of a total colectomy code, you might look at one of the partial colectomy codes. You can't use the 44139 add on code with a total colectomy code, only the partial colectomy codes. For the 2 hours of lysis of...
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    Wiki Excisional Debridement add on code 11045 billed to Medicare with multiple units

    Yes it is! I just sent redetermination requests for 23 claims. I am also having Medicare deny 97598 when I bill it with 97597. They paid the 97597 but deny 97598, it's like they don't have their system updated to know that it is an add on code for 2011, not an either or code. So much time...
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    Wiki Excisional Debridement add on code 11045 billed to Medicare with multiple units

    I had seen this discussed before but I wanted to get more feedback. Our surgeons work also in an outpatient wound center and do lots of debridements. I am receiving current denials from Medicare if I bill for over 4 units with an explanation: "information submitted does not support this many...
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    Wiki Pectoral,deltoid,biceps,triceps fasciotomy

    Thanks! I code for general surgery and this was a bit out of my knowledge zone.
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