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    Wiki Highmark BS and CPT 69210 denials

    Hello, We are being denied by Highmark BS for the procedure code 69210. The denials have been for claims with and without an office visit. The claims submitted with an office visit have been submitted with the appropriate modifier (25). We have not seen any rejections for cerumen removal...
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    Wiki ICD-10-CM for bilateral ear tube placement for hyperbaric oxygen therapy

    Hello, I have a patient that is having bilateral ear tubes-to prevent any problems with hyperbaric oxygen therapy. The patient does not have any otorrhea, vertigo, subjective hearing loss, or tinnitus. No recent URI. I was thinking of Z40.8 but I am not sure. The patient has Medicare...
    • cwater
    • Thread
    • 69436 icd 10 cm myringotomy pre-procedure tubes
    • Replies: 0
    • Forum: ICD-10
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    Wiki Novitas Solutions JL bundling of benign lesion of .5cm or less with closure

    Medicare is bundling excision of benign lesion .5cm or less with intermediate closure. Based on the CPT manual instructions that intermediate and complex closures should be reported separately, my physician wants to add a 59 modifier to the closure. It is my understanding that Medicare...
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    Wiki transphenoidal pituitary tumor approach

    I am with an Otolaryngology practice in PA and one of our physicians has done a case with a Neurosurgeon. I need some advice regarding coding. They did a transphenoidal pituitary tumor together where our physician opened endoscopically and assisted the neurosurgeon. The neurosurgeon did 62165-62...
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    Wiki coding help zygomatic arch biopsy

    For the below op report my physician coded 20205 and 21034 -52. The CPT 21034-52 denied as an invalid modifier. How would you bill for the biopsies of the soft tissue of the zygomatic arch. Would you use 20200? Procedure: Op-Biopsy of the RT masseter muscle and the RT zygomatic arch...
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    Wiki code corrections and modifiers

    Ultimately the physician is responsible for codes, modifiers and diagnosis that are submitted on a claim. I am looking for information on what a certified coder can do vs. a non certified medical biller. Can a medical biller who is not certified add a modifier to a claim or must this be done...
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    Wiki code corrections and modifiers

    Ultimately the physician is responsible for codes, modifiers and diagnosis that are submitted on a claim. I am looking for information on what a certified coder can do vs. a non certified medical biller. Can a medical biller who is not certified add a modifier to a claim or must this be done...
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    Wiki code corrections and modifiers

    Ultimately the physician is responsible for codes, modifiers and diagnosis that are submitted on a claim. I am looking for information on what a certified coder can do vs. a non certified medical biller. Can a medical biller who is not certified add a modifier to a claim or must this be done...
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    Wiki code corrections and modifiers

    Ultimately the physician is responsible for codes, modifiers and diagnosis that are submitted on a claim. I am looking for information on what a certified coder can do vs. a non certified medical biller. Can a medical biller who is not certified add a modifier to a claim or must this be done...
  10. C

    Wiki code corrections and modifiers

    Ultimately the physician is responsible for codes, modifiers and diagnosis that are submitted on a claim. I am looking for information on what a certified coder can do vs. a non certified medical biller. Can a medical biller who is not certified add a modifier to a claim or must this be done...
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    Wiki Trach coding

    How would you code the scenario below? The tube actually exits the trachea and the opening starts to narrow causing potential airway obstruction and the physician has to dilate the stoma and re position a trach tube, which is not simply a regular trach change but rather dilation of the stoma...
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    Wiki consult or new patient coding assistance needed

    1. If physician sees a patient who has paperwork that says “referral” or “transition of care” on it from the PCP or other referring provider, is this a consult or a new patient e/m? We have seen some of this paperwork have “referral” and “consult” on the same pages and my physician wants to...
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    Wiki consult or new patient?

    1. If physician sees a patient who has paperwork that says “referral” or “transition of care” on it from the PCP or other referring provider, is this a consult or a new patient e/m? We have seen some of this paperwork have “referral” and “consult” on the same pages and my physician wants to...
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    Wiki CPT help needed endoscopic medially maxillectomy with removal of inverting papilloma

    How would you code removal of an inverting papilloma from a maxillary sinus with an endoscopic medially maxillectomy? Your assistance would be greatly appreciated. Thanks, Camille Waterhouse
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    Wiki checklist for chart review

    Hello, Does anyone have a sample checklist for when payers are requesting charts for an audit? For example I'm looking for the following documents: chart note, procedure note, consult letter, etc? I want to be sure we have all needed documents per chart. Thanks, Camille Waterhouse, CPC
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    Wiki checklist for audits

    Hello, Does anyone have a sample checklist for when payers are requesting charts for an audit? For example I'm looking for the following documents: chart note, procedure note, consult letter, etc? I want to be sure we have all needed documents per chart. Thanks, Camille Waterhouse, CPC
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    Wiki consultation documentation requirements

    I am looking for clarification. A consultation requires the written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source. The consultant's...
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    Wiki Consult documentation requirements

    I am looking for clarification. A consultation requires the written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source. The consultant's...
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    Wiki Consult documentation requirements

    I am looking for clarification. A consultation requires the written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source. The consultant's...
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    Wiki Aetna and medical review by Onet 30802 vs 30140

    s anyone having CPT 30140 denied during medical review by Onet for Aetna? We are billing Aetna for CPT 30140 and when Aetna sends the operative notes to Onet for review, Onet denies the 30140 and states that CPT 30802 is supported instead. CPT 30140 Submucosal resection inferior turbinate...
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    Wiki coding assistance 30140 vs 30802

    Based on this excerpt from the operative note, how would you code this, 30140 RT or 30802? Using a coblater to incise mucosa and resect the submucosal soft tissue and bone, SMR of the right inferior turbinate was performed. A tunnel was made between the right bony membranous inferior...
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    Wiki 30140 vs 30802 medical review denials

    Is anyone having CPT 30140 denied during medical review by Onet for Aetna? We are billing Aetna for CPT 30140 and when Aetna sends the operative notes to Onet for review, Onet denies the 30140 and states that CPT 30802 is supported instead. CPT 30140 Submucosal resection inferior turbinate...
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    Wiki Chart Auditing-Compliance Commitee Otolaryngology

    I am interested is establishing a process/committee to audit Otolaryngology physician charts internally. We want to verify that medical necessity documentation is being met for procedures and that the documentation supports the CPT's billed. Has anyone set up an internal auditing process or...
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    Wiki Laryngoscopy, direct, with Prolaryn injection into vocal cord

    Laryngoscopy, direct, with Prolaryn injection into vocal cord Is there any provider that is performing a direct laryngoscopy with a theraputic injection into the vocal cord(s) in the office? My provider wants to perform this service in the office. We will be submitting CPT 31570 for the...
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