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  1. K

    Wiki Diagnostic Mammo

    Even if they are entititle for an annual screening? by coding the mass wouldnt that not be covered by payer?
  2. K

    Wiki Diagnostic Mammo

    Hello everyone - If a patient in 2023 has been just following up every 3-6 months on a mass on her breast by just doing a limited ultrasound to just keep an eye on it and then comes in 2024 for one year surveillance exam, would the diagnosis still be Z12.31?
  3. K

    Wiki Audiologist

    I can't seem to find a definitive answer, we have an audiologist billing for E/M 99202-99215 with audio testing's, can audiologist bill for E/M?
  4. K

    Wiki MOCA Test

    Thank you, After speaking with a provider who does the MOCA, provider mentioned there is no written plan, they usually do the test and then schedule the patient to come back for results and written plan is done on follow up. With saying that, that would not constitute a 99483, correct?
  5. K

    Wiki Chronic Migraine Headaches

    Thank you, i agree.
  6. K

    Wiki Fracture Care Coding

    Hello - Noticed our urgent care provider and orthopedic provider try to bill the same fracture manipulation/non-manipulation code. But we know only one should be able to bill it. If a patient is seen at our urgent care and applies a splint and wants the patient to follow up with orthopedic...
  7. K

    Wiki Chronic Migraine Headaches

    We have a neurologist who says all his new/established patients are usually a level 5. Provider is not using TIME to determine his level of service, its all based on MDM. There has been discussion that his documentation is meeting a level 4 and not a five. Can someone review this example...
  8. K

    Wiki Telehealth Services- Audio only

    Hello everyone. For CMS of allowable telehealth services, can someone help me understand how you interpret this: Cells that contain the answer “yes” under the column heading Can Audio-only Interaction Meet the Requirements? Does that mean you can do audio only if video fails...
  9. K

    Wiki MOCA Test

    Anyone familiar with Montreal Cognitive Assessment (MOCA) test. I been searching for correct CPT and the closes I have found is CPT 96125 or 99483, any help would be greatly appreciated it.
  10. K

    Wiki G0444 with 99202-99215

    Depression screening G0444 is bundled into office visit but able to unbundle with correct modifier, Does anyone know if we should be using modifier XS or XU on G0444 when done during an office visit treating for other conditions?
  11. K

    Wiki Modifier PT/33

    Hello everyone - for screening that turned into therapeutic Is modifier PT or 33 be on all codes when multiple interventions are performed example 45385 - PT 45380 - PT, XS or 45385 - PT 45380 - XS would love to know how everyone is else is capturing it.
  12. K

    Wiki Joint Injection Documentation

    Would you agree they are missing detail elements of a procedure, not really describing the procedure.
  13. K

    Wiki Joint Injection Documentation

    Hello - Sometimes I get confused on what is proper documentation for a minor office procedure (joint injections). I have some providers who don't really enter a proper step by step procedure note, they just put what was done. Is this okay to still code the joint injection? Example:
  14. K

    Wiki T1013 Sign language or oral interpretive services, per 15 minutes

    There is really no specific detail information on this code, is this allowed/reimbursed when family member interprets for patient or clinical staff? Or this to used only when a physician's office has their own interpreter service?
  15. K

    Wiki Modifier 51 - Fundus Photography

    Hello everyone - I noticed many of our providers does eye plugs procedure CPT 68761 and fundus photography CPT 92250 on same day. Is CPT 92250 considered a multiple procedure to append modifier 51? Per NCCI edits you can code/bill together on the same day.
  16. K

    Wiki ACTH/CRH stim testing

    For the time the patient is there doing the test, is that billable since provider keep monitoring? or do you just code the following below 8xxxxx J code route 96374 or 96372 blood collection 36415
  17. K

    Wiki ASC - modifier 78

    We got a denial from Medicare using modifier 78 on a patient who had to return back to surgery due to findings of Cataract (lens) fragments in eye. The diagnosis that was used was H59.021. Has anyone run into this issue and what was your resolution? I wasn't aware in ASC modifier 78 is not...
  18. K

    Wiki Albuterol Inhalation Treatments

    Hello everyone - A bit confused as how to code when multiple inhalation treatments are given to a patient. I have read we only code CPT 94640 once per episode of care, regardless of how many treatments given, is this true? and where is the coding guideline for this so i can support our coding...
  19. K

    Wiki Cryotherapy Ablation

    Anyone familiar with the following procedure of Cryotherapy Ablation, are the right codes to use 30801/30802/30999 and or/ C9771
  20. K

    Wiki Angina - office

    We have many providers who capture HCC " unstable angina " in outpatient office setting when there is no chest pain occurring or anything, just states below. Which if they capture it then it is saying patient is having onset chest pain right there and then and emergency treatment is needed...
  21. K

    Wiki Acute on chronic respiratory failure with hypoxia

    I have a question regarding the diagnosis J96.21 being captured in an office setting, are we allowed to capture it especially if patient is on O2 as needed? Help :/
  22. K

    Wiki Inheritest Core Panel

    Thank you so much for your help
  23. K

    Wiki Inheritest Core Panel

    Hello - Is anyone familiar with Inheritest Core Panel for prenatal patients? Does anyone know the specific CPT codes that are used for this particular test? Help :/
  24. K

    Wiki Procedure Note Documentation

    This is a in office procedure and sometimes i get confused on what is proper documentation for minor office procedure. I always thought there should be a detail note on how the procedure was done, kind of like step by step. Is this proper documentation?? S: here for banding of one residual...
  25. K

    Wiki Slant back

    Anyone else run into this problem in trying to figure out correct procedure for an ingrown nail without anesthesia. The closes I got was CPT 11719, no documentation of being a dystrophic nail, so considering it nondystrophic. Procedure "nail border was trimmed with a nail nipper. No...
  26. K

    Wiki Fall risk

    If a patient comes in for an AWV and has a fall risk screening done but has no history of falls or hasn't fallen, what would be the correct diagnosis to link to quality measure codes 3288f/1101F? Should we just link primary diagnosis of AWV?
  27. K

    Wiki Well Child Visits

    Does anyone know if well child visits CPT 99381-85, 99391-95 can be done via telehealth?
    • KoBee
    • Thread
    • Replies: 1
    • Forum: E/M
  28. K

    Wiki Tobacco F codes

    Does anyone know what the conditions in parentheses mean, does this mean you can only use this F code if patient has the following conditions of (CAD, CAP, COPD, PV) (DM) (IBD)?? 1036F Current tobacco non-user (CAD, CAP, COPD, PV) (DM) (IBD) 4004F Patient screened for tobacco use and...
  29. K

    Wiki No Final Dx

    I have a specific provider who at times doesn't like to use a SOAP template or put a final diagnosis, I can make assumption as to why the patient is there or I can capture signs and symptoms, but for prenatal care, is it okay to make assumption here and capture O code for encounter of pregnancy...
  30. K

    Wiki ASC G0260/77002

    Hello everyone - Our practice codes and bills for our surgery centers (ASC) in UB and 1500, billing dept has been getting denials for CPT 77002 as bundled on UB. But LCD for G0260 states " For ASC facility claims only: G0260 must be billed with fluoroscopy (77002) or CT (77012)". So should...
  31. K

    Wiki ASC G0260/77002

    Hello everyone - Our practice codes and bills for our surgery centers (ASC) in UB and 1500, billing dept has been getting denials for CPT 77002 as bundled on UB. But LCD for G0260 states " For ASC facility claims only: G0260 must be billed with fluoroscopy (77002) or CT (77012)". So should...
  32. K

    Wiki Consults

    I still get a bit confused on Consults vs Referral. I think our providers get confused themselves, I find myself at times trying to find the easiest way to explain the difference. If the consulting provider puts an order for the patient to come back and see them, that is not help constitute a...
  33. K

    Wiki Final Diagnosis

    Having a debate, as a coder if no final diagnosis is documented, it is okay for us to capture signs and symptoms. We have a provider who feels there is no need to document a final diagnosis and want us to assume the diagnosis. If anyone was looking at this chart note, would you just make an...
  34. K

    Wiki Depression Screening G0444

    Hi there- Description of code has a time component
  35. K

    Wiki Internal Med vs Family practice

    We have an internal med provider is billing new patient codes for patients who have seen a family practice provider within the last 3 years, are they considered two different specialties? I did read the following, which sound different per age Family doctor treats patients of all ages, while...
  36. K

    Wiki Documentation compliance

    there is a provider whom doesn't seem to properly document currectly, or should say without a SOAP template. Can someone review this example and let me know what they think. That is all the chart note says. 42-year-old is seen today for a follow-up to outline uterine fibroids. She delivered...
  37. K

    Wiki Prenatal Visit Dx, Elderly

    I get a bit confused on prenatal visit diagnosis for patients over 35 years old. Example: 42 yr old, here for prenatal visit, has had normal pregnancies before, she is currently in third trimester. Should i be using dx O09.513 Supervision of elderly primigravida, third trimester or Z34.83...
  38. K

    Wiki Prenatal visit Dx, elderly

    I get a bit confused on prenatal visit diagnosis for patients over 35 years old. Example: 42 yr old, here for prenatal visit, has had normal pregnancies before, she is currently in third trimester. Should i be using dx O09.513 Supervision of elderly primigravida, third trimester or...
  39. K

    Wiki Documentation

    Does anyone know if just mentioning cervical (neck), Thoracic (mid back) and Lumbar (low back) enough documentation? I have read that documentation must indicate the specific segments/areas manipulated. Just want to make sure
  40. K

    Wiki New Covid Vaccines

    Does anyone have more clarity on the new covid vaccines https://www.ama-assn.org/system/files/vaccine-short-descriptors.pdf Does this mean after Aug 14, 2023 can a practice start billing those codes? CPT 90480, 91318-91322, and all others will be deleted?
  41. K

    Wiki Level of service

    I read usually a chiropractor would rarely bill level 4 or 5 but most common would-be level 2 or 3. But I'm having trouble when to determine Dx of back, low, neck pain would fall under problems addressed and procedure treatment of manipulation. Straightforward or low? Anyone run into these...
  42. K

    Wiki Dx normal pregnancy, unspecified

    Hello everyone - Need some help understanding when to use diagnosis Z34.90-Z34.93? Any good sources out there to help me? greatly appreciated, thanks. Z34.00- Z34.03 = first pregnancy, no complications Z34.80- Z34.83 = additional pregnancy, not first time, no complications Z34.90- Z34.93 =
  43. K

    Wiki G0444 Depression Screening

    G0444 is a time component HCPCS code. Annual depression screening, 5 to 15 minutes Our system generates a questionnaire to our patients thru an online portal to fill out prior to coming in for AWV. Best practice is whether the score is 0, shouldn't providers document in their chart note, day of...
    • KoBee
    • Thread
    • Replies: 1
    • Forum: E/M
  44. K

    Wiki AWV G0439

    I have read that there is no need to wait 12 months between visits as long as the visits are in different calendar years. This is where the confusion comes along. Our practice has done date to date to be on the safe side. say patient had AWV til December 15, 2022, they now have to wait 12...
  45. K

    Wiki AWV G0439

    In need of some help for accuracy on when its okay to code/bill a subsequent AWV. Would appreciate any source that gives details. Thanks Medicare guidelines state " covered once every 12 months"...
  46. K

    Wiki Office Procedure note

    I am getting mixed information as to what is considered compliance or not in a patients chart note to support an in office procedure, can any one help or take a look at the following example if this is acceptable. CPT 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg...
  47. K

    Wiki Depression Screening G0444

    By any chance would you have any examples of some time statements i can reference to our providers to use, this could work great to add to our templates to better help them out.
  48. K

    Wiki Depression Screening G0444

    Thank you, appreciate it
  49. K

    Wiki Depression Screening G0444

    can anyone clarify if providers are to be documenting time in their chart note on how long it took them to go over depression screening? I noticed some of our providers do not document time but do mention the score. Can someone help me?
  50. K

    Wiki Follow up after condition

    Trying to figure out what would be the appropriate diagnosis for a patient who is following up with orthopedic in office setting from a shoulder arthroplasty, pass 90 day global, follows up one every 2-3months and wants patient to continue doing physical therapy. There is no complaints from...
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