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  1. X

    Wiki Practicode

    You can e-mail practicode.support@aapc.com and request your Practicode to be reset. Or, you can click on the Help menu at the top, and then click on Contact Help Desk. Fill out the request form and submit. It does not happen overnight. I believe it took around a month for mine to be reset. I...
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    Wiki New patient

    At what point did the patient leave?
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    Wiki Endocrinology and weight mgmt

    I say, take what you can get! Congratulations on the employment.
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    Wiki Coding polysubstance versus each individual substance, documentation

    Who exactly coded polysubstance abuse (F19.10)? Was it the provider him/herself or a coder abstracting the provider's note?
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    Wiki Bariatric Surgeries and DX

    That is correct. 1. E66.01 (primary) 2. Z code for BMI > 35 (Z68.35 - Z68.45) 3. ICD-10 for co-morbid condition Medicare tends to be easier to find what you need. Coverage of bariatric surgery is described in the Internet Only Manual (IOM): Medicare National Coverage Determinations Manual...
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    Wiki Bariatric Surgeries and DX

    Who is the payer?
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    Wiki Board certification for Hand specialty

    Three taxonomy codes. 207XS0106X - Orthopaedic Surgery - Hand Surgery 2082S0105X - Plastic Surgery - Surgery of the Hand 2086S0105X - Surgery - Surgery of the Hand So, a “hand surgeon” can be an orthopaedic surgeon, a plastic surgeon, or a general surgeon, each having completed fellowship...
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    Wiki new vs established.

    That would be incorrect. For office visits, “new” versus “established” is based on when the patient was last seen and by whom. AMA CPT 2024 Professional Edition, p. 4, Neither new nor established patient office visits require a physical examination. AMA CPT 2024 Professional Edition, p. 7,
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    Wiki NPs billing out almost all 99214s

    I wonder if the docs would be okay with you telling them how to do their job. They have the MD. You have the CPC. They are basically telling you your CPC is meaningless. I'd be offended.
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    Wiki Billing Screening vs Family History Colon ca

    Yes. Family history is not a symptom. Family history of colon cancer is relevant history and should be included on the claim. Being asymptomatic and having a positive family history of colon cancer does not convert a screening colonoscopy into a diagnostic colonoscopy. Unless the provider...
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    Wiki NPs billing out almost all 99214s

    Who has the final say in billing? You or them? I mean, if you were to bill 99213, is someone going to reprimand you?
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    Wiki Help with code order for billing

    Was 43254 performed on one lesion and 43251 on another lesion?
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    Wiki Infusion Start Time Question

    Preparation, patient education, and patient assessment are incorporated (bundled) into the first hour of infusion, hence the first hour of infusion is weighted heavier (higher RVU) than subsequent hour(s) of infusion.
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    Wiki DX Z40.01

    @carlystur means Z15.01. Primary: Genetic susceptibility to malignant neoplasm of breast (ICD-10-CM Z15.01) Secondary: Encounter for prophylactic removal of breast (ICD-10-CM Z40.01)
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    Wiki J2919

    See also the attached Field Descriptions.
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    Wiki Help! uncomplicated or systemic

    Certainly not systemic. Systemic means that it involves the entire body. The provider should be documenting chronic versus acute in the notes especially after re-evaluation of the patient after completing treatment modalities (e.g., physical therapy). However, after 3 months, pain is usually...
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    Wiki J2919

    See the attached PDF. Info obtained from following source: https://www.cms.gov/medicare/payment/part-b-drugs/asp-pricing-files Which NDC are you using for the Solumedrol?
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    Wiki NEED HELP 1.LAPAROSC REDUCTION INCARCERATED INCISIONAL HERNIA. 2.INCISIONAL HERNIA REPAIR WITH 4X9 INCH INLAY WHAT CODE SHOULD I USE

    Either CPT code 49592, 49594, or 49596, the key being that the hernia was incarcerated. The header of these codes is: The next aspect that you have to specify is the total length of the hernia defect measured prior to opening the hernia defect, which is measured as the maximal craniocaudal...
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    Wiki ICD10 code

    Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm (ICD-10-CM Z09) Encounter for adjustment and management of cardiac pacemaker (ICD-10-CM Z45.01)
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    Wiki School Based Health Center POS?

    03 School
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    Wiki BCBS Medicare and 87804, 87804-59 issue

    https://www.aapc.com/codes/coding-newsletters/my-pediatric-coding-alert/you-be-the-coder-87804-two-flu-tests-three-coding-options-article https://www.aapc.com/blog/49147-get-multiple-flu-tests-paid/ https://www.aapc.com/discuss/threads/87804-and-modifier-92.29036/...
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    Wiki occupational therapy group vs one-on-one coding

    https://www.law.cornell.edu/regulations/alabama/Ala-Admin-Code-r-625-X-8-.01 What have you read that contradicts what she is stating in regards to the number of OT students she may supervise?
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    Wiki Excision of masses-Path shows one is lymph node

    Almost sounds to me like the provider was not aware they were excising a lymph node in the posterior auricular region; almost sounds like they were under the impression they were excising cysts [only].
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    Wiki Testosterone testing

    Who is the payer? What is the reason for the testing?
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    Wiki Billing for 76391 MRE

    Maybe we are misunderstanding each other. Yes, you can perform an MRE without performing an MRI of the abdomen. MRE is typically used for the liver (although it beginning to be used on some other parts of the body). An MRE performed on the liver does not include any other organs, unlike an MRI...
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    Wiki 22 modifier with obesity

    The provider has stated the patient is morbidly obese. You can abstract that information for coding purposes, i.e., E66.01. Then, assuming the patient's height and weight have been documented at some point during the pre-op evaluation period by surgeon's or anesthesiologist's staff, calculate...
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    Wiki Peripheral Arterial Disease Coding – Lower Limb Thrombosis

    Hmmm, I'm familiar with the tool. I re-read through the PDF and went back to the tool, but I still don't see where it provides a list of all the ICD-10 diagnoses that support the medical necessity of the CPT/HCPCS code. Maybe I am lost, but I don't see it.
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    Wiki Billing for 76391 MRE

    Depends on what was ordered by the provider. MRE can be performed in addition to MRI of the abdomen, but by itself, if that was the only thing the provider ordered, you would not bill for anything except for 76391.
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    Wiki 11970 & 19370 on same breast

    Yes, per CMS NCCI Edit File, add modifier -59 to 11970 and the appropriate laterality modifier to both.
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    Wiki Initial Prenatal visit??

    The initial office visit for confirming pregnancy is not part of the global OB package (and this appears to be such a visit). The prenatal flow sheet or OB flow record will be started at the first visit included in the global OB package...
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    Wiki Peripheral Arterial Disease Coding – Lower Limb Thrombosis

    Could you explain how to do that on CMS?
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    Wiki How would you code physician Performed 76817 and a sonographer performed 76817 TC Billed Same Day, under Same Provider

    Add modifier -76 to the repeat ultrasound.
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    Wiki Limited Ultrasound in office, Billing?

    Assuming your office has the ultrasound equipment and an ultrasound technician (i.e., technical component) and your provider is providing the interpretation and report (i.e., professional component), then you can bill the service globally (i.e., without modifiers -26 and/or -TC). POS would be...
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    Wiki Interventional Cardiology Help!

    When we input 76937 into CMS Physician Fee Schedule, it clearly shows that the service has both a professional a technical component, as indicated by modifier -26 and -TC, respectively. https://www.cms.gov/medicare/physician-fee-schedule/search?Y=0&T=4&HT=0&CT=0&H1=76937&M=5 However, when we...
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    Wiki Diagnostic Mammo

    It's no longer screening when there's a mass. Even if a patient were to self-refer and show up for a screening mammogram (per patient request), unless the patient is deceptive, the patient is going to provide the facility with info that she has a mass, and that screening mammogram is going to be...
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    Wiki Diagnostic Mammo

    Make sure the provider is following the ACR appropriateness criteria. https://acsearch.acr.org/list https://acsearch.acr.org/docs/69495/Narrative/ If indeed the criteria states a mammogram is indicated, it would not be a screening mammogram; it would be a diagnostic mammogram. Therefore, you...
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    Wiki Place of Service Code - Professional Claims

    Please review the following: https://www.aapc.com/discuss/threads/in-office-surgical-suite.174067/
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    Wiki 76700 billed with 76775-XU

    (Why mention 76776 if it was not performed? Typo?) Code for 76770 and 76775-59 (instead of 76775-XU). This may be just an instance where the payer (non Medicare?) does not accept modifier XU. If denied, appeal and submit the clinical documentation that justifies the medical necessity of both a...
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    Wiki 76706 Screening AAA for patient over 75

    Yes, and I would only code 76775. I would not code any CPT code for a duplex scan (e.g., 93978), as it does not appear that there is adequate documentation to justify coding it. Instead, it appears that the spectral/Doppler was only used for a quick look to check whether flow is present [in the...
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    Wiki Preparing for the CPC exam and I am extremely confused regarding guidelines in the CPT coding book. I hope someone can help.

    I think it's possible to pass CPC without a medical background. The more resources you use in studying (study guide, practice tests, etc.), the better. I have no doubt that you can do it if you put your mind to it.
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    Wiki Barbotage

    https://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/reader-question-code-barbotage-as-joint-injection-article
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    Wiki MOCA Test

    CPT 99483 for 60 minutes of total time. CPT 99417 for 75 minutes or longer of total time. I believe the expectation is that everything specified under CPT 99483 is performed on the same day. See the following for more info...
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    Wiki APRN and MD see patient on 2 different days, new patient for both?

    AMA CPT 2024 Professional Edition, p. 4, “But the patient saw an APRN first...” Id., p. XV, Based on that, it seems quite clear to me that the physician cannot bill for a new patient visit.
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    Wiki ICD10 Z76.89

    Z00.00 Encounter for general adult medical examination without abnormal findings ?
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    Wiki Do you bill other diagnostic symptoms with the diagnosis of ICD10 I21.4.

    Interesting. I would not code any of those symptoms if indeed the provider specified the diagnosis as I21.4. Reason is simple: dizziness, chest pain, and shortness of breath are all symptoms of a myocardial infarction. According to AAPC 2024 ICD-10-CM Expert, p. G5, I’d have to assume the...
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    Wiki Preparing for the CPC exam and I am extremely confused regarding guidelines in the CPT coding book. I hope someone can help.

    [Edit: Long story short, yes, 20 years of medical experience: 6 military; 14 civilian. I would say I learned most about coding in my current position, but it has been very minimal contact with coding. But, what minimal contact it is, I make the most of it by learning and researching.] I...
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    Wiki CPT 99024

    No, 99024 is used for reporting purposes, not for payment purposes. The payment for visits reported by 99024 is already included in the global surgery fee.
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    Wiki 14021 w/ mod 50?

    Per CMS Physician Fee Schedule, cannot use laterality modifiers (LT, RT, 50) for 14021. The same applies to most integumentary procedure codes, as the skin is considered a single organ without laterality. If indeed two distinct sites were involved, code 14021 twice, with modifier -59 on the second.
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    Wiki Peripheral Arterial Disease Coding – Lower Limb Thrombosis

    Don't think that the course can be further specified for that particular condition. To note, such specificity is possible in ICD-11 via extension codes: XT5R Acute XT1L Subacute XT8W Chronic
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    Wiki Preparing for the CPC exam and I am extremely confused regarding guidelines in the CPT coding book. I hope someone can help.

    The CPT code discusses tumor resection. 52234 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm) Resection is surgery to remove tissue or part or all of an organ. Biopsy is is a procedure to remove cells...
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