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Wiki Coding for a total vaginal hysterectomy with laparoscopic removal of tubes/ovaries
This surgery represents a laparoscopically assisted vaginal hysterectomy and you would code either 58552 or 58554 depending on the weight of the uterus which might just be more than 250g given the additional work required. -
Wiki myomectomy 58140 vs 58146 when only 3 myomas but weighs 540 grams total. which code do we choose?
The weight only applies to intramural fibroids (ones that are imbedded in the uterine wall), not surface myomas or a combination thereof. So if all of myomas were intramural with a weight over 250 g you go with 58146. If they are all surface myomas you code 58140. -
Wiki Counseling patient on options for pregnancy
Yes, the US has confirmed pregnancy. -
Excision of fibroid of vulva
Vulvar leiomyomas are very rare and are frequently initially identified as a Bartholin's glad cyst which was the case here. However, 56630 represents a radical vulvectomy, which was not performed (a partial radical vulvectomy includes partial or complete removal of a large, deep segment of skin... -
Wiki OB ULTRASOUND
No. You are not performing a repeat procedure on the same fetus. Per a CPT Q&A: For reporting multiple gestation fetal biophysical profiles, code 76818 or 76819 should be reported once for each fetus. Fetal biophysical profile assessments for the second and any additional fetuses, should be... -
Wiki OB code sequencing - we're having a debate
The ICD10 guidelines do not address this issue directly, but in multiple examples they have provided via their Q&A they indicate that as long as the primary/first listed Dx is from Chapter 15, the other diagnoses used would follow whatever rule was attached to the O code reported. But keep in... -
Wiki Assistance with Hysterectomy Codes
You are correct. This qualifies as a total laparoscopic hysterectomy rather than a LAVH because they severed all attachments via the scope. The uterus can be removed vaginally or via the scope and this would still be coded as 58571. -
Wiki Cervical Polyp Removal
Keep in mind that each CPT code is valued both on physician time and equipment used. In the case of 57500, a cervical biopsy forceps or scalpel would have to be used and the typical time to do the actual removal is 15 minutes. Using ring forceps would not make this the same thing as a biopsy... -
Wiki 76998 in office for IUD placement
Per an ACOG Q&A: Ultrasound guidance may be reported in conjunction with other procedures, when appropriate, with CPT code 76998, Ultrasonic guidance, intraoperative. When reporting code 76998, if there is no hard copy or stored digital image of the ultrasound, the service is not billable. An... -
Wiki OB global billing
Since you did not do the delivery, split bill this. If you had done the delivery, you would have billed insurance 1 for their visits, then could have billed global care for insurance 2 (if they allow it) with a modifier -52 for reduced antepartum services under their coverage policy responsibility. -
Wiki 59025
This answer is not wrong, but an NST can begin at 32 weeks if there is a medical indication. -
Wiki 59025
ACOG has guidelines for an NST, and in general, you would not begin testing until 32 weeks gestation. The diagnostic value of NSTs before 32 weeks varies and has high false-positive rates due to the immaturity of the fetal heart. This means that the there are insufficient fetal heart rate... -
Wiki Subsequent visit and discharge same day
No. 99234 is only reported when the hospital ADMISSION and discharge happen on the same calendar date (even if a different times on the same date of service). You have said this is subsequent care and then a discharge visit on the same date. In that case, you add all the day's documentation... -
Wiki IUD insertion problem
But what she said was could she use the -52 on the J code (note the insertion code). -
Wiki 11981 modifier?
No as the procedure is the same no matter which arm you use and you would never insert in both arms so no differentiation would be required. -
Wiki G0101/Q0091/S0610/S0612 annual exams!
I created the attached document with regard to billing Medicare which you might find helpful. It includes different scenarios, use of the codes (both CPT and ICD10) and references in case anyone wants to know "where does it say that." I have updated it to reflect rules in effect in 2024. -
Wiki IUD insertion problem
You would not use a modifier -52 on J7297 - you did not provide a reduced service and this is a code for a supply not a service. If Lilleta will not reimburse you, I'm afraid you are out of luck. But if the Mirena fit, the Lilleta should also have fit as they are both 1.3 x 1.3 inches. The... -
Wiki 58100 and 58563
Per the CPT Assistant Q&A in September 2015: Q: Would it be appropriate to report code 58563, Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation), when the dilation and curettage (D&C)/hysteroscopy and the endometrial ablation... -
Wiki Mastitis in The Pregnancy Global Period
If she is in the antepartum period, the modifier -24 cannot be used (the definition is unrelated E/M in the POSTOP period). If she has not delivered, she is not in the postop period. You can certainly code for the mastitis and if if is denied (and there was no additional prenatal care done at... -
Wiki Laproscopic left salpingectomy AND ovarian cystectomy
I would need to see a description of the actual work done rather than just a summary to help with this. -
Wiki hysteroscopy
If the second procedure was performed using the hysteroscope, only 58563 would be appropriate to bill. The denial message makes no sense because as you say, 58558 has 0 global days. They must have some other type of edit in place. Perhaps they are looking for a modifier such as -58 (staged... -
Wiki Hospital re-admission for obstetric hematoma of pelvis
No not included. This is definitely an unforeseen complication that is being treated medically and should be billed separately per CPT rules. -
Wiki Laparoscopy bilateral Salpingectomy with incidental liver perforation and adhesions.
Okay, since there are no other takers on your case, I will jump in. First, you should only be linking diagnosis codes to the procedure that describes why the procedure was performed. Adding a string of diagnosis codes that are not related may lead to review of the entire claim by the payer or... -
Wiki Patient self swabs for STI testing - how to bill
Not unless you incurred practice cost expenses over and above those you would occur doing business as a practice. Also note that 99000 has no RVUs assigned so if and when it is paid, it will be strictly payer determined. In general, 99000 was developed to take account of costs to the practice... -
Wiki Principal diagnosis for cesarean section due to previous traumatic birth (4th degree tear)?
If the previous 4th degree laceration causes an abnormality of the perineum so that vaginal delivery was not possible, you could go with an O34.74 code (3rd trimester as there is no code for complicating delivery). There is also the Z87.59 code for personal Hx of complications from pregnancy... -
Wiki Late transfer of care subsequent visit
I am still not sure what you are asking. Code 59425 is a "global" antepartum visit code. It can only be billed with the OB provider has seen the patient a total of 4-6 times before another provider delivers, or there is a transfer of care, or termination of pregnancy. The code 59426 is a... -
Wiki Delivery and Initial Newborn Exam
It would depend on payer policy and then ensuring that if it is allowable by your particular payer (this service is NOT part of global OB care services per both CPT and ACOG), and the physician documents the expected work. 99460 requires a maternal and/or fetal history, examinations, ordering... -
Wiki Question for Vagina delivery with repair for 3A laceration
Per this note, it does not appear that the midwife did the repair so a modifier -22 would not be appropriate as even if the MD had delivered the baby, he/she would be able to bill the 3rd degree repair separately. Without dimensions you are stuck so you need to go back to the provider for that... -
Wiki ANTEPARTEM CARE ONLY OR ANY PORTION OF OB GLOBAL
I am assuming that the physician who performed the cesarean was not affiliated in any way to the provider/s who did the antepartum and postpartum care. You have 2 choices. Bill 59425 or 59426 depending on the total number of antepartum visits and then 59430 for PP care (outpatient). If the... -
Wiki Wedge Resection of labial lesion
You are going to need a medical indication for the diagnostic laparoscopy - it is not a look see in the sense that he is scouting out the lay of the land before doing abdominal surgery (which is not performed). If he were doing it to ensure he does not puncture the uterus during the... -
Wiki 59515 delivery and pp care
If these physicians are all billing under the same Tax ID, you bill globally no matter where the patient was actually seen. It is transfer of care within your practice, not a transfer of care from an unaffiliated practice. -
Wiki Cystectomy with excision and removal of the cyst in toto.. help please
First a lesson in medical terminology. Cystectomy is a medical term for surgical removal of all or part of the urinary bladder. Some physicians refer to the removal of a cyst as a "cystectomy" but this is not the usual medical definition for this term. If you do not already have one, a book... -
Wiki Can we bill the drugs used during a hysteroscopy in office
Yes, if you are billing the drug and you administered it, bill. Again, the payer will decide. -
Wiki changing 76805 to 76815
So are you saying that you have already billed and been paid for 76805 a few weeks earlier? If so, and there was no issue with the first one, what is the medical indication for the second one? You should never bill for something that was not documented and undercoding is as bad as overcoding... -
Wiki Can we bill the drugs used during a hysteroscopy in office
Pain medication is usually not included and if you supplied the drug, you can bill - payment on the other hand will be up to the payer. The atropine they may not be paid for as it would be used as part of the pre-op prep to prevent secretions in the respiratory tract during surgery. A local... -
Wiki H&P billing before delivery
The H&P is an integral part of the delivery code. If the two providers are not affiliated with each other in any way and do not have a coverage agreement, you can handle this in one of 2 ways. The non-delivering provider can add a modifier -56 to the delivery code for the preoperative care, and... -
Wiki Help with Dilation and curettage under ultrasound guidance with placement of Bakri uterine balloon.
Correct. The modifier -22 would be listed first as it is the one that impacts payment. The rule of thumb in the case of more than one modifier is to code the “functional” modifier first, and the “informational” modifier second. The distinction between the two is simple: you always want to list... -
Wiki excision of granulation tissue
Since the location is specific to the vagina, I would report N89.8 as the most accurate code in this instance. The integumentary codes are primarily for conditions of the skin, hair, nails, etc (outside covering of the body). While the opening into the vagina is referred to as a "myocutaneous... -
Wiki 76830 and 76856
Well first you would not bill 56817 (pregnant uterus TV ultrasound) with 76856 (non-pregnant uterus ultrasound) on the same date of service, especially as the pelvic ultrasound is normally done first with a full bladder followed up with the TV with an empty bladder. If your first ultrasound is... -
Wiki methotrexate
It may not matter once you do the math except how the payer might look at it. If you billed J9250 (5mg dose) for the 90mg injected (3.6 ML total X 25 MG per ML) you would report a quantity 18. If you billed J9260 for this quantity you would get a quantity of 1.8. I think I would got with the... -
Wiki methotrexate
Will you do me a favor and obtain the NDC number for the drug your office orders? The reason I am asking is that the FDA does not list a 10 ml vial with 250mg on its site for this drug. The dosage is calculated by the physician per body surface so the amount would vary from patient to patient... -
Wiki Preoperative visit for elective repeat C-sect
From your question it appears that the patient had already decided to have the cesearan prior to the preop visit. In that case, the preop is is included in the work required to do the cesarean and as such not separately billable (the code for cesarean includes physician pre-operative time of... -
Wiki Help with Dilation and curettage under ultrasound guidance with placement of Bakri uterine balloon.
Actually, the balloon was placed under ultrasound guidance, not the D&C. I would keep is simple and code 59160-22, 76998 (76986 was deleted in 2007). This will still give the payer the same information, but may avoid a first submission denial for the unlisted code. -
Wiki Confirmation of Pregnancy Visits being incl. in Global Charge?
I have attached a reply from ACOG back from 2021 that may help you. -
Wiki G0101 Denied with Preventive Code
Medicare's "Carve Out" Rule Will Help Compute Your Patient's Fee Published on Fri May 19, 2017 in OB/Gyn Coding Alert covers this topic. Many years ago Medicare expressly published this carve-out rule and ACOG also published a coding document that explains all of the coding combinations and... -
Wiki add on code 99459
Given that using a chaperone is not a diagnosis and there is no diagnostic code that would pertain to this, the code you have used is correct since she would not have needed the chaperone (or the pelvic pack) unless this was performed. Insurers sometimes (no surprise there) like to delay... -
Wiki OPEN RSO surgery
Why are you thinking 49000? This is an open abdominal procedure to remove the right ovary and part of the tube. No matter the reason the surgery was started (exploratory) you only code for the final procedure performed - in this case the RSO. The code would be 58720. -
Wiki G0101 Denied with Preventive Code
G0101 is a carve-out service from 99397, not an additional service to 99397. In the covered years, Medicare pays for their portion of the exam and the patient pays the remainder. In a non-covered year, the patient pays the full amount of 99397. -
Wiki Patient self swabs for STI testing - how to bill
And to add to your answer, we should also know why this practice is billing 99000 at all. If the patient is collecting the swab and they are only doing the labeling and leaving the sample for the lab to pick up, this code would not apply at all. I assume they are billing 36415 to get paid for... -
Wiki add on code 99459
Medicare does not pay for preventive services using the CPT E/M codes so these codes would not be billed to Medicare in any case and 99549 could not be an add-on code in that case. They will pay for problem E/M visits and if a pelvic exam is performed during that visit, the 99459 would apply...