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  1. K

    Wiki ERCP COMPLETE?

    Is the following a complete ERCP? If it is not, guidelines say to look at EGD 43235 but does this meet the qualifications for an EGD? Procedure The Trade in program from Olympus. Removed 180's was introduced through the mouth, with the intention of advancing to the bile ducts. The scope was...
  2. K

    Wiki EGD Foreign Body removal 43247

    Two questions; 1. If EGD report states food bolus was pushed into the stomach can this be billed as 43247? The CPT description uses the words, removed, withdrawn, so this has me thinking the bolus must actually be removed from the body completely via the mouth. The flexible fiberoptic endoscope...
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    Wiki Veterans Affair-Renal Dialysis

    Can anyone give any guidance on the following situation; ESRD Dialysis center goes to nursing home to provide renal dialysis to a patient with ESRD. We bill the claim to VA, however they are denying stating we need an AY modifier stating the renal dialysis is for condition not related to ESRD...
  4. K

    Wiki GERD and Ulcerative proctitis

    When a patient is having an EGD performed for an indication of GERD but the exam is normal, would you still use K21.9 or would Z87.19 (personal History of other diseases of the digestive system) be more appropriate? Also somewhat of the same question on colonoscopy being performed with an...
  5. K

    Wiki Fujinon Intelligent Chromo Endoscopy system

    Can anyone give me any insight regarding the use of the Fujinon Intelligent Chromo Endoscopy (FICE)System. Our providers perform an EGD using white light and the FICE system and they want us to bill 43239 and 43499-59 (for the FICE system) but payers deny the 43499-59 as bundled. I am not real...
  6. K

    Wiki EGD diagnosis

    Pre-indicator states Reflux, sometimes GERD(this is an on going issue), however the procedure report/findings state normal esophagus, normal stomach, normal duodenum. Would you still use the reflux/GERD ICD-10 code? Thank you
  7. K

    Wiki Bundling-Modifiers

    What modifiers are being used for bundling issues on 45385 & 45380(separate areas/polyps) and now on 43249 & 43239. These are all bundled but modifiers allowed however they all also have multiple procedure/endoscopy indicator of 3. We have always used a 59 on the 45385 & 45380 but now it is...
  8. K

    Wiki Actemra

    Is anyone having problems with Medicare denying J3262 as a duplicate. We have 3 different vials that each have their own NDC # so when a patient receives 600 mg(1-200 mg vial and 1-400 mg vial) we bill on two lines: j3262 x 200 (w/respective NDC) and J3262 x 400(w/respective NDC) but in December...
  9. K

    Wiki GI Endoscopy(45378, 45380, 43235, 43239 etc) and Anesthesia 2018 (00731, 00811, 00812

    Is anyone else having trouble with payers bundling anesthesia and GI Endoscopies? I do not understand why they created new anesthesia codes to be more precise if they were just going to bundle them? Having similar problem with conscious sedation 99152, only a modifier is allowed and being used...
  10. K

    Wiki EGD documentation

    When auditing documentation of an EGD, does a statement such as "The colonoscope was introduced through the mouth and advanced to the second part of the duodenum" provide sufficient documentation as proof that the esophagus, stomach and duodenum were examined? Would a picture of the gastric...
  11. K

    Wiki 96413 verses 96365

    Can someone explain the difference between 96413 & 96365? We administer infusions of drugs such as Remicade, Actemra and Orencia. We have always been told to bill 96413 to Medicare and 96365 for all other insurance companies, but we are now having some debate about whether we should be using...
  12. K

    Wiki 64450-50

    My provider has indicated 4 units of 64450 performed bilaterally (64450-50). Can someone tell me if I bill these all on one line x 4 units or do I need to bill them on separate lines with a "51" modifer(64450-50-51) as I see it has a multiple surgery indicator of "2". My payer is Tricare however...
  13. K

    Wiki Calculating units for Nerve Conduction

    Can someone tell me how to correctly calculate the number of units for nerve conduction studies. Example Rt median Sensory- long finger Rt Ulnar Sensory- Little finger Rt median Sensory- Thumb Rt radical Sensory- Thumb Lt median sensory-long finger Lt Ulnar sensory- little finger Lt Median...
  14. K

    Wiki 77014-26 BID-Tomotherapy

    Can 77014-26 be billed twice in one day for a patient that is BID Tomotherapy? Is it payable twice in one day?
  15. K

    Wiki IMRT Plan

    Can two IMRT plans be billed on the same day, when one is for pelvic sidewalls and the other is Paraaortic LN?
  16. K

    Wiki needle localized partial mastectomy

    Is needle localization billable with a partial mastectomy(19301) and if so what CPT code should be used? Thank you
  17. K

    Wiki ICD9 Help-ductal adenocarcinoma of breast

    I am trying to figure out what ICD 9 code to use for poorly differentiated ductal adenocarcinmoa of the breast. The doctor states ER positive which I know will be V86.0, and that no lymph nodes are involved, but that is all it states.:o
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