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    Wiki MDM Question

    With the new guidelines for 2021 when choosing an E&M level between the 99213 and 99214. When someone has 2 acute problems (ex. otitis media and hives) for the number and complexity of problems addressed would that be a low or moderate? We were having some group discussion and wanted to clarify...
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    Wiki TCC

    We are a CAH and yes the nurse works for the hospital. Our provider runs the wound clinic so we normally bill for both the facility and the profee. In this instance he orders the cast to be changed every week and wound care nurse just does it.
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    Wiki TCC

    Can a certified wound nurse perform and bill for CPT Code 29445 total contact cast? We are wondering if we can bill this out both on the professional side and facility side or if we just bill the professional side for the wound care nurse and then for facility charges bill for the supplies...
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    Wiki Z00.00 vs. Z01.419

    For a family practice office when a patient comes in for phyiscal and a women also has her pap/pelvic done, which dx would be more appropriate to use? This would be for a commercial patient. Z00.00 and Z12.4 or the Z01.419? Thanks for any input!
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    Wiki Coding Audits

    Wondering if anyone has outsourced coding audits and if so what company did you use? Good/bad experiences?
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    Wiki Rapid Rhino

    If a patient comes into the clinic and has a rapid rhino placed, can we bill for both the procedure (30901) and the supply for the rapid rhino or is that supply included in the procedure? Thanks!
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    Wiki Positive Occult Test

    If a patient has a positive fecal occult test during their yearly exam and then the patient is scheduled for colonoscopy, would this be screening or diagnostic? The patient has a family history of colon cancer so is supposed to get one every 5 years and the last 2 were normal. Thanks in advance...
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    Wiki Multiple vp's

    If we have someone inpatient and they have multiple vp's (36415) on the same day, is it okay to charge for each vp on that day? Thanks for any input!
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    Wiki Colonoscopy with multiple biopsy

    If a patient has a colonoscopy and they have a polypectomy done where one polyp was taken off by cold biopsy and another was taken off by hot biopsy; do you code both the 45380 and the 45384 and then put the 59 modifier on the 45384? Thanks!
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    Wiki 36415 - there a modifier

    When someone in the ER gets their blood drawn more than one time, is there a modifier you put on the 2nd 36415? The lab techs think we should put the 91 modifier on the 2nd 36415 but it hits an edit in our system. So just seeing what other places do in this situation. Thanks for any input!
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    Wiki Shave bx

    We do quite a few shave biopsies on Medicare people in our clinic. The LCD only covers benign lesions, so what should be done when the path comes back as malignant? Any help is appreciated!!
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    Wiki Prevnar 13

    Will Medicare pay for/cover a patient to have the prevnar 13 booster (90670)? If not, is this patient payable?
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    Wiki Modifer 25 - If a patient comes

    If a patient comes into the ER and they end up doing a chest xray, is it necessary to put the 25modifier on the ER charge? We do our own xrays at our facility but then send them out to be read.
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    Wiki Progesterone injections

    Does anyone else bill for progesterone in cottonseed oil injections? If so what J code is approptiate to use? The J3490 (unclassified drugs) or the J2675 (progesterone)? Thanks in advance for any help!
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    Wiki Foot care clinic

    We had our podiatrist quit our foot care clinic and we are now looking into having a RN do these services, which include the trimming of dystrophic and nondystrophic nails. Does anyone know is something we would still be able to bill for. We will still be using the G0127 and the 11719, can we...
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    Wiki Preventive

    When a women comes in for their yearly/pap, we normally use the dx codes v70.0 and v72.31. We now have some insurance carriers saying they will only pay if we use the v72.31 as primary. How is everyone else doing these?
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    Wiki Dx ?

    When a shave biopsy to a lesion is done, is it appropriate to wait for the pathology report or to put the diagnosis the dr has put before the path report is available? The shave bx need a covered dx and if we wait for the path report and it comes back malignant then the claims will be denied...
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    Wiki Modifier 59 - seperate IM injections

    We have providers that will sometimes give 2 seperate IM injections. Does anyone know how to appropiately bill the 96372? Should it be listed once with 2 units or should it be listed out twice with the 2nd one having a 59 modifier? I did find a CPT assistant that says you can do it with the 59...
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    Wiki CPT Code 54450

    We have been using the cpt code 54450 when a newborn comes into the clinic after a curcumsicion and they have penile adhesions that the doctor says they take down by stretching. And that is pretty much all they say. Is this the correct code to use and is that enough documentation to be billing...
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    Wiki Modifier 25 ?

    We were just questioning the usage of modifier 25 on an office visit when they give an injection (96372) at the same visit. :confused:
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    Wiki Lesion removal codes

    When our doctors remove lesions such as shave bx or excisions, we always wait until the pathology report comes back and then use that dx. There is an LCD for removal of benign skin lesions so anytime I code a shave bx or the 17110 and the dx comes back as malignant it is coming back that it...
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