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    LOPS- G0245, G0246, G0247

    Hi! Can someone talk to me billing for LOPS? I know the guidelines per CMS, but just recently tried sending out a couple to trial them and they came back as missing HCPS- I sent the G0246-25 G0247-Q8, DX E11.42, L60.3, with referring provider and date last seen as well. -Does the podiatrist...
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    Wiki Diabetic Footcare Documentation

    Hello Folks! When the pt comes in for diabetic footcare is it required for the Dr. to document in their note who the PCP is and the date last seen?? I have a couple providers who just will not document this information. The front desk calls the PCP's office and obtains this information so we can...
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    Wiki Mutually inclusive for routine foot DM care

    Hello fellow podiatry coders! Wondering if you can offer some assistance. I am having difficulty with this scenario. Dr. see the pt dx look like E11.42, E11.51, L84, dystrophic 6 nails and elongated nails 4 nails, L60.3 & Q84.5 and Q8 lets say. 11719-Q8- DX E11.42,E11.51, Q84.5 11721-59,Q8- DX...
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    Wiki Assistance please Ortho coders....patellectomy?

    Hello all you Ortho gurus! Looking for an appropriate CPT code for a patellectomy due to hardware failure after a TKA. Pt has already had if reconstructed (27422), now it is time to remove it. DX T84.022-Instability of internal right knee prosthesis. What would you use? Excision? As always...
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    Wiki Denial for CPT 27650

    DX- Chronic Achilles tendinosis with partial tear CPT - 27650 Debridement and repair Achilles tendon. The tendon was entirely detached through lengthening the incision proximally and, actually, in both directions. The terminal portion of the tendon was left attached to periosteum and fascial...
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    Wiki RVU-Fee Schedule Columns---???

    Hi All Could someone tell me what the different columns are when I look at RVU on the Medicare Fee schedule- there is the Work RVU (which I am aware)-then transitioned non-fac PE-RVU, Fully Implemented Non Fac PE RVU, Transitioned Facility PE RVU, Fully Implemented Facility PE RVU and MP RVU. I...
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    Wiki DME documentation guidelines...first denial!

    Hello All! Can someone shed some light on documentation guidelines for orthotics, shoes and boots? I am familiar with CMS guidelines/requirements for diabetic shoes. But out of the blue I have received a denial for a pair of orthotics for a 8yo whom did not require a prior auth, (called and...
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    Wiki AWV...who can see the pt?

    The AWV may be performed by a health professional, which is defined as: • a doctor of medicine or osteopathy as defined in Section 1861(r)(1) of the Social Security Act, a physician assistant, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5) of the Social...
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    Wiki Aspiration with injection

    Howdy Folks- when a pt comes in and the provider aspirates fluid from a knee and then replaces it with cortisone. What is the proper way to code and get paid for these? 20610 & 20610-RT then with the J3301 or 20610 X2. I am struggling getting paid for this type of procedure. Thank you! TW
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    Wiki 99211 for COVID swab

    HI! I am having a hard time justifying why we should bill a 99211 for a COVID swab when we don't have any vitals, or any other elements of a nurse visit. Basically the note is just a means to put the order in for the swab and the pt is swabbed in a parking lot or sent to a lab. The pt might not...
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    Wiki Routine eye exam-nurse visit?

    If a patient comes in for an eye exam- 99173 because they have to renew their drivers license (doesn't happen often but DMV's are closed in NY right now) is this a nurse visit in addition to 99173. And while we are at it what DX can we use? :unsure: Many thanks!
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    Wiki Home Visit after surgery-billable?

    If the surgeon makes a home visit after surgery to do a dressing change, no complications, is it global to the surgery or is a billable home visit? Thank you!
    • twalls
    • Thread
    • Replies: 1
    • Forum: E/M
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    Wiki Looking for insight billing 92250 for DM retinopathy in PCP office

    Hi! We are about to begin Fundus (IRIS) exams for our diabetic patients to monitor for retinopathy. I am looking for coding, medical necessity, reimbursement guidelines or overall experiences you have come across with payors, providers or patients. We live in rural NY and I think this is a great...
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    Wiki New Pts VS Est Pt when seeing PA's in different specialities same tax ID's....?

    I have called Medicare multiple times now and am told the same thing. They do not look at subspecialty. So if a patient saw a PA in another practice (same tax ID/NPI) they will not pay another new patient visit. Years ago Medicare would look at taxonomy, but they no longer do that. Is this...
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    Wiki Well Child Visit with minimal issue

    So, I have this ongoing issue with a provider that wants to add every issue as an E/M to a WCV and would like some feedback from some more seasoned Peds coders. If a child comes in for WCV and says two days ago I fell and my wrist hurts, Dr examines the wrist, states its tender, orders xrays-...
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    Wiki Depression screen 96127-billed when only positive?

    Hi! PHQ2 & PHQ9, the nurse begins the 2 and if positive the provider continues on with the 9. Regardless of the outcome, if the provider conducted the entire screening for depression, it is billable with no financial responsibility to the patient? And what about the PHQ2? Thank you as always...
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    Wiki Workers Comp by PA in ED for fracture care

    Patient comes to ED for fracture care is seen/treated by the ortho PA, then comes to the office three days later to see Dr (same PA/DR-ortho office). 1) Can the PA bill for the fx care? 2) If he can't would fx care be billed at the follow up visit with the Dr? 3) Can the PA see workers comp...
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    Wiki Camp, school, working papers with new providers that hasn't seen them

    Hi! So I have new peds providers that has not seen the patients and they have already their wellchild visits within the year with the previous Dr. and they need paperwork filled out, the Dr. wants to bring them in and see them before filling out and signing off on it. How would you bill this and...
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    Wiki Can I get your thoughts...28297 vs 28295 or something else all together

    Procedures: 1. Lapidus fusion, left. 2. Bunionectomy with Akin osteotomy, left. 3. Osteotomy of shortened left 2nd metatarsal. 4. Arthroplasty, left 2nd toe. Description Of Procedure: The patient was brought to the operating room and placed on the table in supine position. General...
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    Wiki Healthy Colonoscopy follow up...medical necessity??

    Pt comes back in for results of the colonoscopy, they have already come in for a pre-appt that wasn't billable because they were healthy, now they are coming for their results...unnecessary? Thanks for your thoughts..my thought is send him a letter and see pts that need to be seen. :confused...
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    Wiki 58340-SIS..Does the Doc have to dictate?

    Is it enough to bill 58340 from the radiologist's documentation that Dr. Smith injected the saline, or does the Dr. Smith have to dictate the procedure to bill? thank you for your input!
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    Wiki Is this even billable..thoughts? Otho is to new...Please & Thank you!

    DIAGNOSIS: Status post closed reduction of right distal radius fracture. PROCEDURE: Splitting of cast, right arm. INDICATIONS: This is a 12-year-old male, status post closed reduction of a silver-fork deformity of the right distal radius. DESCRIPTION OF PROCEDURE: The patient was placed in a...
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    Wiki New to Podiatry Surgery ...*Help Please**

    Preoperative Diagnoses: 1. Hypertrophic bone/malunion, left navicular. 2. Chronic synovitis with arthralgia, left ankle. Postoperative Diagnoses: 1. Hypertrophic bone/malunion, left navicular. 2. Chronic synovitis with arthralgia, left ankle. Procedure: 1. Open repair of malunion/nonunion...
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    Wiki New to OB GYN..Can I bill

    Can I bill 99406- smoking and tobacco use cessation counseling visit with an annual exam such as 99385,99386 ect? We would always bill the 99406 with E/M codes in colon rectal but I am not sure how it works with OB. Thank you! Tammy, CPC
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