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    vulvar skin tag removal

    The general guidance is to use a location specific code if it exists. If they are skin tags being destroyed or removed, that is not the same as removing a mass/lump/lesion to biopsy. I would use 11200 for skin tag removal from the vulva. 11200 even states "any area".
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    Wiki Telehealth Place of Service Codes 02 or 10

    Located!! My MAC (NGS) came out with this fact sheet stating: "If the patient receives the telehealth service from a location that is not a facility they would normally receive care, such as their car or work, then POS 10 would be appropriate based on this description provided by CMS in the...
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    Wiki Telehealth Place of Service Codes 02 or 10

    I would agree with POS 10. My personal opinion is the the descriptors of the POS codes can be misleading. POS 10 generally means not a facility. POS 10 would apply to anywhere the patient is living, in addition to workplace and a variety of others. There was a FAQ or additional reference...
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    Wiki New patient

    I don't think this would be billable as there is no medical decision making, no assessment, and no plan. Even if you determined it could be billed on time, in a situation like this, I would not bill.
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    Wiki OB global billing

    I agree with @mmckibbin. Almost all my carriers would want this split billed to new insurance 59426 7+ antepartum 59410 vaginal delivery with postpartum care
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    Wiki Billing audit for an 11 clinician Primary Care Clinic/s

    This is a community forum. If you are asking AAPC to perform an audit, you need to contact them directly. https://www.aapc.com/business/audit-services
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    Wiki Preadmission Testing via Telehealth

    If you don't know the scenario, then no one can answer this for you. Just about any common PST testing (EKG, CXR, bloodwork) I could think of can't be done when the patient is at home. If you would like to provide that information, then others can give advice.
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    Wiki Post op visits - one doctor performs the surgery & another doctor

    If both clinicians are the same group, same specialty, you would code for the typical surgery code. There is no reason to split the coding with -54/-55, as from a coding perspective and insurance perspective they are in exactly the same group practice. If this is a frequent occurrence and...
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    Wiki 2 DIFFERENT SURGERIES 2 DIFFERENT PROVIDERS

    Depending on how extensive the surgery itself is, you might consider that not opening and not closing the patient is resulting in reduced work and -52 MIGHT be a consideration. If it was a 6 hour intensive surgery, then maybe not. If it was a typical 1 hour procedure that only took 25 minutes...
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    Wiki Board certification for Hand specialty

    Exactly. As @CBLENNIE explained, the key is how the provider is credentialed. I will add that while most carriers use taxonomy, others (namely Medicare) use a shorter list of 2 digit specialty codes that does not contain as many subspecialties as taxonomy. "Hand Surgery" is given it's own...
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    Wiki Modifier needed for inpatient

    By coding rules, different providers of different specialties should not require a modifier for that reason alone. There is a modifier -AI for the initial inpatient visit which goes on the admitting physician's claim. Other than that, this must be a carrier rule/guideline. Perhaps their...
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    Wiki Preadmission Testing via Telehealth

    Some additional context could be helpful here. I'm not certain how you could perform "testing" via telehealth. Where is the patient and where is the provider?
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    Question Post-Signature Addendums in EHRs/EMRs?

    In any EMR, when there is an addendum, the change may be sort of "behind the scenes". The EMR is required to track who/what/when the change was made, but often the initial view or printed view is a "prettied-up version." I know our EMR displays what the current signed version is, and you have...
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    Wiki new vs established.

    What reference are you using that states a new patient requires a physical examination?
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    Wiki Subsequent visit and discharge same day

    In many practices, if the intent is that the patient will have all her postpartum care with the same provider who delivered, we would hold the billing until at least the first office postpartum occurs, and then bill for delivery + PP. However if you are not providing the PP, then as indicated...
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    Wiki Open procedure for removal of dermoid cysts of ovaries

    58925 Ovarian cystectomy, unilateral or bilateral The provider removes a cyst from one or both ovaries via an abdominal incision. Clinical Responsibility The provider places the patient in the supine position and administers a general anesthetic. The provider incises the lower abdomen just...
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    Wiki Bladder irrigation 51700

    My apologies. I was reading your post as whether you should advise them to document differently even if currently documented correctly. I do not know enough about urology from a clinical perspective to understand the difference, and perhaps a discussion with your providers could be helpful...
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    Wiki Dx lap including lysis of adhesions

    With the additional information supplied, I would lean further toward laparoscopic lysis of intestinal adhesions.
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    Wiki NPs billing out almost all 99214s

    To me, the bottom line is the AMA E&M guidelines including the definitions. Those guidelines clearly state if you order a test, you count the order, and the review is included. You can't state an acute, uncomplicated is more than it is simply because the patient is pediatric. If the NPs are...
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    Wiki Gyn Preventive visit and separate e&m for sterilization

    A preventive visit that also documents a recommendation/discussion of a surgical procedure, I would consider an additional separately billable E&M service. Now, a note that says "discussed contraception methods including OCP, IUD, and tubal ligation." without real documentation about a surgery...
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    Wiki EPIC in Physician-Owned Primary Care Office

    Switching your EHR & PM is definitely possible. There are definite downsides as you mentioned. You will also have reduced staff productivity during the transition and will need to allot for training time. You are only addressing the revenue cycle challenges here, not to mention the clinical...
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    Wiki How to code procedure "lysis of vaginal adhesions"?

    If they are vaginal adhesions (not labial), there is no code. Here was another discussion about it with suggestions for comparison codes depending on how much work is being done: https://www.aapc.com/discuss/threads/vaginal-lysis-of-adhesions.185936/?view=date#post-508864
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    Wiki Infusion Start Time Question

    The infusion times are the medication administration time. You should not count time for work done before the actual infusion starts. I can't imagine any chemotherapy nurse indicating a start/stop time as anything other than infusion time. 96413 Chemotherapy administration, intravenous...
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    Wiki Bladder irrigation 51700

    The provider should document whatever they performed. As a coder, you can provide general education to document what they perform. You should not tell them to document something they did not perform in order to bill a code. 51700 Bladder irrigation, simple, lavage and/or instillation
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    Wiki Layered, Intermediate, Complicated Closure, when do you use this kind of code?

    Either you are missing key information, or this closure was not layered. There is no contamination of the wound, nor debridement. I don't see where they are performing an intermediate closure. Nylon sutures are not absorbable. It is likely the provider performed a simple skin closure with...
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    Wiki Bladder irrigation 51700

    I would NOT use 51700 for catheter irrigation. I would include that work in the visit as I do not believe there is a separate code for foley (or other urinary catheter) irrigation.
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    Wiki Moderate or High level with cancer talk

    I'm on the same page as @sls314 here. Stating risks/treatments that don't even apply to this patient are not relevant and should not be part of leveling the visit. If the problem is high (level 5), data is anything less than extensive (level 4 or below), I would consider this paragraph as...
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    Wiki Multiple acutes

    This is from the full AMA guidelines: Number and Complexity of Problems Addressed at the Encounter One element used in selecting the level of office or other outpatient services is the number and complexity of the problems that are addressed at an encounter. Multiple new or established...
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    Wiki IUD insertion problem

    -52 is not a valid modifier for J7297 and I don't think would be appropriate in this scenario anyway. You could consider -53 or perhaps -JW. Before billing insurance, I would at least ASK my rep to consider replacing. I have no firsthand experience to advise whether or not an insurance would...
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    Wiki consult by phone

    Take a look at 99446-99449 & 99451. If your physician did not provide a written report to the ER clinician, then I don't think it would be billable.
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    Wiki If a hysterectomy is performed and there was a fibroid within the uterus, is the fibroid weight included in the total weight for code selection?

    Yes, the weight includes the weight of the fibroid. The idea is that you are receiving higher payment/more RVUs for a more complex surgery. The large fibroid(s) that enlarged the uterus made for a more difficult surgery. In fact, I'm not even sure how they could exclude the fibroid weight if...
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    Wiki G2211 Defined - Anyone Have Examples?

    1) I have not seen any denials with patient responsible. I have seen bundling denials. Also, for patients with deductible/co-insurance, they may owe for G2211. 2) RVUs are available several places. Any online encoder, some CPT books, and CMS all publish this information. The national total...
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    Wiki Personal History of Cancer-- Invalid principal diagnosis?

    I agree with @sls314 that Z08 would be appropriate for that situation (assuming no sign/symptoms issues). When I was thinking of "procedure" I was thinking of something more involved. To me, a cystoscopy (or colposcopy) is really more of an exam/look with a specialized device. But yes, they...
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    Wiki Personal History of Cancer-- Invalid principal diagnosis?

    I suppose I would first question why you are doing a procedure if the treatment of the malignancy is completed. I've only used for surveillance visits. The description states "follow-up examination". Z08 Encounter for follow-up examination after completed treatment for malignant neoplasm...
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    Wiki add on code 99459

    Please read the thread. This was already answered on 05/15/2024 by @nielynco and is part of the instructions in your CPT book or online encoder for 99459.
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    Wiki LAPAROSCOPIC HAND ASSISTED RIGHT HEMICOLECTOMY

    That phrase is from the sample op note regarding a ligasure device, not from the actual op report for this case. I would also have to query the physician on this. I have limited GI experience, but I simply don't see where it converted from laparoscopic to open. My gyn docs always state...
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    Wiki DX Z40.01

    I would not use Z40.01 for the consultation to discuss a prophylactic mastectomy. I would use it on the actual surgery. For the visit, consider Z71.89 along with Z15.-- and/or family history codes. Z15.-- cannot be primary diagnoses per the guidelines: Z15 Genetic susceptibility to disease...
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    Wiki Laproscopic left salpingectomy AND ovarian cystectomy

    After reading the op note, my initial probable impression seems correct. The provider was removing the cyst which happened to be on the tube. There was one specimen removed. It would not be appropriate in this situation to bill both 58662 and 58661.
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    Wiki Dx lap including lysis of adhesions

    I only code gyn surgeries and agree with @Orthocoderpgu. You code what was done. 58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) If the provider performed lysis of adhesions of the ovary and/or fallopian tubes via laparoscopy, that is the...
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    Wiki Physician Assistant

    I agree that the issue may be your PA is not fully through the credentialing process. Regarding supervising physician on the claim, you definitely SHOULD include that if you are part of a large multispecialty group. Otherwise you may wind up with incorrect new patient denials. If you are a...
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    Wiki add on code 99459

    This may be the longest thread I've ever participated in. 😆 I just wanted to share some information I discovered today regarding 99459 and United Healthcare/Oxford. Apparently, when this code was loaded into their systems, it was under the preventive category and not as an add on. As a result...
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    Wiki add on code 99459

    That is poor documentation by any standard. I would not use 99459 if the ENTIRE documentation of pelvic exam is "no suspicious lesions". We don't even know what organ didn't have the suspicious lesions. If a one time thing and the provider typically documents appropriately, I would just code...
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    Wiki Billing Office Visit INSTEAD OF Procedure

    So, the other coder suggested intentionally using an incorrect code for the purposes of receiving payment for a service that is not covered. My answer is "NO!!!!!!!" https://www.cms.gov/files/document/overviewfwacommonfraudtypesfactsheet072616pdf
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    Wiki PA billing

    You should 100% credential your ACPs for any carrier that will. If I recall correctly, only 1 carrier in my area does not. Here is why it is important to credential your ACPs. 1) Not all carriers follow incident-to. Incident-to is a Medicare guideline that some commercial carriers follow, and...
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    Wiki Consultation Codes

    The misunderstanding, overuse and abuse of consultation codes is why over 90% of carriers (not just Medicare) will no longer pay them. The physician meaning of consultation is very different than the coding requirements of a consultation. I suggest you read the requirements for consultation...
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    Wiki Laproscopic left salpingectomy AND ovarian cystectomy

    Yes - this is not the op note. I will say the "Operative findings: large left adnexal cystic mass involving fallopian tube" hints that both codes are not appropriate here. Likely the surgeon was performing the cystectomy and the left salpingectomy was simply part of removing the cyst. But...
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    Wiki PA billing

    Billing for ACPs is really the same regardless of specialty. Is there something specific you had a question about?
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    Wiki Global Period Guidelines

    To me, the best reference ever for the global surgical package is the CMS Global Surgery Booklet (click for document). I would note you indicate you are billing for the hospitalist. If that physician/group did not perform the surgery, then the global surgical package does not apply.
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    Wiki OB Split package

    To clarify, the patient received all OB care by the same practice? If so, this should be billed global to the insurance (unless one of those carriers that don't accept global ob). Internally, your practice can determine a way to credit the physician for the work done prior to leaving...
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    Wiki How would you code physician Performed 76817 and a sonographer performed 76817 TC Billed Same Day, under Same Provider

    I would confirm there was medical necessity for the patient to require 2 OB sonograms in your office on the same day. If the physician already personally scanned the patient and saw a concern, why was the sono tech needed to also scan the patient? However, only the clinician should make the...
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