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    Wiki non-facility NA indicator

    One of our orthopedics does CPT 25000 in the office setting. Aetna has denied the claim stating per CME Physician Fee Schedule codes 25000 have a status indicator of NA in the non-facility field which indicate it is rarely or never performed in the non-facility setting. I do see the NA...
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    Wiki orthopedic practice injection kits

    What are the steps for an Orthopedic Practice to dispense injection kits like a pharmacy. What are the requirements to be compliant with all federal regulations. If I can be pointed in the right direction I don't mind doing the research Thanks for your help! Peggy
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    Wiki PT cap CMS

    I saw the information below listed on the CMS website and have a few questions: 1. Does a "claim" represent a date of service or all DOS for the same patient 2. When they reference eligible claims do they mean per physical therapist or any physical therapist for a specific patient 3. Lastly...
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    Wiki Omnipaque - am trying to find out

    Thanks! I appreciate the help- we will try that!
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    Wiki Omnipaque - am trying to find out

    am trying to find out if Omnipaque is payable in a PROCEDURE ROOM - not an ASC. Omnipaque is a contrast media used to assist with fluoroscopy. thank you for your help!!
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    Wiki 29876 and 29880

    So, we billed a procedure to Medicare showing CPT 29876 as the primary procedure and CPT 29880 as the secondary procedure based on the RVUs. Medicare flipped them on us and listed 29880 as the primary procedure. Did something change that we are not aware of with the RVUs for these two codes...
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    Wiki Cpt code for patellar tendon

    My doc did an open patellar tendon debridement and I was going to code it as 27599 (unlisted). I need a comparable code to go with it though and I am not able to find one. I may be using the wrong code to begin with...... Thank you for your help with this! Peggy
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    Wiki Patellar clunk syndrome after TKR

    Notes from the doctor state: "The scope was initially placed into the suprapatellar pouch, revealing the anticipated focal scar tissue at the superior pole of the patella that is so consistent with the patellar clunk syndrome. the amount of scar tissue was significant. Medial and lateral...
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    Wiki Achilles tendon debridement - Our surgeon did the following procedure:

    Our surgeon did the following procedure: "... Incised down the paratenon. Paratenon was then split and elevated medial and lateral to facilitate later closure. I then freed up any adhesion of the Achilles tendon to the deep surface of the paratenon. Also inserted a Freer to free up any...
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    Wiki NPP with Specialtist for New Patient

    Meagan Thank you so much for your help and also for the link! It was very useful to us! Peggy
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    Wiki NPP with Specialtist for New Patient

    Patient X was seen as follows: 1-08-15 99203 with Orthopedic surgeon 1-15-15 99213 with NPP - (Physician Assistant) 1-22-15 99203 with Podiatrist Medicare denied the Podiatrist charge: Only one initial visit is covered per specialty per medical group. New patient qualifications were not...
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    Wiki New HCPCS modifiers to define subset of mod 59

    I recently read an article stating there are 4 new modifiers which are collectively referred to as -X{EPSU}. My question is: Can they be applied to all carriers or just CMS. The new modifiers with description are: XE Separate Encounter[/B], A service that is distinct because it occurred...
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    Wiki ultra sound denial with Medicare

    We sent the appeal with a copy of the ultra sound picture along with all corresponding notes including the surgery notes. Medicare came back with the following denial: ? The record is lacking documentation that the failure of the initial attempt at the knee joint injection where the provider...
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    Wiki 2nd carrier paying less than primary

    Looks like no one is getting lunch yet! :) I appreciate the responses and hopefully between we can find a more concrete answer. I will reach out to the insurance carriers as well and post what I find out....however, they may not agree either.... This is why I love billing so much!
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    Wiki 2nd carrier paying less than primary

    We have a patient where primary paid their allowed amount and the co-pay/co-insurance was submitted to the secondary carrier. The secondary carrier came back stating the primary paid more than the secondary allowed amount and did not remit payment. The question is: Is the patient responsible...
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    Wiki CPT codes in a Procedure Room

    I have a Shoulder, Elbow, Hand surgeon that is asking me if the following CPT procedure codes are paid if done in a PROCEDURE ROOM - not an ASC. I do not know where to find this information. Can anyone direct me please? Thank you for your help! The CPT codes in question are: 29848 64721...
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    Wiki CPT code for branch block ablation

    Can anyone tell me what the appropriate CPT code(s) would be for a medial branch block with radiofrequency ablation? Thank you in advance! Peggy
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    Wiki Billing ER consults for NON-Medicare patients

    NGordon Thank you for the information! It was very helpful!
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    Wiki Billing ER consults for NON-Medicare patients

    Which CPT code is the most appropriate for a patient who had a consult done by one of our docs who is a non-ER physician if the patient is NOT Medicare. Is it appropriate to use the 99221-99223 series? Thank you!
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    Wiki whiting out info on 1500

    My PMS vendor is telling me they need documentation from CMS or some other insurance carrier stating a provider is not permitted to white anything out on a HCFA. The problem we have with the PMS vendoe is they do not include the primary carrier adjustment to the payment and when we submit a...
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    Wiki Hip and Knee Xrays prior to total joint surgery

    Thank you very much E! I appreciate the reply!!
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    Wiki x-rays prior to total joint surgery

    Thank you very much for the information and the link!
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    Wiki Hip and Knee Xrays prior to total joint surgery

    I was recently told that x-rays such as length done prior to total joint surgery are included in the global surgery payment and that you should only bill technical component of these x-rays. This is news to me. I understand it originally came from Orthopedics Coding pink sheet. Is this...
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    Wiki x-rays prior to total joint surgery

    I was recently told that x-rays such as length done prior to total joint surgery are included in the global surgery payment and that you should only bill technical component of these x-rays. This is news to me. I understand it originally came from Orthopedics Coding pink sheet. Is this...
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    Wiki modifier 58

    The two physicians are NOT in the same practice but I believe they are both of the same specialty - Orthopedics
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    Wiki modifier 58

    While on call my physician saw a patient who came into the hospital for a reduction of a hip dislocation. The patient had a THR on the SAME HIP 2 weeks earlier by ANOTHER PHYSICIAN. The patient doe not want to go back to the original surgeon but would like to continue with my doc. My question...
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    Wiki Modifier question

    While on call my physician saw a patient who was in for a hip dislocation. The patient had a total hip replacement on the SAME HIP 2 weeks prior by ANOTHER physician. The patient does not want to go back to the original surgeon but wants to continue with my doc. My question is: is modifier...
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    Wiki cast application

    our physician billed 24530 with 29065 and the carrier is dening as 29065 as incidental to.
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    Wiki consultations written or verbal

    we are having a lively discussion in my office regarding whether conultations from a PCP to a specialist must be written or verbal. This is not for a medicare patient as we do realize MDC does not recognize consults. Can anyone give me a link or explain the logic as to whether a consult must...
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    Wiki separate dictation/documentation for MDC pts with x-rays

    Thanks Debra! I appreciate the quick response!!
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    Wiki separate dictation/documentation for MDC pts with x-rays

    I need clarification for Medicare patients. I work for an orthopedic practice and one of my doctors told me x-rays need to be included in the original dictation BUT also needs to have a separate dictation/documentation. I am not aware of a Medicare rule stating this. I went onto their...
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    Wiki separate dictation for x-rays

    I need clarification for Medicare patients. I work for an orthopedic practice and one of my doctors told me x-rays need to be included in the original dictation BUT also needs to have a separate dictation/documentation. I am not aware of a Medicare rule stating this. I went onto their...
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    Wiki shoulder scope converted to open procedure

    thank you! I appreciate the help and explanation
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    Wiki shoulder scope converted to open procedure

    Debra - Please see below. Thanks for your assistance! Proc: Standard posterior arthroscopic portal was made in the right glenohumeral joint. a working anterior arthroscopic portal was made using needle localization. Probe was inserted. There was a type 1 SLAP tear and this was debrided to...
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    Wiki shoulder scope converted to open procedure

    My doc did a shoulder arthroscopy, type 1 SLAP debridement of the superior labrum, multiple forein bodies and loose body remove and open revision rotator cuff repair. He wants to bill it as 29827 and 23412-59. I am not sure this is correct coding. Please advise.
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    Wiki modifier 76/78

    My physician did a THR with ORIF of subtrochanteric fracture on 2-26-13. The patient subsequently fell on 4-8-13 On 4-16-13 he did a hip revision on the same hip with a ORIF femur fx. The procedure of 2-26-13 was coded with 27130 and 27244-59 Can I coded the second procedure with 27138-78...
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    Wiki comparable code for labral cyst of the shoulder

    Thanks!
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    Wiki comparable code for labral cyst of the shoulder

    My doctor used 29999 for the debridement of Labral Tear/Labral Cyst. I am trying to find a comparable code. I appreciate any help!!
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    Wiki Denial for 27093 in the asc

    Medicare is denying CPT CODE 27093 (injection procedure for hip arthrography; without anesthesia. We used ICD 9 code 715.95. They state 27093 is not on the ASC list of ceovered surgical procedures. My dilemma is I cannot locate a list of covered surgical procedures in the ASC. Can anyone...
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    Wiki implants in ASC setting

    Dear Wanna - thanks so much for your input - it really helps!
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    Wiki billing 29915 and 29916

    Our physician did a hip arthroscopy anterior labral repair lateral labral debridement with major synovectomy and acetabuloplasty We billed it out with 29916 as the primary code and 29915 as the secondary because per the CPT book "do not report 29916 for labral repair secondary to...
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    Wiki 29915 and 29916

    Our physician dis a hip arthroscopy anterior labral repair lateral labral debridement with major synovectomy and acetabuloplasty We billed it out with 29916 as the primary code and 29915 as the secondary because per the CPT book "do not report 29916 for labral repair secondary to...
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    Wiki implants in an ASC setting

    implants in ASC setting Dear W Burns Thank you so much!! I never thought to use the modifier. Your help is very much appreciated!
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    Wiki implants in an ASC setting

    We are trying to get our implants paid by CMS and are currently using C1713 which is not a recognized code by CMS for ASC setting. My question is - would L8699 or A4649 be appropriate HCPCs codes for implants?
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    Wiki implants in ASC setting

    We are trying to get our implants paid by CMS and are currently using C1713 which is not a recognized code by CMS for ASC setting. My question is - would L8699 or A4649 be appropriate HCPCs codes for implants?
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    Wiki Mod 54 and 55 clarification

    Thank you very much for clearing up the confusion for me! I am a new coder and in reading the modifiers it seemed very convoluted.
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    Wiki Mod 54 and 55 clarification

    I have a physician who did a procedure (with 90 day global) for SURGICAL CARE ONLY. We used modifier 54. His partner in the same practice is doing only the post op. The patient was seen 10 days later and I am being told to bill the same surgical codes using modifer 55. Any future visits will...
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    Wiki Mumford procedure CPT 29824

    I have a denial stating cpt 29824 needs to indicate the size of the removal of the distal clavicle. I cannot find where it is documented this is needed - my physician wants to know where it is written he has to document the size of the removal. Do anyone have any suggestions where i can find...
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    Wiki mumford procedure - I have a denial stating cpt

    I have a denial stating cpt 29824 needs to indicate the size of the removal of the distal clavicle. I cannot find where it is documented this is needed - my physician wants to know where it is written he has to document the size of the removal. Do anyone have any suggestions where i can find...
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    Wiki Focused Aspiration of Soft Tissue

    I recently read an article about Dr. Steve Stahle performing a procedure called Focused Aspiration of Soft Tissue, otherwise known as F.A.S.T. It is used for things like Tennis elbow. I understand it is payable by insurance carriers (per the article) but I cannot find a CPT code for this...
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