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  1. smoore123

    Wiki Cochlear Implants Excessive Fat Removal (Post Auricular)

    Hi All, I am hopeful someone can assist me with identifying the most appropriate CPT code for a procedure. Here is the scenario we are trying to verify precertification. We have a patient that has excessive fat and tissue that needs to be removed post auricular (behind the ear) so the cochlear...
  2. smoore123

    Wiki Telephone Therapy services longer than 30 minutes

    It depends on payer specific rules and if they are waiving the video component for telehealth services during the PHE. Many are. If so then the psychotherapy codes if that is what they are doing. Sorry more info is needed
  3. smoore123

    Wiki Billing telephonic sessions for Psychiatrists and APNP

    CMS requires audio AND real time video for telehealth billing E/M services modifier 95 (for telehealth) and POS it is normally done in. If the provider does telephone audio only use the telephone E/M codes only for practitioners that can perform E/M services. These are time based codes be sure...
  4. smoore123

    Wiki Telehealth for Psychologists & LCSW?? Modifier AJ,GT, & 95

    What MAC do you belong to ?
  5. smoore123

    Wiki bill psychotherapy codes before assessment?

    It really depends on your facility and policies. May I ask why they would see the patient for psychotherapy 4 times before doing the full psychiatric diagnostic evaluation? I am curious what the rationale is from the providers prospective performing 4 therapy sessions before the full work up...
  6. smoore123

    Wiki Confused

    Agreed these should be coded with path.
  7. smoore123

    Wiki Take advantage of the healthcon pre-conference sessions!!

    Take advantage of the HealthCon Pre-Conference sessions being offered. Lean Six Sigma SPECIALS being offered!! Purchase Friday and Saturdays Lean Six Sigma Sessions receive Saturday at ½ price!! FRIDAY April 26th 8:00 AM -5:00 PM: CPC Review Class FRIDAY & SATURDAY 8:00 AM -5:00 PM: Risk...
  8. smoore123

    Wiki Unable to obtain ROS

    This is directly from the Novitas FAQ's: 11. When a physician performs an E/M service and the patient is not able to provide history, if the physician documents “patient in a coma,” “patient not able to respond,” “patient unresponsive,” can they count a comprehensive history? When a physician...
  9. smoore123

    Wiki Provider audits per year

    This is a moving target for us. We are continually bringing on new providers and loosing some. Our role in our organization isn't just to provide audits we are also required to onboard and train any new providers which includes pre-reviewing there charts until they reach a 90% accuracy rating or...
  10. smoore123

    Wiki Modifier 25 Help

    This is a fantastic article written by Mike Miscoe about modifier 25 that includes all of the regulatory guidance resources you would need to support your decisions. Although not your specific scenarios still relevant. Quote: For reimbursement, the provider must sufficiently document the E/M...
  11. smoore123

    Wiki Can neurologist bill 96040 genetic counseling?

    This code is for genetic counselors to utilize. As stated in CPT, "For genetic counseling and education provided to an individual by a physician or other qualified health care porfessional who may report E/M services use the appropriate E/M codes.
  12. smoore123

    Wiki Director/Coder, HIM

    The ICD-10CM guidelines state the following: 17. “Code also” note A “code also” note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction. The sequencing depends on the circumstances of the encounter.
  13. smoore123

    Wiki New Job as Supervisor Coding & Auditing

    Great Read for Leaders Extreme Ownership by Jocko Willink and Leif Babin is a great read. I have recommended it to many people and they have had a lot of positive feedback. It's not your typical boring leadership book. They have some you tube videos as well. Congratulations on your...
  14. smoore123

    Wiki AAPC CPC practice exam

    I agree the practice exams are invaluable! This helped me identify the areas I needed to focus on to become more proficient.
  15. smoore123

    Wiki EPIC Questions

    We are going to Epic in October of 2019. I don't have much to offer right now but I have heard it streamlines your coding processes off of work lists and I am told our coders will work a lot of the billing edits but I guess that will depend on your facility. If EPIC has a listserv you may find...
  16. smoore123

    Wiki Twins delivery

    The billing scenario you have given does align with ACOG's guidance, however I don't know if the different providers are being taken into consideration. You could submit a coding inquiry to them. The modifier 77 scenario mentioned above is interesting and I wonder if it would work? Sorry not...
  17. smoore123

    Wiki Coding guideline

    Your question is to general you need to be more specific, but I would start with looking at your CPT guidelines for emergency department services.
  18. smoore123

    Wiki new pt vs est pt

    If these family practices all bill under the same tax ID as part of an entity they would considered established.
  19. smoore123

    Wiki Never Smoked Status Code

    No need.
  20. smoore123

    Wiki calculating the HPI level

    Excellent !! My mistake. Have a great day! Steph
  21. smoore123

    Wiki calculating the HPI level

    Karl, I believe you misunderstood me. I agree with you. I don't feel that context should be counted. I was including that CPT assist to support my rationale maybe I wasn't clear.
  22. smoore123

    Wiki calculating the HPI level

    Per CPT Assistant, April 1996 Context To understand the context, a physician may obtain a description of where the patient is and what the patient does when the symptoms or signs begin. Is the patient at rest or involved in an activity? Is the symptom aggravated or relieved, or does it recur...
  23. smoore123

    Wiki System administrator?

    Hi Julia, I would contact the AAPC directly. They have a live chat option if you click on the "contact us" link from the website that I have found very helpful.
  24. smoore123

    Wiki Billing np/pa !help!

    Each individual payer has their own rules and it will depend on your contract and payer policies. There are some payers that do not credential mid-levels and they require you to bill them out under a supervising physician. It is in your best interest to make sure you understand their policies...
  25. smoore123

    Wiki E/M with Treadmill

    With the information you have provided it does not appear that it was a service supportive of an E/M with modifier 25. The bottom line is was the service significant AND separately identifiable AND does the documentation support it. I would recommend looking up the information that CMS or your...
  26. smoore123

    Wiki e/m question

    If they are both cardiologist then the patient would be considered established because they are the same specialty within the same group. We have a practice that has Cardiologists and Vascular Surgeons when one refers to the other they would be considered a new patient because of the different...
  27. smoore123

    Wiki exam date 10/21/17....still waiting results

    HI All, I know it is very frustrating while awaiting your results for the exam. I remember checking like 20 times a day :) Please remember (which I know can be difficult when nervous) the proctor to examinee instructions that were read to you state, "Please allow 7-10 for business days for...
  28. smoore123

    Wiki In need of coding assistance with OHVIRA

    This is a tough one: Q52.4 Other congenital malformations of vagina Q63.8 Other specified congenital malformations of kidney
  29. smoore123

    Wiki No Addictions Noted :confused:

    A pertinent PFSH is a review of the history area(s) directly related to the problem(s) identified in the HPI. Is addiction related to the presenting problem(s) of the visit and identified in the HPI?
  30. smoore123

    Wiki CMS Guidance on Coding and Billing DOS on Professional Claims

    Be sure to review this. When the service includes a physician review and/or interpretation and report, the date of service is the date the physician completes that activity. https://www.cms.gov/Outreach-and-Edu...ds/SE17023.pdf UPDATE this has been rescinded...
  31. smoore123

    Wiki CMS - Guidance on Coding and Billing Date of Service on Professional Claims

    Be sure to review this. When the service includes a physician review and/or interpretation and report, the date of service is the date the physician completes that activity. https://www.cms.gov/Outreach-and-Edu...ds/SE17023.pdf UPDATE: This has been rescinded...
  32. smoore123

    Wiki E/M Global Package Question

    Here's a great reference from CMS that explains what is part of the surgical package. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/GloballSurgery-ICN907166.pdf
  33. smoore123

    Wiki E/M Global Package Question

    Here's a great reference from CMS that explains what is part of the surgical package. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/GloballSurgery-ICN907166.pdf
  34. smoore123

    Share Your Favorite Coding Resources

    This is a forum to post your favorite resources. You make want to post this on the billing forum.
  35. smoore123

    Wiki Sos

    Code 757-236 is correct for the left axillary and subclavian angiography. Modifier LT should also be added to specify the side of the study. The non-selective catheter placement should also be coded. Sindce access was via the left radial artery and a catheter was used for contrast injection in...
  36. smoore123

    Wiki Ultrasound for gestation dating diagnosis code

    I would check the payer policy. Many of them list the diagnosis codes that they consider acceptable and support medical necessity. We typically utilize the supervision of pregnancy codes (Z34.XX) when it is just for dating (in the 1st trimester codes 76801, 76805) and there isn't a uterine date...
  37. smoore123

    Wiki New ABN Form Effective 6/21/2017

    Hi All, Make sure you are CMS compliant and are using the new ABN Forms effective 6/31/17. Below there is a link to the website to download the new form. https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.html
  38. smoore123

    Wiki Post-op for one surgeon in practice, follows up with a different surgeron ??

    Correct! Post op if still within the global 99024.
  39. smoore123

    Wiki hypertensive heart disease

    Hi Melanie, You would not code the I10 you would use the hypertensive heart disease code I11 and the I50 code.
  40. smoore123

    Wiki Muskoskeletal vs extremities

    Clubbing, Cyanosis and Edema would be Cardiovascular. When you are not sure what organ system I found it helpful to look up what the terms being utilized mean and what causes them.
  41. smoore123

    Wiki HPI - Location

    Agree With Thomas if I wasn't clear in my previous post... [sis-tem´ik] pertaining to or affecting the body as a whole.
  42. smoore123

    Wiki E/M & Psychotherapy services

    I have attached the LCD for Mental Health Services you may find helpful.
  43. smoore123

    Wiki Inpatient Admission 4 Weeks Prior to Delivery

    Good Morning, This would not be considered routine OB care and I would submit these services to the payer. Make sure the documentation supports the diagnosis for the admission to convey this to the payer. I would also recommend reviewing the payers policy many payers have policies in place on...
  44. smoore123

    Wiki modifier 26

    Modifier 26 is not an appropriate modifier for 20606. 20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting 20606...
  45. smoore123

    Wiki MDM Question

    2 points.
  46. smoore123

    Wiki Billing for a second consultation

    That is correct you can bill for a consult if the 3 R's have been met (documentation of the request, rendering the service, and report back) and it is not a transfer of care.
  47. smoore123

    Wiki Data Points review with another Provider

    Talk with another provider (2 points).
  48. smoore123

    Wiki MDM Question

    Hi Cindy, If I am understanding this correctly the provider reviewed labs and x-rays, total 2 points. Its hard to give you an accurate answer without reviewing the documentation. Did he personally review and summarize the x-rays and review labs if so that would be 1 point for the lab(s) and 2...
  49. smoore123

    Wiki Any regional conferences this year?

    Melanie said they are considering 2 additional Regionals to St. Louis. Perhaps it's because they recognize the cost associated with going to Hawaii. The same for those in Hawaii to us states side this gives them a great opportunity to attend! Stay tuned for official announcements on the AAPC...
  50. smoore123

    Wiki ? Regarding Billing OV prior to surgery

    That is correct here is a CMS resource for your reference. https://www.cms.gov/...and...MLN/MLNProducts/.../GloballSurgery-ICN907166.pdf
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