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    Wiki Professional Component claim denial

    My guess is that whoever is billing for the technical component did not use a modifier, so they were paid the global fee.
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    Wiki pt not seen code

    In general, the provider needs to have a face-to-face encounter with the patient in order to bill an E&M service.
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    Wiki EWSL in urinary bladder

    If the calculus was in the bladder, you might want to look at 52317 or 52318
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    Wiki Your favorite underrated coding tools

    https://www.cms.gov/medicare/physician-fee-schedule/search I use this daily! You can quickly check RVUs, global periods, whether multiple surgeons, co-surgeons or assistant surgeons are allowed on any code. You can even check list of codes or a range of codes if you want. You can also check...
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    Wiki vagus nerve stimulator

    Could your patients have any of the contraindications that would cause this to be considered "not medically reasonable and necessary" according to the LCD: Hypoglossal nerve neurostimulation is considered not medically reasonable and necessary when any of the following contraindications are...
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    Wiki General Surgeon "Fellow"

    Medicare makes payments to teaching hospitals for training residents and fellows in approved training programs. Fellows cannot bill for the services they perform during their training program.
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    Wiki Is the CODIFY + EBOOKS bundle worth getting?

    I had Codify at my last company and the best part (to me) was the free CEUs
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    Wiki Billing Telephone Services for Providing Test Results over the Telephone

    This is from the CodingIntel website: The AMA is consistent in this instruction. If you order a diagnostic test, say a CBC at a patient visit, reviewing the results that day, or, a day later, or at the subsequent visit, it is part of the order. When the patient returns to the office two weeks...
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    Wiki Is face to face required for Subsequent Inpatient?

    It states under the Evaluation and Management section of the CPT "professional services are those face-to-face services rendered by physicians and other qualified health care professionals who may report evaluation and management services". The provider needs to have a face to face encounter...
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    Wiki Greater occipital nerve block J-codes

    I have found that most carriers want J3490 for compounded drugs. The only two that I encountered so far that want J7999 are Medicare and UHC Medicare plans.
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    Wiki Spinal Cord Stimulator Electrodes Implant - Anthem denial

    The AANS suggests billing 63650, 63650-59 if a second electrode is placed
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    Wiki Final Diagnosis

    Being able to determine the correct diagnosis from the note is what we Coders are trained to do!
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    Wiki Complex Closure or Adjacent Tissue Transfer?

    https://www.aapc.com/blog/45313-complex-repair-vs-tissue-transfer-rearrangement/#:~:text=Undermining%20of%20adjacent%20tissue%20to,close%20a%20wound%20or%20defect This blog post was from 2019 but I like the description of the difference between complex closure vs adjacent tissue transfer...
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    Wiki 63052 with 22633 Edits

    KZA had an article about this at the end of June: "KZA contacted the relevant specialty societies who. in turn, immediately contacted Medicare's NCCI officials. The outcome? NCCI admits that this edit was published in error and will be rescinded as soon as possible, but likely not until the...
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    Wiki Do Your Surgeons Select Their Own Surgical Codes (CPT)?

    Also some of them. For the same reasons as Cmama12
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    Wiki 44143 vs 44141

    Hope this helps! There are the two general types of colostomies performed. A loop colostomy is usually temporary, while an end colostomy is performed when your condition is considered irreversible. The difference between them is mainly in what happens to the two ends of your colon after it’s...
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    Wiki You be the coder ! (Simple Shoulder Surgery)

    I'll play! 29807 29826
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    Wiki New to inpatient coding 99231 or 99024--help please

    It is not required to bill the 99024 services in most states. But, as always, there are exceptions! :) There are 9 states that are required to report global services: Data Collection on Resources Used in Furnishing Global Services The Medicare Access and CHIP Reauthorization Act of 2015...
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    Wiki Craniectomy and Laminectomy for the same tumor

    The foramen of Luchscka is located in the posterior cranial fossa. Have you looked at codes 61615 or 61616?
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    Thanks to AAPC

    Congratulations and enjoy your retirement!!! You will be missed around here
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    Wiki MD transects ICD lead

    Did they accidentally transect the lead? If so, this would be a case of "you break it, you bought it" and would not be billable. The physician shouldn't get paid to fix his or her mistake.
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    Wiki What modifier should we include with CPT 28510?

    My guess is they are looking for the TA-T9 modifiers to indicate which phalanx/phalange was fractured: TA Left foot, great toe T1 Left foot, second digit T2 Left foot, third digit T3 Left foot, fourth digit T4 Left foot, fifth digit T5 Right foot, great toe T6 Right foot, second digit T7 Right...
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    Wiki Mues for cpt code 26145

    https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/How-To-Use-NCCITools.pdf I have attached a link to the Medicare guide explaining how to use the MUE table. It shows that column D is the underlying category of rationale for each MUE (in this case...
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    Wiki Telehealth billing for PA

    The CPC guidelines stated that the codes can be used by a physician or other qualified health care professional who may report E&M services, but the insurance carriers may have other ideas! I have seen some carriers asking for office E&M's, some using the Telephone codes, some stating to use...
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    Wiki cardiac catherization procedures coding guidance

    I always liked this one https://www.medtronic.com/content/dam/medtronic-com/us-en/hcp/reimbursement/documents/coronary-coding-sheet.pdf
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    Wiki MOONLIGHTING RESIDENTS

    https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/teaching-physicians-fact-sheet-icn006437.pdf Medicare's guidelines regarding this are on page 6 of the attached
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    Wiki Remove electrodes

    If it's done via Craniotomy look at 61535 If there is no craniotomy, CPC Assistant July 2019 suggested "report an unlisted code or sum the lengths of the wounds closed and use a repair code (e.g. 12032). I just got ones of these last week and we're trying the unlisted code.
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    Wiki Billing compounded drugs

    https://www.aapc.com/discuss/threads/pain-pump-refills.175854/ I found this answer from a couple of years ago. We use J3490 and put each drug name, dose and NDC number information in box 19
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    Wiki Base Units in anesthesia coding; Where to find???

    https://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center My take on it is that the base units do not have anything to do with code selection and that is why they are not in the code book. They are part of the billing process - not coding. I found the above webpage with a google search...
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    Wiki Anesthesia billing

    It has been a loooong time since I coded Anesthesia services, but I can answer the first part of your question: Anesthesia services are calculated using Base + Time. You already know that the code has a base of 5, so we don't need to explain that part. Time is calculated as one unit for every...
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    Wiki Billing by NP or PA ??

    Each State has their own laws regarding the scope of practice for Nurse Practitioners or Physician Assistants. You will have to look into the laws in whatever state the NP or PA is practicing in to find out what they are allowed to perform independently.
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    Wiki Billing Patients Less Than Allowable Amount?

    We have contracts with Medicare Managed Care plans that pay us at a higher rate than the Medicare rates, so I don't this that it is unusual that you received more. You should see if you can get a copy of your Fee Schedule from the carrier to verify what your contracted rates are, as they could...
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    Wiki 93458 or 93460

    IDK if @Tink126 is around, but we use these: https://www.medtronic.com/content/dam/medtronic-com/us-en/hcp/reimbursement/documents/coronary-coding-sheet.pdf
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    Wiki AETNA DENIALS MAINLY WITH W BEGINNING OF ID#

    Do you have Nurse Practitioners and Physician Assistants in your Group? I ask because we have recently started seeing claims performed by physicians of different Specialties in our group being denied to each other. It turns out that one of the Specialist claims was performed by an APP --...
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    Wiki AETNA DENIALS MAINLY WITH W BEGINNING OF ID#

    My guess is that they still use Consultation codes 99241-99245 99251-99255. There aren't many payers out there that do, but the fact that they are saying they only allow one "initial" visit per day leads me to believe that they want Consult codes from consulting physicians. It is always best...
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    Wiki inpatient coding

    Whenever I get this denial I check to see if the payer still accepts Consultation codes. Because they are saying they do not want two initial E&Ms on the same day, it leads me to believe that they are looking for a different code set for providers who perform consults. I work in New York and...
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    Wiki Insertion of CVC Using Seldinger Technique

    When I am in doubt, I will google the name of the catheter they note in the report and it will usually tell you whether or not it is a tunneled or non-tunneled catheter. As for the Seldinger technique, there is no separate code for that, so some things to look for when selecting these codes are...
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    Wiki What is the difference between codes K57.30 and K57.32?

    K57.30 is Diverticulosis K57.32 is Diverticulitis
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    Wiki Help for PCI procedure and Angiogram

    Usually when this happens with my providers it is because they want to wait until the pateint is stabilized before they perform the procedure. The patient could be in shock, acute renal failure, having a hypertensive crisis, having a CVA, have something broken that needs to be fixed first...
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    Wiki Consult Codes

    It's easier to list who does! In New York, our Medicaid, WC and NF carriers still accept them. We have also found that Aetna Commercial Plans do and Amerigroup Medicaid Managed Care does as well. And that is it as far as we know.
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    Wiki Interactive Complexity and Translation Services

    The "Federal Statute" being referred to is section 1557 of the Affordable Care Act: Under the Final Rule, "oral and written language assistance services must be provided free of charge, in an accurate and timely fashion and must protect the privacy and independence of the individual with Limited...
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    Wiki 2021 E/M Clarifications to MDM

    The whole point of these changes is that you can use either the MDM or the time when selecting your code level. As long as the documentation supports the code I would use whichever one gives me a higher level. So your document supports a 99213 using MDM and a 99214 using time, why wouldn't you...
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    Wiki 99221 or 99231 for IP consult

    The hopsital inpatient codes are not impacted by whether or not the pateint is a new patient to the doctor, they are selected based on what type of encouter it is for the hospital stay. If it is the first visit with the patient during the inpatient stay you select from the 99221-99223 codes. If...
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    Wiki Which would be the correct code?

    This might help: My two cents are I would select 43239 because they took multiple gastric biopsies so the intent of the surgery was not to specifically look at the small intestine.
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    Wiki TAVR, MICRA, WATCHMAN

    We add the size and type in the free text box for TAVR (ex: "29mm Edwards Sapien S3") If you have the Model number I would add that too I do no bill for the MICRA but I would guess that you can do the same (ex: Micra Model MC1VR01) We add the NCT number in the free text box for Watchman. So it...
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    Wiki Enterolysis vs twisted distal bowel

    What about 44055? It states correction of malrotation by lysis of duodenal band or reduction of volvulus
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    Wiki When the secondary pays more than the Medicare allowed amount

    Nowhere on this thread was it stated that the secondary payor is a Medigap plan. I have been in this industry since 1999 and I can tell you that I can count on one hand the number of times that it has happened, but it HAS happened. Usually the patient has a commercial plan that is NOT a...
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    Wiki When the secondary pays more than the Medicare allowed amount

    The rule is that you cannot accept more than your contracted amount: So, for example, say your charge is $200: Medicare allowed amount is $100. They pay $80 and you bill the balance to "carrier B" for the $20 Your contract with carrier B allows $150. Since you are allowed to collect your...
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    Wiki Advice???

    I believe Residents are assigned to a specific Attending Physician. The Attending will add an attestation to the Resident's note after having a face-to-face with the patient and then it is billed under the MD with a -GC modifier.
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    Wiki What do with Pacers and Loops

    We are using G2066 in place of 93299, so anywhere we would have billed 93299 in 2019 we are using G2066 in 2020. Hope that helps!
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