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  1. S

    Wiki "Up to" and "More than" for codes 93241-93248

    Thanks for the explanation!
  2. S

    Wiki "Up to" and "More than" for codes 93241-93248

    Thank you Thomas for your response. I did not see the language as that straightforward. For example, if I can take up to 3 days off, the whole third day is included so I wouldn't have to return until the 4th day. If I have more than 3 days to finish a project, the soonest it would be due is...
  3. S

    Wiki "Up to" and "More than" for codes 93241-93248

    Does "up to" include the 7th day and "more than" begin on the 8th day? For example, a holter monitor is placed and data is collected for 7 days and 8 hours. Are the global services coded as 93241 or 93245? Thanks
  4. S

    Wiki Interprofessional consult (99446-99451) once every 7 days

    When a provider is asked to review records twice on the same patient within 7 days, is there any way to charge for the second service? For example: *On day one the consultant discusses the case with the requesting provider and completes her report. This takes 40 minutes and she charges 99449...
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    Wiki Medicare consult for domiciliary, rest home, assisted living visits

    Thanks for the link Cindy. I had seen it but didn't understand why they would say "report the most appropriate available code to bill Medicare for services that were previously billed using the CPT consultation codes" but then require Outpatient codes for Observation patients instead of the...
  6. S

    Wiki Medicare consult for domiciliary, rest home, assisted living visits

    If a doctor is asked by an appropriate source to do a consult on a patient in the above settings, what codes should we use to bill Medicare? Do we just use the 99324-99337 codes or do we use the 99201-99215 codes? Outpt Consult codes 99241-99245 can be used for these settings but will Medicare...
  7. S

    Wiki "CXR Looks Good" - 1 point or 2?

    Thanks! I would expect to see a little more detail in an independent review and we ask that providers specify when they're looking at an image. The problem is that 1 point is the difference between Moderate and High MDM for this particular audit so I like to see if I'm in the majority when it...
  8. S

    Wiki "CXR Looks Good" - 1 point or 2?

    My provider looked at the chest x-ray image but only documented "CXR looks good". Would you give 1 point for review of Radiology test or would 2 points be ok since he used the word "look", implying independent review of the image? Thanks, Sue
  9. S

    Wiki PCP billing TCM for routine TKA by Ortho

    I'm hoping someone can shed some light on this subject. The MLN guide for TCMs state"You may not bill TCM services and services that are within a post-operative global period (TCM services cannot be paid if any of the 30-day TCM period falls within a global period for a procedure code billed by...
  10. S

    Wiki Low or Moderate MDM for history of CVA, etc?

    The provider lists 3 Diags: 1) History of CVA w/residual deficit - She is doing very well with no signs or symptoms indicating recent stroke. Her BP within target range, no hx of DM. Meeting target goal for cholesterol. Risk of stroke in the future is reviewed. She will continue current meds...
  11. S

    Wiki Is Cancer considered High Risk?

    I agree Thomas. I'm thinking High risk might be appropriate for cancers that involve treatment options that include chemotherapy and/or surgery but would appreciate other opinions also. Thanks, Sue
  12. S

    Wiki Is Cancer considered High Risk?

    There's been some discussion in our office regarding cancer risk. Would it be appropriate to consider any type of current cancer as High Risk under Presenting Problem in the MDM table? When a patient is dx'd with DCIS, adenocarcinoma or other type of breast cancers, the general surgeon bills a...
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    Wiki Cardiomyopathy and Congestive Heart Failure-HPI and MDM

    Does everyone give credit for cardiomyopathy and CHF separately? My provider is documenting "3C" for his HPI using CAD, CHF and Cardiomyopathy. If he states all are stable, then knowing whether to count one or both is the difference between a 99213 and 99214. Is CHF a type of cardiomyopathy or...
  14. S

    Wiki Opiod Induced Constipation-Pain Management

    When a patient presents for a refill of meds and has new drug induced constipation, would this be considered a separate diagnosis under "Number of Diagnoses or Management Options"? Would I give 1 point for the stable chronic pain and 3 points for the new drug induced constipation OR would I...
  15. S

    Wiki Erythema migrans-? Lyme disease

    Thanks for the feedback!
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    Wiki Erythema migrans-? Lyme disease

    If the patient has erythema migrans and the provider is testing for Lyme disease by sending out for blood work, what code would be used? The encoder the providers use all link erythema migrans to the Lyme disease code (A69.20) even though Chronicum was not noted in the chart. In the ICD-10...
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    Wiki Pediatric Prolonged Visit

    Per CPT, the E/M codes can be used for meeting with the patient and/or family. The prolonged services codes are split into "direct" or "without direct" patient contact. We have a minor who was brought in and the provider did examine the patient but then sent her out of the room so that she...
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    Wiki 2 Providers repairing one laceration

    When a doctor closes the deeper layers of a laceration and leaves the PA to close the surface layer, is it ok to bill under the doctor? I'm assuming it's because the PA doesn't have the experience in this walk-in facility but I'm not sure if we can bill for this since we're not a teaching...
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    Wiki Can specialists provide LDCT counseling?

    Can anyone point me to CMS regulations (other than the MLN article) regarding who can bill for G0296? In a webinar from AAPC dated 04/20/16, the presenter said pulmonologists could not bill for this-only the PCP. The MLN from 2015 seems to support this. At least 2 specialty societies have a...
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    Wiki Using 45385 with 45381

    Hi afalcon, I have a question since you didn't mention the -59 modifier in the above quote Are you saying you would add it to 45381 when tattooing the area around the lesion that was removed by 45390 or are you saying not to use the -59 and rely on a review of the notes included with the claim...
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    Wiki G0296 Written Order Requirement for LDCT

    CMS states: Written orders for lung cancer LDCT screenings must be appropriately documented in the beneficiary’s medical record, and must contain the following information: • Date of birth; • Actual pack–year smoking history (number); • Current smoking status, and for former smokers, the number...
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    Wiki Transition in Care coding

    Federal Register As far as I've found, the information regarding billing TCMs with the date of the face-to-face service has only been listed in the Federal Register. On page 37 of the pdf printout, they state they are adopting recommendations to allow date of service and that they "will revise...
    • SUEV
    • Post #7
    • Forum: E/M
  23. S

    Wiki Split/Shared Visits based on Counseling Time

    I am looking for any documentation from CMS regarding split/shared visits that states the service can be billed based on time when over 50% of the time spent by both the NPP and MD/DO was for counseling/coordination of care. Does anyone know of any references directly from Medicare? Thanks, Sue
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    Wiki Billing TCM

    As far as I've found, the information has only been listed in the Federal Register. On page 37 they state they are adopting recommendations to allow date of service and that they "will revise the existing subregulatory guidance" but I haven't been able to find anything that shows it's been done...
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    Wiki 99497 Advance Care Planning

    The code description for 99497 includes "first 30 minutes". Does this mean it's non-billable if the planning is less than 30 minutes (like critical care requirements)? Based on the CPT Assistant article "Time-based Codes Reporting" from 8/2014, I understand the 99498 wouldn't be added until 46...
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    Wiki Documentation for Allergen Testing 95044

    When a provider does patch testing, what should be documented in the chart? Is "patches applied" for the 1st visit and "negative results" for the final reading enough? Should each allergen and the result be listed individually? The provider is stating she is doing the standard NA tests of 50...
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    Wiki Two NP's Billed with E/M Codes???

    NPs are not specialists Hi, From my understanding, being an NP is it's own "specialty" so the fact that the NPs are located in 2 different specialty practices doesn't help. If the pt saw an MD and NP, both would be payable but not when a patient sees 2 NPs on the same day.
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    Wiki Anticoagulation Therapy Management

    When a patient has stable afib and is on appropriate anticoagulation therapy so requires no changes, is this credited as 1 diagnosis point or 2? The provider has been told he would get credit for the questions he asks about the Coumadin so it would be treated as a separate diagnosis. Since...
  29. S

    Wiki Tobacco Abuse F19.10?

    Thanks Adam. So if the provider only documented "abuse", would you equate that to "dependence" when picking a code?
  30. S

    Wiki Tobacco Abuse F19.10?

    We are using a system that lists Tobacco "abuse" as F19.10, "Other psychoactive substance abuse". It seems odd that all the other substances that have their own F1_ code have abuse as an option, but not nicotine. Is everyone else using F19.10 or are there only 2 clinical options for...
    • SUEV
    • Thread
    • Replies: 4
    • Forum: ICD-10
  31. S

    Wiki Contraception Discussion

    Missing elements Thanks SEM. I did consider the comprehensive preventive medicine codes but did not feel the criteria for the comprehensive "age and gender appropriate history" exam was met since there wasn't a review of systems done. The history was limited to GYN. There was a comprehensive...
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    Wiki Contraception Discussion

    If a patient comes in to discuss starting contraception and has no other complaints, per CPT guidelines this would be considered preventive so directs us to the 994xx codes. I have been told that if an exam is done at that visit though, it would then be billed using the 992xx (problem) E/M...
    • SUEV
    • Thread
    • Replies: 2
    • Forum: OB/GYN
  33. S

    Wiki Anthem & "All Other Systems Negative"

    Does anyone have any documentation that Anthem accepts the above phrase? Per their E/M policy, it seems they require all 10 systems to be individually documented (at least that's the way I'm reading it). Here's part of their policy: C. Review of Systems (ROS): The level of the ROS needs to be...
    • SUEV
    • Thread
    • Replies: 1
    • Forum: E/M
  34. S

    Wiki Multiple Acutes on Table of Risk

    If a provider is managing 2 acute uncomplicated illnesses, does the Presenting Problem(s) column stay at Low Risk? I have always credited it as such but am wondering if anyone moves 2 acutes up to Moderate risk. I couldn't find any articles or anything on it so am hoping for either...
    • SUEV
    • Thread
    • Replies: 0
    • Forum: E/M
  35. S

    Wiki MDM for Needle Phobia

    Could needle phobia be considered a new problem (3 pts), chronic w/mild exacerbation (Mod risk) or would it be considered a Self-limited/minor problem (1pt) with minimal risk? The patient was rx'd Ativan to take prior to getting his screening labs done. Thanks, Sue
    • SUEV
    • Thread
    • Replies: 0
    • Forum: E/M
  36. S

    Wiki Contraception counseling & Acute problem

    Pt request for contraception Thank you for your responses. The note does not tie in the contraception (preventive) with the UTI (problem) which is why I'm hesitant to code the 99214 based on time. The reason for the appt was frequent urination but in regards to the contraception, the HPI also...
    • SUEV
    • Post #5
    • Forum: E/M
  37. S

    Wiki Contraception counseling & Acute problem

    I understand that when the provider discusses contraception, the visit should be coded with the 99401-99404 codes which are based on 15 minute increments. I have a provider who saw a patient for an acute problem as well as contraception. The documentation shows over 50% of this 30 minute visit...
    • SUEV
    • Thread
    • Replies: 4
    • Forum: E/M
  38. S

    Wiki Critical Care Place of Service(s)

    A cardiologist provided critical care in one facility, then during an ambulance ride, and then at another facility before handing the patient off to other providers. Any suggestions on how to bill for this? I'm not sure if using POS 21 for the first facility would be appropriate since the...
    • SUEV
    • Thread
    • Replies: 1
    • Forum: E/M
  39. S

    Wiki Update of 3 Chronics for ENT

    My provider is stating that when he sees a patient for history of cancer, current xerostomia and stable dysphagia, this is a moderate mdm due to 3 stable chronics. He does not give the duration for the xerostomia and dysphagia and states that we should know these are chronic diseases. It seems...
  40. S

    Wiki "New" Problem points for problem seen before

    If a patient hasn't been seen in 3 years, the patient is considered "new" for E/M coding. If the patient's problem isn't new to the provider though, is it considered an established problem or a new problem again? For example, a patient was seen 4 yrs ago for epilepsy. The seizures are now...
  41. S

    Wiki History of Skin CA MDM

    I'm new to dermatology and have found that many coders suggest using the E/M codes 9921x-9920x for full body skin exams. If a patient has a history of skin ca and nothing is found, I'm coming up with straightforward MDM. Is that correct? If the pt is new, would you consider this a new...
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    Wiki 19301 multiple times same breast

    Hi, We are getting a denial for billing 19301 and 19301-59 on the same breast. Anthem is stating "Physicians and the ama agree the duplicate edit reflects a bilateral procedure and does indicate multiple partial mastectomies per breast". I cannot find anything that states this code can only be...
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    Wiki Does surgery=add'l work up planned

    Pre-Op Labs Thank you for responding Pam. Just to clarify-if the ER has already drawn the labs and the surgeon reviews them and decides to bring them to surgery, that would be a new problem without work-up planned. If the labs haven't been done yet and the surgeon decides to bring the pt to...
  44. S

    Wiki Does surgery=add'l work up planned

    When a patient is seen for the first time by the surgeon and they're diagnosed with a disease that requires surgery to treat it (i.e., appendicitis), would this be considered a new problem with additional work up planned? There will be pre-op labs done but the diagnosis is established at the...
  45. S

    Wiki TEE Teaching and Consent signing

    If a provider from a different specialty orders a TEE (93312) and the pt's scheduled for an appointment at cardiology to go over what the procedure is, answer any questions, and get consents signed before the procedure in a couple of days, is that cardio appt billable or is it included as part...
  46. S

    Wiki Proper use of -59?

    28289 (Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint) and 28160 (Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each) are bundled together. The podiatrist did make a separate incision for...
  47. S

    Wiki Mgmt of Chronics Billable during Global?

    If a patient has a cardiac procedure for afib and has comorbidities such as HTN and/or DM, etc., can the provider bill for the post-op visits with a -24 modifier if they are also responsible for monitoring the comorbidities? This would apply for both the hospital stay as well as follow up...
  48. S

    Wiki Modifier 24 for antibiotic reaction?

    Thank you! Sue
  49. S

    Wiki Modifier 24 for antibiotic reaction?

    A provider prescribed antibiotics at the same time he did an I&D for an abscess. 2 days into the 10 day global period the pt returned because she was having a reaction to the antibiotic so he changed the meds. Would this visit be considered a post-op complication or treatment related to the...
  50. S

    Wiki Would CMS cover reaction to treatment?

    A medicare patient was given pain meds and an antibiotic in the ER for a dental abscess (which is not covered by Medicare). The patient had a reaction to one of the meds (not sure which) so came to our office due to itching, chest pain, etc. Does anyone know if Medicare will cover this even...
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