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  1. M

    Wiki Vitamin D Injection

    Good Afternoon, Does anyone have any experience with Vitamin D injections? What is the HCPCS J code for this and are they payable. We have a clinic looking into providing these and I haven't been able to find much information. Thanks!
  2. M

    Wiki Saphenous Nerve Block

    Hey all - Our providers are performing Popliteal and Saphenous nerve blocks for acute postop pain management for patients having ankle/foot surgery. I am just looking for some confirmation that codes 64445 and 64450 (Saphenous appears to be the distal thigh area) are the correct codes for the...
  3. M

    Wiki Management of PT/INR

    This clinic does have their CLIA certificate, but from my understanding this specific lab isn't run at the clinic itself and is sent out. I will, however, verify that with the provider. So if they aren't running the lab test at the clinic would it just be the 36415? It is my understanding...
  4. M

    Wiki Management of PT/INR

    We have a clinic we bill for and they will see patients at the clinic for a lab draw to manage PT/INR. The lab draws are initiated by cardiology but because of the patient's proximity to the clinic they perform the labs, with results faxed back to our providers) to manage the...
  5. M

    Wiki ASC Facility with post op pain block

    I would agree with Lisa. If the anesthesia provider is performing the block it will bundle into the anesthesia code billed and if the same provider is on the 0xxxx charge and the block charge the XP wouldn't apply. We generally stick with the 59 modifier for our postop pain blocks.
  6. M

    Wiki Anesthesia for Colonoscopy done in POS 11

    Hello All, I am just trying to verify if anesthesia done for Endoscopic GI procedures (00731, 00811, 00812, 00813) would be payable in a POS 11. I have a CRNA group who is looking at a possible new location. The group is located in Virginia. Thanks in advance!
  7. M

    Wiki Lap Prostatectomy with dx Laparoscopy Question

    Good Morning, I have a general surgeon who was asked to help gain access and check for scar tissue due to previous abdominal surgery. My general surgeon worked with the Urology surgeon to perform a diagnostic laparoscopy before the general surgeon scrubbed out and Urology (with the help of an...
  8. M

    Wiki Inpatient Swing Bed Consultation

    Hello There - If a patient has been transferred from Inpatient Status to Swing Bed within the hospital and a general surgeon provides a consultation would we bill with a Nursing visit E/M? From what I could find from CMS we would follow what the facility is billing. Is that correct? CMS IOM...
  9. M

    Wiki ARNP with a PMHNP-BC Cerficiation

    Good Afternoon, I work for a billing company and one of our clients who until now just provided regular office visit/procedures to patients had a provider who recently got the Psychiatric-Mental health Nurse Practitioner (PMHNP-BC) certification. Does anyone work with NPs who have this...
  10. M

    Wiki Pessary Question

    Thanks. I was going to suggest to her to keep them on hand for another patient.
  11. M

    Wiki Pessary Question

    Hey All - One of my providers is having issues with patient's being seen for a pessary fitting. The pessary is then ordered, but before the patient returns to be fitted they subsequently decide to go the surgery route which leaves my provider with the cost of the pessary and she is unable to...
  12. M

    Wiki Off Campus Outpatient POS

    Good Morning, One of the CRNAs that we bill for has an opportunity to work at an outpatient center that is considered off campus, billed with a place of service 19. Does anyone have any experience with this? Is it something that needs to be specifically stated in the providers contracts with...
  13. M

    Wiki Colonoscopy

    Are they being seen again due to poor prep, etc with the previous colonoscopy? Was the previous colonoscopy a screening? If that is the case you would append the 53 modifier to the colonoscopy that was incomplete (i.e., the first one). Below is what Medicare states regarding...
  14. M

    Wiki Anesthesia for Screening Colonoscopy after a Positive FOB

    I did submit a question to one of the CMS local contractors and received a call back. She stated the KX modifier is not needed on anesthesia claims.
  15. M

    Wiki Anesthesia for Screening Colonoscopy after a Positive FOB

    Hey All - I see that CMS has posted guidance stating that a KX modifier should be appended to the screening colonoscopy code to indicate such service was performed as a followup to a positive stool based test. It doesn't specifically state it should be applied to the anesthesia code as...
  16. M

    Wiki MIPS Measures

    Good Morning - For the previous years we have been doing traditional MIPS measures via claims for one of our general surgeons as he is the only provider in his practice and within this practice goes to 5 hospitals. Since CMS has retired many of the measures that we had previously reported on...
  17. M

    Wiki Hospitalist and General Surgeon Visit on same day

    Good Morning, Our General Surgery group recently became hospital employees and since they transitioned to the hospital Tax ID we have had issues with visits denying when a hospitalist sees the patient on the same day as our provider. Is there a way to get our charge paid or would these visits...
  18. M

    Wiki Blunt Trauma/MVC - Emergent C-Section - Followed by Exp. Lap

    I have a case where the patient was in an MVC, was pregnant, brought in the ER where an Emergent C-section was performed by an OB. Patient had no pulse. After the C-Section took place in the ER the patient was taken to the OR where the provider I am billing for performed an Exploratory Lap...
  19. M

    Wiki Chronic Pain Management Practice

    Good Morning, Does anyone have any good resources to help with E/M coding in the setting of a Chronic Pain Management Practice? Generally speaking the patient's are established patients seen every 30 days to renew opioid scripts, and I am just looking for some source of guidance in regards to...
  20. M

    Wiki Medicaid and New Anes codes (01937, 01938, etc)

    Good Afternoon, We have been encountering Medicaid denials from Colorado and Alabama for the new anesthesia codes of 01937, 01938, 01939, 01940, 01941, 01942 stating that they are not yet on their 2022 fee schedule and therefore they will not process these claims. I am just wondering if anyone...
  21. M

    Wiki LCD denials

    With this type of denial you are going to need to look at the patient's secondary diagnosis to see if they have any secondary conditions that are included in the Coding and Billing Article for LCD L35049. Those secondary diagnosis should be included on the claim for any anesthesia codes that...
  22. M

    Wiki Postop Pain Rounding

    Has anyone encountered a provider performing Postop Pain rounds for blocks placed on the previous day in an outpatient setting. The patient's are technically outpatient, but held 23 hrs and thus are in the ASC the day following surgery. Can you bill for postop pain rounding in this instance...
  23. M

    Wiki 2020 MIPS Options

    Good Afternoon Everyone, I am just throwing this out there to see what others are doing. I work for a billing company and we have previously been using a QCDR for MIPS reporting for our providers that are above the low volume threshold. Our providers that generally meet that mark work doing...
  24. M

    Wiki Help with correct coding for lip cyst excision

    Good Afternoon, I am hoping someone can point me in the right direction for this excision of a lip cyst. I think the part that is tripping me up is that the went thru the sub-q tissue. Any help would be appreciated. Below is the operative report: The patient was kept NPO for 8 hours pre-op...
  25. M

    Wiki 00811/00812/00731 in Office Setting

    Good Afternoon - Does any one know if anesthesia codes 00811,00812,00731 can be billed in POS 11? Thank you.
  26. M

    Wiki Allergy Billing

    Good morning all, I am hoping someone can help me out here. We recently starting billing for a family practice clinic and they do have patient's whom they see for allergy injections. I know that for the administration of the injection we bill either 95115 or 95117. When they mix their vials...
  27. M

    Wiki Coding Suggestion Needed

    Thank you!
  28. M

    Wiki Erector Spinae Nerve Block Medicare Denial

    Good Afternoon, We received a denial from Medicare for a CRNA performed Erector Spinae block billed with code 64999. The redetermination letter states that they are denying this as they do not consider the providers current qualifications as a CRNA to be sufficient to provide the service and...
  29. M

    Wiki Coding Suggestion Needed

    Good Afternoon, I am hoping someone can help me out with what they believe we can code for this MD's participation in the patient's C-section. There was already a primary surgeon and assistant surgeon present. Below is the note from my provider: Called to OR for emergent consultation on a...
  30. M

    Wiki Family Practice Billing Help

    I would be interested in this as well. Our company is going to start billing for a family practice clinic and I have specialized in Anes/Pain Management and Interventional Radiology and I'm feeling a bit lost with all of the procedures beyond the E/M portion. So if anyone has any educational...
  31. M

    Wiki PENG Nerve Block and 4 in 1 Nerve Block

    Good morning all, We have some providers who want to start performing the PENG Nerve Block and the 4 in 1 Block for postop pain management. I have been looking around and haven't had any luck finding a source for a CPT code for these procedures. Should the unlisted 64999 be used? Thanks
  32. M

    Wiki Sedation for Retrobulbar Block

    If an anesthesia provider provides sedation while a surgeon is performing a retrobulbar block (pre-op to ocular surgery), but does not participate in the anesthesia once the ocular surgery starts(done by MD/RN monitoring) how do you appropriately code for the anesthesia providers services?
  33. M

    Wiki Screening Colonoscopy denials with PR-49

    Has anyone had any luck with these denials? We are seeing the same thing.
  34. M

    Wiki VA Choice Authorization for Custom Orthotics

    Good Afternoon, I am just wondering if anyone has any experience with VA and custom orthotics? We have a provider who is getting the authorizations for the patient's visit, but may then recommend custom orthotics or DM Shoes. Do they need a new authorization for these services? Thanks!
  35. M

    Wiki Co-surgeon on inclusive part of a larger case

    Good Afternoon - I have a case where Surgeon A is performing a Lap Pyeloplasty and has asked Surgeon B to be in the OR for the Laparoscopy due to prior mesh placement by that surgeon (surgeon B). Surgeon B has documentation of the initial laparoscopy and after they gain access and review mesh...
  36. M

    Wiki Billing CRNA's

    If you are billing for a CRNA who is medically directed by an MDA you would use the QX modifier. If the CRNA is the only provider on the case and is not medically directed then use QZ. Hope that Helps!
  37. M

    Wiki 99153 moderate sedation add on code denials for modifier

    Tiffany - I would try sending appeals on your 99152 denials. As long as your documentation supports I would note that as of 1/1/17 moderate sedation was no longer included in the 45378 (or whatever surgical code you are billing) and should be separately reimbursable.
  38. M

    Wiki Repair of Bilateral Fallopian tube tears at time of cesarean delivery

    Good Afternoon All - I have this procedure where my surgeon was called in as the other provider who performed the c-section noticed that the patient was bleeding. Repair of the fallopian tube tears was performed. I am leaning towards an unlisted code, but wanted to see if anyone else had any...
  39. M

    Wiki Anesthesia for GI Endoscopy new codes

    When to utilize 00811 and 00812 Hey All - Just wondering if anyone can give some insight into how they are going to utilize these codes when a screening turns diagnostic. I now Medicare has stated to use anesthesia code 00811-PT when the patient starts as a screening and the procedure turns...
  40. M

    Wiki Abg qcdr

    Hello there - Is anyone using Anesthesia Business Group (ABG) for MIPS reporting? I am a little confused on one of their measures and was hoping to find someone else that has used them before. Thanks!
  41. M

    Wiki Quality reporting via a QCDR

    Good Morning All - We are new this year to doing our quality reporting (now MIPS) via a QCDR. I just wanted to ask this question of anyone else who has used a QCDR before. What do you do (measures-wise) when it takes CMS so long to approve the QCDR measures? The QCDR we are using didn't...
  42. M

    Wiki 64415 interscalene block for post op pain management

    So the key here is to have proper documentation when billing a post op pain block that is done by anesthesia. I am assuming with the shoulder surgery the mode of anesthesia for the procedure is General. I always tell me providers they need: -Documentation by they surgeon requesting that...
  43. M

    Wiki PQRS Measure #404

    Good morning All - I have a quick question that I am hoping someone else has an answer for. :) For Measure #404 - Anesthesiology Smoking Abstinence one part of the measure states: "Seen pre-operatively by anesthesiologist or proxy prior to the day of surgery" Does anyone have a definition of...
  44. M

    Wiki 2016 PQRS - Conundrum

    Good Morning All - As I was perusing the CMS PQRS website once again I noticed that Nerve block codes such as 64415, 64447, etc are included in the CMS list of Face-to-Face Encounter Codes. According to that then you would need to be reporting on a cross-cutting measure however the only...
  45. M

    Wiki Anesthesia for a Genicular RFA

    Good Afternoon All - I have a CRNA who provides MAC anesthesia for pain procedures. He has had a couple of patient's who have had a Genicular Ablation and I was wondering what anesthesia code is best to use for this. I haven't really been able to find much info on this so any help is...
  46. M

    Wiki Z12.11 vs. Z86.010

    Thanks for your quick response!! It is much appreciated.
  47. M

    Wiki Z12.11 vs. Z86.010

    Good Morning All - This may have already been covered but I have a question. We had a patient who presented for a 5 yr. follow up due to a personal history of colon polyps. This is the stated diagnosis on the operative report. The facility billed Z12.11 and then Z86.010 per the AHA Coding...
  48. M

    Wiki Labor and Delivery question

    Hello - I am hoping to get some opinions on how to correctly bill for the following situation. The patient presented and received a labor epidural done by the MDA only (AA). The patient was later brought to the OR for Vaginal delivery and this portion had both an MDA (QY) and a CRNA. Any...
  49. M

    Wiki Facility charge for Pain Management

    Good morning All - I am trying to help out a CRNA who does pain management procedures at a Critical Access Hospital (no pass thru at this facility). They have moved him off the OR floor and given him his own procedure room due to case volume. I am not familiar with the facility side so I...
  50. M

    Wiki Routine Foot Care

    11055/11056 Good Evening All - I am working with WPS Medicare and when they updated their LCD in February it appears that they as well changed it to only pay for codes 11055/11056 when the patient has a systemic disease. All of my previously paid paid codes are no longed payable. Am I...
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