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  1. L

    Wiki nephroureteral stent removal

    look at 52310
  2. L

    Wiki Cpt 36475

    If you're coding/billing anesthesia, you need the ASA Crosswalk. You look up the procedure the surgeon performed in the Crosswalk, and it will tell you which anesthesia code to use. The surgeon performed 36475, so it is not appropriate for you to bill it for an anesthesia provider. The...
  3. L

    Wiki Nitrous oxide used for analgesia in ER

    According to the ASA, the only appropriate code is 01999. file:///C:/Users/Andrew/Downloads/2016-01-05-coding-for-nitrous-oxide-for-labor-analgesia.pdf
  4. L

    Wiki screening vs diagnostic

    You need to query the provider to find out if it's performed due to the patient having diverticulitis or if it's a screening and the diverticulitis is incidental
  5. L

    Wiki Prostate cancer with cancer symptoms

    Check the guideline. ;)
  6. L

    Wiki Scar Revision

    You are to use the appropriate complex repair CPT code for scar revision.
  7. L

    Wiki Two supported COPD-type codes w Excludes1 notes. Keep what, remove what & why?

    You would only code the Emphysema in this case.
  8. L

    Wiki Skin Excision vs Lipoma Excision (114xx, 2155x)

    Lipomas are found between the skin and muscle.
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    Wiki Anesthesia PLAN vs Anesthesia TYPE

    The plan is the intended method, and the type is the method used. In the case attached, it would be General. Anesthesia providers base their anesthesia method on the patient's health ascertained through the history and physical performed prior to the anesthesia service.
  10. L

    Wiki Skin Excision vs Lipoma Excision (114xx, 2155x)

    It states "lipoma" which would be billed with a 2000 code, however the repair is bundled and would not be billed for a 2000 code.
  11. L

    Wiki Fracture

    What codes did you come up with?
  12. L

    Wiki Removal of Epidermoid cyst

    What CPT code did you come up with?
  13. L

    Wiki Coding DM type 2 with Hypertension and Hyperlipidemia

    In the ICD-10 index, the listed complications below Diabetes are the only ones we may presume a connection per my auditor. All others will need to be documented as being related.
  14. L

    Wiki pre evaluation for cancelled procedure

    If it's properly documented, yes.
  15. L

    Wiki diagnosis for 64445?

    I would have to see the op note to be sure then.
  16. L

    Wiki diagnosis for 64445?

    You would code sciatica only.
  17. L

    Wiki Saphenous Nerve Block

    Saphenous nerve block above the knee: 64447 Saphenous nerve block below the knee: 64450 Sciatic nerve block (aka popliteal): 64445
  18. L

    Wiki diagnosis for 64445?

    64445 is a nerve block of the sciatic nerve that is usually performed for pain management (ie, post-traumatic, post-operative). As an anesthesia coder, I code that with G89.18, when it's documented for post-operative pain management. That said, what is the diagnosis documented in the note...
  19. L

    Wiki ASA for PRP injection

    Look at the codes for closed procedures.
  20. L

    Wiki Combined congestive heart failure

    Yes, if there is a combination code, we are to use it per the ICD-10 guidelines.
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    Wiki CPT 64415 and S42.021A

    We need to start with who performed this service (surgeon or anesthesiologist) and why. There's not enough information to determine if the coding is correct to begin with. Generally, if a surgeon performed this block intraoperatively, it's bundled. If it was performed for post-op pain by an...
  22. L

    Wiki Pre-anesthesia evaluation diagnosis code for a separately reported E/M

    If you're looking to bill an E/M separately from the anesthesia service strictly due to the patient's poor health due to complex co-morbidities, please know that the E/M is not separately billable regardless of the patient's medical status. The H&P is bundled.
  23. L

    Wiki CABG s/p MI ICD-10 code

    What you're describing is procedure, and a diagnosis is your "why". The diagnosis would be the reason the procedure was performed. You will need to query the provider to determine your "why".
  24. L

    Wiki help with appropriate modifier

    I think that we would need to see the op note to be sure 27301 is the correct CPT code, as this is not usually performed in office and requires anesthesia. 10060 or 10061 may be more appropriate, but it's not possible to know.
  25. L

    Wiki Commercial Payors Screening colonoscopy turns diagnostic

    For commercial insurance, use 00812-PT when a screening colonoscopy turns diagnostic. Z12.11 will be listed first followed by the finding(s). Medicare and Medicare Advantage Plans require 00811-PT when a screening colonoscopy turns diagnostic. Modifier 33 is not used in this scenario for...
  26. L

    Wiki UHC Denying G89.19 for 62322-59

    After reviewing the codes in the 2024 ICD-10 manual, I don't see G89.19 listed. Perhaps that's why you received a denial.
  27. L

    Wiki cpt codes 27216 & 27217

    Under 27216 and 27217 there are a parentheticals stating to report bilateral procedure with modifier 50. For the Medicaid case, I would appeal with notes if they don't accept modifier 50.
  28. L

    Wiki Hydrodistention under MAC

    MAC is monitored anesthesia care which will be indicated by the anesthesiologist, so 52265 is not appropriate. 52260 is the correct code.
  29. L

    Wiki Gastric Ulcer w/hemorrhage

    Go to K25.x in the ICD-10 manual, and you will see a coding tip regarding this scenario.
  30. L

    Wiki Anesthesia Diagnosis

    You would place the reason for the procedure first. In this case, I don't think it would be F41.9 (Anxiety, unspecified), as that would not be a primary reason for pain management treatment.
  31. L

    Wiki Ortho dx codes issues

    You're totally correct. Per the guidelines, we may only code definitive diagnoses. "Consistent with" is not definitive.
  32. L

    Wiki Need help understanding diagnostic Laparoscopy converted to laparotomy with rt salpingoophorectomy

    Laparoscopic converted to open (laparotomy) would only be coded as open.
  33. L

    Wiki o34.219

    Yes
  34. L

    Wiki Can I bill for packing changes if procedure was not done in our practice?

    Look at 12021 to see if that meets your needs.
  35. L

    Wiki Laparoscopic Inguinal Hernia Repair TAPP Technique

    15734 (Muscle, myocutaneous, or fasciocutaneous flap; trunk) would never be billed with a code outside of the Integumentary section. Surgical closures are bundled. In addition, the TAPP technique is not a flap, rather it's the approach. Therefore, it's not separately billable. TAPP is the...
  36. L

    21556 & 13132

    As a general rule, CPT codes outside of the Integumentary section have the closure of the surgical wound bundled.
  37. L

    Wiki Can you bill for a pre op and a post op/repeat block in the pacu if the 1st block failed

    Post-op pain blocks may only be billed once per day.
  38. L

    Wiki Sepsis in outpatient

    Treatment = active diagnosis Completed treatment = history (does not apply to chronic diseases)
  39. L

    Wiki T50.905A

    According to the last paragraph second sentence, you cannot code an adverse reaction to nitrofuantoin. It specifically states that it's unclear if the patient had an adverse reaction or if the flu-like symptoms were coincidental.
  40. L

    Wiki T50.905A

    The primary code should be the nature of the adverse effect followed by the code for the adverse effect (ie, T50.905A) per the guidelines.
  41. L

    Wiki Medicare is not paying 76937-26 for 93503

    According to Optum's Encoder, 93503 includes access site imaging.
  42. L

    Wiki paraspinal abscess?

    Look at G06.x
  43. L

    Wiki 45378/G0121 and use of Z12.11

    If the primary reason the patient is having a colonoscopy is for a cancer screening, Z12.11 is the correct code. Sometimes, providers will state a patient is having a screening when experiencing symptoms, and the colonoscopy is performed to find the problem. This is a diagnostic procedure and...
  44. L

    Wiki CPT 99140

    You're correct. 99100 is only billed for patients under 1 & over 70. However, which insurance we bill 99100 and/or 99100 to are the same. I edited my reply above. They are only billed to commercial insurance and not government insurance (ie, Medicaid, Medicare, managed Medicaid, Medicare...
  45. L

    Wiki How to follow and code DM due to HTN?

    According to the ICD-10 manual, code first the underlying condition. In this case, it's HTN (I10). I10, E08.9 is correct. E11.59 is DM with other circulatory complications. This implies a circulatory condition is due to the DM. E08.x is DM due to an underlying condition. I hope this helps.
  46. L

    Wiki ASC Facility with post op pain block

    While some insurance accepts other modifiers for post-op pain blocks, I have had success with 59 on nerve blocks. 29827/01630 64415-59,RT G89.18
  47. L

    Wiki CPT 99140

    59 is not meant to be appended to 99140, as 99140 is an anesthesia add-on code that indicates an emergent case in which the patient's life or limb is in danger. It is not a procedure and may not be billed alone. 99140 is only billed to commercial insurance for patients younger than one year and...
  48. L

    Wiki Question with colonoscopy coding

    K63.89, as the condition is not definitive.
  49. L

    Wiki Unspecified Laterality - WHY????

    Sometimes providers don't document laterality. I see it every once in a while but not too often.
  50. L

    Wiki Migraine Nerve Block Injections

    Based on the CPT manual, 64400 targets the trigeminal nerve & its branches that includes the auriculotemporal nerve. 64405-targets the greater occipital nerve 64450-targets the lesser occipital nerve 64615 target muscles which is not supported by your documentation.
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