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    Wiki MCR audit downcoded E/M

    Thank you !
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    Wiki MCR audit downcoded E/M

    Medicare requested records as a random audit. The Consult Note as ff: DOS 1/xx/2021 Reason for Consultation: Severe aortic valve stenosis status post aortic valve replacement surgery History of Present Illness: Ms ABC is a 60 y.o. Caucasian woman with multiple complex medical problems. She has...
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    Wiki PLEASE HELP! - EKG Reporting

    Our hospital uses a system (Ephiphany Cardio-server) that requires the doctors to log in, read and check boxes or free type his interpretations. Typical interpretative statements may include "sinus bradycardia", "mild interventrular conduction delay" ,"junctional rhythm" "sinus rhythm", "non...
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    Wiki ECHOCARDIOGRAM 93306

    Our cardiologist does echocardiograms once every year as indicated as follow up to valve diseases, aortic stenosis surveillance. In some cases, pulmonary hypertension surveillance is done once or twice a year. In my experience, unless you are specifically checking for ejection fraction changes...
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    Wiki Dx for LBBB

    I agree with Thomas. When "unspecified" appears in the names of codes, it does not mean it is an unspecified code. The spirit of ICD 10 in requiring specificity, is that when there is a clearer diagnosis, the providers are required to use that. The ICD 10 codes in the books are meant to be a...
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    Wiki Heart Failure

    I50.22 would be sufficient for the specificity of the CHF. I wouldn't put the other heart failure code I50.89.
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    Wiki Cardiac cath documentation for moderate conscious sedation

    Thanks Sharon and Jim !
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    Wiki Cardiac cath documentation for moderate conscious sedation

    We always get a denial for moderate conscious sedation from United Healthcare. I attended a coding seminar available from their website. https://cx.uhc.com/content/uhc-provider/uhconair/en/coding.html and they mentioned that the documentation should state there is an independent trained...
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    Wiki 23 hr observ and changed to Inpt

    Pt was initially admitted as 23 hr observ on Day 1 so we coded 99215 (pt is established in our clinic), however, on Day 3 pt was admitted as an inpt. Do we go back and code Day 1 as inpt 99221-99223 consult code or start as a follow up code 99233-99231 on Day 3? Pt is Medicare pt. Thanks.
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    Wiki Modifier -59, XE in cardiology

    Thank you Tom. Do we both -59 on one of the test or on both? Scenario: Inpatient EKG read 93010 Inpatient Echo read 93306-26 Do we put -59 only on one or the other? Scenario: In office echo 93306 same day as in office carotid 93880 Do we put -59 on both lines? Thanks!
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    Wiki Modifier -59, XE in cardiology

    We received a claims analysis letter from Amerigroup, stating that our provider fell outside of average utilization of the ff modifier. -59, XE I queried our system and found the root cause. Frequently our provider consults on cases, reads EKGs and echoes, stress test for the same patient, all...
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    Wiki EKG interpretation with ER visit billing question

    we can still bill as 93010. bec different npi and tax id is used for the formal interpretation. hope this helps.
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    Wiki Coding for Preop for Bariatric Surgery

    I can't seem to find a code for bariatric surgery other than the Z code Z98.84. I don't think its correct to use this as a preop Z01.810 and Z98.84. Can i use obesity code instead? Thanks
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    Wiki COVID dx on echoes and EKGs

    Our physician performs ancillary services, reading EKGs and echocardiograms, for the ER. Our coder went to the AHIMA and CDC websites and pulled out a bunch of info regarding COVID coding. She is a perfectionist and wants to code things by the guidelines. From what she understood from the...
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    Wiki COVID dx suspected confirmed

    We have a biller that believes that everyone we bill has to be checked for COVID bec insurance will pay fully (deductible and copay) if there is a dx of covid suspected/confirmed. She goes into the hospital system looking at the labs to check for COVID dx. We had warned her that it would be a...
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    Wiki Angina pectoris (use additional code to identify: Z77.22...)

    I have a curious question: I have noticed under I20 angina pectoris there is this note that says: Use additional code to identify: exposure to environmental tobacco smoke Z77.22 history of tobacco dependence Z87.891 occupational exposure.. Z57.31 .... Is this a MUST...
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    Wiki Location of testing interpretaion

    CMS has issued guidance that states that the POS should be assigned for wherever the patient received the face-to-face service. So, if the patient had an echo at a hospital as an outpatient, the correct POS for the physician's interpretation would be 22. It was included in Change Request 7631...
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    Wiki How to code echo on 16 yr old?

    Thank you both for your clarification. Appreciate it!
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    Wiki How to code echo on 16 yr old?

    16 yr old patient. Referred to hospital for echo - family history of sudden cardiac death, check for LVH. Results : Physiologic mitral and tricuspid regurgitation. no significant valvular pathology. I feel i cannot code I34.0 and I36.1 because it says there no valvular pathology. What code...
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    Wiki Place of service

    Thanks !
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    Wiki Place of service

    Thanks Amanda. The procedure was done at another doctor's office and we read it in our office. So POS 11 Office is appropriate ?
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    Wiki Place of service

    We read echocardiograms for echoes performed by another facility through a cloud based CPAC system. We bill for the reading part 93306-26 and they will for the technical component. We read them in the clinic. Therefore, we think we should be it as place of service 11 office. The downside to...
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    Wiki MEDICARE EKG QUESTION

    I would bill on separate lines with modifier -76?
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    Wiki MI codes I21.A1 vs I21.4

    Thank you !
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    Wiki MI codes I21.A1 vs I21.4

    We queried the physician and he did say that he meant paroxysmal tachycardia owing to the fact that patient also had atrial fibrillations, paroxysmal.. Coder says NOT GOOD ENOUGH, the physician has to have it documented, add the word "paroxysmal" to tachycardia, go to med records and add an...
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    Wiki MI codes I21.A1 vs I21.4

    So we just code it as I21.A1 without the tachycardia bec we cannot code it as paroxysmal tachycardia ? Under the definition in the book, Code also the underlying cause, if known and applicable, such as : anemia, COPD, heart failure, paroxysmal tachycardia, renal failure, shock. Is this a case...
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    Wiki MI codes I21.A1 vs I21.4

    The cardiologist consult as ff: Chief Complaint: Elevated troponin consistent with Non ST elevation myocardial infarction, afib w RVR, tachycardia bradycardia, acute CHF. Assessment: 1. NSTEMI, acute but type 2 due to demand ischemia from tachycardia This throws our coder off bec all she sees...
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    Wiki Appropriate Use Criteria Coding for Nuclear Stress Test

    Thank you!
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    Wiki Appropriate Use Criteria Coding for Nuclear Stress Test

    Our hospital started the AUC program for radiology. The referring doctors' office does the AUC and provides the hospital with the preauth numbers. Our physician supervises and interprets the nuclear stress tests. Should we be asking the hospital for the preauth numbers? Or use the modifier QQ on...
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    Wiki Appropriate Use Criteria for Advanced Diagnostic Imaging

    https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program/index.html
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    Wiki Atrial fibrillation of unknown duration

    The afib codes are really confusing. The physician has explained that the terms used in communication among healthcare providers may sometimes not be exact to the terms used in the coding books (which our coder insists on documenting exact words from coding book).
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    Wiki Atrial fibrillation of unknown duration

    Doctor documented that patient has newly detected atrial fibrillation of unknown duration. He circled superbill dx as persistent. Our coder insisted that since it is unknown duration it should be coded as unspecified. Which is correct? Thanks!
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    Wiki New Atrial Fibrillation Code

    Thank you David!
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    Wiki medical necessity denials by Medicare for 78452

    I am curious if they are implementing in advance the AUC diagnostic guidelines for 2020. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AUCDiagnosticImaging-909377.pdf
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    Wiki EM documentation changes for 2020

    Thank you !
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    Wiki EM documentation changes for 2020

    I got a flyer from McVey about documentation changes coming soon. Has anyone heard from CMS or other insurances on what could it be? Is it drastic?
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    Wiki Denial of 78452 while in Obs status

    Hi Christina, I just read your post. We had this problem also. For Humana, you can request retro prior auth from the ordering doctors. For UHC, Cigna sometimes we ask the hospital to inform us, or the doctor looks at the ins and call our office to preauth it. 23 hr observ stay is really tricky...
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    Wiki New Atrial Fibrillation Code

    Thank you Thomas. You have always been the voice of reason. I have asked our cardiologist to clarify and he patiently explained that in medical terms, permanent chronic afib means it is a shared decision by both patient and physician(s) that nothing will be done about the afib. He said that...
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    Wiki New Atrial Fibrillation Code

    It's just been less than 2 weeks of new code book update and we just got our new code book. We saw some patients and provider has documented chronic atrial fibrillation (under the 2019 ICD book). Coder is saying doctor needs to go back to each encounter for the past 2 weeks, starting Oct 1 and...
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    Wiki Rheumatic vs. Non-rheumatic valve disease

    Our provider says that non rheumatic valve diseases occurs in 95% of our cases. So when he dictates e.g. aortic valve regurgitation we code it as I35.1 (non rheumatic aortic valve insufficiency). He will dictate rheumatic valve disease if it is rheumatic. Thats how he was taught in fellowship...
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    Wiki billing 93306, 93000 and 99214

    Did you used modifier -25 for the 99214, modifier -59 for the 93306 and 93000? Also try using different DX codes that support the procedures. Good luck!
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    Wiki Humana EKG's 93010

    Humana sometimes bundle the 93010 Ekg reading with the ER E/M. Would using a modifier on the EKGs or E/M help?
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    Wiki billing self pay in optometry

    Can your system accept a modifier and be programmed that accounts with that modifier be identified as selfpay?
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    Wiki UHC Smart Edits for Echo paging thomas7331 mitchellde

    Echo performed in office Indications: Hypertensive heart diseases without heart failure, aortic insufficiency, mitral insufficiency, heart murmur Measurements... 2-D Echo... Color and Spectral Findings... Conclusions: 1. Mild concentric LVH with LVEF of 60-65% 2. Mild left atrial enlargement...
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    Wiki Coding Diabetes with Hypertension

    I agree with thomas7331. Diabetes does not cause hypertension nor vice versa.
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    Wiki POS for EKG - billing debate paging mitchellde thomas 7331 HELP

    Thank you !
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    Wiki 99406

    We have an inpatient addicted to meth and other drugs. Physician has documented that he advised the patient to stop using. Is it billed as 99406 or is there another appropriate code?
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    Wiki POS for EKG - billing debate paging mitchellde thomas 7331 HELP

    MM7631 Special Considerations for Services Furnished to Registered Inpatients When a physician/practitioner furnishes services to a registered inpatient, payment is made under the PFS at the facility rate. To that end, a physician/practitioner/supplier furnishing services to a patient who is a...
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    Wiki Stupid question on EKG

    Kathryn, Thank you for your enlightening answers. Can you kindly provide which chapter i can find this? My coder is very obssessive with the rules and would need to see it on the ICD 10 book before accepting my answers. The R94.31 is what we use for the low QRS voltage. However, she insists...
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    Wiki place of service for ekg paging thomas 7331

    Thank you ! Appreciate your wisdom.
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