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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 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

    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 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 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

    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 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

    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 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 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 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 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 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 place of service for ekg paging thomas 7331

    Hi everyone, I have a question on place of service for ekgs performed in the Er and admitted subsequently. The EKG reports states the location as Admit In Rm 420. However, when i queried and looked at the sequence of time (have to open patient chart in hospital system), it seems like the place...
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    Wiki Stress test and EKG on same day, different provider

    I'm billing EKG interpretation for our provider and saw that for the same date, another provider from a different group performed a stress test. Insurance is Medicare. How should I bill this to not prevent denial on both providers? I can bill it out faster but I don't think I should be "racing"...
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    Wiki Stupid question on EKG

    We have an EKG report as : Interpretive Statements Sinus Rhythm Possible left atrial enlargement Low QRS voltage in limb leads Cannot rule out anterior infarct, probably old Morphology grossly unchanged Our coder coded as I50.23, I51.7, R94.31. This patient was also seen as inpt for CHF, etc...
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    Wiki E/M for inpatient consult paging mitchellde thomas7331

    Our billing office is under the impression that the following notes can be leveled at inpatient consult level 3. Humana thinks otherwise and wants to pay us a level 1. Please give me your input if I should fight it. They are now beginning to request records for other inpatient consults. I am...
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    Wiki NSTEMI coding paging mitchellde

    I have an interesting case for y'all. Patient was admitted to the hospital. Elevated troponin documented as "probably type 2 NSTEMI on 4/9/19. Patient was transferred to another hospital where cath was done showed no significant blockage but some cholesterol plaque. Our doctor mentioned...
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    Wiki CAD with other angina

    We have a coder who insist that the doctor should qualify what kind of angina if the doctor states CAD in his dictation. Typically it is I25.118 CAD with other forms of angina. She insists that the doctor types in stable/exertional/equivocal angina in his notes. We are confused by this bec we...
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    Wiki 93280-26 Cardiac Pacemaker Programming Place of Service

    We have some cardiac pacer programming done by Medtronic at our office. Medicare is denying for CO-5 procedure inconsistent with place of service. We have been billing this for the past many years and have not had any problems. Any suggestions? Thanks!
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    Wiki Reporting NSTEMI Type 2 27 days paging mitchellde

    Hi everyone, I have an interesting case needing your opinion. Patient had knee replacement surgery and post surgery complained of chest pain. Tests revealed elevated troponins which physician classified as NSTEMI. Upon further diagnostic testing, it was revealed it was a Type 2 NSTEMI which...
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    Wiki Post infarction angina. paging mitchellde

    Patient was admitted to the hospital with shortness of breath, tests showed elevated troponin. He has a history of old infarct involving old inferoapical area. Doctor had the dx of NSTEMI, Type 2. Cath a few days later showed mild diffuse disease of LAD, RCA, and circumflex artery. Patient came...
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    Wiki Should we code borderline to mild? paging demitchell

    Trying to referee a coding debate here. Coding echo reading for primary physicians. Junior coder doesn't code "borderline to mild left atrial enlargement" as cardiomegaly since query with doctor says that it's not clinically relevant. Senior coder says that's wrong and it should be coded. 1...
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    Wiki 23 hr observation in ICU?

    We are an independent practice from the hospital, so we sometimes have difficulty communicating with hospital if they change the status of patient stay from inpatient to 23 hr observation or vice versa. We have a case of patient being admitted to ICU chest pains, 10/10, short of breath but...
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    Wiki Echo coding

    We are following guidelines on billing echocardiogram based on results. E.g. mild mitral insufficiency (I34.0), mild aortic insufficiency (I35.1). However, if patient has indications that makes the echocardiogram medically necessary, e.g. shortness of breath, murmur, CHF, etc.. doesn't it make...
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    Wiki Medicare Sequestration

    I have an interesting observation with regards to Medicare sequestration. I understand we don't have much say about the federal sequestration of 2% for Medicare patients. We do have a positive adjustment code 144 (1.5% MIPS incentive) which makes the sequestration a little less painful...
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    Wiki Is it mandatory for all services to be billed?

    Just a curious question. If a physician reads radiology xrays, EKGs, etc and the biller missed billing the professional component (due to paper shuffle, some may be missed), is that "illegal"? A biller at our office says that it will harm the patient and it will cause trouble for the practice...
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    Wiki Coumadin check CLIA waived

    I have a problem with some insurances particularly BCBS Medicare Advantage on payments on CLIA waived Coumadin level check. We bill 85610 QW for those and BCBS MCR pays $2.34 on those. (The cost of the PT INR strips are approx $5-6). Some patients said that on some other offices its billed as...
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    Wiki Chronic (permanent) atrial fibrillation/Paging mitchellde and coding king

    We have been diligently following codes to a T. We have encountered some situation wherein we thought that once a patient has Chronic Atrial Fibrilltion I48.2 it will always be Chronic because that's what it says in the code book. I had queried our physician and apparently the code book makes...
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    Wiki Post infarction angina

    A seminar attended by a coder from another office mentioned something about post infarction angina. In what situation should we be using it? We typically use I25.118/I25.110 for our patients. Thanks.
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    Wiki Adjusting Coumadin levels

    We have a couple of patients who are living in nursing homes. They do their INR check there and call us to adjust their Coumadin dosages. Can we bill for those over the phone adjustments? We have never billed them and have always provided them free but just curious if there's a code we could use?
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    Wiki How to read "include" and "exclude" in the book

    I'm taking exam and learning to go in depth on reading the CPT book. 36100-36218 INCLUDES introduction of catheter and cath of all lesser order vessels used for approach local anesthesia, placement of catheter needle, injection of contrast, power injections, pre and post...
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    Wiki Diastolic Dysfunction in Echoes

    Diastolic dysfunction in echoes. What code to use? I50.3? I had asked some forums and i was told its unspecified heart disease. Confused?
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    Wiki Starting a billing service

    I am thinking of starting a billing service to augment our family income and have health insurance I work as biller/coder in a small rural practice. Due to the administrative burdens and increasing office cost, I am sensing our physician is getting physically tired of demands from all sides of...
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    Wiki Medical record retention for physician who suddenly died

    One of the doctors in our rural area had suddenly passed away. His office manager (my friend) is getting conflicting info on how long or if she has to be the custodian of records. They use EClinical where she has to pay monthly to keep the records accessible. She has asked her lawyer, the...
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    Wiki HIPAA and releasing of med records

    We have another provider's office asking for patient's INR results from last 4 visits. Our front office would not release it without patient's signature/consent. Is that correct? We are new in town and don't want to give the impression that we are delaying the care but also don't want to...
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    Wiki Hypertensive Urgency

    My coder came to me saying that the doctor is not using hypertensive urgency for a patient who walked in with 190 mm Hg blood pressure. Our doctor just dictated it as hypertension, severe (I10). Is there a standard range limit wherein it can just be hypertension (severe) vs hypertensive...
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    Wiki First level appeal for Medicare

    We have a patient with Jr after his name. (e.g. John Smith Jr). Our billing system would not recognize eligiblity if it is entered as John Smith Jr. but it would read it if it's typed as John SmithJr. However, our claims for 2018 keep on being denied by Palmetto GBA (TN MAC) as invalid, and if...
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    Wiki Need help with ICD defibrillator coding

    Patient was admitted due to defibrillator misfiring. Our physician went to the hospital bringing the defibrillator machine and interrogated and as per patient request (patient is terminal), turned off the defibrillator. Question: 1. Do we use 93289 (interrogation device evaluation (in person)...
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    Wiki Hypertensive Heart Disease

    I attended a seminar that the speaker states that there are some heart conditions that "never go away" and should be coded and be in the assessments in every visit, e.g. Hypertensive Heart Disease, Chronic Kidney Disease, Heart Failure, etc. She told us we "could get in trouble" if we don't do...
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    Wiki Risk Adjustment Chart Review

    We are a solo practitioner but sees patients with heart problems and other co morbidities. Bec we are in a rural area and not a lot of specialists here, we see a lot of complex patients. We are getting swamped with request for records from insurances, like 120 from BCBS, 80 from Humana, 50 from...
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    Wiki 99152- Moderate sedation

    We bill moderate sedation 99152 as per new changes in 2017 guidelines when performing cardiac cath. It pays somewhere between $11-12. However some insurances e.g. Humana denies it. Are there some changes I'm not aware of? Thanks!
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    Wiki Risk Adjustment

    We are getting so much requests (as in 120 chart requests just for BCBS alone, another 74 for Humana) for risk adjustment. We are a single provider office and perenially short staffed due to budget problems. I am using my weekends to submit but it feels like the vendors (ArroHealth, Cioxx...
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    Wiki What codes to use? Paging Coding King

    We have a pt that came to our office for regular follow up of his cardio problems. During the visit, he requested a letter be written to support his driving a school bus (that's his regular job and he needs an annual "clearance" to drive due to his heart problems). Doctor did his usual check up...
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    Wiki Carotid ultrasound denial from Medicare

    The doctor indicated that he is checking for "patency for carotid and vertebral circulation to evaluate atherosclerotic burden" and ordered a carotid ultrasound. Biller billed Z13.6 Encounter for screening cardiovascular disorder (unacceptable pdx). Patient has symptoms of...
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