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    Wiki Condyloma/skin tag removal

    11420 also requires an incision, so would not be applicable for removal with a scissors.
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    Wiki Nexplanon Removal

    ACOG has a LARC coding guideline, but to reiterate what was said above, a provider should not be standardly charging an E+M in this situation. Here is a snip from a PDF version
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    Question Modifier 82 Same Specialty?

    Yes usage of mod 82 is not speciality related.
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    Wiki OB code sequencing - we're having a debate

    Thanks, agree O10 - I'm just so used to adding the additional codes - however, for anemia there is a "use additional code" note under O99 category heading, which would apply to all codes in that section.
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    Wiki Assistance with Hysterectomy Codes

    Hi, unless I missed something, it appears all the uterine attachments were severed via the scope, and the specimen was removed vaginally. I would code 58571. For an LAVH, you would see the uterosacral/cardinal ligaments severed via a vaginal approach.
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    Wiki OB code sequencing - we're having a debate

    As we all know, the Chapter 15 guidelines state that Chapter 15 codes have sequencing priority over codes from other chapters. After many, many years of OB coding, we are now having a discussion as to whether this means that ALL the O codes should be listed before ALL the other codes, or if it...
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    Wiki Coding for pessary

    Usually that is all done at the same session, and 57160 includes fitting and placement. For my two cents, I would bill 57160 for the fitting, and wouldn't bill additionally for the insert. Clinical Responsibility The provider performs a vaginal exam to determine the proper type and size of...
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    Wiki Assist or not with Adhesions/Hysterectomy

    Hi, we see this situation fairly often. The lysis can be billed by the gen surgeon. As the gen surgeon didn't assist with the hysterectomy, 58150-80 is not applicable.
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    Wiki Z39.0

    Yes, you would use it in that situation but it is not limited to that situation. https://www.aapc.com/codes/coding-newsletters/my-ob-gyn-coding-alert/reader-questions-heres-what-dx-to-report-for-pp-hospital-visit-171442-article I don't know what you would use it for on the facility side..
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    Wiki 59200

    59200 has an MUE of 1, MAI 3. You are unlikely to be paid more than once - you would need to have documented medical necessity and appeal the denial. https://www.cms.gov/files/document/revised-modification-medically-unlikely-edit-mue-program-mm8853.pdf
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    Wiki Z39.0

    Well Z39.0 in and of itself doesn't specifically have anything to do with whether the delivery was in hospital or out of hospital. There is no requirement per se to use it, as far as I am aware. Typically the patient would be admitted and stay 1-2 nights if there were no complications, so you...
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    Wiki Z39.0

    Hi, not quite sure I understand what you're asking. If a delivery occurred outside of the hospital, then a delivery would not be billed, but Z39.0 could be used on any E+M services provided.
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    Wiki Late transfer of care subsequent visit

    59425 would not be coded for an initial visit, or do you mean that the first OB is charging 59425?
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    Wiki Intrauterine Fetal Demise - Help!

    It is still a missed abortion as far as the diagnosis goes. You would code your e+m and any delivery of placenta if documentation supports.
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    Wiki Intra operative consult for accidental injury ICD 10

    I have never heard of this. However, it would not be appropriate to use an S code in this instance. See Chapter 19 Coding Guidelines with regard to coding of iatrogenic injuries.
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    Wiki 76830 and 76856 with doppler

    Hi, so you are clinic based and not hospital? There is no edit of any kind on 76830 and 76856, so a modifier 59 is not applicable. Caution with 93976 - this is often dropped inappropriately. . Generally, they are doing a quick look for flow and this is not separately billable. See below...
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    Wiki O-codes in urgent care clinic

    The provider needs to document that it is incidental, you can't just add it. If it's not documented you should be using the O code. This is from the Chapter 15 guidelines - Codes from chapter 15 and sequencing priority: Obstetric cases require codes from chapter 15, codes in the range O00-...
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    Wiki Help with Delivery

    The delivery note really should stand alone . Even if you are coding a global code at the time of delivery, you are not pulling information from other places. Some doctors are very detailed and put all the info in their notes; others have the bare minimum. You can encourage them to add it...
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    Wiki Ultrasound coding with abortion care

    Hi, the pre-procedure ultrasound would be billable, but the post procedure is "checking their work"and they can't bill for cystoscopy, ultrasound, etc done for this purpose. The ultrasound guidance should cover the entire procedure, including making sure the uterus is empty.
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    Wiki New pt consults for hx of cancer dx code

    Hi I would use the Z08 followed by the history code. If it is not a follow up related to her history of cancer, why is she seeing Hem Onc?
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    Wiki Can you charge Critical Care WITHOUT Time Noted?

    Hi, you definitely need to have the time stated in the note in order to use a crit care code and yes, they can add time after, although I don't know if there is a deadline for that.
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    Wiki Modifier 51

    Total RVUs
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    Wiki DX code Question: Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy (44146) at the same time as 58953

    Yes, it is entirely fine to use the cancer dx as primary.
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    Wiki add on code 99459

    As it is an add-on code, you would need to be billing one of the parent E&M codes. For a biopsy, you would be billing the biopsy code, 99459 would not be applicable.
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    Wiki Help with ICD 10 codes in Oncology dpt

    See the guidelines from Chapter 2, section c and also section 4. If the treatment is only for the complication, you would code the complication first, followed by the neoplasm code.
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    Wiki Unlisted Procedures

    Yes we always have to send a letter.
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    Wiki Modifier AS vs 80

    You are correct. AS is the correct modifier to use for an advanced practice provider.
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    Wiki Prolonged Visits

    Also, be aware that Medicare has different time requirements for billing prolonged care; eg for an established patient cpt states 55 min time must be documented, but Medicare requires 69 min. etc
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    Wiki Hysterectomy Assist after C-Section

    Yes, it will go to claim edits - can you force it out? Otherwise you could also use an abdominal code. Either way, you will likely have to appeal with explanation and notes.
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    Wiki Antepartum Inpatient Discharge & Readmission on same day

    Commerical payer?
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    Wiki 59151 with left ovarian cyst drainage

    Hi, 58805 would be open. Here you could use 49322
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    Wiki Sulcal Laceration

    We have never billed anything extra for a "regular " sulcal laceration repair. If it was extensive and there was documentation to support a mod 22, then yes.
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    Wiki ob or non ob ultrasound

    Yes, retained POC is a pregnancy related indication.
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    Wiki Pregnancy Test before an X-ray..

    You could use the Z32 code. There is also Z01.812. Sorry no idea about the insurance coverage.
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    Wiki ob or non ob ultrasound

    Hi, per CPT assistant if the indications for the ultrasound are pregnancy related, including signs and symptoms of pregnancy, the OB code should be used, even if the outcome is that the patient is not pregnant.
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    Wiki Diagnostic laparoscopy with conversion to exploratory laparotomy and control of bleeding

    Definitely need more details - without the note, hard to say but this is a code in the Cardiovascular section - Codify states Tips Code 35820 differs from other excision or repair codes because it takes place in the circulatory system. This means the provider’s concern is with managing a...
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    Wiki Assistant at Surgery

    Hi, I don't know that it is a CMS requirement - it may be - but it's also very much a reimbursement issue. Many payers will not reimburse an assistant without this information. Here's a link to the Novitas assistant at surgery modifier fact sheet - there are links there to CMS where you might...
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    Wiki Bladder repair due to adhesions during Csection

    Hi, I believe you mean 51860? I haven't seen anything like this where they purposefully cut into the bladder itself, but my read of this is he was releasing the bladder from the adhesions. Lysis of adhesions would bundle - if he documents extra time, work etc, you could add a mod 22.
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    Wiki laparoscopic L ovarian cystectomy with evacuation of hemoperitoneum

    Hi, per NCCI removal of fluid (blood) from a body cavity is included in all diagnostic and surgical laparoscopy. I would go with mod 22
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    Wiki Need help understanding diagnostic Laparoscopy converted to laparotomy with rt salpingoophorectomy

    Hi, per your title, it was a salpingo-oophorectomy so your code would be 58720. You would not separately code 49000 - NCCI bundling.
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    Wiki Return to OR after D&C complication - Help!

    Hi, without seeing the note, if it was a missed abortion O02.1 then 59820 or 59821 would be the correct code for the intial treatment. Following that, although unusual on the same day, it would seem to be an incomplete abortion (perhaps O03.1) and you could use 59812-78. You could also bill...
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    Wiki Intrauterine Fetal Demise - Help!

    This is correct. You wouldn't code 59821 because there was no surgery. Also there is a note in CPT not to use weeks of gestation with codes in section O00-O08 The induced abortion codes are for terminating a pregnancy with a living fetus.
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    Wiki Hysterectomy & Myomectomy

    Hi, assuming the path weight was <250g, I would only code 58571. You can't code for removing something from an organ you are already removing - it (the myomectomy) would be included in the greater procedure, which is the hysterectomy. It was also performed to facilitate removal. If it was...
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    Wiki Code from context in HPI

    Just listing dx is not enough to code them. The documentation must reflect some sort of assessment. Are you familar with MEAT/TAMPER ?
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    Wiki Can a diagnosis discussed in the H&P documentation be used on the delivery?

    Hi Cathy, agree it is frustrating when useful dx aren't in the delivery note. We have been told that we can only pull from the delivery note, unless they have a statement referring you back to the H+P. If I find an example of one like that, I will come back and add it.
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    Wiki 57410 Pelvic examination under anesthesia (other than local)

    We see this (57410) fairly regularly with patients who can't tolerate an exam in the office for various reasons.
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    Wiki Smitt sleeve

    If a provider inserts a Smitt Sleeve (CPT 57156) on the same day that another provider inserts the tandem and/or vaginal ovoids for clinical brachytherapy (CPT 57155), then CPT 57156 would be considered a mututally exclusive procedure This is an old thread but I felt compelled to correct this...
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    Wiki Removal of Nexplanon in subcutaneous tissue

    Since CPT says "deep, eg subfasical, intramedullary, or intra-articular" I would say that subcut would therefore be included in 11982. If the provider documents extra work, time, etc you could add a 22 mod but I would still use 11982
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    Wiki Billing for deliveries performed by Certified Nurse Midwife

    I imagine the rules could differ per state as well as per payer. For the states I bill, the CNM is able to bill. No physician necessary. There is one exception in one of the states I bill with a specific insurer (Cigna) and for those it has to be billed under an MD.
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    Wiki OB PHYSICIAN SERVICES WITH MEDICARE AS PRIMARY PAYER

    Hi, can you be more specific? Your charges are being denied? What do the denials say? We bill global if appropriate for Medicare.
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