Search results

  1. E

    Wiki Pre-Payment Audits from Medicare

    I would like to hear if anyone else is experiencing these lovely audits from Medicare? The codes that are being looked at(from my clinic) are mostly 99204, 99205 and 99215's. I agree with Medicare on their findings 75% of the time. The problem I have are inpatient consults(in theory), that...
  2. E

    Wiki bone-patellar tendon-bone autograft

    thanks!!
  3. E

    Wiki bone-patellar tendon-bone autograft

    Doctor performed "anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft". Would I code 27416 and 29888? It's end of the month so crunchtime and any help is appreciated!!!
  4. E

    Wiki *** New Opportunity for CPC's!

    From my experience(not a good one). yes, they are all about the money. They say 100% money back guaranty but don't stand by their word. Proceed cautiously!
  5. E

    Wiki Inpatient rounds with a midlevel

    Thanks Debra. Awesome info.
  6. E

    Wiki Inpatient rounds with a midlevel

    My clinic is hiring a midlevel provider to be stationed at the hospital for Cardiology patients and rounds. I am looking for any information that would be useful. Some scenarios would be: if the midlevel only sees the patient; if the midlevel only sees the patient twice in one day; if the...
  7. E

    Wiki G0403

    Is a screening EKG still a benefit when billed during the first 12 months of Medicare enrollment? G0403 with V70.0??
  8. E

    Wiki No RVUs for add-on PCI codes?

    Does anyone know why there are no RVUs assigned to the add-on PCI codes. For example, 92921 has no RVUs attached to it? How are you billing these...at what price? I would love to hear from anyone that knows anything about this!!!
  9. E

    Wiki Heart cath code sheet 2013

    Rhonda, Please email me a copy. Tanks. lfuhrmann@longmontclinic.com
  10. E

    Wiki Solestra injections for fecal incontinence

    The Solesta rep told us to bill 46999 for the procedure and J3490 for the Solesta. On line 19 write "Solesta 4 1 ml submucosal inj NHRIC 89114085003". I have not seen a payment yet.
  11. E

    Wiki new contraception cpt code?

    Is there a new CPT code for the topic of contraception? One of the OB-GYNs that I work withsaid she heard there was.
  12. E

    Wiki Transitional Care Management Services - As I understand

    Can anyone point me to where I can get a copy of the Final Rule? Either here or lfuhrmann@longmontclinic.com. Also how are those that use this code keeping track of all the requirements for billing?
  13. E

    Wiki DOS for TCM codes 99495/6

    A recent Part B Newsletter said "the date of service can be the end of the calendar month that TCM services from discharge up to 29 days post-discharge were provided". It is not the date of the face to face visit which would be too early "because the time is still running until day 29" for TCM...
  14. E

    Wiki 2013 changes

    Could you email the crosswalk please? Tanks. lfuhrmann@longmontclinic.com
  15. E

    Wiki APC of GAVE

    Anyone willing to share any information(coding or otherwise) about aragon plasma coagulation GAVE?
  16. E

    Wiki EGD vs Upper GI

    can someone please tell me the difference between an EGD and an upper GI? Tanks!
  17. E

    Wiki can somebody help me?-I'm VERY new

    I would code this 43248 if a guidewire was used.
  18. E

    Wiki diag code for avm

    What is the diagnosis code for when an arteriovenous malformation is found during a colonoscopy?
  19. E

    Wiki Transitional Care Management - the CPT codes

    who is "they" in "they are covering the TCM charges $30 more than 99214"?
  20. E

    Wiki New CPT code 44705

    the definition sounds like it's the code for fecal transplants.
  21. E

    Wiki what is G0123?

    Please, can anyone tell me what this code is describing? One of my providers was told(many years ago) to bill it with pap smears. I ran a report and found that no insurance covers this service. Medicare doesn't, commercial plans do not...Thanks for your help if you choose to reply.
  22. E

    Wiki repair direct and indirect inguinal hernia repair w/mesh

    the physician repaired two hernias(one direct and one indirect) during the same operative session. Both were inguinal and non-reducible. Do I code one or both? You are correct-the diag code I chose was wrong. Thanks.
  23. E

    Wiki Unlisted Code

    we research the price of a listed code with similar work involved and determine a price to submit to the insurance company. Rather than let them guess, hopefully we are being proactive this way.
  24. E

    Wiki repair direct and indirect inguinal hernia repair w/mesh

    A couple questions: Documentation states the patient had a prior right inguinal herniorrhaphy. So these repairs are recurrent even though not in the same exact location? Since the repairs are done from the same incision is one bundled into the other? I came up with 49521 with 550.91...
  25. E

    Wiki isn't this "double dipping?"

    One is for Humana. On 4/24 he billed a 99245 then billed 99236 on 5/17/12. The 4/24/12 consult is stamped with no interval changes in physical condition and filed as documentation of the admit/discharge same day.
  26. E

    Wiki isn't this "double dipping?"

    thanks and I agree with all of you, however if someone could cite a reference I would be golden. I am reviewing the CPT book now and reviewing the initial hospital care rules.
  27. E

    Wiki isn't this "double dipping?"

    Provider sees a patient and bills the appropriate e/m code. This same patient is admitted within 30 days and when I look for documentation of the admit code(same doctor), I find the office visit note, only stamped with "no interval changes in physical condition" and signed by the provider. I...
  28. E

    Wiki prophylactic mastectomy

    If patient has cancer left breast and has bilateral mastectomy performed(prophylactic on right), isn't there a law or policy that insurance has to pay for both?
  29. E

    Wiki more essure questions

    On 4/27/12 successful coil placement left side. 2 attempts at right were unsuccessful. On 5/25/12 successful coil placement right side. 58565-52 for 4/27/12 procedure 58565-76/52 for right What is the correct way to code. The second procedure is bundled to the first.
  30. E

    Wiki submitting notes to Medicare

    Since Medicare will only accept claims sent electronically, how are you sending unclassified codes that require documentation?
  31. E

    Wiki Allergy detailed physical exam

    Does anyone have an allergy PE(Detailed-1995 guidelines) that they would be willing to share with me? I would really appreciate it!!
  32. E

    Wiki coding prev and problem oriented visit

    If the documentation supports the coding of a preventive and problem oriented service and the provider has not seen patient in 3 years(nor anyone from the specialty) I am inclined to educate the provider that both services cannot be billed with a new patient code. For example, cannot bill 99386...
  33. E

    Wiki ultrasound shows cleft palate

    What diag code would I use for pregnant woman consult with ENT for the ultrasound showing a cleft palate?
  34. E

    Wiki Splitting OB care

    Dr. A does ante and post partum care. Dr. B delivers twins and performs bilateral tubal ligation. One baby is vaginal and one cesarean. How do I code so both docs get paid appropriately? Mostly Dr. A...do I use 59426 and 59430? Patient was seen>7 OB visits. The CPT book says 59430 is a...
  35. E

    Wiki EMR and the medical assistant

    None if you are talking about the physical exam. The MD must do that part.
  36. E

    Wiki meaningful use

    ritas927, where, on the CMS web site, is this info? I tried looking but couldn't find...
  37. E

    Wiki meaningful use

    I haven't been reading much on meaningful use but now coding is involved, I think, so I better get on it. The software lead at my clinic has told the pediatricians that they have to code 97802(nutrition) S9451(physical activity) with the well baby/child checks in order to be eligible for...
  38. E

    Wiki OB global package/cervical dilator

    59200 My doctor puts X2 on 59200. Can this code be used more than once? Modifier or units=2?
  39. E

    Wiki patient unable to repond

    What is the rule when an unconscious patient admitted after police found him on the sidewalk? How do I audit the HPI and ROS? "The patient is an unknown white male found down on the sidewalk by police. He is somnolent and unable to give any history. ROS/PFSH could not be obtained due to the...
  40. E

    Wiki New Medicare Services for Obesity Therapy and Screening and Counseling for STIs

    The only documentation I have found is in the MM7641 in a yellow box it states "Obesity counseling is not separately payable with another encounter/visit on the same day. This does not apply for IPPE claims, claimscontaining mod 59, and 77XXX claims containing Diabetes Self-Management Training...
  41. E

    Wiki Medicare covers screening and counseling for obesity

    MM7641 has a list of provider specialty types that will be reimbursed for G0447. Registered dieticians are not on the list. Nurse Practitioner, Certified Clinical Nurse Specialist and Physician Assistant are the auxillary providers that are eligible.
  42. E

    Wiki Medicare covers screening and counseling for obesity

    I don't "see" registered dieticians as an acceptable specialty type for the IBT for Obesity.
  43. E

    Wiki why?

    why isn't modifier 33 mentioned in the 2012 CPT book?
  44. E

    Wiki capsular plication

    By golly it is....thanks.
  45. E

    Wiki capsular plication

    Is there a code for "capsular plication and interval closure". This was performed for shoulder multidirectional instability.
  46. E

    Wiki intradiscal injection

    L4-5 and L5-S1 discogram with intradiscal cortisone injection and right S1 transforaminal epidural...can anyone guide me on how to code...
  47. E

    Wiki spinal fusion

    thanks nyyankees, I sent you a private message.
  48. E

    Wiki spinal fusion

    HELP: New doctor/new procedures; how do I code 1.Decompression L4-5, L5-S1 2. Transforaminal interbody fusion L4-5 on the right and L5-S1 on the left. 3. Biological implant placement X 2, 2 PEEK cages one in 8 mm height at L5-S1 and the second one at 10 mm height at L4-5. 4.Posterior...
  49. E

    Wiki unilateral screening mammo

    is there any documentation that states how to code for this?
  50. E

    Wiki Digital Mammogram

    how does one code for a unilateral digital screening mammo?
Top