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    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...
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    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!!!
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    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...
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    Wiki G0403

    Is a screening EKG still a benefit when billed during the first 12 months of Medicare enrollment? G0403 with V70.0??
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    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!!!
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    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.
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    Wiki APC of GAVE

    Anyone willing to share any information(coding or otherwise) about aragon plasma coagulation GAVE?
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    Wiki EGD vs Upper GI

    can someone please tell me the difference between an EGD and an upper GI? Tanks!
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    Wiki diag code for avm

    What is the diagnosis code for when an arteriovenous malformation is found during a colonoscopy?
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    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.
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    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...
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    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...
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    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?
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    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.
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    Wiki submitting notes to Medicare

    Since Medicare will only accept claims sent electronically, how are you sending unclassified codes that require documentation?
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    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!!
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    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...
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    Wiki ultrasound shows cleft palate

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

    why isn't modifier 33 mentioned in the 2012 CPT book?
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    Wiki capsular plication

    Is there a code for "capsular plication and interval closure". This was performed for shoulder multidirectional instability.
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    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...
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    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...
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    Wiki unilateral screening mammo

    is there any documentation that states how to code for this?
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    Wiki quadricep repair

    Can anyone provide the CPT code for quadriceps tendon repair?
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    Wiki Medicare physical

    How do you handle it when a patient makes an appointment for their "free" physical only to find out that in order to receive this benefit the service provided is actually establishing a screening schedule and different from a "normal" physical exam? It seems to me the problem and solution lies...
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    Wiki new patient

    I have several e/m questions: if a non-medicare new patient receives both preventive and problem oriented visit am I compliant by coding, say, 99386(new patient) and 99203(new patient). Same visit date. Also, I do know modifier 25 goes on the problem oriented visit but don't know why that is...
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    Wiki I&D without incision

    Is it true that if there is no incision, I cannot code 10120? The patient wanted to try removing a splinter without opening the area. The physician manipulated the ares and was eventually able to express a wooden splinter, 2 cm in length. In the note, the area is described as "an entry wound...
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    Wiki S-codes

    I code for a multispecialty clinic and the urgent care sometimes dispenses oral meds which are S-codes. I code the professional side and have never been reimbursed for these when I submitted them. The one UC doc is saying different. Anyone with some documentation or a reason why insurance...
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    Wiki screen for PP depression

    The pediatricians often perform postpartum depression screenings at the 4-6 month well baby visit(99420). If anyone could share info on this code I would be grateful. Do you get reimbursed by any payers? Does the charge go on baby or mom's account? ANY INFO would help!
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    Wiki body composition study via dexascan

    Is anyone doing this? if so how are you coding it(CPT and ICD-9/professional side)?
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    Wiki 52310-bilateral?

    My software tells me that cpt code 52310(cystourethroscopy with stent removal)cannot be billed with mod 50. Can I assume this cannot be performed bilaterally(which my doctor is trying to bill)?
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    Wiki Control of bleeding

    My GI docs think that it is okay to code 45382 whenever they use an endoclip if they remove a polyp and the site bleeds. The documentation may say something like "two sessile polyps were excised by hot snare and retrieved. Endoclips placed". Thoughts?
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    Wiki polyposis syndrome

    Anybody know the diagnosis code for polyposis syndrome?
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    Wiki coumadin clinic

    Does anyone know where I can find the guidelines when billing a coumadin clinic? There's an article in the Part B Insider that mentioned CERT audits but I would like more information on what to audit.
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    Wiki 2011 vaccine administration codes

    I would like to get some feedback on the processing of the new admin codes 90460 and 90461. The clinic I am at uses "exploding sets" for the providers to use when coding the vaccines given. This makes it impossible to "clump" all the 90460s into units. Also, do you find that when the vaccines...
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    Wiki 90460 denial as dup but its not

    We knew it was coming but now what do you do when 90460 is billed more than once on a date of service? Several carriers are saying it's a duplicate even though the diagnosis is different and the guidelines state to code this way. Modifier 59?? Does anyone follow the rules in this business...
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    Wiki Ptns - How are the treatments

    How are the treatments using PTNS coded in 2011. My physician is using 95971 which I am not sure he should be coding. What exactly is this code describing and is it appropriate to use? What documentation supports it's use?
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    Wiki twins

    Anyone getting reimbursed extra when billing 59510-22 for global OB care for twins? Any hints on how to get more than the alloweable for these higher risk, more time and overall extended care for these patients?
  42. E

    Wiki recurrent sinus infections

    How do you code for recurrent sinus infections and/or recurrent bronchitis?
  43. E

    Wiki 30465 and 30520

    Are these 2 codes bundled per your experience? I have 2 sources I use to check edits. Encoder says they are not bundles. The other source says they are and modifier not allowed. Just curious if anyone knows how United, Cigna, the Blues or Aetna would process?
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    Wiki 48 hour holter charges

    when coding 93224-93225 what is the correct date of service to bill? Hookup date or disconnect date or does it matter?
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    Wiki claims reprocessing

    Anyone using Trailblazer as their MAC with their experience getting extra monies for nuclear cardiology codes I would appreciate any info! Will they take a spreadsheet and what info do they want? you can e-mail me at: lfuhrmann@longmontclinic.com or throu this forum.
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    Wiki 76830 and 76856

    per Encoder these 2 codes are not bundled. The report combines the findings into one but is clearly two approaches. The insurance I am having an issue with is Aetna. They are inconsistent however always bundle one into the other and only pay for one-sometimes the transvag and sometimes the...
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    Wiki 17360

    Does this have to be performed by a physician? Can an aesthetician perform and bill for this?
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    Wiki inpatient charges

    Does anyone have a charge ticket they could share with me? Presently, when my providers see patients at the hospital, the visit is "recorded" on an index card with handwritten scribble for what they did, diagnoses, POS etc. This then gets handed to their nurse who has to translate the scribble...
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    Wiki interstitial brachytherapy

    Patient with prostate cancer and decides to proceed with brachytherapy. First a prostate volume was obtained using a transrectal ultrasound probe(is this billable??). Next, "needle placement was performed. A total of 15 peripheral needles were placed. These were then loaded with 48 seeds...
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    Wiki 90375 unit dose

    Anyone out there know what the unit dose for 90375 is?
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