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    Wiki Nephrostogram a few days later?

    I bill for a radiology practice, the professional component only. They placed a catheter 12/18/23, CPT 50433, the insurance paid that fine. They read and reported on a nephrostogram 12/26 as the patient had some hematuria. We used CPT 74425, which has been denied by insurance saying it needs to...
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    Wiki Frequency of Nursing Home E/M billing

    I bill for the MD in a nursing home, and we are a bit worried about billing to Medicare, mostly because he received a "warning letter" in February regarding the frequency he billed the code 99310, which we have greatly reduced since then. I am now a bit worried about how often he sees/bills E/M...
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    Wiki Deleted NCCI edits

    We have been questioning the "definition" of deleted in NCCI edits. We have received a denial from Wellcare for 76856 on the same date as 76830. They did pay 76830. The NCCI table shows the edit was deleted in 2004, so we are a little confused about what deleted really means. With this...
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    Wiki Emailing documents

    We are a billing company for quite a few offices in the area. Patients sometimes ask us to email their invoice/bill, but we don't have secure email. When we take credit card payments, the site we use for those has the option to email receipts but they sometimes would like the bill as well. If...
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    Wiki Medicare billing-9944x with Z11.59 covid screen code

    We have billed this with the -CS modifier and are getting the denial: ROUTINE EXAM OR SCREENING PROCEDURE PART OF A ROUTINE EXAM. I see in a medicare COVID FAQ that this seems to be how it should be billed. Any one else had this issue and/or know how to fix it?
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    Wiki Tib/Fib MRI for hand tendon rupture

    I bill for a radiology group, and we are pretty stumped as what to do with this one! Report as follows: MR Lower Leg Right WO Contrast 73718 PROCEDURE: MR Lower Leg Right WO Contrast 73718 CLINICAL INDICATION: EVALUATE RT PLANTARIS LONGUS TENDON FOR FUTURE SURGERY PLANNING OF RT INDEX...
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    Wiki Tib/Fib MRI for hand tendon injury

    I bill for a radiology group, and we are pretty stumped as what to do with this one! Report as follows: MR Lower Leg Right WO Contrast 73718 PROCEDURE: MR Lower Leg Right WO Contrast 73718 CLINICAL INDICATION: EVALUATE RT PLANTARIS LONGUS TENDON FOR FUTURE SURGERY PLANNING OF RT INDEX...
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    Wiki Tib/Fib MRI for hand tendon injury?

    I bill for a radiology group, and we are pretty stumped as what to do with this one! Report as follows: MR Lower Leg Right WO Contrast 73718 PROCEDURE: MR Lower Leg Right WO Contrast 73718 CLINICAL INDICATION: EVALUATE RT PLANTARIS LONGUS TENDON FOR FUTURE SURGERY PLANNING OF RT INDEX...
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    Wiki Tib/Fib MRI for wrist tendon injury?

    I bill for a radiology group, and we are pretty stumped as what to do with this one! Report as follows: MR Lower Leg Right WO Contrast 73718 PROCEDURE: MR Lower Leg Right WO Contrast 73718 CLINICAL INDICATION: EVALUATE RT PLANTARIS LONGUS TENDON FOR FUTURE SURGERY PLANNING OF RT INDEX...
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    Wiki 2019 DOS for 11701 denying?

    I bill for dermatology office, and recently got a denial from United Healthcare that I just don't understand! Date of service is 12/31/2019 and we used CPT code 11701. I know that was deleted for 2020, but on the last day of 2019? I'm wondering if the new code should be used, or what their...
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    Wiki 11701 2019 DOS denying?

    I bill for dermatology office, and recently got a denial from United Healthcare that I just don't understand! Date of service is 12/31/2019 and we used CPT code 11701. I know that was deleted for 2020, but on the last day of 2019? I'm wondering if the new code should be used, or what their...
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    Wiki 12/31/19 11701 denying?

    I bill for dermatology office, and recently got a denial from United Healthcare that I just don't understand! Date of service is 12/31/2019 and we used CPT code 11701. I know that was deleted for 2020, but on the last day of 2019? I'm wondering if the new code should be used, or what their...
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    Wiki -GG Mod with Medicare Mammograms

    I bill for the professional side of radiology, and we have only had one or two patients this year have a screen and diagnostic mammo on the same day. So far we have had a hard time getting these paid. We are putting the -GG on the diagnostic mammogram, for one patient in particular, this is what...
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    Wiki LOTS of chest x-rays in one day, modifier?

    We bill for a radiology group located in (but separate from) a hospital. A patient had a PICC placement done, and it was very hard to get placed, and ended up having 11 chest x-rays in one day to get everything placed correctly and functioning. We have never had a problem getting these x-rays...
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    Wiki Secondary cause code for injury caused by hitting inanimate object?

    Me and the others in my office (radiology coding) are having a hard time coming up with a secondary code for the patients that come into the ER for punching something and hurting themselves. It happens pretty often that there's hand x-rays with no broken bones or anything, but it's from someone...
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    Wiki Colonoscopy with insertion of chest tube?

    This has to be one of the most confusing things I have ever seen! I guess I'm having a hard time getting over the chest tube. Can anyone help me code this? Is it just the colo? POSTOPERATIVE DIAGNOSIS: Probable sigmoid volvulus. PROCEDURE PERFORMED: Colonoscopy with insertion of chest...
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    Wiki Multiple same site x-rays for pre and post reduction of fractures/dislocations

    We are having a hard time deciding how to bill for these types of procedures. It is multiples of the exact same study, i.e. shoulder x-ray for a dislocation, the first study to see the problem, and the second/subsequent to make sure it is set correctly. My first question is, since these are all...
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    Wiki Naturopath and Billing Secondary Payers

    Our office does billing for a naturopath, and he happens to see a few Medicare patients. They all have secondary coverage, mainly VT BCBS. Our problem is in billing them. What is the correct procedure for these patients? The codes he is billing are NOT non-covered CODES, its all E/M visits. The...
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    Wiki Procedure code/Modifier inconsistency?

    I have been getting these back on a few of my radiology patients, and I don't know what to do to resolve the issue! One was 93880-26 with Diag 780.09 93970-26 with R22.43 70470-26 with 780.4 I just don't understand why some of these just don't like the modifier!
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    Wiki Intraoperative consult?! HELP!

    The surgeon I code for was called in for an intraoperative consult, on a patient having a laparoscopic salpingo-oophorectomy: The Veress needle was inserted at the level of the umbilicus but was not successful and a 12 mm port Hassan was inserted instead. A 5 mm port was in the suprapubic...
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    Wiki 78 vs. 79

    A woman has a laparoscopic tubal and then develops a hernia a few days later in her port site. If I am billing for the hernia repair, which modifier do I use? 78 makes sense because the original surgery caused this issue 79 makes sense because its a different body area, technically. I'm...
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    Wiki Colonoscopy post-op help needed

    Could someone help me out with this one please? This is only a week or so after the procedure. I just don't know what kind of modifiers I should use? S. Here today in follow-up of his colonoscopy. He had a colonoscopy done for screening purposes and had a large tubulovillous adenoma in his...
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    Wiki Vasectomy surgical post-op period

    I code for a general surgeon who often does in-office vasectomies. We recently had a patient come back in who still has a VERY high sperm count, and may have to have the procedure re-done. This appointment being 4 months after the original surgery. My question is, is this now an E/M visit, or...
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    Wiki Pre-Colonoloscopy office visit

    I just want to make sure I have this straight. Colonoscopies include pre-exam if they fall on the day of or before the procedure. This is what I have, is it billable? He is a new patient to us, and it isn't scheduled for at least a week. S. This is a 67-year-old gentleman who has a history of...
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    Wiki Wound debridement 2nd time, modifier?

    Patient had an ulcer debrided done 7/10, came back on 7/20 and the doctor did basically the same thing, I'm confused what modifier I should use. 78 or 58, or should it just be a post-op visit? They were both done in office, if that will help. Thanks in advance!
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    Wiki DX for Surgeon consult:suspected breast lump

    This is what I have for office notes, and we are all stumped on what to use for a diagnosis? It isn't a screening per se, she has no pain and apparently the only one thinking she has anything wrong is her primary Dr.! S. Here today because of a possible breast lump. She states she had a...
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    Wiki F/U episode of diverticulitis

    A patient was seen in the hospital and treated with antibiotics, and then referred to our surgeon for follow up. This is the note I have: S. Here today in follow-up of her episode of diverticulitis with either a small abscess or large diverticulum. She is currently feeling well and has no...
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    Wiki Is this billable, if so, how?

    This is what I have, not sure if it would be a simple 99201, but what diagnosis would I use? The patient is set up for colo 10 days after this appointment. S. Referred for a screening colonoscopy. He is due and is being seen in the office because of question of his renal function. He sees a...
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    Wiki Er visit followed by surgery 2 days later

    I'm wondering how you would bill, if at all, the ER visit done 2 days before the lap cholecystectomy. I don't think that would fall under the surgical package, but the whole ER part is what really confuses me. Anyone have any ideas?
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    Wiki Dx for cyst sent to path, path not back yet....

    This is what I have, not sure what to use for a diagnosis: S. Here today because of a cyst on her lower back in the midline which she states has been there for a couple of years. It has not changed much but when she exercises and presses her back against something it bothers her. PMH...
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