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  1. O

    Wiki Plica, scar tissue procedure

    Code 29877 is for the debridement / shaving of chondral tissue. So code 29877 would not fit plica/scar tissue.
  2. O

    Wiki Consultation Codes

    If the E/M is based off MDM, and your provider can't treat the patient due to the circumstances, I don't see it as a billable visit. If they can't treat the patient, how can they get credit for MDM?
  3. O

    Wiki Dx lap including lysis of adhesions

    You need to code what was performed. Very possible with the adhesions being treated that the patient's symptoms will decrease or go away. Full disclosure I only code ortho surgeries.
  4. O

    Wiki Consultation Codes

    A referral is not a consultation.
  5. O

    Wiki CPT open procedure debridement of biciptal groove

    Code 11043 is in the integumentary system for the debridement of open wounds. Your provider did not debride an open wound, so you can eliminate the codes from the integumentary system. Your provider made an incision to get to the bone, so the code is going to be from the musculoskeletal system...
  6. O

    Wiki Can medical coders make addendums?

    I think you know the answer, just need something in writing. No, coders cannot document. I'm aware of a company that went from charts to an EMR, and the EMR initially allowed the coders to document. The coding manager found out, went to the IT department and changed their access to coders could...
  7. O

    Wiki H&P

    I've been working in an orthopedic clinic for 10+ years. My guess is that your work flow is probably the same. In orthopedics there really is no H&P "per se". The providers initial visit with the patient will usually be used as the "H&P" at the hospital. That initial visit could be at the clinic...
  8. O

    Wiki Excision 11400 or 25075

    I suggest working with your provider on increasing the specificity of the documentation. Code 11400 is for the removal of basically epidural lesions. Code 25075 is for the removal of deeper subcutaneous lesions. In this case lipomas. There's no doubt that this is what the provider did, however...
  9. O

    Wiki Auditing PA assist at surgery

    What was the given reason for the error? Does the surgical procedure allow an assistant? Does the insurance allow PA's to assist? Something had to be incorrect on the surgeon's codes for it to be "dinged". More information is needed.
  10. O

    Wiki J7327 Modifier ?

    I wonder if they are looking for that modifier. I just asked someone in the clinical staff if they had ever not given the entire syringe and she said no. She's been injecting for 8 years. But they might want that modifier !
  11. O

    Wiki 64640 can this cpt be reported more than once on a dos?

    It has an MUE of 5. On the second and third lines you would want to add -59 or -XS to show that it's an additional procedure.
  12. O

    Wiki J7327 Modifier ?

    Just an FYI. H/A products such as Euflexxa and Synvisc do not come in vials that are drawn from. They come in pre-dosed syringes and the entire syringe is injected. Three injections are performed about a week apart to complete the treatment.
  13. O

    Wiki 64718 and 24359

    I'm not sure what your referring to. I would apply the same coding rules with 64718 and 24359 as any other two codes that hits an edit. As your aware using a -59 modifier is never automatic, the codes have to qualify for the -59 modifier.
  14. O

    Wiki 11951

    You have an up-hill battle since this is used for cosmetic purposes and for post breast reduction surgeries which is why it's getting denied the way it is. Most insurance companies have a MD working as a medical director for them. This is probably the person who you need to get a hold of. A...
  15. O

    Wiki Lemaire Procedure

    I have been coding orthopedic surgeries for over ten years now. I have personally not seen this procedure yet which surprises me. However doing a bit of research leads me to believe you. I don't know why your compliance department would not agree. Code 27427 is for an extra-articular...
  16. O

    Wiki CPT 20561 documentation requirements

    I have personally never coded this, but this is very similar to medication being injected into muscles for trigger points. I would want documented what was used to clean the area where it would be performed. The technique used to place the needs, how many needles and specifically which muscles...
  17. O

    Wiki billing question

    Full disclosure, I code orthopedic surgeries so this is not in my line of work. Since there is an edit between the codes in order to bill both with a modifier, they have to qualify for the -59 modifier. In this case what makes both of these codes billable?
  18. O

    Wiki Ortho OP note question

    Your going to need to send this back to the provider to update the note. There is nothing in that note to indicate that there was any bone debridement. That needs to be documented in the body of the note. Code 11044 is for debridement of open wounds, this is not an open wound. The provider had...
  19. O

    Wiki Ortho OP note question

    Pointers. In orthopedics the diagnosis is very important. Why is the provider doing this? That is missing. Is this the entire note? I don't see bone debridement in that note. If the incision started at the tip and went to the MCP joint, was the joint capsule at the MCP or I/P entered into as...
  20. O

    Wiki Question

    For trigger point injections you would only be billing out one code per session. Code 20552 is for 1-2 muscles that are injected. Code 20553 is for "three or more".
  21. O

    Wiki Aetna - Complex Repairs w Exc of Benign lesion - Any Complex Repair

    Is there a size conflict between 11402 and 13101? Code 11402 goes up to 2cm which includes margins. Code 13101 starts at 2.6cm. If the lesion was 2cm in size, why would it be paired with a closure code which is larger? I would look at that and make sure that all requirements for complex closure...
  22. O

    Wiki CPT 20670

    Agree with above. Without seeing documentation my guess would be 20670 is not related to 14040. I've never seen a tissue transfer that had to be held down by an implant. Amy is correct, your going to need a modifier but will need to do some research so you can use the correct one.
  23. O

    Wiki Can I bill for packing changes if procedure was not done in our practice?

    13160 would be performed in the OR. This is actual closure of he wound, not just repacking. So no.
  24. O

    Wiki CPT code 25609 and 25652

    You don't see this combination very often. Lucky you!
  25. O

    Wiki Another hardware removal question

    Something else to keep in mind is that you are dealing with a patient that is still growing. While the hardware may not be problematic, it could be as the patient grows. So there is medically necessity to remove it.
  26. O

    Wiki Procedure note documentation

    Good luck, I know that not every provider is open to coding insights and corrections.
  27. O

    Wiki CPT code 25609 and 25652

    There is no combo code for these two.
  28. O

    Wiki Procedure note documentation

    Now I understand. For the reduction of the fracture, the provider needs to identify the fracture, site and laterality. None of that is included. The provider then needs to describe the manipulation process which brought the bones back into alignment. Just stating that the alignment was...
  29. O

    Wiki Procedure note documentation

    I'm confused. In your initial posting you state that "This is the complete note" Now your saying that you can't evaluate this until you have the complete documentation. Is the provider going to add or modify the existing documentation?
  30. O

    Wiki Procedure note documentation

    What is your assessment or thoughts other than you don't think it's enough for fracture care? The two codes provided do hit an edit, so would you bill both codes or would you consider one bundled?
  31. O

    Wiki How would you code this, removal of hardware with THA

    Have you read the CMS NCCI surgical policy manual which addresses this issue?
  32. O

    Wiki Unlisted surgery codes

    That would depend on the "comparison" code that is submitted with it which shows, in general, the amount of work and effort that was done in order to complete the procedure. Insurance is not going to base a payment on an unlisted code which is why they need a comparison code and a copy of the op...
  33. O

    Wiki CPT code 25020 & 29848

    Code 25020 is performed to treat compartment syndrome. The incisions can be very long. I have seen them go pretty much from wrist to elbow almost. This is because a "compartment" is filling with fluid such as blood. Think of blowing up a balloon. If this happens inside the body, it becomes a...
  34. O

    Wiki 26121 and 26123

    I'm looking at it this way. You know that multiple digits with both palmer and joint capsule releases are possible to report together on the same hand. That's code 26125. The reason for the MUE of one for code 26123 is because you have to use the add-on code for additional digits. But as you can...
  35. O

    Wiki What are the legal and reimbursement repercussions of incorrect dx codes?

    If I could only add modifiers, if needed, I would be looking for other employment.
  36. O

    Wiki What are the legal and reimbursement repercussions of incorrect dx codes?

    Sounds like your providers/practice are going to learn a lesson the hard way. Decreased revenue and increased denials are obviously in your favor. Good Luck. Years ago a company that I used to work for switched to an EMR thinking that the EMR could choose the E/M and the providers could choose...
  37. O

    Wiki 26121 and 26123

    Not the incisions necessarily. You have one procedure being performed on the little finger, and treating that little finger is not going to treat the index finger. In other words, you have two separate procedures treating two separate anatomical structures. So yes, in this situation, a -59 or...
  38. O

    Wiki 29806 w/ 29807?

    I wished I could help you. It always amazes me that providers don't want to heed the NCCI edits. They can bill both, but they won't both get paid and if you bill it repeatedly that could be interpreted as an attempt to defraud.
  39. O

    Wiki Orthopedic surgeons

    If the graft was used for the ACL repair I would use that diagnosis for the graft,
  40. O

    Wiki RT modifier vs specific finger modifier

    This is where you may need to follow the "Golden Rule". The insurance has the gold, so they make the rules. Not every insurance company will see everything the same way. Personally I would have used a F6 modifier. I'm not aware of any "concrete" coding rule for this. I would be more apt to send...
  41. O

    Wiki Arthroscopic rotator cuff revision

    In ten years I have never had a RTC repair denied. What did they give you as a reason for the denial?
  42. O

    Wiki PRP injection with Euflexxa

    We will need to paint with a broad brush for this. Generally speaking insurance companies won't pay for Euflexxa when performed PRP. Even though the PRP is self pay, if the insurance finds out that PRP was performed, good chance they will ask for their money back. I'm starting to see insurance...
  43. O

    Wiki Anti-Kickback statute question

    If I were the clinic manager I would not allow this just from a business point of view. People come to see a doctor, not be sold something. If she wants to put pamphlets in the clinic that the patients can pick up and read while they wait, that would be more acceptable.
  44. O

    Wiki preop visits

    Per CPT Assistant, no. Pre-op exams are included in the work RVU for the surgical procedure.
  45. O

    Wiki Need Help with CPT Codes!!! I am coding 24346,24344,24366,24685, CPT codes 64718 and 24345 bundle

    Do you agree? Disagree? Why?
  46. O

    Wiki Billing a preventative exam with pre-op exam

    What catches my attention is the words "Billing for pre-op exams". Pre-op exams are included in the surgical procedure.
  47. O

    Wiki Phrase Enough for Bilateral?

    I've noticed over the years that even though a procedure might be performed bilaterally, that there are slight differences in the procedures which makes them unique to that patient. If your provider wants to use a statement stating that the same procedure was performed on the contralateral side...
  48. O

    Wiki Total shoulder replacement WITH Biceps tenodesis

    It's not an article. In the AAOS CODE-X if you type in a CPT code, it will list all the minor procedures that are included (bundled) and those that are not included. If you can find someone with Code-X they could email it to you. Our company decided that EncoderPro was enough and stopped paying...
  49. O

    Wiki Podiatry

    I don't have a copy of the PP any longer. My computer died and I did not have a back-up file.
  50. O

    Wiki Internal elbow joint stabilizer.

    Do you know if this stabilizer is meant to stay in? Or is it meant to be temporary? I've never seen anything like this before.
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