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  1. O

    Wiki Quick coding challenge: Septic Arthritis

    What is the code for septic arthritis, not in the spine, not due to bacteria?
  2. O

    Wiki You be the coder ! (Simple Shoulder Surgery)

    Yes, there is a reason for doing this. Experienced coders, without using EncoderPro, Codify, Google or any other program, so just using the coding knowledge you have upstairs, select the code/s that you would bill out. A doctor performed surgery and wrote down the codes for the procedures...
  3. O

    Wiki TKA one year post op visit

    I'm posting this for a friend: Patient comes to doctor one year after TKA. There are no issues (clicking or locking), X-rays shows implants are in place. No signs of infection. Patient is told no issues and come back in a year. 99212 or 99213?
  4. O

    Wiki CPT for cephalomedullary nail placed for multiple myeloma?

    Has anyone come across this before?
  5. O

    Wiki Are you an above average foot and ankle surgery coder?

    If your an above average foot and ankle surgery coder and willing to bounce ideas back and forth, please let me know.
  6. O

    Wiki Open Superior Capsule Reconstruction

    So now that providers are performing the superior capsule reconstruction arthroscopically, mine did two not arthroscopically but open. The RTC tendons were beyond repair and retracted. A graft was anchored down at the glenoid and humerus. I'm considering 23466. Anyone know if I am on the right...
  7. O

    Wiki How would you code this? Distal clavicle injury.

    Patient had a shoulder injury. Physician labeled this as a "Distal Clavicle Derangement" Surgery was performed open. Doc found a loose piece of bone and removed it and then debrided the end to smooth it out. So other than removing the loose piece of bone it's the same as an open Mumford...
  8. O

    Wiki Are you an excellent Foot & Ankle coder?

    Patient has a developed a foot deformity over the years and the surgeon goes in and cuts most of the tendons and separates several joints in the ankle and foot. In all my years of coding I have only had one similar for someone with 'Stiff Man Syndrome" and it was years ago. If you have seen a...
  9. O

    Wiki Will PCP possibly do referral on a condition that they have not treated?

    Have a Tricare patient. All of our providers are specialists and require a referral. Patient never gets evaluated by their PCP and comes to our office. Will PCP possibly do a retro auth when the PCP has not evaluated the patient for their condition?
  10. O

    Wiki ICD.10 Iliopsoas tendon impingment

    I'm coding for a hip surgeon again which I have not done for about 3-4 years. Wondering what diagnosis code you are using for the iliopsoas tendon impingement syndrome? I have not coded this very often and not for a while. Would like your input. Thanks.
  11. O

    Wiki Any surgical coders using "Codify"?

    I have used EncoderPro for years. I'm wondering how Codify stacks up against Encoderpro since codify seems to be about half the price.
  12. O

    Wiki Seeking PRN orthopedic surgery coding work

    I am employed full time but hours are cut back a bit right now. I have been coding general orthopedic surgeries for the past seven years. I'm set up to work from home now. Best coding surgical procedures of the shoulders, foot/ankle and knees. I do not have experience coding spine.
  13. O

    Wiki CPT for removal via debridement of the quad tendon?

    Patient has calcium buildup in the quad tendon. Doc opened the area and debrided the calcifications out. What code do you use for this? 27328 vs 27372 or another code? Any suggestions would be helpful. I have not seen this before.
  14. O

    Wiki Hand coders please do me a favor, tell me which codes are proper to submit please

    The following was done to the left middle finger. Please tell me which codes that you think are correct to submit. All procedures were performed on the same tendon through the same incision. 26433 Repair of extensor tendon, not in Zone II 26445 Tenolysis of extensor tendon (performed...
  15. O

    Wiki Billing for pre-op visits is a national trend ???

    I have an admin who is pushing some of the coders to find a way to bill for "pre-op" visits. The admin is under the impression that there is a legitimate way to do so. I have not heard anything like this and would like to hear from anyone who has "found a legitimate way" to bill for pre-op...
  16. O

    Wiki AAOS presenter saying that pre-op visits are billable?

    I heard a rumor that a speaker at the AAOS conference is telling the physicians that pre-op visits are billable (like 99213) and should be billed. Can anyone out there confirm this?
  17. O

    Wiki Can 27640 be billed in this situation?

    Doc was working on the posterior tibialis tendon and decided the groove it was sitting in was not deep enough. So he dug out the bone for it and has put down code 27640 for that. However, there was no osteomyelitis or any other pathology, just a shallow groove. I am reluctant to bill 27640 in...
  18. O

    Wiki Where do I find that we can't bill for fracture during surgery?

    I knew I would need this sooner or later. My doc was performing a procedure and broke the patient's bone during surgery. And of course he want to bill for treating the fracture he caused. Where can I find documentation that you can't bill for a fracture that occurs during surgery? I have a...
  19. O

    Wiki Why release the abductor hallucis fascia?

    Patient has plantar fasciitis & tarsal tunnel syndrome. procedures: abductor hallucis fascia release TT release Plantar fascia release Why would the halluces fascia be released?
  20. O

    Wiki Any suggestions for on line foot & ankle coding help, like SuperCoder or whatever?

    Any suggestions for on line foot & ankle coding help, like SuperCoder or whatever? A foot and ankle specialist joined the group about a year ago. I had never coded foot and ankle before so I wanted to learn as he grew. However, he is now extremely busy and performing very complicated...
  21. O

    Wiki ICD.10 code for draining Sinus?

    I see this every once in a while and am now wondering what ICD.10 code other coders are using for this procedure. In the case that I am working on now, the doc is dissecting down to a hematoma near the calcaneus and finds a draining sinus about 0.5cm square. What diagnosis code do you use for...
  22. O

    Wiki PIP dislocation and bill Hammertoe code?

    Patient has a dislocation of the PIP joint on the toe. Doc does an implant for fusion was inserted to keep the toe in place. Here is what I don't understand. My doc wants to bill the "Hammertoe" code as well 28285. No where in the documentation does it state that the patient has hammertoe. So I...
  23. O

    Wiki Anyone know the CPT code for "ORIF of Subtalor Joint Dislocation"?

    Patient has talus fx as well as dislocation of subtalor joint. Doc performed ORIF of subtalor joint dislocation, anyone know the code for this?
  24. O

    Wiki Code for removal of cyclops lesion in intercondylar notch?

    Physician performed a Lateral Meniscectomy (29881) and then excised a Cyclops lesion from the intercondylar notch. Anyone know the code for this procedure?
  25. O

    Wiki In your opinion, does this documentation support 29826?

    "I resected the hypertrophic bursa converting the acromion to a Type1 acromion" Keep in mind that the type of acromion before treatment is never documented, such as Type 3 or Type 2.
  26. O

    Wiki Coding Poll: How often have you seen a knee loose body that measured 1cm X 1cm?

    Just wondering if others out there have seen loose bodies in the knee this size on a regular basis, or even at all. Please let me know if you have ever seen a loose body this size or not. Thanks.
  27. O

    Wiki Which insurance companies allow 29877 or 29874 with other knee procedures?

    Does anyone know of any national insurance companies that pay for debridement (29877) and/or the removal of a loose body (29824) with other knee procedures?
  28. O

    Wiki Can you "repair" the peroneal tendons by repairing the "retinaculum" ?

    Can you "repair" the peroneal tendons by repairing the "retinaculum" ? Patient had an ankle injury and the retinaculum over the peroneal brevis and longus was torn. The physician repaired the retinaculum which holds these down. However, the physician wants to bill for repair of dislocating...
  29. O

    Wiki CPT ORIF distal Ulna (metaphyseal) fracture

    Patient has a distal radius & ulna fracture. Both were repaired with plates through separate incisions. The code for the distal ulna fracture seems to always point to the "styloid" of the ulna. Well the styloid was not fractured or treated. It was the metaphyseal portion. A plate was used for...
  30. O

    Wiki Thank you Alan Pechacek, M.D.

    Since coders don't have a medical degree, it can be challenging to code certain procedures. I have noticed that you have helped several coders, including me, answering questions. On behalf of all coders that you have responded to thank you so much for your time and effort. I know your answers...
  31. O

    Wiki Would you give the doc a 29826 ?

    doctor does the subacromial decompression, and then debrides a bone spur off the acromion. Impingement is documented. So do you think that the doc meet the qualifications for a 29826? Thoughts?
  32. O

    Wiki Question for Alan Pechacek MD

    AETNA has decided that degenerative meniscal debridement (Meniscectomy) is "Experimental" now. I'm sure that you have treated many degenerative tears over the years. Do degenerative tears have an outcome that is far less than traumatic meniscal tears? (Leading to this decision maybe) Just...
  33. O

    Wiki CPT for a HAGL procedure?

    OK. This is the first time that I have seen a HAGL procedure documented. In reading my op note, it seems to be more of a capsule repair that a ligament repair. Does anyone know if there is a separate code for HAGL procedure? I'm not having any luck finding a code for it. Thanks.
  34. O

    Wiki Any insurance pay for robotic surgery? 20985

    We have a new provider who does joint replacements and uses robots to help with surgery. Does any insurance pay for code 20985 separately or do they bundle this? Any advice from what you have seen would be helpful. Thanks.
  35. O

    Wiki Comparison code for meniscus trephination?

    Every once in a while the physician will treat a meniscus tear with trephination which is reported with the unlisted code. I'm just wondering what comparison code you are using in this situation. Thanks for your input!
  36. O

    Wiki Bill tumor code for bursectomy on a Haglund's Deformity?

    I have a foot surgeon right out of fellowship. He is wanting to bill the code for a tumor removal when he does a bursectomy during Haglands surgery. Wondering if anyone else has seen this? Seems that the bursectomy would be part of the surgery and not reported separately. But hey, what do I...
  37. O

    Wiki 29823 can be billed with 29824, 29824, 29828 only CMS has updated policy manual

    I just looked at the CMS policy manual. There are significant updates this year. Everyone should go over it. But I have been waiting for CMS to update the debridement section. As of 1/1/2017 29823 can be billed with 29824, 29827, 29828 only when performed on the same shoulder. All other...
  38. O

    Wiki Meniscectomies being denied as "experimental" treatment all of a sudden

    Does anyone know why the insurance companies are denying meniscectomies as experimental all of a sudden? This has been standard treatment for decades; literally.
  39. O

    Wiki Bill for hardware removal when you perform arthrodesis at the same location?

    Patient had a toe replaced which failed. My doc removed the artificial toe (implant) and performed arthrodesis. None of the codes hit an edit, but generally when you have to remove an implant to perform a procedure we normally don't bill the implant removal. Does this sound right or are your...
  40. O

    Wiki Would you bill for implant removal?

    History: Patient had a toe implant. Later it failed. My doc removed the implant and performed an arthrodesis where the implant was removed. The codes don't hit an edit, but I am under the impression that if an implant has to be removed to perform the procedure that it would not be billed...
  41. O

    Wiki Can you bill 20680 for the toe implant replacement?

    Background: Patient had a toe implant placed, which failed later. Now my doc is removing the implant and doing an arthrodesis. The codes don't hit an edit, but I am under the impression that if you have to remove an implant to perform a procedure, that you should not bill for the removal of...
  42. O

    Wiki CPT for ldebridement of large osteophyte proximal humerus

    Patient was opened and doc found a large osteophyte that had split the supraspinatus. Doc took a burr and rongeurs to smooth the bone down. What CPT would you bill? This is an open procedure, not arthroscopic. Any thoughts would be appreciated. After looking at all codes I have decided that...
  43. O

    Wiki Get paid more by performing minor procedures in the office rather than hospital?

    One of my hand surgeon's was speaking to another physician and was told that he was performing minor surgeries in the clinic and getting paid more than if he performed them at the hospital or at a surgical center. Does anyone know if this is true? Can you get paid more for performing the...
  44. O

    Wiki Anyone know why Medicare is denying total knee replacements all of a sudden?

    Patient had a TKA. Medicare is denying it due to the POS (which is IP, I really don't think that they want this performed O/P). Does anyone know why this is happening? I have not seen this before.
  45. O

    Wiki CPT for intercuneiform fx?

    What CPT is used for this? Doc wants to bill 28615. Neither of us can come up with an code for just the cuneiforms. Middle and Lateral cuneiforms were involved. Any suggestions would be appreciated.
  46. O

    Wiki Does ankle instability support Brostrom procedure? 27695?

    Doc turned in op note with Brostrom procedure performed. Only dx I can see that I could link to it is ankle instability. However, in checking my Encoder, ankle instability does not support 27695. Only sprains does. Does anyone know if ankle instability will support a Brostrom?
  47. O

    Wiki Need CPT for removal of large spur off the inferior pole of the patella

    Doc made incision and cut down to the patella. The spur was about 1.5 X 2cm. Right now I'm leaning towards 27350-52 since the spur was so large, but maybe someone has done this before? What do you think?
  48. O

    Wiki Mentor (kind of) for foot & ankle coding

    I have been coding surgeries in an ortho office for a few years and we recently had a foot and ankle specialist join the group. If there are any experienced foot and ankle coders who would like to give me a few "pointers", that would be appreciated. Just send me a private message to contact me...
  49. O

    Wiki Is the patellar tendon inside the knee joint capsuel?

    Dumb question. Is the patellar tendon inside the knee capsule?
  50. O

    Wiki How do you bill MRI visits?

    Patient has had an accident and hurt their shoulder. Doc requests that the patient get an MRI. Patient has the MRI and then comes back to review the MRI with doc. My question is: how are you billing the MRI review visit? They are not repeating the history and exam, only reading the MRI and going...
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