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  1. J

    Question 2 visits on one day--what modifiers should be used in physician's office?

    No modifier is appropriate in this situation. You would combine the notes and submit one code for either total MDM or total time. Here are some recent articles with better explanations: https://healthcare.trainingleader.com/2024/01/two-em-visits-same-day/...
  2. J

    Wiki 25 mod and MDM

    Pt visit + minor procedure, visit meets 25 modifier rules: Can we use the decision for that minor procedure in the MDM/risk for the office visit? A few of us have not been able to find authoritative guidance as to yay or nay. CMS says the decision is not included in the global package for the...
    • JDACPC
    • Thread
    • Replies: 1
    • Forum: E/M
  3. J

    Wiki Chief complaint

    Yes. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf
  4. J

    Wiki IV Contrast and High Risk

    If you're not already familiar with the American College of Emergency Physicians (ACEP), they are a great resource! And they have great conferences, worth every penny! :D Here is a link to their FAQs which covers your question but you may want to run it by your superiors to be sure they...
  5. J

    Wiki Copy & paste MDM

    I have a new cardiology provider documenting on EVERY note "No need for SBE prophylaxis. No Cardiac medications recommended. No activity restrictions." I understand each note needs to stand alone, so maybe it would be relevant in some cases, but this is on every single visit note. SBE is pretty...
    • JDACPC
    • Thread
    • Replies: 0
    • Forum: E/M
  6. J

    Wiki critical care code 99219 question

    Yes, clinics included. Critical care is not an "in-patient only" code, can be billed at any location.
  7. J

    Wiki critical care code 99219 question

    99291 - Critical care, first 30-74 minutes, per CPT code range notes: 30 minutes or more direct care provided by physician or other qualified health care professional to critically ill or injured patient, any location
  8. J

    Wiki Pediatric Cardiac Rehab

    We're looking into starting Pediatric Cardiac Rehab services. I understand the documentation and billing, but I researched some of our major carriers polices and only one mentioned Pediatrics, stating coverage would be decided "on a case-by-case basis." Does anyone successfully get paid for...
  9. J

    Wiki 6 minute walk test

    I'm looking for the exact components that need to be recorded for the 6MWT/94618. CPT definition does not spell out each minute documentation, but CPT Assistant shows "Data on oxygen saturation, heart rate, and distance measured at 1, 2, 3, 4, 5, and 6 minutes are reviewed. Review blood pressure...
  10. J

    Wiki 6-minute walk test

    I'm looking for the exact components that need to be recorded for the 6MWT/94618. CPT definition does not spell out each minute documentation, but CPT Assistant shows "Data on oxygen saturation, heart rate, and distance measured at 1, 2, 3, 4, 5, and 6 minutes are reviewed. Review blood...
  11. J

    Wiki Split/Shared Critical Care time

    How is your organization handling time statements when the visit is a Split/shared CC visit? Are you requiring separate statements for total visit time, shared/overlapping time, and critical care minutes? Is there any official guidance on this question? I've read everything from CMS and our...
    • JDACPC
    • Thread
    • Replies: 1
    • Forum: E/M
  12. J

    Wiki Inpatient telehealth/PHE - time or MDM rule?

    For inpatient services, consult/initial visit, during the PHE, can we determine the LOS by time or MDM, or is this only for office/outpatient? Confused on what guidance is the most up to date at this point. We have a new ID consultant performing telehealth inpatient visits. Quite a difference...
    • JDACPC
    • Thread
    • Replies: 1
    • Forum: E/M
  13. J

    Wiki Lung plug device?

    Is anyone using a lung plug device and coding additional services or a 22 modifier for the radiologist's work? They are stating it's "extra work" but I'm not convinced. I have the reimbursement guide, but not helpful for professional radiology coding, and I cannot find anything on how to...
  14. J

    Wiki Fellows - attestations

    In regards to attestations, fellow and resident rules are interchangeable, correct? I am being told it's ok to bill if a fellow documents an E&M visit without an attestation but an attestation is required on surgical notes. This makes no sense to me, attestations should be required no matter...
  15. J

    Wiki How long does a doc have to complete a note?!

    Not that I'm condoning late notes but there is a difference between "unethical" and "illegal." The guidelines are somewhat vague, along the lines of "as soon as possible" but check with your MAC and office/hospital bylaws. After that, you have to deal with carrier filing limits so be sure...
  16. J

    Wiki Correcting E/M codes after audit

    An improper claim is an improper claim, no matter the level. It's the office's responsibility to get the claims corrected without fear of future audits. Corrected claims happen all the time, it may or may not trigger an audit. If you ignore the corrections, that will certainly look worse on...
  17. J

    Wiki Physician wants proof

    Here's an HCPro article that cites the Coding Clinic with the "black and white" info you need: http://www.hcpro.com/HIM-274483-5707/QA-Suggestive-documentation-could-require-clarification.html
  18. J

    Wiki 2014 breast biopsy - guidance only

    I've researched but I can't find an answer to this specific scenario, only information on the new codes: With the new breast biopsy code changes, how do we bill only for the ultrasound guidance by radiologist (biopsy is performed by the surgeon). Can we still use 76942? Will this deny...
  19. J

    Wiki Planing of osteoma?

    21029 was suggested for planing of a forehead osteoma? A 15 blade was used to create an incision which was beveled to be parallel to the hair follicles. This was taken down to the periosteum which was then carefully elevated inferiorly beyond the osteoma using a Freer elevator. Using a...
  20. J

    Wiki Who orders PAT?

    Referring doctor sends patient to see the IR doc (consult) for possible procedure. If a procedure will follow, who orders the pre-procedure testing? There are delays in scheduling because of resistance from the ordering doctor as well as confusion on the admitting side as to who the actual...
  21. J

    Wiki CPMA Exam Format Question

    If you click on "Certification" in the blue bar at the top, then click on CPMA, that page will give you the "Exam Breakdown". Under "Medical Record Auditing Abstraction" it currently says: Audit Cases including: •52 questions (24 audit cases) You may have to score them on the auditing tool to...
  22. J

    Wiki diagnosis code anyone?

    I arrived at 202.74
  23. J

    Wiki Critical care time

    Please review the Critical Care Services guidelines in CPT. The time must be documented but it MUST meet critical care guidelines above all. I don't have anything solid in front of me but the many training sessions I have done state it doesn't have to say "40 minutes of critical care" you just...
  24. J

    Wiki Physician Billing for IVR

    According to CPT, the guidance is not included in 50392. "Radiological supervision and interpretation is reported with 74475, 76942, or 77012, when performed."
  25. J

    Wiki Physician Billing for IVR

    There is no profressional/technical split on the 50392 so the 26 is not appended. On the guidance code, there IS the split, so you are correct with the 26 modifier on that one.
  26. J

    Wiki OB U/S AFI measurement??

    If you look at the lay description, it only states "assessing amniotic fluid." I'm sure this is open to interpretation but at the very least you have to be able to determine the rad "assessed" the amniotic fluid (rather than "measured" the fluid). That could be accomplished by a statement as...
  27. J

    Wiki V58.81

    Is anyone getting denials on V58.81 for your PICCs and CVCs? We were told this is the appropriate dx for line placements by our outside auditing company but Novitas is denying. We've been told to use the condition which necessitated the line by another auditing company but that doesn't make...
  28. J

    Wiki ICD10forums.com

    Thanks!!
  29. J

    Wiki Intake form

    Yes, you can use the pt questionnaire for the ROS but as you state, the doc MUST document that he reviewed the information and comment on pertinent positive findings in the note. He should also document the actual questionnaire (date and initials) and keep the form with the record.
  30. J

    Wiki Radiology Questions

    Depends on the reason for exam: Is the other hand for comparison only? Comparison views are usually unbillable but check your carrier policy. If both are diagnostic, and both hands are on one plate, you have 1 view left and 1 view right. Since there is no 1v hand, you have to append the 52...
  31. J

    Wiki 19295

    Long story short: It is now listed as technical-component only. Here is the long story: This is from the RBMA listserve, ACR's Diane Hayak, Director, Economics & Health Policy posted the following information: In the 2012 Relative Value Scale Update Committee (RUC) database, the practice...
  32. J

    Wiki Help Coding xray views

    One plate does not necessarily mean one view, as in this case. You have 2 views of the right and one view of the left. The left may have only been included as a comparison, and thus unbillable (according to most official guidance); check your order. Another example where one plate does not...
  33. J

    Wiki 76942 with 19103

    CPT Assistant March 2010 states one surgical component and one guidance code should be reported for each lesion. However, according to CMS National Correct Coding Policy Manual (Chapter 9), Medicare (and others), only allow ONE guidance code PER ENCOUNTER, not per lesion, number of biopsies...
  34. J

    Wiki well visit&E&M codes

    From the research I have done on this, you can bill the "problem visit" separately but you have to follow the 25 modifier guidelines. I have actually taken the preventative visit note, crossed out everything required for that code and had to determine if there was enough "Significant...
  35. J

    Wiki POI/POS Billing

    I'm working with Radiology and we are in the early stages of making this work but it's my understanding you submit the technical portion to the state MC carrier where the test was actually performed, then if the interpretation was done somewhere else, for example from the radiologist's home or...
  36. J

    Wiki Requesting HELP from the experts?

    If you are billing a carrier you have a contract with, the MOST you are allowed to collect from the carrier and patient combined is the allowed amount.
  37. J

    Wiki E&M vs modifier 25

    The 25 is always appended to the E/M code. Please be sure you are confident the irrigation is separately billable and not included in the E/M (even though it's a separate issue). It's my understanding that irrigation alone (without impaction and instrumentation) is not separately billable.
  38. J

    Wiki 74010 vs 74020??

    "Supine AP and bilateral posterior oblique imaging of the abdomen" 74010 "requires at least three views" but does not include "cone views" nor does it include decubitus or erect views as in 74020. Thoughts?
  39. J

    Wiki Kenalog Billing

    Shayna - be sure your claims are being submitted with the NDC number. Also, J3301 is an "NOS" code so you should have a spot on the claim to add a desciptor for the specific drug, like "Kenalog 10mg." Hope that helps!
  40. J

    Wiki Obesity couneling

    There was some discussion on this in January. Not sure if there is anything definitive but there is some MC info. You may have to research your major carriers to see how they want it submitted. https://www.aapc.com/memberarea/forums/showthread.php?p=252779
  41. J

    Wiki Opinions needed

    My opinion is, yes, give credit. The provider took the time to ask and the field is documented with the information. There is no requirement as to who in the family had the cancer, or even what type.
  42. J

    Wiki Credit for ROS

    You can pull ROS from the HPI paragraph. He does mention palpitations which would cover for the cardiovascular ROS. "See HPI" or "As per HPI" is perfectly acceptable if it's actually documented in the HPI. You're right about not using it for both HPI and ROS, you would have to use it for...
  43. J

    Wiki HCC auditing

    There was just a webinar on that a couple weeks ago. It's available now under the Resources/Events/On Demand link in the blue bar above. "HCC Coding and Documentation: A Coder's View"
  44. J

    Wiki 4X4 Rule for detailed exam

    You need 4 elements in 4 organ systems. Eyes is one organ system, the note would have to mention 4 elements, like, pupils equal (1), round (2), reactive to light (3), and accomodation (4). In this example you only have two elements for the eye system and eight-ten for the...
  45. J

    Wiki 44799 unlisted procedure, intestine

    The way we handle unlisted codes is to find a "comparable" code and submit with that usual fee amount. We do not set a standard fee for unlisted codes. Since you will have to submit the documentation with the claim anyway, the carrier will determine how much of that fee they will pay, so...
  46. J

    Wiki pre-rad pregnancy test?

    If the patient isn't sure if she might be pregnant, can we bill for a urine pregnancy test prior to the service? If so, does it actually get paid? Thank you!
  47. J

    Wiki Unwanted Tobacco Cessation Counseling

    You should check some of your major carriers as to the requirements for billing and co-pays attached (some carriers may require some type of tobacco-related illness in order to cover the service). There are also frequency limitations in place. We can't assume every patient counseled will quit...
  48. J

    Wiki 95 vs 97

    Unless your compliance program and/or MAC says otherwise, you can use whichever guideline benefits the provider most, whichever one gives you the higher level.
  49. J

    Wiki 76536 x 2?

    Ultrasound of the thyroid for "questionable goiter" and a separate report for neck for "questionable swelling of the soft tissues of the neck." Can we code for each? Thanks!
  50. J

    Wiki respiratory therapists - equipmt training

    Anyone?
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