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  1. 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
  2. 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
  3. 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...
  4. 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...
  5. 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...
  6. 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
  7. 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
  8. 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...
  9. 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...
  10. 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...
  11. 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...
  12. 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...
  13. 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...
  14. 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?
  15. 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!
  16. 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!
  17. J

    Wiki respiratory therapists - equipmt training

    Can we bill for the RT counseling, teaching, and training patients on sleep equipment etc? The RT is all incident-to billing. I'm thinking along the lines of the 94664 for the nebulizer demo but I don't see a code for the sleep equipment. Thanks!
  18. J

    Wiki complete graft ultrasound

    Ultrasound examination of the left-sided axillary / bi-FEM vascular graft. Patent arterial flow is seen within visualized segment of the native left subclavian artery. Selected images throughout the length of the bypass graft including proximal anastomosis, axilla, left flank region, lower...
  19. J

    Wiki time based

    "This afternoon I had the opportunity to spend 60 minutes with the patient and her husband thoroughly reviewing her prior history, current clinical status, laboratory studies, and multiple imaging exams." It does not state that over half was spent in counseling/coordination of care but can this...
    • JDACPC
    • Thread
    • Replies: 2
    • Forum: E/M
  20. J

    Wiki reposition g-tube

    Why not 43761? Initial fluoroscopy identified unchanged position of recently placed G-tube in the left upper quadrant. Under sterile conditions, following application of local anesthetic and after time out was performed, anchoring suture was removed and pigtail catheter slowly withdrawn using...
  21. J

    Wiki Ros??

    Debate going on about whether there is ROS documented: Clinical history: Venous insufficiency Consultation: The patient presents for evaluation and consultation for possible left lower extremity vein treatment. The patient reports a longstanding history of varicose vein problems resulting...
    • JDACPC
    • Thread
    • Replies: 3
    • Forum: E/M
  22. J

    Wiki 49083 -paracentesis coding

    We are getting dinged by an outside auditor for our paracentesis coding regarding guidance. Auditor states the guidance must document the actual needle placement and doesn't feel the "ultrasound guided...paracentesis" is enough. This is a sample report: The patient was placed supine on the...
  23. J

    Wiki "Semiquantitative" ventilation analysis

    One of our rads has started using the phrase "semiquantitative" ventilation analysis for the vent scans. Are we thinking too much? Can we ignore the "semi?" Following ministration of aerosolized radiopharmaceutical, lung ventilation imaging was performed in multiple obliquities. These were...
  24. J

    Wiki Documentation of SPECT

    Somewhere, in the cobwebbed recesses of my brain, I seem to recall reading that if the stress test documents the long axis, short axis, etc, this means SPECT was done. I cannot find anything to corroberate this today however. Can anyone set me straight on the proper documentation to code...
  25. J

    Wiki intervertebral disc aspiration AND bx

    All sources point to 62287 for the interverterbral disc aspiration OR biopsy. What if both are done at the same encounter? I understand the aspiration is usually bundled with the biopsy but I have no "official" documentation to appease the doc that this is the code for the biopsy or how to...
  26. J

    Wiki Knee views?

    Technique: Lateral and AP views in neutral, internal and external rotation of the right knee There is some debate here, any insight would be helpful. Thank you!
  27. J

    Wiki 99144-59

    Medicare patient had conscious sedation on two completely separate encounters on same DOS. The second encounter was denied with the 59 modifier attached. Any way to get this paid? This seems to me the perfect 59 scenario and this is a valid modifier (perhaps not for Highmark but no policy to...
  28. J

    Wiki needle localization wire - non breast

    Report states: With CT guidance, an 8 cm mammographic localization wire was positioned with its tip just deep to the node and the thickened reinforced part of the wire within the node itself. 19290 specifically states breast. Any references for this or an idea of an unlisted code? Thank you!
  29. J

    Wiki Buddy taping = brace??

    28510 vs 29550 - doc says taping a toe is equal to a brace so use 28510. Pt came from ER with toes buddy taped. Doc removed tape from 4th/5th toe and retaped 3rd/4th toe. Can anyone supply black & white evidence that this is not the case. Thank you!
  30. J

    Wiki CAD denied w/G0202

    Highmark MC, TriCare, and Pennsylvania BS are now denying the CAD with the G0202. I'm seeing this on other forums. Has anyone had success with submitting these for reviews? If so, can you provide what types of info you submitted? A previous post stated one state no longer bills both. Which...
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