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  1. delphinus777

    Wiki ASC implant billing

    This all depends on your individual insurance contracts. (It would state if they require an invoice during billing, what the percentage increase is for the implant(s) used, as well as if they reimburse for the type of implant used). Just FYI-*all Medicare plans include implant cost in...
  2. delphinus777

    Wiki Cpc study guide

    Just a little bit of my approach. You have to look at the approach of the surgery and understand the way each section of the CPT book is laid out. Aspiration, Biopsy, Incision, Excision, removal, Laparoscopy, Hysteroscopy, Arthroscopic...etc...., also site/location. For example...the...
  3. delphinus777

    Wiki HELP! Pain Mgmt LCD's for Medicare

    I hate the website now. I found a link to look for LCDs on CMS.gov. You do the advanced search and click the small bullet to search "Local Coverage Documents". Then select your state. Click the box to search by CPT code. Enter the code and then click SEARCH BY TYPE. Hope this helps...
  4. delphinus777

    Wiki cataract procedure

    From what you explained I would code the intended surgery with the modifier discontinued after anes. 66984-74. The patient had a complication. Additional diagnosis...v64.1 and the complication diagnosis code. thats my two cents
  5. delphinus777

    Wiki ASC facility Code

    Was a procedure performed? If so, please read: ASC Services Included in the Facility Payment. Facility payments for ASCs include the following services which are not paid separately: ? Nursing services, services of technical personnel, and other related services; ? Use by the patient of ASC...
  6. delphinus777

    Wiki 10060 and 11730 on the same toe

    CPT code 11730 would require a modifier to show it was separate from the I/D...different area...separate incision...etc.......HOWEVER- if the Surgeon removed the nail plate and did an I/D of the abscess located beneath then it can not be billed separately. Thats my two cents. :-)
  7. delphinus777

    Wiki ASC Facility in Texas HELP

    Be sure to perform procedures only on the ASC list. Look for your local area fee schedules pertaining to Medicare. Years ago there was a program that would help with setting billable fees for your area but it was associated with an insurance company. Long story short, it was a conflict of...
  8. delphinus777

    Wiki Ileal Looposcopy -CPT code?

    I am looking for a code for ileal looposcopy. CPT 50688? its not really a Cystoscopy....52000...So confused. :confused: OP Note: Procedure: Ileal looposcopy. Surgeon: XX, M.D. Anesthesia: None. Indication: This is a 65-year-old woman with a history of bladder cancer underwent radical...
  9. delphinus777

    Wiki G0168 will it reimburse for asc's

    I think it all depends on the carrier you are billing it to. Here is a "Tip" from Supercoder for G0168: Medicare Stipulates G0168 for Tissue Adhesive If the physician only uses liquid skin adhesive (Dermabond) to close a wound, you should report G0168 If the physician uses sutures or...
  10. delphinus777

    Wiki Eyelid abscess drainage by needle aspiration

    Check out CPT codes 10021 or 10160.
  11. delphinus777

    Wiki metatastic squamous cell carcinoma

    If the pathology came back as metastatic SCC then i would code the 198.XX series. In the Coding guidelines [2013 ICD-9-CM book] under the official ICD-9-CM guidlines for coding and reporting, page 8 Chapter 2 Neoplasms; [b] Treatment of secondary site; it states ......."When a patient is...
  12. delphinus777

    Wiki carcinoma question

    I would code it as either Basal or other. Not squamous or IN-SITU. Here is an informative site for you. http://www.epathologies.com/pcoll/derm/p_ref/ca_baso_wee.htm
  13. delphinus777

    Wiki Quality Reporting G Codes for an ASC

    Quality Measure Reporting in 2012 (Webinar Recorded on 06/05/2012) You can not register for that website until January 2013. Then you can report between July 1 and August 15. This webinar was very informative! They say for the coding aspect of the QR there is a minimum of 2 G codes and a...
  14. delphinus777

    Wiki Quality Reporting G Codes for an ASC

    _UPDATE 6-15-2012_______________________________________ Medicare Quality Reporting Alert: Change in G-code Reporting ASCA has learned from the Centers for Medicare & Medicaid Services (CMS) that ASCs should not use the quality data G-codes on claims where Medicare is the secondary payer...
  15. delphinus777

    Wiki Quality Reporting G Codes for an ASC

    I am using the diagnosis pointers for the surgical procedure. So far my testing of these codes are good. I figure if I get myself into the habit of using them now before the start date I won't having anything to worry about.
  16. delphinus777

    Wiki first listed code?

    I would code both. I figure you're telling a story....patient is coming in to remove and replace because of a mechanical complication of the IUD. *Disclaimer ---thats just how I would code it.
  17. delphinus777

    Wiki Implant coding qiestion

    If the anchors are the same.....I bill out one line L8699 with 2 units and the total price. Check with the carrier regarding L8699/C1713
  18. delphinus777

    Wiki ASC wants to bill nipple tattooing

    11920 is on the ASC list and can be performed [non cosmetic reasons, I'm sure]. If the patient is coming in for a Nipple/areola reconstruction, the NCCI edits states; Code 11920 is a column 2 code for 19350 , but a modifier is allowed in order to differentiate between the services provided...
  19. delphinus777

    Wiki injections

    These codes are on the ASC list. If the documention supports the procedure(s) being performed they can be done...{verify with the patients insurance carrier as well to see if an auth is needed and if they allow it. Also, if other procedures are performed at the same setting check the CCI edits...
  20. delphinus777

    Wiki Any suggestions - Posterolateral corner avulsion with articular

    27405 for the posterolateral corner tear, 27403-59 for the semi-open meniscus repair [modifier, it's column 2 code to 27405}, and then the 29874 for the arthroscopic removal of the loose body. That would be my selection. :D
  21. delphinus777

    Wiki Quality Reporting G Codes for an ASC

    QUOTE FROM ASCA; ASCs will be required to include this list of G-Codes on Medicare claims with dates of service on or after October 1, 2012. ASCs that fail to include these codes will face reductions in their future Medicare reimbursements. ASCs may begin using the codes on April 1, 2012, on a...
  22. delphinus777

    Wiki Quality Reporting G Codes for an ASC

    Quality Reporting Manual https://higherlogicdownload.s3.amazonaws.com/ASCACONNECT/ASC_Quality_Measures_Specifications_Manual.pdf?AWSAccessKeyId=1RMAN8YH8YCNBW6KAZG2&Expires=1335964743&Signature=DEwXMybdcBCziY4mJmXgIPTqi%2F0%3D
  23. delphinus777

    Wiki implant codes in ASC C1713 vs L8699

    Trays..... Well, you'll probably get a different answer from every coder...but as far as misc. supplies go and the A4649 code, I bill out supplies that are beyond the normal reimbursement. A good example would be the Novasure device used in GYN procedures. The reimbursement for the procedure...
  24. delphinus777

    Wiki New to ASC coding

    Hi Tina, Besides the websites for all your local insurance carriers, some good sites to look around are the ASC Association; http://www.ascassociation.org/Home/ They also have info regarding the Quaility Reporting which is new to ASCs for Medicare-...
  25. delphinus777

    Wiki Quality Reporting G Codes for an ASC

    The site that has good info is the ASCA site......on the left side it even has a hyperlink to FAQs and a hyperlink further expanding all the G-codes. http://www.ascassociation.org/ASCA/FederalRegulations/Medicare/QualityReporting/
  26. delphinus777

    Wiki implant codes in ASC C1713 vs L8699

    In my experience it comes down to the carrier you are billing. How they prefer you to bill it. Also if you have contract I would check them. I've only billed out implants with the L code and supplies with the A4649 as well as some drugs with the C codes. I've seen other coders bill using the C...
  27. delphinus777

    Wiki Quality Reporting G Codes for an ASC

    Thanks for the input bdobyns & dstruve. I only loaded the G codes that we would use, we do not use any prophylactic's here........but for arguments sake just say we did.....patient had no issues and was also given the IV antibiotic for SSI on time.....would you code both the G8907 & G8916 on...
  28. delphinus777

    Wiki Quality Reporting G Codes for an ASC

    Hi ASC coders! I have loaded the new ASC quality reporting G-codes for medicare. I entered the codes that my facility would use. G8907: [Patient documented not to have experienced any of the following events; a burn prior to discharge; a fall within the facility; wrong...
  29. delphinus777

    Wiki Novasure help!

    I sent you a private message regarding this and OON ASC experience I've had.
  30. delphinus777

    Wiki Place of service for an ASC

    The few physican owned ASCs I've worked for all use the POS 24. They were still considered a free standing ASC facility.
  31. delphinus777

    Wiki Coding Con 2011 Vs. ASCA's Winter Coding Seminar

    Hi Ellie, Both Christina Bentin and JoannSchade-Boyce are a wealth of information regarding ASC coding/billing. I think you need to look over the agendas for both seminars and see which one works for you. It seems the Orlando ASC agenda is set up better to where you can get all the info needed...
  32. delphinus777

    Wiki Colonsocopy Screening Question

    I would request the H & P to see if the patient had any history of polyps [v12.72] or personal history of cx [v10.05]. If no history is documented then the v76.51 is used for just the screening. Regardless of the findings, the screening code should be sequenced first with any additional dx codes...
  33. delphinus777

    Wiki Surveillance of uncertain behavior neoplasm

    History of uncertain behavior... Interesting. I know the renal pelvis is part of the ureter and being it is uncertain you might want to look at 236.91. There is no "V" code for such a dx... {that I know of}. Just my 2 cents.
  34. delphinus777

    Wiki Pain Management codes

    mendezdenise: In my opinion, I would not use the 62311 for the ligament injection. The procedure description for 62311 states "The solution is injected into the epidural or subarachnoid space", whereas 20550 description states "The physician injects a therapeutic agent into a single tendon...
  35. delphinus777

    Wiki Embedded portion of an IUD - to scope or not to scope.

    THANK YOU so much!!!!
  36. delphinus777

    Wiki Right SI joint Radiofrequency thermal ablation

    I am only reading 3 levels. So I would code 64622-RT, 64623-RT and 64623-RT ...really not too much info on the fluoro in the op note.... but maybe 77003 {wordy pain management doctors- LOL}
  37. delphinus777

    Wiki Embedded portion of an IUD - to scope or not to scope.

    58301 or 58562 :confused: The physican used a hysterscope and then a small hysteroscopic grasper to remove the remaining portion of the IUD. I find I am over thinking this! 58301 does not state the technique. So I am leaning towards the 58562 because of the hysteroscopy. Any thoughts??
  38. delphinus777

    Wiki billing for inguinal hernia and spermatic cord lipoma

    I agree with MBORT. I bill them all the time. An article from BeckersASC.com January 25, 2011 issue, written by Lolita M. Jones, RHIA, CCS regarding "7 Common Surgery Center Coding Errors". She pulls this information from the July 2000 CPT Assistant stating "the AMA clarified that when a...
  39. delphinus777

    Wiki asc low cost or free webinars?

    This site has a free one...... http://www.inquisit.org/Inquisit/ListProducts.aspx?type=ceu&list=ceu&id=4 This has some lower cost CEUs: https://codingwebu.com/user/student_reg_public.asp?referrer=53108 This breaks down how/where for...
  40. delphinus777

    Wiki Need Help with Billing Question

    Here is an older thread regarding itemized bills for an ASC.... https://www.aapc.com/memberarea/forums/showthread.php?t=10318
  41. delphinus777

    Wiki foreign body giant cells and removal??

    Not really. It really doesnt state anything other than debris. The foreign body giant cell is a response to a foreign body. What was the debris? You should request the H&P to see what lead up to the mass, abscess and the reaction. I would code more towards excison of the mass [you'll need a size...
  42. delphinus777

    Wiki Billing for devices with facility

    At my facility we bill out rev code 270 with HCPCS A4649 for medical supplies [such as the Novasure device] and rev code 278 with HCPCS L8966 for implants [such as Adiana birth control]. We are contracted with some of our carriers and it is written into the contract with these HCPCS codes. We...
  43. delphinus777

    Wiki modifier question

    I would not create a charge line for that item because it was given to your facility free of charge. Also on a different note the GL modifier is not an approved for ASCs. Hope this helps.
  44. delphinus777

    Wiki Removal of Ventilation tube in Canal

    In some cases a patch is used. Its the decision the surgeon makes. Here is a good article: http://archotol.ama-assn.org/cgi/reprint/124/4/417.pdf Also, with the left ear the Dr. states after removing dry debris in the canal "there was an extruded tube". Not sure where it was extruding from but...
  45. delphinus777

    Wiki Ingrown Toenail

    You need more info on how much the surgeon took out of the nail. Was it the plate or did they go down to the matrix? That would be the decision maker right there. The block [sadly] is included.
  46. delphinus777

    Wiki Removal of Ventilation tube in Canal

    Maybe I am missing something... I didnt read there was a perforation in the right to warrant 69610. Shouldnt both be 69424? Debridement included as well as the patch for the hole from the tube.
  47. delphinus777

    Wiki help with cpt code 19380

    Not sure if you're asking if you can code both 19340 and 19380. You can if the existing breast prosthesis is being replaced with a prosthesis of a different configuration after the recontruction/revision. Hope this helps.
  48. delphinus777

    Wiki 14040 or 14060???

    I guess it all depends on where the orignal lesion was removed from. Thats just my opinion :-)
  49. delphinus777

    Wiki Billing NON-USED neurostimulator lead

    Yes! The doctor opened it with all intentions to use it. It can not be used again. Every penny counts! :D
  50. delphinus777

    Wiki post-op pain block

    I agree with MBORT. To code this service you need to show it was separate from the anesthesia services as well. Here are some articles regarding this below...
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