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    Wiki E/M MDM Orthopaedic question

    I agree and recommend always looks at E/M visits on a case by case basis no matter the specialty. I work with a pediatric ortho group and often find when working with them that because they are so high volume that they are missing documenting things that they do or not being specific enough...
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    Wiki Pharmacoresistant epilepsy

    Hello, I wanted to get others opinions on whether you would consider the following as moderate or high under the number and complexity of problems addressed: pediatric patient with pharmacoresistant epilepsy being seen by neurologist who also has autism spectrum disorder, intellectual...
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    Wiki E/M Utilization Benchmark Tool

    Would anyone have any resources/recommendations for benchmarks for pediatric specialists??
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    Wiki Remote Coding Tests

    Don't feel bad, I have years of experience and so does one of my friends and both of us failed the Maxim test and have no clue why! They seem desperate as I've received emails from several of their recruiters. I think they need to take a closer look at their test and see why they can't get any...
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    Wiki G-tube change in clinic by NP/PA

    Hello, I am seeing different information on whether a NP or PA can change a g-tube in the clinic. Some references state "physician" and some do not. The group I work with is a pediatric GI group who assumes care of g-tube patients in our feeding tube clinic after they get out of the hospital...
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    Wiki Botox vial shipped from patient's pharmacy

    We've had situations in the past where the insurance company wanted the drug on the claim even if it was supplied by their specialty pharmacy to indicate what was administered that day - you would think they would know since they supplied; however it is sometimes done via a separate division...
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    Wiki 99212 & 99214 billed together on same day?

    No, if the patient sees a physician/APP the nurse visit is not separately billable. The only other billable service would be something that has it's own CPT code for example an injection/infusion that is within the nurse's scope of practice in your state provided under direct supervision and...
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    Wiki 99212 & 99214 billed together on same day?

    Can you provide more context as to why there would be the need to bill two E/M would be billed on the same visit same day?
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    Wiki Opinions needed re: chronic vs self-limited on leukemia patient

    I am currently working on a documentation review of a new NP in our Hem/Onc department. I have a case where the patient is 7 y.o. and 29 months post therapy and now in follow-up phase for ALL - per note clinically doing well and no evidence of recurrence. The patient did have a recent episode...
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    Wiki Assistance needed with thumb deformity repair case

    Hello, I am learning ortho procedures for our pediatric hand surgeon and have read this op note over and over and am to the point of confusion. Can someone assist me with what codes you are getting? The MD requested 26471 and 26483; however I'm missing where a graft was used. Reason for...
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    Wiki Office Procedure note

    I agree with Amy's response and the earlier thread that she refers back to has very useful information that you can utilize to educate your provider. I personally would feel it would not support and would query/educate the provider in the requirements.
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    Wiki Palliative Care auditing

    Yes, they follow the same E/M guidelines as other physicians. Palliative care physicians/APPs are usually consulted to provide symptom management recommendations or to assume care of the patient for symptom management. Under the new guidelines, I would look closely for whether the...
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    Wiki Risk under new 2023 guidelines (also posted under urology for opinions)

    Hello, I have a question from one of our pediatric urologist regarding low vs moderate risk in the MDM for a patient with an undescended testicle and plan is for exploration and orchiopexy. He's not asking about a specific patient and ours range anywhere in age from a couple of weeks old to...
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    Wiki Level of Risk under 2023 E/M guidelines

    Hello, I have a question from one of our pediatric urologist regarding low vs moderate risk in the MDM for a patient with an undescended testicle and plan is for exploration and orchiopexy. He's not asking about a specific patient and ours range anywhere in age from a couple of weeks old to...
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    Wiki Fracture care MDM

    My primary job is provider education; however I use cases that I audit for each provider to make it more personalized education for them in hopes that they learn from it and do better going forward. I also receive cases from the coding team that they did not agree with the providers coding -...
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    Wiki Fracture care MDM

    Thank you Amy for your input :) I completely agree much of what I see in ortho is not an "every time" and that's been difficult to explain to the providers as well as the coding team. I did agree in this case with the level 2 as the data and risk both ruled out a level 3 and agreed on the S...
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    Wiki Fracture care MDM

    Hello, I'm having a difference of opinion with a colleague regarding whether a closed fracture goes from an acute uncomplicated injury to a self-limited or minor problem just because it is healing and doesn't need to have a cast replaced or braced. My colleague is stating that once the...
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    Wiki Procedure note required documentation

    I have an outsourced ASC billing group that is stating that the MD has to have the note in "op note" format as their patient was a pediatric patient would would not be able to tolerate injection procedure in the clinic setting so it was performed in the ASC under anesthesia when it is normally...
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    Wiki Split Shared "Same Calendar Day"

    I personally would still consider "same calendar day" from midnight to midnight on the same day. So if your NPP sees the patient on Monday, then your MD would need to see the patient on Monday also prior to midnight. One thing to consider - sometimes physicians will see the patient; however...
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    Wiki Peanut desensitization in ped patients

    Hello, Our pediatric allergy practice has started doing peanut desensitization visits and are looking for opinions on how to best capture this. The patients present to the office with a suspected peanut allergy per symptoms/reactions after eating peanuts/peanut containing products. They...
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    Wiki Fracture care for multiple fractures

    Thank you very much for sharing! I'm meeting with them next week and we are going to review fracture care coding and this is one of their "hot topics" in this area in addition to overwrapping bi-valved cast or splints to convert to a closed cast post surgery/reduction. If you have any...
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    Wiki EPIC

    I have worked in Epic in multiple locations and the training does not come via Epic itself but through each system as Epic has different set-ups depending on what the facility wants. I've seen some have more user friendly set-ups than others. Despite the differences, I much prefer it over...
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    Wiki Audit topics for EM Services

    Hello, Can you please clarify? Most I would think audit E/M services to ensure the level is appropriate for the documentation and also audit the diagnosis. Not sure what you mean by "various topics to audit"
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    Wiki Provider Audit Information

    1. I audit all - physicians as well as APPs. We're a multi-specialty practice with 22 specialties and anywhere from 2-12 providers in each area 2. I usually do 10-15. 10 if office based only and 15 if they also do hospital rounding and/or procedures/surgeries 3. Just me auditing. One of our...
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    Wiki Cast overwraps

    Hello, Is anyone out there billing for cast overwraps in the case where a cast was applied after surgery and is bivalved to allow room for post-op swelling then at office post-op visit it is being overwrapped to close the cast rather than replacing replacing to maintain stabilization of the...
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    Wiki Fracture care for multiple fractures

    Hello, I am looking for advice/opinions from other ortho groups regarding on how they handle fracture care billing for multiple fractures treated with the same cast. An example that I have now is a distal radius/ulnar fractures along with a humeral lateral condyle fracture both on the same arm...
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    Wiki Need advice from any Allergy/Immunology clinic coders

    Hello, I was wondering how your clinics handle oral food challenges - specifically when the testing has to stop secondary to a reaction that is treated. From what I found from the AAAAI, 3M and the CPT book, if a patient has a treatable reaction to an oral food challenge, you should stop the...
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    Wiki Need opinion from an Allergy coder

    Hello, I wasn't sure where to post since there is not an Allergy/Immunology forum. I work with a pediatric allergy clinic as part of our multi-specialty practice and have a question surrounding food allergy testing. I have had three patient's in the past two weeks who have all not gotten...
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    Wiki not responding to treatment--how counted

    Here is information that I use that was presented by the AMA during their symposium last fall introducing the new guidelines: "Stable" is defined by the specific treatment goals for an individual patient. A patient that is not at their treatment goal is not stable, even if the condition is...
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    Wiki Anesthesia for lab draws

    Hello, We have a pediatric ASC and I was wondering if anyone out there codes/bills for general anesthesia for lab draws for severely autistic pediatric patients? If so what anesthesia code are you using for these? I have verified that it would be general and not MAC being done due to the...
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    Wiki Fracture care for re-fracture

    Hi everyone, I wanted to get some additional opinions on this case I have been researching. Our ortho clinic had a child who fractured his wrist and saw our providers and we initiated a fracture care global period for him. He underwent two casting changes/checks and was okayed to be...
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    Wiki Question for CPEDC's

    Hello, Is anyone else having difficulty finding CEUs to apply to their CPEDC credential? I know that the American Academy of Pediatrics has their yearly CEUs with the purchase of their specialty book each year, but I'm in kind of a unique situation. My CEUs needed were increased secondary to...
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    Wiki How to handle interview coding questions with no experience?

    I agree with Sharon - be honest (but not apologetic) about your lack of practical experience, study up on the specialty you are interviewing for and be confident in yourself. As a past coding manger, I was often more impressed and more willing in most cases to hire a newly credentialed coder...
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    Wiki Are there employers in the coding industry who value accuracy more than productivity?

    Since you've been coding ortho for a while, have you thought about going into auditing? I too struggled with productivity; however was fortunate enough that I had my CPC instructor as well as my employer recognize my strengths for accuracy and suggested going the path of auditing versus coding...
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    Wiki Which medical specialty pays the most for coders?

    I've always heard the vascular surgery and neurosurgery specialties, but I don't know for a fact.
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    Wiki CEMC Credential

    Hi Thomas, thank you! I do probably 90% clinic (other 10% ASC pro-fee and hospital inpatient so that’s why I was wondering. I’ve been debating getting it but with my particular group and like you said they’re applying to office E/M, I was wondering if holding off might be best.
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    Wiki CEMC Credential

    Hello, I was wondering if anyone has heard if the CEMC credential will change to reflect the E/M changes going into effect in 2021? I’m interested in obtaining it; however I would like it based on the new guidelines versus the old. Thank you
    • TTcpc
    • Thread
    • Replies: 2
    • Forum: E/M
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    Wiki Time documentation for discharge

    I've worked a lot with hospitalists and other inpatient providers and have never run across this either. While we do educate that it is best to use the total time in actual minutes spent, we do not "ding" the providers on an audit/review if they use the greater than 30 minutes statement. I...
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    Wiki How do you code for the Pediatric Symptom Checklist done in the office? 96127? 96110?

    In searching it seems the AAP has a little contradiction. I found an older article 2005 that stated 96110; however all of the newer articles that I have found state to use the 96127. I agree with you, the 96127 sounds more appropriate and would go with the newer information.
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    Wiki Auditing for medically impossible days

    I agree with Thomas and having had something similar myself, I would ask if you have an EMR that you can verify the patient appointment times/provider's calendar or template use? Utilization/comparison of those might help build a stronger case that you could take to your senior management.
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    Wiki Time Based E/M

    I forgot to add, don't forget to watch for template of the same time statement repeatedly...especially in regards to the total time and the content of the counseling. I've had to work on that with some of mine.
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    Wiki Time Based E/M

    Not necessarily the elements, but the medical necessity must be. For instance, I work with pediatric specialty groups some of which are more "hands off" than "hands on" meaning their visits are more review of data ordering tests, and not necessarily having information to support HPI on...
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    Wiki Time Based E/M

    Hi, I've seen both ways done; however when I was taught auditing, my instructor told us to always check the note for the "elements" (history, exam, MDM) level and the time and use which is most advantageous to the provider. Most I have come across have met higher on the time; however I have...
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    Wiki Does anyone code from home & love their employer?

    Check with MedKoder - they're a growing company and have an opening posted for a Coder III with hem/onc experience. I applied and they will test your skills pre-offer and the health benefits aren't that great unless you live Louisiana. The only reason I couldn't work for them was my current...
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    Wiki E/M Level 99214

    Hello, In pediatrics we do have some payers that will allow an E/M for the parents/legal guardian to come to the office and discuss their child's care with the provider without the child present - we limit this to established patients only though. The E/M is based on the CPT guidelines of...
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    Wiki Searching for Entry Level Coding Position

    No, an externship requires two years and two letters from employers vouching for your experience working with the coding sets during that time. From AAPC: "To remove your apprentice designation via on-the-job experience, you must obtain and submit two letters of recommendation verifying at...
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    Wiki Help needed with new changes from 96111 to 96112-96113

    Hello, I'm hoping someone may have the same situation or can provide some guidance/opinion on the change from the 96111 which was deleted and replaced this year with the 96112-96113. In our pediatric practice we have a staff member who has a Master of Arts in Educational Psychology who is...
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    Wiki Hierarchy for coding injections and infusions

    In addition to what the AAPC has to offer via webinars and articles, here is one good one: http://bok.ahima.org/doc?oid=105755#.XKe4yZhKiUk Be very careful and pay close attention to the guidelines for route, time, and hydration as these are the three areas that are greatest focus of audit...
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    Wiki one year work experience, so no one will hire me

    I have to agree with Pathos...why and what purpose does it serve to revive such an old thread without any new/useful information? I actually hold both sides at fault in this...the student for not doing more research beyond the promises that some of these coding schools make in their...
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    Wiki Bridles for NG tubes

    Hello, I'm wondering if someone could assist me with trying to figure this out. Our pediatric GI mid-level was shown bridles that could be used to help keep NG tubes in place for our pediatric patients. From what I have found the NG bridles are a tube/clip mechanism applied to the NG tube and...
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