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    Wiki G0101 Denied with Preventive Code

    Hi all, I'm hoping to get some clarification on this. We are unsure if we are supposed to bill a patient the fee for G0101 if Medicare is denying due to it not being after the 24 months when billed with a preventive code. Example: We billed 99397 with G0101. Medicare denied G code and patient...
    • bonnienorth55
    • Thread
    • g0101 medicare billing preventive exams
    • Replies: 4
    • Forum: OB/GYN
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    Wiki Need Help-Multiple procedures!

    My brain has been spinning in circles trying to figure out what is bundled & what's not o_O Op report info listed below: Indication for surgery: Pt w/large incisional hernia with multiple episodes of small bowel obstruction. Findings: 1. Enterocutaneous fistula secondary to previous mesh 2...
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    Wiki Adhesiolysis at time of C-Sec sep providers

    I have a case where our provider was performing a C-section and ended up needing to call in another provider to perform lysis of adhesions of the bladder. Our provider never punctured/did anything with the bladder; the urologist came in, did their part, then our provider stepped back in to...
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    Wiki Transgender Pregnancy

    Has anyone ever had to code for a transgender pregnancy? The patient is Female to Male. I see CMS rules state to attach modifier KX to the delivery code but I'm having a hard time finding much out there specifically about this scenario. Any insight would be greatly appreciated! Wondering if...
    • bonnienorth55
    • Thread
    • female to male pregnancy transgender transgender pregnancy
    • Replies: 2
    • Forum: OB/GYN
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    Wiki 49622 IP only code performed OP

    Hello, I have a patient who had a lap para ileostomy hernia repair with mesh done in the outpatient setting (Was discharged same day). Our office billed 49622 but of course that was denied due to it being a status C code for inpatient only. 44346 and 44314 have been considered as alternatives...
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    Wiki E/M w/IUD removal/insert

    Hi all, I'm looking to get some input on this denial I'm dealing with: The patient came in for an IUD check back on 10/05/2021 (was having issues and was undecided if she wanted to try and replace it). She requested a replacement visit a little over a year later on 11/03/22 and had her IUD...
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    Wiki Medicare 59400 with mod 22

    Hello, I have a question for anyone who can help regarding billing a vaginal delivery 59400 to Medicare with modifier 22. We billed it out with mod 22 attached since primary dx is O09.523 for elderly pregnancy and got this SMARTEDIT rejection back: "SMARTEDIT PATTERN 26411 MODIFIER 22 IS NOT...
    • bonnienorth55
    • Thread
    • delivery medicare mod 22 obgyn coding
    • Replies: 2
    • Forum: OB/GYN
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    Wiki Vulvar Resection Ulcer

    Hi all, I have been going in circles with this procedure and would appreciate any help/advice! Our provider performed a "right vulvar resection" for a non-healing ulcer of the vulva. The body of the report reads: "The labia was marked with a pen so that the entire non-healing ulcer could be...
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    Wiki Unbundling OB Global Package

    Hi all! I have a patient whose insurance only covers total OB care if they've been enrolled for 90 days. She hasn't met that criteria so our plan is to bill the delivery and post partum only code then go back and bill out the antepartum only visits. I'm having a hard time finding information on...
    • bonnienorth55
    • Thread
    • global antepartum ob global unbundling global
    • Replies: 2
    • Forum: OB/GYN
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    Wiki Complex Wound Closure

    Hi all, I have always struggled with how to code for wound repairs and dealing with the measurements. My doctor has on his report: 1. Right buttock wound sharp excisional debridement 15 x 8 cm with complex layered wound closure. 2. Left buttock wound sharp excisional debridement 18 x 5 cm with...
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