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    Wiki Pennsylvania Trustmark HOP (PSERS) secondary claims

    Good morning. This question is specific to Pennsylvania providers and Medicare crossover claims. Is anyone finding Medicare primary with crossover to Trustmark (HOP) claims not actually being crossed over to Trustmark? We have quite a backlog of unpaid Trustmark HOP secondary claims that are...
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    Wiki EGD with biopsy and scope advanced beyond the second portion of the duodenum to the 4th portion but not including jejunum.

    I agree with the provider - 44361 only.
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    Wiki High Risk Screening Colonoscopy

    If the patient presented for a high-risk screening colonoscopy, and is status-post treatment for the condition which justifies the use of Z86.010, I sequence the diagnosis codes as Z12.11 (primary dx); Z09 (secondary dx because the ICD-10-CM Parent Code notes for Z86 state to "code first" any...
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    Medicare Screening Colonoscopy LCD's

    Which MAC? I do not think there is a specific LCD (at least for Novitas / Pennsylvania) for a high-risk screening colonoscopy. The guidelines for what is considered "high risk" and screening frequencies are given in the Medicare Preventive Services Quick Reference chart. Link - MLN006559 –...
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    Wiki Surgical Laparoscopic procedure with diagnostic Sigmoidoscopy

    What was the reason for the sigmoidoscopy? If it was done to check the patency of the anastomosis, then it should not be reported separately.
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    Wiki Colonoscopies - surveillance vs. screening

    Yes, this absolutely makes sense - I appreciate your input and thank you. I cannot even find screening guidelines, high risk guidelines, etc, for our local BCBS. It is crazy how there is little transparency and guidance with surveillance regimens. I feel bad for the patients who are...
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    Wiki Colonoscopy after a positive stool test.

    I have many questions about the new guidelines. If we follow what many commercial guidelines tell us, Z12.11 is used in the absence of symptoms or findings. R19.5 is a finding so I do not think Z12.11 would be applicable. However, under the guidelines, a follow up colonoscopy for a positive...
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    Wiki Colonoscopies - surveillance vs. screening

    Hi and thank you for your reply. I'm stuck at past history of polyps.. if a patient presents for a surveillance colonoscopy due to a past history of a polyp, is that previous polyp considered a "finding" which commercial insurances would consider non-screening criteria? Even though the...
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    Wiki Colonoscopies - surveillance vs. screening

    Hello and thank you for your reply and link.
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    Wiki Colonoscopies - surveillance vs. screening

    Hello. To me, coding guidance for surveillance colonoscopies is murky, at best. How are you all coding and billing surveillance colonoscopies for commercial insurances? i.e. repeat colonoscopy for a past finding (polyps) Surveillance colonoscopies are usually done at more frequent intervals...
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    Wiki P1-P6 modifiers

    I am new to Anesthesiology billing and wondered if anyone can provide guidance about this- Medicare (Novitas) and Medicaid (Pennsylvania) do not make any additional reimbursement for the physical status modifiers or for the qualifying circumstances add-on codes, but should we still be putting...
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    Wiki Cholecystectomy with wedge portion of liver

    Our surgeon performed a laparoscopic cholecystectomy and indicated in the note that he removed a wedge of the liver with the gallbladder because there was no definable plane between the gallbladder and liver. The specimen was sent to pathology. Can a wedge resection of the liver be charged...
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    Hi! Nice to meet you.

    Hi! Nice to meet you.
    • bethb
    • Profile post comment
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    Wiki Laparoscopic partial cecectomy (no anastomosis) coding

    I am on the fence with coding for a laparoscopic partial cecectomy (partial cecum and appendix stump) without anastomosis. Patient is S/P appendectomy, many years ago, and presented with continuous right sided abdominal pain. I have read forums and literature that suggest using CPT code...
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    Wiki Callus shave

    Thank you for your help! Beth
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    Wiki Callus shave

    Can codes 11055-11057 be used for billing a shaving of a callus? The procedure note states callus shaved with #10 scalpel. I am thinking that a shave of a callus is included in the E&M code and 11055-11057 should NOT be used since the procedure was a shaving and not paring or cutting. Any...
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    Wiki Lesion excision vs. Skin Tag CPT codes

    I'm second guessing myself on this one. The provider excised a lesion and sent it for pathology. Pathology diagnosis is skin tag. The provider is wanting CPT 11402 (benign lesion excision) to be billed. But, has asked if the 11402 should be changed to 11200, removal of skin tag, based on the...
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    Wiki Cysto with stent removal during ESWL global

    laurenb27, Thank you very much for the reply! Beth B. CPC
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    Wiki Cysto with stent removal during ESWL global

    Patient had left ESWL on 12/27/2018. 2 weeks later patient has cysto / left stent ureteral stent removal. Is the stent removal considered part of the ESWL global or can the stent removal be reported separately? Thank you in advance!
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    Wiki Cpt 43760

    Thank you very much for your help!
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    Wiki Cpt 43760

    Can CPT 43760 be used for a "reinsertion of gastrostomy" at bedside? Thank you in advance.
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    Wiki Preventive Exams Medicare patients

    Thank you very much for the information. The Medicare wellness exam components are not all met or documented in the note, so I am not inclined to code the AWVs or IPPEs. The patients present for a "preventive exams" or "physical exams", which are not covered by Medicare, but that information...
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    Wiki Preventive visits and Medicare patients

    We have a situation where "preventive health care" and "preventive examinations" are scheduled for Medicare patients. Medicare denies payment, of course, and we are asked to code the visit to an established E&M code, because the Medicare IPPE and Annual Wellness Exam components are not met. I...
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    Wiki Preventive Exams Medicare patients

    We have a situation where "preventive health care" and "preventive examinations" are scheduled for Medicare patients. Medicare denies payment, of course, and we are asked to code the visit to an established E&M code, because the Medicare IPPE and Annual Wellness Exam components are not met. I...
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    Wiki 3 finger fractures same hand

    Hi. I am hoping someone can help me with this one. The patient was diagnosed with 3 fractured fingers of the right hand: the index finger, the long finger, and the ring finger. Closed treatment without manipulation was done for each fracture. 2 splints were applied: one splint for the long...
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    Wiki Open Ventral hernia repair with panniculectomy

    Our patient had a large hernia, approximately the size of a volleyball. Our surgeon elected to perform a partial panniculectomy so the hernia could be closed reasonably without a giant (seroma) cavity. I am having trouble visualizing this. :( There is a CCI edit between the codes 49561 and...
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    Wiki Enertocutaneous fistula

    Looking for any advice, please. Our patient was on the OR table for a laparoscopic sigmoid resection with coloproctostomy. Our surgeon indicated that a laparoscopic "take-down" of an enterocutaneous fistula with oversewing of the small bowel was also done. I am not sure "take-down" is the...
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    Wiki More shoulder woes... 29823

    Orthocoderpgu, Thank you so much for the information you have shared with me!
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    Wiki More shoulder woes... 29823

    Orthocoderpgu, thank you very, very much. Your information helps! Would you be willing provide some advice with regards to billing for a biceps tenotomy, with a shoulder arthroscopy ( w/ limited debridement) and subacromial decompression / acromioplasty? I have found conflicting information...
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    Wiki More shoulder woes... 29823

    I am getting really close to understanding this:D I am still a little confused about the reporting for the following scenario. I found that if a provider performs a subacromial decompression, biceps tenotomy, and debridement of the anterior labrum, CPT code 29823 can be reported. But can...
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    Wiki Biceps tenotomy

    snolan--thank you SO much for your input. Very appreciated :D
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    Wiki Biceps tenotomy

    Wow. I am finding many differences of how to code for an arthroscopic biceps tenotomy during shoulder arthroscopy. I cannot seem to make sense of it all. Or find a conclusive, agreed upon, coding solution. Does anyone have any recent and up-to-date information? Ortho surgeon performed: 1...
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    Wiki Fracture care 101

    Looking for clarification with regards to global fracture care and cast changes (I'm newer at this--but learning!) :p Global fracture care is 90 days and includes initial casting and/or strapping... Can re-casting [due to a loose cast, mal-fitting cast] be billed separately during the global...
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    Wiki 64405 question

    I am not very familiar with coding / billing for nerve blocks, in this case, an occipital block. The CPT code is 64405. The physician indicated that he used 0.25cc bupivacaine, 0.25cc xylocaine, and 0.5cc of depo medrol 40 mg /cc. Forgive me if I am asking a crazy question-- Are the...
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    Wiki Sacral nerve implantation of neurostimulator

    Would a procedure done on the "contralateral" side of the sacral nerve (transforaminal placement) be considered a bilateral service? Our note states "procedure performed again on the contralateral side" Would the placements be considered bilateral placements? Thanks! Beth
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    Wiki Repair coding help

    Thank you very much for your help :)
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    Wiki Repair coding help

    Hi. Our physician removed 6 lesions by excision: 3 from the right flank 3 from the left groin All excision coding has been completed, but I am stumped with coding the closures. All repairs are intermediate based on the notes. Right Flank closure total was 13 cm Left Groin closure total...
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    Wiki New to General Surgery coding

    I am starting a new coding adventure soon--I will be diving into general surgery coding. Does anyone have suggestions on specific courses or classes I can take? Is there any specialized training available (on-line)? Or any suggestions on good resources to have at hand? I am nervous, to...
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    Wiki No ROS done

    Thank you so much for your help! Much appreciated!
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    Wiki No Review of Systems documented or done HELP!

    Thank you so much for your help. Much appreciated!
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    Wiki No Review of Systems documented or done HELP!

    Hi. I am looking for suggestions and input for this scenario. I am fairly new to E&M code reviews and am stumped on this. A new patient presents to the office. I have read the documentation through and through and found that no Review of Systems was done. I asked the provider, who responded...
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    Wiki No ROS done

    Hi. I am looking for suggestions and input for this scenario. I am fairly new to E&M code reviews and am stumped on this. A new patient presents to the office. I have read the documentation through and through and found that no Review of Systems was done. I asked the provider, who...
    • bethb
    • Thread
    • Replies: 2
    • Forum: E/M
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    Wiki EGD and Colonoscopy aborted procedure

    I am looking for suggestions for this scenario. I am on the fence as to whether we can bill the endoscopy / colonoscopy procedures with a -53 modifier or if no procedure should be billed at all. Place of service was outpatient hospital. The patient was given preoperative anesthesia to achieve...
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    Wiki Physician Assistant as an assistant surgeon

    Thank you for your reply. I am shaking my head over the lack of assistance from UPMC Health Plan.
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    Wiki Physician Assistant as an assistant surgeon

    Anyone out there have information regarding billing for our physician assistant who is an assistant surgeon to the M.D. for UPMC Health Plan insurances? Here is my dilemma: UPMC Health Plan is not forthcoming with their rules and guidelines for billing such services. I have contacted customer...
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    Wiki 82270 question

    I am receiving a software edit when I billed out a 82270 (FOBT) with a modifier -33 appended to a non-Medicare insurance carrier. I may not be thinking this correctly, but the -33 signifies a USPSTF recommended service. If we bill the screening based on that, wouldn't a modifier -33 be...
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    Wiki Dialysis-Monthly Capitation Payment Medicare

    Hi. I have a billing question regarding the reporting ESRD related services under Monthly Capitation Payments for Medicare. A group practice has 2 physicians. Physician 1 saw the patient on 10/23, 10/26, and 10/28. Physician 2 saw the patient on 10/5. If I am understanding correctly, the...
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    Wiki Medicaid and routine venipuncture

    Our Medicaid (Pennsylvania) is not paying for CPT 36415, as it is not on their fee schedule. 36415 is billed frequently for family practice, and Medicaid will not provide me with any "coding" information or crosswalks, but states there is an "alternative" code that can be billed. I have...
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    Wiki Flu Vaccines

    ..so Medicare will not reimburse for any CPT code reported for the flu vaccine?? (90655-90660)
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    Wiki Flu Vaccines

    Hi! I am starting Family Practice billing. I am more accustomed to billing and coding for specialties so I am starting out slow here. I am a little stumped with flu vaccine billing. Medicare references show that Q codes (HCPCS) can be used. Can the CPT codes be billed to and reimbursed by...
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