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    Wiki 96372

    What about when the physician administers the injection at an ASC? We have been getting denials for invalid POS for 96372.
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    Wiki Calculus Removal Same side

    Yes, 52356 for the lithotripsy and stent placement in the kidney, 52352-XS for the basket removal of the stones in the ureter.
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    Wiki 52005?

    Gotcha, thanks for the clarification on the 52005!! I do disagree with 50590-LT only, because it does take additional time/effort to reposition the machine and treat a stone in another organ. And it can be billed with a 22 or possibly even 2 units with an XS if the payer accepts...
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    Wiki 52005?

    Even so, 52005 is not documented here, correct? Just making sure I'm not missing something. All I saw was 52000. This patient also has a commercial plan, so it's possible that they will pay for the 50590 for both the kidney and the ureter. My other suggestion was to use modifier 22 for the extra...
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    Wiki Help with OP Note

    Thank you so much for looking at this so thoroughly! I appreciate your help.
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    Wiki 52005?

    The physician wants to bill 52005 here but I don't see enough evidence in the documentation that the ureter was catheterized. Wires cannot be billed for, correct? And 76000 is bundled with 50590. Thoughts? The patient was brought into the OR and placed in dorsal lithotomy position on the...
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    Wiki Billing for RN services with no supervising provider in the office

    With the new allowance of virtual supervision for incident-to (provider is available via audio/visual communication), could a nurse provider certain services (cath changes, injections, etc) and then bill under the provider that's providing the supervision?
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    Wiki Help with OP Note

    Hi all, any help with this OP note is appreciated. One of my coders used: 50590, 52318, and 52315-XU. 52315 was denied, of course. I'm thinking 52356 would have been more appropriate here since the stent was initially placed during this encounter and you can't bill for removing a stent you've...
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    Wiki Guideline on 52352 for Stone Fragment Removal after Laser?

    I have a couple providers that are adamant they should be allowed to bill 52352 when removing fragments of a stone they just lasered. I have explained that removing the fragments of a stone you've just lasered is inherent to the lithotripsy code (52356 or 52353) but I need more solid evidence...
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    Wiki Bladder irrigation 51700

    I would never advise them to document something they did not perform. I was asking for clarification of the difference between the two procedures, but no worries if you do not know. I just wonder if my providers say they irrigated the catheter free of clots when in reality they irrigated the...
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    Wiki Bladder irrigation 51700

    So for a patient with gross hematuria and clots, what documentation would you expect? Our providers often just say that they irrigated the catheter free of clots.. but they should be documenting that they irrigated the bladder free of clots?
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    Wiki High level urology problems?

    Thank you for your torsion examples! I'm trying to talk about some examples of high level problems. I'm aware that there's more to determine the overall MDM. Problems addressed is the element that I find is the least often at a high level, so I wanted some opinions on what other coders consider...
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    Wiki Bladder irrigation 51700

    51700 is not appropriate when irrigating a catheter, correct? I've seen mixed opinions on this, but I recently found this statement from the NCCI manual from 2022 "Irrigation of a urinary catheter is included in the global surgical package. CPT code 51700 shall not be misused to report...
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    Wiki Personal History of Cancer-- Invalid principal diagnosis?

    Awesome, thank you!!
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    Wiki Personal History of Cancer-- Invalid principal diagnosis?

    Thank you so much!
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    Wiki Personal History of Cancer-- Invalid principal diagnosis?

    We often do surveillance cystoscopies for patients with a history of bladder cancer.
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    Wiki Personal History of Cancer-- Invalid principal diagnosis?

    Can Z08 be used with procedures too?
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    Wiki Personal History of Cancer-- Invalid principal diagnosis?

    Thank you both for the guidance! I found what I needed. I think I got caught up and misunderstood this list, but it's just saying that these Z codes can ONLY be listed first when used, not saying these are the ONLY Z codes that can be listed first. Z08 was my first thought-- that we should be...
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    Wiki Personal History of Cancer-- Invalid principal diagnosis?

    The ICD-10 guidelines were updated and we are now seeing denials when using Z85.51 as the principal diagnosis on an office visit. What would you suggest we use if, for example, a patient is coming in for a follow up with a personal history of bladder cancer and no other issues? Or if we perform...
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    Wiki Saturation Prostate Biopsy Denials 55706

    Thank you for this. I also can't find anything from Medicare. Not sure why they don't have a policy or guidelines on this.
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    Wiki Co-Surgeon mod 62

    If two providers of the same specialty (and same practice) are working together to perform the same procedure simultaneously, they both still must have their own OP note in order to bill -62, correct? It is not enough for one to document using "we" and list the other as the co-surgeon.
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    Wiki Saturation Prostate Biopsy Denials 55706

    Hi all, We have been seeing an increasing number of denials for 55706 from Aetna, BCBS, and Tricare who now seem to be requiring TWO prior negative biopsy results. In the past I always believed it was one. I also recently received a denial from Humana stating our record didn't make it clear...
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    Wiki Software Advancements for Charge Entry?

    Hi all, We are soon switching to Veradigm which I am unfamiliar with, but I'm hoping some of you may be able to help me come up with some requests for customizing our coding/charge entry/billing workflow. Is there a feature or process perhaps that is built into your system that you love or...
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    Wiki High level urology problems?

    Hi all-- I'm wondering what you guys consider high MDM level problems.. The Painters explained that the problem must be of such a severity that the patient needs to be stabilized or immediately taken to the hospital. But what if they are already there? What about an infected stone and the...
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    Wiki 51700 for Foley irrigation?

    I've read mixed opinions on this.. does the provider need to place the catheter and then irrigate in order to bill 51700? Or if my doc comes in for a consult and the catheter is already placed and they just irrigate it, is that included in the E/M? Thanks!
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    Wiki Fusion biopsy denial

    Hi, I bill for these all the time. You can't bill for the 76376-26 because the radiologist that read the MRI/CT has already billed for that code and provided those services. You can only bill the 55700 and the 76872-26. 55706, mentioned above, is for saturation biopsies only and has a number of...
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    Wiki Nephrostogram by Xray Tech?

    Hi Jim! Thanks for the reply. They were billing 74425 on its own in the past and now it's not getting paid. I'm not sure why this is. I understand that it's now bundled with 50431/50432 but they weren't billing those codes. The Xray department also just told me that they don't document much...
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    Wiki Nephrostogram by Xray Tech?

    And yes! They're asking because they said 74425 is no longer being paid and they were wanting to switch to billing 50430/50431 and I'm not sure that's correct if an Xray tech is injecting contrast to take the Xrays.
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    Wiki Nephrostogram by Xray Tech?

    Physician. But the office asking me this said the Xray techs perform this injection of contrast and the imaging.
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    Wiki Nephrostogram by Xray Tech?

    How would you bill a nephrostogram being performed by an Xray tech? Per the lead tech, "The patient already has a nephrostomy tube in place before they come in to us. We don't place them here at this facility. So we inject contrast into the nephrostomy tube they already have and then take some...
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    Wiki EWSL in urinary bladder

    52317 and 52318 both state "crushing or fragmentation of calculus by any means in bladder and removal of fragments;" so I would choose one of these. Likely 52318 for "complicated" since an ESWL machine was used.
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    Wiki Modifier 53 - does the CPT procedure code global period still apply when discontinued

    Hi, do you have a source? Looking for the same answer.
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    Wiki E&M in POS 24?

    Can a physician bill for an E&M at an ASC? I'm thinking yes, as long as they use POS 24 but I'm not 100%.
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    Wiki G2211-- Self pay?

    Thanks!
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    Wiki Hospital Shared Visits MDM

    Thank you!! And their new policy makes it very easy for physicians to get full credit without seeing the patient at all. Just trying to make sure their documentation is adequate and that I'm leveling the visits correctly based solely on their MDM rather than anything the APP documents.
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    Wiki compounded semaglutide administration guidance

    I have some info regarding billing for an E/M and an injection (sorry, nothing on the specific FDA questions). Question: When is it appropriate to bill for an E/M visit on the same day as an injection? Answer: There are two scenarios where this may be supported. When There is an Unrelated...
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    Wiki Hospital Shared Visits MDM

    Am I correct that if a shared visit is being billed under the physician because they performed the MDM, the visit is leveled based on the physician's documentation alone? Like you can't combine the MDM from the APP and the MDM from the physician to level the shared visit, correct?
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    Wiki G2211-- Self pay?

    I don't think it would be appropriate to bill a self pay patient for G2211 but I'm really not sure if there's a guideline on this?
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    Wiki New and confused by insurance policies.

    I've been asked to do this as well. I can usually find a policy for the larger companies like UHC, Cigna, sometimes Humana, but sometimes there just isn't one available yet and you can either wait for more info to be released or bill it and see what happens.
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    Wiki Payment Reduction for APP Performing Procedure/Tests?

    Is payment reduced to 85% when an APP performs procedures/tests and bills directly (not incident-to)? Also, how are we to know which procedures/tests can be billed incident-to? Thanks.
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    Wiki Procedures billed by APPs

    I've received several questions recently on whether or not certain procedures can be performed in office by an APP alone (51720, 95972, Eligard/Firmagon injections, etc.). Most codes as long as they are not surgical can be performed by an APP since they are a qualified healthcare provider...
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    Wiki 52284 Optilume

    Thank you, that's what I was thinking as well. Hopefully there will be more complete guidance on it soon.
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    Wiki 52284 Optilume

    Hi all-- Anyone know what site of service 52284 will be payable with? Office? ASC? Not able to find anything on this.
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    Wiki Germline Genetic Testing Insurance Coverage?

    Trying to establish a list of insurances that have a policy related to germline testing for hereditary cancer (work in Urology- prostate cancer). Anyone have anything on this? So far I've only been able to find applicable policies for Medicare, UHC, Humana and Cigna on their websites. Any help...
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    Wiki Does 64561 Require Anatomical Modifier?

    Normally for a bilateral PNE we bill 64561 with modifier 50, but for the 1st stage permanent implant we bill 64561 alone. Does LT or RT need to be added for the permanent lead?
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    Wiki Help with Cystolitholapaxy

    52317 or 52318 also state "simple" or "complicated" respectively, so size may not necessarily be the only way to choose.
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    Wiki Lap single lymph node removal during nephrectomy?

    During a laparoscopic partial nephrectomy the surgeon also removed one left perihilar lymph node to check for metastases. How would I code this? 38570? Or the unlisted 38589 and comp to 38570 (or other code)? Thanks.
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    Wiki Why was I marked wrong? (Practicode Case ID: OPD7411)

    Thank you very much!! I appreciate the input, I was questioning myself and wanted to be accurate when relaying that advice to my providers.
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    Wiki Why was I marked wrong? (Practicode Case ID: OPD7411)

    @csperoni Quick question regarding your answer. Is it completely necessary for the provider to use the word "images"? For example, if they document "CT scan without contrast did not reveal any drainable abscess. Actually, the kidney looked decreased in size suggesting improvement, some...
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    Wiki iTind for BPH

    Hi! Please see the files attached. I received these directly from the Director of Field Reimbursement with Olympus. I hope this helps!
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