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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 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 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

    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 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 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 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 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

    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 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 Scrotal Post Op Wound Fulguration of Bleeding

    Indication for operation: Pt is s/p incision and drainage of scrotal abscess, now with recurrent arterial bleeding from the wound Operation performed: Wound exploration with fulguration of bleeding sites Description of operation: After informed consent was obtained, he was brought back to the...
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    Wiki 52601 and 52700 together?

    Would you bill both 52601 and 52700 in this scenario? Thanks! After informed consent was obtained, the patient was taken to the operating room. After successful induction of general anesthesia, a preoperative dose of antibiotics was given. The patient was placed in the dorsal lithotomy position...
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    Wiki Incident-To and HMOs?

    Could someone please confirm this for me? We're trying to navigate authorization/referral requirement questions while educating our staff on the rules of incident-to billing. If a patient has an HMO and we get a referral/auth for the doctor, then the patient sees the ARNP instead, and the ARNP...
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    Wiki Commercial Coverage for Shared/Split Hospital Visits?

    Anyone know which commercial payers have adopted Medicare's Shared/Split visit policy? I know UHC has a policy and accepts them but unsure of the others.
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    Wiki Duplicate Documentation Progress Notes

    I have a provider that will see a patient on two separate days in the hospital, but the hospital progress note documentation is exactly the same. How would you approach this? Do you code it again and assume the situation was unchanged or do you inform the provider it can't be billed when the...
    • toria11
    • Thread
    • Replies: 2
    • Forum: E/M
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    Wiki Is a ureteral stone with hydronephrosis an acute illness w/ systemic symptoms?

    My thinking is that the ureter and the kidney are two separate organs so this would be a case in which the acute condition (ureteral stone) is affecting another organ (kidney - hydronephrosis). Thoughts?
    • toria11
    • Thread
    • Replies: 0
    • Forum: E/M
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    Wiki Medicare Advantage Plans and Incident-To Billing

    It's always been my understanding that Medicare advantage plans follow Medicare guidelines and therefore accept incident-to billing-- I'm unable to find specific policy information on this for each major carrier (except UHC). Thoughts? Is this what you believe to be true too? Thanks.
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    Wiki Pessary Cleaning Visit MDM?

    My providers are stating that in the past they would bill these visits as a level 4 because they are doing a pelvic and UA on them every time, removing the pessary cleaning it and replacing it. How would you level these visits with the new rules? I would say the best option would be to document...
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    Wiki Balloon Dilation of Prostatic Urethra?

    Hi! How would you code this balloon dilation of the prostatic urethra for BPH? Thank you! POSTOPERATIVE DIAGNOSIS: BPH refractory to medical therapy. PROCEDURES PERFORMED: Cystoscopy with balloon dilation of prostatic urethra with Optilume DCB balloon procedure. The patient was taken to the...
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    Wiki Suprapubic or Retropubic Simple Prostatectomy?

    Could someone please help me determine if this should be billed with 55821 or 55831? The note says the incision was extraperitoneal and it seems the bladder was opened which would point me to 55821, but the doctor selected to bill 55831 and the prostatic capsule was incised directly so I'm just...
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    Wiki Wound Exploration/Dressing Change in OR

    Hi! This patient had an I&D of a perineal abscess which was billed as 10061. Two days later, the patient was returned to the OR for "Wound exploration and dressing change." How would you code this procedure? Thanks!! JF 20220209
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    Wiki Intraoperative Consult/Ureter Identification?

    Hi! Please see the note below, I'm not sure how to code this. The physician is calling it a consult but he did dissect into the pelvis to check on the ureter. Thoughts? Thank you as always!! Consultation REASON FOR CONSULTATION: Help identifying the left ureter. INDICATIONS FOR PROCEDURE: The...
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    Wiki Urethral Balloon Dilation and Bladder Tumor Resection?

    How would you recommend coding this? I haven't come across a balloon dilation of the urethra before and I'm not sure if it's just included in the tumor resection. It seems I will need to query the provider on the size of the tumor.. Thanks! Indication for operation: 78-year-old male with...
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    Wiki Bladder Biopsy/Fulguration

    Hi! This patient underwent a repeat bladder biopsy due to abnormal scans, my question is whether the fulguration is billable in this case? It seems to me like the biopsy site was fulgurated for hemostasis since there was no apparent lesion of the bladder. Am I correct on this? If so, I would...
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    Wiki Transurethral Resection of Previous Bladder Tumor Site?

    When the physicians takes another resection of a bladder tumor SITE, would that still be billed by size with 52224-52235? Or would it be more appropriate to bill 52204 since there is no tumor? It also isn't completely clear to be whether the fulguration was for hemostasis or not in this case...
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    Wiki Laparoscopic nephroureterectomy with bladder cuff, regional lymphadenectomy?

    Hi! How would you code this? The provider suggested 50548 and 51703, but I'm wondering if there's a way to bill for the laparoscopic removal of the bladder cuff and lymph nodes? Perhaps with the addition of 38571-52? Thanks for your help! POSTOPERATIVE DIAGNOSIS: 1. Left renal pelvic mass...
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    Wiki 54164 or 54163?

    Hi! Would you code this as 54164 or 54163? Thanks!! Indication for operation: Excess foreskin at the frenulum. 48 yo male s/p circumcision in 2016, who c/o excess skin ventrally. It is causing intermittent pain/burning sensation. It is bothersome with intercourse Preoperative diagnosis: Excess...
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    Wiki Ureteral Foreign Body Removal & Nephrectomy?

    Hi! Am I only able to bill for the laparoscopic nephrectomy in this case? Thank you. POSTOPERATIVE DIAGNOSIS: Left ureteral foreign body and injury. PROCEDURE PERFORMED: 1. Left ureteral exploration with removal of foreign body. 2. Hand-assisted laparoscopic nephrectomy. INDICATIONS...
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    Wiki Urethral Meatotomy and Urethroplasty?

    Hi! How would you code this? I was thinking 53400? Thank you! Postoperative Diagnosis Urethral meatal stricture fossa navicularis stricture BPH with obstruction Procedure Performed Urethral meatotomy urethroplasty distal Type of Anesthesia General Indications Urethral stricture...
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    Wiki Scrotal Debridement and Incisional Biopsy?

    Hello! How would you code the following? I was thinking 11042 for the debridement but then read it may not include genitalia.. Thank you! POSTOPERATIVE DIAGNOSIS: 1. Chronic ulcerative scrotal lesion. 2. Humira-related psoriasis. PROCEDURE PERFORMED: Scrotal wound debridement and...
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    Wiki Urethral Realignment, Cystoscopy, & Difficult Foley?

    How would you code this? I'm thinking 52281-22? Thank you! POSTOPERATIVE DIAGNOSIS: 1. Urethral disruption, status post traumatic Foley removal. 2. History of prostate cancer, status post robotic prostatectomy with bilateral pelvic lymph node dissection. PROCEDURE PERFORMED: Flexible...
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    Wiki Removal of Two Nerve Stimulators before InterStim Placement?

    "Patient has a long history of overactive bladder. In 2005 a patient had a pudendal stimulator placed which did not work and is still in place. The patient also had an InsterSim stimulator that was placed several years later but it has stopped working because the battery is dead and she has not...
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    Wiki Inguinal Exploration and Hydrocelectomy

    Hi! How would you code this since the hydrocelectomy was performed from an inguinal approach? Is 55040 my only option here despite the exploration? Thanks! PREOPERATIVE DIAGNOSIS: Acute left scrotum, rule out torsion; rule out tumor. POSTOPERATIVE DIAGNOSIS: Left hydrocele. Normal left...
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    Wiki 51102 or 51040?

    Would this be coded as 51102? I'm questioning whether 51040 would be more appropriate because he did "cut down" to the instrument through muscle, fascia, etc. under general anesthesia. Thanks!! Procedure Performed Suprapubic cystostomy tube placement Type of Anesthesia General Indications...
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    Wiki Ureterectomy with ureteral reimplant and Boari flap w/ left pelvic lymph node dissection?

    Hi! Is 50785 the only code I can bill for this procedure? I read an article that said I could bill "50785 for the reimplantation via the Boari technique, 50650-51 (Ureterectomy, with bladder cuff [separate procedure]; Multiple procedures) for the excision of the segment of the ureter and...
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    Wiki Suprapubic Tube Placement, Cystoscopy, and Difficult Foley?

    Hello! How would you recommend I code this? 52000 alone? Thanks! POSTOPERATIVE DIAGNOSIS: 1. Urinary retention. 2. Urethral stricture with a history of prostate cancer. PROCEDURE PERFORMED: 1. 12-French punch suprapubic tube placement. 2. Cystoscopy, dilation of urethral stricture and placement...
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    Wiki Bladder Neck Tumors

    Hi! Would you code this as 52500 for bladder neck resection? Help is appreciated! POSTOPERATIVE DIAGNOSIS: History of bladder cancer with bladder tumors. PROCEDURE PERFORMED: Cystoscopy, transurethral resection of bladder tumors with fulguration. ANESTHESIA: General. INDICATIONS: Please see...
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    Wiki PCNL with New Access?

    Hi! I'd like a second opinion on how I've coded this procedure. Thanks! 50081-LT 50432-52-LT 52332-50 52005 74420-26 Indication for operation: Bilateral staghorn calculus. Plan for staged bilateral PCNL. We will first treat the left staghorn calculus which measures 5.1 x 2.9 x 2.4 centimeter...
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    Wiki 52310 or 52315?

    Hi! Would 52315 be appropriate for this procedure? The patient had an encrusted ureteral stent, the stent was removed and the encrustations fell off into the bladder and needed to be crushed in order to be removed. Thanks for your help! Indication for operation: Patient with bilateral stents...
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    Wiki Penile Skin Tethering?

    How would you suggest I code this? Would this qualify as a circumcision revision? POSTOPERATIVE DIAGNOSIS: Altered circumcision incision line. ANESTHESIA: General. PROCEDURE PERFORMED: Revision of circumcision. DETAILS OF PROCEDURE: This gentleman has presented to us with the above-mentioned...
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    Wiki Is Kidney Flushing Considered Manipulation?

    Just curious if flushing the kidney is considered manipulation as described in 52352 or if my only choice here is 52351 along with 52332. Thank you!! POSTOPERATIVE DIAGNOSES: 1. Bilateral nonobstructing renal stones. 2. History of UTI. 3. Status post renal transplant. ANESTHESIA: General...
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    Wiki 54162 or 54163?

    Would the following be billed as a circumcision revision or excision of penile adhesions? I read that a "skin bridge" is just another term for adhesions but I want to be sure. Thanks! POSTOPERATIVE DIAGNOSIS: Penile adhesion/skin bridge post circumcision. INDICATIONS FOR PROCEDURE: The patient...
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