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  1. kimmcelderry@gmail.com

    Wiki post-traumatic synostosis

    Thanks Amy! Yes, I used the fracture sequela also. I don't have access to the coding clinic either, but I did see reference to the article.
  2. kimmcelderry@gmail.com

    Wiki post-traumatic synostosis

    I can only find a code for congenital radioulnar synostosis. What code do you think is best for post-traumatic? I used Other disorder of bone, forearm. Any other suggestions?
  3. kimmcelderry@gmail.com

    Wiki fibula fractures

    Thank you! Thats the code I went with because there wasn't anything better
  4. kimmcelderry@gmail.com

    Wiki Q4010 denials

    What payer is denying?
  5. kimmcelderry@gmail.com

    Wiki fibula fractures

    Does "other fracture of upper and lower end of fibula" mean the fibula is broken in 2 spots? How do you code for example, a nondisplaced transverse fracture of right fibular head. It's frustrating/confusing to have upper end of tibia fracture codes, but not for fibula. Thanks!
  6. kimmcelderry@gmail.com

    Wiki 27280 and 22848

    Hi there, my MD wants to bill bilateral SI joint fusion 27280 with PSF and pelvic fixation. He states since the fixation crosses over the SI joint, we can break the bundling of 27280 and 22848. Anyone have info on this?
  7. kimmcelderry@gmail.com

    Wiki Laminectomy for abscess

    I considered that, but I was hesitant since it is all one incision and one abscess, though large.
  8. kimmcelderry@gmail.com

    Wiki Laminectomy for abscess

    Hi there, the MD and I are trying our best to code this correctly, I say 63266-22. (He wanted 63016 with 18 units of 63048) Any thoughts or input is appreciated. Posterior decompression, C7/T1, T1/2/3/4/5/6/7/8/9/10/11/12, T12/L1/2/3/4/5/S1/S2, microscope assisted Post-Op Diagnosis Codes:*...
  9. kimmcelderry@gmail.com

    Wiki T10-11 fracture

    Thanks, I appreciate your help.
  10. kimmcelderry@gmail.com

    Wiki T10-11 fracture

    The codes for traumatic thoracic fractures have T9-10 and T11-12. No T10-11. The code range is S22.0-S22.9 The only codes for separate bones are T1-4.
  11. kimmcelderry@gmail.com

    Wiki T10-11 fracture

    Yes, traumatic.
  12. kimmcelderry@gmail.com

    Wiki T10-11 fracture

    Is there a code for fracture of T10-11? I only see T9-10 or T11-12. Which one is more accurate? Here is what the MD reported: "Thoracic fracture at T10-T11 with three column injury" Thank you
  13. kimmcelderry@gmail.com

    Wiki vertebral fracture care with graft

    For CPT 22325, the coding companion states to separately report any graft 20930-20938. I've tried to report the grafts, but they are always denied as bundled. Specifically, 20937 is not an add-on to 22325. I'm thinking that despite being able to "report" the graft, it is not payable. Anyone...
  14. kimmcelderry@gmail.com

    Wiki Scoliosis fusion

    The MD documents posterior fusion for scoliosis (pediatric) at T3-T5 and L5-S2. He submitted 2 units of 22800 which I know isn't right. Instrumentation is T3-S2. "Spine was decorticated, bone grafted at T3 through T5 and L5 through S2 with autograft" Is this just one unit of 22800? Thank you
  15. kimmcelderry@gmail.com

    Wiki Laminectomy with foraminotomy of S2

    In addition to PSF, the phys states he performed a Ponte osteotomy L5-S1 and a laminectomy, facetectomy, foraminotomy of L5, S1 and S2. I know the 22212 is bundled with 63047 (L5-S1) But what about the S2? "Attention was directed towards the Ponte osteotomies at L5 S1 where there was...
  16. kimmcelderry@gmail.com

    Wiki Cervical osteotomy and fusion help

    The physician describes a Posterior Pedicle Subtraction osteotomy at C7. Also, extracavitary fusion C6-T1. I only see codes for 3 column osteotomies as thoracic or lumbar, same for the extracavitary fusion. Any suggestions? "After the instrumentation, I started C7 pedicle subtraction...
  17. kimmcelderry@gmail.com

    Wiki Help!!! New to spine coding

    My coding would be: One level of PSF is 22612 with 22842 for the instrumentation (looks like 4 segments). The decompressions, per segment, would be 63047, 63048 x2. Then the auto/allografts 20936/20930 (dont bill to medicare products)
  18. kimmcelderry@gmail.com

    Wiki How to properly bill for cpt 20526 bilateral with 1ml of Kenalog and 3ml of lidocaine

    Most payers are wanting 20526 with 50 modifier. Some may still accept/want 2 lines with RT and LT. Kenalog is J3301 (NDC 0000-02293-28) billed in whatever units your provider is giving. 10mg = 1unit. The Lidocaine is typically not billed to insurance.
  19. kimmcelderry@gmail.com

    Wiki PIP Contracture release

    The physician incised the A3 pulley, but contracture remained. So he incised the volar plate and other supporting ligaments to release the joint. Is this 26525? Is the volar plate part of the capsule? I was also thinking 26455. TIA
  20. kimmcelderry@gmail.com

    Wiki Wrist fusion with bone graft

    25810 includes obtaining graft, so it's included. Also, 25810 and 25210 are bundled.
  21. kimmcelderry@gmail.com

    Wiki Stress reaction ICD

    I can't find a code for "Stress reactions" specifically in the feet. Not a fracture, no trauma. Is there a code only for reaction? TIA
  22. kimmcelderry@gmail.com

    Wiki Modifier 22

    Hi there, Occasionally I am asked to append 22 mod to surgical claims. The only way I've found to get additional compensation is by appealing after the claim has processed. I've tried to research a better way, but payers don't normally explain how best to submit supporting documentation...
  23. kimmcelderry@gmail.com

    Wiki Rotator Cuff Repair

    23406 is a Tenotomy
  24. kimmcelderry@gmail.com

    Wiki Finger contracture manipulation

    Thank you so much! Great info.
  25. kimmcelderry@gmail.com

    Wiki Finger contracture manipulation

    No it was dislocated and treated 2 months prior. This is just contracture resulting from that. I have EncoderPro which doesn't give much detail regarding billing.
  26. kimmcelderry@gmail.com

    Wiki Finger contracture manipulation

    My provider manipulated a patient's finger PIP and DIP joints with just a digital block in-office. Would this be billed as unlisted or is it not billable? Thank you. "PREOPERATIVE DIAGNOSIS: Contracture left ring finger PIP joint post dislocation. PROCEDURE: Manipulation PIP and DIP...
  27. kimmcelderry@gmail.com

    Wiki Baker's cyst I&D

    Thanks I am going to try that.
  28. kimmcelderry@gmail.com

    Wiki Medicare and 3rd level facet blocks

    Ok I'll try it! Thanks!
  29. kimmcelderry@gmail.com

    Wiki Baker's cyst I&D

    I can't find a cpt for I/D of a baker's cyst in the same encounter as an arthroscopic meniscectomy (29881) Any ideas? This is not an excision! Please see this portion of the note: Thank you for your help!
  30. kimmcelderry@gmail.com

    Wiki Medicare and 3rd level facet blocks

    Are you getting them paid? I have the same M47.816 dx on all three levels.
  31. kimmcelderry@gmail.com

    Wiki Medicare and 3rd level facet blocks

    Hi there, recently Medicare made it policy to deny 3rd level blocks. The LCD states they can be appealed upon denial, but I'm not sure when/why a 3rd level block would be medically necessary? What are grounds for appeal? Thanks for any help.
  32. kimmcelderry@gmail.com

    Wiki Sacrococcygeal injection

    Thanks for your reply, but this is not an SI joint injection. This is for the sacro-coccygeal joint. There is no laterality.
  33. kimmcelderry@gmail.com

    Wiki Sacrococcygeal injection

    Using fluoro, my doc injected the sacrococcygeal joint with depomedrol/marcaine/contrast and wants to bill 20605. However, this cpt requires RT/LT. Any advice? This is for coccyx pain. TIA!
  34. kimmcelderry@gmail.com

    Wiki Baker's cyst aspiration during other knee procedures

    Would I be able to bill an aspiration done at the same encounter for arthroscopic medial/lat meniscectomies and patella chondroplasty? The provider wants to bill 29880, 29879, 20610-59. Thank you!
  35. kimmcelderry@gmail.com

    Wiki Insurance company refusing to take back overpayment

    Thank you for the responses. The 2 BCBS policies both have the same coordination of benefits. The secondary's allowable is higher, causing overpayments. My supervisor and I agree that we will just adjust the contractual write-offs to match the secondary's payments since they will not take back...
  36. kimmcelderry@gmail.com

    Wiki Insurance company refusing to take back overpayment

    Hi there, I have a patient with 2 BCBS policies. The secondary is a medicare advantage plan and has a higher allowable than the primary, so the claims are all overpaid. I called BCBS and they told me they "cant tell me how to run my books" and couldnt advise on what to do with the...
  37. kimmcelderry@gmail.com

    Wiki 0 day global procedure with E/M

    I asked them to provide me with their policy on this and they said they didn't have it. I will probably appeal since they couldn't provide me with this information and there are no CCI edits on billing these codes together. Thanks!
  38. kimmcelderry@gmail.com

    Wiki 0 day global procedure with E/M

    Hi there, I've written off several e/m visits due to them being bundled with 64455 by BCBS. I want to know if I should be appealing these denials instead. We are billing 99213-25 (verified separate e/m) 64455 xray Jcode BCBS states that even with the 25 mod, the 99213 is bundled with the...
  39. kimmcelderry@gmail.com

    Wiki Telehealth xrays

    Hi there, I work for an ortho clinic so we have our own xray equipment. We normally bill out xrays without a modifier for in-office visits, but with telehealth the patient came in a few days earlier for xrays. We are receiving denials for billing xrays with a TC mod when the pt physically comes...
  40. kimmcelderry@gmail.com

    Wiki flouroscopic guidance denial

    The procedure was for Rt T2, T3, T4, and T5 intercostal nerve blocks. So guess we should only be billing 64421?
  41. kimmcelderry@gmail.com

    Wiki flouroscopic guidance denial

    Thank you so much for your answer, Sharon! It seems so clear to me now lol. I don't see any dictation regarding sedation, but I will keep that in mind in the future.
  42. kimmcelderry@gmail.com

    Wiki flouroscopic guidance denial

    Hi there, I am not very familiar with billing in pain management procedures and we received a denial I am unsure about. We billed in this order: 77002-59 ( all with G58.8) 64420-RT 64421-RT J1020 The denial states "the related or qualifying claim/service was not identified on this claim" I...
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