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    Wiki Is there always so much WALKING?

    You can actually book for April 2025 right now! Disney only requires a deposit, and its totally refundable. The rates are actually pretty cheap right now, so if you have a couple hundred dollars laying around, you can book the hotel now and if AAPC has it cheaper in October just get a refund!
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    Wiki Is there always so much WALKING?

    I’ve been to Coronado before, and I was more thinking of the actual convention center itself, which it looks like it’s just once central hallway, unless they’re planning on doing something else with it. Caesars Forum is literally double the size of the Coronado meeting space. I was actually...
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    Wiki Scar Revision

    L90.5 wouldn’t meet medical necessity requirements for benign lesion removal codes, but L91.0 should. If the surgeon is revising a scar for cosmetic reasons, insurance won’t cover that.
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    Wiki Harrahs resort fee

    and it’s a discount. When I called on Tuesday to ask if the price from the healthcon website included the resort fee, the rep originally told me it was $45 per day!
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    Wiki Is there always so much WALKING?

    I would love to attend next year in Orlando, but for those who have attended previously…..are we always required to walk 4-5 miles per day at the conference? Everything seemed REALLY spread out.
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    Wiki Short Term Disability

    They certainly can; there is no guarantee, but its certainly possible!
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    Wiki Mass excision with hernia repair?

    My surgeon wants to bill 22901,15734, and 49560 (I know this is a deleted code) for the following documentation: I feel like this documentation really only supports 15734. Help?
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    Wiki Free Nipple Graft with Gynecomastia surgery

    Well, per the AMA it is considered inclusive to bill 15200 with 19318, even if you do free nipple grafting....so by that extension 15200 is acceptable for free nipple grafts.
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    Wiki CDEO Credential

    I found it pretty easy; it touched on a lot of concepts that I harped on at work as a coder. I finished in about 2.5 hours and passed on my first attempt. Only a handful of jobs that I have seen really "recognize" it in the sense that they will increase your pay for it, but I feel like I "use"...
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    Wiki E/M decision making

    E/M coding has been very streamlined as of 2021. It's much easier to calculate MDM. What problems are you having?
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    Question Intermediate Repair Face/Scalp

    Copied directly out of my CPT book: So in other words, if a physician surgeon documents something like " The skin was closed in two layers deep 4-0 PDS" or "small amount of undermining needed to reduce tension", that should be enough to demonstrate intermediate.
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    Wiki Vomer flap AND "linear"palatoplasty?

    Does this sound like 42200 and 42235, or just 42235?
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    Wiki "Bilateral" muscle flaps on same limb?

    Hello everyone, I have a surgeon emailing regarding coding that was done, and I want to have documentation/literature of the correct coding for some things before I reply. fasciocutaneous flaps (15733-15738); in almost every single surgery, my providers "suggest" bilateral fasciocutaneous...
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    Wiki Finding a Job with status "A"

    Here is a list of companies/websites that hire CPC-A's that I send out to my students: These companies/third-party employers hire CPC-A's: Ciox Health The Judge Group CSI Companies Addison Group Wellstar Health System Tenet Health Novant Health Inova Health Catalyst Health Group...
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    Wiki Anatomy Question, as it relates to coding

    Would you/does coding anatomy consider the sacrum a part of the trunk, or a part of the lower extremities? Surgeon created a muscle flap using the gluteal muscle for a 4 year old. The operative not simply says : Surgeon pushed back that it should be coded as a "trunk" muscle flap, which has a...
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    Wiki What is my surgeon referring to?

    1. Did you ask him? Maybe you should discuss his documentation and give feedback? If you are not comfortable, have you asked a manager or supervisor? Documentation is, unfortunately, not part of my job description when it comes to IP cases (when this appears its always in relation to a complex...
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    Wiki What is my surgeon referring to?

    I have a surgeon who does a lot of maxillofacial and craniofacial traumas. When he does these, he almost always lists the recommended primary procedure code as I have no idea what procedure he is trying to communicate to me. So far I have been able to just attach the 22 to a different...
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    Wiki 19364 include nipple graft?

    If the nipple is actually being reconstructed and tattooed from a new piece of skin, then you would use 19350. If the surgeon is just removing the nipple, putting it on ice and then replacing it/grafting it into the DIEP flap, I believe that would be considered a part of the 19364 and not...
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    Wiki Resources for POS restrictions?

    The note does clearly identify that there was a 2x3cm lipoma/tumor found intramuscularly. We also perform MOHs, so we do have the ability to do more complex procedures in a dedicated surgical suite, but the suite does not have its own designation, its still considered part of the office. This...
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    Wiki Resources for POS restrictions?

    I have a provider who performed a 21932 in office, and the claim is denying for inappropriate place of service. I'm sure this is correct, but I just cannot find any specific resource that says you can't perform this procedure in an office setting. If we want to write it off, we have to have...
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    Wiki Split graft considered "closed"?

    I am coding for plastic surgery, but this is technically wound care. Surgeon placed a 22x18cm split-thickness graft over a traumatic, non-healing wound and then attached a wound vac. Is a split-thickness graft that has been meshed considered "closed", or is the wound vac placement considered...
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    Wiki No opportunities for an Edit only based Coder

    You definitely have experience, but you do have to present it the right way. Are you getting interviews? If not, redo your resume so that it highlights your experience. Are you getting interviews? If you're getting interviews but not getting hired, then you need to think about how you talk about...
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    Wiki Does this support a separate E/M charge?

    I'm auditing documentation/reviewing insurance denials to see if they are eligible for appeal. We billed a 99213 for a patient with a diagnosis of HS. Patient was seen 30 days prior and billed for an office visit then, which was paid. This date of service the provider performed ILTAC injections...
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    Wiki 17108 within global period of 17108

    Hello all, I have a denial from Humana for 17108-76 for a port wine stain. This destruction was performed within the global period of the previously performed 17108, and we generally get the code paid with a modifier 76, however today its denying as inclusive. I don't see how billing the exact...
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    Wiki Multiple units same MOH's site?

    I have a situation I have never encountered before. One of my doctors performed a MOH's procedure, and the first stage defect is 5cmx6.5cm. The stage was separated into 32 blocks. If I bill a 17313 and 17315, that will only cover a maximum of 20 blocks. Can I bill multiple lines of 17313 to...
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    Wiki Billing a Nursing Home Discharge and Assisted Living Admission Same Day

    He can bill both, as long as he bills under the appropriate TIN and POS. Then depending on how he gets paid he may or may not actually get paid for both….because the SNF will not get paid for discharge day, only the admitting ALF.
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    Wiki Incentivized Pay increase instead of base pay raise

    If you have that much experience, it’s time to find a new job. Honestly, I’m not even sure if providing you a bonus based on a specific dollar amount is legal. I would imagine even if it is legal, the dollar amount they would choose would be difficult to hit. If it wasn’t, they would just give...
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    Wiki Help with CPT for drainage and debridement of abscess

    Was there necrotic tissue present? Or just devitalized tissue? 11042 would be surgical debridement of necrotic tissue, which includes removing healthy tissue to ensure a clean wound. 97597 is "Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high...
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    Wiki Denial codes PI-B10 and PI-B15

    Some payers do require -59 modifier on 11103, so you can try adding that. The 11102 should also have a -51 modifier attached. In the past we did not need to add -51, however in the past 6 months or so we have seen a sharp increase in denials in my practice where insurance wanted a -51.
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    Wiki Preventive Screening Info Sheet?

    Does anyone have a handout they'd care to share, or a link to a good template, for front desk personnel to use when patients call/ask about their "free" skin cancer screening not being free?
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    Wiki Medicare billing rule too many procedures?

    Kind of. Basically the patients claim history looks something like this (not including modifiers): 06/30/22 11603 13121 07/09/22 11602 13101 17263 07/12/22 17313 13101 07/21/22 17313 13121 08/09/22 17313 12032 08/18/22 17004 11102 09/12/22 17261 11602 13101 The last date of service is...
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    Wiki Medicare billing rule too many procedures?

    I know this rule exists, but for the life of me I can't figure out what its called/how to find it. Basically I have a patient who has come in pretty much every other week from July until September and had some kind of excision or destruction done. One of the claims has 3 lines; a destruction...
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    Wiki CDEO

    I actually took the CDEI prep course through the #freeaapc earlier in the year, but I was way out of my element on that. So I purchased the study guide for the CDEO and just based on using that, plus other relevant experience, I was able to pass the CDEO exam on my first attempt. I am not...
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    Wiki 99441-99443 Help?

    This is a personal question. Messaged a provider via the patient portal, she returned my message by call--did not tell me I would be charged for her calling me--and then billed my insurance. Do the telephonic E/M codes include time spent reviewing medical records prior to the call, etc, or are...
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    Wiki Guidelines for no residual malignancy

    There is no policy—they’re using the fact that the pathology report for the same DOS as the excision shows no malignancy, so they’re saying it’s being billed incorrectly. Since you generally can’t use previous documentation to support your current claim, we need to have some sort of guideline...
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    Wiki Guidelines for no residual malignancy

    The denials are usually generic; “billing errors” or “not supported”. Yes, they are requesting medical records, and the pathology that is done to confirm the clean margins is being sent, which is why they are denying it (since the pathology shows no malignancy), essentially ignoring the...
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    Wiki Guidelines for no residual malignancy

    We have had a recent influx of denials for inappropriate billing for this exact scenario: -Provider takes shave biopsy and pathology comes back as malignant (specifically SCC). -Provider schedules follow-up excision to confirm clean margins. -Claim for follow up excision is denied as...
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    Wiki Mohs closure

    I would check with the individual payer contract. At my practice we usually do not. Maybe a few times a month I get a denial where the repair has denied as inclusive and I send it out again with the -51, but we process over 10,000 claims per month, so its really not that frequent.
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    Wiki Modifier 59 causing claim to deny?

    This is what/how it was billed: 17311 17312 13131 11604-59 11604-59-76 12034 13121 They are claiming the first 11604 should not have the -modifer 59 attached (this is per two different reps) the denials are "procedure modifier was invalid on the DOS".
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    Wiki Modifier 59 causing claim to deny?

    I have always thought that if a modifier -59 got added onto a claim accidentally that it wouldn't affect payment. I personally have been looking at claims for over seven years and have never seen a payer deny a line simply because there was a modifier -59 attached. However we are receiving a...
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    Wiki Experience with eAssist Dental Solutions?

    I am looking for a per diem/flexible part time job for extra spending money, to boost my savings, etc. I already have a full time job so my hours are fairly limited. I came across eAssist Dental Solutions on a career website (I think maybe Indeed?) and I was wondering if anyone has had any...
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    Wiki Can you be reimbursed for dressings in dermatology?

    L97/“chronic ulcer”, or anything from chapter 19 “Injury, poisoning and certain other consequences of external causes” depending on what the notes say.
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    Wiki Procedure Documentation Guidelines

    This provider in particular is A++ with most of his documentation,, so he personally would not be on pre-pay review, which is part of the problem. A couple of our providers are on pre-pay review with some insurance companies...but those providers also don't second-guess me when I tell them "fix...
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    Wiki Advice on getting into entry level position

    How does your resume look? e.g. if you're applying as a surgery scheduler, do you have on your resume that you were responsible for scheduling appointments for x number of clinics or x number of doctors, or scheduled x number of surgeries per day? Do you have "customer service" skills listed...
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    Wiki Procedure Documentation Guidelines

    Yes! We include number of lesions for ILTAC injections, and its really such a small amount of additional work the pushback doesn't make sense at all. In our practice, the MA's do act as scribes, but for our providers with seniority (this provider in question owned the practice up until about 6...
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    Wiki Procedure Documentation Guidelines

    Can anyone direct me to either general or specific documentation guidelines for cryotherapy that state that the number of lesions treated must be notated? I have a very petty MA who is fighting me on including the number of lesions treated in the actual procedure note because she feels like its...
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    Wiki 17312 MUE edits

    17312 has an MUE of 4 units. Any units after 4, you would want to use 17315. So it would look like 17311 17312 x4 17315 x3
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    Wiki CPC-A Looking For Full Time Remote Position

    Hi Rebecca, I just saw this on my Linkedin feed..... https://www.linkedin.com/jobs/view/medical-coder-cpc-a-at-the-judge-group-2959648015/
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    Wiki Telehealth Billing Help Needed

    You may be billing incorrectly. Per the AMA, you should be billing the appropriate E/M code with POS 11 and a modifier 95, and the appropriate test (or a nurse visit, depending on the test performed). https://www.ama-assn.org/system/files/covid-19-coding-advice.pdf Page 6 is for dealing with...
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    Wiki Billing Question for POS 11

    What services are you trying to bill? For services billed under a POS 11, you wouldn't need a referring provider on the claim; you can bill it out like any normal office visit claim.
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