Search results

  1. S

    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.
  2. S

    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?
  3. S

    Wiki Vomer flap AND "linear"palatoplasty?

    Does this sound like 42200 and 42235, or just 42235?
  4. S

    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...
  5. S

    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...
  6. S

    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...
  7. S

    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...
  8. S

    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...
  9. S

    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...
  10. S

    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...
  11. S

    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...
  12. S

    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?
  13. S

    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...
  14. S

    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...
  15. S

    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...
  16. S

    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...
  17. S

    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...
  18. S

    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...
  19. S

    Wiki Modifier for 2 different levels of providers performing 2 procedures same day?

    Hey everyone, One of my providers has recently begun to "split" his procedures--he performs the actual MOHs and then brings in one of his PAs to close while he either starts another procedure on a different patient or sees other patients in the office. How would we bill this? Just two separate...
  20. S

    Wiki Anatomical Face map?

    Hey everyone, I have a provider who performed a MOHs on a patient in early December and based on the photos of the site, it is very clearly the face (the site is on the temple), however, he marked it as "preauricular" on our internal MOHs documentation, in the chart, and on the pathology...
  21. S

    Wiki Removing the "A"

    So I have been working as a coder since October of 2019 when I passed my exam, however, because my position previous to my current one was a "full revenue cycle" position (meaning I did coding, billing, A/R, and payment posting) my supervisor at the time did not feel comfortable vouching that I...
  22. S

    Wiki BCBS Denials

    I posted this in the derm forum but no one could figure it out, meanwhile, we are still getting denials! Our practice is located in FL, and FL Blue is denying malignant excision codes (11600-06, 11620-26, and 11640-46) specifically when we are removing basal cell carcinoma. Their denial reason...
  23. S

    Wiki How to decipher between low/moderate MDM

    I have a particular provider who is not a huge fan of documentation, and generally relies on his diagnoses and/or his prescriptions to justify billing a 99204/14 vs the 99203/13. According to all of the training he (and our other providers) have been given, anything Rx is going to fall under a...
  24. S

    Wiki BCBS denying malignant excisions as benign?

    We have recently recieved an influx of denials on malignant excisions for basal cell carcinoma due to the fact that --according to BCBS-- BCC is considered benign "because it is unlikely to metastasize". There is a whole slew of things wrong with this statement, and with the implications on...
  25. S

    Wiki Multiple Procedures...

    One of my providers was initially performing a malignant excision of an SCC on the patient's shoulder. This SCC also happened to be located on top of a large mass (slightly larger than a softball), which turned out to be a lipoma. Of course, once the excision was done the lipoma started leaking...
  26. S

    Wiki New Patient Office Visit Denials?

    Hello, I work for a dermatology office, and we are seeing a LOT of denials for new patient office visits when they are billed with *any* procedure--biopsy, premalignant destruction, malignant destruction, benign destruction....doesn't matter. It does seem to only be an issue when there are only...
  27. S

    Wiki Mohs and 88331 performed on same DOS

    Hello all, I have one provider that I bill for who has a bad habit of billing 88331 as a separate encounter on the same day he does a Mohs surgery. Of course, it’s never paid because the 88331 is inclusive of Mohs. My question is this: if the provider is using it pre-operatively to confirm...
  28. S

    Wiki Add ons denying as bundled

    We’ve recently been getting a lot of add on codes denied from MA and Medicare plans when they are billed with 17110. Examples: 99203-25: pays 17110: pays 17000-XS: pays 17003 x12: denied as unbundled/included in previous payment or 99203-25: pays 17110: pays 17004-XS: pays 11102-XS: pays...
  29. S

    Wiki The Great Modifier 59

    I’m newly working in dermatology, so I just want to make sure I have this correct; Frequently our providers will perform premalignant destructions (17000-17004), benign destructions (17100 & 17111) and tangential/shave biopsies (11102 & 11103) in the same visit (along with an E/M code). Along...
  30. S

    Wiki Realistic Expectations

    Hello! Just looking for a little bit of input here, if I'm being unrealistic or my manager is. I bill for a series of LTC facilities. Currently, we have +/-750 residents across 20 facilities with some type of Medicare/Medicaid. In other positions I have been in, anywhere from 95%-98% QA (aka...
  31. S

    Wiki Problems with Practicode?

    This morning I tried to log in to Practicode and this is what I'm getting. My modules never load! Anyone else having this problem?
Top