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  1. antoniamay

    Wiki Skull Based Surgery for Excision of Vestibular Schwannoma

    Hello, I am new to Skull Based Surgery coding and am really confused on these cases. From the research I found I have seen I should be using 61526 instead of 61595 and 61616 for Vestibular Schwannoma's. The physician states the reason he is using 61595 and 61616 is the approach but to me it...
  2. antoniamay

    Wiki Multiple Colonoscopy billing

    Is there a specific denial you are getting?
  3. antoniamay

    Wiki QHIV-86703

    I would contact whoever at your lab is in charge of contracting to see if you can get contracted, then if you get contracted, you can appeal all the claims. Also make sure they are getting your patients to sign financial responsibility forms if you don't so you can bill them when their insurance...
  4. antoniamay

    Wiki Diagnoses for billing the TC of diagnostic tests

    So I will assume this is Medicare? :ROFLMAO:, I only laugh because of the trauma involved in this. So I am not sure your internal policies if you can append a new diagnosis from the interpretation, I am not a radiology coder, but I would think if supporting documentation shows its medically...
  5. antoniamay

    Wiki QHIV-86703

    That sounds like a benefit denial then, the member may not have coverage to out of network labs.
  6. antoniamay

    Wiki JCode for Fluorouracil

    I won't be a ton of help on this but I can say this the correct code is J9190. I noticed this Vial is sold at 2.5g/50ml did you mean 2.5g instead of mg? If you are doing a 50ml injection then you just bill the J9190 - JZ indicating there was no waste from the vial, if you only did a 25mL...
  7. antoniamay

    Wiki QHIV-86703

    What are the DX codes you are using and what is the denial reason you are getting?
  8. antoniamay

    Wiki Multiple Colonoscopy billing

    The LCD A57342 on Medicare states to use modifier 59. I am wondering if that is why they are being denied, or it could be the payer that you are billing has their own policy stating they will only pay for 1 despite the number of lesions? These codes do have an edit that they hit up against as...
  9. antoniamay

    Wiki X2 Relationship Modifer

    I would not think so, but I am just going based on the description and my understanding of Accutane, because sometimes Accutane is successful after the initial treatment and sometimes it needs repeated correct? My thought is X4 is more appropriate since length of time episodic but is focused on...
  10. antoniamay

    Wiki Micorobilology Lab denial

    I assume they are talking about 87800 and 87801. Which in this case it would look like you need to bill both because some are direct probe and some are amplified probe techniques.
  11. antoniamay

    Wiki How to code the following? I get conflicting answers from supervisor

    58100 doesn't appear appropriate to me because its without cervical dilation. So they have not advised you the appropriate code? I still think its going to be the 58558. I wish I was more helpful
  12. antoniamay

    Wiki modifiers needed?

    It won't matter what modifier you append they will deny it always with those codes because its just part of the procedure.
  13. antoniamay

    Wiki modifiers needed?

    Ahh, I see then you will not be able to bill the J7050. According to the CMS Manual System, the fluid used to administer the drug(s) is incidental hydration and is not separately payable. Therefore, you cannot bill for the saline used in a bubble echo. However, you can bill for the...
  14. antoniamay

    Wiki Dx code for mammograms Z12.31

    It appears to be diagnostic because it suggests to code also the inconclusive mammogram R92.2 with the R92.3 as well so at that puts it under abnormal or inconclusive it would probably be denied if billed as screening.
  15. antoniamay

    Wiki How to code the following? I get conflicting answers from supervisor

    This sounds like 58558 to me, but I am not an OB coder. What is the discrepancy of codes you are discussing?
  16. antoniamay

    Wiki modifiers needed?

    https://med.noridianmedicare.com/web/jeb/topics/drugs-biologicals-injections/chemotherapy-and-nonchemotherapy-bundling-and-unbundling-of-services-and-supplies If the patient received it as a means for Hydration it may be payable, but I have not usually seen a patient receiving Saline with an...
  17. antoniamay

    Wiki modifiers needed?

    Why did the patient receive Saline? And what is the Place of service?
  18. antoniamay

    Wiki Acupuncture add-on codes

    So the primary code for 97814 is 97813 (with electrical stim) and the primary code for 97811 is 97810 (without electrical stim). You cannot use an add on code for another code if its not the primary procedure
  19. antoniamay

    Wiki modifiers needed?

    I don't show 37050 is a CPT code
  20. antoniamay

    Wiki Is there a cpt code for a type 1 medialization thyroplasty?

    I am thinking they are probably suggesting 31591
  21. antoniamay

    Wiki Shoulder Hemiarthroplasty converted to Reverse Total Shoulder

    Is there a way to paste in the op note without any patient identifying information? Thanks!
  22. antoniamay

    Wiki Cpt codes 97606 and 15273, 15274

    So the 97606 includes treating the wound, the 15763-64 are for skin grafts so mesh material if its just surgical dressing wouldn't apply to this. I would suggest maybe looking at the other codes in the 97606 series as the wound size is included in the full description. I hope that makes sense.
  23. antoniamay

    Wiki Gender Affirming procedural coding education

    I would look up your payers resources most plans if you google Aetna Gender Affirming Guidelines or BCBS it will give you resources on what they allow and don't allow. I think that different payers set up different rules in this case I would defer to those sites to guide you in some ways.
  24. antoniamay

    Wiki HELP, I'm New.....

    I could write a novel about this. I think the A has its good side and downside and this is the downside. You are basically going to go through your studies again with Practicode or you can get on the job experience, which can be tough but some places do hire people with an A. There are also...
  25. antoniamay

    Wiki Sport Physicals

    Z02.5 is allowed to be a Primary Diagnosis, also I believe CPT assistant says that if the Sports Physical is not done with the yearly well visit exam then you use an office visit CPT as well, usually Lowest MDM on either new or established, so level 2.
  26. antoniamay

    Wiki Assistance with IP Mental Health and Substance abuse with Outpatient and Partial Hospitalization programs

    Hello, I am wondering if anyone can help me understand some things on a job I accepted for an inpatient facility that also has outpatient and partial hospitalization programs as well. Looking to maybe have a phone call or do a zoom meeting or something if possible :)
  27. antoniamay

    Wiki Why was I marked wrong? (Practicode Case ID: OPD7259)

    Susan is correct, the facility will bill for most of that not the ER physician. It looks like this is for an outpatient test so that's where you are off is you are trying to bill facility things. I hope that makes sense :)
  28. antoniamay

    Wiki Medicare Advantage Guidelines for CC Hours

    If you’re in Maryland you’re Jurisdiction J so Novitas would have them on their site! I’m not sure the plans themselves would use different times unless you’re getting a specific denial. https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00081590
  29. antoniamay

    Wiki Medicare Advantage Guidelines for CC Hours

    So just as a general rule all Medicare Plan Sponsors have to at minimum cover what Medicare does, but they each are allowed to cover over and above what Medicare does in order to entice more members to sign up with their plans however that’s usually extra vision or dental coverage or maybe a gym...
  30. antoniamay

    Wiki Size of Complex Closure documentation WITHIN the body of the note

    So this is more of a coding basic, so way back in the very beginning, you may remember we learned that the procedure note or operative report contains 4 sections - The Header, indications for surgery, the detail or body of the procedure, and the findings. As a coder, we should not be selecting...
  31. antoniamay

    Wiki Is code G0463 for Medicare patients only ?

    Its because of the Type of Test you are studying for - Its all Outpatient Hospital Coding with COC. As an outpatient hospital facility, There are two types of emergency departments: Type A - available 24/7 - Visits to a Type A emergency department are billed with 99281-99285 Type B - dedicated...
  32. antoniamay

    Wiki Intercostobrachial Nerve Blocks for Tourniquet Pain and Interscalene Blocks billed at the same time

    I had a coding question I was hoping someone can help me clear up because it’s clear there is not really a ton of guidance online on this procedure available. I am wondering the correct code for Intercostobrachial Nerve Block since it is done in the upper arm I can see either 64415 or 64450...
  33. antoniamay

    Wiki New CPT 92650 for Newborn Hearing screening

    On December 28th it looks like they ruled that 92650 will not be covered under Medicare but did accept the recommended values from the ASHA, AAA, AAN, and AAO-HNS for VEMP (92517, 92518, 92519), AEP, and electrocochleography (ECochG, CPT 92584) testing for Medicaid programs and commercial...
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