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    Wiki Urethrocutaneous Fistula Due to Piercing?

    Oh me too, no worries lol. You're welcome.
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    Wiki Urethrocutaneous Fistula Due to Piercing?

    No answer, but I ended up using 54326 for this procedure. I felt like 54326 was more appropriate for this one since there was a urethroplasty involved. I used 53520 for the initial fistula closure, note below: Findings: Approximately 1 centimeter fistula that was closed in 2 layers Drains: 20...
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    Wiki Coding 76942 and 76872

    If you don't own the ultrasound equipment and use -26 on the 76872, would 76942 be the best code to use instead?
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    Wiki APP Credit for Shared Visits?

    Late follow up question, but is there a certain percentage that should be assigned to the APPs? Or is this practice specific? Some have suggested 85% to APP and 15% to the MD for shared visits paid at 100%. Thoughts?
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    Wiki Shared/Split Visits and Commercial Payers?

    Thank you for your reply! The issue is I haven't been able to find any information on some carrier websites/manuals. Some don't have a split/shared visit policy and don't list modifier FS on their modifier reference policy. I've only been able to find anything for commercial UHC. Since it's a...
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    Wiki Shared/Split Visits and Commercial Payers?

    Which commercial carriers accept shared/split inpatient visits? I've been trying to make a list. I see UHC does. They have it listed as a split/shared visit policy and they list modifier FS on their modifier reference policy. Any other carriers accept this? I see that BCBS of Minnesota accepts...
    • tori.a
    • Thread
    • Replies: 4
    • Forum: E/M
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    Wiki Hospital Shared Visit Language Template

    Does anyone have a language template for their docs to use when documenting MDM for a shared hospital visit? Thanks for the help!
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    Wiki Incident-To

    Does anyone have a list of payers that allow for "incident-to" billing? I'm trying to compile a list of commercial and Medicare advantage plans that accept the billing practice. Thanks!
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    Wiki Urethrocutaneous Fistula Due to Piercing?

    I would code this as 54326 rather than 53520, but I'm wondering your thoughts since the diagnosis is a fistula due to a piercing rather than hypospadias. I still feel the 54326 most accurately represents what was done. Thanks! Indication: history of distal urethral cutaneous fistula secondary...
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    Wiki Dx Clot Retention?

    I've been using R31.0 and R33.8 but I'm wondering if there is a better way to represent this diagnosis? Thanks!
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    Wiki APP Credit for Shared Visits?

    Thank you very much for your detailed answer! Very helpful.
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    Wiki One Channel Urodynamics using EasyPro1.. 51728-52?

    ANSWERED: Single channel CMG = 51725 per device rep!
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    Wiki Antegrade Pyelogram w/ PCNL?

    Now that the descriptions for 50080/50081 include "imaging guidance," does this mean an antegrade pyelogram would not be separately billable? Or does it refer more to fluroscopy, for example? Thanks!
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    Wiki APP Credit for Shared Visits?

    If billing under the physician for a shared hospital visit, how does the APP get credit for performing part of the E/M service? I know it only gets billed once, under the physician in this case and with an FS modifier, but within the practice how would the APP get credit as well?
    • tori.a
    • Thread
    • Replies: 4
    • Forum: E/M
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    Wiki One Channel Urodynamics using EasyPro1.. 51728-52?

    Hi all, one of my urologists used the EasyPro1 device to perform one channel urodynamics for a patient.. he says when he was trained on the device he was told to bill 51728-52. I can't seem to find any info on this. I've read that 51728-52 is billed when using a penile cuff but that is not the...
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    Wiki Category 2: Independent interpretation of tests - new 2021 documentation criteria

    What if the ortho ordered the X-ray? Or rather, gave the patient a requisition to go get an Xray done at an outside facility and did not bill for the xray. Could they still get credit for their independent interpretation of the images?
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    Wiki Undiagnosed new problem with uncertain prognosis?

    Undiagnosed new problem with uncertain prognosis: When does a problem go from being new to chronic? For example, patient has an elevated PSA at their new patient appointment (new problem), some tests are ordered, then they follow up in one month. Could we use "undiagnosed new problem" again...
    • tori.a
    • Thread
    • Replies: 1
    • Forum: E/M
  18. T

    Wiki Independent Interpretation?

    Independent Interpretation: If my urologist orders the patient to go for a CT scan (at an independent imaging facility) and then reviews the images and interprets them, can they get credit towards the MDM for their independent interpretation? Some say no because my doc ordered it, but others say...
    • tori.a
    • Thread
    • Replies: 1
    • Forum: E/M
  19. T

    Wiki Independent Interpretation 2023

    Perfect, thank you so much!
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    Wiki Independent Interpretation 2023

    To follow up on this, what if the provider reviews the images and states "mild right hydronephrosis" as their interpretation but also states that they also reviewed the report. Could their interpretation still be counted even though they also reviewed the report? (Obviously wouldn't count both...
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    Wiki Urinary Frequency MDM Problem Type?

    Thank you so much for the reply! That helps a lot. What about severe hydronephrosis with no known cause yet? Would this be considered an acute illness with systemic symptoms? I never see any urology based MDM guidance so I appreciate you.
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    Wiki MDM Problem Type for Hydronephrosis?

    Severe hydronephrosis, unknown cause. Would this be considered an acute illness with systemic symptoms?
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    Wiki Modifier 25 Changes?

    I can't thank you enough for your reply here. So detailed and helpful, I reference it often when I need a reminder. Thanks!
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    Wiki Urinary Frequency MDM Problem Type?

    Patient presents for urinary frequency for years-- would this be considered a stable, chronic illness on the MDM table? Also has nocturia and occasional dysuria. Thanks! Pt. presents for eval. of urinary frequency for years. Nocturia x3. However, when she wears her CPAP, it goes down to 0-1...
    • tori.a
    • Thread
    • Replies: 3
    • Forum: E/M
  25. T

    Wiki 57287 or 57288?

    Struggling between 57287 and 57288.. Surgeon lists this as a SPARC under "procedure performed" but it kind of seems like he tightened the existing sling? Thoughts? Thanks The patient had significant previous surgery, pelvic adhesions and vaginal adhesions. We opened up the vagina and indeed...
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    Wiki Cystotomy for Bladder Tumor Resection?

    Leaning towards unlisted code but not sure what to benchmark to? 51020? Also, would the lymphadenectomy be included? 38770? Any suggestions appreciated! Procedures Panel 1 Procedures: RIGHT URETERAL EXPLORATION (R) CYSTOTOMY WITH OPEN REMOVAL 5 CM BLADDER TUMOR RIGHT PELVIC LYMPHADENECTOMY...
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    Wiki Pessary Cleaning Visit?

    Thank you so much for your detailed answer! This is really helpful.
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    Wiki Pessary Cleaning Visit MDM?

    Thank you so much! I agree completely-- this is the answer I gave them. It definitely varies case to case but without any other complaints/issues I think a level 3 (at most) would be appropriate.
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    Wiki MDM When Not a Candidate for Treatment?

    Thank you all! It doesn't seem the provider documented his consideration in my example.. He really just documented the reasons why he isn't going to treat them.
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    Wiki Pessary Cleaning Visit?

    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...
    • tori.a
    • Thread
    • Replies: 2
    • Forum: E/M
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    Wiki Hydrocelectomy.. Not Excised?

    How to bill for a "Lord's procedure" where the hydrocele sac is folded in on itself and sutured without total excision? A right transverse hemiscrotal incision was then made and dissection carried through subcutaneous tissue until the tunica vaginalis was incised. The hydrocele fluid was then...
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    Wiki 52000 or 52310-52?

    Cystoscopy performed, Bladder: No trabeculation. No tumors. Normal mucosa. Two small stones adherent to prior TUR sites along the posterior wall.. No evidence of cystitis Notes: Grasping forceps were passed and 2 small bladder stones were freed from the posterior bladder wall...
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    Wiki MDM When Not a Candidate for Treatment?

    Urologist called to see patient for renal stone.. patient has a high number of comorbidities so provider decides patient is not a candidate for treatment of the stone. This patient's problems are addressed, but due to the high risk, treatment is considered and ultimately decided against. How...
    • tori.a
    • Thread
    • Replies: 4
    • Forum: E/M
  34. T

    Wiki Debridement of necrotic tissue for Fournier Gangrene.

    I would suggest 11004 since it includes muscle/fascia debridement and is the most accurate code for your case and specifically Fournier Gangrene. 11004: Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum
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    Wiki Modifier 25 Changes?

    I have a follow up question to this. An example, really. What would you say to my example of a hospital based new patient evaluation with the decision to perform a ureteroscopy on the same day due to intractable pain? What would need to be documented in order to be paid for the E/M in addition...
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    Wiki Modifier 25 Changes?

    Thanks for the reply! We're being told that Noridian is conducting a nationwide audit of the use of modifier 25 and that the only criteria they provided was "unrelated" so it has caused quite a stir. But what you stated there, "The E/M service doesn't have to be 'completely' unrelated to the...
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    Wiki Modifier 25 Changes?

    As of 1/1/2022 the NCCI updated its definition of modifier 25 to specify that the E/M service must not only be separately identifiable and above and beyond what's included in the procedure, but also "unrelated." Our urologists are now being told they cannot bill a hospital consult, for example...
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    Wiki Modifier 25

    My question regarding this definition of modifier 25 is on page 15 where it states "The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately...
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    Wiki Observation/Inpatient Codes for 2023?

    As of right now, if the patient's insurance is Medicare or follows Medicare guidelines, do not use the 99221-99223, 99231-99233 for patients under Observation unless you are the admitting provider. Medicare still considers Observation codes to be billed by the admitting physician only. So...
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    Wiki Observation/Inpatient Codes for 2023?

    Per Maggie Mac, we are to refer to the CMS Federal Register: Per the Federal Register (attached), see page 528 which states that CMS is not changing their billing guidance for observation care when multiple providers see a patient. Therefore, per this guidance, the consultation provided by the...
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    Wiki Bladder Tumor Biopsied, Not Resected?

    Would you code this as 52204? "The tumor was in a very difficult spot to reach. Using cold cup biopsy forcep the tumor was tjhen biopsied. It was approx. 7-10 millimeters in size. Hemostasis achieved with the Bugbee electrocautery."
  42. T

    Wiki Observation/Inpatient Codes for 2023?

    Thanks! Yes maybe CPT will say it's allowed to use the new merged codes but so many payers follow Medicare guidelines it'll be very limited. Thanks for your reply!
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    Wiki Needle Aspiration of Urethral Diverticulum?

    I was thinking 53240-52 but would love your opinion! Thanks. "The diverticulum was gently compressed and there appeared to be small amount of cloudy discharge within the urethra. With more pressure on the diverticulum, additional fluid was not able to be expressed. The cystoscope was then...
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    Wiki Transitional Care Unit/Rehab in Hospital?

    I code for urologists, if they see a patient who has been discharged from inpatient status but is residing in the transitional care/rehab unit IN the hospital, how would we bill? This is new to me, my initial thought was that this would be considered inpatient rehab and we would use inpatient...
    • tori.a
    • Thread
    • Replies: 0
    • Forum: E/M
  45. T

    Wiki Observation/Inpatient Codes for 2023?

    Hi, thanks for the reply. I've read the AMA guidelines but they don't specify if the new merged codes (99221-99223, 99231-99233) can be used by a provider who is not the admitting physician. I did receive an answer from Maggie Mac who stated: Per the CMS Federal Register, see page 528 which...
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    Wiki Observation/Inpatient Codes for 2023?

    I desperately need clarification on the new initial/observation care codes for 2023. Now that the observation codes are being merged with the initial inpatient hospital codes, do consulting/specialist physicians still have to use the office/outpatient codes when they see a patient in the...
    • tori.a
    • Thread
    • Replies: 17
    • Forum: E/M
  47. T

    Wiki Vaporization of Prostate?

    My initial thought was to bill this with 52630 but it's throwing me off that the note states "No tissue was taken." I'm thinking maybe the doc meant no tissue was sent to pathology and there were no "chips" because he used electrocautery, but what do you think? PROCEDURES PERFORMED: Cysto...
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    Wiki Cpt code for removing a suprapubic catheter

    What would you benchmark the unlisted code to? I have a case where the tube went through a piece of small bowel during another surgery, Urologist came in to remove it. Small incision was made, general surgery dissected bowel off the bladder, then the suprapubic tube was removed and the opening...
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    Wiki Cysto w/ passive dilation

    Hi! Found this article that states 52281 would be the more accurate code compared to 52000. https://www.aapc.com/codes/coding-newsletters/my-urology-coding-alert/readerquestionyesyoucanreport52281evenwithoutusingdilators-159859-article
  50. T

    Wiki Bladder Biopsy Question

    That's what I was leaning towards as well. Just wasn't sure since he fulgurated the whole area. Thank you so much!
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