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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 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 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
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    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
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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 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
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    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?

    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
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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 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."
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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
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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
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    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 Bladder Biopsy Question

    How would you code the following? 52204 or 52235? The site had been previously resected. He recently underwent cystoscopy and the center of the previous resection appeared to be somewhat hyperemic now. He had one lesion that definitely appeared superficial. I thought I could take a couple of...
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    Wiki Vestibule injections with Exparel?

    Diagnosis is urethral pain, vaginal pain.. I was thinking maybe 64430? Or maybe the muscle trigger point codes? 20552/20553? Thanks for your thoughts!
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    Wiki Intraoperative Scrotal Exam?

    Not sure how to code this. Physician performed an intraoperative exam. Urologist was called to OR after left hemiscrotum was noted to be enlarged and firm. Pt already under anesthesia undergoing lap hernia repair. Findings: Left hemiscrotal exam shows either a large spermatocele or epididymal...
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    Wiki PCNL?

    Hi! Is this a PCNL? I'm being thrown off by the wording and need a second opinion. 50080? INDICATIONS FOR PROCEDURE: The patient previously presented with a large left renal stone and underwent left percutaneous nephrolithotomy and presented today for a second-look flexible nephroscopy with...
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    Wiki Transperineal Anastomosis Biopsy Post Radical Prostatectomy?

    How would you code for a transperineal biopsy of a possible prostate cancer recurrence post radical prostatectomy? POSTOPERATIVE DIAGNOSIS: History of prostate cancer with questionable recurrence at an anastomosis (post radical prostatectomy in 1996) PROCEDURE PERFORMED: Cystoscopy and...
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    Wiki Fulguration of Bleeding Fascia at SP Tube Site?

    At first I was thinking 51710 and 52332-50 but it seems like more work was involved to control the bleeding of the SP tube site. Thoughts? Thanks!! FINDINGS: Mildly brisk venous bleeding from granulation tissue of suprapubic tube tract at the level of the fascia. Bilateral ureteral stents were...
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    Wiki Ureteral Reimplant into Dome with Psoas Stitch - Open?

    Hi, how would you code the following? I was thinking 50650 but I'm not sure the bladder cuff was dissected here or how to code for the reimplant since it was performed open and not laparoscopically? Thanks for your help! PROCEDURE PERFORMED: 1. Left distal ureterectomy. 2. Ureteroscopy with...
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    Wiki Female urethral meatoplasty?

    Hi, would you bill the following using code 53450? The provider suggested 53430 but I think 53450 might be more appropriate. Thanks! POSTOPERATIVE DIAGNOSIS: Urethral meatal stenosis. PROCEDURE PERFORMED: Formal urethral meatoplasty So, she received appropriate preoperative antibiotics in the...
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    Wiki Open Ureteral Stent Removal through Bladder?

    Hi, this patient underwent an open cystolithotomy (51050) and I'm wondering if I need to bill separately for the ureteral stent removal that was performed during the procedure? The note states the stent was delivered out of the bladder through the incision and I'm not sure how I would code that...
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    Wiki Ureteral Dilation with Scope?

    Is it appropriate to bill 52344 for a ureteral dilation done with a scope rather than a balloon, incision, etc? The provider states that a stenotic area of the ureter was dilated but only the scope was used. The provider states in his note that he "advanced the ureteroscope into the ureter and...
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    Wiki Separate Op Note for Cath Placement?

    Question.. I code for a urologist and he came in at the end of the surgery below to place a foley catheter. The note below was dictated by the primary surgeon (not my urologist) and states "Please see urologist's operative note" for description of the cath placement. My provider wants to bill...
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    Wiki Discontinued Vasectomy?

    This was performed in an ASC but I am billing for the physician. Would modifier 52 be appropriate here? Thanks. POSTOPERATIVE DIAGNOSES: 1. Fertile male. 2. Morbid obesity. PROCEDURE PERFORMED: Attempted vasectomy. ANESTHESIA: Local. DETAILS OF PROCEDURE: This gentleman presented to us and was...
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    Wiki 50548 and adrenalectomy?

    I know the adrenalectomy would be included in 50545, but is it appropriate to report separately with 50548? Thanks!! Indications: procedure for Malignant neoplasm of left renal pelvis Procedure Details: Patient was properly identified and brought back to the operating suite. He was placed...
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    Wiki Laparoscopic left nephroureterectomy & transurethral incision of left ureteral orifice?

    Hi! How would you code this? Thanks! POSTOPERATIVE DIAGNOSIS: 1. Obstructing distal left ureteral mass with associated lymphadenopathy consistent with high-grade urothelial carcinoma. 2. Atrophic left kidney. PROCEDURE PERFORMED: Hand assisted laparoscopic left nephroureterectomy...
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    Wiki Wound Closure, Irrigation and Drain Placement?

    Hi! How would you code this? I suggested 12044 for the intermediate closure but is there a way for the physician to be paid for the drain placement/irrigation? Another physician performed the initial debridement of the Fournier's gangrene. OP note below. Thanks!!
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    Wiki Excision Ulcerative Penoscrotal Lesion?

    Hi, how would you code this? Thanks!! POSTOPERATIVE DIAGNOSES: 1. Scrotal lesion suspicious for squamous cell carcinoma. 2. History of squamous cell carcinoma of the penis. 3. Neurogenic bladder with urinary incontinence managed with chronic condom catheter. PROCEDURE PERFORMED: Excision of 4...
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    Wiki Removal of Appendix Testis and Orchiopexy?

    Hi! How would you code this? I was thinking 54640 for the Orchiopexy, but wasn't sure if the removal of appendix testis would be included in this? Thanks!! POSTOPERATIVE DIAGNOSIS: Intermittent testicular torsion. PROCEDURE PERFORMED: Prophylactic bilateral orchiectomy, scrotal approach...
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    Wiki PCNL w/ Dilation of Ureteral Stricture?

    Hi! This patient is status post left PCN placement and has a left ureteral stone and left ureteral stricture. At first I thought this would be 50080 and possibly 50575, but need some help. The provider states "proceedure performed" is a left renal endoscopy with left ureteroscpy with holium...
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    Wiki SP Tube Site Polyp Removal

    Hi! How would you code for the polyp removal? Thanks!! POSTOPERATIVE DIAGNOSIS: SP tube polyp. PROCEDURE PERFORMED: Excision of SP tube polyp. ANESTHESIA: MAC. DETAILS OF PROCEDURE: The patient was prepped and draped in standard manner using MAC anesthesia. At this time, we removed the old...
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    Wiki Penile Lesion 54060 or 11420-11426?

    Hi! Would 54060 be appropriate here based on the method of excision (electrocautery and then cauterized the lesion) and location of the lesion? Or should I query the provider on the size of the lesion and bill 11420-11426? Pathology came back as seborrheic keratosis (benign). Thanks for your...
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    Wiki Bladder Bx, Fulguration, Hydrodistention and Instillation?

    Hi! How would you code the following: POSTOPERATIVE DIAGNOSIS: Erythema and history of stress incontinence. PROCEDURE PERFORMED: Cysto, bladder biopsy, fulguration, hydrodistention, and heparin instillation. ANESTHESIA: General. DETAILS OF PROCEDURE: The scope was placed in the bladder without...
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    Wiki Hydrocele Drainage and Inguinal Orchiectomy?

    Would I bill for both the drainage of the hydrocele and the orchiectomy or just the orchiectomy? Thanks!! PROCEDURES PERFORMED: 1. Left scrotal hydrocelectomy and then aborted followed by. 2. Left inguinal orchiectomy. ANESTHESIA: General. DETAILS OF PROCEDURE: This 47-year-old who was referred...
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    Wiki Bill for Dilation or Complex Cath Placement?

    In a case like this when both urethral dilation and catheter placement is performed, is it most correct to bill for the dilation or for a complex catheter placement? I always question myself when choosing which to bill. Thanks!! POSTOPERATIVE DIAGNOSIS: Urethral stricture disease. PROCEDURE...
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    Wiki 51702 or 51703 in ER?

    Hi! How would you code the following? The provider wants to bill 51703 but this note says he did not have any difficulty. Would this be enough to qualify as an E/M? He was discharged from the hospital on 11/26 then returned to the ER next day for inability to void. Thanks! DATE OF CONSULTATION...
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    Wiki Laparoscopic Nephroureterectomy Converted to Exploratory Laparotomy?

    Hi, how would you code this? I was thinking 49000 and 58662? Or is it more accurate to code the discontinuation of the open nephroureterectomy? Thanks!! POSTOPERATIVE DIAGNOSIS: Right ureteral stricture, atrophic right kidney. PROCEDURE PERFORMED: Exploratory laparotomy. ANESTHESIA: General...
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    Wiki IPP Removed and Replaced?

    Does it seem to you like the original pump was only repositioned? The provider wants to bill 54410 but I'm thinking the original pump was not replaced? I'm just not 100% sure and I don't want to assign modifier -52 in error. Thanks! POSTOPERATIVE DIAGNOSIS: Malfunctioning genitourinary penile...
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