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  1. K

    Wiki SBRT management and treatmetn

    A patient had SBRT treatment to two distinct and separate areas. He had the right lung treated 4/18, 4/20, 4/24, and 4/26/2023 (77435) evaluated 4/24/2023 and then the left lung 4/17, 4/19,4/21,4/25,4/27/2023 (77435) evaluated 4/17/2023, the documentation supports the right and left lung on...
  2. K

    Wiki NSCL carcinoma w/large cell Neuroendocrine features (pathology)

    Would this be considered NSCL cancer (C34.12), large cell Neuroendocrine (C7A.090) or other malignant neuroendocrine (C7A.8) The physician's dictation states Large Cell Neuroendocrine but he is using the lung code of C34.12. I'm waiting for a response from him but thought that I'd post the...
  3. K

    Wiki Need lymphoma expert!

    He will be treating the soft tissue, marginal zone b-Cell lymphoma. Treatment will be to that area, soft tissue of the thoracic spine. I agree he still has the follicular but we will be directing treatment to the soft tissue of the lower thoracic spine, MZL. Would it be the NHL of the extra...
  4. K

    Wiki RNA versus DNA

    If the physician states RNA positive for a cervical cancer patient, may I use R87.820 "HPV DNA test positive"? Her dictation states RNA positive and the pathology supports RNA positive. If not, what is the correct code?
  5. K

    Wiki Need lymphoma expert!

    I am hoping for a lymphoma expert.... Dictation: Patient was diagnosed with a follicular lymphoma in the summer 2021. He subsequently underwent palliative chemotherapy with Bendamustine and Rituxan which was completed in January of this year. He tolerated this treatment with no significant...
  6. K

    Wiki 77427

    I bill after the 5th fraction is completed. If the patient starts on 5/1/2022, the the first date of 77427 is 5/1/2022 (5/1, 5/2, 5/3, 5/4, 5/5/2022), charge is billed. Hope this helps
  7. K

    Wiki Radiationn Oncology: CPT 77435 bill for incomplete SBRT course of treatment?

    You can bill the 77435 for 3 fractions out of a planned series of 5. The same rule would apply as you can bill 77427 for the final 3 fractions, as in a 28 fraction course of treatment
  8. K

    Wiki G6017 NOT COVERED BY NC MEDICAID

    Where are you billing from? The professional component (OP facility) for respiratory gating/tracking, G6017-26 is the correct code for intra-fraction localization/tracking target or patient motion during RT. Some payers will accept 77387-26 (not Medicare).
  9. K

    Wiki R87.820 for RNA+

    Thanks you for the response, it is documented in the record. She has high-risk HPV positive by RNA ISH. I guess I'm confused because of the descriptor stating DNA?
  10. K

    Wiki R87.820 for RNA+

    May I use R87.820 HPV DNA test positive for an RNA test positive for a cervical cancer patient?
  11. K

    Wiki Multiple Disciplinary Conference

    I'm reading in the MDC guidelines that the physician must see the patient prior to the MDC in order to bill the appropriate E/M code? If he sees the patient for the first time at the MDC, is this a nonbillable service? Reporting participants shall have performed face-to-face evaluations or...
  12. K

    Wiki MDC...again

    I'm reading in the MDC guidelines that the physician must see the patient prior to the MDC in order to bill the appropriate E/M code? If he sees the patient for the first time at the MDC, is this a nonbillable service? Reporting participants shall have performed face-to-face evaluations or...
  13. K

    Wiki prostate recurrence after prostatectomy

    I know I read this information but can't remember. We have a patient that had prostatectomy, and now rising PSA after radiation. Does this get coded as an active prostate C61, R97.21. Z79.90. I think I read that it is treated as active disease.
  14. K

    Wiki Metastatic disease versus recurrent endometrial

    I have a patient treated with radiation 2019 for endometrial cancer. She was s/p TLH/BSO at that time and is back and per the physician with: Recurrent endometrial adenocarcinoma to the vaginal cuff (initial diagnosis 01/2021: stage IA, no myometrial invasion, grade 1) Is this a metastatic...
  15. K

    Wiki Covid testing

    I get it! Much appreciated!
  16. K

    Wiki Covid testing

    is the secondary code necessary? The physicians document doesn’t indicate “suspected, only testing before Laryngoscopy.
  17. K

    Wiki Covid testing

    Patient is presenting for scheduled office visit with scope... physician wants patient tested for covid prior to procedure.. we are an OP facility, radiation oncology.. what is the correct icd10 code to support testing.. Z01.818 (facility states to use) or Z11.59. Thanks for all help.
  18. K

    Wiki Recurrent versus Metastastes

    Thanks! Thanks.
  19. K

    Wiki Recurrent versus Metastastes

    First off, I do know the difference between local recurrence and distant recurrence. We have a patient that had treatment for supraglottic cancer, 2012, treated and eradicated. The patient returns with a mediastinal mass, no biopsy, no pathology. The doctor is stating 'recurrent head and neck...
  20. K

    Wiki Prophylactic radiation therapy

    PCI/Hetero bone We are having difficulties with the proper ICD 10 coding for prophylactic radiation therapy. We have two different scenerios: 1) if patient is having prophylactic brain therapy due to lung cancer Z41.8 and 2) prophylactic radiation to prevent heterotopic ossification following a...
  21. K

    Wiki CPT 77280 bundled with 77301

    77014 has already been bundled into 77280- 77290; neither code now exists as a billable entity with IMRT 77301. Regarding the 77280, if done as a preport/verification simulation, prior to starting the actual treatment, it is billable. 77280-77290 (initial set up) is considered bundled if used...
  22. K

    Wiki Z51.11 - to drop or not to drop...

    Z51. I read guidelines that state "when the purpose of the encounter is to deliver antineoplastic chemotherapy" then the Z51.11 is the primary diagnosis. You should assign secondary diagnosis codes for the cancer and for any complications that result during that encounter from the chemo...
  23. K

    Wiki Coding w/o a pathology

    Patient referred to our oncologist with a solitary pulmonary nodule, no pathology. The physician has entered a cancer diagnosis into the patient's EMR. She states that this is a clinical diagnosis based on her findings and patient history. I have advised her against this in the event that...
    • KMayercsik
    • Thread
    • diagnosis diagnosis coding medical records request pathology patient
    • Replies: 6
    • Forum: Diagnosis Coding
  24. K

    Wiki Credentialing of new provider/incident to.

    What are the rules for using a new provider, not yet credentialed with Medicare. Also, can you use a locum tenen for NP's and incident to billing?
  25. K

    Wiki Low Dose CT for lung cancer screening, S8032

    Can anyone tell me anything about this code? I pulled up the NCD effective 2/5/15, but is the S code billable to Medicare/Medicaid and private insurers? I could not find it on the CMS.gov fee schedule look up tool either. Any information is appreciated.
  26. K

    Wiki Lymphoma coding....

    pre-operative diagnosis: Brain Tumor final diagnosis: Large B-cell lymphoma (primary) Is the correct code 202.80 - lymphoma large b-cell solid organ sites or 200.50 - CNS lymphoma solid organ sites. I know that most CNS lymphomas are B-cell. I am so confused on the lymphoma coding....:confused:
  27. K

    Wiki Lymphoma's -HELP!!!

    Lymphoma Hi Tony; The patient was in remission per a CT on 2/27/13 and documented by the MedOnc. A recent MRI is showing several brain lesions. In 2011 he was treated and the path shows diffused large B Cell brain, which I thought should be 202.80. The MedOnc coded it 200.50They referred him...
  28. K

    Wiki Newbie ?

    Inpatient Consult Medicare won't pay the consults 99251-99255, they will pay the 99221-99223 codes. The requesting physician applies an AI modifier to indicate that he is the submitting the initial visit. Your physician should bill the 99221-99223 codes.
  29. K

    Wiki Lymphoma's -HELP!!!

    Hi All! Patient presented with a primary CNS lymphona in 2012. A recent MRI shows lesions in the brain, frontal lobe and occiptal lobe, and refers to 'metastatic disease'. Would this be coded as immunoproliferative neoplasms in relapse? Help!!!!!
  30. K

    Wiki ROS...again

    Our doctors are using templates for our new EMR system. One of the blurbs in the ROS section is "As above in the HPI, Otherwise all others as documented in the EMR on 1/1/12 (DOS)." The nurse documents the ROS and upon review the only problems the patient complained about were constipation...
  31. K

    Wiki Documentation of Counseling Time for E/M selection

    I was told that you must document what you counseled the patient on and the time spent doing it. Our docs state that I spent 80 minutes with the patient with over 45 minutes spent face to face discussing treatment options, this versus that, prognosis, coordinating care with....etc., etc. Hope...
  32. K

    Wiki Copayment collection spread sheet

    The center that I currently work for does not collect copayments from our patients. However, we will be providing services to another facility and I would like them to start this process right from the start. Does anyone out there have a spreadsheet ready to go to document the copay, DOS...
  33. K

    Wiki BCBS Refusal to pay E&M and Procedures

    BSDE procedure We are having a similiar problem getting our E & M codes and our Clinical Treatment Planning codes to pay on the same date. As a matter of fact, BSDE has made a Radiation Therapy payment policy instructing to pay only one or the other on the same date. CCI edits allows both...
  34. K

    Wiki Locum Tenem billing

    We have a locum tenen that comes in for a few days each month. He can not cover for over a consecutive period of 60 days, but if he works for one week in June, he can come back for a week in July and the 60 day period starts again.
  35. K

    Wiki radical prostatectomy w/rising PSA

    A patient is presenting with a rising PSA (790.93) after prostatectomy in 2007. The physician plans to treat the patient with radiation. Could I use the v58.0, 185, 790.93 or would I need the V58.0, 790.93, V10.46. Any direction would be helpful.
  36. K

    Wiki Neuroendocrine w/small cell features

    The pathologist does not code it but listed the final diagnosis as 'neuroendocrine carcinoma w/small cell carcinoma features of the lung, LML" Our local carrier will not pay for neuroendocrine (209.30) because it is not listed as a code under the medical necessity indications for RT, but will...
  37. K

    Wiki Neuroendocrine w/small cell features

    Pathology reads, neuroendocrine carcinoma with small cell carcinoma features, poorly differentiated, Lung, RML. The physician says 162.4, but I am thinking 209.30. Thanks in advance.
  38. K

    Wiki 77014- ct guidance for treatment planning

    77014 You would need to bill a simulation on the same day (77280-77290) with this code, so you would not want to do another on the same day.
  39. K

    Wiki 77014- ct guidance for treatment planning

    Neuroendocrine CA w/small cell features. Just checking this out since our local carrier will not cover the Neuroendocrine series of ICD-9 codes. The pathology reads "neuroendocrine carcinoma with small cell features, poorly differentiated' of the Lung, RML. Is this coded 209.30? Thanks in...
  40. K

    Wiki recurrent vs metastases

    Patient had breast primary, mastectomy in 1985. Presents now with soft tissue mass to the chest wall. The pathology states well-differentiated mucinous adenocarcinoma morp features consistent with mammary primary. The physician states locally recurrent breast on chest wall. Locally recurrent...
  41. K

    Wiki Hx of VS active disease

    Thanks!
  42. K

    Wiki Hx of VS active disease

    I recently had a conversation with one of our physicians about coding the encounter when it is felt that the patients active disease, CA of pharynx turns to HX of pharyngeal CA. She coded and encounter for hx of on one date of service as the reason for the encounter and then two months later...
  43. K

    Wiki signature log/attestation statement

    I posted this in "compliance", but no one is viewing this section! I was recently denied, upon appeal, for an illegible signature. I want to implement a sign.log/attest stment, but would like to review what other practices have put into place. Our physician's are requied to initial all...
  44. K

    Wiki Attestation/Signature Log

    I have recently been denied, upon appeal, due to an illegible signature. I want to implement a signature log and/or attestation statement. Our physicians have plans, calculations, devices, etc. that require a signature/initial to show their participation in all phases of treatment. I have read...
  45. K

    Wiki Attestation page

    Hi all! I was recently denied on an appeal to Highmark Medicare because of an illegible signature. It did not meet the requirements as outlined in the CMS manual. Has anyone done an attestation page for the patient chart for multiple providers? I would really like to view one so I can have an...
  46. K

    Wiki Small Cell vs Neuroendocrine

    We have a patient sent to us from a cancer center in a different state. The doctor diagnosed it as small cell carcinoma of the esophagus, mets to the brain. Histology is small cell neuroendocrine. The pathology states small cell neuroendocrine carcinoma. It was coded 209.79 & 209.30, and is...
  47. K

    Wiki Neuroendocrine vs Small Cell

    I submitted a claim for a radiation therapy (RT) for treatment of a secondary neuroendocrine tumor. The pathology states, "small cell neuroendocrine carcinoma". Medicare does not list these codes (209 series) as medically necessary for RT. The physician said that it is "small cell" and should...
  48. K

    Wiki Physician plan oversight/facility setting

    I have looked up information on the CPO codes on our Medicare website (Highmark-DE). The physicians are hospital employees, so if the patient is home (POS 12) and the physician is providing any CPO services, can they bill for the CPO services? Any help with this will be very much appreciated...
  49. K

    Wiki Locum

    I am searching for the time period allowed by Medicare (IE: 3 months, 6 weeks, etc.) for billing for Locum services. I understand the modifier usage but want to be sure that we are compliant as far as time goes. Thanks for any and all information!
  50. K

    Wiki Care Plan Oversight

    I was approached about billing for services when the patient is on Hospice and the physician is involved in the patient care and plan (prescriptions, communications, assessment, etc.). The physicians are employed by the hospital and work in an outpatient facility (cancer). I guess I am getting...
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