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    Wiki G89.29 primary diagnosis denial

    We got a denial for our pain management provider that states "diagnosis inconsistent with procedure code". We billed G89.29 as the primary diagnosis for 99204. This is a BCBS medicare advantage plan. Has anyone else had this issue? Thanks
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    Wiki bilateral knee xray

    Medical necessity needs to be met, so whatever it takes to make that clear. I think that if the diagnosis covers both knees, he can state "both knees show osteoarthritis" instead of stating them separately. If he has a diagnosis for only one knee, you may have a hard time showing medical...
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    Wiki Interbody fusion

    Probably too late to help now, but for the other two levels, 63047-59, 63048.
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    Wiki Manual reduction of uterine prolapse

    Thanks so much for your help! I really appreciate it! :)
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    Wiki Intertrochanteric fracture fixation with prophylactic fixation femur

    Patient presents with pathological IT femur fracture (osteoporosis). Surgeon wants to bill 27245 with 27187. Can the 27187 be billed if there is no separate incision/plating? He placed a 10x380 TFN. My gut says no, but I can't find any documentation to share with the surgeon.
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    Wiki Manual reduction of uterine prolapse

    Please help! I'm an orthopedic coder and this is out of my wheelhouse. My surgeon had a patient in for hip surgery and noticed a prolapsed uterus. He called the gynecologist who said to manually reduce it, which he did. What CPT would you use for this? I can't find anything other than the...
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    Wiki lumbar spinal fusion

    Probably too late to help you now, but no, I don't see any documentation for L4-5.
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    Wiki Debridement CPT -Shldr - infection

    Did he replace either of the components (humeral or glenoid)? Or did he only remove the polyethylene and debride?
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    Wiki Help w/ coding 27385

    I wouldn't use an arthrotomy code since he didn't go into the joint capsule. If the intent was to repair the quad, you could use 27385-52 for reduced services. Another option would be the unlisted 27599.
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    Wiki Irrigation of incisional ulcer , foot

    I have in my notes to "Use 11042-11047 when the only procedure performed is wound debridement. If a wound is debrided and closed, use the repair codes. Use these codes for foot ulcers and vascular ulcers." Unfortunately, I didn't save a link to where I got that information! :)
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    Wiki RT lateral tibial plateau fracture diagnosis with ORIF

    Yes, 27535 is correct. S82.121A is for fracture of lateral condyle right tibia
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    Wiki orhto question

    I would use 28140-59 (column 2 for 28810), 28810, 28810-59, with corresponding anatomical modifiers
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    Wiki Ultrasling denials day of surgery

    Is this a Medicare patient? Our DME MAC requires that we use place of service home for Medicare. We use POS home for commercial insurance as well. I can't answer anything regarding the date of service other than we usually dispense the DME prior to or after the surgery, so I'm not sure if having...
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    Wiki L4, L5-S2AI spinopelvic fixation vs instrumentation CPT?

    27280 will include fixation instrumentation, and the instrumentation add-on codes can't be used with this code. (Use 22846 in conjunction with 22100-22102, 22110-22114, 22206, 22207, 22210-22214, 22220-22224, 22310-22327, 22532, 22533, 22548-22558, 22590-22612, 22630, 22633, 22634, 22800-22812...
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    Wiki Physical Therapy Billing

    Our physical therapist has his own NPI and taxonomy, and his services are billed under his NPI . We never bill his services under an MD. Here's some information that may help: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf
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    Wiki dexamethasone 10mg/ml

    Were you able to figure this out? I'm curious to know. If not, what is the NDC number? AAPC coder has a list of NDC numbers and it shows how many units to bill for each one.
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    Wiki Radiculopathy/Spondylosis HELP!!

    I agree with you. Spondylosis with radiculopathy M47.26 or M47.27.
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    Wiki Billing

    MUE for this code is 2, however, I would add 59 (or XS for Medicare) for the two additional fingers. 26116-F5, 26116-59-F6, 26116-59-F7.
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    Wiki Changes for CPT 27132/27130

    I think they have misunderstood something here. They have taken the THA off the IPO list, not changed the code. We are scheduling our THAs as outpatient procedures. I can't imagine changing the code to 27132 just because it's an inpatient only code. Also, just because something is not on the...
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    Wiki Spine surgery

    Without seeing the note: For the L5-S1, I would use 22614. This add-on code can be used with 22633 for a second level without interbody fusion. If he does a decompression at that level, 63047-59 (no 51). 63047 bundles w/22633. Don't forget your bone graft codes. What is the 15777 for?
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    Wiki Coding removal if same surgeon placed external fixation

    Yes, with 58 modifier on the ex-fix removal
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    Wiki application of splint

    I don't know why you can't bill for the E/M. Your doc is being referred to and is billing out under a separate tax ID than the Express care, correct?
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    Wiki Kypho with percutaneous posterior instrumentation?

    Please help! We have a patient that had a lumbar burst fracture. Doctor did a kyphoplasty and added posterior instrumentation percutaneously (pedicle screws, rod). He wanted to bill 22514 and 22842, but I told him we couldn't add the 22842 to the kypho. I felt that 22514-22 would be more...
    • fltbaroque
    • Thread
    • instrumentation kypho kyphoplasty modifier 22 spine coding
    • Replies: 1
    • Forum: Orthopaedics
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    Wiki CPT Exploration for possible dural tear?

    How would you code? Patient is post-op decompression in which a dural tear was repaired. Patient continues to have increased pain and is suspected to have a CSF leak. Procedure is exploration only, finding no csf leak or additional tear. Doctor opened previous incision, explored down to the...
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    Wiki Wrist fibroosseous tunnel release

    Is this for carpal tunnel syndrome? Open procedure, 64721 I've never seen the term fibroosseous before, but found this: "The carpal tunnel is an inelastic fibroosseous tunnel defined by the carpal bones and the flexor retinaculum"
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    Wiki Excision of mass palm and skin incision right thumb

    Look at 11420 series for dermal excision of the thumb, L98.8 Look at 26115-26111 for subcutaneous mass, D17.9
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    Wiki Synovectomy DIP joint

    Interesting that there's a code for the PIP joint, but not DIP. I would probably use an unlisted code and compare to 26130, since 26140 includes extensor reconstruction.
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    Wiki Arthrodesis Posterior from T5 TO PELVIS

    So, is the fusion from T5-L5 plus SI Joint fusion? No, 22610 and 22612 should not be coded together. You should pick one for your primary and the rest would be add on 22614. 22612 has the higher RVU. Yes, SI joint fusion should be coded separately.
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    Wiki kyphoplasty ICD-10 DX for a Medicare patient

    Have you checked your LCDs? Can you use M80.88XA Other osteoporosis with current pathological fracture? M80 guidelines in ICD10 "includes osteoporosis with current fragility fracture"
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    Wiki Re: Routine foot care

    I'm attaching the requirements for billing routine foot care for Medicare patients. Hope this helps.
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    Wiki Help with Podiatry Coding-E&M-Routine Foot Care- Ingrown Toenail

    I would bill an office visit with 25 modifier and 11721 for nail debridement. Is this a Medicare patient? If so, routine foot care is not payable unless certain requirements are met.
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    Wiki SPINE SURGERY WITH A CO-SURGEON

    I would add 20930 for the BMP, but otherwise, yes, that's how I would code it.
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    Wiki Spine & Ortho

    Hello Lisa, When you bill one line with the 50 modifier, you should double the fee. This was confirmed at a recent Karen Zupko conference. Tobi Chandler, CPC, CRC, CGIC
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    Wiki removal of index finger nailbed tissue

    Look at 11760 From AAPC coder: The nail bed can be injured due to laceration, crush, or avulsion. This procedure is performed to repair such damage. Clinical Responsibility The physician removes the nail and repairs the nail bed. He can perform a hematoma evaluation or drain blood with...
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    Wiki FDS repair

    This sounds more like an articular fracture (DIP fx). If that's the case, I would code 26746. If it's a distal phalanx fracture, then 26765. There's no suturing of the tendon, no advancement or reattachment, so I would not code a tendon repair. There's no documentation of complex laceration...
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    Wiki Abscess

    Here's the description of 10061 per AAPC Coder: When the patient is appropriately prepped and anesthetized, the provider makes a circumferential incision over the target area of abscess. He deepens the incision through the vascular inner layer of skin and down to the deep level of abscess...
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    Wiki Peroneal Tendoscopy and Malleolar Osteotomy via Arthroscopy

    1. For the peroneal tendoscopy, I would use unlisted code. 2. For the arthroscopy, I would use 29898, as it includes bone spur removal
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    Wiki Appropriate coccyx injection code

    Yes, I would as those are therapeutic. Hope this helps!
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    Wiki Porokeratosis

    I'm no expert by any means, but I can tell you what my research has led me to! I've struggled with this one also because there is never anything to indicate that the condition is congenital. I've seen different websites offer different suggestions. Some podiatry sites suggest L74.8 Other eccrine...
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    Wiki closed reduction(small finger) plus open (ring finger)

    In that case, yes you can bill the closed procedure for the small finger and the open procedure for the ring finger. 26605 is a column 2 for 26615, so it would require a 59 or XS modifier (depending on payor).
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    Wiki Drug delivery devices

    No, it's still a good code. Per AAPC coder, 11981 is for subcutaneous implants. CPT directs to 20700-20704 for deep implants (subfascial, intramedullary, or intra-articular)
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    Wiki closed reduction(small finger) plus open (ring finger)

    Was the closed reduction performed on the small finger metacarpal as well? Or only attempted on the ring finger?
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    Wiki Appropriate coccyx injection code

    Look at 62323 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging...
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    Wiki 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa(eg. shoulder, hip, knee, subacrominal bursa)

    20610-50 (don't forget to double the fee amount)
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    Wiki Diabetic Foot Exams with debridements, etc

    This is a good reference guide that I found online. However, I will say that since Medicare requires so much documentation with the class findings, our Podiatrist has decided to charge only an office visit for these services...
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    Wiki Unlisted Code

    This is from AAPC Coder: "When reporting an "unlisted procedure code" to describe a procedure or service, it will be necessary to submit supporting documentation (e.g., the procedure report/OP notes) along with the claim to provide an adequate description of the nature, extent, need for the...
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    Wiki Aspiration seroma lumbar spine

    This one has me stumped. Patient has seroma of lumbar spine. Procedure is percutaneous aspiration and drain placement. Note reads: "A needle was placed in the seroma under live fluoroscopy. A small amount of contrast was injected to verify good position and about 80 cc of bloody brownish fluid...
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    Wiki What Injection code can I use?

    20612 is for aspiration and/or injection of ganglion cyst(s) any location
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    Wiki How many coders do you have in your clinic?

    Thanks for the info. I need to have an idea of what other coders are doing so I can take it to my boss! :)
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    Wiki How many coders do you have in your clinic?

    I've been begging for help in my clinic and wonder if I'm off base. We have 8 surgeons (3 of them spine), 4 midlevels, 1 physical therapist and 2 PTAs. I code and post all of the encounters for all patients (1000 per week), plus code and post all surgeries. Also have to enter/verify insurance...
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