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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 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 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 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 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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    Wiki Revision ACDF during global

    Patient has a fall within 2 weeks of ACDF and returns to the operating suite. New diagnosis is "mechanical complication of implant". Surgery is revision of ACDF with increased difficulty (22 modifier). My question is this: which modifier would you use? 58 - because it's more extensive than the...
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    Wiki Adjustment of implant after SI Joint Fusion

    How would you code this? One month after SIJ fusion, patient returns to the operating suite for adjustment to implant. Nothing is removed, only adjusted. Note reads: "We used finger dissection to palpate the implant, was able then to guide the implant in appropriate position...using the mallet I...
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    Wiki Endoscopic fasciectomy w/excision of bone spur?

    Procedure done is endoscopic debridement of plantar fascia with excision of calcaneal spur. Doctor wants to bill 28118 and 28060. First of all, if it was an open procedure, I would think 28119 would be more appropriate. Secondly, wouldn't an unlisted code 29999 be the only choice here? I looked...
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    Wiki Excision rheumatoid nodule elbow CPT

    Everything I see for excision of rheumatoid nodule for the elbow shows CPT 24120, excision of bone cyst or benign tumor of head or neck of radius or olecranon process. What if the nodule is not attached to the bone, but is attached to a tendon? Would you use 20476 / 20473 excision, tumor, soft...
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    Wiki Fracture care without fracture diagnosis

    Frequently, our providers will charge fracture care when there is "no definitive fracture seen" or "possible fracture". They may send the patient for an MRI to verify the fracture. Am I correct in assuming that fracture care should NOT be charged unless they are SURE it's a fracture?? Also, if...
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    Wiki Billing for non-credentialed Nurse Practicioner

    We have a new NP that is not yet credentialed with all payers (only MCR and MCD). The physician wants to bill everything under his NPI. Not all of the encounters meet incident to requirements, some are new patient visits or new chief complaints. Also, not all payers go by MCR guidelines on...
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    Wiki Myodesis to metatarsal stumps

    CPT? Patient had partial amputation of right foot and came back to the operating suite for delayed primary closure, rotational skin flap and "Myodesis of intrinsic muscles to metatarsal stumps". I'm okay up until the myodesis. What I've read is that this is attaching the muscle to the bone and...
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    Wiki Intramedullary nail radial shaft fracture

    Need help please! Patient presented with both bone shaft fracture radius and ulna. The doctor states in his note: "I placed a small flexible intramedullary nail in her radius. I did not have to open this." He also states in procedure description: "I initially made a small incision just proximal...
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    Wiki ORIF osteochondral lesion of the knee

    Please help! I'm leaning towards an unlisted code, but would appreciate input. There was no allograft or autograft, just fixation of osteochondral lesion. The note reads: Postop Dx: Right knee medial femoral condyle osteochondral lesion, displaced Operation performed: Right knee arthroscopy...
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    Wiki Excision olecranon bursitis with skin removal

    Need help please! Procedure performed: Excision of large olecranon bursitis with complex skin closure and excision of elliptical shaped skin, approximately 10 x 4 centimeters attached to the bursa. Procedure detail states that "approximately 10 x 4 cm of skin elliptical shape was excised with...
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    Wiki Incidental carpal tunnel release?

    We had a patient with flexor tenosynovitis in the operating suite for I&D of flexor tendon sheaths. During the procedure, the physician performed a carpal tunnel release "to get to the flexor pollicis longus". Can I code and bill for the carpal tunnel release, or would it be considered...
    • fltbaroque
    • Thread
    • carpal tunnel flexor tendon incidental tenosynovitis
    • Replies: 2
    • Forum: Orthopaedics
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    Wiki Second fracture during global

    Please help.....I have two patients with essentially the same procedures. Patient had hemiarthroplasty for femur neck fracture (27236). Two weeks later, patient falls and has greater trochanteric fracture. Procedure performed "ORIF greater trochanteric fracture with revision of...
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    Wiki Exchange of hardware?

    Coding gurus, I'm at a loss on this one. We had a patient that had ORIF of a proximal humerus fracture and then, a month later had a second procedure. Indications: Prominent hardware and suture abscess. Operation Performed: Left shoulder superficial I and D with exchange of proximal locking...
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    Wiki Percutaneous pinning olecranon?

    Please help with this coding scenario: Patient has fracture of "proximal radius fracture which is just distal to the growth plate" with a proximal olecranon fracture. Procedure is ORIF of right proximal radius fracture with closed reduction, percutaneous pinning of olecranon fracture. Would you...
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    Wiki Meeting medical necessity in the OV note

    Does this meet medical necessity? A patient fills out paperwork and there are sections labeled "family history", "past medical history", "social history" and "review of systems". The doctor states in his note, "I went over patient's history and review of systems and it is in the chart". How can...
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    Wiki Review of Systems

    Please help! One of the physicians in our practice routinely uses this statement when making an initial hospital visit or consult: "Review of systems: Reviewed. The patient's review of systems found on the patient's chart under physician documentation is noncontributory." How could that even...
    • fltbaroque
    • Thread
    • auditing e/m review of systems
    • Replies: 2
    • Forum: E/M
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    Wiki Foreign body removal patellar inferior pole

    Ortho coders, how would you code this scenario? Removal of foreign body right patellar inferior pole and repair of inferior pole patellar tendon 6 year old female had pellet gun shot into her right knee, fb was embedded within the inferior pole of patella. The joint was not entered. Open...
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    Wiki Remote coding for physician fees

    I would love to work remotely, but all of my experience has been in an office setting. Most of the remote jobs that I have seen require inpatient, ED or ASC coding experience. Does anyone know if there are remote jobs available for someone that has only office experience? Thanks in advance for...
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    Wiki Crush injury of foot, fracture care

    We have a patient who had the following injuries: Open fracture distal phalanx right great toe Open fracture distal phalanx right second toe Closed fracture distal phalanx right third toe Closed fracture distal phalanx right fourth toe Our physician performed irrigation and debridement and...
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    Wiki Transfer of care within the Practice

    One of our doctors saw a patient in the ER and billed fracture care, but the patient did not like him and wanted to transfer to another one of our docs for his follow-up care. That means everything doc #2 does is in the global period, and doc #1 gets paid. Is there anything that can be billed...
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    Wiki Hardware removal with exchange of helical blade

    Coders, please help! We have a patient who has an intramedullary implant in her hip. The doctor's note states "left hip hardware removal with exchange of helical blade for shorter helical blade". Would you code this 27245-52 since he is not replacing the nail? If so, would you add 20680 for the...
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    Wiki Fenestration of parameniscal cyst

    Does anyone know if there is a separate code for fenestration of parameniscal cyst during arthroscopic meniscectomy? Thanks for your help! Tobi Chandler, CPC
    • fltbaroque
    • Thread
    • arthroscopic cyst fenestration meniscectomy parameniscal
    • Replies: 1
    • Forum: Orthopaedics
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    Wiki Excision giant cell tumor of bone

    Please help! Patient diagnosed with giant cell tumor of bone. I need help with CPTs for: 1. Excision of extraosseous mass, left shoulder 2. Curettage and bone grafting of left acromion plus cement injection into the left acromion Thank you! Tobi C., CPC
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    Wiki Modifier 25 for Nurse Practitioner?

    Can the Nurse Practitioner use modifier 25 on an E/M visit if her supervising physician does a minor procedure the same day? Thanks in advance for your help! Tobi Downs, CPC, CGIC
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    Wiki Modifier 57 - colonoscopy or an endoscopy

    If a patient comes in for an office visit and is sent directly to the surgery center for a colonoscopy or an endoscopy, would it be appropriate to use a modifier 57 on the office visit? Thanks!
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