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    Wiki Screening vs. Diagnostic Colonoscopy

    This happens to me all of the time. From the direction of past audits, I can only code what's on the op note. If it comes back from billing saying "no, this was for BRBPR", then I ask the Gastro doctor to please add that dx to the op note (and it's no longer a screening.) I'm thinking that...
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    Wiki 31575 anatomy components required of suggested?

    Before these findings were listed, does the doctor mention "flexible larygoscopy" or "flexible fiberoptic laryngoscope was used"? I think that needs to be stated somewhere. You and I know that you can't 'visualize' these anatomical components without a scope, but the payers want it...
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    Wiki Modifier -33

    I use -XS -PT with MCR and MCR plans (if there is a second line....only -PT on first line) because our MCR contractor will deny with a -59-PT and say a more specific modiifer is needed. But these are commercial and again, it's not the payers, per se, it's the editing software that doesn't like...
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    Wiki Modifier -33

    What I was getting at was when you have a screening colonosocpy turned diagnostic for a commercial payer, patient 50 yo, for example. The doctor removes a polyp with a cold biopsy forceps and removes another polyp with a snare. I would code this: 45385 -33 45380 -59 -33 or 45385 -33 45380 -33...
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    Wiki 30140 for turbs with FESS

    As long as it's the inferior (like you highlighted) turbinates, like 30140, for instance, there's no NCCI edit between that and the FESS codes. Chapters 1 and 5 of the NCCI policy Manual (01/01/24 revision) don't have anything specific to 30140 except you can't code something separately that...
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    Wiki 58100 and 58563

    Were they both done at the same operative session? If yes, I would think the 58100 is considered bundled into the "larger" procedure. A modifier is allowed to break the NCCI edit between 58100 and 58563 but I wouldn't separately code for it because 58100 is listed as a "separate procedure."
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    Wiki incomplete colonoscopy due to blockage

    If the intent was a total colonoscopy, then I would code 45380 -74 for 'ASC or Outpatient Hospital' facility coding for a procedure discontinued after admin of anesthesia or after initiation of procedure. The doctor was unable to advance the scope to the terminal ileum. Hope that helps.
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    Wiki Post Op Adhesions Shoulder

    Anyone know of a dx I can use for post operative adhesions in a shoulder? There is NOT a stated dx of adhesive capsulitis anywhere in the documentation. And there's not any impingement or ankylosis mentioned, either. The only thing I have is 'shoulder pain' but was hoping for something else...
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    Wiki Anti Reflux Mucosal Ablation (ARMA)

    Can you post the op note (with ppi redacted)? Without an op note, I was looking at 43257 if the doctor used an EGD/scope to perform this. If coding pro fee, use a -52 or -52 modifier if doc didn't advance the scope all the way to the duodenum. If coding fac fee, use a -52 or -74. Sometimes...
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    Wiki removal of intraoral gingival cyst

    You are correct. 21048 includes an intra-oral osteotomy. If it was removal of soft tissue cyst with no closure, then I would use the 40810. Hope that helps.
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    Wiki Modifier PT/33

    Do you have any/know of any documentation re: the -33 can be used on more than one colonoscopy on the same dos for commercials? Our Medicare contractor has no problems with the -PT being used on multiple colonoscopies but the commercials send it back. Thanks!
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    Wiki Screening colonoscopy through stoma

    I thought the -KX modifier was used if the patient was presenting for a screening colonoscopy after a positive result from a stool based test. I didn't see the dx to show that here but maybe I'm missing it? I would just code the 44388.
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    Wiki 58571?

    I agree with above. Maybe include patholgy notes in your appeal to show "uterine body and cervix" were specimens and weight ? Just a thought.
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    Wiki Aborted Endoscopy

    I'd be more apt to use a Z53.8. Hope that helps.
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    Wiki Modifier -33

    Does anyone have any documentation that directs coders to use modifier -33 only once per dos? Would appreciate any references, etc. Thank you in advance.
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    Wiki IUD insertion under anesthesia

    Thank you. I think the Z91.49 is appropriate. It seems as though the payers don't want to allow anything for facility charges on these insertions. Thanks again.
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    Wiki IUD insertion under anesthesia

    Patient presents for placement of Mirena IUD under ultrasound guidance in OR. Has "history of pain, trauma and anxiety form previous GYN exams in clinic." 58300 is an office based procedure. I'm wondering if anyone knows of any ICD-10 dx codes to use to indicate the medical necessity of doing...
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    Wiki DL with esophageal dilation

    Have you looked at 31528? If the original intent was direct laryngoscopy with dilation. Hope this helps.
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    Wiki Peroneal Debridement, Foot

    Debridement of the peroneal tendons has been discussed in this forum before but there are varying answers. There was no tear. Pre and post diagnosis was right peroneal tendinitis. Op note: "There were many crossing veins. I did open the peroneal tendon sheath. The 2 tendons were in separate...
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    Wiki Screening colon only reaches descending colon

    If the intent was to perform a complete colonoscopy (and not a flex sig), then I would code 45378 -53 for pro fees and 45378 -74 if you are billing for facility. Attached is an article from the AGA. Hope this helps.
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    Wiki Excision of Nasal Lacrimal Duct Cyst

    I'm looking at 31239 but that may not be appropriate. When it says 'patient was turned back over to Oculoplastics', does that mean there was another surgeon working 'above' trying to re-create a lacrimal passage or trying to open this one up and spotted the cyst? Lay description for 31239: The...
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    Wiki Lap Chole with Repair of abdominal hernia

    CPT ASST May 2021: Question: At the time of a laparoscopic cholecystectomy, the surgeon discovered a previously undiagnosed umbilical hernia. The surgeon extended the surgical incision of one port site to repair the umbilical hernia. May both procedures be reported? Answer: No, only report...
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    Wiki CPT Category II codes

    https://www.ama-assn.org/system/files/cpt-cat2-codes-alpha-listing-clinical-topics.pdf You have to go to the ama website and type "alphabetical clinical topics listing" in the search. It says to go to the ama site and click on the Category II link. Hope this helps.
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    Wiki LEFT FRONTAL SINUSOTOMY WITH LEFT TOTAL ETHMOIDECTOMY AND RIGHT TOTAL ETHMOIDECTOMY

    You are correct with the total ethmoid and frontal on the left 31253 -LT and the lone total ethmoid on the right 31255 -RT. But there's an 'excludes' underneath the 31253 for the 31255 and an NCCI edit with a modifier allowed to break the edit, since it's happening on 2 different sides. So it...
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    Wiki 30520 with 30140

    From AMA CPT Knowledge Base: 30140: If turbinate surgery (codes 30130 or 30140) is performed at the same session as a septoplasty (30520) or rhinoplasty (30462, 30420) can the turbinectomy be reported in addition? Answer: From a CPT coding perspective, it would be appropriate to report a...
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    Wiki 47562 and 47563 (2023)

    It sounds like 47563. "A cholangiocatheter was placed followed by the cholangiogram. Please see the findings for details. " Hope this helps.
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    Wiki CPT for excision of os navicular + reattachment posterior tibial tendon

    I just found 28238. But now questioning can I separately code the 28304? or would that be considered part of the 28238 procedure? Thanks!
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    Wiki CPT for excision of os navicular + reattachment posterior tibial tendon

    "Attention was turned to the medial ankle. A new incision was made over the os navicular. Found the edge of the posterior tibial tendon and began dissecting it off the bone from superior to inferior. The os navicular was identified within the tendon. It was removed. It was attached to the...
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    Wiki Billing 28112

    I was trained that the toe modifiers were for the toes, not the foot/metatarsals. Has this changed? And none of the payers I work with accept the -51 modifier anymore, but maybe that's a geographical thing, so we would use the -59, -RT modifiers.
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    Wiki Reconstruction Facial, MOHS RECONSTRUCTION NASAL

    I see the flap for the tip, 14060, and the FTSG to the ala, 15260. I'm not seeing separately reportable complex closure, 13151. Undermining to separate the flap from the underlying tissue isn't separately reportable with the flap code. Hope that helps
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    Wiki ASC G0260/77002

    77002 has a payment indicator of "N1", meaning it's not covered in an ASC. But the LCD clearly states to include it with the G0260 if fluoroscopy was used. Maybe an accounting/policy question for the individual ASC. On non-covered services, does the ASC still want the service billed and at...
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    Wiki dx code for removal of implant to reduce risk of ALCL

    Have you looked at Z40.8?
  33. N

    Wiki Same mass multiple techniques used Colonoscopy

    If you are following NCCI, you would code only one of the techniques. From 2023 NCCI Correct Coding Policy Manual, Chapter VI, DIgestive System, pg VI - 15: 25. The NCCI PTP edit with Column One CPT code 45385 (Flexible colonoscopy with removal of tumor(s), polyp(s), or lesion(s) by snare...
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    Wiki Screening colonoscopy with 2 techniques for polyp removal

    Yes, the screening diagnosis code should go on both. Thanks, clarkmegan. I wonder if the payers will only cover ONE preventative screening TECHNIQUE (regardless of modifiers) and that fact isn't mentioned or it's buried in their payment policies.
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    Wiki Screening colonoscopy with 2 techniques for polyp removal

    WIthout seeing the op note, it sounds like you'd code both techniques separately, such as 45385 and 45380 - 59 (or -XS for MCR), if a snare was used on one polyp and a cold biopsy forceps on the other. The answer of the "33 or PT on both" is a weird one, based on payers payment behaviors. I...
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    Wiki Complex Closure or Adjacent Tissue Transfer?

    Seeing that it is extensive undermining and not any additional incisions, I'd say this was complex closure. Hope that helps.
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    Wiki HELP PLEASE!

    I'm getting 28296 -LT, 28308 -LT and 28110 -59-LT. It sounds more like a 28296 osteotomy for the first metatarsal head. For 28289, the lay description reads: Osteophytes and part of the metatarsal head are excised. Bony irregularities may be removed using a chisel and edges smoothed with a...
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    Wiki CPT Assist conflict CC HCPCS

    We have the same discussions in our facility coding group. We talk each case over when this happens. I've noticed some of the payers' claims adjudication software follows the CPT Asst guidelines, based on their denials, even though we're billing for the facility. There isn't a hierachy, per...
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    Wiki Coding for laparoscopic removal of tubes, malpositioned IUD and pieces of ovarian cyst walls

    Thank you for your help. Wasn't sure about the 58661 and 58662 together.
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    Wiki Colonoscopy coding - When coding colonoscopies

    Correct. You only code the adenomas and not add the K63.5. If all you have is hyperplastic, then code hyperplastic. Hope this helps.
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    Wiki Colonoscopy Screening - Medicare

    Indications for procedure included "worsening constipation who comes in for evaluation of this condition". Since this is a diagnosis, I wouldn't code this as a screening. I wouldn't use the Z12.11 and wouldn't use the -PT modifier. Hope this helps.
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    Wiki Medicare C1778

    C1778 has an ASC Payment indicator of "N1", meaning it's not separately payable in an ASC.
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    Wiki G0260 Medicare denial to medical necessity

    Oh interesting. Thanks for the tip.
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    Wiki Coding for laparoscopic removal of tubes, malpositioned IUD and pieces of ovarian cyst walls

    Op report: "A 5 mm Visiport was advanced through the abdominal wall using direct visualization with the laparoscope. Intraperitoneal placement was confirmed. A second 5mm port was placed under direct visualization in the LLQ. A 8mm port was placed suprapubically under direct visualization...
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    Wiki G0260 Medicare denial to medical necessity

    Also gettting denials. Adding a 77002 - 59 was mentioneed in one of the LCD's I read from another contractor, adding a plain 77002 was mentioned in the LCD from my contractor (NGS). So, at least according to the LCD's, adding a 77002 is correct. But why the sudden denials of G0260 for ASC's...
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    Wiki Elbow mass dx and cpt

    You probably know we can't code anything after statements like "this could represent..." from the pathology because it's guessing. However, the fact that the pathologist didn't say "cyst of skin" or "follicular cyst" or "epidermal cyst" leads me to NOT using a code from the L72 group. It may...
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    Wiki You be the coder ! (Simple Shoulder Surgery)

    Perrfect. Thank you. For some reason I mistakenly thought 29823 was in that "OK" group (29824, 29827 + 29828). Thank you both for your help!
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    Wiki You be the coder ! (Simple Shoulder Surgery)

    Thank you! Can you explain why the 29823 can't be billed with the 29807? Is it just "can't be billed with the SLAP repair" or does it need to be billed as a stand alone? And - I thought the 29826 could be an "add-on" to the 29823. Thanks for any info!!!
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    Wiki You be the coder ! (Simple Shoulder Surgery)

    I'll try this.......29807, 29823, 29826......are you going to tell us the answer?
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    Wiki Endoscopic mucosal resection (EMR)

    Yes as long as the doctor resected 2 separate polyps, one with EMR and a separate one with a snare alone. You can't code 45390 and 45385 for the same polyp. They're bundled. Hope this helps.
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