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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 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

    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 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 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 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 Need Medicare Reference

    I am looking for a reference from CMS/Medicare that states you cannot code a screening colonoscopy diagnosis code along with a sign or symptom diagnosis code. The definition of 'screening' means 'the absence of signs or symptoms', so in my mind you would never code them together. And this is...
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    Wiki Arthrodesis foot joints

    I would appreciate any thoughts anyone has on this. Patient comes in for right tarsometatarsal joint fusion (initially would be 28740) and THEN the right 1st and 2nd cuneiform bones were pinned/screwed together. "There was widening of the joint with stress under c arm fluoroscopy. Patient had...
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    Wiki Excision calcaneus enthesophytes with re-insertion of Achille's

    I want to use 28118 but this was not a Hagglund's. It was 'large osteophytes.' Also looking at 28200 (per CPT ASST May 2011) for Achille's debridement. OP NOTE: Incision was made midline down through the skin and subcutaneous tissue. We split the Achilles tendon with a 15 blade mid portion...
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    Wiki New -PT modifier requirements

    Good morning, Has anyone recently come up against using the -PT for Medicare plan screening colonoscopy turned diagnostic? Transmittal: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Transmittals/r11304cp Page 47 = "Implement new edit of 120 (Incorrect reporting of modifier...
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    Wiki CPT for Superior Trunk Block

    Hi. The anesthesiologist did a "superior trunk block" (instead of interscalene) for a shoulder surgery for post op pain, requested by surgeon for post op pain, etc., etc. I looked online and while there are a ton of articles about how the superior trunk is better than the interscalene, I can't...
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    Wiki Unilateral thyroid lobectomy with central neck dissection

    ENT coders - any ideas with documentation here would be greatly appreciated. Surgeon removes left thyroid lobe with isthmus AND does a central neck dissection. If it was a total (both lobes) thyroidectomy with central neck dissection, I could code 60252: Thyroidectomy, total or subtotal for...
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    Wiki Need HCPCs code for patellar tendon allograft used in an ACL repair

    Usually I just code CPTs but the C1889 was denied on this ACL repair for the patellar tendon allograft. Does anyone know what an appropriate HCPCs would be? Thank you for any and all thoughts!
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    Wiki Septoplasty with Osteotomies

    Need another set of eyes to take a look at this one. Wondering if 30420 would be the appropriate code for the following: We then turned to the septoplasty. A 15 blade was used to make a hemitransfixion incision. Mucoperichondrial flap was elevated to the bony cartilaginous junction and...
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    Wiki For hammertoe - Packing PIP with bone auto grafting after fixing with k-wire, also packing MTP with bone auto grafting, 2nd left

    I need help. The first part of the procedure was (28750-LT) fusion of hallux MTP joint with screw and plate for hallux rigidus. So the 'was harvest of bone distant'? answer is 'not really'.....from the already opened incision over the MTP of the hallux next to the 2nd MTP and PIP she was...
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    Wiki Open excision osseous loose bodies from distal quadriceps tendon

    I'm stumped and need help. Open excision loose bodies from the quad tendon and also debridement of osteophytic ridge on the patella with anchors used afterwards to fix the tendon to the patella .......op note below: Based on review of MRI scan, vertical incision was made along the junction of...
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    Wiki Excision of breast lesions, needle localized

    If anyone can shed light / share credible documentation, I'd sure appreciate it. The patient had 2 suspicious areas of the same (right) breast identified preoperatively by 2 separate needle localizations (2 separate wires and clips.) The surgeon identified both and excised both OUT OF THE SAME...
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    Wiki Cranialization of frontal sinus

    Does anyone know the code(s) for cranialization of frontal sinus? 31804 and 31805 are no longer valid cpt codes. Thank you in advance for any thoughts.
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    Wiki Compounded vs. Non-compounded foam sclerosant

    The surgeon is using Sotradecol 3%. When it's exposed to air, it turns into a foam. During the procedure, it is exposed to air and the foam is injected into the vein for sclerotherapy. Is this considered compounded or non-compounded sclerosant? Does starting with the liquid vials and adding...
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    Wiki Tracheoesophageal fistula with insertion of speech prosthesis

    The lay description for CPT code 31611 reads: "The physician constructs a tracheal esophageal fistula for vocalization. The physician makes a horizontal neck incision and dissects the tissues between the tracheostoma and the esophagus. The esophagus is incised and a laryngeal speech prosthesis...
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    Wiki cleaning out ear tubes under general anesthesia

    Patient had ear tubes in place but they were plugged with debris. Surgeon suctioned out/cleaned out the tubes - which included suctioning out fluid from the middle ears - did not remove the tubes. Can't find a code that fits so looking at 69799. Anyone have any thoughts? Thank you in advance...
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    Wiki Ruptured Breast Implant Replacement with Capsulectomy

    Surgeon removes ruptured breast implant materials, entire capsules are excised and new implants are placed. Patient has distant history of bilateral mastectomies with reconstruction. One resource states 19371 and 19340. The 19371 includes removal of old implant. It doesn't include removal of...
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    Wiki Need help with SI joint injection w/ultrasound guidance

    Anesthesiologist injects kenalog under live ultrasound guidance into the left and right SI joints. Medicare patient - NGS is the contractor. LCD says nothing about ultrasound guidance - just flouroscopic and CT - and those are included in the 27096. So - 20552 with 76942 or am I way off here...
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    Wiki Documentation Request

    I'm not familiar with CRNA billing and if anyone out there could point me to some documentation, I'd sure appreciate it. Anesthesiologists perform ESI's in our ASC. A Medicare patient had an ESI performed by the anesthesiologist and a CRNA administered conscious sedation. Typically sedation...
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    Wiki Nasal deformity status post nasal fracture

    Any thoughts on this would be appreciated: ..the patient had a small hump mostly on the left side of her nasal dorsum as a result of trauma. The patient had been assaulted. Local anesthesia was infiltrated and a left intercartilaginous space and a left intercartilaginous incision was made and...
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    Wiki Seroma Capsule Excision

    Surgeon drains a post-operative subq seroma and then excises the seroma capsule, closing with a drain placed in layered closure. Question - don't want to use I+D - he did more than that. Can't use 10180 - there was no infection, just a seroma. Benign lesion excision with layered closure? Anyone?
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    Wiki 28285? - "Attention was directed towards

    Op note: "Attention was directed towards the third digit, right foot, where two semielliptical converging incisions were made over the PIP joint. Island of skin was removed. Dissection was carried out using sharp and blunt technique. PIP joint was identified, transected the medial and...
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    Wiki inguinal hernia

    Correct.
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    Wiki Resection head of proximal phalanx and middle phalanx

    "......two semielliptical converging incisions were placed across the proximal and distal interphalangeal joint. Head of the proximal and middles phalanx were delivered in the incision, both heads hypertrophied. At the surgical neck, a sagittal saw was used to perform a through and through...
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    Wiki Diagnosis code for 'reactive gastropathy'?

    This may be a repeat but I can't seem to find it anywhere - what icd-9 code do you use for 'reactive gastropathy'? (not 'portal hypertensive gastropathy') ...535.50? Thanks in advance.
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    Wiki Need help with op note - blunt technique

    I'd appreciate any thoughts on coding this... Attention was directed to the left foot where a linear incision was made from the first mid shaft of the metatarsal to the mid shaft proximal phalanx medial to the extensor hallucis longus tendon. Dissection was carried out using sharp and blunt...
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    Wiki Debridement Dilema...

    Need help. Any thoughts here would be appreciated. Patient had multiple non-healing wounds from a pressure washer injury to his right hand. Patient was wearing gloves at the time and the material removed came from the gloves. ....Esmarch was used to exsanguinate the right upper extremity...
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    Wiki Need help with op note.

    "..Patient was placed on the table in the supine position. Right arm was abducted 90 degrees and her arm, flank and right breast were prepped and draped in the usual sterile fashion. The patient had a nonhealing radiation ulcer from a previous lumpectomy. She had a very large overhanging skin...
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    Wiki Lesion Removal from Mastectomy Site

    Would appreciate thoughts/information about this scenario. Surgeon removes a lump from the chest wall - where a mastectomy has been previously performed for a breast cancer. Path comes back epidermal inclusion cyst. Any other time this would be integumentary codes...114xx with 12xxx if...
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    Wiki 28285 with 28150?

    All same digit.....the surgeon removed the head of the proximal phalanx to correct hammertoe. Then - because of 'extreme deformity,' the entire middle phalanx was removed. Redundant tendon was shortened and a K-wire was inserted between the distal phalanx and the MPJ. All through the same...
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    Wiki Replacing expanders with implants..

    Sorry to beat a dead horse but I need help... CPT Assistant Aug 2005 states regarding breast reconstruction - if a surgeon is removing tissue expanders and replacing them with permanent implants, 11970 is to be used. It also states "In certain instances, considerable capsular adjustments are...
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    Wiki Need Diagnosis Help

    Patients come in having problems conceiving. This is before an 'infertility' diagnosis has been made. Blood tests and/or ultrasounds may be ordered. What diagnosis would be appropriate for these? V26.29? Some insurance policies have no coverage for 'infertility' diagnoses but these tests...
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    Wiki Adhesions of Middle Ear

    The surgeon took down middle ear adhesions - involving the malleus, incus, stapes - and lysed middle ear scar tissue. The lay description of 69450 involves just adhesions to the tympanic membrane....it doesn't seem inclusive enough... 69631 includes the middle ear surgery but the tympanic...
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    Wiki Contracting with payers - carve outs for bioengineered skin substitutes

    If anyone out there has any information about this, I would greatly appreciate it. If you are negotiating a contract with a payer and you want to 'carve out' separate payment for Strattice* (a bioengineered skin substitute), what code would you use? Lifecell - the company that makes Strattice*...
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    Wiki COLONOSCOPY and HEMOCLIP

    Physician did a colonoscopy on a pt and removed a polyp with a snare. He then placed a hemoclip on the spot to 'prevent bleeding complications.' 45385? -or- 45385 and 45382? If you could provide rationale with your answer, that would be great. I don't want to add the 45382 because it...
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    Wiki CPT anatomy help please

    Patient had a soft tissue mass excised from his buttock. It wasn't a sebaceous cyst or anything that origibnated in the skin, - it was sub-q - so I would use a 'excision soft tissue tumor' code. Do I pick from 21930-21936 ....back or flank? or Do I pick from 27043-27059 .....pelvis and hip...
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    Wiki Need ICD-9 diagnosis code help.....

    Does anyone know a diagnosis code for obstructive defecation? One of the symptoms of this is constipation but I can't find a more exact diagnosis code. I'd appreciate any thoughts....
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    Wiki Exostosis confusion and podiatry coding confusion

    Please help - any thoughts would be appreciated! Here's an op note: ..".Attention was directed to the dorsum of the right mid foot in between the tibialis anterior tendon and EDL tendon along the lateral margin of the tibialis anterior tendon. Subcutaneous tissues were dissected...
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    Another 69610 vs.69620 question - !!!

    Here's the excerpt from the op note: "The right ear is examined. There is a 40% anterior inferior perforation. The margin of the perforation is freshened with a straight pick and a cups to the right and left. Epithelium is removed. An IS joined tenoid is used to excoriate the lateral aspect...
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    Wiki Excision of nonhealing wound

    If anyone has any thoughts on coding for this op note, I would really appreciate help.... ...prepped and draped in the usual sterile fashion. Local anesthesia was infiltrated around the periphery of the open wound which was 3mm to 4mm in diameter. Methylene blue was instilled into the wound...
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    Wiki Need Guidance on Rhino/Septo -plasty

    Hi there. I'm not sure what to do here - this is the op note - .....a tranfixion incision was made. The patient had significant caudal septal deviation to the right side obstructing his nasal airway. Mucoperichondrium was then raised both caudally and superiorly and the caudal septum that was...
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    Wiki Breast Reduction/Revision/Reconstruction

    I would appreciate any help on this plastics case. I'm thinking 19318-50 and I want to also code for a reconstruction (19366 or 19380?) but I don't know if I can code that on top of the reduction. Or - do you only code for revision of reconstructed breast? The patient had already went through...
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    Wiki Coding help needed - having trouble coding

    :) Hi there! I have an op note here that I'm having trouble coding. If anyone has any thoughts, I would love to hear them. The measurements of the lipomas were not taken, per the surgeon. The patient was taken to the OR, placed on table in the supine position. After induction of general...
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    Wiki 19350 with 15130? Nipple Reconstruction

    Hi everyone. I'm trying to figure out if I can code separately for dermal grafts used during a nipple reconstruction. I am using 19350. And in the description in cpt, it says the physician excises graft skin, etc., but it makes no mention if the graft can be coded separately. I checked the...
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    Wiki Need Help Coding Exostectomy of Distal Phalanx

    Can anyone help me with finding a code? The doctor used a high speed rotating burr to perform an exostectomy of condyle spurs on the third toe, distal phalanx. I can't use 11752 - he didn't excise the tuft. I like 28124 but he didn't excise any bone, just exostosis. Can't use 28153 - din't...
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