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  1. H

    Wiki Weight loss leading up to bariatric surgery

    Patient has 37.4 BMI and presents for bariatric surgery. Sleeve gastrectomy approved by Medicare replacement plan. Patient goes through the nutrition counseling, psych eval, etc. and proceeds to drop BMI to 33.5 just before surgery. BMI is now under the required 35. I can't find where it clearly...
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    Wiki 78,80 modifier usage

    Thanks so much for the feedback!
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    Wiki 78,80 modifier usage

    The previous was a 90 day global and the surgery was done within the global. 78 was applied to both primary and assistant surgeon claims. Patient has Medicare replacement so I think you are correct - it is payer specific not wanting 78 on the assistant. We will resubmit corrected with 80 only on...
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    Wiki 78,80 modifier usage

    Patient had surgery by Dr. X. Dr. X was in a practice with several general surgeons and left the practice during global period. Dr. Y was consulted on a Dr. X patient with post op pain, CT showed free air and intussusception. Dr. Y took patient to OR and requested assistance with Dr. Z. Dr. Y...
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    Wiki UTS guided breast bx

    I'm pretty sure I know the answer - just looking for confirmation. 19083 is percutaneous breast bx with UTS guidance. As UTS guidance is in the definition the reimbursement for UTS technical and professional components are included, correct? In other words, it would be wrong to bill 19083 as...
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    Wiki 92622 new code

    Has anyone billed this new code for BAHA? Are payers paying (commercial and CMS) you? Does anyone have guidance on documentation requirements - specifically regarding time documentation?
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    Wiki Q6 locum tenens in Florida

    Does anyone know which payers (other than Medicare) accept Q6 modifier and which do not in Florida? I'm researching myself now but any help is greatly appreciated. Thanks, Hunter Smith,CPC
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    Wiki New '23 hernia code documentation

    I have some guidance on how to select codes from the new hernia codes from various sources but I'm not able to find anything from CMS. Does anyone have guidance from CMS on how to document the size of the defect? Specifically, in the AMA/CPT book it states "the hernia defect size should be...
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    Wiki General Surgeon "Fellow"

    Thanks so much. Now... it appears the surgeon is post residency and working toward becoming a "Fellow of the ACS", he is not doing a "fellowship in a surgical sub-specialty", he can perform and bill surgeries by himself, is employed by the practice, and is credentialed with the payors. Dr. A is...
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    Wiki General Surgeon "Fellow"

    Surgeon A is primary surgeon, performs left mastectomy. Surgeon B is a Fellow that is acting as an assistant surgeon and performs right mastectomy at same time. Surgeon A is in OR entire time Surgeon B is, Surgeon A dictates note for himself and in the note refers to Surgeon B as the assistant...
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    Wiki 99211 for Home Sleep study

    I definitely would not support billing 95800 when they pick up the machine as there are too many things that could go wrong that lead to this being seen as fraudulent (equipment didn't work, patient did not hook up correctly, patient had to go to ER for something unrelated, etc.). While I can...
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    Wiki Wire localization separately reportable?

    Any assistance on resolving a debate is greatly appreciated. Surgeon is placing wire localization in the OR with ultrasound or stereotactic guidance prior to beginning any other procedure (biopsy, lumpectomy, mastectomy). After completing the wire localization the surgeon then begins and...
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    Wiki Reverse shoulder CPT

    23472 is the code for a total shoulder arthroplasty, whether traditional or reverse, correct?
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    Wiki 99211 for Home Sleep study

    So we have a debate if we can/can't bill a 99211 for the visit when a patient comes in to get their home sleep study equipment. The nurse note: All instructions clearly communicated and demonstrated to patient for home sleep study using the ARES. Placing the ARES on after thoroughly washing...
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    Wiki E&M based on time, what can be included?

    Thanks, but I want to make sure you understand the tests are being reported separately for reimbursement.
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    Wiki E&M based on time, what can be included?

    Documentation: Greater than 60 minutes was spent on today's visit including review of multiple outside records, appropriate physical examination, review of today's testing with the patient and her husband, discussion of options for further evaluation, ordering of testing and documentation of...
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    Wiki Decision for surgery mod new hernia codes

    With the new anterior abdominal hernia codes that have 0 day global period are we to use mod 25 for the decision for surgery E&M or mod 57? Thanks for any assistance, Hunter Smith, CPC
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    Wiki Measuring defect on new hernia codes

    I understand the guidelines on the new hernia codes are to measure the defect prior to surgery, prior to incision. However, can anyone offer guidance if the surgeon identifies the size of the defect after inserting the trocars/camera and defining the defect size from "inside" the patient vs...
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    Wiki Excision epidermal inclusion cyst

    Happy New Year! Need some help with an excision code debate: A 2.5 skin incision was made. The incision extended all the way down to the subcutaneous tissue. The platysma muscle was identified and divided. Deep to the platysma muscle there was an epidermal like mass that appeared to be well...
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    Wiki Coding assist please

    Nickelclaw, Thanks so much! Hunter Smith, CPC
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    Wiki Coding assist please

    Please advise how you would code this to resolve two conflicting opinions: After supine and general anesthesia through laryngectomy stoma... Next, using the anterior commissure laryngoscope the oral cavity, oropharynx into the neopharynx is well visualized. No evidence of recurrent disease...
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    Wiki parastomal hernia of ileal conduit

    Thanks. What are your thoughts on 50728 - Revision of urinary-cutaneous anastomosis (any type urostomy); with repair of fascial defect and hernia?
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    Wiki Parastomal hernia

    What about 50728? Revision of urinary-cutaneous anastomosis (any type urostomy); with repair of fascial defect and hernia. Thoughts?
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    Wiki Parastomal hernia

    I agree if it was a colostomy for the colon but this was associated with a parastomal hernia around the urostomy. The patient previously had an ileal conduit created to remove urine.
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    Wiki Parastomal hernia

    Debate on the correct coding of the following operative report. Assistance is greatly appreciated. "The parastomal hernia was located somewhat slightly superior and lateral to the conduit. We make an incision after anesthetizing the area about the 9 o'clock position outside of the ostomy bag...
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    Wiki parastomal hernia of ileal conduit

    Debate on the correct coding of the following operative report. Assistance is greatly appreciated. "The parastomal hernia was located somewhat slightly superior and lateral to the conduit. We make an incision after anesthetizing the area about the 9 o'clock position outside of the ostomy bag...
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    Wiki 47562 or 47563

    Ongoing debate about if cholangiogram is documented and can be billed. From the Op note: "At this point, ICG interrogation was then performed and the ICG cholangiogram demonstrating the gallbladder, cystic duct, and the common duct features. Next, dissection was then performed using the...
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    Wiki Infusion with hydration

    Exactly what I was thinking. Thanks so much for the clarification as well as the link to the CMS article.
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    Wiki Infusion with hydration

    Patient received infusion of Remicade. Remicade is administered with NS. Patient has Medicare Advantage plan. Do I bill: a) 96413/96415 based on time of infusion for the Remicade, or b) 96360/96361 based on time of infusion of NS, or c) both 96413/96415 and 96360/96361 based on time of...
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    Wiki Wound Vac

    I'm billing for the professional fee for the provider to place the wound vac in the OR, supplied by the hospital. I am not billing for the wound vac itself, the hospital is doing that.
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    Wiki Drain seroma post-op billable?

    Thanks so much I appreciate all of your feedback and it does support my position.
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    Wiki Drain seroma post-op billable?

    Thomas - the argument is that it is not on every patient, on rare occasion and global period is to deal with the "common, expected" situations. Therefore it is billable as an unusual/unexpected complication not covered under the global surgical period. Also, on page 7 of the Global Surgery...
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    Wiki Drain seroma post-op billable?

    Current debate between coders and surgeons: I&D or drain seroma (related to surgery) is separately billable and not "included" in the global period. Yes/No? Please provide references for use in the debate. Thanks so much, Hunter Smith, CPC
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    Wiki Excision coding advice

    Orthocoderpgu, Thanks! That is exactly what I was concerned about as well. Ambiguity in depth as well as 2 procedures stated as done but only documented one. Thanks again.
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    Wiki Excision coding advice

    Having a debate on correct coding of the below. Any help is greatly appreciated. Procedure: excision with intermediate layered closure Preop diagnosis: mid back and low back lesion Postop diagnosis: same Location: mid back, low back Size of lesion: 1x1, 2x2cm mm Size of defect: 3, 1cm mm...
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    Wiki Spinal op note help

    We are currently trying to confirm correct coding - I have run this through the Codify Scrubber already - but looking to confirm nothing missed as well as modifiers that scrubber is not clear on. Stab incision was made over the left PSIS and a stealth frame was inserted. Intraoperative CT scan...
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    Wiki When can I bill for the NP

    I agree with Thomas7331. Your MD's need to understand "incident to" billing.
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    Wiki Unlisted surgery with other surgery codes

    So, we have an unlisted code for a surgical procedure and other surgical procedures were done. The comparative CPT has a higher RVU than the other codes that have a CPT. Based on this, should the unlisted code be billed first and subsequent codes have the -51. Or, is there a rule that the...
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    Wiki Wound Vac

    Received a denial for 97605 from Humana. The denial states "submitted medical records does not include documentation that supports negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound...
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    Wiki 99424 require 30 minutes?

    Hi, I know codes with the time listed in the definition require 51% of the time to be met to enable the code to be billed. Is anyone aware this standard does not apply to 99424, the new code for principal care management? Thanks for any assistance and links you can provide and Happy New Year...
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    Wiki Screening or diagnostic colonoscopy?

    So a friend had a colonoscopy, first done in 2012, 2 polyps found and removed. Second colonoscopy done 2015 1 polyp found and removed. Third colonoscopy done 6/2021 1 polyp found and removed. Never had any symptoms, melena, etc. Colonoscopy was done at ASC partly owned by the GI that performed...
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    Wiki Hyperbaric Supervision (99183)?

    There were LCD's to follow but now the LCD's are retired and I'm unable to find any guidance on what is required to get these paid. Can anyone give me guidance on what is required to get these claims paid? CMS is denying every claim for not meeting "medical necessity" for DX codes that...
  43. H

    Wiki Add 99211 to Prolia only visit

    Thomas, thanks for your reply. My post was to settle a disagreement and your post helped. I agree 100%. Hunter Smith, CPC
  44. H

    Wiki Add 99211 to Prolia only visit

    Good point about the column 2 edit, I hadn't thought about it that way but I agree. My post was to show my client that I did know what I was talking about and your response helped my case. Thanks for your reply! Hunter Smith, CPC
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    Wiki Add 99211 to Prolia only visit

    Thanks! I agree and knew this already. I was trying to get my client to understand the seriousness of what she was asking of me. You are correct, she is not certified, in fact, she's 6 months into the medical field and has a lot to learn. Interestingly I gave the exact same quote to my client...
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    Wiki Add 99211 to Prolia only visit

    Currently I'm billing a 96372 along with the Prolia J Code. The plan of care had already been determined, Prolia shots, etc. Office manager feels there should be more profitability in the "visit" than the 96372 and the thin margin on the Prolia. Office manager thinks nursing should start...
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    Wiki LAP APPY THEN RETURN TO OR

    Patient presented for emergency lap appendectomy and surgery was completed with no complications. However, post-op patient started declining, hypotensvie and tachycardic. MRI of abdomen revealed massive hemoperitoneum. Patient was informed and then disclosed that he regrettably had not told the...
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    Wiki GY on S codes

    I am billing S0164 and S9379 to Medicare Texas (Novitas). Patient previously had BCBS primary and they paid $57+/day combined for the two codes. Patient has daily home infusions so $57+ = over $1,700/month in reimbursement from BCBS. Now that Medicare is primary they are rejecting on receipt...
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    Wiki Covid and telemedicine rules

    Thomas, Thanks so much! Hunter Smith, CPC
  50. H

    Wiki Covid and telemedicine rules

    Can anyone tell me with the pandemic relaxed rules on telemedicine if CMS eliminated the requirement to do a physical exam on a new patient? Any links to source information is greatly appreciated. Thanks, Hunter Smith, CPC
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