http://www.supercoder.com/forum/ Supercoder: Recent Posts en Sat, 31 Jul 2010 01:45:08 +0000 http://www.supercoder.com/forum/topic/prenatal-visits#post-1286 Fri, 30 Jul 2010 16:32:05 +0000 Cindy Kuyers 1286@http://www.supercoder.com/forum/ <p>I have a patient that came to our office for 3 prenatal visits and then moved. I submitted each visit with e/m code 99214. I can not bill global for 3 visits. the only codes for antepartum that I know of are 59425(4-6 visits) and 59426(7 or more)I am getting a denial from insurance stating "services are included in global ob care". I have spoken with insurance co. and they state that they only except global billing. Has anyone ever run into this problem before? </p> http://www.supercoder.com/forum/topic/laceration-global-period-question#post-1285 Fri, 30 Jul 2010 13:45:20 +0000 Melissa Wilkinson 1285@http://www.supercoder.com/forum/ <p>Please bear with me on this question, as I'm new to billing.</p> <p>If a laceration was treated at an ER, then we see the patient as follow up and further treatment. Does the Global period follow the patient or is it limited to the ER. Can we charge the 1st office visits and subsequent ones?</p> <p>Thanks in advance for your input. </p> http://www.supercoder.com/forum/topic/rfa-help-asap#post-1284 Fri, 30 Jul 2010 13:22:19 +0000 Nancy Smith 1284@http://www.supercoder.com/forum/ <p>Please do not take offense but I need an answer from someone who is certified in Pain Management. I have a provider that will not take any one's word except from someone who is certified in Pain. My question is we have a provider who si doing RFA's of the left L4, L5, S1, S2, S3 and SA. He is billing 64622 x 1 and 64623 x 4. The other Pain provider states this is incorrect and that he should be billing CPT code 64640 for S1, S2, S3 and SA. Please help me with this because I am fairly new with Pain Management. I would also need something in writing to support what I am saying. </p> http://www.supercoder.com/forum/topic/lab-exam-after-physical#post-1283 Fri, 30 Jul 2010 13:18:14 +0000 Jan Wheeler 1283@http://www.supercoder.com/forum/ <p>pt comes in for physical and form filled out for school. comes back (7) days later for u/a dip to be put on form. v20.2 was used @ 1st visit. v72.69 for just the u/a at 2nd visit? </p> http://www.supercoder.com/forum/topic/chest-x-ray-with-central-line-insertion#post-1282 Fri, 30 Jul 2010 06:52:47 +0000 alex wills 1282@http://www.supercoder.com/forum/ <p>As per CCI edit there is a bundling issue between the CVC codes and x-ray, so you cannot code these codes together. For peripheral placement there is no bundling issues. X-ray can be billed only if there is a separate diagnosis not related to CVP. </p> http://www.supercoder.com/forum/topic/bundling-of-cpts-urodynamics#post-1281 Fri, 30 Jul 2010 05:39:42 +0000 Ash 1281@http://www.supercoder.com/forum/ <p>There is no CCI Edits between these codes, but 51795 is a deleted code for 2010 (replaced by 51728-51729). Medicare bundles surgical tray (A4550) with the main surgical procedure. </p> http://www.supercoder.com/forum/topic/destruction-versus-biopsy#post-1280 Fri, 30 Jul 2010 05:18:42 +0000 Ash 1280@http://www.supercoder.com/forum/ <p>This cannot be true. Mod 59 is applied to the column 2 codes in case of a CCI edits with a status indicator of '1' as is the case here between 17000 and 11100, the later being the column 2 code. 11101 is an add-on code for 11100. Show the CCI Edits rules and the descriptor for modifier 59 to the payer. </p> http://www.supercoder.com/forum/topic/chest-x-ray-with-central-line-insertion#post-1279 Thu, 29 Jul 2010 20:28:53 +0000 Rita Harman 1279@http://www.supercoder.com/forum/ <p>can you code a chest x-ray with a central line placement if not done under fluoro? </p> http://www.supercoder.com/forum/topic/bundling-of-cpts-urodynamics#post-1278 Thu, 29 Jul 2010 19:07:43 +0000 Emmanuel Graham 1278@http://www.supercoder.com/forum/ <p>all perform on the same day<br /> 51726,51797,51736,51784,51798,a4550,51795 </p> http://www.supercoder.com/forum/topic/destruction-versus-biopsy#post-1277 Thu, 29 Jul 2010 13:36:40 +0000 Nancy Smith 1277@http://www.supercoder.com/forum/ <p>I have an insurance company stating that when a destruction (17000) is billed with a biopsy (11100 &amp; 11101) that we need to put a 59 modifier on all three cpt codes. They state this is the correct guideline that they found in the Principles of CPT COding. Since when is this appropriate? Thanks for your help as always </p> http://www.supercoder.com/forum/topic/coding-cad-414#post-1276 Wed, 28 Jul 2010 10:34:09 +0000 Amy Hoffman 1276@http://www.supercoder.com/forum/ <p>I partially disagree. According to coding clinic, when a provider states CAD or coronary artery disease, this is insufficient to code anything other 414.9 </p> http://www.supercoder.com/forum/topic/rotovirus-vaccine-admininstration-codes#post-1275 Wed, 28 Jul 2010 08:46:01 +0000 Jennifer Godreau 1275@http://www.supercoder.com/forum/ <p>While codes 90467 and 90468 apply only to children younger than 8 years of age, that is not the sole requirement for using the 90464-90468 code range. The physician, NP, or PA must have provided vaccine counseling and documented the counseling in the chart.</p> <p>If the FP provides -- and documents -- vaccine counseling, you would be correct in using 90467 or 90468 for the administration to a baby. However, without physician or nonphysician practitioner (NP or PA) vaccine counseling, Rotovirus administration would fall under either 90473 or 90474. </p> http://www.supercoder.com/forum/topic/rotovirus-vaccine-admininstration-codes#post-1274 Wed, 28 Jul 2010 08:43:03 +0000 Jennifer Godreau 1274@http://www.supercoder.com/forum/ <p>Rotovirus vaccine is only given to children less than the age of eight at 2 ,4,6 months and is given orally. I believe we should only ever use admininstration codes '90467' and '90468' oral administration for persons less than 8 years of age. Alternatively, could 90473 or 90474 apply?</p> <p>Holland </p> http://www.supercoder.com/forum/topic/coverage-in-a-hospital-base#post-1273 Wed, 28 Jul 2010 08:35:45 +0000 Jennifer Godreau 1273@http://www.supercoder.com/forum/ <p>The concern would be whether the insurer would view the Hemonc or radiologst as qualfied to be the supervising physician. If they would be able to provide the required monitoring/intervening, I think direct supervision by another physician specialty would be allowed.<br /> Jen Godreau, CPC, CPEDC<br /> Content Director, SuperCoder.com</p> <p>BTW: I'm going to ask Deborah Dorton, the editor for Radiology Coding Alert her opinion. </p> http://www.supercoder.com/forum/topic/incident-to-for-a-np-in-gi-offic-e#post-1272 Wed, 28 Jul 2010 08:28:41 +0000 Jennifer Godreau 1272@http://www.supercoder.com/forum/ <p>An NP can see a new patient for an office visit or for a consult but based on the patient's status the encounter does not meet indicent to requirements. Therefore, you should instead report the service under the NP's NPI, not the gastroenterologist's.</p> <p>Incident to requires:<br /> the physician provide direct supervision, which means he must be immediately available (meaning on the same floor or office suite; he does not have to be in the exam room)<br /> the patient and problem are established (meaning the MD must have already treated the patient for the problem and established a plan of care.</p> <p>Jen Godreau, CPC, CPEDC </p> http://www.supercoder.com/forum/topic/coverage-in-a-hospital-base#post-1271 Wed, 28 Jul 2010 08:11:19 +0000 Miriam Carvajal 1271@http://www.supercoder.com/forum/ <p>Does anyone have the rules regarding respect to physician coverage? If the physician has to leave the site on an emergency can the HemOnc or Radiologist act as the covering physician to continue the patient treatments on the Linac?<br /> Miriam Carvajal<br /> University of Miami<br /> Radiation Oncology </p> http://www.supercoder.com/forum/topic/incident-to-for-a-np-in-gi-offic-e#post-1270 Wed, 28 Jul 2010 03:32:05 +0000 Tira Hargis 1270@http://www.supercoder.com/forum/ <p>CAN A NP SEE A NEW PT OR CONSULT UNDER INCIDENT TO?<br /> DOESN'T INCIDENT TO MEAN THAT NP WILL BE SEEING PT WHILE<br /> PHYSICIAN IS IN THE SUITE, SUPERVISING. </p> http://www.supercoder.com/forum/topic/hip-chiari-osteotomy-and-hip-shelf-arthroplasty#post-1269 Tue, 27 Jul 2010 22:34:43 +0000 alex wills 1269@http://www.supercoder.com/forum/ <p>27156 is ok for Chiari osteotomy, but you need to provide some Px details for the self hip arthroplasty. </p> http://www.supercoder.com/forum/topic/keeping-of-medicare-and-insurance-eobs#post-1268 Tue, 27 Jul 2010 21:15:10 +0000 Ash 1268@http://www.supercoder.com/forum/ <p>Seven years seems to be the time you need to retain your EOB documents. DocuVantage (www.docuvantage.com) and San Diego County Medical Society (www.sdcmc.org) are some of the organizations who have clearly specified that EOBs should be stored for a period of seven years. You may contact your payers to know what they have to say on this. </p> http://www.supercoder.com/forum/topic/patient-seen-2-times-same-day-by-same-provider-in-office#post-1267 Tue, 27 Jul 2010 13:55:21 +0000 Maria Dills 1267@http://www.supercoder.com/forum/ <p>Did the patient come back for the same reason? If not then you can bill with modifier 25 using new dx.</p> <p>You can also use modifier UF; "services provided in the morning" for the morning appt. and modifier UH "services provided in the afternoon"<br /> (i.e., 99213-UF 724.2; 99213-UH with add'l dx's) or you can just bill a higher level 99214 or 99215. </p> http://www.supercoder.com/forum/topic/keeping-of-medicare-and-insurance-eobs#post-1266 Tue, 27 Jul 2010 08:22:39 +0000 michele dubay 1266@http://www.supercoder.com/forum/ <p>Does anyone have any idea how long we need to keep the paper trail on the Medicare &amp; insurance eob's. I've heard different opions some say 5-yrs some 7-yrs. Any feedback would be appreciated </p> http://www.supercoder.com/forum/topic/hip-chiari-osteotomy-and-hip-shelf-arthroplasty#post-1265 Tue, 27 Jul 2010 05:28:48 +0000 Crystal Peavey 1265@http://www.supercoder.com/forum/ <p>could someone give my opinions on the CPT codes for the above.<br /> I have come up with 27130 for the left hip shelf arthroplasty.</p> <p>The Chiari osteotomy I am unsure of but I am leaning towards 27156.<br /> This is my first stab at these procedures.</p> <p>I am very appreciative of any help that can be offered. </p> http://www.supercoder.com/forum/topic/coding-cad-414#post-1264 Mon, 26 Jul 2010 12:20:40 +0000 Patricia Patterson 1264@http://www.supercoder.com/forum/ <p>Wonderful response!!! </p> <p>Your answer is right on point for the codes I need to use. Thank you </p> http://www.supercoder.com/forum/topic/53400-or-53410#post-1263 Mon, 26 Jul 2010 06:20:26 +0000 VIOLA BROWN 1263@http://www.supercoder.com/forum/ <p>Please see above.</p> <p>Thank<br /> Viola </p> http://www.supercoder.com/forum/topic/shoulder-sgy-help#post-1262 Mon, 26 Jul 2010 04:16:16 +0000 Ash 1262@http://www.supercoder.com/forum/ <p>I would go with 23412 and 23120, because 23120 descriptor says partial claviculectomy which has been done here. </p> http://www.supercoder.com/forum/topic/coding-cad-414#post-1261 Sun, 25 Jul 2010 21:30:20 +0000 Ash 1261@http://www.supercoder.com/forum/ <p>The situations when you can report 414.00 are:</p> <p>1. When the patient has a history of CABG and the documentation does not specify anything more about the affected vessel (e.g. whether native or graft)<br /> 2. The patine had CAD but the documentation is silent about whether the patient had undergone a CABG or not.</p> <p>If the document specifies that it is a native coronary artery or the patient has a hx of CAD without a CABG, then you need to roport 414.01.</p> <p>Similarly, for a CAD in a grafted vessel you need to report 414.02-414.05 based on the documentation. The other two codes in the series (414.06 &amp; 414.07)specify CAD of native or grafted vesseels of a transplanted heart. </p> http://www.supercoder.com/forum/topic/shoulder-sgy-help#post-1260 Sun, 25 Jul 2010 15:47:13 +0000 Betsy Rivera 1260@http://www.supercoder.com/forum/ <p>im thinking 23412 and maybe 23130-59 b/cuz it's type II acromion, but no 23120 bcuz no size is mentioned, according to AAOS &amp; AMA 8-10mm should be documented</p> <p>26yr old female with impingement syndrome of right shoulder. patient had failed to omprove despite extensive course of PT and antiinflammatories. patient had MRI with evidence of impingement syndrome and synovitis of AC joint.<br /> A linear incision was centered over this anterior and lateral aspect of the acromion and brought medially. A bovie elctrocautery was used throughout the case for hemostasis. upon obtaining the clavipectoral fascia the place was developed to create a mobile window and the bovie elecrocautery was used to perform deltoid on full thickness ablation of the deltoid tendon off of the acromion and the lateral clavicle. The anterior aspect of the acromion was noted to have a type II acromion and a Darrach retractor was inserted undersurface the coracoacromial ligament resection. The anterior aspect of the acromion was then resected with the oscillating saw and a darrach retractor was then further inserted under the acromion and the undersurface of the acromion was resected with the oscillating saw. Followed by use of the oscillating foot rasp to smooth the roughened edges down great care was taken to ascertain that the resection and decompression the performed to the lateral most aspect of the acromion. The lateral clavicle was inspected and there was noted to be hypertrophic spurring along the inferior aspect and this was debrided with the oscillating foot rasp followed by resection of the lateral aspect of the clavicle with the oscillating waw followed by use of the oscillating foot rasp. copious irrigation ensued. at this point a bursectomy was performed. there was noted to be over the supraspinatus tendon at the anterior aspect of the acromion and partial thickness tear of the superior surface of the supraspinatus tendon. this was not a full thickness tear. A 2-0 PDS suture was used in a figure of eight fashion to reapproximate this defect. the remainder of the cuff was inspected and found to be intact. the subscapularis and infraspinatus tendons were all noted to be intact and a glove finer was inserted and no further adhesions were appreciated. </p> http://www.supercoder.com/forum/topic/coding-cad-414#post-1259 Sat, 24 Jul 2010 09:07:45 +0000 Patricia Patterson 1259@http://www.supercoder.com/forum/ <p>This question is for the hospitalist inpatient setting. </p> <p>When the physician states only that patient has CAD or history of CAD when are codes <code>414.00</code> or <code>414.01</code> applicable ?</p> <p>Also, when the physician states patient has CAD with CABG or patient has history of CAD with CABG which code is appicable?</p> <p>Thank you </p> http://www.supercoder.com/forum/topic/cone-beam-77014-igrt-77421-documentation-time#post-1258 Fri, 23 Jul 2010 02:49:16 +0000 Ash 1258@http://www.supercoder.com/forum/ <p>Physician's signature should be present on all the copies to show that the images have been reviewed by the physician. Simply looking at the images on a screen does not suffice. When the physician signs them is not of much importance as long as it does not come in the way of the treatment plan or the practice followed by your office. </p> http://www.supercoder.com/forum/topic/rf-procedure-billing-radio-frequency#post-1257 Fri, 23 Jul 2010 02:24:03 +0000 Ash 1257@http://www.supercoder.com/forum/ <p>The descriptors for these codes say 'each level' &amp; 'each additional level' respectively which means you need to report 64622 for the first level and then 64623 for the next level. When the procedures are done bilaterally, you need to append modifier 50 (or LT &amp; RT) to each of them. So the final codes are: 64622-50, 64623-50, and 64623-59-50 (the last one is for the second additional level). </p> http://www.supercoder.com/forum/topic/80048-w80053-why-deny#post-1256 Fri, 23 Jul 2010 01:36:34 +0000 alex wills 1256@http://www.supercoder.com/forum/ <p>If you check the bundling issue between these codes then you can see that CPT Code 80048 is a column 2 code for 80053, and these cannot be billed together in any circumstances. As per CCI edit a '0' modifier is applicable in this case. </p> http://www.supercoder.com/forum/topic/cone-beam-77014-igrt-77421-documentation-time#post-1255 Thu, 22 Jul 2010 16:35:45 +0000 Miriam Carvajal 1255@http://www.supercoder.com/forum/ <p>"Although direct supervision" doesn't mean physician must be present in the room during the procedure, but in the vicinity and available in person if needed. May a physician sign all copies of IGRT/Brain Lab images at the end of the morning clinic or all at the end of the day? or it requires looking at real-time images on a computer screen and alerting if changes are required, which can be done remotely (based on patient condition).</p> <p>We urgently need some advise.<br /> Thank you, </p> http://www.supercoder.com/forum/topic/80048-w80053-why-deny#post-1254 Thu, 22 Jul 2010 15:37:21 +0000 Jan Wheeler 1254@http://www.supercoder.com/forum/ <p>'80048 and 80053 billed together' </p> http://www.supercoder.com/forum/topic/80048-w80053-why-deny#post-1253 Thu, 22 Jul 2010 15:34:27 +0000 Jan Wheeler 1253@http://www.supercoder.com/forum/ <p>why deny code 80048 and pay for 80053? </p> http://www.supercoder.com/forum/topic/rf-procedure-billing-radio-frequency#post-1252 Thu, 22 Jul 2010 12:13:30 +0000 Maria Dills 1252@http://www.supercoder.com/forum/ <p>How would you code Bilateral 64622 64623 plus 2 add'l levels? </p>