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Supercoder - Ask an Expert? Forum: - Recent Posts http://www.supercoder.com/forum/ Supercoder - Ask an Expert? Forum: - Recent Posts en Sun, 12 Feb 2012 12:05:47 +0000 Jami Deerfield on "Office visit with procedure" http://www.supercoder.com/forum/topic/office-visit-with-procedure#post-11354 Sat, 11 Feb 2012 21:15:54 +0000 Jami Deerfield 11354@http://www.supercoder.com/forum/ A patient comes into the office for a procedure, 97597 Debridement, would I code 99213 for the office visit with modifier 25 and 97597, or would I just code 99213 and 97597? Also, how would I code the same procedure a week later, when the patient comes in again? Sanjit Mishra on "high bladder and omental adhesions" http://www.supercoder.com/forum/topic/high-bladder-and-omental-adhesions#post-11353 Sat, 11 Feb 2012 20:54:50 +0000 Sanjit Mishra 11353@http://www.supercoder.com/forum/ 654.91,648.91 Sanjit Mishra on "What Dx for this colonoscopy?" http://www.supercoder.com/forum/topic/what-dx-for-this-colonoscopy#post-11352 Sat, 11 Feb 2012 20:27:26 +0000 Sanjit Mishra 11352@http://www.supercoder.com/forum/ Status for the other hospital: Patient had been there for follow-up of a possible liver transplant. Status at visit to your doctor: The other hospital requested for a screening colonoscopy by your doctor. * * .....[Interestingly, the chief complaint listed by your doctor is "Constipation"]...this can't be considered as a symptom here, because the reason for visit is screening, and it is at this point that the patient may have been asked by your doctor if any problems the patient has just because the doctor is going to conduct screening colonoscopy, and to know if any existing problem may complicate the procedure. The patient's answer in this case as "constipation" doesn't mean that your doctor has decided for a colonoscopy as a treatment option for constipation. * Your doctor had also performed a screening colonoscopy of the same patient 2 months back, so he knew that such a frequent colonoscopy may not get paid, for which the doctor might have documented "constipation" as chief complaint. Most important is that the findings of endo was normal. * As you know, the coding guidelines are very clear on this issue, if the patient presents for a screening then the screening dx remains primary regardless of the findings, the findings will be secondary. The best fit screening code is G0121 for being not at high risk. So, you can code: G0121 with V76.51 and 564.0x In such a case, choose to sign an ABN and bill accordingly with modifier GA. Leesa Israel on "CPT CODE" http://www.supercoder.com/forum/topic/cpt-code-7#post-11351 Sat, 11 Feb 2012 02:26:31 +0000 Leesa Israel 11351@http://www.supercoder.com/forum/ I am guessing the physician removed the tubing and that is what you need the code for. In that case, if the urologist removes the foreign body endoscopically (via cystoscopy), take a look at CPT code 52310 (Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) or 52315 (... complicated). * I hope this helps. * Best, Leesa * Leesa A. Israel, BA, CPC, CUC, CMBS Executive Editor, The Coding Institute Manager, TCI Consulting & Revenue Cycle Solutions Email: <a href="mailto:leesai@codinginstitute.com">leesai@codinginstitute.com</a> <a href="http://www.codinginstitute.com" rel="nofollow">http://www.codinginstitute.com</a> Alinda Johnson on "ALLERGY ; PROVIDER DOCUMENTS NAD FOR PSYCH SYSTEM ;BC SAYS NO MUST BE CONSTITUTI" http://www.supercoder.com/forum/topic/allergy-provider-documents-nad-for-psych-system-bc-says-no-must-be-constituti#post-11350 Fri, 10 Feb 2012 22:42:03 +0000 Alinda Johnson 11350@http://www.supercoder.com/forum/ CAN OUR ALLERGY PROVIDER USE THE NAD FOR HIS PSYCH EVALUATION IN A COMPREHENSIVE EXAM. THIS IS HIS TEMPLATE HE HAS USED FOR YEARS ON PAPER. STEDMANS DICTIONARY SAYS IT STANDS FOR (NADISTRESS) MENTAL OR PHYSICAL APPERANCE. I WOULD APPRECIATE ANY WRITTEN ARTICLES ON THE SUBJECT . I NEED TO APPEAL BY 2/16/12. THANK YOU ALINDA D. JOHNSON AJOHNSON @DEDHAMMEDICAL.COM Maiu Reismann on "10060-100601 vs 26010-26011" http://www.supercoder.com/forum/topic/10060-100601-vs-26010-26011#post-11349 Fri, 10 Feb 2012 22:23:49 +0000 Maiu Reismann 11349@http://www.supercoder.com/forum/ Should drainage of finger abscess be billed using 10060-10061 or 26010-26011? Sanjit Mishra on "Inpatient drug and alcohol treatment" http://www.supercoder.com/forum/topic/inpatient-drug-and-alcohol-treatment#post-11348 Fri, 10 Feb 2012 22:01:58 +0000 Sanjit Mishra 11348@http://www.supercoder.com/forum/ Plz refer to the link: <a href="http://www.oasas.ny.gov/admin/hcf/BillingCodes.cfm" rel="nofollow">http://www.oasas.ny.gov/admin/hcf/BillingCodes.cfm</a> maarit on "Office visit after lumpectomy" http://www.supercoder.com/forum/topic/office-visit-after-lumpectomy#post-11347 Fri, 10 Feb 2012 21:41:41 +0000 maarit 11347@http://www.supercoder.com/forum/ Thank you, Sanjit maarit on "Endoclips on mucosal rectal tear during colonoscopy" http://www.supercoder.com/forum/topic/endoclips-on-mucosal-rectal-tear-during-colonoscopy#post-11346 Fri, 10 Feb 2012 21:38:32 +0000 maarit 11346@http://www.supercoder.com/forum/ Uneventful, screening colonoscopy 45378, but a 0.5 mm long mucosal tear in distal rectum was noted and 2 endoclips were placed to that short and apparently superficial tear as it is in distal rectum in close proximity to rectal outlet and rectal veins. How would you code the clips and what would be the Dx: 863.45? thanks maarit on "What Dx for this colonoscopy?" http://www.supercoder.com/forum/topic/what-dx-for-this-colonoscopy#post-11345 Fri, 10 Feb 2012 21:33:43 +0000 maarit 11345@http://www.supercoder.com/forum/ PT is followed for possible liver transplant by another hospital and they requested a screening colonoscopy. She had a screening colonoscopy by us about 2 months ago. This is a Medicare PT. the chief complaint is listed as constipation by our doctor. The result of the endo was normal: 'Surveillance colon exam in 5 yrs if lever transplant takes place." What Dx and CPT should I use? There is no mention of personal history of polyps or high risk. Thank you for advice. Tori Dobbs on "Two specialties - Same inpatient stay" http://www.supercoder.com/forum/topic/two-specialties-same-inpatient-stay#post-11344 Fri, 10 Feb 2012 21:26:00 +0000 Tori Dobbs 11344@http://www.supercoder.com/forum/ Can a specialist (admitting doc)and the patients Primary Doc both bill for visits during the same inpatient stay? maarit on "Endoclip placement on a tear during ERCP?" http://www.supercoder.com/forum/topic/endoclip-placement-on-a-tear-during-ercp#post-11343 Fri, 10 Feb 2012 21:24:13 +0000 maarit 11343@http://www.supercoder.com/forum/ I have coded the below OP report as follows: Dx 574.51, 574.21 CPT 43264, 43262, 43271, 43235 -59, 43273, 74360 I'm unsure if the documentation supports EGD and the fluoro. Also, how would you code the placement of an endoclip on a tear...or would this be bundled? The side-viewing duodenoscope was passed through the mouth and advanced with ease to the 2nd portion of the duodenum. The visualized esophageal and gastric mucosa are normal. The ampulla appears a bit prominent but has no evidence of recent stone passage. Cannulation of bile duct was achieved on first attempt with wire guide. Common bile duct was filled with contrast.numerous filling defects. Because of the numerous stones, a sphincterotomy was followed by 8 mm CRE balloon dilatation of the cut and then a 12 and 18 mm stone extraction balloons were used to extract the stones. There was a 4 mm long mucosal tear above the roof of the sphincterotomy and there an endoclip was placed to close it down. After clip was placed the bile duct was cannulated again and non-occlusion by the clip was verified. Fluoroscopy interpretation during procedure by myself. Sue Bolton on "arthroscopic shoulder surgery coding" http://www.supercoder.com/forum/topic/arthroscopic-shoulder-surgery-coding#post-11342 Fri, 10 Feb 2012 21:16:26 +0000 Sue Bolton 11342@http://www.supercoder.com/forum/ Arthroscopic sheath introduced into the posterior joint- excellent visualization achieved. Massive rotator cuff tear with virtually bald humeral head. . Rotator cuff was extensively scarred down, esp anteriorly involving 3 tendons including subscapularis, supraspinatus & infraspinatus. Posterior leaf was more mobile than anterior leaf. Multiple releases performed to release the subscapularis as much as possible & bring it posterior as well as mobilizing the posterior aspect of the cuff tear anteriorly.There was a complex pattern of tearing. Biceps tendon was completely subluxed anteriorly. This was released after tagging and incorporated into the repair with effectively a soft tissue biceps tenodesis. Margin convergence suture initially using multiple margin convergence to reconnect anterior part of tear to posterior part of tear. Multiple anchors implanted to bring down to a roughened footprint. Did not get watertight closure but did get complete coverage of humeral head, partial repair of subscapularis obtained. There was some tearing of the labrum & SLAP trephination repair of superior glenoid after biceps released, roughing up the glenoid & providing vascular access with 18g needle thru SLAP lesion. There was multiple piece of loose body, these were debrided and removed from the joint. Decompression anterior & lateral aspects of acromion out right to the AC joint & across the AC joint with modified Mumford with removal of distal inferior clavicle where it was impinging on the cuff. Balkrishna B Sundar on "CPT CODE" http://www.supercoder.com/forum/topic/cpt-code-7#post-11341 Fri, 10 Feb 2012 20:57:13 +0000 Balkrishna B Sundar 11341@http://www.supercoder.com/forum/ Please provide me with a proper CPT code I can bill on a psychiatric patient that keeps on inserting a rubber tubing into his urinary bladder? Sanjit Mishra on "DRUG SCREEN 80101 VS G0431 FOR MEDICARE PATIENT" http://www.supercoder.com/forum/topic/drug-screen-80101-vs-g0431-for-medicare-patient#post-11340 Fri, 10 Feb 2012 20:40:11 +0000 Sanjit Mishra 11340@http://www.supercoder.com/forum/ As per my review, the given ICDs don't map to CPT G0431. Carol Reinke on "dx code" http://www.supercoder.com/forum/topic/dx-code-6#post-11339 Fri, 10 Feb 2012 20:22:25 +0000 Carol Reinke 11339@http://www.supercoder.com/forum/ what dx code would you use for screening lymphedema? thanks carol reinke Sanjit Mishra on "arthroscopic shoulder surgery coding" http://www.supercoder.com/forum/topic/arthroscopic-shoulder-surgery-coding#post-11338 Fri, 10 Feb 2012 20:08:22 +0000 Sanjit Mishra 11338@http://www.supercoder.com/forum/ Sorry! I wanted more detailed documentation of medical records, so that it will be possible to consider for additional CPTs. Going by CCI edits, I would like to reccommend: 29827, 29828, 29824, and 29826 Sanjit Mishra on "Office visit after lumpectomy" http://www.supercoder.com/forum/topic/office-visit-after-lumpectomy#post-11337 Fri, 10 Feb 2012 19:52:47 +0000 Sanjit Mishra 11337@http://www.supercoder.com/forum/ Medicare Fact sheet on modifier 24 says: Do not use when medical record documentation does not clearly indicate the E/M was unrelated to the surgery. * Here, it is definitely a related one, so no need of using modifier 24 to be attached to 99215 * Sometimes, in such cases, coders use to bill with modifier 24 and get reimbursement. But, getting reimbursement doesn't justify the correctness of coding. Sue Bolton on "arthroscopic shoulder surgery coding" http://www.supercoder.com/forum/topic/arthroscopic-shoulder-surgery-coding#post-11336 Fri, 10 Feb 2012 19:48:07 +0000 Sue Bolton 11336@http://www.supercoder.com/forum/ 29823- Rotator cuff was extensively scarred down, esp anteriorly involving 3 tendons. Multiple releases anterior & mobilize of posterior cuff tear. 29828: Biceps tenodesis. 29807: SLAP trephination repair superior glenoid after biceps release. 29819-59: Multiple piece of loose body debrided and removed from the joint. lawrence kanter on "A9505" http://www.supercoder.com/forum/topic/a9505#post-11335 Fri, 10 Feb 2012 19:38:50 +0000 lawrence kanter 11335@http://www.supercoder.com/forum/ I Do not understand the answer! maarit on "Office visit after lumpectomy" http://www.supercoder.com/forum/topic/office-visit-after-lumpectomy#post-11334 Fri, 10 Feb 2012 19:33:29 +0000 maarit 11334@http://www.supercoder.com/forum/ Members are supposed to get professional answers within 24 hrs? Sanjit Mishra on "Billing E&M code with 95180 (rapid desensitization)" http://www.supercoder.com/forum/topic/billing-em-code-with-95180-rapid-desensitization#post-11333 Fri, 10 Feb 2012 18:48:26 +0000 Sanjit Mishra 11333@http://www.supercoder.com/forum/ Evaluation and management codes reported with allergy testing or allergy immunotherapy are appropriate only if a significant, separately identifiable service is administered. When appropriate, use modifier -25 with the E&M code to indicate it as a separately identifiable service. Obtaining informed consent is included in the immunotherapy. If E & M services are reported, medical documentation of the separately identifiable service should be in the medical record. Sanjit Mishra on "arthroscopic shoulder surgery coding" http://www.supercoder.com/forum/topic/arthroscopic-shoulder-surgery-coding#post-11332 Fri, 10 Feb 2012 18:34:51 +0000 Sanjit Mishra 11332@http://www.supercoder.com/forum/ I will recommend 29827, 29824, and 29826, and would like if you can documentation details for coding other CPTs. Sue Baker on "Pulmonary" http://www.supercoder.com/forum/topic/pulmonary#post-11331 Fri, 10 Feb 2012 18:31:45 +0000 Sue Baker 11331@http://www.supercoder.com/forum/ Our doctor bills for a 99214-25, 94640 and 94060. Medicare says that 94640 bundles with 94060 but a modifier may be used to unbundle the code for reimbursement. Do you know what modifier I would attach to 94640? lawrence kanter on "A9505" http://www.supercoder.com/forum/topic/a9505#post-11330 Fri, 10 Feb 2012 18:07:06 +0000 lawrence kanter 11330@http://www.supercoder.com/forum/ Medicare, here in florida have been denying cpy code A9505 with adjustment code N362, which means exceeds maximum units per day. we have always used 1 unit at 100.00 and we use 5 units(500.00) now, as of 01/01/12 it is being denied, I called the local medicare and the woman answering the phone told me that is was an unpublished edit that was activated 01/01/12, but she could not tell me how many units i can use or where i can find the answers to this questions, oh yeah, she said i could appeal it or make corrections and re-file but she could not tell me how many units are exceptable now, anyone have any answers,please help!!! Desperate!! Jessica Weathers on "peroneus brevis transfer with posterior tibial tendon repair" http://www.supercoder.com/forum/topic/peroneus-brevis-transfer-with-posterior-tibial-tendon-repair#post-11329 Fri, 10 Feb 2012 18:06:03 +0000 Jessica Weathers 11329@http://www.supercoder.com/forum/ What would be the appropriate way to code this scenario Peroneus brevis debride and transfer to the posterior tibial tendon with additional repair of the posterior tibial tendon. 27691 + 27659? if we are transferring the PB to the PT and then PT requires additional suturing and anchoring to repair it after the PB is transferred would you separately bill them out? Thanks in advance!!! Donna Christian on "Veinwave Radiofrequency Skin Procedure CPT?" http://www.supercoder.com/forum/topic/veinwave-radiofrequency-skin-procedure-cpt#post-11328 Fri, 10 Feb 2012 18:05:37 +0000 Donna Christian 11328@http://www.supercoder.com/forum/ Our general surgeon is using the Veinwave radiofrequency for nasal spider varicosities. Would this be an unlisted CPT 37799? Thank you. sandy lukert on "Billing 28308 twice" http://www.supercoder.com/forum/topic/billing-28308-twice#post-11327 Fri, 10 Feb 2012 16:54:31 +0000 sandy lukert 11327@http://www.supercoder.com/forum/ 1. Left foot Weil osteotomy of the second metatarsal. 2. Left foot Weil osteotomy of the third metatarsal. 3. Gastrocnemius lengthening. We billed 27685, 28308, 23808/51 Insurance is denying 28308 as included in 23808. This CPT is per digit. Can anybody help? Is there something that we need to do that we did not? Any help is appriciated. Operative report below to help.. We identified and separated out the gastroc from the from the soleus underneath it and then I placed retractors around and isolated the gastroc and then performed a Strayer gastrocnemius lengthening, when we completed this, we are able to gain additional dorsiflexion of about 5 to 7 degrees. Once we completed this, we irrigated with copious bacitracin laden irrigation. We sutured in a lengthen position, the lengthened out gastroc with interrupted sutures. We close the subcutaneous tissue then with 3-0 Vicryl sutures and close the skin with interrupted 3-0 nylon sutures. We then placed sterile dressings around this. We then turned our attention to performing the Weil osteotomy to the left forefoot. We made approximately 5 cm incision over the dorsum of the left foot in second web space. The incision was carried down by blunt and sharp dissection, care protecting surrounding neurovascular structures. Using this incision, we gained access both medially and laterally to the second MTP joint and the third MTP joint. We made arthrotomies on the dorsum of both of these joints and elevated the capsule medially and laterally to expose the MTP joints. After gaining exposure, we then prepared for Weil osteotomies by protecting the soft tissues. We used a thickened blade on the second and third metatarsals and we performed a oblique Weil osteotomy of the second and third metatarsals, when we completed these osteotomies, we had appropriate shortening back these metatarsals and we temporarily pin the shortened Weil osteotomies into the desire position. We verified the degree of shortening and positioning on multiple planes of fluoroscopy. We were satisfied with the with the amount of shortening. We then placed many fragment screws from dorsal to plantar in a standard fashion. We gained good purchase and good stabilization of the Weil osteotomy, placing too many fragment screws in the second metatarsal and one in the third. When we completed this, there was overhanging bone left from the Weil osteotomy, we used a combination of rongeur and a rasp to smooth and remove the overhanging bone. We then took the second, third MTP joints through a range of motion and found good stable range of motion. There was no mechanical block to motion. At this point we irrigated with copious bacitracin laden irrigation. We then placed two 0.045 K-wires to the tip of the second through the second and third toes across this second third MTP joints under direct visualization. We placed these K-wires with the second, third MTP joint in plantar flexion. We checked the position of these pins on a multiple planes of fluoroscopy. We were satisfied with the position. We bent the K-wire, cut them short, and placed protective caps over these. We then irrigated with copious bacitracin laden irrigation. Sanjit Mishra on "Laparoscopy cholecystectomy" http://www.supercoder.com/forum/topic/laparoscopy-cholecystectomy#post-11326 Fri, 10 Feb 2012 16:31:12 +0000 Sanjit Mishra 11326@http://www.supercoder.com/forum/ Only 47600 Sanjit Mishra on "Sleep Study Plus Oxygen" http://www.supercoder.com/forum/topic/sleep-study-plus-oxygen#post-11325 Fri, 10 Feb 2012 16:26:15 +0000 Sanjit Mishra 11325@http://www.supercoder.com/forum/ In the context, it may seem not to separately bill for oxygen as it is part of the Sleep Study. But, if the following conditions are complied with, I think we can bill for the Oxygen: You can bill for Oxygen when there is a written order for the oxygen. “Oxygen PRN” is not satisfactory for Medicare reimbursement. The physician’s order must state the oxygen device and/or the specific flow rate or concentration of oxygen desired. A prescription for “oxygen PRN” or “oxygen as needed” does not meet these requirements. An intermittent or PRN oxygen therapy order must include time limits and specific indications for initiating and terminating therapy. * If the Medicare contractor notes the use of continuous oxygen without periodic assessment of arterial PO2, it may request additional documentation to determine the medical necessity for the service. * There is no CPT code for oxygen, and hospitals should not bill for oxygen using the unlisted CPT code 94799. Hospitals should bill it with the revenue code 0271, designating it as a supply. It must be billed in “measurable” units, such as per liter, per hour, per quarter hour, per minute.