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Outpatient Facility Coding Alert

Case Studies:
Test Yourself With 4 Colonoscopy, EGD Coding Cases
Sometimes, the best way to learn a new coding trade or to brush up on a current skillset i... Read more
CPT® Coding:
Code MR/CT and Radiographic Arthrograms With Ease Using This Guide
Distinguish between radiographic and fluoroscopic imaging in the report. If your outpatie... Read more
See What’s New With MIPS Performance Thresholds and More
Do your part to maximize reimbursement with positive payment adjustments. As part of the ... Read more
You Be the Coder:
Discern Between Arthrogram, Therapeutic Injection With Examples
Question: What's the difference between a radiographic arthrogram and a therapeutic inject... Read more
Reader Question:
Use 2 Codes for Hydrocelectomy With Hernia Repair
Question: What's the code for a hydrocelectomy when it's performed with an incarcerated he... Read more
Reader Question:
Treat Indicative Diagnoses as Definitive Findings
Question: In the impression of the report, the provider documents that “contrast opacifi... Read more
Reader Question:
I.D. Key Differences Between Port, Pump Catheter Infusions
Question: I'm debating between 36561 and 36563 for a procedure involving the insertion of ... Read more
Coding Guidelines:
Ensure Reimbursement for Terminated Procedures With These Tips
See what circumstances warrant 0, 50, and 100 percent payment. Coding for terminated proc... Read more
CPT® 2020 Updates:
See What’s New in Radiology for CPT® 2020
Take note of some important code description revisions. As is the case with the radiology... Read more
CPT® Coding:
Make Occipital Nerve Block Coding as Pain-Free as Possible
Know exactly how to code for a GON, LON, and TON nerve blocks.  Consider a clinical ... Read more
Reader Question:
Verify 3-D Reconstruction for MRCP Services
Question: I'm working on an exam header that states MRI/MRCP Abdomen with and without cont... Read more
Reader Question:
Refer to CMS Policy Billing for Corneal Transplant HCPCS Codes
Question: Is V2785 included in the corneal transplant code 65756? Michigan Subscriber An... Read more
Reader Question:
Understand Full Meaning of Separate Procedure
Question: Our payer is stating that 31231 and 31237 cannot be billed together on the same ... Read more
You Be the Coder:
Know What’s Included in Turbinate Reduction
Question: Following a septoplasty to remove a septal spur, the surgeon performed an inferi... Read more
Get the Most Out of These CPT® 2020 Updates
Don't disregard some crucial code description changes. From a general outpatient facility... Read more
Policy Changes:
Implement This Major Policy Change for Modifier 26, TC Billing
CMS is doing a complete overhaul of DOS billing. Sometimes, policy changes within the cod... Read more
Gain Auditor Insights on Discontinued Procedure Modifiers
Begin by getting all your documentation in order. When a provider discontinues a procedur... Read more
Reader Question:
Don’t Report Ordering Dx Without Addendum
Question: If you've got a report without a diagnosis that meets the CPT® code's Local Cov... Read more
Reader Question:
Check With Provider for CT and Fluoro in Same Encounter
Question: I'm working on a fluoroscopic-guided lumbar puncture. At the beginning of the re... Read more
You Be the Coder:
Channel Global Surgery Guidelines for Postop Within Global Period
Question: A patient presents for a follow-up visit two weeks following a total thyroidecto... Read more
ICD-10-CM Updates:
Get Busy Learning This Brand-New Set of ICD-10-CM Codes
No specialty is safe when it comes to ICD-10-CM 2020. The 2020 edition of ICD-10-CM is ju... Read more
Begin Prep Now for New PAMA Rules and Regulations on ADIS Orders
See what it takes to streamline the process between ordering and furnishing providers. Th... Read more
CPT® Coding:
Work Out 3 Unique Cataract Coding Cases
See how well you understand cataract bundling rules. Cataract services can be nuanced and... Read more
Reader Question:
Think Outside the Joint for ALL Reconstructions
Question: What CPT® codes will I report for an anterior cruciate ligament (ACL) repair al... Read more
Reader Question:
Use This Modifier for Transgender Screening Mammograms
Question: How do I code for a transgender patient receiving a screening mammogram? We... Read more
Reader Question:
Discern Between US Codes for Intraoperative Services
Question: Should I report 76536 for ultrasound (US) guidance during a total thyroidectomy?... Read more
You Be the Coder:
Append Appropriate Modifier for OR Complication Treatments
Question: Our physician performed a cystoscopy, a right retrograde pyelogram, and a r... Read more
ICD-10-CM Coding:
ICD-10 Challenge: Work Out This Tricky MRI Report
Hint: Break down the impression into individual components. If you've coded for an indepe... Read more
Stay on Top of 92502 Guidelines and Policies With This Guide
Use all sets of authoritative resources at your disposal. There are some instances where ... Read more
CPT® Coding:
Learn the Fundamentals of 38531 Coding With 2 Helpful Tips
Prevent unexpected denials by keeping an eye out for bundled services. When 2019 arrived,... Read more
Reader Question:
Know Which Dxs Correspond to ABI, Flow Velocity
Question: On a complete bilateral duplex scan of the lower-extremity arteries, I am confus... Read more
Reader Question:
Stick to ICD-10-CM Index for Orbital Erosion of the Skull Diagnosis
Question: What diagnosis code would you report for orbital erosion? Alabama Subscriber A... Read more
Reader Question:
Implement X{EPSU} Payer Rules into Practice Guidelines
Question: Which payers accept the X{EPSU} modifiers? I've heard that you should only repor... Read more
You Be the Coder:
Refer Back to NCCI Edits for Marker Placement With 38505
Question: Can I code for clip placement with an axillary lymph node biopsy? Also, the surg... Read more
CPT® Coding:
Abide By These Key Cerebral Angiography Coding Rules
Channel guidelines from a variety of different sources. Diagnostic cerebral angiograms ar... Read more
Report MIPS Radiation Codes, Avoid Negative Payment Adjustments
Give your provider the best shot at a positive payment adjustment. Merit-based Incentive ... Read more
E/M Coding:
Watch Out for E/M Pitfalls with Pre-Colonoscopy Screenings
Know when, when not to include an E/M code. Physicians performing colonoscopies in an out... Read more
Reader Question:
Make Proper Distinctions Between Myringoplasty, Tympanoplasty
Question: What's the difference between a tympanoplasty and a myringoplasty? I was under t... Read more
Reader Question:
Bank on This Criteria for 31267 Reporting
Question: I'm coding a maxillary antrostomy. The doctor documents a small amount of tissue... Read more
Reader Question:
Take Indication, Impression into Account When Choosing Dx
Question: I'm working on a chest X-ray with an indicating diagnosis of chest pain and... Read more
You Be the Coder:
Think Twice Before Reporting 66982 for Capsular Cataract Staining
Question: Can I report complicated cataract code 66982 if the surgeon uses trypa... Read more
Case Studies:
Properly Account for Bundling, Laterality, Modifiers in This Surgical Example
When in doubt, report modifier 59 over X{EPSU}. If you're working on a detailed surgical ... Read more
Boost Your Aftercare, Follow-Up Dx Coding Skills With 2 Examples
Proper code sequencing is only half the battle. The inexperienced coder might use terms l... Read more
CPT® Coding:
Break Down the Nuances of This EGD, Colonoscopy Example
Note when the surgery changes from diagnostic scope to surgical endoscopy. When you're ta... Read more
Reader Question:
Report Single Code for COPD, Bronchiectasis Dx Combo
Question: What is the ICD-10-CM code to report for chronic obstructive pulmonary disease (... Read more
Reader Question:
Avoid Denials, Check Code’s LCDs, ICD-10-CM Crosswalk
Question: We received a denial for code 92511 for due to an incorrect diagnosis code. The ... Read more
You Be the Coder:
Know What to Report for Septal Spur Excision
Question: I'm working on a functional endoscopic sinus surgery (FESS) involving a left max... Read more
CPT® Case Studies:
Use Op Reports, I.D. Fundamentals of Cystourethroscopy Procedures
Use these three operative reports to drive the point home. Every surgical specialty has i... Read more
CPT® Coding:
Code X-Ray-Guided Tube, Catheter Placement According to NCCI Policy
Use key points on reporting initial and secondary X-rays for line and tube placements. Co... Read more
Enhance Your Assistant Surgeon Modifier Reporting With This Guide
Plus, know how to report PA, NP, and CNS-assisted surgeries. Coding some operative report... Read more
Reader Question:
Go Unlisted With Femoral Hernia Repairs
Question: What CPT® codes should I use to report a laparoscopic bilateral inguinal hernia... Read more
Reader Question:
Bundle Catheter Placement into TUIP Code
Question: The surgeon performs a cystoscopy with transurethral incision of the prostate (T... Read more
Reader Question:
Consider 1 or 2 Oblique Views on Hip X-Rays
Question: I'm working on a unilateral right hip with pelvis X-ray. The provider has docume... Read more
You Be the Coder:
Don’t Leave Reimbursement on the Table With Incomplete Op Reports
Question: My physician performed a 38500, but did not document the closure. I inquired and... Read more
CPT® Coding:
Keep Your UPPP, Pharyngoplasty Coding in Check With These Examples
Learn what to look out for in the documentation. There are plenty of variables to conside... Read more
ICD-10-CM Guidelines:
Bust This Rheumatic Heart Valve Disease Coding Myth
See what pitfalls to avoid when coding heart valve conditions. The world of procedural an... Read more
NCCI Updates:
Acclimate Yourself With These 2019 Integumentary, Cardiovascular Updates
Avoid unnecessary denials by staying on top of some important new hospital and physician e... Read more
Reader Question:
Break Down Coding Dynamics for Multi-Sinus Balloon Dilation
Question: How do I code a bilateral frontal sinus balloon dilation and a left sphenoi... Read more
Reader Question:
Check Bilateral Surgery Indicator Before Billing Bilaterally
Question: Can I use modifier 50 when submitting code 17110 if lesions were removed fr... Read more
Reader Question:
Know What Qualifies as Incidental, Separately Billable Intraoperative Appendectomy
Question: While performing an open gallbladder removal, the surgeon noted localized perito... Read more
You Be the Coder:
Consider Peripheral, Major Veins When Choosing Between 36561, 36571
Question: What is the CPT® code for a left cephalic port-a-catheter placement for a 50-ye... Read more
Get Familiar With Modifier JW Use in OPPS Settings
See how guidelines differ in outpatient facility settings. When billing and reporting for... Read more
Adhere to Rules on Single-View Chest, Abdomen X-Ray Coding Cases
Learn how to navigate between parenthetical notes and other authoritative sources. Someti... Read more
CPT® Coding:
Case Study: Know When to Code Hernia Repair With Colon Resection
Learn the rules for separate services. From a coder's perspective, some of the more chall... Read more
Reader Question:
Consider this C Code for MRI Breast With Contrast
Question: How should I report a magnetic resonance imaging (MRI) scan of the breast with c... Read more
Reader Question:
Report C9749 for Latera Implant in OPPS Setting
Question: I have a doctor that performed a “placement of bilateral Latera® implants for... Read more
Reader Question:
Make These Considerations When Choosing Vulvar Excision Code
Question: The doctor removed a 10 cm vulvar mass from a patient. The mass was external and... Read more
Reader Question:
Consider Modifier 79 for Unrelated Procedure Within Global Period
Question: The provider performed a debridement endoscopy (31237) at a one-month check-up v... Read more
You Be the Coder:
Check for Specific Criteria on Duplex Scan Reports
Question: On a scrotal ultrasound (US) with duplex scan, the provider docum... Read more
CPT® Case Study:
Break Down Each Step of This Oropharyngeal Resection Procedure
Use all the resources at your disposal to reach the correct coding choice. The process of... Read more
CPT® Guidelines:
Avoid These Pitfalls on 2019 Breast MRI, CAD Combo Coding
Plus, don't let this semantic error send you into a coding tailspin. By this time of year... Read more
ICD-10-CM Coding:
Report External Cause Codes Accurately and Confidently With These Tips
Add clarity and context to your primary diagnoses with external cause codes. Although not... Read more
Reader Question:
Consider CT Shoulder Arthrography, CT Upper Extremity 1 in the Same
Question: What's the CPT® code for a computed tomography (CT) arthrography of the shoulde... Read more
Reader Question:
Check Medicare Criteria for AAA US Screenings
Question: What criteria need to be met in order for a Medicare patient to qualify for an a... Read more
Reader Question:
Note Circumstances of Postop Pain Before Determining Dx Code
Question: A patient is seen by the physician two days following an ethmoidectomy. The pati... Read more
Reader Question:
Know How to Sequence Complication, Condition Codes Properly
Question: How should I code a diagnosis of chronic nasal bleeding following sinus surgery?... Read more
You Be the Coder:
When in Doubt, Use Clinical Responsibility as a Reference
Question: My physician is suggesting that we report code 30117 for the removal of a nasoph... Read more