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Wiki Intrauterine death 16 weeks, induction
Yes, as at the time of treatment the fetus was dead and retained at the beginning of the procedure. -
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Wiki Cerclage Removal
Per the 2007 CPT Assistant: Question How is the removal of cerclage sutures reported? AMA Comment Cerclage of the cervix during pregnancy is reported by means of codes 59320, Cerclage of cervix, during pregnancy; vaginal, and 59325, Cerclage of cervix, during pregnancy, abdominal. The... -
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Wiki 76805 versus 76811 ultrasound
I would suggest you read the attached article. It is up to the provider whether they want to perform 76805 and then because of a finding refer the patient for 76811 to an appropriate provider. If the patient is initially being seen by a MFM specialist he/she may simply order 76811 based on... -
Wiki Attempted C-section delivery- Modifier 53 or 52?
I would have to agree that modifier -53 would not be correct in this situation because you are trying to bill a global service, not just the delivery. You could have used -52 and let them know your provider did not do the delivery, but only if you also intend to provide all the PP care as well... -
Wiki 76816 vs 76815 ultrasounds
I think 76815 would be the more correct. They are doing it for growth, but no re-evaluating any fetal growth parameters, just amniotic fluid, position and heart rate. -
Wiki Laparoscopy with partial omentectomy and vaginal Cuff repair
I would code this as a diagnostic laparoscopy and an unlisted code for the vaginal cuff repair. There is no code this a laparoscopic omentectomy - partial or complete so it is unlisted and perhaps you can include the work with 49320 adding a modifier -22. We have discussed many times on this... -
Wiki 99459
No you would not. The code is for practice expense only and so it would only be reimbursed if the practice bore the expense. If you look at the CMS RBRVS data base you will see that the facility indicator column indicates an NA for this code meaning it is only applicable in a non-facility... -
Wiki Help with ICD code for laceration for both labial and vaginal during delviery
As the patient had both a perineal and vaginal laceration, ICD10 instructs you to use O70.0 instead (see included terms under code O70.0). -
Wiki Intrauterine death 16 weeks, induction
59855 would match the work performed. But be sure to also report the diagnosis of fetal death prior to 20 weeks when you submit this code even though the termination would be considered by the uninformed to be "elective." -
Wiki vaginal polyp removal
I completely agree with your assessment on this. -
Wiki Laparoscopic suture ligation
You can't bill a diagnostic laparoscopy and a procedure via the laparoscope as the diagnostic part is inherent in the procedural surgery. Hence, 49320 and 58660 will always be bundled. I agree that 37617 is an open procedure so would not apply here and if the bleeding was noted as a result of... -
Wiki 58100 or 57500
I disagree with reporting 57500. You can report 58100-22 if you like, but since this code includes an endocervical biopsy if performed, I doubt you will get paid anything extra. Your documentation supports the EMB with an incidental finding that is taken care of the at the same time. -
Wiki Jada Removal
For anyone wanting to know more about how the JADA is applied, removed and the required follow-up use this link. https://www.organon.com/canada-en/wp-content/uploads/sites/5/2024/08/JADA-Quick-Reference-Guide.pdf . There is currently no CPT code for this procedure so you would report 59899... -
Wiki Pessary Fitting Unsuccessful
So if they did not instruct the patient on how to insert it and how to care for it, part of the work was not done. Modifier -52 does not stipulate what portion was not done, just that the expected work was not completed. You should submit this information to the payer. -
Wiki Pessary Fitting Unsuccessful
Per the vignette submitted with this code to CPT the work would be as follows: Insert the fitting pessary into the vagina. Assess the prolapse reduction. If inadequate reduction is achieved or the device is immediately painful, remove the device and select and place an alternative pessary... -
Wiki pp depression
No. 96160 did not change, in my answer I inadvertently indicated the incorrect code number (99160) in my response which is not a valid CPT code and of course did not catch the mistake. -
Wiki Required NST Documentation - 59025
Please note that I am not trying to be political, but be aware that if the federal government reduces or eliminates dollars for Medicaid, your good documentation may make the difference between payment or no payment. If the State Medcaid program has fewer resources, they will begin to more... -
Wiki Coding for donor egg procurement from egg bank
Please supply more information. 58999 implies a procedure not procurement. If the egg is purchased from an egg bank it is a supply, not a procedure, and at present there are no codes for this unless you want to go with an unlisted supply code or make up a dummy code to use internally if this... -
Wiki Tubal Ligation Question
No. Both codes have the exact same RVUs assigned so are the same work and both are bilateral. So just pick one and bill it only. -
Wiki HSG facility billing question
Yes it is. You can find the link at: https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-payment-rates-addenda -
Wiki Required NST Documentation - 59025
Not 2 orders as the NST when done on twins will be done on both (unless one is deceased), but the report must clearly indicate that both were tested and the result for each. -
Wiki HSG facility billing question
I just checked the ASC procedure list for 2025 and 58340 is listed as a packaged service so no separate facility payment is made by Medicare. -
Wiki 58558
The procedure does not change, just the reason for doing it. In this case since it is for IVF you will have to use a diagnosis code that may get a denial for medical necessity or no coverage for that reason. That code would be Z31.83. -
Wiki OB Care Package
No, there is no minimum and the exact number of visits has never been specified. CPT has used the recommendations that were formulated back in 1930 to help control preeclampsia: that is on visit a month from week 4-28, once every 2 weeks from week 29-36 and weekly at 36 weeks until delivery... -
Wiki 58558
The code 58558 does not require that a specimen be sent to pathology. If this procedure was performed and documented you report it along with the stated reason for doing it. -
Wiki methotrexate
90782 was deleted from CPT in 2006 and replaced by 96372. Please make sure you have a current copy of the book or at least access to a CPT look-up program that is current. -
Wiki Is this billable?
Please access this article for excellent information. Most of the telehealth codes require patient initiation but regular E/M telehealth does not. If would not call this documentation supporting much more than a 99211 at best. Sounds like there should be some inservice education regarding the... -
Wiki methotrexate
The math says use the J code with a quantity of 1.46. If this does not fly and you wasted part of one bottle you could code the J code x 2 and an additional J code with a JW modifier to that some was thrown out. Here is an article on the subject of medication wastage... -
Wiki Q0091 Not Paid
Why are you asking this and attaching it to an older thread about Q0091? The policy you link gives you codes you can bill which includes Q0091), but why would you bill a lab code if you did not perform the test? Let the lab take the brunt of payment or non-payment for the service. Also, if... -
Wiki Is this billable?
As far as I can tell unless the teaching physician was virtually supervising, it is a no go. However, the teaching physician can bill for the personal service they did, but not take credit for what the resident did. The scenarios for 2025 as below" Below are scenarios describing virtual... -
Wiki methotrexate
You can bill 96401 (Chemotherapy administration, subcutaneous or intramuscular; non hormonal anti-neoplastic) for the injection of methotrexate in most cases since CPT has clarified that this code can be used for anticancer drugs that are given for non-cancer diagnoses. Some payers may disagree... -
Wiki 99459
Is there some problem with just indicating a chaperone was present? This has been debated since the inception of this code. In my opinion, it was valued based on the use of the pelvic pack and a chaperone so it should be documented (a simple statement should suffice). This statement also... -
Wiki methotrexate
As we had discussed, the code is by dosage - 50 mg per injection (J9260). So you bill a quantity that reflects the amount injected. If the methotrexate you are using was manufactured by ACCORD, report code J9255 instead (represents the same dosage as J9260). -
Wiki Vulvar Bleeding following Vulvar Biopsy
Yes, you should include this as part of the E/M service. Simple wound repair codes require use of staples, sutures or tissue adhesives to be billed. -
Wiki OBGYN Newsletter
Going forward they have been discontinued, but we are still hear at the Coding Forum. I was the technical editor for the ob/gyn coding alert and have been the moderator for this forum since its beginning. So you will still get the answers you need and I believe the old issues are archived so... -
Wiki Hysteroscopy with removal of dislodged Paraguard IUD arm
I would only bill 58558. This was like an "oops" while performing the intended procedure and I would not try coding separately for it. There is no real provider work involved in removing an imbedded IUD arm as it was done passively. And a basic rule under CPT guidelines is that if you insert a... -
Wiki Endometrial Cryoablation with Ultrasonic Guidance
The CPT clinical vignette describes the work as follows: Connect a probe to the cryoablation console and deploy a sterile drape. Precool the machine. Place a Foley catheter and fill the bladder. Place a tenaculum on the anterior cervical lip and apply traction. Evaluate and dilate the cervical... -
Wiki advice on billing visit w/dx of lynch syndrom
Z15.09 is the only correct diagnosis for Lynch syndrome. But as we know a Z15 code is not to be listed as the primary diagnosis. If he is doing a transvaginal ultrasound to check for ovarian or endometrial cancer, you can use a screening code for this condition followed by the Z15.09. If... -
Wiki "Repair" of laceration months after delivery.
As the posterior fourchette is where the labia minora meet, you could technically report this code. But keep in mind that the assignment of relative value units for this code was based on something more than a quick release of a single adhesion (the code was intended to describe adhesions that... -
Wiki Coding for preterm delivery in 2nd trimester
Or if permitted you can bill globally with a modifier -52 to reflect fewer than expected antepartum visits. -
Wiki Global maternity
If you are referring to Premera you will follow their guidelines at the following link: https://www.premera.com/paymentpolicies/CMI_129382.pdf -
Wiki OB TRIAGE BILLING
The ACOG article does not deal with coding. CPT guidelines for ED visits state ED services are provided in a hospital-organized department for this provision of emergency services 24/7. In order to be accredited, a hospital ED must abide by the federal law which means it is open 24/7 and cannot... -
Wiki 58580
As in what do you need insight about? Coverage? The procedure requirements? Per the vignette used to add this code to CPT: " typical patient: A 38-year-old female presents with heavy menstrual bleeding for 6 months. Examination reveals an eight-week sized uterus. A human chorionic... -
Wiki 58545 and 57500
You can bill, but be sure to add a modifier -59 to this code. The payer will decide if the procedure is incidental or separately payable. Make sure you link the correct Dx code to the polyp removal and that the documentation discusses the procedure in detail. -
Wiki 99459
On April 6, 2024 the following Q&A was posted by the CPT Assistant: May CPT code 99459 be reported if the patient declines the need for a chaperone for a pelvic examination during an E/M visit? CPT add-on code 99459, Pelvic examination (List separately in addition to code for primary... -
Wiki doppler and OB Global
If the documentation supports 76820, you would bill for it. Per the vignette for this code the intraservice work would be as follows: "A segment of the umbilical cord is visualized. A duplex Doppler sampling gate is placed over a portion of an umbilical artery almost perpendicular to the axis... -
Wiki Post partum IUD
Yes, it should be. ACOG has published a recommendation on coding for it which can be found at: https://www.acog.org/education-and-events/publications/larc-quick-coding-guide -
Wiki Removal of endometriosis from umbilicus
We would need to see the documentation of the work to render an opinion.