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  1. L

    Wiki Appendectomy w/ partial cecectomy and ileocecectomy

    I am having a similar issue - Appendectomy w/partial cecectomy - Laparoscopy - "we identified the cecum. There was some atypical attachments of the ileum to the appendix. Using the vessel sealing device we took down the fatty attachments. We were now able to retract the appendix up off the...
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    Wiki 22 Modifier

    copy of OP report - sorry I took the OP report off - I noticed one place I hadn't blacked out patient info
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    Wiki 22 Modifier

    I have a patient that had multiple large polyps, that took some time to remove. I would like to add Modifier 22 as it was an extensive procedure. I am trying to figure out the best way to submit. Submitting electronically I have no way of adding records. Would you bill electronically and...
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    Wiki Meritain Insurance

    Not sure I picked the right discussion - but - does anyone have any contact information for Meritain? I am trying to use the provider portal, but something isn't working correctly. It tells me to contact our Meritain Account Representative - we don't have one - does anyone? The phone # on the...
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    Wiki Modifier 52 on a screening colonoscopy

    I am in PA. Billed Medicare G0105 with modifier 52 because he had a poor prep. Cecum was reached so I didn't use 53. Medicare is denying the claim. N519 Invalid combination of HCPCS modifiers. Claim/service lacks information which is needed for adjudication. Is there a rule about this, can...
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    Wiki Sitz Mark Study

    We are considering ordering a patient to have a Sitz Mark study done. If we purchase and provide the capsule they need to swallow - how would I bill her insurance for that?
  7. L

    CPT code 45385 & 45380

    I didn't think you could use both 45385 and 45380 if both polyps were in the same area of the colon.
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    Wiki Can a physician self refer for a procedure

    We are a colon/rectal practice, one doctor, he is doing Anal Manometry in our office with equipment he purchased. Medicare denied claims without a referring doctor. Patient is a long time patient that dr. felt would benefit from this test, so he referred to himself to do the test in our...
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    Wiki E/M hospital codes

    I have a patient that was in the hospital. He went home for a few days, then he was readmitted. I billed the readmission as an Initial Hospital visit - 99223, but my claim is being denied. Codes - 16 - Claim/service lacks information which is needed for adjudication". I can't figure out what...
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    Wiki HIGH RISK SCREENING FLEXIBLE SIGMOIDOSCOPY

    I have a patient that had most of her colon removed. She has a family history of colon cancer and MD is doing a flexible sigmoidoscopy. Is there a High Risk Screening code for flex sig? I now G0104 for screening, but what about high risk?
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    Wiki coding sequence?

    I work for colon/rectal so no EGD's done here. I use modifier 59 when using 45385 and 45380 for different areas of the colon. I use PT for screening turned diagnostic. 53 for incomplete. I've tried using 52 when patient has a poor prep, but it doesn't seem to help when they have it repeated...
  12. L

    Wiki Pouchoscopy with snare polypectomy

    i don't think that would work. That says unlisted for small intestine, but it is the rectum.
  13. L

    Wiki Pouchoscopy with snare polypectomy

    What CPT code would you use for a pouchoscopy with snare polypectomy. Patient has familial polyposis. Dr. snared 3 polyps in the very short rectum. I don't see an option for snare polypectomy with a pouch, only biopsies. any suggestions?
  14. L

    Wiki Colonoscopy into terminal ileum with biopsies

    What code do you use for this? As far as I can tell there isn't a specific code available. Scope being done to r/o Crohn's
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    Wiki coding sequence?

    I am not a certified biller - just "promoted" to this job. I have been billing Z12.11 as the primary code for a screening colonoscopy when a patient has a history of colon polyps. Isn't that correct? I follow that with personal history of polyps and then the findings. I've been getting paid...
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    Wiki anorectal manometry

    We recently started to do Anorectal manometries in our office. I am told to bill 91122, 91120 for this. Does anyone know if I need modifiers? I have seen 26, PT mentioned. But what about 59? Any insight would be appreciated. Thank you
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    Wiki Humana rep

    Does anyone have a phone or Email for a Humana Rep? Are there any Humana reps?
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    Wiki understanding remark codes

    I've been getting claim denials with the following remark codes - 16 - claim/service lacks information which is needed for adjudication. Claim submitted like we usually do. On the same claim - N521 MISMATCH BETWEEN SUBMITTED PROV INFO & PROV INFOR STORED IN SYSTEM. And N152 -...
  19. L

    Wiki No Surprise Billing Act

    I started seeing "N860 Alert: The Federal No Surprise Billing Act QPA calculate member cost" on EOB's. Can anyone explain this to me. Thanks.
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    Wiki Order of DX codes

    When billing for a screening colonoscopy, patient has a history of polyps, family history polyps and a polyps was snared at this colonoscopy. I always list the Z12.11 first, then Z86.0100, Z83.719, D12.3. Should I be putting the D12.3 that was found at this particular colonoscopy higher in the...
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    Wiki Aither Heatlh

    Has anyone ever dealt with Aither Health? I have been trying to get claim information, no one ever picks up the phone, have tried multiple times, probably been on hold a total of 2 hours or more. Tried to sign up for the provider portal but I never get an email like they say I will. Have...
  22. L

    Wiki Need help again with coding for removal of skin lesion

    Patient had 1cm verrucous appearing mass in the anal canal. Pathology came back as High-Grade Squamous Intraepithelial lesion. I used Dx code R85.613 and CPT Code 11401. However, that dx code doesn't come up as a Group 2 diagnosis code for that CPT code. Would that fall into the 46924 CPT...
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    Wiki Billing/coding for hospital visits

    thank you! I will look for one of those
  24. L

    Wiki claim rejected for diagnostic colonoscopy

    I never knew there was a code like that! Thanks
  25. L

    Wiki claim rejected for diagnostic colonoscopy

    We had a patient that had a colonoscopy in March of this year and had several large polyps removed, including with EMR. Provider rescoped in October to make sure completely removed. I submitted the claim as a diagnostic 45378 since it was only 6 months, I didn't think screening codes were...
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    Wiki NCCI EDITS AND RECONSIDERATIONS

    thank you. I am asking about getting Codify, seems like a good option.
  27. L

    Wiki Billing/coding for hospital visits

    Thank you. I am basically untrained, moved to this position in a small practice that used to use a billing company but moved it in house. I ask alot of questions.
  28. L

    Wiki Billing/coding for hospital visits

    Would you be able to point me to a good source for coding these hospital visits? A worksheet or check list, anything that would help me get them right the first time. Thank you
  29. L

    Wiki Billing/coding for hospital visits

    Thanks for your input. I appreciate it. I will tell the provider to do better documentation :)
  30. L

    Wiki Billing/coding for hospital visits

    Oops. I already new I used the Initial code x2 and I fixed it. Looking at her hospital record, it looks like she might have been seen by a general surgeon prior to calling in the colon/rectal surgeon. I attached the consultation report. Any insight would be appreciated.
  31. L

    Wiki Billing/coding for hospital visits

    I work for a colon/rectal surgeon. He was called into a hospital case for a patient with a parastomal hernia with an abdominal abscess. I billed visit as 99223 for the initial visit. And 99222 and 99232 for subsequent visits. UHC asked for records. They are stating that the records don't...
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    Wiki medicare deductible/supplement payments

    Thank you!
  33. L

    Wiki medicare deductible/supplement payments

    Not Medicaid.
  34. L

    Wiki medicare deductible/supplement payments

    We have a difference of opinion - looking for the correct information or where to look for it. If a patient has Medicare Primary and PR is say $50, claim send to supplement/2nd insurance and they make a payment of $25 with PR 0.00 = are we allowed to bill the patient for the other $25 that...
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    Wiki QMB and deductibles

    If we have a patient that has Humana (HMO D-SNP) claim processed with a PR towards deductible. Patient doesn't have a second insurance - including state Medical Assistance - can we bill the patient? It states he is QMB, but still say PR is deductible. Another question along the same lines...
  36. L

    Wiki ER visit then procedure

    Patient comes to the ER. Found to have a perirectal abscess - colon/rectal surgery is called and they do an H&P. Following the H&P patient underwent an I&D of the abscess. Can I bill for the H&P - initial hosptial care and the I&D or just the I&D. I seem to get confused on this every time...
  37. L

    Wiki Poor Prep

    Sorry if this has been asked and answered - but how do you handle repeat screening colonoscopies due to a poor prep. If doctor doesn't reach the cecum I use modifier 53. But if they do reach the cecum, Patient at average risk - so normally they wouldn't be able to have another colonoscopy for...
  38. L

    Wiki PCP'S & Cologuard

    I've been having that issue too. I started adding Modifier KX.
  39. L

    Wiki order of CPT codes

    I know the rule is to usually list the higher RVU code first, however - we see a new patient using 99204 then Dr. examines patient and treats an internal hemorrhoid 46221. The procedure has a higher RVU - I usually list the 99204 with modifier 25 first. then the procedure. Correct? Or should...
  40. L

    Wiki Pre exisiting condition

    Thank you for this information!
  41. L

    Wiki Pre exisiting condition

    I have a patient that has familial polyposis. Has had it for many years. His insurance now - UHC/GOLDENRULE - is telling us that his flexible sigmoidoscopy with polypectomies won't be covered due to a pre-existing condition clause in his plan. They paid for his procedure previously, but now...
  42. L

    Wiki Reason code M81

    Patient had a chronic anal fissure. I used ICD 10 code K60.1 which is the only code I can find for a chronic anal fissure. I'm not sure how much more specific I can get.
  43. L

    Wiki Column one, column two

    I am in Pennsylvania.
  44. L

    Wiki Reason code M81

    I have several claims that weren't paid by Amerihealth Caritas (PA Medicaid plan) with the reason code of M81. You are required to code to the highest level of specificity. And 16 Claim/service lacks information which is needed for adjudication. I am not sure what these mean. On one patient...
  45. L

    Wiki Column one, column two

    Thank you. That helps!
  46. L

    Wiki Column one, column two

    Thank you. I was hoping it was easier :) I have looked for the Endoscopy codes and the spread sheet is SO BIG I have a hard to following the info. Maybe my problem is more I don't know how to use Excel to get to the info I want. Thank you for your help
  47. L

    Wiki Column one, column two

    Can someone point me in the right direction - where do I find these Columns. Thanks
  48. L

    Wiki NCCI EDITS AND RECONSIDERATIONS

    I am looking for a somewhat standard way of asking for reconsideration. Usually when billing a 45385 and a 45380. Also 45388 and 45385. I state per NCCI Edits that both codes are payable when in different areas of the colon. I am just looking for the proper wording that others use when...
  49. L

    Wiki Hospital visit, surgery

    I have a patient that came to the ER with abdominal pain etc. She was seen by the provider I work for, then went to surgery that same day. Can I bill for the Hospital H& P (99223) with modifier 57 - this took place in the ER. Since surgery happened the same day do I need to submit 2 claims...
  50. L

    Wiki Missing or Invalid Diagnosis

    that's my thinking too, but I doesn't seem to be theirs
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