coding advice needed

  1. O

    Question Covid Vaccine Coding Help

    Hi All, Wondering if I might be able to get your input here, I'm not finding may resources online for the most up to date coding of covid vaccines and the administration of them. We are offering the spikevax option, from what I can find in out CPT 2024 code books, utilizing Appendix Q. 91301...
  2. M

    Wiki Help Needed -- J9271 denied for CO-B15?

    My oncology office has received a denial from Humana for Keytruda (J9271) as part of a patient's treatment regimen, citing reason code CO-B15 with the remark "The required initial service for this drug was not processed, received or allowed." J9271 was billed with a clinic visit (modifier 25...
  3. S

    Wiki Any Recommendations?

    Hey! I'm in a pickle. I'm having so much difficulty understanding how to code. I'm looking for additional practice from websites or anything you guys recommend. Please let me know :)
  4. E

    Wiki Sacroiliac Fusion

    Hello! I've been having issues understanding when to use 27279 vs 0775T. I understand that both codes are determined based on the transfixation of the sacroiliac joint. To me...this definitely is a 0775T however, I've gotten so many denials for this code that it's making me doubt the coding...
    • ericka123449
    • Thread
    • coding advice needed orthopedic surgery sacroiliac fusion
    • Replies: 1
    • Forum: Orthopaedics
  5. A

    Wiki How Many Procedural Cases a Day is the Norm?

    Hi! I was wondering for a medical coder who works at a private practice for cardiology (interventional, general, and EP) and is the only coder for 14 providers what the norm would be for the amount of reports being submitted a day? I only code for hospital procedures. So I am doing all of the...
  6. S

    Wiki I need coding help for a surgical procedure

    Hello, I don't generally code inpatient. I have a complaint that a surgical procedure for an overnight patient in the hospital for surgery (surgeon) was coded incorrectly. What would be considered accurate for 31256 CPT with ICD10 H53.9 ? Can you please tell me how this would be coded for...
  7. N

    Wiki 88323 clarification. Please help!

    I work for a pathologist that receives material from other physicians. Sometimes for interpretation or slide prep. Oftentimes both. I have been running into an issue with 88323. We receive specimen and we prep the slides and read them. The provider insists that we can bill 88323-26 and 88305-tc...
  8. L

    Wiki Best Noridian NCCI Reference available Online?

    I suspect based on my denials that the source I'm using isn't correct. Is there a reliable online source to compare codes against Noridian specific NCCI edits? Thanks!
  9. M

    Wiki Intraoperative ultrasound coding

    Hello! This question is related to intraoperative radiologic guidance in surgery. I work in neurosurgery where we do craniotomies/craniectomies, spinal decompressions/fusions, shunts, etc. We typically code for microscopes 69990 and/or stealth navigation 61781 along with procedures. Recently...
  10. P

    Wiki 99072 reimbursement?

    Anyone have luck yet with 99072 reimbursement? Medicare is still not paying, correct? Any luck with other payers? Thank you! Pam
  11. S

    Wiki Workflow for AMB/SDS facility side

    Hi, I’m just trying to get an idea how everyone’s workflow goes for Ambulatory/Same Day Surgery for facility side? Do you group the same procedures together and code them all at the same time? Or just sort them by DOS and do a different procedure each chart? I’m trying to get ideas on how to...
    • Somertoms
    • Thread
    • advice ambulatory surgery coding advice needed coding productivity facility coding productivity sds workflow
    • Replies: 0
    • Forum: Outpatient Facilities
  12. T

    Wiki Focus Respiratory Panel PCR

    Hello Community! I have another question, this time on Focus Respiratory Panel coding. Please let me know how you would code this report. I appreciate any help!! Nasopharyngeal Swab, Focused Viral: VIRUSES NP SWAB- INFLUENZA A NOT DETECTED INFLUENZA B NOT DETECTED RESPIRATORY SYNCYTIAL VIRUS...
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    Wiki ESRD coding question

    In Nephrology our providers see patients who are on home dialysis in the dialysis center once for a monthly face to face visit and labs..... We are currently billing with CPT code 90963 based on pts age, billing under facility POS (63). This is what the providers have been told to use prior to...
  14. V

    Wiki Therapeutic Wound Exploration and lysis of lumbar adhesions.

    Our pain management doctor performed a procedure which was authorized under CPT code 11043 - Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less. This is what the doctor documented: The patient was brought back into the...
  15. J

    Wiki Billing for Osteoclasis

    The surgeon did a skeletal fixation distal radial fracture 25606- He also states Osteoclasis- He drilled multiple holes into the bone going from the radial side ulnarly and then making the wire go dorsal and volar. He swears there is another code for osteoclasis. I know there isn't a specific...
  16. E

    Wiki 64718 with 24305?

    Good afternoon, Based on NCCI edits, code 64718 (column 2) is bundled into 24305 (column 1), however the RVU for code 64718 is higher than that of 24305. Is there ever a scenario where both codes are billed for the same arm but 64718 is reimbursed over 24305? Thank you, Eva Wade, CPC-A
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    Wiki 99211 , 96372 coding when patient brings his own Testosterone Medication

    I work for a Urology Practice. The patient brings his own medication for Testosterone. We are questioning coding for 99211 &/or96372. The nurse is injecting medication the patient brings to office. In the Office note signed by the MD it is documented as there is HPI, PQRI, Allergies, Medication...
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    Wiki 51700 with 51703

    I have a question I need confirmation on. 51700 & 51703. Our scrubbing program has terminology that I want to clarify. 51700 is the 2ndry procedure to 51703 therefore it is the one bundled and should not be billed with 51703? Usually the cath's are the 2nday procedure and are bundled with a...
    • tera828@yahoo.com
    • Thread
    • bundled or billable coding advice needed urology urology catheter
    • Replies: 1
    • Forum: Urology
  19. F

    Wiki Can you code Partial colectomy w/ small bowel resection

    please help ;) Can you code for both an open or Lap partial colectomy w/ anastomosis and small bowel resection together? if so, do you add modifier 59 on resection? We are having trouble with reimbursement for both in the same setting. example 44140, 44120-59 Or is the resection bundled into...
  20. F

    Wiki Partial Colectomy w/ anastomosis and small bowel resection

    please help ;) Can you code for both an open partial colectomy w/ anastomosis and small bowel resection? if so, do you add modifier 59 on resection? We are having trouble with reimbursement for both in the same setting. example 44140, 44120-59 Or is the resection bundled into the partial...
  21. J

    Wiki Coding Pressure Ulcers in the same area

    I'm need of clarification. When a patient has 2 pressure ulcers in the same area (ie. 2 separate ulcers on the left buttock, stage 2), would the code be used twice since the guidelines states "assign as many codes ... to identify all ..."? Or would coding it once suffice since both ulcers are...
    • jessicalao
    • Thread
    • coding coding advice needed guidelines icd 10 coding pressue ulcer
    • Replies: 2
    • Forum: ICD-10
  22. M

    Wiki TRIBAL FQHC

    I work for a Tribal FQHC and have some questions regarding procedures not associated with a G code under FQHC guidelines. It has been our directive to split out the procedure codes (for example I&D, wart removal, etc) and submit those to Medicare B. However, when I am researching FQHC...
  23. X

    Wiki EndoPat Coding

    Is anyone performing the EndoPat? If so, what code are you using and are you getting paid by the carriers, especially Medicare.
  24. L

    Wiki D22.5 and D22.39 coded togther on OV?

    We had some claims rejected by IBX (we are in PA) and when we called they said they were denied because the provider coded D22.5 (nevus on trunk) and D22.39 (nevus on face) both on the Office visit 99213. They said those codes cannot be used together. Dr states pt came in for DN on the trunk...
    • LBernat7
    • Thread
    • coding advice needed denial codes dermatology
    • Replies: 2
    • Forum: Dermatology
  25. J

    Wiki Tech Testing

    Hello - A patient comes in for testing with a technician ordered by Dr. B. Dr. B does not review the results until the patients appointment a few days later, can you bill globally for the test on the day the test was administered? Or do you have to bill with a TC modifier on the day of testing...
  26. A

    Wiki Urgnet Care Setting using Ammonia Salts

    Hello - Has anyone ever had a situation where an Urgent Care would be using Ammonia Salts? If so is that included in the E/M or can that be billed separate. I am unable to find any information on this topic. Thank you, Aimee -CPC
  27. A

    Wiki Resection of carpal trapezium w/internal brace stabilization for thumb base arthritis

    Hi all, I would like an expert opinion on which CPT code is most appropriate for what looks like a "suspension version" of a CMC arthroplasty. Per op report: "...A marked amount of arthritis at the trapezial carpometacarpal joint was identified. The trapezium was osteotomized in 3 places...
    • aknapp1117
    • Thread
    • arthroplasty coding advice needed coding and documentation cpt trapezium
    • Replies: 1
    • Forum: Orthopaedics
  28. S

    Wiki 7th character for re-repair

    I work at an orthopedic specialist facility and came across a patient who re-ruptured her Achilles and came in for a re-repair. It looks like we are using the CPT code 27650 and the ICD 10 is T81.32x. However, I'm not sure which 7th character to use? Do we treat this as a initial care (since it...
  29. A

    Wiki Medically Necessary Contact Fit and Materials

    Trying to figure out the best way to bill and receive reimbursement for scleral contact lenses. My doctor wants to use 92313 with H18.59 diagnosis, but Medicare allowable reimbursment is only $90.71. With contact lenses the total charge will be $2500.
  30. K

    Wiki administration for oral Dexamethasone

    Our pediatrician wants to bill J8540 for the oral medication; which I believe is accurate, but he also wants to know if there is a CPT / HCPCS available for administering the oral medication. I've reviewed the HCPCS 2018 book, and have only come across H0033, but it's under the Mental health...
    • khenry0829
    • Thread
    • coding advice needed dexamethasone help with coding/billing oral administration pediatrics
    • Replies: 0
    • Forum: Pediatrics
  31. A

    Wiki What code to use after 90972 for follow-up services with same doctor

    I am seeking guidance on which code to use the day(s) after 90792 for a follow-up with the same doctor that did the 90792. We were once instructed to use 90791 for the follow-up and now that I've helped my supervisor to understand that this is not appropriate, I'm having a hard time figuring out...
  32. L

    Wiki Pulmonology-- A7003 with 94060

    I have a group that is billing an A7003 Which is the disposable nebulizer kit with a 94060 which is **Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration **. Since this is part of the test I would think that the A7003 would be inclusive as...
  33. M

    Wiki Confused about Billing-Need Help

    HI, I have a few questions and hope someone here would be a great resource with some help! My first question is about contractual obligations/adjustments. Normally practices/providers have their charged/billed amount as above the medicare allowable. So say they bill 99214, $125 is their...
  34. N

    Wiki New at the industry need advice

    Hi! I am a makeup artist and a mom of a smart, vibrant boy. In the search for a better life for my son, I started a medical records certificate. I am three classes away from completing my Medical Records Certificate. I have to admit that now that I can see the end of this journey I am...
  35. J

    Wiki Atherosclerosis and Angina

    I was researching the code for atherosclerosis with angina. Per the ICD-10 manual appears the correct diagnosis code would be I25.9 Chronic Ischemic heart disease, Unspecified which is not associated with an HCC. Is that correct?
    • jniebylski
    • Thread
    • angina cardiovascular disease coding advice needed hcc risk
    • Replies: 2
    • Forum: Risk Adjustment
  36. C

    Wiki coding help zygomatic arch biopsy

    For the below op report my physician coded 20205 and 21034 -52. The CPT 21034-52 denied as an invalid modifier. How would you bill for the biopsies of the soft tissue of the zygomatic arch. Would you use 20200? Procedure: Op-Biopsy of the RT masseter muscle and the RT zygomatic arch...
  37. H

    Wiki Workspace/Computer Lens billing

    I am wondering how other offices bill a Workspace/Computer Bluetech Lens with AR. I think it should be billed with V2200 code for bifocal, V2782 for Trivex material, V2745 for tint and V2799 for Near Variable Focus upgrade. This is how it works with VSP but I am having trouble with my commercial...
  38. L

    Wiki Help with Immigration Green Card E/M billing

    I'm still new to my place of work. I've recently run across charts where the patient is being seen only for immunizations/Green card immigration paperwork. Currently, patient's are only billed for the administration of the immunization(s). I believe a PE specific to immigration requirements...
    • LauraNewYork
    • Thread
    • coding advice needed green card immigration
    • Replies: 1
    • Forum: E/M
  39. L

    Wiki Oct 1 2017 change to L57.0 code-needs additional code??? HELP

    Hi we are in Pennsylvania we regularly treat and bill L57.0 code under the 17000/17003/17004... I saw in the proposed changes and deletions upcoming is one that states that you need to use an additional code to identify the source of the ultraviolet radiation? We have never had to do that ever...
    • LBernat7
    • Thread
    • 17000 17003 coding advice needed coding and documentation dermatology
    • Replies: 2
    • Forum: Dermatology
  40. L

    Wiki History Codes used as DX for F/U Office Visits????

    I have recently seen several of the following scineros and I just wanted to get some clarification: Patient comes in and has a full skin exam and Z12.83 is used as well as all applicable history codes (say Z85.828 hx of BCC or Z85.820) on the office visit that day and maybe the patient has...
    • LBernat7
    • Thread
    • coding advice needed evaluation and management history of
    • Replies: 4
    • Forum: Dermatology
  41. A

    Wiki Coding for Complete Abdominal Ultrasound

    I have CPT 76700 and it was sent to my office with the diagnosis of Z71.1 - Person with feared health complain in whom no diagnosis is made. The patient presented for evaluation of possible gallstones. Our study concluded the patient did not have gallstones. Is this diagnosis still acceptable...
  42. M

    Wiki Bronchoscopy Coding -- HELP PLEASE

    I am very new to coding for different bronchoscopies and I wanted to post this report and see if I could get some feedback as to whether or not the community thinks I am doing this correctly. I coded the following reports as: 31652 and 31624. DX: R59.1 and R91.8. Description: Patient was...
  43. C

    Wiki consult or new patient?

    1. If physician sees a patient who has paperwork that says “referral” or “transition of care” on it from the PCP or other referring provider, is this a consult or a new patient e/m? We have seen some of this paperwork have “referral” and “consult” on the same pages and my physician wants to...
  44. K

    Wiki possible limits on billing 96127 emotional/behavioral assessments

    My new boss says that we can only bill for these assessments once per patient. I see that we are allowed only 2 units on a claim but I can't see anywhere where it says bill only once per patient. Anybody out there have any other info on this?
  45. K

    Wiki Correct coding/billing of a CDL physical

    I have a new job at a clinic where they are coding CDL physicals as a sick visit -99214- with the dx of Z02.4 and billing it to the patients insurance and most of our contracted insurances are paying for them. They also have patients who come in for a pre-travel visit when they are going out of...
  46. A

    Wiki Lucentis Injections

    Hello Everyone, My administrator has asked me to verify payment of a Lucentis Injection for a patient who has a MediCal HMO. The facility has an authorization for the procedure, which includes the J2778, as well as the 67028. The IPA for the HMO is stating as long as I have the approval, it...
  47. B

    Wiki Revenue Code 200 ICU

    Hello thank you in advance to any response I receive to this question. I am CPC who deals primarily in Professional coding and billing for my daily work. I'm trying to learn a little more about facility coding to aid a friend who had spent some time in the hospital recently. This individual was...
  48. M

    Wiki Since when does Medicare bundle 76942 with 76872

    For years Medicare has accepted these codes for a prostate ultrasound and biopsy with no bundling issues. This is the order we billed them 76872, 55700, 76972. Since July I have been getting flagged that 76942 is a component of 76872 and a modifier is allowed to differentiate between the...
  49. C

    Wiki Strapping & supplies

    Are supplies (99070 ect) allowed to be billed w/ strapping codes? (29540 ect):confused:
  50. F

    Wiki Coding Question, Please help

    Can I code for a synvisc injection in the right knee and a synvisc injection in the left knee on the same day for the same patient and put a lt and rt as the modifier with the cpt code for a medicare patient and his secondary is tricare for life? Please help. Will I get reimbursed for the full...
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