Coding Challenge

Infusion Coding Education: Remicade

Coding Hint: Watch for ‘add-ons’ during Remicade sessions Question: An established patient with a plan of care in place for his Crohn’s disease of the ileum reports to the gastroenterologist for a Remicade infusion. The infusion started at 10:00 a.m. and ended at 11:42. The patient reported nausea during the infusion, so the gastroenterologist administered 200 mg of Benadryl from 10:41 [...] Related articles:

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November 9, 2009
Coding Challenge / modifier 59

Cardiology Coding Question: Separate Reporting for 37204

Question: Should I separately report right and left bronchial artery embolization? Answer: You should report 37204 (Transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method, non-central nervous system, non-head or neck) twice for right and left lung embolization at the same encounter. In addition, if the cardiologist [...] Related articles:

  1. Cardiology Coding Education: Pacemaker Lead Check Question: The cardiologist documented testing pacemaker leads using fluoroscopy...
  2. 2 New 2010 CPT Codes for High-Tech Cardiology ServicesSteer clear of Cat. I codes for intravascular spectroscopy — here’s...
  3. OB or Not OB: That’s the Ultrasound Coding QuestionQuestion: For an ultrasound, the radiologist documented measurements of the uterus,...

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November 7, 2009
CCI / Coding Challenge / modifier 59

Eye Surgery Coding Challenge: Denials for 15823 & 67904

Question: I started receiving denials for 15823 and 67904. To report this combo, should I use a modifier? Answer: If the ophthalmologist performs the blepharoplasty (bleph) with excessive weight (15823, Blepharoplasty, upper eyelid; with excessive skin weighting down lid) on one eye and the blepharoptosis (ptosis) repair (67904, Repair of blepharoptosis; [tarso] levator resection or advancement, [...] Related articles:

  1. Spinal Surgery Coding Challenge: Is Hemilaminectomy Bundled With Fusion?Question: Our orthopedic surgeon turned in a note that says,...
  2. Avoid This Blepharoplasty Coding Blunder  Don’t settle for denials for a functional surgery that...
  3. Spinal Surgery Coding Challenge: Tethered Cord Release & Dural Tag RemovalQuestion: My neurosurgeon released a tethered cord under the microscope,...

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November 4, 2009
Coding Challenge / radiology

Radiology Coding Education: Is 76705 OK for Back?

Question: For a lower back ultrasound of a soft tissue mass, which CPT code is appropriate? Answer: Code 76705 (Ultrasound, abdominal, real time with image documentation; limited [e.g., single organ, quadrant, follow-up]) is appropriate for this lower back ultrasound. Although the code descriptor states “abdominal” and not “back,” CPT Assistant (May 2009) clarifies that 76705 is appropriate [...] Related articles:

  1. New From CPT Assistant: Help with Trunk Ultrasound Coding Do you know exactly what’s in the mediastinum? Your US...
  2. Double Ultrasound Codes Spell Double Trouble With AuditorsAuthorities scrutinize medical necessity for 76830 & 76856. The OIG...
  3. 5 Lessons Radiology Coders Should Learn From CCI 15.3Wonder if there’s a method to the 76001 madness? Here’s...

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November 2, 2009
Coding Challenge / E/M / modifier 25

Ophthalmology Coding: GDX, VF, & Temp Plugs — How Many Modifiers?

Question: A patient came in for a GDX and visual field (VF) tests. During the same visit, the ophthalmologist put in temporary plugs. Can we get paid for all services on the same day? I know the office visit needs a modifier. Do I need to put one on the GDX & VF, too? Answer: Provided the [...] Related articles:

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October 31, 2009
Coding Challenge / E/M

Does My E/M Coding Have to Match Hospital’s E/M Coding?

Question: My physician removed a catheter in an outpatient hospital exam room. Should I include this removal as part of the E/M? If E/M is appropriate, will the hospital also report an E/M? And, if so, do the physician and hospital E/M codes need to match? Answer: You should include simple Foley catheter removal as part [...] Related articles:

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October 28, 2009
Coding Challenge

Closed Treatment of Hip Dislocation – Codes 27250 – 27252

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October 27, 2009
Coding Challenge

Closed Treatment of Fracture Great Toe – Codes 28490

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October 27, 2009
Coding Challenge

Does CNS Count as NP for Time-Based Coding?

CNS = NP = PA for CPT, but Check State Law Question: Does a certified nurse specialist (CNS) count as a nurse practitioner (NP) for reporting 99213 based on time? Answer: Yes, for CPT purposes, a certified nurse specialist billing under his own provider number counts the same as a nurse practitioner or physician assistant. So if [...] Related articles:

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  3. Mid-Level E/M Coding BreakdownOur chart shows you how to choose among 99212, 99213 &...

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October 26, 2009
Coding Challenge

Will a CLIA Waiver Help Our Practice’s Bottom Line?

Question: During a practice meeting last week, the subject of Clinical Laboratory Improvement Amendments (CLIA) waivers came up. We are currently not CLIA-waived, and we will discuss it again at next month’s meeting. I was wondering if you could offer any input? Should we apply for a CLIA waiver? Answer: Whether or not the waiver is [...] Related articles:

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October 25, 2009
Coding Challenge

Coccygeal Fracture – Closed Treatment – Code 27200

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October 22, 2009
Coding Challenge

Carpal Scaphoid – 25622 – 25624

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October 22, 2009
Coding Challenge

Aspiration Ganglion Cyst – Code 20612

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October 22, 2009