Is E/M Possible Pre-Colonoscopy?

Question: A local family physician refers a patient to our gastroenterologist for a diagnostic colonoscopy. The patient reports to the practice and meets the gastroenterologist for the first time. After answering some patient questions during a brief introduction, the gastroenterologist performs a diagnostic colonoscopy with brushing. The patient had never met the gastroenterologist before. Is the time he spent with the patient [...] Related articles:

  1. Are These Colonoscopy Codes Bundled?Challenge: Can you report codes 45380 and 44388 together? Answer:...
  2. Don’t Wait for CPT: Maximize Virtual Colonoscopy Payment Now Learn whether to file an ABN with 0066T, 0067T....
  3. Gastroenterology Coding Education: Bravo Cap Placements Question: A new patient reports to the gastroenterologist with complaints...

Comments Off on Is E/M Possible Pre-Colonoscopy?

Audits: HDI RAC Targets TC, Modifier 26 & More

Want to know what RAC contractors will be looking for next? Here’s the link. Recovery audit contractors (RACs) are working hard to expand their lists of approved issues, and you should keep a close eye on your services in these areas as well. Health Data Insights (HDI), the RAC contractor for Region D, posted 66 new approved [...] Related articles:

  1. CMS COVERAGE DECISIONS: MACs Can Make Exceptions to LCDsRACs can make exceptions only to approve claims. Coders know local coverage...
  2. RAC Fact Did you know that those new RAC auditors out...
  3. RAC Fact: Watch Out For Medicare’s Once-in-a-Lifetime Services G0389 & the IPPE codes may be potential RAC...

Comments Off on Audits: HDI RAC Targets TC, Modifier 26 & More

Ophthalmology Coding Challenge: Flashers & Floaters

How’s Your EO Coding & Billing? Test Yourself With This Scenario. Question: A patient reports flashes and floaters but the ophthalmologist does not find evidence of retinal pathology on routine ophthalmoscopy. Are we justified in billing for extended ophthalmoscopy (EO)? Answer: If the ophthalmoscopy is a routine part of a patient’s eye exam, do not [...] Related articles:

  1. Ophthalmology Coding: RT/LT or Modifier 50? Prevent Uni-Bi Reporting Errors With This Expert Insight Don’t...
  2. Ophthalmology Coding: GDX, VF, & Temp Plugs — How Many Modifiers?Question: A patient came in for a GDX and visual...
  3. Eye Surgery Coding Challenge: Denials for 15823 & 67904Question: I started receiving denials for 15823 and 67904. To...

Comments Off on Ophthalmology Coding Challenge: Flashers & Floaters

Time Your Surgical Collections Right by Referencing Payer Contracts

Find out if you’re legal in collecting patient portion before providing the surgical service. Don’t be too hasty in collecting a patient’s copay and deductible up front. “While in theory, the practice of collecting deductibles up front may sound good, you should check your carrier contracts to be sure you are allowed to do this before requesting [...] Related articles:

  1. Checklist: Collect Surgical Deductibles Up Front to Improve A/RThis 3-step checklist will boost your bottom line. With fewer...
  2. Medical Billers: Test Your Collections Know-How Here This nifty tool tells you if collections cluelessness is...
  3. 10 Carrier Contract Negotiation Tips Carrier contract negotiation is often a long, difficult process....

Comments Off on Time Your Surgical Collections Right by Referencing Payer Contracts

10060 Won’t Wash for Some I&Ds

Careful: A pilonidal cyst I&D is a separate animal. Question: A patient presents to the ED reporting pain in her spine. During the exam portion of a level-three E/M, the physician discovers that the painful area is red, and slightly warm to the touch. The patient also has a low-grade fever that she says she noticed about [...] Related articles:

  1. Winter Laceration Repair: How Do I Code For Dermabond?Warning: Your coding will vary depending on who’s getting the...
  2. Know What Separates FBR From E/M or Lose $80 in Pay Here’s why ‘incision’ with non-scalpel instrument could be an...
  3. Wound Closure Coding: Make the Simple, Intermediate DistinctionAccounting for depth is a tricky task when coding closure....

Comments Off on 10060 Won’t Wash for Some I&Ds

Radiology Coding Challenge: Total Spine MRI Without Contrast

Question: Which CPT code should I use for a total spine MRI without contrast? Answer: You won’t find a single CPT code that describes a “total spine” MRI, but you may report a code for each region the radiologist examines: • 72141 — Magnetic resonance (e.g., proton) imaging, spinal canal and contents, cervical; without contrast material • 72146 — Magnetic resonance (e.g., [...] Related articles:

  1. Which HCPCS Code Should I Use for Eovist MRI contrast? Question: Which HCPCS code should I use to report...
  2. Radiology Coding Challenge: Rate Your Reformatting SkillsQuestion: My radiology report documents axial CT slices from the...
  3. Radiology Coding Challenge: Why is Medicare Denying a 38792, 78195 ClaimTip: Discover true meaning of 38792 note Question: The physician...

Comments Off on Radiology Coding Challenge: Total Spine MRI Without Contrast

How Do I Code An Arthroscopic To Open Ankle Surgery?

Question: Our surgeon attempted to remove a loose body in the ankle arthroscopically, but it was too large so he had to perform an open removal. Do I bill only for the open procedure, or include the arthroscopic attempt as a discontinued procedure? Answer: Because your surgeon completed the procedure as an open case, you’ll report [...] Related articles:

  1. 4 Tips Position Your ‘Multiple Scope’ Codes PerfectlyOrtho coders: Here’s what you should do when there’s no...
  2. Coding Challenge: Foot Foreign Body Removal Vs. Soft-Tissue FBRQuestion: Our physician performed a foreign-body removal (FBR) on a...
  3. Medicare Coverage for Bariatric Surgery: Do You Know These BMI Guidelines?Question: I heard that Medicare made some changes about diabetic...

Comments Off on How Do I Code An Arthroscopic To Open Ankle Surgery?

How Do I Code Genetic Counseling By A Physician

Limit 96040 to Trained Counselor Question: May we report 96040 if our physician is performing genetic counseling? Answer: You should report 96040 (Medical genetics and genetic counseling services, each 30 minutes face-toface with patient/family) only for a trained genetic counselor’s services. (Currently, the American Board of Genetic Counselors [ABMG] certifies genetic counselors in the US and Canada.) [...] Related articles:

  1. E/M Coding: Support Higher-Level Family Counseling Sessions 7 V codes show why $55 more for a...
  2. How Do You Code for a Metastatic Tumor? Question: What is the difference between a primary and secondary...
  3. Time-Saving Forms for Coding Cessation CounselingWe’ve got the DAST, CAGE inks to help you make...

Comments Off on How Do I Code Genetic Counseling By A Physician

Urology Reimbursement: Coding for MESA, TESA

Question: Could you please give me the most current coding guidelines for the MESA and TESA procedures? The last I was aware, we were to use unlisted procedure codes. Is that still correct? Answer: You should still use unlisted procedure codes to report microsurgical epididymal sperm aspiration (MESA) and testicular sperm aspiration (TESA, sometimes called TESE [...] Related articles:

  1. Urology Coding Challenge: Gold Seed Marker Placement Plus TRUS Question: How should I report the placement of gold...
  2. Urology CPT 2010: 3 New Codes, 2 Deletions Change Your Urodynamics CodingUrodynamics income will go down by half, experts calculate. You will...
  3. Wake Up Your Reimbursement By Capturing Sedation Pay Reporting CS with a ‘targeted’ service puts a denial...

Comments Off on Urology Reimbursement: Coding for MESA, TESA

Surgical Coding: Scar Revision on Previous Mastectomy Site

Tip: Find mastectomy scar revision in wound repair Question: Our surgeon performed a scar revision on the site of a previous mastectomy. The procedure involved excising a 16.5 cm curved scar before performing a layered closure. How should we code this? Answer: You should use complex wound repair codes for the scar revision procedure that you describe. [...] Related articles:

  1. Surgical Coding Mysteries: The Case of the Separate MeshBeware Separate Mesh Removal Question: The surgeon performed the following:...
  2. Surgical Coding: Modifiers 58, 78, and 79SURGICAL MODIFIER CHOICES Surgery Modifier Choices are Key to Surgery...
  3. Partial Mastectomy Coding: 19302 Vs. 19301 Plus 38500 Here’s how you know when to include a lymph...

Comments Off on Surgical Coding: Scar Revision on Previous Mastectomy Site

Coding Keloid Scar Removal

Watch out: Avoid this unlisted code. Question: Is removal of a keloid scar considered an unlisted procedure? What is the right code? Answer: Use 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular lesions; up to 14 lesions) with diagnosis 701.4 (Keloid scar). 17110 and 7111 [...] Related articles:

  1. Check Destruction Method Before Assuming 17110You could gain $30 if a shave is also performed....
  2. Surgical Coding: Scar Revision on Previous Mastectomy SiteTip: Find mastectomy scar revision in wound repair Question: Our...
  3. Lesion Destruction Coding: Match Dx & Procedure Codes Like a Pro Tip: All ‘Verruca’ codes fall under one CPT code,...

Comments Off on Coding Keloid Scar Removal

CPT 2010 Code Selection Chart for Paravertebral Facet Joint Injections

CPT 2010 introduces a slew of new codes for paravertebral facet injections, so why not consult our handy flow chart to help you select the correct code? © Neurology Coding Alert. To read the full article on the new facet joint injection codes for 2010, download your 2 FREE sample issues here. Was it painful for you to [...] Related articles:

  1. Pain Management Coding Update: Facet Joint Injection CPT Changes for 2010Pain management, anesthesia, orthopedic, physiatry & neurology coders get ready...
  2. Facet Joint Injection Coding for 2010Marvel Hammer’s Quick Start Guide to changes you’ll face in...
  3. Save Time Coding Facet Injections With This Coding Tool Hint: Location, number and substance are key. Several factors...

Comments Off on CPT 2010 Code Selection Chart for Paravertebral Facet Joint Injections

Pain Management: 2 Providers, 2 Postop Pain Injections

Double 76942 OK for second provider? Question: Two providers from the same physician group performed two separate postoperative pain injections on the same patient, on the same day. Each provider used ultrasonic guidance during the procedure, but I’ve been told to report 76942 only once per day. How should we report both services? Answer: You can bill [...] Related articles:

  1. Pain Management Coding: Endoscopic Lumbar Nerve DecompressionHint: Think ‘unlisted procedure.’ Question: One of our physicians is...
  2. Pain Management Coding: TPI Do’s and Don’ts for Pay You Can KeepSample ICD-9 codes to support medical necessity for trigger point...
  3. Check New HCPCS Codes to Keep Pain Management Claims on TrackCatch the changes to botulinum toxin and neurostimulator electrode codes....

Comments Off on Pain Management: 2 Providers, 2 Postop Pain Injections

CMS Makes Key Changes to ABN Modifiers

We’ve got the new instructions you’ll need to follow. CMS will update the ABN modifiers effective April 1, according to MLN Matters article MM6563, dated Oct. 29. The ABN descriptors will read as follows: Modifier GA — Revised to read, “Waiver of liability statement issued as required by payer policy.” You’ll use this when a required ABN was issued. Modifier GX — [...] Related articles:

  1. CIGNA Opens Black Box: Get Paid With Modifiers 25 & 59 You now have clear-cut policies to apply, including 1...
  2. Still Using the Old ABN, NEMB Forms? Stop Now Surprise! Here’s when the new form puts you on...
  3. Got Multiple Modifiers? How To Sequence Them on the Claim Coders like to say that modifiers help them tell...

Comments Off on CMS Makes Key Changes to ABN Modifiers

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,...

Comments Off on Cardiology Coding Question: Separate Reporting for 37204

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...

Comments Off on Radiology Coding Education: Is 76705 OK for Back?