Category: Coding Coach

New vs Established Patient
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New vs Established Patient

September 22, 2022 Question: I am a contracted physician with a group practice (Practice A) in our town. I have an opportunity to contract with another practice (Practice B) not in the same town, but near enough that my patients could see me in either location. My question has to do with the definition of...

Overreading a Diagnostic Imaging Study
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Overreading a Diagnostic Imaging Study

September 22, 2022 Question: I sent a patient out to the hospital for a CTA and the patient brought in the actual images and the radiologist’s report for me to review. Can I charge 76140 (Consultation on X-ray examination made elsewhere, written report) when I personally interpret those images and write my own report? Answer:...

Pharyngectomy Code
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Pharyngectomy Code

September 22, 2022 Question: Is code 42950, Pharyngoplasty (plastic or reconstructive operation on pharynx), reportable when a free skin flap with microvascular anastomosis, is not performed and a limited pharyngectomy is done? Answer: No, you should report CPT code 42890 when a limited pharyngectomy is performed not CPT 42950 (Pharyngoplasty (plastic or reconstructive operation on...

Billing Multiple Units
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Billing Multiple Units

September 22, 2022 Question: When billing 4 units of 11620 (4 charges with 1unit a piece with 76 modifier) to a Medicare Advantage plans we are getting denied for MUE stating that 3 units can only be reimbursed on the same date. Will changing the modifier to 59 bypass this edit or is it Medicare’s...

Coding a Decompressive Craniectomy
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Coding a Decompressive Craniectomy

September 22, 2022 Question: In a recent head trauma case, a decompressive craniectomy was performed with a partial temporal lobectomy, due to extensive damage. A hematoma was also evacuated. can we bill for the 61323 decompressive craniectomy code with lobectomy since only a partial lobectomy was done? And what about cooing for the hematoma evacuation?...

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Coding Coaches