January 19, 2023 Question: Our Otolaryngologist routinely does repairs after Mohs surgery. What CPT code do I report for a paramedian forehead flap to reconstruct a nasal defect after Mohs surgery. Answer: The correct code to report is CPT code 15731 (Forehead flap with preservation of vascular pedicle (e.g., axial pattern flap, paramedian forehead flap)....
December 15, 2022 Question: In 2023, will the level of service be determined by history, exam and medical decision making, or will this change? I have heard it is changing. Answer: Beginning January 1, 2023, consultation codes 99242-99255) for both inpatient and outpatient services will be based on medical decision making or time. However, keep...
December 1, 2022 Question: What needs to be documented to support billing CPT code 95076/95079? Answer: Complete documentation is critical for oral challenges. Be sure to document: Time testing begins and ends The amount of food or drug given Any adverse reactions Discussion of test results *This response is based on the best information available...
November 17, 2022 Question: My physician always bills an E/M service with CPT codes 95076/95079. Is this allowed? Answer: It’s rare to bill an E/M code with an oral challenge unless the provider needs to treat for a reaction (intervention therapy – a separate service) or the provider saw the patient for an unrelated office...
November 3, 2022 Question: Can you bill a nursing visit when a patient comes in for an allergy injection? Answer: The routine preinjection and post injection evaluations by the nurse or MA would be included in codes 95115-95117 and would not be eligible to report separately. When documentation supports that a significant, separately identifiable evaluation and management...
October 20, 2022 Question: What is the difference between an implant and a foreign body? Answer: On page 90 of the Current Procedural Terminology (CPT) Professional Edition 2022, the definition was added to the guidelines. “An object intentionally placed by a physician or other qualified health care professional for any purpose (eg, diagnostic or therapeutic)...
October 10, 2022 Question: I work at an ENT clinic and my physician is doing biopsies of the soft palate and I’m not sure if this is coded as 11104 or goes under biopsy vestibule of mouth 40808? Thank you so much for your help with this! Answer: If the physician is doing a biopsy...
September 27, 2022 Question: Do I use CPT code 42950 when 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 pharynx). *This response is based on the best information available as of 09/27/22. ...
September 8, 2022 Question: We have a patient with 2 commercial payers (BCBS and Cigna). A consultation code was submitted to BCBS, and they paid according to our contract. However, Cigna is refusing to process the claim since they no longer pay for consult codes. Am I allowed to change the CPT code and rebill...
August 25, 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...
