October 6, 2022 Question: I work at an ENT clinic and my physician is doing biopsies of the inner cheek and 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...
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...
August 11, 2022 Question: Can I bill an office visit in the global period if the diagnosis is different from why I did the original procedure? Answer: Yes, as long as the diagnosis is not for a related issue (e.g., complication from the original procedure). The documentation must be clear that the condition is unrelated...
July 28, 2022 Question: My coder just told me about the new guidelines for 2021 office visit codes. She said I no longer have to document a History. This doesn’t seem right to me. Answer: You are wise to ask because that’s not exactly true. It is correct that the History will no longer be...
July 14, 2022 Question: Can I use modifiers on an unlisted code? What about global period modifiers such as 58, 78 or 79? It seems reasonable to append those modifiers to the unlisted code. Answer: There is not a single right answer to this question. CPT said, in an old CPT Assistant, that generally modifiers...
June 30, 2022 Question: The guidelines that came out in 2021 for E/M services is for all types of E/M services, right? Answer: No. The 2021 E/M guidelines are for office/outpatient visit codes only (99202-99215). You will still need to use the 1995/1997 guidelines for all other E/M services, even consultations in the office. *This...
June 16, 2022 Question: Thank you so much for all the information you gave out in Chicago at the KZA Convention. We always have great take-a-ways when we leave there. I do have a question for you regarding incident-to billing for Medicare. One of my physicians is stating that her attorney told her being “under...
June 2, 2022 Question: I was at your conference this past weekend and I was wondering if you could clarify something for me. When a physician sees a Medicare patient in the hospital, and it is their first time seeing the patient however they are NOT the admitting physician, they can only bill a subsequent...
