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Modifiers on Unlisted Codes. Yes or No?

Modifiers on Unlisted Codes. Yes or No?

September 22 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…
New vs Established Patient

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…
Overreading a Diagnostic Imaging Study

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…
2021 Evaluation and Management Codes: Is a History and Exam Required?

2021 Evaluation and Management Codes: Is a History and Exam Required?

September 22, 2022 Question: After a recent audit and review with my physicians, they are telling me that they do not need to document a history and/or exam any more…
Pharyngectomy Code

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…
Billing Multiple Units

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…
Choosing a Modifier with a Colostomy Revision

Choosing a Modifier with a Colostomy Revision

September 22, 2022 Question: What modifier is used to report a colostomy revision during the global period of the stoma creation? Answer: A modifier 78, return to the OR for…
Coding a Decompressive Craniectomy

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…
E/M Visit During the Global Period

E/M Visit During the Global Period

September 8, 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…
Stent and Embolization Coil Used in Same Session

Stent and Embolization Coil Used in Same Session

September 8, 2022 Question: The surgeon used a stent and then inserted an embolization coil for an aneurysm. Are both billable? Answer: If the stent is placed to provide a…
Excisional Debridement Two Fractures:

Excisional Debridement Two Fractures:

September 8, 2022 Question: Our surgeon treated a patient who presented with an open fracture of the distal tibia and fibula. The surgeon performed an excisional debridement down to and…
Secondary Payor Doesn't Recognize Consultations

Secondary Payor Doesn't Recognize Consultations

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,…
Coding Mesh Placement in Hernia Repairs

Coding Mesh Placement in Hernia Repairs

September 8, 2022 Question: If mesh is placed for a laparoscopic hernia repair can an unlisted code be reported for the mesh placement? Answer: No. All laparoscopic hernia repair codes…
Secondary Payor Doesn't Recognize Consultations

Secondary Payor Doesn't Recognize Consultations

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,…
Radiofrequency Ablation

Radiofrequency Ablation

August 25, 2022 Question: We have been reporting CPT code 64625 with 3 units when we perform a radiofrequency ablation of the nerves innervating the sacroiliac joint at levels S1.…
2021 Evaluation and Management Codes: Is a History Required?

2021 Evaluation and Management Codes: Is a History Required?

August 25, 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…
Billing for Lesion Intervention Crossing Territories

Billing for Lesion Intervention Crossing Territories

August 25, 2022 Question: Our vascular surgeon documented a single intervention for a lesion that crosses the margin between the fem/pop and tibial/peritoneal territories. Should we bill one code or…
2021 E/M Guidelines and Consultation Codes

2021 E/M Guidelines and Consultation Codes

August 25, 2022 Question: I am new to an Orthopaedic practice where the coders do all the coding. The current coding staff is applying the 2021 E&M Guidelines to all…
New vs Established Patient

New vs Established Patient

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…
Attempted Foreign Body

Attempted Foreign Body

August 25, 2022 Question: When billing a foreign body removal code of 10120, the surgeon incises the finger and looks around for 25 mins and no foreign body is found,…
Billing for Intraoperative Injury

Billing for Intraoperative Injury

August 25, 2022 Question: A major blood vessel was accidentally nicked while a general surgeon was performing a complex case. A vascular surgeon was called in to repair the blood…
Billing for Costotransversectomy

Billing for Costotransversectomy

August 25, 2022 Question: If the exposure is thoracic, for example in a thoracic corpectomy, and the documentation states a costotransversectomy was performed, can that be billed separately? Answer: Costotransversectomy…
Modifiers on Unlisted Codes. Yes or No?

Modifiers on Unlisted Codes. Yes or No?

August 11, 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…
Angiogram Billing for All Vessels Viewed

Angiogram Billing for All Vessels Viewed

August 11, 2022 Question: Can we bill for all vessels mentioned if they are documented within the angiogram? Answer: No. You should only bill for vessels that are targeted and…
E&M Coding Based on Time

E&M Coding Based on Time

August 11, 2022 Question: Our surgeon saw a new patient in the office yesterday. His documentation supported reporting the E&M using time instead of based upon MDM. My question is…
E/M Visit During the Global Period

E/M Visit During the Global Period

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…
Use of Modifier 52

Use of Modifier 52

August 11, 2022 Question: My surgeon was called into a laparoscopic operation that was already underway, to perform extensive lysis of adhesions. Does he need to use a modifier 52…
Coding for Spine Procedures that Cross Spinal Junctions

Coding for Spine Procedures that Cross Spinal Junctions

August 11, 2022 Question: How do you report a spinal procedure for example, arthrodesis or laminectomies when two spinal are involved. For example., both thoracic and lumbar spine? Answer: Report…
Coding for Wound Surgical Preparation

Coding for Wound Surgical Preparation

July 28, 2022 Question: When billing for the muscle flap codes 15733, 15731 etc., can we also code for the surgeon’s cleaning and prepping by debridement before closing the wound…
Hip Injection

Hip Injection

July 28, 2022 Question: I did a left hip intraarticular steroid injection and used fluoroscopic guidance. Can I report the guidance in addition to the procedure? Answer: Yes, you would…
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