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Secondary Payor Doesn't Recognize Consultations

Secondary Payor Doesn't Recognize Consultations

January 19, 2023 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,…
Secondary Payor Doesn't Recognize Consultations

Secondary Payor Doesn't Recognize Consultations

January 19, 2023 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,…
Modifier 52 vs. 53

Modifier 52 vs. 53

January 19, 2023 Question: We are confused about the difference between modifier 52 and 53. What is the difference? Answer: Modifier 52 Reduced Services is used when the procedure or…
Consultations in 2023

Consultations in 2023

January 19, 2023 Question: I am putting together E&M Guideline educational information for my providers based on the 2023 changes for reference throughout the year. I did some education in…
Forehead Flap

Forehead Flap

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…
Secondary Payor Doesn't Recognize Consultations

Secondary Payor Doesn't Recognize Consultations

January 19, 2023 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,…
Global Period for Debridement

Global Period for Debridement

January 19, 2023 Question: I thought the global period of debridement of muscle or bone was 10 days. Is that true? Answer: The debridement codes were revised in 2011 and…
E&M Coding Based on Time

E&M Coding Based on Time

January 19, 2023 Question: When choosing the level of E&M we are confused about the History and Exam. If we choose a level of E&M based on time, does this…
New vs Established Patient

New vs Established Patient

December 15, 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…
Consultation Coding in 2023

Consultation Coding in 2023

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.…
Consultation Coding in 2023

Consultation Coding in 2023

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.…
Retinacular Repairs

Retinacular Repairs

December 15, 2022 Question: Our surgeon documented a repair of the patella tendon with repair of the medial retinaculum repair. The surgeon wants to code for the retinacular repairs and…
Consultation Coding in 2023

Consultation Coding in 2023

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.…
Consultation Coding in 2023

Consultation Coding in 2023

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.…
Debridement Coding

Debridement Coding

December 15, 2022 Question: If 10 sq. cm subcutaneous tissue is debrided from the right leg and 20 sq. cm is debrided from the left leg, is it coded as…
Counting Laminectomy Levels

Counting Laminectomy Levels

December 15, 2022 Question: I am confused and hoping you can clarify a coding question I have. I thought I understood how to report laminectomy levels, however, after recently reading…
Excisional Biopsy

Excisional Biopsy

December 1, 2022 Question: My physician is insisting that I bill an excision biopsy using a punch as a punch biopsy (11104). The documentation says the lesion was removed in…
2021 E/M Coding Guidelines

2021 E/M Coding Guidelines

December 1, 2022 Question: In the 2021 E/M revision guidelines, how does Time affect billing for a teaching physician’s E/M service when the resident spends a great deal of time…
Oral Food Challenge

Oral Food Challenge

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…
Coding for Trauma Resuscitation

Coding for Trauma Resuscitation

December 1, 2022 Question: How do we bill for a trauma resuscitation? Are there codes for hanging fluids and packed cells? Can we use the CPR code 92950? Answer: There…
Foreign Body Removal

Foreign Body Removal

December 1, 2022 Question: A patient had a craniotomy a week ago and the provider is doing a removal of a retain drain of post op wound in the operating…
Secondary Payor Doesn't Recognize Consultations

Secondary Payor Doesn't Recognize Consultations

December 1, 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,…
E/M Visit During the Global Period

E/M Visit During the Global Period

November 17, 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…
Cleft Lip Repair

Cleft Lip Repair

November 17, 2022 Question: What CPT code do I use to report the repair of the cleft lip with a cross lip pedicle flap and sectioning and inserting the pedicle?…
Stent vs. Embolization or Both

Stent vs. Embolization or Both

November 17, 2022 Question: If the surgeon uses a covered stent and performs an embolization on a patient with a pseudoaneurysm, can we bill for both the stent and removal…
E&M Coding Based on Time

E&M Coding Based on Time

November 17, 2022 Question: Our physicians default to time for almost every office encounter. We are working with them on documentation and what work contributes to total time and what…
Billing an E/M Service on the Same Day as an Oral Food Challenge

Billing an E/M Service on the Same Day as an Oral Food Challenge

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…
Denial for 99214

Denial for 99214

November 17, 2022 Question: I work with Dermatologists. I have taken a couple of your online webinars. I have a question regarding a denial of office visit 99214, I hope…
What Does “Separate Procedure “Mean in a CPT Code Description?

What Does “Separate Procedure “Mean in a CPT Code Description?

November 17, 2022 Question: What does “separate procedure” mean when it follows a CPT code description? Answer: Per CPT: Some of the procedures or services listed in the CPT codebook…
Counting Laminectomy Levels

Counting Laminectomy Levels

November 17, 2022 Question: I am confused and hoping you can clarify a coding question I have. I thought I understood how to report laminectomy levels, however, after recently reading…
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