Ensure That Diagnosis Matches Patient’s Condition

Posted on 03. Jul, 2012 by dchandhok.

Question: When I bill Medicare for deep debridement (11042) using the diagnosis the physician supplied—709.9—I’m getting denied payment. What diagnosis should I use for debridement?

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Avoid Confusion Over Hyperbaric Oxygen Therapy

Posted on 18. Jun, 2012 by dchandhok.

Question: Our pulmonologist recently treated a patient with pulmonary symptoms such as dyspnea and severe non-productive cough attributed to Type 1 decompression sickness following a scuba diving incident. The patient also showed symptoms of joint pains, fatigue and peripheral edema. Our pulmonologist treated the patient with hyperbaric oxygen therapy to relieve the symptoms he was facing. I am confused whether to use C1300 or 99183 to report this procedure that our pulmonologist performed?

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When Can You Add 38780?

Posted on 04. Jun, 2012 by dchandhok.

Question: If my urologist does a radical nephrectomy with a retroperitoneal lymph node dissection, does code 50230 include all that or should I report 38780 with 50230?

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Separate Depth Needed for Modifier 59 Appended Debridement, Per AMA

Posted on 18. May, 2012 by jennifer.godreau.

CPT® Assistant March 2012 gives tons of examples on proper usage of modifier 25 and modifier 59 including with debridement, arthrocentesis, knee pain at a preventive medicine service, and more. Test your skills with this example (“Debridement Guidelines Update”, CPT® Assistant, March 2012, p. 5):

“A patient undergoes debridement of a subcutaneous wound on the left arm measuring 10 sq cm, a subcutaneous wound on the right arm measuring 20 sq cm, and a 10 sq cm wound, including the bone on the left foot.”

“Although located at (more…)

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Report E/M, ECG, and Tobacco Counseling?

Posted on 14. May, 2012 by dchandhok.

Question: How should I report the following case for an established patient?

• More than 10 minutes discussing importance of quitting smoking
• Comprehensive history, comprehensive exam, moderate MDM
• ECG and interpretation
• Occasional palpitations, benign HTN, tobacco use, atypical chest pain, COPD.

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Which Modifier for Bypass Graft?

Posted on 30. Apr, 2012 by dchandhok.

Question: When the cardiologist places a stent in a coronary bypass graft, which modifier should we use? For example, if the patient has a saphenous vein graft going from the aorta to the right coronary artery, should we use a modifier to identify the graft?

 Answer: Typical payer policies will instruct you to append modifier RC (Right coronary artery) for the case you describe.

Here’s why: When the cardiologist places a stent in a coronary graft, you should use an anatomic modifier just as you would if she placed the stent in a native coronary vessel. For many payers, you will find written policies instructing you to base the modifier you use for the graft on the vessel the blood flows into.

Modifiers: The modifiers in question are RC, LC (Left circumflex coronary artery), and LD (Left anterior descending coronary artery).

In your example, the graft attaches to the aorta and the right coronary artery, allowing blood to flow into the right coronary artery. Therefore, when reporting stent placement in this graft, you should append modifier RC. For instance, you may append RC to 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel).

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Generic vs. Brand Name Won’t Change Your J3301 Billing

Posted on 17. Apr, 2012 by dchandhok.

Question: My doctor is using Kenalog 40 (NDC 0003029328) from Bristol Myers Squibb. He says J3301 is not the correct code to bill because that is a generic code. Is there a different code to differentiate generics from non-generic when billing? (more…)

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Coding Advice for F1-F9

Posted on 01. Apr, 2012 by dchandhok.

Question: I’ve seen conflicting advice on whether to use finger and toe modifiers with radiology codes. What’s your advice? (more…)

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37202 for Nitroglycerin Injections?

Posted on 19. Mar, 2012 by dchandhok.

Question: Can I charge for nitroglycerin injections x 2 when performing a right posterior tibial angioplasty and right peroneal angioplasty? If so, which codes do I use for the full service?

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37191-26 For This 2012 Case?

Posted on 05. Mar, 2012 by dchandhok.

Question: Our doctor did an IVC filter placement. The old codes were 37620, 75940. I was wondering if the new code would be 37191-26. Also documented with the filter is venography (75825) and cath intro (36010) with intro sheath extremity venous (36005). Can all of these be used, or is this a bundling issue in 2012?

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