Archive for 'Coding Challenge'

Reader Question: Turn To 64493 for Lumbar Pars Injection

Posted on 10. Sep, 2014 by .

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Question: For a patient who is diagnosed with lumbar pars defect, can we report code 64493 for a lumbar pars injection? Is this the correct CPT® code?

North Carolina Subscriber

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Reader Question: Beware Fundoplication Bundles

Posted on 27. Aug, 2014 by .

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Question: We had a case where the surgeon had to “redo” an old fundoplication while performing a laparoscopic hiatal hernia repair with placement of Sirgisis mesh. How should we code this, and can we separately report the fundoplication? 

SuperCoder.com Subscriber

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Reader Question: Choose Best Code for Follow-Ups, Not Just 99212

Posted on 13. Aug, 2014 by .

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Question: We recently finished our first internal audit and found a potential issue: One of the doctors told me that he only chooses level 99212 when it is a follow-up from a previous visit. He chooses levels 99213 and above for everything else. I do not believe it is that simple because I thought even if it was not a follow-up visit, something like a minor cold might warrant 99212. Can you advise?

North Dakota Subscriber

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Reader Question: Sometimes 20552 Applies Instead of 27096

Posted on 23. Jul, 2014 by .

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Question: Our physician did an SI injection in the office without any image guidance as the C-arm was not functioning. Should I bill 20552 or 20610?

Minnesota Subscriber

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Reader Question: Understand When G0268 Outweighs 69210

Posted on 09. Jul, 2014 by .

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Question: I billed G0268 with 92511 and had the appropriate documentation for support. One of our private payers denied the G0268 because the “related qualifying service” (Audiologic Function Testing) wasn’t billed for the same date of service. I didn’t realize you needed an audio evaluation to bill G0268. Has something changed with the codes? 

West Virginia Subscriber

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Reader Question: Track Post-Op Visits With 99024

Posted on 25. Jun, 2014 by .

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Question: One of the doctors in our group saw a new patient in the emergency room for a dog bite. She sutured lacerations of the face. The patient came to our office one week later to see another of our doctors who removed the sutures. The second provider documented a 99213; however, shouldn’t this be a postop visit? 

Minnesota Subscriber

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Reader Question: Focus on ‘Incident-to’ Rules

Posted on 11. Jun, 2014 by .

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Question: The following scenario occurred in our practice: Physician A covered an established patient office visit for physician B who was across the street with a patient in the hospital. They want me to bill the office visit incident-to physician B even though he was not in the office at the time. Can I do that? (more…)

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Reader Question: Make a Call to the Payer to Determine Whether E/M is Bundled With Surgery

Posted on 27. May, 2014 by .

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Question: We had a patient present to the office for a relatively minor problem. Our doctor provided an E/M service and sent the patient home. Later, the same patient suddenly developed terrible pain. He contacted the same doctor who had him go to the hospital for an emergency procedure.

The E/M deserves separate reimbursement, but I’m not sure which modifier to use. Modifier 57 is a decision for surgery and there was no decision for surgery during the initial office encounter. I want to use modifier 25 as the E/M was a separately identifiable service on the same day as a procedure, but the procedure puts the patient into a 90-day global period. I can’t use modifier 22 as it’s not supposed to be used with an E/M service. How should I bill for this? (more…)

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Reader Question: Nonexistent Payment Follows Incomplete Claims

Posted on 13. May, 2014 by .

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Question: Our practice has a few claims that have missing or incorrect information. I’m not sure what to do with these claims. Should we just put them through anyway and keep our fingers crossed? (more…)

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Reader Question: Avoid Location Based Assumption of Critical Care Codes

Posted on 23. Apr, 2014 by .

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Question: After a patient with severe abdominal pain and hemoptysis in the ER was admitted to the ICU, our gastroenterologist saw the patient for a consult. The patient was lethargic and a poor historian, so most of his information came from prior medical records. Our doctor did not document time. Can we charge for critical care since the patient was in the ICU?

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