Archive for 'Coding Challenge'
Posted on 10. Sep, 2014 by rpandit.
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
Posted on 27. Aug, 2014 by rpandit.
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?
Posted on 13. Aug, 2014 by rpandit.
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
Posted on 23. Jul, 2014 by rpandit.
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?
Posted on 09. Jul, 2014 by rpandit.
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
Posted on 25. Jun, 2014 by rpandit.
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?
Posted on 11. Jun, 2014 by rpandit.
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…)
Posted on 27. May, 2014 by rpandit.
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…)
Posted on 13. May, 2014 by rpandit.
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…)
Posted on 23. Apr, 2014 by rpandit.
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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