For those of you who work in dermatology with a provider who performs MOHS surgeries, I have a question. How common or uncommon is it for a patient who is having a MOHS procedure to also have other lesions excised during the same DOS. The other lesions excised would be non-Mohs excision, i.e. CPT 11401-11406, 11600-11606, etc.
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Tag Archives: additional
Medicare Annual Wellness Visit and additional Well Woman Exam
Hello, fellow coders:
One of my providers performed an AWV and a separate well woman exam on two different dates of service. Since both were preventive, triggering use of G0468 (we’re an FQHC), Medicare paid the first well woman visit, but denied the AWV. My billing manager wants the provider to change the CPT code to an office visit (G0467) to get it paid, but the provider coded both correctly as preventive, with SOAP notes corroborating the coding. Has anyone had any luck in getting both an AWV and a well woman visit paid by Medicare?
Thanks,
Combing patient records for additional diagnosis codes reaps massive returns for Medicare Advantage plans
Where to find additional code description
Hello!
I am not sure where to find this additional information when coding, but for example, the AMA CPT book states that 29888 is the Arthroscopic ACL repair. The AMA just gives that description, yet I am told it includes the graft. Where do I look to find out if a code includes additional procedures like a graft or mesh..etc when the AMA book doesnt give further description?
Is there another program/reference I should be searching in addition?
Thank you!
FQHC Dual encounters, what constitutes “significant additional work”
When working pediatric notes, as an FQHC we are allowed to bill for a dual visit "whenever a problem or abnormality (i.e., exercise-induced asthma, migraine headaches, otitis media, prescription management) is addressed and requires significant additional work to perform the required key components and is medically necessary". We have a note that is documented as "stable on medication, but on drug holiday for the summer. Gave mom instructions on how to restart medications". Can I get your thoughts on if this would fall under prescription drug management?
:confused:
What is a general length of time to which "restarting medication" is considered significant? Your input is greatly appreciated.
:confused:
What is a general length of time to which "restarting medication" is considered significant? Your input is greatly appreciated.
Additional Information About Changes Coming in 2019
As mentioned in last month’s officer news, requirements for chapters will be slightly different in 2019. Six educational events will still be required but not all events must be traditional meetings. Events that will be approved are defined as: Traditional meetings – A minimum of 4 are required annually Officers are present All attendees are […]
AAPC Knowledge Center
New Problem to examining MD: Additional Work-up versus No Additional Work-up
Hi! I am a new CPC-A working on the Practicode. I am using the E/M Audit Tool to assign points for MDM. I am also using tools from E/M University. A lot of the cases I am working through are in the ED. I am missing the mark on leveling – I just coded 2 practice cases in a row that I should have coded 99285, but I thought they were 4s. If the examining doctor is discharging a patient because they are stable but advising them to make the next available appointment with a specialist or other physician, is this considered a New Problem with Additional Work Up Planned since the physician is counseling them to see another physician? I thought it was No Additional Work up Planned because the patient was being discharged. Thanks in advance. E/M leveling is a learning process for me :).
CMS published additional instructions for processing updated Part B therapy claims
PCNL with additional work (more than 50081?)
Looking for some advice on the following (the relevant details are in bold):
POSTOPERATIVE DIAGNOSIS: Left kidney stones.
OPERATION: Left percutaneous nephrolithotomy.
The patient has upper pole kidney stones,
one of them more medially, approximately 14 mm to 15 mm
greatest length on CAT scan, another one smaller 8 to 9 mm at
another part of the upper pole. On his arrival to the preop area,
the patient was sent to Interventional Radiology and the Dr.____
placed a nephroureteral access catheter with two wires going into
the bladder. In his opinion, the patient has the large stone burden
within a diverticulum with acute angle towards the pelvis which was
demonstrated on nephrostogram although he was able to easily pass
the wires.
The patient was identified in the waiting room and brought into the
OR on the stretcher. General anesthesia was administered. A Foley
catheter was placed. The patient was then flipped onto the OR table
into the prone position. Two rolls were placed under him. Axillary
rolls and shoulder pads were secured as well. All pressure points
including elbows and feet were secured. The patient’s left flank
was then prepped and draped in the sterile surgical fashion.
Time-out was performed. Consent and laterality were verified. The
patient received 2 g of Ancef before Interventional Radiology and
another 160 g of gentamicin before the PCNL.
Fluoroscopy was brought in. Both stones were identified on fluoro.
Due to the very medial location of the nephroureteral stent and the
medial stone, the nephroureteral access catheter was going in at a
complete vertical direction very medial close to the spine. The
C-arm thought to be rotated 45 degrees. At this point, I prepped
the nephroureteral access catheter with some additional Betadine and
removed the two wires that he had placed, a new Amplatz Super Stiff
wire and a regular Sensor wire. I then slowly removed the
nephroureteral access catheter to the level of the renal pelvis and
injected some contrast to opacify the collecting system confirming
the larger stone burden location more medially where the ureteral
access sheath was going through. Another stone still in the upper
pole but at a much lateral position on the kidney was identified
with an acute angle between the two stones. Next, the
nephroureteral access catheter was removed. The point of wire entry
into the skin was extended with a #11 blade approximately 12 mm.
Next, a NephroMax made by Bard balloon was inserted over the Amplatz
wire. The 30-French sheath was placed over the wire as well. I
then advanced the balloon tip to the level of the upper pole calyx
where the stone was and inflated the balloon to 18 cm of water. I
then attached the 30-French sheath over the balloon into the calyx
and removed the deflated balloon and removed it. Next, I introduced
a 26-French nephroscope using continuous irrigation was inserted
through the tract into the upper pole. Careful inspection revealed
that the patient had multiple conglomerate of stones rather than one
large stone measuring in size from 3 to about 6 to 7 mm. Due to the
acute angle of the infundibulum, I had a hard time rotating the
nephroscope to access all the stones, but I was able to insert the
ultrasonic Lithotripter, and using ultrasound and some LithoClast
activity I removed some of the stone burden. The patient still had
multiple stones deeper in the calyx and therefore removed the rigid
nephroscope and inserted a flexible cystoscope into the calyx, and
using a Nitinol basket I was able to retrieve the remaining stones.
At least six or seven of them were manually removed and sent for
specimen. Reinspection revealed no residual stones in the medial
calyx. I could not access the other upper pole calyx with the
remaining stone due to the acute angle between the two calices. The
renal pelvis was inspected. It was intact. I did not see any
stones in the renal pelvis or UPJ. Next, the collecting system was
opacified, and over the Amplatz wire I passed a 6 x 28 stent through
the nephroscope and noted coiled in the bladder and in the renal
pelvis. Next, the nephrostomy sheath was removed and after _____ I
passed a 22-French Council tip Foley catheter over the Sensor wire.
The tip of the catheter was noted to be in the upper pole calyx
although I did migrate somewhat distally after the balloon was
inflated with 1.5 mL of sterile water, but I was able to easily
irrigate the system. Some extravasation was noted, mostly from the
tract coming out adjacent to the 20-French Council tip. No
significant bleeding was noted. The Council tip nephrostomy tube
was secured to the skin with a 3-0 nylon stitch. A 4 x 4 dressing
and Tegaderm were then used to secure it in place. I then flipped
the patient into the supine position. The patient tolerated the
procedure well, was extubated, and sent to the recovery room in
stable condition.
Initially, I was going to bill just 50081 for the PCNL and 50684 for contrast. However, the level of detail & reading I’ve done suggests I can add on 52352 for the work involving the cystoscopic (vs the nephroscope) basket removal of calculi and 50395 (or 50432?) as I think the #11 blade incision extension counts as a new access? Perhaps I’m overanalyzing this one. Any help would be appreciated. Thanks.
Standards for additional reimbursement or reduction with modifiers
Hello,
I know many are at the discretion of the payer but is there a set standard that payers go by when determining if a modifier warrants additional payment (ie. -22) or reduction (ie. -52) and by what percentage? If so, who sets this standard?
I know many are at the discretion of the payer but is there a set standard that payers go by when determining if a modifier warrants additional payment (ie. -22) or reduction (ie. -52) and by what percentage? If so, who sets this standard?
Thank you.