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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

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2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

Append Modifier 22 to Extraordinarily Complicated Procedures

Understand the additional work required to receive rightful payment on modifier 22 claims. Values assigned to CPT® codes assume an average service with an expected range of complexity. However, there are times when the code used to report a service does not adequately describe the work involved. When the procedure performed has exceeded the normal […]

The post Append Modifier 22 to Extraordinarily Complicated Procedures appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Surgical Complications Don’t Have to Be Complicated in New York City

AAPC’s Regional Conference in New York City (Aug. 19-21) is the place to be for everyone on the revenue management side of healthcare; it provides the latest education, networking, vendors, and opportunities to keep you ahead of other healthcare business professionals. If you are a medical coder, biller, or auditor you’ll find it’s a treasure trove of career resources ― […]

The post Surgical Complications Don’t Have to Be Complicated in New York City appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Complicated Coding issue involving Cataract surgery on a juvenile for PCS Cataract su

I would like some Coding help in determining What CPT’s and what current ICD-10 Codes can be billed for cataract surgery with sulcus lens placement, pars plana vitrectomy, with lens implant retrieval of implant that dropped into the vitreous space during surgery, right eye. This is complicated in that the cataract surgery was performed by the Primary Ophthalmologist on a juvenile patient for PSC cataract OD and then this patient experienced a posterior capsule rupture during I & A necessitating pars plana vitrectomy with lens implant retrieval by another Ophthalmologist, who is the Retinal Surgeon in the same Ophthalmology Practice. Also, can this be coded as a Two-Surgery Case with a -62 modifier on each surgery? Also, the CPT Codes the Retinal Surgery said to use for his portion of the surgery were 67036, 67121, and 66986.

Which modifiers would I use for each surgery for each provider?

Medical Billing and Coding Forum

Please read! Too complicated to title, thank you!

CTS performed a debridement and removal of sternal wires on patient with non-healing thoracotomy. Patient receives serial wound vac changes until wound is ready to close. Reconstructive Plastics specialist performs myocutaneous muscle flaps to close and CTS is the assist. Operative note states pt will be admitted under CTS service. Since the CTS only assisted can he bill for subsequent daily visits or is he still bound by the global surgery rules? Haven’t been able to find any sources that address this particular scenario.

Thanks in advance for your help!

Erin E

Medical Billing and Coding Forum

Twin Delivery – Complicated

I have a patient that was pregnant with twins and her water broke at 35 weeks. She went to our hospital and the midwife delivered the first baby (Baby A) vaginally. The second baby (Baby B) ended up being delivered via C-Section by the M.D. I know one will be global and the other delivery only, but what modifiers would you use to get both claims paid since there are two different providers? Thanks in advance for any help you can give.

Medical Billing and Coding Forum

Need help with complicated multiple surgeries

Hi, Can anyone help me with some CPT codes for a patient who had multiple surgeries? On 9/13, she had a sigmoid colon resection with end to end anastomosis. For that I am using 44147. She developed peritonitis, and on 9/18, she had a re-opening of the laparotomy, irrigation and drainage, repair of an anastomotic leak, and a diverting loop ileostomy. The wound was closed with loose surgical cliips. For the ileostomy, I am using 44310; don’t know if I can charge for the repair of the anastomosis or what code I would use for it (44799?). She developed leukocytosis, and on 9/21, had a second look laparotomy and washout. Fluid collections were aspirated, abdominal cavity was irrigated. The wound was not closed, but a wound vac was applied. I was thinking 49002 for the re-opening of the laparotomy, and 97605 for the wound vac, but don’t know if there’s anything else I can charge. On 9/23, she went back for a limited abdominal exploration (separated multiple loops of small bowel), suctioned out some fluid, and applied wound vac. Don’t know if I can charge 49002, as the wound was left open last time. On 9/25, she went back to OR and was found to have a rupture of a suture line at the anastomosis. She had irrigation and drainage, closure of the rectal stump, closure of proximal descending colon, lysis of adhesions, wound vac. Doctor commented that the small bowel, mesentery, omentum and abdominal wall remained edematous and non-compliant. Again, I don’t know if I can charge for the closure of the rectal stump ( that was to repair the rupture of the anastomosis), or what code I would use for it. They were going to do a loop colostomy, but the descending colon did not have enough mobility to reach the skin level, so they closed it off (oversewn to a blind end) and will re-evaluate it in 48 hours. Don’t know what code to use for that. I’m guessing some of these will be unlisted. On 9/27, she had mobilization of the splenic flexure, end descending colostomy (opening was lateral and cephalad to the umbilicus), irrigation and drainage, and wound vac. Not sure if I should use 44141, 44143, or something else, as at this visit, they didn’t remove any parts of the colon.
Any help on this mess would be appreciated, as it is just beyond my experience.
Thank you!
Donna H.

Medical Billing and Coding Forum

Compliance Is Not Complicated

To be sure your providers and employees are following all rules and regulations to keep your medical practice compliant, you should create a compliance program. The Office of Inspector General lists seven core components for an effective compliance program. Implement standards through written policies and procedures Providers and employees need written policies or procedures to […]
AAPC Knowledge Center

Complicated attempt at coil retrieval

Here is the op note: I haven’t seen anything like this before, so I was hoping to get some ideas from all of you. Thanks!

Procedure: 1. Bilateral pulmonary angiogram.
2. Attempted coil retrieval

TECHNIQUE: A 7 French sheath had been previously placed in the left arm fistula. This was exchanged over wire for a 90 cm 7 French sheath. This was placed in the right atrium and then the right ventricle. The coil was well see on all views. The coil appeared to be inferior to the ring of the tricuspid valve.

Multiple attempts were made to place a catheter near left of the coil to touch over the wire. These were all unsuccessful. The location of the coil was uncertain on fluoroscopic images alone. A 4 French pigtail catheter was placed into the left pulmonary artery. A left pulmonary arteriogram was performed.

The catheter was then placed into the right pulmonary artery. A right pulmonary arteriogram was then performed. The catheters exchanged for another 5 French catheter. Additional attempts were made to get close to the coil.

These were unsuccessful. The catheter and sheath were then removed and a short 7 French sheath was left in the fistula in the left arm. This was secured in place with 2-0 silk.

Findings: Cardiac: The patient has had a previous surgery and radiopaque band is seen at the tricuspid valve. The coil was well seen inferior and slightly to the left of this valve.

Left pulmonary arteriogram: Left pulmonary arteries branch normally. No filling defects are seen. The coil was not contained in any pulmonary arteries.

Right pulmonary arteriogram: Right pulmonary artery fills normally. No filling defects are seen. The coil was not in the right pulmonary arteries.

I am super unsure on how to code this. I don’t do ANY cardiac catheterizations, so I don’t want to make a misstep here. Please help!

Medical Billing and Coding Forum

complicated picc line removal hosp vs pro

I’m looking for a bit of clarification.

Our Hospital coder is saying we should bill this with 37197-74

37197
The physician places a needle into a blood vessel. A guidewire is threaded through the needle into the vessel and the needle is removed. A catheter is threaded into the vessel and the wire is extracted. The catheter, equipped with a grasping instrument, travels to the site of the foreign body typically using imaging guidance. The instrument grasps the foreign body, typically a fractured catheter, and retrieves it. The catheter is removed and pressure is applied over the puncture site to stop the bleeding.

My other PB coder and I do not think you can bill for a picc line removal in general but especially since it appears to be sutured to the patient. The most we think we might possibly be able to bill for is the fluoroscopy 76000-26

76000

A radiologist or other qualified health care provider supplies separate fluoroscopic monitoring of the body for up to one hour for procedures that do not include fluoroscopy as an integral component. This code is reported separately to describe the professional work component entailed in providing fluoroscopic monitoring. If formal contrast x-ray studies are done and included as a part of the procedure to produce films with written interpretation and report, fluoroscopy is already included and cannot be separately reported.

Any thoughts?
:confused:

Name of procedure: Attempted removal of PICC line under fluoroscopic guidance
*
Assistant Dr______________*

Indication: This patient is a_____________with multiple medical problems who presented with cardiogenic shock. He had a PICC line placed. He then had open heart surgery. Subsequently, he developed leukocytosis and concern for systemic infection. An attempt was made to remove his PICC line, but that was not successful. He went to interventional radiology yesterday and the PICC line could not be successfully removed. Dr._______discussed the situation with me, and we agreed to repeat an attempt to remove the PICC line in the EP lab with higher quality fluoroscopy and with the option to use locking stylets if appropriate.
*
Description of procedure: The patient presented for the procedure transported from the ICU in his baseline intubated state, with his ICU nurse in attendance. His right arm was prepped and draped in sterile fashion. He is on multiple IV antibiotics currently, and those were continued.
*
D and of the PICC line had been tied in a not; I was able to untie that not, and observe that this is a triple-lumen PICC catheter. I then advanced a Platinum Plus wire down the largest lumen of the PICC line, and under fluoroscopy we were able to observe that the Platinum Plus wire stopped when it met resistance about 1 inch from the distal tip of the PICC line, in the SVC. Simple traction on the PICC line at that point demonstrated that we were not able to pull the tip of the PICC catheter back. I then passed the Platinum Plus wire down one of the other 2 smaller lumens, and met resistance at the same exact site. When the wire was passed down the third lumen of the PICC line, I was able to advance it beyond the level of obstruction, and actually out the distal tip of the PICC line and into the right atrium and we confirmed that on fluoroscopy. Traction was again applied to the PICC line and Platinum Plus wire, but to no avail. The PICC line appears to be firmly adhered to the SVC about 1 inch proximal to its tip, likely by a suture placed by Dr. ______at the time of the open heart surgery. We had hoped that the suture had merely encircled the PICC line, pinning it to the SVC, and that it could be removed with adequate traction under fluoroscopy. However, the inability to pass the Platinum Plus wire through 2 of the 3 lumens of the PICC line suggests that the suture may actually puncture the side wall of the PICC line, obstructing those 2 lumens internally.
*
After further discussion of any other options we might have for transecting the PICC line in the intravascular space (and I had no suggestions that I felt afforded adequate safety for that maneuver), we aborted further attempts to remove the PICC line. Dr. _______ plans to take the patient to the operating room for open removal of the PICC line sometime within the next 24 hours.
*
Estimated blood loss: Less than 10 mL
*
Fluoroscopy: 10 minutes, 233 mGy
*
Contrast: 0 mL
*
Immediate competitions: None
*
Conclusion: Unsuccessful attempt to remove PICC line under fluoroscopic guidance. The PICC line appears to be sutured to the SVC.
*

Medical Billing and Coding | AAPC Forum