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

Consultation CPT Code for international adoption

I need help coding a consultation for potential adoption of international adoptee from China; no one was present at time of service so there was no vitals, ROS or physical exam. The charge was entered under a current patient’s chart but the patient was not present.
The provider states a consultation can be charged without the patient present since it directly affects the patient’s health. We can used diagnosis code Z02.89 but can the consultation code be charge since the patient was not present?
Thank you for your help,
Gina

Medical Billing and Coding Forum

Pathology Consultation of outside slides 88321

Discussion among the pathologists is 88321 x1 for the patient OR 88321 for each surgical case submitted. Can someone help clarify this?

EX: Patient A – slides submitted from outside facility: endometrial case from 2017, hysterectomy from 2017, a second endometrial later in 2017 and vaginal biopsy 2018. Some of us say 88321 x1 but a some say we should be able to do 88321 x4 for the different surgical cases. 😮

Medical Billing and Coding Forum

External cause codes in Consultation sercvices

Hi Team,

I would require ICD-10-CM clarification for External cause coding. The Nephrologist visits CKD patient in inpatient hospital who was admitted for femur fracture. The fracture occurred due to fall.

We are coding CKD codes with injury and external cause codes. I am not sure if we can code initial external cause codes for Nephrologist. The nephrologist is not involved in ortho treatment, should we code external cause codes for consultation services other than ortho/injury services?. Do we have any guidelines for this?

Regards,
SG

Medical Billing and Coding Forum

Consultation for ” screening colonoscopy”

Curious as to your opinion of a "Consultation".

The assumption is that the HPI, Exam are adequate with the exception of the following wording…:

Referring physician "requests a consultation for: screening Consultation."

HPI starts out with "Pt. presents for evaluation"….

"Impression: Female presents for a screening colonoscopy"

"Plan: Colonoscopy…. pt. elects to proceed."

My lead coder says it is ok to bill as a Consult. I say it is not since the pt. doesn’t have a complaint or problem…

Medical Billing and Coding Forum

99254 initial consultation and next day 49204 surgery with mod 80 denied

My provider was on call at a facility and looks like he saw a pt for initial consultation. The next day he assisted in surgery for this pt. Aetna denied the 99254 as global and the 49204 reason denial is N674-Not covered unless a pre-requisite procedure/service has been provided and also B15-This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Looked in cpt book but doesn’t state anything should be done additional for this surgery. I am thinking its the pts policy and coverage but rep told me just to send medical records. Any idea what this pre requiste procedure/service could be?

Medical Billing and Coding Forum