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Cardiac mass/lipoma coding dilemma

Hello, everyone!
I have an General Internal Medicine report in which the primary diagnosis is Endocardial mass found using a transesophagel echocardiogram with left atrial lipomatous serum. And I am completely stumped on how this may be coded because I cannot find a specific code for a cardiac mass or lipoma. I have been tossing around several of the codes I have listed below. But I am not sure which one would be the most correct because he doesn’t specifically say lipoma, just lipoma serum. Can I assume it is a lipoma just from the serum description? Does anyone have any idea of what would be most appropriate?

D17.79 Benign lipomatous neoplasm of other sites.
R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation
R22.2 Localized Swelling,mass, and lump, trunk

I appreciate everyone’s help!

Medical Billing and Coding Forum

Injection dilemma

I have a provider that performed 2 different injections: 64493, 64494 & 64495 on the L4-L5 & L5-S1. The provider also performed 20610 on the Rt knee. I can’t get the claim to go out due to it hitting an edit that 64494 & 64495 are a component of 20610 and are not billable together. The 20610 has a -59 modifier attached. I can’t find a solution around this other than not billing out the 64494 & 64495.

OP Note: She was placed in a prone position. With fluoroscopic assistance, the L4-L5 and L5-S1 Medial Branch interspace was identified. After Betadine x 3 and 1% lidocaine local infiltration, a 25-gauge 3.5 inch needle was inserted and guided per fluroscopy into the transforaminal space and a AP/Lateral/ and oblique view were done. Not applicable cc of Omnipaque contrast was injected which revealed a normal bilateral epidurogram. This was confirmed with AP and lateral views. There was good injection done at bilateral L4 and L5 medial branches patient tolerated well 1 mL at each site of mixture of 1% lidocaine and 0.25% Marcaine patient tolerated well pain went from an 8/10 to 0/10 at 5 and 20 minutes will keep a pain log will follow up for possible RFA. Procedure: Right knee injection anterior approach, Betadine prep , 1.5 inch 25 gauge needle, no bleeding no complications. Moon injection of 80 mg Depo-Medrol 3 mL lidocaine no bleeding or complication bandage placed.

HELP!!!!
Thanks

Medical Billing and Coding Forum

Assessment and E&M code dilemma

I have a provider who puts sometimes 10 or more diagnoses in her assessment and always wants to bill a 99214 or 99215. In the chief complaint the patient was there for a med refill for HTN or DMII and she will re-diagnose things from a list of chronic problems but not mention them in her HPI or do a physical exam. How should I approach this? I’ve been told I’m being too picky or demanding. What can I do to remedy this problem?

Medical Billing and Coding | AAPC Forum