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Tag Archives: Done

When time spent counseling is the driving factor for E/M and a procedure is done

Posted on by
I’m hoping someone can advise me on this dilemma
I have a provider who will use time spent counseling as the driving factor for E/M.
Example
Pt her for f/u DM,HTN,Hyperlipidemia etc, ROS HPI PFSH and Exam are comprehensive to detailed ,med changes made counseled on diet ….
However sometimes the patient will request a joint injection or lesion removal during the appt and the procedure is done during the visit
he documents 30 minute appointment with >than 50% face to face etc-99214
adding 20610-50 for bilateral knee injections
Am I wrong in thinking that in that 30 minutes the knees were injected as well ?
I’d like to address this with him ,however I know that this will not be received well so I’m hoping someone can confirm or not whether I’m right or wrong
and if there is any information I can use to support changing
Thany you in advance
Cheri

Medical Billing and Coding Forum

Pulmonary Function Test interpetation done before a New patient viist

Posted on by
Hello Everyone-

I am hoping someone can shed some light on this one.

Our doctors interprets pulmonary function tests for the hospital. Last year, the hospital sent one of our doctor’s a pulmonary function test on a patient to be interpreted, the patient was not one our patient. There was no face to face, just an interpretation. The interpretation was billed with the 26 modifier and paid. This year the patient came in to see one of our doctors for the first time. We billed a new patient visit, however the insurance company, a Medicare replacement plan, continues to deny the claim stating a "new patient code" is inappropriate.

I have sent two appeals already and they continue to advise to resubmit a corrected claim because the "new patient code" is inappropriate. Am I missing something here?

Thank you,

I

Medical Billing and Coding Forum

Surgeries done in Op Suite then transported to Lithotripsy Suite

Posted on by
My physician performs cysto’s with pyelograms and if needed, stent removals, placements, etc…

THEN

he dictates that he "trasports the patient to the lithotripsy suite and placed supine on the table".

I can’t find any real guidance on whether this would be considered a separate procedure by definition of a "separate encounter".

Any thoughts? If you agree or disagree, do you know of any documentation out there that supports either side?

SB

Medical Billing and Coding Forum

Tee done with a PFO

Posted on by
Hi, I am questioning what Tee code should be used with a PFO. He does not state ICE was done.
Report states: the wire was placed into the left upper pulmonary vein under TEE imaging and fluoroscopic guidance. Sheath was removed and delivery system was advanced into lt artial cavity. and device was delivered etc.

He then states; There was TEE and Fluoroscopic demonstration of adequate device placement. The device as then deployed successfully with no significant shunt observed on color flow Doppler imaging of TEE. The 9F sheath was withdrawn.

I see no mention of a probe being placed. Little confused on If and what code to use.

Thanks in advance!

Medical Billing and Coding Forum

Hysterectomy following C-section, done by a diff. Dr., at same DOS

Posted on by
Our Dr. is called in as a specialist for complex cases, to perform a hysterectomy right after a C-section.

What code should we be billing the Hysterectomy? C-section was done by another Dr. (not in our practice). Our Dr. simply is doing the hysterectomy, bladder sling, etc. 58150 ? But the patient was cut open already….maybe with a Mod 52 (reduced services)? Or Mod 62 (two surgeons)?

Any help would be much appreciated!

Medical Billing and Coding Forum

Neurology General Coding/Billing & Billing for E/M, EEG, LP done same day in hospital

Posted on by
Am working in office for neurologist who does consultations in hospital. Was told only ICD-10 codes related to neurology should be listed on claim when billing CPT E/M Consult/Followup and Procedures codes for services provided to patients while in hospital by our doctor.

Question 1: Was informed we should first list the "admitting diagnosis" (not the "principal diagnosis") found on the hospital’s billing summary along with only the neurology codes listed. Does this sound right?

Question 2: Should we be listing ICD-10 codes for co-morbidities and/or complications that affect the neurologist’s treatment/medical management of patient? For example, patient has stroke and also has AFib. Shouldn’t we list the ICD-10 codes for both stroke and AFib?

Question 3: When a consult or followup are done on the same date of service as an EEG and/or lumbar puncture (spinal tap) as an inpatient, what modifiers should be attached to E/M and/or procedure codes for the neurology specialist performing them? Debating use of modifier 59 vs. XE when FUp, EEG, and lumbar puncture are done at different times on same date of service. Also, do we have to use HCPCS code AF on E/M or procedure codes to indicate specialist physician service as well as -59 or -XE modifier?

Any helpful advice/guidelines would be appreciated. Thank you.

Medical Billing and Coding Forum

Best modifer to use when Spirometry or EKG’s are done during an office visit

Posted on by
Admittedly I struggle with when to use modifer 25 verses 59
If a patient has COPD and the provider is looking to assess lung function during a routine follow up appointment
Or
If a patient c/o chest pain duuring a follow up appointment for his diabetes and HTN and the provider orders an ekg
If in both scenerios the providers staff performs the procedures the results are interpreted by the ordering provider and documentation supports same
I beleive a modifer 59 would be most appropriate ,however not completely sure.
I maybe overthinking this but is the use of either modifier determined by reason for the diagnostics whether it be done as an annual assessment(but not duing an annual exam) on the same day to save the patient another seperate visit or diagmostic to rule out a condition or a concern
If anyone can help clear the air I would appreciate your help I have researched abd looked at several examples but still find this confusing
Thank you
Cheri

Medical Billing and Coding Forum

Billing out if CRCS not done in 30 days

Posted on by
We have some patients come into the office and see a mid-level provider and decide to do their screening colon. We hold onto the claim until after they are seen, and then mark it as inclusive to the screening colonoscopy done, with a zero fee. Then we have other patients who come in, hem and haw about getting a colonoscopy done, and after holding it the 30 days we bill them out. I do not believe this is the correct way to go about this (these are traditional Medicare patients I am speaking of). I know we do not bill the patient if Medicare denies, so we end up eating the cost. My issue is that the facility side is paid but not the professional side. We have nothing else to code except the Z12.11 because they ARE symptomatic and just coming in as a pre-colonoscopy visit. What are others doing with regards to this type of visit?

Medical Billing and Coding Forum

Help with billing cataract surger done on MC patient in Skilled Nursing

Posted on by
We billed a cataract surgery 66984 plus the reporting G codes to Novitas (We are an ASC in TX). Novitas paid and then denied/recouped due to the patient being in a SNF at the time of her surgery.
Is there a modifier that could have been used on this? 54 for Surgical Care Only??
We were told to send the claim and op notes, etc to the SNF in which we did and now we are unable to get ahold of them.
Any help would be much apprectiated.

Janet

Medical Billing and Coding Forum