I have a question for any incident to experts. We are billing the therapists incident to our nurse practitioner who has seen the patient, created a treatment plan and routinely sees the patient for med management. This nurse practitioner is leaving the practice. Am I correct that we can bill under another nurse practitioner just as we would bill under a covering doctor if it was a doctor who established the treatment plan. It’s been suggested that we can bill under the doctor because he signs off on the treatment plans but I don’t think that is correct. What about billing under a PA in the office as the supervising if a nurse practitioner established the treatment plan? Thoughts?
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Tag Archives: Experts
OB Experts Read!!Ob care and Delivery. Commercial primary and Medicaid secondary
Hello guys!
Any guidance is highly appreciated. If a patient has commercial insurance as primary and Medicaid secondary. How would you bill their OB care and delivery. Commercial bills global codes but Medicaid does not. Reason I ask is because she has a deductible with her primary but Medicaid will not cover the codes we bill to commercial if we were to forward the claim to Medicaid. Please advise! I am so confused!
What are the experts saying about PDPM?
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Any hand coding experts?! Please help! I&D w/ finger amp
Can anyone please take a look at this op note below and tell me how you would code it? I’ve been looking at this note to long and its all a blur now! Insurance is Medicare. There’s a lot going on here in addition to whats written in the procedures performed section. I appreciate any help! Thanks in advance
Procedure Performed:
Left index finger amputation consisting of disarticulation at the MCP joint
Irrigation and debridement of the mid palmar space
Irrigation and debridement of the thenar space
Irrigation and debridement of the status post dorsal subcutaneous space
Irrigation and debridement of the webspaces between the thumb and index finger and index finger and long finger
Procedure was begun with an incision along the mid axial line at the level of the distal phalanx. Immediate and extensive purulence was encountered and the decision was made to proceed with amputation at the level of the DIP joint. A fishmouth incision was created the DIP was amputated, and septic joint involving the DIP was identified. One drill was then used to debride the distal aspect of the DIP joint which did demonstrate osteomyelitis within the middle phalanx we then turned our attention to the A1 pulley as extensive swelling was present along the radial aspect of the hand and longitudinal incision was made at the level of the A1 pulley and immediately upon entering the subcutaneous tissues, extensive purulence was encountered in the soft tissues overlying the A1 pulley. Dissection was carried down to the level of the A1 pulley, pulley was incised, and purulence was identified within the flexor tendon sheath. Tendon demonstrated extensive fraying consistent with chronic infection and the tendons were retracted to expose the joint capsule incision was made within the joint capsule and extensive septic arthritis involving the MCP joint was identified with involvement of the base of the proximal phalanx. An additional incision was made overlying the thenar musculature and immediately upon spreading within the subcutaneous tissues with tenotomy scissors, a large amount of purulence was encountered within the thenar space and upon further dissection, purulence was encountered within the mid palmar space. As extensive purulence continued to be encountered along the radial aspect of the hand, we turned our attention to the dorsum of the hand, an incision was made in the webspace of the thumb and index finger, again with purulence encountered within the webspace with purulence tracking dorsally into the subcutaneous space of the hand finally, an incision was made in the interosseous space between the second and third digits, again with purulence involving the webspace between the index and long finger and also with purulence tracking through the palm of the hand between the second and third metacarpal to the palmar aspect of the hand. At this point, with osteomyelitis extensively involving the distal, middle, and proximal phalanx as well as the DIP and MCP joints and the flexor tendon sheath of the index finger, the decision was made to perform a disarticulation of the index finger. A fishmouth style incision was created, the index finger was disarticulated, and the finger sent to pathology. We then turned our attention to further dissection through the multiply named incisions prepared previously with care taken to spread through muscle compartments and deep spaces with tenotomy scissors to prevent iatrogenic injury to nerves or vessels of the hand. Purulence did not extend beyond the third metacarpal palmarly or dorsally approximately 15 cc of purulence was encountered dorsally and volarly between the long finger and thumb. Any devitalized tissues were removed including bone, tendon, flexor tendon sheath, subcutaneous tissues, and skin. Instrumentation used to perform this debridement included 15 blade, tenotomy scissors, and curettes. After debridement had been completed, 6 L of normal saline with polymyxin and bacitracin were utilized with cystoscopy tubing in an attempt to fully irrigate the wounds and remove any remaining purulence all wounds were again spread with tenotomy scissors to ensure that no further pockets of purulence remained, and after we had confirmed that all abscesses have been broken up, all deep spaces drained, and purulence and necrotic material removed to the best of our ability, the tourniquet was deflated. Hemostasis was then obtained with a combination of bipolar electrocautery and Bovie electrocautery and all incisions were loosely closed with interrupted 3-0 Prolene. 3 1/4 inch Penrose drains were placed him a 1 within the amputation site, 1 within the thenar space of the hand, and 1 within the dorsal subcutaneous space of the hand. Both wounds closed and drains placed, dressings were applied which consisted of Xeroform, 4 x 4’s, Kling, Kerlix, and an Ace wrap. Patient was then awakened from general anesthesia and transported the holding area in stable condition.
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Experts On The Safety Of Medical Ultrasound Domestic Issues – Ultrasound, Medical Equipment,
Institute of Acoustics, Chinese Academy of Sciences
researchers, the National Acoustic Standard Ultrasound Technology Committee – acoustic branch of the Secretary-General, Professor Niu Fengqi a recent interview, repeatedly stressed that clinicians should know about ultrasound safety regulations, knowledge and operating skills, and actively used with caution, and to prohibit application of non-medical purposes; the safety of diagnostic ultrasound is conditional, its technical progress is a benefit and Risk Coexisting double-edged sword.
Ultrasound diagnosis of the safety concept
80 years since the last century since the ultrasound was seen as a safe sound technology is widely used in China, and even become a routine pregnancy check means.
But now, the situation has changed. Bovine Fengqi told reporters, Ultrasonic wave Clinical diagnosis as information carriers must have certain safety limits in order to ensure that no parts were irradiated produce harmful biological effects. To biological effects of ultrasound on the fetus, for example, Expert Most concerned about fetal ultrasonography in the temperature, that is, the impact of thermal effects, because a large number of studies have demonstrated a teratogenic effect fever. Therefore, the focus of the study shall seek to define the possible biological effects caused by temperature and exposure time, and then determine the cause of such a temperature rise of the ultrasonic output level, and then based on these data to establish the scope or standard security applications.
Cattle Fengqi that the ultrasonic sound is nothing wrong with the early publicity, “which is based on the low output in terms of sound intensity.” Today, echocardiography (M Ultra), pulsed wave spectral Doppler, color flow imaging, the realization of many new features, often is to enhance the sound intensity for the pre-conditions and the thermal effects and mechanical effects, etc. they simply repeating what exacerbated by strong increases. The higher the sound intensity, the greater the depth imaging, image more clear, the higher signal to noise ratio when collecting information. There is no doubt enjoying the benefits of such high-tech, while the potential risk of ultrasonic irradiation is also increasing. Because of this, the international ultrasound medical sector ALARA principle of “necessary in the clinical diagnostic information can be obtained under the premise to be used at the lowest possible sound output.” This principle provides that the power output should be done with a suitable detection; If in doubt, should be low output, only when necessary, improve them; when used in obstetrics, the operating mode of each key should be placed in the lowest output adjustment state until the probe by the operator when necessary to improve the sound power.
Should keep abreast of changes in international norms
Then our clinical application of ultrasound to whether strict compliance with the relevant provisions of the security risk does not exist? Niu Fengqi not think so.
He pointed out that clinical application of color Doppler ultrasound and other high-end equipment, almost all produced in the United States and other Western countries. Published in 1985, FDA “for medical ultrasound diagnostic equipment acoustic output measurement and reporting guidelines” set forth in the body parts of the diagnostic space peak – average sound intensity (Ispta) (the most closely linked with the temperature parameters) expressed the greatest sound output: Ophthalmology , 17 mW / mm; fetus and others (including the abdomen, Pediatrics , Small parts), 94 mW / mm; heart, 430 mW / mm; peripheral, 720 mW / mm. The U.S. government in 1991 liberalized the output value of ultrasonic sound, FDA again in 1993 to achieve safe way to do Ultrasound significant changes on the one hand While the diagnosis of the biggest parts of the field restrictions remain the original value of sound intensity, but the actual product the maximum output capacity to 720 milliwatts is all relaxed / square cm; the other hand, to avoid patients suffering from high intensity irradiation of the calamity, attached prerequisites: diagnostic equipment required to install the corresponding acoustic output display system, that additional thermal index (TI ) and (or) mechanical index (MI) screen display, and provides two indices allowed limit in clinical adjustment by the operator to control the buttons on. This regulation will be greater and the ultimate responsibility to the doctor (or medical physicists), they must understand the acoustic output measurements and used to guide clinical exploration, based on differences in the clinical target selection is safe without excessive sound output level.
Ultrasound diagnostic equipment to enhance the acoustic output of the control, the International Electrotechnical Commission (IEC) in 1992 established “acoustic output of medical ultrasound diagnostic equipment disclosure requirements” (IEC61157-1992) provides the host with the probe for all the combinations work mode, the acoustic output (in water measured value), the spatial peak – average sound intensity (Ispta)
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Any Radiation Oncology Experts?
We are running into a bit of an issue when coding 77300, 77301 and 77307.
The following edits appear:
Column 1 / Column 2
77301 / 77307
Column 1 / Column 2
77307 / 77300
Since 77301 does not allow 77307, once I remove 77307 am I ok to bill 77300?
Or because they all exist together on the original bill, should I remove both 77307 and 77300?
Thanks so much!