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

assistant surgeon issue

I have a primary surgeon that is using another surgeon as an assistant, but all he is using for his documentation for this is the following:

"Again, Dr. >____ assisted with patient positioning, prepping and draping, retraction, closing and dressing application. It was necessary to have him there as an assistant."

There is no mention of the assisting surgeon in the procedure description, just that note at the end. Is this enough to justify having him as an assistant?

Please advise. Thanks!

Deb Larsen, CPC

Medical Billing and Coding Forum

Coding issue

The scenario I have right now is that are MRIs are being done under fluoroscopy and the doctors would like to start doing them under ultrasound normally for the shoulder fluroscopies we would Bill the 23350 for the arthrogram the 77002 with 59 modifier and the A9579. In addition to the 73222 for the MRI itself. If done under ultrasound, would we use 76942, 23350 and A9579. Any help would be appreciated.

Medical Billing and Coding Forum

Z79.890 Hormone Replacement Therapy(Postmenopausal) Gender Issue

I work for an insurance company and I’m seeing this code submitted on claims for males. Any thoughts as to why? Poor coding and misuse? Used for conditions other than postmenopausal like testosterone depletion? Let me know your thoughts why this would be justified for males.

Medical Billing and Coding Forum

E/M Course Answer Issue Incorrect against Rule Re DM and Onychomycosis

I just taken a Mod 8 Test / Qstn No. 1 of the Evaluation and Management Course. DX is: Onychomycosis and DM, I selected Answer C, however the online test is only accepting Answer A to be the correct answer.
However this goes against it’s Reasoning which states:

* There was no mention of diabetic neuropathy or ulcer
* There was no documentation that the onychomycosis is a diabetic complication
* Pt. was seen for foot check, and the onychomycosis was found during this check
* Resulting this to be coded as 1st Dx: Oychomycosis B35.1 and 2nd DX: DM E11.9

Please correct this issue or explain why the system is accepting Answer A rather than Answer C. Thank you for your help.

ojt

Medical Billing and Coding Forum

Help wanted with Billing issue

I work for an FQHC and we have several outstanding clean claims that have not been paid. These claims go back to 2015 and some more recent; 2016-2017. Per the website all the claims were paid in January however we still have not received payment. I called yesterday and was informed that all these patient’s work for the same employer who has filed bankruptcy and they will not be paying these claims. The rep was very rude to me and told me that all these claims are the patient responsibility and they can take it up with their employer. I then called all the patients and I was told that as of 1/31/17 they no longer had insurance so I called American Plan Administrators back to find out whey there were not paying for these dates since the Bankruptcy was filed in 2017 and the majority of these claims were in 2015 and 2016. I was told "whatever was paid was paid, whatever wasn’t paid is not our problem". I told them that one of these dates were in October 2015 and they paid dates in November and December of 2015 so I am not understanding what the issue is and I was rudely told they are not paying the claims and the patient’s are responsible. I am not sure what rights we have and I do not feel that is right that the patient be responsible when their employer did not pay premiums that they paid in!

I asked them to send us something stating they are not paying these claims and they will not send us anything either. Therefor we will have no documentation to transfer these charges to the patient!!

I am at a lost and have no clue how to proceed.

Medical Billing and Coding Forum