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2016 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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Need Florida Medicaid Equivalent of CPT

Hello there,

We had a patient that had a stomach surgery on 10/10/17 with a G-Tube insertion. Patient presented back to the hospital on 10/20/17 with an infected surgical wound. On 10/21/17 our surgeon reopned the surgical incision, packed it, and ordered a wound vac placed. The Wound Care Nurse put a VAC in later. We want to bill out 12021, but the state of Florida Medicaid does not recognize this code. Is there a similar code that can be used?

Thank you

Medical Billing and Coding Forum

Need help with complicated multiple surgeries

Hi, Can anyone help me with some CPT codes for a patient who had multiple surgeries? On 9/13, she had a sigmoid colon resection with end to end anastomosis. For that I am using 44147. She developed peritonitis, and on 9/18, she had a re-opening of the laparotomy, irrigation and drainage, repair of an anastomotic leak, and a diverting loop ileostomy. The wound was closed with loose surgical cliips. For the ileostomy, I am using 44310; don’t know if I can charge for the repair of the anastomosis or what code I would use for it (44799?). She developed leukocytosis, and on 9/21, had a second look laparotomy and washout. Fluid collections were aspirated, abdominal cavity was irrigated. The wound was not closed, but a wound vac was applied. I was thinking 49002 for the re-opening of the laparotomy, and 97605 for the wound vac, but don’t know if there’s anything else I can charge. On 9/23, she went back for a limited abdominal exploration (separated multiple loops of small bowel), suctioned out some fluid, and applied wound vac. Don’t know if I can charge 49002, as the wound was left open last time. On 9/25, she went back to OR and was found to have a rupture of a suture line at the anastomosis. She had irrigation and drainage, closure of the rectal stump, closure of proximal descending colon, lysis of adhesions, wound vac. Doctor commented that the small bowel, mesentery, omentum and abdominal wall remained edematous and non-compliant. Again, I don’t know if I can charge for the closure of the rectal stump ( that was to repair the rupture of the anastomosis), or what code I would use for it. They were going to do a loop colostomy, but the descending colon did not have enough mobility to reach the skin level, so they closed it off (oversewn to a blind end) and will re-evaluate it in 48 hours. Don’t know what code to use for that. I’m guessing some of these will be unlisted. On 9/27, she had mobilization of the splenic flexure, end descending colostomy (opening was lateral and cephalad to the umbilicus), irrigation and drainage, and wound vac. Not sure if I should use 44141, 44143, or something else, as at this visit, they didn’t remove any parts of the colon.
Any help on this mess would be appreciated, as it is just beyond my experience.
Thank you!
Donna H.

Medical Billing and Coding Forum

All You Need to Know About Medical Translation

The following are the most frequently asked questions about medical translation and our own attempt at providing the answers to these questions:

Who does the medical translation?

Translation agencies that specialize in medical translation have their own team of qualified translators, specifically doctors, nurses, medical technologists, and pharmacists who have expert knowledge of the languages they are working on. The most frequently translated languages in the medical field are: German, French, Italian, Spanish, Portuguese, Polish, Swedish, Japanese, Korean, and Chinese. Because this is a more specific and technical type of translation, medical translation is always done under the guidance of an expert supervisor and always includes references.

What is it done for?

Hospitals, pharmacies, and medical advertising agencies require medical translation services, especially those that are expanding into the medical tourism industry. Manufacturers of medical equipment are also now required by national governments to translate their packaging, labels, and how-to manuals into the language of the foreign country they are catering to. Also, in international medical conferences, which are attended by experts in various medical disciplines from all over the world, scientific papers have to be translated into different languages to allow every participant to understand the research in his own native language.

What medical documents are usually translated?

All sorts of scientific documents are processed by medical translation agencies. This does not only include packaging, labels, instruction books, but also a wide range of documents such as medical brochures, user guides for medical staff, instruction manuals for patients, patient reports, clinical studies, medical charts, drug prescriptions, medical multimedia applications, medical questionnaires, psychology papers, hospital discharge summaries, insurance claims, research protocols, general medical documents, and other documents containing medical terminologies.

What is the process of medical translation?

A translation agency oversees the process of translating a medical document, usually dividing the process into different steps that are taken care of by different individuals. These steps consist of the following:

Extraction. Reading or listening to and understanding the text as it is initially recorded.

Translation. Interpreting the text in its source language and rewriting it in the target language.

Editing. Extracting and translating the original text by another person. This is done to get a second (or even third or fourth) opinion on the meaning of the text and to make sure that quality is at its best.

Publishing. Recording the text in its original format (i.e. text document, Web page, e-learning software, etc.)

Proofreading. Checking the medical translation for discrepancies in formatting.

Native Review. Evaluation of the translated material by a medical expert who speaks and understands the target language.

How is quality ensured?

Research is an important component of medical translation. This does not only consist of medical research, but also an intensive looking into the grammar and vocabulary of the target language. This is often the most challenging portion of translating medical documents. The initial draft, which is usually kept confidential until an expert ensures its quality, is then evaluated and improved by other translators before it is again placed under the scrutiny of an expert supervisor followed by a medical expert who is also a native speaker of the target language.

Charlene Lacandazo is a marketing executive for Rosetta Translation, a leading full-service translation agency in London, UK. Rosetta Translation specialises in medical translation, as well as interpreting services worldwide.

The Need For Clarity In Medical Histories

Chronicles of history are important in the study of the present. Historians refer to ancient literature and art to trace back the roots of modern phenomena and traditions. Comprehensive pieces of art and literature are essential in the study of history. Otherwise,they will be useless in explaining ancient practices and beliefs.

Same is true in preserving medical records. Medical records are technically called medical history. Medical histories contain documents on check-up, diagnosis, prescription, and treatment of patients. Collectively, these are archived in a hospitals library of medical history.
Doctors and medical professionals refer to these documents every patients check-up session. A medical history is essential in the continuous treatment of a patients ailment. Hence, medical histories must be clear and comprehensive to ensure the accuracy and precision of medical information.

A medical history is contained in a medical report. Medical reports are created by medical transcriptionists. These reports are taken from a doctors diagnosis and treatment form which are sent to the transcription department after a patients check-up. In the past, diagnosis and treatment forms are in a handwritten format. These are compiled in an envelope which serves as a patients medical history. Included in this envelope are the expenditure records of medical billing companies.

The format of medical histories improves with the discovery of word processors. This advanced technology enables medical transcriptionists to convert diagnosis and treatment forms in a more comprehensive manner. The invention of Continuous Speech Recognition (CSR) and Speech Recognition (SR) system makes medical transcription easier. These systems automatically digitize voice-recorded reports of doctors in a word document. Medical transcriptionists simply review and check possible mistakes in the CSRs and SRs medical report. Some medical billing companies also use CSR and SR technology.

Nevertheless, CSRs and SRs still cannot be at par with the reports of medical transcriptionists. CSRs and SRs cannot recognize mumbled and mispronounced words; hence they cannot be and encoded in a medical report. It can lead to patient misdiagnosis and medical errors that could be dangerous to the patients health. On the other hand, medical transcriptionists provide a comprehensive medical report with accurate information on a patients medical condition. Because of this, most hospitals and medical billing companies still hire the services of medical transcriptionists.

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need help to code peripheral


This patient has a history of nonhealing lesion and pain in the right foot, previous intervention at Christiana Hospital earlier this year with SFA popliteal angioplasty. He initially had improvement after his procedure in the spring time but has now had recurrent pain and noninvasive studies have revealed significant distal right SFA stenosis and subtotal occlusion of the anterior tibial vessel. Angiography is requested with possible intervention.
After obtaining informed consent the patient a 5 French sheath was placed in the left common femoral artery and a 5 French contra catheter was positioned abdominal aorta, aortography was performed. Catheter was then withdrawn and aortoiliac injury gram was performed and the catheter was advanced across the aortic bifurcation into the right common femoral artery selectively over a hydrophilic wire. Selective right lower extremity digital subtraction Angiogram with runoff was performed. After I identification of the lesions in the distal right SFA and ostial segment of the anterior tibial vessel, the original sheath and catheter were exchanged out over a stiff support wire for a 6 French by 65 cm destination sheath which was then positioned into the right SFA selectively. With some difficulty a 0.035 hydrophilic wire was able to be advanced through the subtotal occlusion in the ostial segment of the right anterior tibial vessel with use of a 4 French 120 cm glide catheter with an angled tip. The glide catheter was positioned in the proximal anterior tibial and the 035 wire was exchanged for a 0.014 journey wire. Thereafter scoring balloon angioplasty with a 2.5 followed by a 3.0 mm balloon was performed of the ostial proximal segment of the right anterior tibial and distal popliteal vessel. Angiographic result was excellent with brisk restoration of flow in the right anterior tibial, preservation of flow in the tibioperoneal trunk peroneal and proximal posterior tibial vessels as well. Noncritical disease in the distal popliteal was unchanged. Thereafter scoring balloon angioplasty was performed of the distal SFA proximal popliteal stenosis at the abductor canal, at the superior aspect of the patellar shadow. 5 mm scoring balloon angioplasty was performed followed by placement and application of a 6 mm x 60 mm Lutonix drug-eluting stent, 28 atm pressure. After prolonged drug application and balloon removal angiographic result was excellent with brisk runoff down 3 vessel proximally, anterior tibial vessel patent as well as the peroneal to the ankle with distal occlusion of the posterior tibial. The sheath was then removed to the left iliofemoral system and iliofemoral angiography on the left revealed the sheath in the common femoral artery and closure was obtained with a Mynx closure device without complication.
Central aortic pressure 120/70.
Diagnostic digital subtraction angiography:
Abdominal aorta was patent no ectasia no aneurysm, 2 left renal artery single right renal artery patent celiac SMA and inferior mesenteric arteries. Aortic bifurcation was patent with patent common internal and external iliac vessels bilaterally.
On the left common femoral vessel was patent with patent proximal left SFA and deep femoral.
On the right common deep and superficial femoral vessels were patent. The distal SFA had a calcified tubular narrowing of 80% or greater distant the abductor canal and proximal popliteal. Moderate calcification was present. The mid popliteal was patent across the knee the distal vessel has eccentric stenosis of 50% which appeared nonflow limiting. Immediately below the origin of the anterior tibial vessel was subtotally occluded with TIMI grade one flow into this anterior tibial. The tibioperoneal trunk and peroneal vessels were patent, the peroneal was large and was the major vessel all the way to the ankle. The posterior tibial vessel was patent to its distal one third just above the ankle mortise and was occluded at this point with some bridging collaterals. Anterior tibial vessel beyond its subtotal ostial occlusion was patent to the ankle.
As detailed above scoring balloon angioplasty and opening of the right anterior tibial vessel was performed.
Scoring balloon angioplasty and drug-coated balloon treatment was performed of the distal right SFA proximal popliteal lesion at the abductor canal.
Summary and conclusions:
Nonhealing lesion right foot severe ischemia.
Successful opening of the right anterior tibial vessel, patient now has proximal three-vessel runoff, occlusion of the distal segment of the posterior tibial vessel with large peroneal collateralizing the vessel distally and anterior tibial now patent to the ankle and dorsalis pedis.
Successful treatment of the right distal SFA stenosis as detailed above with patent popliteal
Bilateral patent aortoiliac vessels.
*I was going to code as 75716-xu,75625,37224-rt, 37228-rt but I always get confused whether to code as 75630 instead of 75716,75625 ? or when to code 75630
thanks in advance

Medical Billing and Coding Forum

Need Guidance on Setting up new organization? Lab? Non Pharmacy or DME???

I have been approached by a company to start coding for them however I am questioning the start up classification.

It is being set up as a lab however he states a "full service tissue/blood bank that works in the areas of stem cell collection, process, preservation and delivery of products to hospitals and physicians.

I am not familiar, at all, with NON-pharmacy set ups and health insurance companies.

My main issue is keeping my certification and leading this guy in the right direction. He informed me the prior billing company could not obtain a BC/BS provider number just to submit claims because his company wasn’t required by the state to have a Laboratory license since blood was not being mixed or manipulated etc. and the product is not considered a DME therefore BC/BS did not have a classification for his entity. He was told to obtain a CLIA/CLIA waiver and CAP certificate,to set up a lab. A blood bank does not fall under any of BC/BS categories and an independent lab was the closest category they could associate his services with. He provided BC/BS the documentation from the state clearly showing there is no equivalent license for a blood/tissue bank as FDA requires therefore no CAP certificate or CLIA/CLIA waiver could be issued. The Chief Compliance Officer of the State clearly wrote "Since your organization is not manipulating the cells collected to make a pharmaceutical drug nor supplying the patient or doctor with a medical device, no drug or device distributor or manufacturer license is required! He had no problems previously with Cigna or UHC so I’m not sure what to do.

I have done some investigation and I have seen where companies have registered as NON Pharmacy, DME and also Lab? I’m curious because the prior company he worked with, same scenario, BC/BS would not pay because he couldn’t obtain a provider number with BC/BS. The reason was BC/BS states your a clinic or lab. He wrote to the state as he would purchase it from another company and sell it to the surgeon therefore since he wasn’t officially manipulating blood products, he wasn’t classified as a lab and this type of product is also not considered DME.

If you have any knowledge, please let me know as I’d like to get this contract but do not want to mislead him. Thanks s

Medical Billing and Coding Forum

Medical Schools Need to be Revamped

One of the best ways to reform health care is to start at the very beginning. There are great measures that can be taken before people become doctors that can have huge (positive) effects on the entire system. You see, there are many issues that begin at the medical school level, long before doctors have ever obtained their MD degrees, that snowball into later periods and eventually lead to issues that are at the heart of the problems plaguing our current health care system. By addressing some issues in the beginning, we can prevent some of the problems from occurring later. Let’s call this an educational system version of early detection and treatment.

Let us start with one of the biggest issues facing health care now and work backwards. The biggest issue for most Americans in the price. Due to insurance policies and/or current illnesses, some may feel this sting more than others. Nonetheless, health care costs are gaining a percentage of the national GDP every year. Our economy simply cannot continue to function if medical costs put a stranglehold on the nation’s disposable income. One of the problems with this lies with simple supply and demand. Demand for medical services is nearly infinite (so long as people choose to stay alive) and supply definitely finite. In fact, it is very finite. One need not watch the news for very long to hear someone reference the great shortage of medical professionals. The biggest reason for this is that there are a finite number of medical schools with a finite number of slots in each class available.

We need to open more medical schools and expand ones currently in existence. Creating more doctors increases the supply and drives the prices down. This is simple economics. People may think the current sizes are optimal, but they should realize that medical schools are currently run by medical professionals. Greatly increasing the supply of doctors is not in their best interest. By maintaining a steady demand for doctors in the industry, salaries stay higher. By maintaining a growing demand for medical school slots, med schools can charge higher wages. It’s good for those geese, but not for the gander.

Another major problem is the cost of medical school. It is flat out astronomical. Many doctors come out of six year programs with well over six figures worth of debt. If you’re thinking “big deal, they can afford it (eventually), it doesn’t affect me” – think again. They are not going to pay that off by going through couch cushions, they’re going to make that up (either directly or indirectly) through patient fees. This affects everyone.

While there is no clean and easy solution that benefits everyone immediately – medical schools in Cleveland and Orlando have been offered to qualifying students for free with positive early results. While these schools are publicly funded, the argument is that they cost the public far less in the short term compared to eventual overall costs. This argument is backed by pretty strong evidence when surveying the current lay of the land.

Another solution would be to work with foreign medical schools to line up their curriculum more so with American requirements. While many of these schools are currently viewed as degree mills, dangling the carrot of accreditation with them would go a long way to ensuring that they have acceptable standards and curriculum. This solution is not idea, it would be difficult to control entities that operate abroad, but it is a possible solution that does not represent one extra dime paid by American taxpayers.

The bottom line is this: more doctors = lower costs.

– Felix Chesterfield Other items: MD SchoolsCaribbean Medical Schools

I need help with nerve blocks guys..

Hi! Can anyone help me with this?

I got confused because of the terminated attempts. How would you code the following?

– Left L5 dorsal ramus nerve branch block under fluoro guidance with radiologic interpretation.
– Attempted right L5 dorsal ramus nerve branch block under fluoro guidance with radiologic interpretation (terminated at this level due to vascular uptake in the spinal needle despite multiple attempts.)
– Bilateral L4 medial nerve branch blocks under fluoro guidance with radiologic interpretation.
– Left L3 medial nerve branch blocks under fluoro guidance with radiologic interpretation.
– Attempted right L3 medial nerve branch block under fluoro guidance with radiologic interpretation (terminated at this level due to vascular uptake in the spinal needle despite multiple attempts.)

I would very much appreciate your inputs.

Medical Billing and Coding Forum

Medical Errors – What You Need To Know

Errors are inevitable in life. However, these can be avoided and prevented. Definitely, no one wants to experience the consequences of mistakes, most especially those that have significant implications such as medical errors.

Medical errors happen when anything that was planned does not progress as it should. These can happen anywhere in the health care system such as in clinics, hospitals, pharmacies, patients’ homes, doctors’ offices, and outpatient surgery centers. Moreover, these can involve diagnosis, laboratory reports, medicines, equipment, and even surgery. As such, these can practically happen to anyone, at anytime, and anywhere.

However, there are some precautionary measures that can be observed in order to prevent these from happening. Medical errors are not so easy to correct because these entail significant outcomes and results. In fact, these can even lead to injury and death. Thus, because of the degree of the seriousness of the consequences of medical discrepancies, purchasers of group health care, physicians, health care providers, government agencies, and medical practitioners are working together to ensure a safer health care system for everyone.

On the other hand, there are some instances when you are just on your own, and you need to protect yourself against medical discrepancies. Moreover, it is most important to be aware of these things in order to know how to appropriately react when confronted with such situations.

One of the most practical ways of protecting yourself from these discrepancies is by becoming an active member of your health care team. According to research, people who are involved in their health care are more likely to achieve better results. After all, the more involved you get, the more informed you become.

By being active in your health care team, you can interact with your doctors and health care providers constantly and keep records updated. It is important to make sure that your doctor knows about everything that you are taking; whether these are prescription medicines, dietary supplements, herbs, and vitamins. Moreover, it is also necessary to inform your doctor about allergies and adverse reactions that you may have on particular medicines. You also need to provide all health professionals that are involved all the necessary information about you.

One of the causes of medical errors sometimes is incorrect or incomplete information. Thus, in order to protect yourself from such, you should give the correct and complete health information that medical practitioners may need from you. It also pays to ask questions from time to time, most especially on the type of medicine that you are being prescribed of, or the type of medical procedure that you might be advised to undergo.

In addition, reliable and efficient medical supplies are also solutions to medical discrepancies. You may not totally agree to this, but most cases of inappropriate diagnosis are attributed to faulty medical equipment and devices. While these should be the lookout of medical practitioners too, it is also very important to ensure that equipment and apparatus are functioning properly, and are giving the correct information.

Basically, all these ways of protecting yourself against medical errors boil down to being aware and keeping others informed. With the proper information and communication, these can be minimized, and eventually eliminated.

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