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Tag Archives: only
ED visit-patient presented with “anxiety” but left after only having blood work done.
The hospital billed only the Z code indicating the patient left before treatment could be rendered. They should also bill the "anxiety" symptom code, correct?
Billing Office Visit + other and then only getting reimbursed the smaller amount
I’m trying to bill a 99213 along with an 81000. I’m getting messages from the carrier that they’re paying for the 81000 and bundling the 99213 under it (so I’m being reimbursed less than $ 10 for a service over $ 100). Is providing a modifier 25 for 81000 a way to get around this?
Thank you!!
Physical therapy insurances that only pay for evaluation on first visit
I’m having a hard time trying to find information about which insurances will only pay for the evaluation code for the patient’s first visit with physical therapy. Does anyone know what the insurances are or where I can find that information? Thank you!
need help with vein graft balloon angio only
PROCEDURES
1. Coronary angiogram
2. Left heart catheterization
3. Graft angiogram
4. Percutaneous intervention and balloon angioplasty of vein graft to OM1.
5. Right iliofemoral angiogram
1. Coronary angiogram
2. Left heart catheterization
3. Graft angiogram
4. Percutaneous intervention and balloon angioplasty of vein graft to OM1.
5. Right iliofemoral angiogram
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Right groin was draped and prepped in a sterile fashion. Patient was premedicated with 1.5 mg Versed and 100 mcg fentanyl IV. After injecting 2% lidocaine, right common femoral artery was accessed with the help of micropuncture with some difficulty due to previous scarring and 6 French femoral sheath was inserted. 6 French diagnostic catheters were used to cannulate left and right coronary artery. 6 French FR 4 catheter was also used to cannulate the vein grafts. Patient was proceeded with intervention of the vein graft of obtuse marginal branch. Overall patient tolerated procedure well. Right iliofemoral angiogram was performed and femoral sheath was pulled and manual pressure was applied for 20 minutes with good hemostasis. FemoStop was applied at Bell pressure for persistent hemostasis.
*
LEFT HEART CATHETERIZATION
Left ventricular end diastole pressure was 18 mmHg. No significant gradient across aortic valve.
CORONARY ANGIOGRAM
1. Left main was calcified with 70-80% distal stenosis.
2. Left anterior descending artery had severe diffuse disease proximally before it was 100% occluded for previous stents
3. Left circumflex artery was 100% occluded proximally
4. Right coronary artery was under percent occluded at the origin.
*
GRAFT ANGIOGRAM
1. Vein graft to LAD was under percent occluded (chronic)
2. Vein graft to RCA was patent. Stent was noted in the mid body of the graft which was patent with 80% in-stent restenosis. 50-60% stenosis noted in distal RCA after anastomosis before the bifurcation of PDA and PLV branches. PDA branch was patent with no significant disease given collaterals to distal LAD. PLV branch was patent.
3. Vein graft to obtuse marginal branch was patent with TIMI II antegrade flow. Stent at the ostium had 99% in-stent restenosis. There was also 80-90% stenosis of mid part of the body of the graft within the previous stent. Distal part of the vein graft was patent.
*
PERCUTANEOUS INTERVENTION OF VEIN GRAFT OBTUSE MARGINAL BRANCH
6 French JR4 guide catheter was used to cannulate the vein graft to OM 1. Heparin was used for anticoagulation. Initially filter wire was attempted for distal protection which was unsuccessful to advance due to significant ostial stenosis. 0.014 BMW guidewire was advanced and vein graft to OM stenosis was successfully crossed without difficulty. 2.5 x 15 mm noncompliant balloon was advanced and both lesions of vein graft was predilated at 16 followed by 18 atm. Nitroglycerin intracoronary was given. Subsequent angiogram revealed TIMI-3 antegrade flow and distal part of the body of the graft but still residual significant stenosis at the ostium. 3.5 x 15 mm noncompliant balloon was advanced and both lesions of vein graft were dilated at 16 atm couple of times. Adenosine followed by nitroglycerin were given through guide catheter. Subsequent angiogram revealed wide-open vein graft to OM with TIMI-3 antegrade flow and no evidence of dissection or perforation. No evidence of distal embolization. Patient was hemodynamically stable and asymptomatic at the end of procedure.
RIGHT ILIOFEMORAL ANGIOGRAM
Right common femoral artery was patent. Sheath insertion was just below the origin of the inferior epigastric artery..
IMPRESSION
1. Severe native 3 vessels coronary artery disease.
2. Patent vein graft to OM1 with 99% ostial stenosis within the stent as well as 80% instent restenosis within the mid body of the graft. (Likely culprit)
3. Patent vein graft to RCA with 80% in-stent restenosis.
RECOMMENDATIONS
Patient has complex coronary disease as described above. He had multiple intervention of vein graft in the past including 3 intervention in vein graft to OM last year. He has significant instent restenosis of drug-eluting stents. Recommend evaluation by cardiac surgery for possible redo CABG. Continue aggressive medical treatment.
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should I do 93459,92937 -lc since this is vein graft balloon angio or 92920? I bill for hospital
thanks in advance
Vaccines only
NEED HELP…How do I bill shots only the child was seen by provider but didn’t have any issues just needed shots
the only diagnosis given from the provider is Z23
the only diagnosis given from the provider is Z23
*originally we billed 99213 with Z23 and admin code but the office visit was denied
thank you in advance !!!
CPT code 96150 and 96151 only for CSW????
Hello,
I have pain Physicians and NPs performing risk assessments on patients at each visit. I would like to use 96150 and 96151 in conjunction with E/M codes 99201-99204 and 99211-99214. I looked at the MCR LCD for 96150 and 96151. It speaks of a CSW. Does that mean that is the only provider type allowed for that code? Can a Physician or NP perform those services and bill that code also? These codes best describe the assessment. They are using the information given to help determine the patient’s pain level. And also basing the medical decision making, and plan off of these assessments. Patients are being asked about their prescription/illegal drug uses, alcohol use, and how medication is used.
Please help!!
C Section only with 58611
Is anyone having issues getting these two codes paid? I am getting denials stating the required modifier is absent. The 58611 is an add on code and doesn’t require a modifier. Help please.
Attempted Bi-V Pacemaker – Only one active lead – Please HELP!!!
Can someone please help! He placed a bi-v generator and RV lead. He plugged the atrial port and isn’t planning to place an atrial lead. He is planning to come back in 4-6 weeks to place the LV lead.
The patient will ultimately be left with a bi-v generator and active RV and LV leads but for now the patient essentially has one active lead.
The patient will ultimately be left with a bi-v generator and active RV and LV leads but for now the patient essentially has one active lead.
Any help is MUCH appreciated!!!
PREPROCEDURE DIAGNOSES:
1. Atrial fibrillation.
2. Rapid ventricular response.
3. Tachymedia.
4. Cardiomyopathy.
POSTPROCEDURE DIAGNOSES:
1. Atrial fibrillation.
2. Rapid ventricular response.
3. Tachymedia.
4. Cardiomyopathy.
PROCEDURE: Attempted Bi-V pacemaker implant but complicated by dissection of the CS.
PROCEDURE COURSE: Mrs. Young presented to the EP lab in the fasting state. She was in AFib with RVR. The procedure was performed under conscious sedation with the assistance of our anesthesia colleagues. She was administered 2 grams of Ancef prior to the start of the case. After the huddle, she was prepped and draped in usual sterile fashion. After the timeout, a pocket was created in the left subclavian space using a blade, blunt dissection and electrocautery. After hemostasis was achieved in the pocket, using the 1st rib approach, venous access was obtained x 2 over the first guidewire, a 7-French tear-away sheath was placed in the SVC. Through this lead, an MRI compatible Medtronic pace is 5076 lead was advanced into the RV apical septum and the helix was extended despite yielded excellent pacing and sensing parameters with sensing of 14 millivolts and capture threshold of 0.25 volts with a pacing impedance of 532. The sheath was removed and the lead was tied down to the pectoralis fascia with nonabsorbable suture. Over the second guidewire, a 9 French sheath was placed and through this a straight Attain and a Josephson catheter and this was unable to cannulate the CS. Then, we used a medium hook Attain and this too was unable to cannulate the CS and then we used the larger hook Attain and this was able to finally get access into the CS. It was difficult as it was a fairly posterior takeoff but got access that was not overly difficult; however, upon advancing the sheath noted that in placing the sheath in the CS. Then, with a balloon tipped catheter, a venogram of the CS was performed showing that we had dissected the CS. I did try to pass a wire, but it was never in the true lumen and was unable to place a guidewire. She remained hemodynamically stable through this. Given this and I now have an idea of where the CS was located. I think that the best course of action will be to bring her back in approximately 4-6 weeks and place an LV lead at that time and do the AV node ablation. The 9-French sheath was removed and hemostasis achieved with manual pressure. The pocket was then cleansed with vancomycin solution and then a BiV pacemaker was used to plug in the atrial port as there was no plan in putting an atrial lead given that she has now permanent atrial fibrillation. The LV lead port was plugged and the RV pace sense lead was attached to the device and the device and leads were placed into the pocket. Pocket was then closed in 3 layers with absorbable suture. Device check confirmed appropriate capture and sensing of the RV lead then Steri-Strips and dry sterile dressing were placed over the wound. Mrs. Young tolerated the procedure well without apparent complications. A chest x-ray will be obtained tonight. Plan will be to return in approximately 4-6 weeks for addition of an LV lead at that time and AV node ablation. She is set up at VVI 50.
UC visit for Immunization only
I have a patient that went to the UC, saw the NP, and they only wanted to be seen for a Flu Shot. What would be the appropriate E/M to bill with the 90686 code that the provider billed for? Thanks!