There are times when a physician will be performing both covered and non-covered procedures at the same operative session. For example, the surgeon may be performing a septoplasty for a deviated septum (J34.2) and nasal obstruction (J34.89), which is a covered service. The patient wants to have a cosmetic rhinoplasty performed at the same time. […]
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Tag Archives: performed
Cell Block Performed On Pap
If the remaining fluid from the pap vial is centrifuged and a cell block prepared and interpreted can we bill an 88305?The pap was originally interpreted by a pathologist and an 88141 coded and billed. Then at a later date the cell block was prepared. There was also an IHC stain done on the cell block.
Not stating surgery performed in the post-op note
My physician saw a patient in the office for a post op visit. The patient had a major surgery. No where in the post-op note does he state what the surgery was. Is it necessary to state the surgery that was done in the HPI? I thought it was. He describes in the Exam that staples were removed and part of the incision was slightly open with drainage noted.
C/S performed by Resident
We had a patient that delivered by emergency c/s which was performed by the Resident. Dr. was on the way to perform. Would you bill for the c/s or just the hospital visits and the postpartum visit?
Billing for a primary procedure when you only performed the add on portion
Hello,
I am looking for some insight as well as need to know where I can find in writing, or examples of in writing, topics related to the following scenario:
I am looking for some insight as well as need to know where I can find in writing, or examples of in writing, topics related to the following scenario:
Billing for a surgical assistant ONLY.
The assistant is scheduled for a CABG. Assitant gets there and ONLY performs an EVH. The assistant notates "EVH only". And the operative report submitted prior to billing states this as well. Primary surgeon bills 33533,33518,20926, 33508.
Which is correct (legally and following coding guidelines) for the assist to bill their portion?
1. The assistant billing company submits a claim with 33533, 33518, 33508 (20926 is NAR for assistant payment) to the commercial insurance company for payment.
OR
2. The assistant billing company uses another policy to bill for the assistants services without billing the commercial insurance since documentation stipulates the assistant did not participate in any other procedure outside of add on CPT 33508.
I am of the mindset for option 2. But need something extra besides my knowledge as a certified coder to back this up and provide up the chain of command so to speak.
TIA!
Posterior 22612 and anterior 22558 approaches performed together
I have a surgeon who is questioning why they do not get reimbursed 100% for both codes as they were performed with different approaches. Would insurances accept an appeal based on this or do we just have to accept the multiple procedure reduction on the second code? Thanks in advance for any answers.
2021F Dilated Macular or Fundus Exam Performed, Including Documentation or G8397?
Greetings. Large Ophthalmology Group. Patient was seen a week before for New Patient Routine eye exam without dilation (cpt code 92002)- Patient is on High-Risk medication for HTN, Thyroid dysfunction, and is BORDERLINE diabetic. Patient seen again yesterday for JUST the Dilated macular or fundus exam performed, with all documentation salient to fundus findings. I see that the provider reported 2021F. Wouldn’t the better option have been to either 1) Bill G8397 or 2) Inform the patient that they ".. have medical conditions that warranted further evaluation with a Dilated Medical Exam, so we will just skipt the DFE Screening (that is already included in the patient’s insurance) and instead do the more thorough retinal Medical exam that is billed through your Medical Insurance." ? This could have then been billed with a CPT Code of 992**. Your input is strongly encouraged. I look forward to your replies. 😀
69210 VS 69209 when both are performed on the same day
Can anyone help me with the following scenario?
Placed hydrogen peroxide drops in the left ear, letting it soak for app 5 min. Attempted removal of wax with lighted curette, with some success. Flushed ear with lukewarm water to remove the remainder. Confirmed removal of wax with otoscope.
Can the most extensive procedure (69210-REMOVAL OF CERUMEN WITH INSTRUMENTATION) be billed?
Who bills for intubation performed by an RT?
For an intubation procedure performed by an RT under MD supervision, should the MD bill for the procedure (CPT 31500), with the RT listed as ‘service provider’ on the claim? I could not find an NPI# for the RT, and could not find any guidance on this.
OIG Reports Hospital Billing Issues – Adding Modifier 59 for RHC when Heart Biopsy is performed on the same day
In one of the recent reports, the Office of Inspector General (OIG) cites significant issues in which hospitals are making coding errors on Medicare claims. Correct coding of claims is important for hospitals to avoid improper payments, which can lead to recoveries of overpayments. The Centers for Medicare & Medicaid Services (CMS) encourages hospital billing and coding personnel to review the OIG reports and take steps to avoid the problems identified in those reports. It is also very important that claims submitted are supported by documentation in the beneficiary’s medical records.
In the report, “Hospitals Nationwide Generally Did Not Comply with Medicare Requirements for Billing Outpatient Right Heart Catheterizations with Heart Biopsies,” the OIG analyzed claims to determine if hospitals were correctly reporting modifier -59 for RHCs and heart biopsies. The OIG found that in billing for outpatient RHCs with heart biopsies, hospitals often use modifier -59 inappropriately, which leads to significant overpayments and overpayment recoveries on claims for these services.
For detail information on OIG audits & findings, visit: https://oig.hhs.gov/oas/reports/region1/11300511.pdf