Click here for more sample CPC practice exam questions with Full Rationale Answers

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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

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2018 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

Practice Exam

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

Coding for MIS Procedures With Direct Visualization

Consider code descriptors, surgical anatomy, technology used, and type and amount of visualization. Most CPT® codes get added to the code book each year without any mention as to whether the procedure is open or percutaneous, also known as minimally invasive surgery (MIS). Recently, the code development process is accounting for newer procedures that are […]

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AAPC Knowledge Center

Append Modifier 22 to Extraordinarily Complicated Procedures

Understand the additional work required to receive rightful payment on modifier 22 claims. Values assigned to CPT® codes assume an average service with an expected range of complexity. However, there are times when the code used to report a service does not adequately describe the work involved. When the procedure performed has exceeded the normal […]

The post Append Modifier 22 to Extraordinarily Complicated Procedures appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Explore Coding Complexities of Skin Procedures

Part 1: Consider skin lesion removal type and depth, intent, and lesion location to avoid common coding mistakes. Accurately coding dermatological procedures can seem like a daunting task. Code selection can be confusing because skin procedure codes require you to consider several factors such as the type of removal, lesion size and location, pathologic results, […]

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AAPC Knowledge Center

Differentiate Separate Procedures with Modifiers 59 and X[ESPU]

When you have distinct, separate procedures, know which modifiers will get the claim paid in full. Modifier 59 Distinct procedural service acts as a “universal unbundling” modifier for procedures that are normally included as part of another procedure, or “bundled.” The modifier tells the payer that there are special circumstances that warrant separate reporting (and […]

The post Differentiate Separate Procedures with Modifiers 59 and X[ESPU] appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Modifiers with multiple procedures

I work for a hospitalist group. Our physician billed a critical care 99291 with 36556 (insertion of non-tunneled centrally inserted central venous catheter) and a 31500 (intubation). I know I need to append a modifier 25 to the 99291, however I can’t seem to figure out what (if any) modifiers to use on the two procedures. Do I need a modifier 51 on the 36556? Help please and thank you!

Medical Billing and Coding Forum

Unrelated Procedures or Visits leading up to the “Pre-Operative” Period

Scenario:
A member is inpt., provider is billing code 99232-24 (DOS 01-28-19) mod. 24 as member is still post-operative of another 90-day procedure…

Now day after (01-29-19) provider billed 99232-24-57 as they are seeing the member in post-op but also made same day decision for another 90-day procedure (61510-58).

How should the 01-28-19 DOS be billed as it is the day prior to decision of the major surgery and provider is indicating unrelated and decision was made the next day/same day 01-29-19?

01-28-19 99232-24 denied because the visit was billed by the same provider within the 61510’s pre-operative period.
01-29-19 99232-24-57
01-29-19 61510-58

Medical Billing and Coding Forum

Dental procedures provided in a facility..HELP!!!

Hello, I am trying to figure out how a facility bills/gets reimbursed for dental services provided in an OP surgical setting-by an oral surgeon that is a DMD or DDS. We have typically used 41899 or other 4XXXX range CPT codes and received minimal if any reimbursement. Now with Medicaid using EAPG’s they provide package payments based on dental services and are looking for the D codes. In the CDT book, many of the D codes have a facility RVU assigned and the professional claim all use the CDT codes on them as the surgeons are dental/credentialed (DMD DDS). I have multi-tiered questions here:
1. Is it non-compliant to have the facility claim and the professional be inconsistent? (CDT versus CPT)
2. For dual eligible beneficiaries, shouldn’t the claims be coded with CDT codes to get the correct denial to cross over to Medicaid? (Currently we get a not R&N or med necess denial which does not let the claim go to a secondary payer)
3. For services that would normally be performed in a dental office under conscious sedation or nitrous (such as multiple extractions or massive caries); shouldn’t the services be billed as dental with CDT codes?

CMS has D codes on the hospital OPPS addendum B with status indicators showing blank (not recognized), E (exclusion) or other indicating questionable or possibly payable; so I am thinking the D codes are allowable on a UB?

I know this is a lot and any help is appreciated!!!!

Medical Billing and Coding Forum

Appropriate Coding for unplanned additional procedures during planned surgery

I have searched high and low for an answer to this question and I cannot come to a definite conclusion.

Question: During the course of a planned surgical procedure, if the surgeon discovers some pathology requiring maneuvers that are NOT a part of the major procedure or global surgery package, something considered by the surgeon to be medically necessary and perhaps unrelated to the planned procedure, is this separately reportable? I do not have a specific example at this time.

What is known: In page 10, chapter 1 of the CMS NCCI Policy manual, it is clearly outlined what is considered integral to a planned surgical procedure… a smaller portion inclusive of a larger procedure. This chapter also covers sequential procedures, conversions, and intraoperative complications and what is not separately reportable.

But, Ch1, page 15 of NCCI Policy Manual states: "If exploration of the surgical field results in additional procedures other than the primary procedure, the additional procedures may generally be reported separately." CMS 2018 NCCI Policy Manual, Ch1, General Correct Coding Policies

Can anyone help me out with this?

Medical Billing and Coding Forum

Interpretatin and Report for eye procedures

hi

I have a question regarding I/R, I am noticing a pattern with our physicians that when they indicate a reason for the test they are writing something like this.

Reason for Test – H40.1232 – low-tension glaucoma, bilateral moderate stage, Monitor for progression.

Reason for Test – H40.013 – Open-Angle with borderline findings, low risk, Monitor for progression

I am trying to teach them the correct way to document a chart, all the other pieces of the I/R are good, I am just not sure if something like this is okay.

Any help and/or feedback would be greatly appreciated.

laura

Medical Billing and Coding Forum