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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

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Preventing denials of RPM and related services


First Coast Service Options Inc. (First Coast) wants to ensure you avoid common denials related to “Remote physiologic monitoring (RPM)”, RPM treatment management and digitally stored data services. 

These services are relatively new and have specific coding requirements that must be strictly followed to prevent denials and reduce appeal delays.

Let’s look at each type of service.

RPM services:

Report these services using the following Current Procedural Terminology (CPT®) codes,
  • CPT code 99453 — Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; setup and patient education on use of equipment
    • Used to report the setup and education of the device
  • CPT code 99454 — Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
    • Used to report supplying the device for the monitoring

Collection and interpretation of the remotely captured data only (without treatment or management) is reported with CPT code 99091

For RPM treatment and management services, use CPT code 99457

RPM limitations:

  • Do not report these codes in conjunction with codes for more specific physiologic parameters [e.g., CPT code 93296 (implantable, insertable, and wearable cardiac device evaluations), CPT code 94760 (measure blood oxygen level)]
  • May not be reported when provided with other monitoring services (e.g., CPT 95250 for continuous glucose monitoring)

Additional points of consideration:

  • Do not report CPT codes 94002-94004 (ventilator management codes) in conjunction with these services

For More Information: Click Here 


Coding Ahead

No Copays for Eye exams related to Diabetes?

I recently had a payer Regence Medavantage plan call me and say that we should not charge copays for diabetic eye exams. I can’t seem to find any ruling about this from Medicare or the payer.

Anyone hear of this? Does the dr need to be treating or monitoring the pt for Diabetes?

Thanks,
Edward

Medical Billing and Coding Forum

Pre-auth and related codes

Hi All –

This question was posed to me today and I’m curious to any school of thought (especially official ones) on it.

When a specific surgery is pre-auth’ed but a lesser of the same surgery is billed, do insurance companies connect the dots on related codes?

For example, one of my docs wants to do a lap hysterectomy on a patient. Because we don’t know the size of the uterus beforehand, and the decision on taking tubes and ovaries is usually decided when they get in there, would it be more prudent to authorize the 58554, which is the lap hysterectomy, uterus over 250 gm with removal of tubes and/or ovaries even if once the dictation is coded it ends up being 58550 – lap hysterectomy under 250 gm uterus, no tubes/ovaries removed? Would a claims processor draw the conclusion that the codes are related – one is the "bare bones" of the other? I mean, if you authorize a lap procedure and it ends up being open, it’s easy to fight on appeal based on "doctor planned to do … but when the patient was on the table, they found …. and the decision was made to go open", would the same recourse be had billing a lesser but related code than what was authorized?

If anyone knows any documentation pointing one direction or another, that link would be appreciated as well.

Thank you!!

Medical Billing and Coding Forum

Pre-auth and related codes

Hi All –

This question was posed to me today and I’m curious to any school of thought (especially official ones) on it. I posted it in Billing/Reimbursement as well, but I’ll welcome any of point of view.

When a specific surgery is pre-auth’ed but a lesser of the same surgery is billed, do insurance companies connect the dots on related codes?

For example, one of my docs wants to do a lap hysterectomy on a patient. Because we don’t know the size of the uterus beforehand, and the decision on taking tubes and ovaries is usually decided when they get in there, would it be more prudent to authorize the 58554, which is the lap hysterectomy, uterus over 250 gm with removal of tubes and/or ovaries even if once the dictation is coded it ends up being 58550 – lap hysterectomy under 250 gm uterus, no tubes/ovaries removed? Would a claims processor draw the conclusion that the codes are related – one is the "bare bones" of the other? I mean, if you authorize a lap procedure and it ends up being open, it’s easy to fight on appeal based on "doctor planned to do … but when the patient was on the table, they found …. and the decision was made to go open", would the same recourse be had billing a lesser but related code than what was authorized?

If anyone knows any documentation pointing one direction or another, that link would be appreciated as well.

Thank you!!

Medical Billing and Coding Forum

use of HCPCS code Q0163 when it’s not chemo related?

I’m coding for urgent care and the providers often give oral Diphenhydramine HCL to handle other symptoms that are nothing to do with chemo. Web MD lists all kinds of uses for the drug, non of which are chemo related specifically, yet the only oral HCPCS code for the drug specifically states for use at the time of chemo treatment. (Q0163)

Does anyone know if I can use this code even when not related to chemo or do I have to use the J8499 – prescription drug, oral, non-chemo, NOS? (or some other HCPCS code I may be missing)
Thank you.

Medical Billing and Coding Forum

Non-menopause related vaginal dryness ICD DIAG code?

What is the most specific ICD 10 code for a non-menopausal women experiencing vaginal dryness? From the ICD 10 Index under atrophy/vagina (senile) I see N95.2 which takes you to the menopause/peri-menopausal section. Patient is in her early 30’s. No documentation of low estrogen.

Thanks for the help!

Medical Billing and Coding Forum

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Related Medical Coding Articles

Modifier 78 for return to surgery by different MD for related problem

Please help to clarify what modifier, if any is appropriate for return to surgery post op, during the global period for complications of original surgery by a DIFFERENT surgeon. Since it is not the original surgeon, would a modifier 78 still
be required? If the second surgeon is not in the same group, it seems no modifier is needed. Modifier 79 is not appropriate since the return to surgery was due to a complication of the first.

Medical Billing and Coding Forum