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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

Documenting Return to Office requirement

I am working with a group that is currently under a Pre-Payment Review with Anthem and we are having to send supporting documentation with every claim. As I am reviewing their E/M notes in the EHR I am finding that the Return to Office field is typically blank, yet up in the A/P the doctor typically dictates when and what the patient is to return for. In my previous experience with other practices that used dictation, they still documented the Return to Office field. Is this required, or will it pass since it is stated in the A/P?

Thanks in advance!
Gina

Medical Billing and Coding Forum

Help! Code for return to OR

I have a patient who came in a couple months ago for a repair to the Achilles tendon. She just came back in for another procedure because the doctor suspected the wound wasn’t healing properly. It sounds from the dictation that when the surgeon opened up the incision and cleaned up the wound, the original Achilles partially re-ruptured so he had to re-do that procedure.

The doctor recorded a diagnosis of "right achilles wound dehiscence and concern for achilles suture issues" and also "partial achilles re-rupture." His operative procedure stated "Open achilles debridement and achilles re-repair."

His description of the procedure said: "The right leg was prepped and draped in the normal, sterile fashion. An incision was made over the right Achilles. The incision was taken down through the skin and subcutaneous tissue. The #5 FiberWire medially were balled up in the area of the wound dehiscence creating fluid. I excised the sutures. This left the Achilles tenuous. I then oversewn the repair with running, locking #5 FiberWire once again. This held quite nicely. I then thoroughly irrigated the wound and injected the wound with 0.5% Marcaine with epinephrine. I closed the skin with 0 Vicryl, 3-0 Vicryl, and 3-0 nylon. I placed a bulky, sterile dressing."

How do I code this? I was thinking diagnosis code T81.32XA for the wound dehiscence but I’m not sure on the CPT code. I also don’t know if we should code for the achilles repair and put a repeat procedure modifier on it? I’m guessing we also put a modifier 78 on there?

Any recommendations? Thank you so much in advance!!! :)

Medical Billing and Coding Forum

Proton Cancer Treatment Centers: High on Price, Low on Return

Proton beam treatment is a particle therapy that uses a beam of protons to target and destroy cancer tissue. There are 27 proton beam units across the United States, and 20 more are popping up or under construction, including Mayo which has opened two, four-unit proton centers in Minnesota and Arizona. Upside The advantage of proton beam therapy over […]
AAPC Knowledge Center

External Fixator with Closed Treatment and return to OR for staged ORIF

I have a billing/coding question related to external fixator placement.

Is it commonplace to bill 20690 (uniplanar external fixator) and 27825 (closed manip tx pilon) at the initial surgery, and at the time of the definitive surgery, to bill 27827 (open tx pilon) with a 58 modifier.

The physicians thought is that the closed manipulation is a separate procedure from the external fixator, done as a separate and specific maneuver during surgery, and is a necessary step in temporizing an injury. Therefore, the closed manipulation should be coded separately, and is not inherently bundled into the external fixator code. I just need clarification and a reference, if possible.

This is not a case where fixator is applied and closed treatment did not repair the fracture, and the decision was made to return to the OR for open treatment which would be billed with a -78 modifier.

Questions I have are:
1) Is the physician meeting the global requirements of the closed procedure (number of visits required, etc.)
2) Is it acceptable to bill a patient for 2 related procedures at full reimbursement for the same fracture?

Medical Billing and Coding Forum

return to OR for Ex. Laparotomy with evacuation of hematoperitoneum

what CPT code is appropriate for return to OR for Ex. Laparotomy with evacuation of Hemoperitoneum with ligation of apparent bleeder following TAH?
The pt was brought to the OR day after TAH. Skin incision was re-opened as well as the subcutaneous and fascial incisions. The peritoneum was opened. Blood and clot was evacuated. Bowel was meticulously dissected superiorly and the rest of blood and clot evacuated.

Medical Billing and Coding Forum

Return to Work – Resistance From the Medical Community

How many of you have had difficulties with getting a physician to work with you on getting your employees back to work?

Let’s take a step back and look at it from the treating physician’s perspective. What is their number one objective when they see one of your employees? It’s the health and well being of their patient. They don’t look at their patient as your employee, instead they see their patient.

Companies complain constantly that it’s the doctor’s fault for their high insurance costs and describe them as “socialists in a white coat.” I personally believe people blame the doctors because they’re an easy target and it provides them an opportunity to not look in the mirror. Not too say that the medical community is not part of the problem. They are a huge headache for employers, but you cannot look at them as if they are the enemy.

So how do you ensure that the physician your injured employee visits has all of the necessary information to make a determination based on what is best for all parties involved? There are four main areas that you need to address in order to accomplish this:

1. Functional job descriptions for every position

2. Written transitional duty process

3. Injury packets for both the doctor and the injured employee

4. A solid, communicative relationship with a local occupational health clinic

All of these are extremely important, but I want to laser in on number four because this is the one most companies have trouble with; the relationship with an occupational health provider.

For the sake of argument, let’s say you have created functional job descriptions for all your positions, you’ve got a written transitional duty policy, and you have developed two injury packets for the doctor and your employees.

In many states, you cannot direct your employees to be treated by a specific provider. However, you can develop a comprehensive relationship with an occupational health provider or general practice clinic in your area. Here are the steps you need to take in order to build a quality relationship with the medical community.

1. Conduct research on local occupational health clinics and coordinate a meeting

2. Invite the occupational health doctor to tour your facility or sites

3. After the tour, provide the doctor with an overview of your workers’ compensation process and layout your goals and objectives. Include a list of your modified duty positions, the Return To Work policy, and include the hours available for those positions

4. Have a candid conversation focused on the concerns for the health and well-being of your employees

These proactive steps will build a trusting relationship with the treating physician by addressing any issues he or she may have about a possible work environment wrought with unconcerned management. Doctors who treat injured employees find it much easier to send their patient back to work if they have met your staff, toured your facility or sites and discussed your Return To Work procedures and other concerns. This vital relationship between the employer and the occupational health doctor is the true transitional point from patient back to productive employee. An invaluable step in abating resistance from the medical community.

Jeff Slusser is a Certified Workers’ Compensation Adviser and the founder and CEO of Jarsity.com. Jarsity helps small & mid size businesses reduce their cost of insurance through education and training.

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