If one provider in our lab reads a slide, and then wants a second opinion from another provider in our lab, can we then bill both the 88305 and 88321 for each providers work?
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Tag Archives: Second
Second opinion during post-op period
Medicare pt – had knee scope-is in post op period – wants another opinion-same dx as surgery (meniscal tear)-how would you code?
Peripheral angiography and second order
I keep getting myself confused on coding the peripheral with runoff and second order, anyone please help to correctly code this..:confused:
PROCEDURE PERFORMED:
1. Serial abdominal aortography.
2. Peripheral angiography with runoff to both legs from the distal abdominal
aorta.
3. Moderate sedation.
4. Ultrasound for vascular access of the right radial artery.
5. Second order placement from the left common femoral artery to the right
common femoral artery with the sheath.
6. Balloon angioplasty and CSI atherectomy of the right distal SFA using a 2.0
burr at 60,000 and 80,000 RPM, CSI atherectomy catheter as well as a balloon
angioplasty with drug-coated balloon, 5.0 Lutonix, up to 12 atmospheres for 2
minutes.
7. MynxGrip was placed in left femoral arteriotomy at the end the case with
hemostasis. Wristband placed across right radial arteriotomy at the end the
case with hemostasis.
8. Supervision and interpretation of above.
INDICATIONS:
The patient is a 72-year-old female with worsening bilateral leg pain, right
worse in the left, here for possible peripheral angiography with possible
balloon angioplasty, stent placement, atherectomy as well. Informed witnessed
signed consent placed in the patient’s medical record. The patient understood
the risks, benefits, alternatives, procedure, and wished to proceed. Risks
include, but are not limited to stroke, myocardial infarction, renal failure,
bleeding, limb loss, and death.
DESCRIPTION OF PROCEDURE:
The patient was brought to the cardiac catheterization laboratory in the
fasting state. Right wrist, both groins were prepped and draped in sterile
fashion. 2% lidocaine was infused in right wrist area for local anesthesia.
Using modified Seldinger technique, micropuncture kit and ultrasound for
vascular access. 6-French side-arm sheath was placed in the patient’s right
radial artery. Next, I placed a long pigtail catheter at the level of the
distal abdominal aorta through the wrist. Distal abdominal aortography was
performed. Next, runoff to the feet was performed with digital subtraction.
Next, I did selective angiography of the right leg using the same pigtail
catheter and digital subtraction. Next, I went to intervention. The left
inguinal area was anesthetized with 2% lidocaine. Next, a 6-French side-arm
sheath was successfully placed in the patient’s left femoral artery using a
Destination 45 cm 6-French sheath placed from the contralateral left femoral
artery all the way to the right common femoral artery, second order. Next, I
initially used Advantage wire for sheath placement. This was removed. A
Viper
wire was placed in the distal popliteal artery. Next, I proceeded with CSI
atherectomy with heparin used during the case. ACT greater than 250 seconds.
CSI atherectomy was performed at 60,000 and 80,000 RPM’s. Next, I performed
balloon angioplasty using a 5.0 Lutonix balloon for 2 minutes at 12
atmospheres. Final angiography demonstrated excellent flow. No evidence of
edge dissection or distal thrombus. There was good flow all the way to the
ankle of the right leg.
cpt 67113 second surgery
I am receiving denials for 67113 when it is being done within global period of an initial 67113, even when they were done on opposite eyes. Appropriate modifiers being appended, but NC Mcaid is stating the "original fee includes multiple staged retinal repair. I cannot find anything that defines this cpt in this manner. Any thoughts or advice?
Second opinion needed on earwax removal
I would like the opinion from other coders on this scenario:
Patient presented to our urgent care center, where he was seen by a provider who is new to him. (He has previously been seen by other providers within the group practice.) Patient had a comprehensive history and comprehensive exam done. Patient received a prescription for pain medication, and he had impacted cerumen removed bilaterally by curette. I coded this as 99214-25 and 69210-50. My supervisor argues that we cannot bill the 69210, with her reasoning being that BCBS denied the charge as incidental, and that the diagnosis code for the E/M ended up only being the impacted cerumen, with nothing else wrong with the patient. My argument is that just because something isn’t "payable" by a particular carrier doesn’t mean that it isn’t "billable." The patient did receive a full work-up prior to having the cerumen removed, so I feel that it justifies billing both services. What does everyone else think?
What’s a Good Second Credential for Me?
Getting the first medical coding credential is only the beginning of a career of curiosity and growth. Many coders choose to continue earning credentials in specialty coding and different venues. How do those who choose additional credentials decide what is a good second credential? Opportunities in specialty coding require new competencies, and credentials, they say, reflect […]
AAPC Knowledge Center
Second CPC attempt coming up and I am panicking
Hello all,
Here is a little bit of background. I went through coding training in 2017, landed a coding job at my local hospital in January 2018. My new job requires that you get your CPC before your 1 year mark. I took my first attempt in March and got a 65%. I ran out of time and had to speed guess on 18 questions. Yeah, 18 questions. It was horrible, I left in tears.
My next try is in the middle of July. I bought the practice AAPC exams, I have been highlighting my guidelines, I also bought the CPC exam review. So here is my plan for this next try: I am going to start at the end. I am slow with some CPT sections but really quick with everything else so I was told my best bet would be to start in the back and work to the front. I am also going to NOT wear earplugs this time because last time I didn’t hear the proctor say the 30 minute mark. I also got a hotel room right next to the hospital where the test is because I live an hour and a half away and I DO NOT want to risk anything going wrong. I have been seriously trying to study everyday. It’s hard because I go to work at 6am and don’t leave until 4:00pm and then after making dinner and packing lunches, I am absolutely exhausted so I really do try. I’ve been studying for months. So I have a few questions for you all:
1. How often did you study for your exam?
2. I keep seeing people recommending to read the answers first then the question. I am worried if I do that, I will forget which code is which and I will have to go back and look at the answers again after I read the question. Am I not understanding this tip right?
3. Any other advice?
I am absolutely petrified. I am a HORRIBLE test taker. All through high school and college all the way to now, my late 20s. I can’t let my boss down, I cannot let my family down. Can you all tell I am sorta a mess? lol I took one of the 50 question AAPC exams and got a 72% so now I am even more worried. Granted I took the test right in the middle of horrible allergy attack and I couldn’t see out of my right eye lol.
Thank you for any suggestions or calming me down 😛
Taking a second look at overlapping surgeries
New studies show overlapping surgery isn’t as risky (or as time saving) as once thought.
routine healing surgical wound, subsequent care at second facility
I need help getting started on the right track for coding a healing abdominal surgical wound. This patient had lysis of adhesions two days prior to transfer to another hospital. The patient was transferred for an unrelated condition to the abdominal surgery, nevertheless did receive attention to the wound which included removal of some of the staples. There were no complications of surgery, so where do I start in looking for the proper code for the abdominal wound. Is it considered a laceration and what external code would be appropriate?
10060 vs 10061 using coding clinic second quarter 2017
:confused:from the AHA coding clinic second Quarter 2017
Ask the Editor–and I apologize if this is a rehash.
Ask the Editor–and I apologize if this is a rehash.
A patient underwent an incision and drainage procedure at our facility. According to the operative report, an incision was made over the lesion and purulent material was expressed. Loculations were broken up using forceps and more of the material was expressed. The drainage cavity was then irrigated, packed and dressed with sterile gauze.
Would it be appropriate to code an incision and drainage (I&D) as complicated based on documentation that a drain or packing was used? There are many articles available that provide varying opinions and we would appreciate an official response. Should the term complicated be documented or may the coder use the drain or packing as an indicator of a complicated procedure?
ANSWER
No, it would be inappropriate for the coder to assume that the incision and drainage is complicated based on the use of a drain or packing without confirmation from the physician. When the documentation is unclear the coder should query the physician for clarification.
With that said my question is- If I’m not basing a complex I&D on whether the provider used packing or a drain, can use the fact that they probed for loculations, or explored the abscess further to come to a 10061(complex; multiple) for a more complex procedure? I’m asking in the absence of a query would probing and/or breaking up loculations be evidence of a complex I&D? According to the coding clinic we just can’t assume placement of a wick or drain is evidence of the complexity but it says nothing about probing, or breaking anything up shouldn’t be used to determine the complexity. I know it’s at the discretion of the provider, but unless they state it was complex OR if there was more than one abscess then what other indication is there to code a 10061 for the (complicated;multiple except for the obvious more than one)?
Do we call everything a simple I&D unless the provider states it’s complex?
Thank you!