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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

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

COVID-19 Causes CMS to Issue Nonessential Surgery Guidelines

 CMS wants all providers to cancel or postpone all low-acuity surgeries. The Centers for Medicare & Medicaid Services (CMS) is limiting “all non-essential planned surgeries and procedures, including dental, until further notice,” according to statement the agency released March 18. This measure is designed to have a twofold effect: increase the amount of ventilators and […]

The post COVID-19 Causes CMS to Issue Nonessential Surgery Guidelines appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Revised Moh’s Surgery Guidelines


Revised Moh’s Surgery (MMS-  Mohs Micrographic Surgery) Guidelines:

The mentioned below updates are effective from dates of service on and after Sept. 1, 2019.

According to CMS, Mohs surgery should only be performed by a “doctor of medicine (MD) or doctor of osteopathic medicine (DO)” who is specifically trained and highly skilled in Mohs techniques and pathologic identification

In order to maintain the quality of care and services delivered to our members, UnitedHealthcare will only reimburse Mohs surgery to an MD or DO who is specifically trained in both dermatology and pathology

If either the removal of the tumor or the pathology is delegated to another physician or other qualified health care professional, not under the same tax ID number, the Mohs code will be denied.

CMS guidance indicates that pathology examination of the tissue specimen is an inclusive component of Mohs and should not be reported separately.

Accordingly, UnitedHealthcare will deny the pathology examination, if separately reported.

Source: New Guidelines for Mohs Surgery


Coding Ahead

Assistant at Surgery Modifiers Require Specific Documentation


Over my almost 30-year surgical coding career, the documentation for assistant surgeons consisted of only the name of the assistant surgeon in the operative note header. Most often there was no mention of the role of the assistant surgeon in the body of the operative note; it was assumed the assistant surgeon provided an extra set of hands to execute the surgery. That used to be enough for payers, but not anymore.

Payers Want More Info:

Payers no longer consider the assistant surgeon’s name in the header only as sufficient documentation. They want the body of the operative note to indicate what the assistant surgeon contributed to the surgery. They also want documentation in the operative report to explain why an assistant surgeon was used at a teaching institution rather than a qualified resident.

Support Modifier 82:

An “assistant at surgery” is a physician who actively assists the physician in charge of a case in performing a surgical procedure. The “assistant at surgery” provides more than just ancillary services. 

The fact sheet states, “Documentation must include information relating to the unavailability of a qualified resident in this situation.”

This means you cannot assume there wasn’t a qualified resident available. To support modifier 82, the operative note should state,
  • why there was no qualified resident available; and
  • why a non-resident assistant had to assist with the surgery.

When coding or auditing surgeries performed at a teaching facility, make sure this information is included in the body of the operative note.

The operative note should clearly document the assistant surgeon’s role during the operative session.”

This means that the mention of an assistant surgeon only in the operative note header is not enough to support coding for and billing for an assistant surgeon’s services. 

The operative not needs to include what the assistant surgeon contributed to the surgery in the body of the operative note.

Assistant at Surgery indicators:

  • 0 = Payment restrictions for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity
  • 1 = Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at Surgery may not be paid
  • 2 = Payment restrictions for assistants at surgery does not apply to this procedure. Assistant at Surgery may be paid


Coding Ahead

Assistant at Surgery Modifiers Require Specific Documentation

Over my almost 30-year surgical coding career, the documentation for assistant surgeons consisted of only the name of the assistant surgeon in the operative note header. Most often there was no mention of the role of the assistant surgeon in the body of the operative note; it was assumed the assistant surgeon provided an extra […]

The post Assistant at Surgery Modifiers Require Specific Documentation appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Emergency room vs hospital Ambulatory surgery center

I have a payor who is taking a UB-04 billed with a 270, 450 and 360 and paying it off of an ASC fee schedule.
this is a minor surgical procedure a minor ER visit 99283 surgical 11042. I know according to Texas Medicaid facilities are assigned a HASC number to use when billing as an ASC but I cannot find any other information I do not see that the facilities are billing with anything different then NPI etc….
I do not believe you should take an ED visit and make it ASC.
Can anyone with knowledge of Medicaid help maybe I missed something in the manual that says to apply this way?
thank you

Medical Billing and Coding Forum

Complicated Coding issue involving Cataract surgery on a juvenile for PCS Cataract su

I would like some Coding help in determining What CPT’s and what current ICD-10 Codes can be billed for cataract surgery with sulcus lens placement, pars plana vitrectomy, with lens implant retrieval of implant that dropped into the vitreous space during surgery, right eye. This is complicated in that the cataract surgery was performed by the Primary Ophthalmologist on a juvenile patient for PSC cataract OD and then this patient experienced a posterior capsule rupture during I & A necessitating pars plana vitrectomy with lens implant retrieval by another Ophthalmologist, who is the Retinal Surgeon in the same Ophthalmology Practice. Also, can this be coded as a Two-Surgery Case with a -62 modifier on each surgery? Also, the CPT Codes the Retinal Surgery said to use for his portion of the surgery were 67036, 67121, and 66986.

Which modifiers would I use for each surgery for each provider?

Medical Billing and Coding Forum

General Surgery Rounds

Chief complaint: GS
HPI:0
ROS: 0
Subjective: Urine input/output, o2 sats, BP
Exam: Const, Lymph, Resp, MSK, Skin, cardio, Neuro

Assessment plan: sepsis, diabetes, ARF, AKI, intestinal obstruction, dehydration, hypokalemia

Surgeon performing rounds on a patient, is this acceptable as 99233?

Is it always necessary to have a chief complaint and an HPI for the inpatient E/Ms ?

Medical Billing and Coding Forum

Help with spine surgery coding

Looking for proper Medicare coding for the following complicated surgery. Please let me know if any of the anticipated codes I put below would be incorrect, bundled, need modifiers, or if there is anything else should be added or replaced with a more appropriate code.

Patient has chronic back pain, failed back syndrome and adjacent segment disease. Patient was scheduled for TLIF with exploration and also has an existing implanted intrathecal pump. Perhaps someone has access to a program that you can put in the codes and it will you. Greatly appreciate it!

1. Exploration of prior instrumented fusion at L2-L3 (22830)
2. Removal and re-implantation of spinal hardware (22852 & 22849)
3. Revision of intrathecal catheter with laminectomy (62351)
4. Interrogation of intrathecal pump (62367)
5. T11-S1 Posterolateral arthrodesis (T11-T12 22610, T12-L1 22614, L1-L2 22633, L2-S1 22614 x 4) using autograft and allograft (20930. & 20936)
6. Left L1 Osteotomy to decompress left L1 nerve root and correct kyphosis (22214)
7. Right L1 Laminectomy and discectomy, interbody mechanical device placement to decompress right L1 nerve root and correct kyphosis (22633 & 22853)
8. T11 to S1 segmental instrumentation (22843)
9. L5-S1 laminectomy (63005 & 22612)
10. Fluoroscopic guidance, computer navigation (77011, 77003 & 61783).

Medical Billing and Coding Forum

Help with hand surgery please

DIAGNOSIS: Open complex dislocation to the left fourth digit involving volar plate collateral ligaments with near total avulsion of the fingertips with involvement of the digital nerves.

OPERATION PERFORMED
1.Open irrigation and debridement including removal of foreign material, devitalized soft tissue extending down to tendinous structures involving open complex dislocation.
2.Repair of ulnar collateral ligament.
3.Repair of radial collateral ligament.
4.Repair of radial digital nerve.
5.Repair of ulnar digital nerve.
6.Repair of volar plate of interphalangeal joint.

INDICATIONS FOR OPERATION: This patient is status post a very complex dislocation in which he nearly totally avulsed his finger and due to extensive ligament tendon injuries he was sent for a specialist consultation. This was much more complex than a normal tendon or ligament repair, which is often done by emergency room physicians. The patient was referred by ____[CLINIC].

This patient’s occupation is construction, and on this date, he did have a very large piece of concrete fall on him, severing and causing a near avulsion, open dislocation, of which his finger bent over backwards completely with the bone protruding and only connected by some soft tissue, nearly completely ripping all the ligamentous structures of the interphalangeal joint.

OPERATION IN DETAIL: After sterile preparation and draping in the normal fashion, and a regional digital block anesthesia, tourniquet exsanguination of the fingers, the digit was approached. The collateral ligaments were repaired using 4-0 PDS suture. The wound was also cleansed and irrigated copiously using antibiotic saline solution. Removal of foreign body, devitalized, crushed soft tissue was done for the open complex dislocation. The patient also had near complete amputation. There were 2 significant sized digital nerve branches, which were repaired under magnification using an epineural repair using micro technique and micro instruments and they were my own microinstruments.

However, prior to this, the patient also had disruptions of the volar plate. This is thought to be one of the main causes of the patient having no flexion of the digit and minimal movement.

The volar plate was repaired after using PDS suture. The profundus tendon was examined and found to be intact. It required no repair other than the surrounding structures around it. The patient did regain some movement after this; however, did not have forward flexion. He did have function of his extensor tendon and it was thought that part of the flexor belly was in spasm; however, the proximal and distal portions of the flexor tendon were intact upon extensive traction of the area prior to the repair of the previous mentioned structures.

Detailed instructions and appropriate dressings were used for the patient with followup discussed with the patient. He was also under the instruction that he should be very careful, keep his finger splinted at all times, and we will start him on a hand rehabilitation regimen, which will take months before he is able to have fairly normal function of the digit and it will not be back near its normal strength for 4 to 6 months.

Medical Billing and Coding Forum