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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

Multiple Surgery Codes for ASCs

Does anyone know where I could find a document that CMS puts forth that shows whether a code is deemed "S" (surgical code, subject to multiple surgery reduction) or deemed "F" (facility code, not subject to multiple surgery reduction)? I like to have these things in writing when possible. I haven’t had luck scouring through the CMS website. A link would help, if possible. :)

Thanks for any help!

Janel Bieniek,
RHIT, CPB

Medical Billing and Coding Forum

L1833 billing on same date as outpatient surgery

One of the surgeons I bill for dispenses L1833 knee braces to some of his outpatient surgery patients. United Healthcare commercial plan used to pay for these braces, but around April 2018, it stopped paying and started denying the braces as part of the global service. I called and spoke to a rep about a policy change. She denied any knowledge of a change in policy and suggested I do a reconsideration. UHC denied the reconsideration stating the claim was paid correctly. Does anyone have any advice they can share? Thank you.

Medical Billing and Coding Forum

bleph surgery with lesion removal question

I know the answers I read from you on the AAPC site were from 2015, but I need to rebill a 15823 mod 50 with a lesion removal 11440. I originally billed with a 51 mod and it was denied. What should I have done as Medicare naturally paid the lesser and denied the bleph as inclusive.

Medical Billing and Coding Forum

Cervcial and Lumbar combined surgery

I have a Cervical fusion revision surgery and a Lumbar Laminectomy that was performed during the same OR day/time. Any suggestions on how to code/bill this? Do my codes still go in RVU order? Do I just need to make sure my diagnosis pointers are ok? Any special modifiers? Any suggestions would be a great help!

Thanks so much!

Medical Billing and Coding Forum

Decision for surgery was made… and then the surgery was cancelled. Can we bill?

I’m not sure what’s correct for this visit:

The patient was seen on 8/1 and the decision was made to proceed with a partial mastectomy. Consent forms were signed and surgery was scheduled for the end of the month. The patient was seen again on 8/10 because she had questions about the procedure and recovery time. Since the decision for surgery had been made at the 8/1 visit, the 8/10 visit was not charged. (8/10 visit is being considered global since the decision for surgery was already made and the visit was related to the surgery)

The patient has decided to postpone the surgery and it has not been rescheduled. (she’s seeking another opinion) In this case, does the visit on 8/10 now become billable? Or should it be left as a global visit since a surgical plan was in place when the patient was seen on 8/10?

Haven’t had this come up before now, and I’m interested to see how everyone else handles it.

Thanks :)

Medical Billing and Coding Forum

Z42.8 Encounter for other plastic and reconstructive surgery following medical

Hello, I am a new pro fee coder and will greatly appreciate your expertise with using Z42.8. Recently, I coded a few cases with Z42.8 and I was wrong, I am not convinced with the answer given and therefore, would like to get your opinion. Case: pt is coming to see a plastic surgeon to discuss a plastic surgery After healed medical procedure for cleft palate (for example). The doctor is saying that the pt is a good candidate and the surgery can be scheduled/considered. I used Z42.8 as the prim dx and then Q code. I was told that I cannot use Z42.8 because pt is not having surgery ‘right now’ or the office note doest not say’ Pre-op visit". But to me, pt and doctor are discussing the plastic surgery. Pt is New to the plastic doctor. May I use Z42.8 as prim? Z42.8- Encounter for other plastic and reconstructive surgery following medical procedure or healed injury. Another case could be: pt has mastectomy done and is coming for discussing a plastic surgery.
Thank you in advance.

Medical Billing and Coding Forum

Billing insurance for pre-op and post-op visits for a cash pay surgery

One of my providers posed this question.

A pt has a surgery done and must pay cash (for denial, elective surgery, etc.). Other specialists practices are telling us they are still billing the pt’s insurance for the pre-op and post-op visits. (Even those w/in the global period). He asked if it would be "correct" to bill this way.

I told my provider that I was uncomfortable doing this, because even though the pt paid cash, I feel it is still a global charge and I am also afraid that if we were audited we would get cited for not billing equally to all of our patients.

Thoughts?

Medical Billing and Coding Forum

Billing H & P for hospital outpatient surgery

I have APP’s that work in the hospital, they do H & P’s for surgeons and as of today we have not billed for this service. They do them > 48 hours before surgery and would typically bill a 99213. I have someone from compliance at the hospital telling me that we can’t do this. If the surgeon did themselves they would bill for it. Do any of you have knowledge about this?

Medical Billing and Coding Forum