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Practice Exam

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

Transfer of care – Discharge?

Inpatient scenario:
Patient breaks arm –
Dr. A – Ortho – admits patient, performs surgery on arm
Dr. B – Hospitalist – is consulted for patient’s heart failure
Patient develops UTI, turns Septic
Ortho signs off on patient, transfers care to Hospitalist.
Can Hospitalist bill discharge?
If yes, what needs to be documented? Is an order for transfer of care indicated?
Thanks for your feedback!

Medical Billing and Coding Forum

99477 – Newborn Transfer of Care

Hello,

Is it appropriate to charge 99477 when a baby is born, admitted, and transferred to a different facility on the same day?

We are a CAH and deliver many babies but do not have a NICU, so we sometimes have to transfer newborns to a facility with a higher level of care. The provider does not document critical care time but does provide direct supervision over our nursing staff who closely observe and monitor the newborn until the transport team arrives.

Thanks in advance for your help!

-Emily

Medical Billing and Coding Forum

Complex Repair vs. Tissue Transfer, Rearrangement

There has been ongoing debate about how to code complex repairs versus tissue transfers and rearrangements. Correct coding requires an understanding of the two surgical approaches. In the latest update to the National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services, the Centers for Medicare & Medicaid Services (CMS) clarifies its definition of these […]

The post Complex Repair vs. Tissue Transfer, Rearrangement appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Critical Care in ER hospital #2 receiving transfer for higher LOC from ER hospital #1

Hello,

I would appreciate some feedback on coding ER Critical Care for the facility side as I am coding for a new situation. The patients have been transferred from one ER dept to a second for a higher level of care. The patients have been diagnosed & possibly treated at the first ER dept but need a neurosurgi or other consult and are then generally admitted at the second hospital. They may undergo full body CT scans & receive IV meds at the second ER dept in addition to a neurosurgi consult or they may just have the consult. I am coding for the second ER facility which follows adapted ACEP facility level coding guidelines. The dxs the trauma patients have include subdural hematoma or vertebral fx unstable or pulmonary contusion or a combination of fxs and head & body injuries.

My question is whether the visit at the second ER dept qualifies for critical care. The guidelines say that possible critical care interventions include ‘major trauma care/multiple surgical consults’. The ER MD is stating critical care has been provided at the second ER so this along with the dx tells me that there is much concern for ‘life threatening deterioration in the patient’s condition’. I am unsure whether neurosurgi consult alone is enough to qualify for critical care especially as the patients have been stabilized to a degree at the first hospital. The cases I am struggling with are NOT the ones where the patient requires emergent endotracheal intubation or CPR, etc. I would like to understand better what constitutes ‘major trauma care’.

I welcome your thoughts on this topic. Thank you,

Ellen

Medical Billing and Coding Forum

nerve transfer

Hi All,

A doctor performed an ulnar nerve transferred to the first motor branch of the flexor carpi ulnaris (64905) at the medial aspect of left elbow. Also billing cpt code 64718 (neuroplasty) he transferred the anterior interosseous nerve end to side to the motor fascicle of the ulnar nerve at the level of the distal forearm. When is it okay to report both codes together since there is a cci edit.

Thank you so much everyone for your replies

Medical Billing and Coding Forum

Transfer care with in same Ortho practice

I have a patient was in an accident and was seen in the hospital by a doctor in our group. The doctor did not operate on the patient, only consulted on the patient’s fractures. The fractures are going to be treated conservatively so the doctor charged the 3 corresponding fracture codes without manipulation. The patient has had 2 post op/follow up appointments with this doctor. Now the patient doesn’t like this doctor and wanted a 2nd opinion from another doctor in the same group, same tax ID #. Is there anything that can be charged like an office visit for a 2nd opinion for the 2nd doctor? I don’t feel like we can do a corrected claim on the first doctor’s fracture charges as the patient did follow up twice with him. Any advice would be much a appreciated. Thanks.

Medical Billing and Coding Forum

Spinal accessory nerve to suprascapular and partial radial to axillary nerve transfer

Hello,

I am new to ortho coding. I am trying to find the cpt codes for nerve transfers.

I came up with:

Spinal accessory nerve to suprascapular transfer 64713

Right partial radial to axillary nerve transfer 64999

I cannot find a code to compare the unlisted code to.

I would appreciate all the help. Here is the op-report. Thank you

The patient was identified in the preoperative holding area. We reviewed the operative indications, operative plan and recovery. The right shoulder was marked as the operative site and confirmed with the patient. He was then brought to the operating room. He was placed in the prone position. All bony prominences were well padded. Preoperative antibiotics were given per standard protocol. The right shoulder girdle and upper extremity was then prepped and draped in the normal sterile fashion.
A timeout was performed per standard protocol, identifying the patient, the procedure and the operative site. All personnel were in agreement and there were no discrepancies identified.
A transverse incision was made over the superior aspect of the scapula, beginning medial to the superior angle and eventually extending over the acromion. The incision was taken through skin, subcutaneous tissue and fascia down to the trapezius muscle. The fibers of the trapezius were split transversely to identify the spinal accessory nerve. Once we identified the nerve, we used a nerve stimulator to confirm its identity and its function. We carried our dissection laterally to identify the suprascapular nerve. We had difficulty identifying the suprascapular nerve. Proximally, we identified a section of the nerve, proximal to the notch, that appeared damaged. We carried our dissection distally to the acromion and the spinoglenoid notch. Unfortunately, the nerve was not identified in the notch despite wide exposure, suggesting that perhaps the nerve was avulsed distally, with the spinoglenoid notch serving as a second tethering point.
*
We decided at this point to revisit the suprascapular nerve at a later time and instead to continue with the partial radial nerve to axillary transfer. The incision was extended longitudinally over the posterior aspect of the arm. The incision was taken through the skin, subcutaneous tissue and fascia down to the triceps. The radial nerve was identified in the triangular space. We identified its branches, and used a nerve stimulator to evaluate the function of each branch. We selected the branch that provided only elbow extension as our donor nerve; another branch that provided wrist extension was preserved. We then carried our dissection proximally to the quadrangular space to identify the axillary nerve. We isolated the anterior motor branch. The donor radial nerve was divided as distal as possible, and the axillary nerve was divided as proximal as possible. The microscope was then brought into the operating field. The nerve ends were prepared and coapted under the microscope using 8-0 Nylon sutures. The repair was reinforced with fibrin glue (Eviseal).
*
We turned our attention back to the suprascapular nerve. Again, we found that the proximal portion of the nerve appeared unhealthy, and distally it was absent from the spinoglenoid notch. As such, a spinal accessory to suprascapular nerve transfer would be nonfunctional, and we abandoned this second nerve transfer, deciding it was best to preserve trapezius function as it was one of the few stabilizing muscles remaining around his shoulder.

Medical Billing and Coding Forum

Medicare Now Considers Hospice Care a Post-acute Transfer

Starting Oct. 1, hospital discharges to hospice care qualify as a post-acute care transfer and may have payment adjustments for Medicare patients. According to the Centers for Medicare & Medicaid Services (CMS) Transmittal 2055, change request 10602, under the policy regulations § 412.4: * When a patient is transferred to another hospital and their stay […]
AAPC Knowledge Center

Transfer of Care

Hoping someone can point me in the right direction.

When a patient transfers care to another PCP office, once the medical records are transferred to the new office is there a time frame that the old provider still needs to see the patient? We have had two situations that I have tried to find written documentation and can not.

1. Patient is discharged from practice A (practice A gives 30 day emergency care) and practice B receives the medical records, when does practice B’s legal obligation to see the patient begin?
2. Patient transfers from practice A to practice B on their own accord, the records are transferred to practice B. When does practice B’s legal obligation to see the patient begin?

We have offices requesting that we see the patients until they are seen there (no matter the time length) because they are "reviewing the records" before they accept the person as a patient.

Any help would be greatly appreciated.
Dawne Townsend, CPC, MA

Medical Billing and Coding Forum