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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

Ent fess balloon codes 31295-31297 versus 31256-31297

I have been in battle with one of our ENT doctor’s regarding his FESS cases- would really like to get some other coder’s opinion on this. (for Hospital case)

here is part of the operative note- Now I would code this using the balloon codes- my understanding has always been- stating pathologic secretions removed is not enough for removal of actual tissues.

Attention was then directed to the maxillary sinus ostium. Beginning on the right side, the middle turbinate was medialized with a Freer elevator. The introducer catheter was next placed within the middle meatus under endoscopic guidance using a 0-degree endoscope. The curve tip of the introducer catheter was positioned within the inferior aspect of the ethmoidal infundibulum. A lighted guidewire was advanced through the introducer catheter and directed through the obstructed maxillary sinus ostium. The wire was coiled within the maxillary sinus. A balloon catheter was advanced over the guidewire. The balloon was positioned to span the maxillary ostium and then was inflated for a few seconds. Thereafter, the balloon, guidewire, and introducer were removed, and the maxillary sinus ostium was examined with an endoscope. The ostium was significantly enlarged and the preoperative obstruction had been relieved. A curved suction was placed through the dilated ostium, and pathologic secretions were removed. The same procedure was used on the opposite left side.

Attention was then directed to the frontal sinus/recess region. Beginning on the right side, the introducer catheter was carefully positioned in the ethmoidal pre-recess leading to the frontal sinus. The lighted guidewire was advanced and manipulated to advance through the frontal recess and enter the frontal sinus. The lighted wire was coiled within the sinus and visualized clearly in the forehead. The balloon catheter was then advanced over the wire to position the balloon within the frontal recess. The balloon was inflated, held for a few seconds, deflated, and then removed. Using an endoscope, the outflow track of the frontal sinus was examined. The track appeared to be significantly enlarged and the preoperative obstruction relieved. The same procedure was used on the opposite left side.

Please advise on how you would code this and what your opinion is of the balloon codes- Doc is stating we are giving an option to use either one. As said my understanding has always been if a balloon is used to inflate and no tissue is removed that the balloon code should be coded and not a regular FESS codes.

Any Help is greatly Appreciated!!!

Medical Billing and Coding Forum

Modifier 58 Versus 78; Which Should You Use?

Sometimes coders are confused when they should apply modifier 58 Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period and modifier 78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure […]
AAPC Knowledge Center

Military Industrial Complex Versus Medical Industrial Complex

Is the military industrial complex 100% evil? Oh, heavens no, however it does need to be kept in check. Obviously, during war times there will be more military spending by any given nation, a time when the country’s treasury is more focused on winning a way, or survival of the civilization. This of course means that those companies that make weaponry stand to make a hefty sum on making those weapons of war. This concerns many and rightfully so.

You see, if those companies lobby politicians to promote certain policies that could lead to a war or cause a lengthened conflict, then they stand to make billions in revenue. The concept of Military Industrial Complex is merely a take-off of Adam Smith’s warnings. Unfortunately, when companies make money through the slaughtering of one’s own race, yes that would be the darkest side of the reality.

Still, on the positive side, a nation that spends healthily on military defense measures is far less likely to be attacked, as their opponents realize the reciprocal will be swift and devastating. An enemy knowing of the economic strength and tight relationship of the industrial military complex with the leadership of the nation, would be wise to think twice about provoking them to serve their political will.

So, those are some pros and cons to the Industrial Military Complex, but what about other such cozy relationships between industry and government? Well, today, we see the Medical Industrial Complex, and oh my gosh it looks like very few in Big Pharma are taking the 50-60% hit on their stock like all the other industries, so what do we do?

Well, it appears the politicians are allotting them these companies, that industry, and the broken healthcare system even more, a $ 690 Billion down payment on a 10-year plan via President Obama’s? So, what’s the difference between the Industrial Medical and Industrial Military Complexes? From Adam Smith’s famous treaties not much in principle or philosophy.

In fact, I just bet Adam Smith would, if he had to choose, side with the Military Industrial Complex over the other, because he knew that government’s first and foremost responsibility was to protect the American People from enemies foreign and domestic, while the purpose of the Medical Industrial Complex is just to make maximum profits at the expense of the people and our government’s treasury. Think on this.

Lance Winslow – Lance Winslow’s Bio. If you have innovative thoughts and unique perspectives, come think with Lance; http://www.WorldThinkTank.net/.

Self Pay versus Insurance you are contracted with

Hi,

I have just uncovered what may be an issue. I was told when I started with my new practice that the physician opted out of Medicare in 2010 (I have the opt out letter). I just received an audit letter/request from one of the insurances we are par with (Excellus BC/BS) for records on patients with their Medicare Replacement plan, stating that it is mandatory we send the records because it is part of the contract. I have a call into the provider rep, but it has not been returned yet. I pulled up the patient’s charts and while I see a copy of the card in the EMR, they have made the patient’s self-pay on the basis of it being a "Medicare Replacement Plan" and therefore I assume, they assumed the office was not par. These are from 2016, but I was under the impression and understanding that if you sign a contract and are par with an insurance you MUST bill the insurance company for the patient. Not make them self-pay. I am trying to find out if the physician opted out of those sections of the contract for Medicare Replacement and Medicaid Replacements, but cannot find a copy of the contract. I guess what I am asking is, if it is in the contract that we are par with their Medicare Replacement Plans, are we legally obligated to bill the insurance? Also is it illegal, to make these patients self pay? I am also thinking they are turning in their bills to the insurance afterward. Any help is much appreciated!

Ali M.

Medical Billing and Coding Forum

Disposable Medical Gowns Versus Reusable Medical Gowns

While the rewards of working as a medical professional surely are immense, the potential dangers that unfortunately accompany this great occupation are nothing to be taken lightly. Fortunately, there have been some excellent developments and innovations in the world of medical supplies that have granted nurses and doctors a great deal of added protection to assist them in maintaining safer working conditions. Among some of the more significant developments in medical supplies that you can look into are medical gowns.

Even though medical gowns and medical scrubs may indeed seem to be relatively simple items that do not require much extra thought or attention, they definitely do contribute a significant amount in terms of not only your daily comfort while you work but also for the degree of safety they provide. But since there are so many different medical gowns and nurse scrubs to choose from it often proves to be a bit of a challenge to know which types will best suit your particular needs. This leads to one of the most common concerns and questions of disposable versus reusable medical gowns.

First, it should be noted that primary purpose of both types of gowns is to provide a comprehensive barrier. Primarily, this barrier is intended to provide a barrier against liquid penetration, such as blood and bodily fluids, originating from the patient during medical procedures. Secondarily, this barrier is also similarly intended to help prevent the transference of bacteria, microorganisms and other potential contaminants into the sterile zone. Even the slightest pressure differences created by the bellowing of the gown can create a small vacuum which essentially pulls contaminants such as dead skin cells into the room, thus jeopardizing the sterile zone.

Therefore, the more invasive the surgery that is underway, the thicker and more comprehensive the barrier of the gown needs to be. Reusable medical gowns are the types that almost always feature a more comprehensive barrier for this purpose. Essentially, the more intensive the surgery and the greater the opening in the body of the patient, the better the barrier that will be needed, thus necessitating the thickness offered by reusable gowns and nurse scrubs.

In addition, surgeries and medical procedures that feature a higher blood count and a greater range of potential risks to the patients will also require the comprehensive barriers offered by reusable gowns.

On the other side of things, disposable medical gowns definitely still serve extremely useful functions. One of the primary reasons you would opt for the use of a disposable medical gown or disposable nurse scrub is when you are dealing with toxic or hazardous materials or when conducting medical operations on patients with highly contagious pathogens. Being able to simply and quickly dispose of the gown makes it very convenient to maintain a completely safe medical facility, drastically reducing the chance of deadly fluids and materials from sticking around. In addition, hospital and clinic administrators often prefer these reusable types because they are cheap enough to offset the cost required to launder the reusable types.

Alexander Sutton applies his direct experience in the medical supplies industry to help nurses, doctors and medical professionals enjoy the safest and most comfortable working experience possible. For more information, please visit Medical Scrubs.

Modifier 25 Versus “Inherent” E/M Services

All billable medical procedures include an “inherent” E/M component, to gauge the patient’s overall health and the medical appropriateness of the service. To report a separate E/M service with modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure […]
AAPC Knowledge Center

new modifier 95 versus GT?

I’m not sure what the difference is between these? It doesn’t say that 95 replaces GT, so what’s the difference? I have a provider that sees all patient’s via telemedicine. I’ve always used the GT modifier. Is that switching to 95 now or is there a way to determine when to use 95 or when to use GT?

Medical Billing and Coding