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Tag Archives: without

lumbosacral microdiscectomy without laminotomy

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Good Morning,
I need some help in finding a CPT code for a lumbosacral microdiscectomy with no mention of laminotomy of any kind. See documentation below. All the resources I’m coming across suggest 63030, but this code mentions a laminotomy.
Thank you,
Laura

A longitudinal incision was then made over the L5-S1 disk space. Using electrocautery, adequate hemostasis was obtained. We dissected down to the lumbosacral fascia. Once we had reached the lumbosacral fascia, we made a longitudinal incision into the fascial layer in line with our skin incision. We then performed a left-sided periosteal dissection to expose both the L5 lamina as well as the S1 lamina. Once this was completed and the lamina of both L5 and S1 was exposed, we then took a localizing x-ray to make sure that we were at the proper disk space. Once we were at the appropriate disk space and this was confirmed, I then used an upgoing curette in order to peel back some of the ligament between the L5 and S1 disk space. Once the false ligament was removed, I was then able to identify the ligamentum flavum. Using a nerve hook, I slowly elevated the ligamentum flavum and Once the ligamentum was removed at this level, I was able to identify the epidural fat as well as the thecal sac. I did use the number 2 Kerrison to continue to dissect out more laterally and removed the ligamentum at that level. I was then able to easily identify the traversing nerve root. I then was able to tell that given her disk herniation the nerve root was actually under quite a bit of tension. I used a number 4 Penfield 4 in order to slowly mobilize the nerve root from lateral to medial and identified the L5-S1 disk space. Once I was able to identify the L5-S1 disk space and mobilize the nerve root medially, I then made a small annulotomy using an 11 blade into the annulus. I then used a Decker as well as an upgoing and straight pituitary rongeurs in order to remove the offending disk herniation. Once I had removed the offending disk herniation, I did place a Penfield into the L5-S1 disk space to confirm that we had removed the disk. We then used a ballpoint as well as a Woodson to undermine the dura at that level to make sure that there was no evidence of any residual bump or disk herniation causing compression at that level. Once we were done with our diskectomy, I made sure that the excursion of the nerve root was significantly improved and there was no evidence of tension on the nerve root.

Medical Billing and Coding Forum

Coding Help! Laparoscopic Paraesophageal Hernia Repair with Mesh, without Nissen

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My surgeon, performed a Laparoscopic Paraesophageal Hernia Repair with Mesh, without Nissen Fundoplication. I am confused as to whether I should use the CPT Code 43282, Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh. Or to use CPT 43289, Unlisted Laparoscopy procedure, esophagus. I have seen places where it says to use the 43282 even though the fundoplasty was not performed and then I’ve seen where it says to use the unlisted code with the description of Laparoscopic Paraesophageal Hernia Repair with Mesh, without fundoplication. Thanks

Medical Billing and Coding Forum

Coding BMI without associated DX

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Hello, I need some clarification, if you will on something. As it pertains to Risk Adjustment Coding, is the coder allowed to extract just the BMI code if documented, without any associated dx also being documented, such as obesity, morbid obesity, overweight? I understand that the BMI codes are secondary codes only so they cannot be primary dx codes, but as far as reporting for risk can the BMI code be reported alone if the provider did not document anything pertaining to the patient’s weight?

Medical Billing and Coding Forum

Therapist meets with a Case Coordinator without patient present

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I have a situation in which a patient’s therapist met with patient’s case coordinator from another agency for 30 minutes in order to provide each other with updates and establish goals between the two services in which she called it an "Interdisciplinary collaboration meeting". The patient was not present during this visit. I’m not having any luck in finding a code in which would apply to this situation? Does anyone have any suggestions?

Thanks!

Medical Billing and Coding Forum

Can well child visits be billed without administering immunizations?

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I work for an FQHC. We no longer have VFC’s for immunizations. Can we bill for well child visits without doing the immunizations? We were trying to see if we can perform the well child visit and send the patients to the health department for immunizations? Please Help!

Medical Billing and Coding Forum

Balloon angioplasty without stent for coarctation of aorta-HELP CODING

Posted on by
Hi all,

Does anyone know what CPT code to report for a balloon angioplasty without a stent for repair of coarctation of the aorta?

Op report reads:

Initial pressures and saturations were obtained as detailed on the accompanying diagram. Pulmonary artery pressures were 13 mmHg. There was a slight gradient from the single ventricle into the ascending aorta. There was a gradient of 16 mmHg from the ascending aorta to the descending aorta. An angiogram was performed in the transverse arch in the region of pressure change. This demonstrated a region of discrete narrowing slightly distal to the left subclavian artery. The transverse arch proximal to the left subclavian measured 13 mm. The aorta at the diaphragm measured 12 mm. The narrowest region measured 7.5 mm. Balloon angioplasty was initially performed with a Tyshak 12 mm x 3 cm balloon to a maximal pressure of 4 atm. This was slightly above the nominal pressure, and the maximal diameter of the balloon was 13 mm compared to a residual waist in the balloon measuring 11 mm. There was a residual gradient of approximately 10 mmHg. An angiogram
demonstrated no evidence of complication. It was elected to repeat angioplasty with a 12 mm high pressure Z-Med balloon to a maximal pressure of 8 atm. There was no residual waist in the balloon. Repeat pressure measurements showed a residual gradient of only 2 mmHg. A repeat angiogram demonstrated no evidence of complication and an increase in the narrowest region to 10 mm. The jugular venous catheter was then manipulated with slight difficulty into the innominate vein. An angiogram here demonstrated a small collateral from the left side of the innominate vein with runoff posteriorly into paravertebral vessels. This collateral did not appear to enter the pulmonary veins or atrium. It was therefore elected not to occlude this vessel at this time.

Medical Billing and Coding Forum

Prolonged Services without Direct Patient Contact

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We have situations whereby the Doctor is conducting a phone call to a patient who is out of state, and at that time the Doctor is reviewing patient Medical History and testing in order for the patient to be set up for a face to face consultation in the near future.

He typically spends 45-60 minutes reviewing and discussing these results and findings with the patient during that phone encounter.

The patient now comes in for their Initial face to face Office visit with the doctor, how would you code this?

Does the Prolonged Service w/out Direct Patient Care apply in this situation?

Medical Billing and Coding Forum

How to Lower Your Blood Pleasure Without Taking Medical Treatment

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A common way for people with high blood pressure is taking medecines in order to control it. However, sometimes, these medecines are not enough strong to lower high blood pressure to normal levels. Lowering to healthy levels also needs some additional measures.

 

Prolonged and Uncontrolled high blood pressure can result in some serious complications like stroke, heart attack or even kidney failure. It is for this reason that you need to do everything you can to control it to normal levels.

 

We are listing some natural ways which could help you immensely to lower your BP and these are easy for you to include in your normal daily routine.

 

1. Have a piece of dark chocolate daily. As per the recent report on Hypertension in the Journal of AHA (American Heart Association), when a person eats small amounts of dark chocolates in daily routine, it contributes to some chemical changes in human body which contributes in dilation of blood vessels thus lowering blood pressure.

 

2. Potassium: It is a magic mineral. It is an important nutrient essential for maintaining electrolyte balance which regulates the muscle and heart’s contraction. It also helps maintain the fluid balance in the body.

 

You can get your daily requirements of potassium from foods like apples, avocados, bananas, oranges, pears, carrots, pears and sweet potatoes.

 

3. Water: It is the miracle medicine given by Mother Nature. When your body goes in the state of dehydration, your BP can shoot up dramatically. When body mechanism begins to retain water instead of allowing it a natural flow, the blood pressure could rise. This action of body is however preventive to save the body cells from dehydrating.

 

Make it a habit to drink good amounts of water daily. It will not only lower your blood pressure but would help to improve your other body functions.

 

4. Walking Is Good For You. Sedentary lifestyle is a bane and cause of many diseases. Over a period of time our inactivity could lead to lot’s of health complications in us. Regular exercise would help us in lowering our blood pressure. The good news is that you need not go for vigorous exercises but just moderate ones to achieve maximum gains.

 

A most recent study which was published in Journal of Epidemiology and Community Health informed us that just 35 minutes of daily walk just three days a week is all that is needed for good health and heart.

 

The above mentioned 4 ways are in fact simple and yet proven ones to lower your blood pressure. But maintaining consistency while practicing them is the only way to gain maximum benefit in long run. You should try making them a part of your daily routine to gain a healthy heart and a fully normal blood pressure.

 

Michael has been writing articles online for 10 years. Check out his latest website MTD Mower Parts which help people find more about MTD Belts.

Related Medical Coding Articles

Billing a patient for a service without submitting to insurance

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I have some providers that would like to charge a patient $ 20 for a B12 injection and not submit it to insurance at all when they are in the office for other services. I’m questioning the legality of this.

For example, a patient with insurance is seen for a sick visit and gets labs and a steroid shot. They pay their copay for this. Can we skip billing the insurance for the B12 drug and admin, and charge the patient right away for the $ 20?

The reason for this is that some plans aren’t covering B12 and the providers want to follow the same guidelines for every patient instead of having to remember which insurance is going to cover it or not.

Thanks so much in advance!
Zory

Medical Billing and Coding Forum