I am stumped. they careflighted the doctor to the scene to finish the amputation and then sent him to the hospital to clean up the amputation. What POS is acceptable?
Click here for more sample CPC practice exam questions with Full Rationale Answers
Laureen shows you her proprietary “Bubbling and Highlighting Technique”
Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page
Tag Archives: Would
Pain Management- How would you code this?
Operation:
1.Right L4 Medial Branch, L5 Dorsal Ramus Branch, S1 Sacral Lateral Branch Block
Anesthesia:
Local with Moderate Sedation
Details of Procedure:
After obtaining informed consent the patient was positioned in prone position on a padded fluoroscopy table. The region of interest was prepped and draped in the usual sterile fashion. 1% lidocaine was used to anesthetize the skin over each target site.
Under fluoroscopic guidance, a 25g 3.5 inch spinal needle was advanced to the location of the medial branches of the right L4 nerves (at the intersection of the superior articular process and the transverse process of the associated vertebral levels). A 25 gauge 3.5 inch spinal needle was guided to the location of the right L5 dorsal ramus at the intersection of the superior articular process of S1 and the sacral ala.
The right S1 sacral lateral branches were blocked at the lateral aspect of the right S1 foramen with a 25 gauge 3.5 inch spinal needle.
*** One provider said to code 64493-RT, 64494-RT. The other to just code one level, 64493-RT.
Thank you in advance!:)
Dickies Medical Scrubs Would Be The Wonderful Choice for All Your Medical Uniform Preferences
Dickies brand is preferred more than all other brands of scrubs. They have been available for almost 100 years now and continue growing with each and every passing year. Today they are the world’s largest vendor of work garments.
The History Of Dickies Medical Scrubs:-
It was only about a decade ago that Dickies medical uniforms were first brought in. Currently however, they top the charts in sales whenever it comes to medical scrubs and uniforms. They are also the number one manufacturer of work dresses in the world today.
New Styles Over The Years:-
Through the years Dickies has presented several new styles of cheap medical scrubs. Actually, there are more than 40 different patterns obtainable today as well. A lot of these designs and styles have very promptly become really popular. This has made possible medical professionals to finally feel comfortable in the garments that they are wearing almost constantly.
Some of the different types of pants that you can select from include:
.Hip flip boot cut pants. The distinctive waistband on such pants can be worn up or flipped down.
.Cargo flare pants. These will perfectly fit your body and allow it to breathe. Lots of people think that these are much better than traditional scrubs but they do help to manage a neat, professional look nonetheless.
A few of the different types of shirts that you can choose from include:
.Cartoon characters. These are excellent for cheering up kids.
.Numerous colors. This includes both Hawaiian and Asian prints.
Regardless of your choices, you should know that all of your outfits are interchangeable, so that you can make even more great outfits from them. Plus, Dickie medical scrubs do provide you a greater selection than any other retailer or producer of discount medical scrubs does.
The Ultimate Word About Dickies:-
Undoubtedly, scrubs have come a long way during the past 100 years. They have changed a lot since the times when nurses’ uniforms were just a shapeless, white, floor length apparel with an apron tied over the top of these. Stuff like WWII really have created some changes here. Such as, at that time elastic was added to the waistband and the length of the apparel was moved up to the thigh. After then there have been lots of other changes as well, with Dickies leading the charge with many of these alterations that have been manufactured today.
Make Dickies your final choice for all medical uniform requirements. Find out other great details on Dickies Scrubs and Cheap Dickies Scrubs today!
How would this be coded?
Can anyone give me some guidance on this? If anyone has any resources or can direct me to any documents that would help with these it would be appreciated!
PROCEDURES:
1. Right heart catheterization with shunt study.
2. Arterial line placement.
INDICATIONS:
Hypoxemia
COMPLICATIONS:
None
DESCRIPTION OF PROCEDURE:
A full PARQ discussion was held with the patient and informed consent was obtained. All questions were answered. He asked us to proceed. He was brought to cardiac catheterization lab, prepped and draped in the usual manner. Local anesthesia given. An 8-French sheath was placed into his right internal jugular vein using direct ultrasonic guidance. Fluoroscopy also confirmed position of the wire prior to sheath insertion. A right radial artery line was then placed using an Angiocath 0.021-inch angled guidewire. The patient was on 3 L nasal cannula for the shunt study. An 8-French Swan-Ganz catheter was then slowly advanced under fluoroscopy into the right atrium, right ventricle, pulmonary artery and pulmonary capillary wedge positions. Pressures recorded in each of these positions. Cardiac output and cardiac index were measured both using thermodilution and Fick methods. Oxygen saturations were also drawn using the Swan-Ganz catheter in the SVC, IVC, high RA, mid RA, low RA, RV base, RV apex, RVOT, main PA, RPA, and wedge positions. Arterial saturation was also drawn from the A line. This was all done on oxygen. In order to enter the inferior vena cava, a 5-French multipurpose diagnostic catheter was advanced over a 0.035-inch angled guidewire into the IVC. IVC saturation was drawn with the multipurpose catheter. The patient then underwent a repeat wedge saturation and arterial saturation on room air. The patient’s O2 saturation on pulse oximetry dropped initially to the 75-78% range within 2 minutes of oxygen discontinuation. After saturations were drawn, peripheral oxygen saturation dropped to as low as 68%. Because of this, oxygen was turned back up to 3 L nasal cannula and a repeat shunt study was not performed on room air. The sheath was removed and hemostasis achieved using manual compression. The patient tolerated the procedure well. There were no complications.
SUMMARY:
1. Mildly elevated right-sided filling pressures with mean RA pressure of 10 mmHg and pulmonary capillary wedge pressure of 17 mmHg.
2. Mean pulmonary artery pressure of 33 mmHg.
3. Normal cardiac output and cardiac index by thermodilution and low-normal cardiac output and cardiac index by Fick methods.
4. No significant left-to-right cardiac shunt is seen.
5. A 9-10% oxygen saturation drop is seen between the pulmonary capillary wedge positions and peripheral arterial saturations consistent with right-to-left shunt.
6. The patient’s hypoxemia is likely related to both cardiac and non-cardiac contributions. The patient was significantly hypoxemic on room air with a pulmonary capillary wedge saturation of 86-87%. This suggests underlying hypoxemia from pulmonary causes. However, the patient also has cardiac etiologies for hypoxemia, including a 9-10% oxygen saturation drop between the pulmonary capillary wedge position and right radial artery consistent with a right-to-left shunt.
7. Mild fluid overload may also contribute.
I came up with 93451 (RHC), and 36620 (arterial line placement). I’m not sure on the shunt study though. Am I on the right path with those?
Thanks for any and all comments!
Do you use AAPC Coder? I would love to learn more about your experience!
Hello!
My name is Mike and I started working at AAPC in November.
Being new to the world of medical coding, I am doing my best to learn all about the great AAPC member community and about your experiences with AAPC products/services.
Do you use AAPC Coder?
Would you kindly spend 10 minutes telling me about your experience?
If so, send me a private message.
I hope to hear from you 
Happy Holidays!
How would you code this?
Procedures performed
1. Left heart catheterization
2. left ventriculogram
3. aortic arch angiogram
1. Left heart catheterization
2. left ventriculogram
3. aortic arch angiogram
A 6 French terumo sheath was placed in the right radial artery. Once the sheath was inserted, 1mg verapamil and 300 mcg of nitroglycerin was injected through the sheath. 5000 units of heparin was given through the IV. Selective coronary angiogram was then performed using a 6 French JL 3.5 catheter and a 5 French JR4 diagnostic catheter. a pigtail catheter was advanced into the aortic arch and hand injection angiogram was performed to try to visualize the subclavian artery and left internal mammary artery. There is poor filling of those vessels, but they did appear to be patent. The JR4 catheter prior to its being removed was advance over a J-wire across the aortic valve into the left ventricular cavity. The left ventricular pressure was measured along with hand injection left ventriculogram. The patient tolerated the procedure without incident. At the end of the case, the catheter and sheath were removed with adequate hemostasis using a TR band. 93458 26 and what other code to use? Another coder at work wants to use 37221, but that’s for Pta and stent. Some help would be appreciated
CPC Certified Medical coder looking for Remote or Onsite job, would like work at US
Hi,
I am a Certified Experienced Coder with Experience of 2 and half years.
I am well versed in Anatomy physiology and Terminology
Experienced in E/M Hematology and oncology, Careworks and Internal Medicine OP
Would like to work at US and have experience with US clients only
Member ID: 01560542
Mail ID :[email protected]
How would this GI ERCP be coded?
EXTENT OF EXAM: second portion of duodenum
Findings: EGD: Normal esophagus, stomach, duodenum. No stent
seen exiting the ampulla. EUS: Linear EUS performed via
esophagus, stomach, duodenum. There is a hyperechoic metal bile
duct stent with acoustic shadowing seen within the CBD. The
common hepatic duct proximal to the CBD stent is normal in
appearance without stones. No gallbladder seen. Homogeneous
pancreas without masses. PD is normal in course and caliber
measuring 1-2 mm in the body of the pancreas. Few 4-6 mm
well-defined, triangular lymph nodes which are mostly hypoechoic
with hyperechoic center. Normal left lobe of liver. Normal
peripancreatic vessels including celiac axis. Normal left
adrenal gland, left kidney spleen. ERCP: TJF scope was used.
Ampulla with signs of previous sphincterotomy but no stent seen
exiting the ampulla. Stent is also visualized on fluoroscopy
and had clearly migrated proximally into the bile duct.
Selective bile duct cannulation easily achieved using balloon
tipped catheter loaded with 0.025 in guidewire. Bile aspirated.
Balloon sweep performed using 11.5 mm balloon to try to move
metal bile duct stent more distally but the balloon removed
moderate amount of stone debris from the stent/bile duct without
moving the bile duct stent. Then, we dilated the ampulla/distal
bile duct using TTS CRE balloon to maximum of 10 mm to help
facilitate stent removal. Following dilation of distal bile
duct/ampulla, the dilation balloon was inflated within the metal
stent and this allowed the metal stent to be moved distally such
that the distal aspect of the stent was now visible outside the
ampulla. The dilation balloon was deflated and removed. Then,
the metal stent was grasped using rat tooth forceps and removed
from the mouth. The scope was reintroduced and selective bile
duct cannulation achieved again using balloon tipped catheter.
Multiple balloon sweeps performed using 8.5 and 11.5 mm balloons
with removal of small amount of stone debris. Occlusion
cholangiogram showed CBD measuring 7-8 mm without any evidence
of leak, stricture or filling defect. Contrast drained very
well. Multiple balloon sweeps performed to clear any residual
contrast. Excellent drainage of bile and contract at the end of
the case. Pancreatic duct intentionally not cannulated and
pancreatogram intentionally not performed. I personally
interpeted all fluoroscopic imaging of bile duct as described
above.
Endoscopic Diagnosis: 1) Proximally migrated fully covered
metal bile duct stent (seen on EUS). 2) ERCP with bile
duct/ampulla balloon dilation, stone debris removal, metal bile
duct stent removal. Cholangiogram shows no further bile duct
stricture, leak or bile duct stones.
what cpt code would I use for a core decompression of the knee
what cpt code would I use for a core decompression of the knee
Would like auditor’s opinion on EHR/claim disparities
I have a question I’d appreciate an auditor’s take on…
When we create claims through our EHR (eClinicalWorks), the claim is a "snapshot in time" … it pulls the coding from the chart and generates the claim. When there’s an issue and the coding needs to be changed, it’s easy enough to correct the claim and submit/resubmit. However this only corrects the claim — the "chart" still contains the original coding. Because of this, we go the extra step to correct the coding in the Progress Note as well. I’m told this is because of concerns that an auditor would see a discrepancy between the chart and the claim. My concern is that we may be doing extra work that’s not necessary.
Sometimes this happens prior to claims going out – it could be something simple like dx codes sequenced incorrectly. Or maybe a code was left off like 90460 for vaccine counseling. An extreme example might be that the provider used an established patient code and they are a new patient (or vice-versa).
Sometimes this occurs when a claim is denied. We have just one HMO that wants infant Well Visits to use codes Z00.110 and Z00.111 … all others want Z00.129 … so this gets missed on occasion. In this case, it’s been a week or more so the charts are locked. We can correct and resubmit the claim easily but we have to have the provider unlock the chart and change to the dx in the Progress Note. I hate bothering providers for this and I feel this is only an EHR quirk … if we had paper charts and a SuperBill you wouldn’t go back to the provider and say "I need to line out this code and draw a circle around this one" would you? The chart has a proper Well Visit dx … just not the one this carrier wants to see.
Of course this is an EHR so there are logs to provide an audit trail to show who changed what. Wouldn’t that be sufficient to explain any disparity?
My question is… Is this extra work necessary and/or prudent? Opinion please – prudence or paranoia?