Search found 59 matches

by fjohnson
Tue Aug 21, 2018 10:33 am
Forum: Medical Auditing Forum
Topic: LCD Requirements - Facet Joint 64490 - 64495; 64633-64636
Replies: 1
Views: 663

LCD Requirements - Facet Joint 64490 - 64495; 64633-64636

Based on the Palmetto facet joint injections LCD L36471, when billing for radiofrequency neurotomy (RFA), if the 3 month history of pain is not documented for the previous two diagnostic medial branch blocks, is the RFA non billable (the two diagnositic MBBs were performed within the 3 month history...
by fjohnson
Mon Aug 20, 2018 2:14 pm
Forum: Medical Auditing Forum
Topic: Time Limitation for initial AWV (G0438)
Replies: 1
Views: 765

Time Limitation for initial AWV (G0438)

Does anyone know if there is a time limitation for the initial AWV (G0438) similar to the IPPE (G0402)? If so, could you send the applicable regulation?
by fjohnson
Mon Aug 20, 2018 1:32 pm
Forum: Medical Auditing Forum
Topic: IPPE/AWV Visits (CPT Codes: G0402, G0438, G0439)
Replies: 2
Views: 936

Re: IPPE/AWV Visits (CPT Codes: G0402, G0438, G0439)

Thank you for this response. I had not thought about the financial impact.
by fjohnson
Tue Aug 07, 2018 10:13 am
Forum: Medical Auditing Forum
Topic: Focused Neurological / Musculoskeletal Exam -Facet Joint Inj
Replies: 2
Views: 871

Focused Neurological / Musculoskeletal Exam -Facet Joint Inj

Has anyone found specific requirements of what a focused neurological or musculoskeletal exam to support this component of facet joint injections, CPT codes 64490 - 64495 & 64633 - 64636?
by fjohnson
Mon Aug 06, 2018 3:47 pm
Forum: Medical Auditing Forum
Topic: IPPE/AWV Visits (CPT Codes: G0402, G0438, G0439)
Replies: 2
Views: 936

IPPE/AWV Visits (CPT Codes: G0402, G0438, G0439)

If documentation does not support IPPE/AWV Visits, does anyone change code to the appropriate (meaning based on review of supporting documentation) E/M code?

Please send regulatory guidance to support this if applicable.
by fjohnson
Fri May 25, 2018 4:17 pm
Forum: Medical Auditing Forum
Topic: Coding/Billing Bone Marrow & Aspirations: 38220,38221,38222
Replies: 0
Views: 792

Coding/Billing Bone Marrow & Aspirations: 38220,38221,38222

In lieu of the new code, CPT 38222 , Diagnostic bone marrow, biopsy(ies) and aspiration(s), when would it be appropriate to bill 38220 (aspiration only) and 38221 (biopsy only) with a modifier 59? Based on CPT Assistant May 2018 page 3 the following is stated: Both codes 38220 and 38221 should not b...
by fjohnson
Tue May 22, 2018 4:34 pm
Forum: Medical Auditing Forum
Topic: DSM V & ICD10 Diagnosis
Replies: 1
Views: 623

DSM V & ICD10 Diagnosis

Has anyone seen an issue with DSM V codes being cross walked to ICD 10 diagnosis codes? Does CMS have any guidelines on DSM V codes cross walked to ICD 10 Diagnosis codes? Here is an example: The provider documents Opioid Use, Severe but the DSM V code cross walks to Opioid Dependence based on the S...
by fjohnson
Tue May 15, 2018 3:52 pm
Forum: Medical Auditing Forum
Topic: Coding Ultrasound services
Replies: 1
Views: 583

Coding Ultrasound services

What are the guidelines for coding an ultrasound when the order is for a limited ultrasound (76775) but the documentation supports a complete ultrasound (76775)? Please send a link to your reference.
by fjohnson
Fri May 11, 2018 5:28 pm
Forum: Medical Auditing Forum
Topic: Billing Laboratory test with Inconclusive/Invalid test resul
Replies: 2
Views: 994

Billing Laboratory test with Inconclusive/Invalid test resul

Good afternoon, Can someone provide regulatory guidance on how to bill laboratory test with a result of inconclusive or the instrument's result was "Invalid Test Result" or "Unable to calculate due to interfering substances." Essentially the laboratory test was performed but the results were invalid...