Search found 26 matches

by pedscoder
Wed Apr 10, 2019 10:44 am
Forum: Medical Auditing Forum
Topic: Observation ordered by resident
Replies: 0
Views: 1996

Observation ordered by resident

Hello,

Can the attending physician bill observation CPT codes if the observation order is not co-signed by the attending? In other words, the resident placed the observation order without co-signature.

Thank you!
by pedscoder
Tue Feb 05, 2019 2:00 pm
Forum: Medical Auditing Forum
Topic: Physician who uses "examination unchanged since last visit"?
Replies: 1
Views: 894

Re: Physician who uses "examination unchanged since last visit"?

We have the exact same problem at our organization. We do not count this as an exam, as there is no proof in what the physician evaluated on that day. The only portion of the E&M that Medicare says is 'allowed' to be reviewed from previous notes is PFSH, as long as there is a notation regarding the ...
by pedscoder
Tue Feb 05, 2019 12:13 pm
Forum: Medical Auditing Forum
Topic: Reporting 95951 when performed for 48 hours
Replies: 1
Views: 567

Reporting 95951 when performed for 48 hours

Hello, Medicare MUE for 95951 is 1 unit per day. Knowing this, how would you report a 48-hour continuous EEG, 95951, that begins 2/1 and ends 2/2? According to Medicare, the physician reports his service (95951-26) on the day he completes his interpretation. If the physician completes his 48-hour in...
by pedscoder
Fri Sep 14, 2018 9:49 am
Forum: Medical Auditing Forum
Topic: Co-surgeon 2 specialty requirement
Replies: 1
Views: 963

Co-surgeon 2 specialty requirement

Hi, Is it only Medicare that requires the 2-specialty requirement for billing co surgeries? "Co-surgery refers to a single surgical procedure which requires the skill of two surgeons, each in a different specialty, performing parts of the same procedure simultaneously." The modifier definition itsel...
by pedscoder
Thu Feb 22, 2018 3:23 pm
Forum: Medical Auditing Forum
Topic: Coding Clinic: surveillance colonoscopies condradicts itself
Replies: 2
Views: 1685

Re: Coding Clinic: surveillance colonoscopies condradicts it

Thank you! Your response is very helpful.
by pedscoder
Tue Feb 20, 2018 12:26 pm
Forum: Medical Auditing Forum
Topic: Examination "No acute distress"
Replies: 2
Views: 1157

Re: Examination "No acute distress"

We count "alert & oriented x3" as psychiatric (which is in your exam example), since "orientation to time, place, person" is part of the psychiatric exam on the 1997 guidelines.
by pedscoder
Mon Feb 19, 2018 12:24 pm
Forum: Medical Auditing Forum
Topic: Coding Clinic: surveillance colonoscopies condradicts itself
Replies: 2
Views: 1685

Coding Clinic: surveillance colonoscopies condradicts itself

Hi, Coding Clinic posted 2 updates in March 2017 regarding colonoscopies. The titles of each article are, "Follow-up colonoscopy after excision of polyp" & "Surveillance colonoscopy". Both scenarios appear the same to me (return for surveillance colonoscopy after polypectomy), however, they have dif...
by pedscoder
Tue Jan 02, 2018 2:48 pm
Forum: Medical Auditing Forum
Topic: Coding from pathology report
Replies: 2
Views: 1436

Re: Coding from pathology report

Hi- The CMS question specifically states, "how should the Hospital Outpatient Coder code this?" I am trying to find a definitive answer for Pro-fee coders. If a surgeon removes a breast mass and his pre/post op diagnosis states "breast mass", but the pathologist documents "fibroadenoma", can the pro...
by pedscoder
Mon Aug 21, 2017 6:09 pm
Forum: Medical Auditing Forum
Topic: Certified Surgical Technicians and billing
Replies: 0
Views: 1108

Certified Surgical Technicians and billing

Hi,

Can Certified Surgical Techs (CST) who have their own NPI bill as assistant surgeons with modifier AS?

Thank you!
by pedscoder
Mon Aug 21, 2017 5:59 pm
Forum: Medical Auditing Forum
Topic: Can assistant surgeons bill UNLISTED procedure codes?
Replies: 1
Views: 951

Can assistant surgeons bill UNLISTED procedure codes?

Hi!

Can assistant surgeons bill unlisted codes? Per CMS physician fee schedule, unlisted procedural CPT codes don't 'allow' modifier As/80/82. Wondering if there is a loophole or way to appropriately get insurance to pay.

Thank you!