Search found 9 matches

by Gibbons86
Tue May 12, 2020 11:55 am
Forum: Medical Auditing Forum
Topic: Shoulder arthroscopic debridement 29822/29823 and subacromial decompression 29826
Replies: 0
Views: 162

Shoulder arthroscopic debridement 29822/29823 and subacromial decompression 29826

Please clarify the NCCI Manual chapter 4 arthroscopic section in regards to 29822 and 29823 and how/if they can billed with 29826. The NCCI manual states the debridement code 29822 is included in all other arthroscopic procedures and 29823 is included unless its billed with 3 specific codes under th...
by Gibbons86
Wed Mar 25, 2020 8:15 am
Forum: Medical Auditing Forum
Topic: Telehealth during COVID19 Emergency
Replies: 0
Views: 2888

Telehealth during COVID19 Emergency

During the emergency waiver for relaxed telehealth guidelines, if a virtual check-in G2012 or telephone EM 99441-99443 (depending on payer) results in an office visit - does the information garnered during that call get combined with the in-office EM toward the overall EM Level 99201-99215? Thank you!
by Gibbons86
Fri Jan 31, 2020 10:16 am
Forum: Medical Auditing Forum
Topic: Modifier 50 and Add-On Codes
Replies: 0
Views: 11882

Modifier 50 and Add-On Codes

CPT updated Modifier 50 guidelines this year for Add-on codes - stating that any Add-on Procedure code performed bilaterally should not be coded with Modifier 50 and instead coded with 2 units. However, some of these Add-on Codes have MUE of 1, so this creates an issue with payment. I have not been ...
by Gibbons86
Wed Jan 29, 2020 10:06 am
Forum: Medical Auditing Forum
Topic: MDM for Single vs Multiple Healing Fractures
Replies: 0
Views: 11763

MDM for Single vs Multiple Healing Fractures

Hello - I would like some additional guidance on the MDM table for situations where a patient is out of the global period for fracture care and is following up in office for their healing fracture. There has been a recent debate as to what constitutes as single vs multiple minor problems and how we ...
by Gibbons86
Wed Oct 16, 2019 1:18 pm
Forum: Medical Auditing Forum
Topic: Laminoplasty and Laminectomy Surgical Auditing/Coding
Replies: 0
Views: 17294

Laminoplasty and Laminectomy Surgical Auditing/Coding

Provider billing 63051 Cervical Laminoplasty with reconstruction using plates and screws from C4-C6. He also used modifier 59 for separately billing 63045 and 63048 for partial Laminectomy at C3 and C7. Please assist me in finding if this documentation supports both codes separately with modifier. T...
by Gibbons86
Mon Sep 16, 2019 8:36 am
Forum: Medical Auditing Forum
Topic: Modifier 58 or 79
Replies: 1
Views: 6500

Modifier 58 or 79

Patient is scheduled for a bilateral Lumbar RFA 64635. However, the right and left facets will be performed on separate DOS. 64635-RT is billed for first procedure on right side. Which modifier would be more appropriate for the Left side RFA performed during the 10-day global period from the right? ...
by Gibbons86
Wed Oct 24, 2018 1:11 pm
Forum: Medical Compliance Forum
Topic: Xray Orders and Coding Compliance
Replies: 1
Views: 14101

Xray Orders and Coding Compliance

Does the Xray Order have to match the Interpretation/Read and essentially what was billed for Clinic Xrays performed by ordering physician? Example) Provider in clinic orders xrays and reads them same day. He selected Xray Bilateral Standing AP Knees (73565) but in his interpretation he clearly indi...
by Gibbons86
Tue Oct 23, 2018 1:41 pm
Forum: Medical Auditing Forum
Topic: Initial Observation less than Detailed History
Replies: 2
Views: 2012

Initial Observation less than Detailed History

The Physician ordered the patient to be in Observation status and the stay was longer than 24 hours in Observation, meeting 99218-99220. However the initial visits History is only Expanded due to missing PFSH and HPI components. Since we do not meet all 3 components for the lowest code 99218, do we ...
by Gibbons86
Thu Mar 29, 2018 9:11 am
Forum: Medical Auditing Forum
Topic: PA performing Injection within multi-specialty group
Replies: 1
Views: 1513

PA performing Injection within multi-specialty group

We have a PA whose supervising physician is a PM&R Specialty. The PA sees an established patient for 2 injections, one being a planned trigger point performed previously last year by another PM&R Physician in the same practice, and then added on a knee injection per the patients additional complaint...