Search found 12 matches

by Gibbons86
Tue Mar 08, 2022 9:00 am
Forum: Medical Compliance Forum
Topic: Assistant Surgeon Not Eligible Codes
Replies: 0
Views: 854

Assistant Surgeon Not Eligible Codes

We have a surgeon requesting we bill for his PA anytime she assists with surgery, including the non-eligible codes per CMS. Originally the request was for Work Comp payers, now they are wondering why we dont just bill everything out to all payers even though they may not get reimbursed and will cert...
by Gibbons86
Wed Jan 20, 2021 5:46 pm
Forum: 2021 E/M Changes Challenge Forum
Topic: Acute complicated or uncomplicated
Replies: 0
Views: 6887

Acute complicated or uncomplicated

Im looking for some help finding examples of orthopedic injuries and if they would be considered complicated or uncomplicated for the following problems addressed, especially when our providers are at the point of recommending Arthroscopic surgery after conservative treatment is not helping. Example...
by Gibbons86
Thu Dec 17, 2020 9:03 am
Forum: Medical Auditing Forum
Topic: Repeat test on separate DOS
Replies: 1
Views: 8785

Repeat test on separate DOS

I am trying to find guidelines regarding billing for repeat testing on separate dates of service. A provider performed a Covid Lab test 87426 prior to elective major surgery, but the surgery was rescheduled after the test was performed so the patient had to be re-tested for the same Covid lab test 8...
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: 4323

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: 7025

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: 15060

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: 14687

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: 20121

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: 9575

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: 23592

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...