Month: March 2019

Coding for Trauma Resuscitation
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Coding for Trauma Resuscitation

March 28, 2019 Question: How do we bill for a trauma resuscitation?  Are there codes for hanging fluids and packed cells? Can we use the CPR code 92950? Answer: There is no specific code for a trauma resuscitation or for administering fluids or blood products. The CPR code is specifically for providing cardiopulmonary resuscitation; chest...

Transforaminal Epidural Injection
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Transforaminal Epidural Injection

March 28, 2019 Question: If I perform a transforaminal epidural injection of L4-L5 on both sides can I report CPT 64483 twice?  Also, when I use fluoroscopic guidance can I report that separately? Answer: If you perform a bilateral transforaminal epidural injection (64483) you can report CPT 64483 with Modifier 50 (bilateral procedure).  Some payors...

Sentinel Node Identification
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Sentinel Node Identification

March 28, 2019 Question: We have a new plastic surgeon and he’s doing a procedure my other guys don’t perform.  The patient goes to radiology for injection of radioactive isotopes then to the operating room where my plastic surgeon excises the skin cancer and then injects blue dye and uses a gamma probe to identify...

Weekend Rounds (Part 2)
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Weekend Rounds (Part 2)

March 28, 2019 Question: Thanks for answering my question last time – I get it now that I would not charge for rounding on post-op patients of my call partners. What about non-surgical patients?  Occasionally we may have a patient hospitalized with a non-operative condition such as septic arthritis for IV antibiotics that require evaluation...

E-Consults?
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E-Consults?

March 28, 2019 Question: One of my colleagues told me that she was doing e-consults with other physicians for Medicare and getting paid.  Is this a billable service? Answer: Yes!  Medicare has added CPT codes 99446-99452 for interprofessional/ telephone/internet/electronic health record (EHR) consultations to the fee schedule, so they are now payable services.  These are...

Modifier 78 vs 59
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Modifier 78 vs 59

March 28, 2019 Question: What modifier do we use if a patient is returned to the OR the same day as the original surgery for post-op hemorrhage? Isn’t it 78 for this complication? Answer: Modifier 78 is a global period modifier and the global period begins on post-op day one. So it is not appropriate...

Skull Base Surgery
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Skull Base Surgery

March 28, 2019 Question: My neurosurgeon did a craniotomy with removal of a frontotemporal meningioma with stereotactic navigation and the microscope.  I coded as 61512, 61781, and 69990-59. However, my doctor disagrees and wants to code as 61583, 61512-51.  What do you think? Answer: First, 61583 – a skull base surgery approach code that requires...

Is Telehealth an Option for Surgeons?
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Is Telehealth an Option for Surgeons?

March 27, 2019 Telehealth is one of the fastest growing sectors in the healthcare field, according to the American Hospital Association. In 2013, 52% of hospitals utilized some form of telehealth/telemedicine. But in the last 2 years, we have seen a steep increase in utilization as the brick and mortar model of healthcare is being...

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Selling your practice? Clean up the coding first.

Selling your practice? Clean up the coding first. Physicians Practice Pearls – March 2019  by Karen Zupko As more and more practices are courted for acquisition, our firm is being engaged by both buyers and sellers to evaluate the accuracy of coding and documentation, and the efficiency of the revenue cycle. The results of these...

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