Month: February 2021

Problems Addressed for New E/M Guidelines
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Problems Addressed for New E/M Guidelines

February 18, 2021 Question: Would bilateral large breasts, on a patient that we are recommending breast reduction, count as 2 problems in the new E/M guidelines for office visits? Answer: No because these two problems will have the same concurrent treatment (breast reduction). Therefore, it counts as 1 problem. *This response is based on the...

Nonselective or Selective
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Nonselective or Selective

February 18, 2021 Question: When does a nonselective catheterization become a selective catheterization? Answer: If the catheter (not just the wire) is manipulated into another vessel beyond the puncture site or beyond the aorta, then it is coded as a selective catheterization. *This response is based on the best information available as of 02/18/21.

Injection of Blood to a Tendon
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Injection of Blood to a Tendon

February 18, 2021 Question: Our orthopaedic sports medicine physician recently injected blood at a tendon insertion site for treatment of tendonitis. The staff drew the blood from the antecubital fossa and gave the syringe to the surgeon. The surgeon said it is not “PRP” as he did not centrifuge the blood and create a concentrate...

New 2021 E/M Coding Guidelines
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New 2021 E/M Coding Guidelines

February 18, 2021 Question: In the new guidelines, how does Time affect billing for a teaching physician’s E/M service when the resident spends a great deal of time with the patient? Answer: Good question!  Only the time of teaching physician would “count” in the scenario you describe.  The new guidelines say that the time of...

Use of Modifier 52
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Use of Modifier 52

February 18, 2021 Question: My surgeon was called into a laparoscopic operation that was already underway, to perform extensive lysis of adhesions. Does he need to use a modifier 52 because the patient was already “opened”, or can we just bill for 44180 Laparoscopic lysis of adhesions? Answer: You would bill for 44180 without a...

In-House MRI and “Counting” Data for New E/M Guidelines
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In-House MRI and “Counting” Data for New E/M Guidelines

February 18, 2021 Question: We have an MRI in house which has made me confused about how to count the data for the neurosurgeon’s E/M code.  Please help. Answer: Good question and let’s simplify things. The AMA specifically states there should be “no incentive”, related to E/M coding, to the physician for ordering tests. So...

Modifier 52 vs. 53
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Modifier 52 vs. 53

February 4, 2021 Question: We are confused about the difference between modifier 52 and 53. What is the difference? Answer: Modifier 52 Reduced Services is used when the procedure or surgery is partially reduced or eliminated by the physician. This is used when a procedure has an existing CPT code, but not all of the...

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