July 11, 2019 Question: Our physicians have instructed us to bill under a physician’s NPI number for all Advanced Practitioners (PA’s and NPs) for all patients for Medicare as we follow incident-to billing. We have been submitting claims for all new and established patient visits regardless of whether there is a physician in the office. ...
July 11, 2019 Question: Can we perform Mohs surgery without a pathology report? Answer: If you review CMS and other payor policies they all require a recent pathology report usually no more than 3 months old confirming the malignancy prior to performing Mohs surgery. *This response is based on the best information available as of...
July 11, 2019 Question: If our docs perform two adjacent tissue transfers on two separate lesions in the same anatomic group by CPT standards, do we add the ATTs together and report one code like with the repair codes? Answer: No, if two lesions from the same anatomic group are removed and both require separate...
July 11, 2019 Question: When are diagnostic angiograms and an intervention (angioplasty, stent, etc) both billable? Answer: Diagnostic angiograms are separately billable during an intervention if no adequate, prior adequate angiogram exists. Code diagnostic angiograms only if: no previous angiogram is available, the prior angiogram is not adequate to diagnose the disease, or the patient’s...
July 11, 2019 Question: My surgeon was called to the OR by an OB-GYN who accidentally lacerated the bowel during an open gynecological procedure. She repaired the bowel with sutures. Should the diagnosis code be the same diagnosis as the reason for the primary surgery? Answer: No. The diagnosis code for your surgeon would be...
July 11, 2019 Question: I heard you speak at the recent AANS coding course – you were awesome and the course was fantastic…everyone should go. The surgeon I work with has a question regarding billing. Some of the hospitals in the area have a Nurse Practitioner or Physician Assistant on staff that see Neurosurgery consults...
July 11, 2019 Question: What’s the best way to do the diagnosis coding for postop visits? I mean, does it really matter since we aren’t billing for a visit? Answer: The ICD-10-CM guidelines for postop/aftercare include the following: If the original diagnosis is trauma (eg, using an S diagnosis code) or a code that requires...
July 11, 2019 Question: What CPT codes do I use for comparison when the surgeon performs a superior capsular reconstruction? I know I have to use an unlisted code. Answer: Great job in knowing that this procedure is reported with an unlisted code. The AAOS recommends comparing this procedure to CPT codes 29827 and 29806. ...
June 20, 2019 Question: My surgeon was called to the OR by an OB-GYN who accidently lacerated the the small bowel during an open gynecological procedure. She repaired the small bowel with sutures. How is this billed, is my surgeon a co or assistant surgeon? Answer: Neither. Repairing the bowel is not inherent to a...
June 20, 2019 Question: I perform an arthroscopic repair of the supraspinatus and subscapularis tendons through separate incisions/portals. May I report CPT code 29827 twice? Answer: CPT code 29827, arthroscopic rotator cuff repair is reported one time regardless of whether one or all four tendons are repaired. Consider adding modifier 22 for the additional complexity...
