April 1, 2021 Question: One of our physician assistants’ saw one of our established Medicare in the emergency room for increasing pain in the area being treated by the physician. The physician assistant made no changes to the plan of care established by the physician. Our physician assistant submitted this as an incident to service...
April 1, 2021 Question: I use two ADMs on each breast during a tissue expander reconstruction. Can I bill +15777 x 4 units? Answer: No, you’ll use the code +15777 once for each breast Question: I’m confused on whether to bill +15777 twice (once on each side) or with modifier 50. Please advise. Answer: Good...
April 1, 2021 Question: Our vascular surgeon did a single intervention on a lesion that was at the juncture of the femoral/popliteal and tibial/peritoneal territories. Can we charge for two interventions? Answer: Lesions that extend across the margins of one vessel vascular territory into another, but can be treated with a single therapy are reported...
April 1, 2021 Question: A new patient presents with a CD of an MRI that was performed at an outside institution and was read by the radiologist. There was no report with the CD. If one of my physicians reads the MRI can we bill for the second reading? Answer: No, reading the MRI that...
April 1, 2021 Question: Would bilateral recurrent acute otitis media, on a patient that will need tympanostomy tubes, 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 (tympanostomy tubes). Therefore, it counts as 1 problem. *This response is based on...
April 1, 2021 Question: I excised an EIC lesion on the chest. I coded this as D48.5 but my coder says this is the wrong diagnosis code. What is the correct diagnosis code? Answer: ICD-10-CM code D48.5 (Neoplasm of uncertain behavior of skin) is incorrect as you have stated the patient has an EIC (epidermal...
April 1, 2021 Question: Our general surgeon performed a radical mastectomy and is now performing a port placement, at a separate session, for the patient. What modifier should we use on the port placement since both procedures are related to her diagnosis of breast cancer? Answer: Although the diagnosis for each procedure is breast cancer,...
April 1, 2021 Question: Under the new E/M coding revisions for office visits, should we document time AND medical decision making for every visit? Answer: According to advice from the AMA (3/24/21 webinar), you should only document one or the other to prevent potential audit confusion and risk. Document time if billing by time OR...
March 18, 2021 Question: My physicians have decided they would prefer to continue to use the E/M 1995/1997 guidelines for office visits instead of the new 2021 guidelines. Do we have a choice? Can we continue to use these guidelines? Answer: The new guidelines apply to office or other outpatient services 99202-99215 and are based...
March 18, 2021 Question: I just realized CPT 19366 was deleted in 2021. Now what code do I use for an oncoplastic reconstruction? Answer: You’re right – CPT 19366 (Breast reconstruction with other technique) was deleted this year. You will code for whatever procedure you end up doing such as an adjacent tissue transfer (e.g.,...
