Category: Coding Coach

Shunt Revision
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Shunt Revision

November 14, 2019 Question: I had to replace the ventricular catheter and the valve on a patient with a VP shunt.  What code should I use? Answer: Actually you get two codes!  CPT 62225 is used for the ventricular catheter replacement and 62230 for the valve replacement.  Both codes are appropriate in this scenario. *This...

Binocular Microscopy
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Binocular Microscopy

November 14, 2019 Question: I oftentimes bill and E/M code with modifier 25 for an office visit and 92504-50 (1 unit) for the binocular microscopy to Medicare.  I get denied on 92504-50 but I am paid on 99212. The denial code is “CO-4 The procedure code is inconsistent with the modifier used or a required...

Modifiers for Free Flap Breast Reconstruction
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Modifiers for Free Flap Breast Reconstruction

November 14, 2019 Question: Do the free flap breast reconstruction codes, 19364 and S2068, allow billing for surgeon, co-surgeon and assistant? Answer: CPT 19364 does allow payment for the surgeon, co-surgeon (modifier 62) and assistant surgeon (modifier 80, 82 and AS). However, many payors do not recognize modifiers 62, 80, 82 and/or AS on S2068....

Definition of Simple versus Complicated
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Definition of Simple versus Complicated

November 14, 2019 Question: What is the definition of simple vs complicated for the I&D codes 10060 versus 10061? Answer: While CPT doesn’t define the difference between “simple” and “complicated”, it is the accepted practice that a simple I&D 10060 is just that. An incision (not just a puncture) is performed, and the abscess is...

SI Joint Injection
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SI Joint Injection

November 14, 2019 Question: My MD performed an SI joint injection with ultrasound guidance in the office. What is the appropriate coding for this procedure? I have seen information regarding not using 27096 (SI joint injection) and using 20552 (trigger point injections) with 76942 (ultrasound guidance) instead. Which is correct? Answer: If using ultrasound instead...

Is a 99214 supported?
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Is a 99214 supported?

November 14, 2019 Question: We have patients who return to the clinic for results of MRI or other diagnostic tests.  The physician performs a repeat exam, reviews the images, and makes a decision for surgery.  We always code these as level four established visits because of the decision for surgery. Our question is, if the...

Coding Right and Left Carotid Stents at Different Operative Sessions
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Coding Right and Left Carotid Stents at Different Operative Sessions

November 14, 2019 Question: The physician staged a patient’s bilateral carotid stent with embolic protection procedures.  The right carotid stent was done first and then the 6 weeks later the left side was done.  What is the correct modifier on the second carotid stent? Answer: The second carotid stent, although staged clinically, is an unrelated...

Use of a Scribe
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Use of a Scribe

November 14, 2019 Question: We are hiring a scribe for the doctor because it will help improve his documentation.  Is there anything we need to know about how to document this? Answer: Yes, absolutely. This situation should be clearly delineated so a third party reviewer can identify the provider who performed the service, and the...

New Patient, or Not?
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New Patient, or Not?

October 31, 2019 Question: If I see a new patient in consultation for a suspicious skin lesion and release them to their primary care provider and they come back to see my partner for eczema one year later on their own, can she report the encounter as a new patient visit?   We are the same...

How do you define “No Qualified Resident Available”?
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How do you define “No Qualified Resident Available”?

October 31, 2019 Question: Our physicians utilize residents during surgery but we have a discrepancy in what is considered a “Qualified Resident”. Some physicians consider a resident qualified to assist day 1 of their residency rotation, while others consider only 4th and 5th year residents as qualified to assist. Can you guide us to documentation...

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Coding Coaches