September 5, 2019 Question: I’ve been dictating CPT and ICD-10-CM codes in my procedure note so that my coder knows what to bill. Recently, we had an insurance company call us out because the codes we billed were not the same as the codes in the procedure note. Now I am not sure what to...
August 22, 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...
August 8, 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...
July 25, 2019 Question: How is angioplasty of a previously place carotid stent billed? Answer: For a patient treated with angioplasty for with occlusion in a previously placed carotid stent, report code 37246, Transluminal balloon angioplasty, (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit) open or percutaneous, including all imaging...
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...
June 20, 2019 Question: What is TCAR and how is it coded? Answer: TCAR stands for Transcarotid Artery Revascularization. It is essentially an open carotid stent procedure. A small incision is made just above the collar bone to expose the common carotid artery. A sheath is placed directly into the carotid artery and connected to...
June 6, 2019 Question: I’ve been dictating CPT codes in the operative note so that my coder knows what to bill. Recently, we had an insurance company call us out because the codes we billed were not the same as the codes in the operative note. Now I am not sure what to do. What...
May 23, 2019 Question: The surgeon accidentally nicked a vessel not involved in the bypass being performed, can he bill for repair of vessel since he had to repair it? Answer: Iatrogenic, intraoperative complications that are repaired at the same operative session are not separately reported. Since the vessel laceration was an iatrogenic injury, inadvertently...
May 9, 2019 Question: The vascular surgeon is called to the OR to repair a blood vessel that was inadvertently lacerated during a colectomy. I she a co-surgeon? Answer: No. The vascular surgeon will report her work with a repair vessel code (35221 if repaired directly). The other surgeon will report the work that he/she...
April 11, 2019 E-Consults? 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...
