March 4, 2021 Question: We have a surgeon who performed an ORIF of an open tibia fracture and placed bone filler allograft in an area where the surgeon felt there was a small bone void. Is this work considered bundled or not? Neither the surgeon or I think it is billable but thought we should...
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...
February 4, 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...
January 21, 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...
December 17, 2020 Question: I’ve heard that all you need to document for family history is the word “none”, and that would count as documenting. Is this enough? Answer: No. Documenting “none” is saying that the patient does not have a family history, and this would not be accurate as we all have a family...
December 3, 2020 Question: Our surgeon performed a reconstruction of a patella dislocation and also did an arthrotomy of the knee with a lateral retinacular release. Our surgeon wants to report 27420 and 27425. When I look at the NCCI edits, I see there is an edit between the two codes. Am I allowed to...
November 12, 2020 Question: I heard that the E/M code guidelines are changing in 2021. Will this apply to all E/M codes? Answer: Good question. The 2021 changes will NOT apply to all E/M codes. The 2021 changes apply only to the new patient, 9920x, and established patient, 9921x, categories of codes. That means you...
October 29, 2020 Question: My physician performed an SI joint injection in the ASC under ultrasound guidance and wants to bill 27096 and 76942. Is this correct? The description of the codes say imaging is included. Answer: No, this is not correct; you are correct to catch the inclusion of the imaging statement. CPT code...
October 15, 2020 Question: Our surgeon frequently documents in the procedure title that an arthroscopic subacromial decompression was performed. We are billing 29826 and are receiving denials from one particular payor stating that the documentation does not support the service. I am looking at the operative notes associated with these denials and see that in...
October 1, 2020 Question: We have a patient who had knee surgery and required a return to the operating suite for treatment of a complication during the global period. We will bill the second surgery with a modifier 78. My supervisor is saying the aftercare needs to be extended another 90 days because the surgeon...
