July 23, 2020 Question: I work with a sports surgeon and we see just a few Medicare patients. The surgeon believes the revised 2021 E/M guidelines will not impact our office practice because of our low Medicare volume. Is this correct? Answer: This is not correct, but it is a common misconception. The revised documentation...
July 9, 2020 Question: I’m a pediatric orthopedic surgeon. Some of my team are reporting the NPWT codes 97605 and 97606 when applying wound vacs after closing at the completion of their surgical cases. As a result, I am told by my coders that NCCI Standards of Medical Practice edits are being generated. The NCCI guidelines define the...
June 25, 2020 Question: I am a pediatric orthopaedic surgeon and many of my patients are too young to give a history. My coders have never given me medical decision making (MDM) credit because they say it is part of dealing with children. Is there anything in the 2021 CPT guidelines for outpatient E/M services...
May 28, 2020 Question: What is the correct code to report for the insertion and subsequent lengthening of the VEPTR device? Answer: VEPTR is the abbreviation for Vertical Expandable Prosthetic Titanium Rib Currently there are no codes for this procedure, where the device is typically attached to the ribs, spine or pelvis. Report an unlisted...
May 14, 2020 Question: Since we have to bring the patients back in for COVID testing and H&P for Joint Commission, can we bill for this visit even though it’s another pre-op visit? Answer: Yes, since the patient was rescheduled due to the pandemic and needs to be seen for a COVID swab prior to surgery,...
April 30, 2020 Question: Our physician conducted a face-to-face telemedicine encounter with an established patient this week. The physician evaluated the patient who had fallen two days prior to the encounter and reviewed online X-Rays from the Urgent Care. His diagnosis was non-displaced right clavicle fracture; he agreed with the treatment plan initiated in the...
April 16, 2020 Question: Can we bill telehealth visits by time alone? Answer: For Medicare claims, telehealth visits can now be billed according to medical decision-making (MDM) or time, so yes, as long as the code indicates it can be a time-based service in the CPT (e.g. 99201-99215). For all other payors, you will need to check...
April 2, 2020 Question: I am a PT with an NPI. Since I can bill under my name which codes do I use for Online Digital Visits? Answer: Physical therapists should use the e-visit codes (98970-98972 or for Medicare use G2061-G2063). Although PTs do have an NPI, they do no bill E/M visits so (99421-99423)...
March 19, 2020 Question: I am looking forward to attending a 2020 KZA National Coding Course. I had schedule conflicts in 2019, but have been told these courses are a “must” for orthopaedic surgeons. There was a patient with a hand fracture that was treated at a different hospital by another surgeon outside of my...
March 5, 2020 Question: Can I bill for a medial meniscus repair and a lateral meniscus meniscectomy done on the same knee? I see CMS has an NCCI edit between the two codes, 29881 and 29882. Answer: Yes, you may report both codes and append modifier 59 to indicate the procedures were performed on different...
