Postpartum only 59430

I have a family practice physician in a hospital owned clinic who does ob/gyn care. He saw a patient 4 weeks after her c-section, and wants to code 59430 in addition to 99213. He did not perform the delivery. Is that allowed ever? If so, please help me find a link to the information stating that so that I can justify coding it that way.
Thanks in advance for your help.

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Diabetes and Pressure Ulcer Guidance

I am very confused with this guidance from the Coding Clinic, Third Quarter 2018: "If a patient is diagnosed with a pressure ulcer associated with diabetic neuropathy and diabetic peripheral vascular disease, it is reportable as code I96, Gangrene not elsewhere classified, and code from L89, Pressure ulcer, rather than as a diabetic skin ulcer. Report additional codes to capture the peripheral angiopathy and neurological complications of diabetes. In this instance, do not associate the...

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Flu shots

I am having Humana Medicare and Wellcare Medicare denying flu shots based on lcd/ncd. I am using 99213 -25 with appropriate dx code 90682 and G0008 with z23 as dx code. Humana denial reason 04@/96, I have called and called and all they say is denying for lcd/ncd. I can not figure this out. Any experience with this anyone?

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Gain Practicode experience to get a medical coding/billing job or just move on?

I have earned my CPC-A this past Sept. and have applied to various medical coding and billing positions. It doesn't surprise me that
no one wants to give me a chance, as I'm aware that it is a difficult field to get into with no experience. I was told by a veteran medical
coder to not let the 'experience preferred' get to me and to apply anyway. So, I was thinking maybe I should gain the one year experience by
purchasing Practicode and possibly I may have a better chance...? Should I start...

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2021 Guidelines--Psychometric data

Hi all! It is stated that reviewing psychometric data counts in the data section. Does anyone have examples?

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CPC-A looking for any entry-level coding position. Resume attached.

I live in Hartford, CT. I am seeking an entry-level coding position for anyone who is willing to give me a chance to show that I am a dependable, hard worker.

Saraswathy Sankar
4 Drummond Dr, Rocky Hill, CT 06067
(732) 589-6380, sankarsaraswathy67@gmail.com

Professional Summary:​

Seeking a position where I can utilize my coding skills, experience with patient records, and background in medical terminology to accurately abstract and...

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Postop Diagnosis code?

Hello!
The patient came in for a hysterectomy. The operative report list the diagnosis as:

Preoperative Diagnosis: Carcinoma In-Situ of Exocervix - D06.1
Postoperative Diagnosis: Same

I remember from my education that we should not code the Procedure until the Pathology Report was available. When it was, it listed the diagnosis as: "Invasive Squamous Cell Carcinoma of Ectocervix."
I queried the provider to clarify my choice of Diagnosis was correct, C53.1 (Malignant...

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Billing questions

How do you fight to get paid on a claim if the insurance company's explanation for denial is: Duplicate claim service?

Also, is referral from a PCP the same as pre-authorization?

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HO modifier Behavioral Health

I am billing a therapy service to Medicare Plus Blues of Michigan. The provider has a Master’s degree. I am using modifier HO and it is being denied. It is telehealth services and I’m using the Psychiatrist as the supervising doctor. Can anyone help?

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CCS VS CIC

Hello, I am just starting my CIC course through the AAPC. When I'm looking on Indeed I have notice there are not a lot of certifications for CIC, but there is a lot for the CCS. Are the CIC and CCS comparable but just done through different companies? Im wondering if a job posting which requires a CCS would accept a CIC certifications. Please advise.

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Fowler Tenotomy w/ Release of Retinacular Ligaments?

Hello Everyone,

One of our doctors performed a central slip repair (26426) with release of retinacular ligaments and a Fowler Tenotomy. I know how to code the main procedure, but I'm not sure of how to code the minor procedures involved. I was thinking possibly 26460 for the tenotomy? Let me know what you think! Thank you in advance!

Here is the report:

OPERATIONS PERFORMED:
1. Repair of left long finger central slip.
2. Release of long finger transverse retinacular ligament.
3...

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Inpatient telehealth f/u consultation for Medicare PT

Our pain management doctor did a telehealth consultation with an inpatient patient. I have to check with him if he used both audio and video, or just a telephone call.

1) If he used both audio & video, do I bill G0406-G0408 with POS 2, or 99231-99233 with POS 21, MOD 95?

2) If he only had a phone call to the patient, can I bill 99231-99233 with POS 21, MOD 95? Or bill 99441 - 99443?

Thank you.

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NP billing same day as MD

Request insights... an Orthopedic group is wanting to set up PreOp clinic serviced by PA or NP to provide EKGs, Labs etc then have patient to go MD/Surgeon for consult and scheduling. Can both E/Ms be billed same day? if so, restrictions?

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CPC EXAM

I'm up in 3 weeks for the CPC exam. Anyone have pointers on how to pass?

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Eye codes/EM Codes

I understand that eye codes are used and sometimes identified by some payors as a yearly routine code, but if a patient comes in for yearly CE with concerns of dry eye, the doc uses an eye code. is it wrong to use an eye code if the pt diagnosis turns to dry eye or an additional medical dx that patient warranted at tos during the exam that was scheduled as a yearly complete eye exam? im a little confused.

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Tympanoplasty ossicular chain reconstruction with stapedectomy

Post op dx: left conductive hearing loss with otosclerosis

Procedure performed:
1. Left tympanoplasty
2. Ossicular chain reconstruction
3. Stapedectomy

A posterior tympanomeatal incision was made using the angled Beaver blade, and then the flap was elevated with a round canal knife and middle ear cavity was entered. The middle ear is clear and the chorda tympani nerve was identified. Following that, the ossicular chain was tested using curved Rosen needle. The patient has completely solid...

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L dx codes

Has anyone else had a problems with claims coming back for dx code in the "L"? I work in dermatology and have had several claims coming back with notes that the dx code isn't effective for this DOS.

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Attention Auditors

I am looking for two experienced auditors for a telemedicine company in Dallas, TX working from home. please message me if interested. Thank you!

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changes for 2121

1. Any specifically identifiable procedure or service (ie, identified with a specific CPT code) performed on the date of E/M services may be reported separately.
   The actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the levels of E/M services when reported separately. Physician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the...

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Coding Overseas

Does anyone know of any companies who hire coders residing outside of the USA? I may be moving to Central America and hope to be able to continue working as an HCC Auditor. Any ideas or suggestions are appreciated.

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BCBS CO spine denials/ requesting I use a different code

I'm looking for opinions on whether my argument is correct and if anyone has seen this as well. No other BCBS in any of my other states have this edit and I am unable to find the policy.

Denial- X-ray of cervical, thoracic, and lumbar are denied as not paid separately. None of the codes are paid. We are being asked to use the entire spine x-rays.

Codes: 72040 for cervical, 72070 for thoracic, 72100 for lumbar. Requesting I use 72081-72084.

My argument- No cci edits and...

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29870 with an open code?

I have an issue that is being debated in our clinic, and am curious what other coders have to say about this.
we have a case where a provider did a diagnostic scope first and then did a lateral release. we ran the NCCI edits and they are not coming up as bundled, but there is that parenthetical with 29870 that says separate procedure. My impression of this parenthetical is that if this is done on the same anatomical area they cannot be billed separately. BUT there is something that I found...

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Cardiovascular Billing for Spinal Fusion

We are having an internal debate on what the appropriate codes would be for a cardiovascular surgeon assisting with a spinal fusion. Would the correct code for the procedure below be 37617? The other provider completed the actual instrumentation.

PREOPERATIVE DIAGNOSIS:
Lumbosacral disk disease.

POSTOPERATIVE DIAGNOSIS:
Lumbosacral disk disease.

OPERATIVE PROCEDURE:
Anterior exposure for L4-L5 anterior lumbar interbody fusion with placement of cage and screws .

INDICATION:
This is a...

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Medicaid denial question

Any advice would be appreciated.
I have an example of a patient that has Humana Medicare Replacement as primary and Medicaid as secondary. Billed amount $2,150. Humana allowed $763.96 and paid $611.17. The coinsurance is $152.79.
Medicaid was billed for the $152.79, but denied. The Medicaid rep. states Medicaid does not pay unless the primary pays 80%. The Medicaid eob says patient responsibility is $0.
Is it correct for Medicaid to deny since Humana didn't pay 80%?
Can the patient be...

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Are there employers in the coding industry who value accuracy more than productivity?

I recently lost my job as a medical coder because I was unable to meet my employer's productivity standards. I know many of my coworkers were struggling with this as well. I've been coding since 2009. My first job was on-site for a privately-owned clinic and my second job was remote for a large healthcare system. I have two certifications - CPC and CEMC. My strength is accuracy but that affects my productivity. I'm very discouraged and starting to wonder if I'm in the wrong industry. I would...

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Experience when apply for job

In October I passed my CPC certification exam...When applying for billing/coding positions, does the billing/coding courses I took count as experience?

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In office Covid testing

We are going to start Covid testing in our office with nasal probe and rapid system for screening our pt's for prior to their surgery in our office. We were informed by McKesson to use CPT code 87426 along with low level office visit and my provider also wants to use U0003 also since we are collecting and doing reading. Which I though U0003 was for Laboratory billing and not sure if this needs to be billed to Medicare instead of 87426? I have looked at a lot of CMS articles and can't find a...

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Locums Tenens

Good Afternoon

I am needing so help with Locums Tenens, we have physicians that wanting to hire a locum tenens physicians to perform Vascular office-based procedures for our dialysis patient. The physician will be out of the office for a few days but once he returns he is wanting the locum physician to continue to perform the procedures and he will be seeing patients in the office and in the hospital. Are we able to bill for the procedures with a Q6 modifier and bill the physician's office...

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CPT codes 99408 & 96127

I am getting denial after denial for CPT codes 99408 & 96127. It doesn't matter if it's billed with a wellness code or an E/M code. I have denials from just about all insurances stating "bundled" Does anyone know of a way to get these codes paid? My provider swears that they should be able to be reimbursed separately.

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DRG list by Specialist

Can anybody knows where can I access a DRG list for hospitals but by Specialist. Thanks for any help!!

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Allograft Templating cpt related to foot

Hello, Can someone assist me in what code to use for the Allograft templating for the attached surgery. Provider has given me 20932 which is not correct. Wondering if unlisted code 27899 is appropriate?

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