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  1. Pam Warren

    Wiki Two surgeons performing a different surgery on one patient

    Yes, they are. This is different from co-surgery which is a single code where different aspects of that same surgery are performed by two surgeons. It's different also from surgical assists, where one provider is the attending and one is an assistant. Team surgery is a single code or group of...
  2. Pam Warren

    Question Do you try to correct codes that are wrong?

    There is a code for patients having both Type II and I.... (Type 1.5...look it up). I guess I am confused as to why if you are working as a coder you wouldn't be expected to code correctly. Is the provider giving you an ICD-10-CM code, or are you coding based on his note language? Either way...
  3. Pam Warren

    Wiki Bleph/ with Ptosis Repar

    My thoughts? Well, it's unfortunate for the patient to unbundle the charges. If the patient's insurance won't pay both, and the provider is credentialed with that payer, you cannot balance bill the patient. Changing the diagnosis to a cosmetic one just to get paid is hovering really close to...
  4. Pam Warren

    Wiki Billing G0463 together with 11042 during a wound clinic visit vs only billing 11042

    If this is provider-based billing for federal payers, you would report the procedure on both the 1500 and the UB. G0463 is the E&M equivalent on the facility side. If you did just the procedure on the professional side, you bill just the procedure on the facility side.
  5. Pam Warren

    Wiki Anticipatory Guidance, guidance

    Anticipatory guidance is going to be patient-specific. It refers to the patient/provider discussions related to any preventive or risk-reduction advice as relevant to the patient's current lifestyle. For example, I am a stained glass artist and my PCP recommends I be tested for serum lead...
  6. Pam Warren

    Wiki OCP Initiation Visit

    What procedure code are you billing? Some payers will not pay for routine/preventive care unless you also bill a routine CPT code (so not an E&M code). Some payers expect there to be a documented condition/complaint in order to pay for an E&M visit. Check payer policies, in this crazy...
  7. Pam Warren

    Wiki Is This Practicode Correct? OPD7245

    you don't need a -25 on the E&M with an EKG read, per the Social Security Act (and CCI edits, too). RVUs were adjusted to compensate for this. This is an ED visit. Check your E&M codes. You do want to submit the correct answers, but it's equally as helpful to learn and understand the...
  8. Pam Warren

    That LCD was retired in March of 2024. When's your date of service? A draft article is in...

    That LCD was retired in March of 2024. When's your date of service? A draft article is in process. DA59664.
  9. Pam Warren

    Wiki Home Care MSW

    Home health care is a payment model where all services are provided by the Home Health agency, and paid under a single consolidated payment that covers everything rendered to the patient. Generally, you cannot bill separately for services exclusively covered under the care plan and reimbursed...
  10. Pam Warren

    Wiki ATTN CPC-A

    My advice (as someone who has been in the field 30+ years and is a hiring manager) is that you should consider looking for other roles in the revenue cycle. It's very difficult to find a coding job without experience. Look at jobs in billing, medical records, front desk representative...
  11. Pam Warren

    Wiki Compliance Help

    reach out to Stephanie Thebarge on the NAB.
  12. Pam Warren

    Wiki Current vs Malignancy

    This is not an additional surgery for malignancy, since there is no current treatment, no prophylactic treatment, nor any indication of current cancer.
  13. Pam Warren

    Wiki Billing Question

    It depends. Does the procedure have any global days? Is the dizziness/anemia a result/complication of the procedure? Is your provider the attending for the admission? The initial hospital /discharge codes are in the E&M section of CPT.
  14. Pam Warren

    Wiki What coding certification would you recommend.

    Why is your manager threatening your job? Before you invest time/money in another certification, try to find out if this is the manager's (unfortunate) tactic, or if the manager is worried about your job performance. If it's the latter, you may want to focus on improving your coding skills in...
  15. Pam Warren

    Wiki HealthCon 2025

    AAPC has contracts with certain large hotel groups and has to schedule conferences within those venues. I do expect to see some variety in the future years, though. Additionally, with the National HealthCon, several things come into play.... a location that is able to accommodate at least...
  16. Pam Warren

    Wiki How does your practice bill new patient visits?

    Ah.....these patients figured out that physicals incur no deductible or co-insurance. It depends......why do these new patients want to see you? Do they simply need to establish care and have no problems that need to be addressed? If so, bring them in for a new patient physical. If problems...
  17. Pam Warren

    Wiki Pre-op Bariatric Psych evals

    Correct coding expects us to assign the procedure and diagnosis that most accurately represents why the patient was seen and for what reason. Tweaking the codes specifically for payment (and I get it.....you want to get paid) is not the way to do this compliantly. Get an ABN if you think you...
  18. Pam Warren

    Wiki Please help is my mental practice over charging me?

    The code that is most appropriate depends on whether your provider is an MD or APP, or a therapist. But maybe you should call and ask them to explain the charges, as it's impossible for any of us to comment without seeing documentation (and please don't share it). Also, check to see if the...
  19. Pam Warren

    Wiki Weird Vasectomy Question

    bill the first one with the -RT modifier with the date and POS for the office. When you go in to do the left side, bill -LT (different date and POS). If you're within the global days, use the -58 for a staged, related procedure and plan to send notes.
  20. Pam Warren

    Wiki HCPCS code for Thoracentecis Equipment?

    It is included in the procedure. https://www.cms.gov/medicare/medicare-fee-service-payment/physicianfeesched/pfs-federal-regulation-notices/cms-1784-f 32554 RUC Kit, Pack, Tray SA070 tray, thoracentesis tray 36.93 1 0 000 32554 RUC Kit, Pack, Tray SA113 Kit, thoracentesis kit 69.91 1 0...
  21. Pam Warren

    Wiki CIC or CCS

    I wouldn't say that one is better than another. CCS is a very challenging examination, and it covers more than just coding. But....it tends to be the certification preferred by hospital-based coding managers over CIC, because it covers a broader scope of HIM information. Overall, most coding...
  22. Pam Warren

    Wiki Adult Day Treatment (H2012)

    Updates to CPT are summarized in the 2025 CPT book. This is published by the AMA, and is copyrighted, so you'll need to purchase the book. The CPT Changes (also published by the AMA) has good explanations. Keep your eyes open for webinars sponsored either by AAPC or Local Chapters; sometimes...
  23. Pam Warren

    Wiki 2025 Telehealth

    Behavioral Health only. Everything else goes back to pre-pandemic status. The only way this would change is if Congress makes a change before they leave session before the holidays. The 2025 PFS final rule discusses this in detail.
  24. Pam Warren

    Wiki Interprofessional specialty codes, Billing sequence for 99204,99451 & 99446

    99452 is not for reviewing the feedback.....it's for the initial referral work. Do not bundle the E&M with the 99252 unless you don't include any of the referral work in the calculation of the E&M; you have to bill separately identifiable services in order to append the -25. If you're new at...
  25. Pam Warren

    Wiki Question regarding a Failed Bilaterial Thoracentesis

    Did they insert the needle into the right side and attempt the procedure? If so, bill it with the -RT-52 modifier for reduced service. If the decision was made to not evacuate the fluid based on the US, then you'd bill only the one side.
  26. Pam Warren

    Wiki DX N51

    N51 would not be appropriate to report scrotal pain. It can be used only if there's a primary diagnosis coded along with it. I ran this through my encoder and N50.82, which is the code for scrotal pain (without the associated primary condition) In looking at the book under Pain, Scrotum...
  27. Pam Warren

    Wiki TRT CODING AND BILLING

    Let's think this through, and maybe we need more information. What medication is being given? Check HCPCS to find out which J code to report. What's the dosage vs. the billable units? It can vary by manufacturer. How is it delivered? Injection (usually), pellet or other? is it a...
  28. Pam Warren

    Wiki Denial for inappropriately coded

    Are they denying based on the CPT code or the diagnosis code? You have submitted an initial hospital visit. Was this the initial visit? Are you the attending? If so, did you add the AI modifier? Was this a visit for a hospital round? (then code from 9923x) series. The diagnosis code D89.9...
  29. Pam Warren

    Wiki Interprofessional specialty codes, Billing sequence for 99204,99451 & 99446

    If your patient is new to the practice/provider, then you can bill the new patient E&M visit. 99451 is billable only by the consultant, not the referring provider. So the 14 day guidance won't apply to your providers, but neither do these interprofessional codes....as the PCP, these aren't...
  30. Pam Warren

    Wiki Possible Fraud

    As a new coder in a new position, please always assume positive intent before your throw around the 'f' word. Your job is to correctly code the services as they are documented. The provider is obligated to act according to the scope of their licensure and provide the most appropriate...
  31. Pam Warren

    Wiki Billing Physical/Occupational/Speech Therapies

    It depends on whether these services are charged in the rehab department and come through the CDM. Usually that's the case. These are services incident-to a physician and are not billed as professional charges. They are bundled into the DRG. Check with the rehab department before you code...
  32. Pam Warren

    Wiki Incident-To Billing - new symptom/condition ???

    "Incident-to" is a Medicare thing. Unless your commercial payers strictly follow CMS guidance, generally you bill under a supervising MD if the state Nurse Practice Act doesn't mandate midlevels being able to bill under their own names. As I think you're finding....commercial payers are many...
  33. Pam Warren

    Wiki Incident-To Billing - new symptom/condition ???

    If your provider does not have an NPI in order to bill Medicare, they should not be seeing patients until that credentialing is in place. Commercial payers will often allow midlevels that are unable to be credentialed to bill under a supervising provider, but that's different than the Medicare...
  34. Pam Warren

    Wiki Behavioral health billing and coding

    Check your state Medicaid's coverage requirements, and your state's board of medicine (scope of practice for midlevels and clinicians). Medicare, and your local MAC will have a large repository of requirements for behavioral health. As does the Code of Federal Regulations (necessary to know if...
  35. Pam Warren

    Wiki Interprofessional specialty codes, Billing sequence for 99204,99451 & 99446

    I think you should read the section in CPT regarding these codes. As the consultant, you cannot bill that interprofessional consultation when there's an E&M visit within the past 14 days or the next 14 days. I'm not sure how your outside specialty group plays into this scenario, and if they...
  36. Pam Warren

    Wiki Do American companies hire coders who live in Canada?

    It depends. Although many organizations will outsource their coding/billing to coders who work in other countries, many other US organizations will allow remote work only for those living in the United States. It has to do with the payroll tax burden with other countries--special forms...
  37. Pam Warren

    Wiki Coc job

    Look for a role as a pro-fee coder in a hospital system. Then you'll be available should a surgical coding position open up. The same concept would apply with your CIC..... you need to be in the right place at the right time, and this is where those kinds of jobs open up.
  38. Pam Warren

    Wiki Wokers Comp telehealth billing

    Neither. (and these codes will expire at the end of the year). 99441-99443.
  39. Pam Warren

    Wiki What specific terms need to be in operative note??

    Does your payer want LT and RT instead? It's a guessing game, honestly.......
  40. Pam Warren

    Wiki E&M on 1500 and UB04

    No, the facility "E&M" for a provider-based clinic is G0463.
  41. Pam Warren

    Wiki J0178 in Coder's specialty guide

    https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=53387 Here's the CMS coverage article.
  42. Pam Warren

    Wiki Lactation billing

    These codes are payer-specific so there's not much regulatory guidance surrounding their use. Some payers want one or the other, but what they are clear on is if there's no condition such as mastitis, use the Z39.1 as preventive care.
  43. Pam Warren

    Wiki Lactation billing

    Under the affordable care act, this is a preventive service, with no cost-share to mom. As such, (and according to payer guidance), the preventive counseling codes should be used, not E&M codes.
  44. Pam Warren

    Wiki coding from HPI

    yes. It is a common misconception that you cannot code from anywhere other than the assessment/plan. If the provider signs the note, and the information is supported, then you can code it.
  45. Pam Warren

    Wiki Help with code 36837

    It is impossible to tell without reviewing the documentation as to whether this is the correct code or not. If it is, then you cannot (and should never) try to report an alternative code simply to receive payment. That would be an example of a violation of the False Claims Act. Make sure...
  46. Pam Warren

    Wiki .5% Bupivacaine units

    .33 x 5= 1.65 mg is the dosage within a .33 ml injection. Round that up to 2 mg. because you can't report fractional units. If 1/2 a mg is the dosage, you would have four units of J0665. And if this is a single dose vial, you can report the wastage. 0.5 mg x 4 (units) is 2 mg. medication...
  47. Pam Warren

    Wiki F52.21 vs N52.9 - Help!

    The problem isn't that it's not allowable for the primary diagnosis....it's the fact that the insurance company doesn't pay for coverage for erectile dysfunction. If that's the diagnosis, that's what you need to use. You should not re-code for payment.
  48. Pam Warren

    Wiki .5% Bupivacaine units

    Unfortunately, you are not correct. And you're misunderstanding the bottle. "5 mg. = 1 ml" means that in each ml of fluid in the bottle there is 5 mg (weight) of bupivacaine. The ml (volume) of the solution injected is not what you code from. You code only the weight of the medication...
  49. Pam Warren

    Wiki Radiology Coding

    The codes are bundled per CCI and CPT. Only report 72083. Read the code description in CPT, which specifically states that 72083 includes the cervical spine. So unless the images were done at separate times, you can't bill both. No payer is going to pay both.
  50. Pam Warren

    Wiki Manometry probe insertion aborted - need advice

    I'm assuming you mean this is a facility charge to be billed on the UB and not a professional charge done at the facility. There's a difference. In the first example, if there's an order for the procedure to be done at the facility, and the procedure was attempted in the facility, use modifier...
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