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Author Archives: cpccertification-studyguide

Modifier q6

This is my first time using a locum, she is filling in for my audiologist. I am using modifier Q6 attached to CPT 92557 & CPT 92567 and I am getting denial from Medicare reason code 4 – The procedure code is inconsistent with the modifier used or required modifier is missing. Do I need a second modifier? I can not find any current info on the Medicare website & what I do find is not clear. Any help would be greatly appreciated!

Medical Billing and Coding Forum – Modifiers

Confusion with employer verbage

I am currently employed as an LPN with 30 yrs of Office Nurse experience , as well in that time for 10 yrs Nurse Manager and 2 yrs Office Manager I changed positions when the group I worked with dissolved. For the last 2 1/2 yrs working as an office Nurse in that time I was fortunate enough to take an on line class and very recently obtained my CPC-A
My question is that the clinic I work with now recognizes only Level I or Level II coder I honestly don’t understand how to respond to their query as to my status I have explained that I have several yrs of ICD-9 coding experience as well as the certificate for completion from Bryant and Stratton for ICD-10,CPT and HCPSII in addition to the CPC-A recently obtained.
I’m certain this is a pay issue and have asked administration what qualifications are required for either the Level I or II position and am still waiting for a response I understand they have never hired a CPC or CPC-A, I’m just not sure how best to respond to their question regarding the Level I vs II status,I have googled with little help
Any direction here would be appreciated
Thank you Cheri

Medical Billing and Coding Forum – Employment General Discussion

coding for pre-op

Good Morning, My internal med Doc does pre-op exams for the patient’s specialist. Am I able to code "pre-op" exam for two visits, the first visit would be the initial request by specialist and reviewing chart with decision based on what is in the chart. The second visit may be needed as a followup because our Doc had to send the patient out for further testing: labs, echo, xray…and then come back for that second visit to review and then make the medical decision. Is this ok in some instances especially when a patient has not had any of the above tests in a year or so? thank you….Marla

Medical Billing and Coding Forum – Internal Medicine

Austin bunionectomy

HELP! new to podiatry coding can anyone help with this coding

POSTOPERATIVE DIAGNOSES:
1. Left foot hallux abductovalgus deformity.
2. Left fifth digit adductovarus hammertoe deformity.
3. Left first metatarsophalangeal joint gouty tophi.

PROCEDURES:
1. Left foot Austin bunionectomy with screw fixation and
medial capsulorrhaphy.
2. Left fifth digit skin plasty for adductovarus deformity
correction.
3. Left first metatarsophalangeal joint excision of gouty
tophi.

PATHOLOGY: Left first MPJ gouty tophi.

ANESTHESIA: MAC sedation with IV anesthetic of 1% lidocaine
plain, 20 mL.

MATERIALS: Stryker 3.0 headed screw, 2-0 Vicryl, 3-0 Vicryl, and
4-0 nylon.

INJECTABLES: 1 mL of dexamethasone given postoperatively as
well as 10 mL of 0.5% Marcaine plain.

TECHNIQUE: The patient presented to the preoperative holding area having been n.p.o. past midnight. All preoperative studies were reviewed and discussed with the patient as well as the risks and benefits. The patient wished to proceed with the proposed procedure. The left lower extremity was marked with indelible ink. The patient received preoperative IV antibiotic of 2 g Ancef.

The patient was then transported to the operating room and placed on the operating room table in supine position. Following this, a time-out was then called between myself, anesthesiologist, surgical nurse, and surgical tech about the procedure to be performed as well as the location of the procedure. All were in agreement. Following IV sedation, the left pneumatic ankle tourniquet was then placed to a well padded area above the ankle joint. A Mayo block was then performed over the left first ray as well as reverse Mayo block for the fifth digit. The foot was then scrubbed, prepped and draped in the usual aseptic manner.

Attention was then directed to the left foot hallux abductovalgus deformity. An incision was made medial to the extensor hallucis longus tendon, contouring this to the deformity itself. The incision was then brought through skin into the subcutaneous tissue. Care was taken to retract any neurovascular structures. Upon doing so, a linear capsulotomy was then performed over the left first metatarsophalangeal joint. The head was then fully exposed and noted to have 1 x 1 cm gouty tophi medial to the metatarsophalangeal joint. This was resected in total and separate from the surrounding bone and soft tissue. The specimen was then passed from the operative field and sent to Pathology for further analysis. Attention was then directed back to the incision site within the left first interspace. The adductor conjoined tendon was then released. Attention was then directed
back to the left metatarsal head. The medial eminence was then slightly dissected to create a flat surface. After this, an Austin bunionectomy was then performed with a sagittal saw with a through-and-through cut through the head of the metatarsal with dorsal arm slightly longer. The capital fragment was then shifted laterally and temporarily fixated with a K-wire from the Stryker screw set. Under fluoroscopic guidance it was noted to be in excellent alignment. A Stryker 3.0 screw was then placed through the cannulated wire into the area under Stryker manufacturer guidelines. Noted in excellent compression and alignment well stable. K-wire was then removed. Further medial eminence was then resected as such to create a smooth surface as well as a barrel bur to smooth out any rough edges. The capsulotomy was then sutured closed with 2-0 Vicryl, but upon doing so it was decided to do a medial capsulorrhaphy to help bring the hallux in a more corrected position, thus a wedge capsulorrhaphy was then removed from the medial side of the left first metatarsophalangeal joint and was sutured/tightened closed, noting the hallux in a more corrective alignment. The rest of the capsule was then closed with 2-0 Vicryl. A wet sponge was then placed in the area.

Attention was then directed to the left fifth digit, where an adductovarus hammertoe deformity was noted. Upon mapping out the skin edges, a semi-elliptical incision was made about the proximal interphalangeal joint. By doing so, a wedge of skin was removed, and by holding the 2 skin edges together it was noted to bring the toe itself in a more corrective rectus position. Thus the area was sutured closed with 4-0 nylon.

All areas were then reevaluated under fluoroscopic guidance and noted to be in excellent alignment. Attention was then directed back to the left first metatarsophalangeal joint of the hallux abductovalgus deformity. A running subcuticular stitch with 3-0 Vicryl was then performed. Mastisol was placed about the area. Steri-Strips were then placed around the skin edges to help keep closure. One mL of dexamethasone as well as 10 mL of 0.5% Marcaine plain was then injected about the region. Areas were then dressed with Betadine-soaked Adaptic, 4 x 4’s, gauze and Kling. Tourniquet was then deflated and immediate hyperemia returned to all digits of the left foot. The left foot was then placed in a slipper cast for added protection. The patient was then transferred to the postoperative holding area with vital
signs intact as well as vascular structures intact to the left foot.

Medical Billing and Coding Forum – Podiatry

Application of Cryotherapy Billing

Hello All,

I am in search of a CPT (if one exists) that would be suitable to use for the application of a cryotherapy device for the following reasons:

Improve recovery time after intense activity or exercise
Increase energy and metabolism
Decrease inflammation in the body (arthritis and other chronic pain conditions etc.)
Faster recovery post-surgery – combined with physical therapy
Increase range of motion
Relieve tendonitis

The unit being used is made by cryousasolutions

I’ve searched via google and bing trying to find a CPT…I myself am leaning towards 97010 as the only option but upper management believes that there may be another applicable code so that we may receive reimbursement. We are not a DME vendor (so no HCPCS).

I think the cryotherapy devices for PT services, unfortunately, fall under the cold pack therapy which most insurance carriers will not pay.

Any feedback will be helpful.

Thanks!

Medical Billing and Coding Forum – Chiropractic

Independent Coding Contractors

If anyone provides independent contract coding please consider a listing at CodersDirect.com.

Each participant receives a mini website in CodersDirect.com where they can display a list of services and other pertinent details. Participants benefit from our 40,000 weekly views and will be included in all marketing efforts.

If interested please view the following link or contact me directly.

http://codersdirect.com/directory/index.php

Thanks,

Mark Sluyter
Msluyter@CodersDirect.com

Medical Billing and Coding Forum – Cardiovascular Thoracic

AAPC Associate recognition

My name is Rik Salomon. I am currently working for CHS as a Coding Analyst. I am CPC credentialed, and currently working on my CRC. I believe I meet all of the current preliminary standards to apply for AAPC Associate recognition. Any suggestions on the required writings/topics to submit for this recognition program? My specialty is ED coding, and would love to expound on this topic. Does anyone suggest another topic? I truly appreciate any feedback. Have a wonderful day!

Rik Salomon, CPC

Medical Billing and Coding Forum – Membership Recognition Program

An HIM director’s holiday wish list

By Dom Nicastro
 
The last month of the year can be a bit stressful. Closing out the books on the prior year. Making sure you leave time for all the holiday get-togethers. The traffic. The lines. The people.
 
It adds up.
 
If you’re an HIM director, it can be hectic in your healthcare facility, too. Not that it’s smooth sailing the first 11 months of the year.
 
Either way, you deserve a few treats yourself this holiday season. Make a few wishes, and who knows?
In fact, we gave an HIM director just that – the platform to make a few wishes this holiday season.
 
So, the floor is yours, Marianne Durling, MHA, RHIA, CDIP, CCS, CPC, CIC, director of Health Information Management and privacy officer at Granville Health System in Oxford, North Carolina. What do you wish for?
 
I wish contract companies would quit poaching my coders.
Most contract companies allow remote work. They pay more than small, county-owned facilities like Durling’s can afford, she says.
 
“Most coders soon find out it isn’t what they expected and the work isn’t always guaranteed, but by then their job has been filled,” Durling adds. “As a manager, I feel bad when I can’t let an employee come back. Some also limit the notification time they will allow staff to give, which can make them ineligible for rehire.”
 
I wish I could implement a full CDI program.
What are the struggles here for HIM directors? What gets in the way of realizing a full program, and what can HIM directors do in light of not being able to have a full program? First, you must decide where CDI fits into your organization’s tree. Does it come under HIM and its coders or does it come under the revenue cycle and work with the utilization review/case management team?
 
“If leaders can’t agree on this aspect then they can’t agree on how to champion for the position,” Durling says. “I think CFOs don’t understand the role and the benefit to the organization and thus won’t approve the necessary funding for an experienced CDI specialist. Since this role is new, I see a lot of leaders making due with coders or clinical staff minimally trained in coding, which means you may be missing some important skills.”
 
I wish the CMS website was more user friendly.
Use professional organization websites and references relative to what you are reviewing, Durling says. When CMS releases a new regulation that will impact family practice physicians, wait a few days or a week then check the American Academy of Family Physicians website.
 
“They get their experts to review the new rulings and regulations,” Durling says, “and then they boil it down in terms that their members can understand and apply to daily practice. This usually works for any specialty. I also find that state Medicaid websites and some [Medicare Administrative Contractor] sites have more user-friendly search features to find what you need than the CMS website.”
 
I wish my staff knew how hard I champion for them with administration.
A good leader needs to spend their time educating the C-suite on what their department does and how it impacts the organization and community. Durling takes this seriously.
 
“While we all know HIM is responsible for producing the claims that brings in the money we are widely considered a non-revenue producing department,” she says. “I’ve worked to find ways to be innovative to cut costs and actually bring in some revenue. By doing this, it keeps HIM in the eye of the administration, and they can see the importance we play in all aspects of the daily operations and how we can be a valued community partner.”
 
I wish payers reimbursed more realistically so our salaries could be more competitive.
Coder salaries are often not truly competitive, and managers can be underpaid–and even overpaid at times. Some get lucky. They avoid the day-to-day operational work because they have other managers under them for each service area they supervise, while others are underpaid if they must do everything because they don’t have the same supervisors or managers.
 
“This is because smaller hospitals still have the same work requirements, but no funding to support extra staff,” Durling says. “If payers paid more realistically, I think it would greatly impact compliance and hospital care.”
 
I wish Santa would come and work for me a day!
“Since Dad is usually Santa, I think in our environment Santa would be the CEO,” Durling says. “I would have him do just what I do every day: on a day of back-to-back meetings, juggle a staff member calling out sick, and some ‘crisis’ from another hospital area, all while dealing with staff drama or conflict.” HIM can be the “forgotten department that everyone knows exists, but no one could tell you exactly what we do,” she says.
 
I wish more hiring managers thought outside the box when it comes to hiring coders instead of just focusing on the credentials.
What should hospitals focus on when hiring coders? Work experience, skills, and personality are far more important than focusing just on the credentials.
 
“I also think that some managers think one credential is better than another, when in reality you are going to train them to do things the way you want them to do it, regardless of their credentials,” Durling says. “I have been around since before coding credentials even existed and sometimes we forget that good policies, procedures, and training can allow anyone with some aptitude and a willingness to learn to be a great coder.”
 
Oftentimes, you’ll see a coder who has a long list of credentials who can’t do the day-to-day job. What does that tell Durling? Maybe they are good at taking tests or memorizing material, but not good at applying the material.
 
“I just think too many managers take the easy way out and think the credentials alone can allow them to find a successful coder, or because they had luck in the past with one type of credential they will only hire those with that same credential, which severely limits their pool of candidates,” she says. “Step outside your comfort zone and you may find a whole world of great employees you never saw before.”
 
I wish we could offer more services to help our patients be better stewards of their personal health information and healthcare in general.
Durling says she’d like to work with her marketing department to educate their community on the importance of accurate health information and why it’s important to protect that information. She would like to help educate local providers that are not fully complaint with HIPAA learn to be compliant, so everyone can provide the same protections. She’d liked to help create a database of verified patients where patients who don’t have any picture ID can be easily verified so they have alternative methods to service their needs and protect their information.
 
I wish I could pay my coders what I know they deserve.
Durling says her staff members multitask, but they are not being compensated for all those other duties.
“We lose good staff members to larger hospitals just because of the higher pay,” she says. “The other problem is location. Because we are rural, we have a smaller local pool of qualified candidates, which means that jobs are harder to fill. We also don’t have the ability to offer remote coding because the high cost of [electronic health record] integration causes us remain a hybrid record system with a lot of paper chart elements.”
 
Smaller hospitals struggle with a smaller candidate pool, broader job duties hybrid systems, and lower salaries.
 
“This is why so many small rural hospitals are merging with larger facilities or corporate healthcare agencies,” Durling says, “but if we lose that community attachment, will it truly benefit the community in the end?”
 
I wish I could win the lottery and afford to revamp and update my department like I want.
“I would do a major remodel to our work area to make it more user friendly for the way we work today, as well as upgrade equipment to reflect our changing tasks,” Durling says. “I would spend the necessary money to back scan all our old records and integrate all our service areas so we could truly be a fully electronic medical record.”
 
“I would also use some funding to create a group to champion for smaller, rural hospitals at the government level,” Durling adds.
 
I wish the hospital staff and community realized just how much HIM really does for the hospital, the community, and patients.
Often board members, like the hospital staff in general, don’t know exactly what HIM does.
 
“I would like to speak to them at each new board installation to talk about what we do and how we serve the facility, providers, and the community,” Durling says. “I would also wish to be able to talk to them about significant changes such as things like ICD-10, HIPAA, or even issues that impact our department such as identity theft. I normally don’t get asked to present to them on these types of topics, but I believe they need to know what to expect and the impact it will/could have on our facility and our community in order to make appropriate decisions moving forward.”

 

Email your questions to editor Steven Andrews at sandrews@hcpro.com.

HCPro.com – JustCoding News: Inpatient