Ms. Pinky Maniri Consulting Group

Ms. Pinky Maniri Consulting Group
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When Do I Use Modifier -25? How Do I Use Medical Modifier 25? What is Modifier 25? - JustMyPassion.Com

Modifier -25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service: This modifier must be appended with an E/M service. This is the modifier you will need to use with the evaluation and management service done on the same day with other procedure done by the same physician. It has to be above and beyond the usual preoperative and postoperative encounter with the procedure. In fact, by using this modifier, it doesn't have to have a different diagnosis reported. The most important thing is that, the E/M level should meet its key components or if it is selected based on time spent with the patient (counseling and coordination of care). You have to be careful in using this modifier. It must meet medical necessity. As you know, there are procedures that already includes all other coordination of care and management.

http://www.justmypassion.com/articles-MBC-11.html

All About Proper Use of Medical Modifiers

How to Use Proper and Right Modifiers for Medical Specialty Services Why do we have to know how to properly use the right modifiers? Well, here are the simple reasons why we need modifiers: 1.The physician performed multiple procedures 2.The procedure performed was bilateral 3.The E/M service was done on the same day of the procedure 4.The procedure was increased or decreased 5.The procedure has both professional and technical component 6.The procedure was performed by other provider (Anesthesiologist, Surgeon Physical Therapist, Speech Pathologists etc.) 7.Procedure on either one side of the body was performed 8.The E/M service was provided within the postoperative period 9.The E/M service resulted to Decision of Surgery 10.Unusual Circumstance But, do you know what are these numerical modifiers?

http://www.justmypassion.com/allaboutmodifiers.html

Laparoscopic Cholecystectomy Converted to Open Cholecystectomy - How Do I Code this Surgical Procedure? What CPT Code Should I Use?

In this scenario, you can only bill for the Open Procedure. So instead of coding it with CPT Code 47562-47564 (Laparoscopy, Surgical Cholecystectomy);

Take a look at CPT Code 47600-47605 for the Open Cholecystectomy.

DX Cross Over - 574.1x (5th digit) and 574.2x (5th digit). Check the pathology report for more specific ICD-9 Codes.

You can use a V-Code as Secondary Diagnosis code V64.4 (Laparoscopic surgical procedure converted to open procedure)

I hope this helps.

You can visit my professional website at www.JustMyPassion.com

Providing free source of useful information for Physicians, OfficeManagers, Medical Billers and Medical Coders since 2005!
 







"How Do I Bill for a Lipoma Removed from the Patient's Neck - What CPT Code to Use?

One of my website readers sent me a coding question via email:

"How Do I Bill for a Lipoma Removed from the Patient's Neck"


You can read my response on this question that I posted on my website:

http://www.justmypassion.com/CPT-Code-Billing-For-Lipoma-Removed-Neck-Area-What-Is-It.html

I hope this will help others who has problem on coding for lipoma, neck.


Thank you!

Ms. Pinky, MS, BSc
Website Owner of   www.JustMyPassion.com  - Providing free source of useful information for Physicians, Office
Managers, Medical Billers and Medical Coders since 2005!

Bilateral Laparoscopic or Open Inguinal Hernia - Should I Bill as 49650 with 2 units?

 One of my readers asked me this question:

Hi, Ms. Pinky,

According to my surgeon, if he does a bilateral laparoscopic inguinal hernia repair, we should bill it as 49650 with 2 units. I don't think this is correct. Please let me know. ~ Lori, NYC



------------ My Reply ----------

The proper way to bill a bilateral procedure is to append a Modifier 50 (Bilateral Procedure).

I do think that all big Commercial Insurance payors, including the smaller ones does recognize the modifier 50 now. I have seen many insurance payors' reimbursement/clinical policy where a modifier 50 must be appended for bilateral procedures.

CPT 49650 is a unilateral procedure.

So I recommend that you bill and code it this way:

49650 - 50   1 unit


You can visit my website .. you will find a lot of useful information there including Hernias and Modifiers.

Modifier 50 is here:
http://justmypassion.com/Modifier-50-How-Do-I-Use-Modifier-Bilateral-50.html

 Billing and Coding Hernias (Laparoscopic and Open) can be found here :

http://justmypassion.com/medical-billing-codes-hernia-repair.html

My Main Website address is: www.JustMyPassion.Com







I hope this helps.






Therapy Functional Limitations and Severity Modifiers are Now Required on your Claims

This is effective January 01, 2013. These are non-reimbursable G-Codes with its accompanied Severity/Complexity Modifier being required on your claims.

Please my complete article on this new change on my website and can be found here --

http://justmypassion.com/Therapy-Coding-Billing-Functional-Limitation-2013.html

New EMG Codes for 2013!

Effective January 1, 2013 - we have a new EMG Codes and some few changes.

Read more on this new codes on my website and be found here -- 

http://justmypassion.com/New-EMG-Electromygography-CPT-Codes-for-2013.html

New Practice? Will you submit CMS 855i or CMS 855B

You will submit the:

CMS 855i - If you are an individual/solo practice owner. Or even if there are more providers in the practice but is only owned by a one individual, then you need to fill out the CMS 855i! 

CMSS 855B - If you are a group of more than 2 individuals forming a medical group or a practice. This is the form you will use if you have business partners or business co-owners of the practice. 

Other related enrollment forms:

Take note about the CMS855R for your other providers joining the practice who are reassigning benefits only. 

CMS 588 for your EFT Authorization

CMS 460 Medicare Participating Physician or Supplier Agreement

Refer to your local CMS contractor. Go to their website and visit their "Enrollment" page to get more information on how you complete the enrollment forms.











2010 Coding and Billing for Anesthesia/Pain Management Professional









2010 Coding and Billing for Anesthesia/Pain Management Professional



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El SeƱor de los Cielos 3



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2012 Coding Guide General Surgery



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How do you code for an Incarcerated Ventral Hernia with Mesh and with Partial Omentectomy and Exploratory Laparotomy?

Look at these codes if these are appropriate based on your surgeon's operative report:

For your incarcerated ventral hernia repair ==>> 49561     Repair initial incisional or ventral hernia; incarcerated or strangulated    

Your Partial Omentectomy code is =======>> 49255     Omentectomy, epiploectomy, resection of omentum (separate procedure)

For your Laparotomy code is ==========>> 49000     Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)


For your MESH, the code is ==========>> 49568      Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair)

Take note that per the CCI Edits:

Your code 49255 (partial ommentectomy) (on column2) is a component of code 49561 (incarcerated ventral hernia repair) (on column 1). With an indication that a modifier is not allowed, so therefore, can not be billed together.

Your code 49000 (exploratory laparotomy) (is on column 2) is also a component of code 49561 (incarcerated ventral hernia repair) (on column 1). With an indication that a modifier is not allowed, so therefore, can not be billed together.

Now, because of this bundling, you can report your hernia repair code 49561 using a modifier 22 (Increased Procedural Services) as like this:

49561-22 (( you might need to submit your claim with the Operative Report to support your surgeon's additional work and time spent on the said procedure.

Your MESH code 49568 has no edits conflict, so you can bill it with your 49561-22.


I hope this helps.

Reference: 2012 CPT Code Book. CPT is owned and a trademark of the AMA (American Medical Association).

Please visit my professional website at www.justmypassion.com.

Medicare Enrollment Form CMS-855 Are Now Being Accepted 60 Days Prior to Effective Date!

Medicare Enrollment Form CMS-855 Are Now Being Accepted 60 Days Prior to Effective Date!

This is a good news for all Part B physicians! Because this used to be a 30 days time frame!

Now, you have 60 days in advance to file your physician's enrollment application before the effective date or "start date" at a new medical practice office.

So if for instance, you have a start date at a new practice of August 1st, you have 60 days before the 1st of August to submit the enrollment application.

Read more about this new change from Medicare Learning Network Matters here. 

I hope you find this a helpful information.

Please visit my website at www.justmypassion.com. 

Coding for incision and drainage of a perianal abscess and rectal examination under anesthesia.

The surgeon did a rectal examination under anesthesia and on the same session also did the incision and drainage of perianal abscess.

How do I code and bill for this?

Look at 46050  for the I&D - 46050 Incision and drainage, perianal abscess, superficial. Global Days 10 days.

And for the rectal examination under anesthesia, you may look at 45990 Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic

But be careful as these 2 codes are not billable together. Because 45990 is a component of 46050.

Per CCI Edits V18.1 Effective April 1, 2012  - 46050 with 45990 on second column has an indicator "0".

Please visit my website at www.justmypassion.com.

What is CPT Code to use for Laparoscopic repair of paraesophageal hiatal hernia. The Surgeon also did fundoplication and did the mesh

 A question sent to me by one of my blog readers:


 Question: What is CPT Code to use for Laparoscopic repair of paraesophageal hiatal hernia. The Surgeon also did fundoplication and did the mesh.

Here's my suggestion, kindly look at:

43282 Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh

As you can see this code includes the implantation of mesh.

Global: 90 days.

Reference: 2012 CPT Code Book. CPT is owned and a trademark of the AMA (American Medical Association).

Please visit my professional website at www.justmypassion.com.

Read the Disclaimer

My blog is for Informational, Communication, Training and Educational Purposes ONLY.

DISCLAIMER

CPT codes, descriptions and other data are copyrights, owned, maintained and are trademark of the AMA (American Medical Association).
~~~~ ** ~~~~
It is in NO way replaces the physicians' documented medical encounter and procedure rendered on the patient.

I do not provide legal and medical health services.
I am NOT an attorney or a physician.

I am not affiliated, working or in relation with any government agencies and offices such as the Center for Medicare and Medicaid Services and the OIG.

I am not affiliated, working or in relation to the American Medical Association.

I am not affiliated, working or in relation with any insurance companies, carriers including the third party payors.

If you DO NOT agree on this disclaimer, I request you to leave this blog immediately.

If you are an owner of any intellectual proprietary, or website link and if you think this is in error that I have linked to your site or have posted your materials-- please do not hesitate to email me at: ms.pinky@justmypassion.com. It will immediately be removed in less than 24 hours.

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