Today, I came across a scenario where three modifiers are used together which is very rare. So, I would like to share that scenario which will surely help to use the modifier wisely. Below is the question with the answer as well. Question :An ophthalmologist performs cataract surgery on a patient’s right eye two weeks after performing cataract surgery on the patient’s left eye. The patient has an age-related nuclear cataract. The patient tolerates the procedure well and remains under the surgeon’s care for eight days after the procedure and…
Read MoreNew HCPCS codes effective from 1st April 2024
CMS published its HCPCS Quarterly Update in March, which heralded the sum of 94 HCPCS Level II code additions, discontinuations, and definition revisions. The changes became effective April 1. 62 added codes 21 discontinued codes 11 revised codes Below are the Newly added HCPCS codes effective 1st April 2024 A2026 Restrata minimatrix, 5 mg A4271 Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per month A4438 Adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each A4564 Pessary, disposable, any type A4593 Neuromodulation stimulator…
Read MoreCommunity Health Integration (CHI) New G code: G0019 & G0022
CMS created 2 new service codes describing CHI services that auxiliary personnel, including community health workers (CHWs), may perform incidental to the professional services of a physician or other billing practitioner, under general supervision. The billing practitioner initiates CHI services during an initiating visit where the practitioner identifies unmet SDOH needs that significantly limit their ability to diagnose or treat the patient. The new G codes for CHI: G0019 – Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of…
Read MoreWhen to use G2211 code by Medical coders
Begining Jan. 1, 2024, qualified healthcare providers can bill an add-on HCPCS Level II code to report the extra time, effort, and associated practice expense involved with caring for Medicare patients across the continuum of healthcare. G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. (Add-on code, list separately in addition…
Read MoreFirst quarter 2024 Coding Clinic update by AHA
The first quarterly release of Coding Clinic focused on the changes and new codes effective April 1, 2024. If you wish to review the updated Official Guidelines for Coding and Reporting, they can be accessed here. Notable changes to the ICD-10 CM coding guidelines include: Section C.1.d.5.b, which speaks to the reporting of sepsis due to a post-procedural infection. This entry reminds us to sequence codes that identify the site of infection first, then follow with the appropriate codes related to sepsis. In addition to the already published listing of codes (grouping T81.41-T81.43 classifying an…
Read MoreCoding guide for CPT Fracture Care in ED facility
Most of the fracture cases are coded in emergency department (ED) facility, hence it is important to understand the different scenarios that a coder come across for these fracture care. Scenario 1 A patient presents to the ED after falling and fracturing his tibia. The emergency physician calls an orthopedic surgeon for a consultation. The orthopedic physician evaluates the patient and performs a closed reduction of the tibia and applies a long leg cast. The orthopedist then takes over managing the patient’s fracture care. In this case the…
Read MoreCPT code 27405, 27407, 27409, 27427, 27428 and 27429 Coding tips
Basics of CPT code 27405, 27407 and 27409 A surgical reconstruction means that the remnant of the torn ACL/PCL is removed, and a new ligament is created with tissue from elsewhere in the body or donated from a cadaveric donor. ACL/PCL reconstruction surgery has been very successful, but there are concerns that it may not be the ideal solution for people who have injured their ACL/PCL. A repair does not require harvest of graft tissue and may provide a shorter recovery time for the patient. These procedures are done by…
Read MoreCPT code 23410, 23412, 23420 and 29827 coding tips
Basics of Rotator cuff CPT code CPT code 23410, 23412, 23420 and 29827 The rotator cuff is a group of muscles in the shoulder that allow a wide range of movement while maintaining the stability of the glenohumeral joint. The rotator cuff includes the following muscles: Subscapularis Infraspinatus Teres minor Supraspinatus A helpful mnemonic to remember these muscles is “SITS“. Rotator cuff tears occur when tendons weaken and pull away from the bone. Acute rotator cuff tears are caused by trauma such as falls on an outstretched hand or throwing…
Read MoreCoding guide for CPT code 23105, 23106, 29820 and 29821
Basics of CPT code 23105 & 23106 Definitions: Arthroscopy: Use of an endoscope to examine the interior of a joint (diagnostic) or to perform surgery on joint structures (therapeutic) Arthrotomy: Surgical incision into a joint that may include exploration, drainage, or removal of a foreign body Synovectomy: Removal of the synovial membrane lining of a joint Diagnosis and Indications for CPT code 23105, 23106, 29820 and 29821 Primary osteoarthritis Rheumatoid arthritis Rheumatoid myopathy with rheumatoid arthritis Rupture of synovium Shoulder arthritis Synovial hypertrophy Coding guidelines for CPT code…
Read MoreCoding Guide for Arthrodesis & Vertebral corpectomy CPT codes
Basics of Lateral Extracavitary Approach (LECA) Spinal exam The lateral extracavitary approach (LECA) requires resection of the ribs, pleura and/or peritoneum and dissection of spinal/paraspinal tissues to access the vertebral bodies/disc. The advantage of this technique is that it provides the surgeon with access to both the posterior and lateral aspects of the spinal canal through the same incision. Documentation of manipulation of the pleura and/or peritoneum is the clue that a LECA was used. Medical terms used in coding LECA spinal exams: Arthrodesis: Surgical fixation or fusion of a…
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