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Coding / Re: Delay Suture of Tendon
« Last post by nli on May 24, 2018, 12:50:23 PM »
Thank you for the insight. I am doing some historical work with codes from the practice.

Essentially is there any guidance on how much time is allowed for one to bill "delay suture of tendon" - - does anyone have a reference for this?

Coding / Re: Delay Suture of Tendon
« Last post by Michele on May 24, 2018, 08:01:38 AM »
The 83.62 seems to be more specific and matches what you have described.  It doesn't mention time of the delay, just "delay suture of tendon"  But I'm confused as to why you are using ICD9, instead of ICD10.
Coding / Re: Billing/Coding a PE & a WW on same visit
« Last post by lpfamilyphys on May 21, 2018, 01:53:26 PM »
I need help with information on the correct way to code this scenario.  Coding to the highest level of specificity is the end game for these claims. Our office does not have a coder, the providers do all of their own coding.  I would like to instruct the providers on the correct way of coding this issue.  We are not seeing any issues for 2018 with either way of coding/billing out these claims when it comes to reimbursement.  It will be for our 2019 reimbursement that this will have an impact on.  So if I can get the providers to code this correctly then there should be no issue with a lesser payment in 2019, as the fee schedules will be based on 2018 claim data.  Thanks for all of the help.  I have just come to a dead end in researching this issue.
Coding / Delay Suture of Tendon
« Last post by nli on May 21, 2018, 09:55:12 AM »

Trying to determine the amount of time that is permitted for a procedure to be listed as "delay suture of tendon". How long does the delay account for; would it be 3 weeks since injury or 6 weeks since initial injury. The code I am between is 83.62 and 83.88.

Thank you for the help!
Billing / Re: cpt 69210
« Last post by PMBS on May 17, 2018, 01:55:56 PM »
Thank you
Billing / Re: cpt 69210
« Last post by kristin on May 17, 2018, 01:22:01 PM »
Medicare doesn't recognize 69210 as being a unilateral procedure, although that is the CPT code description. Therefore, they have adjusted their RVU's to reflect the payment to be for one ear, or both ears. You cannot use a 50 modifier on the code with Medicare at all, since Medicare's edits don't recognize it. Bottom line, when it comes to Medicare, whether you do one ear, or both ears, you can only bill the 69210, no 50 modifier.
Billing / cpt 69210
« Last post by PMBS on May 17, 2018, 08:54:07 AM »
Good morning,

I billed Medicare for cpt 69210.  The procedure was done bilaterally so I used modifier 50.  Medicare denied stating  procedure is inconsistent with modifier or a required modifier is missing.  Missing/incomplete invalid HCPCS.

Any help will be appreciated.

Thank you

So many options. Looking for a HIPAA complaint option and mainly your suggestions. Thank you!

If you're really concerned about this, I'd suggest speaking with an attorney who works in the healthcare field. You may have to pay a fee, but this will eliminate any guesswork. Helpful Hint: Write your question down in a concise and accurate manner and be prepared to take notes when you get an answer (a hand held record works even better!) This keeps the meeting short....lawyers charge by the hour! :)
« Last post by ErickVA65 on May 15, 2018, 08:49:11 AM »
I agree with Michele. I have done with 59 modifiers. Best way is to follow the LCD and NCCI guidelines. It will tell you which you can use.

General Questions / Re: Welcome Members!
« Last post by Michele on May 13, 2018, 08:10:06 PM »
What type of a practice do you have?  Are your receivables lower than you feel they should be?  Just wondering what is making you think something isn't right.
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