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Billing an E/M Service after Mohs when a repair is indicated
Our Mohs surgeons sometimes perform an adjacent tissue transfer or a flap after Mohs surgery. Since they decided to do the flap after Mohs, they want to bill an E/M service with Modifier 57. I don’t think this is correct. Can you help clarify?
Intravascular Ultrasound (IVUS)
How do we code for intravascular ultrasound of lower extremity vessels? Can it be billed along with the placement of a lower extremity stent?
Subcutaneous vs Subfascial
If the provider says in their documentation that they went into the subcutaneous tissue and to the fascia to excise a 4 cm lipoma from the back, is this subfascial? This always trips me up when coding!
“Incident-to” vs “Direct” Billing
Our Nurse Practitioner saw a new patient (Medicare) in the office for evaluation of sinus complaints. He developed the plan of care. The patient was scheduled to follow up with the Nurse Practitioner. The patient returned to the Nurse Practitioner for a return visit with the same problem and no changes in the plan of care. Can he bill this “Incident to” the physician since it is an established patient with an established plan of care and the physician was in the office?
Appealing Intraoperative EEG/EMG Denials
I am new to coding for neurosurgery, and we are receiving denials for intraoperative EEG and EMGs; what documentation should we use for appeal?
Risk of Patient Management
Is a decision to NOT perform an injection with risk factors discussed “moderate” risk?
Ex: The patient has done 6 weeks of physical therapy for their spinal stenosis, which has provided some relief, but he is not at the treatment goal. We discussed performing a lumbar epidural steroid injection with the risks of the procedure, including bleeding, infection, and nerve damage. The patient is a diabetic, and we discussed the risks of the corticosteroid injection elevating blood glucose levels. After this discussion, he elected to continue PT and avoid injection at this time.
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