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4038RE: [MedicalBillers] coding question of the day.

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  • debbie brosnan
    Nov 1 5:22 AM
         I agree with you 100%  I too have been billing for GI for a very long time.  I am also a certified coder.  I took on this new job as the supervisor of a very large practice we have 287 doctors.  We have every specialty except ER.  We just lost our ER doctors to a different contractor.  My boss who is not a CPC but is the manager.  We have a department of coders (7 of them to be exact) some do family practice, some do the surgeons, some do cardiology).  The coder for the GI group disagrees with me.  My boss (whom I have only been on the job for 10 months now) sides with the GI coder.  She actually told me I didnt know what I was talking about in front of a representative from the insurance company. Really didnt make me feel good. 
      Ok enough of my soap box.  THere are two different situations.

      --- On Sat, 11/1/08, Blue <life.angel@...> wrote:

      From: Blue <life.angel@...>
      Subject: RE: [MedicalBillers] coding question of the day.
      To: MedicalBillers@yahoogroups.com
      Date: Saturday, November 1, 2008, 12:33 AM

      What part does she take exception with? Using the modifier 51 or 59?
      Billing 2 colons together? Billing the uppers together? It should be
      billed like this:

      45380 - 59 (some ins co require 51 instead but start with the 59 modifier)
      43255 - 59 (yes this seems odd to have the modifier on the first code but
      it IS correct in this instance)

      Do your diagnoses like this:
      1. 211.3
      2. 531.00 (assuming stomach)
      3. 935.1

      Attach the #1 Dx to the 45385 and the 45380
      Attach the #2 Dx to the 43255
      Attach the #3 Dx to the 43247

      If your doc hasn't been billing like this with all the procedure codes they
      have left a LOT of monies on the table. This is pretty standard stuff
      among GI practices. I've done the billing for 27 GI providers for 20 years,
      attended many seminars, read all the literature, etc. The proof on the
      Medicare website should be good enough for anyone.

      Let me know if you have a specific area you would like me to help come up
      with written proof for your doc.

      Vicki F

      -------Original Message----- --

      From: debbie brosnan
      Date: 10/31/2008 3:18:55 PM
      To: MedicalBillers@ yahoogroups. com
      Subject: RE: [MedicalBillers] coding question of the day.

      I know I can bill these and be paid. I have in the past. What I need is
      the documentation stating its legal. My new boss doesnt believe me. I did
      find on the NCCI website under modifier 59 an example of the colonoscopy
      scenerio. But, she said it wasnt enough proof.

      --- On Fri, 10/31/08, Andrea Cavanaugh <andiec@bellsouth. net> wrote:

      From: Andrea Cavanaugh <andiec@bellsouth. net>
      Subject: RE: [MedicalBillers] coding question of the day.
      To: MedicalBillers@ yahoogroups. com
      Date: Friday, October 31, 2008, 5:35 PM

      I am wondering if Modifier 59 would be appropriate for the second example?


      -----Original Message-----
      From: MedicalBillers@ yahoogroups. com [mailto:MedicalBill ers@ yahoogroups.
      On Behalf Of debbie brosnan
      Sent: Friday, October 31, 2008 4:56 PM
      To: MedicalBillers@ yahoogroups. com
      Subject: [MedicalBillers] coding question of the day.

      Here is my question.

      Patient is having a colonoscopy. During the colonoscopy dr. finds 2
      polyps in different parts of the colon. He chooses to remove the two polyps
      in two different techniques. One a snare and the other a biopsy. He does
      not remove the scope just changes the tips.

      I also, am looking for documentation on a EGD. Pt has a foriegn body lodged
      in throat. Dr. removes the foreign body. (43247) decides to do a
      diagnositic EGD while he is in there, discovers the patient has a bleeding
      ulcer. He cauterized the bleed (43255). Can I bill for both the removal of
      the foreign body and the cautery?

      Thanks for your help


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