Help! I've Fallen and I Can't Get Up
The following claim would need how many sites
What is 2
Procedures:
17000 Destruct Premal Lesion Unit 1
11402 Excision B9 1.1-2cm Unit 2
17003 Destruct Premal Lesion Unit 6
11301 Shave Skin Lesion Unit 2
How many sites are needed to pay on claim review
What is 5
This is the only time that we can pay for a colonoscopy UNB to a colonoscopy on claim review
What is a rolled up facility claim
Only one of these codes should be reported per encounter, unless two separate IV sites are required
What is initial service codes
This smoking cessation CPT code is always left on claim review as we need documentation to see that the time requirement has been met
What is 99407
These can be paid on claim review if there is a lapse of time of 6 weeks or greater since the last time the patient was treated
What are PT and OT re-evaluations
Intermediate and Complex repairs can be matched with which benign lesions
What are lesions that are greater then 0.5cm
Which review guidelines would we follow on the following claim and state if it would be paid or denied
What is M59 and deny
When we do not have enough medications to match to administration codes, if the patient presented through the ER, then we can use this as additional medications to match to. They cannot match with planned procedures
What are REV codes
When these preventative counseling codes are the denied code, we would leave them on claim review as documentation would be needed to support the extended time and that there is no overlap with other EM services reported for the DOS
What is 99402-99404
When this medication is UNB to a joint injection, it is not separately reportable and included in the global procedure
What is lidocaine
When looking at pressure ulcers, we cannot use these to identify tissue levels, so we cannot match them to level specific debridement procedures
What are stages
Which procedure can we pay on claim review when UNB to a hammertoe that would not need modifier support
What is a bunion correction
We can pay for this when it is the denied code UNB to a procedure if we have an approved diagnosis and it is NOT integral to the global surgical package
What is hydration
When these are UNB to an EM, we can only remove if there is clearly no overlap. If there's any potential overlap, we would deny and leave on claim review
What is preventative counseling
On the following claim these would help us to determine if we can pay or deny on claim review. Please also state whether this would be paid or denied
What is modifiers and denied
When procedures are being performed to the toes, anything proximal to this site can support a separate site
What is the distal interphalangeal joint
These are the required components to pay for a EGD with biopsy and EGD with dilation
What is a diagnosis related to the esophagus and a diagnosis for a site lower than the esophagus that makes sense it would be biopsied
Per Top Secret, this drug is approved to be given concurrently with many chemo drugs
What is Leucovorin
This behavioral therapy G code may only be paid if there is a diagnosis for support and only for the first time it is reported by the TIN/specialty
What is G0447/Obesity Behavioral Therapy or G0443/Behavioral Counseling for Alcohol Misuse
When determining the appropriate number of sites for a therapy UNB to a therapy, which CPT codes do we consider
What is the codes hitting an edit and CMT (spinal and extraspinal if listed in same day)
When a wound repair is UNB with these, we will always leave them on claim review (Note: this is not an excision, biopsy, destruction)
What are skin tissue rearrangements and tissue grafts
Radiation Therapy Consults (CPT 77336) should not be reported on the same date of service if this therapy is also performed
What is brachytherapy
These medications are included in procedures and would not be used to support administration codes UNB to procedures. (Please name 4 of the 6 listed)
What are local anesthetics, sedation, antiemetics, antihistamines, antibiotics given prophylactically, and contrast/sedation for radiological procedures
This CPT code can be paid when UNB to an EM when there is a NEW diagnosis of a developmental issue
What is 96110