Can you bill with modifier 59 (Distinct procedure) for a rotator cuff repair (29827) with the limited debridement (29822) of the labrum located in another area on the same shoulder? Or do you bundle the debridement with the procedure because it’s on the same side as the original operation? Or is it more appropriate to append modifier 59 to the debridement because it was performed on a separate area of the shoulder?

Can we bill Medicare for both the professional fee and ambulatory surgery center (ASC) facility fee if the physician performs an abdominal paracentesis in the ASC?

Can we bill for both a bladder scan (51798) and complicated catheterization (51703)? Our Medicare administrative contractor, Wellmark, says the catheterization is included in the allowance of the bladder scan. But its Improve the Claims Adjudication Process (ICAP) edits policy contradicts that while CMS’ policy does not allow for a complicated catheterization in conjunction with a bladder scan performed in an office setting on the same day. Were they right to deny our claim?

When a peripherally inserted central catheter (PICC) line is placed, it is standard practice to do a chest X-ray to confirm placement. Is it appropriate to bill for the chest X-ray in addition to the PICC line insertion?

How do you correctly code Procrit (Epoetin alpha) for patients who don’t have end stage renal disease (ESRD)? Does the coding differ if the facility is a federally qualified health clinic?

How do you define “prescription drug management?” Specifically, how do coders translate the details of the portion of medical decision-making according to CMS’ 1995 & 1997 documentation guidelines?

Does CMS pay for 0276T (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe) and 0277T (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes)?

It’s our understanding that Medicare does not cover audiology tests without a physician’s order. But what if the patient wanted the test anyway? Would it be appropriate to bill with modifier GY (service provided is statutorily excluded from the Medicare program)? Will appending the modifier defer payment responsibility to the patient?