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Question: Do you have any advice for encouraging providers to improve documentation for wound sizing in CPT?
Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, an independent medical coding education consultant, answers some of the many questions she receives pertaining to physician coding for CPT orthopedic services.
Question: What documentation criteria are required to report CPT critical care codes 99291-99292?
Question: I have seen stories in the press about practices charging “administrative fees” for calls, emails and texts from patients. I can’t see how this would be allowed by insurers. Can I really charge for this?
Question: Our Medicare administrative contractor (MAC) has adopted the new local coverage determination (LCD) for trigger point injections (20552-20553). The LCD limits the number of trigger point injections a patient may receive to three sessions per rolling 12-month period. Will the April 24 visit count as the third injection under the LCD?
Question: We have three follow-up questions about the new local coverage determination (LCD) for trigger point injections (20552-20553) that will take effect on April 1.
Question: At our orthopedic practice we sometimes must postpone a patient’s total joint replacement because their BMI is too high. We either refer them back to their PCP for weight loss management or to a weight loss program at another facility. One of our providers is working to become certified in weight loss counseling, which would allow her to provide this service at our practice rather than referring the patients elsewhere. How would this service be billed?
Question: One of the coders I work with consistently uses the subsequent inpatient or observation codes (99231-99233) to bill for hospital H&Ps by their orthopedic surgeons. A typical scenario would be when the orthopedist is called to evaluate a hospitalized patient with a known orthopedic injury who was admitted by another physician. The orthopedist has not previously seen the patient. I am seeing conflicting guidance on this from different sources. Can you please clarify?
Question: Can we report G0136 (Administration of a standardized, evidence-based Social Determinants of Health [SDOH] Risk Assessment, 5-15 minutes, not more often than every 6 months) in the patient’s home? And does the provider have to perform the assessment on the same day as the E/M visit (99341-99345 and 99347-99350), or can they perform the assessment on a different day?
Question: Can you give an example of what needs to be documented for G89.4 (Chronic pain syndrome) showing there is a psychosocial reason for the pain?


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