Compliance Question of the Week – General

General Question for the Week of March 19, 2018

One of our physicians sent a patient to the outpatient department to have a PICC line inserted (36568 or 36569) and have the first round of therapeutic medications (96365, 96366, 96367, 96368) on the same day. Can you please tell us if the insertion of a PICC line and the administration of the antibiotic drug can be charged on the same day with a modifier of 59 or XU?

Read the Answer

General Question for the Week of March 5, 2018

If a record only states “lupus” what would this condition map/code to? I am an auditor at work, and I am in a debate on how to code lupus not otherwise specified (NOS). I say this condition codes to L93.0 but a colleague suggests I am incorrect and that lupus should code/map to M32.9? Do you have any guidance on this particular condition?

Read the Answer

General Question for the Week of January 15, 2018

What are the Medicare rules for a situation when two or more diagnoses equally meet the definition for principal diagnosis? For example, we had a patient who was admitted with systolic congestive heart failure exacerbation and aspiration pneumonia. Both are equally worked up (IV antibiotics, speech eval, NPO, IV Lasix, new echo, etc.).

Read the Answer

CPT® copyright 2023 American Medical Association (AMA). All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →