Compliance Question of the Week – General

If the start and stop times are not documented on an infusion, can I bill an IV push?

What are the documentation requirements to bill for hydration?

A physician ordered a CT of the pancreas without and with contrast, and a CT of the pelvis without and with contrast. Is this documentation sufficient to allow us to bill for 74178?

If hydration is ordered for four hours before and four hours after a CT scan with contrast is performed, can we charge for the hydration hours?

Could a doctor use template documentation like the following in their reports? “IVC, Aorta, Pancreas: Not well seen given a combination of bowel gas and patient body habitus.”This documentation is in all of his US abdomen reports.

What is the difference between oral hydration and intravenous hydration therapy?

My doctor wants me to add modifier 22 to the code for the procedure he performed. I don’t see anything in the report that indicates the case was more difficult. What does the doctor need to document to justify the use of modifier 22?

Is 36000 separately reportable for therapeutic phlebotomy?

New codes 64454 and 64624 were introduced for 2020 for genicular nerve blocks and destruction. Does the doctor need to document anything specific for these codes?

What code would I report for intra-arterial infusions lasting 31 minutes?

I would like to ask a question about computed tomography (CT) colonography, I understand the exam includes 3D rendering image post-processing. Does the radiologist need to mention in the dictation that the post-processing was done under concurrent supervision?

When would I report 96361?