For the Week of September 9, 2024

A patient comes in through ED as STEMI. Straight to CCL, LAD is the culprit vessel. DES placed, C9606. After LAD is stented and flow restored, an ostial diagonal lesion is found resulting in DES to the diagonal. The question is: Is the diagonal DES coded as C9601- DES Additional Vessel, since it was treated in the same manner as the STEMI LAD? Or is it coded C9600 because even though DES, it was not a STEMI vessel like the primary vessel C9606?

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Is a physician’s prescription required for Medicare to cover a screening mammography?

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If we state “PRN Oxygen,” will this suffice when billing Medicare for oxygen?

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From a claims perspective, what are some red flags when reviewing infusion and injection claims?

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To provide you with the most actionable compliance and regulatory questions, we are retiring the pharmacy compliance question of the week to focus on answering more commonly asked questions that safeguard accurate coding and save reimbursement. The pharmacy archive will still be available and is accessible here. Compliance Question of the Week will continue to help you overcome compliance challenges, reduce operational waste, and optimize healthcare.

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