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Pediatric Full-body DEXA Scan

Question: We have a company that would like us to provide a full-body DEXA on a pediatric patient. We are having difficulty determining what CPT would be appropriate for that. Can you tell us that? Answer: There is no CPT code to report a full-body DXA scan. This procedure should be reported using the unlisted...

Modifier GY

Question: Is the GY modifier necessary on all drugs that are considered self-administered when administered in an outpatient setting; emergency department, observation and facility-based clinics? What is the appropriate use of the GY modifier? Answer: It is not necessary to place the GY modifier on drugs considered self-administered. Revenue code 637 – Self-Administrable Drugs may be assigned...

Sodium Bicarbonate Infusion

Question: We are a hospital (technical) setting. Can we bill for a sodium bicarbonate infusion when it is done in conjunction with a CT scan with contrast to prevent Contrast-Induced Nephropathy? The NCCI edit leans towards a yes, with an appropriate modifier.  The bicarbonate is infused to help the patient’s body accept/take the contrast. Answer: As...

Embryo Cryopreservation

Question: If an embryo freeze is performed on day 5 and again on day 6, can the 89258 be charged on both day 5 and on day 6? Answer: Yes, CPT code 89258 – Cryopreservation; embryo(s) may be charged on both day 5 and day 6. The following information is found in AMA CPT® Assistant, April 2004: “Code 89258,...

Reporting Moderate Sedation

Question: Our external billing scrubber is advising to append modifier 25 with CPT 99152 when also billing CPT 36561. Could you please provide any information? They are referencing the “Integrated OCE (IOCE) CMS Specifications V17.1.” Could you please assist? Answer: With the elimination of Appendix G from the CPT book and implementation of new CPT...

Back to Basics: Learning the ABCs of CDM

VitalWare is proud to introduce Bonnie Morris, Director of Professional Services/Revenue Cycle Integrity. Bonnie brings more than 20 years of experience in healthcare, including Clinical Pediatric Services, Medical Auditing and Revenue Cycle consulting. She is a Subject Matter Expert on Charge Description Master Management and Charge Capture and has spent her career guiding compliant Revenue...