Ask the Expert

Q: How do you know when Category III CPT code 0505T is the appropriate code to assign for a femoral popliteal revascularization?

Our experts answer questions about coding for multiple gestations, criteria for reopening a Medicare claim, and more.  

Q: How do we bill for items provided to a patient participating in a clinical trial that are not listed on the billing intention?

Q: What would be reported as the principal diagnosis if a patient was admitted with both a urinary tract infection (UTI) and sepsis? What would be reported first if the patient developed a catheter-associated UTI with sepsis?

Q: How can we ensure key staff are kept up to date on commercial payer changes?

Q: A patient presents to a wound care clinic for assessment of a 15 sq. cm open wound. A nurse evaluates the wound for size, depth, and evidence of inflammation and performs sharp selective debridement. Would it be appropriate to bill an E/M code and if so, should we report modifier -25?

Q: Is there anything that a hospital needs to do regarding HIPAA and the confidentiality of famous patients? Obviously employees shouldn’t snoop, but can you recommend any added protections?

Q: What are some examples of programs that address social determinants of health (SDoH) in an Accountable Care Organization (ACO) setting?

Q: What is the difference between a Medicare claim appeal (redeterminiation) versus reopening of a claim?

 Q: A diabetic patient is diagnosed with a gangrenous decubitus ulcer of the left heel and admitted to the hospital for treatment. If the provider documents an association between diabetes and the decubitus ulcer, which condition should be sequenced as the principal diagnosis?