Part B News | Ask a Part B News Expert

How to handle payer requirements that conflict with AMA guidelines

02/12/2024

Question: According to one of our private carriers there are two possible ways we should report bilateral services with modifier 50 (Bilateral procedure):

Report modifier 50 on two service lines with one unit each.
Report modifier 50 on one service line with 2 units of service.

However, the carrier does not have this in their payment policies. In addition, this private payer’s instruction contradicts other private carriers and our Medicare administrative contractor (MAC). What should we do?

Continue to use the practice address when the place of service is 10

01/29/2024

by: Julia Kyles, CPC

Question: We know the place of service (POS) rules for telehealth services changed this year. Did that change the address we should report in Box 32 of the CMS-1500 form when a patient receives a telehealth visit while at home (POS 10)? We’re not sure if we should use the patient’s home address or continue to report the practice’s address. In addition, our providers occasionally perform telehealth services while they are at home. Which address should we use in that scenario?

Adhere to rules on reporting RTM or RPM during the global period

01/22/2024

by: Laura Evans, CPC

Question: I interpret recent CMS rulemaking that the RTM codes (98975, 98977, 98980 and 98981) are bundled in the global period if they are being performed for the same diagnosis and by the same provider who did the surgery. Am I reading that correctly?

Identify proper use of separate-structure modifier XS

01/22/2024

by: Savannah Schmidt

Question: A physician debrides a hyperkeratotic lesion on a patient’s left foot, second toe. During the same encounter, he performs a debridement of the five toenails. Which CPT codes and modifiers would be reported for this procedure?

3 Q&As: Manage coding errors, burnish documentation, code from reports

12/18/2023

by: Julia Kyles, CPC

The following series of questions and answers deliver key coding and documentation guidance on various sce-narios you may encounter in your day-to-day operations. All Q&As took place during the Advanced Specialty Coding Summit — Anesthesia, a DecisionHealth virtual event that took place in November.

Social determinants of health assessment tools must cover 4 core domains

12/11/2023

by: Julia Kyles, CPC

Question: I am looking for more specific information on code G0136 (Administration of a standardized, evidence-based Social Determinants of Health [SDOH] Risk Assessment tool, 5-15 minutes, not more often than every 6 months).

Understand the 2024 ICD-10-CM cardio coding guideline update

11/06/2023

by: Savannah Schmidt

Question: Do the 2024 ICD-10-CM guidelines include any changes related to cardiovascular condition reporting?

Know when to report SDOH with E/M codes based on MDM

11/06/2023

by: Savannah Schmidt

Question: Are coders required to report a social determinants of health (SDOH) ICD-10-CM code when a CPT code for an E/M service level is based on medical decision-making (MDM)?

Waive co-pay for indigent patients on urgent basis, but be clear it’s not forever

10/16/2023

by: Roy Edroso

Question: Our practice waived a co-pay for an insured patient in a financial hardship case last year. Our reasoning was that the patient needed care urgently and we weren’t comfortable turning them away. The patient has scheduled another visit, however, and we anticipate that the matter will be less urgent and we plan to require a co-pay before treatment. Could the patient refuse and charge patient abandonment on the grounds that we accepted their hardship earlier?

For new integrated services, community helpers do not qualify as official workers

10/16/2023

by: Julia Kyles, CPC

Question: Please provide more information about the community health integration (CHI) service in the proposed 2024 Medicare physician fee schedule... If a Medicare patient can’t drive to their doctor’s appointments, pick up their prescriptions or perform other tasks related to receiving health care, can a treating provider count the services of community helpers who perform those tasks toward CHI? In other words, can drivers and delivery people be auxiliary personnel, as described in the proposed rule?

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