Part B News | Ask a Part B News Expert

PCP notification, not permission, is required for extended ESI treatments

06/12/2023

Question: We were told that we need to contact the patient’s primary care provider (PCP) before we perform epidural steroid injections (ESI) for Medicare patients. It’s hard to get the PCPs’ authorization for the injections. Where can we find proof that we need a PCP’s permission?

Sanctions vs. COVID non-compliant docs don’t automatically lift with end of PHE

06/05/2023

by: Roy Edroso

Question: One of our former physicians had his license pulled for passing “COVID misinformation” during the public health emergency (PHE). Now that the PHE is over, what are his chances of getting his license back?

You can bill 2-hour esketamine code with therapy, and with prolonged codes

05/22/2023

by: Roy Edroso

Question: Our psychiatric provider will administer Spravato (esketamine) to a patient. I know there are codes for this: G2082 (Office E/M, established patient, w/provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation) and G2083 (... ; greater than 56 mg esketamine). But could we use other E/M codes with prolonged services instead? Also, psychotherapy may be performed prior to giving the medication — can we bill that? And should we report the drug separately?

Report the right E/M level for ED patient with exacerbated chronic illness

05/15/2023

by: Savannah Schmidt

Question: A 19-year-old male with asthma who experienced wheezing and shortness of breath for the past two weeks presented to the emergency department (ED). Inhaler use 10-14 times daily offered temporary relief. Physical exams were normal except for tachycardia, scattered wheezing breath sounds, and elevated respiration. The physician completed three tests (complete blood count; complete metabolic panel; influenza A/B, respiratory syncytial virus, and COVID-19 polymerase chain reaction panel), gave the patient a nebulizer treatment and steroids, released him with MDI and steroid burst, and referred him for a follow-up visit with his doctor of primary medicine. Which CPT code would be reported for this visit?

Consider this rule of thumb when selecting MDM complexity for fracture care

05/01/2023

by: Laura Evans, CPC

Question: If a patient has a fractured femur and ankle would this be considered high complexity when coding based on medical decision-making? Just looking for more clarification on what the AMA’s E/M guidelines consider “poses a threat to life or bodily function.”

You don’t need ‘health care cleaners,’ but you do need to meet standards

04/17/2023

by: Roy Edroso

Question: We frequently see ads for “medical cleaning” and “health care cleaning” companies that suggest we need to use their specialty services to meet official guidelines. Is there a law requiring this?

Stick to current POS guidelines for post-PHE telehealth visits

04/10/2023

by: Julia Kyles, CPC

Question: Our practice will continue to perform telehealth office visits (99202-99215) under the waiver extension. Which place of service (POS) should we use for Medicare patients after the COVID-19 public health emergency (PHE) ends?

Be careful about upcoding; DOJ may come after it as a false claim

02/13/2023

by: Roy Edroso

Question: I recently saw a Department of Justice settlement in North Carolina that seemed to be entirely based on a pattern of upcoding E/M. I didn’t know federal prosecutors did that! Is it common?

Don’t try to DIY when you need alternative language options for ABNs

01/09/2023

by: Julia Kyles, CPC

Question: Medicare creates advance beneficiary notices of noncoverage (ABN) in English and Spanish, but the majority of our limited English proficiency patients speak Korean. Does our practice need to create an ABN in the appropriate language when an official version isn’t available?

Give coders a chart, not a calculator to find new prolonged threshold times

12/05/2022

by: Julia Kyles, CPC

Question: We are trying to understand the time requirements for G0316, G0317 and G0318. We thought CMS added an extra 15 minutes to the threshold times listed in the new CPT guidelines.

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