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Question: I have a patient who is on Medicare but was until recently also covered under his wife’s group health plan at work, which made Medicare his secondary payer. He tells me his wife recently retired. She has kept up the insurance for both of them, but our understanding (and the patient’s) is that in this case, the group plan should now be the secondary and Medicare the primary. Medicare doesn’t acknowledge it, though. What to do?
Question: In the 2017 Medicare physician fee schedule, CMS specifically mentions that the newly billable G0505 (Cognition and functional assessment by the physician or other qualified health care professional in office or other outpatient) could be billed with chronic care management, transitional care management and other services. Under what circumstances would you legitimately bill CCM (99490) with G0505?
Question: An EKG was ordered as a pre-op screening before cataract surgery, but it revealed a right bundle branch block. What diagnosis code would you choose to submit with the claim for the EKG?

Question: We have a nurse practitioner (NP) starting who is not yet credentialed but is shadowing our doctors for both her and them to get comfortable with her and the process of the office. One of our doctors is letting her do procedures while she is in the room with her and the NP is dictating the visit, but we will be billing under the doctor. Is this allowed?


Question: When two surgeons are working a patient, when is modifier 62 (Two surgeons) appropriate and when is modifier 80 (Assistant surgeon) appropriate?

Question: Has anyone billed preventive medicine counseling codes 99401-99404 yet? If so, what was the payer response? Of course there was confusion among the physicians as to what these codes were (mixing them up with a physical), so we have not started using them yet.
Question: We got an email from a client who was unexpectedly told that there was a “systematic data error” in the quality calculation for their value modifier (VM) for 2015 and that they have been moved from a 2% negative adjustment to a 0% adjustment. What happened?

Question: A patient of a multispecialty group practice came in to see an internist. She reported herself pregnant — though this had not been medically confirmed... a few weeks later, the pregnancy was confirmed on a visit to our OB... Can the practice use the pregnancy O codes on the first visit, even though they plan to bill the confirmation code Z32.01 for the later ob/gyn visit?

Question: What are the levels of supervision required for phlebotomy, injections or other services of medical assistants and nurses in the office setting? Please list source or link to the Medicare fee schedule database that you reference in your article.
Question: We have a provider who is billing for home sleep studies with 95800. However, CGS Administrators is denying the service with claims adjustment reason code CO-5 (The procedure code/bill type is inconsistent with the place of service). Can you tell us why we’re getting this denial?


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