If a patient receives an injection during a follow up visit (99211 - 99215), can we bill the injection and also bill the office visit with modifier 25? We were told we can only bill the office visit and the injection for a new patient visit.

Part B News brief

Here are your deadlines for filing claims for services in 2010. As is the case in 2009, you have anywhere between 15 and 26 months to file a claim depending on the month a service was provided (PBN 2/16/09).

Your peers are spending more than a whole day accessing Physician Quality Reporting Initiative (PQRI) feedback reports, according to a Medical Group Management Association (MGMA) study. The MGMA recently surveyed its member satisfaction with the PQRI program. Less than half of survey participants were able to access 2008 PQRI reports made available last fall.

With consultation codes no longer paid by Medicare and some Medicare Advantage plans, your specialty practice is getting less money from every patient sent by primary care doctors. But when you bill only the replacement E/M codes on talk-heavy referral visits, you leave money on the table, experts say.

All four Recovery Audit Contractors (RACs) have asked CMS to expand the maximum caps on the number of medical records that can be requested per provider, per 45-day period, says Connie Leonard, director of CMS's Division of Recovery Audit Operations. This is because the RACs want to perform more complex reviews, which require targeted practices to turn over medical records to the RACs (PBN 4/20/09).

Specialty societies have submitted dozens of codes - including some high utilization psychiatric codes - for what experts believe will be a relatively lean AMA RVS Update Committee (RUC) five-year review in 2012. The five-year review is a process where specialty societies and CMS submit codes to the RUC that they believe have incorrectly valued relative value units (RVUs).

Beware of revenue shortfalls showing up in your accounts receivable department - you may have CMS to blame. A billing glitch failed to automatically send certain Part B claims to secondary payers during the first six weeks of 2010 - even though the explanation of benefits (EOBs) sent to your practice said these claims did cross over, CMS says.

You are about to have your Medicare payments slashed 21%, but the Senate is racing against the clock to pass a temporary pay-fix bill to delay implementation of the cut now set to hit your wallet on March 1. Historically, Congress has delayed payment cuts caused by a "flawed" payment formula - and there's no reason to believe it won't delay the cut set for March 1 (PBN 2/1/10). However, in the past Congress has adjusted payments for one or two years at a time. The previous fix passed in December was for just two months and this proposed reprieve is for less than one month.