Part B News | Ask a Part B News Expert

Identify proper use of separate-structure modifier XS

01/22/2024

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?

Monitor 2024 ICD-10-CM guideline revision for COVID-19

10/16/2023

by: Savannah Schmidt

Question: Are there any ICD-10-CM 2024 code or guideline updates related to COVID-19 screening or diagnosis?

Pay attention to Medicare POS limits for procedures in non-facility (office) setting

10/09/2023

by: Laura Evans, CPC

Question: We had a provider perform an excision of prepatellar bursa (27340) in the office, place of service (POS) code 11. Patient has United Healthcare Shared Services-GEHA insurance. They denied the claim stating that CPT 27340 is not billable with POS 11. I have never had this issue before. Are there any coding rules/guidelines that prohibit use of some CPT codes at certain places of service or is this some weird payer-specific rule?

No LT for PAs: With one exception, locum tenens is physicians-only

09/11/2023

by: Roy Edroso

Question: Some of our clinical staff is going on vacation and we’re going to bring in locum tenens providers to cover for them. We have a physician assistant (PA) who wants us to swap in a fellow PA who freelances in a reciprocal billing arrangement. Can we do that?

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