Part B News | Ask a Part B News Expert

Bundling policies likely to block pay for 99000

07/17/2023

Question: Our practice performs and bills for simple tests in our CLIA-waived lab. For more complex tests, the patient comes to the practice, we collect the specimen and send it to an outside lab. In both cases, storing and handling specimens takes extra time and expense. Can we bill 99000 (Handling and/or conveyance of specimen for transfer from the office to a laboratory)?

Count MDM risk level based on viable treatment options discussed at encounter

07/03/2023

by: Laura Evans, CPC

Question: When selecting the level of risk to code based on medical decision-making (MDM), the 2023 E/M guidelines state that you can count the risk of treatment options that were discussed but ultimately not chosen. We are wondering how much discussion must be documented in order to count toward risk? For example, our providers will list the treatment options and then document what was recommended and decided...

Calling patient with test results is not a telephone E/M service

06/26/2023

by: Julia Kyles, CPC

Question: Our physicians and nurse practitioners (NP) prefer to call patients with their test results rather than waiting until the next visit or delegating the task to a member of clinical staff. Most of the calls last at least five minutes, but some can take much longer. Our providers have said we should bill the calls as telephone E/M services (99441-99443) when the patient is a Medicare beneficiary or has a payer that covers telephone E/M. Is that permissible?

Want a J-1 visa doctor? Prepare to work (and pay) for it

06/26/2023

by: Roy Edroso

Question: We’re in a HPSA [health professional shortage area] and have trouble finding appropriate doctors. I’m told there’s a government program that allows qualified foreign doctors who want to work in the U.S. to do so if they commit to working in a HPSA. How do we get in on that?

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

06/12/2023

by: Julia Kyles, CPC

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?

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