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Question: If Medicare beneficiary enrolled in a skilled nursing facility (SNF) under Part A goes to see a practice physician in her office and the doctor performs E/M and an X-ray, orders a lab test and prescribes a drug, how would each of these services be billed by that physician’s office?
Question: We have a non-physician practitioner (NPP) who works with our physicians, and all his work is claimed incident to. Sometimes I’m not sure it’s appropriate. I’m told that as long as the supervising physician is in the office when the NPP works and signs the claim, there’s no problem. Is that so?
Question: A patient presents for an evaluation of unilateral knee pain and we do four standing X-ray views of the knee that capture the contralateral side. We have always billed this scenario as 73564 (Radiologic examination, knee; complete, 4 or more views) with RT or LT as appropriate. There has been some discussion lately that we should bill 73560 (Radiologic examination, knee; 1 or 2 views) for the contralateral views if they are interpreted on. However, I feel if the patient has no complaints on the contralateral side, the medical necessity wouldn't be there even if the X-rays reveal something such as osteoarthritis. Does anyone know of an official source that states whether the contralateral side can be billed or not in the absence of patient complaints?
Question: I saw a story in the news about a Nashville, Tenn., woman who was suing her doctor’s office for not allowing her service dog, who helps with her post-traumatic stress and obsessive-compulsive disorders, to accompany her on her doctor’s visit. Do practices have to accommodate service animals? What if they’re aggressive or the other patients in the waiting room are allergic?
Question: For new patients who are not on Medicare, our office uses the office consultation codes 99241-99245 if referred by a doctor and 99201-99205 if self-referred. The E/M criteria are met for time, history and exam for all codes. Is our use of the consultation codes correct? Is it commercial carrier dependent?

Part B News recently fielded two questions about prolonged services when a face-to-face visit has not occurred:

Question: I heard about a doctor who was in the U.S. on a green card and was detained by immigration authorities. Do I have to worry about my staff who are here on green cards or work visas getting taken away? Can I just decline to hire such people to avoid the problem?
Question: My doctor wants to bill 29125 (Application of short arm splint [forearm to hand]; static) with 29700 (Removal or bivalving; gauntlet, boot or body cast), and from what I understand these codes should not be paired together when the original cast was put on by the same physician. Is that correct policy? If they are not to be billed together, is there anything in writing I can show my providers?

Question: We had a patient walk out of an encounter before the doctor could complete her exam. Is there any way to bill for this?

Question: We have a physician assistant (PA) who sees a patient under the doctor’s supervision for the patient’s first few visits. During those visits, surgery is indicated and the patient then sees the physician to discuss and consent to surgery. Can the physician bill for this visit or is it considered part of the pre-op package? Sometimes surgery is already scheduled before the patient sees the physician. When the surgery is already scheduled but it is the physician’s first time seeing the patient, can this visit be billed?


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