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OK to bill view of asymptomatic knee, but code and document properly

04/16/2018

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?

Check opioid prescribing habits against average for your practice’s specialties

04/16/2018

by: Julia Kyles

Use the latest comparative billing report (CBR) to determine whether your practice’s clinicians may be flagged for a higher-than-average prescribing pattern.

Ransomware hits health care hard; protect your practice with these 10 security steps

04/09/2018

by: Roy Edroso

Ransomware is blowing up and experts warn health care businesses aren’t taking the necessary precautions. Have you?

OIG audit finds sky-high PT error rate; secure correct billing patterns

04/09/2018

by: Richard Scott

Tie up the loose ends in your plan-of-care process when your patients take part in physical therapy services and be careful about the units of service you report per code or you may get tied up in audits backed by the Office of Inspector General (OIG).

Next-generation genetic cancer test gets NCD; for advanced cancer patients only

04/09/2018

by: Roy Edroso and Richard Scott

CMS has cleared a new genetic cancer test for Medicare patients – but be aware that it’s not for every patient, or even every cancer patient.

Your practice must accommodate service dogs — within reason

04/09/2018

by: Roy Edroso

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?

Physical therapy claims rise, denials fall over recent three-year period

04/09/2018

by: Richard Scott

The most frequently reported physical therapy code, 97110 (Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility), topped $1.1 billion in payments in 2016, the latest year of available Medicare claims data.

From the Part B News blog

04/05/2018

Take note of the news that happens between Part B News issues by checking out the free Part B News blog at https://pbn.decisionhealth.com/Blogs/default.aspx. Here’s a sampling from this week.

Medical practice pros urge CMS to streamline E/M reporting, boost MDM

04/02/2018

by: Richard Scott

Physicians and medical practice advocates called on CMS to simplify the current E/M documentation guidelines during a March 21 listening session that the agency convened to gather feedback from professionals who work with E/M reporting on a routine basis.

Foot-dragging on Stark reform leaves APMs at risk, slows growth of program

04/02/2018

by: Roy Edroso

Congressional foot-dragging on reform of Stark and other fraud-and-abuse laws may leave providers in alternative payment models (APMs) subject to penalties even if they’re acting in good faith — which may be making the program too difficult for all but the richest entrants to attempt.

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