Part B News | Part B News

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

10/09/2023

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?

Capture the beat: Correctly report CPT codes for cardio testing, monitoring

10/09/2023

by: Savannah Schmidt

Review the most common types of external diagnostic cardiology tests, examine relevant CPT coding guidelines, and offer reporting advice from expert sources to ensure your billing patterns are capturing the right services.

2022 saw historic drops in Part B utilization and payment; tests rise

10/09/2023

by: Roy Edroso

Based on just-released Medicare Part B claims data, the 15 most-billed codes in 2022 were similar to those in 2021 and 2020, with one major COVID-related exception. But overall Medicare utilization and reimbursement took a big hit compared to prior years.

$850K for misusing modifier 25? Tighten up on policy and patterns

10/02/2023

by: Roy Edroso

An $850,000 DOJ settlement over alleged misuse of modifier 25 serves as a reminder that sometimes modifier misuse rises to something more than a coding dispute and can put you in False Claims Act jeopardy.

COVID comeback may call for masks – and delicacy in reintroducing them

10/02/2023

by: Roy Edroso

As COVID creeps back onto the scene, practices that relaxed their masking and social distancing requirements may want to bring them back. One expert suggests that you use caution lest you turn off patients who have been made skeptical by years of pandemic measures.

Take steps to minimize confusion, ensure compliance if you report telehealth consults

10/02/2023

by: Julia Kyles, CPC

Train coders and providers on Medicare’s rules for telehealth consults (G0406-G0408 and G0425-G0427) and keep a close eye on claims and documentation if your practice performs these services.

Split visits in the office should follow incident-to rules

10/02/2023

by: Julia Kyles, CPC

Question: I recently read that practices can use CMS’ model for split/shared visits in the facility setting to report joint or collaborative visits in the office (99202-99215). Here’s a sample scenario. Can you shed some light on how we should bill these services?

AMA and CMS seem to disagree on bundling of hip arthroscopy codes

10/02/2023

by: Laura Evans, CPC

Question: Medicare’s National Correct Coding Initiative (CCI) includes a code pair listing CPT codes 29916 and 29915 as mutually exclusive procedures but allows you to unbundle the edit with a modifier. But the AMA says not to report the two codes together. Any explanation as to why CMS and the AMA conflict on these codes, other than that CMS is sometimes at odds with the AMA and private payers?

CMS accepts new POS code for outreach involving site/street services

10/02/2023

by: Julia Kyles, CPC

Ignore the earlier version of CMS 100-04, Change Request 13314 and use new place of service (POS) code 27 (Outreach site/street) when appropriate.

Telehealth consults stayed above pre-COVID-19 levels

10/02/2023

by: Julia Kyles, CPC

Medicare claims for telehealth consults fell somewhat in 2021 after a sharp rise in 2020, but the overall total exceeded claims submitted in 2019, according to Part B News analysis of the latest Part B claims data.

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