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Question: When might it be appropriate to report CPT codes for multiday electroencephalograms (EEG)? In addition, should these codes be billed on the day of initiating or ending the EEG study?
Question: The medical decision-making table for office E/M visits (99202-99215), includes “Diagnosis or treatment significantly limited by social determinants of health” as one example of moderate risk. When can we count that toward a patient visit?
Question: I understand how to count tests that are ordered or reviewed for office visits. But I’m not sure how to count “the prior review of external note(s) from each unique source.” Does the review of one note from one physician or qualified health care professional (QHP) from a different group or specialty count as one source?
Question: Our provider did a depression screening billable with G0444 (Depression screening, 15 minutes) and went a little over the 15 minutes required. The provider thinks we should add the prolonged preventive service code G0513 (Prolonged preventive service[s] [beyond the typical service time of the primary procedure], in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes [list separately in addition to code for preventive service]). Our provider didn’t add anywhere near 30 minutes to the session, however. Can we still claim it?
Question: We often perform trigger points (20552-20553) on the same day that established patients come in for E/M visits (99211-99215). I heard that in 2020 Medicare said that we no longer need to append modifier 25 (Significant, separately identifiable E/M service) when the E/M takes place on the same day as a trigger point injection. Is that true?
Question: We’ve had a claim denied on the basis of medical necessity because the provider’s original diagnosis was not covered. Now the provider, after further analysis, has determined that the actual issue is different from what she had originally thought and she wants to change her diagnosis and treatment. Can we resubmit the previous claim with the new diagnosis?
Question: We often do the initial patient contact for transitional care management (99495, 99496) that has to occur within two days of discharge by email or text. Do we need the M.D., or even a nurse practitioner or physician assistant, to do this? Can’t my medical assistant do the outreach?
Question: What’s the difference between modifiers 52 (Reduced services) and 53 (Discontinued procedure)? They seem pretty similar, because in both cases you stop part-way through.
Question: I am not sure how to set the risk level when a physician refers the patient for possible surgery that will be performed by a different doctor. For example, an orthopedic surgeon sees a patient with Dupuytren’s contracture and discusses the treatment options — Xiaflex injection or fasciectomy with the patient. Please help.
Question: Our practice does not have electronic health records (EHR). Instead, we keep paper patient records. I understand the new information blocking rule that goes into effect April 5 requires that I give my patients their protected health information (PHI) in whatever format they request. Will I be in violation of the rule if I can only give them paper?


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