Part B News | Ask a Part B News Expert

Consider this rule of thumb when selecting MDM complexity for fracture care

05/01/2023

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?

Stick to current POS guidelines for post-PHE telehealth visits

04/10/2023

by: Julia Kyles, CPC

Question: Our practice will continue to perform telehealth office visits (99202-99215) under the waiver extension. Which place of service (POS) should we use for Medicare patients after the COVID-19 public health emergency (PHE) ends?

Be careful about upcoding; DOJ may come after it as a false claim

02/13/2023

by: Roy Edroso

Question: I recently saw a Department of Justice settlement in North Carolina that seemed to be entirely based on a pattern of upcoding E/M. I didn’t know federal prosecutors did that! Is it common?

Don’t try to DIY when you need alternative language options for ABNs

01/09/2023

by: Julia Kyles, CPC

Question: Medicare creates advance beneficiary notices of noncoverage (ABN) in English and Spanish, but the majority of our limited English proficiency patients speak Korean. Does our practice need to create an ABN in the appropriate language when an official version isn’t available?

Give coders a chart, not a calculator to find new prolonged threshold times

12/05/2022

by: Julia Kyles, CPC

Question: We are trying to understand the time requirements for G0316, G0317 and G0318. We thought CMS added an extra 15 minutes to the threshold times listed in the new CPT guidelines.

Know how to report a hypertensive crisis in ICD-10-CM

12/05/2022

by: Savannah Schmidt

Question: What is a hypertensive crisis and how is it reported in ICD-10-CM?

Virtual incident-to visits are still a choice during COVID-19 PHE

10/31/2022

by: Julia Kyles, CPC

Question: We conducted a sample review of claims for 2021 and found two visits that were performed by the physician assistant (PA) but billed incident-to on days when the physician was not in the office. When we investigated, we found more claims with the same problem. According to the documentation for each visit the physician was at home but “present” through a real-time, audio/visual Zoom connection. Is there an exception that allows us to bill incident-to this way?

Virtual incident-to is an option through 2023

10/31/2022

by: Julia Kyles, CPC

Physicians can provide virtual direct supervision thanks to one of the many waivers that CMS created in response to the COVID-19 pandemic. Virtual direct supervision gives the practice more flexibility to bill incident-to services, but it is not a permanent policy.

Check state scope laws on who may debride mycotic nails

10/31/2022

by: Laura Evans, CPC

Question: I would like clarification on whether only MDs, DPMs, APRNs or PAs are allowed to perform and bill Medicare for debridement of mycotic nails (codes 11720 and 11721) in the office setting, when all the other criteria for the procedures have been met. Recently, I have been asked about a nail technician or medical assistant performing these procedures under supervision of a MD or DPM and billing the services to Medicare as incident to. I have found no information to suggest that this is appropriate. Am I correct in stating that nail technicians or medical assistants are not qualified to perform this service?

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