Part B News | Ask a Part B News Expert

‘After-hours’ codes can add dollars, and so can ‘during-hours’ codes

10/24/2022

Question: One of our commercial payers offers extra payment from the add-on codes 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed [eg, holidays, Saturday or Sunday], in addition to basic service) and 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service). I get the first code, but the second one just sounds like normal service during normal hours. What’s the deal?

When the patient brings a drug and you inject? Largely OK; charge a penny

10/10/2022

by: Roy Edroso

Question: We have a patient whose testosterone therapy is ordered elsewhere and will be sent to us for injection. I’ve had it drilled into me that we never leave off the drug code when we bill administration, but we clearly can’t charge for the drug. How do we bill?

Use these strategies when a payer inappropriately uses modifier 50

08/29/2022

by: Laura Evans, CPC

Question: We recently sent a claim to Blue Cross of Alabama that included 20610-LT for a left shoulder diagnosis and 20610-RT for a right knee diagnosis. The payer responded that we should have billed these procedures on one claim line with a 50 modifier (bilateral procedure). We replied that this was not a bilateral procedure, but rather two separate procedures done in two separate joints. The payer then stated that because code 20610 has a bilateral surgery indicator of “1” in the Medicare physician fee schedule, modifier 50 should be used rather than RT/LT. There doesn’t seem to be any way to report a major joint arthrocentesis done on different joints on opposite sides of the body. Is there a way to correct the situation?

Directory glitch caused patient overcharge? Under NSA, you pay, not the plan

08/08/2022

by: Roy Edroso

Question: I know the No Surprises Act (NSA) and the CMS rules that put it in practice require that provider directories be kept up to date. But I thought that was all the insurers’ responsibility. The other day I was looking at guidance from a CMS’ Center for Consumer Information & Insurance Oversight (CCIIO) that says, among other things, “Under the No Surprises Act, providers and health care facilities must generally ... refund enrollees amounts paid in excess of in-network cost-sharing amounts with interest, if the enrollee has inadvertently received out-of-network care due to inaccurate provider directory information.” Why is this the providers’ responsibility?

Admit service dogs within reason, but ‘emotional support’ doesn’t fly

06/06/2022

by: Roy Edroso

Question: I have read the Part B News story about service animals in the practice (PBN 4/9/18). Since that story was published, I have seen a lot of coverage of “emotional support” animals and wonder if shared public spaces like the doctor’s office are required to accommodate them as well.

Ensure appropriate documentation for modifier 25

06/06/2022

by: Sarah Gould, CPC

Question: What is the best way to determine if an E/M service is above and beyond the physician work normally associated with a procedure to justify the use of modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service)?

Refer to AMA guidelines, not Medicare, for approved RTM billing

05/23/2022

by: Laura Evans CPC

Question: We have a provider who is performing knee implants that will allow him to bill for the remote therapeutic monitoring (RTM) codes (98980 and 98981). The vendor is telling us that clinical staff can perform these services based on coding information they found online, but a recent CPT Assistant seems to be saying that a physician or qualified health care practitioner (QHP) must personally perform those services and that they can’t be billed by clinical staff. I am not sure how to proceed.

No time limit on incident-to billing if problems are unchanged

05/09/2022

by: Richard Scott

Question: I read your recent article about incident-to billing. One of my practitioners has a question I am unable to answer. Is there a time limit on what is considered a new problem? For example, if a patient is not treated for a particular problem in over a year, is it now considered a new problem? Please advise.

Didn’t get discharge data? Sorry, you can’t charge TCM

05/02/2022

by: Roy Edroso

Question: We performed transitional care management (TCM) on a patient who had been discharged as an inpatient by a provider from a different practice. When our claim went in, the payer did not have the discharge summary on file and denied our claim. What can we do?

Turn to Q codes, modifier JW for discarded CTP products

05/02/2022

by: Sarah Gould, CPC

Question: How do you code and bill for wound debridement involving the disposal of unused cellular-based tissue product (CTP)?

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