Part B News | Ask a Part B News Expert

Avoid absolutes when selecting the level of risk for MDM

03/24/2025

Question: When calculating risk for an E/M visit, is total parenteral nutrition (TPN) moderate risk or high risk? We found some sources that state it should be compared to prescription drug management, which would be moderate risk. Other sources say it should be compared to drug therapy requiring intensive monitoring for toxicity, which is high risk.

Doing the splits: MDM offers more flexibility for split/shared visits

03/17/2025

by: Julia Kyles, CPC

The answers to a reader’s questions about split/shared visits demonstrate that medical decision-making (MDM) can boost your care team’s effectiveness.

CCM codes were not replaced by chronic pain management codes

02/17/2025

by: Julia Kyles, CPC

Question: Did chronic pain care management codes G3002 and G3003 replace chronic care management codes 99490 and 99439?

Can you force patients to get an AWV? Not without risk.

02/03/2025

by: Roy Edroso

Question: I’m a patient of a local primary care practice that recently sent me a letter saying they are “required by CMS to perform and submit annual wellness exam information on each Medicare/Medicare Advantage patient each year. Although CMS does not penalize the member when the AWV information is not submitted annually, your PCP/Provider is reported as being non-compliant with patient care, which does affect our standing and reimbursement with CMS.” For that reason, the letter went on, “our office requires that all patients with Medicare/Medicare Advantage coverage undergo an AWV annually to continue to retain [the practice] as their Primary Care Physician (PCP).” Can they do that?

Clarify risk adjustment goals and financial directives

01/27/2025

by: Jennifer Brettler, DO, FACP, CHCQM-PHYADV

Question: We know that risk adjustment can impact reimbursement, quality of care, insurance plan ratings, and overall performance, but what does risk adjustment really mean?

Consider the pros and cons of furnishing an AWV during same-day E/M

01/06/2025

by: Son Hoang

Question: What are the pros and cons of performing an annual wellness visit (AWV) at the same time as an E/M office visit versus separating them into two visits?

No per-stay limit for infectious disease add-on code

12/16/2024

by: Julia Kyles, CPC

Question: Can the add-on code for infectious disease consultations (G0545) only be reported once per admission or stay in observation?

Third-party biller fraud may hook your practice, unless you protect yourself

11/25/2024

by: Roy Edroso

Question: I recently read about a third-party biller who was charged with health care fraud and eventually entered a plea agreement — but the practice he worked for was not charged. I thought fraudulent medical billings were always the responsibility of the provider whose services were billed. Is it possible for a biller to be guilty but not the provider?

HIPAA Q&A: Navigate data sharing, recent HIPAA rules changes

11/04/2024

by: Rebecca Herold, CDPSE, FIP, CISSP, CIPM, CIPP/US, CIPT, CISM, CISA, FLMI

Question: How should compliance leaders navigate the complexities of data sharing and interoperability initiatives while maintaining strict adherence to HIPAA regulations?

Home BP readings for ‘white coat hypertension’? OK, but probably not RPM.

10/28/2024

by: Roy Edroso

Question: I have a patient who claims “white coat hypertension” — that is, he says his home blood pressure readings are significantly lower than the ones we get in the office. He has a home BP device, a Pressure X Pro, that connects to the internet. Can I take a reading via this device? And, in addition to adding it compliantly to encounter notes, can I claim 99091 (Collection and interpretation of physiologic data [eg, ECG, blood pressure, glucose monitoring])?

Login

User Name:
Password:
Remember me Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.