Part B News | Ask a Part B News Expert

Are no-shows fees legal? Yes, in most cases, but you still may want to avoid

06/17/2024

Question: We charge patients $50 if they miss an appointment. I think it’s helped reduce no-shows. But we had one patient who missed an appointment and has refused to pay the fee. My boss wants to send it to collections, but I want to make sure first: Are we actually allowed to do that? (The patient is on Medicare.)

Stick to documentation requirements for wound sizing in CPT

06/03/2024

by: Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC

Question: Do you have any advice for encouraging providers to improve documentation for wound sizing in CPT?

Ortho CPT coding Q&A: Know units of service, payer policies to capture pay

05/13/2024

by: Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC

Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, an independent medical coding education consultant, answers some of the many questions she receives pertaining to physician coding for CPT orthopedic services.

Reduce denials for CPT critical care E/M services with detailed documentation

05/06/2024

by: Hamilton Lempert, M.D., FACEP, CEDC

Question: What documentation criteria are required to report CPT critical care codes 99291-99292?

‘Administrative’ fees for patient messages? Not if it’s about treatment.

04/29/2024

by: Roy Edroso

Question: I have seen stories in the press about practices charging “administrative fees” for calls, emails and texts from patients. I can’t see how this would be allowed by insurers. Can I really charge for this?

Make sure TPIs scheduled before April 1 will meet new LCD policy

04/29/2024

by: Julia Kyles, CPC

Question: Our Medicare administrative contractor (MAC) has adopted the new local coverage determination (LCD) for trigger point injections (20552-20553). The LCD limits the number of trigger point injections a patient may receive to three sessions per rolling 12-month period. Will the April 24 visit count as the third injection under the LCD?

Heed definitions, dx requirements in new trigger point injection LCD

03/25/2024

by: Julia Kyles, CPC

Question: We have three follow-up questions about the new local coverage determination (LCD) for trigger point injections (20552-20553) that will take effect on April 1.

Check the payer first when selecting codes for obesity counseling

03/04/2024

by: Laura Evans, CPC

Question: At our orthopedic practice we sometimes must postpone a patient’s total joint replacement because their BMI is too high. We either refer them back to their PCP for weight loss management or to a weight loss program at another facility. One of our providers is working to become certified in weight loss counseling, which would allow her to provide this service at our practice rather than referring the patients elsewhere. How would this service be billed?

How to code when the orthopedist is called to evaluate an inpatient

03/04/2024

by: Laura Evans, CPC

Question: One of the coders I work with consistently uses the subsequent inpatient or observation codes (99231-99233) to bill for hospital H&Ps by their orthopedic surgeons. A typical scenario would be when the orthopedist is called to evaluate a hospitalized patient with a known orthopedic injury who was admitted by another physician. The orthopedist has not previously seen the patient. I am seeing conflicting guidance on this from different sources. Can you please clarify?

Check the setting and timing on SDOH risk assessments

02/26/2024

by: Julia Kyles, CPC

Question: Can we report G0136 (Administration of a standardized, evidence-based Social Determinants of Health [SDOH] Risk Assessment, 5-15 minutes, not more often than every 6 months) in the patient’s home? And does the provider have to perform the assessment on the same day as the E/M visit (99341-99345 and 99347-99350), or can they perform the assessment on a different day?

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