Part B News | Ask a Part B News Expert

Patients asking for vaccine exemptions? Stick to medical facts

11/08/2021

Question: We have had some patients calling for an appointment to “get a COVID vaccine exemption.” They seem to have jobs that mandate their vaccination. Do we need to tell our doctors anything? Should we prepare some kind of form?

Spotted a claim error? Before appealing, consider resubmitting or reopening

10/25/2021

by: Roy Edroso

Question: I‘ve heard that, rather than waiting for a denial on a claim so I can request a formal appeal, I can ask to have my claim changed after I’ve submitted it to the Medicare administrative contractor (MAC). I’ve heard this variously called a “reopening” and a “resubmission.” My question is, how do I do it?

How to report debridement procedure with rash treatment

10/25/2021

by: Sarah Gould

Question: A wound care patient with a 25-sq-cm chronic foot ulcer presents with a new cellulitic rash, which is treated using topical medication. During the visit, the physician also surgically removes dead tissue from the ulcer. How would these services be reported in CPT?

Respect patient requests to withhold information from payers

10/11/2021

by: Julia Kyles, CPC

Question: We have an adult patient who is covered by her parents’ insurance. She is scheduled for a service but she said she’ll pay for it herself and we can’t bill insurance. According to the patient, this comes from HIPAA but we aren’t familiar with that part of the rule. Is there any official guidance about it?

Can I use modifier 78 if doctor leaves and returns? Only if patient goes too

10/11/2021

by: Roy Edroso

Question: Our M.D. performed surgery on a patient, finished the procedure and left the OR. The patient decompensated. Immediately, the M.D. was brought back into the OR to fix the problem, which he did. The patient did not leave the OR between the two procedures. Is this a case for modifier 78 (Unplanned return to the operating room by the same physician fol lowing initial procedure for a related procedure during the postoperative period)?

How to capture ICD-10-CM coding for post-COVID-19 conditions

10/04/2021

by: Shannon McCall

Question: The 2022 ICD-10-CM code set includes a new code, U09.9 (Post-COVID-19 condition, unspecified), for post-COVID-19 conditions. When would it be appropriate to report this code?

Streaming a family update via Zoom? Don’t bill as an office visit

09/27/2021

by: Julia Kyles, CPC

Question: My doctor had a telehealth visit with a 75-year-old patient who has well-controlled diabetes and mild cognitive decline. A week later, with the patient’s permission, the physician gave the patient’s adult daughter an update on her father’s health. The conversation took place through Zoom and lasted 23 minutes. The patient wasn’t present. Can we bill the conversation to Medicare as an E/M visit (99202-99215) under the special rules for telehealth services or, alternatively, the new E/ M guidelines?

Don’t miss the revenue opportunity in a doctor’s virtual consult request

09/13/2021

by: Julia Kyles, CPC

Question: The specialists at our practice regularly perform what we call virtual consults and we’re wondering if there’s any payment for their work. Typically, a primary care physician will call or send an email asking for advice on treating one of their patients. It usually takes our doctors a few minutes to review the data the requesting doctor provides and email a reply. But some cases are complicated and include review of several test results, some research and long conversations with the requesting doctor. The patient does not come to our office and, in most cases, our physicians have never seen the patient. We know we can’t bill an office visit (99202-99215), a consult (99241-99245 or 99251-99255) or a virtual visit (G2010 or G2012). Are there any other options?

Cloned notes can lead to legal trouble – run audits, ‘use cases’ to minimize risk

08/16/2021

by: Roy Edroso

Question: We know that if we’re not careful our cloned notes can lead to inappropriate data in an encounter record, which in turn can lead to denials and takebacks. But can you be prosecuted for fraud because of cloned notes?

Don’t chain social determinants of health for MDM risk to ICD-10-CM codes

08/16/2021

by: Julia Kyles, CPC

Question: We are considering the following policy for E/M visits: Coders can’t select moderate risk because a social determinant of health (SDOH) affected the diagnosis or treatment, unless the note supports an SDOH diagnosis code from the Z55-Z65 range (Persons with potential health hazards related to socioeconomic and psychosocial circumstances). That way we can make sure the risk level is supported by the note.

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