Part B News | Ask a Part B News Expert

New diagnosis? Try a corrected claim, but expect pushback from your MAC

05/10/2021

Question: We’ve had a claim denied on the basis of medical necessity because the provider’s original diagnosis was not covered. Now the provider, after further analysis, has determined that the actual issue is different from what she had originally thought and she wants to change her diagnosis and treatment. Can we resubmit the previous claim with the new diagnosis?

Can your MA handle the TCM initial patient contact? Yes — until the patient responds

04/19/2021

by: Roy Edroso

Question: We often do the initial patient contact for transitional care management (99495, 99496) that has to occur within two days of discharge by email or text. Do we need the M.D., or even a nurse practitioner or physician assistant, to do this? Can’t my medical assistant do the outreach?

When figuring out modifier 52 vs. 53, think: What’s the effect on the patient?

04/05/2021

by: Roy Edroso

Question: What’s the difference between modifiers 52 (Reduced services) and 53 (Discontinued procedure)? They seem pretty similar, because in both cases you stop part-way through.

How to set E/M risk level when a different doc does the surgery

04/05/2021

by: Laura Evans, CPC

Question: I am not sure how to set the risk level when a physician refers the patient for possible surgery that will be performed by a different doctor. For example, an orthopedic surgeon sees a patient with Dupuytren’s contracture and discusses the treatment options — Xiaflex injection or fasciectomy with the patient. Please help.

Are you ‘information blocking’ if you don’t have an EHR? Not necessarily — at least for now

03/29/2021

by: Roy Edroso

Question: Our practice does not have electronic health records (EHR). Instead, we keep paper patient records. I understand the new information blocking rule that goes into effect April 5 requires that I give my patients their protected health information (PHI) in whatever format they request. Will I be in violation of the rule if I can only give them paper?

Not much market for cryptocurrency payments in medical practices – for now, experts say

03/22/2021

by: Roy Edroso

Question: I’ve been seeing a lot in the media about cryptocurrencies, such as Bitcoin. They seem to be getting more popular. Should I offer to accept cryptocurrency for payments?

Take cues from the note: How to navigate ‘acute’ and ‘chronic’ conditions

03/15/2021

by: Laura Evans

Question: We are struggling to get our providers to document whether the problems they are treating are acute, chronic or acute on chronic. I have not found a guide or publication that instructs coders what to do if this important information is missing except to query the provider. This is causing a lot of upset within our office and I’m wondering if this is one of those issues for which we should create our own internal policy for documentation?

Can you report patient whose license is a threat? Check local law, board rules

03/08/2021

by: Roy Edroso

Question: I diagnosed a patient with a seizure disorder. I told her to report the diagnosis to the Department of Motor Vehicles (DMV) as it may invalidate her license; I’m pretty sure she won’t do it. If I report her to the DMV myself, am I violating her confidentiality?

You should report encounters at the ‘drive-in’ site as a face-to-face visit

01/25/2021

by: Julia Kyles, CPC

Question: We have patients who can’t take part in an audio/visual telehealth visit, which is currently allowed under the COVID-19 rules. We understand we can report telephone-only visits, but the Drug Enforcement Agency (DEA) requires a real-time, two-way, audio/visual encounter when the doctor or treating practitioner writes a prescription for a controlled substance.

If doctor dies before signing the note, bill with an explanation

01/25/2021

by: Roy Edroso

Question: One of our doctors failed to review and sign the encounter notes on some of his visits — and then, unfortunately, he passed away. Can we bill for the visits?

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