Part B News | Ask a Part B News Expert

For E/M, initial NPP-only visit counts — unless there’s no professional service

08/26/2019

Question: A new patient came in and saw our physician assistant (PA) for some lacerations. She did not see a doctor. A week later the patient returned for follow up with an M.D. For purposes of billing the E/M, is the doctor visit a new patient visit or an established patient billing?

Providers leaving notes unsigned? Let them attest — or make them work weekends

07/29/2019

by: Roy Edroso

Question: Some of my doctors are signing their charts for claims very late — weeks, even months late. Can I submit these claims? If a chart is signed too long after the encounter, is it invalidated?

Pivot to E/M codes when ear-wax removal fails to get the job done

07/29/2019

by: Richard Scott

Question: I have a common scenario that I encounter that I don’t know how to report. If my provider performs a technique to irrigate impacted cerumen in the clinic, but the removal of ear wax is not actually achieved, can I still report CPT code 69209 (Removal impacted cerumen using irrigation/lavage, unilateral)?

Billing an outpatient who’s an inpatient? Bill where they’re admitted, not treated

07/08/2019

by: Laura Evans, CPC

Question: We have a patient who received outpatient care at our hospital clinic. This patient is also currently an inpatient in a rehab orthopedic hospital. We’re getting a Recovery Auditor (RAC) investigation on our charges for the patient stating we cannot bill an outpatient physician visit while the patient is an inpatient. (Our hospital bills an outpatient code on the rehab hospital’s inpatient bill.) The hospitals are both owned by the same system. What can we do?

To avoid denials, ensure CCM initiating visit code G0506 goes beyond norm

07/01/2019

by: Richard Scott

Question: I’m seeing a lot of denials on my initiating visit claims for chronic care management (CCM) services. Is that because I’m reporting the CCM code with a routine E/M code? Do I need to wait for a specific date to bill? Please help!

Focus on opioid review regardless of history, prescriber when reporting AWVs

05/06/2019

by: Richard Scott

Question: Regarding the recent updates from CMS, do we need to document “opioid review” in the wellness visit note if the patient has not recently been on opioids? We have a general “drug use” question on our wellness forms but nothing specific to opioids. Secondly, if the patient is on opioids prescribed by another provider, do we need to document opioid review? When our providers prescribe opioids, we always document review, alternative treatment, failed treatment, etc., so that is not a concern.

Don’t bill for treating even extended family of the doctor — or her associates

04/22/2019

by: Roy Edroso

Question: In the “Charges Imposed by Immediate Relatives of the Patient or Members of the Patient’s Household” section of the Medicare Policy Manual, CMS lists several categories of persons whose treatment cannot be billed to Medicare when the related provider treats them. But if a doctor who is not related to me supervises my treatment, but the NPP who actually performs the treatment incident-to is related to me, can the doctor charge for that? Also, if I’m the spouse of one of the doctors in a practice, are all the doctors in that practice prohibited from charging for my treatment?

Don’t jump the gun with modifier 53 – wait for the anesthetic

04/15/2019

by: Roy Edroso

Question: Our doctors sometimes have to cancel a procedure because of patient prep non-compliance, patient emergency, a fever, etc. Is it okay to just stick modifier 53 (Discontinued services) on the claim?

‘Do-over’ on this split procedure is probably a start-over, too

04/08/2019

by: Roy Edroso

Question: An emergency department physician treated a dislocated shoulder reduction (23655) and billed with modifier 54 (Surgical care only), as the patient’s orthopedist would be handling follow-up care with modifier 55 (Postoperative management only). The patient returned to the ED two months later having fallen and dislocated the same shoulder. Our ED physician once again reinserted the shoulder using closed manipulation. How should the second service be reported?

Pay attention to the details when selecting new psychological testing codes

03/25/2019

Question: My pain management practice is using two forms of risk assessment questioning for our pain management patients -- one cpmputer-based, one on paper. However, the 2019 codes are completely different tham what we were using. How do we code them now?

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