Part B News | Ask a Part B News Expert

Report unlisted code for pleural catheter declotting procedure

01/20/2020

Question: The physician is performing a pleural catheter flush using saline with manual clearance of clots under ultrasound in the outpatient setting. Should we bill an E/M code (99212-99215) depending on documentation or some other code?

Patient’s not trying to quit? Then you should pivot away from ‘smoking cessation’

01/13/2020

by: Roy Edroso

Question: Our doctor saw a patient who complained about his tobacco use but did not clearly express — at least so far as the notes show — a desire to quit. Can we infer from his bringing the subject up that he was asking for cessation help and bill 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes)?

Only charge hospice patients for non-end-of-life issues — unless you’re the attending

12/30/2019

by: Roy Edroso

Question: A patient was brought into our practice by her family for treatment of a sprained ankle. We were told she is currently receiving the Part A hospice benefit. Do I need to contact the patient’s hospice provider, interdisciplinary group (IDG) or anyone else for billing purposes? Do I need to add anything to the billing?

If secondary provider is out of network, so is their charge — but check state law first

12/16/2019

by: Roy Edroso

Question: One of our doctors assisted at surgery and found out later that, unlike the primary surgeon, he’s not credentialed with the payer under whose plan the patient is insured. Given that he’s not the billing provider, how will he be paid?

If multiple biopsies exceed MUEs, expect a denial — unless you can split them by side

12/09/2019

by: Roy Edroso

Question: My doctor recently did 10 biopsies on a single patient and we’re billing 11102 (Tangential biopsy of skin; single lesion) and 11103 (Tangential biopsy of skin; each separate/additional lesion). I see by CMS’ medically unlikely edits (MUEs) update that the former has a practitioner services MUE value of 1, and the latter has a value of 6, so we’re clearly going to exceed that. I fear we’ll get caught in an edit. Is there anything we can do ahead of time to avoid a denial?

Treating patients in the parking lot: You can, but proceed with caution

11/04/2019

by: Roy Edroso

Question: I saw a TV news story recently about how a doctor in Massachusetts treated patients in a parking lot when a power outage made her office unusable. “One patient, I saw in the car,” the doctor said. Was that a good idea? Shouldn’t they have sent their patients to another practice or rescheduled?

Complications drop off HCC risk scores if your provider doesn’t address them

10/28/2019

by: Roy Edroso

Question: Say a doctor sees a diabetic patient, notes blood sugar and increases the insulin dose. The chart includes diagnosis codes for diabetes mellitus (DM) with nephropathy (E11.21) and polyneuropathy (E11.42), but the notes do not otherwise address the polyneuropathy and nephropathy. For risk adjustment purposes, would this map to hierarchical condition category (HCC) 18 (Diabetes with chronic complications) or to HCC 19 (Diabetes without complication)? And if the nephropathy and polyneuropathy are not addressed in encounters, would the patient map to HCC 19, notwithstanding that he was diagnosed with them?

Teaching physicians find eased documentation standards for E/M services

10/28/2019

by: Richard Scott

Question: I saw a recent policy update from CMS about teaching physicians performing E/M services but I can’t understand what it means. Please help!

With secondary insurance, what COB says goes — or you may get stuck with the bill

10/14/2019

by: Roy Edroso

Question: A patient wants to use her secondary insurance as her primary insurance because it offers her a better price point. Are there any circumstances under which this is allowed?

If payers downcode lots of your E/Ms, check your work – and fight if you’re right

10/07/2019

by: Roy Edroso

Question: One of my payers is sending back a few dozen of our claims with the E/M codes downcoded from Level 4s to Level 3s. Is this common? Should we appeal?

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