Part B News | Ask a Part B News Expert

Avoid denials: Don’t bill prolonged services with a nursing home encounter

08/21/2017

Question: Prolonged service code 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) is now bundled into all the nursing facility codes (99304-99318). This doesn't make sense to me. Anybody know why?

Ortho, other specialties can bill CCM but watch the coding fine print

07/31/2017

by: Richard Scott

Question: We've had a request from one of our physicians to report chronic care management (CCM) code 99490 using osteoarthritis as one of the qualifying factors. Has anyone used this in the orthopedic setting? The CCM guidelines mention three conditions that must be met to bill, and I’m wondering if the patient has to meet all three of the criteria and not just some or part of it.

Under QPP, virtual groups not expected to get ancillary services exception

07/31/2017

by: Roy Edroso

Question: In the Quality Payment Program (QPP) proposed rule’s virtual groups section, CMS mentions “self-referral” a few times. Why did that come up?

Does ‘the patient’s wife insisted’ meet medical necessity?

07/17/2017

by: Roy Edroso

Question: A doctor's note on a patient taking treatment for a shingles outbreak reads, "I did not recommend I&D [incision and drainage], but the patient's wife insisted." Is the provider admitting a lack of medical necessity, rendering the procedure unbillable to insurance (Medicare or other)?

Locum tenens is not the answer when a physician passes away

07/03/2017

by: Roy Edroso

Question: May a locum tenens doctor fill in for a deceased doctor?

Look to local payment policies for controlled-substance screening

06/26/2017

by: Richard Scott

Question: My practice is seeing more and more cases of drug screening over the past several months. How can I stay compliant with these screens? Is there a national policy related to correct coding?

Give the green light to medical assistants for cerumen-removal procedure

06/12/2017

by: Richard Scott

Question: Can you bill for a 69209 (Removal of cerumen using irrigation/lavage) when a medical assistant performs the service? The CPT Changes clinical example is for a nurse but my providers feel that it should be able to be billed for when a medical assistant performs it.

Tally total time for same specialists to get compliant with critical care codes

06/12/2017

by: Richard Scott

Question: In the following scenario, is critical-care code 99291 payable for the attending physician and add-on code 99292 payable for a non-physician practitioner (NPP)? Here’s what happened: The physician spent 60 minutes with the patient providing critical care. Later that day, the NPP spent 20 minutes with the patient providing critical care. How should they bill?

You can claim TCM for patients who elect hospice — if they’re at home

06/12/2017

by: Roy Edroso

Question: Can we claim transitional care management (TCM) codes 99495 or 99496 on a patient who is discharged to hospice?

Modifier 78 good for a return trip to the OR — but not the doctor’s office

06/05/2017

by: Roy Edroso

Question: Our patient had a mastectomy and developed a seroma in the post-operative period. We performed drainage of the seroma in the doctor’s office. Can we bill with modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period)?

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