Part B News | Ask a Part B News Expert

Written protocol for inappropriate behavior, however mild, can help

07/14/2025

Question: We have a patient who sometimes brings gifts such as flowers or candy to his provider. The provider has shared with us that she finds this awkward and has asked him to stop, but the patient persists. We have a harassment policy, but it seems like overkill to bring it to bear here. What should we do?

The doc’s practice did the imaging test. Can we still count it toward MDM?

07/14/2025

by: Laura Evans, CPC

Question: How would you count the following tests toward medical decision-making (MDM) in the following two scenarios?

The physician orders an MRI at today’s visit for the patient’s right ankle. His practice performs the MRI three days later and bills the professional and technical component.
The physician orders a CT scan at today’s visit for the patient’s right ankle and the CT is performed on the same date by the physician’s practice, which then bills the professional and technical component for the scan...

Stick to your documentation standards for self-pay services

06/23/2025

by: Julia Kyles, CPC

Question: Our providers have started to perform some services that are 100% patient pay, such as platelet rich plasma injections to treat pain. Do we need a separate policy for documenting services when the record doesn’t need to support a code?

Consult the details for MDM discussions for accurate E/M coding

06/09/2025

by: Julia Kyles, CPC

Question: When our doctors requests a consult from another doctor, how can we tell whether our physician can count the conversation toward “discussion of management or test interpretation with external physician or other qualified health care professional or appropriate source (not separately reported)” in the data review column for medical decision-making (MDM)? Do we need to coordinate with the other physician’s practices that the consulting physicians work for to make sure they aren’t counting it too?

Sharpen audio-only E/M visit documentation and coding

04/07/2025

by: Julia Kyles, CPC

Audio-only telehealth visits are still relevant thanks to another extension of audio-only services from Congress and private payer adoption. Below you will find two recent questions about how to report audio-only visits to private payers. Remember that telehealth coding is an evolving topic; you should watch the plans your practice accepts for new and revised guidance throughout the year.

Avoid absolutes when selecting the level of risk for MDM

03/24/2025

by: Julia Kyles, CPC

Question: When calculating risk for an E/M visit, is total parenteral nutrition (TPN) moderate risk or high risk? We found some sources that state it should be compared to prescription drug management, which would be moderate risk. Other sources say it should be compared to drug therapy requiring intensive monitoring for toxicity, which is high risk.

Doing the splits: MDM offers more flexibility for split/shared visits

03/17/2025

by: Julia Kyles, CPC

The answers to a reader’s questions about split/shared visits demonstrate that medical decision-making (MDM) can boost your care team’s effectiveness.

CCM codes were not replaced by chronic pain management codes

02/17/2025

by: Julia Kyles, CPC

Question: Did chronic pain care management codes G3002 and G3003 replace chronic care management codes 99490 and 99439?

Can you force patients to get an AWV? Not without risk.

02/03/2025

by: Roy Edroso

Question: I’m a patient of a local primary care practice that recently sent me a letter saying they are “required by CMS to perform and submit annual wellness exam information on each Medicare/Medicare Advantage patient each year. Although CMS does not penalize the member when the AWV information is not submitted annually, your PCP/Provider is reported as being non-compliant with patient care, which does affect our standing and reimbursement with CMS.” For that reason, the letter went on, “our office requires that all patients with Medicare/Medicare Advantage coverage undergo an AWV annually to continue to retain [the practice] as their Primary Care Physician (PCP).” Can they do that?

Clarify risk adjustment goals and financial directives

01/27/2025

by: Jennifer Brettler, DO, FACP, CHCQM-PHYADV

Question: We know that risk adjustment can impact reimbursement, quality of care, insurance plan ratings, and overall performance, but what does risk adjustment really mean?

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