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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?

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?
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?

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?

Question: My pain management practice is using two forms of risk assessment questioning for our pain management patients. One is computer-based with staff assistance. The other is done on paper and interpreted by the provider. We were using 96103 (Psychological testing [includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI], administered by a computer, with qualified health care professional interpretation and report) for the computerized risk assessment. However, the 2019 codes are completely different. Can we code 96146 (Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only) for the automated testing and scoring and 96160 (Administration of patient-focused health risk assessment instrument [eg, health hazard appraisal] with scoring and documentation, per standardized instrument) for the paper risk assessment that is scored by the provider?
Question: At the doctor’s office where I work, the patients are often the friends or family members of staff members who assist with the exams. Yesterday, a coworker and I were preparing the charts for the day with our assigned doctor, and my coworker, Jane, told me that one of the patients we were seeing that day was the boyfriend of another coworker, Jill. Later, I happened to be having lunch with Jill in our break room, and she was talking about her boyfriend. I mentioned to her that Jane told me Jill’s boyfriend was coming in for his appointment and asked if Jill was planning on assisting his doctor during the exam. Jill was furious at Jane’s disclosure and said that she would be filing a formal complaint regarding a HIPAA violation. Is this really a HIPAA violation? Could my job really be in jeopardy?
Q: What is the difference between the two types of Remittance Advice Remark Codes (RARC)?
Question: What 2019 CPT updates were made to E/M codes for interprofessional telephone and internet consultations?

Question: I started receiving denials on some of my flu vaccine claims, and my Medicare administrative contractor (MAC) indicated that it couldn’t price the vaccine because I was missing the “NDC.” What is this, and how do I know when to use it?

Question: I’m confused by vaccine coverage when some of the shots aren’t covered by my payer. For instance, I’m getting denials on tetanus vaccines. How do I know which ones are covered? And what should I do when a patient comes in needing a shot that my practice may not get paid for?


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