Part B News | Ask a Part B News Expert

Monitor modifier 25 red flags: Watch frequency, replication

08/17/2026

Question: What are some red flags associated with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) that might trigger payer audits?

Boost communication to augment E/M medical decision-making

06/15/2026

by: HCPro staff

Question: What are some tips for properly documenting E/M visits as it relates to medical decision-making (MDM), particularly when it comes to improving communication with providers?

Patient right of access: Prepare as OCR’s enforcement campaign continues

05/11/2026

by: Dom Nicastro

Federal regulators continue to signal that delayed patient access to medical records is one of the most visible and enforceable areas of HIPAA compliance.

ICD-10-CM updates: How to code for patients with diabetes in remission

04/27/2026

by: HCPro staff

Question: Can you explain when it is appropriate to use the recently added ICD-10-CM code for diabetes in remission?

Remind providers to document their active participation in incident-to services

04/20/2026

by: Julia Kyles, CPC

Question: An auditor from our Medicare administrative contractor recently informed our practice that to bill services incident-to, the supervising physician must actively participate in the patient’s care, which means seeing the patient every 12 months. Is that what active participation means?

Remind surgeons that NCCI rules for post-op pain management still apply

04/06/2026

by: Julia Kyles, CPC

Question: I work for a group of surgeons that wants to start billing for post-operative pain blocks. For example, a transversus abdominis plane block (64486-64489) for hernia repair or an intercostal block (64420-64421) for post-mastectomy pain. In the past they’ve asked the anesthesiologist to perform the service, but they claim that they can bill Medicare under a new rule designed to reduce the use of prescription opioids to manage post-operative pain. Is that correct?

There’s more to high risk than the examples in the E/M guidelines

03/16/2026

by: Julia Kyles, CPC

Question: For the purposes of E/M coding, does intravenous (IV) contrast for diagnostic imaging fit the definition of “Drug therapy requiring intensive monitoring for toxicity” under the high-risk section of the medical decision-making (MDM) table’s “Risk of complications and/or morbidity or mortality of patient management”?

How to report multiple sclerosis medication administration

03/16/2026

by: HCPro staff

Question: How do you code medication administration for a patient with multiple sclerosis?

Subletting a doctor’s office? Make sure you’re covered, not coasting

03/02/2026

by: Roy Edroso

Question: I saw a recent article in the New York Times that discussed, among other things, physicians subletting their or other doctors’ offices. The story had a real estate focus, though, and didn’t get into the legal and regulatory requirements for physicians who do this. What should prospective sublessees be thinking about?

Know when add-on behavioral codes apply to the APCM code set

02/16/2026

by: HCPro staff

Question: How has the 2026 Medicare physician fee schedule final rule, effective Jan. 1, 2026, affected coding of advanced primary care management (APCM)?

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