Part B News | Ask a Part B News Expert

Streaming a family update via Zoom? Don’t bill as an office visit

09/27/2021

Question: My doctor had a telehealth visit with a 75-year-old patient who has well-controlled diabetes and mild cognitive decline. A week later, with the patient’s permission, the physician gave the patient’s adult daughter an update on her father’s health. The conversation took place through Zoom and lasted 23 minutes. The patient wasn’t present. Can we bill the conversation to Medicare as an E/M visit (99202-99215) under the special rules for telehealth services or, alternatively, the new E/ M guidelines?

Don’t miss the revenue opportunity in a doctor’s virtual consult request

09/13/2021

by: Julia Kyles, CPC

Question: The specialists at our practice regularly perform what we call virtual consults and we’re wondering if there’s any payment for their work. Typically, a primary care physician will call or send an email asking for advice on treating one of their patients. It usually takes our doctors a few minutes to review the data the requesting doctor provides and email a reply. But some cases are complicated and include review of several test results, some research and long conversations with the requesting doctor. The patient does not come to our office and, in most cases, our physicians have never seen the patient. We know we can’t bill an office visit (99202-99215), a consult (99241-99245 or 99251-99255) or a virtual visit (G2010 or G2012). Are there any other options?

Cloned notes can lead to legal trouble – run audits, ‘use cases’ to minimize risk

08/16/2021

by: Roy Edroso

Question: We know that if we’re not careful our cloned notes can lead to inappropriate data in an encounter record, which in turn can lead to denials and takebacks. But can you be prosecuted for fraud because of cloned notes?

Don’t chain social determinants of health for MDM risk to ICD-10-CM codes

08/16/2021

by: Julia Kyles, CPC

Question: We are considering the following policy for E/M visits: Coders can’t select moderate risk because a social determinant of health (SDOH) affected the diagnosis or treatment, unless the note supports an SDOH diagnosis code from the Z55-Z65 range (Persons with potential health hazards related to socioeconomic and psychosocial circumstances). That way we can make sure the risk level is supported by the note.

Avoid routinely waiving patient copays; follow these tips instead

08/16/2021

by: Laura Evans, CPC

Question: The doctor asks to not charge a patient for any of their visits. The patient has Medicare. Is it legal to bill Medicare and write off the patient’s portion or to write off the entire charge and not bill Medicare at all?\

How to accurately report multiday EEGs, with and without video

08/09/2021

by: Lori-Lynne A. Webb, CPC

Question: When might it be appropriate to report CPT codes for multiday electroencephalograms (EEG)? In addition, should these codes be billed on the day of initiating or ending the EEG study?

Incorporate social determinants of health into risk calculations

07/19/2021

by: Julia Kyles, CPC

Question: The medical decision-making table for office E/M visits (99202-99215), includes “Diagnosis or treatment significantly limited by social determinants of health” as one example of moderate risk. When can we count that toward a patient visit?

Go to the source when you count review of external notes

07/12/2021

by: Julia Kyles, CPC

Question: I understand how to count tests that are ordered or reviewed for office visits. But I’m not sure how to count “the prior review of external note(s) from each unique source.” Does the review of one note from one physician or qualified health care professional (QHP) from a different group or specialty count as one source?

Using preventive prolonged service codes? Log at least 16 minutes over

07/05/2021

by: Roy Edroso

Question: Our provider did a depression screening billable with G0444 (Depression screening, 15 minutes) and went a little over the 15 minutes required. The provider thinks we should add the prolonged preventive service code G0513 (Prolonged preventive service[s] [beyond the typical service time of the primary procedure], in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes [list separately in addition to code for preventive service]). Our provider didn’t add anywhere near 30 minutes to the session, however. Can we still claim it?

Reminder: Relaxed NCCI edits have been retired; code accordingly

07/05/2021

by: Julia Kyles, CPC

Question: We often perform trigger points (20552-20553) on the same day that established patients come in for E/M visits (99211-99215). I heard that in 2020 Medicare said that we no longer need to append modifier 25 (Significant, separately identifiable E/M service) when the E/M takes place on the same day as a trigger point injection. Is that true?

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