Part B News | Ask a Part B News Expert

Stay clear of bundles, prove medical necessity for same-day visits

08/20/2018

Question: I’m having a challenge with same-day billing. Here’s my situation: The doctor performs an injection with fluoroscopy at the hospital in the morning and then the patient comes to the office for a follow-up on the same day. The doctor would like to bill both services, but I feel like I’m double-dipping. Can I report both? Any help would be great!

Don’t code for foreign body removal when the foreign body isn’t there

08/20/2018

by: Roy Edroso

Question: A patient who steppad and cut herself on a piece of glass months earlier still complained of pain in the area, though the wound was healed. A CT scan showed increased density in the subcutaneous fat on the plantar aspect. Surgery revealed a large, thick, deep callus extending through the dermis down to the subcutaneous tissue and extensive scar tissue. These were excised but no foreign object was found. We’re using 28192 (Removal of foreign body, foot; deep) but is that correct — seeing as we didn’t actually find a foreign body?

Coding a vaper who wants to quit: Don’t confuse vaping with smoking

07/09/2018

by: Roy Edroso

Question: How do I bill if a patient comes in and asks for help quitting e-cigarettes -- that is, vaping? The patient does not smoke regular cigarettes or any other traditional tobacco products; in fact, he says vaping helped him quit cigarettes.

Dig into the CCI manual for guidance on ear wax removal, new patient visits

06/25/2018

by: Julia Kyles

Question: The CCI edits bundle established patient visits (99211-99215) into the ear wax removal procedure. Per this explanation, I would expect a CCI edit for new patient visits, but I don’t sae them. Can you explain why the edits are not in the code set?

Medicare pays for foot orthotics — but under strict conditions

05/21/2018

by: Roy Edroso

Question: We have a podiatrist who is having custom orthotics made for his patients. We have been using L3000 (Foot, insert, removable, molded to patient model, ‘ucb’ type, berkeley shell, each) per his instructions, but Medicare is denying the claims. These orthotics are custom-molded insole inserts. What are we doing wrong?

SNF patient in your office? Bill MAC for E/M, SNF for technical services

05/14/2018

by: Roy Edroso

Question: If Medicare beneficiary enrolled in a skilled nursing facility (SNF) under Part A goes to see a practice physician in her office and the doctor performs E/M and an X-ray, orders a lab test and prescribes a drug, how would each of these services be billed by that physician’s office?

Not all NPP work with a doctor nearby can be claimed incident to

04/23/2018

by: Roy Edroso

Question: We have a non-physician practitioner (NPP) who works with our physicians, and all his work is claimed incident to. Sometimes I’m not sure it’s appropriate. I’m told that as long as the supervising physician is in the office when the NPP works and signs the claim, there’s no problem. Is that so?

OK to bill view of asymptomatic knee, but code and document properly

04/16/2018

by: Roy Edroso

Question: A patient presents for an evaluation of unilateral knee pain and we do four standing X-ray views of the knee that capture the contralateral side. We have always billed this scenario as 73564 (Radiologic examination, knee; complete, 4 or more views) with RT or LT as appropriate. There has been some discussion lately that we should bill 73560 (Radiologic examination, knee; 1 or 2 views) for the contralateral views if they are interpreted on. However, I feel if the patient has no complaints on the contralateral side, the medical necessity wouldn't be there even if the X-rays reveal something such as osteoarthritis. Does anyone know of an official source that states whether the contralateral side can be billed or not in the absence of patient complaints?

Your practice must accommodate service dogs — within reason

04/09/2018

by: Roy Edroso

Question: I saw a story in the news about a Nashville, Tenn., woman who was suing her doctor’s office for not allowing her service dog, who helps with her post-traumatic stress and obsessive-compulsive disorders, to accompany her on her doctor’s visit. Do practices have to accommodate service animals? What if they’re aggressive or the other patients in the waiting room are allergic?

Some payers accept consult codes — but be sure that’s what you did

03/26/2018

by: Roy Edroso

Question: For new patients who are not on Medicare, our office uses the office consultation codes 99241-99245 if referred by a doctor and 99201-99205 if self-referred. The E/M criteria are met for time, history and exam for all codes. Is our use of the consultation codes correct? Is it commercial carrier dependent?

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