Part B News | Ask a Part B News Expert

Locum tenens is not the answer when a physician passes away

07/03/2017

Question: May a locum tenens doctor fill in for a deceased doctor?

Look to local payment policies for controlled-substance screening

06/26/2017

Question: My practice is seeing more and more cases of drug screening over the past several months. How can I stay compliant with these screens? Is there a national policy related to correct coding?

Give the green light to medical assistants for cerumen-removal procedure

06/12/2017

by: Richard Scott

Question: Can you bill for a 69209 (Removal of cerumen using irrigation/lavage) when a medical assistant performs the service? The CPT Changes clinical example is for a nurse but my providers feel that it should be able to be billed for when a medical assistant performs it.

Tally total time for same specialists to get compliant with critical care codes

06/12/2017

by: Richard Scott

Question: In the following scenario, is critical-care code 99291 payable for the attending physician and add-on code 99292 payable for a non-physician practitioner (NPP)? Here’s what happened: The physician spent 60 minutes with the patient providing critical care. Later that day, the NPP spent 20 minutes with the patient providing critical care. How should they bill?

You can claim TCM for patients who elect hospice — if they’re at home

06/12/2017

by: Roy Edroso

Question: Can we claim transitional care management (TCM) codes 99495 or 99496 on a patient who is discharged to hospice?

Modifier 78 good for a return trip to the OR — but not the doctor’s office

06/05/2017

by: Roy Edroso

Question: Our patient had a mastectomy and developed a seroma in the post-operative period. We performed drainage of the seroma in the doctor’s office. Can we bill with modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period)?

Add an E/M to this shoulder pain shot if it’s a new problem

05/22/2017

by: Roy Edroso

Question: We had a patient present with shoulder pain and joint stiffness that had not been evaluated on a previous visit. Our physician examined his shoulder, discussed and documented various treatment options, and they mutually agreed on a shoulder injection. Can the physician bill for an E/M and the procedure with modifier 25 (Significant, separately identifiable E/M service) or just for the procedure alone?

Psychiatric care management codes limited to physicians for billing

05/01/2017

by: Richard Scott

Question: Can a consulting psychiatrist and/or a psychologist bill HCPCS codes G0502, G0503 and G0504 for psychiatric collaborative care management (CoCM) services or is this for the patient’s primary care provider (PCP) only?

Stick to the same DOS when adding up non-face-to-face prolonged care

04/24/2017

by: Richard Scott

Question: When using the newly covered non-face-to-face prolonged service codes (99358, 99359), can you bill them with time that has been accumulated over several dates of service? I’m asking because this seems very conceivable from a clinical perspective.

Many commercial payers — but not all — cover TCM services; check first

04/17/2017

by: Richard Scott

Question: Has anyone seen any information regarding commercial payers and reimbursement for transitional care management (TCM) services? I thought I saw an article stating that these codes would now be reimbursed by commercial payers, but I am unable to confirm this information. Please help.

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