Part B News | Ask a Part B News Expert

For ‘Welcome to Medicare’ exam, do your own vision screen or don’t bill

05/18/2020

Question: The initial preventive physical examination (IPPE) requires a “visual acuity” exam that we cannot request separate payment for. Some of our providers forget this simple step, and that prevents us from getting payment for the service they have performed other than that step. If a patient wears glasses and goes regularly to ophthalmologist for their routine eye exams, can we use this to meet the requirement?

Is it telehealth or something else? One question can clear things up during emergency

04/20/2020

by: Julia Kyles

Question: My providers saw a CMS announcement that practices may report audio-only telephone services. They believe this means they can report phone calls with the patient as telehealth E/M office visits. My interpretation of the guidelines is that they are pertinent to phone calls and that the telehealth codes billed with the usual E/M codes still require audio and video. Who is correct?

Providers, staff calling out due to COVID-19? They may have a case.

04/20/2020

by: Roy Edroso

Question: I have some staff members at my practice, including a medical assistant, who are declining to work because they’re worried about catching COVID-19. Do they have the right to do that?

Closing for COVID-19? Don’t worry about abandonment, but give notice

04/13/2020

by: Roy Edroso

Question: The COVID-19 emergency has forced us to see nearly all our patients by telehealth only, and soon we may have to close down altogether, at least temporarily. Do we have to worry about patient abandonment trouble after this emergency lifts?

Telehealth by phone? Maybe, but use the right codes

04/06/2020

by: Roy Edroso

Question: A provider was using the new flexibility CMS offers to do telehealth visits by Skype when his transmission was interrupted and he had to finish the encounter by talking with the patient on the phone, with no visual component. He was conducting an E/M visit, and his notes suggest a 99212. Can I bill for that?

Attesting to a patient or candidate’s health? Sure, but don’t fudge the truth

03/02/2020

by: Roy Edroso

Question: A local candidate for political office wants his medical records from my office and states that he plans to release them to the public and wants his physician to make a statement about his health. Obviously, under HIPAA he has a right to the records, but is it appropriate for the physician to make such a statement?

Repeating a test? Check with your MAC, use correct modifier and no do-overs.

02/17/2020

by: Roy Edroso

Question: We had to do a series of electrocardiograms (ECG) on a patient in the course of the same day. Is it appropriate to use modifier 76 (Repeat procedure or service by same physician) for this? Also, is 76 appropriate to use for other tests that are repeated for a patient?

Report unlisted code for pleural catheter declotting procedure

01/20/2020

by: Laura Evans

Question: The physician is performing a pleural catheter flush using saline with manual clearance of clots under ultrasound in the outpatient setting. Should we bill an E/M code (99212-99215) depending on documentation or some other code?

Patient’s not trying to quit? Then you should pivot away from ‘smoking cessation’

01/13/2020

by: Roy Edroso

Question: Our doctor saw a patient who complained about his tobacco use but did not clearly express — at least so far as the notes show — a desire to quit. Can we infer from his bringing the subject up that he was asking for cessation help and bill 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes)?

Only charge hospice patients for non-end-of-life issues — unless you’re the attending

12/30/2019

by: Roy Edroso

Question: A patient was brought into our practice by her family for treatment of a sprained ankle. We were told she is currently receiving the Part A hospice benefit. Do I need to contact the patient’s hospice provider, interdisciplinary group (IDG) or anyone else for billing purposes? Do I need to add anything to the billing?

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