Part B News | Ask a Part B News Expert

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

06/25/2018

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?

Without face-to-face visit, you’re stuck holding the bag on prolonged care

03/05/2018

by: Richard Scott

Part B News recently fielded two questions about prolonged services when a face-to-face visit has not occurred:

How to handle immigration enforcement changes that may affect your staff

02/26/2018

by: Roy Edroso

Question: I heard about a doctor who was in the U.S. on a green card and was detained by immigration authorities. Do I have to worry about my staff who are here on green cards or work visas getting taken away? Can I just decline to hire such people to avoid the problem?

Avoid reporting cast-removal code when same provider does the work

02/19/2018

by: Richard Scott

Question: My doctor wants to bill 29125 (Application of short arm splint [forearm to hand]; static) with 29700 (Removal or bivalving; gauntlet, boot or body cast), and from what I understand these codes should not be paired together when the original cast was put on by the same physician. Is that correct policy? If they are not to be billed together, is there anything in writing I can show my providers?

Login

User Name:
Password:
Remember me Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.