Part B News | Ask a Part B News Expert

Consider the pros and cons of furnishing an AWV during same-day E/M

01/06/2025

Question: What are the pros and cons of performing an annual wellness visit (AWV) at the same time as an E/M office visit versus separating them into two visits?

No per-stay limit for infectious disease add-on code

12/16/2024

by: Julia Kyles, CPC

Question: Can the add-on code for infectious disease consultations (G0545) only be reported once per admission or stay in observation?

Third-party biller fraud may hook your practice, unless you protect yourself

11/25/2024

by: Roy Edroso

Question: I recently read about a third-party biller who was charged with health care fraud and eventually entered a plea agreement — but the practice he worked for was not charged. I thought fraudulent medical billings were always the responsibility of the provider whose services were billed. Is it possible for a biller to be guilty but not the provider?

HIPAA Q&A: Navigate data sharing, recent HIPAA rules changes

11/04/2024

by: Rebecca Herold, CDPSE, FIP, CISSP, CIPM, CIPP/US, CIPT, CISM, CISA, FLMI

Question: How should compliance leaders navigate the complexities of data sharing and interoperability initiatives while maintaining strict adherence to HIPAA regulations?

Home BP readings for ‘white coat hypertension’? OK, but probably not RPM.

10/28/2024

by: Roy Edroso

Question: I have a patient who claims “white coat hypertension” — that is, he says his home blood pressure readings are significantly lower than the ones we get in the office. He has a home BP device, a Pressure X Pro, that connects to the internet. Can I take a reading via this device? And, in addition to adding it compliantly to encounter notes, can I claim 99091 (Collection and interpretation of physiologic data [eg, ECG, blood pressure, glucose monitoring])?

When coding eating disorders, start with initial visit, include all services

10/28/2024

by: Son Hoang

Question: What codes should a coder consider for a patient diagnosed with an eating disorder (e.g., anorexia nervosa, bulimia nervosa, and avoidant/restrictive food intake disorder)?

How to code involvement of a case manager in an office visit

09/30/2024

by: Laura Evans, CPC

Question: Have you ever encountered a practice wanting to bill T1016 (Case management, each 15 minutes) for a workers’ compensation visit where the case manager is present and the provider discussed the case with them? The practice wants to report T1016 in addition to the office visit E/M code. When I researched this code it appears to be for behavioral/mental health and not the work comp case manager situation. Do you have any insight on this?

‘No comment’ sounds guilty. Fight bad impressions with a press policy.

09/09/2024

by: Roy Edroso

Question: Recently one of our providers was in the news and reporters called our office. We all refused to comment when contacted. That seemed the safest course, but now we’re wondering if we should have done something else.

Stick with CMS’ prolonged service times for office/outpatient visits

08/19/2024

by: Julia Kyles, CPC

Question: CMS’ prolonged service code G2212 was originally based on the maximum times in the descriptors for codes 99205 and 99215. But the 2024 CPT manual replaced the minimum and maximum time ranges for the office/other outpatient codes with minimum times that the provider must meet or exceed.

Should our practitioners continue to use Medicare’s prolonged service times for office/other outpatient E/M visits, or should they switch to the shorter times for prolonged service code 99417 in the 2024 CPT manual?

Look for these attributes in your top security officer

08/19/2024

by: Julia Huddleston, CIPP/US, CIPM, CCSFP

Question: We are hiring a chief information security officer (CISO). What are the top traits and skills they should have?

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