Part B News | Ask a Part B News Expert

To avoid denials, don’t forget the national drug code on vaccine claims

02/18/2019

Question: I started receiving denials on some of my flu vaccine claims, and my Medicare administrative contractor (MAC) indicated that it couldn’t price the vaccine because I was missing the “NDC.” What is this, and how do I know when to use it?

Be careful about Part D-covered vaccines to avoid payment issues

01/28/2019

by: Richard Scott

Question: I’m confused by vaccine coverage when some of the shots aren’t covered by my payer. For instance, I’m getting denials on tetanus vaccines. How do I know which ones are covered? And what should I do when a patient comes in needing a shot that my practice may not get paid for?

How to report, document body mass index (BMI) in ICD-10-CM

01/28/2019

by: Shannon McCall, RHIA, CCS,CCS-P, CPC, CEMC, CRC, CCDS, HCS-D

Question: Can an ICD-10-CM body mass index (BMI) code be used as a standalone code? If not, what documentation should we look for to justify the use of a BMI code?

How to manage, move suspended claims along

01/28/2019

Question: How can I identify a suspended claim? Is there anything that can be done to move a suspended claim forward?

Don’t skip billing the primary procedure to avoid CCI, maximize money

01/14/2019

by: Laura Evans, CPC

Question: The orthopedic surgeon performed a total shoulder arthroplasty to treat a fracture (code 23472) and in the same encounter, did an open treatment of a proximal humeral fracture (23615) and a biceps tenodesis (23430). Yet codes 23615 and 23430 are bundled as components of 23472 by National Correct Coding Initiative (CCI) edits.This is leading some at our practice to wonder whether it would be better to just submit the fracture reduction and tenodesis codes and skip billing for the arthrodesis. What is the correct response?

Make sure contract demands receipts on changes — or risk unhappy surprises

01/14/2019

by: Roy Edroso

Question: We have a commercial payer that dropped a sudden rate change on us with no notice; we only found out via a paid claim. The payer says it notified us of the change 30 days before the date by which we had to approve it, but we never received any notice at all. How can the payer expect to get away with this?

Ordering tests can up the level of medical decision-making, even pending results

10/22/2018

by: Richard Scott

Question: A nurse practitioner told a patient to return after an office visit if his chest pain worsened, and the provider ordered a nuclear stress test to take place the next day. Can my provider count the plan for the stress test in the medical decision-making for the previous encounter, even if the diagnosis isn’t made until eight days after the face-to-face encounter?

Watch CCI bundles, edits for pulmonary function code and E/M services

10/22/2018

by: Richard Scott

Question: All of a sudden, I am getting denials from everyone for billing 99214-25 with 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). Guidelines say billing the codes together is appropriate unless there is a recent change. Is anyone else seeing denials? Before this month, my claims were going through fine.

Use new Q code for Zilretta injection but watch for payer limitations

10/22/2018

by: Laura Evans

Question: What do you know about payments for Zilretta injections? Anything specific that we need to know about billing?

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

08/20/2018

by: Richard Scott

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!

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.