Part B News | Ask a Part B News Expert

E/M and stress tests: When to report a separately payable service with modifier 25

10/26/2020

Question: A patient with a history of hypertension and high cholesterol visits a cardiologist for an appointment, complaining of occasional chest discomfort during exercise. After the physician completes an office visit, it is determined that the patient needs a cardiovascular stress test, which is performed that day by the same physician. Would it be appropriate to report an E/M code for the visit with modifier 25 (Significant, separately identifiable E/M)?

The latest Correct Coding Initiative edits may have you seeing double

10/19/2020

by: Julia Kyles, CPC

Question: The latest version of procedure-to-procedure (PTP) edits contains hundreds of duplicate edit pairs. The only difference between the pairs is that the first is deleted and the second is valid. This is an example of what we’re seeing... The deletion date is always 12/31/2019. Is this a mistake or is there a reason some pairs look this way?

How to bill during the PHE when doctor calls patient with MRI results

10/19/2020

by: Laura Evans, CPC

Question: Now that our joint surgeons are gearing back up to again perform elective procedures, if the surgeon sees the patient in the office and schedules an MRI for them, can we bill for a telehealth visit afterward to go over the results so the patient does not need to return to the office? Is there a particular telehealth code to report if the doctor calls them with the test results?

When a doctor dies, mind patient records and act fast if heirs are unlicensed

10/12/2020

by: Roy Edroso

Question: If one of our physicians dies, what are we obliged to do besides notify the patients and invite them to transfer care to one of our other doctors?

Asymptomatic but wants a COVID test? Press for medical necessity in notes, use Z-code

10/05/2020

by: Roy Edroso

Question: My patient is visiting aged relatives and wants a COVID test before she goes to reduce the chance of infecting them. How should I code this? And will Medicare deny the charge for lack of medical necessity, as my patient lacks any symptoms?

You don’t need a ‘Refusal of Care’ form — but when patients refuse care, record it

09/14/2020

by: Roy Edroso

Question: I saw a recent report on telehealth that addresses a situation in which the telehealth patient refuses follow-up care. In the scenario, the patient is determined by the provider to require an office visit or a trip to the emergency room, but the patient refuses the follow-up. The authors say a “Refusal of Care” form should be filled out. We have never used such a form. Should we be doing this?

Use the fee schedule’s addendum B to winnow out procedures unsuited for the office

08/10/2020

by: Julia Kyles, CPC

Question: Do you know where we can find a list of procedures that are allowed in an office setting?

Despite PHE, provider signatures remain a must — except for ambulance orders

08/03/2020

by: Roy Edroso

Question: Like many practices, we’re doing a lot of telehealth during the public health emergency (PHE). Does this relieve or reduce our providers’ signature requirements for our Medicare claims?

Can you amend time on encounter notes? Yes — but don’t make a habit of it.

07/27/2020

by: Roy Edroso

Question: I have a doctor who’s billing critical care codes without putting the relevant times in his notes. We send these back to him and he amends them properly. Could this still be trouble for us down the road?

Generous MUEs for office visits haven’t changed the rules for same-day visits

07/20/2020

by: Julia Kyles, CPC

Question: I’m trying to figure out the impact of the new medically unlikely edits (MUE) for E/M codes 99201-99215. All codes have an MUE of 24. Does that mean a patient can see multiple physicians of the same specialty who bill under one tax ID on the same date of service? For example, could I bill two E/M visits if a patient saw Dr. Smith for shoulder pain and then saw Dr. Jones for knee pain?

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