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10/11/2021
Question: We have an adult patient who is covered by her parents’ insurance. She is scheduled for a service but she said she’ll pay for it herself and we can’t bill insurance. According to the patient, this comes from HIPAA but we aren’t familiar with that part of the rule. Is there any official guidance about it?
10/11/2021
Question: Our M.D. performed surgery on a patient, finished the procedure and left the OR. The patient decompensated. Immediately, the M.D. was brought back into the OR to fix the problem, which he did. The patient did not leave the OR between the two procedures. Is this a case for modifier 78 (Unplanned return to the operating room by the same physician fol lowing initial procedure for a related procedure during the postoperative period)?
10/04/2021
Question: The 2022 ICD-10-CM code set includes a new code, U09.9 (Post-COVID-19 condition, unspecified), for post-COVID-19 conditions. When would it be appropriate to report this code?
09/27/2021
Question: My doctor had a telehealth visit with a 75-year-old patient who has well-controlled diabetes and mild cognitive decline. A week later, with the patient’s permission, the physician gave the patient’s adult daughter an update on her father’s health. The conversation took place through Zoom and lasted 23 minutes. The patient wasn’t present. Can we bill the conversation to Medicare as an E/M visit (99202-99215) under the special rules for telehealth services or, alternatively, the new E/ M guidelines?
09/13/2021
Question: The specialists at our practice regularly perform what we call virtual consults and we’re wondering if there’s any payment for their work. Typically, a primary care physician will call or send an email asking for advice on treating one of their patients. It usually takes our doctors a few minutes to review the data the requesting doctor provides and email a reply. But some cases are complicated and include review of several test results, some research and long conversations with the requesting doctor. The patient does not come to our office and, in most cases, our physicians have never seen the patient. We know we can’t bill an office visit (99202-99215), a consult (99241-99245 or 99251-99255) or a virtual visit (G2010 or G2012). Are there any other options?
08/16/2021
Question: We know that if we’re not careful our cloned notes can lead to inappropriate data in an encounter record, which in turn can lead to denials and takebacks. But can you be prosecuted for fraud because of cloned notes?
08/16/2021
Question: We are considering the following policy for E/M visits: Coders can’t select moderate risk because a social determinant of health (SDOH) affected the diagnosis or treatment, unless the note supports an SDOH diagnosis code from the Z55-Z65 range (Persons with potential health hazards related to socioeconomic and psychosocial circumstances). That way we can make sure the risk level is supported by the note.
08/16/2021
Question: The doctor asks to not charge a patient for any of their visits. The patient has Medicare. Is it legal to bill Medicare and write off the patient’s portion or to write off the entire charge and not bill Medicare at all?\
08/09/2021
Question: When might it be appropriate to report CPT codes for multiday electroencephalograms (EEG)? In addition, should these codes be billed on the day of initiating or ending the EEG study?
07/19/2021
Question: The medical decision-making table for office E/M visits (99202-99215), includes “Diagnosis or treatment significantly limited by social determinants of health” as one example of moderate risk. When can we count that toward a patient visit?

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