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Question: My doctor recently did 10 biopsies on a single patient and we’re billing 11102 (Tangential biopsy of skin; single lesion) and 11103 (Tangential biopsy of skin; each separate/additional lesion). I see by CMS’ medically unlikely edits (MUEs) update that the former has a practitioner services MUE value of 1, and the latter has a value of 6, so we’re clearly going to exceed that. I fear we’ll get caught in an edit. Is there anything we can do ahead of time to avoid a denial?
Question: I saw a TV news story recently about how a doctor in Massachusetts treated patients in a parking lot when a power outage made her office unusable. “One patient, I saw in the car,” the doctor said. Was that a good idea? Shouldn’t they have sent their patients to another practice or rescheduled? 
Question: Say a doctor sees a diabetic patient, notes blood sugar and increases the insulin dose. The chart includes diagnosis codes for diabetes mellitus (DM) with nephropathy (E11.21) and polyneuropathy (E11.42), but the notes do not otherwise address the polyneuropathy and nephropathy. For risk adjustment purposes, would this map to hierarchical condition category (HCC) 18 (Diabetes with chronic complications) or to HCC 19 (Diabetes without complication)? And if the nephropathy and polyneuropathy are not addressed in encounters, would the patient map to HCC 19, notwithstanding that he was diagnosed with them?
Question: I saw a recent policy update from CMS about teaching physicians performing E/M services but I can’t understand what it means. Please help!
Question: A patient wants to use her secondary insurance as her primary insurance because it offers her a better price point. Are there any circumstances under which this is allowed?
Question: One of my payers is sending back a few dozen of our claims with the E/M codes downcoded from Level 4s to Level 3s. Is this common? Should we appeal? 

Question: I’ve recently received a spate of denials with duplicate claims messages. Why -- and what can I do to avoid this?


Question: I’ve just heard about a doctor at Cedars-Sinai who was removed from his post after he was formally charged with possession of child pornography. I’m interested to know: If we were, God forbid, to have such a situation at our practice, would we be able to remove the doctor, even if he hadn’t gone to trial and been found guilty? Also, what do we tell the patients?

Question: We have a new physician that has recently joined our surgical group. Some patients from her previous practice have elected to follow her to our practice. Are these patients considered new or established? The patients are new to our practice and tax ID number; however, they are not new to the physician who is providing care to them.
Question: Some of my doctors are signing their charts for claims very late weeks, even months late. Can I submit these claims? If a chart is signed too long after the encounter, is it invalidated?


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