Part B News | Ask a Part B News Expert

Heed definitions, dx requirements in new trigger point injection LCD

03/25/2024

Question: We have three follow-up questions about the new local coverage determination (LCD) for trigger point injections (20552-20553) that will take effect on April 1.

Check the payer first when selecting codes for obesity counseling

03/04/2024

by: Laura Evans, CPC

Question: At our orthopedic practice we sometimes must postpone a patient’s total joint replacement because their BMI is too high. We either refer them back to their PCP for weight loss management or to a weight loss program at another facility. One of our providers is working to become certified in weight loss counseling, which would allow her to provide this service at our practice rather than referring the patients elsewhere. How would this service be billed?

How to code when the orthopedist is called to evaluate an inpatient

03/04/2024

by: Laura Evans, CPC

Question: One of the coders I work with consistently uses the subsequent inpatient or observation codes (99231-99233) to bill for hospital H&Ps by their orthopedic surgeons. A typical scenario would be when the orthopedist is called to evaluate a hospitalized patient with a known orthopedic injury who was admitted by another physician. The orthopedist has not previously seen the patient. I am seeing conflicting guidance on this from different sources. Can you please clarify?

Check the setting and timing on SDOH risk assessments

02/26/2024

by: Julia Kyles, CPC

Question: Can we report G0136 (Administration of a standardized, evidence-based Social Determinants of Health [SDOH] Risk Assessment, 5-15 minutes, not more often than every 6 months) in the patient’s home? And does the provider have to perform the assessment on the same day as the E/M visit (99341-99345 and 99347-99350), or can they perform the assessment on a different day?

Ease the path to diagnosing chronic pain syndrome

02/26/2024

by: Julia Kyles, CPC

Question: Can you give an example of what needs to be documented for G89.4 (Chronic pain syndrome) showing there is a psychosocial reason for the pain?

Select spinal decompression codes based on diagnosis, AMA states

02/26/2024

by: Laura Evans, CPC

Question: We recently read coding guidance in the AHA Coding Clinic (Q1 2023) that appears to state that spinal stenosis should no longer be used as the primary diagnosis for code 63047 and that the code can be reported for other indications. Specifically, the article describes a scenario where “the diagnosis was listed as L4-L5 lateral foraminal stenosis. The question arose as to whether, based upon the diagnosis of stenosis, would it be appropriate to report CPT code 63047... Can you please clarify?

Choose the correct modifier for multiple encounters on same DOS

02/19/2024

by: Savannah Schmidt

Question: A patient underwent a diagnostic nasal endoscopy at 10 a.m. At 7 p.m., the patient developed an epistaxis and the physician had to use some complex cauterizing techniques to control the nosebleed. How would the physician’s services in this scenario be reported?

How to handle payer requirements that conflict with AMA guidelines

02/12/2024

by: Julia Kyles, CPC

Question: According to one of our private carriers there are two possible ways we should report bilateral services with modifier 50 (Bilateral procedure):

Report modifier 50 on two service lines with one unit each.
Report modifier 50 on one service line with 2 units of service.

However, the carrier does not have this in their payment policies. In addition, this private payer’s instruction contradicts other private carriers and our Medicare administrative contractor (MAC). What should we do?

Continue to use the practice address when the place of service is 10

01/29/2024

by: Julia Kyles, CPC

Question: We know the place of service (POS) rules for telehealth services changed this year. Did that change the address we should report in Box 32 of the CMS-1500 form when a patient receives a telehealth visit while at home (POS 10)? We’re not sure if we should use the patient’s home address or continue to report the practice’s address. In addition, our providers occasionally perform telehealth services while they are at home. Which address should we use in that scenario?

Adhere to rules on reporting RTM or RPM during the global period

01/22/2024

by: Laura Evans, CPC

Question: I interpret recent CMS rulemaking that the RTM codes (98975, 98977, 98980 and 98981) are bundled in the global period if they are being performed for the same diagnosis and by the same provider who did the surgery. Am I reading that correctly?

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