Download this month's tool, DecisionHealth Professional Services' E/M inpatient checklist, from the Part B News website, www.partbnews.com.

This week's question is answered by Margie Scalley Vaught, CPC, coding content specialist for DecisionHealth, publisher of Part B News.

Q. I am having trouble getting paid for post-procedure follow-up visits in the hospital. Medicare pays the initial consult and the follow-up(s) leading to the surgery or procedure. However, any follow-up after the procedure gets a denial. Is there any way to get these paid?

When you lose too many staff members because of the swine flu, you potentially face an unpleasant and rare situation: closing your practice.

This chart shows the top 10 most frequently billed codes in 2008 and their net change in utilization from 2007. Drug codes, technical codes and non-physician services (such as lab services) were excluded from consideration, so E/M codes top this list.

There's been an abrupt slowing of a recent downward trend in annual E/M utilization, according to a Part B News analysis of new, 2008 CMS claims data (see main story). The total number of E/M services billed to Medicare fell by about 340,000 claims from 2007 to 2008 - a remarkable change from 2006 and 2007, which saw E/M utilization fall by 4.3 million and 3.6 million claims respectively (PBN 11/17/08).

These pie charts examine the five E/M codes used for established patient office visits, showing their respective percentage share of all established visit E/M utilization. We compare the utilization percentage of each code in 2000, 2007 and 2008; this long window shows a slow but steady shift to billing more high-level codes like 99214 and 99215.

I understand that 94760 (Pulse Ox., $2.89) is usually bundled into the patient visit. Can you give me an example of when we could bill for the service separately?

Only 18% of your peers report a significant increase in the number of patients with flu-like symptoms since Aug. 1, but three-fourths have already ordered a supply of the swine flu vaccine (see story), according to an unscientific Part B News reader survey.

You'll need to do more than just collect the nasal-spray doses of swine flu vaccines now en route to 25 states and spray your patients; different states have different requirements for practices that have requested the vaccine, Part B News has learned (see sidebar).

Allergy services were among the fastest-growing, most frequently denied codes from 2007 to 2008, according to a Part B News analysis of the latest CMS claims data. This chart lists 10 of the fastest-growing, high-denial codes, selected because each saw its utilization and denial rate increase from 2007 to 2008.