Medicare Compliance & Reimbursement

It's time again to determine whether you're a Medicare coding ace or if you still need some assistance with your skills.

Almost every Part B practice codes an E/M chart from time to time, but ample questions exist about how to properly report these services. Today we're putting you to the test with a few reader-submitted questions that will help you understand Medicare's complicated E/M billing and coding rules.

After you review these three Medicare Part B test questions, take a look at the next page to see how you fared.

Question 1: I work for a large hospital with multiple groups of physicians of different specialties. Lately we have started seeing rejections for new patient visits from Medicare when the patient is indeed a new patient for a practice (such as uro-gynecology) because Medicare is saying the patient had been seen before at another practice of the same specialty (uro-gynecology), related to the hospital. The two practices are totally different entities and do not share the patient database or records. Could this have anything to do with taxonomy codes and how they are matched to provider numbers ?

Question 2: My surgeon met with an elderly patient's family to discuss treatment options and the patient's plan of care. The patient was not present for this in-office meeting. Can I still bill Medicare for an E/M service based on the time spent with the family? What about if a patient is there with the family but due to cognitive issues is not mentally "present" or participating?

Question 3: A new patient reported to our office complaining of wheezing and shortness of breath. The physician performed a level-four E/M, and then ordered a spirometry with graphic record (we own the equipment, and the test was performed and interpreted in-house). Encounter notes describe "likely" emphysema, though the spirometry would not be expected to confirm it. How should I handle the diagnosis coding here? Should I wait for a definitive diagnosis before coding this claim?