decisionhealth Newsletters, Part B News - 2014 Issue 1 (January)
Ask Part B News
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Article Overview
This article provides expert responses to common physician practice billing questions. It covers a nurse practitioner sign-off issue tied to state scope-of-practice laws, whether an E/M service may be reported with a colonoscopy-related visit, and how to think about reporting multiple transforaminal injection levels under CPT and Medicare billing expectations. It is intended for physician practices, coders, billers, and compliance staff looking for practical guidance on common outpatient documentation and claims questions.
Why This Topic Matters
The topics addressed are frequent sources of confusion in physician office billing and can affect documentation, claim submission, and payer compliance. Readers can use the article to better determine when a question requires review of state law, when an evaluation service may be separately reportable, and how payer policy can affect procedure reporting.
What You Will Learn
- How state scope-of-practice laws can affect physician review requirements for nurse practitioner office visits.
- How to evaluate whether an E/M service may be reported in connection with a colonoscopy-related encounter.
- How reporting considerations differ for multiple transforaminal injection levels and payer policy review.
- Why Medicare coverage policy and local coverage determinations may need to be checked for claim issues.
Who Should Read This
- Physician practices
- Medical coders
- Medical billers
- Compliance staff
- Revenue cycle staff
Codes Discussed
Modifiers Discussed
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