Mar 18, 2021 | Uncategorized
Bartholin’s Gland Cysts treatment can come in many different forms. With treatment comes coding for the different classifications and procedures to take care of the cysts. Staying up-to-date with coding can help you organize and get ready for treatment. Continue reading below to learn more!nnBartholin’s glands are two fluid-filled swellings that lubricate the vagina prior to and during sexual intimacy. Due to their size, they can easily become blocked or obstructed by bacteria and cause a cyst or abscess Most Bartholin’s cyst are asymptomatic and resolve on their own. If ancyst does not resolve on its own, it can grow larger, swollen, and painful. nnTreatment options:nnSitz baths and time are usually the first line of treatment. In most instances, the cyst will rupture on it’s own. However, if conservative treatment does not work, an incision and drainage may be done with a word catheter inserted into the cyst space. This word catheter is left in place from four to six weeks to help with healing. Another treatment is surgical marsupialization. The physician will grasp the cyst and create a vertical incision between 1.5 and 3.0 cm long. This will drain the gland cavity. After that the cyst will be open and the physician will suture the edges of the sit to form a continuous surface from the exterior surface to the interior surface of the cyst. Clinicians also use lasers and injections to treat these cysts. It is also possible to surgically excise the gland or cyst from the vaginal area. Excision of the cyst is the most invasive treatment option. nnCPT CODING: n
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- 56420: I&D of Bartholin’s gland abscess
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- 56440: Marsupialization of Bartholin’s gland cyst
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- 56740: Excision of Bartholin’s gland cyst.
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nCPT code 56420 is used to report an I&D for a gland that is abscessed. If there was no abscess present, (the cyst was filled with clear fluid), and an I&D was performed, the coder should report one of the following:n
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- 10040: Acne surgery (ie: marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)
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- 10060: I&D of abscess (ie: carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia), simple or single
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- 10061: … complicated or multiple
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nCode 56740 is used to report a complete excision. If the clinician uses a C02 laser or performs a destruction, then report CPT code 56501 (destruction of lesion(s), vulva, simple) or 56515 (…extensive)nnICD 10 CM Coding:n
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- N75.0: cyst of Bartholin’s gland
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- N75.1: abscess of Bartholin’s gland
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- N75.8: Other diseases of Bartholin’s gland
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- N75.9: disease of Bartholin’s gland, unspecified.
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nBe sure to code either a cyst or an abscess. If the clinician notes the presence of bacteria within the abscess, a laboratory code for the specific bacteria can be coded secondary to the abscess code. nn** AMA CPT 2021nn** AMA ICD-10-CM 2021nn** AMA Obstetrics and Gynecology
Mar 11, 2021 | Uncategorized
President Biden plans to address the mental health and addiction crisis after both have worsened since the start of the pandemic. He plans to split the funding for this endeavor between substance abuse and mental health services. Continue reading below to learn more.nnPresident Biden is directing $2.5 billion in funding to address the nation’s worsening mental illness and addiction crisis, an official from the U.S. Department of Health and Human Services tells Axios.nnWhy it matters: Confronting the mounting mental health and substance abuse crisis will be imperative for the Biden administration, even as its primary focus is on combating the broader COVID-19 pandemic.n
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- The funding announced today is designed to increase access to services for individual Americans.
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- The funding surge comes as the president has yet to fill several key permanent positions in agencies that would lead the charge in combating the drug epidemic, including the Food and Drug Administration and the White House Office of National Drug Control Policy.
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- His pick to lead HHS, Xavier Becerra, is expected to be confirmed by a close vote.
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nBetween the lines: The funds will be broken down into two components by the Substance Abuse and Mental Health Services Administration.n
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- $1.65 billion will go toward the Substance Abuse Prevention and Treatment Block Grant, which gives the receiving states and territories money to improve already-existing treatment infrastructure and create or better prevention and treatment programs.
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- $825 million will be allocated through a Community Mental Health Services Block Grant program, which will be used by the states to deal specifically with mental health treatment services.
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nBy the numbers: A survey conducted last year and published in August 2020 by Centers for Disease Control and Prevention showed that 41% of U.S. adults reported struggling with mental health or substance abuse related to the pandemic or its solutions, like social distancing.n
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- Before the pandemic, over 118,000 people died by suicide and overdose in 2019. An HHS official says the administration is expecting that number to increase because of the COVID-19 pandemic.
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- Preliminary data out of the CDC indicates that the number of drug overdoses through July 2020 increased by 24% from the year prior.
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nFlashback: On the campaign trail, then-candidate Biden often spoke about the need to address the mounting mental health and substance abuse crisis in America, an issue that hits close to home. His son, Hunter, has openly discussed his own struggles with addiction.nnThe National Suicide Prevention Lifeline (1-800-273-8255) provides 24/7, free and confidential support for anyone in distress, in addition to prevention and crisis resources. Also available for online chat.nnOriginal article posted on axios.com
Mar 11, 2021 | Uncategorized
This month’s operation report features Spinal Adhesion Barriers. The practice of using spinal adhesions within laminectomies is nothing new and this is considered a standard of practice that is essential for good patient recovery. When performing these operations, there are additional questions to be asked about the coding and billing involved. Continue reading below to learn more!nnDo you have a complicated surgery case that needs help with coding? Welter Healthcare Partners would love to help! Please upload the operative note by clicking on the link below. Remember to remove ALL patient-protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected. n
– Click Here to Submit Redacted Surgery Case Study –
nQuestions to Consider:n
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- How is your spinal practice coding/billing for this additional work?
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- HCPCS code C1765 is used to bill for the device but how are your surgeons being reimbursed?
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n nnDATE OF SURGERY: 12/XX/2020nnSURGEON: D., MDnnASSISTANT SURGEON: M., SA-CnnPREOPERATIVE DIAGNOSIS: Degenerative lumbosacral spine (LS through S1).nnPOSTOPERATIVE DIAGNOSIS: Degenerative lumbosacral spine (LS through S1).nnOPERATIONS: Anterior exposure for lumbosacral spine fusion (L5-S1). Intraoperative fluoroscopy. Vessel Guard patch. Abdominal x-ray reading.nnSPINE SURGEON: Dr. G. G.nnANESTHESIA: General endotracheal.nnESTIMATED BLOOD LOSS: MinimalnnINDICATION FOR SURGERY: This is a 49-year-old male with degenerative lumbosacral spine, who needs anterior exposure £or fusion at the level of the disk LS-Sl.nn nnDESCRIPTION OF PROCEDURE:nnThe patient was brought into the operating room and placed on the table in supine position. After general anesthesia was administered, the intraoperative fluoroscopy was used to identify the level of the disk L5-S1 and the projection of the disk at the level of the anterior abdominal wall was marked with a transversal line in the suprapubic area. The abdomen was prepped and draped in the usual sterile fashion. nnA small transversal incision was done in the suprapubic area on top of the previously placed line and the incision was deepened through the subcutaneous tissue and through the fascia. The fascia flaps were elevated, and at the level of the midline between the rectus muscles, the peritoneal sac was approached and gently dissected and pushed to the left side. It was a little bit more difficult to enter the right retroperitoneal space and below the arcuate line, but it was possible to enter without any complications. The right retroperitoneal space was entered, and the peritoneal sac was further mobilized together. The ureter was pushed to the left side. The ureter was protected and visualized at all time. The vascular dissection was started between the iliac vessels using only gentle blunt dissection to avoid, injuries to the superior hypogastric plexus in this young man. Few presacral veins were identified and divided using bipolar electrocautery and middle sacral artery which was well represented partially imbedded in the soft tissue in front of the spine was divided using bipolar electrocautery, obtaining a good hemostasis. The vascular dissection was further continued using blunt dissection until both iliac vessels were mobilized, completed the right and left side of the spine obtaining a complete clearance of the entire disk space LS-S1. A needle was inserted in the disk exposed, and using intraoperative fluoroscopy, the level of the spine exposure was demonstrated. nnThe SynFrame was placed maintaining the exposure at the level of the disk LS-S1. At this point, Dr. G. came into the operating room and the case was turned to Dr. G. for the orthopedic part of the spinal fusion. After his part of surgery was completed, I came back to the operating room and I took over the case again. very good hemostasis was noted. No injury was seen. At this point, a Vessel Guard patch measuring 5 x 7.5 cm was chosen, was tailored to match the shape of the vertebral space exposed and secured in place with 2 stitches for 4-0 PDS suturing the upper part of the patch to the anterior longitudinal ligament of the vertebral body LS. The patch was able to cover completely the entire anterior aspect of the spine exposed and the hardware used for the fusion. The retractor blades were very carefully gently removed allowing the iliac vessels and the peritoneal sac to come back in a normal anatomical position on top of the patch. At the end of the procedure, very good hemostasis was noticed, very good flow through the iliac vessels. No ureteral injuries and no lymphatic leak. nnThe abdomen was closed in a standard fashion using a stitch with O Vicryl to approximate the rectus muscle below the midline and then the anterior fascia layer was closed with continuous running O loop PDS. The subcutaneous tissue was irrigated. Local anesthesia was injected. At this point, the intraoperative fluoroscopy was used to x-ray the abdomen for the instrument count and no instruments were found in the surgical field. The subcutaneous tissue was closed with continuous running 2-0 Vicryl, and the skin was closed with continuous running 3-0 Monocryl subcuticular closure. Steri-strips and sterile dressing were applied. nnThe patient tolerated the procedure well. At this point, the patient was kept under general anesthesia and turned back to Dr. G. and anesthesiologist for the posterior part of the spinal fusion.
Mar 4, 2021 | Uncategorized
The pandemic increased the number of patients facilities are seeing and this also lead to the increase in the use of self-pay accounts. Your facility may not have been prepared for this sudden increase. Continue reading below to learn some key strategies to better manage your self-pay accounts.nnA study published late last year by the Urban Institute forecasted that over 10 million families would lose their employer-sponsored health insurance during the novel coronavirus (COVID-19) pandemic. As a result, healthcare organizations have observed a growing number of uninsured patients and a rise in out-of-pocket responsibility.nnOn the latest episode of The Revenue Integrity Show: A NAHRI Podcast, NAHRI Director Jaclyn Fitzgerald, CHRI, was joined by Juli Forde, director of strategic partnerships, AR optimization, ZOLL Data Systems in Broomfield, Colorado, for a wide-ranging discussion on how healthcare organizations should approach the new reality of escalating self-pay patient responsibility.nnForde offered several strategies to help organizations maximize reimbursement in these times. The first step, she said, is to ensure empathy and understanding toward the patient. “I think one of the things we do really well is we get a great H&P (history and physical examination) clinically for patients before we move into a treatment plan,” Forde said. “We make sure we really understand them. We need to be doing the same thing financially. So, a wonderful best practice is to obtain one of the solutions available that will partner with you and give you the financial information around the patient. That allows you to come alongside them in a way where they feel heard and they feel understood.”nnOrganizations can obtain a financial profile of an individual without asking invasive questions that make the patient uncomfortable, Forde said. One of the keys is for organizations to harness the new technologies that are available that help organizations understand the patient as a financial individual in addition to knowing them clinically.nn“If you’re still doing revenue cycle the way you did it five years ago, 10 years ago, there’s wonderful technology that you’re missing out on that really helps you deal with this profoundly difficult reality of a greater patient responsibility, a higher denial rate from the payers, an additional regulatory burden being placed on healthcare,” Forde said. “There are tools available that really make those lifts a lot easier and help you to maximize your reimbursement while giving the patients a wonderful experience.”nnIn addition, Forde stressed the importance of charity care. She said healthcare providers must put in place policies based on objective criteria to establish a successful charity care program, which should benefit both the patient and the organization. When organizations ask patients for the amount that they can truly afford based on their own financial characteristics, they see the average patient collection increase significantly, according to Forde. “So it’s very interesting that by appropriately and compassionately discounting the final charge within a compliant charitable discounting program, we actually recoup more of the patient’s self-pay responsibility,” she said.nnTo listen to the full podcast episode, search Revenue Integrity Show on iTunes, SoundCloud, Spotify, or Google Play. The episode is also available to stream on the NAHRI website.nnOriginal article published on nahri.org
Mar 4, 2021 | Uncategorized
The current Public Health Emergency has changed the way CMS has implemented new programs, such as MIPS and APM, and the timeline in which they will be incorporated. As MIPS & APMs continue to move forward, it is important to stay up-to-date about the newest changes in CMS policy and the way these new programs are being introduced. Continue reading below to find out more! nnAmong so many other timelines that were interrupted during our current Public Health Emergency (PHE), Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), also was thrown in a tailspin. Despite the challenges that have presented over the past year, the business of medicine must continue moving forward.nnDuring the PHE, the Centers for Medicare and Medicaid Services (CMS) has delayed the implementation of MIPS Value Pathways (MVPs) until no earlier than 2022. However, the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM) have been finalized for performance year 2021.nnThese elements of the Quality Payment Program (QPP) have also had some added flexibility by CMS during the PHE to encourage greater participation to Medicare Part B providers while removing some of the risk of a negative payment adjustment. As we begin the last month of the first quarter in 2021, it is important to mark March 31st on your calendar as this is the first of three APM participation snapshot dates for 2021. This is then followed by the April 1st opening of registration for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys as part of your MIPS participation.nnThis is not the year to sit back when it comes to your QPP participation. According to MACRA, CMS is required to have the QPP program fully incorporated by 2022.nn n
Click here to learn more on cms.gov
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