Sep 24, 2020 | Uncategorized
Recently, stakeholders have come forward to urge CMS to drop their proposed ACO quality changes. Since this is a time of uncertainty and challenges, many believe these changes are significant and are concerned with mandating these changes during a pandemic. Read the article below to find out more.nnCiting concerns about mandating sweeping new reporting requirements in the middle of a pandemic, some of the nation’s largest physician and hospital associations on Wednesday asked the federal government to drop changes on how Medicare accountable care organizations are assessed for quality.nn”The ACO quality changes proposed are significant and come at a time when ACOs are continuing to deal with challenges and uncertainty caused by the COVID-19 pandemic,” the American Medical Association and nine other stakeholder groups wrote in a joint letter to Centers for Medicare & Medicaid Services Administrator Seema Verma.nn”Just as CMS has proposed to delay moving forward with the MIPS Value Pathways approach due to concerns with COVID-19, CMS should also postpone such a drastic and significant change to the way ACO quality is measured, assessed, reported and scored for purposes of both the MSSP and MIPS programs,” the letter said.nn”The proposed rule, set to take effect in 20201, mandates of how ACOs and other alternative payment models are assessed on quality in the Medicare Shared Savings Program and Merit-Based Incentive Payment System.nnThe stakeholders also complain that the delayed release of the final rule cuts into the time ACOs and other APMs would have to implement the changes.nnSpecifically, the stakeholders urged Verma to reconsider:n
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- Ending the use of the Web Interface reporting mechanism, which has been used since the MSSP’s inception.
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- Removing the pay-for-reporting year currently provided to ACOs beginning an initial MSSP contract as well as individual measures that are newly introduced to the measure set.
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- Changes to the quality measure set ACOs must report under the APM Performance Pathway.
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- Replacing the existing MIPS APM Scoring Standard, which the stakeholders claim “allows each APM to have its own set of unique quality measures and scoring approaches that best fit the particular model.”
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nThe letter was signed by the AMA, American College of Physicians, America’s Essential Hospitals, America’s Physician Groups, AMGA, Association of American Medical Colleges, Federation of American Hospitals, Medical Group Management Association, National Association of ACOs, and Premier.nnOriginal article published on healthleadersmedia.com
Sep 24, 2020 | Uncategorized
It is always a good idea to update your resume, so why not take the initiative now since September is international update your resumé month. Read below for more!nnOne of my favorite things to wake up to in the morning is our local newscasters telling us what is today’s “Nation Day of”. As a connoisseur of mac n’ cheese, and French fries, I especially like to keep an eye on when these days are coming up so that indulgence is less guilt-ridden. In addition to these seemingly underappreciated days, we all know of some of the greater know awareness months out there like breast cancer in October and Heart disease in February. But with so many worthy causes, each month is stacked with a plethora to choose from. Here is one I bet you were not aware of.nnSo be sure to mark your calendars moving forward and use September to reflect on your accomplishments over the previous year and update your resume to include all of your achievements!nnFor more information on updating your resumé, click here!
Sep 17, 2020 | Uncategorized
The AMA has released new COVID-19 CPT codes that healthcare providers can use as a response to additional expenses. Read below for more information on the CPT codes and what each code entails.nnThe American Medical Association (AMA) on September 8 published two new CPT codes for novel coronavirus (COVID-19)-related services, including one that accounts for additional supplies and clinical staff time used to mitigate spread of the virus.nnHealthcare providers can now use CPT code 99072 (additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service[s], when performed during a public health emergency as defined by law, due to respiratory-transmitted infectious disease) to describe the additional supplies and staff time required to support safe in-person interactions with patients during the COVID-19 public health emergency (PHE).nnThis new code was established in response to the significant, additional practice expenses related to activities required to safely provide medical services to patients during the PHE, according to the AMA.nnAs explained in a special edition of CPT® Assistant, providers should use code 99072 only when safety measures are over and above those usually included during an office visit or service. Notably, the new code may only be reported for services rendered in the non-facility place of service settings.nnThe AMA also released a new laboratory testing code 86413 (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [COVID-19] antibody, quantitative) for laboratory testing that provides quantitative measurements of SARS-CoV-2 antibodies.nnOther laboratory testing codes for COVID-19 describe qualitative assessments (positive/negative) of SAR-CoV-2 antibodies.nnBoth new codes went into effect immediately and remain effective until end of the COVID-19 PHE.nnHealthcare professionals can find additional information, including clinical examples for the appropriate use of the new codes, in the accompanying CPT Assistant.nnOriginal article published on healthleadersmedia.com
Sep 17, 2020 | Uncategorized
nnOne of the biggest changes to our ICD-10-CM books for the upcoming new year will be the addition of Chapter 22: Codes for special Purposes (U00-U85). Although this new chapter only consists of two codes and these codes were actually created and valid as early as April 2020, the creation of this chapter is proof that lessons from our current pandemic have been learned. Read below for more!nnHere are the codes, and their guidelines as printed in the Official ICD-10-CM FY 2021 Guidelines;nn
Sep 10, 2020 | Uncategorized
As 2021 approaches and new E/M changes are being implemented, it’s time to prepare your practice and sign up for training. Contact Welter Healthcare Partners and sign up today to have these new policies under your belt before 2021.nn Ginger Avery, CPC, CPMA, CRC, is the Coding and Compliance Manager at Welter Healthcare Partners, Inc. Below, she is providing fourteen operational extremities on how to plan ahead in order to be ready for these administrative changes!nnThe 2021 E/M code changes are set to deliver a powerful mix of updates to help streamline documentation practices and reduce administrative burden. Medical practices are encouraged to start planning now for operational and administrative workflow adjustments that will be a result of this momentous occasion.nn1. Identify/Assign Project Lead. This transition will affect everyone in the organization including coders, billers, other non-clinical staff, clinical staff, and clinicians. A designated project lead will help assure your clinic is prepared to streamline processes before the changes take effect on January 1, 2021.nn2. Make Time for Meetings. Schedule time for meetings to review the changes and address questions. Track goals and milestones during the transition process. Organizations are encouraged to recognize the significance of this event and prioritize time to prepare for changes.nn3. Make a List of Necessary Changes. Forms, templates, and contracts need updated, electronic health records and practice management systems need upgraded, several experts will be noted.nn4. Update Policies, Procedures, Practice Protocols & Compliance Plan. Policies, Procedures, Protocols should all be in alignment with the new guidelines.nn5. Review Medical Malpractice Liability. Although the “counted” documentation requirements have lessened with the updates, clinicians are reminded to tell clear stories, documenting the clinically relevant details of each encounter. The new guidelines state that office visits include “a medically appropriate history and/or physical examination when performed.” Regardless of the changes, it is important to remember that the burden of proof lies within the documented details. Supportive documentation will help guard against fraud & abuse law infractions.nn6. Assess Financial Impact. Guard against an unanticipated financial impact by understanding the rules in advance and performing a prospective payment analysis. Be prepared to adjust business practices depending on practice needs.nn7. Check with EHR vendors. Check with EHR vendors to assure their systems are updated appropriately prior to Jan 1st.nn8. Consider Coding Support. Establish strong coding/auditing resources and expertise early in the planning process.nn9. Conduct Current Coding/Documentation Assessment. Review current documentation practices and system functionality to address specific areas of interest for education development. This small audit sample should be conducted by an outside auditing source to provide an unbiased evaluation with appropriate recommendations.nn10. Provide Education. Educate clinicians appropriately about documentation that impacts medical decision making and how to become proficient with recognizing complexity in alignment with the new guidelines. The new guidelines provide definitions and descriptions that clarify many details that were previously left subject to interpretation. For example, an Undiagnosed new problem with uncertain prognosis is defined in the 2021 guidelines as, “A problem in the differential diagnosis that represents a condition likely to result in a high risk of morbidity without treatment. An example may be a lump in the breast.”nn11. Conduct a Time Study. Have clinicians track the total time related to each patient encounter for the day to determine whether current processes are set to capture total encounter time appropriately.nn12. Understand Employer and Payor Requirements. Employers or payors may still require documentation of additional information above and beyond the new E/M office visit coding guidelines. Careful evaluation of the flexibilities allowed under the new guidelines will ensure that the documentation satisfies any other obligations and requirements that they may be expected to fulfill within their contracts.nn13. Consider How the New E/M Guidelines Impact Your Specialty. For example, pain management practices will use the new E/M guidelines for office visits, but they’ll need to stick to the current guidelines for codes such as subsequent hospital visit code 99232 and subsequent nursing facility code 99308, which were among the top 10 E/M visit codes for the specialty according to the latest Medicare Part B utilization data.nn14. Download and study the materials the AMA has published. The guidance includes a new medical decision making (MDM) table, new coding guidelines for office visits and prolonged service codes and a detailed list of relevant definitions.nnResourcesnnImplementing CPT® Evaluation and Management (E/M) revisionsnnTable 2 – CPT E/M Office Revisions Level of Medical Decision Making (MDM)nn10 tips to prepare your practice for E/M office visit changes
Sep 10, 2020 | Uncategorized
The report below describes a patient undergoing a transcatheter aortic valve replacement. The entire procedure has been documented in detail, describing the step by step process used by doctors to carry out the surgery. Keep reading for more on how this procedure was performed.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. nn– Click Here to Submit Redacted Surgery Case Study –nnDate of Procedure: XX/XX/20nnReferring Physician: A.M., MDnnPerforming Physicians: L. V., MD and S. P., DO. Both co-surgeons participated jointly in this catheter-based procedure.nnAssisting Physician: S. L., MD. A second interventional cardiologist was required for this procedure due to complex anatomic factors resulting in the need for a second operator with complex catheter training.nnAnesthesiologist: A. T., MD and R.S., MDn
Pre-Procedure Diagnoses:
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- Severe, symptomatic aortic valve stenosis
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Post-Procedure Diagnoses:
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- Successful transcatheter aortic valve replacement 23 mm Sapien Ultra
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- No significant paravalvular regurgitation.
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- Transvalvular mean gradient was reduced from 57 mmHg to 3 mmHg
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- Aortic valve pathology: Tricuspid
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Procedures Performed:
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- Transfemoral transcatheter aortic valve replacement
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- Balloon aortic valvuloplasty using an 18 mm Z-med balloon
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- Ultrasound guidance for arterial and venous access.
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- Aortography
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- Perclose Proglide deployment
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nIndications 89 year old female with a history of severe, symptomatic aortic stenosis. The patient was evaluated by a multidisciplinary team and deemed an appropriate candidate for TAVR.n
Description of Procedures:
nThe patient was brought to the hybrid operating room in the fasting and non-sedated state. The patient underwent monitored anesthesia care and was prepped in the usual sterile fashion. Transthoracic echocardiography was obtained for baseline assessment. Using ultrasound guidance and a micropuncture needle, the left femoral artery and left femoral vein were punctured and a 6 Fr sheath and 6 Fr sheath were, respectively, placed using the Seldinger technique. The right femoral artery was punctured and pre-close with Perclose devices was performed. Unfractionated heparin (UFH) was administered to achieve a goal activated clot time (ACT) > 250 sec. A 14 Fr E-Sheath was placed without difficulty.nnA transvenous pacemaker was placed in the right ventricle and threshold testing was performed. A pigtail catheter was advanced into the aortic root and aortography was performed to confirm co-planar angles. The aortic valve was crossed with a AL1 catheter and simultaneous aortic and ventricular pressures were obtained. Next, a Safari wire was placed in the left ventricle. After aortography was performed, an 18-mm Z-med balloon was delivered. After rapid pacing started, balloon aortic valvuloplasty was performed using the Z-med balloon, which was inflated at nominal pressure, and deflated. This was removed via the sheath.nnA 23 mm Sapien Ultra Valve was prepped according to manufacturer’s recommendations. The delivery system was introduced into the descending aorta and the valve was mounted onto the balloon in the usual fashion. The Sapien valve was then advanced across the stenotic aortic valve and carefully positioned during aortography. The valve was deployed during rapid pacing at 180 bpm. The delivery system was removed and transthoracic echocardiography revealed no significant paravalvular leak and a mean gradient of 3 mmHg.nnThe pacemaker was removed and iliofemoral aortography revealed absence of vascular complications (e.g. dissection, perforation). The E-sheath was removed and hemostasis was achieved with application of the Perclose Proglide devices. The contralateral arterial sheath was removed and hemostasis was achieved with application of a Perclose Proglide device. The venous sheath was removed and hemostasis was achieved with application of a Perclose Proglide device.n
Hemodynamics:
nBaseline aortic valve gradient: Mean 57 mmHg Final aortic valve gradient: Mean 3 mmHgnnEchocardiography: Refer to the separate TTE note for full details of the findings. Briefly, there is severe aortic stenosis at baseline. Following implant of a 23 mm Sapien Ultra valve, the gradient improved from 57 mmHg (from previous echo) to 3 mmHg. There is no significant paravalvular regurgitation. No new pericardial effusion at the conclusion of the procedure.nnEstimated Blood Loss: < 50 cc nnComplications: None apparent nnImplantations: 23 mm Sapien Ultra Valve nnContrast: 100 ccn
Summary:
nThe patient underwent successful balloon aortic valvuloplasty and transfemoral transcatheter aortic valve replacement for severe, symptomatic aortic stenosis using a 23 mm Sapien Ultra valve. The procedure was without apparent complication.n
Recommendations:
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- Transfer to the ICU in stable condition.
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- Bedrest for 6 hours.
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- Aspirin 81 mg daily starting tomorrow morning.
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- Restart Eliquis 5 mg po BID in 6 hours if no bleeding issues.
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- Transthoracic echocardiogram to be performed tomorrow to re-evaluate valvular hemodynamics
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