Jan 18, 2019 | Uncategorized
Spotlight analysis finds progress made on numerous fronts, recommends next steps for policymakers, insurers and physiciansnnThe American Medical Association (AMA), Colorado Medical Society (CMS) and Manatt Health released a report today that shows Colorado has implemented meaningful reforms in response to the opioid epidemic though further steps are needed to save even more lives.nnThe Colorado spotlight analysis found that progress is being made to increase access to evidence-based treatment for substance use disorders, several pilot projects have improved care for patients with pain, and increased access to the opioid overdose-reversing drug naloxone has resulted in thousands of lives saved.nn“We conducted this analysis because it’s essential that policymakers know what is working, and where additional progress can be made,” said AMA President-elect Dr. Patrice A. Harris, who also chairs the AMA Opioid Task Force. “Colorado has implemented many important policies that are impacting patients’ access to care. Using this momentum, we think Colorado can go even further to save lives of those affected by opioid use disorder.”nnColorado is the second in a series of individual state studies. The AMA released a study on Pennsylvania last month.nnBased on available data, review of policies, and discussions with key policymakers, the analysis found four key areas where Colorado is succeeding:n
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- Adoption of policies and funding to increase access to medication assisted treatment, including initial steps to reduce administrative barriers, increased funding to address workforce issues, and plans to increase Medicaid coverage in residential settings.
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- Examining compliance with mental health and substance use disorder parity laws through the Colorado Division of Insurance’s review of insurers’ conduct and the establishment of an ombudsman’s office to assist patients in accessing behavioral health care.
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- Increasing Medicaid patients’ access to non-opioid alternatives for pain management, including coverage of non-opioid prescription medications and alternative therapies such as physical therapy, occupational therapy and additional behavioral health care treatment options.
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- Expanding access to naloxone with early legislation and implementation of a standing order for naloxone, Good Samaritan protections, and elimination of prior authorization for naloxone under Medicaid.
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n“This analysis comes at an important time for Colorado,” said Dr. Debra Parsons, CMS President. “Over the last six years, Colorado has developed policies, enacted laws and made important strides to have all stakeholders work together to reverse the opioid epidemic. While we continue these successful initiatives, we must closely evaluate how they are working so we can ensure we are putting our efforts in the right places.”nn
nnThe analysis also highlighted the work of the Colorado Consortium for Prescription Drug Abuse Prevention, which has brought together several hundred stakeholders and continues to develop a data-driven, county- and state-level data dashboard that can be used to help direct resources to areas of greatest need.nnThe analysis also found areas where additional progress could be made:n
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- Eliminating barriers to treatment, including further steps to increase enforcement of mental health and substance use disorder parity.
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- Expanding access to providers of medication assisted treatment, especially in the state’s rural areas.
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- Leveraging successful state pilots to increase access to multimodal pain care and comprehensive benefit and formulary designs.
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- Linking those whose lives have been saved by naloxone with follow-up treatment to begin and sustain recovery.
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- Evaluating state policies and programs to determine what is improving patient care and reduce opioid-related harms, including whether current policies may be resulting in unintended consequences.
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n“Many of the recommendations in this report related to commercial insurance—such as strengthening our market conduct examinations to better enforce mental health parity and more comprehensive front-end reviews of the number of addiction professionals in insurers’ networks—are fair and reasonable approaches that are within our authority to immediately tackle,” said Michael Conway, Colorado Insurance Commissioner and head of the state’s Division of Insurance. “We look forward to working with Colorado’s health insurers and physicians to implement solutions that help ensure consumers receive the care that they need to help end our state’s opioid epidemic.”nnClick here to read original article published on cms.org.
Jan 18, 2019 | Uncategorized
As most medical practices are aware, not all cases are easy to navigate using the latest medical standards. The information below highlights a complicated surgical case along with the correct CPT and ICD-10 codes. Do you have a complicated surgery case need 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 —nn
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- PREOPERATIVE DIAGNOSIS: Perforated descending colon diverticulitis.
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- POSTOPERATIVE DIAGNOSIS: Same.
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- PROCEDURE:
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- Laparoscopic extended left hemicolectorny with colorectal anastornosis.
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- LaparoScopic Splenic flexure mobilization.
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- ANESTHESIA: GeneralnCOMPLICATIONS: None.
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- FINDINGS: Inflammation in the descending colon with perforation.nCOMPLICATIONS: None.
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nINDICATIONS FOR PROCEDURE:nThe patient is a 52-year-old female who presented with worsening pain for several days. She was found to have significant inflammation of the descending colon with extraluminal air and early peritoneal signs on exam. Risks and benefits were discussed with the patient who understood and agreed with the treatment plan.nnDESCRIPTION OF PROCEDURE:nAfter obtaining proper informed consent, the patient was taken to the operative suite where she was prepped, draped and positioned in the usual fashion. Preoperative antibiotics were given, SCDs were placed prior to induction of general anesthesia. A timeout was performed and was correct.nnA 2 cm infraumbilical incision was made and carried through skin and subcutaneous tissue. The fascia was identified, was incised and a 12mm Hasson trocar was inserted. The abdomen was insufflated with carbon dioxide gas. Under direct vision a 12mm trocar was placed in her lower midline in the previous C section scar, and-a 5 mm was placed in the right lower quadrant. The colon was identified. There was some inflammation on the descending colon. Mobilization occurred laterally to medially, starting at the sigmoid colon. The retroperitoneal attachments were taken down. The left ureter was identified over its full course. Dissection occurred proximally up through the splenic flexure. The splenic flexure was taken down from the gastrocolic attachments and the oriental attachments, getting adequate mobilization to anastomose the distal transverse colon down to the rectum.nnDissection occurred distally to the reclosigmoid junction. The mesentery was transected with the Harmonic scalpel from the sigmoid artery, and the left colic artery were taken. This was carried down to the rectosigmoid junction. Using an Endo-GIA 45mm blue load staple, the rectosigmoid junction was transected. Dissection of the mesenteric occurred proximally through the splenic flexure. There was adequate mobilization, and it reached easily down into the pelvis.nnAt this point in lime, a 4 to 5 inch Pfannenstiel incision was made in her previous C-section scar. This was carried down through skin and subcutaneous tissue. The fascia was incised. The muscle was split in the midline. An Alexis wound protector was inserted and the Colon was externalized. There was an area of perforation with a small piece of stool that was exiting the colon. Proximal to this was normal appearing transverse colon. A 2-0 Prolene pursestring was applied. The colon was transected and the specimen was sent to pathology. A 29 EEA anvil stapler was put in the open end of the colon, and the pursestring was tied down and cut. This was then internalized again. The fascia was closed with a #1 PDS. The abdomen was reinsufflated. A 5 mm trocar was placed under direct vision in the Iower midline. Again, it was-checked to make sure there was adequate length to make a tension-free ariastomotis, and there was.nnThe EEA stapler was brought through the anus and brought up anterior to the staple line. The anvil was deployed. The 2 ends were mated and closed. The stapler was fired and removed. Two complete donuts were seen. A proctoscope was then inserted and a leak test was performed with air 3 different times with no air leak that was seen. The pelvis and the left hemi-abdomen were irrigated with a liter of normal saline. There was no other sign for any pathology. A 10 flat JP drain was placed in the pelvis and brought out through the right lower quadrant incision. The abdomen was then desufflated, trocars were removed under direct vision. The fascia of the umbilical incision was closed with an 0 Vicryl suture. Skin was closed with 4-0 Monocryl. Dermabond was applied. The patient tolerated the procedure well. She was extubated and taken to recovery in stable condition.nnCPT Codes:n
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- 44207 – Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)
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- 44213 – Laparoscopy, surgical, mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (List separately in addition to primary procedure)
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nDX Codes:n
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- K57.20 – Diverticulitis of large intestine with perforation and abscess without bleeding
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Click Here to View Full Case
Jan 11, 2019 | Uncategorized
Welter Healthcare Partners, Inc. is one of a select number of organizations in the country which provides Corporate Integrity Agreement (CIA) reviews and is designated as an Independent Review Organization (IRO) on behalf of the Office of Inspector General (OIG).nn Welter Healthcare Partners Consultants are subject matter experts with RAF coding. We have worked with payers, hospitals and physician-owned practices which are dependent on risk adjustment payment models and Hierarchical Condition Categories (HCCs).nnOur specific areas of expertise include:n
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- Risk Adjustment Factor (RAF) program implementation
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- External oversight of existing internal RAF compliance
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- Risk Adjustment Data Validation Audits (RADV)
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- Physician and Coder Education/Support on accurate diagnosis code capture
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- Physician Education on Clinical Documentation Improvement (CDI)
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n Welter Healthcare Partners’s RAF educational services incorporate providers own clinical documentation and one on one assistance to help them meet medical record documentation requirements and complete reporting of diagnosis coding to the highest level of specificity.nnClick here to learn more about the WHP Risk Adjustment Factor Approach and how our certified specialists can help you!
Jan 3, 2019 | Uncategorized
Written By: Toni Elhoms, CCS, CRC, CPC, AHIMA-Approved ICD-10-CM/PCS TrainernDirector of Coding/Compliance nn
It’s that time of the year again! The new 2019 CPT code changes took effect January 1st. Understanding the myriad of upcoming changes is crucial to obtaining the proper reimbursement for your services! The changes for 2019 address a number of interrelated issues. The AMA updated 335 codes to reflect scientific and technological advances in various services including medical, surgical, and diagnostics. Several additions reflect the real possibility of expanding coverage for connected health tools and other new delivery systems to improve healthcare quality. There were many code revisions with guideline, description and instructional note changes. CPT 2019 offers changes that affect nearly every specialty.nn*Please note, this article is not an all-inclusive list; review your 2019 CPT book for complete descriptions of all changes. Appendix B of 2019 CPT provides a summary of additions, deletions, and revisions. — Click here for more informationnnAlso, CLICK HERE to review the final rule for the 2019 Medicare Outpatient Prospective Payment System (OPPS).nnHighlights of the most significant changes:n
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- Exciting new opportunities for telemedicine expansion and coveragen
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- These new codes reflect the key role non-verbal communication technology plays in care coordination between consulting and treating physicians, according to the AMA.
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- CMS will pay for 2 newly defined physicians’ services furnished using communication technologyn
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- HCPCS Code G2012 – Virtual Check-In
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- HCPCS Code G2010 – Remote Evaluation of recorded video and/or images submitted by an established patient
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- 3 new codes for remote chronic care patient monitoring servicesn
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- New CPT codes 99453 and 99454 should be used to report remote physiologic monitoring services during a 30-day period.
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- CPT code 99457 requires live, interactive communication with the patient/caregiver and 20 minutes or more of clinical staff/physician or other qualified health care professional time in a calendar month.
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- 2 new interprofessional internet consultation codesn
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- New codes 99451 and 99152 should be used to report assessment and management services. The codes are based on medical consultative time.
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- 2 new codes added to the Ophthalmology CPT sectionn
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- CPT 92273 should be used to report global response of photoreceptors of the retina
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- CPT 92274 should be used to report photoreceptors in multiple separate locations in the retina and macula
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- Revisions and Additions to FNA and skin biopsy codesn
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- CPT codes 11102-11107 should be used to report skin biopsies based on method of removal including tangential (shave, scoop, saucerize, curette), punch and incisional.
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- Fine needle aspiration (FNA) codes received new instructional updates including the clinical distinction between a fine needle aspiration and a core needle biopsy. Imaging guidance is now inclusive to the nine new codes. Guidelines also instruct that codes are selected based in guidance (included) and add on-codes are appended for each additional lesion.
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- CPT codes 10005-10012 were added to report the specific imaging guidance (ultrasound, fluoroscopic guidance, CT and MRI).
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- Revisions and Additions to psychological and neuropsychological testingn
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- 8 CPT codes 97151-97158 and guidelines were added to Adaptive Behavioral services to address deficient adaptive behaviors.
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- New guidelines and new CPT codes were added to the Central Nervous System Assessments/Tests including 96112 and 91113 for developmental test administration based on time. CPT add on code 96121 for a neuro behavioral status examination for ab additional hour was added. Under Testing Evaluation Services CPT codes 96130-96133 were added for neuropsychological testing evaluation services based on time.
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- CPT codes 96136-96139 were added to report psychological or neuropsychological report testing and scoring. Codes are based on time and whether the service was performed by a technician or clinician. CPT code 96146 is used to report psychological or neuropsychological automated testing using an electronic platform.
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- 4 new breast MRI procedures were addedn
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- CPT Codes 77046-77049
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- Codes are selected based on laterality (unilateral vs. bilateral) and with or without contrast material.
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- 2 new gastrostomy tube placement codes added to define simple versus complex replacement of a percutaneous gastrostomy tube.n
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- CPT 43762 is reported for the percutaneous gastrostomy tube placement including removal without imaging or endoscopic guidance not requiring revision of the gastrostomy tract
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- CPT 43763 requires revision of gastrostomy tract
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- 3 new codes for allograftsn
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- CPT Codes 20932-20934
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- CPT 20932 includes templating, cutting, placement and internal fixation; osteoarticular
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- CPT 20933 includes hemicortical, intercalary, partial
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- CPT 20934 includes hemicortical, complete.
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nContact Welter Healthcare Partners for assistance on 2019 CPT changes.
Dec 20, 2018 | Uncategorized
MERRY CHRISTMAS & HAPPY NEW YEARn——————n
nThe team at Welter Healthcare Partners has been celebrating this joyous season and would like to send our greatest wishes to you this holiday season. We hope you enjoy the joy and cheer that Christmas brings and that you will create memories that will last a lifetime. We are thankful for the joy that each of our clients has brought us over the last year and we are excited for what 2019 has in store.nnAll of us at Welter Healthcare Partners would like to wish you and your families a very Merry Christmas and Happy New Year!nn
Dec 13, 2018 | Uncategorized
To successfully transition to value-based care, health systems must engage their physicians in the process.nnFiguring out the best way to engage physicians, however, is often one of the toughest challenges for organizations as they move from traditional fee for-service (FFS) models to models based on the efficient delivery of high-quality care.nnPhysicians drive the bulk of utilization decisions that influence health outcomes, which is one reason their buy-in is critical for transforming care delivery. Success in this new model requires physicians to adapt to a new way of practicing medicine, as well as to adjust to a new compensation model that rewards clinicians for providing high-quality care and containing costs, rather than on the volume of care provided.nnThe transition may be particularly tough for primary care physicians (PCPs) who are now called to serve as care quarterbacks. In this new world, PCPs will be tasked not only with serving the patients in front of them, but also starting to manage entire patient panels outside of the four walls of their clinics. Unfortunately, physicians are not always prepared to take on these additional tasks and must first overcome a number of systemic hurdles.nnUnderstanding current hurdlesnHealth systems attempting to engage physicians in the transition to value should be cognizant of factors that add to the challenge. For example, until recently most physicians have not been educated on the principles of newer care models based on the delivery of cost-effective outcomes, nor on population health management. Only now are medical schools beginning to incorporate these subjects into their curricula—but the impact remains to be seen. They also must address the ongoing challenge of how to influence physician behavior during the gradual shift away from FFS. Because physicians are still mostly paid on a fee-for-service basis, rather than for coordinating care and quality improvement, they have remained focused on providing more services that drive higher reimbursements.nnPhysicians must also adapt to new care coordination requirements. Traditionally no one provider has been responsible for tracking a patient’s care across all provider types and care settings. What makes it even more challenging is that technologies were not built to support this effort—they were built to sustain the FFS model. Physicians haven’t had to worry about financial penalties for duplicating care, nor for missing opportunities to improve patients’ health. Furthermore, physicians have lacked technologies to help advance care coordination efforts because legacy IT systems were designed primarily to support FFS billing functions and lack interoperability. Value-based care models, however, require PCPs and their care teams to manage care more effectively.nn
In addition, the pressure of these many hurdles is magnified for PCPs because of the historical undervaluation of their services in comparison to their specialist counterparts – despite the complexity and variety of conditions seen in primary care. Meanwhile, physicians are overburdened with regulatory and administrative requirements that squeeze them financially and reduce the amount of time spent on patient care. Attempts by payers and purchasers to enforce value-based behaviors using diverse metrics and proprietary programs add to the overload – particularly if physician compensation is not properly aligned. With all these pressures, it’s little wonder that physicians are experiencing widespread career dissatisfaction and burnout.nnTaking a programmatic approach to drive changenGiven all these challenges, how can a health system successfully engage physicians in value-based initiatives? Ideally organizations should adopt a holistic, prescriptive methodology that is supported by people, processes and technology and strives to achieve the Triple Aim plus One – that is, improved clinical outcomes, lower costs and higher patient satisfaction, plus better physician engagement.nnTo successfully engage physicians and drive change, consider this programmatic approach:n
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- Analyze opportunities and measure the organization’s baseline capabilities to identify targets for initial improvement efforts.
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- Establish physician-led governance, a strong clinical leadership team, and a network of high-performing physicians who share a common vision for better care at a lower cost. It’s key to creating a culture of accountability and implement mechanisms for financial outcome accountability.
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- Align incentives by revamping physician contracts at the group and individual physician levels to emphasize value over volume, to encourage physicians to meet quality and cost goals, and to support higher risk models over time.
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- Enhance care improvement by structuring the care model to deliver accountable primary care. Assess current care management programs and add new offerings as needed.
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- Enable behavior change among physicians and care team members through effective training, education and workflows. In addition, implement technology and tools that provide actionable clinical and financial information at the patient and population level.
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- Build on successes by leveraging data, programs and knowledge resources to find and act upon new opportunities for financial and clinical improvement. Monitor internal and external factors so the organization can adapt to changes in the patient population, the market and government regulations.
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nFor systems to succeed in value-based contracts, physicians must be engaged partners in the process. Health systems and payers must view physicians as strategic assets that deserve the necessary training, operational support and technology investments to succeed in a value-based world.nnA comprehensive physician engagement strategy is critical. Organizations must consider information technology needs, create the right governance structure and provide clinicians with educational and mentoring options. The strategy must also align physician payment and provider workflows with the organization’s financial and clinical goals that drive cost-effective, high-quality outcomes.nnThe transition to value-based care can be challenging – and more so if physicians are not engaged in the process. However, organizations can position themselves for value-based success by embracing a comprehensive and prescriptive strategy that addresses the needs of physicians and positions them for success.nnOriginal article published on beckershospitalreview.com.
