Expect the Unexpected — While Maintaining Productivity! — Professional Development Tidbit
Welter Healthcare Partners is excited to present our helpful career advancing tips and strategies to sharpen the skills prospective employers look for in a coder!nn
nnNo matter how much we plan things out and hope for the best, there will inevitably, always be something that we didn’t think of or plan for. That is why prioritizing, planning, and time management are such important skills to have in today’s job market. When you know what needs to be done and the deadline, you can be ready for anything that may come your way! Expect the Unexpected! You can’t see the future but if you are aware of your surroundings and potential obstacles, you can anticipate a need before it is asked of you. There is no room for procrastination in the ladder to success!
GOP Senators are working quickly in an effort to garner votes to replace the ACA (Affordable Care Act). Check out the most important things to note about this replacement effort, below.nnRepublican efforts in Congress to “repeal and replace” the federal Affordable Care Act are back from the dead. Again.nnWhile the chances for this last-ditch measure appear iffy, many GOP senators are rallying around a proposal by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), along with Sens. Dean Heller (R-Nev.) and Ron Johnson (R-Wis.)nnThey are racing the clock to round up the needed 50 votes — and there are 52 Senate Republicans.nnAn earlier attempt to replace the ACA this summer fell just one vote short when Sens. Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and John McCain (R-Ariz.) voted against it. The latest push is setting off a massive guessing game on Capitol Hill about where the GOP can pick up the needed vote.n
Effective for claims with dates of service on or after Oct. 1, 2017, UnitedHealthcare will reimburse the appropriate evaluation and management (E/M) procedure code which describes the office visit, hospital care, nursing facility care, home service or domiciliary/rest home care reported in lieu of a consultation services procedure code. This notification will be the first of several communications to clarify this change in reimbursement strategy supporting our commitment to the Triple Aim of improving health care services, health outcomes and overall cost of care.nnUnitedHealthcare will align with the Centers for Medicare & Medicaid Services (CMS) and no longer reimburse consultation services represented by CPT codes 99241-99245 and 99251-99255. At the time of the original CMS decision to no longer recognize these consultation services procedure codes, UnitedHealthcare began pursuit of data analysis and trending to better understand the use of consultation services codes as reported in the treatment of our commercial members. Similar to CMS’s findings, our extensive data analysis has revealed misuse of consultation services codes for this population.nnThe current Relative Value Unit (RVU) assignments reflect numerous changes made during recent years to both E/M codes and other surgical services creating an overall budget neutral experience supporting this strategy as a more accurate reflection of services rendered.n
Welter Healthcare Partners is excited to present our monthly Code Spotlight! Each month, Welter Healthcare Partners will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders.nnM48.062 – Spinal Stenosis, lumbar region, with neurogenic claudicationnThe list of ICD-10 code updates is extensive and lumbar spinal stenosis got a makeover with this year’s revision. The previous code M48.06 – Spinal stenosis, lumbar region will no longer be valid as of October 1st. There are now two new code options to replace the old code. These options now include specificity for neurogenic claudication. Spine surgeons and coders will be excited to finally have a code to capture this level of specificity!nnIt is important for coders to understand the clinical definition of neurogenic claudication. “Neurogenic claudication is the medical term used to describe the symptom of pain induced by walking,” according to spinal-healthcare.com, which goes on to call the condition “a hallmark symptom of lumbar stenosis.” Clinical documentation should include indications of trouble walking in the operative notes. If there is no indication of ambulatory issues or other signs of neurogenic claudication, you’ll assign the code for lumbar stenosis without neurogenic claudication; if the note describes the patient as having ambulatory issues due to stenosis, this could indicate claudication, in which case you’ll need to assign M48.062.
As part of the new coding format for our newsletter, Welter Healthcare Partners is excited to offer you a new surgery coding series in which we want to help you! The 2nd week of every month we will highlight a complicated surgical case. This week we are highlighting a general surgery case. We want to hear from you! If you have a complicated surgery case and need help with coding, 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. Click Here To Submit Redacted Surgery Case Study. 
As a result of the many provisions of the Affordable Care Act (ACA), the CMS Innovation Center (CMMI) was created to promote quality healthcare, stronger health outcomes, and encourage fiscal responsibility. CMMI acts as the facilitator for designing the most efficient payment methodology for reimbursing healthcare providers based on value rather than volume. CMMI also provides a platform for doctors, stakeholders, and other health care partners to participate in a collaborative process for generating the ultimate pay-for-performance model.nnCMMI is responsible for the implementation and oversight of Quality Payment Program (QPP), which aligns all other incentive programs such as Meaningful Use, Value Based Payment Modifier, and PQRS. Practices will begin to see the financial impact of QPP starting in 2018. Upcoming CMMI initiatives include:n