Dec 29, 2015 | Uncategorized
They say Private Practice is dying! They say the independent physician is a dinosaur!nnI say private practice is changing, becoming more efficient, more flexible and much more capable! I think the dinosaur in the room (apologies to the elephant) is the ‘everything for everyone 24/7 huge hospital’ which is constantly scrambling to fill beds!nnWe are currently living in a time of short term solutions (seriously, go outside and look around!). In order to fill the beds and feed the dinosaur (not meant to be disparaging, I love hospitals and hospital people!) the hospitals have engaged an old strategy: Employ the docs and funnel the patients! It will work and work well in some markets. It will unwind itself in most, just as it did 10 or so years ago because at the end of the day the math does not work! (We in health care seem to have a ten year idea cycle.)nnThe longer term solution to A) the Cost Curve of health care, B) the Health of the Population and C) the Vitality of Physicians is to have and support Independent physicians who understand and control cost, smaller hospitals which have a specific specialty focus with much less bed days.nn
nn
About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners
nMr. Welter has over 25 years of healthcare industry experience assisting physicians and other providers, hospitals and other facilities with the business side of medicine. Through strategic planning and analysis, Mr. Welter’s main focus is to strategically increase revenues and profitability in this radically changing health care environment.
Mr. Welter has a Masters Degree in Organizational Leadership from Regis University in Denver where he has had an appointment as affiliate faculty in the School for Professional Studies for over ten years. In addition, Mr. Welter holds a faculty appointment at the University of Denver’s University College. In the Health Care Leadership program he teaches Macro Economics in Health Care and Innovative Strategies and Change in Health Care to graduate students.
Dec 29, 2015 | Uncategorized
By Toni Woods, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS TrainernnThe new CPT changes take effect January 1st. Understanding the new codes is crucial to obtaining the proper reimbursement for your services while also staying compliant with current coding and billing requirements. The changes for 2016 address a number of interrelated issues. Clinical practice has evolved and several issues required CPT clarification. CPT 2016 offers most changes in digestive procedures, diagnostic and interventional radiology as well as significant changes in prolonged services.n
n
- 140 New CPT Codes
n
- 134 Revised CPT Codes
n
- 91 Deleted CPT Codes
n
- 365 Total CPT Edits
n
n*Please note, this article is not an all-inclusive list; review your 2016 CPT book for complete descriptions of all changes. Appendix B of 2016 CPT provides a summary of additions, deletions, and revisions.n
Highlights of the changes:
n[toggle title_open=”Evaluation and Management (E/M) Chapter of CPT” title_closed=”Evaluation and Management (E/M) Chapter of CPT” hide=”no” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]Add-on codes for outpatient prolonged services +99354 and +99355 now apply to prolonged face-to-face outpatient psychotherapy as well as to prolonged face-to-face E/M codes. Use a primary E/M or psychotherapy code, one 99354 (30-74 minutes in addition to the time spent on the initial/primary service) per day and as many units of 99355 as needed to match the time spent in prolonged service.nnThere are two new add-on outpatient prolonged services codes:nn+99415 and +99416 are to be used to report prolonged face-to-face clinical staff service with physician, NP OR PA supervision. Same rules apply as above. Please note, documentation must reflect what you did and how long you did it.nn*These add-on codes can never appear on a claim by itself.[/toggle]nn[toggle title_open=”Integumentary System Chapter of CPT” title_closed=”Integumentary System Chapter of CPT” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]Two new codes have been added for soft tissue-marker placement with imaging guidance.n
n
- 10035 – Placement of soft tissue localization device (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion
n
- 10036 – Placement of soft tissue localization device (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; each additional lesion[/toggle]
n
n[toggle title_open=”Respiratory System Chapter of CPT” title_closed=”Respiratory System Chapter of CPT” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]A few new codes have been added for bronchoscopy procedures. These codes now include moderate sedation in the procedural reimbursement. There were also some notable revisions to transbronchial lung biopsies.n
n
- 31652 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtrachael and/or transbronchial sampling (eg aspiration[s]/biopsy[ies], one or two mediastinal and/or hilar lymph node stations or structures.
n
- 31653 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtrachael and/or transbronchial sampling (eg aspiration[s]/biopsy[ies], 3 or more mediastinal and/or hilar lymph node stations or structures
n
- 31654 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s) for peripheral lesions (list separately in addition to code for primary procedure(s)[/toggle]
n
n[toggle title_open=”Cardiovascular System Chapter of CPT” title_closed=”Cardiovascular System Chapter of CPT” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]A few new codes have been added for cardiovascular procedures. Of note, there is a new code to replace the Category III code (0262T) for TPVIs (transcatheter pulmonary valve implantation), which includes all cardiac catheterizations, balloon angioplasty, valvuloplasty, stent deployment, intraprocedural contrast injections, angiography, radiological S&I.nnThere were also notable revisions to the language of thrombectomy codes. Fluoroscopy is now included in all of these procedures.n
n
- 33477 Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed.
n
- 37252 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (list separately in addition to code for primary procedure)
n
- 37253 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (list separately in addition to code for primary procedure)[/toggle]
n
n[toggle title_open=”Mediastinum and Diaphragm System Chapter of CPT” title_closed=”Mediastinum and Diaphragm System Chapter of CPT” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]Two new codes have been added for mediastinoscopy with biopsy.n
n
- 39401 Mediastinoscopy; including biopsy(ies) of mediastinal mass (eg lymphoma), when performed
n
- 39402 Mediastinoscopy; with lymph node biopsy(ies) (eg lung cancer staging)[/toggle]
n
n[toggle title_open=”Digestive System Chapter of CPT” title_closed=”Digestive System Chapter of CPT” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]The digestive chapter had the most code expansion in this year’s CPT changes. There are new codes to report biliary stent placements, biliary catheters, conversions, balloon dilation, etc. There were also significant changes to the guidelines for anal surgery.n
n
- 43210 Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, including duodenoscopy when performed.
n
- 47531 Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg ultrasound and/or fluoroscopy) and all associated radiological S&I; existing access
n
- 47532 Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg ultrasound and/or fluoroscopy) and all associated radiological S&I; new access (eg percutaneous transhepatic cholangiogram)
n
- 47533 Placement of biliary drainage catheter, percutaneous, including diagnostic, cholangiography when performed, imaging guidance (eg ultrasound and/or fluoroscopy), and all associated radiological S&I; external
n
- 47534 Placement of biliary drainage catheter, percutaneous, including diagnostic, cholangiography when performed, imaging guidance (eg ultrasound and/or fluoroscopy), and all associated radiological S&I; external-internal
n
- 47535 Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg fluoroscopy), and all associated radiologic S&I
n
- 47536 exchange of biliary drainage catheter (eg external, internal-external, or conversion of internal-external to external only) percutaneous, including diagnostic cholangiography when performed, inaging guidance (eg fluoroscopy), and all associated radiological S&I
n
- 47537 Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (eg with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging guidance (eg fluoroscopy) and all associated radiological S&I
n
- 47538 Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed and all associated radiological S&I; existing access
n
- 47539 Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed and all associated radiological S&I; new access, without placement of separate biliary drainage catheter.
n
- 47540 Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed and all associated radiological S&I; new access, with placement of separate biliary drainage catheter (eg external, or internal-external)
n
- 47541 Placement of access through the biliary tree and into small bowel to assist with an endoscopic biliary procedure (eg rendezvous procedure), percutaneous, including diagnostic cholangiography when performed, imaging guidance (ultrasound and/or fluoroscopy), and all associated radiological S&I, new access
n
- 47542 Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg fluoroscopy), and all associated radiological S&I, each duct (list separately in addition to code for primary procedure)
n
- 47543 Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (eg brush, forcepts, and/or needle), including imaging guidance (eg fluoroscopy), and all associated radiological S&I, single or multiple (list separately in addition to code for primary procedure)
n
- 47544 Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (eg mechanical, electrohydraulic, lithotripsy) when performed, imaging guidance (eg fluoroscopy) and all associated radiological S&I, single or multiple (list separately in addition to code for primary procedure)
n
- 49185 Sclerotherapy of a fluid collection (eg lymphocele, cyst or seroma), percutaneous, including contrast injection(s), diagnostic study, imaging guidance (eg ultrasound, fluoroscopy) and radiological S&I when performed[/toggle]
n
n[toggle title_open=”Urinary System Chapter of CPT” title_closed=”Urinary System Chapter of CPT” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]Many new codes have been added for urinary procedures. Kidney procedures had the most expansion of this chapter, with new codes added for injections, catheter placements, conversions, and exchanges.n
n
- 50430 Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg ultrasound and fluoroscopy) and all radiological S&I; new access
n
- 50431 Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg ultrasound and fluoroscopy) and all radiological S&I; existing access
n
- 50432 Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg ultrasound and/or fluoroscopy) and all associated radiological S&I
n
- 50433 Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg ultrasound, and/or fluoroscopy) and all associated radiological S&I, new access
n
- 50434 Convert nephrostomy catheter to nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg ultrasound and/or fluoroscopy) and all associated radiological S&I, via per-existing nephrostomy tract.
n
- 50435 Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg ultrasound and/or fluoroscopy) and all associated radiological S&I
n
- 50606 Endoluminal biopsy of ureter and/or renal pelvis, non-endoscopic, including imaging guidance (eg ultrasound and/or fluoroscopy) and all associated radiological S&I (list separately in addition to code for primary procedure)
n
- 50693 Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg ultrasound and/or fluoroscopy) and all associated radiological S&I; pre-existing nephrostomy tract
n
- 50694 Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg ultrasound and/or fluoroscopy) and all associated radiological S&I; new access, without separate nephrostomy catheter
n
- 50695 Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg ultrasound and/or fluoroscopy) and all associated radiological S&I; new access, with separate nephrostomy catheter
n
- 50705 Ureteral embolization or occlusion, including imaging guidance (eg ultrasound and/or fluoroscopy) and all associated radiological S&I (list separately in addition to code for primary procedure)
n
- 50706 Balloon dilation, ureteral structure, including imaging guidance (eg ultrasound and/or fluoroscopy) and all associated radiological S&I (list separately in addition to code for primary procedure)[/toggle]
n
n[toggle title_open=”Male Genital System Chapter of CPT” title_closed=”Male Genital System Chapter of CPT” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]Only two new codes have been added for male GU procedures.n
n
- 54437 Repair of traumatic corporeal tear(s)
n
- 54438 Replantation, penis, complete amputation including urethral repair[/toggle]
n
n[toggle title_open=”Nervous System Chapter of CPT” title_closed=”Nervous System Chapter of CPT” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]A few new codes have been added for nervous system procedures. There are now three codes to identify paravertebral block injections at single of multiple levels.n
n
- 61645 Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s)
n
- 61650 Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory
n
- 61651 Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; each additional vascular territory (list separately in addition to code for primary procedure)
n
- 64461 Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance when performed)
n
- 64462 Paravertebral block (PVB) (paraspinous block), thoracic; second and any additional injection site(s) (includes imaging guidance when performed) (list separately in addition to code for primary procedure)
n
- 64463 Paravertebral block (PVB) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging and guidance when performed)
n
n[/toggle][toggle title_open=”Eye and Ocular Adnexa Chapter of CPT” title_closed=”Eye and Ocular Adnexa Chapter of CPT” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]One new procedure was added to report services for corneal ring implants. There were many revisions to trabeculoplasty procedures and retinal detachments.n
n
- 65785 Implantation of intrastromal corneal ring segmentsn
n
n[/toggle][toggle title_open=”Auditory System Chapter of CPT” title_closed=”Auditory System Chapter of CPT” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]One new procedure was added to report services for removal of impacted cerumen that does not require instrumentation, but irrigation and/or lavage is achieved. This new code should never be reported with the instrumentation code for removal of impacted cerumen (69210).n
n
- 69209 Removal impacted cerumen using irrigation/lavage, unilateral
n
n[/toggle][toggle title_open=”Radiology Chapter of CPT” title_closed=”Radiology Chapter of CPT” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]A few areas of the radiology chapter expanded in this year’s CPT updates. There are new codes for fetal MRIs and nuclear medicine. There were also some notable code bundling changes for diagnostic radiology and brachytherapy. The subsection with the highest number of changes is lower extremities.nnThe term “film” has been replaced by the word “image” for radiation oncology codes. Also, in my cases, the dosimetry calculations are now included in the radiation therapy procedures.n
n
- 74712 Magnetic resonance (eg proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single of first gestation
n
- 74713 Magnetic resonance (eg proton) imaging, fetal, including placental and maternal pelvic imaging when performed; each additional gestation (list separately in addition to code for primary procedure)
n
- 77767 Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes base dosimetry, when performed; lesion diameter up to 2.0 cm or 1 channel
n
- 77768 Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes base dosimetry, when performed; lesion diameter over 2.0 cm and 2 or more channels, or multiple lesions.
n
- 77770 Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel
n
- 77771 Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry when performed; 2-12 channels
n
- 77772 Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry when performed: over 12 channels
n
- 78265 Gastric emptying imaging study (eg solid, liquid, or both); with small bowel transit
n
- 78266 Gastric emptying imaging study (eg solid, liquid, or both); with small bowel and colon transit, multiple days
n
n[/toggle][toggle title_open=”Laboratory/Pathology Chapter of CPT” title_closed=”Laboratory/Pathology Chapter of CPT” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]Many new codes were added to the lab and path chapter of CPT. Most changes related to surgical pathology and genetic testing. Gene names have been updated using the Human Genome Organization (HUGO) approved names. Six codes that were a Tier 2 molecular pathology code have moved to Tier 1, as the procedures were performed with frequencies consistent with their intended clinical use. Tier 2 procedures were revised to include the addition of analytes, revised analyte names, and deleted analytes. HIV testing has been added to the standard OB panel.n
n
- 80081 Obstetric Panel (includes HIV testing) same as 80055 with HIV-1 antigen(s), with HIV-1 & HIV-2 antibodies, single result (87389)
n
- 81170 ABL1 (ABL proto-oncogene, 1, non-receptor tyrosine kinase)(eg acquired imatinib tyrosine kinase inhibitor resistance), gene analysis, variants in the kinase domain.
n
- 81162 BRCA1, BRCA2 (breast cancer 1 and 2) (eg hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis.
n
- 81218 CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (eg acute myeloid leukemia), gene analysis, full gene sequence
n
- 81219 CALR (calreticulin) (eg myeloprofilerative disorders), gene analysis, common variants in exon 9
n
- 81272 KIT (k-vit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg gastrointestinal stromal tumor [GIST], acute myeloid leukemia, melanoma) gene analysis, targeted sequence analysis (eg exons 8, 11, 13, 17, 18)
n
- 81273 KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg mastocytosis), gene analysis D816 variant(s)
n
- 81276 KRAS (Kristen rat sarcoma viral oncogene homolog) (eg carcinoma) gene analysis; additional variant(s) (eg codon 61, codon 146)
n
- 81311 (NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) (eg colorectal carcinoma), gene analysis varienta in exon 2 (eg codons 12 and 13) and exon 3 (eg codon 61)
n
- 81314 PDGFRA (platelet-derived growth factor receptor, alpha polypeptide) (eg gastrointestinal stromal tumor (GIST), gene analysis, targeted sequence analysis (eg exons, 12, 18)
n
- 81412 Ashkenazi Jewish associated disorders (eg Bloom syndrome, Canavan disease, cystic fibrosis, familial dysautonomia, Fanconi anemia Group C, Gaucher disease, Tay-Says disease_ genomic sequence analysis panel, must include sequencing of at least 9 genes, including ASPA, BLM, CFTR, FANCC,GBA, HEXA, IKBAP, MCOLN1, & SMPD1
n
- 81432 Hereditary breast cancer-related disorders (eg hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); genomic sequence analysis panel, must include sequencing of at least 14 genes, including ATM, BRCA1, BRCA2, BRIP1, CDH1, MLH1, MSH2, MSH6, NBN, PALB2, PTEN, RAD51C, STK11, TP53
n
- 81433 Hereditary breast cancer-related disorders (eg hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); duplication/deletion analysis panel, must include analyses for BRCA1, BRCA2, MLH1, MSH2 and STK11
n
- 81434 Hereditary retinal disorders (eg retinitis pigmentosa, Leber congenital amaurosis, cone-rod dystrophy), genomic sequence analysis panel, must include sequencing of at least 15 genes including ABCA4, CNGA1, CRB1, EYS, PDE6A, PRPF31, PRPH2, RDH12, RHO, RPI, RP2, RPE65, RPGR, and USH2A
n
- 81437 Hereditary neuroendocrine tumor disorders (medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma, or paraganglioma; genomic sequencing analysis panel, must include sequencing of at least 6 genes, including MAX, SDHB, SDHC, SDHD, TMEM127, and VHL.
n
- 81438 Hereditary neuroendocrine tumor disorders (medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma, or paraganglioma; duplication/deletion analysis panel, must include analyses for SDHB, SDHC, SDHD and VHL.
n
- 81442 Noonan spectrum disorders (eg Noonan syndrome, cardio-facio-cutaneous syndrome, Costello syndrome, LEOPARD syndrome, Noonan-like syndrome), genomic sequence of at least 12 genes, including BRAF, CBL, HRAS, KRAS, MAP2K1, MAP2K2, NRAS, PTPN11, RAF1, RIT1, SHOC2, and SOS1.
n
- 81490 Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity score.
n
- 81493 Coronary artery disease, mRNA, gene expression profiling by real-time RT-PCR of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score.
n
- 81525 Oncology (colon), mRNA, gene expression profiling by real-time RT-PCR of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence score.
n
- 81528 Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result.
n
- 81535 Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; 1st single drug or drug combination.
n
- 81536 Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; each additional single drug or drug combination (List separately in addition to code for primary procedur)
n
- 81538 Oncology (lung), mass spectrometric 8-protein signature, including amyloid A, utilizing serum, prognostic and predictive algorithm reported as good versus poor overall survival.
n
- 81540 Oncology (tumor of unknown origin), mRNA, gene expression profiling by real-time RT-PCR of 92 genes (87 content and 5 housekeeping) to classify tumor into main cancer type and subtype, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a probability of a predicted main cancer type and subtype.
n
- 81545 Oncology (thyroid), gene expression analysis of 142 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (eg benign or suspicious)
n
- 81595 Cardiology (heart transplant), mRNA, gene expression profiling by real-time quantitative PCR of 20 genes (11 content and 9 housekeeping), utilizing subfraction of peripheral blood, algorithm reported as a rejection risk score.
n
- 88350 Immunofluorescence, per specimen; each additional single antibody stain procedure (list separately in addition to code for primary procedure)
n
n[/toggle][toggle title_open=”Medicine Chapter of CPT” title_closed=”Medicine Chapter of CPT” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]A few areas of the medicine chapter expanded in this year’s CPT updates. There were changes to vaccines, otolaryngology, cardiography, neurology, reflectance confocal microscopy, and ocular screening.[/toggle][toggle title_open=”Vaccines/Toxoids (4)” title_closed=”Vaccines/Toxoids (4)” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]n
n
- 90697 FDA approval pending Diptheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenza type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV-Hib-HepB), for intramuscular use
n
- 90625 FDA approval pending Cholera vaccine, live, adult dosage, 1 dose schedule for oral use
n
- 90620 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB), 2 dose schedule, for intramuscular use
n
- 90621 Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB), 3 dose schedule, for intramuscular use
n
n[/toggle][toggle title_open=”Vestibular Function Tests, With Recording (2)” title_closed=”Vestibular Function Tests, With Recording (2)” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]n
n
- 92537 Caloric vestibular test with recording, bilateral; bithermal (ie 1 warm and 1 cool irrigation in each ear for a total of 4 irrigations)
n
- 92538 Caloric vestibular test with recording, bilateral; monothermal (1 irrigation in each ear for a total of 2 irrigations)[/toggle]
n
n[toggle title_open=”Cardiography (1)” title_closed=”Cardiography (1)” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]n
n
- 93050 Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform(s), digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity artery, non-invasive.
n
n[/toggle][toggle title_open=”Special Dermatological Procedures” title_closed=”Special Dermatological Procedures” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]n
n
- 96931 Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition and interpretation and report, 1st lesion
n
- 96932 Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition only, 1st lesion
n
- 96933 Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; interpretation & report only 1st lesion
n
- 96934 Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition & interpretation & report, each additional lesion (list separately in addition to code for primary procedure) (use with 99631)
n
- 96935 Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition only, each additional lesion (list separately in addition to code for primary procedure) (use with 96932)
n
- 96936 Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; interpretation & report only, each additional lesion (list separately in addition to code for primary procedure) (use with 96933)
n
n[/toggle][toggle title_open=”Other Services and Procedures (1)” title_closed=”Other Services and Procedures (1)” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]n
n
- 99177 Instrument-based ocular screening (eg photoscreening, automated-refraction), bilateral; with on-site analysis
n
n[/toggle]
Dec 17, 2015 | Uncategorized
The Triple Aim:n
n
- Improving the patient experience
n
- Improving the health of populations
n
- Reducing per-capita cost
n
nThe Triple Aim is on all the payer’s minds these days. These three tenants are now being woven into many of the decisions being made about cost, quality, reimbursements, network size, etc. Using these three items in your contracting strategy will help your success. Measuring and being able to report your ability to positively affect these three goals will make your practice more valuable to the health plans.nnThe payers are continuing to engage in the soft-narrowing of their various networks, using the direction of member volume to leverage rates. The “Value Based” PCP relationship appears to be the primary mechanism of this process. Therefore a member is not a member until you have their benefits carefully verified.nnThese days your referral people need to take a couple of extra steps:n
n
- Is the member eligible?
n
- Are we on the PCP and Members list?
n
- What benefits are available for this plan type, product type, etc?
n
n
PAYER UPDATES:
nAetna is in the process of buying Humana.nnAetna is sub dividing its Medicare Advantage product into sub-groups – watch for proper referrals and authorizations!nnAnthem is buying CIGNA. This is a huge merger and will require FTC approval. It will likely take a year or more to happen. The interesting thing about this merger is CIGNA is almost 100% self-funded (ASO) business. Anthem is currently about 50/50 self-insured and fully insured. They are capturing an enormous amount of the ASO business with this merger, an interesting reaction to the Affordable Care Act.nnJuly 1 Anthem updated its RBRBS year to 2014 – The more recent RBRVS years tend to favor the E&M codes at the expense of some surgical procedural codes – watch your reimbursement!nnMergers – Is There Opportunity for Your Practice? Usually during merger activity the health plans want a stable network. There may be a time for each of these (four different major health plans) to take a look at better rates! They all react to these things differently, so we will all need to keep our ears to the ground and look for opportunity.nnColorado HealthOP – They have had an incredible increase in members this year as a partial result of very favorable rate filings with the state. It will be interesting to see their rate fillings and growth as the New Year approaches.nnUnited Healthcare is updating their RBRVS year! They are also increasing their focus on the use of Out-Of-Network (OON) providers. If you are in-network but routinely refer to OON providers it is nearly impossible to increase your in-network rates. United appears to be following Anthem’s recent program to locate and weed out the use of OON providers.nnMedicare and Orthopedics: Medicare has initiated an Orthopedics bundled program called Comprehensive Care for Joint Replacement (CCJR). This program requires 800 pre-selected hospitals in 75 areas of the country to participate. They call it a Bundled Program but really it is a form of Pay-for-Performance in which the hospital gets the money and makes the decisions. More to come on this!nnICD-10 – so far so good? We haven’t seen any wholesale issues just yet. If you are experiencing any trouble please let us know!
Nov 19, 2015 | Uncategorized
The Colorado Division of Workers’ Compensation (DOWC) recently issued final utilization standards and the final Colorado Workers’ Compensation Medical Fee Schedule that affect all workers’ compensation billing, and will go into effect January 1, 2016. Among several significant changes are that these rules and regulations require payers to adopt Medicare’s Resource-Based Relative Value Scale (RBRVS) method of payment. You should be aware of regulatory changes that will affect your billing, coding and processes, and make any necessary business adjustments now to ensure a smooth transition.nnThe DOWC set out to ensure that the transition to the new fee schedule and payment system would be budget-neutral overall; however, providers should examine the rules closely and analyze specifically how fee schedule changes may impact their payments for certain specialties.
R46.2 – Strange and inexplicable behaviornR46.1 – Bizarre personal appearancenF10.921 – Alcohol use, with intoxication deliriumnW22.02XA – Walked into lamppost, initial encounternY90.7 – Blood alcohol level of 200-239 mg/100 ml or morenn 
R51 – HeadachenR46.6 – Undue concern and preoccupation with stressful eventsnZ63.1 – Problems in relationship with in-lawsnn