Apr 22, 2021 | Uncategorized
CMS proposed bi-annual ICD-10 implementation dates that would be in addition to previous coding from last October. With the ongoing COVID-19 pandemic, the industry has had to adapt and evolve quickly. Of course, with new coding comes new standards for the medical industry. Read more below to see the new CMS proposed bi-annual coding dates. nnIn the March 2021 virtual ICD-10 Coordination and Maintenance Committee meeting, the Centers for Disease Control and Prevention’s National Center of Health Statistics (CDC/NCHS) and the Centers for Medicare and Medicaid Services (CMS), announced a new proposal to introduce an April 1st implementation date for ICD-10-CM & ICD-10-PCS updates. This April 1 implementation would be in addition to our existing October 1 implementation for code set updates and revisions, and would be considered under Social Security Act section 1886(d)(5)(K)(vii).nnThis proposal is, in part, due to lessons learned from the ongoing COVID-19 Public Health Emergency (PHE) and the need for the healthcare industry to adapt quickly to rapidly evolving industry standards and the impact it has on the business of medicine. The Committee concluded with a call for public comments on this proposal. All comments must be submitted by May 7, 2021 to CMS at ICDProcedureCodeRequest@cms.hhs.gov.n
To learn about the pros and cons of the proposed bi-annual ICD-10 implementation dates, please click here.
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Apr 16, 2021 | Uncategorized
The house has delayed Medicare 2% sequester cuts through 2021. Sequestration cuts were originally supposed to be implemented this month, however, Congress has acknowledged how detrimental this may be to providers and patients and this has ultimately prompted the extension. Continue reading below to find out more.nnPresident Biden is expected to sign the bill, which has already cleared the Senate.nnKey Takeaways:n
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- To pay for the estimated $18 billion in delayed cuts, the bill increases the fiscal year 2030 sequester cuts.
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- The bill also tweaks the rural health clinic provisions in the Consolidated Appropriations Act, 2021.
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- Specifically, requirement that the payment rate for RHCs be capped at $100 per visit beginning April 1, 2021.
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- The rate will increase gradually based on the Medicare Economic Index, but the AHA said it will remain well below typical provider-based RHC rates.
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- Medicare also faces a separate 4% cut — about $36 billion — owing to the Pay-as-You-Go provisions that kicked in to offset the cost of the American Rescue Plan Act.
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- The House had already passed a bill eliminating PAYGO for the stimulus bill, but the Senate did not act on it.
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nA bipartisan U.S. House on Tuesday night voted 384-38 to delay until the end of 2021 Medicare’s reviled 2% across-the-board sequestration cuts that were supposed to take effect on April 1. The Senate passed the bill 90-2 last month and President Joseph R. Biden is expected to sign it in the coming days. To pay for the estimated $18 billion in delayed cuts, the bill increases the fiscal year 2030 sequester cuts. American Medical Association President Susan R. Bailey, MD, said the overwhelming support in Congress for delaying the cuts “acknowledges that cutting Medicare payments during a pandemic is ill-conceived policy.”nn”Physician practices are already distressed, and arbitrary 2% across-the-board Medicare cuts would have been devastating,” she said. Rick Pollack, president and CEO of the American Hospital Association, said the delay was needed while hospitals and clinicians contend with the coronavirus pandemic and ongoing vaccination efforts. “Even though our country is making great progress by vaccinating millions of people a day, it is clear that this pandemic is far from over and that there is an urgent need to keep hospitals, health systems, and our heroic caregivers strong,” Pollack said.nnAnders Gilberg, senior vice president, government affairs, at the Medical Group Management Association, said his association was “relieved that Congress heeded our call to protect medical groups from the arbitrary 2% Medicare sequester cuts through the end of 2021.” “MGMA has long opposed the sequester cuts, a tax that penalizes medical practices for Congress’ inability to meaningfully address the country’s budgetary affairs,” Gilberg said. “To reinstate the Medicare sequester in the middle of a global pandemic would threaten the viability of physician practices and adversely impact the patients they treat.”nnWith the extension in place, Gilberg urged Congress “to work in a bipartisan manner to expeditiously pass legislation that would prevent an additional 4% Medicare spending cut next year due to the budgetary effects of the American Rescue Plan.” The bill also tweaks the rural health clinic provisions in the Consolidated Appropriations Act, 2021. Specifically, the requirement that the payment rate for RHCs be capped at $100 per visit beginning April 1, 2021. The rate will increase gradually based on the Medicare Economic Index, but the AHA said it will remain well below typical provider-based RHC rates.nnThe bill also includes both Medicare-enrolled RHCs located in a hospital with less than 50 beds and RHCs that have applied for Medicare enrollment as of this date. Medicare also faces a separate 4% cut — about $36 billion — owing to the Pay-as-You-Go mandates that offset the cost of the American Rescue Plan Act. The House had already passed a bill eliminating PAYGO for the stimulus bill, but the Senate did not act on it.nnPollack said the AHA will continue to press Congress and the Biden administration for more “support, resources and tools” for the nation’s hospitals. “This includes continuing to advocate for more overall funding for the Provider Relief Fund, relief for hospitals and health systems with Medicare accelerated payments, hospital and health system priorities to be included in the upcoming infrastructure legislative package and Congressional action by the end of the year on Medicare cuts due to the effects of PAYGO,” he said.nn“To reinstate the medicare sequester in the middle of a global pandemic would threaten the viability of physician practices and adversely impact the patients they treat.”n-Anders Gilberg, MGMA nnOriginal article published on healthleadersmedia.com
Apr 8, 2021 | Uncategorized
CMS pauses payment claims submitted after April 1st until Congress passes the sequester bill. As ideas of the sequester extension have been thrown around, CMS has paused payments to minimize the volume of claims that would be reprocessed. More news should come out soon as Congress returns from recess. Read below to find more about CMS updates. nnThe House is on recess but expected to pass the bill when it returns to Washington, D.C., on April 13. A version of this article was first published April 5, 2021, by HCPro’s Revenue Cycle Advisor, a sibling publication to HealthLeaders. CMS is holding payments for claims submitted on or after April 1 in anticipation of legislation that will extend the suspension of a 2% cut (sequester) to all Medicare payments, according to a special edition of MLN Connects.nnThe Senate recently passed a bill that would eliminate the 2% sequestration of Medicare reimbursements through the end of 2021. The House is on recess but expected to pass the bill when it returns to Washington, D.C., on April 13. According to CMS, temporarily withholding payments will “minimize the volume of claims the MACs [Medicare Administrative Contractors] must reprocess if Congress extends the suspension.” MACs will reprocess any claims paid with the reduction applied, if necessary.nnExtension of the sequester is a major priority for the American Medical Association, American Hospital Association, and other physician groups who believe the 2% payment cut would financially devastate already distressed physician practices. Revenue Cycle Advisor combines all of HCPro’s Medicare regulatory and reimbursement resources into one handy and easy-to-access portal. News is not just repeated from other sources. It is analyzed by our Medicare experts so professionals can comprehend any new rule and regulatory updates thoroughly.nnOriginal article published on healthleadersmedia.com
Apr 8, 2021 | Uncategorized
The AMA has released new 2021 guidelines for E/M clarifications and we have the updates for the new corrections. Stay up-to-date and informed with WHP about new changes in guidelines in coding for E/M. Continue reading below to learn more.nnMarch 9, 2021 – American Medical Association (AMA) released an update to the 2021 Evaluation and Management (E&M) guidelines with clarification of definitions within the previously released guidelines. These updates, although vast, appear to really focus on the Data elements of our Medical Decision Making (MDM).nnThe updated guidelines list the following revisions.n
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- Clarifying when reporting a test that is considered, but not selected after shared decision making.
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- Providing a definition of “Analyzed” for reporting tests in the data column.
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- Clarifying the definition of a “unique” test.
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- Clarifying what is meant by “discussion” between physicians, and other qualified health care professionals and patients.
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- Providing a definition of major vs minor surgery
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Mar 30, 2021 | Uncategorized
This year, we celebrate National Doctor’s Day by recognizing all the hard work and sacrifices during the COVID-19 pandemic of 2020 and 2021. Doctor’s hard work and selflessness have made the biggest differences in our communities as we overcome the hardships of the past year. From frontline work to research, doctors have been working hard to keep our communities safe and healthy.nnFor this National Doctor’s Day, keep in mind the ways doctors have impacted you and how much doctors mean to our society. While we are thankful for all doctors, we would like to send a special “THANK YOU” to our clients as we celebrate YOU on this special day!
Mar 30, 2021 | Uncategorized
The AMA has released new updates for the 2021 Evaluation and Management guidelines. Stay up to date with the newest guidelines and AMA definition clarifications. Welter Healthcare Partners will also be hosting a webinar to review these changes with a link and sign-up available. Read more below to learn more. nnMarch 9,2021 – American Medical Association (AMA) released an update to the 2021 Evaluation and Management (E&M) guidelines with clarification of definitions within the previously released guidelines. These updates, although vast, appear to really focus in on the Data elements of our Medical Decision Making (MDM).nnThe updated guidelines list the following revisions.n
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- Clarifying when reporting a test that is considered, but not selected after shared decision making.
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- Providing a definition of “Analyzed” for reporting tests in the data column.
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- Clarifying the definition of a “unique” test.
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- Clarifying what is meant by “discussion” between physicians, and other qualified health care professionals and patients.
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- Providing a definition of major vs minor surgery.
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n Welter Healthcare Partners will be hosting one more webinar to review these changes and provide examples of when these changes will be relevant to your practice.
Mar 26, 2021 | Uncategorized
Burnout has been the reality for millions of people this past year. Whether it is a change in lifestyle or working too much, it can change the way we approach and do things in our everyday lives. What is burnout exactly and how can we approach these emotions going forward? Read below to learn more.nnHow are you doing? This simple question gets asked a lot these days, and for some of us our standard answer is “ok”. We are asked this at work, by friends, by family, and even strangers in limited interactions while at the grocery store. But what does it really mean? Does the person asking us really care? When it comes to our work life, are we truly aware of how we are doing? Burnout is nothing new.nnWorld Health Organization (WHO) defines burnout as an occupational phenomenon.nIt is included in ICD-10 and identified by code Z73.0. With the release of ICD-11, Burnout received a more detailed definition.nnAccording to the WHO’s website, Burnout is characterized by three dimensions:n1) feelings of energy depletion or exhaustion.n2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job.n3) reduced professional efficacy.nnPersonally, this is not something I ever thought about. Until I listened to a recent episode of NPR’s Life Kit, host Rhitu Chatterjee spoke with professionals regarding burnout and how it affected them personally and psychiatrist on ways to cope with this in your own lives.
Mar 22, 2021 | Uncategorized
The webinar training has been announced for the 2021 E/M technical corrections! Join Welter Healthcare Partners in a webinar training event to go over the newest changes in E/M guidelines and stay up to date on the newest coding changes. Check below for times and dates for the upcoming webinar training and register your practice/organization! nnBy Ginger Avery, CPC, CPMA, CRC nMarch 17, 2021nnSince the release of the January 1, 2021 updated E/M guidelines for office or other outpatient (CPT codes 99202-99215) and prolonged services (CPT codes 99354, 99355, 99356, 99417), the AMA has received an abundance of feedback from clinicians on areas of confusion. The AMA’s CPT Editorial Panel has made several technical corrections to add clarity to these exciting updates. These technical corrections were released March 9th and are effective January 1, 2021.nnThe summary of updates listed below reveals that most of the new information is concentrated on medical decision making (MDM) definitions:nn
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- Total Encounter Time Reporting: Clarification has been made when to NOT count time.
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- Five new MDM definitions added:n
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- Analyzed – referred to in the data element of Table 2 of the guidelines
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- Combination of data elements
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- Discussion
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- Unique Test and Unique Source
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- Surgery: minor vs. major
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- Revised Definitions have been created to clarify the following terms:n
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- Drug therapy requiring intensive monitoring for toxicity
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- Independent Historian
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- Risk
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- Test
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- Clarification provided for separately reported tests and interpretation.
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nMake sure your organization is up-to-date with these recent revisions and has a solid understanding of the new 2021 E/M Guidelines for office visit services. These monumental changes cannot go unnoticed! Register below for a one-hour webinar presented by Welter Healthcare Partners on these crucial updates. If you have any submission issues with the contact form, please email Cody at cwhitworth@rtwelter.com to register. nnAll webinar registrants will receive 5 of Welter Healthcare Partners’s 2021 Office Visit E/M Coding Tools!nn[dt_divider style=”thin” /]nn[gravityform id=”18″ title=”false” description=”false”]nnThese unpredictable updates to our ever-changing healthcare environment should serve as a reminder to visit AMA’s Errata & Technical Corrections regularly for any noted changes. nn
Mar 18, 2021 | Uncategorized
Several technical corrections have been made in the recently released 2021 E/M guidelines. With feedback from clinicians to clarify these new guidelines, new summary updates have been presented to clear up any confusion. Stay updated with the clarified E/M guidelines today. Continue reading below to learn more.nnBy Ginger Avery, CPC, CPMA, CRCnMarch 17, 2021nnSince the release of the January 1, 2021, updated E/M guidelines for office or other outpatient (CPT codes 99202-99215) and prolonged services (CPT codes 99354, 99355, 99356, 99417), the AMA has received an abundance of feedback from clinicians on areas of confusion. The AMA’s CPT Editorial Panel has made several technical corrections to add clarity to these exciting updates. These technical corrections were released March 9th and are effective January 1, 2021.nnThe summary of updates listed below reveals that most of the new information is concentrated on medical decision making (MDM) definitions:n
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- Total Encounter Time Reporting: Clarification has been made when to NOT count time.
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- Five new MDM definitions added:n
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- Analyzed – referred to in the data element of Table 2 of the guidelines
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- Combination of data elements
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- Discussion
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- Unique Test and Unique Source
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- Surgery: minor vs. major
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- Revised Definitions have been created to clarify the following terms:n
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- Drug therapy requiring intensive monitoring for toxicity
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- Independent Historian
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- Risk
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- Test
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n
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- Clarification provided for separately reported tests and interpretation.
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nMake sure your organization is up-to-date with these recent revisions and has a solid understanding of the new 2021 E/M Guidelines for office visit services. These monumental changes cannot go unnoticed! Register below for a one-hour webinar presented by Welter Healthcare Partners on these crucial updates. If you have any submission issues with the contact form, please email Cody at cwhitworth@rtwelter.com to register. nnAll webinar registrants will receive 5 of Welter Healthcare Partners’s 2021 Office Visit E/M Coding Tools!nn[dt_divider style=”thin” /]nn[gravityform id=”18″ title=”false” description=”false”]nnThese unpredictable updates to our ever-changing healthcare environment should serve as a reminder to visit AMA’s Errata & Technical Corrections regularly for any noted changes. nn
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
Feb 25, 2021 | Uncategorized
There are 5 emerging trends in value-based care for 2021. The practice of value-based care has picked up momentum because of the pandemic and pressure has been put on healthcare providers to stay up-to-date with trends. Continue reading below to learn more about the 5 emerging trends in value-based care this year.nnThe pace and pressure to embrace value-based care are picking up. The COVID-19 pandemic exposed the risks and limitations of reliance on fee-for-service reimbursement and, combined with the groundbreaking changes in health care delivery models and regulatory flexibility, indicate a renewed focus on value-based care. This article outlines five of the top trends to watch for in value-based care for 2021.nn1. Leaning Into Value-Based CarenOne of the lessons from 2020 is that reliance on fee-for-service can leave providers vulnerable to volatility and changes in demand. As utilization plummeted during the COVID-19 pandemic, providers who had invested heavily in value-based care have been better able to weather the pandemic and the economic downturn by having a consistent source of revenue despite low utilization. The rapid changes in health care driven by the pandemic only further emphasized the need for providers to lean into value-based care. Beyond the allure of steady revenue streams, new regulatory flexibilities and care delivery innovation creates an opportunity for providers to realize a more rapid rate of return on their investment in value-based care by increasing the portion of their business with value-based care reimbursement.nn2. Continued Innovation and DisruptionnWhile value-based care has always been an area ripe for innovation, 2021 presents a unique set of circumstances that point to a surge of innovation and disruption in both payment and care delivery models. Value-based care had been a priority for the Centers for Medicare and Medicaid Services (“CMS”) under the Trump administration, but there is no reason to expect a change of course away from value-based care. In fact, the Biden administration’s health care goals will likely require an increased emphasis on cost savings, which may result in an even greater push towards value-based care. Some news outlets are reporting that Elizabeth Fowler is a front-runner to lead the Center for Medicare and Medicaid Innovation, further signaling that CMS’s momentum on value-based care will continue. Commercial payors also continue to push towards innovative payment and care models as COVID-19 has highlighted the inequities in the healthcare delivery system and challenges for providers.nn3. Capitalizing on COVID-19 InfrastructurenThe COVID-19 pandemic prompted transformational changes to the health care system that portend continued opportunities to manage patient care and provide quality care in lower cost settings. As a result of the pandemic, both the federal and state governments threw open the doors to allow providers to furnish services via telemedicine and other digital health modalities during the COVID-19 public health emergency. Many of the telehealth waivers have been made permanent. Providers who have embraced digital health as a way to weather the pandemic will also have the opportunity to capitalize on this investment as a way to manage patient care and see a return on investment for services that are typically not reimbursable under fee-for-service arrangements. CMS also created the Hospital Without Walls and Acute Hospital Care at Home programs to increase hospital capacity during the pandemic. Commercial payors have been eager to seize on these opportunities to promote lower-cost services. Providers who have invested in these types of programs similarly provide an opportunity to provide quality care in lower cost environments, which will benefit providers who are fully engaged in value-based care.nn4. New Opportunities for Provider AlignmentnRecent changes to federal law aim to lower barriers to value-based care. In particular, CMS and the Office of Inspector General (“OIG”) created new flexibility under the Stark law and Anti-kickback Statute for value-based arrangements to allow providers to enter into value-based care arrangements that previously may have been prohibited. While the new exceptions and safe harbors still require that arrangements be carefully crafted, they provide new opportunities to align with providers and to incentivize activities that promote value-based goals that were previously unavailable. Additionally, the sweeping interoperability and information blocking rules aim to ensure that patients and providers are able to access health information, further reducing structural barriers to value-based care.nn5. Emphasis on Social Determinants of HealthnFinally, players in the value-based care space—particularly in Medicaid managed care programs—are placing greater emphasis on addressing social determinants of health. Providers and payors are beginning to recognize the crucial role that non-medical factors play in patient health. By solving for these issues—such as transportation, food, housing, language services, etc.—providers and payors are able to realize significant benefits in improving patient health and outcomes while keeping medical costs relatively low. The focus on social determinants of health is an emerging trend in value-based care that is likely to grow as players seek creative ways to manage patient care through value-based arrangements.nnAs providers and payors emerge from the upheaval of the pandemic and the resulting revolutionary changes in health care, we can expect renewed interest in value-based care. Opportunities abound to capitalize on the changes wrought by the pandemic, as well as emerging prospects, by fully investing in value-based care.nnOriginal article published on natlawreview.com
Feb 25, 2021 | Uncategorized
Making the most out of the time we have at work to stay healthy can be a real struggle. Health and workplace environments can alter the way we feel so finding this balance is essential to feeling your best. Continue reading to learn more about workplace health and how to stay active.nnHeart health is essential and should be part of your daily routine both at home and at work. As part of Heart Health Month, this little reminder from the American Heart Association can be printed or saved as your reminder to not let your workload distract you from a healthy life.nnFollow these five exercises as a way to break up your day.nn
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- Start with your commute; try walking or cycling to work. Even if this isn’t possible park further from the entrance or in our current COVID PHE, start with a working walk around the yard or neighborhood. Even a 5-minute walk to the mailbox can be beneficial.
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- Stretch it out; Start at your neck and move throughout your body, taking a few moments to concentrate on each area. YouTube can be a great resource to follow simple full-body stretching routines that can be done in 15 minutes or less.
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- Transform screen time; Use a standing desk or even under desk bike pedals to allow productivity to continue while moving. Even the use of stability ball chairs can help to strengthen and tone core muscles.
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- Walk and talk; the use of headsets and cellphones can allow those lengthy phone meetings to be a great opportunity for movement. You can even do this without braving the cold winter weather by using the stairs or hallways in your buildings.
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- Deskercise; Use your desk, chair, and walls to practice modified exercises. Those heavy codebooks can even be used as weights.
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Click here to learn more about health in the workplace!
nOriginal article published on heart.orgnn nn
Feb 19, 2021 | Uncategorized
MGMA CFO analyzes the financial impact of COVID-19 on physician practices and outlines some long-term strategies that healthcare organizations should implement as a precaution in case another pandemic occurs. These strategies may help avoid the negative financial impact we saw with COVID-19. Continue reading below to learn more!nnThe path forward to a more financially sustainable operation and prosperous future remains tenuous for most medical groups but there are opportunities for leaders who are willing to make the necessary changes.nnWhile hospitals and health systems suffered historic financial challenges related to the COVID-19 pandemic in 2020, medical groups and physician practices were not spared either. These smaller provider organizations endured similar constraints due to declining revenues and rising expenses, a trend that hasn’t ceased thus far in 2021.nnThe path forward to a more financially sustainable operation and prosperous future remains tenuous for most medical groups but there are opportunities for leaders who are willing to make the necessary changes. Akash Madiah, CFO of MGMA, outlines the long-term strategies that medical group executives should follow to be more resilient and less vulnerable if another pandemic or industry-changing calamity occurs.nnThis transcript has been edited for clarity and brevity.nnHealthLeaders: What is your advice for financial executives at provider organizations as they continue to deal with the difficult dynamics caused by COVID-19? Are you optimistic or pessimistic about their prospects? Why or why not?nnMadiah: First, I’d advise that everyone take advantage of the federal financial assistance programs, namely the [CARES Act] Provider Relief Fund, which has now been reopened, and the Paycheck Protection Program. Our government affairs team based in [Washington, D.C.] has done remarkable work advocating for [physician] practices and organizations to receive relief through the pandemic. MGMA members have been involved and active in the advocacy efforts. In one of our grassroots campaigns, we mobilized 2,000 medical practices to send over 7,000 letters to Congress in less than 48 hours and it helped secure sufficient funding for medical practices.nnIn the relief packages, there’s over $175 billion allocated for healthcare providers, so there is available money out there. These programs were put in place to help medical practices and businesses stay afloat and overcome the downside impact of the pandemic. With respect to these programs, they’re loans but there’s an administrative aspect to these. I think with calendar year 2021, there’s going to be a lot of backend work for the medical group community to make sure that the loans and grants are forgiven. That’s the burden for the healthcare community at large, but overall, I’m pretty optimistic about where things are going.nnThe spring and summer of 2020 were the worst of times and the darkest period. We’ve had an uptick since as people feel more comfortable going back to doctor’s offices. [With] people who skipped out on their annual checkups, those dollars aren’t ever coming back, but that’s where those relief programs were meant to help. There is a backlog of elective procedures; I think the trend is going up, and I feel that’s going to continue through the rest of the year, especially with the vaccine rollout.nnHL: What role should the federal or state governments play in assisting these care providers that are facing a dual-threat to their bottom line? Additionally, is there any action that the payer community should take to help their struggling counterparts on the provider side?nnMadiah: As I mentioned, the money is out there, so it’s up to providers to access that. I think the government has responded and everybody should be accessing the dollars based on their eligibility. But now going forward, I think the biggest thing government can do is ease the administrative burden to make sure that reconciliation and forgiveness of loans is easy for the medical groups.nnNeedless to say, medical groups are going to be busy enough this year, and focusing on patient care should be paramount and not bogged down by the administrative burden. I’ll also add that our CEO Dr. Halee Fischer-Wright sent a letter to the Biden administration [earlier this month] asking that medical group practices are included in the vaccine distribution strategy given their role as community providers across the country.nnThe payers are a little trickier, they are under no obligation to help, but I would say any cooperation and long-term view can help since we’re all in this together. [Payers] have a role in supporting the mechanisms that keep both patients and medical practices healthy in 2021, specifically making sure things that helped providers through the pandemic, like reimbursements for expanded telehealth services, continue. Then, like the government, any reduction to the administrative burden, such as relaxed prior authorization, can only help going forward.nnHL: Are you fearful about the continued effort by private equity firms to acquire medical groups or physician practices? What impact do you think that behavior will have on the healthcare industry at large?nnMadiah: When private equity enters an industry, there’s a general sense that they will cut costs, slash-and-burn, and then sell it for a profit. I think that’s probably the most pessimistic view of them. I’m not fearful of them; they’re a player in all industries across America and they can cut costs in a good way and try to create synergies to make sure revenues are increasing. When it comes to healthcare, there’s a fear [that private equity] is going to hurt the patient and decrease access to healthcare. The profit tone that comes along with private equity often takes away from the altruistic tone that we convey with our members at MGMA. That’s the push and pull with private equity.nnThe big question is how will [private equity] generate the returns they’re used to seeing while also improving the patient experience, which again means more access and better outcomes. If they’re willing to invest in technology and processes that can help the industry, there can be an upside. But that comes at a time horizon that’s a little bit longer than they’re typically used to because while healthcare is continually changing, the speed of that change is not always conducive to what private equity is traditionally invested in. With our members there’s general skepticism with what approach [private equity] is going to take; are they going to be investing for the long-haul or are they taking the short-term view and motivated by profits?nnHL: What are the critical long-term strategies that medical group executives should follow to be more resilient and avoid being vulnerable if another pandemic or industry-changing calamity occurs?nnMadiah: The biggest thing is always to be vigilant. On the expense side, make sure there’s no extra waste in your practice and [don’t] worry about cutting things when the money is tight. The other part of that is being on the offensive, to the extent you have the resources to do so. Invest in your organization to make it more efficient or profitable now rather than being reactive in an urgent situation in the future.nnOne example from the pandemic is telehealth. That was a huge lifeline to a lot of practices to make sure revenue was still streaming in, but many practices had not implemented telehealth prior to COVID-19 and they were being more reactive. We’re trying to invest more in data now to make sure we’re looking ahead and being prepared for the future.nn[Referencing] the MGMA year-in-review report, a lot of practices are changing the way they measure their key metrics of success and looking at things on a more frequent basis rather than a monthly basis.nnThis doesn’t just go for healthcare, but reassess space needs. Understand how successful you are as a remote organization and what you should be investing in going forward. That applies to a number of industries across America, but the bottom line is to be proactive, try to foresee what challenges you need to get ahead of, and make sure to invest in those areas to the extent that you can.nnEditor’s note: This conversation is a transcript from an episode of the HealthLeaders Finance Podcast. Audio of the interview can be found here.nnOriginal and complete article published on healthleadersmedia.com
Feb 19, 2021 | Uncategorized
nnCardiovascular coding continues to change and there have been some significant changes so far in 2021. With new shunting codes and add-on codes, it’s important to stay up-to-date with the latest changes. Continue reading below to learn more about the cardiovascular coding changes for 2021.nnWe have all been so focused on the changes in the Evaluation and Management section of the CPT manual that we wanted to spotlight a different code set that also received significant guideline changes in 2021, cardiac shunt procedures.nnIn addition to completely re-written guidelines, we also have three new shunting procedure codes, 33741, 33745, and add-on code 33746. Careful review and notation of all the changes is recommended, you can find the changes starting on page 262 of your CPT manual.
Feb 11, 2021 | Uncategorized
The 2021 E/M updates and elements of MDM are continually being clarified. The article below will address questions and answers over the new E/M Office visit guidelines. Read below to see more about the new updates and information. nnBy Ginger Avery, CPC, CPMA, CRC nFebruary 2, 2021nnQuestions and answers continue to be clarified as we are now a month into utilizing the new E/M Office Visit guidelines that took effect on January 1, 2021. Understanding how to navigate labs and other test results as they pertain to the time and medical decision-making (MDM) elements of the revamped E/M office visit rules can be hard to ascertain. The following details should help improve understanding of the new data review rules. nnData Element:nn
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- When tests are ordered during one visit and reviewed the same test during the next visit, can that count as a data point for both visits?n No. When a clinician orders a test during an E/M visit, the order and review of the test result will count toward the MDM of the first encounter.
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- If we receive a test result two days after the visit, can we count a data point toward that E/M visit for review of the test?n Yes, there’s pre-service work and post-service work associated with the encounter and receiving a test result a couple of days later and responding to it are part of the post-service work of the encounter.
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- Can the independent visualization of a test be counted in the medical decision making if the physician is also billing for the test?nPer AMA, the actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the level of E/M service when reported separately. Clinician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code. The clinician’s interpretation of the results of diagnostic tests/studies (i.e., professional component) with preparation of a separate distinctly identifiable signed written report may also be reported separately, using the appropriate CPT code and, if required, with modifier 26 appended. If a test/study is independently interpreted in order to manage the patient as part of the E/M service but is not separately reported; it is part of medical decision making.
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- If one doctor orders a test that is performed in the practice, but a second doctor bills for the test, can the first doctor count the test order toward MDM for his visit?nPractices should not count a test toward MDM if the ordering practitioner’s practice also performed and billed for the test. Medicare and private payers could view that type of coding as abusive or fraudulent.
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nDocumentation Questions:nn
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- Since history and physical exam are no longer required to level the visit, should these elements still be documented?nYes, history and exam are still part of an evaluation. The documented content should be focused only on the clinically relevant details and cognitive thoughts of the clinician. Document the nature of the presenting illness(es) (subject details with pertinent ROS). Document a medically necessary exam. Documentation is about the quality of the story, not the quantity of details. Avoid importing pages of past medical history, ROS or medication lists that are note relevant or helpful. Clinicians are encouraged to write clear stories that they would like to read.
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- Do I still have to document ROS and PFSH?nYes, when clinically relevant. For example: Patient presents with chest pain. Has been having intermittent chest pain at rest for two weeks. No notable triggers. Positive for headaches and dizziness, no SOB. Patient has a family history of CAD. Remember, documentation is all about the medically necessary story.
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- When coding based on total time does the assessment and plan still need to be documented?nYes. Quality documentation should always be captured. Clear stories that include clinical impressions and plans support the medical necessity and describe the complexity for the services provided, regardless of how you choose to report the visit.
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nOther Common Questions:nn
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- Are commercial plans required to adopt the revisions to E/M codes?nYes. The CPT code set, together with the U.S. Department of Health and Human Services’ Healthcare Common Procedure Coding System, has been adopted as the nation’s standard medical data code set. HIPAA requires that health plans use the most recent version of the medical data code set, they should have implemented these revisions Jan. 1, 2021.n
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- Do the 2021 E/M code and guideline changes apply to all categories of E/M services?nNo. The E/M code and guideline changes are specific for office and other outpatient visits and apply only to codes 99201–99205 and 99211–99215. Inpatient services still need to follow the key component guidelines (1995 or 1997).n
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- When considering High-Risk MDM, there is an example listed: “drug therapy requiring intensive monitoring for toxicity”. What constitutes supporting this definition? When considering this complexity, both the drug and the monitoring must qualify. The new guidelines provide this definition when considering this High-Risk example:n“Drug therapy requiring intensive monitoring (today) for toxicity: A drug that requires intensive monitoring is a therapeutic agent that has the potential to cause serious morbidity or death. The monitoring is performed for assessment of these adverse effects and not primarily for assessment of therapeutic efficacy. Monitoring by history or examination does not qualify. The monitoring affects the level of medical decision making in an encounter in which it is considered in the management of the patient. Both the drug and the monitoring must qualify on the date of the encounter.n
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- Where can the CPT E/M code and guidelines be found?nThe CPT E/M code and guideline changes for 2021 can not only be found on the American Medical Associations’ (AMA) site at this link. They can also be found in their entirety within the 2021 CPT Code books themselves. These guidelines include details about reporting based on the total encounter time, the new level of medical decision-making table and the 22 new definitions that help clarify what the MDM terms mean.
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nAs a reminder, documentation is about painting a clear picture of each encounter. The power of storytelling is evident with these new updates. Quality documentation provides details to support and defend the medical necessity and appropriate complexity of each unique encounter, as well as improves overall patient care and clinical outcomes. Due to President Biden recently issuing several health care executive orders, we can expect policy adjustments that will lead federal auditors and investigators to focus on subjects like: fraud and abuse (especially in the telehealth arena), auditing of provider relief funds received during the PHE, HIPPA compliance, meaningful use, workplace safety and Evaluation and Management (EM) services. With increased emphasis on these interrelated topics, clinicians are encouraged to focus documentation efforts on the cognitive clinically relevant details, regardless of the clinical setting. Document what you do, code what you document. Consider an educational audit review for your clinicians to see if they are taking proper credit for all the work they do by telling great stories in their encounter notes.nnKeep an eye out for more guidance from Medicare and private payers. Currently, Medicare is still working on an update to its documentation guidelines for E/M services. Welter Healthcare Partners provides robust coding and documentation training for these updates, as well as other topics. Please contact cwhitworth@rtwelter.com to book your training now.nnReferences:nAMA CPT® E/M Code and Guideline Changes for 2021nAma-assn.orgnNovitas E/M Documentation RequirementsnNoridian E/M Documentation RequirementsnDecision Health PartBNews
Feb 11, 2021 | Uncategorized
The report below describes a patient undergoing excision of the left dorsalis pedis artery aneurysm. 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 and to learn about the use of the unlisted procedure code for this cardiovascular procedure.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 –
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nn37799: EXCISION DORSALIS PEDIS ARTERY ANEURYSM [COMPARE TO CODE 35152 FOR UNLISTED PROCEDURE] I72.4nn
nDATE OF OPERATION: 01/XX/2021nOPERATING SURGEON: S. G., M.D.nPREOPERATIVE DIAGNOSIS: Left dorsalis pedis artery aneurysm.nPOSTOPERATIVE DIAGNOSIS: Left dorsalis pedis artery aneurysm.nPROCEDURE PERFORMED: Excision of left DP artery aneurysm.nANESTHESIA: Monitored anesthesia care with local anesthetic.nASSISTANTS: None.nINDICATION: The patient is a 40-year-old male with a history of acute onset of left foot pain. Ultrasound demonstrated a pseudoaneurysm versus aneurysm of the dorsalis pedis artery. The patient did not have any blue toes but based on the symptoms of pain and the location, it was recommended he undergo excision. Risks, benefits, and alternatives were discussed with the patient. He consented to procedure.nnDESCRIPTION OF PROCEDURE: On the operative day, the patient was met in the preop holding area. All site verification consent forms were completed and placed in the chart. The patient was then taken to the OR, placed on table in supine position. After induction of general anesthetic, the patient was prepped and draped in usual sterile fashion. Final time-out was then performed by all in attendance to be correct patient, correct procedure, correct site, and the antibiotics had been administered. Using ultrasound, the anterior tibial and dorsalis pedis artery were mapped. Of note, right at the ankle, the dorsalis pedis branched into a medial and lateral branch. The lateral branch was the one that proceeded on to the aneurysmal region. This area again was marked on the skin. At this point, a sterile pulse ox was placed on the great toe and hooked up to the machine for continuous monitoring. An incision remained over the marked area after the area was anesthetized with lidocaine and Marcaine mix. This was carried down through soft tissue using electrocautery. The retinaculum was identified and divided and neurovascular bundle exposed. The dorsalis pedis just distal to the medial branch was vessel looped and a test clamp was performed. This resulted into no deficit of the waveform or pulse oximetry reading in the great toe. Additionally, he had excellent color and signal distal to this test ligation. At this point, I traced distally along the artery until the aneurysmal portion was identified. It was noted that there was no Doppler signal or flow within this vessel in this position. At this point, I then carried the incision down to more normal appearing vessel and then placed 2 clips. This was then removed and opened on the back table revealing some atheroma. At this point, the incision was irrigated. Hemostasis was assured. It was closed in multiple layers with Vicryl and a Monocryl suture. Sterile dressing was applied in addition to Steri-Strips. The patient tolerated the procedure well. No complications.nnESTIMATED BLOOD LOSS: 5 cc. TOTAL FLUIDS: 600 mL.nTOTAL LOCAL: 9 mL.nSPECIMEN: Left dorsalis pedis artery to pathology.
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