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Medical Group Business Services

Medical Group Business Services. Brown Bag Education Series University of California, San Francisco. And Now For Another Fun-Filled Year. Coding and Regulatory Updates for 2008. UCSF Clinical Enterprise Compliance Program. CECP Education Series Wanda T. Ziemba MFA RHIT CHCC CHCO CPC

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Medical Group Business Services

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  1. Medical Group Business Services Brown Bag Education Series University of California, San Francisco MGBS January 2008 Brown Bag Series

  2. And Now For Another Fun-Filled Year Coding and Regulatory Updates for 2008 MGBS January 2008 Brown Bag Series

  3. UCSF Clinical Enterprise Compliance Program CECP Education Series Wanda T. Ziemba MFA RHIT CHCC CHCO CPC Associate Compliance Officer & CECP Educator Ginger S. Reding, BS RHIT Compliance Specialist & CECP Educator MGBS January 2008 Brown Bag Series

  4. Agenda • Overview of Proposed & Final CPT Changes • ICD-9-CM Updates • Question & Answer Session MGBS January 2008 Brown Bag Series

  5. CPT Changes • CPT released October 2007 • New codes reflective of innovative technology • Changes primarily clarifications for usage of multiple codes • Code assignment instructions MGBS January 2008 Brown Bag Series

  6. CPT Changes • Adjustments for HIPAA/Data set purposes • Continuing inclusion for non-MD services • Reduction in ambiguities • Refinement of definitions MGBS January 2008 Brown Bag Series

  7. Inclusive services deleted • Window services detailed • Multiple CPT Assistant references MGBS January 2008 Brown Bag Series

  8. Evaluation & Management Services • New codes – 10 • Revised codes – 9 • Multiple preamble, definition and qualifier changes MGBS January 2008 Brown Bag Series

  9. New in E & M • Team Conferences (99366, 99367, 99368) • With and without patient/family present • No longer to be used for conference with family only • Interdisciplinary medical team only • Non-MD participant has separate code for non-face-to-face • Replace case management services MGBS January 2008 Brown Bag Series

  10. Behavior Change Interventions (99406, 99407, 99408, 99409) • Smoking, tobacco & alcohol cessation services • Time-based services • May not be reported with administration & interpretation of health risk assessments MGBS January 2008 Brown Bag Series

  11. Non-Face-to-Face Services (99441, 99442, 99443) • Telephone services based on time • May not be in conjunction with an E&M in the last 7 days • May not be leading to an E&M event within the next 24 hours or soonest available appointment • May be used with the patient’s guardian MGBS January 2008 Brown Bag Series

  12. On-Line Medical Evaluation (99444) • No previous E&M service within the last 7 days • Uses internet resources in response to a patient’s inquiry • Must involve permanent storage of the patient interaction • Also bundled if within the postoperative period of a previously completed procedure MGBS January 2008 Brown Bag Series

  13. Other E & M Services • Initial Hospital Care, Neonatal (99477) • Requiring intensive observation, frequent interventions and other critical services MGBS January 2008 Brown Bag Series

  14. Changes in Definitions • Nursing Facility (99304-99310) • Critical Care (additional bundled services) • Anticoagulant Management • Team Conferences • Care Plan Oversight • Risk Factor Reduction MGBS January 2008 Brown Bag Series

  15. Anesthesia • New Codes – 2 • Revised Codes – 1 Trends: Anesthesia for guided procedures Definition of acronyms (TIPS) MGBS January 2008 Brown Bag Series

  16. Integumentary • New Codes - 0 • Changed Codes – 2 Trends: Definitions of terminology & procedure descriptions Multiple code assignment instructions Bundled services MGBS January 2008 Brown Bag Series

  17. Musculoskeletal • New Codes – 9 • Changed Codes – 90 Trends: Placement of devices for radioelement application Image guidance procedures New technology in repair & reconstruction MGBS January 2008 Brown Bag Series

  18. Respiratory & Cardiovascular • New Codes – 9 (5 respiratory & 4 cardiovascular) • Changed Codes – 46 Trends: Thoracentesis & pleural procedures New technology – ablations, aneurysm repair, & grafts MGBS January 2008 Brown Bag Series

  19. Digestive • New Codes – 13 • Changed Codes - 26 Trends: Placement of devices for radioelement application Abdomen, peritoneum & omentum Gastrostomy tube services MGBS January 2008 Brown Bag Series

  20. Genitourinary • New Codes – 9 • Changed Codes – 1 Trends: New technology – stent services, ablations, aspirations, defect repairs & reconstruction, approaches Placement of devices for radioelement application MGBS January 2008 Brown Bag Series

  21. Neurological/Endocrine/Eye/Ear • New Codes – 5 (endocrine-1; eye-4) • Changed Codes – 2 Trends: New technology – Vitrectomy, complex injuries Few code assignment clarifications MGBS January 2008 Brown Bag Series

  22. Imaging • New Codes - 8 • Changed Codes – 24 Trends: Code assignment instructions for MRI services Complete cross-references with surgical services Changes in brain imaging, PET scans & stereotactic delivery MGBS January 2008 Brown Bag Series

  23. Pathology • New Codes – 4 • Changed Codes – 6 Trends: Split of metabolic panel Detailing instructions in immunology, microbiology, & reproductive services MGBS January 2008 Brown Bag Series

  24. Medicine • New Codes – 15 • Changed Codes – 117 Trends: Multiple code assignment instructions New codes for hydration therapy, neurostimulator pulse generators, CNS testing, & medication management services Most changes in cardiac catheterization codes, EPS Repeat entries from E&M section MGBS January 2008 Brown Bag Series

  25. Category II • Multiple additions reflective of PQRI • Patient Management – 3 • Patient History – 16 • Physical Examination – 7 • Diagnostics – 33 • Therapeutic & Preventative – 37 • Outcomes – 6 MGBS January 2008 Brown Bag Series

  26. Category III • New Codes – 13 Trends: Spinal distraction devices CAD of digital images EKGs of 64 leads or greater Corneal hysteresis High does electronic Brachytherapy MGBS January 2008 Brown Bag Series

  27. Summary Review current data capture document for updated, additional or deleted codes Follow-up with providers for any new documentation requirements Check PQRI data on line at http://www.cms.hhs.gov/PQRI/35_2008PQRIInformation.asp MGBS January 2008 Brown Bag Series

  28. ICD 9 CMFY 2008 Effective Oct. 1, 2007 MGBS January 2008 Brown Bag Series

  29. www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_Summarytables.aspwww.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_Summarytables.asp • New Diagnosis Codes - Effective 10/01/2007 [PDF 86KB] - • New Procedure Codes - Effective 10/01/2007 [PDF 23KB] - • Invalid Diagnosis Codes - Effective 10/01/2007 [PDF 21KB] -   • Invalid Procedure Codes - Effective 10/01/2007 [PDF 12KB] - • Revised Diagnosis Code Titles - Effective 10/01/2007 [PDF 14KB) • Revised Procedure Code Titles - Effective 10/01/2007 [PDF 17KB]    MGBS January 2008 Brown Bag Series

  30. www.cdc.gov/nchs/icd9.htm • The website for information on ICD 9 CM • Codes listed for each year in PDF format MGBS January 2008 Brown Bag Series

  31. Coordination and Maintenance Committee Agenda, Minutes, and Proposals • ICD-9-CM on CD-ROM • ICD-9-CM Rich text files (.rtf) via FTP: 20072006200520042003200220012000199819971996Addenda • Official GuidelinesConversion table MGBS January 2008 Brown Bag Series

  32. New for FY 2008 • 142 New diagnosis codes • Includes 20 new V codes • 5 revised diagnosis codes • 17 Invalid codes MGBS January 2008 Brown Bag Series

  33. Reason for Changes • Most of the revised and all of the invalid codes are four digit codes that have been expanded to 5 digits for more specific reporting of conditions. MGBS January 2008 Brown Bag Series

  34. V Codes • Used to code reason for encounter for health services • Provides information and documentation on circumstances or problems that influence the patient’s health status, but is not the current illness or injury. MGBS January 2008 Brown Bag Series

  35. GuidelinesFound on the National Center for Health Statistics Website Gives the definitions and rules for “V” categories, such as Status, History of, Follow-up, Aftercare etc. Provides a table showing if the V code can be first listed, additional, or both. MGBS January 2008 Brown Bag Series

  36. New V Codes V68.01 Disability examination Use additional codes to identify specific examinations, screening, and testing performed from V72.0-V82.9 Created to track exams directed towards the determination of disability compensation and benefits. MGBS January 2008 Brown Bag Series

  37. V73.81 Special screening examination, Human papillomavirus (HPV) • V84.81 Genetic susceptibility to multiple endocrine neoplasia (MEN) • V84.89 Genetic susceptibility to other disease MGBS January 2008 Brown Bag Series

  38. Family Planning • V 25.04 Counseling and instruction in natural family planning to avoid pregnancy • V26.41 Procreative counseling and advice using natural family planning MGBS January 2008 Brown Bag Series

  39. Procreative Management • V26.49 Other procreative management counseling and advice Pretreatment • V 26.81 Encounter for assisted reproductive fertility procedure cycle Use additional code to identify the type of infertility Patient undergoing in vitro fertilization cycle • V26.89 Other specified procreative management Completed treatment MGBS January 2008 Brown Bag Series

  40. Personal History V12.53 Personal History of sudden cardiac arrest Sudden cardiac death successfully resuscitated V12.54 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits Stroke, not otherwise specified, without residual deficits MGBS January 2008 Brown Bag Series

  41. Family History • V17.41 Family history of sudden cardiac death • V17.49 Family history of other cardiovascular diseases, Not otherwise specified • V18.19 Family history of other endocrine and metabolic diseases (Other than diabetes mellitus) MGBS January 2008 Brown Bag Series

  42. (MEN) Multiple Endocrine Adenomatosis • A syndrome characterized by adenomas, malignant tumors, or hyperplasia involving more than one endocrine gland. • 258.01 Multiple endocrine neoplasia type I • Involves tumors of the parathyroid glands, pancreatic islet cells, pituitary gland, results in kidney stones and peptic ulcer disease • 258.02 Multiple endocrine neoplasia type IIA • 258.03 Multiple endocrine neoplasia type IIB MGBS January 2008 Brown Bag Series

  43. No longer valid359.2 Myotonic disorders Coordination and Maintenance Committee needs to capture specific statistics. Myotonic dystrophy (MD) is the most common muscular dystrophy in adults, and the second most common muscular dystrophy It is a genetic disorder affecting 1 in 8000 people. MGBS January 2008 Brown Bag Series

  44. 359.21 Myotonic muscular dystrophy • 359.22 Myotonia congenital Begins in childhood • 359.23 Myotonic chondrodystrophy • Onset at or soon after birth, a more sever form of myotonis, muscular hypertrophy, and nultiple skeletal deformities • 359.24 Drug induced myotonia • Use E code to identify drug MGBS January 2008 Brown Bag Series

  45. New Sensory Impairments Codes Conditions Influencing Health Status • V49.85 Dual Sensory Impairment Also known as multi-sensory impairment Blindness and deafness Code first hearing impairment 389.00-389.9 And visual impairment 369.00-369.9 MGBS January 2008 Brown Bag Series

  46. Special Investigations and Examinations Use additional codes to identify special screening examinations V72.12 Encounter for hearing conservation and treatment For environmental acquired hearing loss MGBS January 2008 Brown Bag Series

  47. No longer valid389.2 Mixed conductive and sensorineural hearing lossDue to a defect in the conduction of sounds and the sensory mechanism. New auditory codes will allow the physician to more accurately describe the patient’s hearing loss. • 389.20 Mixed hearing loss, unspecified • 389.21 Mixed hearing loss, unilateral • 389.22 Mixed hearing loss, bilateral MGBS January 2008 Brown Bag Series

  48. Conductive Hearing LossDue to a defect in the sound conducting apparatus of the ear. • 389.05 Conductive hearing loss, unilateral • 389.06 Conductive hearing loss, bilateral Sensory Hearing Loss • 389.17 Sensory hearing loss, unilateral Neural Hearing Loss • 389.13 Neural hearing loss, unilateral MGBS January 2008 Brown Bag Series

  49. 388.45 Acquired auditory processing disorder Trouble in retaining information presented orally, need more time to process information, language difficulty, confusion In the Alpha Index under Delay, delayed development • 315.34 Speech and language developmental delay due to hearing loss Use additional code to identify type of hearing loss Hearing loss from birth to 3 years can have detrimental effects on speech and language development and adverse effects on social development. MGBS January 2008 Brown Bag Series

  50. Eyes • 364.81 Floppy Iris Syndrome Intraoperative floppy iris syndrome (IFIS) The iris does not stay properly dilated during cataract surgery Caused by taking alpha-blockers, such as Flomax Use additional E code to identify cause • 364.89 Other disorders of iris and ciliary body Prolapse of iris, not otherwise specified MGBS January 2008 Brown Bag Series

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