Medicare CPT Codes 2013 | Medicare About Health

Medicare CPT Codes 2013 (pdf download)

Medicare Screening Services 2013
Although Medicare does not cover comprehensive preventive visits such as
those reported with CPT-4 codes. 99381-99397, effective January 1, 2011,
Medicare …

2013 CPT Coding Update now available [.pdf] – American Society for …
New CPT and HCPCS codes for reporting preparation of fecal microbiota. …..
calendar year (CY) 2013, CMS has assigned CPT codes 99487, 99488 and
99489.

2013 CPT® Code Sheet – ITC
System. 2013 CPT® Code Sheet. Coding and Billing. Product Description CLIA
Status. CPT. Code. Modifier. Codes. CPT Quantity for 85576. 2013 Medicare …

http://www.immunize.org/catg.d/p4072.pdf
Influenza Vaccine Products for the 2013–2014 Influenza Season
Product Code. CSL Limited. Afluria (IIV3). 0.5 mL (single-dose syringe). 0. 9
years & older2. 90656. 5.0 mL (multi-dose vial). 24.5. 90658. Q2035 (Medicare).

http://www.aafp.org/dam/AAFP/documents/practice_management/payment/TCMFAQ.pdf
Frequently Asked Questions about Transitional Care Management
A2: There are two CPT codes that may be used to report TCM, effective …. the
Webinar, “What’s new in Medicare and Medicaid payment in 2013” hosted on …

http://www.idsociety.org/uploadedFiles/IDSA/Manage_Your_Practice/Billing_and_Coding/Evaluation_and_Management_Coding_Resources/IDSA%20Billing%20Coding%20Updates%20Webinar%202013.pdf
BILLING AND CODING UPDATE 2013
CPT Coding Update 2013 … “Throughout the CPT code set the use of terms such
as ‘physician,’ ‘qualified … Still awaiting further instructions from Medicare.

http://www.ngsmedicare.com/ngs/wcm/connect/6614a4804f73c1eeb417f64914797481/MMR_May_2013-05_Final.pdf?MOD=AJPERES&CACHEID=6614a4804f73c1eeb417f64914797481
May 2013 Medicare Monthly Review – National Government Services
May 5, 2013 … April Update to the CY 2013 Medicare Physician Fee Schedule …. Article
published May 2013: CPT codes 64553 and 64585 removed from the …

http://www.upmc.com/healthcare-professionals/physicians/Documents/2013-fee-schedule.pdf
2013 Medicare Clinical Laboratory Fee Schedule – UPMC.com
2013 Medicare Clinical Laboratory Fee Schedule. HCPCS Code Modifier
National Limit. Mid Point. Floor. PA. Description. 36415. $0.00. $3.00. $0.00.
$3.00.

http://www.peacehealthlabs.org/publications/Medicare%20Coverage%20Policies/Medicare%20Coverage%20Policies%20-%20COMPLETE%20MANUAL.pdf
Medicare Coverage Policies May 2013 update – PeaceHealth …
determine whether it is necessary to have Medicare patients sign an … For each
policy, you will see its CPT code(s) listed below the heading area and the ICD-9.

http://cdn.freedomoutpost.com/wp-content/uploads/2013/11/2013-ARHPC_ICD-9-CM.pdf
2013 CPT®, HCPCS II and ICD-9-CM Coding … – Freedom Outpost
CPT definitions versus Medicare and various 3rd party payers. •. “Separate
procedures” and unlisted procedures. Pertinent Surgical Coding Concepts.

http://www.carefusion.com/pdf/Interventional_Specialties/Vertebral_Augmentation_Reimbursement_Guide_IS1316.pdf
2013 coding and payment information – CareFusion
… are Medicare national payments for 2013 and do not reflect actual …. CPT®
code. Description. APC. 2013 national payment. Status indicator. Vertebroplasty.

http://www.ethicon.com/sites/default/files/13-0030-Upper-GI-Reimbursement-Fact-Sheet.pdf
2013 Upper GI / ColonoscopyReimbursement Fact Sheet – Ethicon
NATIONAL AVERAGE MEDICARE … Level II Upper GI Procedures (CPT codes:
43250, 43251, 43255, 43258, 43259). $927 … 2013 Ethicon All rights reserved.

http://www.practicemax.com/wp-content/themes/PracticeMax/resources/newsletters/November%20news%20112012.pdf
2013 CPT® Code Changes Cod ing & Billin g Anno u … – PracticeMax
PracticeMax can help your practice transition to the 2013 CPT codes. Following
are just some of … ment (99495-99496, as an alternative to a Medicare G- code).

http://tools.medicine.yale.edu/billingcompliance/files/Medicare%20Monthly/Medicare%20Monthly%202013.08.pdf
Medicare Monthly Review (MMR) August 2013-08 – Yale School of …
Oct 1, 2013 … Add-on HCPCS/CPT Codes Without Primary Codes (SE1320) … 2013 Medicare
Physician Fee Schedule Database (MPFSDB)” and Transmittal …

http://www.doh.wa.gov/portals/1/Documents/Pubs/681018.pdf
CLIA Waived Tests and CPT Codes
Sep 16, 2013 … DOH 681-018 January 2013 ….. *Drug Screen CPT Code Update: 80101QW has
been replaced by code Q0434QW. …… Medicare carrier.

https://www.ubhonline.com/html/pdf/cptChangesDeckDec2012.pdf
2013 CPT Code Changes – Provider Express
Dec 3, 2012 … CPT Code Development. • CPT … Current coding structure doesn’t allow for
accurate description of … APA Current CPT Code Changes 2013.

http://www.kchealthcare.com/media/11116865/h0009_1201_pain_rates.pdf
2013 MEDICARE PAYMENTS foR PAIN MANAGEMENT …
2013 MEDICARE PAYMENTS foR PAIN MANAGEMENT PRoCEDURES1. (
Effective 1/7/13). CPT CODE. DESCRIPTION. PHYSICIAN. IN-OFFICE.
PHYSICIAN.

http://www.healthandwelfare.idaho.gov/Portals/0/Providers/Medicaid/MA13-01%20.pdf
MA13-01 – Health and Welfare
Jan 29, 2013 … This updated release contains the 2013 CPT code and rate changes for … for non
-primary care services at 90 percent of the Medicare rate.

http://www.clslaboratory.com/Files/BillingHandbook/Billing_Guide_CLS.pdf
2013 Billing Guide – CLS
Apr 1, 2013 … 29-30. Medicare NCD & LCD Listings . 31-105. Common ICD-9 Codes … . 106-
108. CLS 2013 BILLING GUIDE: TABLE OF CONTENTS …

http://www.magellanprovider.com/MHS/MGL/getpaid/HIPAA/cptcodechanges-FAQ.pdf
2013 CPT® Codes Changes Background and Frequently Asked …
Apr 19, 2013 … the Centers for Medicare and Medicaid Services (CMS) on an annual basis … on
or after January 1, 2013 that includes the old CPT codes will.

Medicare CPT 82947 | Medicare About Health

Medicare CPT 82947 (pdf download)

Medicare Preventive Services Quick Reference Chart – American …
This educational tool provides information on Medicare preventive services. …
provided includes Healthcare Common Procedure Coding System (HCPCS)/
Current Procedural Terminology (CPT) codes; … 82947 – Glucose, quantitative,
blood.

CPT Codes – CLIAwaived.com
Jun 1, 2010 … Medicare and Medicaid Services or any other public or government organization
or agency. National … CPT Code … 82947-QW. $ 5.62.

LCD for Metabolic Laboratory Panels (L1136)
LCD for Metabolic Laboratory Panels (L1136). All ICD-9 Codes (diagnosis codes
) must be carried to their highest level of specification. CPT/HCPCS Codes.

https://www.medica.com/~/media/Documents/Provider/Laboratory%20Rebundling.pdf
Policy Name Laboratory Rebundling Summary This policy … – Medica
Medica uses the codes indicated in the Centers for Medicare and. Medicaid
Services … Note: For the purpose of this policy, CPT codes 82947 and 82948 are
not.

http://labs.unchealthcare.org/medical-necessity-checking/icd-9-codes/Blood%20Glucose.pdf
Blood Glucose Testing
Medicare National Coverage Determinations (NCD). Coding Policy Manual and
… HCPCS Codes (Alphanumeric, CPT. ©. AMA). Code … ICD-9-CM Codes
Covered by Medicare Program. The individual …. code 82947 only. Special
screening …

http://www.ucdmc.ucdavis.edu/pathology/resource/pdf/annual_notice_for_physicians.pdf
Annual notice for physicians – UC Davis Health System – the …
Human Services, and the Center for Medicare and Medicaid Services (CMS) 63
Federal. Register 45076, 45079 (August … CPT 82947. Glucose; blood, reagent …

http://www.peacehealthlabs.org/publications/Medicare%20Coverage%20Policies/Medicare%20Coverage%20Policies%20-%20COMPLETE%20MANUAL.pdf
Medicare Coverage Policies – PeaceHealth Laboratories
determine whether it is necessary to have Medicare patients sign an Advance
Beneficiary … For each policy, you will see its CPT code(s) listed below the
heading area and the ICD-9. (diagnosis) codes that ….. 82947, 82948, 82962.
Glycated …

http://www.bcbsms.com/assets/docs/HYCodes.pdf
Healthy You! codes
Immunizations are set to pay at any age, unless specified by the CPT code. •
82947: Glucose, quantitative. 82948: Glucose, blood, reagent strip. 82962:
Glucose …

http://www.clslaboratory.com/Files/BillingHandbook/Billing_Guide_CLS.pdf
2013 Billing Guide – CLS
Although it may be obvious that the patient is on medication, Medicare does not
allow ….. CPT 87340 Infectious agent antigen detection by enzyme immunoassay
….. 82947. 1 per year. V77.1 Special screening for endocrine, nutritional …

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/preventive_care_services_coding_guideline_summary.pdf
Preventive Coding Summary – UnitedHealthcareOnline.com
Jan 1, 2014 … CPT® is a registered trademark of the American Medical …. Procedure Code(s):
82947, 82948, 82950, 82951, 82952, 83036, 36415,. 36416.

http://www.acllaboratories.com/site_media/documents/forms/ACL_NCD_Booklet.pdf
ACL Medicare Policy (NCD & LCD) Summary … – ACL Laboratories
Apr 1, 2013 … 82947, 82962 …………………….. 18 – 21 …. Table of Contents. 3. ACL Medicare
Policy Disclaimer and Direct Sources of Coverage Information.

http://www.emhreflab.org/downloads/pdf/medicare-guidebook.pdf
Medicare Coverage Guidebook – Elmhurst Memorial Reference …
Medicare Limited Tests – Estimate of Costs if Not Covered. CPT. TEST NAME …
Glucose Tolerance Test, 2hour. 227.00. 82947. Glucose, quantitative blood.

https://www.codemap.com/abbott/autoreim.pdf
6. What are automated tests and how do they affect … – CodeMap
Medicare’s rules for “automated tests” reimbursement are one of the most
confusing parts … Basic metabolic panel (CPT 80053) 8 automated tests …
individually as 82040, 82947, and 82465 respectively at $15.00 each, the total
Medicare.

http://www.munsonhealthcare.org/upload/docs/cms%20limitations%20guide/cms_limitations_guide_laboratory_services.pdf
CMS Limitations Guide – Laboratory Services – Munson Healthcare
Jan 1, 2013 … Medicare National Coverage Determinations (NCD) ….. Use CPT 87088 where a
commercial kit uses manufacturer defined media for isolation …

http://www.thenationalcouncil.org/wp-content/uploads/2013/10/Ohio-HH-HSAG-Overview-of-HH-Indicators.pdf
Health Homes Presentation_D1 – National Council
The Centers for Medicare & Medicaid Services (CMS). – National …. This
measure is a CMS Health Home Core Quality measure. … CPT: 82947, 82948,
82951,.

https://medicare.fcso.com/Publications_B/1997/138549.pdf
July-Aug 1997 Medicare Part B Update! Publication
(HCFA) has advised Medicare carriers to begin denying claims for diagnostic …..
CPT-CODE(S): 82947QW, 82950QW,82951QW, 82952QW(effective 10/1/96) …

http://www.keepingyouwell.com/Portals/3/docs/ALPS%20files/Estimated%20MC%20Cost,%20Ref%20Lab%2005202013.pdf
TEST CPT CODE * ESTIMATED COST **
May 20, 2013 … (ICD-( codes that DO NOT support Medicare medical necessity) … 82947. 36.46.
Glycosylated Hemoglobin/Glycated Protein 83036. 69.00.

https://www.caresource.com/documents/oh-p-215-codeeditguideprofclaims-pdf/
Code Editing Guidelines on Professional Claims – CareSource
Medicare & Medicaid (CMS) and the American Medical Association, CPT.
Professional and … 82374, 82435, 82565, 82947, 84132, 84295 and/or 84520.

http://www.tmhp.com/tmppm/2009/26_TMPPM09_Independent_Laboratory.pdf
Independent Laboratory – TMHP.com
CPT only copyright 2008 American Medical Association. All rights reserved. ….
The CLIA rules and regulations are available on the CMS website at … 82947-
QW. 82950-QW. 82951- … laboratory services cannot exceed the Medicare
payment.

http://www.upmc.com/healthcare-professionals/physicians/Documents/2013-fee-schedule.pdf
2013 Medicare Clinical Laboratory Fee Schedule – UPMC.com
2013 Medicare Clinical Laboratory Fee Schedule. HCPCS Code …… 82947.
$5.39. $7.29. $0.00. $5.39. Assay glucose blood quant. 82947. QW. $5.39. $7.29.

Alabama doctor excoriates EMR damage to patient health care.

Dear Congressman Brooks,

As a practicing family physician, I plead for help against what I can best characterize as Washington’s war against doctors.

The medical profession has never before remotely approached today’s stress, work hours, wasted costs, decreased efficiency, and declining ability to focus on patient care.

In our community alone, at least 6 doctors have left patient care for administrative positions, to start a concierge practice, or retire altogether.

Doctors are smothered by destructive regulations that add costs, raise our overhead and ‘gum up the works,’ making patient treatment slower and less efficient, thus forcing doctors to focus on things other than patient care and reduce the number of patients we can help each day.

I spend more time at work than at any time in my 27 years of practice and more of that time is spent on administrative tasks and entering useless data into a computer rather than helping sick patients.

Doctors have been forced by ill-informed bureaucrats to implement electronic medical records (“EMR”) that, in our four doctor practice, costs well over $100,000 plus continuing yearly operational costs . . . all of which does not help take care of one patient while driving up the cost of every patient’s health care.

Washington’s electronic medical records requirement makes our medical practice much slower and less efficient, forcing our doctors to treat fewer patients per day than we did before the EMR mandate.

To make matters worse, Washington forces doctors to demonstrate ‘meaningful use’ of EMR or risk not being fully paid for the help we give.

In addition to the electronic medical records burden, we face a mandate to use the ICD-10 coding system, a new set of reimbursement diagnosis codes.

The current ICD-9 coding system uses roughly 13,000 codes. The new ICD-10 coding system uses a staggering 70,000 new and completely different codes, thus dramatically slowing doctors down due to the unnecessary complexity and sheer numbers of codes that must be learned.

The cost of this new ICD-10 coding system for our small practice is roughly $80,000, again driving up health care costs without one iota of improvement in health care quality.

Finally, doctors face nonpayment by patients with ObamaCare. These patients may or may not be paying their premiums and we have no way of verifying this. No business can operate with that much uncertainty.

On behalf of the medical profession, I ask that Washington stop the implementation of the ICD-10 coding system, repeal the Affordable Care Act, and replace it with a better law written with the input of real doctors who will actually treat patients covered by it.

America has enjoyed the best health care the world has ever known. That health care is in jeopardy because physicians cannot survive Washington’s ‘war on doctors’ without relief.

Eventually the problems for doctors will become problems for patients, and we are all patients at some point.

Sincerely yours, Dr. Marlin Gill of Decatur, Alabama

House Postpones ICD-10 Delay Vote, AHIMA Calls for Continued …

The US House of Representatives has postponed their vote on a bill that would delay the implementation of ICD-10-CM/PCS. 

After 40 minutes of debate on the bill and a call for a vote, House officials decided that a quorum was not present, and therefore a vote would not be conducted. Further proceedings on the motion were postponed, and the bill has not yet been slated for another vote. However, another vote could take place later today or in the coming days.

AHIMA has again called on proponents of ICD-10 to contact their congressional representatives and ask that they not delay ICD-10.

The House bill, H.R. 4302 – Protecting Access to Medicare, mainly adjusts the Sustainable Growth Rate (SGR) for Medicare payments, which dictates how much physicians get paid for services. But bill section 212, a seven line section inserted into the SGR patch bill, also states that the Department of Health and Human Services (HHS) cannot implement the ICD-10 code set until October 1, 2015, a year later than the current date of October 1, 2014.

The bill introduced by Representative Joe Pitts (R-PA) states: “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the 13 Social Security Act (42 U.S.C. 1320d–2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.”

House Speaker John Boehner (R-OH) and Senate Leader Harry Reid (D-NV) announced they were working in cooperation on the SGR “patch” bill late Tuesday night. The bill passes a temporary one year patch to prevent a 24 percent reduction in physician Medicare payments that would go into effect March 31. The development of the bill, and insertion of the ICD-10 delay, was negotiated at the leadership level in the House and Senate. 

During the debate, several House representatives mentioned that H.R. 4302 included provisions unrelated to SGR that likely many members of Congress were unaware were included in the bill.

Similar Delay Bill Proposed in the Senate

A Senate bill, S. 2157, features similar language to delay ICD-10 for one year. Senators were expected to vote on that bill next Friday, April 4, though that timeline may change due to the delay in the House.

AHIMA and other proponents of ICD-10 have been rallying members and stakeholders to contact their representatives and senators and tell them to not delay the new code set. On Wednesday thousands of AHIMA members contacted their representatives and called for no further delays of ICD-10.

Further requests to contact senators have been made by AHIMA and the Coalition for ICD-10, an advocacy group of healthcare associations, vendors, and insurers that support the implementation of ICD-10, to stop further delay of the code set.

ICD-10 Proponents Warn of Harmful Implications of Another Delay

AHIMA officials have said that another delay in ICD-10 will cost the industry money and wasted time implementing the new code set. Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.

In a letter to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner, members of the Coalition for ICD-10 said that CMS and other government officials should move forward with the current ICD-10 deadline of October 1, 2014. Coalition representatives include the American Hospital Association (AMA), the American Medical Informatics Association (AMIA), BlueCross BlueShield Association, the College of Healthcare Information Management Executives (CHIME), and vendors like 3M Health Information Systems and Siemens Health Services.

“Although many of the signatories to this letter were at odds over the timing of implementation when the National Committee on Vital and Health Statistics (NCVHS) and HHS embraced ICD-10—which has already been adopted outside the U.S. worldwide—we are now in agreement that any further delay or deviation from the October 1, 2014 compliance date would be disruptive and costly for health care delivery innovation, payment reform, public health, and health care spending,” the letter reads. “By allowing for greater coding accuracy and specificity, ICD-10 is key to collecting the information needed to implement health care delivery innovations such as patient-centered medical homes and value-based purchasing,” the letter stated.

“Moreover, any further delays in adoption of ICD-10 in the U.S. will make it difficult to track new and emerging public health threats. The transition to ICD-10 is time sensitive because of the urgent need to keep up with tracking, identifying, and analyzing new medical services and treatments available to patients,” the letter continued. “Continued reliance on the increasingly outdated and insufficient ICD-9 coding system is not an option when considering the risk to public health.”

The impact of another delay in ICD-10 would be far reaching across the healthcare industry, AHIMA officials said. Many healthcare education programs have been teaching ICD-10 exclusively to students in preparation for the October implementation, while healthcare organizations have invested time and money into preparing staff and systems for the switch.

Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.

The call for a delay likely came as a surprise to CMS. On February 27, Tavenner announced at the Health Information and Management Systems Society Annual Conference that ICD-10 would not be delayed any further, stating “we have already delayed the adoption standard, a standard the rest of the world has adopted many years ago, and we have delayed it several times, most recently last year. There will be no change in the deadline for ICD-10.”

AHIMA Calls on Members to Request Removal of Delay Provision

AHIMA has put out a call to members and other stakeholders to contact their representatives in Congress and ask them to take the ICD-10 provision out of the SGR bill.

When contacting congressional members, AHIMA has instructed callers to state that their representatives/senators:

  • Oppose the specific language in the SGR patch legislation
  • Reach out to the Speaker of the House John Boehner and Senate Majority Leader Harry Reid to remove the ICD-10 language from the bill

CMS estimates that a one year delay could cost between $1 billion to $6.6 billion, according a statement from AHIMA officials. ”This is approximately 10-30 percent of what has already been invested by providers, payers, vendors and academic programs in your district,” AHIMA wrote in a statement, which it encouraged its members to use when contacting Congressional representatives. ”Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished…  Let Speaker Boehner and Senate Majority Leader Reid know that a delay in ICD-10 will substantially increase total implementation costs in your district.”

Contacting Your Congressional Representatives

For more information on contacting your representatives and senators in Congress, visit AHIMA’s Advocacy and Public Policy representative look-up site at http://capwiz.com/ahima/dbq/officials/.

For more information on AHIMA ICD-10 advocacy, visit http://www.ahima.org/about/advocacy.

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DIY ICD-10 conversion – Part 11 | 3M Health Information Systems

At the end of Part 9, we were translating a list of ICD-9 codes – a policy – into ICD-10. We used the 10-to-9 single GEMs with reverse lookup to find ICD-10 codes that should be in your ICD-10 version of the policy. We had some ICD-9 codes left over that no ICD-10 code translated to. You tried to look them up in the 9-to-10 single GEMs. You found some translated to ICD-10 codes already in your ICD-10 policy list, so you could feel assured that their meaning was taken care of. A few may have translated to single ICD-10 codes not already on your list. Those ICD-10 codes (“pink” in CTT) might be appropriate for your policy, but a clinical review of them was recommended.

Finding all the ICD-10 codes that might be on a patient’s record, and that might imply the patient satisfies the policy, is the objective of our process. Have we now found them all? Consider this case from Part 10:

One ICD-10-PCS procedure

037K34Z, Dilation of Right Internal Carotid Artery with Drug-eluting Intraluminal Device, Percutaneous Approach

is the result of translation from a cluster of four ICD-9 procedure codes

00.61, Percutaneous angioplasty of extracranial vessel(s)

00.40, Procedure on single vessel

00.55, Insertion of drug-eluting stent(s) of other peripheral vessel(s)

00.45, Insertion of one vascular stent

Suppose you have 00.55 in a policy designed to pay differently for procedures where a drug-eluting stent is inserted. The policy may also contain 00.60 and 36.07. When you try to translate 00.55, you do not find it in the 10-to-9 singles, and all you find in the 9-to-10 singles is NOPCS.

I picked 00.55 because it is an extreme (though not isolated) example. 00.55 is an ICD-9 adjunct code – a “code” that is never supposed to be coded on its own, but rather included to modify the meaning of another code (in this case the PTCA, 00.61). ICD-10-PCS does not use adjunct codes. Every meaningful combination of 00.61 and its adjunct codes is represented by one ICD-10-PCS code.

Adjunct procedure code 00.55 is just one example of an ICD-9 code that requires other ICD-9 codes to be on the record with it in order to specify the same patients as can be specified with just one ICD-10 combination code. This happens with diagnoses, too, such as:

I25.110, Atherosclerotic heart disease of native coronary artery with unstable angina pectoris

requiring two ICD-9 codes to convey the same meaning

414.01, Coronary atherosclerosis of native coronary artery

411.1, Intermediate coronary syndrome

Let us pursue this second example a little further. Suppose you had a policy for finding all patients with coronary atherosclerosis. 414.01 would be on it. When you translated 414.01 using the 10-to-9 singles GEM table, you would have found I25.10, Atherosclerotic heart disease of native coronary artery without angina pectoris. Good enough? What about those people who also had angina? Assuming you want them too, you would have wanted I25.110 (and several other similar codes) in your ICD-10 policy. But you would not have found them with the process as outlined so far.

So here is where we add the third phase to the process – look up each ICD-9 code in your policy in the 10-to-9 clusters GEM table.

When I recommended dividing the GEMs files into four tables back in Part 6, I suggested making a reverse index for the 10-to-9 singles GEM, but I forgot to suggest that you also do so for the 10-to-9 clusters GEM table. I apologize. With any ICD-9 code in your policy, you will want to see what ICD-9 clusters it is a part of, and that is only practical if you’ve resorted (or re-indexed) the 10-to-9 clusters GEM by ICD-9. CTT and suchlike tools do this for you.

What do you do when you find one of your policy’s ICD-9 codes in a 10-to-9 cluster, and the ICD-10 code you find with it isn’t already on your ICD-10 policy list? In theory, you do not have the whole story – you don’t know what other ICD-9 codes are expected to also be on the record to equal the precise meaning of the ICD-10 combination code you’ve found. We could go through all the rigmarole of using the scenario and choices columns of the table to find them (which we will unfortunately have to get to later) but you really don’t have to know them. (Another benefit of CTT and similar tools is that they will show all that to you with just a few clicks.) No, all you need to do is review the ICD-10 code to see if it deserves to be in your policy. Its code title (or failing that, its Tabular entry) should give you all you need to know.

Going back to our example, I25.110, Atherosclerotic heart disease of native coronary artery with unstable angina pectoris, tells you that the code selects patients not only with coronary atherosclerosis, but also unstable angina. What is the policy about? Everyone with coronary atherosclerosis? Then you want it. Only patients without angina? Then you don’t. You don’t have to know what ICD-9 codes the GEMs equated I25.110 to.

Now let’s look at the adjunct code example. When you looked up 00.55 in the 10-to-9 GEM with reverse index, you didn’t find anything. When you looked up 00.55 in the 9-to-10 singles GEM, you only found NOPCS. There is no PCS code that just means “insertion of drug-eluting stent.” But when you look up 00.55 in the 10-to-9 cluster GEM, you see 202 ICD-10-PCS codes that are expressed in ICD-9 as clusters, where the cluster contains 00.55. According to the GEMs, these are all ICD-10 codes that say, among other things, that a drug-eluting stent was inserted into a peripheral vessel. If your policy applies to all patients where a drug-eluting stent was inserted into a peripheral vessel, then you can safely add all 202 codes to your ICD-10 policy list. If not, you should look at all 202 and pick the ones that satisfy the intent of the policy.

 

Ron Mills is a Software Developer for the Clinical & Economic Research department of 3M Health Information Systems.

You can find the complete DIY ICD-10 series here.

Claims Technology and Preparing for the ICD-10 Transition

Receiving a flurry of bills for months after any medical procedure has become commonplace for patients, and it’s safe to say that most don’t like it. In fact, a patient’s satisfaction drops by about 10 percent after receiving a bill for services, thanks to the confusion and waste involved, according to MedCity News. Implementing claims technology to streamline bills can not only make things easier for patients, but might ease the paperwork and costs for the physician’s practice as well. But where to begin?

There are numerous ways a practice can adopt claims technology and not break the bank. One good option is focusing on technologies that are similar to those already in place, so a software change might not be necessary. Look for claims technology that ties in with patient portals, online claim tracking, smartphone apps and the like. Transparency can also make a difference: Competitive Electronic Marketplaces give the patient an opportunity to choose from a variety of options, allowing for price comparisons, transparency in costs and the ability to “shop around” to get the best deal.

Related: 50% of Providers Have Not Estimated ICD-10 Impact on Cash Flow

Why now is a good time for change

Claims Technology and Preparing for the ICD-10 Transition

With all the changes that have come to healthcare over the past few years, claims technology might seem like just another change that physicians don’t have the time to make. But now is actually the perfect time, thanks to even more changes coming in the months ahead.

On October 1, 2014, physicians will be expected to shift from the old International Classification of Diseases, 9th Edition — commonly known as ICD-9 — to new ICD-10 coding. When this shift takes place, the number of diagnostic codes available to healthcare providers increases from the current 13,000 to well over 68,000. This means in-depth education, training and testing for personnel, who are already adapting to the variety of changes brought about by electronic health records.

The result could be a perfect storm of problems, especially considering that only one of every 10 practices had made significant strides toward the new implementation, according to Medpage Today. But it could also be an opportunity. These changes are definitely coming, so it’s time to take a deep breath and prepare for the overhaul.

How to Prepare for ICD-10

With time running out, how can physicians catch up to the changes that will come about in October? Jennifer O’Brien of Karen Zupko & Associates, a Chicago-based physician practice management consulting firm, offers tips for those who need to speed up their transition to ICD-10.

It starts with preparing for the financial impact that will be felt in the fourth quarter of 2014. O’Brien suggests planning to secure a line of credit that will cover all necessary operating expenses for three to six months. Assume the worst-case scenario of no third-party payments for the final quarter of 2014. To compensate, self-employed physicians should cut their salary by 25 percent through the first three quarters of the year to allow a cushion of payment in the last quarter.

In addition to preparing for the financial hit, physicians should look at how they will actually make the transition. O’Brien offers a plan based on the “Four T’s”:

  1. Team. “Establish a work group for the ICD-10 conversion,” O’Brien said. “The group should plan on meeting weekly. Someone should create and maintain a single work plan that lists tasks, dates and who is responsible.” Include at least one physician, billing and coding specialist, clinical assistant, practice manager and representatives from other areas of the practice that regularly use diagnostic codes.
  2. Testing. “Communicate with your EMR, practice management software vendor, clearinghouse and biggest payors as to if, when and how testing of claims with ICD-10 will be done,” O’Brien said. “Most practices submit claims through a clearinghouse…the practice needs to follow up with the clearinghouse after testing to see how it went.”
  3. Training. Now is the time to get familiar with the changes. “Practices should contact local and national medical and specialty societies to see what ICD-10 training is available for physicians and staff,” O’Brien recommended. “Doctors will need to learn ICD-10 coding so that the documentation such as chart notes and operative reports adequately supports the ICD-10 codes submitted. Other organizations that may have ICD-10 training available are practice management software companies, hospitals, the AAPC and AHIMA.”
  4. Tools. O’Brien recommends the book “ICD-10-CM Mappings 2014,” published by the American Medical Association. “Practices will need to make sure their PMS and EMR systems are loaded with ICD-10-CM codes and will need to order ICD-10-CM books,” she said. Once that is done, “run a list of your 25-75 most common ICD-9-CM codes and ‘crosswalk’ them to ICD-10-CM. Expect a one-to-multiple crosswalk rather than a one-to-one.There are likely to be many ICD-10-CM codes for each ICD-9-CM codes.”

Related: ICD-10 Testing and Readiness: No Longer a Marathon, It’s a Sprint

Between the recent move to electronic health records, the push for claims technology and health payment systems, and the move to ICD-10 right around the corner, physicians and their staff might feel overwhelmed. But getting started right now can mean the difference between a smooth transition and a mad scramble to meet deadlines. Prepare for the ICD-10 changes, and at the same time, implement new claims technology that will result in a streamlined, easy payment system — one that is suitable for both physicians and their patients.

Related: Dr. Weygandt Talks Establishing A Physician First Approach to ICD-10

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