January, 2012

Sometimes, I don't have to do any of the work except to make friends and provide attribution.  Today's installment features a wonderfully concise, helpful guide to CPT coding for breastfeeding related services, care of the National Breastfeeding Center.

Some sample text:

Billing for problems with breastfeeding and lactation is just like billing for any other problem. Using standard evaluation and management codes (E & M) [e.g. Current Procedural Terminology (CPT) codes such as 99212-99215] and diagnosis codes, physicians and other billable licensed practitioners (such as nurse practitioners and physician assistants) may:

• Code based on time, if greater than 50% of time is spent in counseling, education, or coordination of care
• Use modifier 25 appended to a problem-focused visit to bill in conjunction with the well baby visit, when there is extended time spent on feeding problems.
• Bill for care provided for the mother, often as a new patient, in addition to billing for the baby, if history exam, diagnosis and treatment are done for her.

Wow, top-shelf content. Use it.

The free RBRVS calculator has been updated for the 2012 Revised CPT data, which includes a return of the 1.000 GPCI floor, some updated codes, and an increase to the new CF. 

You can see it all here.

At our Users' Conference last summer, Brandon Betancourt gave a presentation entitled, "Practice Makeover: 101 Ways to Transform Your Practice."  I was teaching at the same time, so I couldn't attend, but I did hear the applause at the finish.

I knew PCC had his handouts, so I went through them and was blown away.  Brandon did a tremendous amount of work here!  What an amazing document.  I encourage you all to download this presentation and share it with your office.  He has recently updated it and I am sharing that version of it with you here.

The point of the effort isn't that you must or even should do all of these suggestions.  Some of them will be completely inappropriate for your office.  But, somewhere in this list, there will be a small gem that could transform your practice.  Given the small 10 minute investment to read, I don't know who could reasonably object.  Take a few minutes, and then don't forget to visit his blog.

My only complaint is that item #1 isn't "Work with PCC!"

Holy smokes.

The Governor of NC just issued quite a press release:

"Care management saved N.C. Medicaid nearly $1 billion over four years, according to a new analysis by a national health care consulting firm."  You can read the rest here.

Given that there isn't anywhere close to full PCMH coverage in the NC Medicaid program, these savings are enormous.

I don't have enough details to be satisfied, but this bodes well:

In North Carolina, Milliman used Medicaid claims data to compare the costs incurred by recipients enrolled in one of the state’s 14 regional medical home programs to those of patients that were not. Researchers found that more frequent office visits and treatment of newly diagnosed conditions initially added to per person costs in the medical homes program. But fewer emergency room visits and hospital admissions, combined with greater efficiencies and improved care resulted in better health and sizeable savings over the longer term, the report says.

I like claims-based data, perhaps I'm biased. You can read the rest of this analysis here.

All of this just after the AAP announces that PCMHs benefit kids without special health care needs by lowering their need for sick visits and that parents spend less out of pocket with PCMHs.

In pediatrics, the PCMH concept is going to have a greater effect than MU.  I really believe that it works.  For those of you fighting for payment, I just gave you 4 links to support your cause.  Keep at it!

It looks like your hard work paid off!  From a CMS bulletin dated 12/29/2011:

This change resulted in many questions and potentially unintended consequences for other payers. We want to be clear that Medicaid and other private payers will be able to continue to use code 96110 even though it is a statutorily non-covered service under Medicare. In addition, many State Medicaid programs rely upon Medicare-published relative value units, including those associated with code 96110. At the request of Medicaid and concerned stakeholders, in the next few weeks Medicare will provide the relative value units for this code.

You can read the entire thing here. My thanks Robin Harpole for spotting this.  Why no word from the AAP, yet?

Update: The AAP speaks!

"Revised payment files to reflect corrections and revisions to the physician update amount will be posted on the Physician Fee Schedule portion of the CMS website in the near future. In the meantime, the payment rate for code 96110 will be based on 0.28 total RVUs (0.27 practice expense and 0.01
malpractice)."

Good work!