Posts tagged with cpt

Now here's a combination of topics that no one will ever look for. I don't know, for "search engine optimization purposes" whether mixing two items like this is better or worse than writing two quick blog pieces (and pushing content further down the page or into the archives), but I won't worry about it.

First, many of you have noticed that the traffic on PedTalk and the SOAPM lists had died off for about two weeks. You can see why here:

http://web.mac.com/jsstoller/iWeb/Site/2008%20OCI%20Mission.html
http://web.mac.com/jsstoller/iWeb/Site/End%20of%20mission%20fun.html

...this what Drs. Stoller and Lessin were up to from Mar 6 to Mar 19 - their medical mission to Ghana.

Second, some of you are aware of the fight we have had with the AMA over our RVU calculators. You'll notice that this one only contains a subset of the codes (the most important pediatric ones) and this one requires you download the codes yourself. Their argument was that, due to their copyright of the CPT codes, no one is allowed to publish any more than 30 CPT codes (and the accompanying RVU values). We didn't have the $$ to fight them, so no more free RVU calculator that doesn't require you to download the codes yourself. Anyway, I have enjoyed making a collection of WWW sites that publish full RVU/CPT values. The problem is that I keep finding them everywhere. There are literally dozens, if not hundreds, more. I wonder why the AMA has time to threaten PCC with a lawsuit and not all these folks? [Hint: it has to do with Ingenix losing money.]

It's been a rough week, especially over at PedTalk. The autism/vaccines "debate" has poisoned the waters of discussion pretty badly and I have a feeling that some of the anti-vaccine crowd is trying to cause some technical difficulty for us. They've done it before, so we'll see what Yahoo and others tell me (sorry for being cryptic).
To add to that, most of the news I had to share was negative. I had Dr. Stoller in the WSJ talking about how much UHC stinks (not really news to those of us in the business, but hey). Then there were the articles about primary care doctor shortages (which were linked to MA's new insurance requirement law, but I've asked my clients there about it and they don't report much). And so on.
I decided to share something helpful, positive to get my out of my doldrums and negative focus, so I have two things.
First, to prove that not all movie stars are anti-vaccine, here's a nice link from Salma Hayek (just putting her name here will attract all kinds of the wrong attention). Yes, I am cynical when I see that one has to buy Pampers to get the tetanus shot donated, but at least someone is aiming at the right target. I thank Salma for lending her name to this campaign (presuming she didn't get a bucket of cash). Perhaps she'll read this blog in get in touch. No? You don't think so?
The other thing I was working on was an all-in-one Immunization/Vaccine/CPT/ICD9/Manufacturer table. I have had this information in different places at different times and always make it hard to find. I suppose I could combine it with the CDC price list, perhaps I will. Please let me know if any additions, changes, corrections I can add to it! It provides a list of vaccines, with associated ICD9, CPT codes, descriptions, manufacturer, and product name. Handy dandy. Click below. My extreme thanks to Q, who helped me put this together (ok, she did most of the work).

Q answers our clients' coding questions and ran these two items recently. I've included the questions and her comments, as I think it's time we pay a little attention to these rarely used codes. I'll hit you with some data tomorrow, but let's warm up. The answers are from Q.

Question number 1:

Can you help me figure this out? How would you code the following situation? Baby is born but then placed on Photo-therapy at home by home health services to treat a high bilirubin. Dr. has to order the blood tests and interpret the results for a period of about 4 days when the bilirubin has fallen to an acceptable level.

One day's supervision involves:

• Calling and ordering the blood to be drawn
• Tracking the result
• Calling the mother/health aid with result
• Deciding on further strategy

Up to this point we have never charged for any of this, but it seems to me that it would be legitimate to charge for all the calls, orders, and being interrupted with results sometimes by both the lab and the home health aid. What do you think? How should this be coded? Any help would be appreciated.

Answer #1:

By my guess the 99339 and 99340 codes are the ones you are looking for. They seem to describe, based upon time, the services included in your message. These codes are based upon total time spent for a complete calendar month. So, you will report this only once per calendar month of care and the code should be based upon total time spent for that entire calendar month.

I have one reservation about how this code compares to your description. CPT warns users not to report these codes when patients are under the care of home health. I can't tell specifically from your message if home health initiated care at home or if they remained involved throughout the full episode of care.

I would also advise that the provider rendering the care be sure to document the time spent during each care session (include durations of phone calls and/or consults/discussions) and list topics discussed.

Question #2:

Is it possible to charge for setting up a physical therapy program for a patient? If so - what code?

Depending upon the work being done that could qualify for Coordination of Care services (99339 and 99340). Based upon total time spent for a complete calendar month. So, you will report this only once per calendar month of care and the code should be based upon total time spent for that entire calendar month. CPT warns users not to report these codes when patients are under the care of home health. I would also advise that the provider rendering the care be sure to document the time spent during each care session (include durations of phone calls and/or consults/discussions) and list topics discussed/orders.

Back to me...so what's up next? A discussion about useage, values, good links about when to use them, etc.

I just realized that today's post represents a milestone: 200 entries! Who knew? I started this blog as a lark and it's gotten to the point that if I don't write something every 3 days, I get backed up with too much important information. According to my blog stats, I get just under 2000 unique visitors every month (obviously many more visits than that, total, as most of you come quite often) with dozens of new people every day.

I really appreciate the comments and feedback I get - nearly everything I share comes at someone's request (see below). Please keep them coming. Enough about that.

At our Users' Conference a few weeks ago, Donelle Holle asked our audience about their 99239 usage. You know, the Hospital Discharge Day (>30 Minutes). And if Donelle Holle asks about it, we should listen. Apparently, most of you use the 99238 code when, in fact, you spend more than 30m related to that patient on the discharge day. So Igor dutifully checked and came back with some interesting data. Since 2003, our clients have performed approximately the same number of 99239s every year...given that our customer base has grown during that time, the implication is that the same small number of practices are using the code. Probably very little new adoption.

We learned that the 99239 pays about 20-30% more than the 99238 (which makes sense) and that the 99238 gets used about 10-20x more often than the 99239. Are your discharge days <30m 20x more often than they are over 30m? Perhaps so, but Donelle's hunch that providers may not be aware of the 99239 looks may be correct.

For some reading about the 99239 CPT, this provides a good summary (click through the license bit).

I have some very interesting continued news about TriCare and I've had a piece about Main Street Vaccines building for a week or two, now, but I have to address this issue first.

Earlier this year, I wrote about how there is a measureable difference between the payments for a 90465/90471 and 90466/90472.  Although $1.50 to $2.50 a procedure doesn't seem like much, when you do 10,000 of them, it adds up.  Especially for pediatricians.

So why are there still so many pediatricians who don't even use the proper immunization administration code?!  Ignore, for a moment, the fact that not using a 90465 properly is bad coding practice.  Ignore, for a moment, that you are failing to document with your code that you spent time counseling.  You are losing money.

How often should a practice be billing the 90465 vs. a 90471?  It's difficult to know for sure - what percentage of the kids you immunize are under 8 years old?  Is even a modicum of imms counseling part of your clinical protocol?  Some of our clients insist that they "never" do counseling except for the first in a series of shots.  I not only think that they are factually wrong, but if they were right, they'd be missing an important clinical opportunity.

I don't know the answer, but I have a feeling that most pediatric practices ought to be doing as many, or more, 90465s and 90471s.  Just a gut instinct.  In reality, though, practices are all over the map.  I could simply give you the averages of everything, but the variance is so large, I think it would be worthless.  Let me show you...

...below, I took a random sampling of PCC clients and grouped them into segments based on their ratios of 90465:90471 procedures.  Then mapped them out.  So, on the left side of the graph below (click on it to zoom in) are practices who do very few - sometimes none! - 90465 procedures.  On the other end, you'll find practices who do more 90465s than 90471s - you'll see that some do 4-5-7x more.  

I won't judge who is right and wrong...ok, I take that back.  I'll bet that the overwhelming majority of practices who have a 90465:90471 ratio under 75% are mis-coding and losing money.  Under 50%? Under 25%?  And these are PCC clients, they are supposed to be better.I can't understand it. 

Anyone want to help explain this to me?  Do you really not do any physician imms  counseling in your office, and why not?

Sigh.

I forgot to mention last week that I updated the Build Your Own RVU calculator for 2009.  You can find it and the instructions in the PedSource library.

To make a long story short, for those who don’t know it - I really don’t like the fact that do do any proper RVU analysis of your practice, you have to pay for expensive software.  Especially for software owned by organizations who have admitted to ripping off the very people they claim to serve.  So, I designed a free tool that, using the license for which you are granted permission to access CPT codes (thanks, greedy AMA), you can do the calculation work you need.

Share and enjoy.  Flash-based pediatric coding tool coming soon, I hope.

First, a reminder: this blog is moving. You can find the new launching pad over at pedsource.com/chipsblog, or you can subscribe to the RSS feed (Feedburner, direct).  Start looking there, because that’s where we’ll be shortly.

Meanwhile…the 99174.  Eye screening.  Associated with those fancy in-office money making machines.  I’ve had a handful of folks ask for details - how often do our clients use it?  How much do they get paid?

Much to our surprise, we found one client who used the 99174 in 2008.  And not often, either - just over 3 dozen times.  Average charge: $40, average payment: $9 and change.  Many $0 payments.  Given the sample, I almot wonder if the practice is mis-coding.

Anyone out there billing the 99174?!

Two vital dates for your schedule:

October 1, 2010

This is the new Medicare fee schedule extension date.  Until then, the 2010 Medicare rate will be maintained at the 2009 levels.  Here's an AMA summary:

This afternoon, the Senate passed H.R. 4213, a bill to extend certain tax policies and stimulate job growth, by a vote of 62-36.  The bill includes provisions that would further extend current Medicare physician payment rates until October 1, 2010. The legislation will now be sent to the House, where amendments are possible.  Consequently, it is not certain if this extension of Medicare payment rates can be signed into law before the current Medicare physician payment freeze expires on April 1.

July 22-23 (and 20+21 for PCC clients) 

Even more important - the PCC Users' Conference and Pediatric Coding and Practice Management in July.  To quote, again:

The next PCC Pediatric Coding and Practice Management conference will be a two day event held on July 22-23 at the Sheraton Burlington Hotel and Conference Center in Burlington, Vermont. Further information is typically published in early April.

The next PCC Users' Conference will be a three-day event held on July 21-23 at the Sheraton Burlington Hotel and Conference Center in Burlington, Vermont.  A pre-conference reception will be held on July 20 from 6-8pm.  The PCC Users' Conference is inclusive of the two-day PCC Pediatric Coding and Practice Management Conference referenced above.

We have some really fascinating speakers lined up - some new, some of the usual suspects - and it doesn't get better than Vermont in July.  Save the date.

Updated 05/07/12.

With the help of extra sets of eyes at the Verden Group and the extra-smart people at the AAP, I present to you three versions of the 2011 Immunization Product Table (someone give me a better name).

This differs from previous versions I've done in a couple ways:

• Well, duh, it's updated for 2011.
• It contains CVX and MVX codes for those scoring at home.
• It has an Oral and Intranasal binary value.
• It has both detailed and brief descriptions of the vaccines.
• And, the real inspiration for this new table, it counts components/antigens for coding purposes.

I also made the executive decision to remove nearly all of the formatting so that folks find it a little easier to edit, manipulate, or otherwise incorporate into their systems.  I find that if I do something like "alternate line coloring" for easier reading, it all falls apart when someone deletes a couple rows to make a shorter list.  If anyone is interested, I can make it pretty.

Input, requests welcomed.

V1.2:

2011 Immunization Product Table for OpenOffice.

2011 Immunization Product Table for Excel.

2011 Immunization Product Table for Adobe PDF (kinda' gross because of the amount of info, let me know if you need a better layout)

Some additional links that are useful for this purpose:

• The full CVX list from CDC.
• CPTs mapped to CVS from CDC. 
• CVX mapped by Vaccine brand name care of the state of Washington.