Posts tagged with pediatric coding

Save the date: April 17.

It's not official yet - we're confirming a location - but we hope and expect to produce a pediatric coding and practice management seminar in the greater Washington DC area on or around April 17.  It will be nearly identical to the one we produced in NYC in August.  We hope to get AAP endorsement again and, if everything works out, we may even be able to acquire an educational grant from a generous source that might lower or eliminate the cost for AAP members!

That last item is a bit of a dream still, but it's not off the table.

Anyway, I thought I'd let everyone here be the first to know.  As soon as it's official - speakers, location, date, and content - I'll post it all here.

Last week, Igor and I were looking at the usage of -25 Modified E&M codes as the information about them is a bit of an unspoken subject in our business. I can't find any good, definitive sources so, as usual, we have to create our own.

Two days ago, I posited that the distribution of -25 modified E&M codes should be different from non-modified codes for a simple reason: acute medical issues typically generate their own sick visits and the most common type of modified E&M would be an "Oh, by the way..." Those OBTWs don't often rise to the level of a 99214 or 99215, at least as often as a walk-in would.

That was the thought, anyway. Here are the results, complete with my original estimate of what it would be:

What do we learn? That -25 modified E&M codes actually mimic "normal" E&M codes quite closely. Fewer 99213s, certainly...but more 99214s and 99215s! The opposite of what I predicted. Figures.

So, why were we wrong (I'm trying to spread the blame)? First, we learned that our clients have as many modified E&M codes as non-modified! In other words, even with 22% of our clients not using the codes at all, boatloads of -25 modified codes go out the door of our practices. Why? A faithful reader - who will go unnamed until she asks for credit - offered the following insight:

They are not only when there is an associated well visit
Asthma Checks
When we do spirometry at these visits, we don't get paid unless we put a -25 on the E/M.
Imms visits
When there is a recheck of illness, Imms won't pay unless there is a -25.
Infant Bili-Weight Check Visits
When We do a transcutaneous bili, we need the -25 on E/M.
Sick visits with opth complaints, migraines, injuries
Visual testing won't pay without the modifier.
Sick visits with hearing, tinnitus
Hearing testing requires us to add the -25 on the E/M.
If the modifier -25 is not used , we would get "bundled" payments from quite a few inscos.

Well, that explains that. Perhaps Igor and I will explore looking only at E&Ms at well visits after all! Harumph.

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It's official. PCC's Spring 2008 Pediatric Coding Conference will be held on April 17 at the Capital Hilton in Washington DC.

You can get all of the details here, some of which are repeated below. To sign up, race here. We sold out in NYC last time and this venue is a lot nicer and holds fewer people.

And - yes - the seating will be a huge improvement over NYC. Tables, guaranteed viewing, etc., etc., etc.

Thanks again to our amazing speakers, Dr. Lander for helping make this all happen, and the AAP for endorsing the event. Remember: AAP members get a big discount!

Spring 2008 Pediatric Coding Conference

Developed by PCC and Endorsed by the American Academy of Pediatrics

Thursday, April 17, 2008 — Washington, DC

Put your practice ahead of the curve with PCC's 2008 Pediatric Coding Conference, endorsed by the AAP. Pediatric coding experts address key issues during a full day of courses with question and answer sessions designed to improve your coding practices and reimbursement.

The 2008 Pediatric Coding Conference will be held at the Capital Hilton in Washington, DC.
This is an intensive, one-day session focused on important pediatric issues that effect your practice every day. You'll master the coding basics, get answers to your specific questions during Q&A sessions with our pediatric panel, and gain valuable insight on timely topics about immunizations, pay-for-performance programs, physician compensation, and more. Our expert panel of instructors include AAP Fellows Richard Lander, MD; and Richard Tuck, MD.

Register now. Admission to this conference is only $325 for AAP members ($379 for non-members)!
Thursday, April 17, 2008

Schedule
7:30-Registration and Continental Breakfast
8:00-Welcome and PCC's Free Online Practice Management Tools
8:15-Coding 101
9:00-Give Me the Money: How to Decrease your A/R
9:45-Q&A
10:00-Break
10:30-Procedure Power Coding
11:15-Pediatric Physicians' Compensation Models
12:00-Q&A
12:15-Lunch (provided)
1:30-Vaccine Coding: Preventive Medicine for a Healthy Bottom Line
2:15-Who Wants to Be a Coding Millionaire?
3:00-Q&A
3:15-Break3:45-Thirty Tips in Thirty Minutes
4:15-Q&A

Course Descriptions
PCC's Free Online Practice Management Tools
Your host, PCC, will provide information about free online pediatric practice management resources. These free resources can help you update your pricing, review your coding curve, select an EHR and more.

Coding 101
Super coding expert Richard Tuck, M.D., covers the essentials of pediatric coding with updates for 2008. Whether you are new to coding or feel like you already know it all, there is something here for everyone.

Give Me the Money--How to Decrease Your A/R
The AAP's SOAPM Chairperson, Richard Lander, M.D., will cover the policies and procedures you need to have in place to collect the money that is due to you. Topics will include everything from preparing for HSAs to how your staff can ask for money at the Time of Service and still keep your patients happy.

Procedure Power Coding
Most pediatric offices leave thousands - tens of thousands! - of dollars on the table every year for work that they have done but failed to code properly. National CPT expert, Richard Tuck, MD, will walk you through providing and coding for procedures to increase your bottom line.

Pediatric Physicians' Compensation Models
Developing a fair compensation model is an ongoing struggle for many pediatric practices. PCC's Chip Hart will walk you through the challenges of many real offices to determine what might work for you. The varied skills, personalities, productivity levels, experience, lifestyle demands, and non-financial contributions of those involved are just some of the factors that contribute to the challenge of physician compensation. Hart will provide an overview of existing models and data from pediatric office across the country and identify patterns of success.

Vaccine Coding: Preventive Medicine for a Healthy Bottom Line
Each passing year makes the process of billing for vaccines more difficult. With the introduction of new vaccines, changes in the coding rules, and many insurance companies adding their own interpretations, Dr. Lander will help you navigate the muddy waters to get properly reimbursed. Stop losing money on one of the most expensive, risky - and necessary! - aspects of running your practice.

Who Wants to Be a Coding Millionaire?
Dr. Tuck provides an entertaining and challenging review of coding highlights to maximize your practice income. Whether you work for a practice that is afraid to use 99214s or have already mastered the subtle details of the -25 modifier, this game show format course is a must attend.

Thirty Tips in Thirty Minutes
Join Dr. Tuck and Dr. Lander in a fast-paced barrage of all the little, but important, tips and tricks that didn't make it into the other topics!

About the Instructors
Richard Lander, MD, FAAP
Dr. Richard Lander is a managing partner in a pediatric private practice in New Jersey and is president and co-founder of Resources in Physician Management Services. He is currently a Clinical Assistant Professor of Pediatrics at UMDNJ. Along with his dedication to the care and well being of children and adolescents, Richard has made it a priority to help to ensure that pediatricians are properly remunerated for their hard work on children's behalf. As the president of the NJ-AAP Chapter, he initiated and remains as co-chair of the Pediatric Council. Richard serves on the national Committee on Child Health Financing and chairs the AAP Section On Administration and Practice Management (SOAPM). He has been a consultant to the AAP Task Forces on Reimbursement, the Task Force on Obesity, and the Task Force on Mental Health. Since 1989, he has been an AAP Regional CPT Trainer and has lectured on coding and practice management for the AAP, private enterprises, and pediatric residency programs. He serves on and contributes to several coding newsletter editorial boards.

Richard Tuck, MD, FAAP
Dr. Richard Tuck is a general pediatrician in a private group practice in Zanesville, Ohio. He is also medical director of Quality Care Partners, a southeastern Ohio PHO. Dr. Tuck is a nationally known expert with extensive knowledge of CPT and ICD coding, as well as payer and reimbursement issues, gained through his personal practice and state/national committee involvement. He serves as the American Academy of Pediatrics’ representative to the AMA RBRVS Review Update Committee (RUC). Dr. Tuck received the Buzzy VanChiere award for his efforts to educate pediatricians on appropriate coding. This education assists physicians in obtaining adequate payment for the work they do and maintains access to care for their patients.

Chip Hart
Chip Hart is the Director of PCC's Pediatric Solutions consulting group. Chip's pediatric practice management expertise has helped hundreds of pediatricians increase their financial health. He has conducted many successful negotiations with insurance companies, and worked as a consultant for the American Academy of Pediatrics (AAP) and the AAP Section on Administration and Practice Manangement (SOAPM). As a dynamic and motivating speaker, Chip leads educational seminars and consults for pediatric professionals nationwide. He established the popular "PedTalk" mailing list and moderates this lively forum for pediatric healthcare professionals. Using his varied experiences with pediatric practices for inspiration, he writes regularly about the "Confessions of Pediatric Practice Consultant" (which you can read online at www.chipsblog.pcc.com). Chip has also authored articles on practice management and health care information technology for Pediatric Coding Alert, Beansprout, and Medical Group Management Association.
Location and Accommodations

The conference is held at the Capital Hilton , 1001 16th Street, NW, Washington, DC.

Register now. Admission to this conference is only $325 for AAP members ($379 for non-members)!

The 96110 CPT code...now properly included in AAP preventive care protocols, thanks to Bright Futures. Many practices have performed the screening tests for years, but only few pediatricians actually bill for it. I've seen a lot of folks ask about billing for these important parts of preventive visits, so I thought I'd gather some quick data and helpful advice.

First, the advice. Check out this amazing site and its list of excellent 96110 FAQs and their answers. Awesome stuff from the AAP. I'm going to do some more fishing in here.
There's also this excellent piece from Medical Newswire that goes through each of the services expected from the Bright Futures protocols and how to bill for them. These are two of the best on-line references I've seen in a long time...and I didn't even know that Drs. Tuck and Lessin would be quoted in them, promise!

And, when in doubt, check out the AAP's Medical Home Info WWW site - they have excellent documentation about the use of the 96110 code [updated].
Now, for the eye candy:

Click (or here) on the pic for a better view.
Tight to read, I know, but here's what it tells us: since 2003 (when I believe the definition was last updated), PCC customer usage of the 96110 code has gone from 4% of our clients to 29%. At the same time, those clients who do use it, have increased their volume from an annual average of 301 to almost 2000!
Tomorrow, I'll post the $$. It's any interesting story. Obviously, though, if our clients weren't getting paid for it, they wouldn't be using it. [2008 is projected usage, btw.] Bottom line: what are you remaining 70% waiting for?!
Check out the new poll on the left.

Long overdue, but I did try to get them right. Thanks go out to Donelle Holle as well as Igor and Q who helped check them out before posting.

If you'd like a nice, neat copy, you can download the PDF. I was going to post the entire thing here, but it is much too long. Here is a sample Q/A:

1. What RVU is associated with 99058 (emergency)? Do insurers pay?

The 99058 CPT code has no RVUs. There are, indeed, many insurers that pay the office emergency code however. Of course, payment will vary from one carrier to another – payments are usually between $20 and $75. When using this code, remember to document the fact that the service was indeed an emergency, as we all know that not all walk-ins are emergencies.

Don't forget that we have another AAP-endorsed event scheduled for September!

It's official - go sign up.  Space is limited.  Similar to our previous endeavors but two days, a lot of content, and the largest collection of pediatric practices in one place all year long.  The best part -it's at Disney, you bring your family! 

It's also substantially cheaper than other events held at the same location (or elsewhere) around the same time...

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PCC is pleased to announce that this summer's Pediatric Coding & Practice Management Conference will take place at Walt Disney World® Resort, Florida from July 23-24 2009.

We are planning an exciting conference packed with pediatric practice
management education in a fun-filled learning environment. Mark your
calendars or begin to plan your trip to Walt Disney World® Resort now.

New! Register Now!

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I'd also like to call attention to these archived teleconferences about the Medical Home model that everyone with interest in this issue should listen to:

 

Medical Home Implementation Teleconference Series

The American Academy of Pediatrics is hosting a free
teleconference series to provide child health professionals with
practical strategies for implementing medical home in practice. These
informative calls will be led by nationally recognized experts with the
goal of educating participants about the value of the family-centered
primary care medical home for all children and youth, the availability
of practical tools and resources, and will provide strategies for
improving care and increasing patient/family satisfaction. Note: Calls 3,4, and 5 will be held in a Webinar format to accommodate the demand for additional participation. 

 

Presentations and podcasts are now available online for the first call (held on March 3^rd) at http://www.medicalhomeinfo.org/training/archivescall1.html and the second call (held on March 25th) at http://www.medicalhomeinfo.org/training/archivescall2.html. Descriptions of the calls are listed below:

 

Call #1: Implementing Medical Home for all Children and Youth
Featured Speakers:  
Vera Fan Tait, MD, FAAP; Associate Executive Director, American Academy of Pediatrics

Jeanne McAllister, BSN, MS, MHA; Director, Center for Medical Home Improvement (CMHI); Crotched Mountain Foundation, New Hampshire; AAP Medical Home Implementation Toolkit, Lead Consultant

 

By the end of this event, participants will be able to:

- Learn about essential tools to have in your practice that provide successful Medical Home for all children and youth;

-  Understand how those tools can help your practice pass Level 1 of the National Committee on Quality Assurance (NCQA) standards

 

Call #2: Improving Communication and Co-management Between Specialty Providers and the Medical Home

Featured Speakers:  
Chris Stille, MD, MPH, FAAP;
Co-Principal Investigator with the American Academy of Pediatrics and
the Shriners Hospitals for Children Project; Assoc Professor, UMass
Medical School, Worcester, MA
Jennifer Lail, MD, FAAP; Chapel Hill Pediatrics and Adolescents, PA, Chapel Hill, NC
Donald Lighter, MD, MBA, FAAP, FACHE; Vice President for Quality at WellCare, Inc

 

By the end of this event, participants will be able to:

-
Discuss the importance of primary and specialty care collaboration in
the provision of comprehensive, family-centered care provided in the
medical home.
- Describe the benefits of enhancing communication in the continuity between health systems.
-
Identify 3 practical approaches to enhance communication and
co-management and their potential applications for improved chronic
condition management in their practice.

 
For additional information about the teleconference series, please visit: http://www.medicalhomeinfo.org/training/archives.html

Thanks, Siouxsie, for that info.

I've written extensively about 96110 usage among practicing pediatricians in the past and wanted to provide an update for 2008/9.

96110 Charge Reimbursement Data

(Paid-off Charges, 2008/9)

	Average Charge	Average Ins. Payment	Average Pers. Payment	Average Total Payment
2008	$40.26	$11.01	$1.41	$12.42
2009	$38.40	$12.50	$.98	$13.48

The declining personal charges combined with the increasing insurance payments (increasing at a faster rate) imply that, indeed, more and more payers are picking up this code.

More telling?  That the number of PCC clients using this code increased by more than 50% (Q1 2008 vs. Q1 2009) and now nearly 1/2 of our clients are using this code regularly.  Why aren't you?