Archive for the ‘Anesthesia Coding’ Category

AMA Lobbies Sebelius to Stop ICD-10

07 Feb

The American Medical Association is doing what it can to halt implementation of the ICD-10 code sets. They are doing so by sending a letter to Health and Human Services Secretary Kathleen Sebelius.

Signed by AMA executive vice president and CEO James Madara, M.D., the letter also asks Sebelius to reexamine penalty timelines associated with multiple Medicare health IT initiatives that are underway.

“The timing of the ICD-10 transition that is scheduled for October 1, 2013, could not be worse as many physicians are currently spending significant time and resources implementing electronic health records into their practices,” says Madara.

Madara points out that adoption of the ICD-10 codes is an unfunded mandate that will cost medical practices between $83,000 to $2.7 million to implement (depending on their size). He also invoked President Obama’s executive order that calls for federal agencies to reassess and streamline regulations.

“This is a perfect opportunity for HHS to make good on its commitment to improve the regulatory climate for physicians,” says Madara.

Madara noted that physician investments in government-sponsored EHR meaningful use, electronic prescribing and quality reporting programs coincide with falling Medicare payment rates and tough penalty programs for failing to comply.

“Physicians are being required to meet separate requirements under these three overlapping health IT programs and have been and will be unfairly penalized if they decide to participate in one program over the other.”

Madara had just issued a similar appeal to House Speaker John Boehner.


CMS Delays Version 5010 Compliance Enforcement

30 Dec

The Centers for Medicare & Medicaid Services announced last month that it will delay its requirement for the adoption of a more-robust set of claims transmission standards.

Originally, the switch the ASC X12 Version 5010 standards required of hospitals, physician practices, health plans and claims clearinghouses was set for January 1, 2012. But the CMS announced it would push it back to March 31, 2012.

The announcement came after a significant amount of protest within the medical industry and their inability to be ready to make the upgrade from the Version 4010 standards currently in use. The CMS respond accordingly.

According to the CMS, its decision to push back their enforcement deadline was “based on industry feedback revealing that, with only about 45 days remaining before the January 1, 2012 compliance date, testing between some covered entities and their trading partners has not yet reached a threshold whereby a majority of covered entities would be able to be in compliance by January 1.”

The switch to the Version 5010 standards is consider a necessary precursor to adoption of ICD-10. Those who do not comply by the deadline face hefty penalties. According to the CMS website, “The HIPAA legislation permits civil monetary penalties of not more than $1.5 million per calendar year for a violation of an identical provision.”

According to a Medical Group Management Association member survey, only one in 50 physician group practices has completely implemented the software changes  that are necessary to make the switch to Version 5010.


AMA Fights Against ICD-10

27 Dec

Medical professionals already have their hands full with healthcare reform, they don’t have ample time or resources to comply to changes that come with ICD-10. That’s, in essence, what The American Medical Association’s House of Delegates is saying in their opposition to the demands associated with the mandatory switchover to the International Classification of Diseases 10th Revision family of diagnostic and procedural codes.

The association voted to “work vigorously to stop implementation” of ICD-10, not only due to healthcare reform, but also the federal push for doctors to adopt electronic health-record systems.

“The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients’ care,” said AMA President Dr. Peter W. Carmel in a written statement from the association’s nearly week-long policy meeting in New Orleans.

“At a time when we are working to get the best value possible for our healthcare dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions,” said Mr.Carmel. “The timing could not be worse as many physicians are working to implement electronic health records into their practices. We will continue working to help physicians keep their focus where it should be – on their patients.”

Without giving a name, the AMA cited a study from 2008 that found that a three-physician practice would spend $83,290 to implement ICD-10, and a 10-physician practice would spend $285,195.

With the Medicare and Medicaid electronic health record initiative, there are incentive payment programs under the American Reinvestment and Recovery Act of 2009 for doctors. However, with the transfer from ICD-9 to ICD-10 there are no funds made available to offset costs.

The deadline for the switch to ICD-10 is October 1, 2013. That date has already been pushed back once. The CMS continues to stand by its stance that they have given healthcare providers enough time to make the transition to ICD-10.

“Implementation of this new coding system will mean better information to improve the quality of healthcare and more accurate payments to providers,” said a CMS spokesman. “We will continue to work with the healthcare community to ensure successful compliance.”


2012 HCPCS II Now Available, More Than 430 Changes

16 Nov

The Centers for Medicare & Medicaid Services (CMS) recently released the HCPCS Level II codes that go into effect January 1, 2012. Among the changes are 285 code additions (plus one new modifier), 48 revisions, and 75 deletions. Another 18 codes were added and eight deleted throughout 2011.

The policy requires hospitals to combine the charges and appropriate codes for any outpatient diagnostic and “related” non-diagnostic services, not including ambulance and maintenance renal dialysis, provided within the three-day period immediately preceding an inpatient admission.

Many C and Q codes have been deleted and replaced by new J codes, including C9272 being replaced by J0897 Injection, denosumab, 1 mg; Q2040 replaced by J0588 Injection, incobotulinumtoxin A, 1 unit; and Q2042 replaced by J1725 Injection, hydroxyprogesterone caproate, 1 mg.

There have been a few C codes added for 2012, including C9287 for the lymphoma drug brentuximab vedotin and C9366 for the membrane/skin allograft EpiFix®. Similarly, there are fewer than a dozen new drug/supply Q codes for 2012. Among them are Q0162 for the anti-nausea drug ondansetron, Q2043 for sipuleucel-T, a therapeutic vaccine for prostate cancer, and nine new codes (Q4122-Q4130) for skin substitutes such as Dermacell®, Alloskin™ RT, and Talymed™.

  • A series of new E codes (E0988, E2358-E2359, and E2626-E2633) describe various accessories (e.g., batteries, arm supports) for manual and power wheelchairs.


  • Four new K codes (K0743-K0746) have been added for home suction pumps and supplies for wound healing (i.e., negative wound pressure therapy).


  • G codes for telehealth consultations (G0425-G0427) have been revised to apply both to initial and emergency department services.

The largest number of changes (209 additions, 27 revisions, and 28 deletions) affects G codes used to report quality indicators for the Physician Quality Reporting System (PQRS). Eligible professionals (EPs) who successfully report on quality measures in the PQRS are eligible for a 0.5 percent Medicare payment incentive for years 2012-2014. In 2015, EPs and groups that don’t report quality data successfully will face a 1.5 percent payment reduction in Medicare payments, and a two percent reduction for 2016.


American Academy of Professional Coders Launches ICD-10 Resource

07 Mar

Last week, The American Academy of Professional Coders unveiled an ICD-10 resource on its website to help payers and providers comply with the mandated code sets.

“Our message is simply that ICD-10 will change everything,” said AAPC CEO Deborah Grider.

The United States will begin to officially use ICD-10 on October 1, 2013. While that is still a few years away, it is AAPC’s intent to educate and raise awareness with healthcare professionals in plenty of time before the October 1, 2013 compliance deadline.

The ICD-10 resource page on AAPC’s website includes a code conversion tool, an online application for tracking and measuring the progress of ICD-10 implementation, and interactive floor plans to show how ICD-10 affects different aspects of a doctor’s practice or health plan. Among other features is also a collection of articles discussing ICD-10.

The page also comes with interactive graphics to illustrate how the changes in coding standards will affect different aspects of a health care practice or health plan.

If you are in the medical billing industry or are part of a medical practice, the ICD-10 revisions will be about more than just coding changes. It’s going to change everything about your practice. However, if you do want to concentrate on how it will alter the coding aspect of the game that is certainly a daunting challenge. The number of diagnostic codes under ICD-10-CM will more than quadruple, going from 13,500 to 69,000. And for inpatient procedures, the number jumps from 4,000 codes to 71,000 codes.

That’s a lot of catching up to do. All of this underscores how important it is not to delay in prepping for the changes: 2013 will be here before you know it! For more on all the tools available go to the AAPC’s website.


What are the Costs vs Benefits to the ICD-10?

23 Nov

The most recent medical coding, or International Classification of Diseases, is ICD-10. It was endorsed by the 43rd World Health Assembly in May 1990 and was started to be used in WHO Member States in 1994. But it’s not until 2013 that we will see these revisions in the U.S.

So, how does the ICD-10 differ from the ICD-9 set of codes currently in use in the U.S.? The ICD-10-CM codes are very different. All codes in ICD-10-CM are alpha-numeric. There can be as many as seven alpha-numeric characters. This means that billing software programs must be changed to accommodate the additional digits. This also means more extensive medical billing coder training.

While there won’t be much change in how the physician does his or her documentation in the medical records, the translation process into ICD coding will change. The newer codes will provide more detailed information about the patient’s condition.

It’s interesting to see some of the data comparing what ICD-10 will cost versus what it can save hospitals and healthcare providers. The RAND Science and Technology Policy Institute did a cost/benefit analysis of implementing ICD-10. What they found was that providers will incur costs for computer reprogramming, training coders, physicians, and code users, and for the initial and long-term loss of productivity among coders and physicians.

The cost of sequential conversion (10-CM then 10-PCS) is estimated to be between $425 million and $1.15 billion in one-time costs. There will also be between $5 and $40 million lost in yearly productivity.

But there are benefits as well, many benefits that RAND sees coming from the new detail provided in ICD-10. And, as you will see, they far outweigh the costs.

– More accurate payments to hospitals for new procedures is believed to save $100 million to $1.2 billion.

– There are also benefits from fewer rejected claims, which may be $200 million to $2.5 billion.

– But wait there’s more… in the form of $100 million to $1 billion in fewer exaggerated claims.

– The identification of more cost-effective services and direction of care to specific populations would result in $100 million to $1.5 billion.

– There are also untold benefits that would come from better disease management and better directed preventive care.

In light of these enormous changes coming into effect many anesthesiologists are even more likely to benefit from outsourcing their billing to a medical billing company that specializes in providing anesthesia billing services.


Billing Codes Increase in 2013, Threaten to Slow Billing Process

25 Oct

According to the New England Journal of Medicine, overhead and billing expenses take up as much as 43 percent of a doctor’s annual revenue. When you consider the fact that insurance companies will not always make it easy on you to have your claims paid, it makes it that more daunting. But, when 2013 rolls around, the challenge gets tougher. In fact, you will have 155,000 reasons to consider hiring a medical billing company to handle your claims.

Published by the World Health Organization (WHO), The International Statistical Classification of Diseases and Related Health Problems (ICD-9) currently contains 17,000 billing codes to choose from in order to classify diseases and a wide variety of symptoms, causes, and other variables. But, all that will change on October 1, 2013, when the number of codes will increase to an astounding 155,000 under the ICD-10.

As one might suspect, more codes means longer billing processes. Coders will need to increase their knowledge of anatomy, physiology, and medical terminology. They will also need to work more closely with doctors to work out the kinks in the new coding process.

The United States is late to the game, so to speak, with implementing the ICD-10. Other countries that have been under the latest coding guidelines for years have reported significantly longer turnaround time on their accounts receivable.

But if the transition is handled effectively, those bumps in the road should be short-term. If nothing else, the pending coding changes underscores the value of outsourcing your medical billing needs to a medical practice management company.