AES 2010 Practice Management Course Practice Management Course December 7, 2010 Gregory L. Barkley, M.D. Comprehensive Epilepsy Program Comprehensive Epilepsy Program Henry Ford Hospital Detroit MI Detroit, MI Associate Professor of Neurology Associate Professor of Neurology Wayne State University
Outline Outline Consultation Codes C lt ti C d 2011 Medicare Conversion Factor and SGR October 2010 ICD-9 coding changes of interest 2011 CPT Codes 2011 CPT C d PQRI update p Gearing up for ICD-10 on October 1, 2013 Mi Miscellaneous: Please note, I have removed the cell slice images ll from this set to keep the file size smaller. Images are at: http://www nytimes com/slideshow/2010/11/29/science/20101130 brain 1 html http://www.nytimes.com/slideshow/2010/11/29/science/20101130-brain-1.html
Deadline extended until Dec 10. We specifically need members from: Alaska, Arizona, Arkansas Colorado, Connecticut Delaware, Kansas Kentucky, Maine Mississippi Nebraska Mississippi, Nebraska Nevada, North Dakota Rhode Island, South Carolina South Dakota, West Virginia Melissa Larson Manager, Advocacy Development AAN Professional Association AAN Professional Association Ph: 651.695.2748 FAX: 651.361.4848 mlarson@aan.com www.aan.com\advocacy
Consultation Codes Are Gone Forever Consultation Codes Are Gone Forever CMS t CMS stopped paying for consultations, 9924x and 9925x d i f lt ti 9924 d 9925 • In 2007, > 28 million claims – Money from Consultation codes redistributed to other – physician codes to maintain budget neutrality Other payers stopped paying for consults during 2010 Other payers stopped paying for consults during 2010 • • An attempt this year by AAN and other societies to get • reconsideration of consult codes was rejected reconsideration of consult codes was rejected CMS commented: "in most cases there is no substantial • difference in physician work between E/M visits and services that would otherwise be reported with CPT consultation codes."
Coding an outpatient New Patient visit (3/3 (3/3 or Hx, PE, and MDM) H PE d MDM) History Exam Decision Time Code making elements (minutes) HPI 1 3 f HPI 1-3 facts t 1 5 1-5 Straight- St i ht 10 10 99201 99201 forward HPI 1-3 facts 6 Straight- 20 99202 ROS 1 fact forward HPI 4 facts 12 low 30 99203 ROS 2, PSFH 1 HPI 4 facts, 25 moderate 45 99204 ROS 10, PSFH 3
Coding an outpatient Established Coding an outpatient Established Patient visit (2/3 MDM + Hx or PE) Decision Exam Time History Code elements (minutes) making making Minimal or - - 5 99211 none Straight- HPI 1-3 facts 1-5 10 99212 forward HPI 1-3 facts 6 low 15 99213 ROS 1 HPI 4 facts, 12 moderate 25 99214 ROS 2, PSFH 1 HPI 4 facts, 25 high 40 99215 ROS 10, PSFH 3
9922x Coding an inpatient Initial 9922x Coding an inpatient Initial Care Day (3/3) History (CC History (CC Exam Exam Decision Decision Time Time Code Code always needed) elements making (minutes) (wRVU) HPI 4 facts, 12 Neuro Straight-forward or 30 99221 1 PFSH, SSE or low (1.89) 2-9 ROS 5-7 systems y Full Neuro Full Neuro HPI 4 facts, HPI 4 facts Moderate Moderate 50 50 99222 99222 SSE (25) or 3 PFSH, (2 Chronic with 1 (2.57) 8 Systems 10 ROS exacerbation) Full Neuro High HPI 4 facts, 70 99223 SSE (25) or Threatening, acute 3 PFSH (3 79)
9923x Coding an inpatient Subsequent Day Care (2/3) History History Exam Exam Decision Decision Time Time Code Code making (wRVU) elements (minutes) HPI 1-3 facts 1-5 straight-forward or 15 99231 low (0.76) HPI 1-3 facts 6 moderate 25 99232 ROS 1 fact ROS 1 f t (1 39) (1.39) HPI 4 facts 12 high 35 99233 ROS 2 facts (2.00)
Counseling and Coordination of Care Counseling and Coordination of Care Counseling is a discussion with patient or family about diagnoses Counseling is a discussion with patient or family about diagnoses Counseling is a discussion with patient or family about diagnoses, Counseling is a discussion with patient or family about diagnoses, test results, recommended tests, prognosis, treatment test results, recommended tests, prognosis, treatment alternatives, compliance, risk factor reduction, and patient and alternatives, compliance, risk factor reduction, and patient and family education. f f family education. il il d d ti ti Coordination of care is arranging for care with other health care Coordination of care is arranging for care with other health care Coordination of care is arranging for care with other health care Coordination of care is arranging for care with other health care providers. This includes any type of such activity. providers. This includes any type of such activity.
Counseling and Coordination of Care Counseling and Coordination of Care This can be used This can be used in place of This can be used This can be used in place of in place of the above HX in place of the above HX the above HX-PE the above HX-PE PE-MDM. PE-MDM MDM MDM. • • It uses time It uses time to set LOS to set LOS • The documentation should state: The documentation should state: • Minutes Minutes spent face Minutes Minutes spent face spent face to spent face-to to face to-face face face – That more than 50% That more than 50% of time was counseling and/or coordinating of time was counseling and/or coordinating – care, care, Give some general idea of Give some general idea of what what counsel/coord. care. counsel/coord. care. – Time is: Time is: • Face-to Face Face to Face to face with patient (outpatient) to-face with patient (outpatient) face with patient (outpatient) face with patient (outpatient) – – At bedside and on unit/floor (inpatient). At bedside and on unit/floor (inpatient). No history or exam elements are needed except of course for real patient No history or exam elements are needed except of course for real patient No history or exam elements are needed except, of course, for real patient No history or exam elements are needed except, of course, for real patient • • care purposes! care purposes!
Emergency Room Care Emergency Room Care Most ER services provided by neurologists and neurosurgeons are Most ER services provided by neurologists and neurosurgeons are Most ER services provided by neurologists and neurosurgeons are Most ER services provided by neurologists and neurosurgeons are • • as “consultants” as “consultants” Use Established Patient (99211- Use Established Patient (99211 -99215) codes for Medicare 99215) codes for Medicare • patients seen by anyone in your group in the past three years patients seen by anyone in your group in the past three years ti ti t t b b i i i i th th t th t th Otherwise use Outpatient New Patient (99201 Otherwise use Outpatient New Patient (99201- -99205) codes 99205) codes • If the patient is admitted to the hospital, then use the initial hospital If the patient is admitted to the hospital, then use the initial hospital p p p p , , p p • day codes (99221 day codes (99221- -99223) 99223) Critical Care services provided in ER, e.g. tPA or status epilepticus Critical Care services provided in ER, e.g. tPA or status epilepticus • management: management: management: management: Use Critical Care codes 99291 Use Critical Care codes 99291 - - 99292 99292 –
Critical Care Critical Care 99291 99291 99291 first hour of critical care (31 99291 first hour of critical care (31 74 minutes) first hour of critical care (31 first hour of critical care (31-74 minutes) 74 minutes) 74 minutes) • • 99292 each additional 30 minutes 99292 each additional 30 minutes Coded by time for bedside and unit physician work for an unstable, critically ill Coded by time for bedside and unit physician work for an unstable, critically ill • patient patient p – Not for consultant's time Not for consultant's time – Need not be continuous in any location Need not be continuous in any location • • Generally cannot bill other E/M on same day. Generally cannot bill other E/M on same day Generally cannot bill other E/M on same day. Generally cannot bill other E/M on same day • Exceptions are if an E & M is performed at one time, then a crisis occurs and Exceptions are if an E & M is performed at one time, then a crisis occurs and critical services are performed. critical services are performed. • Make sure you document times carefully so you do not appear to be combining Make sure you document times carefully so you do not appear to be combining times of routine care with critical care times or procedure times. times of routine care with critical care times or procedure times. Not every day in the ICU is critical care!!! Not every day in the ICU is critical care!!! Not every day in the ICU is critical care!!! Not every day in the ICU is critical care!!! • Patients awaiting transfer to GPU are not critically ill Patients awaiting transfer to GPU are not critically ill – Critical care can be provided anywhere including in the clinic Critical care can be provided anywhere including in the clinic • You must document time spent and what you did in your note You must document time spent and what you did in your note •
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