Network News. Volume 15 Number 1 Jan Feb - Mar 2016

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1 Professional Association of Healthcare Coding Specialists (PAHCS) also known as Professional Association of HealthCare Specialists (PAHCS) Network News In this edition Place of Service Changes PAHCS Happenings Advanced Planning Care Code Highlights 2016 E&M Coding Delegate Coding for CEU s Volume 15 Number 1 Jan Feb - Mar 2016 One association with two names, servicing practice administrators, managers and coders in the medical arena. Understanding the Place of Service Changes for 2016 By Dawn Cloud, CMSCS, CHCI, CPC, CMCS, CPOM There are some new changes that will affect your claims coming in January These will apply to outpatient hospital claims, as well as clinics owned by hospitals. If you code for any of these services you need to understand this information. First off we have a new POS (place of service), 19, which is marked in the current copy CPT-4 as unassigned. Medicare is taking this and making it effective 1/1/2016 to be Off campus outpatient hospital. There current description is a portion of an off-campus hospital based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. Secondly, they are revising existing POS 22, which is now On Campus Outpatient Hospital. The new description of this is as follows, A portion of a hospital's main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. Thirdly, as a reminder POS 11, Office is described as Location, other than a hospital, skilled nursing facility (SNF), military treatment facility. Community health center, State of local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis. Medicare states the reason for the change is mostly to help adjudicate Medicaid claims. They state that based on some new Medicaid codes this distinction was necessary to make. Reporting either POS 19 or 22 will get you paid at the reduced facility rate. This will include E/M services performed in these areas. I am, however, not seeing any language that if your clinic is hospital owned that you must report as POS 19 instead of POS 11. I am sure this will be determined by how your clinic is registered with Medicare. In the past I have billed for a facility that had a physician s clinic inside the main hospital. I can only wonder how they will now have to report those services. In any case you may want to seek out the answers from Medicare to determine if you are required to report this new POS. This information was taken from MLN Matters Number: MM9231 found on PAHCS, Like us on FACEBOOK

2 PAHCS Happenings Change of Information If you change jobs, move or change address please contact PAHCS via so we can continue to send you coding material from PAHCS. Keeping us informed will also help to keep our database up to date and you will get newsletters, renewal and/or recertification notifications and other information in a timely fashion. Webinars PAHCS is changing how we do webinars. Members have told us it s sometimes difficult to break away for an hour during work to pay attention to a webinar. Because of this we will now have our speakers build Power- Point presentations, with voice, that we can post on the PAHCS website and you can view them at your convenience. Many will be free, however, some will be pay-per-view events (almost always $25 or less per CEU). As we post these videos we will be sending all members notification when they are available for viewing. We are working with Dawn Cloud, CMSCS, CHCI, CPC, CMCS, CPOM to complete the first one on the Guidance for 2016 CPT Changes for all specialties. We anticipate this being available by the end of January and we ll send s to notify you...assuming we have your correct address. CEU Information PAHCS issues CEU certificates for all PAHCS CEU s issued. We keep track of which PAHCS CEU products you have submitted and when but DO NOT track a cumulative total, nor do we track any CEUs you may have gained from external agencies. Please track this information individually, we ask each member to track their own CEU s and submit them during the re-certification process, once every 2 years. When submitting CEU answers to PAHCS for grading it may take as long as TWO WEEKS to process the results. We ask you to be patient and don t wait until the last minute to get your CEU s required for your recertification. With your help, we can lessen your stress and the stress on our staff. When submitting answers for CEU s please include your name, member # and address. Also include what Quarter & year of Coding for CEU or Package # that you are submitting. Again, this will help lower the stress levels on staff. PAHCS blanket policy for CEU s and examinations DOES NOT allow us to tell you which answers you missed. As a point of information, CEU s should always be done individually and never as a group. PAHCS members can get all of their 24 CEU s required every two years directly from PAHCS for free. The following are CEU opportunities available to you from PAHCS: CEUniversity up to 2 CEU s for each test based on the accompanying article (a total of six articles and 12 CEU s are available each year and it s all on the PAHCS website). All answers must be correct to receive CEU s, so, please make sure you read the article completely. Coding for CEU s 1 CEU available for answering all questions correctly in each PAHCS newsletter. Annual PAHCS Conference CEU s. PAHCS, get the word out. Tell your peers! Page 2 PAHCS Network News Jan-Feb-Mar 2016

3 Quarterly CODING TIPS Advance Care Planning (ACP) CODING Network News Volume 15, Number 1 ISSN Coding Network News is a quarterly publication of the Professional Association of Healthcare Coding Specialists (PAHCS). The 2016 Medicare physician fee schedule will now allow payment for Advance Care Planning (ACP) using procedure codes (Advanced care planning including the explanation and discussion of advance directives such as standard forms by the physician or other qualified health care professional; first 30 minutes, face to face with the patient, family members or surrogate) and (each additional 30 minutes, listed separately in addition to code for primary procedure). These codes represent an additional source of revenue for practitioners. However, appropriate documentation (including time spent on the ACP), is required. A medical office visit is also billable with a 25 modifier when these services are rendered in addition to the ACP. There is no indication as yet whether other carriers will allow reimbursement for these codes. Certainly they should be billed to all carriers if provided, with a signed ABN and a GA modifier. Entire contents copyrighted All rights reserved; reproduction in whole or in part is prohibited. Subscriptions are provided as one of the many benefits of PAHCS membership. For information on advertising, deadlines for article submission or reprint permission, FAX the PAHCS National Office STAY IN TOUCH Local: Toll Free: Fax: Mail: 218 E. Bearss Ave., #354 Tampa, FL Web Site: pahcs@pahcs.org PAHCS offers local testing to meet your individual needs, contact our national office at for more information. Jan-Feb-Mar 2016 PAHCS Network News Page 3

4 NEW CODE HIGHLIGHTS FOR 2016 Here are the New and Deleted codes for 2016 along with some guidelines that are revised or added for For revised codes and full descriptions of the new codes make sure to check your 2016 CPT book. E/M - 2 New ( ) Integumentary 2 New ( ) Musculoskeletal 1 Deleted (21805) CPT ADDITIONS/DELETIONS SURGERY SECTION Pulmonary 3 New ( ) 1 Deleted (31620) Cardiology 3 New (33477, ) 2 Deleted (37202, ) Digestive 16 New (43210, ) 10 Deleted (47136, 47500, 47505, , 47525, 47530, , 47630) Urinary 14 New ( , 50606, , , ) 4 Deleted (50392, , 50398) Nervous System 6 New (61645, , ) 1 Deleted (64412) Ocular 1 New (65785) 1 Deleted (67112) Auditory (ENT) 1 New (69209) MEDICINE SECTION Vaccines 4 New (90620, 90621, 90625, 90697) 17 Deleted ( , 90669, , , 90708, 90712, , 90725, 90727, 90735) ENT 2 New (92537, 92358) 1 Deleted (92543) Cardiovascular 1 New (93050) Neurology 1 Deleted (95973) Dermatology 6 New (90631,32, 33, 34, 35, 36) CHECK YOUR 2016 CPT BOOK FOR DETAILS OF THESE CODES Page 4 PAHCS Network News Jan-Feb-Mar 2016

5 E/M SECTION CPT Changes include the addition of a new subsection, guidelines and 2 new codes to describe PROLONGED OFFICE OBSERVATION CARE services provided by clinical staff in conjunction with physician or other qualified health care profession E/M services and psychotherapy. Revisions on the guidelines for Preventative Medicine Services and Counseling Risk Factor Reduction and Behavior Change Intervention have been made to clarify the use of behavior change intervention codes and the use of modifier 25 SURGERY SECTION CPT Numerous changes with the expansion of the guidelines to include instructions for the use of imaging guidance. Respiratory subsection contains new guidelines, parenthetical notes for reporting bronchoscopy utilizing transendoscopic endobrbronchial ultrasound. Cardio subsection contains new guidelines for the Pacemaker or Implantable Defibrillator and includes refinements & new instructions for reporting transcatheter pulmonary valve implantation Digestive subsection has the addition of extensive guidelines and numerous parenthetical notes pertaining to transhepatic and transcholecystic biliary procedures. A new table has been added to direct users to the appropriate use of new codes in association with catheters and stent procedures. Urinary subsection include some revisions that are editorial in nature pertaining to anatomy and the assignment of primary and secondary procedures as well as numerous code changes. MEDICINE SECTION CPT Vaccine codes have been updated to include Advisory Committee on Immunization Practices (ACIP) abbreviations. Gastro subsection code has been revised to omit the provocation requirement and to specify the study as diagnostic. A detailed set of instructions has been added to instruct on the proper reporting within the Neurostimulators, Analysis-Programming subsection. A new section titled Imaging Guidance has been added to the Medicine Guidelines to provide consistency on imaging guidance throughout the CPT code set. Jan-Feb-Mar 2016 PAHCS Network News Page 5

6 E & M Coding Revisited By Marie Demastus, COCS, CMCS, CHCI Medicare Advantage Plans are required by CMS to audit providers once every two years. Perhaps your office has already fielded some of these audits. What it means to us as providers is that documentation has to be both accurate and precise. There are definite consequences for incorrect coding and documentation. A practice that was billing a large percentage of Level V visits here in central Florida found that after an audit by United Healthcare, their documentation did not support the level of service. The practice was required to refund every single Level V visit billed in the past seven years. According to CPT guidelines, the key components in selecting the level of service are History (problem focused, expanded problem focused, detailed or comprehensive), Examination (problem focused, expanded problem focused, detailed or comprehensive) and Medical decision making (straightforward, low complexity, moderate complexity or high complexity. For new patients, three out of three component levels are required. For established patients, two out of three are required, generally determined by the complexity of the medical decision making. The exception to this rule are visits that consist predominantly of counseling or coordination of care, in which time becomes a factor and must be documented. A thorough understanding of modifiers is required, and a complete listing of all modifiers with explanation is available in Appendix A of CPT. The misuse of modifier 59 now carries a penalty of $10,000 per incident. Specific documentation is necessary when using 24, 25 or 57. Technical and professional components require different modifiers. There are modifiers for each finger and toe, each eyelid, emergency services, waiver of liability, anesthesia, and many, many more. In addition to new or established patient office visits, there are categories for observation, inpatient hospital, discharge services, consultations, emergency, critical care, nursing facility, domiciliary care, care plan oversight, home visits, prolonged services, preventative services and more. Using the correct category of services can be not only the difference of being paid or not, but also the amount of reimbursement received. It is imperative to pay attention to the guidelines and information from basic coding rules to the use of new codes given in the Evaluation and Management section of CPT. For instance, observation care and initial hospital care cannot be billed on the same day. Critical care is billed in addition to the base E & M code. New codes such as 99490, chronic care management are billable. Smoking cessation and are now billable. All of these nuances can affect reimbursement and should be considered at the beginning of each New Year. Page 6 PAHCS Network News Jan-Feb-Mar 2016

7 Let Go and Delegate An Office Manager s Hardest Goal! by Marge McQuade, CMSCS, CHCI, CPOM, CMCS Medical officer managers/administrators are always trying to do more with less, and are always looking for ways to increasing efficiency. In 2016 PAHCS suggests delegating tasks. It can be difficult, but well worth the effort. With too much to do and not enough hours in the day, managers/administrators are left with three options; spend more hours at the office (no one wants that), prioritize (meaning something gets left till tomorrow...or the next day), or they can delegate. Often times delegation is one of the hardest things for an office manager to do. PAHCS suggests starting small, delegate tasks that don t require specific expertise and something that is not critical or sensitive. Delegation will not only saves your time and energy, but it also help to develop skills and confidence in your staff, helping to develop a team atmosphere and find future leaders within the practice. Before you delegate tasks you must consider the following: What skills are needed to complete the task? What s the outcome you re trying to achieve? What are your expectations to get the job done right? Will any training be involved? For example, preparing a month-end report or a month-end summary of activity for the physician might be something an administrator could train a billing manager to do. Such training would involve showing the billing manager how to retrieve and compile the data, how to use an Excel spreadsheet or how to create graphs. Another idea is to assign tasks to staff members who already have skills in a certain area, so that no training is involved Certain tasks should not be delegated. Tasks involving practice financial information, payroll, staff conflict, physician recruitment and other sensitive matters should not be delegated and handled by the Office Manager. When delegating, always define and explain the task and your expectations whether it s a patient call-back or a report to be worked. However, it s important that you don t micromanage. It is not always effective to tell people exactly what to do each step of the way. You need to trust the person you are delegating the task to and they need to have a little bit of freedom to do it their way, and you need to understand that it might be different than your way. It s also important to differentiate between delegating and dumping. People who dump simply push the task off on someone and don t make themselves available for questions. They don t share any insight or direction for completing the task. Delegating involves mentoring and coaching. Be available for staff to come back to you, and you should plan on checking on the progress of the task. For example, if you have a project that needs to be done in a week, maybe check after a couple of days to see how that person is doing and if they need any additional help. Establish a timeline and don t just give them a task and expect that they will have it done when and how you need it because it will most likely not be what you wanted and probably not in your time frame. To avoid this problem, establish a clear definition of when you want the task completed. For example, say I need this back by 3:00 tomorrow at the latest, even though you may not need it until the next day. By doing so, if something doesn t meet your standards, you still have time to fix it. By delegating tasks and empowering your staff to do some of the things that maybe they haven t been asked to do in the past because they needed some extra coaching or mentoring, you are developing a team atmosphere in your organization. Delegating will also make your life easier as you will not be buried under too many projects and it will free you to do a better job on the projects that only you can do as the office manager. Jan-Feb-Mar 2016 PAHCS Network News Page 7

8 1st quarter 2016 Answer all questions below correctly to receive 1 PAHCS CEU. answers to coder@pahcs.org. Be sure to include your name in the . Multiple Choice: Identify the letter of the choice that is the best answers the question. 1. Within each category or subcategory of E/M service, there are levels of E/M services available for reporting purposes. a. b c. d. SMARTER CODING: Two heads are better than one 5-7 unlimited 2. Coordination of care with other providers or agencies without a patient encounter on that day is reported using the codes. a. b. care management counseling a. b. c. d. referral consultation 3. The Review of Systems helps define the problem and clarify the differential diagnosis identify testing that is needed c. d. identify possible management options all of the above 4. An unlisted service or one that is unusual, variable, or new may require a demonstrating the medical appropriateness of the service. Pertinent information should include an adequate definition or description of the nature, extent, and need for the procedure and the time, effort, and equipment necessary to provide the service. a. b. modifier special report c. d. consultation operative report 5. The extent of the history is dependent upon and on the. a. consultations and referrals b. patient and relative s recollection Professional Assn of HealthCare Specialists 218 E. Bearss Ave. #354 Tampa, FL c. clinical judgment and the nature of the presenting problem(s). d. examination and medical decision making PAHCS is in business to help our Members. If you have questions about PAHCS; or ideas on how to make PAHCS better, Please, call our national office at We are open 9-5 M-F (eastern time zone)