Archive for September 2011
The American Medical Association (AMA) has released new and revised CPT® Category II codes, effective Jan. 1, 2012. The changes were posted on the CPT® Category II Codes section of the AMA website on Sept. 14.
Category II codes are supplemental tracking codes used for performance measurement (e.g., the Physician Quality Reporting System). They are intended to facilitate data collection about the quality of care rendered by coding certain services and test results that support nationally established performance measures and that have an evidence base as contributing to quality patient care.
The use of Category II codes is optional. The codes are not required for correct coding and should not be used in place of Category I codes. They describe clinical components that may: typically be included in evaluation and management (E/M) or clinical services; result from clinical laboratory or radiology tests and other procedures; identify processes intended to address patient safety practices or services reflecting compliance with state or federal law.
For 2012, four Category II codes are deleted and replaced by newer codes:
- 4002F Statin therapy, prescribed (CAD) is deleted and replaced by 4013F Statin therapy prescribed or currently being taken (CAD).
- 4006F Beta Blocker therapy prescribed (CAD, HF) is replaced by 4008F Beta-Blocker therapy prescribed or currently being taken (CAD, HF).
- 4009F Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy prescribed (HF, CAD, CKD), (DM) is replaced by 4010F Angiotensin converting enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) therapy prescribed or currently being taken (CAD, HF).
- 4275F Hepatitis B vaccine injection administered or previously received (HIV) is replaced by 4149F Hepatitis B vaccine injection administered or previously received (HEP C, HIV) (IBD).
Several dozen new codes have been added in clinical areas such as angina, tobacco use, Neuropsychiatric symptoms, and more.
For a full list of revisions to Category II codes (as well as a sneak peak at some 2013 codes), see “Update to list of Category II Codes” dated September 14, 2011.
September 29th, 2011
As part of a plan to reduce the federal budget by more than $3 trillion over 10 years, President Obama has proposed $320 billion in cuts to Medicare and Medicaid. Most of the savings ($248 billion) would come by slowing the projected growth of Medicare in the coming decade, according to the White House. The remaining $72 billion would be shaved from Medicaid and other health programs.
The Centers for Disease Control and Prevention (CDC) recently announced new draft guidelines for reducing transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) through solid organ transplantation. The guidelines are meant for organ procurement organizations (OPOs); transplant centers; laboratory personnel responsible for testing and storing donor and recipient specimens; and anyone responsible for developing, implementing, and evaluating infection prevention and control programs for OPOs and transplant centers.
The 2011 Draft Guidelines, which were three years in the making, are an update of the “Guidelines for Preventing Transmission of Human Immunodeficiency Virus (HIV) through Transplantation of Human Tissue and Organs,” released in 1994. Previous recommendations for HIV have been revised, and recommendations to reduce disease transmission of HBV and HCV have been added. Like the previous guidelines, the 2011 draft addresses adult and pediatric donors who are living or deceased, as well as transplant candidates and recipients.
The new guidelines additionally include:
- A seven-step donor risk assessment process
- A nine-step donor screening process
- Required recipient informed consent and testing
- Recommendations for donor and recipient specimen collection and storage
- Guidelines for HBV and HCV-infected donors and transplantation
- A 12-step process for tracking and reporting of HIV, HBV, and HCV
The draft guidelines also offer 14 points for further research, including “Estimate the incidence and prevalence of HIV, HBV and HCV among deceased potential organ donors in the United States” and “Assess interventions (e.g., pathogen reduction methods) to reduce or eliminate the viral burden of HIV, HBV, and HCV in donors or donor organs before or after recovery, but prior to transplantation.”
CDC is accepting public comments on the draft guidelines, and encourages participation from anyone involved in transplantation. The deadline for comments is Nov. 21, 2011.
WellPoint has hired Watson, IBM’s game show-dominating technology, to assist the health insurer in two pilot programs: one for clinical purposes and another for care management.
Eyeing the room-sized computer as a way to keep costs down and improve patient care, WellPoint is impressed by the system’s ability to process human language and research the equivalent of a million books. WellPoint believes the computer has the ability to analyze key data points and suggest the most diagnosis and treatment options for complex cases in three seconds or less, but the payer assures the machine won’t usurp physicians’ decisions.
“Doctors make decisions for patients,” said Sam Nussbaum, MD, Well Point’s chief medical officer. Amednews.com says, however, physician use of clinical decision support tools has risen significantly in recent months, mostly due to requirements under the meaningful use incentive program requiring decision support to be part of electronic health record (EHR) systems eligible for federal money.
A California health care foundation found 72 percent of physician practices in California have implemented decision support tools, including 58 percent of solo practices.
The 2011-2012 seasonal influenza vaccine payment limits are now available on the Centers for Medicare & Medicaid Services (CMS) website.
The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95 percent of the Average Wholesale Price (AWP), except where the vaccine is furnished in a hospital outpatient department. Payment for the vaccine furnished in the hospital outpatient department is based on reasonable cost.
Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations.
Payment allowances effective for dates of service between Sept. 1, 2011 and Aug. 31, 2012 are:
- 90654: $18.383
- 90655: $15.705
- 90656: $12.375
- 90657: $6.653
- 90660: $22.316
- 90662: $30.923
- Q2035 (Afluria): $11.543
- Q2036 (Flulaval): $8.784
- Q2037 (Fluvirin): $13.652
- Q2038 (Fluzone): $13.306
- Q2039 (N.O.S.): locally priced
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