The Drummond Group Inc. (DGI), Austin, Texas, and the Certification Commission for Health Information Technology (CCHIT), Chicago, Ill., were named Aug. 30 by the Office of the National Coordinator for Health Information Technology (ONC) as the first technology review bodies that have been authorized to test and certify electronic health record (EHR) systems for compliance with the standards and certification criteria that were issued by the U.S. Department of Health and Human Services (HHS) earlier this year.

Announcement of these ONC-Authorized Testing and Certification Bodies (ONC-ATCBs) means that EHR vendors can now begin to have their products certified as meeting criteria to support meaningful use—a key step in the national initiative to encourage adoption and effective use of EHRs by America’s health care providers.

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Core Clinical Quality Measures for Eligible Physicians (EPs)

To demonstrate meaningful use of electronic health records (EHRs) under the Final Rule, EPs must report six clinical quality measures. Of these, three are “core” quality measures, which include:

• Hypertension: Blood Pressure Measurement
• Preventive Care and Screening Measure Pair:
  • a. Tobacco Use Assessment
  • b. Tobacco Cessation Intervention
• Adult Weight Screening and Follow-up

If the provider is unable to report on one of these clinical measures because the provider sees no patients addressed by the measures, three “alternate core requirements” are available for reporting:

• Weight Assessment and Counseling for Children and Adolescents
• Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old
• Childhood Immunization Status

Menu Clinical Quality Measures for EPs

In addition to three core quality measures, to demonstrate meaningful use an EP must report on any three additional quality measures, as selected from a list of 38 possible measures.

Breast Cancer Screening Description: Percentage of women 40-69 years of age who had a mammogram to screen for breast cancer

Smoking and Tobacco Use Cessation, Medical Assistance:

• Advising smokers and tobacco users to quit
• Discussing smoking and tobacco use cessation medications
• Discussing smoking and tobacco use cessation strategies description

Percentage of patients 18 years of age and older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies Read more »

A recent article co-written by top government officials and published in the Annals of Internal Medicine touts the virtues of recent health reform legislation. Robert Kocher, M.D., National Economic Council, special assistant to the president for health care, Ezekiel J. Emanuel, M.D., special advisor on health policy, Office of Management and Budget, and White House Director of Health Reform Nancy-Ann M. DeParle, J.D., admit in the article, “The Affordable Care Act and the Future of Clinical Medicine: The Opportunities and Challenges,” that reform will weed out the inept, but those who are up to the challenge will reap the rewards of a superior health care system.

“To realize the full benefits of the Affordable Care Act, physicians will need to embrace rather than resist change,” the authors write.

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DCS Healthcare, recovery audit contractor (RAC) for Region A, posted 11 newly approved audit issues on its website mid-August. Unlike its counterpart, CGI Federal, none of the new issues include medical necessity review. Nine of the new issues are for medical severity-diagnosis related groups (MS-DRGs), another also affects inpatient claims and another affects durable medical equipment (DME) suppliers.

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The Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics (NCHS) posted updates Aug. 5 to the ICD-9-CM Official Guidelines for Coding and Reporting. These guidelines for diagnosis coding are effective Oct. 1.

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Under the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) is expanding Medicare coverage of evidence-based tobacco cessation counseling. Effective Jan. 1, 2011, any smoker covered by Medicare can receive tobacco cessation counseling from a qualified physician or other Medicare-recognized practitioner.

Current Medicare policy covers tobacco counseling only for individuals diagnosed with a recognized tobacco-related disease or for those who show signs or symptoms of such a disease.

“Today’s decision builds on the existing preventive services that are available to Medicare beneficiaries,” said CMS Administrator Don Berwick, M.D. “Giving older Americans and persons with disabilities who rely on Medicare the coverage they need for counseling treatments that can aid them in quitting will have a positive impact on their health and quality of life. As a result, all Medicare beneficiaries now have more help to avoid the painful—and often deadly—consequences of tobacco use.”

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Core Objectives and Measures

All core objectives must be met, unless an exception applies. Several objectives do not allow exceptions.

Core Objective: Use computerized physician order entry (CPOE) for medication orders directly entered by any licensed health care professional who can enter orders into the medical record per state, local and professional guidelines.

Measure: More than 30 percent of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (place of service 21 Inpatient hospital or 23 Emergency room – hospital) have at least one medication order entered using CPOE.

Core Objective: Implement drug/drug and drug/allergy interaction checks.

Measure: The EP/eligible hospital/CAH has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period.

Core Objective: Maintain an up-to-date problem list of current and active diagnoses.

Measure: More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry, or an indication that no problems are known for the patient recorded as structured data. Read more »

The American College of Obstetricians and Gynecologists (ACOG) issued a new recommendation Aug. 23 that advises girls ages 11 to 12—generally before they become sexually active—to receive the human papilloma virus (HPV) vaccination. In some cases, ACOG says, it may be appropriate to vaccinate girls even younger.

“The ideal time for girls to receive the HPV vaccination is before they become sexually active and become exposed to HPV,” said Diane F. Merritt, MD, chair of ACOG’s Committee on Adolescent Health Care. “For this reason, we recommend that girls get vaccinated by age 11 or 12 and possibly as early as age 9, depending on risk factors. For those already sexually active, we also recommend the HPV vaccination for adolescents and young women up to age 26.”

HPV is a sexually transmitted viral infection which has been associated with cervical cancer. Approximately 70 percent of cervical cancers are caused by just two out of 100 identified HPV strains: HPV 16 and 18. About 90 percent of genital warts, another consequence of HPV infection, are associated with two other strains known as HPV 6 and 11.

There are currently two HPV vaccines approved by the U.S. Food and Drug Administration (FDA): Cervarix® and Gardasil®. The Cervarix® vaccine protects against the cancer-causing HPV strains 16 and 18. The Gardasil® vaccine protects against HPV 16 and 18, as well as HPV 6 and 11.

For this service, you would generally report CPT® code 90649 Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use or 90650 Human Papilloma virus (HPV) vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use for the vaccine and 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid) or 90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) for the administration.

ACOG continues to advise against HPV testing for adolescents or young women before vaccination, ruling it pointless and unreliable.

Committee Opinion #467, “Human Papillomavirus Vaccination,” is published in the September 2010 issue of Obstetrics & Gynecology.

Palmetto GBA recently amended its Cataract Surgery Local Coverage Determinations (LCDs) to reflect a focus on the adult patient and a more complete description of functional status.

In response to comments the J1 Part A/B Medicare administrative contractor (MAC) received, the title of the final policy was amended to appropriately reflect the adult patient population. Palmetto GBA also removed the specific Snellen visual acuity threshold from the final LCD. The reporting requirement of the “best corrected” Snellen visual acuity remains, however. As does the expectation that the medical records supporting the cataract extraction identify the activity limitations (e.g., in self-care and mobility) and participation restrictions (e.g., in interpersonal interactions and relationships and community, social and civic life) are also reported.

These terms may be new to physicians, hospitals, and ambulatory surgical centers (ASCs) providing cataract surgery but are reflective of long-standing concepts included in such well-established instruments like the National Eye Institute’s Visual Functioning Questionnaire – 25 (VFQ – 25).

To provide guidance to physicians, hospitals, and ASCs on how best to communicate functional status for patients requiring cataract extraction, Palmetto GBA has incorporated the concepts of the International Classification of Functioning, Disability and Health (ICF) taxonomy into the final version of the LCD.

Below is a case scenario demonstrating the value of going beyond diagnosis by using the concepts of the ICF. Please note that while Palmetto GBA is encouraging physicians and hospitals providing cataract surgery to consider the conceptual framework of the ICF, Medicare does not require the reporting of the ICF codes. Read more »

Palmetto GBA, Medicare administrative contractor (MAC) for jurisdiction 1 (J1), recently reported that the Comprehensive Error Rate Testing (CERT) contractor reported an increase in errors for complete blood counts (CBC) and urinalysis (UA) laboratory services.

According to the CERT report, data indicate two types of common errors:

• Code selection errors
• Standard protocol use in place of patient-specific physician orders

Sample Errors

In an Aug. 18 online article, Palmetto GBA gives the following two examples of common errors:

Example 1: A physician orders a CBC with automated differential WBC count (CPT® 85025 Blood count complete (CBC), automated (Hgb, Hct, RC, WBC and platelet count) and automated differential WBC count) or without automated differential WBC count (85027 Blood count complete (CBC), automated (Hgb, Hct, RC, WBC and platelet count)). Based on internal criteria, the lab examines a blood smear for additional verification. The lab may not report CPT® 85008 Blood count; blood smear microscopic examination without manual differential WBC count for the exam of a blood smear to complete the ordered automated hemogram test (CPT® 85025 or 85027) because National Correct Coding Initiative (NCCI) guidelines indicate it is a bundled service.

Example 2: A physician orders an automated hemogram (CPT® 85027) and a manual differential WBC count (CPT® 85007 Blood count; blood smear microscopic examination with manual differential WBC count). Both codes may be reported; however, an automated hemogram with automated differential WBC count (85025) may not be reported with a manual differential WBC count (CPT® 85007) because this results in duplicate payment for the differential WBC count.

Code Selection

Only lab services ordered by the physician should be provided and billed. A physician’s written order must match the performed service, Palmetto GBA advises.

• Submit CPT® Codes 85014 Blood count; hematocrit (Hct) and 85018 Blood count; hemoglobin (Hgb) to report a hemoglobin and hematocrit level.
• Submit CPT® Code 85027 to report a CBC to measure hemoglobin, hematocrit, red blood cell, white blood cell, and platelet levels.
• Submit CPT® Code 85025 to report a CBC and differential white blood cell (WBC) count to measure the percentages of white blood cell types.

Remember: The medical record must document the medical indication for the ordered services, the specific order written by the physician and the test results of the ordered diagnostic tests.

Improper Protocols

Providers may not perform additional laboratory services based on internal standard or implied protocols, accord to the MAC. Medicare only covers patient-specific orders written by a physician. The following sample protocols are not covered Medicare services and may be subject to a recovery audit contractor (RAC) for corrective action.

• Physician’s written order for a hemoglobin and hematocrit prompts the lab to perform a CBC
• Physician’s written order for a CBC prompts the lab to perform a CBC with differential
• White cells or bacteria discovered in a physician ordered urine test prompts the lab to perform a urine culture without a physicians order

Reference: Chapter 10, NCCI Policy Manual, Volume 15.3

Source: Palmetto GBA