Posts Tagged stage 2

CMS Rule Defines Stage 2 Meaningful Use

If you want to be compliant with Stage 2 meaningful use requirements, you can read the 672 page final rule released by U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), and the Office of the National Coordinator for Health Information Technology (ONC). Hospitals and other providers must satisfy these requirements to receive funding under the second phase of the federal electronic health record (EHR) incentive program. (more…)

September 12th, 2012

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National Provider Call: Stage 2 Requirements for Meaningful EHR Use

On Aug. 23, the Centers for Medicare & Medicaid Services (CMS) published a final rule for Stage 2 requirements and other changes to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Stage 2 requirements are intended to increase health information exchange between providers and heighten patient engagement by giving patients secure online access to their personal health information (PHI). To ensure eligible professionals and hospitals understand these new requirements, CMS is hosting a national provider call on Thursday, Sept. 13, 2-3:30 ET.

On the agenda:

  • Extension of Stage 1
  • Changes to Stage 1 criteria for meaningful use
  • Proposed Medicaid policies
  • Stage 2 meaningful use overview
  • Stage 2 clinical quality measures
  • Medicare payment adjustment and exceptions
  • Q&A

Register for the call on the CMS Upcoming National Provider Calls registration website. Registration will close at 12 pm the day of the call, or when available space has been filled, whichever comes first.

AAPC members can earn one continuing education unit (CEU) for participation. AAPC will accept your emailed confirmation and call description as proof of participation. Please retain a copy of your emailed confirmation for these calls as AAPC will request them for any conference call you entered into your CEU Tracker if you are chosen for CEU verification.

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Companion Guide for 835 Available

Sometimes all you need to make something work is an actual manual where all the parts are explained. Practices implementing version 5010 have access to such a manual from the Centers for Medicare & Medicaid Services (CMS).

“Instructions related to the 835 Health Care Claim Payment/Advice based on ASC X12 Technical Report Type 3 (TR3), version 005010A1″ won’t make your book club sit up and take notice, but it includes explanations of all the fields, their codes, and functions to make complying with the new electronic transaction standards easier. The 10-page manual is free and downloadable.

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Decipher Post Mastectomy Breast Reconstruction Techniques

By Govind Acharya, MD, FACS

Reconstructive plastic surgeons offer several procedures for breast reconstruction. Many women opt for immediate breast reconstruction at the time of mastectomy. Here, we will discuss immediate breast reconstruction using expander-implant and dermal allograft.

Breast Reconstruction Progresses in Three Stages

Stage 1

A patient is scheduled for mastectomy by her oncologic surgeon. As part of reconstruction, the surgeon marks the patient’s midline, inframammary fold, lateral mammary fold, and planned skin excision. Following mastectomy, the pectoralis major muscle is elevated from the chest wall using electrocautery. Care must be taken not to disturb surrounding muscles, such as the pectoralis minor, serratus, and rectus abdominis muscles; although, part of the inferomedial pectoral muscle may be released for better placement of the expander-implant.

A dermal allograft-alloderm is reconstituted, prepared, and placed. The graft is fashioned into an extension of the pectoral muscle pocket. A sterile tissue expander is prepared and placed under the muscle/alloderm pocket and filled with sterile normal saline. Drains are placed and skin flaps are meticulously closed.

Most patients are discharged on the same day, or the day after, surgery. Serial expansion begins in the office after the surgical incision has healed (usually, two to three weeks), and normally continues for four to six weeks.

This portion of the reconstruction is reported with CPT® 19357 Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion and 15777 Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (eg, breast, trunk) (List separately in addition to code for primary procedure). If these procedures occur bilaterally, append modifier 50 Bilateral procedure.

Stage 2

When expansion is complete, the patient is scheduled for removal of the expander and placement of a silicone gel implant. A separate inframammary incision is done to remove the expander, and minor modifications of the pocket may be necessary to exchange the expander and gel implant.

This stage of the procedure is reported with CPT® 11970 Replacement of tissue expander with permanent prosthesis.

Stage 3

This stage includes nipple reconstruction/creation of the nipple bud with flaps (19350 Nipple/areola reconstruction) and areola tattooing (11920-11922), depending on the area tattooed:

  • 11920 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less
  • 11921 6.1 to 20.0 sq cm
  • 11922 each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure)

“Balancing” Procedures

To achieve symmetry with the reconstructed breast, the surgeon may perform “balancing” procedures to the opposite breast. These can include breast reduction (19318 Reduction mammaplasty), mastopexy (19316 Mastopexy) with implant (19340 Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction or 19342 Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction, depending on when the insertion occurs).

Complications

Breast reconstruction using tissue expanders or implants is one of the most commonly used procedures. Complications such as implant rippling, malpositioning of implant, and capsule contracture may occur. Complications are usually handled as secondary procedures. The most common procedure codes are 19380 Revision of reconstructed breast and 19371 Periprosthetic capsulectomy, breast.

What the Future May Hold

There have been recent reports of one-stage breast reconstruction without the use of expanders. Acellular dermis has been used in thousands of surgical patients. In breast reconstruction, it acts as a scaffold for cellular ingrowth and revascularization. There is minimal fibrosis or contracture, and the acellular dermis allows rapid expansion, less pain during expansion, fullness to the lower pole of the breast, and reduced need for reoperation procedures. It has also been shown to withstand radiation therapy quite well with minimal side effects to implant reconstruction. The advent of skin and nipple sparing mastectomy, along with the use of dermal allografts, has made direct implant immediate breast reconstruction feasible.

Govind Acharya, MD, FACS, is board certified in plastic surgery and a member of the American Society of Plastic Surgeons, American Society of Aesthetic Plastic Surgery, a Fellow of American College of Surgeons, and a member of the clinical teaching faculty at the Mayo Clinic, Ariz. He has more than 30 years in practice, and works in private practice in Phoenix, Ariz.

September 1st, 2012

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Stage 2 Meaningful Use Finalized

The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT released final requirements for stage 2 that hospitals and health care providers must meet to qualify for incentives during the second stage of the program, and criteria that electronic health records must meet to achieve certification.

The final rule:

  • Makes clear that stage two of the program will begin as early as 2014. No providers will be required to follow the Stage 2 requirements outlined today before 2014.
  • Outlines the certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they use will work, help them meaningfully use health information technology, and qualify for incentive payments.
  • Modifies the certification program to cut red tape and make the certification process more efficient.
  • Allows current “2011 Edition Certified EHR Technology” to be used until 2014.

The CMS final rule also provides a flexible reporting period for 2014 to give providers sufficient time to adopt or upgrade to the latest EHR technology certified for 2014.

A fact sheet on CMS’ final rule is available at http://www.cms.gov/apps/media/fact_sheets.asp.

A detailed fact sheet on ONC’s standards and certification criteria final rule is available at http://healthit.hhs.gov/standardsandcertification.

The final rules announced today may be viewed at http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1. More information on the Stage 2 rule can be found at the CMS EHR Incentive Programs website at www.cms.gov/EHRIncentivePrograms.

August 23rd, 2012

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