You can’t take anymore Medicare Advantage (MA) patients but they keep coming. Or you learn that MA patients are calling the wrong number or going to the wrong address. What’s wrong? It’s probably their Medicare Advantage Organization’s (MAO) contribution to the MA online provider directory. CMS Finds MAOs Have Bad Info After hearing beneficiary complaints, […]
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Tag Archives: Info
Medical Assistant Careers and Wage Info
When choosing a degree in today’s market, the state of the economy and employment chances is something you want to keep in mind. Some industries are experiencing hard times are experiencing layoffs and shutting down, others are searching for qualified candidates. Doing your research before selecting a degree program, will give you a head up in this tough economy.
Qualified medical assistants is a growing field with a rapidly growing need for services. Baby boomers coming of retirement age and medical advances have spurred the growth of the medical field and employment opportunities. The employment rate is estimated to grow much quicker than average, ranking medical assistants as one of the fastest growing occupations between 2006 and 2016. There are many accredited programs around the country for prospective students, whether through a online college or through a traditional college.
Patients speak most often to medical assistants, they also speak regularly to medical billing, insurance reps and doctors and nurses. A medical assistant will play a primary role in assisting administrators and nurses. A medical assistant will perform both clerical and clinical tasks to enable the smooth functioning of offices. Not only physician’s offices employ medical assistants but also podiatrists, clinics, hospitals and podiatrists. Some of their duties include, measuring vital signs, performing lab tests, scheduling appointments, greeting patients, stocking and ordering supplies, answering phones, drawing blood or explaining treatment procedures to patients and their families. The duties vary from office to office, depending on the location and size of the practice. .
The Medical Assistant profession is highly versatile. Some of the courses a medical assistant will study are physiology, medical terminology, anatomy, medical billing, and pharmacology. Medical assisting programs are typically one to two year courses. An internship may be need to be completed for students in accredited programs so that they gain the hands on experience that is needed.
Medical assistant salaries
Medical Assistants can earn about $ 38,000 per year. Medical Assistant earnings have grown over the past several years and that trend is expected to continue.
Feng is the owner of Acupuncturist Portal, a free resource for anyone interested in the ancient Chinese alternative medicine practice: Acupuncture. Acupuncturist Portal also contains a US national directory of qualified acupuncturists for people who are ready to give acupuncture a try.
Info on Medical Illustration
Medical illustration is just one of the several classifications of illustrations that are designed to provide superior accuracy and clarity to any piece of medical writing. Performed and excelled by professional medical illustrators, this distinctive applied art is used as a technique that offers better communication of any medical teachings that appear in the form of textual material. Medical drawings accompany any piece of biological or medical information in the form of visual representation that focus directly on the subject rather than having its own means of existence. They are therefore used to support the learners by providing them with the clear picture of the subject or the textual information that comes in a medical book or magazine. When complemented with medical illustrations, you will have better understanding of the topic.
Unlike the art of imaginative drawings and paintings, medical illustration is a field that requires strict accuracy and quality as you are aiming to provide the true picture to the learners about the most complex biological forms of life. From simple drawings of human genome or anatomy of human body to the most complicated surgical techniques, you cannot be careless or inaccurate in your work. But, however, with the help of so many tools and modern techniques for expanding and enhancing your illustrations, you can provide better quality and accuracy to the illustrations as compared to the traditional ways of hand drawing. There are so many places where medical illustrations are used in addition to journals and textbooks including the web, advertising, for patient education, trade shows, interactive learning, continuing medical education, museums, television, dental, veterinary as well as legal fields. Along with medical professors and authors, these illustrations are also utilized by the attorneys to provide clear medical information to the jury.
If you are interested in learning the techniques, then there is good career platform that is waiting for you. You can work to complete medical illustration projects for a company or work as a freelancer as this is a profession that is being highly boosted by the medical industry today. You can devote your time to medical legal illustration if you wish to.
Outsource Portrait illustration work to Maa Illustrations, the professional team of certified illustrators offering services on Realistic illustration, Poster Color etc
MIPS: Not Too Late to Submit ACI Info
If you’ve been putting off submitting measures of the Advancing Care Information performance category of the Merit-based Incentive Payment System (MIPS), you still have until June 30. The Centers for Medicare & Medicaid Services (CMS) is encouraging providers to identify and submit measures for the Advancing Care Information Performance Category. Proposals must include specific criteria including […]
AAPC Knowledge Center
CMMI Needs More Info to Develop Pediatric APM
Section 3021 of the Affordable Care Act gives the Center for Medicare and Medicaid Innovation (CMMI) the authority to test alternate payment models (APMs). The goals of these APMs are to reduce program expenditures while preserving or enhancing the quality of care for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiarie
AAPC Knowledge Center
Zika Virus – A Q&A Primer – Info on Zika is changing quickly – here’s what I know as of today (03/02/2016)
This is the most current article that I wrote for Justcoding.com. It is also free to access on their website. However, I suggest becoming a full-subscription member, as they have a huge amount of resources and information available. 
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Zika Virus – A Q&A Primer
by Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP
What is Zika?
According to the Center for Disease Control (CDC) this is the officialdefinition:
The Zika virus is a mosquito-transmitted infection related to dengue, yellow fever and West Nile virus. It was discovered in the Zika forest in Uganda in 1947 and is common in Africa and Asia. It did not begin spreading widely in the Western Hemisphere until last May, when an outbreak occurred in Brazil.
A bit of clinical background
This is information direct from the American Congress of Obstetricians and Gynecologists (ACOG) and the Society of Maternal and Fetal Medicine (SMFM)
The virus spreads to humans primarily through infected Aedes aegyti mosquitoes. Once a person is infected, the incubation period for the virus is approximately 3-12 days. Symptoms of the disease are non-specific but may include fever, rash, arthralgias, and conjunctivitis. It appears that only about 1 in 5 infected individuals will exhibit these symptoms and most of these will have mild symptoms. It is not known if pregnant women are at greater risk of infection than non-pregnant individuals.
Zika during pregnancy has been associated with birth defects, specifically significant microcephaly. Transmission of Zika to the fetus has been documented in all trimesters; Zika virus RNA has been detected in fetal tissue from early missed abortions, amniotic fluid, term neonates and the placenta. However, much is not yet known about Zika virus in pregnancy. Uncertainties include the incidence of Zika virus infection among pregnant women in areas of Zika virus transmission, the rate of vertical transmission and the rate with which infected fetuses manifest complications such as microcephaly or demise. The absence of this important information makes management and decision making in the setting of potential Zika virus exposure (i.e. travel to endemic areas) or maternal infection, difficult. Currently, there is no vaccine or treatment for this infection.
The ACOG and SMFM put forth guidelines for testing of pregnant women, and the laboratory tests are being done exclusively though the guidance of the CDC at the level of the local and state health departments. Many states in the US are developing guidelines to help in identifying who has been exposed, and where an outbreak may take place.
Currently the testing being done is a “Zika” serology IgM testing assay. The reports have been being reported out as “likely positive”, “Inconclusive” and “likely negative” . Unfortunately, the labs do not know and gannot guarantee the sensitivity of the IgM assay.
Symptoms of Zika
Below is a listing of all the known symptoms of Zika virus as put forth by the CDC, however, there may be more that are noted as the Zika Virus becomes more studied in all individuals. Zika is still a virus, and not a bacterial infection, and currently there is not vaccine to prevent it, or a specific medication or antibiotic to treat it with.
• About 1 in 5 people infected with Zika virus become ill (i.e., develop Zika).
• The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week.
• The illness is usually mild with symptoms lasting for several days to a week.
• People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika.
• Zika virus usually remains in the blood of an infected person for about a week but it can be found longer in some people.
Risks of Zika in Pregnant Women and in their sexual partners
Normally Zika virus is transmitted through a mosquito bite, however, the Zika virus can be transmitted from a pregnant mother to her unborn fetus during the time of pregnancy and possibly around the time of birth. It has been noted that Zika virus has been noted in all trimesters of pregnant women, and may possibly be transmitted during the birth process. Sexual transmission of the Zika virus can also occur, however there is limited data, but the CDC has stated that if the patient fears they are infected with the Zika virus to reduce the risk of sexual transmission via abstinence and/or usage of condoms.
Women are not the only ones at risk of contracting Zika virus. Men who have traveled to an area of active Zika virus, or who live in these areas may become infected with the Zika virus too. The CDC has not completely determined if the Zika virus can be transmitted sexually, so the recommendation for men is if you are symptomatic or have a confirmed case of Zika virus, condoms or abstinence is still a best practice. However, it remains uncertain if the mirus persisits in semen even if no longer detectible in the blood.
Fetal Evaluation for possible exposure to Zika
Ultrasound exami is the primary recommendation for pregnant mothers who have been exposed to zika virus. The Ultrasound examinations should focus on development of the fetal brain with intracranial calcifications and microcephaly. Micocephay has been the most frequently reported adverse fetal complication in women who have had the virus while pregnant
SMFM is recommending not only blood tests for pregnant women who have been exposed, but also consider performing serial ultrasound, as frequently as every 3-4 weeks. By obtaining the additional ultrasounds, this would be considered ongoing surveillance. Considering the history of Zika virus and complications to the fetus due to this infection is not known. In addition, the time from exposure and infection from Zika to exhibiting full-blown clinical manifestations is unknown.
The CDC, ACOG and SMFM have put out a number of clinical flow algorhythms for usage with patients’ that have been exposed or live in an area where Zika as been prevalent. However, this is so new, that these recommendations may change very quickly.
Case Study and Coding Consideration
Case #1:
An asymptomatic pregnant woman at 19 weeks gestation, presents to her OB office for her regularly scheduled OB prenatal visit. She informs the receptionist of the possibility she has been exposed to Zika. She has a history of travel to Mexico between 16+0 and 16+5-weeks. She has noted mosquito bites over both legs (calf area). The bites do not appear infected, and look as if they are resolving. Patient states they no longer itch, and does not report any other complaints but her ongoing pregnancy related fatigue. The physician performs a comprehensive history, a comprehensive exam, and will have labs drawn for Zika to be sent to the local district health office. In addition, the physician decides to perform a baseline screening ultrasound exam to follow up from the patient’s first trimester ultrasound anatomy exam from 1 month ago.
Coding Consideration:
CPT:
99214-25 E&M –
76816 Ultrasound
36415 Venipuncture/Lab Draw
ICD-10:
O26.812 Pregnancy related exhaustion and fatigue (2ndtrimester)
Z20.828 Contact with and (suspected) exposure to other viral communicable diseases (Zika Virus)
S80.861A Insect bite of rt lower leg initial encounter
S80.862A Insect bite of lt lower leg initial encounter
Z3A.19 19 weeks gestation of pregnancy
Rationale: The E&M visit would be coded, as it is separately identifiable “outside” the normal pregnancy antenatal care. (A Zika virus exposure is not considered “normal obstetric care”) the follow-up ultrasound/baseline ultrasound is coded for comparison to the previously performed 1st trimester ultrasound. The venipuncture is the only thing chargeable, as the blood was drawn, and sent out to the health district for testing. The sequencing of the pregnancy diagnosis is primary based upon the ICD-10 pregnancy guidelines.
ACOG’s Quick Zika Q&A
Q1. True or False. Pregnant women are at greater risk of infection with the Zika virus than nonpregnant women.
A: False – According to a practice advisory from ACOG and SMFM, “It is not known if pregnant women are at greater risk of infection than non-pregnant individuals.”
Q2. Once a person is infected with the Zika virus, what is the approximate incubation period for the virus?
A:. 3 to 12 days – Following infection with the Zika virus, the incubation period is approximately 3 to 12 days
Q3. The Zika virus spreads to humans primarily through infected Aedes aegypti mosquitoes. Which of the following symptoms may be associated with the virus?
Fever
Rash
Arthralgia
Conjunctivitis
All of the above
A. Although symptoms associated with the Zika virus are non-specific, they may include fever, rash, arthralgia, and conjunctivitis. (eg all of the above)
Q4. In which trimester(s) has transmission of Zika been documented?
A. All trimesters — The transmission of the Zika virus has been documented in all trimesters
Wrap up
At this time, there are still a number of unanswered questions in regard to the Zika virus. However, there is no vaccine currently available, so it is recommended that precaution be taken to avoid exposure to mosquito bites from areas where the Zika virus is prevalent. In the United States and worldwide expert epidemiologists are helping to set forth useful clinical guidelines for identifying and managing patients who have been exposed and currently have the Zika virus. At this time, clinical guidelines are calling for blood tests to be run, and screening ultrasound should be performed on pregnant patients to screen for possible fetal anomalies related to fetal brain development in infected female patients.
When coding, carefully review to see if the physician or provider is stating whether the patient truly has the Zika virus as a diagnosis, or if they are only “screening” for the Zika virus in light of an exposure to the virus. (either through mosquito bite, or sexual transmission).
In addition, currently, ICD-10 does not have a specific code to identify Zika virus. Usage of code B33.8 Other specified viral diseases, would be appropriate. However, If the patient is diagnosed with the Zika virus and has fever with it, then it may be appropriate to use code A92.8 – Other specified mosquito-borne viral fevers. If the patient is pregnant, then usage of ICD-10 code 098.5X “other viral diseases complicating pregnancy, childbirth and the puerperium,” (be sure to use the most specific trimester as the additional character) would be the most appropriate.
If in doubt about the clinical documentation, be sure to query the provider to obtain clarity on the diagnosis noted in the medical record.
References:
www.acog.org/
www.cdc.gov/zika
Editor’s note: Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC and ICD10 cm/pcs Ambassador/trainer is an E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA Privacy specialist, with over 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology, Urology, and general surgical coding. She can be reached via e-mail at [email protected] or you can also find current coding information on her blog site: http://lori-lynnescodingcoachblog.blogspot.com/.
Labs required per drug prescribing info
Good afternoon. I have a question regarding diagnosis for certain tests that are required for patient’s receiving certain drugs. For example, Opdivo requires thyroid testing. In review of the covered codes for TSH testing, there is no code that would cover testing in this case. Another example would be administering B-12 injections for Alimta. Previously there was an ICD-9 code (V07.39) that stated need for prophylactic chemotherapy. This now transfers to either Z41.8 which is an encounter code or Z79.899 for long term/current drug therapy. In my Opdivo example, the patient has not yet received any chemotherapy, so the Z79.899 would not be valid and Z41.8 is not covered.
Also, I have had problems with commercial carriers when using the Z41.8! Any insight would be fabulous!
Thanks in advance
Rachel Brunswick, CPC, CHONC