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Effective April 1, 2022, hospitals will have nine new procedure codes to describe the introduction or infusion of therapeutics, including the additional COVID-19 vaccines recently authorized for emergency use by the Food and Drug Administration. April Update The Centers for Medicare & Medicaid Services first introduced seven new ICD-10-PCS codes for second quarter 2022. The […]
The post 9 New Introduction Codes Added to ICD-10-PCS appeared first on AAPC Knowledge Center.
I have a provider wanting to use 36000 when we cannot bill for actual hydration or an infusion. I’m thinking this would also be when we are sending patients our via ambulance. Medicare and Tricare will not cover this code, but some commercial payers will. My other concern is that KVO is not separately reportable, and maybe this scenario falls under that category.
Also, 96365 states "up to 1 hour" but doesn’t specify a minimum like the other codes do. Is it ok to bill this code for less than 30 minutes when we are infusing an antibiotic?
Any help would be appreciated!!
Medical answering services provide the ideal solution for the medical practitioners who get huge influx of calls from their patients. It is not possible for doctors to attend every call especially during the working hours and therefore several medical practitioners outsource this requirement to companies engaged in providing call-handling services to doctors.
The main function of answering services is to answer the generic queries of patients and to schedule their appointments with the doctor. Thus, the doctor and his staff are freed from the hassle of doing day to day routine jobs. If there are some issues that the doctor should personally look into, the same is communicated to the doctor so that he can do the needful.
The main benefit of medical answering services is that they help the doctors perform effectively. Also, the patients feel good, as they do not have to wait for long to get appointments and answers to their queries. The patients can also communicate through emails as the service provider also answers the e-mails of the patients. If there is something critical then the executive will forward the mail to the doctor or the concerned staff. Another benefit is that the company providing such services takes responsibility for maintaining all database regarding the incoming calls and e-mails. Also, these companies take utmost care in taking regular backup of the data so that the data remains secure even if the server breaks down.
These services are better than the automated answering machines as in case of automated machines patients get sometimes frustrated when they have to dial several digits to reach the doctor’s assistant or to schedule the appointments or to get an answer to a simple query.
Some companies providing these services have fixed working hours while others operate 24 X 7. The medical practitioner can choose the type of services he wants depending upon the volume of calls he receives and the type of his medical practice.
In short, the virtual answering service helps medical practitioners to stay connected to their patients while they are away for work, study, a conference, or enjoying a short vacation. Visit medical answering services for more information.
Postoperative respiratory failure’s introduction into the CMS value-based reimbursement model
By Robert Stein, MD, CCDS, and Shannon Newell, RHIA, CCS, AHIMA-approved ICD-10-CM/PCS trainer
The accurate capture of acute respiratory failure has been a long-standing challenge for CDI programs. The accurate reporting of this condition as a post-procedural event can be even more difficult.
The importance of data quality for post-procedural acute respiratory failure will impact quality outcomes linked to reimbursement under the Hospital-Acquired Condition Reduction Program (HACRP), as well as the Hospital Value-Based Purchasing Program (HVBP), if language in the fiscal year (FY) 2017 IPPS proposed rule is finalized.
In this article we’ll provide insights into how clinical documentation and reported codes may impact payments, and guidance on some common CDI challenges to strengthen data quality.
Performance may impact reimbursement in FY 2018
A quality measure named Patient Safety Indicator (PSI) 11 has existed since 1998, when it was developed by the Agency for Health Care Research and Quality (AHRQ). The measure has been adopted for use by CMS and other comparative databases, such as the University HealthSystem Consortium and Healthgrades, to compare performance across hospitals.
If the proposed rule is finalized as written, how well your hospital performs on this measure will begin to impact hospital reimbursement under the two hospital pay-for-performance programs noted above. Reimbursement impact will begin in:
Performance for this measure will be assessed and scored, and the score will then be rolled into a weighted patient safety composite measure. Performance for the overall composite measure will then determine reimbursement impact. The name of this composite measure is the Patient Safety and Adverse Events Composite, previously known as the PSI 90 composite measure.
The Patient Safety and Adverse Events Composite measure was reviewed in last month’s column. What is important to note for PSI 11 is that performance for this measure will impact approximately 22% of the composite weight:
Data quality and PSI 11 performance
PSI 11 performance is determined by the diagnosis (ICD-10-CM) codes we submit on claims. This is a risk-adjusted measure evaluated using an observed over an expected ratio.
Discharges included in the measure:
Identification of postoperative respiratory events:
Additional details for key measure drivers can be found on review of PSI 11 specifications located on the AHRQ website at www.qualityindicators.ahrq.gov/Modules/psi_resources.aspx.
PSI 11 CDI vulnerabilities
In our review of thousands of medical records for hospitals across the country, we see common challenges which impact PSI 11 data quality. We discuss a few of the common questions we encounter below to assist your internal data quality efforts.
How do I recognize acute respiratory failure?
Clinical criteria to identify if not documented and/or to validate a documented diagnosis include:
What is the definition of "prolonged" postoperative mechanical ventilation?
If the patient is extubated postoperatively, but continues to be treated with supplemental oxygen, when is a query for acute respiratory failure appropriate?
When respiratory failure exists in a post-procedural patient, how do I determine if this is, and/or is not, related to the procedure?
In addition to the above, other record review findings which negatively impact PSI 11 data quality include:
Summary
Value-based care will increasingly utilize claims-based measures to assess quality and cost outcomes linked to payment. To strengthen organizational performance for PSI 11, the following steps are suggested:
Editor’s note
Stein is associate director of the MS-DRG Assurance program for Enjoin, providing clinical insight and education as part of the pre-bill review process. He earned his CCDS credential in June 2013 and completed AHIMA’s ICD-10-CM/PCS coder workforce training in August 2013. Newell is the director of CDI quality initiatives for Enjoin. Her team provides health systems with physician-led education and infrastructure design to sustainably address documentation and coding challenges essential to optimal performance under value-based payments across the continuum. She has extensive operational and consulting expertise in coding and clinical documentation improvement, performance improvement, case management, and health information management. You can reach Newell at (704) 931-8537 or [email protected]. Opinions expressed are that of the authors and do not represent HCPro or ACDIS.
WMS Functions:
Alba360 WMS for Dynamics GP enables extended versions of the Receiving, Inventory, Picking and Shipping transactions to be processed within the data capture system. It supports the following WMS functions.
*Receiving and Put-Away: allows users to receive inventory against purchase orders in Dynamics GP via wireless handheld scanners. The scanning interface identifies the item configuration in Dynamics GP and displays appropriate information and prompts. Lot tracked items and serialized items are also fully supported. Labels can be generated by the WMS systems during Receiving or within the Purchasing and Inventory modules in Dynamics GP. Before printing labels, the user has the option to modify the quantity of labels to be printed in the Receiving Labels Preview window.
*Bin Transfers: PO items are received into the default Receiving BIN configured in Dynamics GP. Alba360 WMS allows BIN transfers for items within unposted Purchase Receiving transactions as well as items in the inventory.
*Picking & Fulfillment: allows picking to be done in waves or on an order-by-order basis. Batches of orders can be processed based on pre-configured delivery rules. Alba360 WMS allows shipping to validate orders being fulfilled through the scanner, preventing errors and providing key information to the warehouse workers. Shipping labels containing customer information and order references are automatically generated during the fulfillment process. It also supports fulfillment workflow based on standard, lot tracked, and serialized item types.
*Site Transfers, Inventory Adjustments & Stock Counts: allows site-to-site transfer transactions, bin-to-bin inventory moves and adjustments via barcode scanner. Users can perform stock counts based on Stock Count Schedules defined in Dynamics GP.
Next Steps:
For more information about services and products from Alba Spectrum, or to speak with a consultant about how Alba360 WMS can benefit your organization, please give us a call at 1-866-528-0577 or email us at [email protected]. You can also visit us on the web at www.albaspectrum.com and request more information through our website.
About Alba Spectrum: Alba Spectrum is a Chicago, Illinois based Gold-Certified Microsoft Dynamics Partner. We specialize in developing solutions and extensions for Microsoft Dynamics GP (Great Plains Dynamics) in the areas of System Integration, Financial applications, E-Commerce and Warehouse Management (WMS). We also provide strategic consulting on the use and adaptation of Dynamics GP within a variety of industries. We serve Microsoft Dynamics Clients and Partners worldwide including United States, Canada, Latin America, Europe, the Middle East & Australia. Local services are available in Chicago, Naperville, Los Angeles, Irvine, San Diego and Houston.
About the Author: Luis Leung is the VP of Product Development at Alba Spectrum Corporation. Luis is a Microsoft Dynamics Certified Professional with over 25 years of experience in software development, business applications, ERP systems implementations, business management consulting and accounting. He was a co-founder of several Microsoft partner organizations and his experience includes projects throughout North America, Latin America and Europe.
Related Medical Coding Articles
Postoperative respiratory failure’s introduction into the CMS value-based reimbursement model
By Robert Stein, MD, CCDS, and Shannon Newell, RHIA, CCS, AHIMA-approved ICD-10-CM/PCS trainer
The accurate capture of acute respiratory failure has been a long-standing challenge for CDI programs. The accurate reporting of this condition as a post-procedural event can be even more difficult.
The importance of data quality for post-procedural acute respiratory failure will impact quality outcomes linked to reimbursement under the Hospital-Acquired Condition Reduction Program (HACRP), as well as the Hospital Value-Based Purchasing Program (HVBP), if language in the fiscal year (FY) 2017 IPPS proposed rule is finalized.
In this article we’ll provide insights into how clinical documentation and reported codes may impact payments, and guidance on some common CDI challenges to strengthen data quality.
Performance may impact reimbursement in FY 2018
A quality measure named Patient Safety Indicator (PSI) 11 has existed since 1998, when it was developed by the Agency for Health Care Research and Quality (AHRQ). The measure has been adopted for use by CMS and other comparative databases, such as the University HealthSystem Consortium and Healthgrades, to compare performance across hospitals.
If the proposed rule is finalized as written, how well your hospital performs on this measure will begin to impact hospital reimbursement under the two hospital pay-for-performance programs noted above. Reimbursement impact will begin in:
Performance for this measure will be assessed and scored, and the score will then be rolled into a weighted patient safety composite measure. Performance for the overall composite measure will then determine reimbursement impact. The name of this composite measure is the Patient Safety and Adverse Events Composite, previously known as the PSI 90 composite measure.
The Patient Safety and Adverse Events Composite measure was reviewed in last month’s column. What is important to note for PSI 11 is that performance for this measure will impact approximately 22% of the composite weight:
Data quality and PSI 11 performance
PSI 11 performance is determined by the diagnosis (ICD-10-CM) codes we submit on claims. This is a risk-adjusted measure evaluated using an observed over an expected ratio.
Discharges included in the measure:
Identification of postoperative respiratory events:
Additional details for key measure drivers can be found on review of PSI 11 specifications located on the AHRQ website at www.qualityindicators.ahrq.gov/Modules/psi_resources.aspx.
PSI 11 CDI vulnerabilities
In our review of thousands of medical records for hospitals across the country, we see common challenges which impact PSI 11 data quality. We discuss a few of the common questions we encounter below to assist your internal data quality efforts.
How do I recognize acute respiratory failure?
Clinical criteria to identify if not documented and/or to validate a documented diagnosis include:
What is the definition of "prolonged" postoperative mechanical ventilation?
If the patient is extubated postoperatively, but continues to be treated with supplemental oxygen, when is a query for acute respiratory failure appropriate?
When respiratory failure exists in a post-procedural patient, how do I determine if this is, and/or is not, related to the procedure?
In addition to the above, other record review findings which negatively impact PSI 11 data quality include:
Summary
Value-based care will increasingly utilize claims-based measures to assess quality and cost outcomes linked to payment. To strengthen organizational performance for PSI 11, the following steps are suggested:
Editor’s note: Stein is associate director of the MS-DRG Assurance program for Enjoin, providing clinical insight and education as part of the pre-bill review process. He earned his CCDS credential in June 2013 and completed AHIMA’s ICD-10-CM/PCS coder workforce training in August 2013. Newell is the director of CDI quality initiatives for Enjoin. Her team provides health systems with physician-led education and infrastructure design to sustainably address documentation and coding challenges essential to optimal performance under value-based payments across the continuum. She has extensive operational and consulting expertise in coding and clinical documentation improvement, performance improvement, case management, and health information management. You can reach Newell at (704) 931-8537 or [email protected]. Opinions expressed are that of the authors and do not represent HCPro or ACDIS.