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For a code that has no relative value units (RVUs) and commands $ 0.00 in Medicare nonfacility fees, 99000 Handling and/or conveyance of specimen for transfer from the office to a laboratory has received a disproportionate amount of attention of late. Part of the reason for that lies in the role the American Medical Association (AMA) […]
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I have a provider that is noting an extended HPI, and Comprehensive exam, then under Assessment and Plan, just stating the diagnosis with the ICD-10 code.
For example, if the doctor is seeing the patient for Sinusitis or dizziness the assessment states:
J32.2 Chronic Sinisitis
R42 dizziness
Sometimes there is nothing else, no notes, orders or expansion in the note anywhere.
Very occasionally there may be an order for an xray or MRI.
I’m not seeing a true assessment and plan, giving their findings on how they got to the diagnosis. There is a disagreement going on that noting the diagnosis that way should count for a point- because it’s noted. I feel like shouldn’t they expand on it in some fashion? Showing their medical decision making? Impressions to score the risk?
Anyone had a provider like this in the past at all and have suggestions?
Earlier this year there was some confusion over CMS’ texting policies. The agency later confirmed that providers are allowed to text patient health information (PHI) using a secure messaging app. However, texting medical orders is still forbidden.
Early life and education
Sara Finkelstein was born in Manhattan and raised in Brooklyn. Her mother introduced her to the use of color and form by arranging fruits and vegetables in bowls. She attended Parsons School of Design on scholarships from the School Art League of NYC and the National Council of Jewish Women, graduating in 1939.
Because she was 4’11” in height, she acquired the nickname “Little Sara,” and then began to call herself Sara Little professionally. She married James R. Turnbull (then executive vice president of Monsanto Chemical) in 1965, but used the name Sara Little for her entire career.
Career
House Beautiful
After college, Sara Little worked at Marshall Fields as a bench designer and assistant art director, then became art director at Blaker Advertising Agency. She was eventually hired as an editorial assistant at House Beautiful magazine, where she wrote the “Girl with a Future” column until she rose to the position of Decorating Editor, which she held for nearly two decades.
At House Beautiful, she anticipated and helped develop the American post-World War II domestic lifestyle. By asking, “how we could help these people put their lives back together through ideas in our magazine?” she encouraged readers to utilize more informal space in the home (in what eventually became known as the family room), share living space with a roommate, and organize small spaces for maximum domestic efficiency (she lived for 20 years in a 400 square foot hotel room from which she also ran her international consulting practice).
Product Design
In 1958, Little left the magazine world and formed Sara Little Design Consultant. At the time, she wrote a trade article for Housewares Review entitled “Forgetting the Little Woman” (although she often referred to this article in subsequent interviews as “When Will The Consumer Become Your Customer?”). Her main argument was that most companies created products for retailers, instead of considering the people who were actually going to use them. The story caught the attention of a few prominent CEO’s and executives, including the heads of General Mills, 3M and the Corning Glass consumer products division. All three companies eventually hired her as a product research consultant to assist in finding new applications for technologies developed for the war effort. She helped create disposable medical and antipollution masks made from non-woven fibers, nutritious soybean candy, and the ubiquitous freezer-to-oven CorningWare that was developed from a material originally used on missile cones.
During her 65-year design career she provided advice on strategic design, consumer awareness, and cultural change to an international slate of companies such as: Procter & Gamble, Coca-Cola, General Mills, Macy, Neiman Marcus, Marks & Spencer, American Can, DuPont, Ford, Nissan, Pfizer, Revlon, Elizabeth Arden, Lever Brothers, Motorola, NASA and Volvo. She consulted on a range of domestic products including housewares, home storage systems, food, counters that cook, microwave cooking products, personal care, medication delivery systems, cosmetics, fabric processes (knit and non-wovens), space suits, furniture, toys, decoration and packaging, household cleaning products, pet care, tapes and adhesives, and car interiors.
Many of her ideas arose from her intense interest in different cultures and the natural world. A self-trained cultural anthropologist, she traveled frequently to destinations such as Borneo, Malaysia, the Philippines, India and Kenya, always on the lookout for how people and animals solved the problems of everyday living. Her design for a pot lid was inspired by observing cheetahs grasping their prey in the wild. t always starts with a fundamental curiosity, she said of her quest for innovative product design. hen I can’t find the answer in a book, I go out and search for it. The excitement of my life is that I have always jumped into the unknown to find what I needed to know.2] In another case, she began the design process for a burglar-proof lock by interviewing thieves in jail.
In 1971, she established the Sara Little Center for Design Research at the Tacoma Art Museum in Washington State to archive and display her collection of over 5,000 artifacts gathered during her travels. The collection includes body coverings and accessories, food preparation and dining implements, textiles, fine and folk art, much of which had influenced her concepts for domestic product design. The collection was deaccessioned from the Tacoma Art Museum in 2003 and is being re-established in Seattle, WA for design scholarship and educational purposes.
Process of Change: Laboratory for Innovation and Design
In 1988, Little founded and for the next 18 years directed the Process of Change: Laboratory for Innovation and Design at the Stanford Graduate School of Business. The Laboratory tracked changing trends in more than 375 areas including education, healthcare, aging, sexuality, food and nutrition, housing, clothing, and manufacturing. Little used this information to fuel her design concepts. “The quality of life of a people dictates what they design, what they make,” she said. “It’s a reflection of life itself.”
In her work with students at Stanford, Little continually emphasized digging deep into the “why” of a product before leaping into the “how,” in order to avoid designing products that only addressed superficial symptoms rather than the deeper need. he designer is the conscience of the company. We can’t expect anyone else to fill this role. That why the Process of Change Laboratory delineated the need to know more. Design requires a background of scholarship, otherwise it remains a visual trick.10]
Teaching, Awards and Honors
In addition to her work at Stanford, Sara Little has been a guest lecturer at schools such as Parsons School of Design, Rhode Island School of Design, MIT, Harvard, Illinois School of Technology, Copenhagen Business School, University of Washington, San Francisco State University and University of California Berkeley.
She received a Distinguished Designer Fellowship from the National Endowment for the Arts in 1988; the Trailblazer Award from the National Home Fashion League (1980), and an honorary doctorate from Academy of Art University (2003). In 2008, Chrysler Corporation established the Chrysler Sara Little Turnbull Scholarship at Academy of Art University. The Modern Art Council of the San Francisco Museum of Modern Art designated her a “Bay Area Living Treasure” in 2001. In 2006, at the age of 89, Sara Little received the Lifetime Achievement Award from Icograda (International Congress of Graphic Design Associations).
Board Service
1948: American Institute of Decorators “Design Associate”
1951-54: Alumni Board, Parsons School of Art and Design
1965-70: Board of Trustees, Parsons School of Art and Design
1990-? Board of Director, Corporate Design Foundation
1991: Board of Directors, Long Term Care Implementation Committee at the Age Center Alliance, Inc. (Palo Alto, CA)
1995: Advisory Member, National Design Forum
2004: Board of Directors, Cooper Hewitt Museum and Committee for the Arts
Footnotes
^ a b c d Vienne, Veronique (November 2000) “The Why of It All”, Metropolis Magazine
^ a b c d “Stanford’s Sarah (sic) Little Turnbull on Design”, Corporate Design Foundation
^ Sara Little Turnbull website
^ Speaking Freely: An Evening with Remarkable Women, KQED Television
^ “Laboratory Director Shuts Red Door”, November 2006, Stanford Business Magazine
^ Tacoma Art Museum website
^ Sara Little Turnbull faculty page, Stanford University
^ Knight, Heather (January 28, 2000) “Mother of Invention”, San Francisco Chronicle
^ Interview with Sara Little Turnbull at TAXI: The Global Creative Network website, 2006
^ Video interview with Sara Little Turnbull conducted in 2006 by Paula Rees, special trustee for Sara Little Turnbull
^ Academy of Art University website
^ “Spreadsheet One: The GSB’s Living Treasure,” February 2002, Stanford Business Magazine
^ “Icograda Design Week in Seattle” AIGA (American Institute of Graphic Arts) website
External links
Sara Little Turnbull official website
Categories: Design | American designers | Product design | Industrial design | American industrial designers | 1917 births | Living people
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If telehealth is the wave of the future, we’re still in the Dark Ages. The public has an ongoing opportunity to submit requests to the Centers for Medicare & Medicaid Services (CMS) for adding or removing services from the list of Medicare-covered telehealth services. This year, however, CMS is proposing not to add the majority of […]
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What’s Your Idea of a Best Seller?
Every once in a while I page through a magazine taking keen interest in the best seller and “must read” book lists that everyone is talking about. I usually tear out the pages for books that are interesting so I can download them later. And then I rarely read them. Or it takes me literally months to finish a book. I love to read, but frankly, after a day of reading code books, and spending a lot of time writing, I just don’t have the eye or mental energy to crack a book for fun.
My idea of a best seller is a string of code books that I use every day. Don’t worry though, I find other ways to have fun that have nothing to do with coding!
The last time I moved, I had lots of friends helping me lug boxes and it didn’t take long for them to zone in on the heaviest ones: they were labeled “code books.” I have code books for various coding systems going back several years and yes, they are heavy. And it’s hard to explain to the layman why I need so many books in such an electronic age. I’ve found it can also be challenging to explain the different code sets to novice coders. But alas, I am going to give it a try in a series of blog posts because you may not be exposed to all coding systems in coding school, but depending on the setting you work in, you may find you have to become familiar with something new.
I Don’t Hate Encoders
Let’s get one thing out of the way first, though. I have no issues with computers or encoders. In fact, I use a computer for almost everything and, like so many people, I am pretty addicted to my iPhone and iPad. But as a coding trainer, I learned by the book and I teach by the book and will always default to the book when I have a question. Encoders are only useful when the user understands the logic behind the program and that logic is based on the book.
ICD-9-CM Volumes 1 and 2: Everyone Does it
You probably aren’t surprised to hear that the government determines which codes we use in the U.S. But you may be surprised to hear that the law that defines those coding systems is a little law called HIPAA. Yes, the same law that addresses privacy and security of medical information also tells us which codes we must use to report healthcare services. This is why some code books boldly state on the cover that they support HIPAA compliance. In order to make health information portable and comparable,the Healthcare Portability and Accountability Act of 1996 (HIPAA) makes sure we’re all speaking a common language, expressed in codes, before we exchange data electronically. The privacy and security provisions are simply byproducts of making sure health care data can be shared electronically.
ICD-9-CM has three volumes. The first two volumes include the diagnosis codes. This includes the tabular (Volume 1) and index (Volume 2). I’ll address volume 3 in part 2 of this series. Bottom line here: every HIPAA-covered entity, which includes hospitals and physicians (and excludes workers’ compensation and car insurers) utilizes ICD-9-CM codes to report diagnoses on a claim.
ICD-9-CM codes have 3-5 digits with a decimal point after the first three digits. All codes are numeric except for V codes, which start with a V and then have two numeric digits and may have up to two more digits after the decimal point; and E codes, which start with an E and have three numeric digits and may have an additional digit after a decimal point. E and V codes are actually “supplementary” codes that are not included in the main part of the ICD-9-CM volumes 1 and 2 code set.
Here are some examples of ICD-9-CM codes:
Examples of supplementary codes:
Here’s another critical tip: if you are buying ICD-9-CM code books, it can be super confusing because there are various publishers and lots of code books with different-yet-similar titles. If you purchase an ICD-9-CM code book for physicians, it will have only volumes 1 and 2. If you buy ICD-9-CM for hospitals, you get all three volumes, or the complete ICD-9-CM code set.
Yes, it’s true. There are so many books and so little time, I haven’t even had time to blog for the last two weeks because I had my nose in two of them. Thank God for smartphones and long waits at the car wash, or who knows how much longer it would been before I posted again!
Three Levels of HCPCS
The Healthcare Common Procedure Coding System (HCPCS) has three different levels and just to make things more interesting, Level I is not usually called HCPCS, it’s called CPT. The Current Procedural Terminology (CPT) was developed and is maintained by the American Medical Association (AMA).
By Physicians for Physicians
What makes CPT so unique is that it is the only coding system in the HIPAA-approved code sets that is developed by physicians for physicians. The codes you see in the CPT code book are the result of various medical and surgical societies coming together with the AMA to decide which procedures deserve their very own CPT codes. Every year at the AMA’s CPT Symposium, coders from around the country gather in Chicago to listen to these physicians present the coding updates for the coming year. It’s an expensive but valuable conference that I think every coder should experience at least once. 
CPT codes are primarily used by physicians to report procedures and services performed in every possible setting where a physician – or qualified health practitioner – may see a patient: his office, the hospital, a clinic, a nursing home, etc. But it doesn’t stop there. CPT is also used to report hospital outpatient procedures. Of course, since there are still a lot of procedures that are performed solely as inpatient, hospital coders use a small number of CPT codes in comparison to pro-fee (physician) coders.
Three within Three
General acute hospitals paid under the Inpatient Prospective Payment System (IPPS) that successfully participate in the hospital Inpatient Quality Reporting Program and are meaningful electronic health record (EHR) users will see an estimated 0.95 percent increase in operating payment rates in 2017, according to a final rule issued Aug. 2. Reflected in this payment update […]
AAPC Blog
