MGBS January 2008 Brown Bag Series Medical Group Business Services Brown Bag Education Series...

MGBS January 2008 Brown Bag Series

Medical Group Business Services

Brown Bag Education Series

University of California, San Francisco


And Now For Another Fun-Filled Year

Coding and Regulatory Updates for 2008


UCSF Clinical Enterprise Compliance Program

CECP Education SeriesWanda T. Ziemba MFA RHIT CHCC CHCO

CPCAssociate Compliance Officer & CECP Educator

Ginger S. Reding, BS RHITCompliance Specialist & CECP Educator


Agenda

Overview of Proposed & Final CPT Changes

ICD-9-CM Updates Question & Answer Session


CPT Changes

CPT released October 2007 New codes reflective of innovative

technology Changes primarily clarifications for

usage of multiple codes Code assignment instructions


CPT Changes Adjustments for HIPAA/Data set

purposes Continuing inclusion for non-MD

services Reduction in ambiguities Refinement of definitions


Inclusive services deleted Window services detailed Multiple CPT Assistant references


Evaluation & Management Services

New codes – 10 Revised codes – 9 Multiple preamble, definition and

qualifier changes


New in E & M

Team Conferences (99366, 99367, 99368)– With and without patient/family present– No longer to be used for conference with

family only– Interdisciplinary medical team only– Non-MD participant has separate code for

non-face-to-face– Replace case management services


Behavior Change Interventions (99406, 99407, 99408, 99409)– Smoking, tobacco & alcohol cessation

services– Time-based services– May not be reported with administration &

interpretation of health risk assessments


Non-Face-to-Face Services (99441, 99442, 99443)– Telephone services based on time– May not be in conjunction with an E&M in

the last 7 days– May not be leading to an E&M event within

the next 24 hours or soonest available appointment

– May be used with the patient’s guardian


On-Line Medical Evaluation (99444)– No previous E&M service within the last 7 days– Uses internet resources in response to a patient’s

inquiry– Must involve permanent storage of the patient

interaction– Also bundled if within the postoperative period of a

previously completed procedure


Other E & M Services– Initial Hospital Care, Neonatal (99477)

• Requiring intensive observation, frequent interventions and other critical services


Changes in Definitions– Nursing Facility (99304-99310)– Critical Care (additional bundled services)– Anticoagulant Management – Team Conferences– Care Plan Oversight– Risk Factor Reduction


Anesthesia

New Codes – 2 Revised Codes – 1

Trends:Anesthesia for guided procedures

Definition of acronyms (TIPS)


Integumentary

New Codes - 0 Changed Codes – 2

Trends:Definitions of terminology & procedure

descriptions

Multiple code assignment instructions

Bundled services


Musculoskeletal

New Codes – 9 Changed Codes – 90

Trends:Placement of devices for radioelement

application

Image guidance procedures

New technology in repair & reconstruction


Respiratory & Cardiovascular

New Codes – 9 (5 respiratory & 4 cardiovascular)

Changed Codes – 46

Trends:Thoracentesis & pleural procedures

New technology – ablations, aneurysm repair, & grafts


Digestive

New Codes – 13 Changed Codes - 26Trends:

Placement of devices for radioelement application

Abdomen, peritoneum & omentumGastrostomy tube services


Genitourinary

New Codes – 9 Changed Codes – 1Trends:

New technology – stent services, ablations, aspirations, defect repairs & reconstruction, approaches

Placement of devices for radioelement application


Neurological/Endocrine/Eye/Ear

New Codes – 5 (endocrine-1; eye-4) Changed Codes – 2

Trends:New technology – Vitrectomy, complex

injuries

Few code assignment clarifications


Imaging New Codes - 8 Changed Codes – 24

Trends:Code assignment instructions for MRI

services

Complete cross-references with surgical services

Changes in brain imaging, PET scans & stereotactic delivery


Pathology

New Codes – 4 Changed Codes – 6

Trends:Split of metabolic panel

Detailing instructions in immunology, microbiology, & reproductive services


Medicine New Codes – 15 Changed Codes – 117

Trends:Multiple code assignment instructions

New codes for hydration therapy, neurostimulator pulse generators, CNS testing, & medication management services

Most changes in cardiac catheterization codes, EPS

Repeat entries from E&M section


Category II

Multiple additions reflective of PQRI– Patient Management – 3– Patient History – 16– Physical Examination – 7– Diagnostics – 33– Therapeutic & Preventative – 37– Outcomes – 6


Category III

New Codes – 13

Trends:Spinal distraction devices

CAD of digital images

EKGs of 64 leads or greater

Corneal hysteresis

High does electronic Brachytherapy


SummaryReview current data capture document for

updated, additional or deleted codes

Follow-up with providers for any new documentation requirements

Check PQRI data on line at http://www.cms.hhs.gov/PQRI/35_2008PQRIInformation.asp


ICD 9 CMFY 2008

Effective Oct. 1, 2007


www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/

07_Summarytables.asp New Diagnosis Codes - Effective 10/01/2007 [PDF 86KB] -

New Procedure Codes - Effective 10/01/2007 [PDF 23KB] -

Invalid Diagnosis Codes - Effective 10/01/2007 [PDF 21KB] -

Invalid Procedure Codes - Effective 10/01/2007 [PDF 12KB] -

Revised Diagnosis Code Titles - Effective 10/01/2007 [PDF 14KB)

Revised Procedure Code Titles - Effective 10/01/2007 [PDF 17KB]


www.cdc.gov/nchs/icd9.htm

The website for information on ICD 9 CM

Codes listed for each year in PDF format


Coordination and Maintenance Committee Agenda, Minutes, and Proposals

ICD-9-CM on CD-ROM

ICD-9-CM Rich text files (.rtf) via FTP: 2007 2006 2005 2004 2003 2002 2001 2000 1998 1997 1996 Addenda

• Official Guidelines Conversion table


New for FY 2008

142 New diagnosis codes

Includes 20 new V codes

5 revised diagnosis codes

17 Invalid codes


Reason for Changes

Most of the revised and all of the invalid codes are four digit codes that have been expanded to 5 digits for more specific reporting of conditions.


V Codes Used to code reason for

encounter for health services

Provides information and documentation on circumstances or problems that influence the patient’s health status, but is not the current illness or injury.


GuidelinesFound on the National Center for Health

Statistics Website

Gives the definitions and rules for “V” categories, such as Status, History of, Follow-up, Aftercare etc.

Provides a table showing if the V code can be first listed, additional, or both.


New V Codes

V68.01 Disability examination

Use additional codes to identify specific examinations, screening, and testing performed from V72.0-V82.9

Created to track exams directed towards the determination of disability compensation and benefits.


V73.81 Special screening examination, Human papillomavirus (HPV)

V84.81 Genetic susceptibility to multiple endocrine neoplasia (MEN)

V84.89 Genetic susceptibility to other disease


Family Planning

V 25.04 Counseling and instruction in natural family planning to avoid pregnancy

V26.41 Procreative counseling and advice using natural family planning


Procreative Management

V26.49 Other procreative management counseling and advice

Pretreatment V 26.81 Encounter for assisted reproductive

fertility procedure cycle Use additional code to identify the type of infertility Patient undergoing in vitro fertilization cycle V26.89 Other specified procreative

management Completed treatment


Personal HistoryV12.53 Personal History of sudden

cardiac arrest Sudden cardiac death successfully

resuscitated

V12.54 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits

Stroke, not otherwise specified, without residual deficits


Family History

V17.41 Family history of sudden cardiac death

V17.49 Family history of other cardiovascular diseases, Not otherwise specified

V18.19 Family history of other endocrine and metabolic diseases (Other than diabetes mellitus)


(MEN) Multiple Endocrine Adenomatosis

A syndrome characterized by adenomas, malignant tumors, or hyperplasia involving more than one endocrine gland.

258.01 Multiple endocrine neoplasia type I

Involves tumors of the parathyroid glands, pancreatic islet cells, pituitary gland, results in kidney stones and peptic ulcer disease

258.02 Multiple endocrine neoplasia type IIA 258.03 Multiple endocrine neoplasia type IIB


No longer valid359.2 Myotonic disorders

Coordination and Maintenance Committee needs to capture specific statistics.

Myotonic dystrophy (MD) is the most common muscular dystrophy in adults, and the second most common muscular dystrophy

It is a genetic disorder affecting 1 in

8000 people.


359.21 Myotonic muscular dystrophy 359.22 Myotonia congenitalBegins in childhood• 359.23 Myotonic chondrodystrophy• Onset at or soon after birth, a more sever

form of myotonis, muscular hypertrophy, and nultiple skeletal deformities

• 359.24 Drug induced myotonia• Use E code to identify drug


New Sensory Impairments Codes

Conditions Influencing Health Status V49.85 Dual Sensory Impairment

Also known as multi-sensory impairment

Blindness and deafness

Code first hearing impairment 389.00-389.9

And visual impairment 369.00-369.9


Special Investigations and ExaminationsUse additional codes to identify special

screening examinations

V72.12 Encounter for hearing conservation and treatment

For environmental acquired hearing loss


No longer valid389.2 Mixed conductive and sensorineural

hearing lossDue to a defect in the conduction of sounds and the sensory

mechanism.

New auditory codes will allow the physician to more accurately describe the patient’s hearing loss.

389.20 Mixed hearing loss, unspecified 389.21 Mixed hearing loss, unilateral 389.22 Mixed hearing loss, bilateral


Conductive Hearing LossDue to a defect in the sound conducting apparatus of the ear.

389.05 Conductive hearing loss, unilateral 389.06 Conductive hearing loss, bilateral

Sensory Hearing Loss 389.17 Sensory hearing loss, unilateral

Neural Hearing Loss 389.13 Neural hearing loss, unilateral


388.45 Acquired auditory processing disorder Trouble in retaining information presented orally, need more time

to process information, language difficulty, confusion

In the Alpha Index under Delay, delayed development 315.34 Speech and language developmental

delay due to hearing loss Use additional code to identify type of hearing loss Hearing loss from birth to 3 years can have detrimental effects

on speech and language development and adverse effects on social development.


Eyes 364.81 Floppy Iris Syndrome Intraoperative floppy iris syndrome (IFIS)The iris does not stay properly dilated during cataract

surgeryCaused by taking alpha-blockers, such as FlomaxUse additional E code to identify cause

364.89 Other disorders of iris and ciliary body

Prolapse of iris, not otherwise specified


Dental Codes 525.71 Osseointegration failure of dental

implant 525.72 Post-osseointegration failure of dental

implant 525.73 Post-osseointegration

mechanical failure of dental

implant 525.79 Other endosseous

dental implant failure


No longer valid787.2 Dysphagia (Difficulty swallowing)

787.20 Dysphagia, unspecified 787.21 Dysphagia, oral phaseCheeks, lips, palate, tongue- food is chewed 787.22 Dysphagia, oropharyngeal phaseTongue base and pharyngeal walls- beginning of

swallowing 787.23 Dysphagia, pharyngeal phasePharynx and larynx 787.24 Dysphagia, pharyngoesphageal phaseUpper esophageal sphincter 787.29 Other dysphagia


More New Diagnosis Codes

079.83 Parvovirus B19 Only strain to affect humans, common in

animals, dogs and cats

50% of adults have been affected, have lasting immunity

Known as fifth disease, rash on face, trunk and limbs, joint pain and swelling

Resolves in 7-10 days


488 Influenza due to identified avian influenza virus

288.66 BandemiaAbnormal excess of immature white blood cells

(band cells) that is not due to a confirmed infection

White blood count is normal, excess of band cells, common in bacterial infections


Complications of Medical Care

999.39 Infection following other infusion, injection, transfusion, or vaccination

999.31Infection due to central venous catheter


733.45 Aseptic necrosis of bone, jawProgressive sclerosis and death of bone tissue.

Studying link to bisphospnates and other drugs (Fosamax, Boniva)

569.43 Anal sphincter tear (healed, old)Presence of a forceful disruption of the anal sphincter

tissues that is not due to acute trauma

Use additional code for any associated fecal incontinence


Roseola InfantumMild viral illness caused by human herpes virus

Presents as Roseola with high fever, most common cause of febrile-induced seizures for children 6-24 months.

Transmitted through contact with saliva

058.10 Roseola infantum, unspecified058.11 Roseola infantum due to human

herpesviurs 6058.12 Roseola infantum due to human

herpes virus 7


Human Herpes Virus

058.21 Human herpes virus 6 encephalitis 058.29 Other human herpes virus

encephalitisHuman herpes virus 7 encephalitis 058.81 Human herpes virus 6 infectionNot diagnosed as encephalitis or Roseola infantum 058.82 Other human herpes virus 7 infectionHuman herpes virus 8 infection, Kaposi’s sarcoma-

associated herpes virus infection


Arteries and Veins

414.2 Chronic total occlusion of coronary artery Complete blockage of a coronary artery without an

acute occlusion, present for an extended duration

440.4 Chronic total occlusion of artery of the extremities

Complete blockage of an artery of the extremities without an acute occlusion, present for an extended duration


415.12 Septic pulmonary embolism Localized collection of pus and bacteria that travels

through the venous system to the heart, into the pulmonary arterial system, lodges in small vessels.

449 Septic arterial embolism Localized collection of pus and bacteria that

originates in the heart or lungs and then travels through the systemic arterial system, lodges in small vessels throughout the body, often in the brain, retina, and digits.


Cellular changes of the vulva

624.01 Vulvar intraepithelial neoplasia IMild dysplasia of vulva 624.02 Vulvar intraepithelial neoplasia IIModerate dysplasia of vulva 624.09 Other dystrophy of vulvaKraurosis of vulva, leukoplakic patches


No longer valid233.3 Carcinoma in situ, other and unspecified female genital organs

233.30 Carcinoma in situ, unspecified female genital organ

233.31 Carcinoma in situ, vagina

233.32 Carcinoma in situ, vulva

233.39 Carcinoma in situ, other female genital organ


Lymphoma

54 new codes for lymphomas Marginal zone Mantle cell Primary central nervous system Anaplastic large cell Large cell Peripheral T cell


Inpatient News

DRGs are now called MS DRGsMedical Severity Diagnostic Related Group

538 DRGs to 745 MS DRGs 335 Base DRGs are broken down toWith Major complication or comorbidity

With Complication or comorbidity

No Complication or comorbidity


POAPresent on Admission

Assigned to all reported diagnoses for inpatient admissions to general acute care hospitals.

Y – Yes N- No U- Unknown W- Clinically Undetermined 1- Unreported/not used


Oct. 1, 2008

Hospitals will not be paid for hospital-acquired conditions

8 chosen for FY 2009

Outcomes will appear on each physician’s quality report.


Documentation

is

key!

MGBS January 2008 Brown Bag Series Medical Group Business Services Brown Bag Education Series...

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