cardiologycodingupdate2018-180209134707

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Information about cardiologycodingupdate2018-180209134707
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Published on March 22, 2018

Author: onlineaudiotr

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slide 1: C a r d i o l o g y C o d i n g U p d a t e s f o r2018 O N L I N E A U D I O T R A I N I N G T e r r y F l e t c h e r C o n s u l t i n g I n c . B y : T e r r y F l e t c h e r C P C C C C C M C C M S C S C M C S CCS - P C C S C E M C A C S - C A S C P - CA www.onlineaudiotraining.com 1 slide 2: ICD-10-CM GUIDELINES RELEASED Just released on Thursday Aug. 10 are the Official ICD-10-CM/PCS Coding and Reporting Guidelines for the 2018 fiscal year totaling 117 pages. The National Center for Health Statistics via the CDC Centers for Disease Control and Prevention has posted the guidelines on its websitehere:https://www.cdc.gov/nchs/data/icd/10cmguidelines_fy2018_final.pdf. Readersshould note that the time frameto which theseguidelines apply to is Oct. 1 2017to Sept. 30 2018. Whenyoureview the guidelines for thiscoming fiscal year pleasetake note the following:  Narrative changes appear in boldtext  Items underlinedhave beenmoved within the guidelines since the F Y 2017version  Italics are used to indicate revisions toheading changes  Theconventionsfor ICD-10-CMare the general rules for useof the classificationindependentof the guidelines and there remain19 of these conventions as in the F Y 2017 guidelines. Convention No. 15 “with” does have some revised narrative so every coding professionalshould readthis over carefully.Here’sa portion of this revision highlightedin blue font: Theword “with” or “in” should be interpreted to mean “associatedwith” or “due to” whenit appears in a code title the Alphabetic Indexor an instructionalnote in the TabularList. These conditions should be coded as related even in the absence of provider documentation explicitly linking them unless the documentationclearly statesthe conditionsare unrelatedor when anotherguideline exists that specifically requiresadocumented linkagebetweentwo conditionse.g.sepsisguideline for “acute organdysfunctionthat is not clearly associated with the sepsis”. 2 slide 3: ACUTE MYOCARDIAL INFARCTIONAMI Definition Change When documenting an AMI keep the following inmind: 1. Timeframe: AnAMI is now considered“acute” for 4 weeks from the time of the incident a revised time frame from the ICD-9 period of 8 weeks. 2. 3. 4. Episode of care ICD-10-CM does not capture episode of care e.g. initial subsequent sequelae. SubsequentAMI ICD-10 allows coding of a new MI that occurs during the 4 week “acute period” of the originalAMI. T ype 1 and T ype 2 Acute Myocardial Infarction Diagnoses to better descript when Ischemic heart disease is involved. 2018 Update ICD-10-CM Code Examples: I21.- I21.- I21.02 I21.4 I21.A1 I21.A9 I22.1 Acute Myocardial Infarction 2018 revision to the definition Type 1 Acute Myocardial Infarction 2018 revision to the definition Type1 S T elevation STEMI myocardial infarction involving left anterior descending coronary artery Non-ST elevation NSTEMI myocardial infarction Myocardial infarction New 2018 Type2 Other myocardial infarctiontype Subsequent S T elevation STEMI myocardial infarction of inferior wall no changes to subsequent ICD-10-CM 2018 will add the new code I21.9 acute myocardial infarction unspecified. This could be helpful when a patient is seenin the ERand it is not clear what stage of AMI the patient is in. 3 slide 4: Six New Hypertension Codes2018 ICD-10-CM 2018 brings us 6 new codes for pulmonary hypertension which effects the arteries of the lungs and the heart. New codes are as follows:  I27.20 Pulmonary hypertension unspecified  I27.21 Secondary pulmonary arterial hypertension  I27.22 Pulmonary hypertension due to left heart disease  I27.23 Pulmonary hypertension due to lung diseases and hypoxia  I27.24 Chronic thromboembolic pulmonary hypertension  I27.29 Other secondary pulmonary hypertension You may see these codes more often with Right Heart Cath coding and possible valve replacement coding. 4 slide 5: Brand-New Category for Heart Failure Section I50- “Heart failure” will add a new category I50.8- Otherheartfailure. The ICD-10- manual will offer new codes to specify when patients have a conditions thatfall under this categorysuch as right ventricular failure or BiV heart failure. These additions include thefollowing: I50.81- Right heartfailure  I50.810 Right heart failureunsp  I50.811 Acute right heartfailure  I50.812 Chronic right heartfailure  I50.813 Acute on chronic right heartfailure  I50.814 Rightheart failure dueto left heart failure I50.82 Biventricular heart failure I50.83 High output heartfailure I50.84 End Stage heartfailure I50.89 Other heart failure There has been an increase within patient medical records documentation of biventricular heart failure new code ICD-10-CM I50.82. This will make coding a bit more specific when ordering tests labs visits etc. Medical Necessity will be easier to support. 5 slide 6: New Specialty Taxotomy Codes Added for2017 Billing: CMS adds 3specialtydesignationsstartingOctober 1 st 2017and 2018 Preparefor the addition of three new specialties that will appear under the provider enrollment chain and ownership system PECOSand that may open up billing opportunities for your provider staff. These specialty codes pertaining to cardiology medical toxicology and cell transplantation providers go into effect Oct.1:  C7-Advanced heart failure and transplant cardiology  C8-Medical toxicology  C9-Hematorpoietic cell transplantation and cellular therapy Some specialty groups are saying this is a big win for medical billing staff and some of the denials that have come from the local Medicare carriers for duplicate billing. When a cardiologist for example and heart failure specialist from the same practice have billed for E/M services on the samedate denials are going to happen. Hopefully with these new designations CMSwill allow for separate services when appropriate. 6 slide 7: 2 0 1 8 E / M s e r v i c e su p d a t e Physician practices should note several changes to E/M codes which includes a new “star” symbol added to C P T to designate possible “Synchronous T elemedicine Health” code inclusions and several revised code descriptor sections. Pay close attention to modifier -95 and - GT • Plush Care • VIPCare • T elehealth • eVisit 7 slide 8: Coding for TelehealthServices-preview Reporting Telehealth Services with the appropriate modifiers- Only ½ thestory Submit your Medicare and Medicaid claims for telehealth services using the appropriate C P T ® orH C P C S code for the telehealth service along with the modifier G T via interactive audio and video telecommunications systems-for example99202-GT . By coding and billing the G T modifier with a covered telehealth procedure code you are certifying that the beneficiary was present at an eligible originating site when your physician or qualified approved practitioner furnishes the telehealth service. By coding and billing the G T modifier with the covered ESRD-related service telehealth code you are certifying that your provider furnishes one “hands on” visit per month to examinethe vascularaccesssite. For Federal telemedicine demonstration programs in Alaska or Hawaii your submitted claims with the appropriate C P T ®or H C P C Scode for the professional service along with the GQmodifier to certify aasynchronoustelecommunicationssystem was used. Reminder: CMS states that POS 02 is effective January 1 st 2017. A CMS transmittal R3586CP mentions that any time claims for telehealth services are reported that include modifier GT or GQ on either the C P T ® or HCPCS code but do not include new POS 02 they will be denied. It also mentions that if the new POS 02 is used and the modifiersare not included the service will be denied by Medicare. Make sure you attend one of our T elemedicine Webinars in 2018 to become even more informed on this topic. Terry Fletcher is a member of the American Telemedicine Association2017 8 slide 9: E/M New vs. Established patient clarification- AVOID denials- Cardiology Specialty in 2018 3 questions to avoid overpayments anddenials Was the patient seenby:    The same provider A provider of the samespecialty A provider of the samesub-specialty Keep in mind that under the E/M documentation guidelines if the patient is new to your practice with an office visit but was seen in the E/R or in the hospital within in the past 3-years they are still considered an establishedpatient. If for example a patient sees a general cardiologist 6-1-2017 in the office for follow up coronary artery disease but during that encounter an arrhythmia is detected an abnormality of the computer of the heart and the patient needs to be referred to an E P electrophysiology physician within the practice.On a different date the patient would be considered a NP for that E P doctor. It helps that E P is a separate taxotomy code to differentiate a general cardiologist from an E P as a subspecialty. However what if the physician referral was to a Peripheral Vascular physician in the same practice no separate T ax ID That is where the debate begins. OIG will be closely monitoring these claims. They have already settled a 700000 claim from 2 medical centers in MASS for “up-coding” incorrectly from established patient visit to a new patient visit when it was not supported. 9 slide 10: Modifier 25Alert-2018 E/M Codes with modifier -25 may face drastic pay reductions forsome practices. Watch your E/M Claims where you append the modifier 25 Significant separately identifiable E/M service if your patients have insurance with a Medicare Advantage carrier that operates in 25 states. This started on August 1 st when Independence Health Group which covers almost 9 million people under private health insurance and Medicare Advantage plans announced via their website and provider emails it would apply a “payment reduction of 50” to an E/M service when it is billed/reported with a modifier 25 on the same date as a minor procedure. The company also said it would cut payment at the same 50 rate for E/M services billed with modifier 25 when a preventative code is also billed. The policy document lists 17 preventative service codes that apply including 99381-99387 99391-99397 G0438 and G0349 the AWV . This revised payment policy will significantly impact reimbursement for many practices around the country. I fear this could have physicians bringing patients back on a different day to get paid for both services at 100. Westrongly urge providers who are participating with this plan to fight it with the provider relations department of that payer. There is no basis for this. 10 slide 11: New Patient relationship Modifiersfor 2018-per CMS Next year CM S plans to give physicians and some non-physician practitioners the opportunity to test drive modifiers that indicate the relationship between provider andpatient. CMSwas requiredto createcodesthat will be appended to Medicare claims to “facilitate the attribution of patients and episodes to one or more clinicians” by MACRA Hereare the proposed modifiersfor the 2018 physician fee schedule: X1- Continuous/broad services Principal care no plannedendpoint X2- Continuous/focused services Clinicians whose expertise is needed for ongoing management X3- Episodic/broad services Clinicians who have broad responsibility for comprehensive needs i.e. hospitalist X4- Episodic/focused services Specialty clinicians who provide time-limited care i.e surgery radiation etc.. X5- Only as ordered by another clinician Example a radiologist or cardiologist who interprets a diagnostic test These modifiers are intended for use by physicians and applicable NPP’s. The Jan 1 st 2018 rollout of the codes is required by law. However the use of the modifiers will not be mandatory in 2018. The modifiers “may be voluntarily reported on Medicare claims and will not effect payment”. They should not be used with quality measures. 11

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