Many providers are not familiar with these codes and are missing out on the
reimbursement for these services. Let me explain services provided in order
to bill for these codes. The provider discusses and shares planning for the
future health care needs of the patient including Advance Directives. Examples
of written Advance Directives would include but not limited to are Health Care
Proxy, Durable Power of Attorney for Health Care, Living Will, or Medical Orders
for Life-Sustaining Treatment (MOLST). This discussion is typically 30 minutes
with the patient, his family, or someone representing the patient. Advanced care
planning focuses on the patient and involves both the patient and the provider
responsible for their care. It empowers the patient to make an informative decision
about their future care including their advanced care decisions. This gives
the patient the opportunity to express their preference for care depending on their
current and future health status and treatment options available. The provider may
enter the actual plan on forms specifically designed for that purpose in the
patients record.

There are two CPT codes for Advanced Care Planning, 99497 which are used for up
to a 30 minute discussion, and 99498 which is an add on code for each additional
30 minutes of the discussion. These codes can be billed at the same time as other
medical services taking place at the same visit before or after the time spent
on advanced care planning. Don’t forget to add a 25 modifier to the office visit
code. The 2017 Medicare allowed reimbursement amounts are 99497 $88.15
and 99498 $76.60.

I am certain many of you have provided these services to your patients and just
bundled it into the office visit code and losing out on and additional
$88-$164.00 per encounter. Add these codes to your superbill and your EMR
templates so they are not forgotten!

As always, Take Advantage for all of your outsourced medical billing needs!

                                        

Review published information on www.cms.gov/icd10

Order the new CMS-1500 (02/12) Paper Claim Forms  (If you have a billing service you don’t need these)

Order ICD10-CM 2014 coding books.  (Even if you have a billing service, you should have these on hand as a reference until everyone is comfortable with the new codes.)

Order ICD 10-CM 2014 mapping charts for your specialty. Typically these will crossover the 50 most commonly used codes for your specialty from ICD-9 to ICD-10.  (We will provide these for our clients)

Conduct provider/staff training.  Schedule webinars for your specialty for you and your staff.  Order any required training materials.

Review the most commonly used ICD-9 codes that you’re presently documenting in your charts.  Determine if the level of detail that your documentation for ICD-9 will be sufficient to select codes from ICD-10. 

In an effort to minimize the impact on October 1, 2014, implement any  documentation changes now that you have the time.  For example: laterality and sequela (late effects), Code extensions: Initial, subsequent, and sequela.

Update your encounter/superbill with the most commonly used codes.   (We will be working with our clients that use encounters to do this)

Workflow for providers, staff, and billing agency’s will be impacted by this change.  Documentation and coding will take longer if coders have to keep requesting additional documentation from providers, this will have an effect on turnaround time for claims.  This may have an effect on cash flow and the provider/employee time schedules.  Have a contingency plan in place to cover additional hours and or additional financial burdens that may surface as a result.

Talk with your EHR vendors, Billing Companies, and IT staff about their preparations and readiness.  (We will be meeting with our clients regarding our preparations and helping them with their readiness plans.)

If you’re a small privately owned medical practice that will need help with their ICD-10 billing, preparations, or technology feel free to give us a call.  We work with many small, privately owned, medical practices and we can provide the resources that the big practices have at a very affordable price so that you can continue in your practice the way you always have!    Call us toll free at 1.877.666.5279

Well Providers its that Influenza time of year again!!   Many of you have already been administering the Influenza Vaccines to your high risk patients.

Don’t forget to update the NDC numbers for each of your vaccines CPT codes before billing.  You will find these on your purchase invoice.  See the table below for the thirteen approved vaccines for the various age levels and types of strains.

 

Name	Manufacturer	Age Range	# of Strains
Afluria	Merck/CSL	9 years and older*	Trivalent
Fluarix	GSK	3 years and older	Trivalent
			Quadrivalent
Flublok	Protein Sciences	18 – 49 years	Trivalent
Flucelvax	Novartis	18 years and older	Trivalent
FluLaval	GSK	3 years and older	Trivalent
			Quadrivalent
FluMist	Medimmune	2 – 49 years	Quadrivalent
Fluvirin	Novartis	4 years and older	Trivalent
Fluzone	Sanofi Pasteur	6 months and older	Trivalent
			Quadrivalent
Fluzone High-Dose	Sanofi Pasteur	65 years and older	Trivalent
Fluzone Intradermal	Sanofi Pasteur	18 – 64 years	Trivalent

Influenza Virus Strains in the 2013-2014 Vaccines

• A/California/7/2009 (H1N1)-like
• A/Victoria/361/2011 (H3N2), or its antigenic equivalent
• B/Massachusetts/2/2012-like (Yamagata lineage)

Quadrivalent formulations will also include
B/Brisbane/60/2008-like (Victoria lineage)

Abbreviations used for influenza vaccines

• IIV: Inactivated Influenza Vaccine (Afluria, Fluarix, FluLaval, Fluvirin, Fluzone)
  (IIV3 = Trivalent IIV; IIV4 = Quadrivalent IIV)
• LAIV (Quadrivalent): Live, Attenuated Influenza Vaccine (FluMist)
• RIV3: Recombinant Influenza Vaccine, Trivalent (Flublok)
• ccIIV3: Cell Culture Inactivated Influenza Vaccine, Trivalent (Flucelvax)

Concurrent Administration

Influenza vaccines may be administered concurrently with other live or inactivated vaccines.

As always “Take Advantage” for all of your billing and practice software needs.  Phone 877.666.5279

There are a few guidelines, but once you master them you will be on your way to helping
your patients with their health and their weight and helping your bottom line as well!!

BMI must be >30.0 and using the 5-A framework you must provide the following:
Assess, (behavioral health risks) Advise, (give personalized behavior change advice) Agree, (collaboratively select treatment goals and methods) Assist, (aid in achieving the agreed-upon goals) and Arrange (schedule follow-up contacts and support). I am sure you’re already doing this in your practice, and may not be getting paid for it.

If guidelines are met CMS covers one face to face visit every week for the first month. One face to face visit every other week for months 2-6, and one face to face visit every month for months 7-12, if the beneficiary meets the 3kg weight loss requirement.

At the six month visit a reassessment and determination of weight loss must be performed to be eligible for additional face to face visits for an additional six months. A minimum of at least
3kg over the course of the first six months of intensive therapy must be achieved and documented. Beneficiaries, who do not achieve a weight loss of at least 3kg during the first six months, must have a reassessment of their readiness to change and BMI is appropriate after an additional six month period.

Use code G0447, face to face behavioral counseling for obesity 15 minutes along with one of the following ICD-9 codes for BMI 30.0 and over (V85.30-V85.39, V85.41-V85.45), you can bill the counseling code G0447 up to 22 times in a 12 month period. Do not bill this code with an evaluation management code, it will deny as inclusive to the evaluation management code.
Reimbursement for this code is in the range of $25-$38 per visit depending on the insurer.

We would recommend that you make up a form just for the obesity management sessions
In order to keep track of the timeframes, number of sessions, and weight reduction, in addition to charting into your EMR. This will allow you to have a quick, clear picture of the patients
progress.

Now you have all the information to help your patients with their weight management and create a new revenue stream for your practice as well!

Please fee free to give us a call if we can be of any help with this or any other billing questions you may have!! Call us toll free at 1.877-666.5279