HealthCare Mobile AppsMobile apps are radically changing the way doctors and patients interact and approach healthcare. Over the last few years, several medical mobile applications were developed that offer quick access to evidence-based medical research from mobile devices. These apps are making it possible for physicians as well as patients to view x-rays, review clinical notes, track health progress and access information regarding any medical condition through major mobile platforms such as iPhone, Android, Blackberry, and Windows. Many physicians are also recognizing the positive possibilities for increased communication with mobile health apps.

According to recent data from Manhattan Research’s Taking the Pulse® U.S. 2014 study, more than 30 percent of physicians recommend mobile health apps to their patients. The poll was conducted during the first quarter of this fiscal year. The online survey polled 3,066 practicing physicians across several specialties, including:

  • Cardiology
  • Gastroenterology
  • Primary care
  • OB-GYN
  • Oncology

In addition to recommending health apps, the survey found that 47% of physicians who owned Smartphones used the devices to show patients relevant videos or images.

Further findings of the study include:

  • Two in five physicians agreed that “using digital technology to communicate with patients will improve patient outcomes,” and the same amount reported that they have increased their use of digital tools to communicate with patients over the past year.
  • Nearly 25% of physicians used secure patient portals to communicate with patients over the past year.
  • More than 20% used secure messaging platforms to communicate with patients.
  • More than 20% used remote patient monitoring.

Apart from the apps that help people in the domain (surgeons, physicians and students), there are many that are targeted towards patients and consumers to help improve their overall healthcare experience. The use of healthcare applications on mobile devices is likely to have considerable impact on medical treatment as consumers are using mobile devices to take more responsibility for their own health care.



In the United States, under the new healthcare law about 8 million people have signed up for private health plans via health insurance exchanges. However, as per the latest reports from federal officials the eligibility of about 2 million people is still in question. The Obama administration is reaching out to hundreds of thousands of new Obamacare enrollees receiving subsidies to resolve serious questions about their eligibility, as many consumer advocates have expressed their concerns that many of them will be required to repay some or all of the subsidies.  The new step was undertaken after federal health officials observed wild discrepancies between official records and applications for coverage on the exchanges.

According to a report in The New York Times, more than 2 million people who have opted for insurance coverage under the new healthcare law have presented personal information that differed significantly from data in government records. The government is demanding additional information from consumers relating to their income, citizenship, immigration status and social security numbers along with any other healthcare coverage that they avail from their employers. Those people who fail to provide additional details required may risk losing their subsidized coverage and may have to repay the same within April 2015. The officials at the Centers for Medicare and Medicaid Services are quickly reaching out to more number of people through phone and email to push them to provide supporting documentation, thereby double checking this data.

Health Insurance Subsidy

Federal subsidies offered for the purchase of private insurance plans are the keystone of the Affordable Care Act (ACA). Reports suggest that eight out of every 10 people who have opted for health benefit plans from October through mid-April via exchanges were fully eligible to receive the subsidies including income tax credits. Till now, the federal government has paid out $4.7 billion in subsidies, and the amount is expected to reach $900 billion in 10 years’ time.

Since June 1, the government has found information provided by certain people in their application does not truly match what was found in other records. This necessitated people to give extra information for insurance eligibility verification. In certain cases, consumers report that they have already sent the required documents to the federal market place and they don’t really understand why they are being asked to send them again. Moreover, supporters of the healthcare law are concerned that some of its top beneficiaries will be disappointed when they find that their tax liability is greater than expected.

The government estimates average subsidies of $4,400 for each person who receives a subsidy. Subsidies may vary based on household income and the number of people in a family seeking assistance. Federal law limits the amount to be repaid by lower- and moderate-income people. Generally, a family consisting of four members with an annual income of $80,000 would be required to repay as much as $2,500. Workers who have access to affordable employer-sponsored coverage that meets basic federal standards are generally ineligible for subsidies.



Cancelled Health Insurance Policy

Many people have had their coverage cancelled by health insurance companies. Last October, Florida Blue cancelled the policies of more than 300,000 customers (80% of its individual plans) on the grounds that the plans did not meet the requirements of the Affordable Care Act.

According to the law, policies sold in the individual market as of January 1, 2014 should have covered the following benefits:

  • Doctor visits
  • Emergency and hospital services
  • Maternity and newborn care
  • Mental health and substance abuse treatment
  • Prescription drugs
  • Rehabilitation
  • Chronic disease management
  • Laboratory work
  • Pediatric services

Individual policyholders across the country were hit. The government soon announced coverage options for consumers with cancelled plans. Consumers have till March 31 to sign up for coverage effective in 2014.

Resources Available for Consumers with Cancelled Health Plans

A cancelled plan can be replaced or renewed. Consumers with cancelled plans can

  • Buy another plan that the company offers in its place
  • They can look for another suitable health insurance plan in a healthcare exchange. Healthcare exchanges help those
    • Who do not have a policy
    • Who already have a policy, but want a better option
  • Buy a plan outside the Marketplace

The five categories of health insurance plans available in the marketplace are:

  • Silver: Plan pays 70%. Customer pays 30%.
  • Platinum: Plan pays 90%. Customer pays 10%.
  • Bronze: Plan pays 60%. Customer pays 40%.
  • Gold: Plan pays 80%. Customer pays 20%.

Catastrophic Coverage

If the plans available in the Marketplace are not affordable, it may be possible for the consumer (if eligible) to purchase catastrophic coverage at the standard price quoted by the insurance company. This can be done by filling out the hardship exemption form available at the CMS website. The consumer has to also explain about the policy cancellation and indicate that the options available in the health exchange are not affordable. This form has to be then submitted along with a copy of the cancellation notice to an insurance company that offers catastrophic coverage in the area and apply for the plan.

What this Means for Healthcare Providers

As insurance companies cancel coverage, health insurance verification becomes even more important to avoid claim rejection. Most medical billing problems and insurance denials occur because insurance benefit information was not verified before services were provided. The typical reasons for denials are

  1. Member coverage terminated or not eligible for this date of service
  2. Services are not authorized
  3. Services are not covered by plan
  4. Maximum benefits have been met

Benefit verification services are available to help physicians verify everything from patient policy status effective date, type of plan, coverage details to payable benefits, exclusions, co-pays, and co-insurance, referrals and pre-authorizations, deductible, life time maximum and more.



ICD-10 Delay – Its Impact on Students

Posted by on July 18, 2014 10:15 am

ICD-10 DelayHealthcare providers, insurance payers and vendors aren’t the only entities that are affected by the unexpected ICD-10 delay of more than a year. Delay in implementing this coding system is detrimental also for students pursuing health information management degrees and trying to prepare for their careers.

On March 31, the U.S. senate passed the “Doc Fix” bill that approved H.R. 4302, the legislation which delays the ICD-10 implementation deadline by one year to October 1, 2015.

Students who have been preparing for the tenth version of codes now find themselves unable to take the certification. Instead, they’re left scrambling to learn ICD-9 so they can get a job before that coding system becomes obsolete next year.

The American Health Information Management Association (AHIMA), in the build up to the vote on the sustainable growth rate and ICD-10 delay, has cited the 25,000 students pursuing their undergraduate degree who have been learning to code exclusively using ICD-10 as a reason to remove the delay from the vote.

The Association of Schools of Allied Health Professions estimates that there are 40,000 scholars and current professionals studying at community colleges and going through professional accreditation programs who will be affected.

Because of the switch that was supposed to happen this year, most educational programs have transitioned from trying to teach both codes to solely teaching ICD-10. Teaching both medical code systems simultaneously makes for a massive workload for both educators and students, partly because ICD-10 requires a more extensive grasp of anatomy. The delay means that the students will need to learn ICD-9 coding for an additional year.

Now the requirement is that they must learn both the coding systems and will likely need a refresher on ICD-10 before the implementation deadline. Education programs have had to reevaluate their ICD-10 transition timelines and continue to teach both the codes to new students. It is very difficult for people new to coding to learn multiple code sets at once.

There are reports that the delay will also have a financial impact on schools. Alfred State College devoted 20 percent of its budget last year to the ICD-10 transition, spending thousands of dollars on training faculty and redesigning its life science and medical terminology courses that support coder training. Delaying implementation will cost the college more money in training new educators and redesigning their transition plan to account for the added time that dual coding education would require.



A retrospective review of the medical records of 150 cardiac patients who had deactivated their implanted electronic cardiac devices (by request) revealed that both physicians and patients are not planning ahead or including their aspirations regarding the deactivation of devices in their advance directives. This is in spite of the fact that except one, all the patients analyzed had quite poor or terminal prognosis at the time the device was deactivated.

The investigation also showed that surrogates rather than the patients themselves had made half of all deactivation requests, and the requests were often made just days before the death of the patient. The author of the study opined that it is very important to encourage patients to execute advance directives with device-specific language so that they can ensure receiving care consistent with their preferences.

The other major findings of the review published in JAMA Journal are:

  • Out of 150 devices, 135 devices were implantable cardioverter-defibrillators
  • 79% of patients underwent deactivation of tachycardia therapies only
  • 55% of deactivations were carried out by nurses while 15% was by industry-employed allied professionals
  • Among 89 advance directives, just one specifically mentioned about the implanted device
  • Median survival after deactivating the cardiac device was only two days
  •  The patients who made the deactivation decision themselves more commonly consulted a palliative-care practitioner

The two commentaries that accompanied this paper deal with the uneasiness felt by many physicians about end-of-life discussions and provide recommendations on how such kind of discussions could be broached. According to the authors of the commentaries, it is necessary to couple technological advancements with greater communication skills for providing quality care to cardiac patients. With an aging population and a corresponding increase in the use of cardiac devices, open communication is necessary between physicians, patients and their caregivers to ensure improved quality of the lives and deaths of terminally ill patients.

Cardiac device monitoring is an important service physicians provide for patients with implanted cardiac devices. Let us consider how a physician is to report cardiac device monitoring with different cardiac devices.

Reporting Cardiac Device Monitoring

When reporting cardiac device monitoring, the following codes are used.

IMPLANTABLE PACEMAKER

  • 93288: Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system
  • 93279: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system
  • 93280: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system
  • 93281: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system
  • 93294: Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional
  • 93296: Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable cardioverter-defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results
  • 93293: Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days

IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR

  • 93289: Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead implantable cardioverter-defibrillator system, including analysis of heart rhythm derived data elements
  • 93282: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead implantable cardioverter-defibrillator system
  • 93283: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead implantable cardioverter-defibrillator system
  • 93284: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead cardioverter-defibrillator system
  • 93295: Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable cardioverter-defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional
  • 93296: Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable cardioverter-defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

IMPLANTABLE CARDIOVASCULAR MONITOR

  • 93290: Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors
  • 93297: Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, analysis, review(s) and report(s) by a physician or other qualified health care professional
  • 93299: Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

IMPLANTABLE LOOP RECORDER

  • 93285: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable loop recorder system
  • 93291: Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable loop recorder system, including heart rhythm derived data analysis
  • 93298: Interrogation device evaluation(s), (remote) up to 30 days; implantable loop recorder system, including analysis of recorded heart rhythm data, analysis, review(s) and report(s) by a physician or other qualified health care professional
  • 93299: Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

Professional and Technical Components

Remote monitoring codes have distinct CPT codes for the professional (physician time and intensity in providing the service along with the activities before and after direct contact with the patient) and technical (resources used for performing the services) components. The Global CPT codes include the professional and technical components for in person codes. If both components of care are rendered in an office setting, there is no need to add modifier to the relevant code. Remote monitoring codes on the other hand, need 2 different CPT codes to be billed together – one code would represent the professional service and the other the technical service as for example CPT 93294 and 93296, 93295 and 93296, 93297 and 93299, and 93298 and 93299, when billing a global service.

It is required to add modifier –26 to the appropriate CPT code when only the professional component is performed. The -26 modifier need not be added if the code represents only the professional services signified by the CPT code description (e.g.  CPT 93294, 93295, 93297, and 93298.) The modifier –TC must be appended to the appropriate CPT code when only the technical component is performed. The modifier –TC is not needed if the CPT code description represents only the technical support service as for example, CPT 93296 and 93299.

Medicare Directives

Now let us look at Medicare requirements in this regard.

  • All remote interrogation services and transtelephonic pacemaker monitoring signified by codes 93296, 93299 and 93293 require general supervision of the technical component
  • All in-person cardiac device interrogations require direct supervision of the technical component

General supervision signifies that the procedure is furnished under the physician’s overall direction and control. However, the physician’s presence is not required during the performance of the procedure. In general supervision, the training of non-physician personnel who actually carry out the diagnostic procedure and the maintenance of the necessary equipment/supplies rests with the physician.

For direct supervision, the physician must be present in the office suite and be always available to provide assistance and direction during the performance of the procedure. However, it does not mean that the physician should be actually present in the room when the procedure is performed.



AMA Approves New Telemedicine Policy

Posted by on July 15, 2014 2:49 am

Telemedicine PolicyTelemedicine has just got a boost with the American Medical Association (AMA) approving a list of the guiding principles presented at its Annual Meeting held from June 7-11, 2014. A component of telehealth, telemedicine generally refers to the provision of clinical services from a distance. The benefits include increased access to specialist consultations, improved access to primary and ambulatory care, and reduced waiting times.

AMA’s recognition will ensure appropriate coverage of reimbursement for telemedicine services on telemedicine. According to the nation’s largest association of physicians, appropriately used telemedicine can greatly improve access to care without compromising patient safety. The AMA says the evolution of telemedicine impacts all of its strategic focus areas:

  • Improving health outcomes
  • Enhancing physician satisfaction
  • Practice sustainability
  • Accelerating change in medical education

The House of Delegates, the principal policy-making body of the American Medical Association has voiced support for additional Medicare pilot programs to enable coverage of telemedicine services, including store-and-forward telemedicine, which involves transmitting medical data (such as medical images and biosignals) to a physician or medical specialist for assessment.

Before a telemedicine service is provided, AMA guidelines require the physician or other health professional to notify the patient of cost-sharing responsibilities and limitations in drugs that can be prescribed via telemedicine. The policy also encourages healthcare providers to verify that their medical liability insurance covers such services before they deliver any telemedicine services, including those provided across state lines.

AMA President Dr. Robert Wah said “We believe that a patient-physician relationship must be established to ensure proper diagnoses and appropriate follow-up care…this new policy establishes a foundation for physicians to utilize telemedicine to help maintain an ongoing relationship with their patients, and as a means to enhance follow-up care, better coordinate care, and manage chronic conditions.”

Telemedicine will improve access for patients to receive health care services remotely as medically appropriate including care for chronic conditions, which is a proven way to improve health outcomes and reduce health care costs. AMA stresses that the same standard of care must be maintained whether the physician is seeing the patient in person or via telemedicine.

The association will also work with the Centers for Medicare and Medicaid Services and other payers to develop and test payment models, and evaluate the effect of various telemedicine technologies on cost, quality, and the patient–physician relationship.

Each year, Medicare pays about $6 million for telemedicine services. Not all costs are reimbursed. Claims for professional telemedicine services should be submitted using the appropriate CPT code or HCPCS code, and the modifier “GT” or “GQ”. Due to the diverse reimbursement rules, hospitals, healthcare organizations, and healthcare systems should be knowledgeable about federal and state reimbursement laws and restrictions that govern medical billing for telemedicine services.



Physical Therapy ServicesPhysical therapy is a dynamic treatment method that helps individuals to overcome disabilities and achieve optimal function and pain relief. As per a new U.S. Government Accountability Office (GAO) report, physical therapy services offered to Medicare beneficiaries increased by about 30% during the period 2004 to 2010. Unlike other healthcare service-utilization increases, self-referring physicians were not responsible for the rise.

It was found that around 4.3 million Medicare beneficiaries had received outpatient physiotherapy treatments worth $4.1 billion in the year 2011. The number of services offered per 1,000 Medicare beneficiaries recorded an increase from 1,223 in 2004 to 1,595 in 2010. The amount of services generated by self-referring family physicians, orthopedic surgeons and internists was 320; the non-self-referred services recorded a significant growth of 41% from 903 in 2004 to 1,275 in 2010.

As part of the study, the Medicare Part B claims (for the year 2004-2010) for orthopedic surgeons, family physicians and internists were examined. These specialties accounted for more than 75% of service referrals. The total number of services referred per provider, the number of services received per beneficiary and the number of beneficiaries referred were also identified. The main findings of GAO report include -

  • Self-referring physicians (for all three specialties) referred higher number of patients for physiotherapy.
  • The total expenditure related to self-referred services reported an increase of 10% from $389 million to $428 million. Non-self referred services showed a dramatic increase of about 57% from $ 1.2 billion – $ 1.9 billion.

Non–self referred PT services can be performed by therapists who can directly influence the amount, duration and frequency of PT services through the detailed written plan of care required by Medicare. This is cited as one of the prime reasons for an increase in non-self referred services.

Physical Therapy Billing Codes

Physical therapy services are reimbursed when the correct CPT codes are used to report the services and medical necessity is established. With a reliable physical therapy billing service, physicians can streamline the claim submission and reimbursement process. Moreover, accurate knowledge of CPT codes may help physicians secure reimbursement of their claims on time with minimum denials. The current physical therapy CPT codes include -

  • 97001 – Physical therapy evaluation
  • 97002 – Physical therapy re-evaluation
  • 97028 – Application of a modality to one or more areas, ultraviolet
  • 97112 – Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and /or proprioception for sitting or standing activities
  • 97750 – Physical performance test or measurement, with written report, each 15 minutes
  • 97140 – Manual therapy techniques, one or more regions, each 15 minutes

Further, the American Academy of Family Physicians (whose specialties were examined in the report) regards physical therapy as one of the most cost-effective and minimally invasive pain management methods when compared to surgery or opioids.



How Powerful a Beacon is HEDIS?

Posted by on July 9, 2014 5:58 am

If you’d want to compare HEDIS to something, a lighthouse wouldn’t be too far-fetched an object of comparison. Quite like the way it guides ships, HEDIS guides people to sign up for the right health plan.

The importance of HEDIS can never be overemphasized. HEDIS or Healthcare Effectiveness Data and Information Set has been developed for measuring the quality and performance of health plans. It functions, along with NCQA accreditation information, as a reliable yardstick by which consumers and organizations taking plans for their staff can compare the health plans on offer. It is a pretty exhaustive yardstick as well, with 75 various measurements incorporated.

HEDIS Measures

What Does HEDIS Accommodate?

HEDIS covers cervical cancer and breast cancer screenings, high blood pressure control, lead level screening in kids’ blood, immunization and weight assessment for kids and adults, etc. If these things are offered better by the health plan, it would be termed as high performing. The HEDIS program is administered by the NCQA (National Committee for Quality Assurance), and its validity is ensured thanks to a foolproof process devised by the NCQA by which certified auditors audit the data.

How is HEDIS Data Collected?

HEDIS data is collected through various processes including medical charts, medical office visits, insurance hospitalization claims, and surveys. Survey measures are conducted by an external organization approved by the NCQA. Clinical measures employ the NCQA-specified hybrid or administrative data collection methodology. The administrative data basically consists of electronic service records such as insurance claims as well as registration processes from clinics, hospitals, labs, pharmacies and clinics.

Improved and Cost-effective Healthcare

Studies reveal that attaining HEDIS measures does result in better health results and cost-effective treatment practices. These conclusions were based on research conducted in 2002 and 2003. Since HEDIS focuses chiefly on care processes, it is an indication of the quality of care the patient receives. This is perhaps the reason why HEDIS measures are widely accepted, with the NCQA claiming that these measures are used by more than 90% of health plans in America for analyzing their performance.

The CMS (Centers for Medicare and Medicaid Services) has mandated health maintenance organizations or HMOs to present HEDIS data of Medicare plans for providing HMO services for enrollees of Medicare under the Medicare Advantage program.

HEDIS is important and certainly a great boon for healthcare in the US.



ICD-10A recent study conducted at the University of Illinois, Chicago reports that pediatricians and other low margin practices may face a significant financial hit during the mandated conversion from the ICD-9 codes to the new ICD-10 codes. These specialists may lose money or data during the transition to ICD-10 medical codes. The results of this study were published in Pediatrics, the Journal of the American Academy of Pediatrics.

ICD medical codes are widely used in handling all significant aspects of healthcare starting from insurance reimbursements, staffing decisions, supply procurement and research. The ICD-10-CM codes are scheduled to be fully implemented on October 1, 2015. This new coding system includes more than 68,000 diagnostic codes when compared to the 14,000 ICD-9-CM codes.

Generally, pediatricians use a comprehensive range of ICD-9 codes relating to numerous categories such as infectious diseases, injury, childcare, and genetic disorders. As part of the study, the researchers utilized a conversion tool named GEMs (“general equivalent mappings”) for the conversion of codes. But it’s highly complex and difficult to interpret. In certain cases, some codes will get easily mapped to the new ones while others will have inconsistent mappings.

Researchers reviewed some of the commonly used codes, in order to analyze how the transition to the new code set is likely to affect the practice. They found that for patient encounters, payment and clinical data may get lost or overlapped in about 8% of these transitions. Moreover, ICD-10 implementation will cost around $83,000 and $2 million per practice, depending on the size.

Researchers used 2010 Illinois Medicaid data to identify ICD-9-CM codes for pediatric patients treated at the University of Illinois Hospital & Health Sciences System. They identified 2,708 ICD-9 codes used statewide and compared them with 174,500 Medicaid pediatric primary-care patient encounters and these encounters amounted to about $12.3 million in Medicaid payments. The medical codes conversion process was categorized (based on degree of complexity of the transition) into 5 different sections ranging from direct equivalent to convoluted. About 26% of the conversions were labeled as convoluted (as they included 23% of State Medicaid pediatric encounters and 16% of Medicaid reimbursements).

Medical practices may not get reimbursed and clinical data loss can happen if pediatricians use incorrect mappings. For example, the ICD-9 code for Twin, mate stillborn maps incorrectly to ICD-10 Twin liveborn.

  • ICD-9 code for “Twin, mate stillborn” – V38.30
  • ICD-10 code for “Twin liveborn” – Z38.30

Most of the pediatric practices perform on a low financial margin and are reimbursed at lower rates when compared to other specialties (especially by Medicaid). Hence, any discrepancies will considerably impact the functioning of these medical practices.



Cervical CancerCervical cancer was once one of the most common causes of cancer death for American women. The American Cancer Society estimates that in 2014, about 12,360 new cases of invasive cervical cancer will be diagnosed and about 4,020 women will die from cervical cancer. Most cervical cancers are caused by persistent infection with certain types of human papillomavirus (HPV). Screening for colorectal and cervical cancers can actually prevent cancer by allowing for the detection and removal of pre-cancerous lesions. The Pap test is the most widely used cervical cancer screening method.

A recent study published online in the journal Cancer finds that the incidence of cervical cancer among women ages 65 to 69 was 84 percent higher than previously reported.

For this study, researchers excluded women who had hysterectomies, in which the cervix was removed because they were no longer at risk and then concluded that the overall rate of cervical cancer was 18.6 cases per 100,000 women. They also found that the incidence rose steadily with age and peaked at ages 65 to 69. They reported that after age 69, the corrected rates of cervical cancer decrease slightly and age 65 to 69 is the time in life when the incidence of cervical cancer peaks.

Inclusion of women with hysterectomies in cervical cancer studies made cancer rate seem lower than it is, researchers say. It’s higher than previously believed, notably in older women and black women.

Oncology professionals, while dealing with all these core research updates should also focus on appropriate reimbursements and frequent coding changes for the screening services provided. Oncology billing and coding is complex and requires a high level of experience and knowledge for appropriate coding, modifier application and payer-specific medical billing. It also requires eligibility verifications and pre-authorizations or authorizations to make sure that treatment given are covered and will get paid for.

The latest ICD codes for cervical cancer screening include:

ICD-9-CM

  • V76.2 Special screening for malignant neoplasm of cervix
  • V76.2 Routine screening Pap test, intact cervix

ICD-10-CM

  • Z12.4 Encounter for screening for malignant neoplasm of cervix
  • Z12.9 Encounter for screening for malignant neoplasm, site unspecified

The authors of the study point out that taking into consideration the high and non-declining rate of cervical cancer in women in the age group 60 – 65 years (the age at which women are eligible to stop screening), it is important to reconsider the risk and screening guidelines for cervical cancer in older women.



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