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ICD-PM promoted by WHO to improve infant death reporting

30th September 2016

According to WHO, every year, worldwide, millions of babies die within the first 28 days of life, and just as many are stillborn. Unfortunately, most stillborn babies and half of all newborn deaths are not recorded in a birth or death certificate. This lack of data prevents countries from taking effective and timely actions to prevent other babies from dying.

ICD-PM is intended to assist healthcare providers and those charged with death certification to correctly document underlying causes of death. This will improve the information available to coders, program managers, statistical offices and academics/researchers.

WHO recently launched three publications to help countries improve their data on stillbirths and maternal and neonatal deaths using ICD-PM.

  • 1) The WHO application of ICD-10 to deaths during the perinatal period: ICD-PM-This is a standardized system for classifying stillbirths and neonatal deaths. This guide is intended to be used with the three volumes of ICD-10. The suggested code should be verified, and possible additional information should be coded using the full ICD-10 volumes 1 and 3; rules for selection of underlying cause of death and certification of death apply in the way they are described in ICD-10 volume 2.
  • 2) Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths- This is a guide to reviewing and investigating individual deaths for the purpose of recommending and implementing solutions to prevent similar ones in the future. It also incorporates ICD-PM classification to help providers complete at least a basic death review.
  • 3) Time to respond: a report on the global implementation of maternal death surveillance and response (MDSR) - This explains how to strengthen the maternal mortality review process in hospitals and clinics. The document also provides guidance for establishing a safe environment for health workers to improve quality of care within clinics and an approach to recording deaths occurring outside the health system, such as when mothers deliver at home.

Emergency preparedness plans mandatory as per the final rule

The Centers for Medicare & Medicaid Services (CMS) has found that many providers and suppliers have emergency preparedness requirements, but those requirements fall short. Hence they have issued a rule which addresses three necessary elements for maintaining access to healthcare services during emergencies.

The rule will help in emergency preparedness requirements that will be consistent and enforceable for all affected Medicare and Medicaid providers and suppliers. According to the rule, three necessary elements for maintaining access to healthcare services during emergencies include: safeguarding human resources, maintaining business continuity & protecting physical resources.

CMS identifies four core elements in the final rule that it considers central to an effective and comprehensive emergency preparedness program which are as mentioned below:

  • 1) Risk assessment and emergency planning- Facilities are required to perform a risk assessment that uses an ‘all-hazards’ approach prior to establishing an emergency plan.
  • 2) Policies and procedures- Facilities are required to develop and implement policies and procedures that support the successful execution of the emergency plan and risks identified during the risk assessment process.
  • 3) Communication plan-Facilities are required to develop and maintain an emergency preparedness communication plan that complies with both federal and state law.
  • 4) Training and test- Facilities are required to develop and maintain an emergency preparedness training and testing program.

Situations when Status T codes need not to be reported

The Comprehensive Error Rate Testing program frequently identifies instances where CPT® and HCPCS Level II codes routinely bundled into related procedure codes are reported separately and paid. This is problematic because Medicare considers all services integral to accomplishing a procedure bundled into that procedure, and not separately payable.

All codes published in the Medicare Physician Fee Schedule (MPFS) are assigned a status indicator (SI). These indicators identify whether a code is active (A), restricted (R), bundled (T or P), etc. Unlike status P (Bundled/Excluded) codes, which are not assigned relative value units (RVUs), status T codes do have RVUs; however, these codes are paid only if there are no other related SI A or R services payable under the MPFS, billed on the same date, by the same provider.

One way to determine if a code carries a status T indicator is to use the national Physician Fee Schedule Search tool. From here, appropriate year is selected, then payment policy indicators option is selected and then single HCPCS code option is selected. Code is entered in the question and all modifiers are selected and then submit button is finally clicked. The status indicator will be located in the second column, labeled Proc Stat.

Important aspects to know about Medical billing for dental offices and the 2017 CDT (Current Dental Terminology)updates

For many of patients, medical insurance may provide better coverage and lower out-of-pocket expenses than their dental coverage for the same procedure. By helping patients receive proper insurance coverage for necessary treatments, it is ensured that they can adhere to a treatment plan and restore their health.

The following is a selection of new codes and how they relate to medically necessary treatments:

  • • D0414 (Laboratory processing of microbial specimen to include culture and sensitivity studies, preparation, and transmission of written report)- This code relates to microbial specimens. That means that the lab processing may be covered by a patient’s medical insurance.
  • • D0600 (Non ionizing diagnostic procedure capable of quantifying, monitoring, and recording changes in structure and enamel, dentin, and cementum)- Procedures covered by this code could be eligible for medical billing if the structural changes are related to a medical condition such as GERD or bulimia or the side-effects of certain medications.
  • • D4346 (The removal of plaque, calculus, and stains from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis)- It is indicated for patients who have swollen, inflamed gingival and generalized suprabony pockets, in moderate to severe bleeding on probing. This should not be reported in conjunction with prophylaxis, scaling and root planning, or debridement procedures. Inflammation is a recognized medical condition, and treating gingival inflammation is especially important when patients have diabetes or heart disease. Because this procedure can treat a condition caused by these systemic diseases, it may be eligible for medical billing.
  • • D9311 (Treating dentist consults with a medical health care concerning medical issues that may affect patient’s plan dental treatment)- This code represents clear acknowledgement of the oral-systemic health link. It’s meant to cover consultations with a patient’s primary care provider and other specialists. For instance, when a patient with diabetes is treated, it is required to collaborate with the person’s primary care physician on issues related to blood sugar control, medications, diet, and exercise. Since diabetes affects the gums and the gums affect diabetes management, these medical consultations can greatly improve a patient’s overall health and well-being. Using this code generally indicates that a systemic medical condition is being treated with oral effects rather than a purely dental condition.
  • • D9993- Patient-centered, personalized counseling using methods such as motivational interviewing to identify and modify behaviors interfering with positive oral health outcomes. This is a separate service from traditional nutritional or tobacco counseling.
  • • D9991(Individualized efforts to assist patients to maintain scheduled appointments by solving transportation challenges or other barriers)- This was put into effect to cover Medicaid patients so they do not miss appointments, and then show up in pain.
  • • D9992 (Assisting in a patient’s decision regarding the coordination of oral health care services across multiple providers, provider types, specialty areas of treatment, health care settings, health care organizations, and payment systems)- This code is used to explain the additional time and resources used to provide experience or expertise beyond that possessed by the patient.
  • • D9994 (Individual, customized communication of information to assist a patient in making appropriate health decisions designed to improve oral health literacy)- It should be explained in a manner acknowledging economic circumstances and different cultural beliefs, values, attitudes, traditions, and language preferences, and adopting information and services to these differences. This requires the expenditure of time and resources beyond that of an oral evaluation or case presentation.
  • • With regard to dental implants, D6081 is a procedure no longer performed in conjunction with D1110 or D4910.D6085 is used when a period of healing is necessary prior to fabrication and placement of permanent prosthetic. Recently revised surgical codes include D7140, D7210, D7250, and D7280.

These new codes will be effective from 2017.

CMS ICD-10 Coding grace period to end on 1st Oct 2016

According to CMS 1st Oct 2016 will be the cutoff date for the use of unspecified or less specific codes when more specific codes are applicable. Although there had been some flexibility during the first year, the coding flexibilities will end on October 1, 2016. Therefore a detailed look at every claim is required to ensure that claim is coded accurately to reflect the clinical documentation in as much specificity as possible, otherwise the claims can be denied.

When ICD-10 was first implemented, providers were allowed some leniency and could use “a valid code from the correct diagnostic family or ICD-10 three character category, even if a more specific code existed.” As long as there was no evidence of fraud, CMS prohibited revenue contractors from denying Medicare fee-for-service claims based on specificity issues with diagnosis codes. However, CMS believes that the 12-month grace period was sufficient to allow providers to transition all of their codes and business practices so that, by now, everyone should be using the correct codes.

CMS cautions that healthcare providers should “report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition however in some instances, unspecified codes are the best choice to accurately reflect the healthcare encounters.

While there are thousands of new codes in ICD-10, there are not thousands of new diseases. More than 1/3 of the ICD-10 codes are repeated codes, where laterality is the only difference. In reality, the greater number of codes makes it easier to find the right one. Because ICD-10 is much more specific and uses a more logical structure compared to ICD-9, it is actually easier to use. Knowing the new codes will help avoid billing errors, or increases in DSO, or in delayed payments, etc. CMS therefore is looking for proactive management of documentation and billing so that reimbursement does not suffer once the “flexibilities” come to an end.

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