WHO Promotes ICD-PM to Improve Infant Death Reporting
Every year, worldwide, millions of babies die within the first 28 days of life, and just as many are stillborn, reports the World Health Organization (WHO) in an Aug. 16 news release. 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, WHO warns.
What Is ICD-PM?
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.
There are three distinct features of ICD-PM:
- It captures the time of a perinatal death in relation to the antepartum (before the onset of labor), intrapartum (during labor, but before delivery) or neonatal period (up to day 7 of postnatal life).
- It applies a multilayered approach to the classification of cause of death. In using ICD-PM, mutually exclusive clinical conditions that lead to the identification of a single cause of perinatal death may be determined and linked with an ICD code.
- It links the contributing maternal condition, if any, with perinatal death.
Three New Guides for Using ICD-PM
WHO recently launched three publications to help countries improve their data on stillbirths and maternal and neonatal deaths using ICD-PM.
The first publication, the “WHO Application of the International Classification of Disease-10 to deaths during the perinatal period (ICD-PM),” 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.
The second publication, “Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths,” 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.
The third publication, “Time to respond: a report on the global implementation of maternal death surveillance and response,” 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.
WHO is also participating in a global multi-partner effort to improve the quality of health information, including data on maternal and child health, through the Health Data Collaborative. More than 30 global health organizations are contributing to the development of a user-friendly package of guidance and tools designed to strengthen countries’ health information systems.
Quick Guide to Modifier 58
Modifier 58 Staged or related procedure or service by the same physician or other qualified healthcare professional during the postoperative period is applied only during the postoperative period of a prior procedure, to indicate that the current procedure is either:
Planned prospectively or at the time of the prior procedure
For example, skin grafts may be performed in stages to allow adequate healing time between procedures. Subsequent skin grafts are expected, following initial procedure.
Tip: Do not append modifier 58 for staged procedures when the code description indicates “one or more visits” or “one or more sessions” (e.g., 65855 Trabeculoplasty by laser surgery, 1 or more sessions (defined treatment series)
2. More extensive than the prior procedure
The physician performed a dilation and curettage (D&C) on April 1, followed by a hysterectomy on April 10. In this case, the D&C (e.g., 58120 Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)) is the initial procedure. The hysterectomy (e.g., 58260 Vaginal hysterectomy, for uterus 250 g or less) is a more extensive procedure during the global period of the initial, related procedure, to which you would append modifier 58.
3. For therapy following a diagnostic surgical procedure
For example, the General Correct Coding Policies for National Correct Coding Initiative Policy Manual for Medicare Services, Chapter 1, explains:
If a diagnostic endoscopy is the basis for and precedes an open procedure, the diagnostic endoscopy is separately reportable with modifier 58. However, the medical record must document the medical reasonableness and necessity for the diagnostic endoscopy.
In this case, the open procedure is a therapeutic procedure following a diagnostic endoscopy.
Successfully Report Medicare Teleconferences
The Centers for Medicare & Medicaid Services (CMS) allows coverage for telehealth consultations, using dedicated G codes. Codes describing initial telehealth consultations apply to inpatients, including those in a skilled nursing facility (SNF), or to patients in an emergency department (ED):
G0425 Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth [problem focused history, problem focused examination, straightforward medical decision making]
G0426 Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth [detailed history, detailed examination, moderate complexity medical decision making]
G0427 Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth [comprehensive history, comprehensive examination, high complexity medical decision making]
Follow-up codes similarly apply to SNF or hospital inpatients, as well as to ED patients:
G0406 Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth [problem focused history, problem focused examination, straightforward medical decision making]
G0407 Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth [detailed history, detailed examination, moderate complexity medical decision making]
G0408 Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth [comprehensive history, comprehensive examination, high complexity medical decision making]
Per the Medicare Claims Processing Manual, Chapter 12, section 190.3.1, subsequent hospital care services are limited to one telehealth visit every three days. Subsequent nursing facility care services are limited to one telehealth visit every 30 days.
Whether reporting initial or follow-up services, the provider must meet all three required elements (history, exam, MDM) to bill a particular level of service. For example, to report G0407, the provider must document at least a comprehensive history, a compressive exam, and high complexity MDM.
Documentation Must Meet Consult Requirements
To demonstrate that the service matches the CMS definition of a consult, documentation should verify the following elements:
- A request for opinion or advice, and a stated reason to substantiate the need for the service. Because the consulting provider bills the service, it’s in his or her best interest to document the request as part of the patient record. Specify that the visit is “consult” (not, for instance, a “referral,” which may signify to the payer a transfer of care rather than a request for consultation). If possible, ask the requesting provider to make the request in writing (e-mail, fax, a note sent with the patient, etc.), and make that part of the record, too.
- A report from the consulting provider, back to the requesting provider. The service is justified only if the consulting physician gives his opinion and/or advice to the requesting provider. Without a report back to the requesting provider, a consultation hasn’t occurred.
Originating Site Must Be Qualified
Telehealth services are available only to those patients in a qualified originating site. Telehealth originating sites must be located in a designated rural Health Professional Shortage Area (HPSA), located either outside of a Metropolitan Statistical Area (MSA) or in a rural census tract, or a county outside of a MSA. To determine a potential originating site’s eligibility for Medicare telehealth payment, visit the CMS website.
Face-to-Face (Usually) a Requirement
Medicare pays only for interactive video consultation services that mimic face-to-face interactions between patients and providers. CMS stipulates that video telecommunications system must permit “real-time communication between … the physician or practitioner at the distant site, and the beneficiary, at the originating site.”
When reporting an approved telehealth service, you must append modifier GT Via interactive audio and video telecommunications systems to the appropriate service code(s). The modifier tells your Medicare contractor that
the beneficiary was present at an eligible originating site when the telehealth service was furnished.
“Asynchronous ‘store and forward’ technology” (e.g., video clips, still images, X-rays, MRIs, EKGs and EEGs, laboratory results, audio clips, and text) is covered only in Federal telemedicine demonstration programs in Alaska or Hawaii. For non “face-to-face” telehealth services, report the appropriate code for the professional service with modifier GQ Via an asynchronous telecommunications system appended.
Pace Yourself in 2017 to Avoid Negative Payment Adjustment in 2019
The physician community has been in a bit of a tizzy since April, when the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rulemaking for implementing quality-based payment — and with good reason. The expectation for eligible clinicians to begin performance reporting at the start of 2017, or face negative payment adjustments in 2019, is daunting, to say the least.
As it turns out, things may not be as dire as first thought. CMS actually intends to offer four ways to participate in the Quality Payment Program (QPP) the first year.
“In recognition of the wide diversity of physician practices, we intend for the Quality Payment Program to allow physicians to pick their pace of participation for the first performance period that begins January 1, 2017,” said Acting Administrator of CMS Andy Slavitt in a CMS blog entry on Sept. 8.
More Ways to Participate
The Quality Payment Program offers two tracks for participation: Merit-based Incentive Payment System (MIPS); and Advanced Alternate Payment Models (APMs).
Slavitt lists in his blog four options eligible clinicians may participate in either of these two tracks during the 2017 performance period to avoid a negative payment adjustment in 2019:
- Submit “some” data to the QPP, including data from after Jan. 1, 2017.
- Submit QPP information for a reduced number of days. This option would allow you to begin later than Jan. 1, 2017.
- Submit QPP information for a full calendar year.
- Join an Advanced APM, such as Medicare Shared Savings Track 2 or 3 in 2017. If you receive enough of your Medicare payments or see enough of your Medicare patients through the Advanced APM in 2017, then you would not only avoid a negative payment adjustment, but qualify for a 5 percent incentive payment in 2019.
More To Come
Slavitt is fairly vague in his explanation of these four options. Hopefully, the QPP final rule, expected out Nov. 1, will explain these options in more detail.
RAC Monitor – The Expanded Role of Hospital Pharmacists
AAPC member Courtney Boss, BS, CPC, wrote an article for RAC Monitor about the evolving role of pharmacists. Boss tells how the Patient Protection and Affordable Care Act (PPACA) has led pharmacy professionals to expand their duties in order to better meet the needs of those they serve. Learn about the broadened role of pharmacists, the coding repercussions, and some of the associated risks in her article, Hospital Pharmacists: Expanded Roles, New Audit Risks.