jberg@itctel.com
Guest
We have a pharmacist that provides education on insulin pumps after the provider has seen them.
Here is a sample of the dictation:
Reason for Appointment
1. Insulin pump start
History of Present Illness
Care Coordination:
Larry and his wife present to the clinic today for an insulin pump start per Dr
Current Medications
TakingAccu-Chek Aviva Plus 3 time per day
Plavix 75 mg Tablet 1 tablet 1 time per day
Aspirin 81 mg TAB 1 tablet 1 time per day
Iron 83mg 1 tab Q Day
Vitamin E 400 unit TABLET 1 tab 2 times per day
Multivitamin 1 tab Q Day
Vitamin D3 1,000 unit tablet 1 tab 1 time per day
tramadol 50 MG Tablet 1 tablet as needed 3 times per day prn
Calcitriol 0.25 mcg capsule 2 tablets 1 time per day
Vitamin C 500 mg TABLET 2 tabs Once a day
BD U/F Short Pen Needle 31G 5/16 Miscellaneous USE TWICE DAILY
ReliOn Insulin Syringe 0.3/30G Miscellaneous USE AS DIRECTED FOR INSULIN
Simvastatin 40 MG Tablet 1 tablet in the evening Once a day
GlipiZIDE ER 10 MG Tablet Extended Release 24 Hour TAKE 1 TABLET TWICE A DAY
Gabapentin 300 MG Capsule 1 capsule at HS
Lasix 40 mg Tablet 1 tablet every day
Avapro 150 mg Tablet 1/2 tablet 1 time per day
Januvia 100 MG tablet 1 tabet 1 time per day
Coumadin 5 MG Tablet 7.5 mg on Mon and Thurs, 5 mg all other days Once a day
NovoLog 100 UNIT/ML Solution as directed via insulin pump
Past Medical History
Chronic anticoagulation
AF (atrial fibrillation)
CAD (coronary artery disease)
Hx of CABG
Antithrombotic drugs (platelet-aggregation inhibitors) causing adverse effect in therapeutic use
Type 2 diabetes mellitus with diabetic chronic kidney disease
Diabetes mellitus type 2 with neurological manifestations
Insulin long-term use
DM type 2 causing vascular disease
DM retinopathy
OSA on CPAP
DM neuropathy, type II diabetes mellitus
CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min
HTN (hypertension)
Current use of beta blocker
Hyperlipidemia
On statin therapy
RLS (restless legs syndrome)
Aspirin long-term use
Morbid obesity
History of amputation of foot
Allergies
Mirapex: pain in legs : Side Effects
Assessments
1. Type 2 diabetes mellitus with diabetic chronic kidney disease - E11.22 (Primary)
Treatment
1. Type 2 diabetes mellitus with diabetic chronic kidney disease
Start Bayer Contour Next Test Strip, as directed, In Vitro, 8 times a day, 30 days, 250, Refills 6 months
Stop Accu-Chek Aviva Plus, 3 time per day
Stop BD U/F Short Pen Needle Miscellaneous, 31G 5/16, USE TWICE DAILY
Stop GlipiZIDE ER Tablet Extended Release 24 Hour, 10 MG, TAKE 1 TABLET TWICE A DAY
Stop Januvia tablet, 100 MG, 1 tabet, oral, 1 time per day
Notes: Pt and wife here today for insulin pump hook up per Dr ________ will provide follow up. Provider in the room for 15 minutes to address all questions. Educated pt was previously on Lantus and Humulin R. Reviewed with provider prior to hook up and he felt that novolog would be best, since the pump uses only fast acting insulin. Dr also instructed patient to stop Januvia and Glipizide. Educated pt will have follow up with provider on 1/8, but can call before if any questions or concerns. Educated pt will need to check his BG readings about 8 times a day and bring all the readings to his appointment with provider . Educated pt this will help provider make adjustment to the pump settings. Educated pt we start the pump with conservative settings and will likely change over time. Insulin pump settings: basal: 1.7 units/ hour Insulin to carb: 1 units/15 grams CHO Correction factor: 1 unit to decrease BG by 20 mg/dl Discussed introduction to insulin pump therapy, basic features, basic programming, bolus wizard calculator, reservoir and infusion sets, trouble shooting for site, tubing, insulin, pump and optimizing options for the pump. Briefly discussed temp. basal feature, dual/square wave bolus and the option to link the meter to the pump. Pt did want to link the meter and this was completed. Called prescription to pharmacy for strips for new meter. Our registered dietitian met with patient and wife for 20 minutes to discuss carb counting. Pt and wife verbalized understanding of this information. Educated pt that lots of information was discussed and may feel overwhelmed. Provided pt with 800 number for 24 hour medtronic customer service for pump questions and discussed when to contact his provider. Pt stated had read through the book and now was feeling a little better about all the information. Educated to review books and online training at anytime, but can call with questions or concerns as well. Total time spent- 2.5 hours.
Procedure Codes
99354 PROLNG SVC OFFICE OP DIR CONTACT 1ST HR
99355 PROLNG SVC OFFICE OP DIR CONTACT EA 30 MINUTES
Follow Up
1/8 with provider
So they want to code the 99215 along with the prolonged service codes. They bill it out under the provider and not the pharmacist. I have a problem with this as it states that the provider is only in the room for 15 minutes. I have tried to address this with my supervisor but they say as long as it is billed out under the provider it is ok. I feel that the codes RUV's are for provider work and not the pharmacists work. Just wonder what any one else thinks about this.
Here is a sample of the dictation:
Reason for Appointment
1. Insulin pump start
History of Present Illness
Care Coordination:
Larry and his wife present to the clinic today for an insulin pump start per Dr
Current Medications
TakingAccu-Chek Aviva Plus 3 time per day
Plavix 75 mg Tablet 1 tablet 1 time per day
Aspirin 81 mg TAB 1 tablet 1 time per day
Iron 83mg 1 tab Q Day
Vitamin E 400 unit TABLET 1 tab 2 times per day
Multivitamin 1 tab Q Day
Vitamin D3 1,000 unit tablet 1 tab 1 time per day
tramadol 50 MG Tablet 1 tablet as needed 3 times per day prn
Calcitriol 0.25 mcg capsule 2 tablets 1 time per day
Vitamin C 500 mg TABLET 2 tabs Once a day
BD U/F Short Pen Needle 31G 5/16 Miscellaneous USE TWICE DAILY
ReliOn Insulin Syringe 0.3/30G Miscellaneous USE AS DIRECTED FOR INSULIN
Simvastatin 40 MG Tablet 1 tablet in the evening Once a day
GlipiZIDE ER 10 MG Tablet Extended Release 24 Hour TAKE 1 TABLET TWICE A DAY
Gabapentin 300 MG Capsule 1 capsule at HS
Lasix 40 mg Tablet 1 tablet every day
Avapro 150 mg Tablet 1/2 tablet 1 time per day
Januvia 100 MG tablet 1 tabet 1 time per day
Coumadin 5 MG Tablet 7.5 mg on Mon and Thurs, 5 mg all other days Once a day
NovoLog 100 UNIT/ML Solution as directed via insulin pump
Past Medical History
Chronic anticoagulation
AF (atrial fibrillation)
CAD (coronary artery disease)
Hx of CABG
Antithrombotic drugs (platelet-aggregation inhibitors) causing adverse effect in therapeutic use
Type 2 diabetes mellitus with diabetic chronic kidney disease
Diabetes mellitus type 2 with neurological manifestations
Insulin long-term use
DM type 2 causing vascular disease
DM retinopathy
OSA on CPAP
DM neuropathy, type II diabetes mellitus
CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min
HTN (hypertension)
Current use of beta blocker
Hyperlipidemia
On statin therapy
RLS (restless legs syndrome)
Aspirin long-term use
Morbid obesity
History of amputation of foot
Allergies
Mirapex: pain in legs : Side Effects
Assessments
1. Type 2 diabetes mellitus with diabetic chronic kidney disease - E11.22 (Primary)
Treatment
1. Type 2 diabetes mellitus with diabetic chronic kidney disease
Start Bayer Contour Next Test Strip, as directed, In Vitro, 8 times a day, 30 days, 250, Refills 6 months
Stop Accu-Chek Aviva Plus, 3 time per day
Stop BD U/F Short Pen Needle Miscellaneous, 31G 5/16, USE TWICE DAILY
Stop GlipiZIDE ER Tablet Extended Release 24 Hour, 10 MG, TAKE 1 TABLET TWICE A DAY
Stop Januvia tablet, 100 MG, 1 tabet, oral, 1 time per day
Notes: Pt and wife here today for insulin pump hook up per Dr ________ will provide follow up. Provider in the room for 15 minutes to address all questions. Educated pt was previously on Lantus and Humulin R. Reviewed with provider prior to hook up and he felt that novolog would be best, since the pump uses only fast acting insulin. Dr also instructed patient to stop Januvia and Glipizide. Educated pt will have follow up with provider on 1/8, but can call before if any questions or concerns. Educated pt will need to check his BG readings about 8 times a day and bring all the readings to his appointment with provider . Educated pt this will help provider make adjustment to the pump settings. Educated pt we start the pump with conservative settings and will likely change over time. Insulin pump settings: basal: 1.7 units/ hour Insulin to carb: 1 units/15 grams CHO Correction factor: 1 unit to decrease BG by 20 mg/dl Discussed introduction to insulin pump therapy, basic features, basic programming, bolus wizard calculator, reservoir and infusion sets, trouble shooting for site, tubing, insulin, pump and optimizing options for the pump. Briefly discussed temp. basal feature, dual/square wave bolus and the option to link the meter to the pump. Pt did want to link the meter and this was completed. Called prescription to pharmacy for strips for new meter. Our registered dietitian met with patient and wife for 20 minutes to discuss carb counting. Pt and wife verbalized understanding of this information. Educated pt that lots of information was discussed and may feel overwhelmed. Provided pt with 800 number for 24 hour medtronic customer service for pump questions and discussed when to contact his provider. Pt stated had read through the book and now was feeling a little better about all the information. Educated to review books and online training at anytime, but can call with questions or concerns as well. Total time spent- 2.5 hours.
Procedure Codes
99354 PROLNG SVC OFFICE OP DIR CONTACT 1ST HR
99355 PROLNG SVC OFFICE OP DIR CONTACT EA 30 MINUTES
Follow Up
1/8 with provider
So they want to code the 99215 along with the prolonged service codes. They bill it out under the provider and not the pharmacist. I have a problem with this as it states that the provider is only in the room for 15 minutes. I have tried to address this with my supervisor but they say as long as it is billed out under the provider it is ok. I feel that the codes RUV's are for provider work and not the pharmacists work. Just wonder what any one else thinks about this.