posted 02/21/2007
Electronic news for February 2007
Read the EdgeBlast and Earn CEUs Toward Your Annual Renewal
You can now earn continuing education units (CEUs) by reading the EdgeBlast. Simply answer the five questions found in the EdgeBlast Test Yourself at the end and submit your answers at the time of your renewal, using the same process you follow monthly for the Test Yourself in the AAPC Cutting Edge. Each EdgeBlast (there are two issued each month) will feature five questions that can earn you .5 CEUs, for a total of 12 CEUs annually.

Americans Walking Away from Physical Activity

by Chris Fraizer, MA, CPC

Barbara McGann, CPC, takes a daily 40-minute walk. The Southern Utah native routinely finds time each day to take her dogs around her Castle Valley neighborhood. On most days she’s also getting out a second time for a 20-minute jog. That’s on top of the Yoga she enjoys.

Barbara says the leisure activity is a habit she picked up years ago to combat extra weight, especially during the past several years of more sedentary work as a coder. But there’s another benefit, she said. “I need the fresh air and sunshine,” she said. “If I don’t get up and move, I feel it.” Barbara’s daily round of exercise is hardly the norm. According to the results of a recent study available from the National Center for Health Statistics (NCHS), physical activity keeps declining among Americans, as fewer and fewer adults find the time to make physical activity a part of their daily routine.

Overall Findings

According to the NCHS report:

  • While there was little change in the percentage of adults who engaged in usual daily activities and leisure-time physical activities between 2000 and 2005, the statistically significant changes that did occur indicate that U.S. adults are becoming less physically active.
  • Between 2000 and 2005, there was an increase in the percentages of adults who spent their usual daily activity sitting, did not lift anything during their usual daily activity, and did not engage in any leisure-time physical activity.
  • During this time period, the percentages of adults who walked during their usual daily activity, lifted heavy loads during their usual daily activity, and engaged in regular leisure-time physical activity decreased.
Statistics
  • Walking as a form of leisure activity is on the decline for women and men between the ages 25–64
    • Year 2000, ages 24–44, 51.6 percent; Year 2005, ages 24–44, 50.7 percent
    • Year 2000, ages 45–64, 48.3 percent; Year 2005, ages 45–64, 47 percent
  • The amount of physical activity on a regular basis is declining for the same age groups, among women and men
    • Year 2000, ages 24–44, 34.4 percent (regularly active); Year 2005, ages 24–44, 32.0 percent
    • Year 2000, ages 45–64, 29.0 percent (regularly active); Year 2005, ages 45–64, 28.6 percent
  • The percentage of females never active continues to increase, while the percentage of women highly active continues to decline
    • Year 2000 (never active), 11.4 percent; Year 2005 (never active), 12.0 percent
    • Year 2000 (highly active), 16.7 percent; Year 2005 (highly active), 16.3 percent
Conclusion

The positive influence that physical activity has on health has been well established. The following are examples of the risks we take from inactivity:

  • Among adults, regular physical activity has been associated with a reduced risk of stroke, impaired glucose tolerance, Type 2 diabetes, mortality, and cardiovascular disease incident events.
  • Engaging in physical activity daily has also proven to be helpful in both losing weight and maintaining weight loss.
This report compares national estimates of physical activity, both usual daily activity and leisure-time physical activity, among adults based on responses to the physical activity questions found in the 2000 and 2005 National Health Interview Surveys (NHIS). The link to the full report is available at http://www.cdc.gov/nchs/nhis.htm.

New Pediatric Immunization Schedules Reflect Changes to CPT® Codes

by Chris Fraizer, MA, CPC

CPT® vaccine codes for 2007 reflect the new pediatric immunization schedule that, for the first time, divides the schedule into two: one for children from birth to six years of age and a second for those seven to 18 years of age.

The Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) released the The 2007 Childhood and Adolescent Immunization Schedules in January and it includes new immunization recommendations for rotavirus, varicella (chickenpox), childhood influenza, and human papillomavirus (HPV).

Schedules

Oral rotavirus vaccine

The new rotavirus vaccine (Rota) is recommended in a 3-dose schedule at ages two, four, and six months. The first dose should be administered at ages six weeks through 12 weeks with subsequent doses administered at four to10 week intervals. Rotavirus vaccination should not be initiated for infants less than 12 weeks of age and should not be administered after age 32 weeks.

CPT® Codes: 90680 (pentavalent, three dose schedule live, oral use)

Varicella (chickenpox)

Children four years to six years of age are now recommended to receive a second dose of varicella (chickenpox) vaccine to further protect against the disease. The first dose is recommended at 12 to 15 months of age. Older children, adolescents and adults should also receive a catch-up second dose if they previously had received only one dose.

CPT® Codes: 90716 (live, subQ)

Childhood influenza

The childhood influenza vaccination recommendation has expanded to include children 24 months to five years old, as well as their household contacts and caregivers. The previous recommendation was for children six months through 23 months. Now children from 6 months through 59 months are recommended for an annual influenza vaccination.

CPT® Codes: 90655 (six-35 months, spllit virus, preservative free, IM), 90656 (3 years and older, split virus, preservative free, IM), 90657 (6-35 months, split virus, IM), 90658 (three years and older, split virus, IM)

Human papillomavirus (HPV)

Girls age 11 to 12 years of age receive a three-dose series of human papillomavirus (HPV) vaccine, with the second dose two months after the first dose and the third dose at least four months after the second dose. The recommendation also allows for vaccination of girls beginning at nine years old as well as vaccination of girls and women 13–26 years old.

CPT® Code: 90649 (a three dose schedule)

Coding

To code, use the appropriate ICD-9-CM V code, along with the appropriate CPT® code immunization code and the appropriate CPT® administration code. Don’t forget that codes 90465–90468 require face-to-face counseling of the patient and family during the vaccine administration; without the face-to-face, use codes 90471–90474. Also, if the child is at the physician’s office for a well child exam, use the preventive medicine service codes 99381–99387 (new patient) or 99391–99397 (established patient); these codes are divided by age groupings.

The ICD-9-CM vaccination codes are:

Oral rotavirus vaccine – V04.89
Varicella – V05.4
Influenza – V04.81
Human papillomavirus (HPV) – V05.8

Great sites to visit

CDC—CPT® Codes mapped to CVX vaccine codes

http://www.cdc.gov/nip/registry/st_terr/tech/stds/cpt.htm

CDC—National Immunization Program

http://www.cdc.gov/nip/registry/

Also, check your State’s immunization registry

For example, authorized users of the Washington State Health Department site (https://fortress.wa.gov/doh/cpir/iweb/main.jsp) can:

  • Add and edit patient records
  • Review vaccination records, adding or editing current and historical immunizations
  • Maintain facility-specific records on vaccinators, physicians, and lot numbers
  • Record required information for each VIS given
  • Access the tools to support a reminder/recall system

The 2007 immunization schedules can be found at CDC's Morbidity and Mortality Weekly Report (MMWR) at http://www.cdc.gov/mmwr.

The immunization tables are available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5551a7.htm (January 5, 2007 MMWR Weekly, the CDC).

Study Data Could Help Relieve that Pain in your Wrist

by Chris Fraizer, MA, CPC

Are co-workers saying the sharp pain shooting up your wrist is nothing more than a passing cramp? Or, maybe similar to you, do they daily encounter risk factors that could cause carpal tunnel syndrome (CTS), but lack the information to modify their work styles?

If you answered “yes” to either of these questions, the results of a three-year $1.45 million grant may provide the evidence you need to prevent pain and injury in the face of a repetitive motion job description.

The grant, funded by the National Institute for Occupational Safety and Health and the National Institutes of Health, is set up to quantify risk factors that may cause common workplace disorders. The research will come out of the University School of Medicine and the University of Wisconsin and will be based on analyzing a total of 1,000 workers from both states to predict the development of CTS, tennis elbow and shoulder tendonitis.

According to a story published in the University of Utah Health Sciences magazine (Winter 2007), the investigators plan to use the data to:

  • Quantify risk factors
  • Use the risk factors against job analysis factors
  • Construct job methods that might prevent the disorders in a broad array of industries

According to the Bureau of Labor Statistics, disorders associated with repeated trauma account for about 60 percent of all occupational illnesses. Of all these disorders, CTS is the condition most frequently reported. The cost associated with CTS and cubital tunnel syndrome (CBTS) accounts for $1 of every $3 spent for workers compensation, with the cost being $3,500 to $35,000 per case.

Although the repetitive motion syndromes account for a majority of work-related injuries, studies indicate a lack of adequate clinical evaluation and guidelines for use in their diagnosis. For example:

  • In a study of medically certified patients with a work-related upper extremity industry disorder, 197 of the 297 of the study’s participants had been diagnosed as having carpal tunnel syndrome although diagnostic lab studies were ordered only 25 times (Concurrent Medical Disease and Work-Related Carpal Tunnel Syndrome, Steven G. Atcheson, MD; John R. Ward, MD; Wing Lowe, PhD, Arch Intern Med. 1998;158:1506–1512)
  • Another study cites a surprising lack of guidelines on diagnosing occupational CTS readily accessible to primary care physicians, and recommends a set of diagnosis and treatment guidelines for managing the many patients that present with work-related CTS (Carpal Tunnel Syndrome as an Occupational Disease, Kao Sy, J Am Board Fam Pract 2003 Nov-Dec;16(6):533–42)

According to other research, workers compensation has been slow to respond to claims of repetitive work related injuries. For example, in a New York Occupational Health Clinic, 79 percent of the claims were not initially accepted by the workers compensation insurer, although of those challenged cases, 96.3 percent were accepted later as work-related injuries. Mean time from claim to settlement was 429 days, physician treatment and workers compensation board approval 226 days, and surgery authorization from the board was 318 days.

EdgeBlast Test Yourself

By answering the following questions you can earn .5 continuing education units to apply toward your annual Academy certification renewal. Simply answer the questions and send in a copy of your work when submitting your CEU package. Put the number of each EdgeBlast included in your submission. The number is available at the top of the page.

Answers to the questions are not always found directly (word for word) in the EdgeBlast in which they appear. While often related to the EdgeBlast content, they require additional resources such as your ICD-9-CM, CPT® and HCPCS manuals.

1. The following is a medically necessary immunization example provided by CMS:

A woman who has diabetes is working in her barn and steps on a rusty nail, which causes a jagged open wound in her foot. An internist examines her and determines that, since she has not had a tetanus shot in 20 years, he should administer a booster. Assuming the physician has never seen this patient before. What are the correct procedure and diagnosis codes for this service?

Answer:

2. A 4-month-old established patient is at a physician’s office for his well child exam. The patient is scheduled to receive his second rotavirus vaccine. After the physician distributes the VIS and discusses the risks and benefits of the immunization with his parents, the vaccine is administered. What are the correct procedure and diagnosis codes for this service?

Answer:

3. A physician repairs injuries known as the “unhappy triad”—meniscus tear (lateral), a torn anterior cruciate ligament and a sprained lateral collateral ligament (LCL)—affecting a football player hit on the outside of the knee during the Superbowl Game. The repairs made arthroscopically are a lateral meniscus repair and an anterior cruciate ligament repair. The LCL injury is treated non-surgically (ice packs). What are the procedure and diagnosis codes?

Answer:

4. The physician performs carpal tunnel release surgery for the treatment of CTS for a patient that has not responded to conservative treatment options, such as wrist splint use and steroidal injections. The surgery involves an enlargement of the carpal tunnel, performed endoscopically, to reduce the pressure on the nerve. What are the diagnosis and procedure codes?

Answer:

5. A study published recently in the New England Journal of Medicine found that nasal-spray version of the flu vaccine protects some young children better than flu shots. What is the CPT® code for the nasal-spray version of the flu vaccine? Incidentally, the nasal flu shot is not approved for children under five.

Answer: