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Issue #111 - October 15, 2008 
AAPC EdgeBlast

CMS Announces RACs
The Centers for Medicare & Medicaid Services (CMS)  awarded contracts to four permanent Recovery Audit Contractors (RACs) as announced in an Oct. 6 Fact Sheet. They are:

  • Diversified Collection Services, Inc. of Livermore, Calif.: Region A, initially working in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and New York.
  • CGI Technologies and Solutions, Inc. of Fairfax, Va.: Region B, initially working in Michigan, Indiana, and Minnesota.
  • Connolly Consulting Associates, Inc. of Wilton, Conn.: Region C, initially working in South Carolina, Florida, Colorado, and New Mexico.
  • HealthDataInsights (HDI), Inc. of Las Vegas, Nev.: Region D, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah, and Arizona. Read more »

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CMS Presses On with PHR Program
CMS is expanding its South Carolina personal health record (PHR) pilot program with TRICARE health data.  The addition eases access to health data for Medicare beneficiaries.

Original Medicare beneficiaries who also received TRICARE benefits now have the option of adding the TRICARE health data to their MyPHRSC personal health records.  Until now, the data has only been available through the Department of Defense systems. Read more »

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GAO: OPPS Imaging Cap Lowered Spending
The rapid growth of imaging services paid for under the Medicare Part B physician fee schedule (MPFS) has slowed since Congress implemented a cap on the hospital outpatient prospective payment system (OPPS), but it has not limited access to Medicare beneficiaries, according to a Government Accountability Office (GAO) Sept. 26 report.

In accordance with the Deficit Reduction Act of 2005 (DRA), Medicare fees for certain imaging services covered by the physician fee-for-service (FFS) schedule may not exceed what Medicare pays for these services under the OPPS. Read more »

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New Bill to Expand Home Health Services
New legislation (S 3613, HR 7114) introduced Sept. 26 by Rep. Edward Markey (D-Mass.) addresses the rising toll of health care costs and the nation’s expanding elderly population. People with chronic conditions account for 76 percent of all hospital admissions, 88 percent of all prescriptions filled, and 72 percent of physician visits, according to the proposed legislation.

Through a three-year demonstration, the Independence at Home Act of 2008 seeks to provide Medicare beneficiaries suffering from multiple chronic conditions access to more affordable at-home services under a plan of care developed by a physician or nurse practitioner. Read more »

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Immunization Alliance Endorses Call to Action
The concern for keeping immunization rates at adequate levels prompted the nation’s leading medical and advocacy groups to join forces to raise the public’s confidence in vaccines. The Immunization Alliance calls on policymakers, public health agencies, physicians, and the public to work together to preserve the health of the nation’s children through immunization. Read more »

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Coding Tips
Corrections and Additions to October 2008 ASC Update
The Centers for Medicare & Medicaid Services (CMS) released the October 2008 Ambulatory Surgical Center (ASC) Update Oct. 3, notifying contractors to download the October 2008 ASC Drug file. In the file are three new drug or biological HCPCS Level II codes, payable on or after Oct. 1.

The new codes are: C9243 Injection, bendamustine hcl, 1 mg; C9244 Injection, regadenoson, 0.4 mg; and C9359 Porous purified collagen matrix bone void filler (Integra Mozaik Osteoconductive Scaffold Putty, Integra OS Osteoconductive Scaffold Putty), per 0.5 cc.

Contractors were also notified of incorrect payment rates in previous updates for a handful of HCPCS Level II codes. The payment rates for three codes were wrong in the January 2008 ASC Drug file. Read more »

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Medical News
CDC Awards ATCC $16.9 Million Contract to Man CDC-IRR
If you fear the influenza virus will mutate and become a pandemic, you’ll be pleased to learn that the Centers for Disease Control and Prevention (CDC) has awarded a $16.9 million one-year contract to American Type Culture Collection (ATCC) of Manassas, Va. to implement the CDC Influenza Reagent Resource (CDC-IRR), a secure, Web-based system intended to improve access to influenza viruses, test kits and other reagents for approved laboratories. Read more »

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HHS Releases New Physical Activity Guidelines
If your idea of exercise is a brisk walk to the refrigerator, you may be falling short on the latest recommendations for physical activity. Adults should get two-and-a-half hours of moderate aerobic activity weekly; children and teens should get at least one hour of moderate to vigorous activity daily, according to the new “Physical Activity Guidelines for Americans,” released by the U.S. Department of Health and Human Services (HHS). The new guidelines recommend both groups engage in muscle strengthening activities, and bone-strengthening activities for children. Go to the HHS Web site for more information about the “Physical Activity Guidelines for Americans.”

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USPSTF: No Colorectal Screening for 76-year-olds
The U.S. Preventative Services Task Force (USPSTF) submitted its latest recommendation for colorectal cancer screening.

In general, the USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy beginning at 50 years old and continuing until  75 years old. The Task Force recommends against screening for colorectal cancer in adults age 76 or older.

These recommendations were published Oct. 7 by the Annals of Internal Medicine and the Agency for Healthcare Research and Quality (AHRQ). Read the published summary recommendations and documentation on AHRQ’s Web site.

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Learn How to Prevent DVT
The U.S. Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ) recently published two new guides to help consumers and clinicians prevent and treat deep vein thrombosis (DVT).

The clinician guide, Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement, instends to help hospitals and clinicians implement processes to prevent dangerous blood clots. The 60-page guide details how to start, implement, evaluate, and sustain a quality improvement strategy. It includes case studies and examples of forms clinicians in the field can use. Read more »

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Voluntary Reporting Best for Identifying Pediatric ADEs
Clinicians typically use medical chart review, voluntary reporting, or computerized adverse drug event (ADE) surveillance to identify pediatric ADEs; however, an Agency for Healthcare Reporting and Quality (AHRQ) Sept. 8 press release says a new study found that surveillance did not detect ADEs in children as well as in adults. Read more »

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Men at Risk for Osteoporosis
Although osteoporosis (low bone mass density or BMD) is considered primarily a problem for older women, a 60-year-old white man has a 25 percent lifetime risk of suffering a bone fracture due to osteoporosis, reports the Agency for Healthcare Research and Quality (AHRQ). Osteoporosis is typically without symptoms and is substantially under-diagnosed and undertreated among men in the United States. A new study reveals certain risk factors for osteoporosis among asymptomatic men can be used to identify those who should be screened for the problem. Read more »

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FDA Approves Nasacort AQ For Children
The U.S. Food and Drug Administration (FDA) has approved Sanofi-aventis’ Nasacort AQ® Nasal Spray (triamcinolone acetonide) for children two to five years of age for the treatment of nasal symptoms associated with seasonal and perennial allergic rhinitis (Medical News Today).

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Differentiate TB From Lymphomas
Abdominal tuberculosis can affect the gastrointestinal tract, peritoneum, and lymph nodes. When the prevalence of abdominal tuberculosis is high, it’s difficult to establish its diagnosis. Lymphadenopathy is the most common manifestation of abdominal tuberculosis and is easily confused with lymphomas involving abdominal lymph nodes in up to 55 percent of cases without other evidence of abdominal involvement. Clinical and radiologic differentiation between the two can be challenging.

To improve the physicians’ ability to distinguish between these entities, a team of researchers at Weifang Medical University of China conducted a comparison of computed tomography (CT) findings in tuberculosis and non-Hodgkin’s lymphoma (NHL) involving the small bowel mesentery (SBM). You might be surprised at their discovery. Read more »

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Doctors Know Little About Consumer-Directed Plans
Physicians feel they know little about consumer-directed health plans, according to a Robert Woods Johnson Foundation study, giving coders the opportunity to help educate physicians and their patients.

The plans, meant to shift more responsibility for health care decisions to the individual patient, often come with high deductibles and include a health savings account.

But 43 percent of doctors said they have heard little, if anything, about these plans, and less than half (48 percent) feel ready to discuss medical budgeting with their patients. Read more »

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Featured Items
CMS Announces RACs
CMS PHR Program
Imaging Cap Lowered
Home Health Services
Immunization Alliance
Coding Tips
Medical News
Coding Job Links
Test Yourself Online


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