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Issue #114 - December 3, 2008 
AAPC EdgeBlast

New Report Prepares Hospitals for Future
Hospitals in particular face daunting challenges for patient safety and quality of care. A Nov. 20 report released by The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) offers guiding principles and actions to prepare hospitals for the inevitable.
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Inventory of HHS
Quality Measures Released

An inventory of quality measures used for reporting, payment, or quality improvement by its agencies and operating divisions was recently announced by HHS.

The HHS measures inventory is available on the National Quality Measures Clearinghouse, an Agency for Healthcare Research and Quality (AHRQ), Web site.
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JCAHO: New Behavior
Standards Announced

Come Jan. 1, 2009, medical personnel are not allowed to have a bad day. That’s when new standards introduced by The Joint Commission for the Accreditation of Health Organizations (JCAHO) in a July 9 sentinel event alert are slated to go into effect.

"Intimidating and disruptive behaviors include overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities," the commission said. "All intimidating and disruptive behaviors are unprofessional and should not be tolerated."
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New Quality Measures
Taken for Dialysis Facilities

The Centers for Medicare & Medicaid Services (CMS) has added two new quality measures to the Dialysis Facility Compare consumer Web site to show the percentage of patients at any given dialysis facility whose hemoglobin levels are reportedly unsafe.

Previously, the Web site only showed the percentage of patients in a facility whose hematocrit levels were at 33 percent or more (or hemoglobin levels of 11 g/dL or more). Read more »

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CMS Selects New Part A/B MAC
National Heritage Insurance Corp. (NHIC) is the newest Part A/Part B Medicare Administrative Contractor (A/B MAC) to be named by the Centers for Medicare & Medicaid Services (CMS).

CMS has awarded NHIC a five-year, cost-plus-award-fee contract to administer Part A and Part B Medicare claims payment in Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont — also known as jurisdiction 14. The contract is reportedly worth about $176 million, according to a press release issued by CMS on Nov. 19.
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Final Rule Issued For PSOs
Health and Human Services (HHS) has issued a final rule for Patient Safety Organizations (PSO) that will go into effect Jan. 19, 2009. The Agency for Healthcare Research and Quality (AHRQ) has already listed 15 PSOs.

The final rule addresses concerns regarding how providers may efficiently collect and analyze patient safety event information with privilege and confidentiality protections while complying with existing reporting requirements seeking similar information. Read more »

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Arm Yourself Against Improper Payment
Although the Medicare fee-for-service (FFS) error rate has dropped from 14 percent in 1996 to 3.6 percent in 2008, that’s still billions of dollars—$10.4 billion to be exact—in improper payments.

The news is always the same. "For Medicare FFS, most improper payments are due to claims for services that were medically unnecessary or incorrectly coded," reports a Centers for Medicare & Medicaid Services Nov. 17 press release. Read more »

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Coding Tips
Telehealth Service Sites Expand
As of Jan. 1, 2009, eligible originating sites for payment of telehealth services will include hospital-based or critical access hospital-based renal dialysis facilities (including satellites), skilled nursing facilities and community mental health centers. This amendment to the Social Security Act is mandated by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. Read more »

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Get Specific with 2009 Lab Codes
New CPT® codes that go into effect Jan. 1, 2009 will allow your lab to code more accurately for advancing diagnostic tests, according to the Coding Institute’s Pathology/Lab Coding Alert (Vol. 9, No. 11).

Let’s say, for example, that a patient presents with chest pain but shows a normal EKG and tropinin-negative test results. The physician orders serum myloperoxidase (MPO). You would have to settle for a generic code, such as 83516 Immunoassay for analyte other than infectious agent antibody or infectious agent antogen, qualitative or semiquantitative; multiple step method to describe the test. In 2009, however, you’ll code this sort of test with total clarity using CPT® code 83876 Myeloperoxidase [MPO]. Read more »

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Take Vital Steps Toward Unlisted Procedures Payment
Getting paid for unlisted procedure codes can be tricky, especially if a procedure is experimental or investigational.

"It’s not unheard of to get paid for unlisted procedures, but it’s not always easy," says Joanne Mehmert, CPC, CCS-P, in Kansas City, Mo. "The insurance company has its own definition of medical necessity." Read more »

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Correctly Code ER Visits with 99140
Working with physicians to specify what constitutes as an emergency, and correctly coding emergency room visits with +99140 Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure) is enough to frazzle any coder’s nerves.

Anesthesia & Pain Management Coding Alert (Vol. 10, No. 10) takes a closer look at 99140, and clarifies how you should (or shouldn’t) use it with qualifying circumstances (QC).

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Medical News
Bloggers Unite for World AIDS Day
On Dec. 1, bloggers from around the world went online to write about and promote awareness of human immunodeficiency virus (HIV)/aquired immune deficiency syndrome (AIDS). The day marked the 20th annual World AIDS Day. Read more »

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FDA Approves Pain Reliever Tapentadol
Health care professionals have an additional choice for treating patients with moderate to severe acute pain. The U.S. Food and Drug Administration (FDA) has approved Tapentadol hydrochloride, according to a Nov. 24 press release. Read more »

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Test Yourself Online
The Test Yourself questions can be accessed online at www.aapc.com/testyourself/. Once you go there and take the test, you can automatically grade your answers, correct any mistakes, and have your CEUs automatically added to your CEU Tracker for submission.

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Featured Items
Report Prepares Hospitals
HHS Quality Measures
AMA: New Behavior
New Quality Measures
New A/B MAC
Final Rule Issued
Arm Yourself
Coding Tips
Medical News
Coding Job Links
Test Yourself Online


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