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Medical Business Journal Jan/Feb 2013



P 15. Breakdown of 2013’s cardiology coding changes for National Heart Month

Inside this Issue: ……………….……………….……………….………………. 2 Upcoming CEU Courses & Certification Program ………………………………………. 8 Potential AIDS Cure Would Make HIV Virus Self-Destruct ….…….……………………. 12 What’s New in Flu ………..……….………...………………………………………. 14 2013 Coding Changes for Cardiology ……………………………………………..….15 Child, Teen Immunization Schedule Combined for 2013 ……………………………..….18 MMI Updates ……………………………………………………………………..….19 CMS News Updates

The Medical Business Journal is brought to you by the Medical Management Institute The Medical Business Journal is a monthly source of up-to-date information on all issues affecting the healthcare industry. Its content ranges from medical coding and billing to healthcare reform Carleigh Benscoter legislature and beyond. The MBJ is not affiliated in any way with the Department of Health and Contributors Human Services, Medicare, or the Centers for Medicare and Medicaid Services. This publication lorem ipsum dolorismet designed set to provide accurate and authoritative information with regard to the subject matter Kathy Dyson quam parumcovered. It is sold with the understanding that the publisher is not engaged in rendering legal, Jennifernunc Donovan accounting or other professional services, and is not a substitute for individualized expert Layout & Design assistance. The CPT codes, descriptors, and modifiers are copyrighted by the American Medical Carleigh Benscoter Association. For more information, please call MMI at 866-892-2765. Editor in Chief

CMS News Updates Attest by February 28, 2013 to Get Paid for 2012 EHR Incentive Programs

Eligible professionals (EPs) who participated in the Medicare Electronic Health Record (EHR) Incentive Program in 2012 must complete attestation for the 2012 program year by February 28, 2013. In order to be eligible to attest you must have completed your 2012 reporting period by December 31, 2012. CMS encourages Medicare EPs to register and attest as soon as possible to resolve any potential issues that may delay their payment. Medicaid EPs should check with their State for their attestation deadline. Resources from CMS: CMS has several resources located on the EHR Incentive Programs website to help EPs properly meet meaningful use and attest, including: • A Registration & Attestation page that includes information on registration and attestation, and links to additional resources. • The Meaningful Use Attestation Calculator, which allows EPs and eligible hospitals to determine if they have met the Stage 1 meaningful use guidelines before they attest in the system. • The Attestation User Guide for Medicare Eligible Professionals, providing step-by-step guidance for EPs participating in the Medicare EHR Incentive Program on navigating the attestation system. • The Attestation Worksheet for Eligible Professionals, allowing users to enter their meaningful use measure values, creating a quick reference tool to use while attesting. Want more information about the EHR Incentive Programs? Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.


CMS News Updates

February 28th is the Last Day for EPs to Submit Medicare Part B Claims EHR Incentive Programs

February 28, 2013, is the deadline for EPs to submit any pending Medicare Part B claims from calendar year (CY) 2012, as CMS allows 60 days after December 31, 2012, for all pending claims to be processed. This means that EPs have 60 days in 2013 to submit claims for allowed charges incurred in 2012. Medicare EHR incentive payments to EPs are based on 75% of the Part B allowed charges for covered professional services furnished by the EP during the entire payment year. If the EP did not meet the $24,000 threshold in Part B allowed charges by the end of calendar year 2012, CMS expects to issue an incentive payment for the EP in March 2013 for 75% of the EP's Part B charges from 2012. Reminder: Eligible professionals (EPs) who participated in the Medicare Electronic Health Record (EHR) Incentive Program in 2012 must also complete attestation for the 2012 program year by February 28, 2013. In order to be eligible to attest you must have completed your 2012 reporting period by December 31, 2012. Medicaid Participants: Please contact your State Medicaid Agency for more details about payment.

How to Avoid 1.5% PQRS Penalty in 2015 by What You Do in 2013 Kathy Dyson | January 16, 2013

registry information for 2013 in early 2014. Registry reporting can be done using a measure group or individual measures.   To learn more about PQRS sign up for our Spring course on PQRS (details on page 10).

Medicare Announces Substantial Savings for Medical Equipment Included in the Next Round of Competitive Bidding Program CMS Media Relations | January 30, 2013

While Medicare is still offering incentives for 2012 PQRS reporting, it will determine if you receive a penalty for not participating in PQRS by what you do with 2013 data. Much like the e-Prescribing program, PQRS started with incentives for participation and migrates towards penalties for non-participation. Don’t get caught in the 1 and ½% decrease in fees in 2015 because you did not report any measures in 2013. Start today by reporting at least one measure on your claims.  If you need help picking a measure, let us know- we can help.  But send in PQRS on your claims.  This is the least expensive and surest way to avoid the penalty. Avoiding this penalty is not the same as earning the incentive.  Even if you don’t have enough ‘successful’ reporting numerators to get the incentive, the fact that you reported will stop the penalty.   While claims-based reporting is the least expensive but most difficult way to earn incentive payments, it is not the best way to get the incentive money.   Registry reporting has the highest success rates for earning incentives. YOU CAN STILL SUBMIT PQRS for 2012 data through March 8, 2013 in most registries.  If you determine that your claims based reporting does not cover enough (3) measures to qualify for the incentive in 2013, then submit

The Centers for Medicare & Medicaid Services (CMS) announced new, lower Medicare prices that will go into effect this July in a major expansion of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. The CMS Office of the Actuary estimates that the program will save the Medicare Part B Trust Fund $25.7 billion and beneficiaries $17.1 billion between 2013 and 2022. Medicare beneficiaries in 91 major metropolitan areas will save an average of 45 percent for certain DMEPOS items scheduled to begin on July 1, 2013.  Medicare beneficiaries across the country will save an average of 72 percent on diabetic testing supplies under a national mail-order program starting at the same time.   A full list of the new prices is available at: “This program has already saved millions for taxpayers and beneficiaries while maintaining access to care,” said CMS Acting Administrator Marilyn Tavenner. “We look forward to building on this CMS News Updates


success by serving more beneficiaries, increasing savings and helping to ensure the long-term sustainability of Medicare.” Medicare’s competitive bidding program replaces its existing fee schedule amounts in selected areas with prices based on suppliers’ bids, saving money for taxpayers and beneficiaries while preserving access to quality products from accredited suppliers. Using market-based prices set through competition will help ensure the long-term sustainability of the Medicare program.  Small businesses represent over half of the winning suppliers in these 91 metropolitan areas. Importantly, the program has maintained beneficiary access to quality products from accredited suppliers in the nine areas where it is currently operating; extensive real-time monitoring data have shown successful implementation with very few beneficiary complaints and no negative impact on beneficiary health status based on measures such as hospitalizations, length of hospital stay, and number of emergency room visits compared to non-competitive bidding areas.  CMS will employ the same aggressive monitoring for the MSAs added in Round 2. In its first year of operation in the nine areas of the country where the program is currently operating, competitive bidding   saved Medicare approximately $202.1 million.  A complete list of the 91 areas where the program is expanding is available at

Jonathan Blum, Deputy CMS Administrator & Director of CMS’ Center for Medicare

4 CMS News Updates

“We rigorously reviewed all bids using our bona fide bid process and ensured that only accredited suppliers that met financial standards and applicable licensure requirements are being offered contracts. This process will ensure that beneficiaries have access to the equipment they need at fair prices,” said Jonathan Blum, Deputy CMS Administrator and Director of CMS’ Center for Medicare. “We will continue to monitor the program closely as it expands to ensure the same success we saw in the program last year, with beneficiaries continuing to have access to all the services they need, while paying a much lower price.” Additional information on the competitive bidding program is available at: 

CMS Tip Sheet for Meaningful Use for Specialists EHR Incentives Program | January 2013

The following 3 pages are provided by the EHR Incentives Program. The fact sheets are intended to give specialty providers tips about how to successfully meet meaningful use measure requirements and navigate the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.

Meaningful Use for Specialists Tipsheet Last Updated: January 2013

Recognizing that not every meaningful use measure applies to every provider, this fact sheet gives specialty providers tips about how to successfully meet meaningful use measure requirements and navigate the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Are you facing measures that require data you don’t normally collect as a specialist? While eligible professionals (EPs) can choose measures that apply to their practice, in some cases, data that has been collected by another provider—for example, a referring physician— can be used to fulfill required measures.

Meeting Meaningful Use In the EHR Incentive Programs, there are exclusions that exempt providers from meeting specific objectives for meaningful use. Those who meet the qualifications for an exclusion will not need to report on that objective and can still receive an EHR incentive payment. Core Measures All providers have to either meet or qualify for an exclusion to every core measure of the EHR Incentive Programs. Exclusions are not based on specialty, but rather on unique criteria for each exclusion. For instance, if recording vital signs (height, weight, and blood pressure) has no relevance to a specialist’s scope of practice, he or she does not need to record them for that measure. Some exclusion criteria may be universally or nearly universally applicable to a specialty due to the scope of practice of that specialty. However, because there is no blanket exclusion for any type of EP, specialists must individually evaluate whether they meet the exclusion criteria for each applicable objective. Menu Measures Providers must select five menu objectives on which to report from the total list of available 10 objectives. However, it is possible that none of the menu objectives are applicable to a particular specialist’s scope of practice. If that is the case, you can usually qualify for the exclusions to the objectives. For example, an EP who writes fewer than 100 prescriptions during the reporting period can claim an exclusion to the objective for implementing drug formulary checks. Thus specialists who do not prescribe medications could claim the exclusion for this objective. If you qualify for all of the exclusions for each of the menu objectives, then select any five menu objectives during attestation and claim the exclusion for each. However, please note that if specialists do not qualify for all of the exclusions to the menu objectives, they should go back and select menu objectives on which they can report. Clinical Quality Measures All providers must report on clinical quality measures (CQMs) in order to demonstrate meaningful use. Specialists are not excluded from this requirement. A number of the available CQMs are applicable to specialists, and CMS suggests that specialists pick quality measures that are relevant to their practices and clinical workflow.

CMS Tip Sheet 5

However, if none of the CQMs is applicable to your scope of practice, your EHR should generate zero values for all of the CQMs since there are no patients in the EHR to whom the quality measures are applicable. Zero is an acceptable value for the CQM denominator, numerator, and exclusion fields during attestation and will not prevent you from demonstrating meaningful use or receiving an incentive payment. If you are a specialist whose EHR generates zero values for all of the CQMs, you should enter zeros in the denominator, numerator, and exclusion fields for the 3 Core CQMs during online attestation. The online attestation system will then prompt you to enter information for 3 Alternate Core CQMs, for which you will also enter zeros in the denominator, numerator, and exclusion fields. You may then select any three measures from the list of 39 Alternate CQMs and report zeros in the denominator, numerator, and exclusion fields. This will complete your CQM attestation.

Using Data Entered by Other Providers CMS encourages specialists to use data supplied by referring and other providers—or accessible through a Health Information Exchange (HIE)—to comply with the meaningful use reporting requirements. CMS understands that some specialists do not interact with patients in the same way as general practitioners. Specialists may not have direct contact with their patients, may not have a need for follow up after an office visit, or may not transition patients to another setting of care themselves, so information exchange, either directly or through an HIE, can be an excellent solution for obtaining reporting data. Please note that neither the HIE nor the referring provider must have certified EHR technology in order for you to incorporate this information into your EHR for the purposes of meeting the meaningful use objectives. Where the information comes from is unimportant as long as you use your certified EHR technology to record and store it. Specialists who share an EHR with other providers also can count in the numerator those patients for whom other providers have entered information. While there are many objectives that require the recording of standardized patient information, these objectives do not specify who should enter the information. Therefore a shared EHR, documentation accompanying referrals and orders, or receiving information through electronic exchange are excellent strategies for meeting these objectives.

Clinical Summaries: Determining Office Visits A specialist who does not have office visits with patients is excluded from the meaningful use objective to "provide clinical summaries for patients after each office visit." For the EHR Incentive Programs, an office visit includes separate, billable encounters that result from evaluation and management services provided to the patient. While CMS does not specify a range of E&M billing codes to which this exclusion applies, we define office visits as: 1. Concurrent care or transfer of care visits 2. Consultant visits*, or 3. Prolonged Physician Service without Direct (Face-To-Face) Patient Contact (tele-health). *A consultant visit occurs when a provider is asked to render an expert opinion/service for a specific condition or problem by a referring provider.

If you do not have any visits that fit into the three categories above, you may claim the exclusion for this objective. 2


CMS Tip Sheet

If a patient is seen by multiple EPs who share an EHR, a single clinical summary at the end of the visit can be used to meet the objective. Therefore a specialist who does not interact with the patient can also count the clinical summary provided by the other EP(s) who saw the patient in order to fulfill this requirement.

Hardship Exceptions CMS recognizes that even with the available exclusions and the flexibility of obtaining information through electronic exchange, certain specialists may find it difficult to demonstrate meaningful use. These specialists may apply for a hardship exception to avoid the EHR Incentive Program payment adjustments that begin in 2015. Information on applying for a hardship exception will be available soon. (For more information about payment adjustments in general, please click here.) Specialists and other providers who apply for a hardship exception based on limited interaction with patients must demonstrate that they: Lack of face-to-face or telemedicine interaction with patients; AND Lack follow-up need with patients CMS also recognizes that certain providers who practice at multiple locations are unable to demonstrate meaningful use because of lack of access to Certified EHR Technology at one or more locations. If you are a specialist or other provider who lacks control over the availability of Certified EHR Technology at one or more of your practice locations and therefore cannot use Certified EHR Technology at practice locations for 50 percent or more of your patient encounters, you may also apply for a hardship exception to the payment adjustments.

CMS Resources for Meaningful Use CMS has created a series of resources to help specialists successfully participate in the EHR Incentive Programs. Some of these resources include: Stage 1 Specification Sheets— Includes the objective, measure, and exclusion for each Stage 1 core and menu objective, as well as a definition of terms, attestation requirements, additional information, related FAQs, and the corresponding standards and certification criteria. Stage 1 Meaningful Use Calculator — Allows providers to test whether or not they would successfully demonstrate meaningful use for the EHR Incentive Programs. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals and An Introduction to the Medicaid EHR Incentive Program for Eligible Professionals—Walks EPs through all of the phases of the Medicare and Medicaid EHR Incentive Programs, focusing on Stage 1 meaningful use requirements. Stage 2 Specification Sheets — Includes the objective, measure, and exclusion for each Stage 2 core and menu objective, as well as a definition of terms, attestation requirements, additional information, and the corresponding standards and certification criteria.


CMS Tip Sheet 7

The Survey Results Are In To help us better understand your individual needs and interests, we recently sent out a survey via email to all of our MMI active students and alumna, as well as the ARHCP members. This survey was intended to help us better understand your interests and individual training needs in the medical coding, auditing, and management fields. The results are below:

CEU/Webinar Topics


Certification Programs

2% 14%

6% 16%



RAC Audits Security Risk Assessment for EMR PQRS (Avoiding Penalties) Anatomy & Terminology for the ICD-10 Transition Health Care Reform Other




ICD-10-CM Medical Billing Advanced Certifications Other

Topics for the Spring Quarter Webinars worth 12 ARHCP Approved CEUs Below: 1. 2. 3. 4. 5.

Security Risk Assessment PPACA PQRS Compliance ICD-10-CM Implementation Planning- First step in certifying if you are a coder or manager.

We will be launching an ICD-10-CM Certification Program (Guide on p. 11) The ICD-10-CM Certification Program will be customized based on your job in the medical field.


MMI Survey Results

Security Risk Assessment What Every Practice Needs to Know HIPAA laws were created many years ago to require practices to comply with various policies and procedures. In 2009, HIPAA regulations were amended and brought more to the forefront with may practices adopting various EMR’s and now having electronic Personal Health Information (ePHI). Meaningful Use Stage 1 Core Objective #15 requires eligible providers to complete a privacy and security risk analysis. A security risk assessment  is stated as a requirement in the federal register on meaningful use. This course will cover the following topics:   1. What is a Security Risk Assessment 2. Necessary safeguards and documentation to comply with meaningful use 3. Next Steps you must take to secure your practice 4. How to pass the SRA audits

Patient Protection & Affordable Care Act (PPACA) Impact on Physician Practices The major points to be covered are: 1. Overview of the PPACA 2. Type of patient traffic/policy options to consider 3. Practice Revenue Opportunities/Impact 4. Employer Health Insurance Coverage Mandates & Employee options Because this topic is so fluid right now, with new updates and interpretations coming out weekly from Health and Human Services, we will be offering updates from this initial class throughout the year.

Sheryl Cherico,

COO of MD Tech Pro Sheryl is the co-founder of MD Tech Pro and serves as the company's resident practice management specialist ensuring that all software, be it third party or proprietary, enhances provider productivity. Sheryl also conducts needs assessments for clients and identifies deliverables, timelines and proposed budgets. Another one of Sheryl’s duties is end-user training and documentation, ensuring that office staff and providers are using software applications to full potential. Sheryl has mastered numerous medical practice software packages over the course of her career, and is an expert at everything from front-end, to backend, to EMR. She has also worked directly for a leading national medical software group. Sheryl has worked as a Practice Manager, Biller and CIO within a large medical practice in the Atlanta Georgia area and brings this wealth of experience to the clients within MD Tech Pro.

Janet Salyer Janet is a former Elementary and Adult Education Instructor, now focusing her efforts as a senior broker at Insurance Planning Solutions, offering coverage for businesses and individuals/ families. As a broker, Janet represents many financially strong and reliable companies. Her expertise includes medical, dental, life, vision, short term or long term disability, long term care, annuities and coverage for those eligible for Medicare. Janet claims to have one of the best jobs in the world. She meets wonderful people and helps them. Janet listens to each client's needs, researches the market, and makes recommendations for their insurance. After the policy is issued, Janet is still on the job making sure her client gets the most from their insurance coverage. We are very proud to introduce Janet Salyer as an instructor on the MMI team!

MMI Survey Results: Spring Quarter


Kathy Dyson Kathy is the new Learning Director for MMI. She is also the CEO of Dyson Consulting Services, a practice management consulting firm. Kathy is a Computer  Science and Business Management professional with 25 years of experience in helping businesses automate their workflows and maximize profitability. Kathy has extensive experience in billing, coding and practice management consulting. She has worked as a biller, coder, front desk receptionist, and office administrator in various PCP and specialty offices. In her new role as the Director of Learning for MMI, she is evaluating and updating all of the MMI Training courses to be more relevant and focused on real world use. Kathy welcomes your input to our new curriculum and course offerings.  She can be reached at

Jen Donovan,

RMC, CPC, RMM Jennifer has been in the field of medical business for nearly 11 years. As an educator, she has traveled extensively teaching for various colleges, hospitals, federal agencies and pharmaceutical companies. She is a subject-matter expert in the areas of CPT, ICD-9, ICD-10, HCPCS II, E/M, Modifiers, Principals, Compliance and Medicare Rules and Regulations. Jennifer is certificated through AAPC and ARHCP (where she served on the Board of Directors from 2004-2012). Having been the former Director of Education and Chief Operating Officer of the Medical Management Institute, Jennifer understands the needs of coders, educators and providers. Additionally, she has authored many articles for health care publications and continues to speak at conferences and seminars across the country. Jennifer can be reached at

10 MMI Survey Results: Spring Quarter

PQRS is Here to Stay If you are a Medicare provider, you need to stay tuned to this course and the updates to follow Centers for Medicare and Medicaid Services (CMS) will move from incentive payments for participating in the Physician Quality Reporting System (PQRS) to penalties in 2015. What you do in 2013 about PQRS determines if you will be penalized in 2015.  CMS has updated the measures and reporting options for 2013.  This course will: • Provide an overview of the current program and it’s policies. • Review  how to get the most out of the incentives that are left for 2013 and 2014. • Provide IMMEDIATE actions to avoid the 2015 penalty of 1.5% • Go over the claims based and registry-based reporting options and much more. • Real world examples of reporting several common PQRS measures.

Understand the OIG Compliance Requirements Is your practice protected? The U.S. Department of Health and Human Services (HHS) will soon require Compliance Plans upon enrollment. Those who have been in the industry for a few years can attest, compliance plans have been, understandably, causing quite a stir.  If you think about it healthcare fraud costs the country nearly $80 billion dollars each year. It is no wonder why the country as a whole, in spite of budgetary problems, is prepared to use substantial resources to curb abuse of the system. This course covers: • OIG Compliance Program Guidance • Already have a plan?  Is well suited for increase accountability? • Core plan elements • Fraud and Abuse Laws and Penalties Sneak peek: this class is also a step in the right direction towards satisfying element #4.

MMI Survey Results: ICD-10-CM Guide to Certification




Clinical Staff


ICD-10 Implementation Planning


Need to be Licensed


Registered Medical Biller

ICD-10 Implementation Planning

Anatomy & Physiology for ICD-10

Anatomy & Physiology for ICD-10

ICD-10 for QHCP

Billing for ICD-10

Basic Coding for ICD-10

ICD-10 for Office Managers

Your Guide to Becoming ICD-10-CM Certified

Specialty Coding for ICD-10

Specialty Coding for ICD-10

ICD-10 for Office Staff

Certification Exam

Certification Exam

Office Readiness for ICD-10


Potential AIDS Cure Would Make HIV Virus Self - Destruct Gabrielle Levy, | January 24, 2013 | All Rights Reserved

T-Cell infected by HIV. (National Institute of Allergy and Infectious Diseases

Australian scientists may have hit upon a form of gene therapy that could lead to a cure for AIDS, causing the HIV virus to 'self-destruct.' Queensland Institute of Medical Research researchers discovered a technique that changes how the HIV virus replicates in the body, creating a mutated form of the virus, the Australian Times reported. Dr. David Harrich's team saw a breakthrough in 2007, when they discovered that the mutated HIV virus, known as Nullbasic, could block the process, called reverse transcription, that allows HIV to damage the immune system. "With money running out, I had my PhD student try one more experiment in late 2007," Harrich told the Times. "The experiment was to test if Nullbasic could render HIV non-infectious. The student came back and said it worked, so I told him to do it again and again and again. It works every time.� Then backed by funding from the Australian Centre for HIV and Hepatitis research, Harrich's team was able to continue to test the theory that his Nullbasic gene therapy could block the exponential replication of the HIV virus. 12 Potential Aids Cure:

"That study showed very clearly that it could protect human cells from HIV infection," Harrich said. "Subsequently we have protected primary human CD lymphocytes from blood from HIV infection using a gene therapy approach with outstanding results.� The increasing level of HIV, which becomes AIDS, cripples the immune system and leaves the infected individual susceptible to minor infections that their bodies would otherwise have no trouble fighting. The results of their research were recently published in a paper laying out the team's findings based on success in laboratory experiments. Harrich plans to start testing on mice this year, but the process to get FDA approval for treatment on humans could take as long as a decade. Read more: Potential-AIDS-cure-would-make-HIV-virus-selfdestruct/3711359041135/#ixzz2JTUZ33Nd Direct Link to original article: blog/2013/01/24/Potential-AIDS-cure-would-makeHIV-virus-self-destruct/3711359041135/

2013 Preventative Services Jennifer Donovan | Education to Prevent Youth Tobacco Use The U.S. Preventative Services Task Force (USPSTF) has drafted a recommendation to prevent tobacco use by school-aged children and adolescents. Education and/or brief counseling would be included in the provider’s evaluation to prevent the initiation of tobacco use. Evidence shows hundreds of thousands of Americans suffer every day with significant tobacco related health problems and yet they can’t quit. Most of them started during adolescents. This particular recommendation focuses on prevention rather than cessation because the return on investment is substantial. According to the USPSTF, tobacco use is the leading cause of preventable death in the United States, accounting for an estimated 443,000 deaths each year. The habit costs the United States $96 billion a year in direct medical costs. Though not specifically mentioned by the Task Force, physicians on board with the preventative cause look to programs such as the Tar Wars Tobacco-Free education program, which has proven to work in preventing youths from experimenting with tobacco. To see a copy of the draft recommendations from the USPSTF, go to: For up-to-date information on the Tar Wars program, Like them on Facebook:

Insurance Planning Solutions Specializing in Individual & Small Group Benefits “We believe that QUALITY SERVICE to our clients is our highest priority”

What we offer: Coverage for small businesses and individuals/families.

We believe each individual, family, employer, and group has their own unique requirements and our job is to find the product, price, and quality plans with coverage that best fits those unique requirements. We believe that honesty, integrity, and professionalism are the foundation for our relationship with our clients.

Why use a broker? Licensed by the state of Georgia, the brokers must stay current in federal and state laws. They are also appointed by insurance companies, having the ability to compare policies from different companies. Ready to review your insurance coverage? For free quotes, contact Janet Salyer at 678-880-7098, or email

2013 Preventative Services


What’s New in Flu Jennifer Donovan | HCPCS codes for flu when reporting to Medicare HCPCS code Q2034 joins the list of brand specific HCPCS codes that replaced the use of CPT code 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use). The current list of influenza virus vaccine codes for Medicare is as follows: • • • • • •

Q2034 (Agriflu) - New code 07/01/2012 Q2035 (Afluria) Q2036 (Flulaval) Q2037 (Fluvirin) Q2038 (Fluzone) Q2039 (not otherwise specified)

CPT codes for other vaccine formulations would be reported if provided. Administration code G0008 and diagnosis code V04.81 would be reported in conjunction with the appropriate vaccine code.

New Insect - Based Flu Vaccine: FLUBLOK As flu season rages across the United States, federal regulators say they have approved a new kind of vaccine. On January 16, 2013, Flublok gained FDA approval for adults ages 18-49. Flublok, available in limited supplies for the current season, is different from other flu vaccines because it isn't made using eggs or an influenza virus. According to Protein Sciences, the vaccine's manufacturer, Flublok's production involves programming insect cells grown in steel tanks to produce large amounts of a particular flu virus protein, known as hemagglutinin (most human antibodies that fight flu infection are directed against hemagglutinin). The FDA says that this method allows for more rapid production, making more of the vaccine available more quickly in the event of a pandemic. This method has already been used in vaccines approved for other infectious diseases. The FDA further states that Flublok contains the elements necessary to help fend off three different flu strains, including H1N1 and H3N2, and it proved 44.6% effective against all influenza strains in circulation, not just the ones that matched the strains included in the vaccine. No HCPCS code has yet been specified for this new vaccine. Resources:,, U.S. Food and Drug Administration News Release, Commissioner, U.S. Food and Drug Administration,,

14 What’s New in Flu

While We’re on the Subject of the Flu...On a Gross Note Your smartphone could be making and/or keeping you sick According to The Wall Street Journal, your smartphone could be posing unexpected health risks. While you may not think of your mobile device as a vast wonder of icky bacteria, these gadgets often contain more germs than many people realize. “We’re feeding the little creatures. We’ve all seen that greasy smear [on the touch screen]. Where there is grease, there are bugs,” explained Michael Schmidt, a professor and Vice Chairman of Microbiology and Immunology at the Medical University of South Carolina. The smartphone’s proximity to the mouth, nose and ears makes these devices a virtual breeding ground for all sorts of harmful bacteria. Many think they’re safe from these germs because they are the only one using the phone, but to the contrary the amount of microscopic nastiness currently living on your touch screen is actually quite robust. Reports state that some smartphones are even dirtier than public toilet seats and could cause conditions such as the flu, diarrhea, and eye infections. Why? How? When? Its simple. People take their phones with them wherever they go, including the bathroom. To boot, very few individuals make an effort to clean their devices. How often do you clean your? (Are you reaching for the alcohol wipes now?) As Dr. Schmidt further points out, some phones aren’t designed to withstand rigorous cleaning. Even if you do decide to keep your phone squeaky clean, it may not survive the process. “It’s really problematic because a lot of manufacturers don’t tell you what coating is on the phone,” he explained. “It’s hard to tell if an alcohol wipe will strip the oil-repellant coating and damage the phone screen.” According to the American Academy of Family Physicians, they are still figuring out all of the health problems these gadgets may ultimately cause. “People are just as likely to get sick from their phones as from handles of the bathroom,” Cain explained. “These are the unintended consequences of new technology that we haven’t seen before so we don’t know all the risks yet.” Are you concerned about the health risks your smartphone could pose?

2013: Coding Changes for Cardiology Jennifer Donovan | In honor of February being National Heart Month, the MBJ brings you a breakdown of 2013’s cardiology coding changes

Several codes have been bundled or re-bundled for 2013 including a focus on percutaneous coronary intervention, pacemaker and ablation codes. New codes were also created for transcatheter aortic valve placement, percutaneous ventricular assist devices and carotid angiography. CMS now includes the work associated with the placement of a stent in an arterial branch into the base code for placement of a stent in an artery, instead of paying for the additional branches. Relative Value Units (RVU)

2013: Coding Changes for Cardiology


Percutaneous coronary Intervention (PCI)

• • •

In this section (outside of the designated Cardiovascular section of the CPT®) there are 13 new codes (92920-92944), one revised code (+92973), and six deleted codes (92980-92984 and 92955-92996). Be sure to check out the new introductory language created to help physicians and coders on the PCI list of services. PCI codes are built upon each other. They now include the work of accessing and catheterizing the vessel, traversing the lesion, radiological supervision, and interpretation (S&I) directly related to the intervention(s) performed, closure of the arteriotomy when performed through the access sheath, and imaging performed to document completion of the intervention in addition any other intervention(s) performed.

Implantable and Wearable Cardiac Device Evaluations

• •

Revised codes (93279-93298) were updated to include, “review and report by a physician or other qualified health care professional.” CPT® 93279-93292 are subject to the Multiple Procedure Payment Reduction (MPPR).


• •

Five new codes and guidelines were developed for bundling ablations with a comprehensive electrophysicologic evaluation and introducing a new bundled code for atrial fibrillation. CPT® codes 93651 and 93652 were identified as potentially misvalued through the “Codes Reported Together 75% or More” screen, and subsequently removed and replaced with 93653-93657.

Transcatheter aortic valve placement (TAVR)

• • •


Eight new codes and guidelines for TAVR (33361-33369). One Category III code (0318T) was also created for TAVR with a transapical approach (proposed prior to FDA approval). CMS National Coverage Determination (NCD) classifies TAVR as “Coverage with Evidence Development” (CED) thus requiring the procedure only be performed by both a cardiothoracic surgeon and an interventional cardiologist. Claims processing instructions for CED can be found via CR 7897 transmittal 2552. This requires each physician to report with modifier 62 to indicate co-surgery payment (62.5 % of the fee schedule amount for each co-surgeon). [table following]

2013: Coding Changes for Cardiology

Percutaneos Ventrical Assist Device (PVAD) • Four new CPT codes and guidelines were developed for the percutaneous insertion, removal and repositioning of a ventricular assist device.

Cervicocereral Angiography

• •

• • • •

Eight new codes were created: 36221-36228. They describe non-selective and selective arterial catheter placement and diagnostic imaging of the aortic arch, carotid and vertebral arteries. Codes 36221-36226 include the work of accessing the vessel, placing the catheter(s), contrast injections(s), fluoroscopic guidance, radiological S&I and closure of the arterlotomy by pressure or application of an arterial closure device. Five new codes were created for foreign body removal and transcatheter thrombolytic infusion: 37197 and 37211-37214. CPT codes 75600-75605, 75635-75658 and 75746-75791 include new parentheticals. New intro language has been included in the echocardiography and cardiac catheterization section of the CPT book. Two new Category III codes for intravascular optical coherence tomography (OCT) 0219T and 0292T, two new Category III codes for left atrial hemodynamic monitory 0293T and 0294T and 10 new category III codes for external electrocardiographic recording 0295T-0298T and Intracardiac Ischemia monitoring 0302T -0307T. Resources: American College of Cardiology (, American Medical Association ( 2013 RVU/RUC Conference notes 2013: Coding Changes for Cardiology 17

Child & Teen Immunization Schedules Combined for 2013 Jennifer Donovan | February 4, 2013 The Center for Disease Control (CDC) along with the Advisory Committee on Immunization Practices (ACIP) and the American Association of Family Practice AAFP have combined child and teen immunization schedules for 2013. Highlights: • The CDC released its 2013 childhood and adult immunization schedules merging the previously separate child and adolescent schedules into a single zero to 18 year schedule. • Infants 6 months through 11 months old who are traveling outside the United States, including industrialized countries, should receive the MMR vaccine (CPT® 90460, 90461). • Two new TDAP recommendations (CPT® 90715) specifically concerning adults 65 years and older and pregnant women are contained in the 2013 schedule. • Two quadrivalent influenza vaccines will be available for the 2013-2014 flu season.

For more information or to download the schedule, go to:


Child, Teen Immunization Schedule Combined for 2013

MMI Updates

New Web site!

We are excited to announce the launch of our new website! Here at the Medical Management Institute, we are very excited to announce the launch of our new website! It will still be accessed at the same address (, however it has a completely new look. With the user experience in mind, we have re-designed everything to fit your needs.

At the bottom of the website, there are helpful links and PDF forms, such as MMI enrollment documents and RMC/RMM/RMA renewal forms. There are also links to our FAQ page, contact page, and even a link to our brand new blog!

Upon visiting the site, you will notice that there are navigational tabs at the top of the page directing you to our coding, management, and auditing training programs. This is where you will go if you are interested in enrolling in a certification program, or where you would direct somebody if you were to refer a coworker or friend.

The MMI blog will be updated weekly, and in most cases daily, with helpful resources, CMS news, and interesting articles. This is also where we will post surveys and news updates on our upcoming courses, so stay on top of this!

To the right, you can access the payment plan options for all of the training programs. This is also the section where you can sign up for an email subscription (which is how you can receive updates on courses and programs, or exclusive discounts on our products), or you can check out our tweets that are updated live from our twitter page (

We are also very proud to announce that we are now hosting the ARHCP on the new website! You will still visit for your RMC/RMM/RMA renewing needs, however it will re-direct you to the new section on the website. Please feel free to explore the new site, and provide us with any helpful feedback/tips/comments...we are eager to hear what you think!

Leave it to us, we will help you get secure MMI Secure will help your organization understand what steps to take in achieving compliance with HIPAA Security Regulations and Meaningful Use.

MMI Secure will provide an assessment comprised of tools,

reports and policies, and procedures so that your practice is up to date, safe, and secure.

MMI Secure reduces the complexity, fuss and presumptions of complying with the law.

Why do you need it? It’s simple. If you have electronic

patient health information (ePHI), you need to secure and protect it! Your practice is required to change and preserve compliance with the regulations set forth in both the HIPAA and the HITECH Acts.

How does MMI Secure differ? We help review and define policies and procedures with lead Physicians and Practice Managers. We help you with your network documentation and contingency and disaster recovery planning.

Assessment Advantages:

✓Peace of Mind in knowing your practice has written proof of compliance

✓Assessment “Best Practices” considered ✓We help you avoid serious implications ✓We help you avoid firm fines ✓Our solution is simple and cost effective To lean more about the immediate benefits of the MMI Secure Assessment or would like to get started today; Call MMI: 866-892-2765

MMI Secure MMI Updates 19


Medical Business Journal Jan/Feb 2013




Jan/Feb 2013 MBJ  

January/February 2013 Medical Business Journal brought to you by the Medical Management Institute (MMI)