Grayscale Version PARA Weekly Update For Users October 13 2017

Date

PARA WEEKLY

UPDATE For Users

Improving T he Businessof HealthCare Since 1985 October 13, 2017 Repr in t ed!

NEWS FOR HEALTHCARE DECISION MAKERS

JANUARY 1, 2018 CMS UPDATES AN ONGOING PREVIEW OF CHANGES YOU'LL NEED TO KNOW QUESTION AND ANSWER -

Revised Diabetic Ketoacidosis

ARTICLES -

Special PARA Presentation Medicare Changes

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Year-End HCPCS Update Process

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Claim Tips For Billing Miscellaneous Items

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The number of new or revised Med Learn (MLN Matters) articles released this week. All new and previous Med Learn articles can be viewed under the type "Med Learn", in the Advisor tab of the PARA Dat a Edit or . Click here.

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The number of new or revised Transmittals released this week. All new and previous Transmittals can be viewed under the type "Transmittals" in the Advisor tab of the PARA Dat a Edit or . Click here.

PARA COMPANY NEWS ABOUT PARA SERVICES CONTACT US

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FAST LINKS: Click on the link for special areas of interest: Page

Administration: Pages 1-22 HIM/Coding Staff: Pages 2-22 Patient Financial Services: 2,4,6,15 Providers: Pages 2,4,12,20

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Laboratory: Pages 15,18,20 PDE Users: Pages 4,5,6,12 Parmacy: Page 16 Finance Depts: Pages 4,5,6,12,17,19

© PARA Healt h Car e Fin an cial Ser vices CPT® is a r egist er ed t r adem ar k of t h e Am er ican M edical Associat ion

PARA Weekly Update: October 13, 2017

REVISED DIABETIC KETOACIDOSIS (ICD-10 CM)

Question: What is the appropriate ICD-10 CM code for type II Diabetic Ketoacidosis (DKA) without coma?

Answer: Effective October 1, 2017, ICD-10 CM codes E11.10,Type 2 diabetes mellitus with ketoacidosis without coma, and E11.11, Type 2 diabetes mellitus with ketoacidosis with coma, were created to identify ketoacidosis in a patient with type 2 diabetes mellitus. This advice is supported by Coding Clinic 4thQtr 2017 and supersedes advices given for dates of service prior to October 1, 2017.

Prior to October 1, 2017, coders were instructed to reportICD-10 CM code E13.10, Other specified diabetes mellitus with ketoacidosis without coma, since there was not a specific code to identify Type 2 diabetes mellitus with ketoacidosis.This advice was provided by Coding Clinic 2nd Qtr 2016.Coding Clinic.

Please refer to PARA Data Editorcode descriptions provided below:

Coding Clinic Fourth Quarter 2017 Page 6:ICD-10-CM New/Revised Codes: Type 2 Diabetic Ketoacidosis Codes E11.10,Type 2 diabetes mellitus with ketoacidosis without coma, and E11.11, Type 2 diabetes mellitus with ketoacidosis with coma, were created to identify ketoacidosis in a patient with type 2 diabetes mellitus.

Diabetic ketoacidosis is a life-threatening condition that affects diabetics when fat is used by the cells of the body as a substitute for glucose. When there is not enough insulin in the body for muscle and fat cells to absorb glucose to use for energy, fat is broken down and ketones are released into the bloodstream.

In a non-diabetic, there are hormones that control the amount of ketones in the body. In a person with diabetes, ketones build up in the bloodstream. Diabetic ketoacidosis most often occurs in people with type 1 diabetes mellitus, because there is very little to no production of insulin to regulate the ketones. While it is rare to have type 2 diabetes with ketoacidosis, it does occur. It commonly follows a precipitating factor such as discontinuation of medication, infection, or severe illness.

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PARA Weekly Update: October 13, 2017

REVISED DIABETIC KETOACIDOSIS (ICD-10 CM)

Signs and symptoms of diabetic ketoacidosis develop quickly. The patient may experience excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness, and decrease in alertness. Blood and urine tests indicate high levels of ketones. During treatment the patient is hydrated, electrolytes are replaced, and insulin therapy is started. Tests are also run to detect any underlying conditions that may have triggered the ketoacidosis.

Question: Diabetic Ketoacidosis (DKA) is most common in patients with Type 1 Diabetes. If the physician does not specify the type of diabetes, should the coder assume the patient has type 1?

Answer: Best practice is to query the physician for the type of diabetes if not specifically documented. The code selection for diabetes in ICD-10 CM is subdivided into five categories: Diabetes due to underlying condition (E08.-), Drug or chemical induced diabetes (E09.-), Type 1 diabetes (E10.-), Type 2 diabetes (E11.-) and Other specified diabetes (E13.-).

DKA is an acute, severe complication of diabetes that mainly develops in patients with type 1 diabetes. However, DKA can occur in patients with type 2 diabetes. Therefore, coders should not assume the diabetic type without further documentation.

Please refer to the PARA Data Editor Code description

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PARA Weekly Update: October 13, 2017

PARA PRESENTATIONS FOR CLIENTS AND ASSOCIATIONS

PARA clients are invited to request PARA to present educational programs at group meetings within their organization or with affiliated groups, such as hospital or professional associations.

PARA staff routinely prepare presentations for facilities and professionals interested in keeping up to date on recent Medicare changes, or to provide education on the basics related to pricing, coding, and billing.

PARA staff are available to develop a presentation on a specific topic at client request, or present a ready-made program.PARA Data Editor Users may review programs which have been developed on the Advisor tab, filtering the document type to ?Presentations?:

For example, PARA staff have made recent presentations on the following topics: - Hospital Chargemaster Pricing Strategies in a Transparent Healthcare Marketplace - CMS Quarterly HCPCS Update - Medicare?s Appropriate Use Program - Billing for Supplies Interested clients are invited to reach out to your Account Executive for further information and assistance.

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PARA Weekly Update: October 13, 2017

PARA YEAR-END HCPCS UPDATE PROCESS

In keeping our commitment to outstanding customer service, PARA clients will be fully supported with information and assistance on the annual CPTÂŽ HCPCS coding updates.

The PARA Data Editor (PDE) contains a copy of each client chargemaster; we use the powerful features of the PDE to identify any line item in the chargemaster which has a HCPCS code assigned that will be deleted as of January 1, 2018.

For this reason, it is important that clients check to ensure that a recent copy of the chargemaster has been supplied to PARA for use in the year-end update.

PARA will produce excel spreadsheets of each CDM line item, as well as our recommendation for alternate codes, in three waves as information is released from the following sources: 1. The American Medical Association?s publication of new, changed, and deleted CPTÂŽ codes; this information is released in September of each year.PARA will produce the first spreadsheet of CPT updates for client review in October, 2017.

2. Medicare?s 2018 OPPS Final Rule, typically published the first week of November; PARA will perform analysis and produce the second spreadsheet to include both the CPT information previously supplied, as well as alpha-numeric HCPCS updates (J-codes, G-codes, C-codes, etc.) from the Final Rule.

3. Medicare?s 2018 Clinical Lab Fee Schedule (CLFS) ? typically published in late November, the CLFS will reveal whether Medicare will accept new CPT?s generated by the AMA, or whether Medicare will require another reporting method (i.e. G0480 ?

G0483 for definitive drug testing in 2016 and 2017.)

Clients will be notified by email as spreadsheets are produced and recorded on the PARA Data Editor ?Admin? tab, under the ?Docs? subtab.

In addition, PARA consultants will publish concise papers on coding update topics in order to ensure that topical information is available in a manner that is organized and easy to understand. PARA clients may rest assured that they will have full support for year-end HCPCS coding updates to the chargemaster.

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PARA Weekly Update: October 13, 2017

CLAIM TIPS FOR BILLING MISCELLANEOUS ITEMS OR TESTS

ll medical billers and AR follow-up teams have experienced billing or claim denials because there is a ?miscellaneous? HCPCS on a claim. The reason is because miscellaneous codes do not provide adequate information for the item being billed.

Unlike established HCPCS for standard procedures and testing, most payers will manually calculate the reimbursement for the claim line reporting the miscellaneous item or testing.

To do this process, however, the provider is expected to supply the additional information on the claim upon submission of the claim.

The type of information required however, varies on the type of miscellaneous service or item that is being reported on the claim.

For example: 1. If the service is a surgery, an operative report will be required to be submitted with the claim submission. This allows the payer to review the procedure and adjudicate the claim correctly.

2. If the service is a diagnostic test, clinical notes should be included. The clinical notes should clearly and precisely describe the patient?s diagnosis, the full name of the test performed and the results of the test.

3. If the item is a DME item, the name of the item, a full description of the item, the name of the manufacturer, the produce code/number and a copy of the invoice should be included with the claim submission.

4. If the miscellaneous item is a drug, the claim should contain the full name of the drug, the manufacturer, strength and dosage, NDC code for the drug and route of administration. This would apply to anesthesia agents .

5. **Special note for 80299: The name of the drug being tested must be indicated in Box 19 of the CMS 1500 claim form (remarks field) or in Box 80 of the UB04 claim.

In the tables on the follow pages of this article, are examples of various procedures and items for which this article is applicable:

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PARA Weekly Update: October 13, 2017

CLAIM TIPS FOR BILLING MISCELLANEOUS ITEMS OR TESTS

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PARA Weekly Update: October 13, 2017

CLAIM TIPS FOR BILLING MISCELLANEOUS ITEMS OR TESTS

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PARA Weekly Update: October 13, 2017

CLAIM TIPS FOR BILLING MISCELLANEOUS ITEMS OR TESTS

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PARA Weekly Update: October 13, 2017

CLAIM TIPS FOR BILLING MISCELLANEOUS ITEMS OR TESTS

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PARA Weekly Update: October 13, 2017

CLAIM TIPS FOR BILLING MISCELLANEOUS ITEMS OR TESTS

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PARA Weekly Update: October 13, 2017

Reprinted

JANUARY 1, 2018 CMS UPDATES

The following Transmittals have been published for the January 1 update.

This list will continue to expand in the coming weeks, and links to all documents can be found in the PDE Advisor tab.

Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2018

January 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing

Files and Revisions to Prior Quarterly Pricing Files

Quarterly Influenza Virus Vaccine Code Update - January 2018

Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 24.0, Effective January 1, 2018

To go to the full Transmittal document simply click on the screen shot.

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PARA Weekly Update: October 13, 2017

JANUARY 1,2018 CMS UPDATES

Instructions for Downloading the Medicare ZIP Code File for January 2018

Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - January 2018

Affordable Care Act Bundled Payments for Care Improvement Initiative - Recurring File Updates Models 2 and 4 January 2018 Updates

Health Insurance Portability and Accountability Act (HIPAA) Electronic Data Interchange (EDI) Front End Updates for January 2018 This link leads to a ZIP file containing several files with several documents.

To go to the full Transmittal document simply click on the screen shot.

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PARA Weekly Update: October 13, 2017

There were FOUR new or revised Med Learn (MLN Matters) articles released this week. All new and previous Med Learn articles can be viewed under the type ?Med Learn? in the Advisor tab of the PARA Data Editor (see example below.) To go to the full Med Learn document simply click on the screen shot or the link.

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PARA Weekly Update: October 13, 2017

The link to this Med Learn: MM10232

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PARA Weekly Update: October 13, 2017

The link to this Med Learn: MM10320

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PARA Weekly Update: October 13, 2017

The link to this Med Learn: SE 17034

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PARA Weekly Update: October 13, 2017

The link to this Med Learn: MM10309

To go to the full Med Learn or Transmittal document simply click on the screen shot or the link.

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PARA Weekly Update: October 13, 2017

There were FOUR new or revised Transmittals released this week. All new and previous Transmittals can be viewed under the type Transmittals in the Advisor tab of the PARA Data Editor. To go to the full Transmittal document simply click on the screen shot or the link.

The link to this Transmittal #R295FM

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PARA Weekly Update: October 13, 2017

The link to this Transmittal #R3883CP

The link to this Transmittal #R3881CP

The link to this Transmittal #R748PI

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PARA Weekly Update: October 13, 2017

The PDE Editor Bulletin Board Tablet lists all articles added to the Bulletin Board

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PARA Weekly Update: October 13, 2017

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