Demonstration of quality is required for distribution of shared savings

Transcription

1 June

2 Demonstration of quality is required for distribution of shared savings Practices will be using CPT II Codes and HCPCS G codes to report compliance with the CI / ACO measures. Quality Efficiency Cost Effectiveness CPT II codes and HCPCS Codes facilitate data collection about the quality of care rendered by coding certain services and test results that support nationally established performance measures and that have an evidence base as contributing to quality patient care CPT II Coding decreases the need for medical record abstraction and chart review, thereby minimizing the administrative burden on providers and other entities measuring quality of care. 6/16/2015 2

3 CPT II codes contain five characters, with four digits followed by the letter F. ACO preventive measures for Diabetes require the reporting of Hemoglobin A1c control. Below are the CPT Category II codes that indicate the control level. Code Code Type Definition 3044F CPT II Most recent hemoglobin A1c level less than 7% 3045F CPT II Most recent hemoglobin A1c level 7-9% 3046F CPT II Most recent hemoglobin A1c level greater than 9% CPT = Current Procedural Terminology 6/16/2015 3

4 CPT modifiers are a combination of two characters codes that are appended to CPT codes to convey additional information regarding the procedure or services offered by the physician or hospital. CPT II code modifiers fall into two categories PERFORMANCE MEASURE EXCLUSION MODIFIERS IP Performance Measure Exclusion Modifier due to MEDICAL Reasons 2P Performance Measure Exclusion Modifier due to PATIENT Reasons 3P Performance Measure Exclusion Modifier due to SYSTEM Reasons PERFORMANCE MEASURE REPORTING MODIFIER 8P Action not performed, reason not otherwise specified 6/16/2015 4

5 HCPCS G codes contain five characters, with a single letter G followed by four digits. ACO preventive measure of Influenza Immunization requires the reporting of whether Influenza Immunization was administered. Below are the HCPCS codes that indicate the status of Influenza Immunization. Code Code Type Definition G8482 HCPCS Influenza Immunization administered or previously received G8483 HCPCS Influenza Immunization was not ordered or administered for reasons documented by clinician G8484 HCPCS Influenza Immunization was not ordered or administered, reason not given HCPCS (commonly pronounced as hicks picks = Healthcare Common Procedure Coding System 6/16/2015 5

6 Not Attributable CPT II Code for Compliance of PCP Importance of Chart Documentation Code on All Patients 6/16/2015 6

7 CPT II codes are billed in the procedure code field; just as CPT Category I codes are billed. Use Category II CPT Codes with Category I CPT/HCPC Codes at the time of service. May not be used as a substitute for Category I CPT Codes CPT II codes describe clinical components usually included in evaluation and management or clinical services and are not associated with any relative value. Quality data code line items (CPT II codes) must be submitted with a charge of zero dollars ($0.00). If your system does not allow a $0.00 line item charge, use a small amount such as $ /16/2015 7

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10 The Toolkit has 2 Documents for every measure: 1. Reference Document: Detailed document identifying all of the criteria related to measure 2. Point of Care Document: Simplified document that identifies exactly what codes to document for specific measure 6/16/

11 6/16/ : Reference Document

12 6/16/ : Point of Care Document

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15 A Protected Provider Resource 6/16/

16 Teri Kaneski, BSN, RN System Director, Clinical Integration and Population Management Edward-Elmhurst Healthcare Phone Fax Marcie Lafido, MSN, CNS Manager, Clinical Integration Elmhurst Memorial Healthcare 155 E Brush Hill Rd. Elmhurst, IL mlafido@emhc.org Printed on 6/16/ :18 AM 16