How Do You Survive In Today s Practice Environment?

Transcription

1 How Do You Survive In Today s Practice Environment? Presented by: Dr. Bruce Maniet, D.O. Bells Medical Clinic Evaluation and Management Codes Nursing Home Visits New 25 min $ New 35 min $ New 45 min $ Established 10 min $ Established 15 min $ Established 25 min $ Established 35 min $ Annual Nursing Home H & P $93.06 Assisted Living Visits New 20 min $ New 30 min $ New 45 min $ New 60 min $ New 75 min $ Established 15 min $ Established 25 min $ Established 40 min $ Established 60 min $ Housecalls New 20 min $ New 30 min $ New 45 min $ New 60 min $ New 75 min $ Established 15 min $ Established 25 min $ Established 40 min $ Established 60 min $ Medicare Wellness Visits Annual Wellness Visits 3 Types Welcome to Medicare Physical G0402 $ Performed within the first 6 months of Medicare Enrollment Initial Annual Wellness Visit G0438 $ Subsequent Annual Wellness Visit G0439 $ *Use Physical Diagnosis Code *Does not have to be performed by Physician 1

2 2

3 3

4 4

5 Preventive Medicine Physicals Benefit of using Physical codes, they are generally paid at 100% and do not go against deductibles. Also other procedures performed on same day and linked to the physical ICD also not applied to deductibles (ie: EKG, Lab, Urinalysis, etc.) New Patient Established Patient Infant (under 1 year) Early childhood (1 4 years) Late childhood (5 11 years) Adolescent (12 17 years) years years years & older Diagnosis Codes V70.0 ICD 9 Routine General Medical Examination at a Health Care Facility Z00.00 ICD 10 Routine General Medical Examination at a Health Care Facility Remember, if you are also treating an established medical condition or find a new condition needing treatment; add the appropriate E/M code with 25 modifier and separate Diagnosis code. Intensive Behavioral Therapy for Cardiovascular Disease G0446 $24.51 One face to face CVD risk reduction visit annually Use code Z13.6 *Do not use with Annual Wellness Visit. Documentation must include all 3 components: 1. Encouraging Aspirin use for the primary prevention of CVD when the benefits outweigh the risks for men aged years and women aged Screening for high blood pressure in adults aged 18 years and older (140/90 non diabetic; 130/80 diabetic). 3. Intensive behavioral counseling to promote a healthy diet for adults with hyperlipidemia, hypertension, advancing age, and other known risk factors for cardiovascular and diet related chronic disease. Annual Screen for Depression. Medicare Screening for Depression Only allowed once in a 12 month period. Use Code G0444 $17.26 *No specific ICD code. Various screening tools are available, CMS does not specify any specific screening criteria. Many use the PHQ 9 Depression Questionnaire. 5

6 Medicare Screen for Alcohol Misuse Medicare allows for screening of Alcohol Misuse. Allowed once every 12 months. Use Code G0442 $17.26 *Is only paid if Misuse is present and counseling been given. Based on 15 minutes. Z13.89 Screening for Alcoholism. Misuse is considered: Women = >7 drinks per week or >3 drinks per occasion Men = >14 drinks per week or >4 drinks per occasion No specified Screening test. Many use: The Michigan Alcoholism Screening Test (MAST) 6

7 7

8 Reimbursement for Tobacco Use Prevention and Cessation Counseling minutes $ Greater than 10 minutes $20.89 Allergy Immunotherapy Allergy Testing Prick Skin Testing. Use Code for each Allergen Tested: $ (ie x 60) Allergy Serum Order serum from allergy pharmacy based on skin test results. Use Code for reimbursement of serum. Average Reimbursement Private Insurance $332.71, Medicare Can have up to 12 Allergens per serum. Average cost for one serum with up to 12 Allergens is $97.00 Allergy Injections 25 Weekly Injections to build up sensitivity and then monthly Professional Service for Allergen Immunotherapy One Injection Medicare $8.04, Insurance $ Professional Service for Allergen Immunotherapy Two Injections Medicare $9.40, Insurance $