Take The Pain Out Of Documentation, Coding And Billing For .
Take the Pain out ofDocumentation, Codingand Billing for PainManagement ServicesTexas Pain SocietyOctober 24, 2014Judi Blaszczyk, RN, CPC, ACS-PMCompliance AuditorAuditing for Compliance & Education, Inc.1 Title of Presentation
OUR GOALSDocumentation EssentialsEMR HazardsMedical NecessityICD-10A Look Back at 2014A look Forward to 20152 Title of PresentationCopyright 2014 ACE, Inc.
Why Compliance?Patient Protection and Affordable Care Act Compliance plans a requirement for Medicare enrollmentThe Compliance Microscope RAC Audits CERT Audits OIG Private payer audits Increased patient awareness3 Title of PresentationCopyright 2014 ACE, Inc.
Are you Proactive or Reactive? Thoroughly understand payer guidelines for deliveryof services and documentation Conduct an internal assessment Identify corrective actionsto promote compliance Educate your staff and physicians4 Title of PresentationCopyright 2014 ACE, Inc.
Making it Through theReimbursement Maze Payers are limiting whatthey will pay for Payers are limiting how muchthey will pay Payers are making it more complexto submit your services5 Title of PresentationCopyright 2014 ACE, Inc.
6 Title of PresentationCopyright 2014 ACE, Inc.
DocumentationKey to ComplianceandReimbursement7 Title of PresentationCopyright 2014 ACE, Inc.
Why is Documentation So Important? The written document creates an impression ofthe care that has taken place If it is not documented, it did not happen Allows capture of services provided Crucial to dealing with medical legal issues8 Title of PresentationCopyright 2014 ACE, Inc.
General Documentation GuidelinesPayers Require Site of service Date of service Clear identity of patient Medical necessity andappropriateness of the servicesprovided Services are accurately reported Signature of provider9 Title of PresentationCopyright 2014 ACE, Inc.
Documentation GuidelinesSources CMS Website MAC websites NCCI Commercial payer publications Industry publications & seminars Specialty societies10 Title of PresentationCopyright 2014 ACE, Inc.
EMR-Friend or Foe?2014 OIG Work PlanWe will determine the extent to which selected paymentsfor evaluation and management (E/M) services wereinappropriate. We will also review multiple E/M servicesassociated with the same providers and beneficiaries todetermine the extent to which electronic or papermedical records had documentation vulnerabilities.Context—Medicare contractors have noted an increasedfrequency of medical records with identicaldocumentation across services. Medicare requiresproviders to select the billing code for the service on thebasis of the content of the service and to havedocumentation to support the level of service reported.(CMS’s Medicare Claims Processing Manual, Pub. No.100-04, ch. 12, § 30.6.1.) (OEI; 04-10-00181; 04-1000182; expected issue date: FY 2014; work in progress)11 Title of PresentationCopyright 2014 ACE, Inc.
EMR-Friend or Foe?“Cut and Paste”, “Pulling Forward”May EqualInaccurate NotesOver-Documentation12 Titleof PresentationCopyright2014 ACE, Inc.
Electronic Signatures1. Must contain authenticated signature “Authenticated by”; “electronically signed by”2. Potential for misuse or abuse System and software products should be protected againstunauthorized modifications Should have adequate procedures and safeguards in place Correspond to recognized standards and laws Check with attorneys and malpractice insurers13 Title of PresentationCopyright 2014 ACE, Inc.
Medical NecessityKey ToOptimizingReimbursement14 Title of PresentationCopyright 2014 ACE, Inc.
What is Medical Necessity?“Under Section 1862 (a) (1) (A) of the Social Security Act.the Medicare Program covers services that are deemedreasonable and necessary. This Section of the Act statesno Medicare payment shall be made for items or servicesthat “are not reasonable and necessary for the diagnosis ortreatment of illness or injury or to improve the functioning ofa malformed body member”. “15 Title of PresentationCopyright 2014 ACE, Inc.
What is Medical Necessity?Services Must Be: Consistent with the symptoms ordiagnoses of the illness or injury undertreatment Necessary and consistent withgenerally accepted professionalmedical standards, i.e., notexperimental or investigational Not furnished primarily for theconvenience of the patient, theattending physician or anotherphysician or supplier Furnished at the most appropriate levelwhich can be provided safely andeffectively to the patient16 Title of PresentationCopyright 2014 ACE, Inc.
DIAGNOSES PROVE MEDICAL NECESSITY Diagnoses tell a storyIn pain patients diagnosis will usually change and getmore specific with different treatments Diagnoses must be clearly documented or easily inferred Diagnoses must document objective and physical findingsto support the medical necessity for the care Keep in mind payer local coverage determinations17 Title of PresentationCopyright 2014 ACE, Inc.
ICD-10 Over 68,000 codes May have up to 7 digits Specificity greatly expanded Includes laterality, episode of care Expanded use of combination codes Will require much more specificdocumentation18 Title of PresentationCopyright 2014 ACE, Inc.
ICD-10Challenges Technology Training Overtime Denials due to poordocumentation Time lost19 Title of PresentationCopyright 2014 ACE, Inc.
ICD-10 RemediesFinancial Bank loans for capital cost e.g. software updates, training Business credit cards Line of creditTraining Point person, committee Take advantage of educational opportunities esources.html20 Title of PresentationCopyright 2014 ACE, Inc.
Preparing for ICD-10-CMStart lifting weights!Implementation10/1/2015CMS ICD‐10 Web site:http://www.cms.gov/icd1021 Title of PresentationCopyright 2014 ACE, Inc.
2014 in Review CPT 2014 Physician Fee Schedule Correct Coding Initiative Local Coverage Determinations Spinal Cord Stimulator & Drug Billing Changes22 Title of PresentationCopyright 2014 ACE, Inc.
CPT 2014CPT 201364613 Chemodenervationof muscle(s); neckmuscle(s) (eg, forspasmodic torticollis,spasmodic dysphonia)23 Title of PresentationCPT 201464616Chemodenervation ofneck muscle(s), excludingmuscles of the larynx,unilateral (e.g., for cervicaldystonia, spasmodictorticollis)Copyright 2014 ACE, Inc.
CPT 2014CPT 201364614 Chemodenervationof muscle(s); extremityand/or trunk muscle(s)(eg, for dystonia, cerebralpalsy, multiple sclerosis)CPT 2014 – 6 new codes, 24 Title of PresentationCopyright 2014 ACE, Inc.extremity & trunkmuscles64642 6464364644 646456464664647
CPT 2014 64642 Chemodenervation of one25 Title of Presentationextremity; 1-4 muscle(s) 64643 ; each additionalextremity, 1-4 muscle(s) (Listseparately in addition to code forprimary procedure.) 64644Chemodenervation of oneextremity; 5 or more muscles 64645 ; each additionalextremity, 5 or more muscle(s) (Listseparately in addition to code forprimary procedure.)Copyright 2014 ACE, Inc.
CPT 2014 64646 Chemodenervation of trunkmuscle(s); 1-5 muscle(s) 64647 ; 6 or more musclesReport only one code once per session.26 Title of PresentationCopyright 2014 ACE, Inc.
Physician Fee Schedule 2014 Medicare took aim at ultrasound with major jointinjections Medicare took aim at epidurals27 Title of PresentationCopyright 2014 ACE, Inc.
Physician Fee Schedule – 2014“As we noted in the proposed rule,we are concerned aboutpotential over-utilization ofthese codes and it was suggestedthat the payment for CPT code76942 and CPT code 20610should be bundled to reduce theincentive for providers to alwaysprovide and bill separately forultrasound guidance.”28 Title of PresentationCopyright 2014 ACE, Inc.
Physician Fee Schedule – 2014Ultrasound needle guidance (76942)2013 payment: 208.56WorkMPPERVU0.670.055.416.132014 payment: 74.1529 Title of PresentationWorkMPPERVU0.670.051.352.07Copyright 2014 ACE, Inc.
Physician Fee Schedule 2014Epidural injections (62311)2013 - payment: 213.32WorkMPPERVU1.540.124.616.272014 - payment: 108.9030 Title of PresentationWorkMPPERVU1.170.091.783.04Copyright 2014 ACE, Inc.
Physician Fee Schedule 2014PQRS 9 measures to earn bonus 3 measures to avoid penalty Measures groups, including backpain restricted to registryreporting31 Title of PresentationCopyright 2014 ACE, Inc.
Physician Fee Schedule – 2014NPPs – State Scope of Practice State law dictates who may provide services orincident-to. Altered the definition of auxiliary personnel toreflect that they meet “any applicable requirements toprovide the services, including licensure, imposed by thestate in which the services are being furnished.”32 Title of PresentationCopyright 2014 ACE, Inc.
NCCI Manual Winter 2014Modifier 59 guidelines revised for 20142013 manual“Under certain circumstances, the physician or other healthcare professional may need to indicate that a procedure orservice was distinct or independent from other services performedon the same day. This may represent a different session or patient encounter,different procedure or ”33 Title of PresentationCopyright 2014 ACE, Inc.
NCCI Winter 2014Modifier 59 guidelines revisedNew language“Documentation must support a differentsession, different procedure or surgery,different site or organ system, separateincision/excision, separate lesion, or separateinjury (or area of injury in extensive injuries) ”34 Title of PresentationCopyright 2014 ACE, Inc.
NCCI Manual Winter 2014E/M during global periodE/M visits are included in theglobal period if they are“related to complications ofsurgery that do not requireadditional trips to the operatingroom.”35 Title of PresentationCopyright 2014 ACE, Inc.
NCCI Manual Winter 2014Urine drug screens- MUE 1 Unit of Service –G0434 (CLIA-waived and moderatecomplexity) orG0431 (high-complexity method) Includes all tests administered during theencounter36 Title of PresentationCopyright 2014 ACE, Inc.
Spring 2014 Spinal cord stimulators Local CoverageDeterminations37 Title of PresentationCopyright 2014 ACE, Inc.
Spring 2014Spinal Cord Stimulators Medicare bundles L8680 into the implantprocedure No separate payment for electrodes Medicare cases moved to facilities38 Title of PresentationCopyright 2014 ACE, Inc.
Spring 2014Local coverage determinations Uniform policies ICD-10 LCDs39 Title of PresentationCopyright 2014 ACE, Inc.
Spring 2014Question: What do Medicarecarriers Noridian, Palmetto GBA &CGS all have in common?40 Title of PresentationCopyright 2014 ACE, Inc.
Answer: A Lumbar Epidural PolicyUniform imaging requirements: Minimum criteria: Plain films to rule out fracture, potentialmalignancies, etc. Advanced imaging (MRI, CT) may be appropriate prior toperforming an LESI.Uniform medication requirements For each session, no more than 80mg of triamcinolone, 80mg of methylprednisolone, 12 mg of betamethasone, 15 mgof dexamethasone or equivalent corticosteroid dosing maybe used.41 Title of PresentationCopyright 2014 ACE, Inc.
Answer: A Lumbar Epidural PolicyUniform provider requirements:Patient safety and quality of care mandate that healthcareprofessionals who perform epidural steroid injections areappropriately trained and/or credentialed by a formalresidency/fellowship program and/or are certified by eitheran accredited and nationally recognized organization or by apost-graduate training course accredited by an establishednational accrediting body Translation (from Noridian):Providers who learned how to perform pain injectionsduring a weekend course don’t qualify.42 Title of PresentationCopyright 2014 ACE, Inc.
Reason for Change:Creation of Uniform LCDswith Other MACJurisdiction.43 Title of PresentationCopyright 2014 ACE, Inc.
Spring 2014LCDs with ICD-10 diagnosis codes Started in late February to meet April deadline Being updated despite ICD-10 freeze44 Title of PresentationCopyright 2014 ACE, Inc.
Summer 2014Proposed Physician Fee Schedule 2015 Epidurals PQRS Global Periods45 Title of PresentationCopyright 2014 ACE, Inc.
Proposed Physician Fee Schedule 2015Epidurals – Good News, Bad News Medicare plans to restore 2013 RVUs,but will bundle imaging46 Title of PresentationCopyright 2014 ACE, Inc.
Proposed Physician Fee Schedule 2015Epidurals – Good News, Bad NewsCode/Total201362311 213.3277003 95.94Total 309.262014 108.90 90.99 199.892015 225.31N/A 225.31From a chart created by Devona Slater, president, ACE, Inc. Calculations basedon RVUs from the proposed rule’s Addendum B and the 2014 conversion factor of 35.82 to calculate fees in the 2015 columns.47 Title of PresentationCopyright 2014 ACE, Inc.
Proposed Physician Fee Schedule 2015PQRS – 3 Changes to Watch For1. Cross-cutting measures Represent “the development of a care planthat most eligible professionals mayperform and is applicable to most elderlypatients in various inpatient/outpatientsettings.” Tobacco use cessation, depressionscreening and body mass index screeningand follow-up.48 Title of PresentationCopyright 2014 ACE, Inc.
Proposed Physician Fee Schedule 2015PQRS – 3 Changes to Watch For2. Back pain measures group deleted3. Fewer claims-based measures CMS wants to go claims reporting free by2017 Consider using as many cross-cuttingmeasures as possible.49 Title of PresentationCopyright 2014 ACE, Inc.
Other Changes to Come?Non-covered services (excerpt from Noridian Draft LCD)“LC-MS/MS and GC-MS at Point-of-Care PhysicianOffice Labs (POC/POL): GC-MS and LC-MS/MS/MS arenot point of care testing technologies and notreasonable and necessary for the immediate care andmanagement of patients. They require extensiveknowledge of the technology, many months tovalidate individual assays, 4-8 hours of complexpre-analytic, analytic and post analytic specimenhandling, and compliance with CLIA regulations.50 Title of PresentationCopyright 2014 ACE, Inc.
Other Changes to Come?Non-covered services (excerpt from Palmetto GBADraft LCD)Palmetto GBA will no longer reimburse for drugconfirmation testing, specific drug quantitation testingor nonspecific analyte testing at POC/POLs andphysician partnered laboratories. Test services referredfrom one physician lab to another physician’s lab willnot be reimbursed ”51 Title of PresentationCopyright 2014 ACE, Inc.
New 2015 Codes and ModifiersNew Distinct Procedural ServiceModifiersCPT 201552 Title of PresentationCopyright 2014 ACE, Inc.
2015 New Modifiers1. XE (Separate encounter, a service that is distinctbecause it occurred during a separate encounter).2. XS (Separate structure, a service that is distinctbecause it was performed on a separateorgan/structure).3. XP (Separate practitioner, a service that is distinctbecause it was performed by a differentpractitioner).4. XU (Unusual non-overlapping service, the use of aservice that is distinct because it does not overlapusual components of the main service).53 Title of PresentationCopyright 2014 ACE, Inc.
2015 New Modifiers Effective January 1, 2015 Created to curb abuse of modifier 59 Medicare will still allow modifier 59 when a morespecific modifier is not available Carriers may require X modifier for codes that have ahigh risk of incorrect billingChange Request 8863 for the One-Time Notificationmanual54 Title of PresentationCopyright 2014 ACE, Inc.
CPT 2015 CPT Pain Code Updates Joint Injections Vertebroplasty & VertebralAugmentation Myelography New Post-op Pain Codes Stimulator Analysis Drug Screens 55 Title of PresentationCopyright 2014 ACE, Inc.
Joint Injections – 201420600 Arthrocentesis, aspiration and/or injection;small joint or bursa (e.g., fingers, toes)20605 ; intermediate joint or bursa (e.g.,temporomandibular, acromioclavicular, wrist, elbow orankle, olecranon bursa)20610 ; major joint or bursa (eg, shoulder, hip, kneejoint, subacromial bursa)Report ultrasound needle guidance with 7694256 Title of PresentationCopyright 2014 ACE, Inc.
Joint Injections 201520600 Arthrocentesis, aspiration and/or injection, small joint orbursa (e.g., fingers, toes); without ultrasound guidance20604 with ultrasound guidance, with permanent recordingand reporting20605 , intermediate joint or bursa (e.g., temporomandibular,acromioclavicular, wrist, elbow or ankle, olecranon bursa); withoutultrasound guidance20606 with ultrasound guidance, with permanent recordingand reporting20610 , major joint or bursa (e.g., shoulder, hip, knee, subacromialbursa); without ultrasound guidance20611 with ultrasound guidance, with permanent recordingand reporting57 Title of PresentationCopyright 2014 ACE, Inc.
Vertebroplasty &Vertebral Augmentation 201422520 Percutaneous vertebroplasty (bone biopsy includedwhen performed), 1 vertebral body, unilateral or bilateralinjection; thoracic22521 ; Lumbar 22522 ; each additional thoracic or lumbar vertebralbody (List separately in addition to code for primaryprocedure)58 Title of PresentationCopyright 2014 ACE, Inc.
Vertebroplasty & VertebralAugmentation – 201422523 Percutaneous vertebral augmentation, includingcavity creation (fracture reduction and bone biopsyincluded when performed) using mechanical device, 1vertebral body, unilateral or bilateral cannulation (eg,kyphoplasty); thoracic22524 ; Lumbar 22525 ; each additional thoracic or lumbar vertebralbody (List separately in addition to code for primaryprocedure)59 Title of PresentationCopyright 2014 ACE, Inc.
Vertebroplasty & VertebralAugmentation – 2014Imaging72291 Radiological supervision and interpretation,percutaneous vertebroplasty, vertebral augmentation, orsacral augmentation (sacroplasty), including cavitycreation, per vertebral body or sacrum; underfluoroscopic guidance72292 ; under CT guidance60 Title of PresentationCopyright 2014 ACE, Inc.
Vertebroplasty & VertebralAugmentation – 2015Vertebroplasty, vertebral augmentation and imaging codes:22520 – 2252222523 – 2252572291 – 7229261 Title of PresentationCopyright 2014 ACE, Inc.
Vertebroplasty & VertebralAugmentation – 201522510 ; Percutaneous vertebroplasty (bone biopsyincluded when performed), 1 vertebral body, unilateral orbilateral injection, inclusive of all imagingguidance; cervicothoracic22511 ; Lumbosacral 22512 ; each additional cervicothoracic or lumbosacralvertebral body (List separately in addition to code forprimary procedure)Moderate sedation is included62 Title of PresentationCopyright 2014 ACE, Inc.
Vertebroplasty & VertebralAugmentation – 201522513 ; Percutaneous vertebral augmentation, includingcavity creation (fracture reduction and bone biopsy includedwhen performed) using mechanical device (eg, kyphoplasty),1 vertebral body, unilateral or bilateral cannulation, inclusiveof all imaging guidance; thoracic22514 ; Lumbar 22515 ; each additional thoracic or lumbar vertebralbody (List separately in addition to code for primaryprocedure)Moderate sedation is included63 Title of PresentationCopyright 2014 ACE, Inc.
Sacroplasty – 2015Sacroplasty codes updated0200T Percutaneous sacral augmentation (sacroplasty),unilateral injection(s), including the use of a balloon ormechanical device, when used, 1 or more needles, includesimaging guidance and bone biopsy, when performed0201T , bilateral injections, including the use of a balloon ormechanical device, when used, 2 or more needles, includesimaging guidance and bone biopsy, when performedModerate sedation is included64 Title of PresentationCopyright 2014 ACE, Inc.
Disc Arthroplasty – 201422856 Total disc arthroplasty (artificial disc), anteriorapproach, including discectomy with end platepreparation (includes osteophytectomy for nerve rootor spinal cord decompression and microdissection),single interspace, cervical;2014 guidance: “For additional interspace cervicaltotal disc arthroplasty, use 0092T)”65 Title of PresentationCopyright 2014 ACE, Inc.
Disc Arthroplasty – 20150092T deleted 22858 ; second level, cervical (List separately inaddition to code for primary procedure66 Title of PresentationCopyright 2014 ACE, Inc.
Knee Injection - 27370CPT 2014CPT 2015Injectionprocedure forkneearthrographyInjection ofcontrast forkneearthrography67 Title of PresentationCopyright 2014 ACE, Inc.
Myelography – 201462284Injection procedure for myelography and/orcomputed tomography, spinal (other thanC1-C2and posterior fossa)72240 Myelography, cervical, radiological supervision andinterpretation72255 Myelography, thoracic, radiological supervision andinterpretation72265 Myelography, lumbosacral, radiological supervision andinterpretation72270 Myelography, 2 or more regions (e.g., lumbar/thoracic,cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),radiological supervision and interpretation68 Title of PresentationCopyright 2014 ACE, Inc.
Myelography – 201562284 Injection procedure for myelography and/orcomputed tomography, lumbar (other than C1-C2 andposterior fossa)62302 Myelography via lumbar injection, includingradiological supervision and interpretation; cervical62303 ; Thoracic62304 ; Lumbosacral62305 ; 2 or more regions (e.g., lumbar/thoracic,cervical/thoracic, lumbar/cervical,lumbar/thoracic/cervical)Radiology codes not deleted. May still be used with 62284 ifdifferent provider69 Title of PresentationCopyright 2014 ACE, Inc.
TAP Blocks – 2014ASRA – Transversus Abdominis Plane (TAP) Block:“ a regional anesthetic technique used to block sensationto the anterior abdominal wall. Prospective randomizedtrials have demonstrated analgesic efficacy of TAP block andcadaveric studies have shown reliable dye spread from T9L1 (iliac crest to the costal margin), although the spread isdependent upon the technique of injection, single versusmultiple injections. “No specific codes, providers report Injection64450 (Injection, anesthetic agent; other peripheralnerve or branch)Continuous infusion64999 (Unlisted procedure)70 Title of PresentationCopyright 2014 ACE, Inc.
TAP Blocks – 2015Unilateral64486 Transversus abdominis plane (TAP) block(abdominal plane block, rectus sheath block)unilateral; by injection(s) (includes imaging guidance,when performed)64487 ; by continuous infusion(s) (includesimaging guidance, when performed)71 Title of PresentationCopyright 2014 ACE, Inc.
TAP Blocks – 2015Bilateral64488 bilateral; by injections (includesimaging guidance, when performed)64489 ; by continuous infusions (includesimaging guidance, when performed)72 Title of PresentationCopyright 2014 ACE, Inc.
95972 – Stimulator Analysis2014Complex spinal cord,or peripheral (i.e. ,peripheral nerve, sacralnerve, neuromuscular)(except cranial nerve)neurostimulator pulsegenerator/transmitter,with intra-operative orsubsequentprogramming, firsthour73 Title of Presentation2015Complex spinal cord,or peripheral (i.e. ,peripheral nerve, sacralnerve, neuromuscular)(except cranial nerve)neurostimulator pulsegenerator/transmitter,with intra-operative orsubsequentprogramming, up to 1hourCopyright 2014 ACE, Inc.
Drug Testing74 Title of PresentationCopyright 2014 ACE, Inc.
Drug Testing – 2015Some codes you won’t see next year:80100 Drug screen, qualitative; multiple drug classes chromatographicmethod, each procedure80101 ; single drug class method (e.g., immunoassay, enzyme assay), eachdrug class80104 ; multiple drug classes other than chromatographic method, eachprocedure80102 Drug confirmation, each procedure82145 Amphetamine (methamphetamine)80154 Benzodiazepines82205 Barbituates (not elsewhere specified)82520 Cocaine (or metabolites)83840 Methadone83925 Opiates82646 Dihydrocodeine (Hydrocodone)82649 Dihydromorphinone (Hydromorphone)75 Title of PresentationCopyright 2014 ACE, Inc.
Drug Testing – 2015What’s new? Terminology Drug class lists All new codes76 Title of PresentationCopyright 2014 ACE, Inc.
Drug Testing – 2015Terminology Qualitative Presumptive Quantitative Definitive77 Title of PresentationCopyright 2014 ACE, Inc.
Drug Testing – 2015Drug class lists 2014 – 1 list 2015 Drug Class A Drug Class B78 Title of PresentationCopyright 2014 ACE, Inc.
CPT 2014 Drug Testing List BecomesDrug Class A List Alcohol (Ethanol) Methaqualone Amphetamines Methylenedioxymethamphetamine (MDMA) Barbiturates Opiates Benzodiazepines Oxycodone Buprenorphine Phencyclidine Cocaine metabolite Propoxyphene Heroin metabolite (6monoacetylmorphine) Tetrahydrocannabinol (THC)metabolites (marijuana) Methadone Methadone metabolite (EDDP) Tricyclic AntidepressantsDeleted: Phenothiazines Methamphetamine79 Title of PresentationCopyright 2014 ACE, Inc.
CPT 2015 Adds Drug Class B List Acetaminophen Carisoprodol/Meprobamate Ethyl Glucuronide Fentanyl Ketamine Meperidine Methylphenidate Nicotine/Cotinine Salicylate Synthetic Cannabinoids Tapentadol80 Title of Presentation Tramadol Zolpidem Not otherwise specifiedCopyright 2014 ACE, Inc.
Why the Detailed Lists?New presumptive codes80300 Drug screen, any number of drug classes fromDrug Class List A; any number of non-TLC devicesor procedures, (e.g., immunoassay) capable of beingread by direct optical observation, includinginstrumented-assisted when performed (e.g.,dipsticks, cups, cards, cartridges), per date ofservice80301 ; single drug class method, by instrumented testsystems (e.g., discrete multichannel chemistryanalyzers utilizing immunoassay or enzyme assay),per date of service81 Title of PresentationCopyright 2014 ACE, Inc.
New Presumptive Codes80302 Drug screen, presumptive, single drug class fromDrug Class List B, by immunoassay (e.g., ELISA) ornon-TLC chromatography without massspectrometry (e.g., GC, HPLC), each procedure80303 Drug screen, any number of drug classes,presumptive, single or multiple drug classmethod; thin layer chromatography procedure(s)(TLC) (e.g., acid, neutral, alkaloid plate), per date ofservice80304 ; not otherwise specified presumptive procedure(e.g., TOF, MALDI, LDTD, DESI, DART), eachprocedure82 Title of PresentationCopyright 2014 ACE, Inc.
Drug Testing – 2015Which class or classes are you testing? Class A Class BWhat testing method was used?Is it billable per date of service or per procedure?83 Title of PresentationCopyright 2014 ACE, Inc.
Drug Screens – 2015 New Definitives80348Buprenorphine80349Cannabinoids, naturalCannabinoids, synthetic803501-3803514-6803527 or more80356Heroin metaboliteOpioids & opiate analogs803621 or 2803633 or 4803645 or more80365Oxycodone84 Title of PresentationCopyright 2014 ACE, Inc.
What’s Next? More Guidance Payment Information Coverage Policies85 Title of PresentationCopyright 2014 ACE, Inc.
Questions?Judi Blaszczyk RN,CPC, ACS-PMAuditing for Complianceand Education, Inc.10561 Barkley Street, Suite 610Overland Park, KS 66212913.648.8572www.aceanesthesiapain.com86 Title of PresentationCopyright 2014 ACE, Inc.
ICD-10 Remedies Financial Bank loans for capital cost e.g. software updates, training Business credit cards Line of credit Training . torticollis) 24 Title of Presentation CPT 2014 CPT 2013 64614 Chemod
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
Silat is a combative art of self-defense and survival rooted from Matay archipelago. It was traced at thé early of Langkasuka Kingdom (2nd century CE) till thé reign of Melaka (Malaysia) Sultanate era (13th century). Silat has now evolved to become part of social culture and tradition with thé appearance of a fine physical and spiritual .
On an exceptional basis, Member States may request UNESCO to provide thé candidates with access to thé platform so they can complète thé form by themselves. Thèse requests must be addressed to esd rize unesco. or by 15 A ril 2021 UNESCO will provide thé nomineewith accessto thé platform via their émail address.
̶The leading indicator of employee engagement is based on the quality of the relationship between employee and supervisor Empower your managers! ̶Help them understand the impact on the organization ̶Share important changes, plan options, tasks, and deadlines ̶Provide key messages and talking points ̶Prepare them to answer employee questions
Dr. Sunita Bharatwal** Dr. Pawan Garga*** Abstract Customer satisfaction is derived from thè functionalities and values, a product or Service can provide. The current study aims to segregate thè dimensions of ordine Service quality and gather insights on its impact on web shopping. The trends of purchases have
pain”, “more pain” and “the most pain possible”. Slightly older children can also say how much they are hurting by rating their pain on a 0-10 (or 0-100) scale. Zero is no pain and 10 (or 100) is the worst possible pain. What a child is doing Often children show their pain by crying, making a “pain” face, or by holding or rubbing .
Chính Văn.- Còn đức Thế tôn thì tuệ giác cực kỳ trong sạch 8: hiện hành bất nhị 9, đạt đến vô tướng 10, đứng vào chỗ đứng của các đức Thế tôn 11, thể hiện tính bình đẳng của các Ngài, đến chỗ không còn chướng ngại 12, giáo pháp không thể khuynh đảo, tâm thức không bị cản trở, cái được
Short-term pain, such as when you suffer a sprained ankle, is called 'acute' pain. Long-term pain, such as back pain that persists for months or years, is called 'chronic' pain. Pain that comes and goes, like a headache, is called 'recurrent' pain. It is not unusual to have more than one sort of pain or to have pain in several places
