Reimbursement/Coding

Reimbursement/Coding

Reimbursement/Coding THE INFORMATION REGARDING REIMBURSEMENT IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY AND REPRESENTS NO STATEMENT, PROMISE, OR GUARANTEE BY THE JOHNSON & JOHNSON DIABETES INSTITUTE, LLC CONCERNING LEVELS OF REIMBURSEMENT, PAYMENT, OR CHARGE. SIMILARLY, ALL CPT AND HCPCS CODES ARE SUPPLIED FOR INFORMATIONAL PURPOSES ONLY AND REPRESENT NO STATEMENT, PROMISE, OR GUARANTEE BY THE JOHNSON & JOHNSON DIABETES INSTITUTE, LLC THAT THESE CODES WILL BE APPROPRIATE OR THAT REIMBURSEMENT WILL BE MADE. IT IS NOT INTENDED TO INCREASE OR MAXIMIZE REIMBURSEMENT BY ANY PAYOR. WE STRONGLY RECOMMEND THAT YOU CONSULT YOUR PAYOR ORGANIZATION WITH REGARD TO ITS REIMBURSEMENT POLICIES. Using SMA tool code for a shared visit Go to Patient Cases section in your book and review the following: Kenny, April and 8 peers & parents Visit is planned for 90 min: vitals, MNT by RD, brief consult with HCP & peer discussion of lapses in self-mgmt Code for this visit using tool Coding for SMA

What determines the 4th digit? What determines the 5th digit? What education code is used? How long does the education have to be? What CPT code is most likely? Diabetes Coding Always use 5 digit code Code to highest specificity Gestational Diabetes Manifestations

Add as 4th digit Complete Code DM1 Controlled: Add as 5th digit TDM1 Uncontrolled: Add as 5th digit TDM2 Controlled: Add as 5th digit DM2 Uncontrolled:

Add as 5th digit 250 None 0 250.0X 1 3 0 2 250 Renal 4

250.4X 1 3 0 2 250 Ophthalmologic 5 250.5X 1 3 0 2

250 Neurological 6 250.6X 1 3 0 2 250 Peripheral Circulatory 7 250.7X

1 3 0 2 250 Other specified 8 250.8X 1 3 0 2

250 Unspecified 9 250.9X 1 3 0 2 Base code 648.03 Example: Code diabetes first: 250.XX Code also manifestation: 250.5 Retinopathy

Coding for SMA 4th digit? Complications/manifestations 5th digit? Glycemia controlled vs. uncontrolled What education code is used? 97804 How long does the education have to be? 30m What CPT code is most likely? 99213 DSME and MNT Complimentary Every single patient should receive BOTH: Diabetes Self-Management Education (DSME) 10 hrs in initial year 2 hrs in all subsequent years Medical Nutrition Therapy (MNT) 3 hrs in initial year Extra hrs can be requested and reimbursed 2 hrs in all subsequent years

Avoi ding payb ac ks Pt Completed/Provider Reviewed S , k c i u Q Nurse and Provider Completed ! t i n a

c S d n a e l p im SMA: E/M Visit Aver. # pts seen 10 # individual E/M pt visits billed by physician/NPP and typical level of Aver. insurance reimbursement 10 x code 99214** @ $/pt

E/M: $/ 1 hr DO THE MATH Traditional Practitioner Appointment: DM Management Only Aver. # pts seen # individual E/M pt visits billed by physician/NPP and typical level of Aver. insurance reimbursement 10 10 x code 99214** @ $/pt E/M: $/ 3.3 hrs

Recently Viewed Presentations

  • Tell Aaron and his sons, This is how

    Tell Aaron and his sons, This is how

    The god of this age has blinded the minds of unbelievers, so that they cannot see the light of the gospel of the glory of Christ, who is the image of God. For God, who said, "Let light shine out...
  • TransitRail: National Commercial Peering Exchange Program

    TransitRail: National Commercial Peering Exchange Program

    TransitRail: National Commodity Peering Program May 16, 2006 Quilt Minneapolis Premise Successful large-scale commodity Peering can... Decrease commodity costs and result in overall savings Reduce reliance on commercial vendors Increase routing efficiency and flexibility TransitRail Is/Will Be...
  • Air Stripping of Volatiles Sometimes volatile compounds (generally

    Air Stripping of Volatiles Sometimes volatile compounds (generally

    Packed tower air stripping is commonly used to remove volatile contaminates ( e.g., tetrachloroethylene, trichloroethylene, benzene, ammonia) from contaminated waters. Increasingly, it is being applied to the renovation of groundwaters that have become contaminated with volatile organic carbon ...
  • Care Coordination and Implementing Services in your office

    Care Coordination and Implementing Services in your office

    Care Coordination. Goes hand in hand with new services. But can be just as valuable alone. Can be new staff or restructure current. Can be part time/full time
  • Foreign Policy - Weshallfightthemonthebeaches

    Foreign Policy - Weshallfightthemonthebeaches

    1902, GERMANY AND THE BOER WAR. During the war, Germany sent armaments and aid to the Boers fighting the British, as well as cheap loans. The size of the shipments was not small-Kruger wished to fully re-equip his troops. This...
  • Global Regulation & Nomenclature of Medical Devices

    Global Regulation & Nomenclature of Medical Devices

    UDI and the GMDN (Global Medical Device Nomenclature) Mark Wasmuth Secretary General GMDN Agency * * * * * * * * * * * * * * * * * Contents Background to GMDN & GHTF Development of GMDN...
  • Milestone II - Weebly

    Milestone II - Weebly

    Schematics. We are working on getting an actual survey of the land that we have to work with. Rebecca, the logistic manager of Strong Missions went out and confirmed the basic measurements taken on the summer recon trip and also...
  • 18    " " Steve Wyborney www.stevewyborney.com :    ?

    18 " " Steve Wyborney www.stevewyborney.com : ?

    Steve Wyborney. רמז מספר 1. מספר הכדורים קטן מ-150. רמז מספר 2. מספר הכדורים הוא אי-זוגי. רמז מספר 4. התבוננו בקובייה שליד הכלי. בתשובה מופיעה הספרה שהיא סכום הנקודות שעל שלוש פאות הקובייה שאנו רואים. רמז ...