Enhance Injection Pay : Just Ask, Listen For Missed Items
Uncircled vaccines, administrations could cost your practice dear
.You thought increasing payments this year is a fairy tale? Well, your magic wand is right at your front desk.
Check-out coding can have a noteworthy financial impact,"reported Norman Chip"Harbaugh, MD, in Vaccine Reimbursement Quite a Quandary"at The Coding Institutes December 2010 Pediatric Coding and Reimbursement Conference in Orlando. Not having the check-out person ensure the pediatrician circles all performed services and procedures can cost a practice with median collections of $556,000 between 2.2 percent to 10.2 percent or $12,340 to $57,000.
To plug those payment holes, train your front desk staff to find two signs of overlooked coding opportunities.
#1:Verify 90476-90749, 90465-90474 on crying departees
If you have a kid age two or younger who comes to the check-out window crying, there is a good opportunity he has just got his required shots. The pediatrician may have circled the apt preventive medicine service code 99381 (Initial comprehensive preventive medicine E&M of an individual infant [age younger than 1 year]) or 99382 ( early childhood [age 1 through 4 years]) for new patients or 99391 (Periodic comprehensive preventive medicine reevaluation and management of an individual infant [age younger than 1 year]) or 99392 ( early childhood [age 1 through 4 years]) for established patients. However, she may have forgotten to code the vaccines (90476-90749, Vaccines, Toxoids) or the administrations (90465-+90474, Immunization Administration for Vaccines, Toxoids). Our medical coder has been reporting only the vaccines without the administration,"one physician conference attendee reported.
Heres a tip: The more eyes you have watching the charge ticket and entry, its more likely you are to avoid missed codes,"points out Harbaugh. On a less than two years of well visit check-out in which the toddler is crying, you can train your check-out staff to query, Howd the vaccines go"?
Say for instance the mother responds, No, Suzie did not receive any vaccines."The checkout person knows, OK, 99381, 99382, 99391 or 99392 as the only CPT code is right,"Harbaugh, a primary care pediatrician practicing in Atlanta explains.
Lets say the mother responds, No, Suzie didnt receive any vaccines."The checkout person knows, OK, 99381, 99382, 99391, or 99392 as the only CPT code is right,"explains Harbaugh, a primary care pediatrician practicing in Atlanta.
If the mother says, Three at one go is very hard,"the check-out person can check with the nurse or medical technician to find out which vaccines the patient received. On the charge ticket, the check-out person can then add the right administration and vaccine codes."
For instance, say the child received MMR, DTaP, and Hib at her 15-month preventive medicine service. The check-out attendant would circle:
For vaccine products:
90707 - Measles, mumps, and rubella virus vaccine (MMR), live, for subcutaneous use
90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than seven years, for intramuscular use
90648 Hemophilus influenza b vaccine (Hib), PRPT conjugate (4 dose schedule), for intramuscular use.
For three shots with physician counseling provided to a child below eight years of age:
90465 Immunization administration younger than eight years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the doctor counsels the patient/family; first injection (single or combination vaccine/toxoid), per day (0.58 relative value units [RVUs])
+90466 each additional injection (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure) (0.29 RVUs)
+90466.
Savings: Catching the vaccines and immunization administrations saves the practice around $224. Missing the administrations alone costs you approximately $42 utilizing the 2009 Medicare Physician Fee Schedule and conversion factor (CF) of 36.0666. The breakdown includes $20.92 for the initial administration and $10.46 for each of the two subsequent administrations. Coupled with losses of $107.25 for the vaccine products (based on average payments) and $74.28 in capital vaccine investment using Harbaughs calculations, youd have had a total loss of $223.53.
Let your ears alert you to injections
Eavesdropping may not be rigueur, however you can use overheard conversations to catch missed services. According to Richard Lander, MD, FAAP, pediatrician with Essex-Morris Pediatric Group in Livingston, N.J, In the ideal (prepayment) coding process, the doctor checks off the code and diagnosis on the superbill and the staff reviews it and catches any errors."
Let us say a pediatrician evaluates a patient for croup and the check-out staff heard the physician tell the nurse to provide the patient a Decadron shot. The pediatrician did not mark injection on the charge ticket. The checkout person checks with the nurse who concurs that the patient received a shot, and the staff then codes the:
injection administration with 96372 (Therapeutic,prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular)
drug supply with J1100 (Injection, dexamethasone sodium phosphate, 1 mg).
Savings: According to the 2009 Medicare Physician Fee Schedule, which uses a national conversion factor of 36.0666, catching that the patient received an injection adds a deserved 0.58 relative value units or approximately $21 to the claim.
Most payers take up this resource-based relative value system in some fashion. The Medicare payment limit for J1100 is $0.09.
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