Basic Guidelines for 2013 Anesthesia Billing and Coding

The proposed 2013 Medicare physician fee schedule contains a 27% pay cut for the top 10 anesthesia codes. Moreover, CMS has released the 2013 OIG work plan stating that Medicare Part B claims will be reviewed closely to determine whether they were supported in accordance with Medicare requirements. Also, the use of modifier “AA” will be scrutinized for Medicare requirements. This should prompt anesthesia groups to re-evaluate certain anesthesia care team scenarios.

While the use of the AA modifier has been determined there are cases that occur in the anesthesia care team model that do warrant additional review. Clear cut billing guidelines do not exist for scenarios where a case starts as medically directed and ends as personally performed, or vice versa. These scenarios can present billing challenges as the existing modifiers of AA (personally performed by the MD), QK/QX (medical direction by the MD/medically directed CRNA) and QZ (services provided by a non-medically directed CRNA) do not fully describe these situations. In such cases, reimbursement is not impacted for groups that employ the CRNAs as the modifiers could affect the payment amount received by the physician group. Provider groups that encounter clinical scenarios which are not accurately described by the current modifiers available may consider seeking clarification from their MAC for clear guidance on appropriate billing procedures.

Lately, CPT 2013 updates have been making the rounds, but there were no new or deleted anesthesia codes. However, revisions have been made to 01991 and 01992 anesthesia billing codes with the description when block or injection is performed by a different physician or other qualified health care professional.

Also, the term “other qualified health care professional” has been included to stress on the fact that CPT does not limit code reporting to specific specialties or providers; instead, scope of practice laws, regulations, contracts, and hospital policy/bylaws determine whether a provider is qualified to perform a service. The individual is also required to be qualified to perform services and independently report it. Clinical staff who do not report their services independently do not fall within the scope of this definition provided by CPT.

ICD-9-CM codes are used in medical billing and coding to describe diseases, injuries, symptoms and conditions. 288.60 ICD-9 code is one of thousands of ICD-9-CM codes used in healthcare. Although ICD-9-CM and CPT codes are largely numeric, the only point of difference is that CPT describe medical procedures and services. 288.60 ICD-9 code is used to report Leukocytosis, unspecified and is a billable medical code that can be used to specify a diagnosis on a reimbursement claim.

Saving Our Medical Industrial Complex With Virtual Doctors

At the start of 2013 many Medicare doctors will watch their reimbursements for Medicare go down by 29%. Consider that if you will, doctors will take a pay cut of 30% in 2013. Many Medicare doctors are sick and tired of all the paperwork, restrictions, and costs dealing with Medicare. Further, the government is very slow to pay the bills, and remember doctors are running a business, often a small business. As more and more doctors decide not to take Medicare patients there will be shortages.

Is there a technological way around this challenge in the future? If you talk to a doctor they would certainly like to be paid more, and they would also like to see malpractice lawsuits disappear, or be drastically reduced. Remember, 30% of what a doctor charges goes to medical malpractice insurance. Think of that if you will, it’s like they are being hit from all sides, and it’s taking a toll on our healthcare industry in the United States.

Is it possible in the future that you won’t ever have to go to the doctor, that everything can be done online? How about in the future with holographic projection and spectral imaging? How about a virtual doctor or how about making yourself a virtual patient in 3-D by standing in front of your computer and sending all the information, it will be as if your doctor is standing there with you, but you save the fuel driving to the doctor, and the waiting time in the lobby. Both you and the doctor save money, and that means that our government when they reimburse the cost for a Medicare visit, the taxpayer pays less.

There was an interesting article in the Wall Street Journal on December 21, 2012 titled “Doctors Move to Webcams,” by Anna Wilde Mathews which noted a number of health care providers using such strategies such as; Well Point, UnitedHealth, and Aetna, American Well Corp. Still, one has to ask what the future of all this might become? Okay so, let’s speculate for a moment while I put on my Futurist hat.

In Kurzweil’s “Accelerating Intelligence” online news there was a piece titled; “The future of medicine is now” published on December 31, 2012 and reprinted from also the WSJ which noted; “Last month, the FDA cleared a new iPhone add-on that lets doctors take an electrocardiogram just about anywhere. Other smartphone apps help radiologists read medical images and allow patients to track moles for signs of skin cancer.”

Of course, there will probably be challenges with this such as fake or even fraudulent folks pretending to be doctors. It is quite possible that your video stream or images of yourself could be hijacked, or a hacker could get into the system and attain that information. Right now, we have HIPPA laws which should suffice. Of course, if you talk to the EFF or Electronic Freedom Foundation I am sure they will have a thing or two to say about all this in the future as well.

Still, can you imagine the benefits of having virtual doctors, and saving the taxpayer from our runaway costs in our medical industrial complex? Indeed I hope you will please consider all this and think on it.

Prevent Toenail Fungus Infections by Adopting a Simple Hygienic Life

Getting your toenails or nails on the fingers infected is not difficult at all. Once you are infected you will have to go through plenty of trouble before you can see your nails as they were before the infection. You can come into contact with the infection within your home, by visiting public places such as swimming pools and gyms or even in the locker room. Exposing your hands and feet to wet and moist conditions is another reason why you could become infected. Unfortunately, many people are unaware about these factors and continue to lead life without maintaining some hygienic habits.

The nails on your body also need attention like any other part because they too are prone to infections, which can take long to treat. This does not mean that you will have to give up on all the activities mentioned above but will only have to ensure that you make an attempt to provide some attention to the nails on your feet and fingers. Ensure that you never leave yourselves exposed to wet conditions for extended periods of time. Working at home will mean that you will be required to do certain jobs, which require you to come into contact with water. In such cases make it a habit to use gloves because they will help in keeping your hands dry.

Do not confine your feet into a pair of shoes throughout the day. Your feet sweat and your shoes provide the fungus the atmosphere it needs to thrive. The fungus can enter the bed of your toenails and begin causing a problem which will make you walk towards the doorstep of a medical practitioner.

Always ensure that you trim and file your nails regularly. Look out for anything that may seem different like spots underneath the nail, signs of your nails crumbling around the edges or even the nail lifting up from the bed. These are indications that you are carrying the infection and must try to find a treatment immediately. Do not panic because this is not a life-threatening disease. It is a manageable infection which will require plenty of dedication from you. There is no need for you to rush towards a doctor because it can be really expensive to deal with costs of the treatments offered. Rather conduct some research and try to locate a company which can give you a good herbal remedy for the infection. You will definitely come across natural treatments for toenail fungus infections, which can be used from the comfort of your home. However, things will be even better if you do not allow the fungus to enter the bed of your toenails in the first place.