The holidays-perfect time to spread the FLU!

IT’S THE HOLIDAY SEASON….TIME TO SPREAD THE FLU!

With all the weather changes we have experienced in the south over the past few months, getting the flu has been the last thing on anyone’s mind.  80 degree temps here in Kentucky in November is unheard of!  We’ve all been taking advantage of getting out in the fresh air (flu?  what flu?).

Well, now we are experiencing our first “Arctic Blast” and my first trip to Kroger this week resulted in witnessing probably the most embarrassing thing we as parents experience….projectile vomiting from a child in the grocery store.  Okay, maybe not the most embarrassing thing in the world but one that certainly had me running for the hand sanitizer and masks (no-I didn’t stick around to help).

And yes, remembering that in fact, the flu season is upon us.

Guidelines for Billing Influenza Vaccines

Medicare pays for one seasonal influenza virus vaccination per influenza season (12 months do not have to pass). Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine.

Medicare will pay both administration fees when a beneficiary receives both the seasonal influenza virus and the pneumococcal vaccines on the same day. Report ICD-10-CM diagnosis code Z23 Encounter for immunization when an individual receives both vaccines, but report separate administration codes for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines.

Medicare Payment Allowances for this flu season (8/1/2016-7/31/2017)

CPT® Code		Payment Allowance
90630	Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use	$20.343
90653	Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use	$37.383
90654	Influenza virus vaccine, split virus, preservative-free, for intradermal use	Pending
90655	Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use	Pending
90656	Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use	$17.717
90657	Influenza virus vaccine, trivalent (IIV3), split virus, when administered to children 6–35 months of age, for intramuscular use	Pending
90661	Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use	Pending
90662	Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use	$42.722
90672	Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use	$26.876
90673	Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use	$40.613
90674	Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use *NOTE-Claims for this code must be held until 1/1/17	$22.936
90685	Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use	$26.268
90686	Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use	$19.032
90687	Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to children 6–35 months of age, for intramuscular use	$9.403
90688	Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use	$17.835

HCPCS Level II Code		Payment Allowance
Q2035	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)	$16.284
Q2036	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)	$16.284
Q2037	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)	Pending
Q2038	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)	Pending
Q2039	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)	Flu Vaccine Adult – Not Otherwise Classified: Payment allowance is to be determined by the local claims processing contractor.

The payment allowance for some codes is still pending. Check the CMS website periodically for updates.

Resources:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html

https://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Provider-Partnership-Email-Archive-Items/2016-12-08-eNews.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending#_Toc468862699

Protect your data with MozyPro®

When you are ready to leave your practice for the day, data backups are probably the last thing on your mind.  However, securing your data off site is not only one of the most important things a practice needs to keep PHI secure, it also protects you from theft and potential hardware failures.

The best of both worlds

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A complete backup strategy

A sound backup strategy involves both a local and an offsite copy of your data. The latest Mozy innovation delivers both with Mozy 2xProtect, included in MozyPro 2.0 for Windows.

Double protection

Mozy 2xProtect automatically backs up files locally to an external drive in addition to a Mozy data center for double protection of your critical business information.

Faster backups

With local backup, you’ll be able to back up large amounts of data quickly—usually within minutes—ensuring your files are backed up locally while they transfer to the MozyPro servers.

We can help your practice comply with the HIPAA Security and Privacy Rules

The Health Insurance Portability and Accountability Act (HIPAA) sets the standard for protecting sensitive patient data. Any company that stores protected health information must ensure that all of the required physical, network, and process security measures are in place and followed. As a provider of HIPAA-compliant backup services that safeguard protected health information, we ensure that your patient data is protected in a way that complies with HIPAA regulations. As a result, we have specific technical and administrative safeguards in place.

Within our Information Security Management System (ISMS), we incorporate a combination of technical, administrative, and physical controls to safeguard personal information consistent with the industry standards and laws. The principles behind each of these standards are for the data owner to retain control of sensitive data and ensure that only authorized parties can view that data.

Pricing Choose the size you need. Monthly or annual contracts are available.
Backup size	Monthly cost	Annual Cost
5GB	$10.00	$108
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100GB	$54.00	$636
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Don't snooze through ICD-10 Category Z codes

Don't snooze through ICD-10

Category Z Codes

Coding from category Z can be a little confusing, but keep in mind that the “Z” codes in ICD-10 were often “V” codes in ICD-9.  Z codes are for use in any healthcare setting.  Z codes may be used as either a first-listed (principle) diagnosis or a secondary code, depending on the circumstances of the encounter.  Like the old “V” codes, certain Z codes may only be used as the primary diagnosis.

Z codes will indicate a reason for an encounter-they do not replace the CPT code.

There are several categories for Z codes:

Contact/Exposure

These codes are for patients who do not show any signs or symptoms of a disease, but have been exposed to it by close personal contact with an infected individual or are in an area where a disease is epidemic.  

Inoculations and Vaccinations

ICD-10 Code Z23 is for encounters for inoculations and vaccinations.  It indicates that a patient is being seen to receive a prophylactic inoculation against a disease.  The CPT/Procedure code would indicate which vaccine or immunization is being given.  Code Z23 may be used as a secondary code if the inoculation is given as part of preventative healthcare, such as a well-baby visit.

In ICD-9, each inoculation/vaccination would have the appropriate “V” code attached to the CPT code.  In ICD-10 those many inoculation/vaccination codes that were used in ICD-9 have been combined in to one code, Z23. 

Status

Status codes indicate that a patient is either a carrier of a disease of has the sequelae or residual of a past disease or condition.  A status code should not be used with a diagnosis code from one of the body system chapters, if the diagnosis code includes the information provided by the status code.

History (of)

There are two types of history codes, personal and family.  Personal history codes explain a person’s past medical condition that no longer exists, and is not receiving any treatment for, but that has a potential for recurrence and may require additional monitoring.

Family history codes are for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease.

  

Screening

Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provider for those who test positive for the disease.

Keep in mind the difference between screening for a disease and a diagnostic examination.  A diagnostic examination is for patients that show signs or symptoms of a disease or disorder (and wouldn’t be coded from this category).

Observation

There are two observation Z codes categories.  Z03 is Encounter for medical observation for suspected diseases and conditions ruled out.  Z04 is Encounter for examination and observations for other reasons.  Observation codes are to be used as the principle diagnosis only.

Aftercare

Aftercare visit codes cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase.  The aftercare Z codes should not be used for aftercare of injuries.

Follow Up

The follow-up codes are used to explain continuing surveillance following completed treatment of a disease, condition, or injury.  They imply that the condition has been fully treated and no longer exists.

Donor

Codes under this category are used for living individuals who are donating blood or other body tissue.  They are not used to identify cadaveric donations.

Counseling

Codes under this category are used when a patient or family member received assistance in the aftermath of an illness or injury, they are not used in conjunction with a diagnosis code when the counseling component of care is considered integral to standard treatment.

Encounters for Obstetrical and Reproductive Services

Z codes for pregnancy are for use in those circumstances when none of the problems or complications included in the codes from the Obstetrics chapter exist, such as in a routine prenatal visit or postpartum care.  Encounters for supervision of a normal pregnancy are always coded first and would not be used with any other code from the Obstetrics chapter.

Outcomes of delivery (category Z37) should be included on all maternal delivery records, and is always a secondary code.

Weeks of gestation category codes (Z3A) are for use only on the maternal record to indicate the weeks of gestation of the pregnancy.  Code from the Obstetrics chapter first any complications of the pregnancy.

Codes for family planning or procreative management and counseling should be included on an obstetric record either during the pregnancy or the postpartum stage, if applicable.

Newborns and Infants

In addition to the Newborn (perinatal) chapter (Chapter 16), the Z codes listed in here are for either health supervision and care of foundling (Z76.1);  Encounter for routine child health examination (Z00.1); and Liveborn infants according to place of birth and type of delivery (Z38). 

Routine and Administration Exams

Unlike its predecessor, the general exam code (ICD-9 Code V70.0), breaks into whether or not the exam is with or without suspected or reported diagnosis.  These codes should not be used if the examination is for diagnosis of a suspected condition or for treatment purposes.  During a routine exam, should a diagnosis or condition be discovered, it should be coded as an additional code.  Pre-existing and chronic conditions as well as history codes may also be included as additional codes as long as the examination is for administrative purposes and not focused on any particular condition.

Miscellaneous Z codes

The miscellaneous Z codes capture a number of other healthcare encounters that do not fall into one of the other categories.  Some of these codes identify the reason for the encounter, others are additional codes that provide useful information on circumstances that may affect a patient’s care and treatment.

Kelly Meeks, RHIT, CCS

Sunrise Services, LLC

www.sunrize.com

Understanding the MACRA final rule

MACRA Final Rule creates a new Medicare Quality Payment Program with two "paths":

MIPS- Merit-based Incentive Payment System

• If you decide to participate in traditional Medicare Part B, then you will participate in MIPS where you earn a performance-based payment adjustment.

APM-Alternative Payment Models

• If you decide to participate in an Advanced APM, through Medicare Part B you may earn an incentive payment for participating in an innovative payment model.

Who is eligible to participate?

• Physicians
• PA's
• NP's
• CNS
• CRNA

Who is not able to participate?

• Hospitals/Medicare part A payments
• FQHCs/RHCs and Medicaid Providers (there is no dual eligible progam)

How can you be excluded from participation?

• You are a 1st year clinician
• You don't see patients
• You do less than 30K and/or have 100 Medicare patients
• You qualify for the Alternative Payment Model