• Announcing the New CCH Health Reform Toolkit.
• Virtual Visits – Are Your Patients Asking?

• Transanal Excision of Rectal Tumor
• Coding Clarification: Endoscopic Injection
• Coding Communication: Paravaginal Defect Repair
• Coding Consultation: Questions and Answers

• 2011 ICD-9-CM annual update
• July 2010 Physician Fee Schedule update
• July 2010 APC update

• National Coverage Determination for magnetic resonance angiography
• Billing and claims processing for automatic Implantable Cardiac Defibrillator (ICD) services

Announcing the New CCH Health Reform Toolkit.

In response to the new health reform laws—Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010—Wolters Kluwer introduces the CCH Health Reform Toolkit, a complete suite of electronic workflow tools for navigating and understanding the near 3000 pages of legislation into easy to understand topics related to the hospital, pharmaceutical, and legal industries.

The Toolkit will further keep you abreast of all future Health Reform impact by automatically tracking related amended regulations, rules, new legislation, and primary source documents, providing access to full text documents and weekly email notifications so that you can keep on top of all guidance and changes that the government agencies release.

Features include: easy to navigate topics; search topics using synonyms; plain English summary of law section with links to fully explanatory analysis; links to full text of enacted law, and amended law in place to reflect Health Reform in ERISA, IRC, and SSA; export all results in Excel, Word, or Email; import action item effective dates for Health Reform Effective Date Lookup to Outlook Calendar creating automatic reminders and instructions for compliance; and customizable results show changes made to a topic to reflect new rules, regulations, legislation, and primary source documents during the last 10 days, 30 days, 90 days, and more…

The suite of tools includes what we call Smart Charts for the following topics: Providers, Medicaid, Drugs and Devices, Law Lookup, Effective Date Lookup, Grants Management, Demonstration Projects and New Programs, and Comprehensive—containing every provision in the Health Reform laws.

The CCH Health Reform Toolkit is available with links to the CCH Medicare and Medicaid Guide laws, regulations and explanations, incorporating in industry trusted content with new workflow tools; or as a stand-alone product incorporating in the e-version of the CCH Law, Explanation & Analysis book on these health reform laws.

To learn more about the CCH Health Reform Toolkit, please go to http://health.cch.com/Products/Health-Reform-Toolkit.asp; or contact your local sales rep at 888-224-7377.

Virtual Visits – Are Your Patients Asking?

There are two ways to define virtual visits. One way is that telemedicine is considered to be any form of information sharing that does not involve a face-to-face encounter; however, CMS does not consider e-mail encounters to be telemedicine. The other way pertains to e-visits, or e-mail encounters, which CMS includes under “telehealth”.

Because of the advances in medicine and an increase in consumer demand, some major health plans are starting to embrace this concept. Make sure you check with your payers for specific coverage of services as some will offer a decreased payment amount from a regular office visit.

CPT defines “e-visits” as an on-line electronic medical evaluation—non face-to-face evaluation and management (E/M) services by a physician or other qualified health professional to a patient using Internet resources in response to a patient’s on-line inquiry.

How does an e-visit work? On example is a patient logs into the physician website and enters his/her complaint along with questions for advice or recommendations. The provider then reviews the record using clinical information from the Electronic Health Record (EHR) and responds to the patient with advice. As long as the criteria are met for an e-visit, the provider can then bill for the encounter.

How does a provider meet the criteria for an e-visit? With an EHR there are components designed for e-visits. By using a secured website, patients are able to log in through a patient portal. Here they could have access to their personal health records. When entering a new complaint templates can be created for specific problems, which would provide a series of questions related to the patients “yes” questions. The information entered by the patient is then pulled into an e-encounter note. It is recommended that disclaimers be shown, such as “If you are experiencing chest pain call 911”, to the patient during data entry.

Though it may be difficult to complete a physician exam, it is not completely impossible as exams can be performed through video, pictures, audio, etc.

When documenting these services, the entire event should be included, remembering that it is an established E/M service. Therefore, two of the three key components of an E/M service (e.g., history, exam, medical decision making) should be recorded.

What are the benefits of an e-visit? E-visits are considered direct patient contact. Some have reported that office visits can be reduced by using online communication with patients, allowing more time with existing appointments and an increase in the number of open appointment slots. If your office is considering e-visits be sure to consider that reportable services involve the physician’s personal timely response to the patient’s inquiry and must involve permanent storage of the encounter. As far as the patient is concerned, e-visits allow the patient to manage time more effectively by accessing the patient portal or physician response from work or from home. Patients have more time to formulate their questions and articulate their problems without feeling hurried. Patients further receive physician responses in writing, giving the patient time to read it as many times as they need to fully understand the diagnosis.

In 2008, CPT established codes for online E/M services provided by both physician and non-physician providers. Along with these codes came guidelines for provision of the service and use of the code(s).

2008 CPT Changes (Insider Guide)

In response to changing consumer and health plan expectations for enhanced access to care, a new focus on chronic disease management, the need to reduce the costs of medical services, and advancements in use of technology by physicians and patients, a new On-line Medical Evaluation subsection, code 99444, and guidelines have been added to report provision of an on-line evaluation and management (E/M) service to patients in a non face-to-face manner.

The guidelines direct that code 99444 is intended to report services provided only by a physician to the patient in response to the patient's on-line inquiry. The patient is required to be an established patient. Code 99444 is also used to report an episode of care initiated by a guardian of an established patient.

Likewise if the on-line service refers to an E/M service performed and reported by the physician within the previous seven days (either physician requested or unsolicited patient follow-up) or within the postoperative period of the previously completed procedure, then the services are considered part of that previous E/M service or procedure and should not be reported separately. Code 99444 should be reported only once, encompassing all of the communication related to the on-line encounter, including related telephone calls, prescription provision, and laboratory orders.

The code to be used for online E/M services provided by a qualified non-physician is 98969. CPT codes for telephone calls are 99441-99443 (telephone evaluation and management service provided by a physician).

Of course, there are challenges for preparing your practice and patients for e-visits. A provider will need to market this service to their patients, review the workflow of and train their staff to help promote the service to the patients. Another challenge relates to Medicare reimbursement for such services. Although Medicare does not provide reimbursement for e-visits because it is a non-covered service, Medicare beneficiaries can be billed directly. A further challenge the provider will need to overcome are the security and privacy requirements of maintaining the required patient and provider data online, which the provider needs to address by implementing an adequate technology infrastructure. At the end of the day, though, the largest challenge may be that while providers have concerns that patients may over-use the e-visit option, payers are also concerned that physicians will begin to abuse it as reimbursement becomes routine.

Overall, e-visits provide an opportunity for a provider to offer timely services to patients, keeping the in-person visits for those that must see a doctor in person. With this said, though, providers must ensure they can overcome the challenges they will face by implementing e-visits into their routine practice so that they will receive reimbursement properly for these services.

AMA Coding Guidance: