Wiki Coding and Health care reform

[tanderson@MCS]

I have been troubled as to why no one challenges health care reform as it relates to coding here is my question Example: V72.31 Routine gynecological examination can be billed along with 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. Correctly coded would be 99396 with V72.31 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years From a correct coding perspective this doesn't make sense. 99215 should only be billed with a sick visit; however, the coding guidelines coming from Health Care reform are a direct conflict to proper coding, not to mention factoring in how the code should be paid. My question for you: Was this considered when put if place? If so, what is the rationale behind the coding?

 

[erossi]

coding and healthcare reform

There is no reason or logic to the healthcare reform bill (aka obamacare; affordable care act),it was designed by the government to take over the health care industry. PERIOD. It is a top down, government controlled, one size fits all answer to a question no one asked. It is a disaster from top to bottom. Not only for coders, billers, and doctors, but for all of us that will be subjected to this nightmare.

 

[Pam Warren]

I'm not sure I follow your rationale. Correct coding has nothing to do with a guarantee of coverage.

The implementation of the ACA has recognized what healthcare providers have known for a long time....we're rewarding physicians and patients when they're sick. Payment has been based on reimbursement at the highest level (think DRG) for the sickest patients and repeat fee-for-service payment for chronic disease regardless if the patient is compliant. The govenment has said, "enough is enough", by reminding us all (whether you want to hear it or not), that taxpayers, employers and the un-insured shouldn't have to ante up because our population can't take care of themselves.

So preventive care is now covered at 100%, meaning we're all rewarded when patients remain symptom and disease free, which is why so many employers are initiating wellness programs at the workplace. With pay-for-performance, providers will be rewarded for keeping patients healthy and compliant, by following evidence-based medicine, and finally, Medicare is covering preventive care through IPPE, AWV, and new in 2013 the Transitional Care Management, to prevent re-admissions through comprehensive post-discharge care. This policy isn't to penalize those that have unavoidable chronic or congenital diseases or conditions, it's a wakeup call for Americans to take control of their lives.

Let's not get into a shoving match on this board about politics, but certainly there are pieces of the ACA that make sense. Of course, sometimes people get sick, and in that case, they should certainly receive treatment. But we're part of a society that wants every last problem, symptom and annoyance to be fixed with a pill. We've created this mess, and now people are squirming because it's been suggested that they're part of the problem.

Regardless of your politics, I see a great deal of opportunity for coders to assist their providers with documentation improvement to help them with P4P and with initiating the wellness programs that are now being reimbursed.