Chapter Two Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 1

Chapter 2: Medicine   Wide variety of services Examples: Cardiac catheterization, chemotherapy, and home health Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 2

Immunization Administration  Report substance administered  Report administration Number of administrations, NOT number of substances Example (patient younger than 7): Tetanus and diphtheria (90702, substance) Administration (90460) Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 3

Medicare/Medicaid Immunizations  Administration reported with G code G0008: Influenza (Z23/V04.81) G0009: Pneumonia (Z23/V03.82) Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 4

Infusions  (up to hour) and (each additional hour) when physician present  (additional sequential) and (concurrent)  HCPCS, Q0081, administration, other than chemotherapy  Substances reported with HCPCS (such as J1265, Dopamine)  Prepackaged solutions for hydration are bundled into hydration codes Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 5

 Excludes Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration   Physician portion of service  Divided by type:  Subcutaneous  Intramuscular  Intravenous  Intra-arterial Therapeutic, Prophylactic, and Diagnostic Injections and Infusions Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 6

Psychiatry   Diagnostic evaluation  Psychotherapy ( )  Therapeutic treatment  Time based codes (30, 45, or 60 minutes)  Codes subdivided based on if in addition to a primary procedure  Provided to patient and/or family member  Time must be documented Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 7

Dialysis  End-stage renal disease (ESRD) Patient will not recover without transplant Physician services reported monthly ( ) Dialysis service reported separately Less than month, report per day ( ) Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 8

Peritoneal Dialysis  Continuous ambulatory peritoneal dialysis (CAPD)— Solution placed into peritoneal cavity (cleans blood)  Codes selected dependent on single or multiple physician evaluation Figure: 2.1 Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 9

Noninvasive Vascular Diagnostic Studies   Noninvasive vascular studies (e.g., Doppler, scans)  Reports: Supervision Interpretation Written report Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 10

Central Nervous System Assessments  Psychological testing  Speech assessments  Developmental assessment  Reported per hour Documented in medical record Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 11

Chemotherapy Administration   Administration ONLY  Chemotherapy agent HCPCS J code, such as oxaliplatin, J9263  Antiemetics for nausea reported separately  Analgesic for pain reported separately Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 12

Photodynamic Therapy  Photodynamic agent injected into tumor ( ) Agent dissipates from noncancerous tissue first Tumor then exposed to laser Destroys cancerous cells Reported first 30 minutes Then 15-minute increments Figure: 2.2 Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 13

Physical Medicine and Rehabilitation   Physician or therapist can report  Services usually based on time documented in medical record  : Reports evaluations Physical therapy, occupational, athletic Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 14

Active Wound Care Management   Negative pressure wound therapy (NPWT)  Controlled application of subatmospheric pressure to a wound  Nonselective debridement: healthy tissue removed along with necrotic tissue  Each code for ongoing care reported on per session basis  Provider is required to have direct patient contact Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 15

Medical Nutritional Therapy (MNT)   Nonphysician medical nutritional services: Medical nutrition Therapy assessment Intervention  Reported in 15-minute segments for individuals  Reported in 30-minute segments for groups Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 16

Special Services   Miscellaneous services 99070: Supplies and material 99024: Postoperative follow-up visit included in global service Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 17

Conclusion Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 18