Title of Meeting: AUC Medical Code TAG Date and Time of Meeting Thursday, March 13, 2014, 9 a.m. to 12 a.m. Location of Meeting HealthPartners Meeting Minutes Minutes By: Judy Edwards and Faith Bauer 1. Welcome and Introductions Attendance tracking Introductions completed by members in attendance and those participants on the telephone. Deb Sorg tracks attendance. If calling into the meeting, please send an email to Deb Sorg at deb.a.sorg@healthpartners.com. Include your name, organization and if you are calling in for another person within your organization Members should provide Deb Sorg with email address changes and new members contact information.. Completed. 2. Antitrust Statement Reviewed available on AUC website. No discussion. 3. Review of last meeting s Minutes The minutes were reviewed, revised and approved with the following corrections: Page 2 Agenda item #6, Collaborative psychiatric consultation - first paragraph: o Second sentence: changed practitioners to physicians o Deleted last sentence Additionally, only telephone calls are legislated, not internet. o Changed practitioner to physicians in second paragraph Agenda item #7, G0463 SBAR o Changed is looking at to read from and accept to require in first sentence of second paragraph. o Medicare to Medica in list of payers Agenda item #10, Autism Early Intensive Intervention Benefit o Changed last sentence in second paragraph to state, For DHS it is effective after 3/1/14; and upon federal approval. Motion to approve minutes with corrections made by Judy Blyth and seconded. Minutes approved Minutes will be sent to MDH for posting on AUC MCT website 4. Collaborative psychiatric consultation Faith Bauer, BCBSMN Andrea reported that DHS reviewed 99499 on two tracks as 99446-99449 are for consulting physicians only. (See MN statutes.) Track 1, for 99499, need to include two additional providers in the guides Psychologist or Advance Practice Registered Nurse (APRN) certified in psychiatric mental health. This change can be done now with an effective date of 7/1/13. Track 2, DHS will have to change state plan coding for consulting psychiatrists and submit to federal for approval. State plan has 99499, with payment rates. Codes are not just for mental health services but also other services. After approval from feds, will change 99446-99449. Will also look at primary care. Visit our website at: http://www.health.state.mn.us/auc/index.html 1
Recommendation: Add the following to the Coding Recommendation Grid with the intent to revise the MN Companion Guide in the next yearly update. Changes to the current guide in red. Effective 7/1/14. Chapter 12, Physician/Nonphysician Practitioners, Collaborative psychiatric consultation Coding for a consultation initiated by the primary care provider (MD, DO, NPP) to psychiatrist, psychologist or APRN for an opinion or advice regarding a patient should be reported using 99499 as follows: Primary Care 99499 HE AG Primary Care 99499 HE AG U4 (non-face-to-face) Primary Care 99499 HE AG U7 (by physician extender) Primary Care 99499 HE AG U4 U7 (non-face-to-face by physician extender) Consulting Psychologist or Advanced Practice Registered Nurse (APRN) certified in psychiatric mental health 99499 HE Consulting Psychologist or Advanced Practice Registered Nurse (APRN) certified in psychiatric mental health 99499 HE U4 (non-face-to-face) Consulting Psychiatrist 99499 HE AM Consulting Psychiatrist 99499 HE AM U4 (non-face-to-face) 5. Autism Early Intensive Intervention Benefit Andrea Agerlie, DHS 6. Modifier -25 on preventive medicine visits (99381-99397) - JoAnne Wolf, Children s Physician Network Andrea suggested Close and re-open when decision made at DHS. TAG agreed to close at this time. Carolyn Larson noted that actions of the American Academy of Pediatrics last year caused the CCI policy to be temporary rescinded. However, the new effective date of the CCI policy is April 1, 2014. DHS must use the CCI edits. There is no current policy in the Companion Guide. Modifier-25 not addressed in companion guide. All payers accept the -25 modifier so this is not a compliance issue, it is a payment issue. Need to work directly with payers she s having problem with. Reporting is uniform and MCT view as payment issue because it is a CCI edit. Leave open for JoAnne s comments. 7. Issue Tracking Grid/Index 8. Doulas Shawnet Healy, DHS The original intent was to develop an index of issues discussed. The draft submitted by Judy Edward reflects what is sent to Executive. MCT will review both index drafts. Validate useful document to understand issue and status, easily updatable and searchable. If no, what suggestions to achieve the goal. Shawnet Healy volunteered to maintain the index. Doula services will be covered by DHS fee-for-service and managed care per MN statutes effective 7/1/14 (pending federal approval). Medical assistance will cover childbirth education and support service. Certified doula means continuous emotional and physical support throughout labor and birth, and intermittently during the prenatal and postpartum periods (subd. 4). MDH will send out SBAR to MCT. Visit our website at: http://www.health.state.mn.us/auc/index.html 2
ALACE is no longer education doulas referred to another organization. DOMA is the primary education resource for doulas. SBAR pending but submitted to discuss because it is a new service and we need to discuss uniform billing method. Oregon has elected submission of the labor and delivery code. Oregon requires the service to be billed by the supervising physician. Discussion/questions: Claim type? Professional claim Provider number? Billed under the NPI of an enrolled provider. Doulas will not be enrolled. Place of service? Home Is this a package or bundle? Why can t it be bundled with OB/GYN or enrolled provider or certified nurse midwife? Doula should be able to charge for session with birth mother. Doula s has been doing their own private billing and receiving payment from the mother. No a global/ per session. It s the patient s choice. Will not allow duplication of services for doulas or lactation consultant (to assist postpartum). What is definition of a session? Per encounter/per day. The definition of the proposed code is per diem/per day. The session must be face-to-face. Suggested DHS define what per session means for doulas. Will their services be distinct? Yes, they will be separate from the normal OB/GYN care. Doula will have to maintain documentation of visits. Can the mother choose any doula? Yes; however, the doula must work with the primary practitioner. How will it look documentation-wise? Modifier to indicated doula service. Refer to DHS for documentation requirements. How will the doc or midwife know when doula has visited mother? The document should be shared with the primary practitioner. Is an MD s order required for doula services? No physician order is needed for a doula Will the services be audited? Yes Many provider contracting issues were discussed. From contracting standpoint, does the doula need to be identified? Has rate been established? How will doula bill partnership with that particular group? How will we know that doulas are linked with provider or how can association be confirmed? How will it work for doula s not connected with provider? What happens if OB/GYN or midwife does not want to work with that doula? Concern is that we have a lot of Everyday Miracles individual agencies are not tied to other organization may want to bill separately. How to have relationship with provider group or birth center? How will this cross-over to commercial? Will need amendments. Shawnet will send out to MCT. Shawnet will meet with doulas for additional information. Can now have larger discussion with code suggested; work with state plan. Possible coding was discussed. The following were initially proposed: S9445 patient education NEC; non-physician for antepartum and postpartum, usually about seven sessions); one to two for antepartum, two to four for postpartum, one for labor and Visit our website at: http://www.health.state.mn.us/auc/index.html 3
delivery (NOTE: the numbers of sessions are not defined in the policy.) 59899 suggested for the doula service during labor and delivery. A modifier will be developed. Faith Bauer was not in favor of 59899 because this is a surgical code and additionally is subject to coding edits. Other possible codes to consider: 99499 unlisted E/M 99199 Unlisted special service, procedure or report 9. Family Planning Services Paula Bernini Feigal, Morning Star 10. Newborn Facility Service Fee Paula Bernini Feigal, Morning Star NOTE: Shawnet Healy sent the following information post meeting: In reviewing my folder on doulas I found that DHS assumed 30 hours of doula service per attended birth and this includes services rendered ante-partum, labor/delivery and post-partum. The fee range in the documentation is $16-$17 per hour. Would it make code selection easier to figure against a 30 hour criteria rather than session or per diem construct? Services are being denied for family planning services performed by qualified MHCP - MA patients seen by certified midwives. If listed as free-standing birth center per MHCP guideline the birth center is POS 25. POS 25 is the most appropriate code for place of service. Can bill professional services under POS 25 in companion guide? Based on guidelines 11 will not be appropriate. This is a payment and contract issue. Recommendation: Companion guide performing services under free-standing birth centers. Who s rendering the service? Because of the licensure of the facility (POS), the midwife cannot be paid for family planning services performed in a birthing center. (Tentative) POS 25 is correct based on MHCP requirements. Services provided in birth center. The codes recommended are room and board and is not allowed in a freestanding birthing center. The AUC did not determine that the revenue code. National standards (NUBC) that this type of bill is outpatient. Room and board (the nursery revenue code) is inpatient only. HCPCS codes are required with revenue code. This is noted in the Companion Guide and is part of the NUBC standards. Newborn care is specified in MN statutes (256D.0625 subd. 54. Recommendation: Add the following to the Coding Recommendation Grid with the intent to revise the 837I MN Companion Guide in the next yearly update. Changes to the current guide in red. Effective?. Freestanding Birth Centers (Not addressed in the Medicare Claims Processing Manual) Licensed birthing centers Medicare publishes limited billing information for free-standing birthing centers. Birth center means a facility licensed for the primary purpose of performing low-risk deliveries that is not a hospital or licensed as part of a hospital and where births are planned to occur away Visit our website at: http://www.health.state.mn.us/auc/index.html 4
from the mother s usual residence following a low-risk pregnancy. See Minnesota Statutes, Sections 144.615 and 144.651 for more information. Low-risk deliveries, and services related to the delivery, performed in a free-standing birthing center should be reported on an 837I transaction including the following data: Type of Bill: 084x Special Facility Freestanding Birthing Center (NOTE: TOB 084x will be considered outpatient. HCPCS codes are required with submitted revenue codes.) Revenue Code: 0724 Birthing Center Note: Ancillary services and/or items relating to delivery or labor 0724 are included under this revenue code and should not be reported separately. HCPCS Code: Appropriate HCPCS code with revenue code 0724 for delivery HCPCS S4005 code with revenue code 0724 when labor does not result in delivery Appropriate HCPCS code with revenue code 0724 for newborn specific services Note: Professional services related to the mother s and newborn s cares are reported on the 837P only. 11. Birth Center Place of Service Paula Bernini Feigal, Morning Star 12. Family Psycho-education Services DHS See #9 POS 25 only for free-standing birthing centers. Based on licensure of state. Family Psycho-education services 7/13 legislation DHS is considering H codes provided to child up to 21 diagnosed in treatment plan H2027 (per 15 minutes) with H modifiers dependent upon if services are to: individual, family as part of individual, family multi-group, trainees. May need to add to grid. Andrea will prepare SBAR 13. Certified Family Peer Specialist DHS Certified Family peer specialist H0038, current H0038-HA modifier or HA HQ modifier. HA is children/adolescent program HA HQ (group setting) Will fit nicely within that group. currently exist in grid 14. Announcements Announcement Shawnet completed medical coding boot camp and will be taking certification exam Judy completed AAPC billing course and will be taking certification exam 15. Next Monthly meeting The next Medical Code TAG meeting is scheduled for April 10, 9:00-12:00, St. Croix room 1st floor, HealthPartners, 8170 Building, Bloomington Treats: Andrea will prepare SBAR Visit our website at: http://www.health.state.mn.us/auc/index.html 5