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FAQ on 1995 & 1997 Documentation Guidelines for Evaluation & Management Services Q. Can a provider use both the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services to document their choice of evaluation and management HCPCS code? A. For billing Medicare, a provider may choose either version of the documentation guidelines, not a combination of the two, to document a patient encounter. However, beginning for services performed on or after September 10, 2013, physicians may use the 1997 documentation guidelines for an extended history of present illness along with other elements from the 1995 guidelines to document an evaluation and management service."

*AACE encourages members and non-members to check with your Local Administrative Contractors and your commercial carriers to determine if they provide further guidance or additional clarification regarding E/M guidelines.

The CMS-1500 Claim Form has been recently revised with changes including those that more adequately support the use of the ICD-10 diagnosis code set. The revised CMS-1500 form (version 02/12) will replace version 08/05. The revised form will give providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes, which is important as the October 1, 2014, transition approaches. ICD-9 codes must be used for services provided before October 1, 2014, while ICD-10 codes should be used for services provided on or after October 1, 2014. The revised form also allows for additional diagnosis codes, expanding from 4 possible codes to 12. Only providers who qualify for exemptions from electronic submission may submit the CMS-1500 Claim Form to Medicare. For those providers who use service vendors, CMS encourages them to check with their service vendors to determine when they will switch to the new form. Medicare will begin accepting the revised form on January 6, 2014. Starting April 1, 2014, Medicare will accept only the revised version of the form.

S e p t e m b e r / O c t o b e r 2 0 1 3

Guide to STAGE 2 of the

EHR EHR certified products that

meet Stage 2 are quite limited

Are you missing the PQRS Incentive payment of .5%?

Educational Resources for PQRS

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• 175 new codes • 107 revised codes • 47 deleted codes

Make sure to order your books soon to get the most up-to-date information for your office! Bundled packages may be cheaper and discounts extended to members too! Books may be ordered from the AMA, AAPC, and most book stores as well.

Pay Close Attention to Your EHR Software! “Notes associated with prescription are not printed to the prescription or to the patient’s chart.” was the reason listed for the recall of some versions of software for Picis Inc’s ED Pulsecheck, according to the FDA website. Copiers Could Cost You HIPAA Penalty Violations “…OCR’s investigation indicated that Affinity impermissibly disclosed the protected health information of these affected individuals when it returned multiple photocopiers to leasing agents without erasing the data contained on the copier hard drives.” Click here for the complete article. REMINDER: “Make sure that all personal information is wiped from hardware before it’s recycled, thrown away or sent back to a leasing agent,” said Office of Civil Rights (OCR) Director Leon Rodriquez. “HIPAA covered entities are required to undertake a careful risk analysis to understand the threats and vulnerabilities to individual’s data, and have appropriate safeguards in place to protect this information.”

For more information on safeguarding sensitive data stored in the hard drives of digital copiers, click here. The National Institute of Standards and Technology has issued guidance on media sanitation here. OCR offers free training on compliance with the HIPAA Privacy and Security Rules for continuing medical education credit here. The HHS Resolution Agreement and CAP can be found on the OCR website.

The Senior Medicare Patrol (SMP) is a group of highly trained volunteers who teach others about health care fraud. SMP volunteers are seniors and professionals such as doctors, nurses, accountants, investigators, law enforcement personnel, attorneys, and teachers. Volunteers use their time and experience to help people with Medicare and Medicaid:

Protect their identity Read their Medicare Summary Notices Avoid falling for scams They work one-on-one with beneficiaries, give presentations to

groups, and represent the SMP at events.

Protect Your Medical Practice Against Fraud

The HIPAA Privacy Rule provides individuals a fundamental right to be informed of the privacy practices of health care providers, as well as to be informed of their privacy rights with respect to their personal health information. Health plans and covered health care providers are required to develop and distribute a notice that provides a clear, user friendly explanation of these rights and practices. The Office for Civil Rights (OCR) and Office of the National Coordinator (ONC) for Health Information Technology have collaborated to develop model Notices of Privacy Practices for health care providers to use to communicate with their patients. Click here for more information and to find the suggested models.

Over 300 CPT® Changes in 2014

United Healthcare’s Network Bulletin

The Network Bulletin is a bimonthly online/email publication featuring important protocol and policy changes, as well as useful

administrative information and clinical resources.

C l i c k h e r e f o r

S e p t e m b e r 2 0 1 3 B u l l e t i n

Please note that where

information in the Network Bulletin conflicts with applicable state

and/or federal law, United Healthcare will follow such

applicable and/or federal state law.

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CPT® Code 84443 (BTNX Rapid Response Thyroid Stimulating Hormone (TSH) Test Cassette (Whole Blood)) was approved as a CLIA waived test effective March 5, 2013. Do not forget to report the CPT® code with the modifier QW now. See MLN Matters MM8439

ASP Quarterly Drug Pricing Files and Revisions to Prior Quarterly Pricing Files - January 2014 CR8448. Read the complete update

WPS Medicare, a Medicare Administrative Contractor, provides guidance on provider signature requirements here. This guidance discusses specific topics such as:

o Dictated Notes and Use of Initials o Electronic Medical Records (EMR) o Physician Orders o Signature Logs or Cards o Attestation Statements

Do you currently provide continuous glucose monitoring services? 95250 – ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording; 95251 - ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; interpretation and report. If you answered yes to the above question, AACE needs your assistance in determining the appropriate work values for these services. Please send an e-mail to Anita Sumpter at asumpter@aace.com

The Provider Compliance Group Interactive Map allows you to access state-specific CMS contractor contact

information. You may receive correspondence from one or several of these contractors in your state. They may request medical records from you, as they perform business on behalf of CMS. You can use this website to access their contact information including e-mails, phone numbers and websites.

November : Na t iona l

D iabe tes & D iabe t i c Eye

D i sease Month

Join CMS in raising

awareness about diabetes, diabetic eye

disease, the importance of early disease detection,

and the related preventive health services covered by

Medicare.

The Diabetes-Related Services

Brochure ●

The Glaucoma Screening Brochure

● Coverage of

Diabetes Screening Tests ●

Overview of Medicare Covered Diabetes Supplies

and Services ●

National Coverage Determination for

Diabetes Outpatient Self-Management

Training ●

Quick Reference for Coding Preventive

and Screening Services

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Preparing for ICD10-CM: The Endocrinology Way The 5 R’s for Successful Transition

Successful implementation of ICD-10 should first focus on REVIEW: What is ICD, where did it come from, who uses

the code sets, what are the codes used for, when codes are used and who is affected/effected by the upcoming change.

Successful implementation of ICD-10 will require endocrinologists and their staff to REFRESH their basic and

endocrine specific coding guidelines and conventions as well as the ICD-10-CM book formats and set up of other endocrine related codes.

Capturing diagnosis codes at the highest level of specificity will require a REVISED approach to documentation. Each office must RENDER training to all staff at some level and be consistent and compliant with continuing education

as new and advanced technology spur growth in the code sets. Understanding the relevance and significance of consistently following guidelines and coding to the highest level of

specificity through complete and concise documentation will result in REPORTING diagnosis that could ultimately improve patient care from a clinical and quality standpoint.

On December 11, 2013, AACE will begin a series of educational opportunities to prepare members and their staff for the transition to ICD-10 that becomes effective October 1, 2014. AACE will offer several short live webinars and record them for future purchase. In 2014, AACE will also offer Endocrine Summits in several locations (TBA) across the country. The Summits will offer an in-depth look at ICD and provide hands on exercises pertinent to endocrine services for participants.

S a v e t h e d a t e – D e c e m b e r 1 1 , 2 0 1 3 - r e g i s t r a t i o n o p e n s s o o n ! C h e c k h e r e f o r u p c o m i n g e d u c a t i o n a l o p p o r t u n i t i e s a t A A C E !

KEEP UP TO DATE ON ICD-10

Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. Sign up for CMS ICD-10 Industry Email Updates and follow them on Twitter.

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Contact Endocoding@aace.com or 904-353-7878 for additional information. All courses, dates and locations are subject to change. Cancellations must be received in writing to the AACE office 48 hours in advance of the course in order to receive a full refund. No-shows or cancellations received after this time are not eligible for a refund. AACE reserves the right to cancel the course with a minimum 48-hour notification. Participants will have the option to attend in an alternate course (if available) or request a full refund.

T h i s a c t i v i t y h a s b e e n a p p r o v e d f o r A M A P R A C a t e g o r y 1 C r e d i t ( s ) ™

Refresh your coding and documentation skills at the New and Improved Fundamentals and Advanced Endocrine

Coding Course! Do you…

…Know there are two different evaluation and management (E/M) guidelines (95 and 97) physicians may select from to document patient visits?

…Know the most common errors or missing information found during E/M audits by commercial and federal insurance carriers?

…Understand the key components in an E/M service and that it takes more than high medical decision making to justify a high level E/M code?

…Have expertise with The False Claims Act and understand what it says about diagnosis coding?

…Know the specific conventions and guidelines pertinent to endocrine services for ICD10-CM (diagnosis coding)?

…Utilize modifiers appropriately or routinely use them just to “get things paid”? Find the answers to these questions and more Thursday and Friday, December 5th and 6th at the Sheraton Miami Airport! Space is limited! See the complete agenda or register here! Cost for AACE member or their staff: $675 per person Non-members $750 per person This activity has been approved for AMA PRA Category 1 CreditTM. The seminar is designed for both physicians, non-physician practitioners and their staff.

Open to AACE members, staff of AACE members

and non-members.

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Education American Association of Clinical Endocrinologists sponsors live conferences and symposia,

online education, and other opportunities to earn continuing medical education (CME) credits.

Noted below is the current list of CME educational activities available. These activities are intended for:

MD's, DO's, NP's, RN's, PA's, CDE's, Pharmacists and other interested health care providers.

NOVEMBER

11/02

New Strategies for Obesity Management: Risk Stratification & Long-Term Weight Control

Chicago, IL

11/02

Diabetes Day for Primary Care Providers

Philadelphia, PA

11/06

New Strategies for Obesity Management: Risk Stratification & Long-Term Weight Control

Webinar

11/06

Scenes and Seminars on Hypoglycemia Management in Diabetes

Webinar

11/09

New Strategies for Obesity Management: Risk Stratification & Long-Term Weight Control

Orlando, FL

11/12

AACE Symposium on the Endocrine Aspects of Obesity

Atlanta, GA

11/13

LDL and Beyond: Current and Future Approaches to Cholesterol Management

Great Neck, NY

11/16

Diabetes Day for Primary Care Providers

Buffalo, NY

11/16

Diabetes Day for Primary Care Providers

New York, NY

11/16

Diabetes Day for Primary Care Providers

Reno, NV

11/21

LDL and Beyond: Current and Future Approaches to Cholesterol Management

Houston, TX

11/23

New Strategies for Obesity Management: Risk Stratification & Long-Term Weight Control

Bethesda, MD

11/23

Diabetes Day for Primary Care Providers

Montgomery, AL DECEMBER

12/05

LDL and Beyond: Current and Future Approaches to Cholesterol Management

Los Angeles, CA

12/07

New Strategies for Obesity Management: Risk Stratification & Long-Term Weight Control

New Brunswick, NJ

12/07

Diabetes Day for Primary Care Providers

Caguas, PR

12/14

New Strategies for Obesity Management: Risk Stratification & Long-Term Weight Control

New Orleans, LA

12/14

Diabetes Day for Primary Care Providers

Newark, NJ

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All medical coding must be supported with documentation and medical necessity. **While this document represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will recognize and accept the coding and documentation recommendations. As CPT®, ICD-9-CM and HCPCS codes change annually, you should reference the current CPT®, ICD-9-CM and HCPCS manuals and follow the "Documentation Guidelines for Evaluation and Management Services" for the most detailed and up-to-date information. This information is taken from publicly available sources. The American Association of Clinical Endocrinologists cannot guarantee reimbursement for services as an outcome of the information and/or data used and disclaims any responsibility for denial of reimbursement. This information is intended for informational purposes only and should not be deemed as legal advice, which should be obtained from competent local counsel. Current Procedural Terminology (CPT©) is copyright and trademark of the 2012 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT©. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

We want to hear

from you! Tell us what you think of Endonomics! Please take a few minutes to take this survey. Your feedback is very important to us as we strive to assist you with a profitable and compliant business office.

o Is Endonomics™ valuable and useful for your office?

o What other topics would you like to see offered in Endonomics™?

o Other comments… AACE's Socioeconomics and Member Advocacy Department's goal is to reach out to the endocrinology business world and become the one- stop- shop, not only for endocrinology clinicians, but their support staff as well. Currently, Endonomics™ is currently a free newsletter for both members and non-members. Interested parties should send an e-mail to Endonomics@aace.com with their name, phone and fax numbers, location and preferred e-mail address to be added to our Practice Support Network database.

Coding TRAC

Tips on Reimbursement And Coding

Did you know there are national Medicare coverage guidelines (NCDs) on blood glucose testing, glycated hemoglobin, thyroid and lipid testing, PSAs, bone density, DSMT, and intensive behavioral therapy for obesity? If not, click here for more information. Your individual Medicare administrative contractors (MAC) may also further define other common endocrine services and/or procedures. Please check your MAC’s website frequently to find changes, additions or deletions of their local coverage determinations (LCDs). Not sure who your MAC is- click here to find your state and local Medicare administrative contractors information.

Modifier 59 "Distinct Procedural Service: Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries)not ordinarily encountered or performed on the same day by the same physician. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used." Click here for article from CMS