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Medigram - April 10, 2008


CONTENTS



TOP STORY

Measles confirmed in Wisconsin; DPH issues guidelines

The Wisconsin Division of Public Health (DPH) has become aware of four cases of measles recently diagnosed in Wisconsin residents (three Milwaukee County residents and one Waukesha County resident), and has issued extensive guidelines (click here) that include case presentations, case definitions, immunization recommendations, health department contact information and more.

Measles virus is very infectious and the illness it causes is often misdiagnosed, particularly during the current era when the proportion of physicians with experience diagnosing and managing patients of measles is dwindling. Timely and aggressive application of isolation, quarantine (when needed), post exposure vaccination or immune globulin prophylaxis and other important control measures is critical.

Health care professionals are urged to heighten their suspicion of measles and report any suspect cases of measles immediately to their local health department. Do not assume that someone else will report the suspected case.

Contact the Wisconsin Immunization Program at 608.267.9959 or your local health department if you have questions.

NEWS BRIEFS

Physician and CMO input still needed for workforce issue surveys

In an effort to capture current and emerging workforce issues for physicians, the Wisconsin Medical Society, in partnership with the Wisconsin Council on Medical Education and Workforce and the Wisconsin Hospital Association, is conducting two surveys. One was sent to anyone identified as a physician in Wisconsin while a second survey was sent to individuals identified as chief medical officers in the state.

With more than 1200 responses to the physician survey so far, it is evident that physicians feel these issues need to be discussed. A survey of this type has not been conducted since 2000, when the Wisconsin Department of Health and Family Services explored the issue.

All physicians and chief medical officers who received an invitation to complete the survey are asked to do so no later than April 23. Please note that if you do not wish to complete your survey on-line, you can fax it to 608.283.5424. Input from everyone is critical for an accurate representation of the issues facing the workforce today, and individual responses will be kept confidential. The final results of both surveys will be used in a report called “Who Will Care for Our Patients? Wisconsin Takes Action to Fight a Growing Physician Shortage” and will aid in efforts to advocate on behalf of physician workforce issues.

If you have questions about the surveys, please contact the Society's Senior Vice President of Quality and Efficiency Nancy Nankivil.


BadgerCare Plus implementation of the NPI–What you need to know!

BadgerCare Plus will begin to accept National Provider Identifier (NPI) numbers and/or the eight-digit Medicaid provider numbers on HIPAA standard electronic transactions May 19, 2008. All other business functions, including paper claims, paper prior authorization requests, paper remittance and status report, and automated voice response, will continue to require the eight-digit Medicaid provider number until further notice. (Wisconsin Medicaid will require the NPI on all electronic and paper transactions in October.)

Health care professionals who have not already reported their NPI to BadgerCare Plus must do so immediately if they plan to include NPI on HIPAA standard electronic transactions. Submitting claims to BadgerCare Plus with an unreported NPI will result in claim denials or delayed processing.

To report your NPI on-line, click here. To report your NPI using an alternate submission method, click here for guidelines published in the March 2008 BadgerCare Plus Update.

Reported NPI numbers will be cross-referenced to the corresponding Medicaid provider number currently on file with BadgerCare Plus. Providers who submit electronic claims to Medicare are required to report their NPI to Medicaid to ensure crossover processing. All paper crossover claims will still require an eight-digit Medicaid provider number on the claim.

NEWSMAKERS

Robert J. Dempsey, MD, to receive 2008 AANS Humanitarian Award

Society member Robert J. Dempsey, MD, of Madison, has been named recipient of the 2008 Humanitarian Award of the American Association of Neurological Surgeons (AANS). The award will be presented Wednesday, April 30 at the AANS Annual Meeting in Chicago.

Doctor Dempsey is being honored for his dedication to advancing neurosurgery in Latin America and east Africa. He has volunteered over the last 15 years, developing educational programs for medical students, trainees and graduate neurosurgeons, primarily in Guatemala and Ecuador. Through his involvement with Medical Mission Ecuador, Dr. Dempsey has helped to revitalize the charity care network of south central Ecuador, including rebuilding of infrastructure, operating rooms, equipment and teaching physicians modern techniques with supplied and donated equipment.

As a member of the Board of Directors and the Secretary of the Foundation for International Education in Neurological Surgery (FIENS), Dr. Dempsey has been active in building the groundwork for neurosurgical training programs in developing countries throughout the world. In addition to Latin America, he has been very active in the east Africa program working with FIENS volunteers. The program has successfully won approval from the Kenyan Ministry of Health to fund the first residency program in east Africa, an area of 3 million people without a current training program. This multinational program will help address the vast maldistribution of medical care and poor regionalization of this area.

Doctor Dempsey has been chair and professor of the Department of Neurological Surgery at the University of Wisconsin at Madison since 1995. He is founder and director of the Multidisciplinary Stroke Program and established the cerebrovascular research laboratories. In 1998, he became the first Manucher J. Javid Endowed Professor in Neurological Surgery.


AMA Foundation recognizes two UW medical students for efforts to aid the homeless

Being homeless wasn’t enough to prevent Society member Jennifer R. Jenkins from becoming a medical student at age 30. Jenkins overcame the odds, and now chooses to give back. In her fourth year of medical school at the University of Wisconsin School of Medicine and Public Health, she returned to the streets to treat the destitute in Pittsburgh. At the AMA's recent 2008 National Advocacy Conference in Washington D.C., the AMA Foundation presented her with its Leadership Award.

Society member Claudia Reardon, MD, a UW Hospital psychiatry resident, was also recognized for her dedication to running a free psychiatric clinic for the homeless mentally ill. She remains actively involved in advocating for mental health treatment through the Wisconsin Psychiatric Association and as a Wisconsin delegate to the AMA.


Sri Vasudevan, MD, receives “Spirit of Caring” award

Pain medicine specialist Sridhar “Sri” Vasudevan, MD, a member of the Wisconsin Medical Society’s Board of Directors, is being recognized for his significant contributions to the medical profession.

Community Memorial Hospital, Menomonee Falls, Advanced Healthcare and Medical Associates sponsor the award, and announced the “Spirit of Caring” award winners on March 31.

“You have advanced your specialty and the overall medical profession through your leadership with state and national organizations,” wrote Michael Unger, MD, Vice-President of Medical Affairs for Community Memorial Hospital, in the notification letter to Dr. Vasudevan. A $1,000 charitable contribution will be made in Dr. Vasudevan’s name.

CAPITOL INSIDER

Smokefree poll shows strong bipartisan support

Due to a strong statewide campaign that included support from more than 30 Wisconsin newspaper editorials and a rally led by seven-time Tour de France winner Lance Armstrong, the idea of a statewide smoking ban is becoming more popular, even across party lines, according to a new poll released Tuesday.

The poll by The Mellman Group and Public Opinion Strategies shows that a statewide smoking ban has gained an additional five percentage points since February 2007, with 69 percent of those polled now in support of the ban.

While the possibility of a statewide smoking ban will have to wait for the next legislative session, two Wisconsin communities, Eau Claire and Marshfield, passed local ordinances last week requiring all public places to be 100 percent smokefree for their 80,000 combined residents. A smoking ban also went into effect in Fitchburg, although some public places are exempt.

Read press coverage about the bans in Eau Claire, Marshfield and Fitchburg.

For more information, contact Jeremy Levin.


Contribute to WISMedPAC / WISMedDIRECT at Friday’s Annual Meeting

With more than 100 seats in the legislature up for election this year, physicians have many opportunities to support candidates that understand and speak for health care issues. Your contributions to WISMedPAC or WISMedDIRECT help support these candidates and also demonstrate the strong voice of physicians throughout the state.

A table will be set up during this Friday’s Society Annual Meeting at Monona Terrace convention Center in Madison. Stop by to learn more about what your contribution can do to help advance health care issues in Wisconsin. Or click here to contribute on-line.

For more information, contact Jeremy Levin.

EDUCATIONAL PROGRAMS

Are you comfortable with the ins and outs of “incident-to” billing?

Medicare’s Incident-to billing can once again be found on this year’s OIG work plan. Are you billing your incident-to services correctly? Find out April 24, when Society Coding and Reimbursement Educator Penny Osmon will host a teleconference addressing some of the common issues related to billing “incident-to” services. Participate in this teleconference and feel satisfied that you know the difference between a split/shared visit and incident-to services. Discussion will include direct supervision requirements, when code 99211 should be billed, how to effectively use scribes and much, much more! Click here to register.

QUALITY CORNER

Save the Date: 2008 Wisconsin Quality and Safety Forum Oct. 21-22

The Wisconsin Medical Society is pleased to join the Wisconsin Hospital Association, MetaStar, the Wisconsin Collaborative for Healthcare Quality, and the Wisconsin Health Information Organization in sponsoring the 2008 Wisconsin Quality and Safety Forum scheduled October 21-22, 2008 at the Kalahari Resort in Wisconsin Dells. This forum is designed for physicians, quality improvement managers/specialists, risk managers, nurse executives, pharmacists, patient care services staff, chief executive officers, administrators, vice presidents, and patient safety improvement team members. Registration materials will be available in August. Watch future Medigrams for additional information. Click here for a save-the-date flyer.

FAQ

Question:
Are the new CPT codes 99406 and 99407 for smoking cessation separately reportable with a preventive medicine service on the same day or are they considered inclusive (similar to the 99401-99404 range of codes)?

Answer:
According to the AMA CPT Knowledge Base, behavior change interventions are for persons who have a behavior that is often considered an illness itself, such as tobacco use and addiction, substance abuse/misuse, or obesity. Behavior change services may be reported when performed as part of the treatment of condition(s) related to, or potentially exacerbated by, the behavior or when performed to change the harmful behavior that has not yet resulted in illness. Any E/M services reported on the same day must be distinct, and time spent providing these services may not be used as a basis for the E/M code selection. Behavior change services involve specific validated interventions of assessing readiness for change and barriers to change, advising a change in behavior, assisting by providing specific suggested actions and motivational counseling, and arranging for services and follow-up.

Therefore, from a CPT coding perspective, if a significant, separately identifiable E/M service (e.g., preventive medicine) is performed by the same physician on the same day as smoking cessation counseling (codes 99406-99407), modifier 25 should be appended and both codes are reported.

Although this reporting method reflects the intent of CPT, third party payers may request that you report these services differently. You may wish to contact your third party payer for specific reporting guidelines. Medicare has specific coverage criteria for these codes and the information was published in this transmittal.

For answers to other Frequently Asked Questions about coding matters and more, click here to review our Education Department’s FAQ archive, or e-mail efaq@wismed.org.