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Medigram - February 19, 2009


NEWS BRIEFS

IHI issues Surgical Safety Checklist Challenge

Building on the success of its 100,000 Lives and 5 Million Lives Campaigns, the Institute for Healthcare Improvement (IHI) has announced a new phase called the Improvement Map. One of Improvement Map’s new interventions is the use of the World Health Organization (WHO) Surgical Safety Checklist, which outlines essential standards of surgical care and is designed to be simple, to be widely applicable, and to address common and potentially disastrous lapses.

To jump-start the use of the Surgical Safety Checklist, IHI has challenged every hospital to adopt the Checklist and use it in a least one operating room on one day by April 1, 2009. To help facilities meet the challenge, IHI’s Wisconsin Node has developed this toolkit, which includes information about the IHI Improvement Map Campaign, the Challenge, background and information on the WHO Surgical Safety Checklist, and information on how to enroll in the Campaign and how to report that you have completed the Challenge.

If you haven’t been part of the previous IHI campaigns, you are welcome and encouraged to enroll and join the challenge. Questions regarding the Improvement Map Campaign and the Surgical Safety Checklist Sprint Challenge can be directed to Judy Frisch, Node Coordinator, MetaStar, at 800.362.2320 or jfrisch@metastar.com.


Wisconsin Medical Journal goes ‘virtual’

The Wisconsin Medical Journal this week launched its new on-line format. This digital platform promises to provide readers with a more interactive experience that is also environmentally friendly.

When you click here you will launch a digital publication that looks identical to the printed edition. (Readers can also access the virtual Journal through the Society’s Web site.) You can turn pages, zoom in and out on content, print and download articles, and even click on links to Web sites included in references and advertisements. This technology also features improved search functionality, allowing you to search each issue of the Journal, including archives, by author, subject and keyword. In the coming months we will add new issues as they are published along with archived editions.

If you currently receive the Journal via e-mail, instead of receiving a listing of articles with links to separate PDFs, you’ll now receive a link to the virtual publication. If you typically received the Journal in its printed form, you’ll continue to do so. However, if you prefer to receive this new electronic version, please e-mail wmj@wismed.org.


Medicare RAC protest resolved; Wisconsin implementation may begin August 2009

The Centers for Medicare and Medicaid Services (CMS) has resolved protests regarding the Recovery Audit Contractor (RAC) awards. Through a settlement agreement, subcontractors will supplement the work of the four national contractors.

The recovery audit program first began as a CMS demonstration project to identify improper payments made on claims to Medicare beneficiaries. Improper payments may be overpayments or underpayments. Overpayments can occur when health care professionals submit claims that do not meet Medicare’s coding or medical necessity policies. Underpayments can occur when health care professionals submit claims for a simple procedure but the medical record reveals that a more complicated procedure was actually performed.

The program is being implemented in all 50 states but will not begin in Wisconsin until at least August 2009. The RAC for Region B, which includes Wisconsin, is CGI Technologies and Solutions, Inc. of Fairfax, Virginia. For more information click here.


Registration Open for Wisconsin Literacy’s 2009 Health Literacy Summit

The Wisconsin Medical Society is pleased to be a supporting partner of the Wisconsin Literacy’s Third Biennial Health Literacy Summit, which will be held in Exhibition Hall at the Alliant Energy Center in Madison on March 31 and April 1. The Health Literacy Summit will feature six plenary speakers and options for 28 health literacy workshops and information sessions. Early registration runs through February 28. General registration ends on March 23. For an agenda, summit highlights, and registration information, click here.

QUALITY & EFFICIENCY

Overcoming misconceptions about EHRs

When discussing Electronic Health Records (EHR), some physicians initially have a negative reaction, citing various reasons not to make the conversion. But EHRs are not going away. The Wisconsin Medical Society is working to help physicians and other health care professionals navigate what may be “unfamiliar territory,” by developing a series of teleconferences to help prepare physicians to make educated choices when considering EHRs. The first step, however is addressing some common concerns and misconceptions. Society Quality and Efficiency Analyst Michelle Klagos spent over three years implementing an EHR at UW Health before joining the Society staff and offers these insights and experiences to physicians and health care staff considering EHR implementation. Click here to read more.

CAPITOL INSIDER

Biennial budget proposal unveiled

Governor Jim Doyle’s 2009-2011 biennial budget proposal was unveiled Tuesday night in an address to a joint session of the Wisconsin Legislature. The Milwaukee Journal Sentinel has a tremendous thumbnail summary of the 1,743-page bill, which is 2009 Assembly Bill 75. (For a more specific look at tax treatment in the budget, check out this Wisconsin State Journal story.) Among the health care highlights:
  • Medical Examining Board Resources: The bill requires the Department of Regulation and Licensing (DRL) to create a new work unit within the department dedicated to the activities of the Medical Examining Board (MEB), including credentialing and discipline investigations. The Society has long supported segregating fees physicians pay for the MEB’s work, and has been working closely with DRL on the department’s efforts to improve service to physicians applying for licensure. This proposal would add additional staff specifically for MEB activities and provide additional spending authority to ensure better service.
  • Statewide workplace smoking ban: The bill prohibits smoking in workplaces, including bars and restaurants. Whether this provision remains in the budget bill is still in question, as non-fiscal items are often pulled from the budget bill. Legislative authors of the proposal still intend to introduce stand-alone legislation in case the provision does not remain in AB 75.
  • Cigarette tax increase: The bill would raise the tax on a pack of cigarettes from $1.77 to $2.52. In his speech, Governor Doyle offered a correlation between the last cigarette tax increase taking effect and a huge increase in the number of people calling the state’s “Quit Line” seeking help to stop smoking.
  • Primary Enforcement for seat belt use: The bill would allow law enforcement to stop a driver for failing to wear a seat belt. Currently, law enforcement can cite a driver for failure to wear a belt, but must have an alternate reason to pull over a driver.
  • No raid on the IPFCF: The budget bill does not include an overt raid on the Injured Patients and Families Compensation Fund (Fund). As the Society’s lawsuit against the state over the $200 million raid in the 2007-2009 biennial budget is still pending, it is not surprising that policymakers would be hesitant to raid again. As the economy continues to weaken, however, we will continue our vigilance in defending the Fund.
The biennial budget bill is in the powerful Joint Committee on Finance, which reportedly will start holding public hearings on the budget around the state the week of March 23. The Committee will then vote on any amendments, then send the bill to the Assembly, which will send it on to the Senate. Both houses will need to agree on identical language before the bill gets to the Governor’s desk for his signature and any vetoes.

For more information, contact Mark Grapentine, JD, for more information.

EDUCATIONAL PROGRAMS

Medicare changes in 2009–Are you ready?

It is no secret that in today’s economy, everyone is feeling a financial pinch in some way. In health care, it is important to continue to assess processes and refine workflows to increase efficiency and use fewer resources. There are many Medicare changes slated for 2009, and now more than ever you need to understand how this will affect your bottom line.

Join us in March as the Wisconsin Medical Society partners with WPS Medicare Part B for face-to-face seminars throughout the state. We will discuss when you can expect to see the Recovery Audit Contractors (RAC) and provide tips for getting prepared now. We will also provide an update on the transition to the Medicare Administrative Contractors (MAC) for jurisdiction 6. Other important topics for discussion that could impact your revenue cycle are e-prescribing, an ICD-10 update, changes to provider enrollment, value-based purchasing, coding and policy updates and much more. We will conclude these all-day sessions with an open Q&A, so come prepared with your most important Medicare questions and get the answers you need to ensure you are prepared for 2009.

For more information or to register for a seminar near you, click here.

QUALITY CORNER

Slide presentations from AHRQ’s 2008 Annual Conference

Slide presentations from the Agency for Healthcare Research and Quality (AHRQ) 2008 annual conference are now available on the AHRQ Web site. This conference was designed to showcase the best of the Agency’s research and provide examples of how that research is being implemented at all levels in health care delivery. Entitled “Promoting Quality... Partnering for Change,” the conference featured presentations in five major themes: health information technology, prevention/care management, effective healthcare, patient safety, and value/innovations/emerging issues. To access the presentations, click here.

FAQ

Question:
What are the documentation requirements when billing for an assistant surgeon or co-surgeons?

Answer:
When utilizing an assistant surgeon, you are asking for an additional pair of hands to accomplish a specific surgical procedure. Four modifiers are used to report this service:

  • 80 Assistant Surgeon
  • 81 Minimum Assistant Surgeon
  • 82 Assistant Surgeon when Qualified Resident Surgeon not Available
  • AS Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist
When an assistant is used in surgery, the surgeon will carry primary responsibility for the procedure. Documentation that supports the medical necessity of using an assistant surgeon must be in the operative report of the primary surgeon. The surgical note should also clearly identify what the assistant did during the surgery and the identity of the assistant surgeon. Both the primary surgeon and the assistant will submit the same CPT code, with the appropriate assistant surgery modifier appended on the claim submitted by the assistant.

Co-surgeons share responsibility for a surgical procedure, each serving as a primary surgeon for separate portions of the surgery. It is common for co-surgeons to be of different specialties. Co-surgery is reported by appending modifier 62 to the co-surgery CPT code and reporting once by each surgeon. If additional procedure(s) are performed by either surgeon, additional CPT codes may be reported by the appropriate surgeon. Documentation must support medical necessity for co-surgeons, and each surgeon must dictate his or her own operative report.

To determine whether a surgical procedure is approved and subject to the assistant at surgery reduction or payable for two surgeons as co-surgery, the Medicare Physician Fee Schedule Database (MPFSDB) should be consulted on the CMS Web site.

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.