CPT s RVU s ICD-10 s Dept of Pediatrics - PowerPoint Presentation

Slide1

CPTsRVUsICD-10sDept of Pediatrics

Laurie

Beckstrom

– Updated 3-2020

CPT (Current Procedural Terminology)A code set organized by the AMA

Updated each year

CPT code book is >1,000 pages

Designed to

describe and categorize any medical, surgical or diagnostic work performed by a physician or APP

Provides uniformity and organization for medical care given to patients

Essential to 3

rd

party payor

(insurance companies)

billing and reimbursement

FY2019:

Dept of Peds generated

399,950 CPT codes

to represent all the work done by our providers

CPT (Current Procedural Terminology)Most CPT codes are

5 digits:

#####

Six sections:Evaluation & Management (E&M): 99201 – 99494Anesthesia: 00100 – 01999; 99100 – 99150Surgery / Procedures: 10000 – 69999Radiology: 70000 – 79999Pathology / Lab: 80000 – 89398Medicine: 90281 – 99607 (eg: dialysis, biofeedback, speech testing, etc.)

CPT (Current Procedural Terminology)Professional (certified) coders from UMB read through documentation provided by the physician and choose the CPT code(s) that best describes the work performed by the provider

E&Ms:

These are the

bread & butter for the department (currently 72% of our charges)Outpatient and Inpatient managementCoders decide which code to choose based on documentation provided, and the level of sickness or medical decision making (MDM)We talk about Levels (usually 3 or 5 Levels in a set)

Procedures:

Documentation must describe the procedure and the work that

was done

CPT (Current Procedural Terminology)E&M coding has several required elements:

History

History of Present Illness (HPI)

Review of Systems (ROS)Past / Family / Social History (PFSH)ExamMedical Decision Making (MDM)Amount and complexity of data reviewedNumber of diagnostic and management optionsRisk of complicationsTime (optional)

The

E&M

level

is determined by the

quality of the documentation:

History, Exam and MDM

CPT (Current Procedural Terminology)

CPT (Current Procedural Terminology)

CPT (Current Procedural Terminology)Surgery / Procedures & Medicine:

Intubation Behavioral testing

Endoscopy Doppler / heart interpretation

Lumbar puncture Speech / hearing tests Vascular embolization PsychotherapyCircumcision Immunization administrationECMO Biopsy Laceration repair Sleep studyModerate sedationRemove nasal FBEchocardiogram Dialysis

CPT (Current Procedural Terminology)Questions about CPT codes?

RVU (Relative Value Unit)Relative Value Units (RVUs):A system designed and maintained by CMS (mostly) to establish a

VALUE

for each CPT code

(all CPT codes are not the same)Helps determine what we charge for each CPT codeA nice way to consistently track physician productivityWhile what we charge increases year to year . . . RVUs stay the sameThis is the system used to benchmark physician performance against national norms by specialtySometimes we call this wRVUs (”work” RVUs) – essentially the same thing

RVU (Relative Value Unit) CPT is assigned an RVU based on this formula:

Physician Work + Practice Expense + Professional Liability = RVU

Physician Work

takes into account:Amount of TIME a procedure takesLEVEL of EXPERTISE requiredRISK involvedRVU x Conversion Factor = Price of a CPT codeEvery January we get a new Dept of Peds Fee ScheduleNewer CPT codes sometimes don’t have an RVU . . . much harder to get paid!

Description

CPT

RVUs

Office Visit New Pt - Level 1992010.48Office Visit New Pt – Level 5992053.17Inpt Hospital Initial – Level 1992211.92Inpt Hospital Initial – Level 3992233.86Hospital Discharge <31 min992381.28Hospital Discharge 31+ min992391.90

Initial Hospital - Neonate

99468

18.46

Initial Ped Critical Care

99471

15.98

Non-Face2Face

99358

2.10

Lumbar Puncture

62270

1.37

Intubation

31500

3.00

Pulmonary Valvuloplasty

92990

18.27

RVU (Relative Value Unit)Where can I go to look up an RVU?

American Academy of Professional Coders

Aapc.com (In “Number of Units” enter “1”)

RVU (Relative Value Unit) Dept of Peds is now tracking physician clinical productivity:

Looking at provider

wRVUs

and clinical work expectationsComparing it to national benchmarks specific to that subspecialty (provided by CPSC).More training when we look at Faculty Clinical Productivity worksheet.

CPT (Current Procedural Terminology)Questions about RVUs?

ICD-10 (International Classification of Diseases – 10th edition)

Diagnosis Coding:

a system to organize and track illness and injury

Official publication of the WHOUSA implemented the 10th edition Oct 2015> 69,000 codesFormat: A##.###AInfections A00-B99 Neoplasms C00-D49Blood D50-D89 Endocrine E00-E89etc. etc. etc.Helpful for billing / reimbursement, research, national trauma / accident, epidemiology info . . . all sorts of things!

ICD-10 (International Classification of Diseases – 10th edition)Physicians include a list of diagnoses / symptoms (with specifics) at the end of the document

Coders use the information to select the correct diagnoses code(s) to represent the reason for the visit.

CPTs – RVUs – ICD-10sQuestions:laurie.beckstrom@hsc.utah.edu