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The Past, Present, and Future of Digital Therapeutics
Published in Oleksandr Sverdlov, Joris van Dam, Digital Therapeutics, 2023
Sarah Cronin, Sophie Madden, Laura Ardill, Kate O'Reilly, Alette Brinth, Chandana Fitzgerald, Tess Huss
Also, in the US, Medicare has made advances to extend coverage to digital solutions like remote monitoring and telehealth—almost 20% of all new codes coming through the CPT process can be classified as having a digital health component (Nathanson, 2020). CPT (Current Procedural Terminology) codes are medical codes assigned to medical, surgical, and diagnostic services. They are set by the American Medical Association and used as a uniform language describing medical services and procedures between physicians, patients, and payers to streamline reporting.71 While some DTx may be eligible for reimbursement under these various codes, we have not yet seen specific CPT codes for DTx. This halts public coverage of such solutions and delays private coverage since commercial payers typically tend to follow and look to Medicare as an example for coverage decisions. DTx companies have been lobbying for a new senate bill that would specifically recognize prescription DTx as eligible for reimbursement, albeit limited to mental health indications. The “S.3532 Prescription Digital Therapeutics to Support Recovery Act” was submitted to the Senate Finance Committee in late March 2020.72 As of May 2021, we are yet to hear of any outcomes from the submission of this proposal, but with increased pressure from lobbyists, we are likely to see reform in the coming years.
Healthcare Payment Systems
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
ICD-10-CM, the International Classification of Diseases, 10th Revision, Clinical Modification, is used to translate documentation of medical diagnoses into numerical codes.2 Procedures and outpatient services are translated into numerical codes using Current Procedural Terminology (CPT) codes. This translation helps to standardize medical record documentation and contribute towards a large data set that is easily extractable for use in large research studies. The ICD system is mainly used to document and research mortality and morbidity. The United States also uses ICD-CM and CPT codes for billing purposes and has been using the 10th edition since October 1, 2015.2
Optimizing Medication Use through Health Information Technology
Published in Salvatore Volpe, Health Informatics, 2022
Troy Trygstad, Mary Ann Kliethermes, Anne L. Burns, Mary Roth McClurg, Marie Smith, John Easter
Classification systems and ontologies are not foreign to the healthcare domain. They have evolved in healthcare alongside our ever-increasing ability to discover and distinguish disease and pathology as well as the ever-increasing number of procedures and services that may be deployed to address those diseases. Examples of widely recognized classification systems include the International Classification of Diseases (ICD), currently in its 10th edition, for terming and classifying diseases, with its sister ICD-PCS for procedure coding maintained by the World Health Organization.26 In the United States, Current Procedural Terminology (CPT) code sets maintained by the American Medical Association are principally used to report medical, surgical and diagnostic procedures using a coding classification system.
Enhancing hospitalists smoking cessation counseling and billing compliance by education intervention: a quality improvement project
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Anum Asif, Hannah Dailey, Heena S. Sheth, Maria Petroulakis
The performance and outcomes data during post-intervention phases were compared to the pre-intervention data from the prior year, March 2018 to Feb 2019. The hospitalist performance was evaluated by compliance with billing for cessation consults during the pre-intervention and post-intervention phases. The medicine financial team queried the Hospital Medicine billing database for CPT codes 99406 and 99407 for the frequency of billing by the participating hospitalists. A friendly reminder email, as well as personal contact, was made in three months if there was no improvement in billing. APPs were not included since they were not doing their own billing at the time. We also utilized the hospital clinical analytics hospitalization database (QlikView) for tracking consult frequency and physician attribution. Our TTS team provided data for current tobacco users, inpatient treatment, and patients discharged on medications.
Preparing for E/M Changes to Outpatient Visits in 2021
Published in Oncology Issues, 2020
At the same time, the American Medical Association (AMA) convened a taskforce dedicated to updating the E/M CPT® codes. The AMA came up with guidelines based solely on medical decision-making (MDM) and time, as well as a dedicated prolonged services code specific to outpatient E/M visits. This meant that history and/or physical exam would no longer be used to determine the billable level. In an about-face, CMS did away with most, but not all, of the changes finalized in the CY2019 PFS rule and instead aligned with those established by the AMA. The agency's decision allows for consistency and continuity of coding and billing for all patients across all payers. Because most commercial and private payers follow AMA guidelines when using CPT codes, it made sense for CMS to do the same and not create more work and confusion for providers.
A Cost-Benefit Analysis of A Community Free Clinic
Published in Journal of Community Health Nursing, 2019
Erin Stillmank, Katie Bloesl, Erin McArthur, Benjamin Artz, Rachelle J. Lancaster
When examining the levels of patient encounters, CPT codes were vital in stratifying patient acuity to better understand the level and types of free care delivered. Nearly 25% of the patient encounters (n = 49) were established patients, meaning they were not new to the clinic and were of low to moderate severity in their presenting problems. Although not germane to this analysis, CPT codes are financial billing indices used to determine amounts of reimbursement for services provided at the time of the encounter. Some research indicates that coding is accurate approximately half of the time, while the rest of cases are under or over-coded (Chao et al., 1998; Kikano, Goodwin, & Strange, 2000) indicating that this method may be an unreliable way to calculate costs. It is difficult to determine if the provider delivering the care would have coded the encounter differently than our team or in a different delivery environment.