SEARCH · PubMed Health

Results for “CPT codes”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources

PubMedDate not supplied

Interpretive reporting of laboratory data: proposed criteria to qualify as a high-quality, limited clinical pathology consultation.

OBJECTIVE: To present recommended criteria designed to improve the computer-based interpretation of laboratory test results. METHODS: Guidelines for providing high-quality test interpretations and an outline for incorporating such criteria into a program for interpretive reporting are presented. RESULTS: Traditionally, when a laboratory reports a test result, the clinician interprets it within the clinical context. More recently, even in the absence of clinical information about the patient, laboratories that report test results, including biochemical thyroid function tests, have begun to insert "informative" statements about the test. These statements fail to provide an adequate limited pathology consultation that merits the CPT code 80500. Such interpretations can be improved by making them optional, specific for the test result, considerations rather than recommendations, and accompanied, on request, by an expanded list of differential diagnoses and an itemization of drugs known to affect the test result. CONCLUSION: High-quality interpretations of laboratory tests should improve patient care, avoid unnecessary costs, and prompt appropriate referrals to specialists.

Journal Article↗

PubMed2026

Genetic Susceptibility to Incisional Hernia Evaluation of Hernia Polygenic Risk Scores.

OBJECTIVES: Incisional hernia (IH) affects 13-30% of people after abdominal surgery, resulting in substantial morbidity and costs. While clinical risk factors have been studied extensively, genomic risk for IH is incompletely understood. We aimed to evaluate the impact of polygenic risk scores (PRS) on IH risk prediction. METHODS: We created and evaluated three PRS for abdominal hernia, ventral hernia and latent hernia susceptibility for prediction of IH in an institutional biobank. The primary outcome was defined as the diagnosis or repair of an IH based on ICD-9/10-CM/PCS and CPT codes. Clinical covariates included age, sex, body mass index (BMI), smoking status, index procedure type, and perioperative surgical site infection. A phenome-wide association study (PheWAS) was performed to assess clinical associations with increased PRS. We then tested the ability of the PRS to improve prediction for IH by modeling clinical covariates with and without PRS in patients who underwent abdominal surgery. Model performance was assessed using 10 iterations of 5-fold cross-validation to estimate Brier scores and area under the receiver operating characteristic curve (AUROC), which were compared using cross-model Bayesian analysis of variance. RESULTS: In 55,809 subjects, assessed PRS was significantly associated with incisional, umbilical, and ventral hernia on PheWAS, with 1.19 greater odds of developing IH per 1-SD increase in PRS (95% CI: 1.13-1.25, P < 0.001). Of 9,909 subjects who underwent qualifying abdominal surgery, 706 developed IH. In this cohort, the latent hernia susceptibility PRS was associated with a 16% increased hazard of developing IH per 1-SD increase (HR 1.16; 95% CI: 1.07-1.26; P < 0.001). Compared to a predictive model using clinical covariates (Brier score = 0.047, 95% CI: 0.046-0.048; AUROC = 0.660, 95% CI: 0.653-0.666), addition of the PRS showed similar Brier score and AUROC estimates (Brier score = 0.047, 95% CI: 0.046-0.048; AUROC: 0.667, 95% CI: 0.661-0.673) at five years. Cross-model Bayesian analysis demonstrated >99% probability of practical equivalence when trying to detect a difference of ≥ 0.02. CONCLUSION: All three PRS for hernia were independently associated with IH, suggesting that genomic factors contribute significantly to IH development. However, none of the three PRS meaningfully improved clinical IH risk prediction in patients who underwent abdominal surgery. This suggests that clinical comorbidities and surgical techniques may be equally as important as genomic architecture.

Bayesian analysis↗

PubMedDate not supplied

Medicare physician fees overhauled. The RBRVS fee system and its implications for hospitals.

Medicare has begun to implement a new payment system for physician services; the system's cornerstone is a resource-based relative value scale (RBRVS) that divides physician services into three components--physician work, practice expense, and malpractice insurance--and calculates a relative value for each component. The relative values for the components are adjusted for geographic differences between regional and national resource costs. Then a conversion factor transforms a relative value into a payment amount. The full RBRVS fee will be paid beginning January 1, 1992, if the fee does not differ by more than 15 percent from the service's adjusted historical payment basis. If the difference generally exceeds 15 percent, the RBRVS fee will be phased in over four years. The Medicare RBRVS fee schedule applies to both office- and hospital-based physicians. Several special provisions apply to physicians ordinarily defined as hospital based--radiologists, anesthesiologists, and pathologists. Other provisions of the fee schedule address site-of-service differentials, electrocardiograms, nonphysician practitioners, new physicians or practitioners, and Health Professional Shortage Areas. Administrators need timely strategies to manage successfully in the new environment and to sidestep lost or delayed reimbursement. RBRVS has financial and operational implications in terms of physician compensation, outpatient hospital reimbursement, new CPT codes, and new outpatient billing procedures.

Allied Health Personnel↗

PubMedDate not supplied

Building a compliance program. Guidelines for physician practices.

Federal investigations of physician billing practices will only grow more intense in 1998. Regular self audit, especially of CPT coding, can help practices stay out of the limelight. An established compliance program and high-ranking compliance officer are also becoming standard. Compliance programs should pay particular attention to "incident to" billing, level 5 E/M codes, time-based E/M codes, codes with both technical and professional component services, consultations, critical care codes and physician care plan oversight. Even group practices that use billing companies need to stay alert. Physicians are liable for the acts of the billing company whether they knew or should have known submitted claims were false.

Financial Audit↗

PubMed1998

Clinical buy-in is key to benchmarking success.

The effectiveness of benchmarking as a tool for improving the quality of healthcare services and reducing costs depends on the completeness of the data and physician acceptance of the findings. Benchmarking analyses based on cost-center data, for example, do not account for many of the actual costs of performing a procedure and, therefore, may be of limited value. Benchmarking studies should use data that provide a complete, detailed picture of what each procedure entails to facilitate consistent comparisons among actual physician practices so that physicians can see clearly how their practices relate to best practices. The current procedural terminology (CPT) coding system can provide an excellent basis for assembling benchmark data.

Abstracting and Indexing↗

PubMed1998

Easing the transition to an RBRVS-based physician compensation system.

In many provider organizations, traditional physician compensation systems based on patient charges have been replaced with resource-based relative value scale (RBRVS) systems, which pay physicians for actual effort expended. Group practices considering adopting an RBRVS-based system should be aware that the transition from one system to another requires careful planning. A four-step process that can ease this transition includes organizing a transition team, comparing CPT codes with the relative-value unit (RVU) schedule, designing and developing an RVU-based report, and analyzing RVU production data.

Accounting↗

PubMed1988

Working toward a more rational pattern of fees.

Following its congressional mandate to reform physician payment, the Physician Payment Review Commission has been examining the concept of a fee schedule. The commission, which operates almost entirely in public, has extensive contact with physician groups and beneficiary organizations, and provides extensive opportunities for formal testimony at public meetings and for frequent informal interactions at the staff level. By sending various organizations a draft outline of issues it hopes to take up in its next report to Congress, it is soliciting suggestions from them long before any decisions are made. Such issues as geographic variation in payment, the ways in which CPT codes are used, a relative-value scale, and the increasing volume of services are being subjected to intense scrutiny, and the commission is drawing conclusions.

Abstracting and Indexing↗

PubMedDate not supplied

Benchmarking: the key to influencing physicians.

Managing physicians to achieve cost reductions can seem impossible, especially when managed care penetration is low. Physicians feel little pressure to change when asked merely to cut costs, especially when their boat is not rocking. But physicians will respond to benchmarking data on CPT-coded procedures that are directly comparable to their own practices. When surgeons see that others take less time to perform a procedure and/or use fewer and lower cost supplies, their competitive spirits are aroused. They become inquisitive about why this is so and then are eager to change by trying new methods and improving their techniques. Science is the key motivator, not savings. When benchmarking recommendations are implemented in a facility, better practice and substantial cost savings are the positive results.

Benchmarking↗

PubMed2000

Findings of a three-year retrospective study to investigate prevalence and incidence of urinary incontinence and overactive bladder in a typical managed care setting.

This study was conducted in a large, integrated HMO to determine the prevalence and incidence of urinary incontinence, identify a demographic profile of patients having the UI subgroup condition of overactive bladder, and collect data to create an economic cost of illness description regarding current diagnosis and treatment practices. Using ICD-9 and CPT codes and prescription drug claims data as markers for the disease, subjects were selected for inclusion in the study. Resource use cost data was collected from this cohort over a three-year period and analyzed for total and mean monthly costs.

Adolescent↗

PubMed1999

Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2000. Health Care Financing Administration (HCFA), HHS. Final rule with comment period.

This final rule makes several changes affecting Medicare Part B payment. The changes include: implementation of resource-based malpractice insurance relative value units (RVUs); refinement of resource-based practice expense RVUs; payment for physician pathology and independent laboratory services; discontinuous anesthesia time; diagnostic tests; prostate screening; use of CPT modifier -25; qualifications for nurse practitioners; an increase in the work RVUs for pediatric services; adjustments to the practice expense RVUs for physician interpretation of Pap smears; and revisions to the work RVUs for new and revised CPT codes for calendar year 1999 and a number of other changes relating to coding and payment. Furthermore, we are finalizing the 1999 interim physician work RVUs and are issuing interim RVUs for new and revised codes for 2000. This final rule solicits public comments on the second 5-year refinement of work RVUs for services furnished beginning January 1, 2002 and requests public comments on potentially misvalued work RVUs for all services in the CY 2000 physician fee schedule. This final rule also conforms the regulations to existing law and policy regarding: removal of the x-ray as a prerequisite for chiropractic manipulation; the exclusion of payment for assisted suicide; and optometrist services. This final rule also announces the calendar year 2000 Medicare physician fee schedule conversion factor under the Medicare Supplementary Insurance (Part B) program as required by section 1848(d) of the Social Security Act. The 2000 Medicare physician fee schedule conversion factor is $36.6137.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2000

Frequency of etiological factors and cost effectiveness of the work up for patients with history of recurrent pregnancy loss.

OBJECTIVE: To assess the frequency of the etiological factors during the evaluation of patients with recurrent abortions. The cost effectiveness of the most frequent positive findings will be assessed. STUDY DESIGN: This is a retrospective study in which 97 patient charts were evaluated and only 90 charts were included in this study. The diagnostic studies for every patient including hysterosalpingogram, endometrial biopsy, cervical cultures for Chlamydia and ureaplasma, and chromosomal karyotyping for the couple were assessed. The cost analysis was based on the CPT coding for each test. RESULTS: The frequency of the tests with highest positive findings were hysterosalpingogram, endometrial biopsy, cervical cultures, and immunologic studies. Chromosomal karyotyping has a low positive yield in evaluation of these patients. CONCLUSION: In evaluating patients with recurrent miscarriages, treating physicians should take into consideration the tests which have a high positive yield as a first step. Chromosomal karyotyping should be evaluated in specific situations.

Abortion, Habitual↗

PubMedDate not supplied

Amblyopia detection by camera: Gateway to portable, inexpensive vision screening (calibration and validation of inexpensive, pocket-sized photoscreeners).

BACKGROUND: Photoscreening can allow early detection of amblyopia. The Gateway DV-S20, and similar models of miniature, digital flash cameras, have similar optical dimensions to existing photoscreeners for less than $200. METHODS: These cameras were calibrated on known, threshold amblyogenic refractive errors induced by placing minus and toric contact lenses on a normal subject's left eye. The DV-S20 was then applied to known amblyopic patients. Students under age 7 were vision screened with patched acuity and sequential photoscreeners (MTI and Gateway). RESULTS: The digital cameras and the MTI photoscreeners produced similar magnitude interpretable crescents for amblyopiagenic refractive errors. They had very similar validation with sensitivities of 80-90% and specificities of 98% for serious eye disorders in known patients and school-aged children. CONCLUSION: Combined with careful interpretation, pocket-sized, digital flash cameras provide a portable and inexpensive digital alternative for pediatric photoscreening. A category 3 CPT code (0065T) can be used for this valid, public health technique: Amblyopia Detection By Camera (ADBC).

Alaska↗

PubMed2005

Deciphering data anomalies in BioSense.

INTRODUCTION: Since June 2004, CDC's BioIntelligence Center has monitored daily nationwide syndromic data by using the BioSense surveillance application. OBJECTIVES: The BioSense application has been monitored by a team of full-time CDC analysts. This report examines their role in identifying and deciphering data anomalies. It also discusses the limitations of the current surveillance application, lessons learned, and potential next steps to improve national syndromic surveillance methodology. METHODS: Data on clinical diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modifications [ICD-9-CM]) and medical procedures (CPT codes) are provided by Department of Veterans Affairs and Department of Defense ambulatory-care clinics; data on select sales of over-the-counter health-care products are provided by participating retail pharmacies; and data on laboratory tests ordered are provided by Laboratory Corporation of America, Inc. All data are filtered to exclude information irrelevant to syndromic surveillance. RESULTS: During June-November 2004, of the approximately 160 data anomalies examined, no events involving disease outbreaks or deliberate exposure to a pathogen were detected. Data anomalies were detected by using a combination of statistical algorithms and analytical visualization features. The anomalies primarily reflected unusual changes in either daily data volume or in types of clinical diagnoses and procedures. This report describes steps taken in routine monitoring, including 1) detecting data anomalies, 2) estimating geographic and temporal scope of the anomalies, 3) gathering supplemental facts, 4) comparing data from multiple data sources, 5) developing hypotheses, and 6) ruling out or validating the existence of an actual event. To be useful for early detection, these steps must be completed quickly (i.e., in hours or days). Anomalies described are attributable to multiple causes, including miscoded data, effects of retail sales promotions, and smaller but explainable signals. CONCLUSION: BioSense requires an empirical learning curve to make the best use of the public health data it contains. This process can be made more effective by continued improvements to the user interface and collective input from local public health partners.

Bioterrorism↗

PubMed2004

The growth of interventional pain management in the new millennium: a critical analysis of utilization in the medicare population.

Interventional pain management has been growing by leaps and bounds with the introduction of an array of new CPT codes, the expansion of interventional techniques, and utilization. Interventional pain management dates back to the origin of neural blockade and regional analgesia, in 1884. Over the years, pain medicine and interventional pain management have taken many approaches, including biological, biopsychosocial, and psychosocial. In the late 1990s and early 2000s, a new philosophy of precision diagnosis and high-tech management has evolved. An interventional pain physician may be either a reductionist, a monotherapist or a combination of the two. Interventionalists have been criticized for excessive undisciplined application of needle procedures. Interventional techniques are performed by many primary specialists (anesthesiology, physiatry, neurology, etc.) and physicians designated by CMS in interventional pain management (-09) and pain management or pain medicine (-72) which went into effect in 2003 and 2002. Overall, the frequency of utilization of interventional procedures has increased substantially since 1998. It is estimated that among Medicare recipients, the frequency of interventional procedures, which includes epidural, spinal neurolysis, and adhesiolysis procedures; facet joint interventions and sacroiliac joint blocks; and other types of nerve blocks, excluding continuous epidurals, implantables, disc procedures, intraarticular injections, trigger point and ligament injections, had increased by 95% from 1998 to 2003. In the Medicare population, facet joint interventions and sacroiliac joint blocks have increased by 222% from 1998 to 2003. Overall, the utilization of various nerve blocks (excluding epidurals, disc injections, and facet joint blocks) in Medicare recipients from 1998 to 2003 were performed approximately 50% of the time by non-pain physicians. Interventional pain management is growing rapidly, under the watchful eye of the government, and third party payors. Establishing an algorithmic approach and following guidelines may improve compliance and quality of care without implications of abuse.

Journal Article↗

PubMed2006

Medicare in interventional pain management: A critical analysis.

Recent years have been quite eventful for interventional pain physicians with numerous changes in the Medicare payment system with a view for the future and what it holds for interventional pain management for 2006 and beyond. On February 8, 2006, President Bush signed the Deficit Reduction Act of 2005, which cuts the federal budget by 39 billion dollars and Medicare and Medicaid by almost 11 billion dollars over five years. The Act contains a number of important provisions that effect physicians in general and interventional pain physicians in particular. This Act provides one year, 0% conversion factor update in payments for physicians services in 2006. Medicare has four programs or parts, namely Medicare Parts A, B, C, and D, and two funds to pay providers for serving beneficiaries in each of these program. Part B helps pay for physician, outpatient hospital, home health, and other services for the aged and disabled who have voluntarily enrolled. Before 1922, the fees that Medicare paid for those services were largely based on physician's historical charges. Despite Congress's actions of freezing or limiting the fee increases, spending continued to rise because of increases in the volume and intensity of physician services. Medicare spending per beneficiary for physician services grew at an average annual rate of 11.6% from 1980 through 1991. Consequently Congress was forced to reform the way that Medicare sets physician fees, due to ineffectiveness of the fee controls and reductions. The sustained growth rate (SGR) system was established because of the concern that the fee schedule itself would not adequately constrain increases in spending for physicians' services. The law specifies a formula for calculating the SGR, based on changes in four factors: (1) estimated changes in fees; (2) estimated change in the average number of Part B enrollees (excluding Medicare Advantage beneficiaries); (3) estimated projected growth in real gross domestic product (GDP) growth per capita; and (4) estimated change in expenditures due to changes in law or regulation. Overall, the frequency of utilization of interventional procedures has increased substantially since 1998. In 2006 and beyond, interventionalists will face a number of evolving economic and policy-related issues, including reimbursement discrepancies, issues related to CPT coding, issues related to utilization, fraud, and abuse.

Aged↗

PubMed1995

Patterns of care received by Medicaid recipients with urinary tract infections.

BACKGROUND: Urinary tract infections (UTIs) occur commonly in children and may lead to substantial morbidity. Most experts recommend urine cultures for diagnosing UTIs in children. In addition, most experts recommend imaging studies in a portion of children diagnosed with UTIs. PURPOSE: The purpose of this study was to assess how rates of performance of urine cultures and imaging studies for children in the Alabama Medicaid program diagnosed with a UTI vary by patient demographics, provider characteristics, and service locations. METHODS: The study design was a retrospective review of Alabama Medicaid claims data. Children were included as UTI cases if they had a Medicaid claim for urinary tract infections during 1991, were continuously enrolled in Medicaid for that year, and were younger than 8 years of age. Claims were grouped into episodes of care, and episodes were assigned to a diagnosing physician. Physician locations were classified as rural, suburban, or urban using demographic data. Specific laboratory and imaging procedures were identified using CPT codes (Physician's Current Procedural Technology Codes, 4th Edition). RESULTS: We identified 404 episodes of UTI occurring in 380 children. Only 47% of episodes were associated with claims for urine cultures. Claims for urine cultures were more frequently filed by pediatricians in urban locations. In the subset of 114 patients with multiple UTI episodes, only 68% had imaging studies specific for the urinary tract. Only 44% received both a voiding cystourethrogram and renal ultrasound. CONCLUSIONS: Claims data suggest that physicians underuse urine cultures in diagnosing UTIs in Alabama pediatric Medicaid recipients. Urban-based pediatricians perform better than other types of physicians. Imaging studies are also used less frequently than is commonly recommended.

Alabama↗

PubMed2003

Procedural coding of spinal surgeries (CPT-4 versus ICD-9-CM) and decisions regarding standards: a multicenter study.

STUDY DESIGN: A comparison of procedural coding systems ( [ICD-9-CM] [CPT-4]) applied to lumbar spine surgery patients from six teaching institutions. OBJECTIVE: To compare the detail reflected by coding systems used to describe spinal procedures. SUMMARY OF BACKGROUND DATA: Administrative databases contain ICD-9-CM procedural codes, which are derived from hospital discharge abstracts. These databases are used, in part, to establish health care utilization patterns and set health care policy. Previous studies have demonstrated inaccuracies in ICD diagnosis coding. However, the literature is void of information regarding the accuracy of ICD procedural coding of spine procedures. METHODS: Data were complete in 143 of 150 lumbar spine surgery patients (aged 17-84 years). Surgeons assigned CPT-4 procedural codes. These codes were compared with ICD procedure codes assigned by hospital medical records staff. RESULTS: On average, in four of six hospitals, there were more CPT codes assigned to patient records by the surgeon than ICD codes assigned by hospital medical records staff. Overall, CPT codes reflected a greater level of detail than ICD codes. CONCLUSIONS: These findings illustrate the increased detail of CPT coding over ICD coding in the spinal surgery cases reviewed. The ICD procedural codes contained in administrative databases tend to underrepresent the complexity of the surgical procedures actually performed.

Adolescent↗

PubMed1993

CPT (current procedure terminology) coding and patient accounting: controlling the process and improving billing efficiency.

As outpatient volumes increase in hospitals across the country, more and more coding responsibilities are being placed with the patient accounts department. Both registration and outpatient billers are involved in assigning current procedural terminology (CPT) codes for surgery and emergency room procedures, as well as maintaining the hospital's chargemaster. Often these responsibilities are assigned without regard for the level of coding expertise and degree of clinical knowledge of the personnel involved, which can lead to significant loss of reimbursement and untimely billing delays. This article addresses common problems and offers suggestions for improving coding, minimizing problems, and increasing billing efficiency.

Abstracting and Indexing↗