News from NEPHO – SEPTEMBER 2020 Edition

PRACTICE CHANGES / UPDATES

• Khalid Syed, MD has relocated from 496 Lynnfield Street Lynn, MA 01904 to
  480 Lynnfield Street, Lynn, MA 01904.  (781) 593-3400  Fax: (781) 477-1138
• Robert Mc Laughlin, MD will be closing his practice North Shore Shoulder effective 10/1/2020
• Eileen Delaney, MD has terminated her affiliation with Beverly Radiological Associates
• Kevin Ennis, MD of The Center for Health Aging has retired effective 8/24/2020

SAVE THE DATE

NP / PA MEETING – CME approved 
Guest Speaker: Dr. Susan Choe – Lahey Endocrinology, Danvers
Date: Wednesday, October 7, 2020 @12:00 noon
Location: GoogleMeet Conference Call
RSVP: lucia.kmiec@lahey.org or contact Lucia Kmiec, Health Coach at 978-880-2318 if you have any questions.

OPEN MEETING II – SCHEDULE BELOW – We are offering 3 meeting dates/times for your convenience.  The same presentation will be conducted at all sessions.  Please note: attending more than one session will not earn additional meeting credit.

Please check the meeting calendar on our website to get the latest meeting status, notification of the Coding and Billing webinars,  Specialty Specific meetings, and POD/IPA meetings.

PAYOR UPDATE

Reminder: Physician’s Order Required for Nutritional Counseling

Harvard Pilgrim reimburses nutritional counseling services provided by a contracted nutritionist or registered dietician, when ordered by the member’s PCP or a participating provider. The Commercial Nutritional Counseling Payment Policy outlines coverage of these services, including which services are and are not eligible for reimbursement and guidelines for proper billing. To view the updates, click here.

Important Replacement Claim Billing Reminders

Harvard Pilgrim would like to remind providers of some key points regarding the correct billing of replacement claims. A replacement claim must completely replace the entire original claim; the information on the replacement claim voids and replaces the previously submitted claim. If providers have omitted charges or changed information on a claim — such as diagnosis codes, dates of service, or member information — providers must submit the entire claim as a replacement claim using type of bill frequency code 7 and include all the previous information, as well as any corrected or additional information. Please note that a replacement claim submitted without type of bill frequency code 7 may be considered a duplicate and consequently denied. To view the updates, click here.

PROVIDER RELATIONS

During these difficult financial times, we realize every bit helps! Please take a moment to visit https://www.findmassmoney.com/app/claim-search to search for your business name for potential funds being held that can be claimed.

Please let us know if you have any helpful websites or resources you would like to share with other practices in future newsletters by emailing Alycia.Messelaar@lahey.org .

Please take a moment to look through recent emails for a communication titled “IMPORTANT – From the Desk of Pierre Ezzi, MD: Updated BILHPN Agreement” sent by Alycia.Messelaar@lahey.org on September 28, 2020. This email requires your immediate attention, as it includes a revised NECoMG Physician Participation Agreements (PPA) that was created to incorporate changes driven by a new agreement signed by the Northeast PHO to participate as a risk unit of the Beth Israel Lahey Health Performance Network (BILHPN.) The letter serves as written notification of termination of your current NECoMG PPA as of December 31, 2020.  The new PPA must be signed and returned by Friday, October 16, 2020 to continue your participation in NECoMG and Northeast PHO.

Print the Signature Page, sign, and return to Alycia Messelaar by Friday, October 16, 2020.
Fax:  978-236-1777
Email: Alycia.Messelaar@lahey.org 

If you have any questions about the PPA, please contact Stacey Keough at 978-816-2010  /  Stacey.keough@lahey.org or Alycia Messelaar at 978-236-1784 /  Alycia.Messelaar@lahey.org.

You may also join one of the information sessions (dates/times listed above in the Save the Date section) to review your questions.

Please reach out to Alycia Messelaar at 978-236-1784 or Alycia.Messelaar@lahey.org to keep NEPHO informed of changes in practice schedules due to COVID-19 (office closures, limited office hours, scope of appointment, telehealth use, phone line to reach staff, etc.) or if you have questions about other practice schedules.

Click here  to access a list of practices who are scheduling in office visits and/or TeleHealth visits at this time.

Please take a moment to review your practice information and reach out to Alycia Messelaar, Alycia.Messelaar@lahey.org with update requests.

The Northeast PHO is here to ensure you are not alone and that we are in this together. We are doing our best to keep your practice as updated as possible with all things COVID-19. Please take a moment to visit the COVID-19 tab on the by clicking here.

Click here to find the most recent links to COVID-19 specific health plan materials and updates. Please note, we have included health plans that NEPHO does not contract with in an effort to help keep you well informed of current COVID-19 updates we have been made aware of. If you have questions or concerns, please reach out to Alycia Messelaar, Alycia.Messelaar@lahey.org.

PHARMACY

September 2020 Pharmacy Update 

Probiotics

The American Gastroenterological Association (AGA) recently published Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders clarifying how effective probiotics are in improving GI disorders. Evidence for probiotic use in “GI health” is limited and results are often conflicting. In addition, data from one species or strain cannot be applied to another.

See the Comparison of Common Probiotics from Pharmacist / Provider Letter, September 2020 to help choose the probiotic product for the indication of interest.

Consider the following in determining when probiotic may be helpful:

• Possibly effective: Probiotics may prevent antibiotic-associated diarrhea in about 1 in 13 patients. But experts disagree over whether probiotics help reduce the risk of  C. difficile from antibiotics.
  • rhamnosus GG (Culturelle, etc.) or S. boulardii (Florastor, etc.) have the best evidence. Not enough evidence that yogurt is beneficial.
  • If recommending probiotics, advise starting probiotics within 2 – 3 days of beginning of antibiotics and continuing 3 days after the course. Separate probiotic from antimicrobials by 2 hours, as antimicrobials theoretically could “kill” good microbes in probiotic.
  • For RECURRENT C. diff… consider boulardii (Florastor, etc.) in addition to standard meds; evidence of benefit in patient who take probiotic for 4 weeks.
  • Ok to take lactis (Activa) for constipation, B. infantis (Align) for irritable bowel syndrome or L. rhaminosus GG or S. boulardii for travelers’ diarrhea.
• Likely ineffective: Educate that probiotics don’t reduce the duration or severity of acute gastroenteritis. Not much evidence probiotics are effective in other GI conditions such as Crohns Disease, ulcerative colitis or diverticulistis.
• Efficacy of one probiotic formulation cannot be extrapolated to other strains, species, or products.

Reference: Pharmacist Letter, September 2020, No. 360902

Please review the September 2020 issue of BILHPN Pharmacy Newsletter  which includes some important articles of interest as noted below:

• High-cost proton pump inhibitors
• New generic Insulins
• SGLT-2 inhibitors & GLP1 receptor agonists and CV disease
• Improving medication adherence
• Possible prescription delivery delays from mail order facilities

For more information or questions, please contact Carol Freedman, NEPHO Pharmacy Manager at carol.freedman@lahey.org

POPULATION HEALTH

October is Breast Cancer Awareness Month

According to the American Cancer Society, Breast cancer is the most common cancer in American women, except for skin cancers. Currently, the average risk of a woman in the United States developing breast cancer sometime in her life is about 13%. This means there is a 1 in 8 chance she will develop breast cancer. This also means there is a 7 in 8 chance she will never have the disease.

The American Cancer Society’s estimates for breast cancer in the United States for 2020 are:

• About 276,480 new cases of invasive breast cancer will be diagnosed in women.
• About 48,530 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is noninvasive and is the earliest form of breast cancer).
• About 42,170 women will die from breast cancer.

I am currently outreaching patients that are overdue for Mammograms and scheduling them directly if the patient agrees to get screened.

Ordering a Mammogram

While an order is not required for patients to get a screening Mammogram, EPIC scheduling requires an order to schedule the screening.  The correct order to enter is “Mammo Screening Tomosynthesis Bilateral”.  For those patients with providers not on EPIC I can enter the correct order in the system prior to scheduling them.

For more information about our local Breast Health Services please click here.

Please click here to see the 2019-2020 ACS Breast Cancer Facts & Figures 

Please let me know if I can be of any assistance talking to your patients about Mammograms and scheduling screenings.

Lucia Kmiec, NEPHO Health Coach
978-880-2318 or lucia.kmiec@lahey.org

CODING TIP OF THE MONTH

OPTUM Newsletter – September 2020 – Vascular Disease

ICD-10 CM and CPT code updates due to COVID 19

Recent updated CPT codes approved by the American Medical Association (AMA) recently announced the addition of two more CPT codes in relation to COVID 19 and the Public Health Emergency (PHE):

• 87426: Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semi quantitative, multiple-step method
• 86408: COVID-19 Antibody
• 86409: COVID-19 Antibody
• 86413: COVID-19 Antibody
• 99072: Miscellaneous Medicine Services
• 0223U: Proprietary Laboratory Analyses (PLA) Codes
• 0224U: Proprietary Laboratory Analyses (PLA) Codes
• 0225U: Proprietary Laboratory Analyses (PLA) Codes
• 0226U: Proprietary Laboratory Analyses (PLA) Codes

Updated ICD-10 CM codes approved due to the COVID 19 pandemic:

• Confirmed case (symptomatic, asymptomatic, or presumptive positive) (U07.1)
• Contact with COVID-19 (suspected exposure) (Z20.828)
• Possible exposure, ruled out (Z03.818)
• Asymptomatic (none or unsure of exposure), ruled out (Z11.59)

Risk Adjustment Coding Reminder:

ICD-10- CM Diagnosis Codes Reset January 1, 2021

The words “risk adjustment” often are paired with the acronym “HCC,” which stands for hierarchical condition categories. HCCs are diagnostic categories assigned based on diagnosis codes on encounter claims or by Medicare Advantage health plans. These categories filter patients into “buckets” that are clinically similar and are expected to have similar cost patterns to predict future healthcare costs.

• Each patient is assigned a risk adjustment factor (RAF) score that is determined by multiple variables, including demographics and chronic diseases. The types of diseases that map to a CMS HCC are high-cost medical conditions and current conditions that impact the encounter in terms of requiring monitoring, evaluation, assessment, or treatment.
• Diagnoses that are excluded from HCC mapping are those that do not predict future cost, such as appendicitis, and those that have a high degree of discretion or variability in diagnosis, diagnostic coding, or treatment, such as symptoms. Diagnosis codes from lab, radiology, and home health claims are not used because they are not reliable and may indicate rule-out diagnoses.
• An important point to remember is that each condition must be mapped at least once in a calendar year. Each January, the facility starts with a “clean slate.” Each chronic non-resolving diagnosis that maps must be reported at least once during the calendar year, on a claim including a face-to-face visit with an acceptable type of provider and in an acceptable setting.

NEPHO will continue to help educate providers through the rest of 2020 to help continue efforts to impact the patient’s health status accurately and offer guidance on new updates coming in 2021.

• The following coding education will be a focus as move into 2020 Quarter 4:
• Evaluation and Management Updates 2021
• ICD-10 CM Updates
• Risk Adjustment Best Practice
• How to Better Capture Chronic Conditions
• NEPHO will be working with providers directly to address education opportunities and to ensure accurate coding and reporting of HCCs is continued through the year. Working together can help ensure compliance and optimal financial results under HCC risk adjustment contract models.

Through pre-visit and post-visit review of our NEPHO providers Diabetes with complications and COPD seem to be an area that are missed the most during follow-up visits. Capturing these chronic conditions help support a better patient budget while better supporting a patient’s health status. The following are examples of coding opportunity for some of the most commonly reported chronic conditions. The examples include documentation requirements supporting the condition(s) and ICD-10-CM code(s) as well as tips to accurately document the condition:

• Diabetes with Hyperglycemia & Diabetes is not controlled. Patient unable to keep blood sugar (BS) low enough. The provider will adjust insulin and see patient for follow up in two weeks. The provider asked the patient to keep log of daily BS during this time frame:
  • ICD-10-CM Codes • E11.65– Type 2 Diabetes Mellitus with Hyperglycemia. • Z79.4– Long-term (current) use of insulin.
  • Documentation/ Coding Tips • E11(Type 2 Diabetes Mellitus) must document type I or II
  • Hyperglycemia – not controlled/uncontrolled diabetes Z79.4 – code to indicate patient uses insulin
• Assessment/Plan Acute exacerbation of COPD with acute bronchitis due to patient smoking. Provider Advises patient on smoking cessation, increases prednisone, prescribed antibiotic and increased nebulizer treatments to every two to four hours. Follow up in five days or sooner if symptoms worsen.
  • Documentation/ Coding Tips Four codes are required for the scenarios above:
    • J440.0– COPD with acute lower respiratory infection
    • J20.9– Acute bronchitis, unspecified
    • J44.1– COPD with (acute) exacerbation
    • F17.218 – Nicotine dependence, cigarettes, with other nicotine-induced disorder

Please reach out to Shawn Bromley at shawn.m.bromley@lahey.org or call 978-236-1704 if you would like to learn more about the new codes updates and/or Risk Adjustment Coding capture.

PATIENT EXPERIENCE COMMENTS

Garden City Pediatrics − 83 Herrick Street
• Can’t say enough good things about Dr. Elizabeth Humphreys and EVERYONE at
• Garden City!!  Always professional and their bedside manner goes above and beyond!

Lahey Health Primary Care, Beverly − 900 Cummings Center
• Dr. Andrew Lenhardt was very thorough and supportive of my interests and concerns.
••I could not recommend him more highly.

Lahey Health Primary Care, Beverly − 30 Tozer Road
• Dr. Gail Ellis is wonderful – very happy with my medical team – thank you so much!

Lahey Health Primary Care, Danvers − 5 Federal Street
• Dr. Mauri Cohen is very understanding and very helpful.

Lahey Health Primary Care, Gloucester − 298 Washington Street 4^th Floor
• Dr. Victor Carabba is an excellent physician who truly cares for his patients and their •
   well-being.

Lahey Health Primary Care, Gloucester − 298 Washington Street 1st Floor
• Great experience on every level with Dr. Amy Esdale.

Lahey Health Primary Care, Hamilton − 15 Railroad Avenue
• Dr. Laurence Gordon is a great physician. He is caring, compassionate, and listens to
• patient concerns before making decisions.

Lahey Primary Care, Manchester − 192 School Street
• Dr. Jana Oettinger is excellent, extremely knowledgeable, caring, and extremely •
   personable.

Leonard Horowitz, MD − 7 Federal Street, Danvers
• Dr. Leonard Horowitz is excellent and always listens to our concerns.

Mindful Medicine − 900 Cummings Center
• Always feel taken care of and respected re: any concerns I bring to Dr. Spencer Amesbury.

North Shore Pediatrics − 480 Maple Street
• Always great, professional care from Dr. Shannon Dufresne and the entire NSP staff.
• Dr. David Danis is an incredible doctor with comprehensive coverage of all our
• daughter’s needs. Super educated with up-to-date procedures and studies.
• Very thorough in describing the issues and the plans to mitigate them.  5 STARS

PRACTICE RECOGNITION