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Results for “Current Procedural Terminology”

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At least 235 records · Page 13Linked to original sources
PubMed2006

Revisiting physicians' financial incentives in Quebec: a panel system approach.

Do Primary Care Physicians (PCPs) react strategically to financial incentives and if so how? To address this question, we follow a quasi-natural experiment in Quebec, using a panel system technique. In so doing, we both correct for underestimation biases in earlier time series findings and generate new results on the issue of complementarity/substitution between consultations with varying levels of technicality. Under both techniques, we show that PCPs are sensitive to the enforcement and subsequent temporary removals of expenditure caps and more generally, to changes in consultations' relative prices over time. These results support the existence of a discretionary power over the choice of consultation, PCPs increasing strategically the number of the more technical (and therefore more lucrative) consultations when pressed to defend their income. This finding for primary care parallels the now well-established DRG creep in hospitals. The panel system approach offers a better account of the complexity surrounding PCPs' decision-making process. In particular, it successfully addresses issues of physician heterogeneity, jointness between consultations and temporal breaks and generates robust estimates of PCPs volume and quality reactions to regulatory changes.

Budgets↗
PubMed2007

Trends in special education code assignment for autism: implications for prevalence estimates.

There is considerable controversy over reasons for observed increases in the prevalence of autism spectrum disorders. We examined trends in British Columbia education database coding of children with autism from 1996 to 2004. There was a significant linear increase in autism prevalence. The proportion of children identified by age 6 increased significantly from 1996 to 1999. When we calculated prevalence assuming onset prior to age 3, previously unidentified cases, particularly among girls in 1996 and 1997, accounted for substantial increases in estimated prevalence. The magnitude of under-identification decreased from 1996 to 2000, and rose slightly in 2001. Analyses of prevalence trends must take into account effects of earlier age at identification and inclusion of previously undetected cases on prevalence estimates.

Age Factors↗
PubMed2006

Children who are medically fragile in North Carolina: using Medicaid data to estimate prevalence and medical care costs in 2004.

OBJECTIVES: The purpose of this paper is to demonstrate a method of using medical insurance paid claims and enrollment data to estimate the prevalence of selected health conditions in a population and to profile associated medical care costs. The examples presented here use North Carolina Medicaid data to produce estimates for children ages 0-19 who are medically fragile. These children with serious health conditions are a small subset of all children with special health care needs. METHODS: The children who are medically fragile were identified through selected procedure and durable medical equipment codes. We profiled the expenditures for all medical services provided to these children during 2004. RESULTS: 1,914 children ages 0-19 enrolled in Medicaid were identified as medically fragile (0.22 percent). The amount paid by Medicaid for these children during 2004 for all medical services was $133.8 million, or $69,906 per child. By comparison, the average expenditure by Medicaid during 2004 for a randomly selected group of children receiving well-child care visits was $3,181 per child. The $133.8 million of Medicaid expenditures for the children who are medically fragile represents 6.8 percent of the nearly $2 billion spent by Medicaid in 2004 for all medical services for all children ages 0-19. CONCLUSIONS: This study presents a standard methodology to identify children with specific health conditions and describe their medical care costs. Our example uses Medicaid claims and enrollment data to measure prevalence and costs among children who are medically fragile. This approach could be replicated for other health care payer data bases and also in other geographic areas.

Child↗
PubMed1994

Maxillofacial prosthetics: a preliminary analysis of Resource Based Relative Value Scale.

A study done by the American Academy of Maxillofacial Prosthetics to evaluate the Medicare Resource Based Relative Value Scale (RBRVS) as it relates to maxillofacial prosthetics. The method of RBRVS formulation is described. The degree of difficulty and treatment time were determined for nine Physicians' Current Procedural Terminology-edition 4 (CPT-4) codified maxillofacial procedures. A preliminary survey indicates that practice expense and malpractice expense ratios were 66% and 1%, respectively. Correlation of maxillofacial procedures to other medical procedures was not performed because an additional study with a greater sample size is needed.

Ear↗
PubMed2004

Medicaid payment for telerehabilitation.

OBJECTIVE: To assess current payment practice for telerehabilitation in state Medicaid programs. DESIGN: Telephone survey. SETTING: State Medicaid programs. PARTICIPANTS: State Medicaid directors. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Descriptive. RESULTS: Half of the 35 state Medicaid programs contacted reimbursed at least some telemedicine services other than radiology in 2002. The primary reason for reimbursing for telemedicine is to make services available when there is no local practitioner. Consultation and evaluation and management services were most likely to be reimbursed (12 states). Seven state programs reimbursed telepsychology, and 4 states reported reimbursing for telespeech and language pathology, physical therapy, or occupational therapy. CONCLUSIONS: Telemedicine helps Medicaid programs deliver specialized care to locations with provider shortages. Telerehabilitation is not yet widespread, despite its potential benefit to people with disabilities who cannot travel to a clinic for rehabilitation therapy. Most Medicaid programs calculate the financial costs and patient benefits when considering payment policies, and about half of states require a state law to allow payment for telerehabilitation. Minnesota, Hawaii, and Nebraska, among the responding states, currently reimburse for telerehabilitation. Research is needed to evaluate the appropriateness of telerehabilitation for Medicaid beneficiaries.

Current Procedural Terminology↗
PubMed2004

Emergency medicine ultrasound policies and reimbursement guidelines.

Every emergency medicine physician should be knowledgeable of current emergency medicine expert policy and recommendations regarding the use of ultrasound imaging technology in the emergency department. In the last 3 years, a number of publications have provided critical information on practice management and reimbursement issues relating to bedside ultrasound performed by emergency physicians. This article summarizes the salient points of these publications. Because of their potential impact and relevance to emergency medicine, specific policies issued from the general house of medicine that relate to ultrasound technology also are included.

Current Procedural Terminology↗
PubMed2006

Enteral stents.

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Current Procedural Terminology↗
PubMed2006

National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes.

BACKGROUND: The increase in obesity coupled with greater acceptance of the field of bariatric surgery has resulted in a substantial rise in the number of weight-loss operations. Because obese individuals are at high risk for surgical complications, concern about the safety of bariatric procedures exists. Earlier investigations of the clinical features associated with surgical complications have produced conflicting results. We sought to identify risk factors for surgical complications in a large, nationally representative population of US veterans. STUDY DESIGN: We analyzed data on bariatric procedures performed at 12 Veterans' Affairs medical centers approved to perform weight-loss operations between 1998 and 2004. Detailed pre-, intra-, and postoperative information and longterm mortality data were prospectively collected using the National Surgical Quality Improvement Program methodology. We used multivariable logistic regression to identify clinical features associated with postoperative complications. RESULTS: Among 575 bariatric patients assessed between 1998 and 2004, 74% were men with a mean age of 51 years. Thirty-day mortality was 1.4%. Overall complication rate was 19.7%. Of those with complications, one-half were of considerable clinical importance, as they were associated with prolonged length of stay. Clinical features that were predictive of adverse events in our multivariable analyses were superobesity, weight>350 pounds, and smoking. A more than 20 pack-year history of smoking was also associated with difficulty in weaning from a ventilator postoperatively. CONCLUSIONS: We identified smoking and superobesity as preoperative risk factors associated with postoperative complications. Future studies should examine the effect of preoperative weight loss and smoking cessation on bariatric procedure outcomes.

Bariatric Surgery↗
PubMed2006

Small rural hospitals and high-risk operations: how would regionalization affect surgical volume and hospital revenue?

BACKGROUND: Because higher hospital procedure volume is associated with better outcomes for many high-risk procedures, regionalization to higher-volume hospitals has been proposed as a way to improve quality of surgical care. The potential impact of such policies on small rural hospital volume and revenue is unknown. STUDY DESIGN: We identified all hospitalizations in small rural hospitals (less than 50 beds) in New York State from 1998 to 2001 that included an ICD-9 procedure code for 1 of 9 procedures for which there is a documented volume-outcomes association: abdominal aortic aneurysm repair, aortic-valve replacement, carotid endarterectomy, colectomy, coronary artery bypass, cystectomy, esophagectomy, pancreatectomy, or pulmonary resection. Revenue from these procedures was estimated using gross charges and payor-specific reimbursement rates. We then compared these estimates with total hospital inpatient revenue for each rural hospital. RESULTS: We identified 14 small rural hospitals where at least one of the nine procedures was performed. All included hospitalizations for colectomy. Aortic aneurysm repairs, cystectomies, and pancreatectomies were performed in three hospitals; carotid endarterectomy in two; and esophagectomy in one. In no hospitals were cardiac procedures or pulmonary resections performed. Estimated average contribution to hospital net revenue for all 9 procedures was approximately 2%, nearly all attributable to colectomy. CONCLUSIONS: If all aortic aneurysm repairs, major cardiothoracic procedures, carotid endarterectomies, cystectomies, and pancreatectomies in New York State were regionalized to higher-volume hospitals, no small rural hospitals would experience substantial impact in terms of rural hospital procedure volume and revenue. Even regionalization of colectomy would have a small impact on inpatient volume and revenue.

Aortic Aneurysm↗
PubMedDate not supplied

Psychiatry billing for nursing home services: understanding coding options.

This article reviews information on coding options, documentation, and payment for both initial and follow-up visits in the nursing home setting. Specific information is provided for both the psychiatry as well as the Evaluation & Management (E&M) code series. Payments are compared for comparable services in order to provide the nursing home psychiatrist with an understanding of the options available. Documentation, background information, and proposed note formatting are also provided. Proper use of the E&M series can provide valuable coding options.

Aged↗
PubMed2005

ROP in New York State.

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Current Procedural Terminology↗
PubMed2006

Considerations in incorporating office-based ultrasound of the head and neck.

OBJECTIVE: The purpose of this study was to determine the cost considerations and strategies for incorporating ultrasound (US) in a head and neck practice. STUDY DESIGN AND SETTING: A retrospective chart review of office-based US procedures from 2001 to 2005 was completed at our academic medical center. Billing and coding for US and US guided fine needle aspiration (USFNA) were examined. RESULTS: The appropriate CPT codes are 76536 for US and 76942 and 10022 for USFNA-related procedures. The USFNA codes should be used repeatedly for correct coding of biopsies from multiple sites. Cost (equipment) sharing between specialties is a potential strategy for office-based US incorporation. CONCLUSION: Based on practice volume, specific CPT coding, and Medicare reimbursements, office-based US equipment and certification costs could be offset in 1 year. SIGNIFICANCE: Office-based US can be readily incorporated with significant benefits to patients. Billing and usage strategies were identified that would improve the economics of providing office-based US.

Biopsy, Fine-Needle↗
PubMedDate not supplied

Clients served and services provided by academic nurse-managed centers.

Currently, no national database for academic nurse-managed centers (ANMCs) exists. These primary care services remain somewhat invisible in the policy and reimbursement areas of the American primary care system and, consequently, are undersupported. The purpose of this article is to describe client and service data from a national study of ANMCs. A cross-sectional survey design was used to collect data from ANMC directors. Usable data were received from 64 centers. ANMCs in the sample were relatively small in terms of patients and volume. Client and service profiles demonstrated variation, which seemed to be reflective of needs relative to populations and communities served. Nearly half of the ANMCs responding served clients of all ages, with services representing the breadth of primary care (i.e., health maintenance and management of minor acute and common chronic illnesses). Evidence of community-focused care was also noted. The reported use of standardized nursing language was low. Standardized medical taxonomies were more commonly used, with International Classification of Diseases, Ninth Revision being the most common. ANMCs provide a small but substantial amount of primary care services in communities served. Findings indicated a need for ANMCs to improve the documentation of their contributions through the use of standardized taxonomies to provide aggregated reporting for policy and research purposes.

Adolescent↗