brittany check. overview patient care commission on cancer standards integrative medicine...
TRANSCRIPT
Brittany Check
Overview Patient care
Commission on Cancer standardsIntegrative medicineConcurrent chemotherapy/radiation patients
Quality improvementQuality reporting system
New methods and technologiesIntracoronary brachytherapyProne breast protocolCBCT planning for bone metastases
Coding updates
Patient Care
Commission on Cancer standardsPatient-centered standards
○ Patient navigation○ Psychosocial distress○ Survivorship
Patient Navigation
Reduce barriers for patientsEducateForm partnerships in communityCoordinate appointmentsPromote self-advocacyInform about trials
Assess and form process to meet specific needs of patients
Psychosocial Distress NCCN distress thermometer
Form process for screening patients
Survivorship
Information for patientDiagnostic tests and resultsCharacteristic of diseaseProcedure datesTreatment summaries
ASCO templates for breast and colorectal
Patient Care
Integrative medicineMay help empower patients, reduce
symptoms, and promote wellnessEvaluate safety vs. efficacy
Integrative Medicine Yoga Massage
Stress
AcupunctureNausea/VomitingXerostomia
Herbs/supplementsNo antioxidantswww.mskcc.org/aboutherbs
Patient Care
Concurrent chemotherapy and radiation patientsCommon for patients with cancer of:
○ GastrointestinaI system○ Head/neck○ Cervical/GYN○ Lung
Chemo/Radiation Patients Most agents used concurrently are
radiosensitizingInhibit repairShift phase in cell cycleIncrease radiation caused damage
Decrease occurrence of distant metastases
Chemo/Radiation Patients Common concurrent chemotherapy
agents:5-FUXeloda (oral 5-FU)CarboplatinGemcitabineCisplatinMitomycinCetuximab (Erbitux)
Chemo/Radiation Patients
Common side effects:
Not combined if agent and radiation cause toxicity to same organ
Chemo/Radiation Patients Extra monitoring Early intervention Dialog for bowel habits Skin care from beginning of treatment Process for getting fluids Icon in Aria for combined
chemo/radiation patients
Quality Improvement
Quality reporting system
Quality Improvement
Improving efficiency5S – sort through, set in order, shine,
standardize, sustainTransportation collaborationIncrease staffing on high-volume machinesPatients asked to arrive 10-15 minutes early
New Methods and Technologies Intracoronary brachytherapy
New Methods and Technologies Prone breast protocol
Used for large pendulous breastsAdvantages
○ Sparing to heart and lungs○ Dose homogeneity○ Reduced respiratory motion
Disadvantages○ Reproducibility
Prone Breast Treatment
Comparison of supine vs. prone for 6 patientsDmax 3.6% lower for prone plans
Supine Prone
Left lung mean 11.4% 1.1%
Left lung maximum 101.6% 56.9%
Heart mean 5.5% 2.7%
Heart maximum 101.6% 85.4%
*of prescribed dose
New Methods and Technologies CBCT planning for bone metastases
Coding Updates
Revenue Cycle2014 Medicare Physician Fee Schedule and
Hospital Outpatient Prospective Payment proposed rules
Accurate as of September 23, 2013. Final rules to be determined around November 1, 2013
Coding Updates
Stereotactic treatmentDiscontinue differentiation between robotic
and non-robotic stereotactic procedures○ Assume there is some robotic element to all
radiosurgery proceduresDeletion of existing G-codes
○ G0173, G0251, G0339, G0340Use 77372 for SRSUse 77373 for SBRT
Coding Updates
PackagingBased on category of service
○ Integral, ancillary, supportive, dependent, adjunctive items
Change ancillary services with status indicator X to Q1○ Q1: Simulations, treatments devices,
treatment planning
Coding Updates
PackagingQ1 services packaged when used with S, T,
or V services○ S: Treatment delivery○ S,T, or V code paid
Q1 services packaged when used together○ Highest reimbursed Q1 paid in quantity 1
Coding Updates
SupervisionAll therapeutic services in hospitals require
direct supervision○ “Direct supervision in the office setting means the physician must be
present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.”
Medical oncologist is not sufficient for radiation therapy procedures according to Revenue Cycle
Enforced in 2014
Coding Updates
Clinic visitsGXXXC code for all levels of clinic visits
○ Discontinue 99201-99205 and 99211-99215○ Does not distinguish between new and
established patients
Coding Updates
Common errorsPhysician orders and medical necessity
not locatedIncomplete or missing documentationIncorrect dates of service used for billingIncorrect CPT codesMissing or late signaturesBilling under incorrect physicianBilling under incorrect location
Coding Updates
Recommendations to avoid mistakesInternal compliance planDaily charge and documentation reviewDaily interface verification auditsInternal audits
Coding Updates ICD-10-CM effective October 1, 2014
Category
Numeric or Alpha (E or V) Numeric
Category, Anatomic Site,
Severity
Alpha(except U) Numeric
Numeric or Alpha (except U)
Category Category, Anatomic Site,
Severity
Extension
Coding Updates
ICD-9-CM to ICD-10-CM 12 codes can be listed on claimsCodes can contain placeholder “X”V and E codes incorporated into main
classification○ Factor influencing, external causes, etc.