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Submitting category II cpt codes to insurance

MU, CQR, PQRS, etc.

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petemarkey

(@petemarkey)

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Aetna is asking that we supply quality measures using category II cpt codes. For example 3074F for systolic blood pressure less than 130.

of course we store the BP in an obs term and quality reporting does the translation for us.

anyone else having to deal with this?

Posted : July 27, 2018 9:20 am

petemarkey

(@petemarkey)

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Same would apply for stuff like counseling for smoking, which GE matches to a snomed, but Aetna wants cpt 4000F

is this the year 2018?

Posted : July 27, 2018 9:25 am

bhoover

(@bhoover)

Posts: 360

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We handle this typically with a function in a form. For example we have a function that is called when the user clicks away from the our vitals form and checks to see if the BMI has been calculated. We then send the appropriate order with the CPT II code with a general diagnosis attached. We do this for a handful of things that need to be reported this way.

Brad

Posted : July 30, 2018 7:50 am

petemarkey

(@petemarkey)

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Thanks for the response, have gotten some similar suggestions offline.

Our real problem here is our billing system (Medisoft) is not integrated with the EMR.

Was thinking/hoping we would always be able to utilize EMR data and not billing data for any type of quality reporting.

Posted : July 30, 2018 8:26 am

bhoover

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For what it's worth all of our carriers seem to want this via claims. It's just the way they have things set up on their end.

Posted : August 3, 2018 7:51 am

petemarkey

(@petemarkey)

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so after all our work with CQR and mappings we have to go it all over again... good grief....

GE didn't have enough insight to know we would have to map to CPT CAT II codes, so they just went all in on SNOMED?

Posted : August 4, 2018 8:57 am

Maribel

(@maribel)

Posts: 65

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Hello Brad I was wondering did you create your own forms or can this function be done to CCC-forms?

Posted : August 7, 2018 7:20 am

petemarkey

(@petemarkey)

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hopefully Brad will let you know, but I would assume ccc "CAMs" could be used. If they can add SNOMED codes (for whatever reason that is what GE did) I would think they could add CPT codes.

Posted : August 7, 2018 8:20 am

Maribel

(@maribel)

Posts: 65

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Petemarkey,

Thank you for the info., I will have to ask GE if I can get a workflow on how to add SNOMED / CAMS to the CCC forms we are currently using. Insurance carriers are also asking us for CPT II codes aswell. Thanks again.

Posted : August 8, 2018 6:40 am

petemarkey

(@petemarkey)

Posts: 373

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here is a webex on CAMs. Again, i am not sure if they support adding CPT codes or just SNOMED.

https://gehciits.webex.com/gehciits/lsr.php?RCID=861702a04d1b644e341e79163b4a5f3a

Posted : August 8, 2018 7:10 am

petemarkey

(@petemarkey)

Posts: 373

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Topic starter

I don't see why CPT codes wouldn't work though

Posted : August 8, 2018 7:18 am

petemarkey

(@petemarkey)

Posts: 373

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Topic starter

although the real solution would be for them to actually add the code to the CCC forms so instead of populating and obs term for diet counseling, etc, they actually add the CPT code, instead of use having to build our own useful EMR.

Posted : August 8, 2018 7:23 am

bhoover

(@bhoover)

Posts: 360

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This is via our own forms. If you use the CCC forms, depending on what you need to send the quality code you might be able to get by with a function in a text component if you can't modify the form.

Posted : August 9, 2018 1:35 am

kaplan32

(@kaplan32)

Posts: 76

Estimable Member

Brad, are you willing to share this form? I was working on creating a form that would automate this via result code. Don't need to reinvent the wheel though.

Posted : August 22, 2018 3:26 am

bhoover

(@bhoover)

Posts: 360

Honorable Member

Unfortunately we do consulting work in addition to our internal development so I can't share it. I would be more than happy to help you as best I can with your development.

To be helpful here is an example of our workflow: One of the CPT codes that we send if for BMI. We have a function that calculates this on our vitals already and writes it to an obs term. What I did was to write a function that is fired in the pageclose handler of our form that looks to see if the BMI has been calculated. Then based on age, insurance plan, BMI etc. it will send send the CPT, print a education handout etc.

Posted : August 22, 2018 6:25 am

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