12/01/15 – Tap Catheters


Question:  What is a TAP catheter, and how should we code for using one?


Answer: Transversus abdominis plane (TAP) catheters are an alternative to epidural analgesia after upper abdominal surgery. It sometimes is also used as an adjunct to anesthesia for abdominal laparoscopic procedures.


If a TAP catheter is used for postoperative pain management, report 64450 (Injection, anesthetic agent; other peripheral nerve or branch). Another option is 64421 (Injection, anesthetic agent; intercostal nerves, multiple, regional block).


If the block is used as part of the anesthesia — not for post-operative pain management — do not report it separately from the anesthesia services code.




Quality reporting: PQRS 2016 — Anesthesia changes, increased focus on registry reporting

As published by DecisionHealth, December 1, 2015 by Julia Kyles, CPC-A

To boost your chances of quality reporting success, make sure your providers are comfortable with CMS’ basic quality reporting formula: nine measures across three national quality domains, one cross-cutting measure for at least 50% of eligible patients. And consider the measures the providers might report next year before the year ends.


The expansion of the value-based modifier ramps up the pressure for physician quality reporting system (PQRS) performance, as CMS will use PQRS compliance to calculate pay adjustments that will be applied at the individual and group level.


And then there was one

Claims-based reporting remains the most popular method of reporting, according the final 2016 Medicare physician fee schedule, but anesthesia providers who perform only anesthesia services will be down to measure 76 (Prevention of central venous catheter (CVC)-related bloodstream infections) next year.


All of the new anesthesia measures, such as prevention of nausea and vomiting, are registry-only. CMS deleted Measure 193 (Perioperative temperature management) and replaced it with registry-only measure 424. CMS kept measure 44 (Coronary artery bypass graft [CABG]: preoperative beta-blocker in patients with isolated CABG surgery) but removed the claims-based reporting option.


CMS will expect anesthesia providers who perform services such as E/M visits to meet the basic PQRS formula.


Check reporting method, domain status

Look closely at the reporting methods for new measures. Of the 37 new measures introduced for 2016, 15 may be reported on claims. Measures such as 414 (Evaluation or interview for risk of opioid misuse) are registry-only.


There are four cross-cutting measures: the new alcohol use measure, breast cancer screening, falls risk assessment and falls plan of care.


CMS changed the national quality domain status for five measures.


MAV still in effect

One thing that CMS didn’t change is the measures applicability validation (MAV) process. When a PQRS-eligible provider does not meet the nine-measure, three-domain, one-crossing-cutting-measure for 50% requirement, CMS will analyze his or her claims data to verify the provider did not miss any measures. Providers who pass MAV will not receive a pay cut.


CMS walks back new survey requirement

Practices with 25 to 99 eligible providers who participate in PQRS through the group practice reporting option (GPRO) will not have to take part in the consumer assessment of healthcare providers and systems survey (CAHPS) in 2016.


CMS announced its intent to expand CAHPS to the smaller practices in the proposed rule but changed its plans in response to comments it received. Instead, it gave all group practices with fewer than 100 providers that use GPRO the option to administer the survey.


The survey remains mandatory for practices with 100 or more providers reporting via GPRO.


CMS Denies 10% of Claims Under New ICD-10 Codes

But only a small number of those denials were due to coding errors.

As published by Outpatient Surgery Magazine, November 3, 2015 by David Bernard

CMS says it rejected 10.1% of Medicare fee-for-service claims submitted with the new ICD-10 codes during the rollout of the new coding system last month — though less than 1% of those denials were due to coding errors.

CMS’s monitoring of claims handling activity has shown near-normal results as compared to a historical baseline.

Between October 1 and October 27, CMS processed a total of 4.6 million claims per day, approximately the same as before the transition. It rejected 10.1% of them, as compared to the usual 10%. Overall, 0.09% of the October claims were rejected due to invalid ICD-10 codes and 0.11% due to invalid ICD-9 codes.

Given the variable amounts of time it takes to process Medicare and Medicaid claims, CMS projects that November’s numbers will give it an even clearer view of the transition’s effects.


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