Derm Coding Consult: E/M coding — What has changed?
Changes to E/M coding will go into effect on Jan. 1, 2021. This article follows up on part one of our series, which introduced the reasoning for these coding changes. We will now focus on key changes for each of the E/M service codes and related code descriptors. Understanding these changes is essential to selecting the correct level of E/M service.
Coding guidance for the 2021 E/M service codes has a clear focus on patient care. By reducing the administrative burden of checking boxes for the History and Examination, the new guidelines allow dermatologists to code for E/M services based on the way they think. These changes promote appropriate coding and payer consistency when audits are performed. Read more about the major changes to E/M coding.
DW Insights and Inquiries: Spironolactone — An increasingly recognized hero in acne therapy
Anecdotally within the dermatologic community, spironolactone has been a wonderfully effective (and indispensable) acne treatment. In my experience spironolactone is a “sure” thing that has become “larger than life” in my acne armamentarium. Yet for many years, evidence-based literature regarding the efficacy of spironolactone has lagged behind our day-to-day experience with it in the dermatology clinic. Keep reading!
Is it ethical to charge patients an infection control fee?
With the need for increased sanitation practices and the escalating costs of personal protective equipment and disinfectants, authors of a recent JAAD article explore whether it’s ethical to pass the higher cost of infection control on to patients. The authors note that current reimbursement models do not account for the cost of required COVID-19 infection control practices, which may force practices to close or implement staff lay-offs, all of which may negatively impact the quality of dermatologic care offered to patients, which would violate the principle of beneficence.
On the other hand, charging patients an infection control fee may result in maleficence, as the increase in cost can make accessing care more difficult, especially for patients of a lower socioeconomic status. The authors also question the legality of providers charging patients with in-network private insurance or Medicare as infection control costs are already embedded within these payments. The authors conclude that the extra cost is inadvisable and recommend advocating for higher insurance reimbursement and/or coverage of appropriate HealthCare Common Procedure Coding System to account for increased cost of infection control.
Members can enroll in the AAD Member Buying Program to save on Personal Protective Equipment from Henry Schein, Cardinal, Medline, and McKesson.
On the front lines in Connecticut
DW Weekly talked to Caroline Nelson, MD, from Yale School of Medicine, about her experiences serving in the internal medicine unit during the COVID-19 pandemic.
DW Weekly: I understand that you have been serving in the internal medicine unit during the COVID-19 pandemic. How did you go about getting involved?
Dr. Nelson: At the beginning of the pandemic, the Yale Internal Medicine Department put out a call for volunteers across the health system to assist in taking care of patients with COVID-19 infection. There were 12 faculty members in our department who volunteered — three of us have served as medicine attendings on the COVID wards so far. The majority of our dermatology residents also volunteered and have been working in the hospital alongside internal medicine residents.
DW Weekly: How has the COVID-19 situation been in your area?
Dr. Nelson: We’ve been hard hit in Connecticut. Our numbers are going down, but the current total COVID-positive inpatients in the Yale New Haven Health System is 485 with 137 of those in the ICU. That’s down from our peak. So far, 2,326 COVID-positive inpatients have been discharged.
DW Weekly: What has your experience been as a dermatologist on the front lines?
Dr. Nelson: I was a hospitalist on the COVID wards, so all of my patients had COVID-19 infection. I had an exceptional senior internal medicine resident and intern working with me. We started rounds at 7:30 a.m., discussing the patients in our workroom prior to rounding in-person. During chart rounds, we wore surgical masks. During in-person rounds, we donned PPE including an N-95 mask, face shield, double gloves, gown, and shoe coverings. There was a dedicated stethoscope in each patient room. Read more.
CMS announces relief for 2020 MIPS participants
MIPS-eligible clinicians who have been significantly impacted by the COVID-19 public health emergency may submit an Extreme & Uncontrollable Circumstances Application by Dec. 31, 2020, to reweight any or all of the MIPS performance categories. Applicants will need to provide a justification of how their practice has been significantly impacted by the pandemic. Learn more and access the Extreme & Uncontrollable Circumstances Application.
Academy seeks assistant secretary-treasurer nominees
Applications and nominations are now being solicited for the position of assistant secretary-treasurer for the American Academy of Dermatology and AAD Association. The term begins March 2022. Daniel D. Bennett, MD, is the current assistant secretary-treasurer.
Members interested in serving the Academy in this position should have significant administrative and financial management experience. The position of assistant secretary-treasurer requires a considerable time commitment. Applicants must be able to serve for six years: three years as assistant secretary-treasurer and three additional years as secretary-treasurer.
To learn more about the position and apply, visit staging.aad.org/AST. Applications are due Jan. 4, 2021. Questions may be directed to Cyndi Del Boccio in the AAD Executive Office at (847) 240-1041 or cdelboccio@aad.org.
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