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In this Issue...
- Transgender Youth Families Win Temporary Ruling Against Impending Enforcement of HB 71
- Medicaid Eligibility Requirements Cause Removal of Thousands of Idaho Children
- Congratulations District 4A Trustee, Dr. Stacia Munn and District 6 Trustee, Dr. Boyd Southwick!
- Attention: All Primary Care & OBGYN Providers - New Pelvic Exam Add-on Code Coming in 2024!
- Physician Vitality Program
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It's Not Too Late to Be an IMA Member!
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IMA Education Webinars - 2024 Schedule
- Register Now! 2024 WWAMI Graduate Medical Education Summit
- Order Your 2024 AMA Coding BooksToday!
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Transgender Youth Families Win Temporary Ruling Against Impending Enforcement of HB 71
As parents of minors with gender dysphoria brace themselves for the impending gender affirming care ban to have begun on January 1, 2024, an Idaho Federal judge blocks enforcement of the law until the pending lawsuit is settled.
House Bill 71 was signed into law by Idaho Governor Brad Little in late April, which would prevent transgender youth from accessing puberty blockers, hormones, and surgeries in the state (although no surgeries are being done). However, families of two transgender teens filed suit against Labrador, stating that the law violates the 14th Amendment, the right to equal protection, and undermines parental rights. Following the hearing, Judge Winmill granted a preliminary injunction, blocking House Bill 71 from going into effect until the lawsuit is settled.
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Medicaid Eligibility Requirements Cause Removal of Thousands of Idaho Children
Program officials began reviewing requirements for Medicaid eligibility and following procedural actions, including removing adults and children who do not meet standards. States, including Idaho, started to remove individuals from Medicaid following the COVID-19 era rules.
Of the 311,000 Idahoans enrolled in Medicaid or CHIP in September, Idaho removed 121,000 people from Medicaid this year, including 77,000 people removed for not providing the state information it had requested. At least 13,000 Idahoans removed for not responding have since re-enrolled in Idaho Medicaid. Still, federal data showed a decline of 27% in the number of children enrolled between March and September.
The decline has impacted over 65,000 children and has alarmed many, including the Department of Health and Human Services, which sent a letter to Idaho Governor Brad Little, pleading for the health care of children not to be overlooked.
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Congratulations IMA District 4A Trustee, Dr. Stacia Munn, and District 6 Trustee, Dr. Boyd Southwick!
We are happy to announce Stacia Munn, MD, was re-elected as Trustee for District 4A, and Boyd Southwick, DO, was elected as Trustee for District 6 to the IMA Board of Trustees.
Each IMA Board member is a liaison between component societies and the association, represents, advocates for, and advises the societies, visits each society, and submits a report to the IMA House of Delegates regarding their trustee district.
IMA looks forward to a productive partnership in working with Dr. Munn and Dr. Southwick. Congratulations!
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Attention: All Primary Care & OBGYN Providers - New Pelvic Exam Add-on Code Coming in 2024!
By Nicole Benson, Gill Compliance Solutions
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Preventive medicine service codes 99381-99397 were identified for potential gender-based
mis-valuation. These codes are based on age, not gender, according to the AMA/Specialty Society, Relative Value Scale (RVS) Update Committee (RUC), and Relativity Assessment Workgroup (RAW). A new CPT code has been created for 2024 to account for the extra resources associated with pelvic examinations. Pelvic examination code 99459 covers the practice expense associated with a pelvic exam, when performed, and will be an add-on code to the primary service of evaluation and management and/or preventive service performed.
Parenthetical CPT guidance instructs the use of 99459 in conjunction with 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242, 99243, 99244, 99245, 99383, 99384, 99385, 99386, 99387, 99393, 99394, 99395, 99396, 99397, which are new and established outpatient E/M services, outpatient consultation services, and new and established age-appropriate preventive services. Please note, no other CPT code can be used in conjunction with the add-on code 99459 apart from those listed. Pelvic procedures that typically require a pelvic exam would include that portion, and the new add-on code would not be applicable to the report.
AMA 2024 Symposium Q&A on Pelvic Examinations by Dr. Levy:
Q. If an E/M is not performed, can the pelvic exam be reported?
A. The pelvic exam code is an add-on code that can only be reported in conjunction with an E/M service or preventive service.
Q. Is the pelvic exam, 99459, reportable with a preventive visit or problem-oriented E/M visit?
A. Yes, this code was added to account for the additional practice expense and inequities in performing pelvic exams. However, this code would not be reported when a procedure warrants or includes a pelvic exam (i.e., an endometrial biopsy or colposcopy).
Q. Would this code be applicable to report in addition to G0101 pelvic and clinical breast examination in conjunction with an E/M or preventive service?
A. Yes, this should be reportable for the additional practice expense. MAC Directors agreed with this response.
As per the 2024 final rule, code 99459 will hold a practice expense of .68 in the non-facility
setting only. However, there are no available bundling edits to verify how Noridian will process
this new code with the CMS-specific screening pelvic and breast exam. It would not be reportable with G0101 alone per the parenthetical instructions. The primary service, E/M, or preventive, would not be reported with a modifier -25 significantly, separately identifiable service because the pelvic exam 99459 is an add-on code to the original service.
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Physician Vitality Program | | |
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The Physician Vitality Program (PVP) offers confidential, affordable, and easily accessible mental health support tailored for Idaho's physicians. It is now available to all medical licensed professionals (physicians, PAs, NPs) who are members of the IMA wherever they practice. PVP was created by Ada County Medical Society in 2016 to address the growing needs of those facing the epidemic of physician burnout, as well as other occupational and personal stressors | |
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The program provides five confidential appointments at no cost, with a strong emphasis on maintaining the privacy of individuals seeking help. While many clinicians have access to Employee Assistance Programs (EAPs) through their insurance plans, they often hesitate to use them due to genuine or perceived confidentiality concerns. ACMS created its own panel of clinically licensed mental health professionals available throughout Idaho and via telehealth and chose those with a reputation for serving medical clinicians. It is suitable for those seeking help for depression, grief, relationship and work challenges, imposter syndrome, and other issues commonly faced by those who practice medicine.
To determine if you are eligible for services, you may verify your IMA membership at https://www.idmed.org/idaho/Idaho_Public/Physician_Finder/Idaho_Public/Physician_Finder/Search.aspx.
To find out more about this program and access appointments, visit the site by clicking the button below.
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It's Not Too Late to Be an IMA Member!
Join thousands of your Idaho colleagues and take advantage of the countless ways IMA can help enhance your professional life.
Idaho Medical Association (IMA) is the leading organization representing physicians in all specialties, practice settings, and geographic locations in our state, and is recognized as the voice of medicine in Idaho. IMA’s mission is to unify and advocate for all Idaho physicians, promote the art and science of medicine, and remain dedicated to improving the health and well-being of all Idahoans.
Idaho Medical Association has over 4,000 members, all Idaho medical professionals who meet the Association's stringent membership requirements. Predominant membership is comprised of over 2,000 actively practicing physicians, including residents, with the balance of members comprised of retired physicians, physician assistants, nurse practitioners, and medical students.
* Don't forget: If you pay your AMA dues through IMA, IMA benefits.
You can easily join IMA by visiting www.idmed.org or contacting us at (208) 334-7888.
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Early bird registration for the GME Summit 2024 is now open!
The University of Washington School of Medicine is sponsoring the 2024 Graduate Medical Education (GME) Summit. The focus will be collaborating to address workforce needs within the WWAMI region and beyond.
Don't miss out on attending the GME Summit on April 25-26, 2024, in Anchorage, Alaska at the BP Energy Center.
Stay tuned in the coming months as they announce speakers.
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Order Your 2024 ICD-10-CM Complete Official Code Set Today!
The newest codes in the ICD-10 book took effect October 1 and your billing staff will need to start using these new codes ASAP! The books are already at the IMA office and can be picked up, shipped, or delivered today! The 2024 ICD-10-CM files contain information on the ICD-10-CM updates for FY 2024. These 2024 ICD-10-CM codes are to be used for discharges from October 1, 2023, through September 30, 2024, and for patient encounters from October 1, 2023, through September 30, 2024.
As part of your membership, Idaho Medical Association offers most coding, billing, and reference manuals at a significant discount. This saves you and your office money when you provide your staff with the tools to help you ward off unwelcome challenges to your revenue. The order form for 2024 publications is available here. If you have questions or if there is a type of book you don’t see, but would like to purchase, please contact Rebecca Adams at rebecca@idmed.org or 208-344-7888 ext. 101.
CPT ® is a registered trademark of the American Medical Association
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