The PULSE of The Physician Alliance
Friday, June 21, 2019
Resource Stewardship Initiative targets over-utilized services
The Physician Alliance participates in Blue Cross Blue Shield of Michigan’s Resource Stewardship Initiative to promote the use of evidence-based medicine for health care stewardship decisions. The initiative works to help physicians improve health care decision making when using medical services, procedures and tests that have been identified as areas of over-utilization and encourages conversations between physicians and patients about appropriate and necessary care. 

TPA target measures help practices identify patterns of poor performance and overuse and develop approaches to improve resource stewardship. A lower metric indicates a higher quality score.
 
The RSI measures for 2019 include:

Education materials were created to assist practices in educating patients on appropriate use of these tests. These posters are available to TPA practices at no charge. Click here to download and print the posters or submit an online order for pre-printed posters.
Patient education helps improve diabetic measures
More than 100 million U.S. adults live with diabetes or prediabetes, according to the Centers for Disease Control and Prevention.

The Physician Alliance has been working with practices to target patients with prediabetes and high-risk diabetic patients to help educate and improve health outcomes. Last year, TPA launched several pilot projects related to these target populations, as well an outreach and education program with support from Merck. Diabetes HEDIS quality metrics are also measures that need improvement within the physician organization.

TPA created several education materials focusing on diabetes that can be distributed to patients. These are great conversation starters for education and action. Available materials include:
  • Patient diabetes self-management form
  • Patient diabetes action plan form
  • 6 ways to manage your diabetes poster
  • 6 tips for lowering diabetes risk poster
  • Diabetic eye exam poster

To view and order these materials, visit the Patient Education Materials tab on the Learning Institute.
Discounted products and services available to members
The Affiliate Partners program provides cost-effective solutions to help physician practices reduce business overhead costs. Each company in the Affiliate Partners program offers premium services at special rates for TPA members.

Current products and services include: ( Download Affiliate Partner list )

401(k)/Wealth Management - Hollander & Lone
Cyber Liability Insurance - Huntington Insurance
Financial Planning Services - VantagePointe Financial Group
Legal Services - Rickard & Associates, P.C.
Medical Answering Service - Ambs Call Center
Medical Debt Collection - Transworld Systems, Inc.
Medical Malpractice Insurance - Coverys
Medical Waste Services - Bio-MED Medical Waste
Mortgage & Banking Services - Huntington Bank
Office Supplies & Solutions - Office Depot
Practice Management Consulting - Kona Medical Consulting
Revenue Cycle Management - CRT Medical
Social Media Management - 4MJ Social

 Visit TPA's website to learn more about the partners' services, special offers and direct contact information.
Coding Corner: Coding for Obstetrics and Gynecology
Accurate diagnostic coding plays a crucial role in identifying the disease burden of the patient population, determining a risk adjusted cost of care score, improving revenue and more. The Coding Corner will provide tips to help improve diagnostic coding.
 
OUTCOME OF DELIVERY
An outcome of delivery code (Z37.--) should be included on all maternal records when a delivery has occurred. These codes would not be reported for encounters subsequent to the delivery. The hospital typically reports these codes on its records. Some payers may also require these codes on the physician claim.
 
NORMAL DELIVERY VS. OTHER DELIVERY
Code O80 (Normal Delivery) is always a principle diagnosis. It should be reported if there is:
  • A full-term uncomplicated delivery
  • A single, healthy infant
  • Absence of complications during the antepartum, during the delivery, or postpartum during the delivery episode Code O80 should not be reported with another code from Chapter 15 (codes O00-O9A). Additional codes from other chapters in ICD-10 may be reported if they are not related to or are in any way complicating the delivery.
 
POSTPARTUM CARE
ICD-10 defines the postpartum period as beginning immediately after delivery and continuing for six weeks.
  • A postpartum complication is a complication occurring within the six-week period.
  • The peripartum period is defined as the last month of pregnancy to five months postpartum.
  • Chapter 15 codes (O00-O9A) can be used after the peripartum or postpartum periods if the documentation supports the condition as pregnancy related.
 
Routine postpartum care is reported using code Z39.2 (Encounter for routine postpartum care).
  • Admissions for routine postpartum care following a delivery outside the hospital is reported using code Z39.0 (Encounter for care and examination of mother immediately after delivery).
  • Care for a postpartum complication is reported using the appropriate code for the complication.
  • Many pregnancy-related complication codes are found in code categories O85-O92, such as code O86.81 (Puerperal septic thrombophlebitis).
 
For information and assistance on improving diagnostic coding, contact Ethica ** at info@ethicaholdings.com

*To ensure best coding practices, please refer to ICD-10-CM Official Guidelines for Coding and Reporting FY 2019 (October 1, 2018 – September 30, 2019)
**Ethica is a wholly-owned subsidiary of The Physician Alliance.
News You Can Use
Featured Affiliate Partner
Coverys provides comprehensive medical malpractice insurance and expert risk analytics and risk management services to TPA members at a preferred pricing.

Learn more about these services.
The Pulse is the bi-weekly e-newsletter from The Physician Alliance, one of Michigan's largest physician organizations serving more than 2,200 primary care and specialty physicians.
www.thephysicianalliance.org - (586) 498-3555