Home Forums Discussions Coding and Billing Category II CPT coding

We are being asked to report the appropriate category II CPT codes. Looking for ways to streamline adding category II CPT codes to the superbill. In the ideal world some of these codes can be dropped automatically. For example: for a systolic blood pressure of 132, the code 3075F would automatically be placed on the superbill. This can also be done for other codified fields such as Hemoglobin A1c.

I know AC does not currently drop these codes automatically (I've recommended the improvement to AC), however, does anyone have any work around to efficiently get these codes reported?

Thanks,
Aaron

BTW, I thought I lost the userboard! So happy to find it again!

It's all manual, but this is what I'm putting together:
1. Run a report in AC that pulls the BP numbers for the day's visits.
2. Copy and paste the results into an existing Excel sheet with formulas which calculate the appropriate CPTII codes.
3. Go back into AC and manually enter the codes.

I'm working on setting up the Excel formulas now. There may be better ways to do this, but I find having a report to follow guarantees we capture the data we need, and it also means entering the codes can be delegated to any staff member. I think our providers have more important things to do than worry about which code goes with which BP reading. I use this system for BMI (to calculate the diagnosis for the 3008F code), and am looking into a way to create reports that find when A1c results come in, and when reports such as eye exams, mammograms, etc are imported and reviewed so the appropriate codes for those can be added as well.

And how is compensation impacted by completing all this work?

these allow us better hedis and other "quality" measures.

capture all high risk icd 10 conitions as our patient are "riskier" which gives us more money when calculating shared savings based on expected costs. so auto export > 4 icd 10 codes to billing is important. as is auto calc bmi icd 10 ocdes.

theses need to be automated for the future of all health system practices. they are critical or people will look elsewhere for solutions.

I understand that there is compensation for collecting this information and providing it to the insurers. I also know that it will be time consuming. Just wondering if anyone has actually done the math to see what the cost would be to taking a pass on it.

Amen, Jon.

AnneMarie, that is a great idea. How can I get the actual BP values from the AC report function? I played around excel and do think it is possible to get it to return the proper code if given a list of systolic or diastolic pressures.

JBS, it is a real pain and seems like we are doing a lot of work for little gain. However, trying to keep my ACO happy, they do say it will end up affecting individual practices if we don't report the codes, although nobody has been able to tell us how much.

Thanks.

Aaron

AC Report
Operator Category Fields Value
>= Vital Signs (most recent) Systolic Blood Pressure 0
>= Vital Signs (most recent) Diastolic Blood Pressure 0
= Notes & Encounters Encounter Date 01/21/20

Click the "Show All Query Results" checkbox to show the values in the results.

Important to note this report should be run daily, because it's going to pull the most current BP values as opposed to the BP values for each visit date. For example, if a patient was seen on January 1 and on January 3, it'll pull the January 3 BP results regardless of which encounter date you're looking up. (I hope that makes sense).




In Excel, here's the formulas (assuming the Systolic BP value is in Column E and the Diastolic BP value is in Column F):

Systolic BP
=IF(E2<130;"3074F";IF(E2>=140;"3077F";"3075F"))

Diastolic BP
=IF(F2<80;"3078F";IF(F2>=90;"3080F";"3079F"))

Ugh, the AC report info didn't post well. Let's try it this way:

Category: Vital Signs (most recent)
Field: Systolic Blood Pressure
Operator: >=
Value: 0

Category: Vital Signs (most recent)
Field: Diastolic Blood Pressure
Operator: >=
Value: 0

Category: Notes & Encounters
Field: Encounter Date
Operator: =
Value: 1/22/20 (or whatever date you're doing this for)