Drug Topics - March 10, 2008 - (Page 62) 62 DRUG TOPICS MARCH 10, 2008 www.drugtopics.com Special Report performing CLIA-waived screenings in multiple locations. A full list of POS codes can be viewed at www.cms.hhs.gov/MedHCPSGenInfo/Down loads/Place_of_Service.pdf. in the past (before 2001) when CMS was known as the Health Care Financing Administration. As more and more payers become aware of the value of pharmacists, the types of reimbursable services which pharmacists can provide will continue to increase. It is of paramount importance, therefore, that pharmacists educate themselves on the coding systems which define these billable services. In a rapidly changing sector of health care, it is no longer enough for pharmacists to have a mere mastery of clinical skills. As with any business model, pharmacists must be cognizant of how to function as true providers in the healthcare system. Pharmacy leaders and entrepreneurial practitioners will continue the push to gain increased provider status in terms of the types of advanced services that patients will come to accept from pharmacists. The fact remains, however, that the success of advancing as providers may not be evident until the profession learns how to bill for these services. References are available upon request. handles corporate development, clinical programs and initiatives, at Sweetbay Supermarket, Tampa, Fla. THE AUTHOR International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) The ICD coding system has matured from its earlier versions, which classified only morbidity and mortality information for statistical purposes (death certificates), to current versions which provide diverse applications for research, healthcare policy, and healthcare finance. The ICD-9 was published by the World Health Organization in 1978. The WHO authorized the U.S. Public Health Service to make an adaptation of the ICD-9 which was more useful for U.S. hospitals. The modified version was named the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9-CM). The ICD-9-CM has three volumes. Volumes 1 and 2 contain diagnosis codes, and Volume 3 contains procedure codes. Since 1988, the United States has required ICD-9CM codes for Medicare and Medicaid claims and most of the rest of the U.S. medical industry followed. A newer version, the ICD-10, had been completed in 1992 and it was adopted relatively quickly in most of the world, except domestically. In 1999 the ICD-10 was adopted in this country for reporting mortality, but the ICD-9-CM codes are still used for morbidity. The National Center for Health Statistics (NCHS), working with CMS, received permission from the WHO to create a clinical modification of the ICD10-CM and has produced drafts of the following two systems: ICD-10-CM (to replace Volumes 1 and 2) and ICD-10-PCS (to replace Volume 3). However, neither of these systems is in place and there is no anticipated date for implementation to phase out ICD9-CM. Although the new codes are not active for use, providers can view these ICD-10-CM codes at www.cdc.gov/nchs/about/otheract/icd9/ icd10cm.htm. A free online searchable coding database for ICD-9-CM codes can be accessed at www.icd9data.com. Pulling all the coding requirements together to bill one claim can be daunting for pharmacists with no prior experience in healthcare coding. It may also warrant mention that the CMS-1500 (08/05) is the proper paper claim form which pharmacists should use when billing Medicare for services such as immunizations and CLIA testing. HCFA forms were used John Yuscavage, R.Ph. What’s the name of a drug based on the picture clues below? Answer on page 86 http://www.drugtopics.com http://www.cms.hhs.gov/MedHCPCSGenInfo/Downloads/Place_of_Service.pdf http://www.cms.hhs.gov/MedHCPCSGenInfo/Downloads/Place_of_Service.pdf http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm http://www.icd9data.com
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