Monday, August 22, 2016

Hypercare - Usage , drawbacka, precaution, ICD and CPT CODE

HYPERCARE EXTERNAL SOLUTION 20

Drysol Dab-O-Matic™ (DOM), Drysol 37.5cc (aluminum chloride hexahydrate 20% w/v topical solution; Person and Covey Inc.) and Hypercare™ (aluminum chloride hexahydrate 20% w/v topical solution; Stratus Pharmaceuticals) are approved by the U.S. Food and Drug Administration (FDA) as astringents to assist in the management of severe hyperhidrosis (axillar, palmar, plantar and craniofacial) and are available by prescription. Xerac AC (aluminum chloride hexahydrate 20% w/v topical solution; Person and Covey Inc.) has been approved for milder cases of hyperhidrosis. 

Hypercare Topical, What of them?

Hypercare or Aluminum Chloride Hexahydate topical is use as an antiperspirant. It works by affecting the sweat-producing cells in out body. It treats hyperhidrosis. It is a condition where our body is producing excessive sweat.

How to use Hypercare Topical?
It is a medication that should be used in the skin only. The areas affected of hyperhidrosis should be dried first before applying the medication. You can dry those areas using a hair dryer if it is necessary. Follow the instruction given in the package on how the preparation and then the usage should go. If there is unclear information, you should consult a pharmacist or a doctor right away.
Make sure that you will not get hypercare medication in the eyes. This should also not be applied to irritated or broken skin.  Even to the skin that is recently shaved, this medication should also be avoided. If by any chance, the medication was applied to these areas, flush it immediately using plenty of water.  

Apply this medication daily during your bedtime maybe 2 or 3 days. When the sweating is already controlled, would be once or twice a week depending on what your doctor will advise. Let the medication dry after application. The medication should be leaved on from 6 to 8 hours. In the morning, you can remove it through soap and water or when you are treating your scalp, shampoo would be more applicable.  After that, towel it dry. It is also important to note that while you are using this medication, you are not allowed to use deodorants or any antiperspirants.

Hypercare Drawbacks

This medication was invented to treat an illness. But like almost everything in the world, this also has its own setbacks. There are some side effects brought by this medication.
On the first application of this medication, there may be irritation, mild itching and tingling that will occur. If there is a persistence of any of these side effects or when it worsens, you should promptly tell your pharmacist or doctor to seek an advice.

But despite these side effects, according to statistics, many of the users of this medication do not suffer from any serious side effect.

There is a rarity in allergic reaction that is serious with using this hypercare medication. However, when you notice symptoms, it is advisable to seek some help. Rashes, itching, swelling, trouble in breathing and severe dizziness is few of those symptoms.

Precautions on Using Hypercare

In using any medication, you need to have some precautions to do. It is important so as you will reap benefit from the medication instead of worsening your condition. This is true in everything even with aluminium chloride. Here are some of the precautions you should do:
·         Tell your pharmacist or doctor if you are allergic to the medication. If you have any other allergies, inform him as well. Inactive ingredients may be in the product. This can lead to allergic reaction and other problems.

·         Tell your doctor about your medical history.

·         Be cautious in using this medication. This can stain your clothing and an even harm metals. Make sure that when applying it, it will not make any contact to those things. Allow it to dry before you put your clothes back on.

·         If you are pregnant, application of hypercare should be done when it is really needed. Benefits as well as the risks should be discussed with your doctor for guidance.

·         There is no guarantee that this medication can be passed to the breast milk. But it is advisable to consult your doctor about it before you go on to breast-feeding.

Interactions
How your medication works is affected by your drug interaction. It can also increase the possibility of facing risk for some serious side effects.

Deodorants, Tinidazole, Metronidazole, Disulfiram and any other antiperspirant are some of the products that can interact with this hypercare drug.

Overdose

There is a harmful effect that can occur when this medicine is swallowed. If there is an overdose that you are suspecting, what you need to do is to call to the center for poison control or the emergency. Do it right away.

It is important to note, that this medication is not allowed to be shared to anyone.

Missed Dose

If you happened to miss your dose, take it as soon as you remembered it. If the time you remember it is just close to the next dose, skip it and just continue your usual routine. Never double your dose to catch up. It will not work at all. It will only bring you some risk you are not ready to face.
Catching up when not necessary should not be done especially when you are under a medication. There are rules you need to follow. Do not just jump to conclusion. This may only harm you in more ways than one.

Hypercare all in all is a good medication. It was created to treat your excessive sweating. It has been proven that this medication is really helpful. With excess sweat, you do not feel that confident with yourself. In times like this treating it is the best way to do.

Aluminum Chloride is the solution and there is no harm in trying it. The important thing is that you know how to use it and you have some guidance.   Tell your doctor about it and ask if he could recommend it you.

Hypercare is a good solution that can help you in your excessive sweating when you use it wisely and properly. Good results will fall upon you. It would always boil down to you in the end. Using it properly and consulting your doctor before applying it can be the solution you have been looking for your hyperhidrosis. There may be side effects but they are not that serious. When you take care taking the medication, it will all end well.


Hypercare is a good and useful drug. We as the user need to use it wisely for it to really work its magic.  


Primary Focal Hyperhidrosis 

Primary focal hyperhidrosis is defined as excessive sweating induced by sympathetic hyperactivity in selected areas that is not associated with an underlying disease process. The most common locations are underarms (axillary hyperhidrosis), palms (palmar hyperhidrosis), soles (plantar hyperhidrosis), or face (craniofacial hyperhidrosis). 

Teatment of hyperhidrosis is considered not medically necessary in the absence of functional impairment or medical conditions. 

Treatment (see table) of primary hyperhidrosis may be considered medically necessary with any of the following medical conditions: 

 acrocyanosis of the hands; or 
 history of recurrent skin maceration with bacterial or fungal infections; or  history of recurrent secondary infections; or 
 history of persistent eczematous dermatitis in spite of medical treatments with topical dermatological or systemic anticholinergic agents. 


Treatments Considered Medically Necessary

 Aluminum chloride 20% solution; 

 Botulinum toxin for severe primary axillary hyperhidrosis that is inadequately managed with topical agents, in patients 18 years and older; 

 Endoscopic transthoracic sympathectomy (ETS) and surgical excision of axillary sweat glands, if conservative treatment (i.e., aluminum chloride or botulinum toxin individually and in combination) has failed.

Secondary Hyperhidrosis 

Secondary hyperhidrosis is excessive sweating that can be generalized or craniofacial sweating, and may occur as a result of olfactory or gustatory stimuli, neurologic lesions, intrathoracic neoplasms, Raynaud’s disease, and Frey’s syndrome.

ICD CODE

ICD-9 Diagnosis codes: Code Description 

705.21 Primary focal hyperhidrosis 
705.22 Secondary focal hyperhidrosis 


 ICD-10 Diagnosis codes: Code Description 

L74510 Primary Focal Hyperhidrosis, Axilla
L74511 Primary Focal Hyperhidrosis, Face 
L74512 Primary Focal Hyperhidrosis, Palms 
L74513 Primary Focal Hyperhidrosis, Soles 
L7452 Secondary Focal Hyperhidrosis

CPT CODE 

Billing/Coding section updated to include CPT code 64999; Unlisted procedure, nervous system

Wednesday, August 17, 2016

CPT CODE 80047, 80048

Basic Metabolic Panel (Calcium, total), 80048

CPT coding guidelines indicate that a Basic Metabolic Panel (Calcium, total), CPT code 80048 should not be reported in conjunction with 80053. If a submission includes CPT 80048 and CPT 80053, only CPT 80053 will be reimbursed. There are 2 configurations for a Basic Metabolic Panel (Calcium, total), CPT code 80048:

A submission that includes 5 or more of the following laboratory component codes by the same individual physician or other health care professional for the same patient on the same date of service is a reimbursable service as a Basic Metabolic Panel (Calcium, total), CPT code 80048.
Panel Code - 80048

Effective January 1, 2008, the CPT Editorial Panel created a new code 80047 Basic metabolic panel (Calcium, ionized) which is an automated multi-channel chemistry (AMCC) code and is currently included in the automated multi-channel chemistry code (AMCC) Panel Payment Algorithm. The new code 80047 is comprised of eight component test codes (see table below). Also, new code 80047 is not a replacement for code 80048 Basic metabolic panel. Both codes 80048 and 80047 are included in the 2008  clinical laboratory fee schedule.

 In order to determine payment for the new code 80047, using the AMCC Panel Payment Algorithm, existing code 82330, Calcium; ionized, will be added as an AMCC panel code. Payment code ATP23 has also been included in the clinical laboratory fee schedule data file to correspond to the AMCC panel code addition.

CPT code 80047 Basic metabolic panel (Calcium, ionized) comprises:

• Calcium; ionized (82330)
• Carbon dioxide (82374)
• Chloride (82435)
• Creatinine (82565)
• Glucose (82947)
• Potassium (84132)
• Sodium (84295)
• Urea Nitrogen (BUN) (84520)

For ESRD dialysis patients, CPT code 82330 Calcium; ionized shall be included in the calculation for the 50/50 rule as defined in Pub. 100-04, Chapter 16, Section 40.6. When CPT code 82330 is billed as a substitute for CPT code 82310, Calcium; total, it shall be billed with modifier CD or CE. When CPT code 82330 is billed in addition to CPT 82310, it shall be billed with CF modifier.

CPT panel code 80047 cannot be billed for services ordered through an ESRD facility. All tests billed for services ordered through an ESRD facility must be billed individually, not in an organ disease panel.



Basic Metabolic Panel (Calcium, total), 80048


CPT coding guidelines indicate that a Basic Metabolic Panel (Calcium, total), CPT code 80048 should not be reported in conjunction with 80053. If a submission includes CPT 80048 and CPT 80053, only CPT 80053 will be reimbursed. There are 2 configurations for a Basic Metabolic Panel (Calcium, total), CPT code 80048:

1. A submission that includes 5 or more of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a Basic Metabolic Panel (Calcium, total), CPT code 80048.


Panel Code  Code Description Must contain 5 or more of the following Component Codes for the same patient on the same date of service


82310 Calcium; total
82374 Carbon Dioxide (bicarbonate)
82435 Chloride; blood
82565 Creatinine; blood
82947 Glucose; quantitative, blood (except reagent strip)
84132 Potassium; serum, plasma or whole blood
84295 Sodium; serum, plasma or whole blood
84520 Urea nitrogen (BUN)



A submission that includes an Electrolyte Panel, CPT code 80051 plus 1 or more of the following laboratory component codes by the same individual physician or other health care professional for the  same patient on the same date of service is a reimbursable service as a Basic Metabolic Panel (Calcium, total) CPT code 80048.

Panel Code - 80048

Code Description 
Includes the following panel:
. 80051     - Electrolyte Panel
.Plus 1 or more of the following component codes for the same patient on the same date of service:
.82310     - Calcium; total
.82565     - Creatinine; blood
.82947     - Glucose; quantitative, blood (except reagent strip)
.84520     - Urea nitrogen; quantitative

Definitions of the GA, GY, and GZ Modifiers



The modifiers are defined below:

GA - Waiver of liability statement on file.

 GY - Item or service statutorily excluded or does not meet the definition of any Medicare benefit.

GZ - Item or service expected to be denied as not reasonable and necessary.



2. Use of the GA, GY, and GZ Modifiers for Services Billed to A/B MACs (B)

The GY modifier must be used when physicians, practitioners, or suppliers want to indicate that the item or service is statutorily non-covered or is not a Medicare benefit.

The GZ modifier must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an Advance Beneficiary Notification (ABN) signed by the beneficiary.
The GA modifier must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny a service as not reasonable and necessary and they do have on file an ABN signed by the beneficiary. (See https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/abn_booklet_icn006266.pdf for additional information on use of the GA modifier and ABNs.)

The GY and GZ modifiers should be used with the specific, appropriate HCPCS code when one is available. In cases where there is no specific procedure code to describe services, a “not otherwise classified code” (NOC) must be used with either the GY or GZ modifier.



3. Use of the GA, GY, and GZ Modifiers for Items and Supplies Billed to DME MACs

The GY modifier must be used when suppliers want to indicate that the item or supply is statutorily non-covered or is not a Medicare benefit.

The GZ modifier must be used when suppliers want to indicate that they expect that Medicare will deny an item or supply as not reasonable and necessary and they have not had an Advance Beneficiary Notification (ABN) signed by the beneficiary.

The GA modifier must be used when suppliers want to indicate that they expect that Medicare will deny an item or supply as not reasonable and necessary and they do have on file an ABN signed by the beneficiary.

The GY and GZ modifiers should be used with the specific, appropriate HCPCS code when one is available. In cases where there is no specific procedure code to describe items or supplies, an NOC must be used with either the GY or GZ modifiers.

GZ Modifier

Effective for dates of service on and after July 1, 2011, A/B MACs (B) shall automatically deny claim line(s) items submitted with a GZ modifier. A/B MACs (B) shall not perform complex medical review on claim line(s) items submitted with a GZ modifier. All MACs shall make all language published in educational outreach materials, articles, and on their Web sites, consistent to state all claim line(s) items submitted with a GZ modifier shall be denied automatically and will not be subject to complex medical review. When claim line(s) items submitted with the Modifier GZ are denied, A/B MACs (B) shall use the following codes: Group Code CO (Provider/Supplier liable) and CARC 50 defined “These services are non-covered services because this is not deemed a ‘medical necessity’ by the payer.

Saturday, August 13, 2016

Modifier “-91 with how to use example



Definition - The “-91” modifier is used to indicate a repeat laboratory procedural service on the same day to obtain subsequent reportable test values. The physician may need to indicate that a lab procedure or service was distinct or separate from other lab services performed on the same day. This may indicate that a repeat clinical diagnostic laboratory test was distinct or separate from a lab panel or other lab services performed on the same day, and was performed to obtain subsequent reportable test values.


Rationale - Multiple laboratory services provided to a patient on one day by the same provider may appear to be incorrectly coded, when in fact the services may have been performed as reported. Because these circumstances cannot be easily identified, a modifier “-91” was established to permit claims of such a nature to bypass correct coding edits. The addition of this modifier to a laboratory procedure code indicates a repeat test or procedure on the same day.


Instruction - The additional or repeat laboratory procedure(s) or service(s) must be identified by adding the modifier “-91”.



EXAMPLE 1:

When cytopathology codes are billed, the appropriate CPT code to bill is that which describes, to the highest level of specificity, what services were rendered. Accordingly, for a given specimen, only one code from a family of progressive codes (subsequent codes include services described in the previous CPT code, e.g., 88104-88107, 88160-88162) is to be billed. If multiple services on different specimens are billed, the “-91” modifier should be used to indicate that different levels of service were provided for different specimens. This should be reflected in the cytopathologic reports.

Wednesday, August 10, 2016

Handling Incomplete or Invalid Submissions


The A/B MACs (A) should take the following actions upon receipt of incomplete or invalid submissions:

• If a required data element is not accurately entered in the appropriate field, RTP the submission to the provider of service.

• If a not required data element is accurately or inaccurately entered in the appropriate field, but the required data elements are entered accurately and appropriately, process the submission.

• If a conditional data element (a data element which is required when certain conditions exist) is not accurately entered in the appropriate field, RTP the submission to the provider of service.

• If a submission is RTP for incomplete or invalid information, at a minimum, notify the provider of service of the following information:

o Beneficiary’s Name;

o Health Insurance Claim (HIC) Number;

o Statement Covers Period (From-Through);

o Patient Control Number (only if submitted);

o Medical Record Number (only if submitted); and

o Explanation of Errors.

NOTE: Some of the information listed above may in fact be the information missing from the submission. If this occurs, the A/B MAC (A) includes what is available.

• If a submission is RTP for incomplete or invalid information, the A/B MAC (A) shall not report the submission on the MSN to the beneficiary.
The notice must only be given to the provider or supplier.

Refer to the implementation guide for the current ASC X12 837 institutional claim format for specifications. If a claim fails edits for any one of the content or size requirements, the A/B MAC (A) will RTP the submission to the provider of service.

NOTE: The data element requirements in the implementation guide may be superseded by subsequent CMS instructions. The CMS is continuously revising instructions to accommodate new data element requirements.

The A/B MACs (A) must provide a listing of the required data elements, including a brief explanation to providers and suppliers. A/B MACs (A) must educate providers regarding the distinction between submissions which are not considered claims, but which are returned to provider (RTP) and submissions which are accepted by Medicare as claims for processing but are not paid. Claims may be accepted as filed by Medicare systems but may be rejected or denied. Unlike RTPs, rejections and denials are reflected on RAs.

Denials are subject to appeal, since a denial is a payment determination. Rejections may be corrected and re-submitted.

Popular Posts