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New Member Benefit! SLIT Information, Consent and Patient Instruction Forms
The AAAAI is pleased to offer patient information, consent and instruction forms related to sublingual immunotherapy (SLIT). The information form is intended to provide the patient/patient's family background on SLIT efficacy, proper administration and safety. The forms provide patient guidance on when and how to treat a SLIT systemic reaction (SLIT Action Plan) and what to do before SLIT administration to ensure optimal safety with this home based therapy (SLIT Pre-Dose Checklist). These recommendations are based on the FDA-approved SLIT tablet product information and multiple published studies.
As an AAAAI members-only benefit, these forms can be edited and customized for individual practices. If you are a member, simply login with your username and password. The forms will open in Word/Excel document format for editing.
RSL Matters
Compounding Update
As everyone is aware, some states have taken action to address physicians compounding medications in their offices. Recently, Maryland has drafted new legislation that attempts to correct previous laws that could limit the ability of physicians to compound medications in their offices. We encourage everyone to continue to monitor their state legislature regarding compounding of medications in one's office.
ICD-10 Codes for Primary Immune Deficiencies
The AAAAI is your source for coding expertise, and continues to build its coding resources for the allergist/immunologist. This month, primary immune deficiency ICD-10 codes are highlighted in preparation for your practice's conversion to ICD-10 on October 1, 2015.
The AAAAI can also answer your day-to-day coding questions with the help of A/I coding expert Teresa Thompson, CPC, CMSCS. If you have a coding question, please email it to coding@aaaai.org. Also, remember to check out additional coding information at the AAAAI website. Here you will find commonly asked coding questions, and ICD-10 codes for rhinitis, sinusitis, urticaria and others.
Pricing Transparency Turning Patients into Informed Consumers
One of the consequences of high deductible health plans is that patients may be "shopping" for their medical care. Online tools now allow patients to compare prices in order to reduce out-of-pocket expenditures. For example, the Health Care Cost Institute reports that Arizonians have per capita out-of-pocket annual spending for health care not paid for by insurance of $697, while Coloradoans spend $768 each year.
The site also reports variations in the cost of common procedures in each state; the cost of an MRI in Arizona varies by only $85, while in Colorado the difference is $231. Large insurers are taking this a step further by reporting negotiated reimbursement rates per procedure for individual providers.
Advocacy Matters
AAAAI Addresses Proposed Rule on Accountable Care Organizations
The AAAAI recently submitted independent comments, as well as comments in conjunction with the American Medical Association (AMA) and others, to respond to proposed revisions to the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program Accountable Care Organization (ACO) Regulations.
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Practice Changers
We have partnered with the editors of JACI: In Practice to bring you monthly "Practice Changers" from recently published journal articles.
Highlighting cutting-edge information keeps you current and assists you in educating patients and physicians who rely on the expertise of our specialty!
Safe vaccination of patients with egg allergy by using live attenuated influenza vaccine. By Anne Des Roches et al.
This was a prospective cohort study to determine whether live attenuated influenza vaccine (LAIV) can be safely used in patients with egg allergy. Sixty-eight pediatric patients with a history of egg allergy (40% with anaphylaxis) and 55 controls aged two to 16 years were vaccinated with LAIV. No patients in the egg allergy group developed signs or symptoms suggestive of an allergic reaction both in the hour of observation following vaccination and at the 24-hour follow up. These results contribute to a growing data set suggesting that LAIV can be safely used in patients with egg allergy. However, additional studies are needed to confirm these findings.
Comprehensive allergy evaluation is useful in the subsequent care of patients with drug hypersensitivity reactions during anesthesia. By Autumn Chandler Guyer et al.
Guyer and colleagues investigated 73 patients with drug hypersensitivity reactions (HSR) during anesthesia. Patients underwent comprehensive allergy evaluation including skin testing to agents administered before HSR. Results were used to provide recommendations for subsequent anesthesia. A causative agent was identified in 13 cases. Forty-seven patients underwent subsequent anesthesia and 45 (97%) successfully tolerated anesthesia. Two patients with recurrent HSR had elevated baseline tryptase levels and were diagnosed with mast cell disorders. This study supports a comprehensive evaluation and management plan for patients with HSR during anesthesia, including skin testing and baseline tryptase level, to minimize the risk of subsequent anesthesia even when the cause is not identified.
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On behalf of allergist/immunologists affiliated with, or considering affiliation with an ACO, the AAAAI discussed concerns related to: access to quality care, exclusivity of care, and potentially limited numbers of referrals to specialists. The AAAAI will remain engaged in addressing proposed CMS policies to ensure quality care and access to specialists among patients.
AAAAI Signs Letter Urging Changes to Certification of EHRs
In coalition with the American Medical Association (AMA) and others, the AAAAI recently expressed concerns among physicians regarding the electronic health records (EHR) certification process, and outlined several recommendations for improvements to the Office of the National Coordinator for Health Information Technology.
EHR system issues raised included: performance, usability, interoperability and lack of patient safety measures. To improve the systems before certification, the AAAAI, with others, made recommendations to decouple the EHR certification process from the Meaningful Use program, reconsider alternative software testing methods, and to seek further stakeholder feedback with other measures. The AAAAI will continue to follow developments concerning EHR certifications, the Meaningful Use program and related issues, and will continue to advocate for the practicing allergist.
Practice & Policy Matters
Submit Comments on Anaphylaxis Practice Parameter by March 25
You are invited to consider and comment on an important document that is currently out for review. The Joint Task Force on Practice Parameters is accepting comments on the draft of a practice parameter titled "Anaphylaxis – A Practice Parameter Update 2015."
AAAAI Reviews Proposed Medicare Policy Changes
The AAAAI recently submitted comments to Novitas regarding the Medicare contractor's proposed Local Coverage Determinations (LCDs) for Allergen Immunotherapy and Allergy Testing for Pennsylvania. Novitas covers Medicare policy administration in AR, CO, DE, LA, MD, MS, NJ, NM, OK, PA, TX, and Washington, DC, and is accepting comments on proposed LCDs through March 5, 2015.
The AAAAI also subscribes to a service called the Policy Reporter, through which payer policies from private payers are tracked for trends and developments in payer coverage that may impact the practicing allergist.
2015 Practice Management Workshop Registration Now Open
Elevate your practice at the 2015 Practice Management Workshop, July 17-19 in Denver, Colorado. Key sessions will prepare your practice for chart auditing and transitioning to ICD-10. In addition, one new session will help you build a successful, patient-centered medical practice while another will offer tips on physician governance in group practice.
Other sessions of interest include:
- Meeting Government Mandates: AAAAI QCDR and More
- Keys to Success in Academic Medicine
- Risk Management, Embezzlement and Fraud Protection
- Finding, Training and Keeping the Right Staff for your Practice
Popular sessions on basic and advanced coding featuring AAAAI coding consultant Teresa Thompson, CPC, CMSCS, CCC, will return, along with those on using social media and assessing your practice's financial vital signs. Also, the workshop will again include a series of sessions designed specifically for fellows-in-training and young allergists just starting out in practice.
Current Procedure Terminology (CPT) Code 99490 for Your Practice
The Chronic Care Management (CCM) Code (CPT) 99490 is now payable by CMS. Patients eligible for these CCM services include those with two or more significant, chronic conditions, expected to last 12 months or more. Diagnosis codes to be reported with CPT 99490 are not specified by CMS.
CCM services are non-face-to-face care management/coordination services for certain Medicare beneficiaries who receive at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month. CMS expects these services to be furnished most often by primary care physicians, but allergist/immunologists may also bill this CPT code, if providing CCM services as specified.
More Tools to Help with the Conversion to ICD-10
The Centers for Medicare & Medicaid Services (CMS) offers ICD-10 resources for small, rural and other medical practices, and tips for conversations with your software vendor and others essential for your successful conversion to ICD-10.
Looking for past issues of Practice Matters? An archive is available at: aaaai.org/practicematters
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