Medical Economics
CONTINUE TO SITE

OR WAIT null SECS

  • Formulary WatchFormulary Watch
  • Managed Healthcare ExecutiveManaged Healthcare Executive
  • Medical Economics
  • Physicians PracticePhysicians Practice
Medical Economics
Medical Economics
Spotlight
View MoreCardiovascular Clinical ConsultChronic ConditionsConcierge MedicineCOVID-19Diabetes Awareness MonthExclusive ContentInfluenzaInsulin Therapy in Type 2 DiabetesIntimate Health Solutions to Support Her Through Life’s JourneysPatient RelationsSexual HealthVaccines
News
All News
Careers
Exclusive Content
Industry News
Legal
Money
Opinion
Practice Management
Technology
Media
Around the Practice
Expert Interviews
Medical Economics Pulse
Medical World News
Off The Charts Podcasts
Conferences
Conference Coverage
Conference Listing
Publications
Medical Economics
CME/CE
Resources
Job Board
Sponsored Resources
Subscribe
eNewsletter
Print Subscription
  • Advertise
  • Contact Us
  • Editorial
  • Job Board
  • Terms and Conditions
  • Privacy Policy
  • Do Not Sell My Personal Information

© 2021 MJH Life Sciences and Medical Economics. All rights reserved.

SpotlightSee All >
  • Cardiovascular Clinical Consult
  • Chronic Conditions
  • Concierge Medicine
  • COVID-19
  • Diabetes Awareness Month
  • Exclusive Content
  • Influenza
  • Insulin Therapy in Type 2 Diabetes
  • Intimate Health Solutions to Support Her Through Life’s Journeys
  • Patient Relations
  • Sexual Health
  • Vaccines
  • Advertise
  • Contact Us
  • Editorial
  • Job Board
  • Terms and Conditions
  • Privacy Policy
  • Do Not Sell My Personal Information
  • MJHLS Brand Logo

© 2021 MJH Life Sciences™ and Medical Economics. All rights reserved.

Getting paid for managing cardiometabolic disorders

October 9, 2009
Virginia Martin, CPC, CHBC
Virginia Martin, CPC, CHBC

The author, president of Healthcare Consulting Associates of N.W. Ohio Inc., has more than 30 years' experience as a practice management consultant, as well as being a certified coding specialist, certified compliance officer, and a certified medical assi

There are a number of disease processes that must be managed, and doing so offers opportunities for reimbursement that you might not have been aware of.

Q: Our practice has a significant number of patients who require management of their cardiometabolic disorders. While we bill for their office visits and the lab work we do in our practice, I feel more should be done to manage these disorders. We are deterred, however, from providing additional services because I don't believe we will be reimbursed for many of the services we could provide. Do you have any suggestions on how we might better care for this patient population and receive proper reimbursement for our efforts?

A: As you are aware, the prevalence of cardiometabolic disorders and associated risk factors has increased significantly during the past 10 years. There are a number of disease processes that must be managed, and doing so offers opportunities for reimbursement that you might not have been aware of.

The first thing to remember when billing for your services is the ICD-9 code for metabolic syndrome ("dysmetabolic syndrome X"), which is 277.7. In addition, remember to code associated manifestations, such as cardiovascular disease (414.00-414.07) or obesity (the 278 series of codes).

Once you have determined the services you wish to provide, estimate the total costs of doing so. (For example, calculate whether it is more worthwhile to contract with a nutritionist or exercise instructor to present classes exclusively for you, or to establish a joint program with these specialists.)

After you have arrived at a global fee for your program, estimate the cost for a typical cardiovascular event. This should consist only of your fees for the office and hospital (admission, ICU care, hospital visits, etc.); it does not include the facility or medication costs.

Finally, present to the top five insurers the financial benefits of preventive care (some of the services, such as lab, blood pressure monitoring, etc., may already be covered services).

In addition to marketing your program to insurers, create educational fliers for your patients and to distribute during community events such as health fairs and senior center presentations. Some patients may sign up for your program even if their insurance only partially covers it, once they are aware of the consequences of uncontrolled obesity, diabetes, hyperlipidemia, and/or hypertension.

For routine office visits in which the patient has not enrolled in your program or the insurer will not pay for a comprehensive preventive program, be sure to use the diagnosis codes associated with the syndrome when reporting your services.

Many times, insurers will pay for annual exams that include risk-factor reduction or for extended exams in which you counsel patients because of the risk factors they exhibit. In such cases, the visit would be billed on the basis of time, with the time spent face-to-face with the patient and counseling content clearly documented in the medical record. Keep in mind that in order to bill for time, your documentation must note that more than 50 percent of the visit was devoted to counseling or risk-factor reduction.

The author, vice president of operations for Reed Medical Systems in Monroe, Michigan, and a Medical Economics consultant, has more than 30 years of experience as a practice management consultant, and is also a certified coding specialist, certified compliance officer, and a certified medical assistant.

Related Content:

Practice Management
What should continue from COVID-19
What should continue from COVID-19
13 hilarious cartoons about being a physician
13 hilarious cartoons about being a physician
To solve the COVID-19 pandemic, empower primary care physicians and pharmacists
To solve the COVID-19 pandemic, empower primary care physicians and pharmacists