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AES 2014 Practice Management Course December 9, 2014 Gregory L. Barkley, M.D. Comprehensive Epilepsy Program Henry Ford Hospital Detroit, MI Associate.

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Presentation on theme: "AES 2014 Practice Management Course December 9, 2014 Gregory L. Barkley, M.D. Comprehensive Epilepsy Program Henry Ford Hospital Detroit, MI Associate."— Presentation transcript:

1 AES 2014 Practice Management Course December 9, 2014 Gregory L. Barkley, M.D. Comprehensive Epilepsy Program Henry Ford Hospital Detroit, MI Associate Professor of Neurology Wayne State University

2 Outline 2015 Medicare Conversion Factor and SGR 2015 CPT Code Changes

3 Noteworthy in % Sequestration cuts remain in place CMS is required by law to cut the Conversion Factor on April 1, 2015 to maintain budget neutrality. The Conversion factor until April 1, 2015 will be $ , down from $ Conversion Factor cut in 2015 is scheduled to be about 21% to $ unless Congress changes the law as it has done annually since (Last year, we were facing a 23.7% cut to $ showing that the SGR deficit has narrowed in the past year.) Unless the fix happens in the next three weeks, the legislation will have to come from a Republican House and a Republican Senate and be acceptable to President Obama in –Republican strategy on budget issues is being internally debated –One group wants to find ways to pass laws & avoid shutdown –Another group is more confrontational with the President –One strategy that may be used is to tie funding that one party wants to a bill that the other party wants to hold each side hostage ICD-10 to begin on October 1, 2015 – REALLY! CMS drops 10-day global in 2017, 90-global in 2018

4 The Medicare Fee Schedule In 2009, the Neurology Member Census showed 37% of Neurology patients are 65 and older and are thus on Medicare Medicare Fee Schedule is an open process Private payers use a closed process but base payments on Medicare Codes are defined by the AMA CPT Editorial Panel Codes are given a relative work value (RVU) by the AMA RBRVS Update Committee (RUC) as a recommendation to CMS CMS reviews RUC values and assigns RVU (~90% unchanged from RUC) CMS publishes annual Conversion Factor (CF) Medicare payment formula is RVU x CF = Payment Annual Medicare payment determined by Sustainable Growth Rate

5 Sustainable Growth Rate (SGR) Law passed in 1997, requires Medicare payments to follow a formula linked to the cost of medical care, MEI Medicare Economic Index (MEI) is a conservative government estimate of the rate of inflation of medical care Annual overrides have prevented decreased payments to physicians since 2002, but the law has not been changed so the deficit keeps building The 2015 CF will be $ to comply with SGR, a cut of 21% unless Congress overrides the cut. CBO estimates the total cost of repeal of the SGR has dropped to $144 billion over 10 years, down from $153.2 B/10 years last year, & down from the peak estimate in 2012 of $376.6 B/10 years

6 Possible Republican Strategy on SGR Fix Heritage Foundation is an influential conservative “Think Tank” Issue Brief #4303 on 11/20/2014 re: SGR Fix made the following points Should be permanent and based upon bipartisan agreement Principle: “Permanent “Doc Fix” must be financed by permanent Medicare savings” Must take into account demographics of baby boomers Possible solutions –Combine Part A & Part B with single deductible, streamline cost sharing –Reform Medigap –Give seniors catastrophic coverage –Gradually raise age of Medicare eligibility –Gradually decrease subsidy of wealthy –Pave way for defined contribution plan (aka Paul Ryan plan)

7 Making Your Voice Heard is Easy

8 Why has the cost of the SGR fix gone down? Has the cost curve been bent? SGR is linked to the Medicare Economic Index. Health care inflation has decreased primarily due to the recession, or is there something else going on? This is a major question and source of political debate There is no doubt that recessions temporarily decrease health care spending in every country In US, major factors have also been bending the health care curve: –The marked increase in insurance policy deductions and in copayments –High deductible plans are changing the way people access health care –Loss of patents on high cost drugs has dropped the cost of medications Now generic drug costs are rising –Hospitals have had decreased reimbursement in ACA and new controls such as increased use of Observation Days, 30-Day Readmission Penalties, POS non-payment policies

9 Out of Pocket Deductibles with “Metal” Plans

10 In 2012, US spent $8745 per capita on healthcare, OECD average is $ Bronze Plan deductible of $5181 puts per capita insurance cost for insurers ~ same as OECD average or OOP costs > most countries spend per capita

11 2012 US: 16.9% of GDP Spent on Healthcare

12 2012 Drug costs are $885 in US vs $414 OECD average

13 OECD Health Expenditure Annual Changes US rise moderated by drop in drug costs & hospital care, started before recession

14 US Health Care Spending Slowdown Similar to HMO Era Will there be a similar backlash? D Lionhardt, NYTimes

15 All Physicians are not Paid the Same, I GPCI makes adjustments in payment based upon location of service Since 2011: some providers are paid more by specialty Primary Care Physician Medicaid parity payments end 12/31/14 unless extended (S. 2694) ACA's Primary Care Incentive Payments (PCIP) in place, Primary care providers are paid a 10% bonus for non-hospital E&M visits. The payments are paid quarterly to primary care physicians. Does not apply to neurologists despite the attempts of the AAN to include neurologists. APRN/PA payments are 85% of the rate that physicians are paid, but for a primary care APRN/PA, with the 10% bonus, their payment for the same level of service is 93% of what a specialist would receive for the same service, say for CPT code

16 All Physicians are not Paid the Same, II Your type of practice and the site of service determines how you will be paid In private offices, payments are global, combining pro fee and tech fee In medical centers, payments to physicians are for professional fees only Technical payments by HOPPS as APCs to medical center Same applies to patients seen in emergency rooms and observation patients who are not admitted and are subject to outpatient copays For inpatients, payments to physicians are for professional fees only Technical payments are bundled IPPS as DRGs paid to hospital

17 CPT Medicare Payment Relative to Site of Services Inpatient care: –Professional fee paid to physician using -26 modifier –Technical fee paid by DRG to hospital using IPPS (DRG values based upon hospital cost reporting) Top-down methodology based upon hospital-supplied cost data Outpatient care: Provider-based billing –Professional fee paid to physician using -26 modifier –Technical fee paid to medical center using HOPPS (APC charges based upon hospital cost reporting averaged for all procedures in the APC) Top-down methodology Outpatient care: private office –Professional fee bundled with technical payment, so-called global billing using CMS MFS largely following RUC recommended values. Bottom-up methodology by RUC PE

18 How to Improve Your Net Revenue, I Control costs Rent, supplies, staff each need to be scrutinized

19 How to Improve Your Net Revenue, II Check to make sure that your staff is not stealing from you If it involves money, someone will try and take it from you Set up checks & balances for for all processes involving money  Always have two people handling money Nearly 83% of 688 practice managers were affiliated at some point with medical offices where employee theft occurred (MGMA Survey 11/5/2010) Nearly 45% of practice managers reported cash stolen before or after it was recorded on the books. Profile of the embezzler: first one in, last to one to leave, never takes a vacation, stops by on weekends, very friendly and helpful; be suspicious of those who have a gambling habit

20 2015 Office-base Fee Schedule For those billing Global N.B. For the following slides, the values are estimates. They do not take into account modifiers such as the GPCI (Geographic Practice Cost Indices). I have done my best to capture this data accurately, but every year, I unfortunately find a few typos in the previous year's slides as I manually update them. Please refer to your state Medicare carrier for the rates for your practice.

21 2015 MFS for Neurology Services* *Assuming conversion factor of $ , EEG minutes – Total RVU: 11.79; -3%, $422.31, -3% – PE: RVU; -3%, $364.06, -3% – Professional: 1.63 RVU, 1%; $58.35, 0% – Physician Work (wRVU): 1.08, No change 95813, EEG > 1 hour – Total RVU: 14.11, 0%, $505.46, 0% – PE: RVU, -1%; $411.67, -2.8% – Professional: 2.62 RVU, 1%; $93.79, 1% – Physician Work (wRVU): 1.73, No change

22 2015 MFS for Neurology Services* *Assuming Conversion Factor of $ , Awake EEG – Total RVU: 10.11, 2%, $362.27, 2% – PE: 8.96 RVU, 3%; $303.92, 3% – Professional: 1.63 RVU, 0%; $58.71, 1% – Physician Work (wRVU): 1.08, No change 95819, Awake and Asleep EEG – Total RVU: 11.53, 2%, $413.11, 2% – PE: RVU, 1%; $354.76, 2% – Professional: 1.63 RVU, 1%; $58.35, 1% – Physician Work (wRVU): 1.08, No change

23 2015 MFS for Neurology Services* *Assuming Conversion Factor of $ , Sleep EEG – Total RVU: 10.43, 4%, $373.37, 4% – PE: 9.27 RVU, 4%; $315.02, 4% – Professional: 1.63 RVU, 1%; $58.35, 1% – Physician Work (wRVU): 1.08, No change 95824, EEG for Brain Death – Practice Expense: none (IPPS only) – Professional: 1.14 RVU, 0%; $40.81; 0% – Physician Work (wRVU): 0.74, No change

24 2015 MFS for Neurology Services* *Assuming Conversion Factor of $ , Overnight EEG – Total RVU: 22.10, 2%, $792.20, 2% – PE: RVU, -9%; $733.85, 2% – Professional: 1.62 RVU, -1%; $58.35, 0% – Physician Work (wRVU): 1.08, No change 95829, Surgery Electrocorticogram – Total RVU: 53.11, +18%, $1,901.34, 2% – PE: RVU, -12%; $1,665.42, 3% – Professional: 9.39 RVU, -2%; $336.16, 2% – Physician Work (wRVU): 6.20, No change

25 2015 MFS for Neurology Services* *Assuming Conversion Factor of $ , Ambulatory Cassette EEG, unattended (Old Oxford Medilog) – Total RVU: 9.26, -1%, $332.20, -1% – PE: 7.66 RVU, -1%; $251.30, -1% – Professional: 2.26 RVU, -1%; $80.90; -1% – Physician Work (wRVU): 1.51, No change 95951, 24 Hour Video EEG Long Term Monitoring – Practice Expense: *Carrier-defined technical expense – Professional: 9.27 RVU, 0%; $330.41, 0% – Physician Work (wRVU): 5.99, No change – Hospital coders: use for inpatient coding – Do not use this code for ambulatory in home recordings, use 95953

26 Claims for 95951, RUC database

27 2015 MFS for Neurology Services* * Assuming Conversion Factor of $ , 24 hour automated ambulatory digital EEG, unattended Use this code for all uses of computerized digital EEG +/- video – Total RVU: 11.80, -3%, $422.05, -3% – Practice Expense: 8.53 RVU, -4%; $256.31, -3% – Professional: 4.65 RVU, 0%; $165.74, 0% – Physician Work (wRVU): 3.08, no change 95956, 24 Hour attended EEG without video (assuming 1 tech:: 2 patients) – Total RVU: 47.02, 1%, $1,683.92, 1% – Practice Expense: RVU, 1%; $1,489.90; 1% – Professional: 5.43 RVU, 0%; $194.02; 0% – Physician Work (wRVU): 3.61, no change

28 2015 MFS for Neurology Services* *Assuming a Conversion Factor of $ , EEG with administration of drugs – Total RVU: 12.94, 5%, $463.58, 4% – Practice Expense: RVU, 7%; $337.21, 7% – Professional: 3.54 RVU, 2%; $126.37, 2% – Physician Work (wRVU): 2.45, no change 95955, EEG during surgery – Total RVU: 6.02, -2%, $215.50, -6% – Practice Expense: 4.95 RVU, -7%; $161.09, -8% – Professional: 1.52 RVU, 0%; $54.41, 0% – Physician Work (wRVU): 1.01, no change

29 2015 MFS for Neurology Services* *Assuming Conversion Factor = $ , EEG Digital Analysis Do not use with as analysis is inherent in – Total RVU: 8.91, -28%, $319.32, -28% – Practice Expense: 5.93 RVU, -37%; $212.64, -37% – Professional: 2.99 RVU, 0%; $106.68, 0% – Physician Work (wRVU): 1.98, no change 95958, EEG monitoring, functional mapping (Wada Test) – Total RVU: 16.39, 3%, $586.01, 3% – Practice Expense: RVU, 4%; $359.05, 6% – Professional: 6.36 RVU, 0%; $226.96, 0% – Physician Work (wRVU): 4.24, no change

30 2015 MFS for Neurology Services* *Assuming a conversion factor of $ , Electrode stimulation, brain, first hour – Total RVU: 8.18 RVU, 2%, $292.83, 2% – Practice Expense: 5.04 RVU, 3%; $133.17, 4% – Professional: 4.47 RVU, 0%; $159.66, 0% – Physician Work (wRVU): 2.97, no change 95962, Electrode stimulation, brain, each additional hour – Total RVU: 7.23 RVU, 2%, $258.46, 2% – Practice Expense: 3.92 RVU, 5%; $88.06, 8% – Professional: 4.77 RVU, -1%; $170.40, -1% – Physician Work (wRVU): 3.21, no change

31 2015 MFS for Neurology Services* *Assuming a Conversion Factor of $35.80 Technical Expenses not defined, only APCs assigned for MEG codes 95965, MEG, spontaneous – Professional: RVU, 1%; $437.09, 1% – Physician Work (wRVU): 7.99, no change 95966, MEG, evoked, single –Professional: 6.18 RVU, 0%; $220.16, 0% –Physician Work 3.99 (wRVU): no change 95967, MEG, evoked, each additional –Professional: 5.41 RVU, 0%; $192.59, 0% – Physician Work (wRVU): 3.49, no change

32 2015 MFS for Neurology Services* *Assuming a Conversion Factor of $ , Analyze neurostimulator, no programming –Total RVU: 1.89, -2%, $67.66, -2% –Practice Expense: 1.40 RVU, -3%; –Physician Work (wRVU): 0.45, no change 95974, Cranial neurostimulation, complex analysis and programming, first hour (3 or more parameters) – Total RVU: 5.89, 0%, $209.42, 0% –Practice Expense: 2.59 RVU, 0% –Physician Work (wRVU): 3.00, no change –Use -52 modifier if less than 30 minutes Cranial neurostimulation, complex, each additional 30 minutes – Total RVU: 3.16 RVU, 1%, $112.76, 1% –Practice Expense: 1.31 RVU, 0% –Physician Work (wRVU): 1.70, no change

33 CPT Medicare Payment Relative to Site of Services Inpatient care: –Professional fee paid to physician using -26 modifier –Technical fee paid by DRG to hospital using IPPS (DRG values based upon hospital cost reporting) Top-down methodology based upon hospital-supplied cost data Outpatient care: Provider-based billing –Professional fee paid to physician using -26 modifier –Technical fee paid to medical center using HOPPS (APC charges based upon hospital cost reporting averaged for all procedures in the APC) Top-down methodology Outpatient care: private office –Professional fee bundled with technical payment, so-called global billing using CMS MFS largely following RUC recommended values. Bottom-up methodology by RUC PE

34 Mapping of Seizure codes to DRGs Terminology is important: –Epilepsy, , maps to DRGs 100, Seizure without MCC, and 101, Seizure with MCC. –Seizure(s), , maps to DRG 100 and 101. –Recurrent seizures, seizure disorder, 345.8x maps to DRG 100 and 101 –Pseudoseizure, Conversion disorder, psychogenic conversion disorder, (even with a secondary code of ), maps to DRG 880, Acute Adjustment Reaction

35 2015 Hospital Outpatient Prospective Payment System (HOPPS) 266 pages This is the explanation for the choices made All codes found here (5200 row spread sheet, EEG codes 4762): for-Service-Payment/HospitalOutpatientPPS/Downloads/CMS FC-Cost-Stats.zip Payment for the technical portion of CPT codes done on Medicare outpatients, a top-down system based upon hospital-reported charges – Averaged charges for a group of similar procedures Some codes benefit by the averaging – As CMS moves procedures in and out of APCs, the average value shifts – Major rearrangement in EEG APCs in 2015

36 2015 HOPPs Changes EEG APCs EEGs have 3 APCs for technical payments EEGs, sleep codes, EMGs, & EPs are rearranged – APC 213 for short EEGs, pays $ – APC 209 for intermediate EEGs, pays $ – APC 435 for long EEGs, pays $ These APCs existed before but the rearrangement of codes and volumes per code changed the average payment – APC 213 paid $ in 2014, will pay $ in 2015 – APC 209 paid $ in 2014, will pay $ in 2015 – APC 435 paid $ in 2014, will pay $ in 2015

37 2015 HOPPS APC 0213 APC 0213 Level I Extended EEG, Sleep, and CV studies – EEG min MOVED to APC 209 – EEG > 1 hour MOVED to APC 209 – EEG awake and drowsy – EEG awake and asleep – EEG sleep and/or coma MOVED to APC APC rate = $ APC rate = $176.56, -3%

38 2015 HOPPS APC 0209 APC 0209 Level II Extended EEG, Sleep & CV – EEG min, MOVED from APC 213 – EEG > 1 hour, MOVED from APC 213 – Sleep/Coma EEG, MOVED from APC 213 – amb. cassette EEG, MOVED to 435 – ambulatory digital EEG, MOVED to 435 – hour EEG w/o video, MOVED to 435 – All night EEG 2015 APC Rate = $230.74, -47% 2014 APC Rate = $ APC Rate = $806.13

39 2015 HOPPS APC 0435 (new in 2014) APC 0435 Level III Extended EEG, Sleep & CV – Amb Cassette EEG, MOVED from 209 – Hr Video EEG – Amb Digital EEG, MOVED from 209 – Hr EEG w/o Video, MOVED from 209 – WADA test 2014 APC Rate = $ APC Rate = $853.93, -1%

40 2015 HOPPS APC 0215 APC 215 Level I Nerve and Muscle Tests – Neurostimulation, analysis with no programming 2014 payment = $ payment = $94.93, 89%

41 2015 HOPPS APC 216 APC 216 Level III Nerve and Muscle Tests – Cortical Stimulation, 1 st hour – 95824, EEG cerebral death only 2015 APC Rate = $272.60, 26% 2014 APC rate = $ N.B., Cortical Stimulation, each additional hour, now has no technical payment This APC also contains NCVs 5-6, 7-8, 9-10, , 13 />

42 2015 HOPPS APC 0692 APC 0692 Level II Electronic Analysis of Devices – Analyze neurostim, simple – Analyze neurostim, complex – Cranial neurostim, complex 2014 payment = $ payment = $128.18, 11% NB, For and 95975, there are no longer technical payments (applies to all add-on codes)

43 2015 MEG HOPPs A.Technical payments for MEG studies in hospital- based outpatient care facilities Does not apply to free standing MEG sites Carrier priced Does not apply to MEG studies done on inpatients Technical fees bundled to DRG In 2013, MEG was listed in APC 0066 Level II Stereotactic Radiosurgery, MRgFUS, and MEG APC 0065 Level I Stereotactic radiosurgery, MRgFUS, and MEG In 2014, MEG switched to APC 0065 IORT, MRgFUS, and MEG In 2015, and now in APC 0446

44 2015 HOPPS MEG payment In 2013, APC 0066, MEG = $2, for For 2014, MEG moved to APC 0065 (with 95966) – APC 0065 Rate = $1,248.28, -50% for MEG – 2013 APC Rate for 0065 was $978.25, +28% for – 95967, no technical payment since it is an add-on code For 2015, MEG and moves to APC 0446 – 2015 APC 0446 Rate = $1,300.45, a 4% increase – No technical payment for since it is an add-on code

45 ICD-10-CM The CDC has released the 2015 version of ICD-10-CM These codes will be mandatory to file claims starting 10/1/2015 The following slides will display just the essential epilepsy and seizure codes – You will need additional learning to code properly Complete instructions and all of the codes can be found here:

46 G40-G47 Episodic and Paroxysmal Disorders G40 Epilepsy and recurrent seizures Note: the following terms are to be considered equivalent to intractable: pharmacoresistant (pharmacologically resistant), treatment resistant, refractory (medically) and poorly controlled Excludes1: [An Excludes1 note indicates that the code excluded should never be reported with the code above the Excludes1 note.] conversion disorder with seizures (F44.5) convulsions NOS (R56.9) hippocampal sclerosis (G93.81) mesial temporal sclerosis (G93.81) post traumatic seizures (R56.1) seizure (convulsive) NOS (R56.9) seizure of newborn (P90) temporal sclerosis (G93.81) Todd's paralysis (G83.8)

47 G40 General Code Convention G40.XYZ Where X = Generalized, Localized, or Special Syndrome Y = Not Intractable (0) or Intractable (1) Z = With Status Epilepticus (1) or Without Status Epilepticus (9)

48 G40.0 Localization-related Idiopathic Epilepsy G40.0 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset Benign childhood epilepsy with centrotemporal EEG spikes Childhood epilepsy with occipital EEG paroxysms Excludes1: adult onset localization-related epilepsy (G40.1-, G40.2-) G40.00 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset without intractability G Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, with status epilepticus G Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset NOS G40.01 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable G Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus G Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus.

49 G40.1 Localization-related Symptomatic Epilepsy with SPS G40.1 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures Attacks without alteration of consciousness Epilepsia partialis continua [Kozhevnikof] Simple partial seizures developing into secondarily generalized seizures G40.10 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures without intractability G Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, with status epilepticus G Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures NOS G40.11 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable G Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus G Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus.

50 G40.2 Localization-related Symptomatic Epilepsy with CPS G40.2 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures Attacks with alteration of consciousness, often with automatisms Complex partial seizures developing into secondarily generalized seizures G40.20 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures without intractability G Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus G Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures NOS G40.21 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable G Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus G Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus.

51 G40.3 Generalized Idiopathic Epilepsy G40.3 Generalized idiopathic epilepsy and epileptic syndromes Code also MERRF syndrome, if applicable (E88.42) G40.30 Generalized idiopathic epilepsy and epileptic syndromes, not intractable Generalized idiopathic epilepsy and epileptic syndromes without intractability G Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus G Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus Generalized idiopathic epilepsy and epileptic syndromes NOS G40.31 Generalized idiopathic epilepsy and epileptic syndromes, intractable G Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus G Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus.

52 G40.A Absence Epileptic Syndromes G40.A Absence epileptic syndrome Childhood absence epilepsy [pyknolepsy] Juvenile absence epilepsy Absence epileptic syndrome, NOS G40.A0 Absence epileptic syndrome, not intractable G40.A01 Absence epileptic syndrome, not intractable, with status epilepticus G40.A09 Absence epileptic syndrome, not intractable, without status epilepticus G40.A1 Absence epileptic syndrome, intractable G40.A11 Absence epileptic syndrome, intractable, with status epilepticus G40.A19 Absence epileptic syndrome, intractable, without status epilepticus.

53 G40.B Juvenile Myoclonic Epilepsy G40.B Juvenile myoclonic epilepsy [impulsive petit mal] G40.B0 Juvenile myoclonic epilepsy, not intractable G40.B01 Juvenile myoclonic epilepsy, not intractable, with status epilepticus G40.B09 Juvenile myoclonic epilepsy, not intractable, without status epilepticus G40.B1 Juvenile myoclonic epilepsy, intractable G40.B11 Juvenile myoclonic epilepsy, intractable, with status epilepticus G40.B19 Juvenile myoclonic epilepsy, intractable, without status epilepticus.

54 G40.4 Other Generalized Epilepsy and Epileptic Syndromes G40.4 Other generalized epilepsy and epileptic syndromes Epilepsy with grand mal seizures on awakening Epilepsy with myoclonic absences Epilepsy with myoclonic-astatic seizures Grand mal seizure NOS Nonspecific atonic epileptic seizures Nonspecific clonic epileptic seizures Nonspecific myoclonic epileptic seizures Nonspecific tonic epileptic seizures Nonspecific tonic-clonic epileptic seizures Symptomatic early myoclonic encephalopathy G40.40 Other generalized epilepsy and epileptic syndromes, not intractable Other generalized epilepsy and epileptic syndromes without intractability Other generalized epilepsy and epileptic syndromes NOS G Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus G Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus G40.41 Other generalized epilepsy and epileptic syndromes, intractable G Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus G Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus.

55 G40.5 Epileptic Seizures Related to External Causes G40.5 Epileptic seizures related to external causes Epileptic seizures related to alcohol Epileptic seizures related to drugs Epileptic seizures related to hormonal changes Epileptic seizures related to sleep deprivation Epileptic seizures related to stress Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) Code also, if applicable, associated epilepsy and recurrent seizures (G40.-) G40.50 Epileptic seizures related to external causes, not intractable G Epileptic seizures related to external causes, not intractable, with status epilepticus G Epileptic seizures related to external causes, not intractable, without status epilepticus Epileptic seizures related to external causes, NOS.

56 G40.8 Other Epilepsy and Recurrent Seizures, part I G40.8 Other epilepsy and recurrent seizures Epilepsies and epileptic syndromes undetermined as to whether they are focal or generalized Landau-Kleffner syndrome G40.80 Other epilepsy G Other epilepsy, not intractable, with status epilepticus Other epilepsy without intractability with status epilepticus G Other epilepsy, not intractable, without status epilepticus Other epilepsy NOS Other epilepsy without intractability without status epilepticus G Other epilepsy, intractable, with status epilepticus G Other epilepsy, intractable, without status epilepticus G40.81 Lennox-Gastaut syndrome G Lennox-Gastaut syndrome, not intractable, with status epilepticus G Lennox-Gastaut syndrome, not intractable, without status epilepticus G Lennox-Gastaut syndrome, intractable, with status epilepticus G Lennox-Gastaut syndrome, intractable, without status epilepticus.

57 G40.8 Other Epilepsy and Recurrent Seizures, part II G40.82 Epileptic spasms Infantile spasms Salaam attacks West's syndrome G Epileptic spasms, not intractable, with status epilepticus G Epileptic spasms, not intractable, without status epilepticus G Epileptic spasms, intractable, with status epilepticus G Epileptic spasms, intractable, without status epilepticus G40.89 Other seizures Excludes1: post traumatic seizures (R56.1) recurrent seizures NOS (G40.909) seizure NOS (R56.9).

58 G40.9 Epilepsy, Unspecified G40.9 Epilepsy, unspecified G40.90 Epilepsy, unspecified, not intractable Epilepsy, unspecified, without intractability G Epilepsy, unspecified, not intractable, with status epilepticus G Epilepsy, unspecified, not intractable, without status epilepticus Epilepsy NOS Epileptic convulsions NOS Epileptic fits NOS Epileptic seizures NOS Recurrent seizures NOS Seizure disorder NOS G40.91 Epilepsy, unspecified, intractable Intractable seizure disorder NOS G Epilepsy, unspecified, intractable, with status epilepticus G Epilepsy, unspecified, intractable, without status epilepticus.

59 R56 Convulsions not elsewhere classified CR56 Convulsions, not elsewhere classified Excludes1: dissociative convulsions and seizures (F44.5) epileptic convulsions and seizures (G40.-) newborn convulsions and seizures (P90) R56.0 Febrile convulsions R56.00 Simple febrile convulsions Febrile convulsion NOS Febrile seizure NOS R56.01 Complex febrile convulsions Atypical febrile seizure Complex febrile seizure Complicated febrile seizure Excludes1: status epilepticus (G40.901) R56.1 Post traumatic seizures Excludes1: post traumatic epilepsy (G40.-) R56.9 Unspecified convulsions Convulsion disorder Fit NOS Recurrent convulsions Seizure(s) (convulsive) NOS

60 Support Your Patients – Buy their products and services. The job you save may be your own. Unless you do funded research, you are in the service industry and your job depends upon having primary producers to pay for your services You should shop locally, particularly if you practice in a small town

61 Professionalism This has been a business talk, but do not forget why you became a physician in the first place. Those blessed with extraordinary gifts have extraordinary obligations. You are expected to give back to the community by donating your talent, your time, and your money to support worthy causes These include: your hospital, nonprofit disease organizations such as the Epilepsy Foundation, the American Academy of Neurology, etc.


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