www.aafp.org/fpm September/October 2011 E/M Coding and the Documentation Guidelines: Putting It All Together 33 17 What Family Physicians Need to Know About ACOs 24 One Last Annual ICD-9 Update Special Feature: ICD-9 Reference Card 26 Remove Roadblocks and Improve Access to Preventive Care 1 Table of Contents 14 opinion The EHR Incentive Program: Consider Waiting for Next Year 45 Coding & documentation Joint Injection + E/M Service? • AWVs and Part D Vaccines • Newborn Heel Stick 47 Practice Pearls Test Your Streamline Processes When Using an EHR Coding 52 The last Word A Life Checkup SkillS 33 AAFP MEMbERS AND PRINT SUbSCRIbERS: EARn 3.25 CME CREdiTS Take the CME Quiz online at http://www.aafp.org/fpmquiz (Preview the questions on page 41.) Job No.: 5009_07701 Publication: Family Practice Management GE Healthcare Centricity Advance Ad Issue: July-August 2011 Bleed: 8.625" Date: 06.15.11 Trim: 7.75" x 10.5" Trim: 8.25" Contact: Whitney Floersch, VSA Partners, Inc. 312.427.6413 Safety: 0.375” Bleed: 0.125” Safety: 7" For patients with type 2 diabetes whose ADVERTISEMENT blood glucose is not well controlled with orals alone GE Healthcare Centricity Advance IS IT TIME TO RETHINK INSULIN? Indications and Usage for Lantus® (insulin glargine [rDNA origin] injection) Lantus® is a long-acting insulin analog indicated to improve glycemic control in adults and children (6 years and older) with type 1 diabetes mellitus and in adults with type 2 diabetes ® mellitus. Lantus should be administered once a day at the same time every day. 10" Safety: Trim: 10.812" Trim: Bleed: 11.25" Bleed: Important Limitations of Use: Lantus® is not recommended for the treatment of diabetic ketoacidosis. Use intravenous short-acting insulin instead. Important Safety Information for Lantus® Contraindications Paper records are so 20th century. Lantus® is contraindicated in patients hypersensitive to insulin glargine or one of its excipients. Warnings and Precautions We’ll help you through your EMR transition, every step of the way. Monitor blood glucose in all patients treated with insulin. Insulin regimens should be modified Your small practice is ready for the clinical and fi nancial benefi ts of an EMR. cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, With Centricity Advance from GE Healthcare, you can reap them in weeks, not months — or method of administration may result in the need for a change in insulin dose or an adjustment at a low monthly fee. And as your partner, we’ll be there to support your transition every in concomitant oral antidiabetic treatment. step of the way, from setup and training to achieving meaningful use. So before long, you’ll Do not dilute or mix Lantus® with any other insulin or solution. If mixed or diluted, the solution may experience new levels of effi ciency — and we’re certain you won’t miss paperwork a bit. become cloudy, and the onset of action/time to peak effect may be altered in an unpredictable ® Learn more today — visit www.gehealthcare.com/emrpartner or call 800-535-7921. manner. Do not administer Lantus via an insulin pump or intravenously because severe hypoglycemia can occur. Insulin devices and needles must not be shared between patients. Please see additional Important Safety Information for Lantus® continued on the next page. From the maker of LANTUS® SoloSTAR ® © 2011 General Electric Company September/October 2011 Vol. 18 No. 5 17 26 features 17 What family Physicians Need to Know about aCOs Julian D. Bobbitt, JD Accountable care organizations could be the next big thing in health care delivery. Here’s what you need to know – and what you need to do – now. 24 One Last annual ICD-9 update Cindy Hughes, CPC The ICD-9 codes that take effect Oct. 1 will be the last. ICD-10 will be implemented in 2013. 26 remove roadblocks and Improve access to Preventive Care Elizabeth W. Woodcock, MBA, FACMPE, CPC, Eric Whicker, Leann Hostetler, RN, and Devon Nichols, MBA Learn how a few procedural changes dramatically increased this 52 practice’s visit rates for well-child care. 33 e/M Coding and the Documentation Guidelines: Putting It all together Emily Hill, PA-C tOOLs IN tHIs Issue It’s time to test your E/M coding skills. iCd-9 Codes for Family continued ➤ Medicine: The FPM Short list See the insert following page 24. The Evaluation and Management CONNeCt WItH FPM guidelines at a glance Follow us on Twitter at See page 36. http://www.twitter.com/FPMjournal These tools are among 150+ tools kane available online in the FPM Toolbox at be our fan on Facebook at ean S www.aafp.org/fpm. http://www.facebook.com/FPMjournal han, han, n c COMING sOON rO m: • communicating bad news Cover illustration by Adam Niklewicz, a North Haven, O to Your patients Conn.-based illustrator who has worked with prominent OTT b clients such as Business Week and USA Today. TO p TO m September/October 2011 | www.aafp.org/fpm | FAMilY PRACTiCE MAnAgEMEnT | 1 O Fr DePartMeNts To sign up to receive FPM by e-mail, visit http://www.aafp.org/ fpm/digitalfpm. FPM is indexed in meDLIne, pubmed and cumulative Index 10 FRoM ThE EdiToR to nursing & allied health Literature. The journal is available the ruC under fire in full text at http://www.aafp.org/fpm, and FPM content is Robert L. Edsall available online through ebScO and mD consult. Time may be running out for the group that helps divide Family Practice Management (ISSn 1069-5648) is published six times a year by the publications Division of the american the Medicare pie. academy of Family physicians, 11400 Tomahawk creek park- way, Leawood, kansas 66211-2680. phone: 800-274-2237. 12 lETTERS periodicals postage paid at Shawnee mission, kansas, and at FPM and payment reform • Finding the right balance of additional mailing offices. printed in the U.S.a. copyright © 99214s • Improving clinical care with FPM 2011 by the american academy of Family physicians. postmas- ter: Send address changes to Family Practice Management, 14 oPinion 11400 Tomahawk creek parkway, Leawood, kS 66211-2680. the eHr Incentive Program: Consider Waiting for Next Year David C. Kibbe, MD, MBA It may get easier and cheaper to earn the incentive. 41 CME Quiz AAFP members and print subscribers: Complete the quiz online (http://www.aafp.org/fpmquiz) for 3.25 CME credits. Preview the questions in this issue. published by the american academy of Family physicians 45 Coding & doCuMEnTATion Cindy Hughes, CPC Joint injection + E/M service? • Annual wellness visits and Part D vaccines • Newborn heel stick The information and opinions presented in FPM reflect the views of the authors, not those of the journal or the aaFp, 47 PRACTiCE PEARlS unless so stated. The staff makes every reasonable effort Streamline processes when using an EHR to provide accurate, authoritative information, but FPM is intended only as a guide; it does not replace coding manuals 52 ThE lAST WoRd and other such resources. a Life Checkup It is the policy of the aaFp that all FPM authors and editors disclose relationships with commercial entities before their role Don Kalman, MD in developing editorial content is confirmed. Disclosure docu- When was the last time you took an honest look at ments are reviewed for potential conflicts of interest. If conflicts are identified, they are resolved before confirmation of partici- your life? pation. Only those who have no conflicts of interest or whose conflicts have been successfully resolved were involved in this 9 ConTACT uS cme activity. We publish a disclosure statement with each relevant article, and we inform readers of any pertinent relation- 48 ClASSiFiEdS ships disclosed. 51 indEX oF AdVERTiSERS FPM accepts advertising judged to be in harmony with the purpose of the journal. acceptance does not constitute endorsement by FPM or the aaFp. educational Objectives Family Practice Management aims to promote the ideals of family medicine and to help readers improve their knowledge Prefer FPM IN PrINt? and skills in several areas: You can still get the FPM • high-quality, cost-effective patient care • effective, ethical practice in managed care print edition that you • computerizing practice and maximizing the usefulness know and love! Subscribe for of computers just $30 (for aaFp members) • Diagnosis and procedure coding • career and practice development and have it delivered to • Developments in medicare and other federal health you six times a year. care programs • The evolving health care system and the place of family Go to http://www.aafp.org/ medicine in it fpm/subscribe or call • balancing the demands of professional and personal life 800-274-2237. • Developing and exercising leadership skills 2 | FAMilY PRACTiCE MAnAgEMEnT | www.aafp.org/fpm | September/October 2011 Bleed: 8.625" Trim: 8.25" Safety: 7" For patients with type 2 diabetes whose ADVERTISEMENT blood glucose is not well controlled with orals alone IS IT TIME TO RETHINK INSULIN? Indications and Usage for Lantus® (insulin glargine [rDNA origin] injection) Lantus® is a long-acting insulin analog indicated to improve glycemic control in adults and children (6 years and older) with type 1 diabetes mellitus and in adults with type 2 diabetes ® mellitus. Lantus should be administered once a day at the same time every day. 10" Safety: Trim: 10.812" Trim: Bleed: 11.25" Bleed: Important Limitations of Use: Lantus® is not recommended for the treatment of diabetic ketoacidosis. Use intravenous short-acting insulin instead. Important Safety Information for Lantus® Contraindications Lantus® is contraindicated in patients hypersensitive to insulin glargine or one of its excipients. Warnings and Precautions Monitor blood glucose in all patients treated with insulin.