Notes from the Chair
Trina Limberg, BS, RRT, FAARC, MAACVPR
Thank you for joining and renewing your section membership. A special thank you to those who contribute to our community on AARConnect by posting questions and sharing experiences to help your colleagues. For most of us, caring for the chronically breathless is a passion. Our patients and their families let us know just how important our insights, empathy, and care are to changing their lives and their ability to cope with the challenges imposed by their disease. What an awesome privilege it is to make a difference for them on any scale. This is where we derive our inspiration.
As posted on AARConnect, I will be serving in the chair position in 2016. I anticipate we will elect a new chair during the AARC Elections in the fall. If you are interested in running for the position, please contact me. I’d be happy to talk with you and to provide information about the role. In the meantime, I look forward to serving as your chair and getting to know as many of you as I can.
The Bulletin will be published twice this year and I would love to have some articles in the second edition that have been submitted from section members. If you have anything you want to contribute please keep in mind we have an editor at the AARC to help us get our content into polished form. Pulitzer Prize winning writing is not required! The main thing is to share our stories, because we can all learn so much from each other.
I have been in contact with Shawna Strickland, the AARC associate executive director of education, to solicit her help in arranging a “virtual section meeting” that would take place via the AARC’s Webcast Central. My hope is to promote a forum for discussion on current topics and concerns. Some of the other sections have hosted virtual meetings and have found them to be of great benefit.
I wish you all success with your programs.
Specialty Practitioner of the Year: Russel Sison-Tojino, RRT, AE-C
Congratulations to Russel Sison-Tojino, RRT, AE-C, for being named our 2015 Specialty Practitioner of the Year. Russel received the honor at AARC Congress 2015 in Tampa, FL, last November.
An RRT for more than 15 years, Russel is a pulmonary rehabilitation specialist at the University of California, San Diego, where she is known for striving for excellence and advocating for her patients. She has supported and participated in clinical research projects to improve the care for COPD patients, earned her Asthma Educator-Certified credential, and served in the ALS clinic as a contributing member to a multidisciplinary team. Her contributions there were considered crucial to achieving ALS program certification.
Russel embraces a diverse community of referred patients, treating all with respect and regard. She is an excellent clinician who brings pride to the profession and to our specialty.
OIG Report Targets Individual Treatment Plans
Trina Limberg, BS, RRT, FAARC, MAACVPR
At UC San Diego Health, we are experiencing consistently high referral rates (50+ monthly) for our pulmonary rehabilitation program. Many of you are seeing high referral rates as well. I know some of you may be thinking, what a great problem to have. It is — but it also comes with non-patient care work time; time that is often under-recognized by upper management.
For example, considerable time is often needed to screen referrals and medical records, and to call and schedule patients. Here at UCSD, we are currently running reports and sharing them with administration to engage on the need for a review of FTE allocation based on non-productive indirect work. It is so important to screen and schedule patients in a timely manner, but with high referral rates wait lists are becoming the norm.
As our patient volumes increase, writing more Individual Treatment Plans (ITPs) and managing outcomes can also be challenging, including getting those physician signatures needed to meet regulatory requirements. Tracking ITP reassessment due dates can be burdensome as well. Letting the ITP slide, however, can have dire consequences for your program.
The Office of Inspector General (OIG) recently released a report summarizing audit findings of a cardiac and pulmonary rehabilitation program that illustrates the problem. The ITP was just about the only documentation reviewed, and clearly the most important.
In summary, due to documentation deficiencies, money was returned to the federal government via the Centers for Medicare and Medicaid Services for PR services rendered.
The ITP must meet the regulatory standard for assessment, reassessment every 30 days, and generally at discharge. CMS requirements for pulmonary rehab reimbursement that must be documented via the ITP include —
- Physician-prescribed exercise,
- Education or training,
- Psychosocial assessment,
- Outcomes assessment, and
- An individualized treatment plan.
We have used the OIG report as an opportunity to revisit our ITP form content and format. I hope you find the information useful as well and will share it with your medical director and rehab colleagues.
Out with the ICD-9, In with the ICD-10
Trina Limberg, BS, RRT, FAARC, MAACVPR
As most, if not all, of you know, ICD-10 integration occurred late 2015. Those ICD-9 codes you knew better than your own body weight are long gone. Most of us have electronic systems that provide conversions that populate a list of options, i.e., J44.9 COPD, upon charge entry. If you are responsible for this task then you know it can be time consuming and tedious.
For example, J44.9 COPD may populate a list of over 15 other descriptors using the same ICD-10. Multiple diagnoses may be cross walked from a very extensive list of former ICD-9 codes. We have dealt with this issue by adding the ICD-10 and specific descriptors to the appointment notes so that everything populates to our department’s daily appointment report. This makes charge entry easier and more precise.
Additionally, there may have been some changes at your Medicare Administrative Contractor (MAC) in the ICD-10 codes listed for qualifying non-COPD diagnoses such as restrictive lung diseases for respiratory therapy services. In California, the new Local Coverage Determination (LCD) policy for the contracted MAC (Noridian) excludes the ICD-10 equivalent to the old ICD-9 of 515 for post inflammatory fibrosis. There is no listing for ICD-10 J84.10 pulmonary fibrosis, unspecified. However, there is a listing for J84.89, other specified interstitial pulmonary diseases.
The Respiratory Care (Respiratory Therapy) LCD Policy L34149 was updated last October. You will want to check your LCD and review any ICD-10 updates to be sure you are in compliance with the rules for providing and billing respiratory care services with non-COPD Medicare covered claims.
This ICD-9 to ICD-10 conversion site may help you manage the situation.
Section Connection
Specialty Practitioner of the Year: Use our online nomination form to nominate a fellow section member for our 2016 Specialty Practitioner of the Year award.
Recruit a new member: Know an AARC member who could benefit from section membership? Direct them to section sign up. It’s the easiest way to add section membership to their overall membership package.
Section discussion list: Go to the section website and click on “Discussion List” to start networking with your peers via the AARC’s social networking site, AARConnect.
Attention budding authors: If you have an interesting story to share about your program or would like to write about an issue important to continuing care/rehab RTs, email your contributions to Trina Limberg by the deadline stated below.
Next Bulletin deadline: August 1