Advanced Diagnostic Imaging - Use of QQ Modifier

Advanced Diagnostic Imaging – Modifier QQ

This impacts physicians and facilities that bill Part B services for advanced diagnostic imaging to their Medicare Beneficiaries. The new item in this process is the reporting of the Healthcare Common Procedure Coding System (HCPCS) modifier QQ on the claim line for an advanced diagnostic imaging service that is paid for by CMS.

In 2014 the Protecting Access to Medicare Act (PAMA) implemented a new program that was geared towards increasing the rate of appropriate Advanced Diagnostic Imaging for the Medicare beneficiaries. The services that are included in this program are as follows:

• CT Scans

• PPET Scans

• Nuclear Medicine

• MRI

The goal was once a qualified practitioner ordered a service listed above, the practitioner was required to consult a Clinical Decision Support Mechanism (CDSM). The process would guide the individual practitioner through the electronic portal so they could access the Appropriate Use Criteria (AUC). While utilizing this system, the provider could use the CDSM to determine if the test ordered would or would not meet the AUC guidelines.

An appropriate setting for these tests to be performed are:

• Physician offices

• Hospital Outpatient Departments

• Emergency Departments

• ASCs

The payment models include the Physician Fee Schedule and the Hospital Outpatient Prospective Payment System (OPPS), and the Ambulatory Surgical Center payment model.

This program is slated to have a complete roll-out by January 2020. At that point, a consultation with a qualified CDSM will be required and the results of the consultation will need to be attached to the claim. The information needed is the NPI of the ordering physician and the identification of which CDSM that was consulted. As in the past, if there are extenuating circumstances where the provider cannot access the system due to a significant hardship or it is an emergent situation there may be exceptions made.

By placing the modifier QQ on the claim, starting in July 2018, that will identify the claim as having the following:

•         The ordering healthcare professional consulted a Qualified Decision Support Mechanism

•         The related data was provided to the healthcare professional

•         The services were provided in a qualified setting

•         The services were paid for through an approved payment model

Ultimately, this process will ensure that only tests that are medically necessary, meeting the CDSM criteria, will be approved and paid for, eliminating the ordering of tests that may not be needed as they do not meet the CDSM criteria.

Reference

Medicare Learning Network. (2018). Appropriate use criteria for advanced diagnostic imaging -voluntary participation and reporting period – claims processing requirements – HCPCS modifier QQ. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10481.pdf

Proposing a Contemporary Ars Moriendi

Author:

Anthony Ughetti, MHA

December 2018

Proposing a Contemporary Ars Moriendi

This blog is an outgrowth of my recent MHA Capstone Project with Saint Joseph’s College.  This author contends that significant confusion, inefficiency, and rancor exist in the current state of end-of-life care.  In response, the author proposes a contemporary ars moriendi that can serve as a framework for standardization of end-of-life-care. This can help resolve existing barriers and lead to a “holier” death and dying process for patients, families, and providers. 

Thesis and Call to Action

Although hospice and palliative care services have existed for decades, there remains confusion and contention about what the services entail, when they should be initiated, and what benefits flow from them.  Such confusion negatively impacts the patient and family experience of the dying process and leads to inefficiencies in the delivery process.  This author proposes a solution in the form of a contemporary ars moriendi - a set of rules and guides that can help clinicians, patients, and society better understand end-of-life services.  Moreover, it can promote service delivery in a way that leads to efficiency, cost-savings, and a happy, holy death for the patient.

Ars moriendi?  What does that mean?

This blogger contends that the last time society and the medical profession achieved consensus about the “right way” to pursue the death and dying process was in the 14^th century, concurrent with the Black Death plagues and the concomitant explosion in the number of deaths.   Theologians, philosophers, clergy, and caregivers codified a series of edicts and social mores into a coherent document termed ars moriendi, which in English translates to “the art of dying.” Thus, at that time, and for about the next two centuries, a common framework for death and dying was promulgated amongst professionals, laity, providers, patients, and families. In the views of this writer, contemporary society could significantly benefit by returning to a contemporary ars to guide current death-and-dying ministry.

End-of-Life Care in the U.S.:  State of the Art

In contemporary society and medical practice, there is no consensus about ways to achieve a “holy” or “happy” death:

·       Some (Gawande, 2014) contend there is no way to control the end-of-life process: “I am leery of suggesting that endings are controllable”.

·       Others (Brescia, 2017) appear to foster confusion about the difference between hospice and palliative care, as well as when they should be initiated: “Hospice care is more associated more frequently with home care.”  “Palliative care requires continuous presence of doctors and staff”.

·       Still others argue that in contemporary times, “we are able to choose the rituals we perform with our dead, nor do we have to believe what our parents believed” (Order of the Good Death, 2018).

Which view is “right”?  Which is “wrong”?  Who decides?  Can consensus be reached?

My proposal:  An Ars with a Triple Goal

To clear the confusion and promote consensus, the author proposes a contemporary ars moriendi that promotes three primary goals:

·       Uniform naming, branding, and terminology regarding the terms “hospice” and “palliative care”;

·       Promotion of election of the appropriate end-of-life service early in the disease process;

·       Cost savings and improved utilization of medical services in the terminal phase.

Achieving these three goals will substantially improve the death and dying process for patients, families, providers, and society as a whole.

Implications for Health Administrators

I contend that a contemporary ars would impart significant benefits, including the following:

·       Better understanding of the dying process, better symptom control and a greater sense of community and support of all throughout the death and dying process;

·       With the demographics of an aging American population, society will need more efficient and standardized methods to manage the wave of dying older adults;

·       Any efforts that seek to reduce confusion (such as agreeing upon standard nomenclature) and contain costs (such as reducing futile high-cost curative efforts when death is imminent) will benefit the medical industry and society as well;

·       Ultimately, the death process may become more peaceful and “holier” for all if the triple aim of the contemporary ars is realized.

Limitations of this proposal:

The key limitation of this proposal is that it represents only the author’s perspectives. It is   not intended to be a definitive answer.  However, it is hoped that this work will advance the dialogue, generate additional discussion, and further refine and advance the goals proposed by the contemporary ars.

The author is hopeful that such discussions may generate even more new, novel ways of refining the death and dying process - ultimately improving the experience for patients, families, and providers.

Selected Resources/References

Berry, L., Castellani, R., & Stuart, B. (2016).  The branding of palliative care.  Journal of

Oncology Practice.  Doi:  10.1200/JOP.2015.008686.

Brescia, M. (2018).  The nature and treatment of human suffering.  Health Progress July-August

2018: 9-13.

Gawande, A. (2014). Being mortal:  Illness, medicine, and what matters in the end.  London,

England:  Wellcome Collection.

Order of the good death website (2018).  About.  Retrieved from

http://www.orderofthegooddeath.com/about