{'fraction_non_alphanumeric': 0.028425851434700992, 'fraction_numerical': 0.012603915258782515, 'mean_word_length': 5.48695652173913, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Billing for palliative consultations a prerequisite for the field's maturation.

Billing for palliative care consultations is an essential function of efficiently run palliative care programs. Despite the obvious advantages of being paid for our work, many practitioners have found the process difficult to master. The most successful programs have built effective working relationships and are in regular communication with their colleagues in billing and coding, leading to mutual education, enhanced efficiencies, and better income with fewer denials. Some Medicare intermediaries have denied payment because until now, Medicare had not recognized palliative medicine as an official specialty. This problem is resolved, thanks to the work of Judi Buckalew and the public policy committee of the American Academy of Hospice and Palliative Medicine. A new code designating hospice and palliative care as a recognized medical specialty (Table 1), is set for implementation on October 1, 2009, by the federal Centers for Medicare and Medicaid Services (CMS). Billing for palliative care is the same as for consultations by any other medical specialty. It requires a procedure=service code from the American Medical Association’s Current Procedural Terminology (CPT), usually for evaluation and management (E&M), and an International Classification of Diseases, 9 Revision (ICD-9) diagnosis code. Medical charges are based on location (inpatient=outpatient=home), and either complexity or time, with documentation needed to support the billing level. Palliative care providers must be careful to avoid using the same diagnosis (ICD-9) code as colleagues in the same specialty who may be seeing the patient and billing for their services on the same day. For example, an oncologist providing chemotherapy for lung cancer will use the diagnosis code for cancer, while a different oncologist providing a palliative medicine consultation may bill for a symptom, such as dyspnea. These concurrent visits can be paid, but only if the coding distinguishes the palliative care consultant’s service from the attending physician’s, typically by using a different ICD-9 code. (See Table 2 for additional modifiers that may be used on bills.) Since palliative care consultations typically require a significant time commitment, services also quantify their time spent in counseling, coordinating care, and informationgiving and bill accordingly, but with mixed success. Medicare intermediaries or carriers (now called Medicare Administrative Contractors or MACS) have varied in their acceptance of prolonged time codes. To ensure appropriate payment for prolonged services, it is critical for palliative care providers to understand the circumstances under which prolonged service codes (inpatient 99356 and 99357 and outpatient 99354 and 99355) may be used. Specifically, Medicare currently bases payment for prolonged services on CPT 2008, which requires that prolonged services must occur face-to-face with the patient. Hence, a family meeting held in a conference room in an intensive care unit (ICU), while the patient is intubated and sedated down the hall, does not qualify for prolonged service codes. When CMS adopts the new CPT 2009 guidelines, the rules will change to allow use of prolonged service codes for non– face-to-face services, including charting, speaking with other providers, meeting with families, and reviewing imaging and laboratory studies. Furthermore, use of prolonged service codes requires documentation of encounter onset and completion (e.g., 1:30 pm to 3:00 pm, 50% spent face-to-face with the patient in coordination and counseling). Other billing problems reported by palliative care practitioners include: