This blog posting is a call to arms and I am asking everyone that reads it to take action and help us!
Here is the story... it was decided on April 26th of 2010 that Medicare will, as of January of 2011, no longer cover Gastroparesis as a stand alone primary diagnosis, meaning that Idiopathic Gastroparesis will not be covered for reimbursement.
This comes from http://www.kslaw.com/Library/publication/HH042610_Rule.pdf on page 196 section 7 (a) which reads-
"Unacceptable Principal Diagnosis Edit: Addition of Code for Gastroparesis
It has been brought to our attention that code 536.3 (Gastroparesis) has a “code first underlying disease” note. This note indicates that code 536.3 should not be used as a principal diagnosis. Therefore, code 536.3 should have been included on the list of unacceptable principal diagnoses in the MCE. We agree that code 536.3 should have been included on the list of unacceptable principal diagnoses in the MCE. Therefore, for FY 2011, we intend to add code 536.3 to that list"
In layman's terms this means that Idiopathic Gastroparesis, or Gastroparesis that is not attributed to another disease and covered under that disease or condition's coding will not be covered as of January of 2011 under this ruling.
When searching through the medical coding index database I discovered that Gastroparesis has only one coding number (536.3) and no differential for an Idiopathic code. This means that the term is a blanket term and since the majority of Gastroparesis cases are of a known cause the fact that there is a Idiopathic Gastroparesis was overlooked or unknown to those that made this decision. I found examples of other conditions of Idiopathic nature that did have their own coding separate and listed as Idiopathic. (EX- Diagnosis code 356.8- specified Idiopathic peripheral neuropathy).
The very idea that Idiopathic Gastroparesis will not be covered by Medicare because of what may very well be ignorance of the numbers of patients who have no diagnosis beyond the Idiopathic nature is disturbing and needs to be brought to the attention of Medicare and the Department of Health and Human Services as well as our Representatives and Congressmen.
You can find the contact information for your representatives by clicking on www.senate.gov .
G-PACT, a non-profit organization that works hard for those with Gastric motility Disorders (their site is www.g-pact.org) has also gathered the following information for those who wish to help change this new ruling before the June 18, 2010 at 5pm deadline-
"In addition to senators and representatives, you may also contact CMS (Center for Medicare and Medicare Services) the following ways no LATER than June 18, 2010 at 5 PM EST:
ADDRESSES:
When commenting on issues presented in this proposed rule, please refer to file code CMS-1498-P.
Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.
You may submit comments in one of four ways (please choose only one of the ways listed):
1. Electronically. You may submit electronic comments on this regulation athttp://www.regulations.gov/. Follow the instructions for "Comment or Submission" and enter the file code CMS-1498-P to submit comments on this proposed rule.
2. By regular mail. You may mail written comments (one original and two copies) to the following address ONLY:
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-1498-P,
P.O. Box 8011,
Baltimore, MD 21244-1850.
3. By express or overnight mail.
You may send written comments (one original and two copies) to the following address ONLY:
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-1498-P,
Mail Stop C4-26-05,
7500 Security Boulevard,
Baltimore, MD 21244-1850.
4. By hand or courier.
If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) before the close of the comment period to either of the following address:
Room 445-G,
Hubert H. Humphrey Building,
200 Independence Avenue, SW,
Washington, DC 20201.
(Because access to the interior of the HHH Building is not readily available to persons without Federal Government identification, commenter's are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)"**
**The above quoted information was provided on Facebook and does not imply that G-PACT has endorsed this blog and are not to be held liable for any of my opinions or information that I provided If there is a typo or misinformation in my cutting and pasting or any of the information I have given it is on my part alone.
There is a reason why I am sharing all of this with you...
We need every voice we can get... every person that is willing to take a moment and write a letter or an e-mail to take just a moment and voice their concerns on this matter.
The Private Insurance Companies take their cue from the Government and will see this as a 'green light' to cease coverage of Idiopathic Gastroparesis leaving those of us with this diagnosis in harms way but more importantly at the moment there are people who are disabled due to the severity of their condition and on Medicare who are looking at a very bleak future if this oversight is not corrected.
It should be a very easy fix, simply changing the wording of the coding from "Gastroparesis" to "specific Idiopathic Gastroparesis" and recognising that it is a primary diagnosis on it's own and that there are people that never find any root cause for their condition. Simply because no root condition is ever found does not mean that these people do not suffer and need the proper medical care and supervision.
I hate to put pressure on this, but there is a timeline involved and only a short amount of time to do something to help fix this.
Every single voice matters... please join yours in the outcry to change this before it is too late.
Thank you
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