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AMA Announces Vaccine-specific CPT Codes

In preparation for when novel coronavirus (SARS-CoV-2) immunizations are approved for public use the American Medical Association (AMA) recently published an update to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes.  Working closely with the Centers for Disease Control and Prevention, the CPT Editorial Panel has approved a unique CPT code for each of two coronavirus vaccines as well as administration codes unique to each such vaccine. The new CPT codes clinically distinguish each coronavirus vaccine for better tracking, reporting and analysis that supports data-driven planning and allocation. Importantly, these CPT codes are available prior to the public availability of the vaccines to facilitate updating of health care electronic systems across the U.S.

“An effective national immunization program is key to bringing the coronavirus pandemic to an end,” said AMA President Susan R. Bailey, M.D. “Correlating each coronavirus vaccine with its own unique CPT code provides analytical advantages to help track, allocate and optimize resources as an immunization program ramps up in the United States.”

For quick reference, the new Category I CPT codes and long descriptors for the vaccine products are:

91300 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use

91301 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use

All the new vaccine-specific CPT codes will be available for use and effective upon each new coronavirus vaccine receiving Emergency Use Authorization or approval from the Food and Drug Administration. In addition to the long descriptors, short and medium descriptors for the new vaccine-specific CPT codes can be accessed on the AMA website, along with several other recent modifications to the CPT code set that have helped streamline the public health response to the SAR-CoV-2 virus and the COVID-19 disease.

Questions on CPT coding and content should be directed to the CPT Network, the authoritative source for CPT coding answers. Also, consult the AMA online library of COVID-19 CPT coding and guidance.

Nurses Association Addresses Hospital Closures

The Minnesota Nurses Association held a press conference in November to discuss both job losses and hospital services that will disappear with the shutdown of two St. Paul area hospitals. Hundreds of nurses’ jobs will be affected by the closure of MHealth Fairview’s Bethesda and St. Joseph’s hospitals.

 “To take away nurse positions and beds during a pandemic is foolish and just nonsense,” said MNA union president Mary C. Turner while describing how care for patients across the East Metro will drastically change over the next year to two years and what patients and their families will be forced to do for care moving forward. Kelly Wiler, a nurse who works in the COVID unit at St. Joseph’s Hospital, said, “My COVID unit is full and it’s been full for weeks...How can you close a hospital during a pandemic?”

MHealth Fairview has defended the closings due to financial concerns, claiming additional positions have been made available in other existing facilities and that similar actions have occurred nationwide.

The MNA has called on state officials to help find a solution that will allow at least emergency room services to continue at St. Joseph’s without interruption.  Both Allina and Regions Hospital have agreed that the closings will put an additional strain on care for patients in the area, especially in the midst of a pandemic.  With cases spiking, patients waiting hours for emergency room care or being diverted statewide, the discussion will be ongoing as to when and how to transition the critically needed space.

Essentia Health Develops Thyroid-based treatment for Critical COVID Patients

Two critically ill patients have recently benefited from an experimental thyroid hormone-based treatment designed to block lung failure and speed up recovery. Dr Tim Rich of Essentia Health Duluth and Dr David Ingbar of the University of Minnesota Medical School began research in 2009, during the H1N1 pandemic, also known as the ‘swine flu’ pandemic, when patients were dying of acute respiratory distress syndrome (ARDS). Autopsies of those patients found that many of the victims’ lungs had low levels of T3, a thyroid hormone that is typically easily detectable.  COVID19 creates similar respiratory distress where patients may lack the hormone T3, which reduces inflammation and plays a role in cells along the lining of the lungs absorbing fluids

The research team has recently received federal approval to proceed with a phase 2 trial of a therapy for very ill COVID patients. Two patients were given the experimental treatment, which had never been used before, and both responded positively beyond expectations. Beyond making full recoveries, both patients X-Rays showed no lung scarring and there was no need for supplemental oxygen. While impossible to rule out recovery due to other treatment, the results were very promising and plans are underway to recruit new trial participants.  The drug is administered directly to the lungs through a breathing tube, unlike other thyroid hormone therapies. It has the potential to be nebulized, and could be used for other ARDS related conditions.  The next step is to expand the trial size and plans are underway to recruit new participants.

Children’s Minnesota Launches Anti-vaping Campaign

Children’s Minnesota has recently launched a multimedia anti-vaping campaign, which includes a partnership with TikTok influencer Dr. Rose Marie Leslie, a family medicine resident. CHC is also creating a variety of educational materials including: a video series for inpatient teens, resources for parents to help guide conversations and specialized clinical content for health care professionals. Funding for the program came through donation from the grateful family of a patient who had been treated for vaping-related lung injuries at Children’s Minnesota in 2019. “While vaping has been marketed as safe, it is a dangerous habit that can have devastating consequences. Like COVID-19, we are still learning about vaping and its long-term effects on the body, but we know that it’s linked to lung conditions and worry it may increase the risk for more severe COVID-19 symptoms,” said Dr. Anne Griffiths, pediatric pulmonologist at Children’s Minnesota. “In the midst of the pandemic, we need to be more vigilant than ever about educating the public health risk that vaping poses.” According to the Minnesota Department of Health, e-cigarette use is increasing among students. Data from Minnesota student surveys show 8th grade e-cigarette use nearly doubled from 2016 to 2019, and one in four 11th graders now use e-cigarettes.

Report Addresses Pandemic-Related Drug Shortages

A recent report from the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota focused on the vulnerability of the U.S. drug supply chain to shortages of drugs and their active pharmaceutical ingredients, and especially those made in other countries, principally China and India. There are growing shortages in the U.S. and Europe for COVID-19-related drugs. Twenty-nine (73%) out of the 40 COVID-19 treatment drugs and 67 (43%) of the 156 critical acute drugs are in shortage status as the new case surge occurs. Drug production is further compromised with the growing case-related manufacturing shutdowns occurring in Italy and India. There is an urgent need for new, more effective policy with robust transparency to solve the persistent drug shortage issues plaguing the U.S. healthcare system.

“Ensuring a Resilient US Prescription Drug Supply” identifies the pressing issues facing the U.S. drug supply chain. It also proposes several recommendations, which if implemented, will provide a new national entity focused on better understanding the complex reasons for drug shortages and will establish a systematic approach for analyzing, predicting, preventing and mitigating drug shortages.

In the U.S., the lack of visibility into the upstream drug supply chain severely hampers the ability of the market and of policymakers to monitor and address drug quality issues. It also facilitates market conditions that lead to drug shortages. Additionally, a number of serious threats to the U.S. drug supply chain could precipitate a major shortage, intentionally or through natural causes, and such disruptions could lead to major healthcare consequences and costs.

“The urgency with the drug shortage supply issue is related directly to the major increase in COVID-19 cases that we will experience in the coming months,” said Michael Osterholm, PhD, MPH, CIDRAP director, and co-principal investigator of the Drug Supply Project.

Cancer Legal Care Announces ICARE Program

Cancer Legal Care, an advocacy organization for cancer patients, recently announced the formation of the Insurance Claim Advocacy REsolution Program (ICARE).  In the past year insurance denials for patients with cancer have increased by over 20%.  The new program provides claims review and potential remediation at no charge and without any income eligibility restrictions.  They provide expertise beyond what the existing care team may be able to offer at a time when patients and families are challenged financially, physically and emotionally.  An example from their pilot study for the program involved  the case of an 11-year-old boy recently diagnosed with Hodgkin’s lymphoma. His oncology team determined that a newer type of chemotherapy would provide optimal outcomes, including a reduced risk of permanent lung damage.  The insurance company denied the newer treatment leaving the family with at least $165,000 out of pocket cost. In review of the case, ICARE was able to craft a 53-page appeal, based on similar national cases, and within three days the insurance company reversed the denial and covered the optimal treatment.  Cancer Legal Care and ICARE are funded by donations and provide resources families dealing with cancer they may not otherwise have access to.   For example, average fees for a law firm to file the appeal would have cost well over $20,000 and may not have included the same national expertise with new therapies and the insurance coverage of cancer cases.

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Mayo Facing Patient Data Breach Lawsuits

Mayo recently revealed a former employee had improperly accessed the medical records of more than 1600 patients. So far, two lawsuits have been filed in Olmsted County District Court involving patients.  Both cases have been filed as class action complaints because of the large number of patients involved in the breach. More than 1,600 patients, including more than 1,000 from Minnesota, had their medical records examined by a former Mayo health care worker who had no right to look at them, according to the complaint. The lawsuits identify a former employee, believed to be a surgeon.

The filing seeks a class designation for all patients whose records were improperly examined. The suit asks to extend back two years in order to capture others whose information may have been compromised. It seeks compensatory damages in excess of $50,000 and the right to pursue punitive damages. It alleges a violation of the Minnesota Health Records Act, which forbids accessing a record locator or patient information service without authorization as well as a common law invasion of privacy and negligent infliction of emotional distress.  Mayo issued a statement in October that said the former employee may have viewed information about the name of the patient, demographic information, date of birth, medical record number, clinical notes, and in some cases images. Mayo does not comment on pending litigation. A case management conference is scheduled in December for both lawsuits.

Sanford and Intermountain Announce Merger

Intermountain Healthcare and Sanford Health have signed a letter of intent to develop a strategic partnership. Intermountain employs more than 41,000 caregivers and serves the health care needs of people primarily in Utah, Idaho, and Nevada. It is an integrated, not-for-profit health system headquartered in Salt Lake City, Utah, with 225 clinics, a medical group, 24 hospitals (one that is virtual), homecare, telehealth, health insurance plans, and other services.  Sanford Health is headquartered in Sioux Falls, South Dakota and the organization spans 24 states with 48,000 employees, 46 hospitals, 1,500 providers and 366 Good Samaritan Society senior care and living centers. The combined organization will employ more than 89,000 people, and operate 70 hospitals, many in rural communities. It will operate 435 clinics across seven states, provide senior care and services in 366 locations in 24 states, and insure 1.1 million people. The organization will have headquarters in Salt Lake City, Utah, and corporate offices in Sioux Falls, South Dakota.  The merger is expected to close in 2021 pending federal and state approvals.