Volume 32 • Number 8 • August 2011
Database of perks, payments
Law will allow patients to see value,
nature of industry gifts to physicians
Prepare your practice
by Jessica Pupillo • Correspondent
Accepting gifts like coffee mugs, duffel bags and
notepads could place a physician’s name in a new public
database created by the Physician Payments Sunshine
provision of the Patient Protection and Affordable Care
Act of 2009.
The new law, which takes effect on Jan. 1, requires
manufacturers of medical products covered by Medicaid,
the Children’s Health Insurance Program or Medicare
to report direct payments and gifts of more than $10
to physicians or teaching hospitals. That includes knickknacks, stock options, research grants, consulting fees
and travel to medical-related conferences. If gifts valued
at less than $10 reach $100 annually, then all payments
must be disclosed. The law exempts items and samples
that benefit patients.
In addition to payment and gift information, drug
and device manufacturers also must report the recipient’s
name, specialty, address, National Provider Identifier
(NPI), nature and purpose of the gift, and any relation
to a particular drug, device, biological or supply. All of
this information, with the exception of NPI numbers,
will be made available to the public through an online
searchable database published by Sept. 30, 2013.
from the AAP Division of Health Care
Finance and Quality Improvement
Potential conflicts on display
See Industry gifts, page 8
Massive measles eradication effort
aims to cut disease in Mozambique
By now, you should be aware that as of Oct. 1,
2013, the International Classification of Diseases
will be updated from the 9th version clinical modification (ICD-9-CM) to the 10th version (ICD-
10-CM). That means you no longer should submit
ICD-9-CM codes for services provided on or after
Oct. 1, 2013, because the claims will be rejected
by your clearinghouse or payer.
Instead, the ICD-10-CM code set must be used.
According to the Centers for Medicare & Medicaid Services (CMS), no grace period will be
offered, and the Oct. 1, 2013, deadline is firm.
To ease the transition, it was recommended to
the ICD Coordination & Maintenance committee
to freeze both the I- 9 and I- 10 code sets. The committee agreed, and the last annual update to the I-
9 and I- 10 code sets will take place on Oct. 1, 2011.
On Oct. 1, 2012, there will be only limited updates
to ICD-9-CM and ICD- 10 code sets to capture
new technology and new diseases. On Oct. 1, 2013,
the same applies for the ICD-10-CM code set.
Another change already under way is the platform by which ICD-10-CM codes can be submitted electronically to carriers. Since the current
electronic version is not set up to handle the ICD-
10 code structure, CMS is implementing the 5010
transaction. See the July issue of AAP News for
details on this transition (http://aapnews.aappub
CMS officials are urging all practices to begin
their preparations as soon as possible. It is important
to develop a timeline for implementation. Resources
See Coding, page 9
In this issue
“Children everywhere smile,” said Margaret C. Fisher, M.D., FAAP, pictured here with two Mozambique boys who received measles vaccine, vitamin A and deworm- ing tablets during a massive immunization campaign. Dr. Fisher represented the Academy at the campaign’s launch. See page 9.
AAP News wins top
Whom do you want to lead pediatric issues in your district
and nationally? Voting begins Sept. 1. Find position statements about candidates for president-elect and district
chairpersons and the National Nominating Committee.