CPT 2012 - AAPCstatic.aapc.com/5548A1AF-4C9F-49A2-BFE0-BFA7D... · CPT ® 2012 on the Horizon ® e....

Plus: OB • Burn Coding • Coding Evolution • Personal Injury • Sequencing Modifiers

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Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC

CPT® 2012 on the HorizonCPT® 2012 on the Horizon

Brochure Inside

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Coding Edge AD_RVGCrosswalk 09_2011_print.pdf 1 8/1/11 3:25 PM

www.aapc.com December 2011 3

[contents] 7 Letter from the Chairman and CEO

9 Letter from Member Leadership

10 Letters to the Editor

13 Coding News

In Every Issue

14 Deliver Coding Expertise for Maternal-fetal Medicine Specialist Services PamelaK.Kostantenaco,LPN,CPC,CMC

20 Account for Percentage and Depth when Coding Burns CharleneEndre-Burgett,MS-HCM,CMA,CPC,CPM-MCS,CMSCS

24 Establish Teaching Objectives JeanneYoder,CPC,CPC-I,RHIA,CCS-P

35 Get a Sneak Peek at CPT® 2012 RaemarieJimenez,CPC,CPMA,CPC-I,CANPC,CRHC

38 Better Record Keeping Drives Coding Evolution BarbaraFontaine,CPC

40 Medical Coding Wasn’t Always a Profession DeborahM.Pounder,RN-BSN,CPC,CCS-P,PCS

42 Invest in Yourself for 2012 StephanieCecchini,CPC,CEMC,CHISP

44 Code Obstetrical Care with Confidence KerinDraak,MS,RN,WHNP-BC,CPC,CEMC,COBGC

50 Attack Bogus Billing in Personal Injury Cases JeremyReimer,CPC

On the Cover: Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC, enjoys a day of sun, surf, and CPT® 2012 in Pompano Beach, Fla. Cover photo by Kelly West Photography (http://kellywestphotography.com).

Special Features

Education

Coming Up

Contents

December 201138

Online Test Yourself – Earn 1 CEUGo to: www.aapc.com/resources/ publications/coding-edge/archive.aspx

23 Quick Tip: Sequencing Modifiers

38 Coders’ Voices

42 Added Edge

44 ICD-10 Roadmap

50 Coding Compass

27 2012 AAPC National Conference

46 Newly Credentialed Members

20

• Tubal Sterilization

• Brain Death

• Code-o-lution

• OIG 2012 Work Plan

• Neuroendoscopy

Features

35

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4 AAPCCodingEdge

Volume 22 Number 12 December 1, 2011

CodingEdge(ISSN:1941-5036)ispublishedmonthlybyAAPC,2480South3850West,SuiteB.SaltLakeCity,Utah,84120,foritspaidmembers.PeriodicalpostagepaidattheSaltLakeCitymailingofficeandothers.POSTMASTER:Sendaddresschangesto:CodingEdgec/oAAPC,2480South3850West,SuiteB,SaltLakeCity,UT,84120.

Serving 111,000 Members – Including You!

December 2011

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x American Medical Association .......................5www.amabookstore.com

American Society of Anesthesiologists ..........2www.asahq.org/Shop-ASA

Coding Institute, LLC ............................. 11, 13www.SuperCoder.com

Coding Institute, LLC ................................... 43www.Audioeducator.com

CodingWebU .................................................26www.CodingWebU.com

Contexo Media ..............................................19www.contexomedia.com

HealthcareBusinessOffice, LLC ....................22www.HealthcareBusinessOffice.com

Ingenix is now OptumInsightTM, part of OptumTM ............................................17www.shopingenix.com

Leesburg Regional Medical Center and The Villages Health System ...................10www.cfhacareers.com

Medicare Learning Network® (MLN) ............49Official CMS Information for Medicare Fee-For-Service Providers http://www.cms.gov/MLNGenInfo

NAMAS/DoctorsManagement ................. 6, 52www.NAMAS-auditing.com

ZHealth Publishing, LLC ...............................51www.zhealthpublishing.com

Serving AAPC MembersThe membership of AAPC, and subsequently the readership of Coding Edge, is quite varied. To ensure we are providing education to each segment of our audience, in every issue we will publish at least one article on each of three levels: apprentice, professional and expert. The articles will be identified with a small bar denoting knowledge level:

Beginning coding with common technologies, basic anatomy and physiology, and using standard code guidelines and regulations.

More sophisticated issues including code sequencing, modifier use, and new technologies.

Advanced anatomy and physiology, procedures and disorders for which codes or official rules do not exist, appeals, and payer specific variables.

APPRENTICE

PROFESSIONAL

EXPERT

Chairman and CEOReedE.Pew

[email protected]

Vice President of Finance and Strategic PlanningKorbMatosich

[email protected]

Vice President of MarketingBevanErickson

[email protected]

Vice President of ICD-10 Education and TrainingRhondaBuckholtz,CPC,CPMA,CPC-I,CGSC,COBGC,CPEDC,CENTC

[email protected]

Directors, Pre-Certification Education and ExamsRaemarieJimenez,CPC,CPMA,CPC-I,CANPC,CRHC

[email protected],CPC,CPMA,CPC-I,CMRS

[email protected]

Director of Member ServicesDanielleMontgomery

[email protected]

Director of PublishingBradEricson,MPC,CPC,COSC

[email protected]

Managing EditorJohnVerhovshek,MA,CPC

[email protected]

Executive Editors MichelleA.Dick,BS ReneeDustman,BS [email protected] [email protected]

Production Artists TinaM.Smith,AAS ReneeDustman,BS [email protected] [email protected]

Advertising/Exhibiting Sales ManagerJamieZayach,BS

[email protected]

Addressallinquires,contributionsandchangeofaddressnoticesto:

Coding EdgePO Box 704004

Salt Lake City, UT 84170(800) 626-CODE (2633)

©2011AAPC,CodingEdge.Allrightsreserved.Reproductioninwholeorinpart,inanyform,withoutwrittenpermissionfromAAPCisprohibited.Contributionsarewelcome.CodingEdgeisapublicationformembersofAAPC.StatementsoffactoropinionaretheresponsibilityoftheauthorsaloneanddonotrepresentanopinionofAAPC,orsponsoringorganizations.Cur-rentProceduralTerminology(CPT®)iscopyright2010AmericanMedicalAssociation.AllRightsReserved.Nofeeschedules,basicunits,relativevaluesorrelatedlistingsareincludedinCPT®.TheAMAassumesnoliabilityforthedatacontainedherein.

CPC®,CPC-H®,CPC-P®,CPCOTM,CPMA®andCIRCC®areregisteredtrademarksofAAPC.

• CPT 2012 Professional Edition• ICD-9-CM Professional Edition for Physicians

Volumes 1 and 2 • HCPCS 2012 Level II Professional Edition• Principles of ICD-10-CM Coding • CPT Changes 2012: An Insider’s ViewItem #: OP131412EPJ List price: $463.75AAPC discount: $254.95

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Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81

D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2

Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81

PRINCIPLES of

ICD-10-CM CODING

Deborah J. Grider, CPC, CCS-P

D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 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E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81

PRINCIPLES of

ICD-10-CM CODING


D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 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A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81

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D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60

D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60

Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81

PRINCIPLES of

ICD-10-CM CODING


D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81

CODING


Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81

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Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2 D29.20 T79.6 T78.01 L81.8 K00.7 R10.827 G44.209 Z01.82 Z79.3 F19.90 E60 Q25.7 E70.29 Q64.11 M26.34 P92.6 R55 J67.0 D75.1 R14.3 Q85.8 F16.90 R45.81 Z55.0 F41.1 S01.439 D89.0 Z51.0 F48.8 A25.9 P22.0 H15.05 R09.89 E55.9 Q33.2


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2011 AccomplishmentsIn 2011, AAPC grew from 101,000 to 111,000 members. We added a compliance credential, Certified Professional Com-pliance Officer (CPCO™), and launched a sister company, AAPC Physician Servic-es. The number of local chapters grew from 460 to almost 490, and we began delivering two monthly e-newsletters: ICD-10 Connect and BillingInsider. We also trained more than 6,000 coders on ICD-10 implementa-tion. We will launch general code set train-ing in September 2012 and specialty code set training in January 2013.

Two Amazing ConferencesIn April, we held a great national conference in Long Beach, Calif. and in September, we hosted our largest ever regional conference in Nashville, Tenn. We thank those who presented and attended—it’s all of you who make these conferences awesome.I look forward to seeing all of you at the 2012 AAPC National Conference in Las Vegas.

Always Lowest Priced CodebooksFor the past 4 years, AAPC has worked hard to reduce the cost of your codebooks. Other vendors have noticed and are lowering their prices. We believe without our work, other vendors would still be charging high prices. We are proud to continue to offer the lowest cost code books and hope you will continue to support our efforts.

Stay Strong During Uncertain TimesThere has been a lot to be grateful for with-in AAPC this year, but there also is much uncertainty surrounding us. As you begin a new year, many of you will probably ask

yourself some of the following:• Did I/we successfully implement the

5010 standard for electronic claims filing?

• Will Medicare reimbursement rates actually be cut?

• Will the economy begin to come out of its slump?

• Will my home ever be worth more than I owe on it?

• Can I get a good paying job?• And even more serious for some:

When will our soldiers come home?

We feel all of these issues, if not within our-selves, then within our families or for our neighbors, friends, and coworkers. In addi-tion to our families, it is our coworkers who will help us face many of these issues—at work, in our local chapters, online, and at AAPC—as fellowship and support of our peers are two of the best features of AAPC membership. It is my hope and prayer that we can unite together for the common good of everyone and see more peace, more freedom from stress, more enjoyment with our families, and more time to smell a few roses along our paths.I wish each of you a Merry Christmas. May you and your families enjoy the holiday sea-son, and may you continue to march for-ward with the optimism that comes from being American, free and strong.

Your friend,

Reed E. Pew Chairman and CEO

There has been a

lot to be grateful

for within AAPC this

year, but there also

is much uncertainty

surrounding us.

Where Did the Year Go?LetterfromtheChairmanandCEO

We’ve come to the end of another year. I can’t believe it’s been nearly 12 years since Y2K, 10 years since 9/11, and five years since AAPC asked me

to lead the organization.

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As the holidays approach, I find my-self counting the days to Christmas like a child and looking forward to

time spent with family and friends. I also find myself wondering about the challeng-es and possibilities the new year may bring. The challenges I contemplate go beyond those usually brought on at this time of year: shoveling snow, driving on ice, bundling up in multiple layers to keep Jack Frost at bay, and driving to and from work in the dark.The challenges I speak of are those we all face in the next year as health care reform continues to progress. Instead of bemoan-ing that which I cannot change, I am deter-mined to view the coming challenges as an opportunity in disguise and I encourage ev-eryone to join me. If we look for future pos-sibilities and the prospect of growth and de-velopment in ourselves and in our careers, then we will fare well.Change is not new to health care. To illus-trate this, take a look at the entertaining re-cap of health care administration chang-es over the last 40 years in Barbara Fon-taine’s, CPC, article, “Better Record Keep-ing Drives Coding Evolution,” on page 38. For those of you who were in the middle of those changes, challenges, and occasional hot messes encountered during health care’s evolution, health care administration must seem light years beyond anything you could have imagined when you were completing claim forms on a typewriter.

Evolution ContinuesHealth care reform has created and will cre-ate many changes for coding and billing, making 2012 an excellent time to focus on growing your current skill sets. Over the next several months, become aware and fa-miliarize yourself with some of the changes coming down the pike. Learn about pend-ing and new legislation, such as the Afford-able Care Act, and new health care delivery

models, such as accountable care organiza-tions (ACOs).With the implementation of ICD-10 com-ing in 2013, everyone should spend 2012 preparing for the switch to the ICD-10-CM code set. Start by developing a better un-derstanding of anatomy and pathophysiol-ogy (A&P)—the key to using ICD-10 suc-cessfully. To that end, chapter officers should consid-er having a meeting or workshop focused on A&P. Members will also find an abundance of resources available on AAPC’s website designed to increase knowledge and under-standing of A&P, including online stud-ies and webinars. You can also look to your local college and national conference ses-sions if you need to brush up on your own specialty. This season, give yourself the invaluable gift of knowledge for 2012 and beyond.

Resolutions for the New YearNew Year’s resolutions typically include those for losing weight, quitting smoking, or spending more time with family. These and many others are excellent resolutions, but speaking from personal experience, they are usually short-lived. For the upcoming year, I propose we make a new resolution that is focused on advancing our skills and knowledge, and dedicated to helping our fellow AAPC members. A couple of ways we can reach out to other members include:

• Attending chapter meetings and networking with other members.

• Becoming a mentor. Reach out to new coders you work with; contact your chapter’s member development officer and offer your services; or contact a local career college or an AAPC certified instructor in your area and offer to mentor a recent graduate.

With the time of giving here, look to the new year with optimism, and focus on mak-ing 2012 a banner year.Wishing you happy holidays and blessings for this season and beyond.

Best Wishes,

Cynthia Stewart, CPC, CPMA, CPC-H, CPC-IPresident, National Advisory Board

Evolve with Health Care Reform

LetterfromMemberLeadership

10 AAPCCodingEdge

LetterstotheEditor Pleasesendyourletterstotheeditorto:[email protected]

Billing Separate Brain and Pituitary MRIs? Call PayersIn response to “Report MRI x 2 for Separate Brain, Pituitary Stud-ies” (October 2011, page 9), I would like to add that although Medi-care does not directly address the issue of separate magnetic reso-nance imaging (MRI) for pituitary imaging, it has addressed the similar issue of inner auditory canal (IAC) MRI with brain MRI.Medicare Monthly Review, Issue No. MMR 2010-10, “Article for Magnetic Resonance Imaging - Supplemental Instructions Article - A48016” states, “MRI IAC (inner auditory canal) should be billed using the appropriate CPT® code from the series 70551-70553. If MRI of the IAC is performed with MRI of the brain, it is consid-ered part of the procedure when done on the same day and cannot be paid separately.” Rodolfo P. Bangilan, CPC, CPC-HThank you for the additional information.

The Medicare Monthly Review article referenced (www.cgsmedicare.com/kyb/

pubs/Review_Archive/MMR201010.pdf) claims to base its recommendation on guidance provided in the American Medical Association’s (AMA’s) CPT® Assistant, March 2005. In response to a question about the appropriate code to report for an MRI of the internal auditory canals, “Coding Consul-tation: Question and Answers” indicates, “a code from the 70551-70553 series should be reported for an MRI of the internal auditory canals, as appropriate.” CPT® Assistant does not, however, state that IAC MRI is an inclusive component of brain MRI, as Medicare Monthly Review asserts.

As noted in the October 2011 Coding Edge, payers often will not recognize separate reporting for brain MRI and MRI of nearby structures, regard-less of AMA or specialty society recommendations. When in doubt about whether you should report the studies separately, as always, question your payer for details. CE

Correction: Medicare IOM Supercedes Carriers ManualRegarding “Document Shared Visits for Optimal Reimbursement” (September 2011, pages 36-37), the reference to the Medicare Car-riers Manual is incorrect. The manual is valid only for information that has not been moved to the Internet Only Manual (IOM). The current rule on split/shared evaluation and management (E/M) ser-vices is found in IOM Pub. 100-04, chapter 12, section 30.6.1.B (www.cms.gov/manuals/downloads/clm104c12.pdf).The specific instruction concerning the reporting of an E/M vis-it shared between a non-physician practitioner (NPP) and a physi-cian remain the same as those outlined in the article. Per the IOM:“In the office/clinic setting, when the physician performs the E/M service the service must be reported using the physician’s Unique Physician Identification Number (UPIN) or National Provider Identifier (NPI). When an E/M service is a shared/split encounter between a physician and a non-physician practitioner (NPP, such as a nurse practitioner, physician assistant, certified nurse specialist or certified nurse midwife), the service is considered to have been per-formed ‘incident to’ if the requirements for ‘incident to’ are met and

the patient is an established patient. Ifincident to” requirements are not met for the shared/split E/M service, the service must be billed under the NPP’s UPIN/PIN, and payment will be made at the ap-propriate physician fee schedule payment.When a hospital inpatient/hospital outpatient or emergency depart-ment E/M is shared between a physician and an NPP from the same group practice and the physician provides any face-to-face portion of the E/M encounter with the patient, the service may be billed un-der either the physician’s or the NPP’s UPIN/PIN number. How-ever, if there was no face-to-face encounter between the patient and the physician (e.g., even if the physician participated in the service by only reviewing the patient’s medical record) then the service may only be billed under the NPP’s UPIN/PIN. Payment will be made at the appropriate physician fee schedule rate based on the UPIN/PIN entered on the claim.” CE

Hernia MishapRegarding “Code Fat Albert’s Hernia Repair” (November 2011), I noticed on page 32 that CPT® 49586 is used for the repair. I believe this is a typographical error, since this code does not exist. Sandra Beazell, CPCSeveral readers noted this error. The correct code choice should've been

listed as 49585 Repair umbilical hernia, age 5 years or older; reducible. CE

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HCPCSReleaseCodeSets/ANHCPCS/list.asp) going into effect Jan. 1, 2012. Changes include 285 code additions (and one new modifier), 48 revisions, and 75 deletions. Another 18 codes were added and eight codes were deleted throughout 2011. Level II modifier PD Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days has been added to help hospitals identify those services that fall within the Medi-care “3-Day Payment Window.” The policy requires a hospi-tal to combine the charges and appropriate codes for any out-patient diagnostic and “related” non-diagnostic services (oth-er than ambulance and maintenance renal dialysis) provided within the three-day period immediately preceding an inpa-tient admission. Many C and Q codes have been deleted and replaced by new J codes. To name a few: C9272 has been replaced by J0897 In-jection, denosumab, 1 mg; Q2040 has been replaced by J0588

Injection, incobotulinumtoxin A, 1 unit; and Q2042 has been replaced by J1725 Injection, hydroxyprogesterone caproate, 1 mg. A handful of C codes have been added for 2012, including C9287 for the lymphoma drug brentuximab vedotin and C9366 for the membrane/skin allograft EpiFix.® There are fewer than a dozen new drug/supply Q codes for 2012. Among them: Q0162 for the antinausea drug ondansetron; Q2043 for sipuleucel-T, a therapeutic vaccine for prostate cancer; and nine new codes (Q4122-Q4130) for skin substitutes such as Dermacell,® Alloskin™ RT, and Talymed.™A series of E codes (E0988, E2358-E2359, and E2626-E2633) newly describe various accessories for manual and power wheelchairs. Four new K codes (K0743-K0746) have been added for home suction pumps and supplies for wound heal-ing (i.e., negative wound pressure therapy). G codes for telehealth consultations (G0425-G0427) have been revised to apply both to initial inpatient and emergency department services.The largest number of changes (209 additions, 27 revisions, and 28 deletions) affects those G codes used to report qual-ity indicators for the Physician Quality Reporting System (PQRS).

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ExpertFeature

By Pamela K. Kostantenaco, LPN, CPC, CMC

Deliver Coding Expertise for Maternal-fetal Medicine Specialist Services

Complicated pregnancies require optimal care with greater time and risk.Maternal-fetal medicine specialists’ practices receive patients by referral, most prominent-ly from obstetricians and gynecologists (OB/GYNs). Patients are generally limited to those with high-risk pregnancies and whose care requires advanced expertise and greater time and risk. Let’s review the ultrasound studies commonly performed by these specialists.

Scanning for Fetal Problems

Code 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and ma-ternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation is not a routine scan; it is for a known or suspected fetal anatomic or genetic ab-normality (i.e., previous anomalous fetus, abnormal scan this pregnancy, etc.). The perfor-mance of 76811 would be rare outside of referral practices with special expertise in the iden-tification of, and counseling about, fetal anomalies. Code 76811 describes the extensive fetal examinations that have become possible over the last decade, known as “level II,” “targeted,” “comprehensive,” or “genetic” scans. Some clin-ical indications that complicate pregnancy to perform this study are:

{{ Malaria{

{{ Infection{and{viral{diseases{

{{ Diabetes{mellitus{

{{ Drug{dependence{

{{ Congenital{cardiovascular{disorders{

{{ Twin{pregnancy{with{or{without{fetal{loss{and{retention{of{one{fetus{

{{ Triplet{pregnancy{with{or{without{fetal{loss{and{retention{of{one{or{more{fetus

{{ Quadruplet{pregnancy{with{or{without{fetal{loss{and{retention{of{one{or{more{fetus(es){

{{ Hydrocephalic{fetus{causing{disproportion{

{{ Other{fetal{abnormality{causing{disproportion,{

{{ Central{nervous{system{malformation{in{fetus{{

{{ Chromosomal{abnormality{in{fetus{

{{ Hereditary{disease{in{family{possibly{affecting{fetus{

{{ Suspected{damage{to{fetus{from{viral{disease{in{the{mother{

{{ Suspected{damage{to{fetus{from{other{disease{in{the{mother{

{{ Suspected{damage{to{fetus{from{drugs{

{{ Suspected{damage{to{fetus{from{radiation{

{{ Other{known{or{suspected{fetal{abnormality

{{ Unspecified{known{or{suspected{fetal{abnormality{affecting{management{of{mother{

{{ Rhesus{isoimmunization{

{{ Isoimmunization{from{other{and{unspecified{blood-group{incompatibility{

{{ Poor{fetal{growth

{{ Polyhydramnios{

{{ Oligohydramnios{

{{ Elderly{primigravida{

{{ Elderly{multigravida{

{{ Abnormality{in{fetal{heart{rate{or{rhythm,{Umbilical{cord{complications

{{ Some{payers{are{considering{adding{the{following{as{new{indications{for{this{study:{

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Feature

{{ Obesity{complicating{pregnancy,{childbirth,{or{the{puerperium,{

{{ Pregnancy{resulting{from{assisted{reproductive{technology

Now that we understand some clinical indi-cations for this study, let’s discuss the depth of the maternal and fetal anatomical evalu-ations. Components considered integral to 76811 are marked with an asterisk (*). Evaluation of Intracranial, Facial, and Spinal Anatomy:

{{ Lateral{ventricles*,{third{and{fourth{ventricles{

{{ Cerebellum*,{integrity{of{lobes*,{vermis*{

{{ Cavum{septum{pellucidum

{{ Cisterna{magna{measurement*{

{{ Nuchal{thickness{measurement{(15-20{weeks)*{

{{ Integrity{of{cranial{vault

{{ Examination{of{brain{parenchyma,{(e.g.,{for{calcifications)

{{ Ear{position,{size{

{{ Face{

{{ Upper{lip{integrity*{

{{ Palate*{

{{ Mandible{size

{{ Facial{profile*

{{ Orbital{sizes{and{separation{(e.g.,{hypertelorism,{hypotelorism){

Evaluation of the Chest: {{ Presence{of{masses*

{{ Pleural{effusion*{

{{ Integrity{of{both{sides{of{the{diaphragm*{

{{ Appearance{of{lung{parenchyma*

{{ Appearance{of{ribs{

Evaluation of the Heart: {{ Cardiac{location{and{axis*{

{{ Outflow{tracts*

{{ Echogenicity{

Evaluation of the Abdomen: {{ Bowel{echogenicity*

{{ Adrenal{glands

{{ Gallbladder{

{{ Liver{

{{ Spleen{

{{ Ascites*

{{ Masses{

{{ Calcifications{

Evaluation of Genitalia: {{ Gender{(whether{parents{wish{to{know{the{sex{of{child){

Evaluation of Limbs: {{ Number,{size,{and{architecture*

{{ Anatomy{and{position{of{hands*

{{ Anatomy{and{position{of{feet*

Evaluation of the Placenta and Cord: {{ Placental{cord{insertion{site*

{{ Placental{masses*{

{{ Umbilical{cord{(number{of{arteries){

Evaluation of Amniotic Fluid: {{ Semi-quantitative{evaluation{(amniotic{fluid{index){when{appropriate{

Evaluation of the maternal anatomy is a re-quired component for this study. If the ova-ries are not visualized, etc., there must be a notation in the ultrasound report to reflect this (e.g., “ovaries non-visualized due to late gestation”).

Nuchal Translucency Screening

Nuchal translucency screening (76813 Ul-trasound, pregnant uterus, real time with im-age documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first ges-tation) must be done between weeks 11 and 14; an accurate date of conception is impor-tant for an accurate result. (A recent study found that nuchal translucency scans done during week 11 were the most accurate be-cause the fold is most translucent then.)Nuchal translucency screening can be combined with blood tests for more de-

finitive results. For example, the first tri-mester blood test measures the free human chorionic gonadotropin (beta-hCG) hor-mone, pregnancy associated plasma protein A (PAPP-A). Low levels of PAPP-A early in pregnancy indicate increased risk of genet-ic abnormalities, heart problems, and pre-term birth. The results of these two blood tests plus the nuchal translucency screen-ing, known as the first trimester combined screening, can be combined into one num-ber that represents the likelihood of a genet-ic abnormality.Required components of the procedure are:

• Fetal viability• Crown-rump measurement• Nuchal thickness measurement

Example:{The ultrasound transducer is ori-ented until a mid-sagittal view of the embryo is obtained. The embryo is observed at high magnification until the embryonic neck is in a neutral position and spontaneous embryonic movement allows for differentiation between the outer edge of nuchal skin and the amnion. At least three separate measurements of the distance between the inner edges of the nuchal translucency are performed. The largest measurement from an acceptable image is compared to crown-rump length and gestation-al age-specific medians. A new risk of Down’s syndrome (trisomy 21) is calculated.

Doppler Umbilical Scanning

There are very few clinical indications to perform 76820 Doppler velocimetry, fetal; umbilical artery. Umbilical artery Doppler velocimetry is considered medically neces-sary in pregnancies complicated by intra-uterine growth restriction, oligohydram-nios, twin-to-twin transfusion syndrome (TTTS), and/or discordant fetuses. Dis-cordant fetal growth is common in multi-ple gestation, and usually is defined by a 15-25 percent reduction in the estimated fetal weight of the smaller fetus when compared

Umbilical artery Doppler velocimetry is considered medically necessary in pregnancies complicated by intra-uterine growth restriction, oligohydramnios, twin-to-twin

transfusion syndrome (TTTS), and/or discordant fetuses.

16 AAPCCodingEdge

Feature

with the largest. When used in this set-ting, accepted guidelines indicate that deci-sions regarding timing of delivery should be made using a combination of information from the Doppler ultrasonography and oth-er tests for fetal well being, along with care-ful monitoring of maternal status.

Example: The physician reviews the prena-tal records and reviews previous ultrasound reports and/or films. Next, a visualization is ob-tained of a segment of the umbilical cord, and a duplex Doppler sampling gate (the amount of sample volume) is placed over a portion of an umbilical artery most perpendicular to the axis of the gate. Gain and filters are adjusted to ensure adequate recording of diastolic flow. Two to four waveforms are recorded during the period when fetus is inactive and fetal breath-ing is absent. Electronic calipers are used to measure peak systolic and end diastolic frequency shift. One of several commonly used indices is then calculated.

The results of two to four waveforms are av-eraged, and comparison of specific normal values to gestational age is made.

Doppler Cerebral Artery Scanning

Middle cerebral artery (MCA) Doppler ve-locimetry (76821 Doppler velocimetry, fetal; middle cerebral artery) is considered medi-cally necessary for pregnancy complicated by either TTTS or suspected fetal anemia in conditions such as isoimmunization and parvovirus B-19 infection.A variety of fetal and maternal blood ves-

sels are evaluated by Doppler wave form analysis to assess the risk of adverse perina-tal outcome. The most commonly interro-gated vessels are the umbilical arteries. Um-bilical artery Doppler flow velocimetry has been adapted for use as a technique of fe-tal surveillance, based on the observation that flow velocity waveforms in the umbil-ical artery of normally growing fetuses dif-fer from those of growth-restricted fetuses. Abnormal flow velocity waveforms are cor-related histopathologically with small-ar-tery obliteration in placental tertiary villi and functionally with fetal hypoxia and ac-idosis, as well as with perinatal morbidity and mortality.

Example: The physician reviews the prenatal records and the previous ultrasound reports and/or films. A real-time ultrasound is per-formed to locate the fetal head. The anterior wing of the sphenoid bone is identified, as well. Color Flow Doppler is used to image the circle of Willis. A pulsed Doppler gate is placed over the middle cerebral artery near its origin from the circle of Willis, and transducer probe orien-tation or gate orientation is adjusted to ensure angle of insonance is close to zero degrees. Two to four measurements are then obtained and the highest velocity is recorded. A compari-son of peak systolic velocity is performed to published gestational age-specific norms. The patient is informed of the results. The results are then communicated, and recommendations made to the referring physician. The written

report is then prepared and signed.

Fetal Echocardiograms

Fetal echocardiogram 76825 Echocardiog-raphy, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording is a detailed eval-uation of cardiac structure and function. This is independent of the detailed fetal an-atomical evaluation previously described by 76811 Ultrasound, pregnant uterus, real time with image documentation, first trimester fe-tal nuchal translucency measurement, trans-abdominal or transvaginal approach; single or first gestation. Fetal echocardiography typi-cally involves a sequential, segmental analy-sis of three basic areas (atria, ventricles, and great arteries and their connections).The following cardiac images should be ob-tained during 76825:

• Four-chamber view• Left ventricular outflow tract• Right ventricular outflow tract• Three-vessel and trachea view• Short-axis views (“low” for ventricles

and “high” for outflow tracts)• Aortic arch• Ductal arch• Superior vena cava• Inferior vena cava

Maternal indications for 76825 include: • Autoimmune antibodies, anti-Ro

(SSA)/anti-La (SSB)

Middle cerebral artery (MCA) Doppler velocimetry is considered medically necessary for pregnancy complicated by either TTTS or suspected fetal anemia in conditions such as isoimmunization and parvovirus B-19 infection.

isto

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Pgi

am

CPT is a registered trademark of the American Medical Association. 11-26465 11110043 08/11 © 2011 Optum. All Rights Reserved.

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Feature

• Familial inherited disorders (e.g., Marfan syndrome)

• First-degree relative with congenital heart disease

• In-vitro fertilization• Metabolic disease (e.g., diabetes

mellitus and phenylketonuria)• Teratogen exposure (e.g., retinoids

and lithium)Fetal indications include:

• Abnormal cardiac screening examination

• Abnormal heart rate or rhythm• Fetal chromosomal anomaly• Extracardiac anomaly• Hydrops• Increased nuchal translucency• Monochorionic twins• Unexplained severe polyhydramnios

Doppler Echocardiography

This procedure, 76827 Doppler echocardiog-raphy, fetal, pulsed wave and/or continuous wave with spectral display; complete, can be reported with 76825 Echocardiography, fe-tal, cardiovascular system, real time with im-age documentation (2D), with or without M-mode recording when the clinical indications exist. Spectral, continuous wave, color, and/or power Doppler sonography can be used to evaluate the following structures for poten-tial flow or rhythm disturbances:

• Pulmonary veins• Foramen ovale• Atrioventricular valves• Atrial and ventricular septa• Aortic and pulmonary valves• Ductus arteriosus• Aortic arch

After any ultrasound study, post-service work includes:

• Preparing a comprehensive report for the medical record

• Discussing the findings with the patient and referring physician when appropriate

• Reviewing and signing the prepared report

Conveying normal ultrasound results to the patient is a component of the ultrasound charge. Counseling or any further discus-sion with the patient (if there are abnor-mal findings) and developing management/treatment plan options, are not considered a component of the ultrasound report, and can be reported separately with the appro-priate evaluation and management (E/M) code.

Example: Patient is sent for an ultrasound procedure. During the study, you identify a fetal cardiac anomaly. A discussion takes place with the patient and/or family members, explain-ing the cardiac anomaly, further radiological studies (fetal echocardiography, Doppler, etc.), recommendations to seek another professional opinion from a pediatric cardiologist, possible surgical options, etc. This type of discussion would not be considered a component of the ultrasound, and can be reported separately with the appropriate E/M code. Some payers may require you to attach modifier 25 Significant, separately identifiable evaluation and manage-ment service by the same physician on the same day of the procedure or other service to the E/M code.

Pamela K. Kostantenaco, LPN, CPC, CMC, is president of PKK Consulting and lead coder for the Society for Maternal-Fetal Medicine (SMFM) Coding Committee since its inception in 2001. She has been instrumental in develop-ing coding resource materials and has been keynote speaker for coding courses by SMFM.

She has more than 25 years of coding-related experience, spe-cializing in providing consultative services to clients in the OB and maternal-fetal medicine fields.

Maternal-fetal Medicine SpecialistsMaternal-fetal medicine specialists, also known as “perinatologists” or “high-risk OBs,” are OB/GYNs who receive two to three years of additional training, educa-tion, and practice experience to gain spe-cial competencies in various obstetrical, medical, and surgical complications of pregnancy. These competencies include:

• Intensive care in the area of complicated pregnancies

• Genetics• Obstetrical ultrasound• All of the procedures used in the

field of maternal-fetal medicine such asfetal surgery, complex ultrasound studies, percutaneous umbilical blood sampling, fetal intravascular transfusions, genetic procedures, etc.

The maternal-fetal medicine specialist provides education and research concern-ing the most recent approaches and treat-ments for obstetrical problems. The ma-ternal-fetal medicine specialist promotes and delivers the most optimal care for these complicated pregnancies.Maternal-fetal medicine specialists are complementary to OBs in providing con-sultations, co-management, or direct care for complicated patients, both before (pre-

conceptual counseling) and during pregnan-cy. The relationship be-tween the obstetrician and the maternal-fetal specialist will depend on the acuity of the con-dition and local circum-stance.

Conveying normal ultrasound results to the patient is a component of the ultrasound charge.

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20 AAPCCodingEdge

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By Charlene Endre-Burgett, MS-HCM, CMA, CPC, CPM-MCS, CMSCS

Account for Percentage and Depth when Coding Burns

How often does your practice see a patient with the common sunburn? Or, some-one whose burn resulted in a blister? Burn coding is often forgotten in the physician practice setting, which leaves money on the table. A review of types of burns com-monly seen in a physician practice, and some quick tips, will help you reclaim your rightful reimbursement.

Degrees of Burns (Depth of Burn)There are six degrees of burns. We’ll focus on first- and second-degree burns and cod-ing for a physician practice setting. A first-degree burn is a superficial burn of the outermost layer of skin, or epidermis. Examples include sunburn or being scalded with hot water from the sink. The skin turns red and there is no blistering. Although painful, the function of the skin is not compromised.A second-degree burn damages the second layer of skin, the dermis. These are “partial-thickness burns.” Typical causes include contact with a hot iron, chemicals, or boil-ing liquids. An initial sign of second-degree burn is blistering. Second-degree burns are the most painful, and there is an increased risk of infection compared to a first-de-gree burn. If the second-degree burn covers a large percentage of body area, emergen-cy care may be needed due to the patient’s risk of going into shock and need for fluids.Third- through sixth-degree burns are typically addressed in the hospital setting, and require fluids and extensive debridement, skin grafting or amputation; the latter two burn degrees are usually fatal, and are determined by autopsy.

Rule of Nines (Body Surface Area)Burns are categorized by percentage of body area. For example, “he has a second-de-gree burn over 30 percent of his body” is a common way to describe a burn. Percent-ages are determined using “The Rule of Nines,” and knowing this rule is essential for CPT® and ICD-9-CM coding of second-degree and higher burns.A baby’s body area is measured differently than an adult because its head and tor-so have more skin area than their appendages. A second-degree burn, even at a low-er percentage of skin area, presents a greater risk and requires more emergent care than for an adult with the same type of burn. Each area of the body has a percentage amount assigned, and all the percentage amounts added together equal 100 percent (see Rule of Nines illustrations for percentage breakdown).

CPT® Coding for First- and Second-degree BurnsTo determine a CPT® code for burn treatment, the medical record must document the degree of the burn and the percentage of body area affected. For second-degree burns, it’s important to document information on what is done during the visit be-cause burn coding can be used for a dressing change or debridement.

Professional

Get the proper reimbursement for burn treatment in the physician’s office.

istock.com©Microgen


Feature

Typical procedure codes include:16000 Initialtreatment,firstdegreeburn,whennomorethanlocal

treatmentisrequired

16020 Dressingsand/ordebridementofpartial-thicknessburns,initialorsubsequent;small(lessthan5%totalbodysurfacearea)

16025 Dressingsand/ordebridementofpartial-thicknessburns,initialorsubsequent;medium(eg,wholefaceorwholeextremity,or5%to10%oftotalbodysurfacearea)

16030 Dressingsand/ordebridementofpartial-thicknessburns,initialorsubsequent;large(eg,morethan1extremity,orgreaterthan10%oftotalbodysurfacearea)

CPT® code 16000 is for initial treatment only, whereas codes 16020, 16025, and 16030 are for initial and subsequent visits. CPT® does not specify a maximum number of subsequent visits; however, a specific health plan may have a maximum number.Note that 16020, 16025, and 16030 state “dressing and/or debride-ment.” It is appropriate to report these codes when patients are coming in specifically for dressing changes and the application of a burn prod-uct, such as Silvadene cream (silver sulfadiazine).Burn treatment codes can be used in addition to an office visit; howev-er, the office visit must be medically necessary and modifier 25 Signif-icant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service must be appended to the office visit. A separate, medically necessary office vis-it might occur, for instance, to prescribe medications such as antibiot-ics and pain medication.Coding example: A wheelchair-bound patient presents to the office after dropping a pot of boiling water onto her lap. Exam reveals sec-ond-degree burns on both upper legs—anterior and posterior—and on the genital area. Areas are dressed with Silvadene cream and ban-dages. Patient is told to return in three days for possible debridement, along with dressing change. Patient is prescribed medication for pain management.To calculate the percentage of area burned, total both upper legs for 18 percent (9 percent for the upper portion of each leg) and add an addi-tional 1 percent for the genital area. A total of 19 percent of body area is affected. CPT® code 16030 is appropriate in this example because these are par-tial thickness burns covering more than one extremity or 10 percent of

Rule of Nines

HeadandNeck9%

HeadandNeck18%

Trunk(Back)18%

Trunk(Back)18%

Trunk(Front)18%

Trunk(Front)18%

18%

9%

WholeLeg18%

WholeLeg14%

WholeArm9%

WholeArm9%

Perineum1%

9%

14%

22 AAPCCodingEdge

Feature

Code Sunburns with AccuracyIn most areas of the country, during the spring and summer months people tend to spend more time outdoors and often are unprepared for the sun’s radiation, resulting in the com-mon sunburn. Patients may present to the office complaining the pain is uncomfortable, or that they are concerned that it is “a lot worse than any sunburn they have ever expe-rienced.” Not much medical intervention is required for this type of visit, which typically is coded 16000 Initial treatment, first degree burn, when no more than local treatment is required.

Unless there is significant, separately identifiable management of the sunburn beyond local treatment, a separate E/M code is not appropriate. If the patient also wants to ad-dress an additional medical issue, an E/M code with modifier 25 appended and linked to an appropriate diagnosis for that issue is justified.

Sunburn is not classified to ICD-9-CM category 940-949; instead, solar radiation is coded with 692.71 Contact dermatitis and other eczema, due to solar radiation; sunburn and 692.76-692.77. If the “sunburn” is due to excessive time in a tanning bed, the proper diagnosis is 692.82 Dermatitis due to other radiation.

If the “sunburn” is due to excessive time in a tanning bed, the

proper diagnosis is 692.82 Dermatitis due to other radiation.

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Feature

body area. Depending on the provider’s documentation, an evalua-tion and management (E/M) code in the 9920x-9921x series is also appropriate when appended with modifier 25.

Diagnosis Coding for BurnsICD-9-CM codes for burns can be found in the “Injury and Poison-ing” section, specifically in the 940-949 range (except for sunburn: see the “Code Sunburns with Accuracy” infobox). Burn codes from 940-946 involve specific body areas, including multiple sites. For code 948 Burns classified according to extent of body surface in-volved, the ICD-9-CM codebook instructs, “This category is to be used when the site of the burn is unspecified, or with categories 940-947 when the site is specified.” The code requires a fifth digit if the burn is third degree; otherwise, use the appropriate four-digit code based on the percentage of burned body surface.The appropriate diagnosis codes for our example above, for instance, would be:

946.2 Blisters,epidermalloss[seconddegree]

948.1 Burnsclassifiedaccordingtoextentofbodysurfaceinvolved;10-19percentofbodysurface[afifthdigitisnotappropriateinthiscasebecausethisisnotathird-degreeburn]

E Codes Add PrecisionIn addition to the codes describing the type of burn and body area, a variety of E-codes may be called upon to describe how the injury oc-curred. For example, E958.1, E968.0, and E988.1 are burns due to fire. A burn caused by a hot liquid in an assault is coded to E968.3 Assault by hot liquid. Or, an accidental burn by hot liquid (as in our example) would be identified with E924.0 Accident caused by hot sub-stance or object, caustic or corrosive material, and steam; hot liquids and vapors, including steam.

Charlene Endre-Burgett, MS-HCM, CMA, CPC, CPM-MCS, CMSCS, has 26 years of health care office management experience, as well as 15 years of coding experience. She is the administrator for North Scottsdale Family Medicine in Scottsdale, Ariz.

CPT® does not specify a maximum level of subsequent visits;

however, a specific health plan may have a maximum level.

A Coding Edge reader wrote to ask, “When using modifiers for CPT® codes, do you list them on the claim by importance, or just place them either way on the claim?”

Although we weren’t able to find definitive rules from either the Centers for Medicare & Medicaid Services (CMS) or the American Medical As-sociation (AMA), payers generally agree that payment modifiers—those that directly affect reimbursement—should be sequenced first. Level I payment modifiers include:

26Professionalcomponent

50Bilateralsurgery

53Discontinuedprocedure

54Surgicalcareonly

55Postoperativemanagementonly

56Preoperativemanagementonly

62Twosurgeons

66Surgicalteam

78Returntooperatingroomforrelatedprocedureduringpost-opperiod

80Assistantsurgeon

81Minimumassistantsurgeon

82Assistantsurgeon(whenqualifiedresidentsurgeonnotavailable)

91Repeatclinicaldiagnosticlab,sameday

Informational or statistical modifiers (e.g., any modifier not classified as a payment modifier) are sequenced after payment modifiers, if multiple modifiers apply.

For example, a procedure defined as unilateral is performed on both sides of the body, so modifier 50 would apply. As well, the same physician performs the procedure during the global period of a previous procedure to which it is unrelated, so modifier 79 Unrelated procedure or service by the same physician during the postoperative period would apply. Because modifier 50 is a payment modifier, it would be sequenced first and modi-fier 79 (an informational modifier) would be sequenced after it.

If multiple informational/statistical modifiers apply, you may sequence them in any order (as long as they are sequenced after any payment modifiers).

In some cases, you may need to apply more modifiers than will fit in the claim form. In these circumstances, append modifier 99 Multiple modifiers first and list all other applicable modifiers (in proper sequence) elsewhere on the claim (e.g., box 19 on the CMS-1500 claim form), and indicate the CPT® code to which the modifiers append.

The above are general rules: Your payer may specify slightly different guidelines. As always, when in doubt, check your contracts or payer web-site, or contact your payer for advice (whenever possible, insist on getting advice in writing).

Sequencing Matters with Modifiers

Quick Tip

24 AAPCCodingEdge

Added Edge Apprentice

Establish Teaching ObjectivesSix steps will bring you closer to teaching success.

By Jeanne Yoder, CPC, CPC-I, RHIA, CCS-P

To teach coding, compliance, or any other topic success-fully, you must have objectives. Establishing objectives early helps you to develop direction, and to designate achievable goals for your students. When all the objectives have been met, your class is a success. Here is my step-by-step method for creating teaching objectives.

Step 1: Determine What Needs to Be Learned

Why are you having the class? Did a coding audit reveal that provid-ers need to learn the difference between coding a screening versus diagnostic colonoscopy? Or, perhaps you are trying to satisfy the an-nual continuing education requirements, and everyone expressed an interest in ICD-10-CM.As an example, let’s assume what is needed is a hands-on introduc-tion of ICD-10-CM.

Step 2: Identify Limiting FactorsThis isn’t a perfect world and you don’t have unlimited resources. Here are a few limitations to consider:

• Time: Do you have 45 minutes at a monthly “eat-and-learn” brown bag lunch with a lecture, or eight hours at the annual chapter educational conference?

• Student experience: Will this class be for anyone in the hospital who shows up, or for coders with a range of experience?

• Number of students: Will this be a face-to-face meeting with 12 students, or an AAPC annual audio conference for the new CPT®/HCPCS Level II codes, with more than 2,000 telephone lines?

• Materials: For instance: Will there be computers available for each student; handouts and a PowerPoint presentation; or, just a few code books to share?

Answers to the above questions could alter your teaching approach radically. For our example, let’s assume the resources are two hours of class time with 30 experienced coders as students. We have one ICD-10-CM book to share for every three students, and a large classroom with tables and a screen for presentations.

Step 3: Develop ObjectivesObjectives identify what you want students to be able to do, and al-low students to organize their thoughts and know what to expect. When the class is open for enrollment (e.g., anyone can attend), it is also helpful to list prerequisites or a minimum level of knowledge.When deciding on your objectives, keep in mind these points:Objectives need to be specific and measurable. Non-specific words include “be aware of,” “understand,” “be exposed to,” and “in-ternalize.” More specific words include, “identify,” “select,” “list,” “write,” “draw,” “solve,” “repair,” “construct,” and “assign.” Remem-ber: Objectives are used to demonstrate achievement. It is difficult


Added Edge

to demonstrate that someone “developed a sense of appreciation of the differences between ICD-9-CM and ICD-10-CM,” but you can measure if the student is able “to list seven important differences be-tween ICD-9-CM and ICD-10-CM.”Objectives need to be achievable. In two hours, even the most ex-perience coding students won’t be able to “leave with a firm, in-depth understanding of ICD-10-CM.” But, after a two-hour class, every-one could “list seven differences between ICD-9-CM and ICD-10-CM; and code sample encounters highlighting the major differenc-es between ICD-9-CM and ICD-10-CM.” Objectives need to demonstrate success. Rote learning isn’t enough. Students should be able to apply their learning. Focus on imparting knowledge, not just reciting information.Objectives need to be measured. This does not mean asking, “So, did everyone learn at least seven differences between ICD-9 and ICD-10?” Instead, students need to participate actively. For instance, each student must demonstrate that he or she knows seven differenc-es between ICD-9-CM and ICD-10-CM, and how those differenc-es will affect coding.Objectives do not identify the method of instruction. For in-stance, an objective would not be: “Using PowerPoint slides in a lec-ture format, teach about ICD-10-CM,” or “Discuss the benefits of ICD-10.” Objectives are not a course overview. For example: “Introduction to differences between diagnoses in ICD-9-CM and ICD-10-CM with special emphasis on the changes to trauma, obstetrics, physical therapy, and burns.” Rather, objectives need to state what the student will be able to do at the end of class, at what level of accuracy, and un-der what circumstances. The objectives for our example class could be stated as: “1. List sev-en of the most important differences between ICD-9-CM and ICD-10-CM (each student should pick the seven that are most important to him or her); and, 2. With at least 80 percent accuracy, code sam-ple encounters highlighting the major differences between ICD-9-CM and ICD-10-CM diagnoses.”

Step 4: Use Your Objectives to Plan the ClassFor instance, in the first hour of our example class, we could focus on our first objective (List seven of the most important differences between ICD-9-CM and ICD-10-CM.), and in the second hour we would focus on your second objective (With at least 80 percent ac-curacy, code sample encounters highlighting the major differences

between ICD-9-CM and ICD-10-CM diagnoses.).Encourage student participation (no more passive students with lim-ited retention). Tell students at the beginning of class that there will be questions based on the objectives. If a stated objective is “List sev-en major differences between ICD-9-CM and ICD-10-CM,” stu-dents will be listening for the differences. Coding sample encoun-ters with at least 80 percent accuracy, while highlighting the major differences between ICD-9-CM and ICD-10-CM, requires students to demonstrate their knowledge, and helps to dispel “I’ll never learn that” objections. Assigning students to work in groups (for instance, having three students share a code book) allows for teamwork and a diversity of viewpoints, which encourages success.

Step 5: Keep Objectives in Mind While TeachingWith our two sample objectives in mind, the class might break down like this:Hour 1: After covering a few ICD-9 vs. ICD-10 differences, ask students to take one minute to write a paragraph on how the differ-ences could be applied in their workplace. At the end of the first hour, have each student review the differences and pick the seven most im-portant to him or her. Ask students to circle those seven differenc-es and then hand in the sheet. During break, calculate which seven differences are most important to the class as a whole. After break, quickly go over this “Top Seven” list. Hour 2: Work through an example using the No. 1 difference with the entire class. Then, ask the groups to work through some ex-amples based on the top second and third differences. Come together to review the answers. Instruct each group to select and work on ex-amples in their specialties, and have the groups present their answers to the entire class. Review any examples that students found trou-blesome. By coding examples, students reinforce the first objective.

Step 6: After Class, Improve Your ObjectivesBy defining an achievable success in a measurable way, and obtaining student buy-in at the beginning of class, you and your students will achieve success. But there’s always room for improvement. Invite stu-dent feedback, and use it to hone your teaching skills.

Jeanne Yoder, CPC, CPC-I, RHIA, CCS-P, is retired from the U.S. Air Force and is now a contractor working for the TRICARE Management Activity. She pre-sented at the 2006-2009 AAPC national conferences. Her goal is to have quality data to help make quality decisions.

Assigning students to work in groups (for instance, having

three students share a code book) allows for teamwork

and a diversity of viewpoints, which encourages success.

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Greetings AAPC Members:

It gives me especially great pleasure to invite you to what will be our 20th national conference! Just a few short years after the official start of this organization we headed to the Bahamas for a cruise. There were few attendees at that first conference but they came with high hopes and expectations that this fledgling enterprise would help them further their careers as medical coders and lend much-needed credibility to this profession.

Today, our once-small band of conference attendees has grown exponentially. The 2012 conference will feature tracks in Coding, Audit and Compliance, Revenue Cycle Management/EMR, Outpatient Hospital Facility, and ICD-10, not to mention the ever-popular Anatomy Expo. Congratulations on all you’ve done to succeed in this industry – you are the ones who took the initiative and raised the standard of what this profession has become. Please join us for the updates and changes, as well as the overall wealth of information found at an AAPC Conference. Best regards,

Reed Pew Chairman & CEO of AAPC

Invitation from Reed Pew

Conference at a Glance

AAPC NATIONAL CONFERENCE APRIL 1-4, 2012

Special Early Bird Pricing Ends January 20, 2012

conference + Private Hotel PackageStarting at $1199 - ($1335 after January 20)

conference + Shared Hotel PackageStarting at $970 - ($1085 after January 20)

conference Only - $695 - ($795 after January 20)

conference datesFriday, March 30 to Sunday, april 1 – Pre-conference EventsSunday, april 1 to Wednesday, april 4 – National conference

registering for conference and Hotelyou can register online at www.aapc.com/lasvegas, submit the registration form at the back of this ad, or call aaPc’s conference department at 800-626-2633, option 4.

conference and Hotel informationrio Hotel and convention center3700 West Flamingo rd.las Vegas, Nevada 89013

For a detailed agenda by date and time or for more information visit our conference website at:www.aapc.com/lasvegas

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Welcome to Fabulous Las VegasVegas has something for everyone. cruise along the world famous Strip, enjoy a leisurely stroll down historic Fremont Street where you can view a dazzling light show that spans an entire city street, or plan ahead to enjoy one of the many popular Vegas attractions:

• Enjoy a concert or a Broadway-style attraction like cirque du Soleil, Phantom of the Opera, or Blue Man Group.• Escape the city and take in the natural beauty of lake Mead or enjoy a helicopter tour of the Grand canyon.• Treat yourself to a luxurious day at the spa or shop ‘til you drop at some of the world’s most famous designer boutiques.

regardless of how you choose to spend your spare time, we hope you enjoy the wide variety of options offered only in fabulous las Vegas. Have a great conference!

aaPc conference staff is doing everything they can to make this 20th conference the best yet. in addition to our numerous professional seminars and networking events, attendees can choose from the following additional events for a nominal fee. Visit the conference website at www.aapc.com/lasvegas for complete details.

• Hoover Dam Discovery Tour with photo opportunity of lake Mead & colorado river. ($70 includes box lunch) • Las Vegas City Night Life Tour includes fountains, volcanoes, dueling pirate ships, Fremont Street

Experience, and personal photo opportunity in front of world-famous “Welcome to las Vegas” sign. ($45) • Indian Country Grand Canyon West Rim Bus Tour includes transportation, breakfast, snack, lunch at

Grand canyon West, drive through Black canyon, Joshua Tree Forest, a stop at Hoover dam and more. ($150) additional $30 ($180 total) includes walk on the Skywalk, a unique glass floor bridge 4,000 feet above the floor of the Grand canyon.

Of course, Vegas is well known for its amazing array of casino games and slot machines. The rio all-Suite Hotel and casino is home to the World Series of Poker. So keep your head up, go all-in and hope for that kicker on the river because this year’s conference is going to be off the hook!

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A Day in the Life of a Radiation Oncology Coder –Lashelle Bolton, CPC, CPC-H, CPC-I

Advanced E/M – Jaci Johnson, CPC, CPC-H, CPMA, CPC-I, CEMC

Advanced Spine Surgery Documentation & Coding – Zoran Maric, MD

Breast Reconstructive Surgery—Physician to Coder – Govind Acharya, MD / Susah Ward, CPC, CPC-H, CPC-I, CEMC, CPCD, CPRC

Cardiology Coding in the Cath Lab – Terry Fletcher, CPC, CCC

Cardiothoracic – John Seccomb, MD

Coding Primary Care from a Provider Perspective – Stephen Spain, MD, CPC

Current Issues in Coding Ethics – Brad Hart, CPC, COBGC

Diagnostic Radiology – Caren Swartz, CPC, CPMA, CPC-I, CPC-H, CIC

Dissecting a General Surgery Operative Report – Lynn Pegram, CPC, CPC-I, CGSC

DME—Staying off the OIG Hit List – Barbara Fontaine, CPC

Documenting for HCC Codes – Lynn Myers, MD, CPC

Don’t Go Crazy! Mental Health Coding – Chandra Stephenson, CPC, CPC-H, CPMA, CPC-I, CANPC, CEMC, CFPC, CIMC, COSC/ Linda Hallstrom, CPC, CPMA, CPC-I, CEMC

E/M Observation and Critical Care in the ER – Lynn Severn, CPC, CPMA

ENT – Teri Gatchel, MBA, CPC

Excision Repair and Wound Care – JD Rosdeutscher, MD

Fractured Fairy Tales – Cynthia Everlith, CPC

GI Journey – Terry Fletcher, CPC, CCC

Got GYN? 2012 Updates – Glade Curtis, MD, MPH, FACOG, CPC, CPC-I, COBGC

Gray and Complex Areas of Anesthesia Billing – Judy Wilson, CPC, CPC-H, CPC-I, CANPC

ICD-9 for Medical Necessity – Lisa Phillips, CPC, CPC-I

Lab and Path Updates for 2012 – Corrie Alvarez, CPC, CPC-I, CEDC

Modifiers: How to Choose What to Use – Nancy Clark, CPC, CPC-I

Mysterious World of OB Ultrasound – Lori-Lynne Webb, CPC, COBGC

Nephrology – Debra Lawson, CPC

Neurology—Brains and Drains – Cyndi Stewart, CPC, CPC-H, CPMA, CPC-I

Neuro and Peripheral Interventional – David Zielske, MD, CPC-H, CIRCC, CCC

Non-Vascular Interventional Radiology – Pamela Fleming, CPC

Pacemakers and Defibrillators – David Dunn, MD, CPC-H, CIRCC, CCC

Pain Management – Deborah Farmer, CPC

Pediatric Perspectives – Kimberly Rosdeutscher, MD

PT/OT – Kim Cohee, PT, DPT, MS, OCS, MBA

Pulmonary/Respiratory – Manar Alshahouri, MD

Routine Preventive Services – Karrie May, CPC

Shoulder and Knee Surgical Procedures – Teri Gatchel, MBA, CPC

Spine Updates 2012: Are You Prepared? – Barbara Cataletto, MBA, CPC

Understanding Molecular Pathology – Corrie Alvarez, CPC, CPC-I, CEDC

Urology – Michael Ferragamo, MD

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CodingMedical coding has been the heart and soul of aaPc and its national conferences since the beginning. The coding lineup for our 2012 las Vegas conference is no exception. The following 38 sessions are dedicated to coding and coding specialties. General topics include icd-9, E/M, documentation, Modifiers, HcPcS, and coding Ethics. Specialty sessions include Gastroenterology, General Surgery, interventional techniques, and Neurology. This track will add the ‘guts’ to your conference schedule and address your current coding concerns and dilemmas.

General Sessions:Keynote - Reed Pew, CEO, AAPCPhysician/Coder Relationship and Documentation in ICD-10 - Rhonda

Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC / Joseph C. Nichols, MD

Advancing Your Coding Knowledge, Expertise and Career with Social Media - Darren Carter, MD

Other Exciting Topics include: Understanding PATH Guidelines - Amy McCreight, CPC, CPMA, CEMCOIG/RACs - Lillie Washington, CPCThe Sleepy Patient and Exhausted Biller - Jill Young, CPC, CEDC, CIMCMedicare Preventative Services - Behrokh Golshan, CPC ACOs - Annie Boynton, CPC, CPC-H, CPC-P, CPC-I / Cynthia Stewart, CPC,

CPC-H, CPMA, CPC-IRobotic Assist in the OR - Lori-Lynne Webb, CPC, COBGCUnderstanding Mid-Level Billing - Kate Tierney, CPC, CPC-P, CPMA,

CEMC, CGSC, COBGCDocumentation for a Compliant Encounter - Lynn Myers, MD, CPC Understanding Diabetes for ICD-9 and ICD-10 - Sheri Poe Benard, CPC,

CPC-H, CPC-P, CPC-I


4 54

aaPc Health care compliance sessions provide critical information needed to mitigate risk and comply with regulatory guidelines to prevent fraud and abuse by processes integrated within the revenue cycle. The compliance focus provides expert guidance on key issues that medical practices are facing today and includes an open forum for your specific questions.

Case Studies in Auditing – Peggy Stilley, CPC, CPMA, CPC-I, COBGCDeveloping an Effective Auditing Compliance Plan – Melody Irvine, CPC, CPMA, CPC-I, CEMC HIPAA Security – Christopher Parrella, JD, CHC, CPC, CPCOHIPAA- Privacy: Responding to Investigations – Michael Miscoe, Esq., CPC, CPCO, CASCC, CCPC, CUC Health and IT Compliance in Medical Practice – Stephanie Cecchini, CHISP, CPC, CEMC OSHA CLIA for Auditors and Coders – Ann Bachman, MT, CLC, CMPMSurgical Auditing – Shannon DeConda, CPC, CPMA, CPC-I, CEMC The Future of Compliance is Here: 2012—Are You Ready? – Jean Acevedo, CPC, CENTC

Audit & Compliance

Given the increasing financial and operational complexity of medical practices, aaPc is offering a focus on revenue cycle Management and Electronic Medical records (EMrs). These courses will help improve your practice’s bottom line by focusing on key revenue cycle functions and providing expertise to support your practice through all stages of an EMr system.

Revenue Cycle Management / EMR

Appeals and Collections – Jackie Stack, CPC, CPC-I, CEMC, CFPC, CIMC, CPEDCContract Negotiations 101 – Marcia Baruchler, MPH, CPC, CPC-H, CPC-I, CPHQEMR: Pearls and Perils – Bruce Rappoport, MD, CPCHow Payment of ICD-10 is Redefining RCM – Michael ArrigoSlippery Slopes of Electronic Health Record Systems – Maryann Palmeter, CPC, CENTCThe Cost of Alienating a Patient—Strategies to Increase Patient Pay Revenue – David Morrissey, CPBE, MDH, BA

What others are saying:“i was certainly in awe of how well everything ran and the professionalism of the aaPc conference staff and army of volunteers. amazing coordination and a great experience for all attendees.”

- Syd Stevens, cPc, cMic


w w w.aapc.com/lasvegas6 7

These sessions focus on the knowledge and skills for professionals working in outpatient hospital setting or ambulatory Surgical center. They are dedicated to providing information on the various issues of coding and reimbursement for outpatient facility services. if you are currently, or would some day like to become a cPc-H, this is the track for you.

Outpatient Hospital Facility

ASC Coding and Billing Fundamentals – Brenda Chidester-Palmer, CPC, CPC-I, CASCC, CEMCClinic Services – Catrena Smith, CPC, CCC, CCS-PCompliance for Hospital Outpatients – David Lane, Ph.D., CHC, CAPPMEffective Methods to Maximize Reimbursement – Raemarie Jimenez, CPC, CPC-I, CPMA, CANPC, CRHCICD-10-PCS – Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDCEliminating Infusion Confusion – Maryann Palmeter, CPC, CENTC/ Rita Genovese, CPCSurgical Reimbursement Methodology – Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHCKey Performance Indicators: Moving from Data Collection to Improved Patient Care – Melissa Brown, CPC, CPC-I, CFPC

ICD-10 This year aaPc will offer five sessions for icd-10 education. concentrating on the knowledge and the skills necessary for a successful implementation of icd-10, this group includes a session on icd-10-PcS as well. Together, these sessions provide information on revenue cycle, health care reform, and the emphasis icd-10 places on anatomy and pathophysiology.

icd-1O implementation Pre-conference Boot camp ($695)aaPc curriculum covers a broad range of topics to prepare coders, billers, practice managers, and physicians for the upcoming changes. This 2-day camp includes:

• Where to Begin – Organizing the implementation Effort• introduction to icd-10 coding – crosswalks and Mapping• Hands-on coding Exercises and documentation case Studies• Templates, Tools, resources, course Manual and icd-10-cM Book

Anatomy and Physiology for ICD-10 – Katherine Abel, CPC, CPMA, CPC-IHow Payment of ICD-10 is Redefining RCM – Michael ArrigoICD-10-PCS – Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDCManagement Strategies for a Successful ICD-10 Transition – Kim Reid, CPC, CPMA, CPC-IPhysician/Coder Relationship and Documentation in ICD-10 – Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC / Joseph C. Nichols, MDPayer Checkpoint: ICD-10 – Angela Boynton, CPC, CPC-H, CPC-P, CPC-I



What others are saying:“Had a great time at the national conference. Great speakers, great education and great networking! i meet someone new every year at conference that i continue to stay in contact with. Thanks to all of you for putting on another fabulous conference!”

- Joanne Wolf, cPc, rHiT, Minneapolis

6 7

Anatomy Expocelebrate the wonders of human anatomy at our very popular aaPc anatomy Expo. This fast-paced event offers an in-depth look into the complex machine we call the human body. doctors from a variety of specialties will use anatomical models, devices, and videos to provide an insider’s look at the anatomic and physiologic nuances of the human body. Novice and expert will find this session fun, informative, and exhilarating.

Pre-Conference Events (Optional)

Friday, March 30ICD-10 Implementation 2-Day Boot Camp ($695) - See previous page for course description.

CPC-H® 1-Day Boot Camp ($599 Includes Free CPC-H® Exam) - This intense course teaches fundamental coding skills and payment methodologies needed to work in an outpatient hospital/facility setting. attendees will be prepared to take aaPc’s cPc-H® exam. course covers facility departments and guidelines, correct application of cPT®, HcPcS level ii procedure and supply codes, and icd-9-cM diagnosis codes. if you already have your cPc®, this boot camp is a great tool to learn and earn your cPc-H® in just 8 hours.

Saturday, March 31AAPC Examinations: Core - $300, CIRCC® - $400, Specialty - $245, CPCOTM and CPMA® - $325all aaPc exams are administered at the 2012 las Vegas conference.

Teach the Teacher Course ($195) - This workshop provides certified instructors with tools to improve their teaching and communication skills. Workshop is divided into segments including a hands-on anatomy section and successful instruction of evaluation and management for certification and career. Great opportunity to network with other instructors. Earn 8 cTUs or 8 cEUs for participation in this workshop.

CEUSEarn up to 18 cEUs for attending all educational sessions at conference. This conference is approved for 21.6 cEUs by the california Board of registered Nurses. Some sessions at this conference qualify for specialty cEUs. you may choose to use those sessions for either your core credential or towards your specialty credential, but not both. Sessions eligible for specialty cEU credit are listed online at www.aapc.com/lasvegas.

Networkingattendees generally rank the ability to network and meet like-minded individuals as one of the main benefits of conference attendance. Member networking is a key focus for this year’s conference. in addition to the “Get to Know your local chapter” session and member luncheon, first time conference attendees will benefit from mingling with experienced veterans from all arenas of the coding world.

w w w.aapc.com/lasvegas

Payment information charge $ _______________

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company check/Money Order Enclosed for $ ______________

Conference only:AAPC Member Registration $695 Early Bird (until January 20) $795 Regular

Non-member Registration $995 Early Bird (until January 20) $1095 Regular

Register at www.aapc/lasvegasor Complete and Submit this Form2012 AAPC LAS VEGAS NATIONAL CONFERENCE REGISTRATION FORM

Conference Cancellation Policy: if written notice of cancellation is received by March 9, 2012, a refund (less a $50 cancellation fee) will be given, but only in cases of extreme emergency. No refunds will be given for cancellations requested after March 9, 2012. refunds will not be given for “no shows.”

Hotel Cancellation Policy: all cancellations must be made at least 7 days prior to arrival date. cancellations made less than 7 days prior to arrival will be charged a fee. refunds will not be given for “no shows.”

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ICD-10 Boot Camp $695 March 30-31 (Two Full days) | 8 a.m.-5 p.m. | 16 cEUs

CPC-H Boot Camp $499 Members (includes Free Exam)

March 30 | 8 a.m.-4:30 p.m. | 8 cEUs

Teach the Teacher Workshop $195 (aaPc Members Only)March 31 | 8 a.m.-4:30 p.m. | 8 cTUs/8 cEUs

AAPC Certification Exams (All exams available) March 31 | 8 a.m.-1:40 p.m. | $300 for core exams (Specialty exams are $245; circc® exam is $400, cPMa® and cPcO™ are $325)

cPc® cPc-H® cPc-P® circc® cPMa® cPcO™ Specialty Exam: ________________

PRE-CONFERENCE EVENTS

Make company check payable to aaPc and send to:AAPC Attn: Conference Department2480 South 3850 West, Suite B, Salt Lake City, UT 84120

Rio Members Non-membersPrivate room: $1,199 $1,499Shared room: $970 (per attendee) Sharing with: _________________

Room Requests Two Queen Beds One King Bed

Number of persons staying in hotel room ______________

(additional fee of $30/person/night for more than two occupants)

Conference and Hotel Packages:The following packages include conference registrationand three nights (check in Sunday, april 1, check out Thursday, april 4). The pricing below increases after January 20, 2012. The shared room package is for two attendees purchasing that option and sharing a room together.

Additional Hotel Nights - $180 per night Number of Nights: _______ x $180

TOTAL $ __________________ arrival date ___________________ departure date ____________________ check-in Time 4:00 pm check-out Time 11:00 am


By Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC

Cover Story

Get a Sneak Peek at CPT® 2012Whether it’s new modifiers, E/M, radiology, or Category II codes, we have the outlook for what’s on the horizon.CPT® 2012 arrives with over 500 code changes, plus minor additions to the Evaluation and Management Services Guidelines. The revised evaluation and management (E/M) guidelines clarify the “three-year rule” for new versus established patients, stressing “A new patient … has not received any professional services from the physician or another physician of the exact same specialty and sub-specialty who belongs to the same group practice, within the past three years” [emphasis added]. In this context, CPT® 2012 defines “profes-sional services” to mean any face-to-face service “rendered by a phy-sician and reported by a specific CPT® code(s).” To help determine a patient’s status easily, CPT 2012® re-establishes the “Decision Tree for New vs. Established Patient” that was includ-ed in CPT® 2010, but left out in 2011.

ModifiersThe “Instructions for Use of the CPT Codebook” are unchanged, as are the Anesthesia, Surgery, and Medicine sections guidelines. Ap-pendix A adds two modifiers not found on the inside front cover of the book, however.Modifier 33 Preventive services has been effective since Jan. 1, 2011, but appears in CPT® for the first time. Append this modifier when reporting preventive services delivered “in accordance with a US Preventive Services Task Force A or B rating in effect” and “other preventive services identified in [legislative or regulatory] preven-tive services mandates.” Examples include the Medicare initial pre-ventive physical exam (G0402) and annual wellness visits (G0438 and G0439). Do not apply modifier 33 for separately reported services specifical-ly identified as preventive (such as screening mammography, 77057; screening colonoscopy, G0105 or G0121; or prostate screening with PSA, G0103). If the physician converts a screening colonoscopy to a diagnostic colonoscopy (e.g., 45385), you should instead append modifier PT Colorectal screening test converted to diagnostic test or oth-er procedure to the diagnostic colonoscopy code to indicate the pro-cedure began as a preventive service.Append modifier 92 Alternative laboratory platform testing when:

• A laboratory test is performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable, analytical chamber;

• the test does not require permanent dedicated space; and,• the test is designed to be carried or transported to the vicinity

of the patient for immediate testing at that site.For Medicare payers, modifier 92 indicates point-of-service HIV testing (86701-86703 and 87389) only. Per Centers for Medicare & Medicaid Services (CMS) transmittal 2277 (www.cms.gov/transmittals/

downloads/R2277CP.pdf), modifier 92 is effective Oct. 1, 2011 for this purpose. Modifier 92 was introduced in CPT® 2008, and Medicare will allow you to apply the modifier retroactively to claims filed on or since Jan. 1, 2008.

EvenMs.Jimenez’scat,Caesar,wasinterestedinthisyear’sCPT®changes.

36 AAPCCodingEdge

Cover Story

Category I ChangesThe majority of changes to CPT 2012® involve Category I codes, to include over 200 new codes, more than 180 deleted codes, and more than 130 revisions. Only the Anesthesia (00100-01999) and Sur-gery: Urinary System (50010-53899) portions of CPT® were un-touched this year.

Evaluation and ManagementE/M changes include the addition of “reference times” to Initial Ob-servation Care codes 99218, 99219, and 99220. For example, the de-scriptor for 99220 now specifies, “Physicians typically spend 70 min-utes at the bedside and on the patient’s hospital floor or unit.” The new language allows physicians to report the initial observation care codes using time as the key component, when counseling or coordi-nation of care dominates the encounter.Prolonged Services codes 99354-99355 (office or outpatient) and 99356-99357 (inpatient or observation) gain instructions stating these codes may be used by physicians or other qualified health care professionals. These add-on services specifically include total face-to-face time with the patient, as well as non face-to-face services on the patient’s floor or hospital/nursing facility unit during the same session. The time does not have to be continuous, but only a single prolonged service code may be reported per day.Prolonged services without direct patient contact (99358-99359) also gain guidelines, clarifying that these add-on services may be provided on a different date than the related, primary service (which must have been face-to-face, but need not have a reference time). Added guidelines now precede the Inpatient Neonatal and Pediatric Critical Care (99468-99476) and Initial and Continuing Intensive Care Services (99477-99480) codes to define more precisely the ser-vices included and how the codes are applied.

IntegumentaryThe big news in the Integumentary section is a near complete over-haul of the skin replacement/skin substitute codes. Many codes in the 15300-15431 range have been deleted, replaced by fewer (and much simplified) codes, such as 15271 Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area and +15272 … each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure). The replacement codes (15271-+15278) do not include supply of the graft, which may be reported separately. Add-on code 15777 Implantation of biologic implant (eg, acellular der-mal matrix) for soft tissue reinforcement (eg, breast, trunk) (List sepa-rately in addition to code for primary procedure) has been established to describe biologic implant for soft tissue reinforcement. Many oth-er integumentary code descriptors include minor revisions.

MusculoskeletalChanges to musculoskeletal codes involve mainly descriptor revi-sions, either to clarify the intent of the service or to describe bun-dled services. For example, descriptors for percutaneous vertebro-plasty (22520-22522) specifically identify bone biopsy as an includ-ed service when performed. A number of injection procedures (e.g., 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when per-formed)) now clearly include image guidance.Two new codes (22633 and 22634) describe arthrodesis via com-bined posterior and posterolateral technique with posterior inter-body technique.

Respiratory SystemCodes describing thoracotomy and other procedures of the lung and pleura undergo significant changes, to include nearly a full page of new instructions and added parenthetical notes. Every “removal of lung” code (32440-32491) has been revised. There are six new codes for thoracotomy (32096-32098, with biopsy; and 32505-+32507, with wedge resection), and an entirely new category (32601-32674) has been established for video-assisted thoracic surgery (VATS), which includes a dozen new codes.

CardiovascularPacemaker or Pacing Cardioverter-Defibrillator codes (33202-33249) have undergone frequent revisions in the past few years, and 2012 is no exception. There’s an additional page of instructions for code application, as well as a quick reference chart to help with code selection for the insertion, removal, etc. of a pulse generator and its various components. Over a dozen codes in this section have been revised, with nine codes added.Combination codes were added to report renal catheterization and angiography (36251-36254). The new codes include the radiologi-cal supervision and interpretation. Added instructions clarify that replacement of ventricular assist de-vice pump (33981-33983) includes removal of the new pump, as well as connection, de-airing, and initiation of the new pump.

DigestiveThere are relatively few changes to this section of CPT®. Several par-enthetical notes have been added to clarify code selection. For in-stance, a note added to the Stomach: Laparoscopy codes (43644-43659) instructs, “For laparoscopic implantation, revision or re-moval of gastric neurostimulator electrodes, lesser curvature [mor-bid obesity], use 43659.” Three new codes (49082-49084) describing abdominal paracentesis replace deleted codes 49080 and 49081. Liv-er biopsy (47000) now includes moderate sedation, when provided.

CPT® 2012 re-establishes the “Decision Tree for New vs. Established

Patient” that was included in CPT® 2010, but left out in 2011.


Cover Story

Genital SystemsThere are no changes in the Surgery/Male Genital System portion of CPT®. The Surgery/Female Genital System codes also are un-changed, but several parenthetical notes have been added through-out the section. Among these is instruction to report 11981 for in-sertion of a non-biodegradable contraception implant, and 11976-11981 for removal with subsequent insertion.

Nervous SystemCodes 64622-64627 have been deleted, replaced by 64633-64636 for destruction of paravertebral facet joint by neurolytic agent. The new codes specify location (cervical or thoracic and lumbar or sacral) and the number of joints injected (single and each additional). Many additional code descriptors have undergone revision to better spec-ify the intent or application of the code. For example, the term “ar-ray” was added to implantation of neurostimulator code (64553-64565 and 64575-64585) descriptors to clarify that the codes are applied per array, not per individual electrode (an array may contain several electrodes). New parenthetical notes and instructions appear throughout the section.

Eye/Ocular Adnexa and Auditory SystemThese sections include only minor changes, including new paren-thetical instructions (e.g., “For fitting of contact lens for treatment of disease, see 92071, 92072”) and the deletion of 69802 Labyrin-thotomy, with perfusion of vestibuloactive drug(s); with mastoidectomy.

RadiologyOf the many changes to the Radiology section, the most significant include the creation of new codes to report intra-operative radiation treatment delivery (77424, 77425) and intra-operative radiation treatment management (77469). New instructions specify that ra-diation treatment management is reported in units of five fractions or treatment sessions, regardless of the actual time period in which the services are furnished.Atherectomy codes 75992-75996 have been deleted and replaced with other codes. For instance, in 2012, in place of 75995, use Cate-gory III code 0235T Transluminal peripheral atherectomy, open or per-cutaneous, including radiological supervision and interpretation; viscer-al artery (except renal), each vessel.

Path and LabCPT® 2012 establishes an entirely new section for molecular pathol-ogy, including two full pages of instruction and dozens of new codes for Tier 1 (81200-81383) and Tier 2 (81400-81408) molecular pa-thology procedures. Molecular pathology procedures involve analy-ses of nucleic acid to detect variants in genes that may be indicative of germline or somatic conditions, or to test for histocompatibility anti-gens. Code selection is based on the specific gene analyzed.

Parenthetical notes now accompany HIV-1 and HIV-2 testing code 86703 (single result) to clarify proper coding for alternative testing, such as HIV-1 antigens(s) with HIV-1 and HIV-2 antibodies (87389), and when to ap-ply modifier 92 with 86701-86703 and 87389.

MedicineDescriptor revisions clarify immunization coding (90460, +90461) by vaccine component, rather than per injection. Esophageal motil-ity studies will no longer be reported with 91011 or 91012; instead, you will use revised codes 91010 (for motility study) and +91013 (an add-on code for stimulation or perfusion). Code 92070 is deleted and replaced by two new codes (92071 and 92072) for contact lens fitting to treat ocular surface disease or to manage keratoconus, re-spectively. A full page of instructions has been added for sleep medicine test-ing, and new codes have been added to report needle electromyog-raphy, per extremity (95885, limited; and 95886, complete) or non extremity (95887). Hydration codes (96360 and +93631) also come with significant additional instructions in 2012, to better explain the meaning of “initial infusion,” “sequential infusion,” and “con-current infusion.”

Category III CodesOver 30 new Category III codes have been added to CPT® 2012, including those for intramuscular autologous bone marrow cell therapy (0263T-0265T), percutaneous laminotomy/laminectomy (0274T, 0275T), corneal incision (0289T, 0290T), and more. Cat-egory III codes describe emerging technologies and, unlike Catego-ry I “unlisted procedure” codes, allow for tracking and collection of specific data. If a Category III code is available, it must be reported instead of a Category I unlisted procedure code.Look for more: We’ll be covering specific information on individu-al CPT® code changes in upcoming issues of Coding Edge.

Are{you{ready{for{2012?{Order{your{2012{codebooks{today!{See{page{8{for{purchasing{information.

Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC, is AAPC director of education, and AAPC representative to the CPT® Editorial Panel.

Good weather, a good friend, and a good

codebook—what more does a girl need?

RaemarieJimenez,PompanoBeach

To discuss this article or topic, go to www.aapc.com

38 AAPCCodingEdge

Coders’ Voices

Better Record Keeping Drives Coding EvolutionStories from the beginning of coding show us the importance of today’s more efficient electronic era.

By Barbara Fontaine, CPC

Survival demands evolution, and such is the case with the coding. Medical coding has come a long way since paper records and micro-fiche. The expectation for better record keeping and the trend to-ward using electronic health records (EHRs) are the driving forc-es behind upcoming changes. To provide you with a better idea of how far our industry has come, read the following “old time” coding stories from seasoned coding experts. If you haven’t already, I think you’ll quickly realize that evolution is a good thing.

In the Beginning, There Was Paper, No Coding, and No Compliance“There was no coding, nor was there compliance. If the surgeon performed an appendectomy, we would just type ‘appendectomy’ on a claim form that had a piece of carbon between two sheets. The forms were typed up every day and the physician would sign each one. Then we mailed them out. Everything was documented on a handwritten ledger card. The providers charged according to what the carriers would pay. The idea was to not have any out-of-pocket expenses for those patients with insurance. Insurance was meant for catastrophic, mostly hospital services. There wasn’t obstetrics (OB) coverage unless a patient required a C-section (Patients would stay seven days in the hospital for that!). X-rays and labs had an annual di-agnostic benefit (for a good policy) of $50-100 per year.

“When I worked as a claims examiner at Blue Cross in the 1970s, we’d batch claims in groups of 20 and we’d first check a patient’s el-igibility via microfiche. If the patient was eligible for benefits, we’d calculate the benefits based on the patient’s plan. The group benefits were listed in large binders on our desks. We flipped through pages in the binder and ‘priced’ the line items. We’d then run a calculator tape on the amount that should be paid to the provider. Claims ex-aminers had a quota to handle 10 claims per hour. When each batch was complete, an auditor would take the batch and randomly pull two claims out to quality check (QC). The expectation was a 90 per-cent accuracy rate. We had a saying in our group (amazing I still re-call this), ‘If in doubt … route.’ If we had a question about a test, procedure or diagnosis, we’d route it to someone in medical review, who’d likely ask for medical records. When we routed a claim, we’d get credit for it as part of our quota of 10 claims per hour.”Elizabeth Acquistapace, CPC

Handwritten Ledger Cards Were Stored Alphabetically in Metal Trays“I remember the days when we had to take a ream of paper down and cut it to the size of statements (about half the size of a normal sheet), and then stand at the copy machine with a cassette that would hold them while copying each patient statement from their ledger card for monthly billing. After getting all the statements printed, we then had to sort and place stickers on them, such as ‘past due’, ‘please call,’ etc. Because there was never enough time during the day to stuff the envelopes, we’d take them all home and stuff them for mailing. When we finally got a postage meter, we thought we were in heav-en because we could just run the statement envelopes through it and not have to lick each stamp.”Margie Scalley Vaught, CPC, CPC-H, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR

When Physicians Bought Personal Typewriters for Office Staff“Boy, those were the days! I remember sitting at my desk with a man-ual typewriter and a stack of continuous claim forms behind my typewriter. I typed out each individual form for a skilled nursing fa-cility (SNF) with Medicare A beds, and billed Medicare B supplies where possible. Make a mistake? Forget it and start over again, be-

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Coders’ Voices

cause trying to erase and correct mistakes just made a mess of the form and it wasn’t always legible.“The senior physician’s wife did the coding and billing in the office while I managed the other aspects of the practice. I’ll never forget the day she walked into my office, slammed the CPT®, ICD-9, and HCPCS Level II books and said, ‘I’m outta here! You’re the coder!’ This was before coding was considered a profession. There wasn’t certification, much less classes, workshops, or networks. I’m amazed I managed to learn what I did without any resources at all!”Linda Martien, CPC, CPC-H, CPC-I, CEDC

Do We Really Need a Book?“No one taught me to use the ICD-9 book and I couldn’t figure out why there was an alphabetic section and a numeric section. I thought, ‘How silly! How would anyone remember numbers to look up codes that way?’ I didn’t know the chapter guidelines were there until a few years after I had been coding. Gee, they really do tell you how to use the book!”Tracy Bird, CPC, CPMA, CEMC, CPC-I, FACMPE

Carbon Paper Days“When I started all of this, diagnosis codes were written out and we handwrote or typed the information on forms using carbon paper so we had a copy. I spent a lot of days with blue fingers. I remember hospital charts in those little metal boxes with the flip tops because those were thought to be more sanitary.”Donna Nugteren, CPC, CEMC

Finally, NCR Paper!“I remember working in the emergency room (ER) of a small, ru-ral hospital where our records were kept on a four-part, handwrit-ten form. The top layer was the original and the three copies beneath were on no-carbon required (NCR) paper: one copy for the patient’s personal physician, one for any specialist referred to, and a copy for the patient. We thought NCR paper was really wonderful because we finally didn’t have to deal with carbon paper. The only problem was that if you forgot and picked up one of the clip boards and used it to write a note, a shopping list, or a phone number; it came through on the bottom three copies. You would not believe how hard it was to read those copies. One time, a primary care provider’s (PCP) of-

fice called our ER doctor to find out what he meant by the diagno-sis BLTNM, only to find out it meant bacon lettuce and tomato, no mayonnaise—it was his lunch order.”Barbara Fontaine, CPC

The Beginning of the “Electronic” Era“My start began when IBM Selectric typewriters were used; I’m sure at the time they were cutting edge and quite costly. Today, when I Google ‘Selectric typewriter,’ I am directed to the Selectric Typewrit-er Museum. This shows just how far technology has come. Comput-ers were used to enter patient demographics, charges, and payments back in the early 1980s; calculators were used to run a tape of verifi-cation on the total of charges and payments entered. Appointment books were used for scheduling. Insurance claim forms (prehistor-ic HCFA-1500s) were generated on a giant printer and initialed by a staff member who represented the provider. Secondary claims would get an explanation of benefits (EOB) strip, hand-cut from a copy of the full page (to keep patient privacy). Overtime occurred when the end of the month rolled around. Statements were generated on that

From Paper to EHR, This Coder Knows the IndustryElizabeth{Acquistapace,{CPC, was honored as AAPC’s “Oldest Coder” at the 2011 National Conference Awards Luncheon in Long Beach, Calif. As she accepted recognition in front of over 2,000 people, she had a bright gleam in her eye. It’s been a memorable road, and in each position of her career she has em-braced new technology and has evolved with the industry.

Hard{Work{Goes{a{Long{WayWith three young children at the time, Acquistapace started working in a health care facility in 1949 as a PBX switchboard operator in a tuberculosis sanitarium. During the next decade, she worked as a medical assistant and transcriber in a single physician’s office. Three more children later, she worked at a hospital as a billing clerk. Next, she became a biller and transcriber for a four-physician medical group—not even her seventh child could slow her down! While in her 60s, she became an instructor in medical terminology, transcription, and billing. In her 70s, she tried out coding, and one day she wandered into her daughter, Corrie{Alvarez’s,{CPC,{CPC-I,{CEDC,{PMCC, class and eventually became a Certified Professional Coder (CPC®). As a coder she has reached out to coworkers, assisting them with their production and quality issues. Now in her 80s, she still enjoys working full time. She inspires everybody she meets with her strong work ethic and willingness to help others.

Acquistapaceatthebeginningofherhealthcarecareer.Acquistapacecontinuestowork,buttakestimeoutforfamilyandfun.

40 AAPCCodingEdge

To discuss this article or topic, go to www.aapc.comCoders’ Voices

Medical Coding Wasn’t Always a ProfessionAs procedural and diagnoses code sets and insurance evolve, so is medical coding professionalism.

By Deborah M. Pounder, RN-BSN, CPC, CCS-P, PCS

Individuals applying CPT® and ICD-9-CM codes now had to be mindful of ever-changing payer guidelines. From this, grew a demand for professional medical coders.

same giant printer, hand sorted and sep-arated, and envelopes were manually stuffed for mailing. Coding was much easier back in the day, CPT® codes were not required (Imagine that!). ICD-9 was the only code set to learn. There were no coding classes or any formal training.”Brenda Edwards, CPC, CPMA, CPC-I, CEMC

The Electronic Revolution Is HereBilling, coding, and documentation have come a long way and our past has brought us to an efficient, electronic rev-olution. Today we are looking at patient records on iPhones and other handheld devices. Prescriptions can be sent elec-tronically to a patient’s pharmacy across the city, alleviating errors due to poor handwriting. Insurance policies can be verified immediately with a few key-strokes. The billing and coding world as we know it is changing and it’s chang-ing fast. Where will we go from here?

Barbara Fontaine, CPC, serves on the AAPC Chapter Association (AAPCCA) Board of Directors and is business office supervisor at Mid County Orthopaedic Surgery and Sports Medicine, a part of Signature Health Services, a large multi-specialty organization. She served on

several committees before becoming a local chapter of-ficer. In 2008, she earned the St. Louis West, Mo. local chapter and AAPC’s Coder of the Year awards.

In elementary school, how many of you dreamed of being a professional medical coder? Not many, I’d guess. Why? Probably because coding, compared to health professions such as medicine and insurance, is relatively recent.

Hippocrates, the “Father of Western Medicine,” studied symptoms and treatments more than 2,400 years ago. Accident insurance can be traced to the 1860s. As the United States expanded west, insur-ance could be purchased for injuries incurred while traveling. When anesthesia and antisepsis improved after World War I, medical care moved into structured settings such as hospitals. As hospitals and physician practices became more common, so did health insurance.

Medical coding (using alphanumeric or numeric code sets to identify procedures and diagnoses) evolved from the need to standardize health service reporting, and to capture data about services and the beneficiaries receiving them for government-sponsored programs. ICD-9 was developed in 1948 as a diagnosis coding system to collect information about death (mortality) and disease (morbidity). HCPCS/CPT® for coding services and surgeries was published in 1966, using a four-digit code. The system expanded to five-digit codes as more services and procedures were added.

In the 1980s, Medicare and Medicaid required physicians and health care facilities to use HCPCS/CPT® codes when reporting claims. The National Correct Coding Initiative (NCCI) was introduced in 1996 to prevent “unbundling” of component services at a time when medical coding had become much more complex. Individuals applying CPT® and ICD-9-CM codes now had to be mindful of ever-changing payer guidelines. The demand for professional medical coders increased.

Coders Need Specialized TrainingA professional is defined as a member of a vocation founded upon specialized educational training. Because they “know better,” professionals are held to a higher ethical and moral standard. Enter AAPC, which was founded in 1988 to provide education and professional certification to physician-based medi-cal coders, and to elevate the standards of medical coding by providing student training, certification, education, networking, and job opportunities. AAPC now boasts more than 100,000 members, with more than 64,000 members certified for medical coding.

Future Calls for Evolving ProfessionalsWhat does the future hold for the medical coding profession, and how do you prepare? The only cer-tainty is continued evolution. For example, as ICD-10 approaches, you must come to understand it and find ways to help your physicians, nurses, and associates understand it, as well.

In many elementary schools you can find this advice on classroom walls:

{{ Show{up. {{ Ask{questions.

{{ Pay{attention. {{ Don’t{give{up.

As a professional medical coder, you need to show up for meetings and conferences; pay attention to changes in Medicare and other insurance guidelines; ask questions of physicians, insurance personnel, and each other; and, lastly, never give up.

Deb Pounder, RN-BSN, CPC, CSS-P, PSC, worked as a nurse in hospital surgical units for 20 years before taking on Medicaid chart audits. She now performs physician chart audits and coding reviews for Schenck SC in Appleton, Wis. and is active in her AAPC chapter.

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42 AAPCCodingEdge

Added Edge

Invest In Yourself for 2012Evaluate your skills and create a plan for your coding future.

There’s no scarcity of advice on the Internet on how to lose weight, tone up, drop bad vices, or spend your money. Before you spend a dime trying to figure it all out, first spend time

considering your future. This is the time of year when you gage your success on accomplishments of the past year and consider how you can better yourself in the year to come. It all boils down to one ques-tion: How will you invest in yourself for 2012?If you’re like many of us, the word “invest” conjures thoughts about bulls, bears, and money you can’t afford to lose. An investment real-istically is nothing more than a sincere commitment to use today’s resources to achieve an end goal in your future. That’s easier said than done—if you have ever seen exercise equipment double as dusty modern art, you know exactly what I mean. The first step in invest-ing in yourself is to accept that it isn’t easy; it will cost you time, mon-ey, or both. The next step is to ask three important questions:

• Where am I today? • Where do I want to be? • How will I get there?

Where Am I Today?There are many reasons why it’s important to evaluate your skills be-fore you plunge into your career plan. For example, you may be an expert at differentiating between an evaluation and management (E/M) consult and a new patient office visit, but if your practice only sees Medicare patients, that skill gives you no leg up. Having a limit-ed skill set reduces your career options. Some predict changes in the coder’s role as electronic health record (EHR) software systems do more up front. This will provide you with several new opportunities, as some skills are transferable.

Where Do I Want to Be?You already have the personal equity with which to prepare for the future. Coding also requires flexibility and the willingness to learn and develop new skills. Developing new skills to be proficient in the latest technology, for example, will help to protect your current job, and possibly position you as an expert in a new, advancing field. With combined experience, knowledge, and proven skills, you'll be able to leverage yourself into several new job roles.

How Will I Get There?There are several job paths and roles coders can choose from that are necessary and up-and-coming to the future of health care. With the resources and credentials available through AAPC, you can invest in the areas that will help you achieve your coding goals.

Boost Your Annual Income and Coding Know-howIntegrating medical coding and reimbursement rule changes into a practice’s reimbursement processes is important to a physician prac-tices’ bottom line. Because of this, hiring skilled, certified coders is a wise investment for employers. Both hiring managers and physi-cians are more likely to approve certified staff because credentials carry significant weight and will help them avoid hiring mistakes. The average salary is 20 percent higher for a Certified Professional Coder (CPC®) than for a non-certified coder, according to AAPC’s annual salary surveys.To hold CPC® credentials, you must have knowledge of anatomy, physiology, and medical terminology to correctly code provider di-agnoses and services. If you are not yet certified, AAPC’s CPC® cre-dential is the gold standard for medical coding in physician office settings.

Boost Your Credibility in the Hospital SettingYou may decide to invest in another area that is growing: the out-patient ambulatory setting. Jobs in this arena are opening up faster than ever due to a shift of more physicians joining hospital groups. With the emergence of accountable care organizations (ACOs) and increasing regulatory scrutiny, physicians are looking for cost-ef-fective solutions that will allow them to continue practicing medi-cine. One solution many physicians have found to be advantageous is working under a hospital’s umbrella. The Certified Professional Coder-Hospital Outpatient (CPC-H®) credential prepares a coder for this growing trend. In addition to your CPT® and ICD-9 coding skills, the CPC-H® exam validates the specialized payment knowl-edge necessary for these outpatient facility jobs.

Boost Your Marketability in a Regulatory EnvironmentGovernment and commercial carriers are increasing their focus on identifying fraud, waste, and abuse. Passage of the Fraud Enforce-ment and Recovery Act (FERA), the Health Information Technol-ogy for Economic and Clinical Health (HITECH) Act, and the Pa-tient Protection and Affordable Care Act (PPACA) have substantial-ly increased government enforcement authority for false claims and privacy/security violations. Mandatory compliance programs as an enrollment condition in federal health care programs, like Medicare, make once optional compliance efforts a necessity. As a result, com-pliance career opportunities are opening up in the health care arena.As the need for formal compliance plans grows, medical practices will require help driving the implementation and maintenance of such a program. Health care compliance certification addresses the ever-growing compliance requirements of the various laws, regula-

By Stephanie Cecchini, CPC, CEMC, CHISP


Added Edge

tions, rules, and guidelines. Holding AAPC’s Certified Profession-al Compliance Officer (CPCO™) credential is a good way for you to demonstrate to employers your thorough understanding of the key requirements necessary to effectively develop, implement, and mon-itor a health care compliance program.

Boost Your EHR Knowledge and Auditing SkillsMedical auditing is another critical component of a compliant and profitable physician practice. Government and private payer scruti-ny is creating the need for physicians to perform regular internal au-dits. And, as EHRs and data sharing become more prevalent, coders will need to verify whether EHR systems are correctly coding docu-mentation and Medicare guidelines and other governmental regu-lations are being met.Coders also are excellent candidates for training and certification in

the roles of practice management and health information technology (IT). Their strong understanding of health care, operations of a med-ical office practice, medical staff, and networking make them prime candidates to branch out into these areas. As a Certified Profes-sional Medical Auditor (CPMA®), you will be able to use your prov-en knowledge of coding and documentation guidelines to improve a practice’s revenue cycle, and directly improve their bottom line.Investing in yourself requires a healthy balance. Making a plan takes thought and time. If you want to own the result, you have to own the process. Think about what you want to achieve for yourself and your career in 2012. Then, go to www.aapc.com and find a way to achieve it.

Stephanie Cecchini, CPC, CEMC, CHISP, is vice president of product develop-ment at AAPC.

To discuss this article or topic, go to www.aapc.com

Developing new skills to be proficient in the latest technology,

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44 AAPCCodingEdge

ICD-10 Roadmap

By Kerin Draak, MS, RN, WHNP-BC, CPC, CEMC, COBGC

Code Obstetrical Care with ConfidenceLearn ICD-10 obstetrics coding to help achieve a seamless transition from ICD-9.

ICD-10 implementation will bring lots of changes to ob-stetrical coding. Coders and clinicians will need to work collaboratively to achieve a seamless transition from ICD-9. Detailed clinical documentation will allow coders to as-sign codes to the greatest specificity. Now is a good time to review the most significant changes to obstetric coding in ICD-10.

ICD-10 Coding Will Be in Line with Clinical DocumentationClinicians calculate pregnancy length based on a women’s menstrual cycle. The average menstrual cycle is 28 days. Clinicians base the length of a pregnancy on 10 cycles, or roughly 40 weeks. If a woman has a shorter cycle length, her due date would be less than 40 weeks; if a woman has a lon-ger cycle length, her due date might be more than 40 weeks (normal pregnancy length is between 37-42 weeks). For this reason, clinicians do not talk in months of pregnancy, but rather in exact weeks and days. This is one area in ICD-10 where coding language will match medical language. ICD-9-CM categories 640-648 and 651-676 require a fifth digit to indicate whether the encounter is antepartum or postpartum, and whether a delivery has also occurred. In ICD-10-CM, episodes of obstetric care are eliminated and replaced by trimesters. This change is a great benefit because it is much more specific to document that a wom-en is 25 weeks gestation than to document that she is five months pregnant.

Count Weeks and Days to Find the TrimesterTrimesters are counted from the first day of the last men-strual period and, according to ICD-10-CM, are defined as:First trimester – less than 14 weeks, 0 daysSecond trimester – 14 weeks, 0 days to 28 weeks, 0 daysThird trimester – 28 weeks, 0 days until deliveryThe majority of ICD-10-CM codes in chapter 15: Preg-nancy, Childbirth, and the Puerperium have a final char-acter indicating the trimester of pregnancy. The provider’s documentation of the number of weeks may be used to as-sign the appropriate code identifying the trimester. Assign-ment of the final character for trimester should be based on the provider’s documentation of the trimester (or number of weeks) for the current admission or encounter. Each cat-egory that includes trimester codes has a code for “unspec-ified trimester;” however, you should avoid the temptation to assign an unspecified code instead of querying the pro-

vider or reviewing the documentation. It may be easier, but it may not always be reimbursed.

Code from When Complication Care BeginsIt is common for women experiencing preterm labor to be hospitalized for days, weeks, or even months. When a wom-an is admitted to the hospital for complications of pregnan-cy during one trimester, and remains in the hospital into a subsequent trimester, the trimester character for the an-tepartum complication code should be assigned based on when the complication developed, not the trimester at the time discharge.

Trimester Isn’t Always Coded SpecificallyThe trimester of pregnancy may not be indicated if a con-dition always occurs in a specific trimester, or the concept is not applicable. As well, certain codes have characters for only certain trimesters because the condition does not oc-cur in all trimesters. For example, pre-eclampsia cannot oc-cur before the 20th week of pregnancy (as such, there is no code to report first trimester):O14.0-Mildtomoderatepre-eclampsia

O14.00unspecifiedtrimester

O14.02secondtrimester

O14.03thirdtrimester

O14.1-Severepre-eclampsia




Physician documentation must indicate the severity of the pre-eclampsia (e.g., mild to moderate or severe).

Encounters for Routine PregnancyICD-9-CM offers two codes to report routine, outpatient visits for uncomplicated prenatal care. As shown in the fol-lowing code comparison, ICD-10-CM includes 12 codes, four of which are unspecified. ICD-9: V22.0Supervisionofnormalfirstpregnancy

ICD-10:Encounterforsupervisionofnormalfirstpregnancy

Z34.00unspecifiedtrimester

Z34.01firsttrimester

Z34.02secondtrimester

Z34.03thirdtrimester

To discuss this article or topic, go to

www.aapc.com


ICD

-10

-CM

Roa

dmap

ICD-10 Roadmap

ICD-9: V22.1Supervisionofothernormalpregnancy

ICD-10: Encounterforsupervisionofothernormalpregnancy





ICD-9: Nocodeavailable

ICD-10: Encounterforsupervisionofnormalpregnancy,unspecified





A code from category Z34 should be assigned as the first-listed diagnosis for routine obstetric care. Code Z34.00 should not be used after a due date has been determined, but can be used when there are unknown dates. These women are usually scheduled for an ultrasound to determine ges-tational age.

Coding High-risk PregnancyICD-9-CM codes from category V23 describe supervision of high-risk pregnancies, and should be used as the first-list-ed diagnosis. There are a total of 18 codes available for re-porting high-risk prenatal care in ICD-9-CM.In ICD-10-CM, the sequencing for the first-listed diagno-sis is slightly different. Prenatal outpatient visits for high-risk patients should be reported with a code from catego-ry O09 Supervision of high-risk pregnancy and should be the first-listed diagnosis. Of the 60 codes available for reporting high-risk prenatal care in ICD-10, here are a few examples:ICD-9: V23.0Pregnancywithhistoryofinfertility

ICD-10: Supervisionofpregnancywithhistoryofinfertility


O09.01firsttrimester



ICD-9: V23.89Otherhigh-riskpregnancy

ICD-10: Supervisionofhigh-riskpregnancyduetosocialproblems


O09.71firsttrimester



Account for Multiple GestationsAnother change for ICD-10 will be code extensions to de-note the specific fetus in multiple gestation pregnancies. Most clinicians refer to multiple gestations as fetus A and fetus B. Similarly, in the nursery, clinicians refer to the ba-bies as twin A and twin B. ICD-10 uses numbers instead of letters as the seventh character fetal extension. Where ap-plicable, a seventh character should be assigned for certain categories to identify the fetus for which the complication code applies.The seventh character “0” should be assigned for a single gestation when the documentation in the record is insuffi-cient to determine the fetus affected and it is not possible to obtain clarification. 0 = not applicable or unspecified1 = fetus 12 = fetus 23 = fetus 34 = fetus 45 = fetus 59 = other fetus

Timing MattersLastly, ICD-10 changes the timeframes for abortion vs. fe-tal death and early vs. late pregnancy. ICD-9-CM code 632 Missed abortion defines early death before completion of 22 weeks gestation with retention of dead fetus. ICD-10-CM code O02.1 Missed abortion defines fetal death before com-pletion of 20 weeks gestation with retention of dead fetus. Similarly, ICD-9-CM code 640 Hemorrhage in early preg-nancy is defined as hemorrhage before completion of 22 weeks; ICD-10-CM category O20 defines hemorrhage be-fore completion of 20 weeks gestation. Parting tip: You might have noticed throughout this arti-cle that all the ICD-10-CM codes in chapter 15 start with the letter ‘O.’ Probably one the biggest challenges we face will be keeping the ‘O’ delineated from a ‘0.’

Kerin Draak, MS, RN, WHNP-BC, CPC, CEMC, COBGC, has been in the health care field for nearly 19 years. She has more than 11 years of clinical experience in women’s health, and has been the coding educator for a 220+ multispecialty clinic since 2004. She is active in her local chapter, and a member of AAPC’s National Ad-visory Board (NAB).

The provider’s documentation of the number of weeks may be

used to assign the appropriate code identifying the trimester.

46 AAPCCodingEdge

AkeishaSinanan, CPCAliciaReichert, CPCAmandaKayeEstevez, CPCAmberMullins, CPCAmieStanley, CPCAmyDavis, CPCAmyMccracken, CPCAmyWaller, CPCAndreaAgerlie, CPCAndreaGuerrieri, CPCAndreaKayCuaron, CPCAngelaFermin, CPCAngelaKaySmith, CPCAngieStevenson, CPCAnjaAplan, CPCAnnRoth, CPC-HAnnaSwierzewska, CPCAnnetteAppenzeller, CPCAprilClayton, CPCArlenePLee, CPCArleneWalczak, CPCArunC, CPCAshimaRohilla, CPCBarbaraACooper, CPCBarbaraAMatthews, CPCBarbaraJSweezy, CPCBarbaraLeeSylvander, CPCBeckyKushlan, CPCBelindaDarleneMusser,CPC, CPC-H,CANPCBessieRoa, CPCBethThornton, CPCBhanuVangara, CPCBradBaldridge, CPCBrandyCooper, CPCBrendaChristian, CPCBrendaJLucia, CPCBrendaLynnStevens, CPCBrentMonesmith, CPCBrigidNelson, CPCBrittneyDunahoo, CPCCarlaLynetteMcFadden, CPCCarlaWright, CPCCarmenArvelo, CPCCarolGutierrez, CPCCarolynHudson, CPCCarrieJenkins, CPCCassieErnest, CPCCatherineDHoward, CPCCathyAnnKozial, CPCCathySuber,CPC, CPC-HCharlaReese, CPCCharlesRivera, CPCCherieRPuthoff, CPCCherylAndrews, CPCCherylBailey, CPCCherylCarter, CPCChristinaPond, CPCChristinaSkalla, CPCChristyAnnBrown, CPCChristyHeffernan, CPCCindyVanDenHeuvel, CPCClaudiaVereniceVargas, CPCCourtneyToporek, CPCCrystalGayleFryer, CPCCrystalLynnHood, CPCCrystalTolliver, CPCCynthiaLynnHubbard, CPCCynthiaMLawhorne, CPCCynthiaMann, CPCDanaHunter-Tatum, CPCDanaKeys, CPCDanielleCohen, CPCDawnMSehl,CPC, CPC-HDeanSpeller, CPCDebaleenaDanda, CPCDebbieMyers, CPCDeborahCarr-Brown,CPC, CPC-HDebraMiller, CPCDeniseAllegro, CPC

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RudainaSwais, CPCRuthTabolt, CPCSadieMontzBecnel, CPCSakuraKoumarn, CPCSalamatuKadiri-Tahiru, CPCSamanthaALymperopoulos, CPCSandraFender, CPCSandraGonzalez, CPC-HSandyOdell, CPCSarahParish, CPCSarahShaw, CPCShandaWhite, CPCShanmughaRaoRadhakrishnan, CPCShannonEGodbold, CPCShanthiKV, CPCSharleneLewis, CPCSheilaRichards,CPC, CPC-HShelleyMJohnson, CPCSheriHermann,CPC, CPC-HSherriPettyjohn, CPCSherriWilliams, CPCSherryFeierfeil, CPCShirishaKommu, CPCSidikatOriowo,CPC, CPC-HSilviaCFoote, CPCStaceyLynnMason, CPCStaceyMarieBrylski,CPC, CPC-HStaceyPlyler, CPCStacieFlagel, CPCSusanBlurton, CPCSusanBrock, CPCSusanLynes, CPCSusanMichelleAmenta, CPCSuzanneCarolWinters, CPCTammiJacobs, CPCTammieAdams, CPCTammieLawson, CPCTammyWadfordGaskins, CPCTartishaJeraineThompson, CPCTarynStorm, CPCTeresaBodensteiner, CPCTeresaBowers, CPCTerryMeddaugh, CPCTiffanyJeanRivera, CPCTinaMarieNavarro, CPCTmeakaChanneDavis-Henry, CPCTonishaGentile, CPCTracieBurns, CPCTracieHoffman, CPCVadivelAdaikkalam, CPCValerieGeneWestbrook,CPC, CPC-H,CEDCVanessaANicholas, CPCVenkateswaraRaoVadigina, CPCVickiBRenner, CPCVickieHicks, CPCVictoriaChoma, CPCVirginiaScramlin, CPCWaverlynAlexander, CPCWaynetteBrink, CPC-HWilliamKlyn, CPCWinnieMScott,CPC, CPC-H,CPMAYolanderM.Goodwin, CPCYvonneMarieBragalone, CPC

ApprenticesAanchalTooteja, CPC-AAbegailBanaga, CPC-AAbigailOversmith, CPC-AAdrianNigrin, CPC-AAdrienneJohnson, CPC-AAdrienneMeyer, CPC-AAishaCoker, CPC-AAlanHester, CPC-AAlelignDessie, CPC-AAlexConrad, CPC-AAlexandraEMarch, CPC-AAlexandriaFontes, CPC-AAlexsaJakiela, CPC-A

AllisonAnnWilliams, CPC-AAllisonMcFarland, CPC-AAlynMitchell, CPC-AAlysePhillips, CPC-AAmandaBaker, CPC-AAmandaDeRoso, CPC-AAmandaFreestone, CPC-AAmandaHanel, CPC-AAmandaJamison, CPC-AAmandaMarieDumsar, CPC-AAmandaMarieMyers, CPC-AAmandaMillner, CPC-AAmandaPowell, CPC-AAmandaSmith, CPC-AAmberDefond, CPC-AAmberWebb, CPC-AAmyCase, CPC-AAmyChristineWright, CPC-AAmyCook, CPC-AAmyKundert, CPC-AAndreSession, CPC-AAndreaCrockett, CPC-AAndreaEllis, CPC-AAngelaDubose, CPC-AAngelaMBurns, CPC-AAngelaMarieBoulton, CPC-AAngelaMichelleThompson, CPC-AAngelaWeifenbach, CPC-AAngeliGaleFernandez, CPC-AAngelicaBouchard, CPC-AAngelicaNavarro, CPC-AAngeliqueDondero, CPC-AAngieHein, CPC-AAnitaBastian, CPC-AAnitaCrisman, CPC-AAnitaDDilce, CPC-AAnitaDellHardman, CPC-AAnnThomas, CPC-AAnnaMWalker, CPC-AAnnaMaeAcevedo, CPC-AAnnaMarieKozak, CPC-AAnneBabinsky, CPC-AAnneCenat, CPC-AAnneNewhall, CPC-AAnnettePayne, CPC-AAnnyLee, CPC-AAprilLott, CPC-AAprilMilano, CPC-AAraceliSotelo, CPC-AArmadiaWilliams, CPC-AAshleyFettig, CPC-AAshleyKissinger, CPC-AAuroraDelbon, CPC-AAvinashRajBhashker, CPC-ABarbaraBoekeloo, CPC-ABarbaraJeanKremer, CPC-ABarbaraL.Jewell, CPC-ABarbaraLibby, CPC-ABarbaraMBeck, CPC-ABarbaraOlsen, CPC-ABeatriceFRobinson, CPC-ABelindaBergeron, CPC-ABenesaRuiz, CPC-ABenjaminRipplinger, CPC-ABergenBrinton, CPC-ABernadettePopp, CPC-ABernardCaburian, CPC-ABethChamberlain-Staples, CPC-ABethTrask, CPC-ABettyFluharty, CPC-ABeverlyClark, CPC-ABhupeshTomar, CPC-ABindhiyaSureshBabu, CPC-ABlagovestaTagareva, CPC-ABobbiColeman, CPC-ABobbiKirouac, CPC-ABobbieWLewis, CPC-ABonnieGarland, CPC-ABrandieWolfe, CPC-A

newly credentialed members


BrandyPowell, CPC-ABrendaJ.Sullivan, CPC-ABrendaOdom, CPC-ABrendaRoper, CPC-ABrentRobinson, CPC-ABrianDoherty, CPC-ABrittanyKoemm, CPC-ABrittanySteele, CPC-ABrookeFuhrman, CPC-ABunnyMathre, CPC-ACaminadeMoscatiello, CPC-ACandaceGraham, CPC-ACandiceHuff, CPC-ACariannFinney, CPC-ACarolTews, CPC-ACarolAnnGMartin, CPC-ACarolBBilodeau, CPC-ACarolBarman, CPC-ACarolBrown, CPC-ACarolCarr, CPC-ACarolFabian, CPC-ACarolynSinger,CPC-A, CPC-H-ACarolynZelle, CPC-ACassandraVenesky, CPC-ACatherineKelley, CPC-ACatherineReynolds, CPC-ACathyEKirk, CPC-ACathyPinegar, CPC-ACeliaSmith, CPC-ACeuquoahDiggs, CPC-ACherylBerniceBaker, CPC-ACherylD'orazio, CPC-ACherylHunt, CPC-ACherylKaliMcGuffey, CPC-ACherylKurimski, CPC-ACherylLynnRunde, CPC-AChristinaBeutler, CPC-AChristinaHess, CPC-AChristinaJeppson, CPC-AChristineDominick, CPC-AChristineLewis, CPC-ACindyGalvao, CPC-ACindyKnowlton, CPC-H-AClaraSelf, CPC-AClaudiaBenitez, CPC-AClaudiaHorita, CPC-AColleenGilliam, CPC-AColleenValliere, CPC-AConnieLGraham, CPC-AConnieLPitz, CPC-AConnieMcKnight, CPC-ACoreenRiddick, CPC-ACoreyIanLewis, CPC-ACorissaSouth, CPC-ACourtneyDawnHarris, CPC-ACraigKeisling, CPC-ACrissyCCunningham,CPC-A, CPC-H-ACristinaCMitra, CPC-ACrystalHerrada, CPC-ACynthiaRaskey, CPC-ACynthiaSicre, CPC-H-ACynthiaAllen, CPC-ACynthiaColley, CPC-ACynthiaEckholm, CPC-ACynthiaGonzales, CPC-ACynthiaJacobson, CPC-ACynthiaSaetern, CPC-ADailynRios, CPC-ADanaFillmore, CPC-ADanaKSmith, CPC-ADanelleMendoza, CPC-ADanielleJohnson, CPC-ADanyelRichardson, CPC-ADarciBianchi, CPC-ADarlaJeanellMorrison, CPC-ADarleneHruska, CPC-ADavidRosenberger, CPC-ADavidSuchowski, CPC-ADawnLuannePaine, CPC-A

DawnMCoughlin, CPC-ADawnMarieSullivan, CPC-ADawnRalph, CPC-ADeannaKayHutchison, CPC-ADebbiePhillips, CPC-ADebbieDAdams, CPC-ADebbieEverett, CPC-ADeborahC.Brothers, CPC-ADeborahKowal, CPC-ADeborahOlson, CPC-ADeborahWestfall, CPC-ADebraAnnSearles, CPC-ADebraGeanCochran, CPC-ADebraSlaughter, CPC-ADebraWilliams, CPC-ADeirdreJones, CPC-ADeirdreMitchell, CPC-ADeloresWay, CPC-ADenaLouiseGoodson, CPC-ADeniseAnnMacMillan, CPC-ADeniseCramer, CPC-ADeniseEikanger, CPC-ADeniseJones-Adams, CPC-ADeniseLynnHansbrough, CPC-ADeonnaRScarbrough, CPC-ADerrickWilburn, CPC-ADianeAbbott, CPC-ADianeKamp, CPC-ADianeLatshaw, CPC-ADianeLihota, CPC-ADianeMarieSchrader, CPC-ADiannaCamp, CPC-ADiemchiTran, CPC-ADixieShoemaker, CPC-ADollyDeLeon, CPC-ADoloresPegram, CPC-ADonnaAshe, CPC-ADonnaBuchanan, CPC-ADonnaDwyer, CPC-ADonnaHuston, CPC-ADonnaProfeta, CPC-ADonnaWallace, CPC-ADoreenJHumphrey, CPC-ADouglasFisher, CPC-ADrParasBedmutha, CPC-ADvigeshPatel, CPC-AElaineDominicaAnzalone, CPC-AElaineFanSchneider, CPC-AElaineSharp, CPC-AElizabethCary, CPC-AElizabethKGriffin, CPC-AElizabethRBrockman, CPC-AElizabethRyan, CPC-AElizabethSYoung, CPC-AEllenCartwright, CPC-AEmilyLouiseWilliams, CPC-AEricaGeorge, CPC-AEricaKristoff, CPC-AEricaNMiller, CPC-AErraramVenugopalChary, CPC-AEugeniaMarieKing, CPC-AEvaSkuka, CPC-AFallonGrice, CPC-AFeliciaDianneCooper, CPC-AFeliciaSweeney, CPC-AFrancineRobb, CPC-AFranklinBautista, CPC-AFredriccaGAnderson, CPC-AGabrielleParent, CPC-AGaneshKumarKudupudi, CPC-AGenevaCrawford, CPC-AGeraldineHansen, CPC-AGinaClemeaux, CPC-AGloriaAnnSimmons, CPC-AGloriaIOrengoRamirez, CPC-AGopeshPandey, CPC-AGoundlaKranthiKumar, CPC-AGraceSSapio, CPC-AGretchenLLaursen, CPC-A

GuduriNarayanaRao, CPC-AGunturiNagavardhanReddy, CPC-AGwenHewitt, CPC-AHDonaldStewartJr, CPC-AHatiqeEgriu, CPC-AHazelVea, CPC-AHeatherQuinn, CPC-AHeatherRigsby, CPC-AHeatherRubert, CPC-AHeidiAnnHusman, CPC-AHeidiVanHorn, CPC-AHelenNFeliciano, CPC-AHollyDonaldson, CPC-AHollyGoddard, CPC-AILong, CPC-AIdaIlianaRivera, CPC-AIngridPettway, CPC-AIreneEnglish, CPC-H-AJackieMarsh, CPC-AJacklynJohnson, CPC-AJacquelineKester,CPC-A, CPC-H-AJacquelynTAutie, CPC-AJaimeBethThunstrom, CPC-AJaimiClementi, CPC-AJaimieMayoThompson, CPC-AJamiFord, CPC-AJamieDeniseBurchell, CPC-AJanaCaulk, CPC-AJaneAClarke, CPC-AJanellBevier, CPC-AJanetRose, CPC-AJanetRoyer, CPC-AJanetSpencer, CPC-AJaniceLynnBurnett, CPC-AJaniceMyers, CPC-AJasmineLateceBond, CPC-AJasonDonVeal, CPC-AJasonHarry, CPC-AJeanBarnett, CPC-AJeanMZelinski, CPC-AJeannetteABlack, CPC-AJeffreyRGaskill, CPC-AJeniceJackson, CPC-AJenniferAmeliaConner, CPC-AJenniferAnneMaliniemi, CPC-AJenniferBaldwin, CPC-AJenniferJordan, CPC-AJenniferLake, CPC-AJenniferLawson, CPC-AJenniferLynnVitak, CPC-AJenniferMayeaux, CPC-AJenniferMcCann, CPC-AJenniferMurray, CPC-AJenniferNeilson, CPC-AJenniferRussell, CPC-AJenniferSusanWest, CPC-AJenniferUngurean, CPC-AJennyWhitworth, CPC-AJeriPringle, CPC-AJeriTimmons, CPC-AJerryDMcCoy, CPC-AJessicaAnneHart, CPC-AJessicaCarney, CPC-AJessicaNicoleWomack, CPC-AJessicaSchuster, CPC-AJessikaBush, CPC-AJillAvent, CPC-AJoMazzetta, CPC-H-AJoAnnGallagher, CPC-AJoannaLopez, CPC-AJoanneLee, CPC-AJoanneLeifheit, CPC-AJo-AnneMalm, CPC-AJoelMedina, CPC-AJohannaBorda, CPC-AJonathanGellar, CPC-AJordanDeacon, CPC-AJosephPBenoit, CPC-AJudithKarlin, CPC-A

JudyLaMothe, CPC-AJuliaAMcClaskey, CPC-AJulieBennett, CPC-AJulieDeniseBoyett, CPC-AJulieDraper, CPC-AJulieanneByrd, CPC-AJustineHaraldson, CPC-AKaliMcallister, CPC-AKamalKant, CPC-AKaminiGupta, CPC-AKannamSantoshLakshmi, CPC-AKarenAConnor, CPC-AKarenAloy, CPC-AKarenBake, CPC-AKarenEgolf, CPC-AKarenLahey, CPC-AKarenMarieBolt, CPC-AKarenNash, CPC-AKarenTLong, CPC-AKarenWells, CPC-AKarenWest, CPC-AKariHeater, CPC-AKariMoran, CPC-AKarinLeigh, CPC-AKarlaPhillips, CPC-AKatharineGerke, CPC-AKatharineVanCampen, CPC-AKathleenBaucke, CPC-AKathleenHesselbacher, CPC-AKathleenVictor, CPC-AKathrynAnneHarris, CPC-AKathrynMartin, CPC-AKathyBassman, CPC-AKathyCHarmon, CPC-AKathyJohnson, CPC-AKatieDake, CPC-AKatinaFornwalt, CPC-AKayleeAnnBrown, CPC-A,CPC-H-AKayleighFrancesIams, CPC-AKeishaAprilSheffield, CPC-AKeiyannaLanayWashington, CPC-AKellyHamilton, CPC-AKellyMoore, CPC-AKelsyGreninger, CPC-AKendraFugitt, CPC-AKennethPLemanski, CPC-AKeondraWilburn, CPC-AKerriSokol, CPC-AKevinMannix, CPC-H-AKimberlyAMeehan,CMM, CPC-AKimberlyAkerberg, CPC-AKimberlyCFryar, CPC-AKimberlyCatherinePage, CPC-AKimberlyCharette, CPC-AKimberlyGoss, CPC-AKimberlyKGreer, CPC-P-AKimberlyMccoin, CPC-AKimberlyPost, CPC-AKimberlyRoseKessler, CPC-AKraigStephenBowers, CPC-AKristianSparks, CPC-AKristieAnnFissler, CPC-AKristinGrove, CPC-AKristinMiller, CPC-AKristinaLiberatore, CPC-AKrystynaZavislak, CPC-ALa-iadAnnMixonStout, CPC-ALakshmiPrasannaPothini, CPC-ALaTashaBatts, CPC-ALatashaMichelleElsberry, CPC-ALaTonyaLWilliams, CPC-ALatoshiaEurine, CPC-ALauraHollman, CPC-ALauraMcConnell, CPC-ALauraOsorio-Tellez, CPC-ALauraShell, CPC-ALaurenGrohs, CPC-ALaurenLongacre, CPC-ALauriPastman, CPC-A

LaurinDesso, CPC-ALavelleCharlesNew, CPC-ALaVonneBlock, CPC-A LawrenceSWien, CPC-ALeighAnnLudolph, CPC-ALeslieAnnTate, CPC-ALeslieNickerson, CPC-ALeslieReneeRoberts, CPC-ALeslimarDRamos, CPC-ALiliaAnaIbuado, CPC-ALindaAWhite, CPC-ALindaElizabethBresnock, CPC-ALindaMarieGilliam, CPC-ALindaMarieSutton, CPC-ALindaNmiMiller, CPC-ALindaPace, CPC-ALindaRobinson, CPC-ALindaVickers, CPC-ALindaWilds, CPC-ALindseyLara, CPC-ALisaHileman, CPC-ALisaJoanBrown, CPC-ALisaKosto, CPC-ALisaMarieBrewer, CPC-ALisaMichener, CPC-ALisaRFisher, CPC-ALisaStiens, CPC-ALisaTasi, CPC-ALisaTyson, CPC-ALoisJeanHelmick, CPC-H-ALorenaOlmos, CPC-ALoriAndrews, CPC-ALoriAnneSmith, CPC-ALoriCarbone, CPC-ALoriLouiseMoss, CPC-ALoriePyrtle, CPC-ALorriMclellen, CPC-ALucianaMariaMullins, CPC-ALuzAranda, CPC-ALynnDuprey, CPC-ALynneStorm, CPC-AMadeleineMcCrea, CPC-AMaeReed, CPC-AMalvikaKShergill, CPC-AMandiMarieErickson, CPC-AMandyFender, CPC-AManichanhMcCullough, CPC-AManishSaini, CPC-AManitaSeth, CPC-AMaraHarris, CPC-AMarciBlack, CPC-AMarcieBindner, CPC-AMargaretAnnJohansson, CPC-AMargaretClarke, CPC-AMargaretJohnstonHannah, CPC-AMargaretSteward, CPC-AMarggieYVelezGonzalez, CPC-AMargieVanderMaas, CPC-AMargoWright, CPC-AMariaDroumbalas, CPC-AMariaWinston, CPC-AMarianneHubert, CPC-AMarieMiller, CPC-AMarisaCeralde, CPC-AMarkettaSanders, CPC-AMarlenMatz, CPC-AMarleneTompkins, CPC-AMarshaEverett-Snyder, CPC-AMarthaCampbell, CPC-AMarthaCelesteMiller, CPC-AMarthaSherattaIrby, CPC-AMaryAnnLucas, CPC-AMaryAnnSexton, CPC-AMaryAnnShults, CPC-AMaryAudet, CPC-AMaryElizabethGrimmett, CPC-AMaryEllenRuggles, CPC-AMaryFleming, CPC-AMaryHobbs, CPC-A

Newly Credentialed Members

48 AAPCCodingEdge

Newly Credentialed Members

MaryJaneCibich, CPC-AMaryKayGunnell, CPC-AMaryLCarrillo, CPC-AMaryLChampion, CPC-AMaryLeeSavory, CPC-AMaryLouBryant, CPC-AMarySly, CPC-AMaryWeber, CPC-AMary-JoBlackmer, CPC-AMatthewHwang, CPC-AMatthewS.Stein, CPC-AMaureenRearick, CPC-AMeganAllysonSmith, CPC-AMeganDeLiberis, CPC-AMekkondaSunitha, CPC-AMelanieWoodward, CPC-AMelindaGary, CPC-AMelindaM.Ruble, CPC-AMeLisaSopena, CPC-AMelissaAnnShirley, CPC-AMelissaHollie, CPC-AMelissaJeanMiller, CPC-AMelissaShaull, CPC-AMeriTedford, CPC-AMicahDallman, CPC-AMichaelWirsing, CPC-AMicheleAnnMishler, CPC-AMicheleEast, CPC-AMicheleJRobison, CPC-AMicheleWalker, CPC-AMicheleWall, CPC-AMichelleBrown, CPC-AMichelleDMartin, CPC-AMichelleDavis, CPC-AMichelleFrailey, CPC-AMichelleLopez, CPC-AMichellePettlon, CPC-AMichelleSims, CPC-AMichelleTebbe, CPC-AMichelleWong, CPC-AMihaelaRalucaBurch, CPC-AMikeSMyers, CPC-AMilenaMutter, CPC-AMindiOlsen, CPC-AMinervaRosa, CPC-AMiriamMedina, CPC-AMistyStringfellow, CPC-AMitziG.Lampert, CPC-AMohammadJaveedAkthar, CPC-AMonicaEarle, CPC-ANancyHernandez, CPC-ANancyAlviso, CPC-ANancyLee, CPC-ANancyLorey, CPC-ANancyMelissaGoode, CPC-ANancyRSnider, CPC-ANataliaAHammond, CPC-ANatalieStepek, CPC-H-ANatalyaCharrosaAcoff, CPC-ANevelynOrtolaza, CPC-ANicoleHarris, CPC-ANicoleHudec, CPC-ANicoleTorrey, CPC-ANicosiaWilcox, CPC-ANikitaSabraBritt, CPC-ANikkiKonzem, CPC-ANikkiLyons, CPC-H-ANistalaBijayaKumar, CPC-ANoreenACooper, CPC-ANormaEscudero, CPC-AOliviaMontoya, CPC-AOxanaGugel, CPC-APamGardner, CPC-APamelaAnnKehlet, CPC-APamelaMorthimer, CPC-APamelaOxendine, CPC-APamelaSDeSantos, CPC-APanchyPeoples, CPC-AParrySairaju, CPC-APatreaMattheis, CPC-APatriciaHorrell, CPC-APatriciaAnnGinter, CPC-APatriciaDePaola, CPC-APatriciaEdwards, CPC-APatriciaLouiseWard, CPC-A

PatriciaMena, CPC-APatriciaMurillo, CPC-APattyFarnan, CPC-APaulMalone, CPC-APaulSacco, CPC-APaulaKelley, CPC-APaulaPowell, CPC-APaulineLynetteBlack, CPC-APeggyWHughes, CPC-APegiGibson, CPC-APennyRoche, CPC-H-APeterCooper, CPC-APhyllisShobe, CPC-APreciousReneeTate, CPC-APremLataMalhotra, CPC-APrincePillai, CPC-APritiVirdi, CPC-ARachaelEPatton, CPC-ARachelCrawford, CPC-ARachelHall, CPC-ARachelSmith, CPC-ARadhikaBandhineni, CPC-ARamanujapuramSreekanth, CPC-ARaquelLazcano, CPC-ARaymondGriffith, III,CPC-ARebecaTruman, CPC-ARebeccaBabcock, CPC-ARebeccaMcDonald, CPC-ARebeccaPowell, CPC-ARebeccaWillms, CPC-ARebekahRay, CPC-ARecitaLClemons, CPC-ARegallaRaviKumar, CPC-AReginaGohier, CPC-AReginaSharp, CPC-ARenaeMiller, CPC-AReneeHufnell, CPC-ARhondaSchlecht, CPC-ARichCirivilleri, CPC-ARichardMathias, CPC-ARichardPalmerII, CPC-ARinaPatel, CPC-ARitaWall, CPC-ARobertErickson, CPC-ARobertGarcia, CPC-ARobertaZenn, CPC-ARobertoGomezJr, CPC-ARobinCluck, CPC-ARobinLHahn, CPC-ARobinLeeMushkin, CPC-ARobynRDavis, CPC-H-ARochelleHurst, CPC-ARohiniPralhadWakchaure, CPC-ARonJones, CPC-ARonaldDawson, CPC-ARonnaHoward, CPC-ARosaJimenez, CPC-ARosaJuliaLugo, CPC-ARosalinaSolorzano, CPC-ARoseannMortali, CPC-ARosettaJohnson, CPC-ARosieLMoher, CPC-ARozanneMBlagsvedt, CPC-ARuiyanJing, CPC-ARuthIturrios, CPC-ASachinGoyal, CPC-ASafaAbedrabbo, CPC-ASallyO'Neill, CPC-ASalvadorAMercado, CPC-ASandeepAhuja, CPC-ASandraColeman, CPC-ASandraKelly, CPC-ASangitaSubba, CPC-ASantoshPant, CPC-ASaraBethGieselman, CPC-ASarahMurphree, CPC-ASarahSabbara, CPC-ASarahStraus, CPC-ASaritaAnkerla, CPC-ASatishYadavBoini, CPC-AScottDages, CPC-ASekaiPeterson, CPC-P-ASeleneZuniga, CPC-ASepaliARajapaksaLekamRalalage, CPC-AShaeClawson, CPC-A

ShalanCorlieto, CPC-AShametraMcintyre, CPC-AShannonDeniseMock, CPC-AShannonJayapal, CPC-ASharaElaineKlem, CPC-ASharleneKayBerry, CPC-ASharonEbrecht, CPC-ASharonHarrell,CPC-A, CPC-H-ASharonPhillips, CPC-ASharonRamsey, CPC-AShaunaHarrison, CPC-AShaylaRielly, CPC-ASheaM.Vogel, CPC-ASheilaKunkel, CPC-ASheilaLenoir, CPC-ASheilaMMeade, CPC-ASheldonBarlow, CPC-ASheliaLynnMeeks, CPC-AShelleyGreenhill, CPC-H-AShelleyR.Pease, CPC-AShellyMurakami, CPC-ASherriGriffith, CPC-ASherriWieder, CPC-ASherrySmith, CPC-AShirleyHunt, CPC-AShurrellMeyer, CPC-ASianMoiraPalmer, CPC-ASoledadMyers, CPC-ASonjaAAyers, CPC-ASonjaBurris, CPC-AStaciMatthews, CPC-AStacyJohnson, CPC-AStephanieAnnSharkey, CPC-AStephanieDonaubauer, CPC-AStephanieGriffin, CPC-AStephanieHiett, CPC-AStephanieWhitney, CPC-AStephanieWiggs, CPC-AStephanieWilbur, CPC-AStephenJSideropolis, CPC-AStevenHolloway, CPC-ASueArico, CPC-ASumaraShaw, CPC-ASunilKumar, CPC-ASusanDavis, CPC-ASusanEAdams, CPC-ASusanFaulk, CPC-ASusanFlores-Doud, CPC-ASusanFlores-Doud, CPC-ASusanGallagher, CPC-ASusanJones-Cobb, CPC-ASusanMcCormick, CPC-ASusanRice, CPC-ASusanSheffler, CPC-ASusanThompson, CPC-ASusanneFeinour, CPC-ASusiePeterson, CPC-ASuzanneBlanton, CPC-ASuzanneCDudley, CPC-ASuzanneMichelleLewis, CPC-ASuzieBartholomew, CPC-ASwaroopGopinathNair, CPC-ATamaraSanders, CPC-ATashaWillis, CPC-ATeresaBragg, CPC-ATeresaBruce, CPC-ATeresaFinger, CPC-ATeresaJacquelineJackman, CPC-ATeresaLFrank, CPC-ATeresaWolcott, CPC-ATerriAnderson, CPC-ATerryGerlat, CPC-ATheendaHart, CPC-ATheresaBroomhead, CPC-ATheresaGallinger, CPC-ATheresaMacRae, CPC-ATheresaTraughber, CPC-AThereseMika, CPC-ATiffaniAliciaWolfe, CPC-ATiffanyFay, CPC-ATiffanySkurjo, CPC-ATimMcBride, CPC-ATinaMarieMcCullough, CPC-ATomiLynnGibbs, CPC-AToniSibley, CPC-A

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SpecialtiesAnaLizaMCruz,CPC, CEMCAngelaS.Blunk, CPMAAprilBurgess, CENTCAprilJoyEspaniola,CPC, CPMA,CEMCAracelyNoemiColon,CPC, CPMAArleneCapiaux, CIRCCAutumnMarieMartin,CPC, CEMCBarbaraHutzell, COBGCBonnyRisen, COBGCBrandyHeffner, CUCBrianMeredith,CPC, CPMACassandraWMcKibben, CPC,CFPCCatheryneIStormo,CPC, CPMACharmaineAGordon, CPC,CPC-H,CIRCC,CCCChayaHoward,CPC, CCCCherylBaer,CPC, CPMAChristineJohnson, CENTCColleenFrancesParks, CRHCDarleneJohnsonLovett,CPC, CPCO,CPMADavisEdge, CGICDianaJeanAnastasi,LPN, CPC,CHONCDonnaLisaMashburn,CPC, CPCDDonnaMZanoli,CPC, CPMAElizabethAnnDeVoe, CPC,CPC-H,CPMAEllenRisotti, CPC,CPMA,CEMC,CFPCEmilyJCapps, CPC,CPC-P,CPMA,CIMCFeliciaDeniseMerrell,CPC, CPMA,CPC-IFrancesAnnAli,CPC, CEMCHeatherMBeard,CPC, CEMC,CGICJaimeRHouck,CPC, CPMAJayapradaKethireddy,CPC-A, CEMCJenniferM.Connell,CPC, CENTCJenniferSuzanneAldrich,CPC, CFPCJohannaLegaspi,CPC, CPMAJoshuaCaillouet,CPC, CASCCJulieAnnJensen,CPC, CGSCJulieAnneMackay,CPC, CEMCKarenLGrable,CPC, CEMCKarenMcArthur, CGSCKathleenDenisePhillips,CPC, CEMC,CENTCKathyDavidson, CHONCKellyRaines, CIRCCKenaLynnHouston,CPC, CEMC

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The Medicare Learning Network® (MLN) Products Provider Compliance web page has the tools to help FFS providers prevent errors and improper payments.

See the Medicare Learning Network’s Provider Products Compliance web page at

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Official CMS Information forMedicare Fee-For-Service Providers

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Official CMS Information forMedicare Fee-For-Service Providers

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http://go.cms.gov/CodingEdge

We can help.

Understanding how to avoid commonbilling errors can be complicated.

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MLN CodingEdge Dec.2011 PRINT FINAL.pdf 1 10/18/11 4:39 PM

50 AAPCCodingEdge

Bogus billing is a big problem in personal injury cases, and it’s getting worse. Unlike health insurance companies—which scru-tinize every bill submitted for payment—auto insurance companies and self-insured carriers often have little recourse to dispute medical charges. To make matters worse, unethical physicians sometimes seize the opportunity to submit exaggerated bills. A coding analysis is one weapon to combat these fraudulent practices.There are several ways providers can falsify bills for personal injury suits. In any other setting, these bills would not be reimburs-able due to the provider’s failure to comply with coding rules and regulations.

UpcodingUpcoding occurs when a provider bills for a more complex and/or higher-cost proce-dure than was actually performed. Upcod-ing predominantly occurs with evaluation and management (E/M) visits, and often is seen on a patient’s initial visit. Although the patient may present with minor complaints, the physician will bill a level 4 or 5 office vis-it. The patient might return for one or more follow-up visits, with the same complaints and symptoms or to refill medication. Per CPT® guidelines, these visits would be cod-ed as a level 1 or 2 visit. Dishonest medical providers may try to upcode these to level 4 or 5 visits.Surgical procedures are another place to look for upcoding. The physician performs “surgery” on the patient that consists of a minimally-invasive procedure, performed via needle puncture of the skin. Rather than report a percutaneous procedure code, the provider bills an “open” procedure. Reim-bursement for an open procedure can be as much as three times that of a percutaneous procedure.

UnbundlingAnother trick used to inflate medical bills is unbundling. This is when a medical pro-vider bills separately for the components of an all-inclusive procedure, and occurs most frequently when hospitals and physicians charge separately for the components of a surgery. Most surgeries are part of a global package that includes:

• A preoperative visit before surgery• Intra-operative services, devices,

implants, and anesthesia (technical component)

• Surgical aftercare• Office visits during the post-

operative period of the surgery (typically 90 days) that are related to recovery from the surgery

• Post-surgical pain management by the surgeon

• Supplies• Other miscellaneous services

If the treating physician unbundles these charges and bills for each one separately, the result is a much higher bill.

Inconsistent CodingPersonal injury doctors may also code in-consistently. This might occur when mul-tiple patients in the same accident go to the same doctor. Despite the patients’ separate complaints, the physician assigns the same diagnosis to each of them. Inconsistent coding can also be found in re-cords where a patient underwent a surgi-cal procedure. For example, a patient sees a physician after an accident and the physi-cian diagnoses the patient with various ail-ments in order of significance (e.g., neck pain, headaches, shoulder pain, low back pain). In cases with inconsistent coding,

the patient’s main diagnosis changes to cor-respond with the planned procedure; for example, low back pain becomes the pri-mary diagnosis when lumbar back surgery is scheduled. Another example of inconsistent coding is when the procedure(s) listed on the physi-cian’s bill do not match the procedure(s) on the facility’s bill. For example, if the physi-cian’s bill contains an “unlisted” procedure, and the facility’s bill shows a spinal fusion, it is an immediate red flag that one or both of the bills is not coded properly. What effect do coding violations have on a personal injury case? First, these violations work to increase the patient’s bills. Cod-ing violations also falsify the patient’s in-juries (and medical record) to support the treatments that have been (inappropriate-ly) rendered.

Recognize and Question Bogus BillingRecognizing the potential for coding vio-lations is the first step in fighting these un-scrupulous practices. The next step is to have the bills evaluated by a coding expert or to consult with an attorney with expertise in this area. If it is determined coding vio-lations exist, a coding expert can offer trial testimony to educate the jury about the cod-ing and billing abuse and its significance. By challenging a physician’s coding, defense at-torneys can get the jury to question the va-lidity of the bills generated by the physician. The more attention you bring to these pho-ny billing practices, the more difficult it will be for these practices to continue.

Jeremy Reimer, CPC, is president of Medical Coding Litigation Services, which provides medical coding and billing review to insurance carriers, legal counsel, and companies involved in personal injury litigation. He is vice-president of AAPC's Brandon, Fla. chapter, a member of the American College of Forensic Examiners, and a frequent lecturer on medical coding and

billing fraud. Mr. Reimer can be reached at: [email protected].

Attack Bogus Billing in Personal Injury CasesCompliant coding is the best defense against falsified bills for personal injury suits.

Coding Compass

By Jeremy Reimer, CPC

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