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HEALTHCAREBUSINESS MONTHLYCoding | Billing | Auditing | Compliance | Practice Management

December 2015

Let Blood Transfusion Payment Flow: 25

Keep revenue roads clear of denial roadblocks

Watch Out for Identity Thieves: 42

Protect patients from losing their medical identities

Note Medical Scribes: 50 Qualified scribes can streamline processes

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[contents]■ Coding/Billing ■ Practice Management ■ Auditing/Compliance

[continued on next page]

Healthcare Business Monthly | December 2015

40 Make the Most of HCCs

Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I42 Nobody Is Immune

to Medical Identity Theft

Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI

50 The Medical Scribe: A Hot Commodity

Renee Dustman

COVER | Coding/Billing | 29

Sneak a Peek at 2016 CPT® ChangesG.J. Verhovshek, MA, CPC, and Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC

4 Healthcare Business Monthly

Healthcare Business Monthly | December 2015 | contents

12

22

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■ Code of Ethics10 Ethics Update Strengthens

AAPC Membership

AAPC Ethics Committee

■ AAPC Chapter Association

12 Make Your Chapter a Success

Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC

■ Added Edge14 How a Credential Is Born

Glenda Hamilton, CPC, COC, CPMA, CEMC, CPC-P

■ Coding/Billing16 Medicare Primary Care

Center Exception Update

Maryann C. Palmeter, CPC, CENTC, CPCO

20 Claim All Your Pennies for Discontinued Procedures

Sarah W. Sebikari, MHA, CPC

22 Specimen Validity Testing

Frank Mesaros, MPA, MT (ASCP), CPC

26 Coding that Brings You to Your Knees

Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P

■ Facility25 Blood Transfusions: Document

Properly for ICD-10-PCS

Diana H. Williams, BS, CPC, CCS-P, CCS, CPMA

■ Added Edge36 Distance Learning:

Choose Wisely

Dawn Moreno, PhD, CPC, CBCS, CMAA, MTC, CPL, CLT

■ Auditing/Compliance44 Handling PHI

Disclosure for Genealogists

Joseph de Beauchamp, PhD

■ Practice Management 47 Boost Your Immune

System with Office Yoga

Bridget Toomey, CPC, CPB, CRCR, RYT-200

54 Onboarding Employees in a Small Office

Ellen M. Wood, CPC, CMPE

■ Member Feature56 Military Members:

Trained for Success

Michelle A. Dick

DEPARTMENTS7 Letter from CEO

8 Letters to the Editor

9 Healthcare Business News

10 Code of Ethics

66 I Am AAPC

EDUCATION60 Newly Credentialed Members

Online Test Yourself – Earn 1 CEU

www.aapc.com/resources/publications/ healthcare-business-monthly/archive.aspx

COMING UP: • 2015 Salary Survey • 2016 OPPS • OIG Work Plan • Pediatric Vaccination • 36415 Venipuncture

On the Cover: John Verhovshek, MA, CPC, and Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, give you a sneak peek into what changes are in store for CPT® 2016. Cover design by Kamal Sarkar.

ZHealth Publishing, LLCwww.zhealthpublishing.com

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Volume 2 Number 12 December 1, 2015Healthcare Business Monthly (ISSN: 23327499) is published monthly by AAPC, 2233 South Presidents Drive, Suites F-C, Salt Lake City UT 84120-7240, for its paid members. Periodicals Postage Paid at Salt Lake City UT and at additional mailing office. POSTMASTER: Send address changes to: Healthcare Business Monthly c/o AAPC, 2233 South Presidents Drive, Suites F-C, Salt Lake City UT 84120-7240.

Serving 153,000 Members – Including You!ve

ndor

inde

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Director of PublishingBrad Ericson, MPC, CPC, COSC

[email protected]

Managing EditorJohn Verhovshek, MA, CPC

[email protected]

Editorial Michelle A. Dick, BS

Renee Dustman, BS

Designer Mahfooz Alam

Kamal Sarkar

Advertising Jon Valderama

Address all inquires, contributions, and change of address notices to:

Healthcare Business MonthlyPO Box 704004

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

©2015 Healthcare Business Monthly. All rights reserved. Reproduction in whole or in part, in

any form, without written permission from AAPC® is prohibited. Contributions are welcome.

Healthcare Business Monthly is a publication for members of AAPC. Statements of fact or

opinion are the responsibility of the authors alone and do not represent an opinion of AAPC,

or sponsoring organizations.

CPT® copyright 2015 American Medical Association. All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not as-

signed by the AMA, are not part of CPT®, and the AMA is not recommending their use. The

AMA is not recommending their use. The AMA does not directly or indirectly practice medi-

cine or dispense medical services. The AMA assumes no liability for data contained or not

contained herein.

The responsibility for the content of any “National Correct Coding Policy” included in this

product is with the Centers for Medicare and Medicaid Services and no endorsement by the

AMA is intended or should be implied. The AMA disclaims responsibility for any consequenc-

es or liability attributable to or related to any use, nonuse or interpretation of information con-

tained in this product.

CPT® is a registered trademark of the American Medical Association.

CPC®, COCTM, CPC-P®, CPCOTM, CPMA®, and CIRCC® are registered trademarks of AAPC.


Go Green!Why should you sign up to receive Healthcare Business Monthly in digital format?

Here are some great reasons:

• You will save a few trees.

• You won’t have to wait for issues to come in the mail.

• You can read Healthcare Business Monthly on your computer, tablet, or other mobile device—anywhere, anytime.

• You will always know where your issues are.

• Digital issues take up a lot less room in your home or office than paper issues.

Go into your Profile on www.aapc.com and make the change!

December 2015

Ask the Legal Advisory BoardFrom HIPAA’s Privacy Rule and anti-kickback statute, to compliant coding, to fraud and abuse, there are a lot of legal ramifications to working in healthcare. You almost need a lawyer on call 24/7 just to help you make sense of all the new guidelines. As luck would have it, you do! AAPC’s Legal Advisory Board (LAB) is ready, willing, and able to answer your legal questions. Simply send your health law questions to [email protected] and let the legal professionals hash out the answers. Select Q&As will be published in Healthcare Business Monthly.

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Letter from CEO

Work Worth DoingA s I reflect on the past year, I am remind-

ed of something Theodore Roosevelt said: “Far and away the best prize that life has to of-fer is the chance to work hard at work worth doing.” Events outside AAPC and your re-quests provided many challenges and oppor-tunities we resolved to address. Our drive to serve members prompted several accomplish-ments this year, and I’m grateful to be part of an organization that achieved the following:150,000th Member – We welcomed Ele-na Kuklina, PhD, as our 150,000th mem-ber this year. The Centers for Disease Control and Prevention (CDC) health scientist and Emory University adjunct professor joined AAPC to seek training and certifications that would help her in her obstetrics and gynecol-ogy research. ICD-10 Implementation –AAPC members and staff were instrumental in making this year’s long-awaited ICD-10 implementation go smoothly. AAPC members served as ed-ucators, coordinators, and leaders in the in-dustry as the country transitioned from ICD-9 to the new diagnosis code set. AAPC will continue to support you with advanced train-ing opportunities, based on what you’ve told us you want to learn about this new code set and its use. Code of Ethics – The National Advisory Board’s Ethics Committee released an updat-ed Code of Ethics to better respond to mem-bers’ changing work environments. Simpli-fied and meaningful, the Code of Ethics holds members to the highest standard. Adherence to these ethical standards instills public con-fidence in the integrity and professionalism of AAPC members.More Customer Service Staff – To help serve you better and reduce wait times, we more than doubled AAPC’s Service Center staff since the beginning of the year. We also added Online Chat as another way for you to reach an AAPC customer service professional.New Certifications and Products – As part of AAPC’s effort to support your requests and emerging opportunities, we developed the

Certified Inpatient Coder (CIC™) and Certi-fied Risk Coder (CRC™) credentials and cur-riculum. New online education modules help members of all disciplines. Look for more training and credential opportunities in 2016 to keep current with the business of health-care. Improved, Less Expensive Codebooks – AAPC responded quickly to member feed-back surrounding our AAPC codebooks. We made a number of adjustments that will make the books easier to use as coding and educa-tion tools. The low priced books continue to help practicing coders and students. HEALTHCON – We had record-breaking attendance at AAPC national conference this year. We hope you enjoyed all of the new tracks and sessions we added to better meet your needs. AAPC continues to augment its impact as we serve members through meaningful certifi-cation, education, and service. We have com-pleted a great deal but have a lot more hard work worth doing. AAPC will continue to serve members through meaningful certifica-tion, education, and service. — and that’s our prize as we find ways to better serve you and the organizations for which you work. Here’s to a successful 2016!

Sincerely,

Jason J. VandenAkkerCEO

AAPC members and staff were instrumental in making this year’s long-awaited ICD-10 implementation go smoothly.


TCI-1

Please send your letters to the editor to: [email protected] to the Editor

Speak Up and Be Heard!Do you have a question regarding information found in Healthcare Business Monthly? Or maybe you have a difference in opinion you would like to share with your peers?

Write us at: [email protected].

One Inhalation Treatment per Patient Encounter“Don’t Leave Money on the Nebulizer Table” (September 2015, pages 24-27) indicated that pay-ers may allow you to report multiple units of CPT® 94640 Pressurized or nonpressurized inhala-tion treatment for acute airway obstruction or for sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device). Since January 2014, Medicare is not among these payers. The January 2014 National Cor-rect Coding Initiative update, chapter XI, section J, states:

CPT code 94640 should only be reported once during a single patient encounter regard-less of the number of separate inhalation treatments that are administered. If CPT code 94640 is used for treatment of acute airway obstruction, spirometry measurements be-fore and/or after the treatment(s) should not be reported separately.

Ken Camilleis, CPC, CPC, CPC-I, COSC, CMRS, CCS-P, CCS-P

www.aapc.com


September 2015

Take the Teaching Physician Quiz: 38

Get schooled in teaching hospitals’ physician guidelines

Put a Cork in Revenue Leakage: 44

Get to the root cause by resolving communication issues

Directors: Take Compliance Seriously: 56

Know what you’re supposed to oversee

September2015_HBM.indd 1 12/08/15 9:11 pm


Healthcare Business News

AAPC - Coder

AMA Asks HHS to Make AAPC an ICD-10 PartnerIn a letter to U.S. Department of Health & Human Services (HHS) Secretary Sylvia Burwell, American Medical Association (AMA) Ex-ecutive Vice President and CEO James L. Madara asked the agen-cy to add AAPC as a Cooperating Party for the ICD-10 Coordina-tion and Maintenance Committee. AAPC has the necessary exper-tise, experience and can serve as the voice of physicians lacking in to-day’s Cooperating Parties.Parties making up the ICD-10 Coordination and Maintenance Com-mittee include the Centers for Disease Control and Prevention’s Na-tional Center for Health Statistics; the American Hospital Association (AHA); and the American Health Information Association (AHIMA). The parties are responsible for the development and maintenance of the International Classification of Diseases (ICD) code set mandated for use in the United States.“AAPC’s 141,000 [now 153,000] members represent the highest lev-el of expertise in the industry in the areas of medical coding, medical billing, medical auditing, compliance, and practice management,” Madara said in the letter. Being made a partner would help the committee, as well as AAPC members, Jaci Johnson Kipreos, CPC, COC, CPMA, CPC-I, CEMC, president of the organization’s National Advisory Board, said. Representation at coordination and maintenance meetings will help coders better contribute to the development of the codes they use to establish medical necessity. “This represents a huge success in the

growth of AAPC as well as recognizes the importance and contribu-tion of its members,” she said.Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COB-GC, CPEDC, vice president of strategic development for AAPC, said, “With payment reforms and changes in the coding system, it is now vi-tal for the cooperating parties to contain inclusion of physician coding representation, and AAPC is the best equipped to do that.”Read the complete article on news.aapc.com.

New Year Payment ReleasesThe Centers for Medicare & Medicaid Services released final rules October 10, 2015, detailing how the agency will pay for physician ser-vices provided in 2016 to patients covered under Medicare. Among the key policies finalized in the 2016 payment rules are:

• Finalizing the Home Health Value-Based Purchasing model• Finalizing updates to the “Two-Midnight” rule• Finalizing the End-Stage Renal Disease Quality Incentive Program• Beginning the new physician payment system post the

Sustainable Growth Rate formula, and supporting patient- and family-centered care

• Finalizing a provision to empower patients and their families regarding advance care planning

Read all about it on the CMS website at: www.cms.gov/Newsroom/MediaRe-leaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-30-2.html.

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-30-2.html

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-30-2.html


By AAPC Ethics Committee

■ Code of Ethics

T here are six ethical principles of professional conduct: in-tegrity, respect, commitment, competence, fairness, and responsibility. In previous issues, we’ve discussed ethical

responsibilities of AAPC members, the impact of negative con-duct, and how to maintain integrity and respect. This month, we’ll focus on being committed and competent.

CommitmentAccording to the Urban Dictionary’s top definition, “Commit-ment is what transforms the promise into reality. It is the words that speak boldly of your intentions. And the actions which speak louder than words. It is making the time when there is none. Coming through time after time after time, year after year after year. Commitment is the stuff character is made of; the power to change the face of things. It is the daily triumph of integrity over skepticism.” Before you make a commitment, consider carefully the possi-ble outcomes of your decision. A commitment obligates you to do something. Some commitments, like marriage, can be life altering. When you take a job, you’re making a commitment to show up and do the job well — whether it’s a paid position and your employer has committed to compensate you, or it’s a vol-unteer effort.Volunteering for your AAPC local chapter shows commitment to your professional growth and the development of chapter members. When we commit to AAPC membership, we com-mit to “upholding a higher standard,” which includes the re-sponsibility to continually increase our level of professional competence. We commit to the AAPC Code of Ethics and the AAPC Chapter Association Code of Ethics, as well. Adherence to standards, like commitment, ensures public confidence in the integrity and service of medical coding, auditing, compli-ance, and practice management professionals who are AAPC members.AAPC Chapter Association board members work with local chapter officers and members, as do the local chapter represen-tatives at AAPC headquarters in Salt Lake City, Utah. In doing

Ethics Update Strengthens AAPC

Membership

Part 3: Foster the ethical principles of commitment and competence.

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Code of Ethics

so, we see commitment demonstrated consistently by local chapter officers and members, the people who volunteer their time and ener-gy to strengthening local chapters. They are committed to the vision and mission of AAPC. They are committed to advancing the work of those who are involved in the business of healthcare by teaching, mentoring, proctoring, and supporting local chapter members. Sim-ilarly, AAPC advisory board members, such as the National Advisory Board, Ethics Committee, and Legal Advisory Board, make a com-mitment to serve AAPC members. Without these committed mem-bers and staff, AAPC could not function effectively.The commitment you express to yourself, AAPC, and employers in-cludes an obligation to comply with standards that exist in every pro-fessional discipline. Without these standards, we cannot represent ourselves as a professional discipline. As you consider your commit-ment to professional conduct, think about your willingness to en-hance and improve your professional image, and the image of health-care professionals across the globe.

CompetenceAAPC’s commitment to core values includes competence, which ad-heres to:

• Developing and achieving a skill set that fosters high quality, effective work product and work process;

• Maintaining credentials and coding expertise through ongoing continuing education, networking, and professional development; and

• Maintaining a strong knowledgebase of key principles, including an awareness and understanding of applicable laws and regulations surrounding ethical and competent, professional coding.

Competence, as defined by the Business Dictionary, is “A cluster of related abilities, commitments, knowledge, and skills that enable a person (or an organization) to act effectively in a job or situation.” In medical coding, competence requires more than memorizing codes or understanding physician office habits; it requires professional cod-ers to describe the physician/patient encounter sufficiently to the pay-er for reimbursement on behalf of the provider.Coding is the last link in the chain of the physician/patient interac-tion. It tells the payer why the patient presented for care, what hap-pened, and when. This step requires a high level of trust from the phy-sician that the coder comprehends the note describing the patient’s

problems and treatment, and from the payer that the codes submit-ted for payment correlate with the provider’s documentation and the patient’s condition.Competency cannot be emphasized enough. AAPC’s Ethics Com-mittee occasionally encounters disputes involving competency. Such issues rarely involve actual knowledge and skill, but instead involve member conduct, where a coder knew or should have known his or her actions deviated from generally accepted standards and practices. Taking shortcuts, not engaging in due diligence, failing to adhere to the “rules of the road,” and engaging in inappropriate behavior can lead to review before the AAPC Ethics Committee panel. For ex-ample, coders should question circumstances where the quantity of claims processed is more important than ensuring the codes on the claims are correct. If elected to represent a local chapter, it’s necessary to become ac-quainted with AAPC’s Local Chapter Handbook, which covers roles, expectations, and general guidance regarding chapter financ-es. If designated to proctor an AAPC certification exam, it’s im-portant to remember that AAPC credentials (your credentials) are highly regarded in the healthcare industry. They are earned based on merit. Test-takers must achieve credential(s) on their own, with-out the help of others. No one would seek care from a physician or advanced practice professional who cuts corners. Similarly, no one would want someone who is unprincipled to be responsible for cod-ing their claims.The coding profession’s role in healthcare is becoming more impor-tant with the transition to ICD-10 and the shift from fee-for-service to value-based compensation. Such importance is reflected by the in-creased discussion surrounding these transformative changes.AAPC seeks to ensure membership reflects the very best of compe-tent and trustworthy professionals who are relied on to help physi-cians and other providers be properly compensated for their services. The AAPC Code of Ethics should serve as a road map to all who nav-igate the business of healthcare.

AAPC Ethics Committee

Competence, as defined by the Business Dictionary, is “A cluster

of related abilities, commitments, knowledge, and skills that enable

a person (or an organization) to act effectively in a job or situation.”


By Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC

AAPC Chapter Association

Make Your Chapter a SUCCESSTips to help officers advance the business side of healthcare.

This is the season of giving, being thankful, and new beginnings. As

I think of AAPC local chapters, I can’t help but recognize how our local chap-ter officers are selfless individuals who give freely of their time, knowledge, and wisdom to help all AAPC members excel in their careers.

We congratulate newly-elected officers and want you to know you are not alone. Officers rotating out have plenty of knowledge and experience to

help you get a jumpstart on achieving a thriving chapter through the com-ing year. And you can always ask for assistance from your AAPC Chapter As-

sociation regional representative, too.

Officers Promote Member SuccessAs a chapter officer, you play an essential role in promoting AAPC’s mission

statement, “Advancing the business side of healthcare.” Part of your role is to provide an educational forum for AAPC

members to: • Receive low or no cost continuing education units (CEUs);

Happy Holidays from the AAPC Chapter AssociationThe AAPC Chapter Association board of directors encourages every officer and member to take time for family and friends during this holiday season. Stop, relax, and enjoy each other’s com-pany. We often are so involved with our daily activities that we forget to enjoy the time. Best wishes to all of you and your families this season, and in the coming new year.

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AAPC Chapter Association

• Network and establishing an environment where less experienced members may interact, learn, and be mentored by those with more experience; and

• Make regular AAPC’s certification examinations available throughout the country.

Without your assistance, AAPC could not fully advance the business side of healthcare, and local chapters could not function effectively. Because your role is so important, AAPC offers several tools to sup-port your leadership for a successful term. Everything you need to op-erate your local chapter is available at www.aapc.com/memberarea/default.aspx, after you log into your AAPC membership account.

Tips to Start the Year RightA few items you’ll need to check off for a successful and exciting start are:1. Download and review the 2016 AAPC Local Chapter Handbook

– Most of the answers to your questions have been addressed in the soon-to-be-released 2016 AAPC Local Chapter Handbook. Officers must abide by the guidelines and check for changes, ef-fective October 1.

2. Attend the Local Chapter Officer Training – Offered by AAPC Chapter Association and the AAPC Local Chapter Depart-ment, this is in-depth training to help you understand what it takes to operate a successful AAPC local chapter, as well as AAPC’s expectations of all its officers. The training provides additional resources available on AAPC’s website and how to find officer-related information. A leadership training session is available at AAPC HEALTHCON and additional sessions are offered around the country throughout the year. These officer training sessions are four hours, and well worth your time.

3. Abide by the following chapter officer expectations:

Officer elections:• Ensure the roles of president, vice president, secretary, and

treasurer have been filled. à Chapters with average attendance of fewer than 40

members at local chapter meetings can combine the positions of secretary and treasurer into one position.

à Chapters with an average attendance of 40 or more members at meetings are encouraged to elect an education and member development officer in addition to the four main positions above.

• Submit online election verification to AAPC, which includes the names of the newly elected officers, city, state, and contact information within 10 days of elections.

à All elected chapter officers must agree to the terms in the Chapter Officer Agreement, indicating their promise to serve as officers for one year;

à AAPC is allowed to post the officers’ names and contact information on the AAPC website for each chapter member’s access; and

à All elected officers must maintain current AAPC membership.

Meetings:• Hold officers’ meetings routinely and distribute the minutes of

these meetings to chapter officers and other meeting attendees in a timely manner by uploading a PDF copy to the chapter’s online library.

• Hold at least six chapter meetings and four exams per year, in a friendly and professional manner. Chapter officers must share responsibility to proctor all chapter-sponsored exams.

à Encourage all officers to participate in the planning of events such as May MAYnia, chapter seminars/conferences, fundraisers, etc.

à Encourage and include chapter members to participate through committees.

Finances:• Retain all financial and non-financial chapter records and

documents.• Comply with all requirements related to the use of local

chapter funds, including the submission of the monthly Profit and Loss Statement no later than the fifth of each month and for the end of the year by December 31.

• Ensure you have a minimum of two signatures on the local chapter checking account and are authorized to sign each check drawn from the local chapter bank account.

• Ensure appropriate use of chapter funds, as outlined in the Local Chapter Handbook.

• Submit all required paperwork and agreements.Above all, remember you serve voluntarily to represent your chap-ter members and AAPC, and are expected to act ethically and with integrity. Ensure you promote AAPC and its mission on a local lev-el and communicate all local concerns to AAPC in a timely manner.

Officers Stay Dedicated and True BlueThe commitment of our volunteer officers is seen in all areas of our profession. I am impressed by the dedication of everyone involved in carrying out the AAPC mission statement, during challenging and rewarding times. Thank you for your service to our members. Your commitment moves us forward and demonstrates integrity, account-ability, dignity, and respect.

Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, specializes in dermatology coding. A national speaker on coding and regulatory issues, she presents at American Academy of Derma-tology annual and summer meetings, AAPC regional conferences, and several other venues. Mc-Nicholas has a wide range of experience in various medical specialties and practice settings. She is also a certified and approved ICD-10-CM/PCS expert and trainer, a member of the AAPC Chap-ter Association, and has served office for the Des Plaines, Ill., local chapter.


By Glenda Hamilton, CPC, COC, CPMA, CEMC, CPC-P

When I first became certified, AAPC offered only Certified Pro-fessional Coder (CPC®) and Certified Outpatient Coding

(COC®, formerly CPC-H) credentials. The Certified Professional Coder-Payer (CPC-P®) was added next. Soon after, a beta-test was offered to chapters for the Certified Evaluation and Management Coder (CEMC™) credential. These core credential certifications re-quired equal continuing education units (CEUs).As AAPC grew, members requested a greater range of specialty cre-dentials. Coders who worked in a single specialty found the CPC® or COC® credential difficult to earn because the exams tested on multiple specialties. AAPC decided to redesign the specialty exams to stand alone, so a core credential was no longer mandatory to sit for a specialty exam. If you have worked in a specialty practice for years and want to vali-date your expertise in that specialty, then acquiring a specialty cer-tification is the way to go.

The Birthing ProcessIf you don’t see a certification for your specialty on the AAPC website, you can request that it be added. Go to the “Specialty Medical Coding Certification” webpage at www.aapc.com/certification/specialty-credentials.aspx, and click the link at the bottom right corner that says, “Don’t see your specialty? Tell us.” When the survey

pops up, select your specialty or, if it isn’t listed, enter it. Then, click “Done.” Here begins the possibility of a new credential. But the process is complicated. If there is a large response requesting the same field of expertise, the process moves forward. Medical societies are contacted to make sure competing credentials with similar requirements are not being duplicated. It’s also neces-sary to determine whether the credential is needed in the industry, and whether it will meet industry standards.When a credential is determined to be necessary, a test committee is formed. The committee is made up of five experts, with at least two years’ experience in the specialty. AAPC staff runs the committee. Work on the exam committee includes the following steps:

• Competencies needed to perform the job are determined.• Competencies are vetted by employers.• AAPC oversees the development, review, and vetting of

all questions based on the determined competencies. The question bank includes questions used for the certification exam and test preparation materials (study guides and practice tests).

Most coding exams include:• Anatomy and physiology

How a Credential Is BornHow a Credential Is BornHow a Credential Is BornUnderstand the process of expanding specialty credential options.

■ ADDED EDGE

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Credential

• Medical terminology• Coding concepts for the specialty• Medical record abstraction of office notes and procedures, if

applicable• Evaluation and management (1995 and 1997

Documentation Guidelines for Evaluation and Management Services)

• Compliance• Payment methodologies

Beta Testing Ensures a Thorough ExamA question bank for the certification exam is developed next. Ques-tions are pulled for a beta exam, which is used to gather statistics for question performance. Expert coders in the field are evaluated

on performance for each question. These statistics are used to vet the accuracy of each test question. Beta testers also complete a sur-vey to determine whether all competencies were covered, the diffi-culty level of the exam was appropriate, and the proper amount of time was allotted.Only after all of the steps and statistics in the process are complete is a decision made whether to offer the certification exam. Then, just maybe, we witness the birth of a credential!

Glenda L. Hamilton, CPC, COC, CPMA, CEMC, CPC-P, brings over 25 years of experience to practice management, coding, reimbursement, education, and consulting as a business owner. She joined Cooper University Hospital in 2005 as clinical documentation educator. Hamilton is now senior compliance auditor at Cooper. She has held many officer positions over the past 10 years at the Cherry Hill, N.J., local chapter. Hamilton started multiple charitable projects in the chapter and believes in paying it forward.

If you don’t see your specialty certification on the AAPC website, you can request it to be added.

ADDED EDGE

Visit aapc.com/ask-an-expert to get expert answers to your healthcare questions.

Whether you are settling a coding dispute or need a response from a reputable source, AAPC Ask an Expert provides the answers you need. Post a coding, billing, auditing, prac-tice management or compliance question and receive a response from an AAPC Expert within one business day. The AAPC Expert team includes professionals from all facets of the business of healthcare. Get answers to tough questions from a source you can trust.

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By Maryann C. Palmeter, CPC, CENTC, CPCO

■ CODING/BILLING

■ Coding/Billing ■ Auditing/Compliance ■ Practice Management

Medicare Primary

Care Center Exception

Update

Clarify the rules, and understand documentation requirements and limitations when reporting services.

Medicare Primary

Care Center Exception

Update

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The final rule for teaching physician presence and documentation requirements under Medicare Part B has been in effect since July

1, 1996. Over the years, the Centers for Medicare & Medicaid Ser-vices (CMS) has revised and clarified the rule. Let’s assess the cur-rent regulations to see how they affect coding and billing in your medical practice.

Billing GuidelinesGenerally, to bill Medicare Part B for services involving residents, the teaching physician must personally perform the service, or at least be physically present during the critical or key portions of the service. Only specified services performed by residents under a “pri-mary care exception” (within an approved Graduate Medical Edu-cation Program) may be billed to Medicare Part B under the teach-ing physician’s provider number without the teaching physician there to perform the service. The primary care center exception is not limited to primary care or family practice residency programs. Per CMS, the exception could apply to any residency program with requirements that are incom-patible with the teaching physician physical presence requirement. Residency programs most likely to qualify for the exception include family practice, general internal medicine, geriatrics, pediatrics, and obstetrics/gynecology.

Attest in WritingFor the exception to apply, the center must attest in writing to the Medicare administrative contractor (MAC) that the following con-ditions have been met:

1. The services are performed in a center located in an outpa-tient department of a hospital or another ambulatory care entity in which the time spent by the residents in patient care activities is included in determining Medicare Part A pay-ments to the hospital.

2. The residents involved have completed more than six months of a residency program.

3. The teaching physician directs the care of no more than four residents at a time, and directs the care from such proximity as to constitute immediate availability.

The primary care center exception is not limited to primary care or

family practice residency programs.


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4. The teaching physician has no other responsibilities at the time (including the supervision of other personnel) and man-ages responsibility for those patients seen by the residents.

5. The patients seen are an identifiable group who consider the center to be the continuing source of their healthcare, and are cognizant that residents under the medical direction of teaching physicians furnish services. The residents follow the same group of patients throughout the course of their residency program.

Centers exercising the exception do not need to obtain prior approv-al, but they must maintain records demonstrating that they quali-fy for the exception.

Services Included Under the ExceptionThe range of services residents may furnish under the exception in-cludes:

• Acute care for undifferentiated problems or chronic care for ongoing conditions, including chronic mental illness

• Coordination of care furnished by other physicians and providers

• Comprehensive care not limited by organ system or diagnosis

Under the exception, residents may provide reasonable and neces-sary, low- to mid-level evaluation and management (E/M) servic-es, and other specified services, without the presence of a teaching physician. Specific procedure codes that may be billed under the ex-ception include:

CPT® CodesNew patient office or other outpatient visit: 99201, 99202, and 99203Established patient office or other outpatient visit: 99211, 99212, and 99213

HCPCS Level II Codes

G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficia-ry during the first 12 months of Medicare enrollment

G0438 Annual wellness visit, includes a personalized prevention plan of service (PPPS), first visit

G0439 Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit

For services other than those listed above, the general teaching phy-sician policy applies.

Append Modifiers ProperlyModifier GE This service has been performed by a resident without the presence of a teaching physician under the primary care exception must be appended to services billed under the exception. Services that do not meet the requirements for an exception revert to the gener-al teaching physician guidelines, and claims must include modifier GC This service has been performed in part by a resident under the di-rection of a teaching physician.

Follow 4-to-1 Ratio RulesA teaching physician may not supervise more than four residents at any given time, and only residents who have completed more than six months of an approved GME program may furnish billable pa-tient care without the teaching physician’s physical presence. Al-though residents with less than six months in an approved GME program do not qualify for the exception, they are counted among the four residents under supervision of the teaching physician. See the following chart for scenarios of how the 4:1 ratio affects billing.

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CODING/BILLINGTo discuss this article or topic, go to www.aapc.com

Documentation Requirements To qualify for the exception, the teaching physician must document the extent of his or her participation in the review and direction of the services furnished to each patient.

Good Teaching Physician Note ExampleI have reviewed with the resident Jane Doe’s medical history, phys-ical examination, diagnosis, and results of tests and treatments and agree with the patient’s care as documented in the resident’s note.This is a good teaching physician note because it specifies that the teaching physician reviewed and discussed the history, phys-ical examination, assessment, and plan provided by the resident, and it supports the teaching physician’s agreement with the plan of care for the patient. Poor Teaching Physician Note ExampleI have discussed the case with the resident. This note is poor because it does not specify what was discussed with the resident, nor does it support the teaching physician’s di-rection of the services furnished to the patient.

Resources“Guidelines for Teaching Physicians, Interns, and Residents,” www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Teaching-Physicians-Fact-Sheet-ICN006437.pdf

Medicare Claims Processing Manual, Pub. 100-04, chapter 12, www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

Maryann C. Palmeter, CPC, CENTC, CPCO, is director of physician billing compliance with the University of Florida Jacksonville Healthcare, Inc., where she provides professional direc-tion and oversight to the billing compliance program of the University of Florida College of Medicine-Jacksonville. Her extensive experience in federal and state government payer bill-ing and compliance regulations has been gained through executive level positions on both

the physician billing and government contractor sides of the healthcare industry. Palmeter served as a Nation-al Advisory Board member from 2011-2013 and as secretary from 2013-2015. She was named AAPC’s 2010 “Member of the Year” and is a member of the Jacksonville, Fla., local chapter.

Sample Scenarios with 4-to-1 Ratio

Resident with six months or less in residency program.

New resident A

Resident with more than six months in residency program.

Old resident B


Old resident C


Old resident D

Exception applies to old residents B, C, and D, but not to new resident A. Follow general teaching physician rules for new resident A.

Apply modifier GC to charge for new resident A.

Apply modifier GE to charges for residents B, C, and D.


New resident A


Old resident B


Old resident C


Old resident D


Old resident E

Exception does not apply to ANY residents because the 4-to-1 ratio is exceeded. Follow general teaching physician rules for ALL residents.

Apply modifier GC to charges for ALL residents.


New resident A


New resident B


Old resident C


Old resident D

Exception applies to old residents C and D, but not to new residents A and B. Follow general teaching physician rules for new residents A and B.

Apply modifier GC to charges for new residents A and B.

Apply modifier GE to charges for old residents C and D.

www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Teaching-Physicians-Fact-Sheet-ICN006437.pdf



www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf


By Sarah W. Sebikari, MHA, CPC

■ CODING/BILLING


A discontinued procedure is one that is halted prior to completion but after anesthesia has been induced, usually because the pa-

tient’s health is at risk. Modifier 53 Discontinued procedure is ap-pended to the procedure code to indicate such an occurrence. Used improperly, modifier 53 can get you in hot water. Let’s consider the proper use of this modifier in a physician setting.

Modifier 53 DefinedModifier 53 is used to denote a discontinued surgical or diagnostic procedure, and indicates that the provider aborted the procedure as a result of an unexpected event or a complication that put the pa-tient’s welfare at risk. Per CPT® instruction:

Under certain circumstances the physician or other qual-ified health care professional may elect to terminate a sur-gical or diagnostic procedure. Due to extenuating circum-stances, or those that threaten the well-being of the patient,

it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure.

The American Medical Association (AMA) created modifier 53 in 1997 to distinguish between services discontinued at the provider’s discretion, and those discontinued as a result of extenuating circum-stances that cause a risk to the patient.

Supporting Documentation RequirementsTo append modifier 53, certain documentation criteria must be met, and that documentation must be available for payer review. Documentation must substantiate the discontinued procedure and support medical necessity. Specifically:

• The operative report must indicate anesthesia was induced and the procedure started. Anesthesia may include local, regional block, moderate/conscious sedation, deep sedation, or general anesthesia.

• If a scope was used, documentation must support that a scope was introduced prior to termination of the procedure.

• Documentation must indicate in detail the reason the procedure was discontinued. The more detail, the easier it is for the payer to manually adjust the claim, rather than hold it for further review (held claims delay reimbursement and subsequently affect operations).

Examples of documentation that would warrant use of modifier 53 include:

• The patient encountered difficulty breathing during the procedure; therefore, the procedure was terminated.

• As a result of extensive hemorrhaging, the procedure was discontinued.

• The patient suffered continued arrhythmia, so the procedure had to be aborted.

• An adverse reaction to anesthesia caused the patient to convulse, prompting a discontinuation of the procedure.

Claim All Your Pennies for Discontinued ProceduresWhen a procedure is cut short due to complications or risks, be sure to meet payer reporting criteria.

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• The patient was unable to tolerate the procedure as a result of morbid obesity.

In addition to operative notes, the Center for Medicare & Medic-aid Services (CMS) requires documentation stating the percentage of the procedure performed; however, most commercial payers will determine the percentage of the procedure completed based on doc-umentation in the operative report.

Reimbursement Reimbursement for procedures billed with modifier 53 is based on how much of the procedure was performed, as documented in the operative report. This shows the significance of clear and concise documentation detailing the extent of the procedure. The CMS Physician Fee Schedule Relative Value Files list a sepa-rate Relative Value Unit (RVU) for some codes based on modifi-er 53. For example, CPT® 45378-53 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure) has already been reduced on the fee schedule. Typically, however, payers manually price procedures billed with modifier 53.

Tips:• Send an operative report with the claim so the payer will

determine reimbursement. Expect a reduced reimbursement rate, so do not reduce your fee in advance.

• Do not report elective cancellation of a procedure prior to anesthesia with modifier 53.

• Do not report evaluation and management or time-based services with modifier 53.

• Only append modifier 53 to physician services.• Do not append modifier 53 to laparoscopic or endoscopic

procedures converted to an open procedure, or when a procedure is converted to a more extensive procedure.

Example 1A patient with pneumonia of an unspecified nature was sched-uled by Dr. Bronco’s office for a surgical bronchoscopy with bi-opsy. On checking in at the endoscopy suite, the patient signs an informed consent. The patient is prepped and draped in normal

sterile fashion, general anesthesia is administered, and a flexible bronchoscopy under fluoroscopic guidance is inserted through the oropharynx to the trachea. On visualization, a lung mass is noted. Biopsy forceps are inserted to obtain a biopsy and the pa-tient starts to bleed uncontrollably. At this point, Dr. Bronco de-cides to terminate the procedure after controlling the bleeding, as this caused evident risk to the patient’s life.

The appropriate procedure code 31628 Bronchoscopy, rigid or flexi-ble, including fluoroscopic guidance, when performed; with transbron-chial lung biopsy(s), single lobe is billed with modifier 53 appended to signify the procedure was started and discontinued by the phy-sician, since the risks of continuing the procedure would be high.

Example 2A patient who has been experiencing severe headaches for the past two month is scheduled for a spinal tap. On arrival, the pa-tient is prepped and sedated. While performing the spinal tap, Dr. Tap realizes the patient is experiencing difficulty breathing and is moving and twisting in pain. Dr. Tap notes that the pa-tient’s well-being is at risk, and decides to immediately halt the procedure.

Code 62270 Spinal puncture, lumbar, diagnostic is billed with mod-ifier 53 appended to alert the payer that the procedure was discon-tinued. By appending modifier 53 in this instance, you also poten-tially avoid a denial for duplicate billing if the procedure is complet-ed successfully in the future.

Risk Management ReminderWhen a discontinued procedure is aborted as the result of potential risk to a patient’s life, risk management must be notified.

Resources:AMA, 2015 CPT® Professional EditionCMS Medicare Claims Processing Manual, chapter 4, section 20.6.4

Sarah W. Sebikari, MHA, CPC, is employed by Summit Health Management a Physician Practice Management Organization in New Jersey as a coding compliance education lead for their Coding Compliance department. She has been in the healthcare field for over 12 years, with experience spanning from multiple-specialty physician to outpatient coding and reim-bursement.

To append modifier 53, certain documentation criteria must be met, and it must be available for payer review.


By Frank Mesaros, MPA, MT (ASCP), CPC

■ CODING/BILLING


You may know it as adulteration, specimen validity, or specimen in-tegrity testing; regardless of terminology, Medicare does not cov-

er it, but other insurance plans do. The key to reimbursement is to understand the tests, determine if they are medically necessary, re-view payer policies for coverage parameters, and be sure your physi-cian’s documentation is supportive.

Urine Evaluation and ReportUnderstanding how to evaluate urine drug screens for adulterations, substitutions, and potential false results is complex, but vital to in-terpreting their results. A detailed medication history — includ-ing prescription, nonprescription and herbal medications — and proper knowledge of medications that cross-react with urine drug screens are essential for assessing cross reactivity that may affect re-sults. (Moeller 2008) Urine tests can appear in a report as adulterated, substituted, or di-lute. An adulterated urine specimen contains a substance that is not

normally found in urine, or that normally is found, but is in abnor-mal concentrations. Adulterants work by interfering with immuno-assay and/or confirmatory assay function, or they convert the target drug into compounds not detected by the test. Synthetic urine products can be submitted when urine specimen collection is not observed; however, more commonly, water or sa-line solution is substituted. Diluting the urine sample to the point where the targeted drug is below the cutoff concentration is a way to get a negative result. (Substance Abuse and Mental Health Ser-vices Administration)The National Correct Coding Initiative (NCCI) manual (chapter 10, section E) says:

Providers performing validity testing on urine specimens utilized for drug testing should not separately bill the valid-ity testing. For example, if a laboratory performs a urinary pH, specific gravity, creatinine, nitrates, oxidants, or oth-

Specimen Validity TestingDetermine coverage and be sure to maintain documentation.

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Validity Test

CODING/BILLINGer tests to confirm that a urine specimen is not adulterated, this testing is not separately billed. … [a] laboratory test is a covered benefit only if the test result is utilized for manage-ment of the beneficiary’s specific medical problem. Testing to confirm that a urine specimen is unadulterated is an in-ternal control process that is not separately reportable.

Medical NecessityTreating physicians typically order specimen validity testing to make patient-specific therapeutic decisions, including those relat-ed to medication compliance and illicit drug use. In the absence of this validity testing, a patient may succeed in deceiving a physician through the submission of an adulterated urine specimen. This may have the unintentional effect of masking the presence of some un-derlying medical conditions by providing misleading urine drug test results. (Kirsh 2015) Concerns of drug abuse and noncompliance are considerations pain management physicians routinely assess. Specimen validity testing provides evidence that, when taken into consideration with oth-er indicators (e.g., incorrect pill counts, suspicious behaviors, clini-cal symptoms), may assist the medical management of the patient, including the initiation of a conversation regarding potential drug abuse, mismanagement of medications, or diversion of prescribed drugs. (Ko 2013)

Coverage Varies, but Is a No for MedicarePalmetto Government Benefits Administrator states their position in policy M00024, consistent with the NCCI manual:

… a diagnostic laboratory test must be ordered by the treat-ing physician and the test results must be used in the man-agement of the beneficiary’s specific medical problem. Al-though some laboratory requisitions allow the ordering physician to designate specimen validity testing (e.g., creat-inine, oxidant, pH, specific gravity) to ensure that a patient specimen has not been adulterated, the results of this testing are not used in the management of the beneficiary’s medi-cal problem. Therefore, Palmetto GBA has determined that specimen validity testing is a statutorily excluded service.

Similarly, Florida Medicare administrative contractor First Coast Service Options does not cover specimen validity testing including, but not limited to pH, specific gravity, oxidants, and creatinine. (First Coast Service Options, Inc., 2014) Cigna coverage policy 0512 regarding drug testing indicates rou-tine tests to confirm specimen integrity are not covered because they are not considered medically necessary. (Cigna 2015) Because the phrase “routine tests” is used, you can argue that although routine integrity testing is not covered, integrity testing when specifically requested may be covered.A federal employee health benefit plan for mail handlers (Mail Han-dlers Benefit Plan) on urine drug testing specifically indicates CPT® codes 81002 Urinalysis, by dip stick or tablet reagent for bilirubin, glu-cose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific grav-ity, urobilinogen, any number of these constituents; non-automated, without microscopy; 81003 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; auto-mated, without microscopy; and 82570 Creatinine; other source as ad-ditional tests that may be appropriate to verify a urine sample was not adulterated when specifically ordered by the authorized request-ing provider. Coventry Health Care, an Aetna company, has a urine drug testing policy with the same coverage wording. In a document published on the Anthem Blue Cross Blue Shield website titled “Urine Drug Screening – A Practical Guide for Cli-nicians,” laboratory tests are specifically specified, indicating con-tamination should be considered if test results for pH, specific grav-ity, urine creatinine, or urine nitrite levels are outside predetermined levels. (CARES Alliance 2010)Specimen validity testing is mandatory for the Department of Trans-portation workplace drug and alcohol testing programs. (Section 40.89(b) 2008) The U.S. Department of Health & Human Services drug testing standards were first published in 1988. In 2004, signifi-cant revisions requiring specimen validity testing on federal employ-ee donor urine specimens were included. (Bush 2008)Although specimen validity testing is arguably medically necessary, routine use fits into Medicare’s definition. This does not, however, take into account conditions where there may be medical value in the tests. Check the relevant coverage policies to determine whether this testing is covered and what documentation to maintain.

Specimen validity testing is typically ordered by treating clinicians who use the results to make therapeutic decisions

regarding specific medical problems of their patient, including those related to medication and illicit drug use.


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

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ResourcesBush, Donna M., “The U.S. Mandatory Guidelines for Federal Workplace Drug Testing Programs: Current status and future considerations,” Forensic Science International 174 (2-3): 111-119, 2008.CARES Alliance, “Urine Drug Screening - A Practical Guide for Clinicians,” 2010: www.anthem.com/painmanagement/documents/Urine_Drug_Screening.pdf.Center for Substance Abuse Treatment, “Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs,” Treatment Improvement Protocol (TIP) Series 43 (Substance Abuse and Mental Health Services Administration): http://buprenorphine.samhsa.gov/tip43_curriculum.pdf Cigna, “Cigna Medical Coverage Policy - Drug Testing,” October 15, 2015: https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0513_coveragepositioncriteria_drug_test.pdf.The Centers for Medicare & Medicaid Services (CMS), NCCI Policy Manual for Medicare Services, chapter 10, section E.Coventry Health Care, “Urine Drug Testing Coverage,” American Foreign Service Protective Association: www.afspa.org/home/pdfs/FEHBP-Urine-Drug-Testing-Coverage.pdf.First Coast Service Options, Inc., “Controlled Substance Monitoring and Drugs of Abuse Testing,” First Coast Service Options. November 15, 2014: www.medicare.fcso.com/Fee_lookup/LCDDisplay.asp?id=DL35654

K.E. Moeller, Lee, K.C., and Kissack, J.C., “Urine Drug Screening: Practical Guide for Clinicians.” Mayo Clinic Proceedings 83 (1): 66-76.

Kenneth L. Kirsh, Christo, P.J., Heit, H., Steffel, K., and Passik, S.D., “Specimen validity testing in urine drug monitoring of medications and illicit drugs: Clinical implications,” Journal of Opioid Management, 11 (1): 53-59.Mail Handlers Benefit Plan, “FEHBP Urine Drug Testing.” www.mhbp.com/web/groups/public/@cvty_mailhandlers_mhbp/documents/document/c075890.pdf

Mancia Ko, Merritt, P., and Dawson, E., “Specimen Validity Testing - Focus on Screens looks at interpreting urine drug assay results.” Practical Pain Management. June 1, 2013: www.practicalpainmanagement.com/resources/diagnostic-tests/specimen-validity-testing.Palmetto GBA, “Specimen Validity Testing (M00024),” MolDX. September 4, 2014. Section 40.89(b), 49 CFR, June 25, 2008.Substance Abuse and Mental Health Services Administration, “Clinical Drug Testing in Primary Care (TAP 32),” chapter 4, page 43.Substance Abuse and Mental Health Services Administration, “Clinical Drug Testing in Primary Care (Technical Assistance Publication Series - TAP 32),” chapter 5, pages 52-54.Tellioglu, Tahir, “The Use of Urine Drug Testing To Monitor Patients Receiving Chronic Opioid Therapy for Persistent Pain Conditions,” Medicine and Health Rhode Island 91 (9), pages 279-80, 282.

Frank Mesaros, MPA, MT(ASCP), CPC, is CEO of Trusent Solutions, LLC, a management consulting firm specializing in the laboratory industry. Trusent provides revenue stream in-tegrity services to regional laboratories, hospital based laboratories, and physician office based laboratories. He is a member of the Harrisburg, Pa., local chapter.

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www.anthem.com/painmanagement/documents/Urine_Drug_Screening.pdf

http://buprenorphine.samhsa.gov/tip43_curriculum.pdf

https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0513_coveragepositioncriteria_drug_test.pdf

https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0513_coveragepositioncriteria_drug_test.pdf

www.afspa.org/home/pdfs/FEHBP-Urine-Drug-Testing-Coverage.pdf

www.medicare.fcso.com/Fee_lookup/LCDDisplay.asp?id=DL35654

www.mhbp.com/web/groups/public/@cvty_mailhandlers_mhbp/documents/document/c075890.pdf

www.mhbp.com/web/groups/public/@cvty_mailhandlers_mhbp/documents/document/c075890.pdf

www.practicalpainmanagement.com/resources/diagnostic-tests/specimen-validity-testing


By Diana H. Williams, BS, CPC, CCS-P, CCS, CPMA

FACILITY ■


Timely documentation reviews can help you to find problematic coding. With ICD-10 implementation, blood transfusion facility

coding is one area you may want to check for medical record deficien-cies. The first step to ensuring your physician documentation is suf-ficient is knowing what you must look for.

Assign the Right CharactersBlood transfusions can be found in the Administration section of ICD-10-PCS with the first character 3, meaning procedures to put in or on a therapeutic, prophylactic, protective, diagnostic, nutrition-al, or physiologic substance. The second character for a blood trans-fusion is a 0 Circulatory (system), and the third character is 2 Transfu-sion (putting in blood or blood products). This brings you to the ICD-10-PCS table that begins with 302. See the following excerpt from Table 302 for reference:

Section - 3 Administration Operation - 2 Transfusion: Putting in blood or blood productsBody System - 0 Circulatory

Body System/Region Approach Substance Qualifier

3 Peripheral Vein4 Central Vein5 Peripheral Artery6 Central Artery

0 Open3 Percutaneous

G Bone MarrowH Whole BloodJ Serum AlbuminK Frozen PlasmaL Fresh PlasmaM Plasma CryoprecipitateN Red Blood CellsP Frozen Red CellsQ White CellsR PlateletsS GlobulinT FibrinogenV Antihemophilic FactorsW Factor IXX Stem Cells, Cord BloodY Stem Cells, Hematopoietic

0 Autologous1 Nonautologous

Character 4 specifies the body system/region and identifies the site where the substance is administered — not the site where the sub-stance administered takes effect. The body systems/regions for ar-teries and veins are peripheral artery, central artery, peripheral vein and central vein.Locate where this is documented in the medical record and, specifi-cally, if an artery or vein was accessed for the transfusion. Most of the

time this is a peripheral vein, but it should be documented as such. You don’t want your documentation to fall short for coding purpos-es. Conducting a review can be very helpful here. Character 4 of the seven character code for the transfusion must be: 3 Peripheral Vein; 4 Central Vein; 5 Peripheral Artery; or 6 Central Ar-tery.For the 5th character, Approach, you must select either 0 Open or 3 Percutaneous. Check your documentation and, if necessary, reach out to your providers to ensure this information is captured and present in the medical record. The final two characters necessary to complete the code are character 6 Substance, and character 7 Qualifier. There are many choices for character 6, and some pertinent are: H Whole Blood, K Frozen Plas-ma, L Fresh Plasma, N Red Blood Cells, P Frozen Red Cells, Q White Cells, and R Platelets. Character 7 Qualifier has two options: 0 Autologous and 1 Nonau-tologous. Following these steps, for example, the correct code in ICD-10-PCS for a red blood cell transfusion accessing a percutaneous peripheral vein using nonautologous cells is 3023N1.

Documentation Is KeyFind out how many of these procedures are performed a day in your facility. Be sure you can locate proper documentation in each patient’s medical record. When you find the documentation, ensure it holds up for coding and possible review. Timely reviews can assist you and your organization to answer these important questions. Ensure that you can document and code blood transfusions correctly, and keep the revenue road clear of prevent-able roadblocks.

ResourcesICD-10-PCS Introduction, Administration Section

Diana H. Williams, BS, CPC, CCS-P, CCS, CPMA, has over 30 years of experience in healthcare as a consul-tant, coder, educator, auditor, manager, and medical insurance professional. She is a multi-specialty surgical coder, specializes in evaluation and management audits and works in clinical documentation improvement. You can reach Williams at [email protected]. She is a member of the Pensacola, Fla., local chapter.

TRANSFUSIONSDocument Properly for ICD-10-PCSAssign correct characters and keep the revenue road clear of denial roadblocks.



By Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P

■ CODING/BILLING


Last month, we discussed coding arthroscopic knee procedures. Now, let’s address coding open knee procedures, as well as non-

operative services, including injections and fracture care.

Open ProceduresThere is a wide range of CPT® codes (27301-27599) that covers the gamut of open knee services, such as incision, excision, repair/revi-sion/reconstruction, fracture/dislocation treatment, etc.Manipulation of the knee joint 27570 Manipulation of knee joint un-der general anesthesia (includes application of traction or other fixation devices) usually is bundled into a surgical procedure, and is rarely paid unless it’s done alone.Because of the anticipated recovery time of a few days, total knee arthroplasty (TKA), 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfac-

ing (total knee arthroplasty) is an inpatient procedure (POS 21). The most common diagnosis to justify a TKA is severe osteoarthritis (ICD-10 M17.- or ICD-9 715.26/715.36).

Know the LingoTo verify TKA procedural notes, watch for words such as medial, lateral, patellofemoral, and tibial. Progress notes should confirm the osteoarthritis is so severe there is bone-on-bone encroachment. (Payers may want to see a copy of the dictated notes.)For a TKA revision (27486 Revision of total knee arthroplasty, with or without allograft; 1 component and 27487 Revision of total knee ar-throplasty, with or without allograft; femoral and entire tibial com-ponent), watch for key words such as “removal and replacement of polyetheline liner” or “poly exchange,” and determine whether both the femoral and tibial components were removed. If only the liner was removed and replaced, report 27486 with modifier 52 Re-duced services.

Don’t Get Tripped Up By Common ErrorsA common error is failing to document or code a tendon transfer, which can be reported separately with 27396 Transplant or trans-fer (with muscle redirection or rerouting), thigh (eg, extensor to flexor); single tendon. The tendon repair codes also can easily be confused with 27437 Arthroplasty, patella; without prosthesis, which refers to a bone/joint repair rather than a tendon repair. This is a classic exam-ple of how important it is to read the entire report and to understand exactly what type of tissue is being repaired, as well as to account for all procedures performed during the operative session (some of which may not be included in a primary procedure and would not trigger National Correct Coding Initiative edits).

More Tricks of the Trade• Fracture/dislocation care coding (27500-27566) depends

on the specific anatomic site, type of fracture, and approach (closed, open, percutaneous).

• Report a bone graft (e.g., 20902 Bone graft, any donor area; major or large) if the graft is harvested from a non-adjacent site (i.e., through a separate incision), and when the graft is not included in the CPT® descriptor for the surgery.

• You might be able to report multiple units of 27403 Arthrotomy with meniscus repair, knee (possibly with modifier 59 Distinct procedural service/XS Separate structure) if the

Coding that Brings You to Your KneesPart 2: Open surgical procedures and non-operative procedures

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open meniscus repair is done on both the medial and lateral compartments. Check your specific payer’s guidelines, and be sure there is adequate supporting documentation in the operative note.

• Coding for patella surgeries can be tricky. A relatively common procedure is a patellar tendon repair, coded as 27380 Suture of infrapatellar tendon; primary or 27381 Suture of infrapatellar tendon; secondary reconstruction, including fascial or tendon graft. The latter includes obtaining and using a fascia or tendon graft.

Non-operative Knee TreatmentsServices to treat early osteoarthritis and other chronic or acute knee conditions include steroid or nonsteroidal anti-inflammatory drug (NSAID) injections, and various non-operative fracture treatments. These are just temporary alternatives to surgery.If the provider performs an appropriately documented and med-ically necessary exam prior to injection, you may report the sup-ported evaluation and management (E/M) service with modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service appended, as well as 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guid-ance or 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting. Sometimes, depending on the recommended medication, an injec-tion regime is planned to cover more than one session. In such a case, there is no separately identifiable E/M service after the initial ses-sion. You may also report the HCPCS Level II code for any medica-tion injected in the doctor’s office (e.g., Euflexxa® J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose or Syn-visc® J7325 Hyaluronan or derivative, synvisc or synvisc-one, for in-tra-articular injection, 1 mg); however, it’s important to read the pa-tient’s chart notes and to understand contractual arrangements with local payers. If the medication is supplied by pharmacy script (as is often the case), reporting the supply is double-dipping. Another type of nonsurgical knee treatment consists of fitting the patient to an orthosis, such as a splint or cast in the event of a frac-ture. Such a service is reported as “closed treatment without manip-ulation” and any of the following might apply:

27508 Closed treatment of femoral fracture, distal end, medial or lateral condyle, without manipulation

27516 Closed treatment of distal femoral epiphyseal separation; without manipulation

27520 Closed treatment of patellar fracture, without manipulation

27530 Closed treatment of tibial fracture, proximal (plateau); without manipulation

27538 Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee, with or without manipulation

Although nonsurgical, these treatments have a 90-day global peri-od; therefore, any related office visits during this time are included

in the treatment. These visits are reported using 99024 Postopera-tive follow-up visit, normally included in the surgical package, to indi-cate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure, which is a zero-charge postoperative visit. If the physician determines at such an encounter that the patient failed non-operative treatment (e.g., still experiencing pain caused by the fracture) and decides to perform surgery within 48 hours, you may report an E/M code with modifier 57 Decision for surgery appended. If a new problem (including the same condition on the contralater-al knee) is discovered during this 90-day period, you may report the appropriate E/M code with modifier 24 Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period appended.

Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P, is an educational consultant and PMCC in-structor. He is also a professional coder for Signature Healthcare, a health system covering much of southeastern Massachusetts. Camilleis’ primary coding specialty is orthopedics. He is a member of the Hyannis, Mass., Cape Coders local chapter.

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HBM-Sep-2016-Advance-Your-Career-Full-Page-1.1-Print-Ready3.pdf 1 9/11/2015 1:14:04 PM


By John Verhovshek, MA, CPC, and Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC

CODING/BILLING ■


Sneak a Peek at ChangesSee what procedural coding changes will affect you most.

CPT® 2016

The release of the 2016 CPT® codebook brings us approximate-ly 350 new, revised, or deleted codes, as well as many new guide-

lines, coding tips, and parenthetical instructions. Here are some highlights.

What’s New for Prolonged Clinical Staff ServicesNew for 2016 are two, time-based, add-on evaluation and manage-ment (E/M) codes to describe prolonged clinical staff services pro-vided with direct patient contact:

+99415 Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Manage-ment service)

+99416 each additional 30 minutes (List separately in addition to code for prolonged service)

Services must be directly supervised by the physician or qualified healthcare professional. As defined at 42 CFR 413.65, “direct su-pervision” means that the physician or nonphysician practitioner must be present on the same campus where the services are being furnished.

Time counted toward +99415 and +99416 does not have to be contin-uous; however, time spent by clinical staff performing other, separate-ly reported services does not count toward prolonged services time.Note that facilities may not report +99415 and +99416.

No News Is Good News?There are no changes to CPT® modifiers this year. Anesthesia coders can rest easy, as well: There are no CPT® code changes for anesthesia services in 2016.

Endobronchial Ultrasound Gains CodesEndobronchial ultrasound (EBUS) combines ultrasound with bronchoscope to visualize the airway wall and adjacent structures. The technique allows surgeons to obtain sample tissue from the lungs and nearby lymph nodes; for example, to diagnose and stage lung cancer, detect infections, and identify other lung conditions.

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Code 31620 (which previously reported EBUS) is deleted and re-placed by three new codes:

31652 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with en-dobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures

31653 with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchi-al sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures

31654 with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnos-tic or therapeutic intervention(s) for peripheral lesion(s) (List separately in addition to code for primary procedure[s])

Intravascular Ultrasound Now Includes Radiological S&IOver the past several years, radiological supervision and interpreta-tion (S&I) increasingly has become an included component of many procedures. The trend continues in 2016. For example, non-coronary intravascular ultrasound codes 37250 and 37251 (which did NOT include radiological S&I) are deleted, to be replaced by two new add-on codes that describe identical pro-cedures, but now include radiological S&I. The codes are:

37252 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeu-tic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure)

37253 each additional noncoronary vessel (List separately in addition to code for primary procedure)

Cholangiography-related Codes Get an Overhaul Cholangiography is visualization of the bile ducts using an injected contrast medium to locate obstruction(s). Cholangiography codes 47531–47541 are deleted and replaced by a new set of codes describ-ing injection of the contrast medium (47531, existing access and 47532, new access), placement/revision/removal of biliary drainage catheter (47533-47537), stent placement (47538-47540), access for rendezvous procedure (47541), removal of stones from the biliary ducts (+47544), and more.

New Urinary Imaging ProceduresCPT® 2016 introduces 50430 and 50431 for antegrade nephrosto-gram and ureterogram (imaging procedures for diagnostic assess-ment of the urinary system), and designates revised and replacement codes for urinary catheter procedures. For example, 50433 Placement of nephroureteral catheter, percutane-ous, including diagnostic nephrostogram and/or ureterogram when per-formed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access de-scribes percutaneous nephrostomy to place a nephroureteral cathe-ter that drains internally and/or externally (via new access). Report a single unit of 50433 for each renal collecting system/ureter ac-cessed (e.g., 50433 x 2, if both renal collecting systems/ureters are accessed.). The procedure includes diagnostic nephrostogram and/or ureterogram (when performed), as well as imaging guidance and all associated radiological S&I.Additional codes are added to describe percutaneous conversion of a nephrostomy catheter to nephroureteral catheter (50434),

Over the past several years, radiological supervision and interpretation (S&I) increasingly has become an included component of many procedures. The trend continues in 2016.

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and removal and replacement of an existing nephrostomy cathe-ter (50435).

Intracranial Thrombolysis Gains a CodeThrombolysis is the breakdown of blood clots. For 2016, you’ll re-port this service with CPT® 61645 Percutaneous arterial translumi-nal mechanical thrombectomy and/or infusion for thrombolysis, intra-cranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s) for thrombolysis for intracranial arteries us-ing mechanical thrombectomy (clot removal) or infusion. Diagnostic angiography, fluoroscopic guidance, selective catheter-ization and thrombolytic injection(s) are included, although you may separately report diagnostic angiography of a non-treated vas-cular territory. Also included are neurologic and hemodynamic monitoring of the patient, and closure by manual pressure, arterial closure device, or suture. You may report 61645 once per intracrani-al territory treated. The intracranial territories include right carotid circulation, left carotid circulation, and vertebro-basilar circulation. There are also new codes for prolonged administration of pharma-cologic agent(s) in any intracranial artery, for any reason other than thrombolysis:

61650 Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guid-ance; initial vascular territory

+61651 each additional vascular territory (List separately in addition to code for primary proce-dure).

Three New Codes for Paravertebral BlockA paraspinous block completely desensitizes the affected spinal seg-ment (generally for pain relief). CPT® 2016 adds three codes to re-port thoracic paravertebral block (PVB) by injection (single and ad-ditional) or continuous infusion:

64461 Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)

+64462 second and any additional injection site(s) (includes imaging guidance, when per-formed) (List separately in addition to code for primary procedure)

64463 continuous infusion by catheter (includes imaging guidance, when performed)

Radiologic Exam Codes Get More PreciseNew codes describing radiologic exam of the spine now provide greater specificity as to the number of views. For example:

72081 Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view

72082 2 or 3 views

72083 4 or 5 views

72084 minimum of 6 views

Earwax Removal by Lavage Now a Distinct ServiceImpacted cerumen (ear wax) can cause symptoms including pain, dizziness, and loss of hearing. In years past, removal of impacted cerumen not requiring instrumentation has been reported using an appropriate evaluation and management (E/M) code. The American Medical Associa-tion (AMA) added a parenthetical note to CPT® 2014 instructing, “For cerumen removal that is not impacted [see above] or does not require instrumentation, eg, by irrigation only, see E/M service code, which may include new or established patient office or other outpatient services ….” The AMA also revised the CPT® descriptor for 69210 to specify “requiring instrumentation.”

For 2016, the rules have changed. You may still report 69210 Removal impacted cerumen requir-ing instrumentation, unilateral for removal of cerumen requiring instrumentation; however, removal by lavage now has its own code, 69209 Removal impacted cerumen using irrigation/lavage, unilateral, and no longer is reported as an E/M service. CPT® 2016 now instructs, “for cerumen removal that is not impacted, see E/M service code….”

Note that both 69209 and 69210 are unilateral procedures; for removal of impacted cerumen from both ears, append modifier 50 Bilateral procedure to the appropriate code.

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The new codes replace several now-deleted codes, such as 72069 and 72090.Similar changes affect codes describing radiologic exam of the hip(s) and pelvis. Two examples include:

73502 Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views

73523 Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views

Clinical Brachytherapy RevisedMany codes describing services related to clinical brachytherapy are deleted and replaced, while several other codes are revised. For example, deleted codes 77785 and 77786 are replaced by the fol-lowing:

77770 Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, in-cludes basic dosimetry, when performed; 1 channel

77771 2-12 channels

77772 over 12 channels

Also added are new codes for skin surface brachytherapy, 77767-77768.

Pathology and Laboratory: Refining Test Methods and MoreThere have been many changes to the Pathology and Laboratory chapter for 2016, most of which are based on methods used to per-form various tests. For example, a new code was created to report an obstetric panel with HIV testing: 80081 Obstetric panel (includ-ing HIV testing). Ten new codes are added to the Multianalyte Assays with Algorith-mic Analyses (MAAA) section to report risk scores for rheumatoid arthritis, coronary artery disease, heart transplant rejection, and on-cology (including colon, colorectal, gynecologic, lung, and thyroid).

Cleaning Up the Vaccine CodesThere are over 60 revisions to vaccine codes for 2016, almost all of which are minor “housekeeping” changes. Many obsolete vaccines are deleted (for example, 90645 and 90646); and many vaccine de-scriptors are revised to provide greater clarity, with no affect on code application. For example, the abbreviation “HepA” is added after the name of the vaccine in the descriptor for 90634 Hepatitis A vac-

cine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramus-cular use, but code use does not change. In a few cases, revisions are more substantial. For example, the de-scriptor for 90647 Haemophilus influenzae type B vaccine (Hib), PRP-OMP conjugate, 3 dose schedule, for intramuscular use is revised to delete “3-dose schedule,” and to change the vaccine to “Hae-mophilus influenzae type” B. Also added is 90625 Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use and two codes for me-ningococcal recombinant protein and outer membrane vesicle vac-cine (90620, 90621).

Special Otorhinolaryngologic ServicesCaloric vestibular testing is used to evaluate the vestibular nerve. For 2016, the former code for caloric vestibular testing (92543) is deleted and replaced by two new codes:

92537 Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations)

92538 monothermal (ie, one irrigation in each ear for a total of two irrigations), which more precisely define the test protocol.

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Special Dermatological ProceduresA new series of codes (96931-96936) now describes reflectance confocal microscopy for cellular and sub-cellular imaging of skin. The technique allows for imaging of skin lesions in vivo (no biopsy is necessary).More information is available in AAPC’s December workshop, “New Year, New Updates,” in several cities December 2-14. Check out the Education section on AAPC’s website for more information.

John Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Hendersonville-Ashe-ville, N.C., local chapter.

Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, is vice president, Member and Certification Development and a member of the Weston, Fla., local chapter.

No Time for Electronic Analysis of Neurostimulator Pulse Generator System In prior years, electronic analysis of implanted neurostimulator pulse generator system was a time-based service. For 2016, that’s no longer the case. Code 95972 Electronic analysis of implanted neuro-stimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent pro-gramming has been revised to eliminate the time element “up to one hour,” while 95973 (previously used to report each additional 30 minutes beyond the first hour) has been deleted.

There have been many changes to the Pathology

and Laboratory chapter for 2016, most of which are based on methods used to

perform various tests.


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■ ADDED EDGEBy Dawn Moreno, PhD, CPC, CBCS, CMAA, MTC, CPL, CLT

Selecting a comprehensive coding and billing curriculum will help you to land your first industry job.


Distance Learning

ADDED EDGE

Advanced curriculum and training is necessary to a medical cod-er’s or biller’s success. Not all online programs are equal, howev-

er. The reality is that there are subpar schools on the Internet. You must do your homework before you buy in.

Detect Subpar SchoolingThere are a few ways to spot a subpar school or curriculum right away:

• The school offers only its “own,” proprietary reference materials. Schools that do not use the gold-standard textbooks in teaching medical coding/billing may create their own texts to reduce supply costs. Proprietary training is OK, with professional textbook backup.

• Course hours are skimpy compared to schools and curriculums that offer comprehensive training programs. Subpar training covers only the basics; the credit or course hours are low and the foundational knowledge is brief. Medical coding requires a skill that is developed over time, requiring much practice, working closely with a qualified, certified instructor to hone your skill set to an employable level.

• Lack of one-on-one assistance. Very large schools that do not have enough instructors will resort to tactics such as telling students to contact the instructor only via email. The student may wait a week or more for exam results or to have a simple question answered. A good school will require instructors to answer student questions within 24 hours and to have exams graded and back to students within 48 hours. Anything else is shortchanging the student.

• They usually cost the same or more than quality education programs. This is because profit is the first priority. A good school balances the desire to make a fair profit with the desire for an excellent reputation in the industry, gained by helping students.

• They try to enroll you without making sure it is a good career fit for you. A good school will enroll students that it feels are apt to be successful. If a prospective student says she dislikes working on the computer all day, it’s obvious that she will not enjoy coding or billing.

New graduates with subpar training may miss out on job opportu-nities because they can’t pass an employer’s test, or because they sim-ply do not have the skills to perform the job. Their money has been spent, and they are often left “high and dry,” without any support. A scaled down education doesn’t generally offer monetary savings — subpar schools often charge nearly the same as the really good schools — and may end up costing you more in lost opportunities. If you scale down your education, you are also scaling down your potential success in the industry.

Curriculum Aimed at SuccessA comprehensive and advanced curriculum is necessary to your suc-cess as a new medical coder/biller. Regardless of what anyone tells you, medical coding is not easy to learn. It takes a lot of practice to build your skill set to an employable level. A comprehensive pro-gram includes, at least:

• Professionally written textbooks by credible sources.• Access to a qualified and certified instructor. A good

instructor will answer questions within 24 hours and grade exams within 48 hours throughout your training.

When you talk to potential schools, be sure you (and not just your tuition money) are important to them.


Distance Learning

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• A minimum of 800-1,000 hours of coursework to give the student enough knowledge and practice to excel in the workplace.

• ICD-10-CM training in addition to CPT® and HCPCS Level II. Medical coders and billers use all three codes sets and must understand them, thoroughly.

• Comprehensive foundational training in medical terminology, anatomy, physiology, and in the anatomy and terminology of each medical specialty. If a student does not have this detailed training, there is no way he or she will pass the AAPC’s Certified Professional Coder (CPC®) examination.

• Plenty of hands-on practice, rather than just reading a computer screen and taking online quizzes. There should be textbooks and coding/billing scenarios with which to practice.

• Excellent post-graduate support to assist students with resumes and guide them on where and how to land a job.

Good schools teach and encourage members to join the industry’s professional association, AAPC. They also encourage students to test for AAPC’s CPC(R) credential after graduation, and provide guidance and assitance. They provide externships so students get hands on experience in the industry and to remove apprentice sta-tus from their credentials. Similarly, new medical billers should obtain AAPC’s Certified Pro-fessional Biller (CPB™) credential to prove expertise in medical bill-ing. Certification and AAPC membership promotes professional-ism, documents proven skills to an employer, and allows the new graduate to shine above others who are not certified. In the job market, new graduates are competing against older, more experienced coders and billers; new medical coders and billers must possess a stellar skill set to compete. They must score well on em-ployment tests and interviews. They must have comprehensive knowledge of all medical specialties, terminology, and anatomy to earn AAPC’s Certified Professional Coder - Apprentice (CPC-A®) entry-level status. Having this credential assists new coders in get-ting his or her foot in the door, and opens up industry networking opportunities.

Face the Truth and Shop AroundYour future success starts with choosing a program that is advanced in nature, has many hours of practice, and offers career guidance. Here’s a list of questions you should ask any school before you enroll:

• Can I contact my instructor by phone and email? Is there a time frame in which he or she is supposed to respond?

• What textbooks do you use?• Do you discuss the software used for medical coding/billing

in the industry? • Are your materials proprietary, or do you use professionally

written and widely accepted textbooks in your program? • How many credit or course hours is your program? • Do you assist with my resume and give me guidance on how

to land my first job? • May I speak to one or two graduates of your program? • How long have you been in business? • Are you a member of the Better Business Bureau (BBB)?

(Check the BBB website to see if there are multiple complaints against the school.)

• How much hands-on practice do I get in your program? • Are there any other possible fees I may incur after enrolling?

(Hidden fees are common among subpar schools.)When you talk to potential schools, be sure you (and not just your tuition money) are important to them. Are they asking the right questions to determine whether you are a good fit for medical cod-

Your future success starts with choosing a program that is advanced in nature, that has many hours of practice, and that offers career guidance.


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ing/billing? Are they trying to rush you off the phone after five min-utes, or trying to get you to sign an enrollment agreement before you feel comfortable?Medical coding/billing is a great career choice — being part of the medical field can be interesting, rewarding, and financially lucra-tive — but becoming a medical coder or biller is not easy. The train-ing time usually takes six months, or more (although a very moti-vated student working through a course full-time can finish faster). Finishing quickly is not the priority. Learning the material of an ad-vanced, detailed, in-depth curriculum is your goal.

Dawn Moreno, PhD, CPC, CBCS, CMAA, MTC, CPL, CLT, is the admissions manager of Medical-Technical-Administrative Career Center (MTACC) and has worked in the online adult education industry as a content writer, instructor, and director in medical coding, medical billing, medical office management, and medical transcription. She has written for national industry publications such as Healthcare Business Monthly, NCRAs Journal of Court Reporting,

BC Advantage magazine, and industry blogs and publications. Moreno’s passion is in helping adults learn new career skills to change their lives for the better, and her motto is that one is never too old to learn something new. She is a member of the Albuquerque, N.M., local chapter.

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By Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I

■ CODING/BILLING


Accuracy and specificity in diagnosis coding and medical documentation are critical in risk adjust-

ment payment models. Over the next few months, we’ll look at several commonly under-coded condi-tions in the Medicare hierarchical condition catego-ry (HCC) model diagnosis code categories and discuss strategies for improving documentation.

COPDHCC 111 in Medicare 2014* CMS HCC Model Category The category of chronic obstructive pulmonary disease (COPD) includes many different respiratory condi-tions. The word “chronic” provides very important in-formation in this category. If the provider is defaulting to an unspecified asthma or bronchitis code, the pa-tient will not be considered in this measure. The doc-umentation should specify the condition (e.g., chronic obstructive asthma, emphysema, or chronic obstruc-tive bronchitis): for example, “Chronic bronchitis with cough, patient advised to quit smoking.”There are several pulmonary conditions associated with this HCC. In patients with pulmonary disease, it’s also important to document and code, when pres-ent, hypoxemia and or acute/chronic respiratory fail-ure. If your patient is oxygen dependent, the doctor must document the reason for the oxygen. You cannot assume the relationship. *HCC risk coding is retrospective. The 2014 model is the most re-

cent one being used.

CHFHCC 85 in Medicare 2014 CMS HCC Model Category Chronic heart failure (CHF) is one of multiple cardio-vascular conditions associated with this HCC. Multi-ple codes specify heart failure by type and acuity. The HCC also includes cardiomyopathies and pulmonary hypertension, which should be specified by type. Re-member: You cannot assign a diagnosis from find-ings on a chest X-ray, echocardiogram, electrocardio-gram, etc. The provider must interpret and document his findings.

Make the Most of HCCsPart 1: Bolster documentation for commonly under-coded conditions.


Risk-adjusted Payment: What’s at Stake?As healthcare moves from fee-for-service to focusing on risk adjustment, you must pay close atten-tion to providers’ documentation. In a risk-adjusted payment model, the more severe or complex a diagnosis, the higher the risk value assigned to it. A risk adjustment value is assigned to each diag-nosis code that falls into the payment model. Codes are then grouped into a hierarchical condition category (HCC).

Hospital and physician claims are the main sources of data that drive the risk adjustment model. Pro-viders in the outpatient setting have been paid on a fee-for-service model for so long, many neglect their diagnosis code documentation and reporting. If medical documentation lacks the accuracy and specificity needed to assign the most appropriate diagnosis code, providers face the possibility of reduced payment in a performance-based payment model.

HCCs


Many patients with these conditions are stable on medication. In this case, it’s very important for the provider to link the med-ication use to the disease it’s used to treat (e.g., “chronic diastolic CHF, stable on Lasix”).

Angina PectorisHCC 88 in Medicare 2014 CMS HCC Model Category“Chest pain” and “angina” are not interchangeable for coding. Chest pain is not a risk adjusted diagnosis because chest pain can be caused by many non-cardiac conditions. The provider should specify the type of angina, when known. Angina that is controlled on medication should be documented and coded (e.g., “Angina stable on Isordil”).

Diabetes with ComplicationsHCC 18 in Medicare 2014 CMS HCC Model CategoryDiabetes is one of the most frequently under-coded conditions in risk adjustment. Many providers default to diabetes without com-plications due to habit or because of how their electronic health record is set up. Correct coding requires the type and method of control to be documented. The provider needs to establish a di-rect correlation when a patient with diabetes has a complication or manifestation. Documenting statements such as “due to,” “caused by,” or “secondary to” are sufficient to make the link between the diabetes and the documented complication (e.g., “stage IV chron-ic kidney disease due to diabetes - GFR 20; considering dialysis”).

The Big PictureThese are just a few of the categories in the Medicare HCC mod-el. There is great opportunity for outpatient coders to have a very positive affect in their practice, as well as in our industry. Focus-ing on a few, simple documentation improvement strategies at a time will help to illustrate patients’ true severity of illness. Cor-rectly documenting and coding diagnoses will ensure better pa-tient care, as patients are more easily identified for care manage-ment by Medicare and other health plans. This data ultimately serves to provide the industry with financial forecasting and plan-ning, which drives the cost of care.

Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, is a risk coding and education special-ist for Capital District Physician’s Health Plan. She enjoys teaching PMCC, auditing, and ICD-10 classes. Gianatasio is president of the Albany, N.Y., local chapter and a member of the National Advisory Board.

Diabetes is one of the most frequently under-coded conditions in risk adjustment.

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■ AUDITING/COMPLIANCEBy Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI


Many forms of identity theft may stem from a medical record breach. Thieves may use someone else’s identity to seek medical care, open new utility accounts, receive cred-it cards, conduct online transactions, apply for home loans, buy cars, get a job, com-

mit crimes, or file for fraudulent government benefits. Medical records contain a plethora of information all in one place. This is a jackpot for thieves. Medical identity theft poses a risk even greater than financial breaches. Consider someone claiming to be you and seeking medical care. Perhaps he or she has a serious medi-cal condition that you do not have. Now this condition is on your permanent record. What if the thief is a drug addict, has a terminal illness, or a different blood type? Now, the thief ’s medical profile is part of yours. Often, thieves will visit emergency rooms and leave the bal-ance of the medical bill to the “real” person to pay. Unpaid bills go to collection agencies and affect credit ratings. The provider, also a victim, is left with unpaid services.

The Devastation of Medical Identity TheftConsider the true case of the drug-addicted, pregnant woman who delivered a baby us-ing a stolen health insurance card. The baby was born addicted to drugs and with other se-rious health concerns. The mother abandoned the baby the next day. The real insurance cardholder was visited by authorities and had her children taken into protective custody. She was a suburban housewife with no history of drug use. Fortunately, she was able to get her kids back later the same day, but she had to prove she had not delivered a drug-addict-ed baby the day before.

Nobody Is Immune to Medical Identity Theft

Take steps to protect your practice and its patients from being victimized.

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In another case, a college student signed up to donate blood, but was told she could not donate because she was HIV positive. It was many years and thousands of dollars later before she was able to correct her medical record and reclaim her identity. The ramifications of a medical identity theft don’t end there. A false medical profile can be devastating emotionally and financially: Vic-tims may be denied life insurance, fired from their job, or even re-ceive death threats.

Medical DevicesOther medical identity theft risks include medical alert devices, implanted defibrillators, continuous positive airway pressure ma-chines, and insulin pumps. These devices connect to networks. So-phisticated hackers can intercept the data and access these devices and the personal information associated with them. If a device has a signal that can be hacked, the user is at risk. Consumers can con-tact the device manufacturer to determine how the data is protect-ed and how the company responds to data breaches.

TakeawaysConsumers expect healthcare providers to be proactive in prevent-ing and detecting medical identity theft. According to a recent Po-neman study, 48 percent of respondents surveyed said they would consider changing healthcare providers if their medical records were lost or stolen. If a breach occurs, 40 percent expect prompt notifica-tion to come from the responsible organization.Everyone who touches a medical record must be hyper vigilant. The U.S. Federal Trade Commission’s Red Flags Rule requires business-es and organizations to develop and implement procedures to de-tect suspicious activities or patterns of behavior that suggest identi-ty theft. Some of the measures are as simple as asking for photo iden-tification. Providers should ask for photo ID (government issued is preferred) and maintain a photo in the chart. Patients should pro-tect their information, including their health insurance ID card.

Tips and ResourcesVictims can take advantage of their rights under the HIPAA Priva-cy Rule. To learn more about medical identity theft and how to pro-tect yourself, check out these tips and resources:

• File a complaint with the FTC at www.ftccomplaintassistant.gov or by phone at 1-877-ID-THEFT (1-877-438-4338); TTY: 1-866-653-4261; and see info at www.ftc.gov/idtheft.

• File a report with local police, and send copies of the report to their health plan’s investigations or privacy department, their healthcare provider(s), and the three nationwide credit reporting companies: Equifax, Experian, and TransUnion. Information on how to file a police report and reach the credit reporting companies is at www.ftc.gov/idtheft/consumers/defend.html.

• Look for signs of other misuses of personal information by reviewing credit reports. The law requires each of three major nationwide credit-reporting companies to give people a free copy of their credit report each year if they ask for it, at www.AnnualCreditReport.com or 1-877-322-8228.

• Inaccurate or fraudulent information can be reported at www.ftc.gov/idtheft. You can also learn how to get inaccurate information corrected or removed.

Medical identity theft is serious business, and should be acted on immediately to help mitigate risk. Many employers and insurance companies offer credit protection and monitoring services. Some companies also offer medical identity fraud alert systems. Everyone should look at options and take necessary precautions.

Sources:Ponemon Institute© Research Report, Fifth Annual Study on Medical Identity Theft, February 2015: http://medidfraud.org/wp-content/uploads/2015/02/2014_Medical_ID_Theft_Study1.pdf

Experian, “Combating the Rising Tide of Medical Identity Theft”: www.experian.com/assets/data-breach/white-papers/medical-fraud-resolution.pdf

Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI, is director of the Blue Shield of Califor-nia, Special Investigations Unit. Her specialties include healthcare fraud investigation, pre-vention, and resolution. Massey has extensive experience in health insurance plans and man-agement and trains on healthcare fraud, coding, and ICD-10. She is on AAPC’s National Advi-sory Board, and also served from 2007-2009. Massey is a member of the Sacramento, Calif., local chapter.

Consumers expect healthcare providers to be proactive in preventing and detecting medical identity theft.

Identity Theft: A Serious ProblemAccording to the Ponemon Institute, 2.3 million Americans were victims of medical identity theft in 2014. Victims will tell you, medical identity theft is one of the most expensive and time-consuming types of identity theft to resolve. Protected health information (PHI) breaches affect not just patients, but also providers and health plans. In 2010, Ponemon Institute con-ducted a survey that concluded the average cost incurred to resolve a medical data breach is more than $20,000, or $211 per record.

More than 50 percent of victims are not aware their identity has been stolen for a year, or more. Victims may become aware of a breach when they are turned down for credit. Often, collection agency letters and phone calls are the first indication identity has been stolen or breached. Medical identity theft victims might also suffer embarrassment from disclosure of sensitive personal health conditions.

www.ftc.gov/idtheft

www.ftc.gov/idtheft/consumers/defend.html

www.AnnualCreditReport.com

www.ftc.gov/idtheft

http://medidfraud.org/wp-content/uploads/2015/02/2014_Medical_ID_Theft_Study1.pdf

www.experian.com/assets/data-breach/white-papers/medical-fraud-resolution.pdf


■ AUDITING/COMPLIANCEBy Joseph de Beauchamp, PhD


Heritage societies and genealogists often request access to personal health information (PHI) of patients and the deceased and are,

therefore, subject to HIPAA privacy and security rules. To prevent a HIPAA compliance breach that could lead to possible jail time and a lofty fine, it’s important to know what heritage society researchers and genealogists do, how they handle PHI, and your role in disclo-sure of information for their research.

Experience Speaks VolumesWhen I was young, I was an idealist. I thought, “What you don’t know, won’t hurt you.” Now that I have grown up and have over 40 years of career experience under my belt, I know ignorance can in-deed hurt you. It’s no excuse in the eyes of the law, and you can go

to jail for it. When you understand the ramifications of the HIPAA security and privacy rules and PHI breaches, you can avoid breach-es and the consequences that come with them.

Ensure Clients’ Identity and IntentionsThe first critical point of engagement should be for the researcher to identify the client and his or her intentions. Proper client identifica-tion is important because certain documents might be discovered to which the “purposed” client is not entitled, such as in the case of heritage or estate matters. Heritage societies use a notary to detect false identification. Nota-ries are critical in the discovery process for heritage matters because they are licensed to investigate the identities and to check for false

Handling PHI Disclosure for Genealogists

Awareness of your responsibility for protecting client and family medical information is essential.

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identification proofs, such as government photo identification and Social Security cards. The use of a false Social Security card, birth certificate, or drivers’ licenses is punishable up to 15 years in jail, with no statute of limitations. (Justice, August 30, 2012)A genealogist or historian must identify the applicant or client be-fore engagement; not knowing your applicant or client is not a le-gitimate excuse that will keep you out of jail if a HIPAA breach oc-curs. Not properly checking the identification of the person can lead to her or him fraudulently obtaining health records and oth-er financial information. There are cases where people are serving 45 years in jail, and have received fines as much as $158 million for such offenses.

How Medical Records for Research Affect YouWhen a heritage society is asked to obtain records for a person, it might include health records such as birth certificates, death certif-icates, and even DNA results. These records fall under HIPAA, and should never be copied, scanned, or sent over the Internet via email. Genealogists also should never hold these records in their care be-cause the risk is too high. Violations of healthcare records carry pen-alties of 20 years imprisonment and million dollar fines. (American Medical Association, February 17, 2009) If you mail medical record documents to a heritage society, you must be clear in your disclosures that these places of business are beyond your control. If you don’t know what a genealogist or heritage society is doing with the documents, make sure this is disclosed to the client. The information discovered may affect estate or title of property documents. They might also assist in property settlements with di-vorce or annulment. To leverage risk, make sure:

• The client is entitled to see the documents. Disclose in all cases to every client what and how you will retain the files.

• You have permission for sending or copying documents.• You know where you are sending documents. Over 83

percent of medical facilities and financial institutions holding files of persons are breached.

• You know to whom you are sending documents and what they are doing with those documents. You bear the full responsibility of the law for sending and storage of information belonging to the client.

• You safeguard this information for five years. The Office of

Inspector General and the Department of Justice have the right to check your safeguards at any time during this period. Occupational Safety and Health Administration also has the right to investigate and arrest you for any reason stated or not stated at any time.

Remember Who You AreYou are a member of a professional organization, and know what your code of ethics dictates you to do. If you volunteer for a non-profit organization, such as a heritage group or first response orga-nization, never avoid the duties and responsibilities of protecting client information. Recently there has been a wave of interest in DNA tracking and pub-lishing of this information; avoid retaining and accepting this in-formation. When handling PHI, please advise your clients to care-fully review the disclosures with their attorneys before they under-go any DNA testing. You have a responsibility to your clients/pa-tients to make them aware of the possible consequences. If you send any documents, disclose this to your client, even if you are volun-teering without pay. Helping people to discover their roots is very rewarding, but it comes with much responsibility. Pay attention to those around you and their intentions. Knowing the heritage society, genealogist, and customer, and what you can legally do to help them, is a critical part of your responsibility. What you don’t know can hurt you.

ResourcesAmerican Medical Association, HIPAA Violations and Enforcement, AMA and 42 USC 132o-5, 1-3; February 17, 2009.Dictionary, B. L., Ignorantia juris non excusat, St. Paul: Black’s Law Dictionary, 2014.Justice, 9. C.-A, False Identification, 18 USC 1028 (a) (7), Department of Justice, August 30, 2012).AMA, HIPAA Violations and Enforcement, 42 USC 1320-5, 1-3; February 17, 2009.Justice, O., Office of Public Affairs; Harris County, Texas: Justice News, September 15, 2015.George J. Annas, J. M., The New England Journal of Medicine, “HIPAA Regulations - A New Era of Medical Records Privacy?” 5120 et, seq., April 10, 2003.

Joseph de Beauchamp, PhD, carries Doctorates of Philosophy in Theology, Finance, and Psychology. He runs a Medical Level I secured facility enforced under HIPAA, works as a recov-ery agent for government payers, and serves hospice patients in heritage and genealogical so-cieties as both a chaplain and advisor. He has helped over 70,000 families and patients in a ca-reer spanning over 40 years. De Beauchamp is a member of the Las Vegas, Nev., local chapter.

When a heritage society is asked to obtain records for a person, it might include health records such as birth certificates, death certificates, and even DNA results.

Handling PHI Disclosure for Genealogists


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Stay healthy at your desk by using postures that stimulate immunity.

By Bridget Toomey, CPC, CPB, CRCR, RYT-200

PRACTICE MANAGEMENT ■


As the winter months begin, so does the cold and flu season. When a staff member is sick, the germs spread quickly and

before you know it the absence list is a mile long. We can all take precautions to help stay healthy this winter. Being bound to a desk or office space is no longer an excuse not to move your body throughout the day. Here are some office yoga postures that specifically work to boost your immune system.

Photo by Stephanie Knutson Photography.


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BackPosture: Sit comfortably at the front of the chair. Keep your feet flat on the floor, about hip distance apart.Technique: Place your hands on your thighs. Inhale, expand the chest forward, driving the rib cage out and up by push-ing back the shoulders. Exhale, bring the shoulders in front and retract the chest in. Keep the chin level with the floor during all movements. Continue for 10 repetitions.Benefits:

• Helps to break up knots in the shoulder blades.

• Encourages blood flow to the upper torso.

Being bound to a desk or office space is no

longer an excuse not to move your body

throughout the day.

Photos by Stephanie Knutson Photography.

ArmsPosture: Sit comfortably with a straight spine, either at the front of the chair or all the way to the back. Keep your feet flat on the floor, about hip distance apart.Technique: Bring your hands to chest level, interlock your fingers, and turn your palms outward. Inhale, stretch both arms forward. Exhale, raise both arms over your head with the palms up to-wards the ceiling. Inhale, bring the arms back down out in front of the body with the palms out. Exhale, bring the hands back to the center of the chest. Repeat 10 times.Benefits:

• Improves blood circulation in the arms.• Expands lung capacity.


Office Wellness

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

ChestPosture: Sit comfortably with a straight spine, ei-ther at the front of the chair or all the way to the back. Keep your feet flat on the floor, about hip dis-tance apart.Technique: Grip the fingertips of both hands to-gether and bring them to chest level with the fore-arms parallel to the ground. Inhale. Suspend the breath and, without separating the hands, try and pull the hands apart. Exhale. Inhale and pull again. Repeat 10 times. Benefits:

• Opens up the heart center and chest.• Stimulates the thymus gland.

Shoulders Posture: Sit comfortably with a straight spine, ei-ther at the front of the chair or all the way to the back. Keep your feet flat on the floor, about hip dis-tance apart.Technique: Interlock the fingers and bring the arms up over the head. Bend the head, arms, and torso to the left, stretching the right side of the body. Hold this posture with long deep breathing for 10 seconds. Then bend the head, arms, and torso to the right and feel the stretch on the left side of the body. Hold with long deep breathing for 10 seconds. Repeat 10 times. Benefits:

• Opens up the lungs and enhances breathing. • Helps to circulate clean air throughout the

body, keeping the body energized.

References:Akhar, Shameem. Yoga in the Workplace, Chenni: Westland Ltd, 2010.

Bhajan, Yogi. The Aquarian Teacher, Santa Cruz: The Teachings of Yogi Bhajan, 2010.

Thakur, Bharat. Desktop Yoga, New Delhi: Wisdom Tree, 2007.

Bridget Toomey, CPC, CPB, CRCR, RYT-200, teaches Kundalini yoga at Heartland Yoga in Iowa City, Iowa. She is certified by the Kundalini Research Institute as a Kundalini yoga teacher and is a member of the International Kundalini Yoga Teachers Association. Toomey works for the University of Iowa Hospitals and Clinics in Patient Financial Services as a revenue cycle co-ordinator, where she supervises staff on the physician Iowa Medicaid team. She is a member of the Iowa City, Iowa, local chapter.


By Renee Dustman

■ Coding/Billing ■ Practice Management ■ Auditing/Compliance

■ PRACTICE MANAGEMENT

HIPAA regulations, ICD-10 documentation requirements, elec-tronic health records (EHRs), and quality initiatives, among oth-

er things, have put a lot of demands on physicians’ time. To regain focus on healing people, many physicians and hospitals are hiring medical scribes to delegate administrative tasks.

The Role of the Medical ScribeFor centuries, scribes have been documenting important events for recordkeeping. It’s been a natural progression for scribes to enter the healthcare industry. Their usefulness for capturing accurate and de-tailed documentation (handwritten, electronic, or otherwise) of the physician/patient encounter is undeniable.

Although there are no prevailing federal regulations concerning the use of scribes in the healthcare setting, there are plenty of opinions for what a scribe may do. The Joint Commission takes the stand that a scribe “does not and may not act independently” but can document the physician’s or practitioner’s dictation and/or activities. The healthcare certifying organization goes further to say that scribes may assist practitioners in navigating EHRs and in locating information such as test results and lab results.Medicare administrative contractors (MACs) also may have some-thing to say on the matter. Cahaba GBA, for example, published guidance in the form of a local coverage article (A52695), in which

They streamline the documentation process so physicians can concentrate on healing patients.

THE MEDICAL SCRIBE: A Hot Commodity

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it reiterates The Joint Commission’s opinion and adds, “The physi-cian who receives the payment for the services is expected to be the person delivering the services and creating the record, which is sim-ply ‘scribed’ by another person.”The Jurisdiction J MAC further states that when a scribe indepen-dently records the past, family and social history and the review of systems (ROS) for an evaluation and management (E/M) service — in as far as the scribe is simply documenting the physician’s words and activities during the visit — the physician may count that work toward the final level of service billed.Examples of information entered by a scribe into the EHR or chart may include:

• History of the patient’s present illness• ROS and physical examination• Vital signs and lab values• Results of imaging studies• Progress notes• Continued care plan and medication lists

Scribes are generally not credentialed medical personnel and, there-fore, rarely qualify to enter computerized physician order entry (CPOE) in the EHR to meet meaningful use requirements. The Centers for Medicare & Medicaid Services (CMS) realizes there are exceptions:

If a staff member of the eligible provider is appropriately cre-dentialed and performs similar assistive services as a med-ical assistant but carries a more specific title due to either specialization of their duties or to the specialty of the med-ical professional they assist, he or she can use the CPOE function of CEHRT [certified EHR technology] and have it count towards the measure. This determination must be made by the eligible provider based on individual workflow and the duties performed by the staff member in question.

A scribe might also be responsible for expediting patient flow through surgery under direction of the medical doctor or other qualified healthcare provider, and facilitating patient flow by assist-ing the provider in navigating through electronic documentation including entering orders, reviewing lab/test results, post-op notes, medication reconciliation, and discharge summaries.

A scribe’s responsibilities are ultimately controlled by the regulatory requirements and policies established by the provider, and the level of risk an employer is willing to accept.

Legal RamificationsAs with any employee or contractor who has access to patient re-cords, a scribe must abide by HIPAA and HITECH regulations.Compliance with the Record of Care and Provision of Care stan-dards also apply. It is important to be certain that the scribe’s servic-es are used and documented appropriately, and that the documen-tation is present in the medical record to support that the physician actually performed the service.For example:

• The scribe must sign (name and title), date, and time stamp all entries into the medical record — electronic or manual.

• The role and signature of the scribe must be clearly identifiable and distinguishable from that of the physician or licensed independent practitioner or other staff.

The scribe cannot enter the date and time for the physician or prac-titioner. Although allowed in other situations, a physician or practi-tioner signature stamp is not permitted for use in the authentication of scribed entries; the physician or practitioner must actually sign or authenticate through the clinical information system, and do so be-fore the physician or practitioner and scribe leave the patient care area. The provider’s note should indicate:

• Affirmation of the provider’s presence during the time the encounter was recorded

• Verification that the provider reviewed the information• Verification of information accuracy• Any additional information needed• Authentication, including date and time

It’s The Joint Commission’s stand that scribes may not make inde-pendent decisions or translations while capturing or entering infor-mation into the health record beyond what is directed by the pro-vider; nor does the agency support scribes entering orders for physi-cians or practitioners. As the use of scribes becomes more prevalent, the potential for ex-panded legal guidance and direction grows. Physicians using scribes

A scribe’s responsibilities are ultimately controlled by the regulatory requirements and policies established by the

provider, and the level of risk an employer is willing to accept.


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

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must monitor federal and state regulatory changes to ensure their practices consistently meet compliance standards. Cer-tified scribes will become in high demand, as their credentials will negate much of that liability.

Becoming a Medical ScribeWorking as a medical scribe requires more than just good pen-manship and computer skills. A qualified, employable scribe comes equipped with a broad range of skills, such as:

• Knowledge of medical terminology and technical spelling

• Basic anatomy• Familiarization with HIPAA Privacy and Security Rules• Medico-legal risk mitigation• An understanding of the essential elements of

documenting a physician-patient encounter and E/M levels

• Knowledge of federal initiative requirements• General knowledge of the roles and responsibilities of

medical personnel and billing practices• Strong interpersonal and communication skills

You will also need at least a high school diploma and at least one year of experience in the healthcare field.As a scribe, you may find employment or contract work in var-ious settings, including physician practices, hospitals, emer-gency departments, long-term care facilities, long-term acute care hospitals, public health clinics, and ambulatory surgery centers.

Resourceswww.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFaqId=426&ProgramId=47

www.cms.gov/medicare-coverage-database

www.healthit.gov/providers-professionals/meaningful-use-definition-objectives

https://questions.cms.gov/faq.php?faqId=9058

Renee Dustman is an executive editor at AAPC.

Medical Scribes Improve ProductivityProScribe, a medical scribe employment service, collected and compared data from a five-hos-pital system over a three-year period to demonstrate the impact of scribe services on physician productivity, throughput metrics, and patient satisfaction. The results are impressive.

ProScribe was also able to demonstrate a 20 percent increase in provider productivity after one year of scribe services. The five-hospital system saw an increase of 40,000 patients from year 1 to year 3.

In ProScribe’s case study, there were demonstrated improvements in door-to-provider times and door-to-discharge times, as well as a significant decrease in the number of patients who left without being seen.

Source: www.proscribemd.com/scribe-services/

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http://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFaqId=426&ProgramId=47

http://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFaqId=426&ProgramId=47


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By Ellen M. Wood, CPC, CMPE

■ Coding/Billing ■ Practice Management ■ Auditing/Compliance

■ PRACTICE MANAGEMENT

Bringing new employees up to speed requires a significant invest-ment, which may be especially challenging in smaller offices

lacking a formal training program or other dedicated resources. For practice managers in small and growing offices (two to 10 practitio-ners), there are several ways to ease the process.

First, Find a MatchSuccessfully integrating a new employee into your office depends on finding the right person for the job.When writing a help wanted ad — and when conducting interviews — name the exact qualities you are seeking in an employee and the requirements of the job. Rather than saying, “must be motivated and willing to multi-task,” list the typical duties the job entails, and stress the specific skills an applicant must have.

For example, important qualities for front desk staff are the ability to stay positive even if a patient is being unpleasant, and not to take patients’ negative comments personally. The interview process lasts a long time, and involves several steps. When resources are tight, you can’t afford to hire the wrong per-son. During an initial interview, try to gauge the individual’s lev-el of professionalism and seriousness about the job. You may want to test the applicant’s skill or knowledge. When interviewing some-one for a coding/billing position, for example, you might ask the ap-plicant how he or she would handle a few real-life scenarios you’ve had in your office (such as complaints about a wrong billing code).If you are impressed with a candidate after an initial interview, in-vite the person back to spend an hour observing the job he or she would be doing (have the individual sign a confidentiality agree-ment first). Do this on a busy day, so he or she can see what is expect-

Onboarding Employees in a Small OfficeInvest in new employees and focus on the benefits small practices offer.

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ed. Some candidates may find they are not interested after they see what really goes on. The smaller an office, the more everyone must work together and contribute to a positive environment. You may want to bring your top two or three candidates back for a group interview with exist-ing staff. This gives staff a stake in the future employee’s success, and allows them to share the credit for new hires. Review staff ques-tions for the candidate ahead of time to be sure they are appropriate. Quality healthcare is a mission, not a job, and it takes a certain kind of person to work in our industry. Throughout the interview pro-cess, consider how an applicant’s personality will help (or hinder) his or her success. Employees must be resilient and even-tempered. The busy, messy, day-to-day realities of a healthcare office may dis-appoint idealists or the faint of heart.For example, general surgeons deal with life and death daily. They often treat trauma victims in the hospital, and occasionally must be the bearers of bad news. Patients are likely to be physically stressed and generally worried. Emotions run high and frustrations build. Even the nicest people can snap when things aren’t going well. In addition to professional competence, healthcare workers must have thick skin, humility, and patience.

Training Tips to Boost CompetencyWhen training new employees, get creative. For example, HIPAA and Occupational Safety & Health Administration (OSHA) train-ing videos (often with accompanying exams to test employee com-prehension) are widely available simply by searching online. Check with your professional colleagues (for example, at your next AAPC chapter meeting) and ask if they have effective resources they’d rec-ommend or share. You might also look to your vendors to provide low- or no-cost training. For instance, the service that collects used sharps must offer OSHA training to its employees. As part of your contract with the company, ask that they share training materials (such as binders or an instructional DVD) with your staff. If your internal systems include a training component, take advan-tage of them. For example, some electronic health records (EHRs) include webinars to teach employees how to use the system. Have employees view the webinars throughout their initial 90 days, and beyond, so they learn to become efficient in the system with less tri-al and error.For each position, ask an experienced employee to make a check-off list of daily, weekly, and monthly responsibilities. The new-hire can

check off items on the list as he or she is trained on each area. The list can also double as a reminder of regular tasks to be completed. You may want to ask experienced employees to create a three-ring binder for each position that describes what needs to be done and how to do it. For example, a binder might include instructions on how to order scans for each payer.

Keep Tabs, Get Feedback, and ImproveAssessments are useful to provide feedback to employees, but also to ask for feedback. Conduct 90-day self-assessments of your new-hires to help answer these questions:

• What tasks are you most comfortable doing?• In what areas are you least comfortable?• What parts of your job do you like and not like?• How can the practice help to make your job easier?

Never punish an employee for his or her opinion; use the respons-es as feedback to improve the overall practice. For example, a fresh set of eyes may recognize a more efficient way to complete a task, or may notice a weakness in training. One of the main advantages of a smaller practice is that you can adopt new processes fairly quickly, with a minimum of red tape. Self-assessments also help pinpoint and curtail employee problems before they escalate. You are better off hearing about and respond-ing to a complaint before a disgruntled employee “poisons the well” and turns other employees negative. For example, an employee who is unhappy with your “earned time off” policy may be willing to talk through the issue, so he or she no longer needs to complain to other employees. Above all, at every step along the way, it’s important to have trans-parency and to clearly define employee expectations. This contrib-utes to everyone’s peace of mind and satisfaction, which will im-prove employee morale.

Ellen Wood, CPC, CMPE, has worked in the medical field for over 20 years and has been a certified coder for over 13 years. She is the practice manager for Seacoast General Surgery and an adjunct professor at a local community college. Wood’s experience includes employee mentoring and oversight of meaningful use policies and objectives, PQRS, and ePrescribing programs. She helped to start the first New Hampshire local chapter, Seacoast-Dover, and served on its board.

The smaller an office, the more everyone must work together and contribute to a positive environment.


■ MEMBER FEATUREBy Michelle A. Dick

You may remember military slogans such as “Be all you can be,” (Army), “It’s not just a job; it’s an adventure,” (Navy), “Aim high”

(Air Force), and “The few, the proud, the Marines.” They were con-cise, tough slogans that prompted pride and excitement for our country. Although powerful slogans, they don’t capture the true emotion of serving in the military and the discipline, unbreakable bonds, and life-long friendships soldiers experience.Our military personnel are a rare and beautiful breed that only a ser-vice member can truly understand, and we are honored to have them as AAPC members. The training and experience the military creates produces excellence in the workplace and in life.Let’s meet just a handful of AAPC’s military members:Caren J. Swartz, CPC-I, CPMA, COC, CRC, CPB - served 1982-1990 (1982-86 active duty, 1986-90 active reservist). Rank: petty officer 3rd class, Sub base Groton, Connecticut; operating room technician (scrub) active reservist at Willow Gove, Pennsylvania, naval air station, then Bethesda Naval, Bethesda, Maryland; hospi-tal Corps school in Great Lakes, Illinois, then operating room (OR) school in Portsmouth, Virginia.Rob J. Pachciarz, CPC, COC, CIRCC, CASCC - served from 1987-1991 as a communications/computer systems operator at Eak-er Air Force Base (AFB) in Blytheville, Arkansas.Jeanne Yoder, RHIA, CPC, CPC-I, CCS-P - 27 years as a hospi-tal administrator. Rank: 2nd lieutenant through lieutenant colo-nel. She spent 17 years as a medical logistics officer at Hill Air Force Base, Utah; Kadena Air Base, Okinawa, Japan; Altus AFB, Oklaho-ma; Brooks AFB, Texas; Philadelphia at Defense Personal Support Center; medical records at Sheppard AFB, Texas; billing for TRI-CARE Management Activity in Falls Church, Virginia; and data analysis at Bolling AFB in Washington, D.C.Sherry Blackwell, CPC - served in the Air Force Reserves from 1981-2014, retired with the rank of Master Sergeant (E-7). She was deployed in countries such as Germany, Spain, Egypt, Italy, and Panama. She served active duty for two years in 2003, Baghdad, Iraq, and then was deployed to Ali Al Salem Air Base, Kuwait in 2006 and 2010. Her last deployment was in 2012 to Manas Transit Center in Bishkek, Kyrgyzstan. Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA - served from 1979-1989. From 1979-1981, Pennsylva-nia Army National Guard, 1/103rd Armor Basic Non-Commis-

MILITARY MEMBERS Trained for Success

We are honored to have the crème de la crème bettering our organization.

Rob J. PachciarzCaren J. Swartz (left)

Jeanne Yoder Sherry Blackwell

Michael D. Miscoe


Military Members

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sioned Officers Course (Distinguished Graduate), rank: Special-ist-4. From 1981-1985, United States Military Academy, West Point, New York, graduated with bachelor’s degree in Electrical En-gineering, rank: Cadet - Commissioned 2nd Lieutenant, Branch, Aviation. From 1985-1986, Fort Rucker, Alabama, Aviation Of-ficer Basic Course (Distinguished Graduate), Air Assault School, Airborne School (Fort Benning, Georgia), Rotary Wing Aviator Course (Distinguished Graduate), Attack Helicopter Qualifica-tion Course, rank: 1st Lieutenant. From 1986-1989, 5/9 Air Caval-ry, 25th Infantry Division, Schofield Barracks, Hawaii. Current sta-tus: service disabled veteran.

Why Did They Choose Medical Coding?Swartz’s military OR experience led her to coding; she became in-creasingly interested in the billing/practice management side of medicine. She said, “It was important to me to learn what drove pay-ment and why, since this was not something that was ever spoken about on active duty.” The more Swartz learned, the more she want-ed to educate herself to ensure the best pay for physicians. “I need-ed to educate them based on payer policy as well as coding rules,” she said.Blackwell started her coding career while working in the business office of a county hospital as a cashier. She said, “My interest was sparked from working side by side with the ER coders and listening to them discuss cases when extracting codes.” Blackwell applied for and accepted a Department of Radiology coding position. She has been a coder since 1985 and is supervisor of anesthesia and surgi-cal services coding for Medical University of South Carolina Phy-sicians.Miscoe went into coding as a result of developing a medical billing program. He said, “Curiosity led me to study coding, documen-tation, and billing rules, and I noted how they varied from payer to payer.” This led Miscoe to steady progression of consulting and shortly thereafter, working as a forensic coding expert, and then to health law and law school. Now he is AAPC’s National Adviso-ry Board president-elect, Legal Advisory Board member, and Eth-ics Committee chair, a compliance and health law expert, and le-gal consultant.

Yoder became a coder because she had a degree in biology and need-ed a job. She said, “A member of the northern Illinois fencing club, where I fenced, recommended I get into the Medical Record Ad-ministration program at the University of Illinois Medical Center.” She did, and the rest is coding history. Pachciarz chose coding simply “to be of better service to the phy-sician practices [he] served by helping them with denials and oth-er coding needs.”

Applying Military Skills to Coding WorkYoder has applied to her coding career what she learned in the U.S. Air Force as a medical logistics officer, TRICARE manage-ment, and a data analyst. She said to run a practice well, “you need good data that tells you who your patients are, the conditions they have, the level of health they want, and how much they are will-ing to do to have that level of health.” You also need to know “what can be done to help them, what you actually provide, and the re-sources involved.” Yoder says coding tells the story, which she learned throughout her coding career. “Standard code sets (e.g., ICD, CPT®/HCPCS Level II, NDC) … need to be maintained.

Spreading Smiles During War Sherry Blackwell, CPC, served 33 years in the Air Force Reserves and retired with the rank of Master Sergeant. During her service she enjoyed her deployments the most. She traveled to many countries such as Germany, Spain, Egypt, Italy, and Panama. After 911, she was called to active duty in 2003 for 2 years, and was deployed to Baghdad, Iraq. Blackwell’s greatest joy during this time was trying to bring smiles to war zones. She recalls the experience:

While deployed I worked in a support function in which we worked with the troops that were in-transit to Afghanistan, Iraq, and other countries within the Theater of Operations. Our job was to make sure the arrival to their deployment destination was as smooth as possible. This was a difficult job because most of the time I was looking into the eyes of a scared 19-year-old who was heading into a war zone, not knowing what to expect. If I could make them smile by greeting them with a smile, a pre-paid card to call home, or even a candy bar and soda, I felt like I had made his or her day a little better. That is what made me love my job!

The opportunities offered to me would have never been offered as a civilian.


Military Members

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I’ve found that corrupting a code set to collect something for which it was not intended is usually a mistake,” she said. Code sets need to be easily collectable, well defined, and worth more than the re-sources to collect. Miscoe said skills he brought from the military to his current work include “leadership fundamentals, problem-solving skills, confron-tational tolerance, and knowledge that with effort, I can succeed at any task.”Pachciarz said what he carried to his coding career from his military experience is a “discipline to get where I need to be on time; respect for a chain of command; importance of functioning as a team; and attention to detail.”Blackwell agrees with Pachciarz about discipline being a skill she brings to her career. She also brings a deep respect for her fellow air-men that she said has been a great attribute in her civilian career.As for Swartz, everything she does today stems from her military training. She said, “All the anatomy and terminology in every note

I read as a coder, I learned from this training.” She constantly ques-tioned the physicians, asked about disease, anatomy, and the proce-dures that took care of health issues, and she learned about different specialties and procedures. Swartz said, “The opportunities offered to me would have never been offered as a civilian.”

Favorite Military ExperiencesReflecting on his experiences, Pachciarz said that “working and liv-ing alongside others with the same common goal of loving and pro-tecting our great country” was his favorite part of serving in the mil-itary.Swartz cherishes the life-long friendships she has made. She said, “It’s a feeling that people in the civilian community cannot appre-ciate — bonds between people who have served. They understand what that truly means.”Miscoe’s fondest memories were of flying attack helicopters, and he loved the Cavalry mission. He said, “Beyond that, my favorite part about serving was that it gave me the opportunity to earn the free-doms that I enjoy, as well as the incredible opportunities that this country provides to those willing to work and take advantage of them.” Miscoe recognizes the incredible investment that the coun-try made in his schooling and additional training. “Service to our country provided a way to balance the ledger,” he said.Yoder added to Miscoe’s assessment of military favorites and con-cluded, “I was happy to pay back some small part of what this coun-try provides.” Thank you for your service military members. AAPC honors and salutes you.

Michelle A. Dick is executive editor at AAPC.

Why Did You Join the Military?Some of our military members served to follow in family member’s footsteps. For others, it was American pride and giving themselves to our country. Here is why these members served this great nation:

“I always wanted to do something that contributed to society, and I felt there was no better way than defending the country I loved.”- Sherry Blackwell, CPC

“I actually never thought about not joining the military. Everyone in my family served.”- Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA

“My father served as an MP in the Air Force, my brother a crew chief in the Marine Corps. I knew I would get excellent training and really wanted to serve my country in some way.” - Caren J. Swartz, CPC-I, CPMA, COC, CRC, CPB

“I love my country and many in my family served, as well.”- Rob J. Pachciarz, CPC, COC, CIRCC, CASCC

“After backpacking around Europe during college, and seeing a variety of governments in action, I decided that although there may be problems in the USA, it was the best country around.”- Jeanne Yoder, RHIA, CPC, CPC-I, CCS-P

I was happy to pay back some small part of what this country provides.


NEWLY CREDENTIALED MEMBERS

Magna Cum LaudeMagna Cum LaudeMagna Cum Laude

Amande Lee, CPC-AAmruta Paranjape, CPC, CPMA, CEMCAnna Odor, CPC-AAshley Generallo, CPCBarbara Michelle Bess, CPCChristine Vienneau, CPC, CIRCCChristine Yost, CASCCDawn James, CPCDonna Malone, CPC, CRCEllen Bryant, CPMA, CRCIsabella Demedici, CPC-AJennifer Wood, CPC-AJulia Santiago, CPC, CRCKathleen McKula, CPC, CPMA, CEMCKelli Rain, CPC, CPMAKelly Lauer, COC-A, CPC-AKristen Driver, CPCKristin Colbert, CPC-ALaura E Sheriff, CPC, CRCMadhura Malvankar, CPC-AMahathi Chadalavada, CPC-AMarla S Miller, COC, CPCMary C Grove, CPC, CIRCCMary Peabody, CPC, CPMANicholas Massa, CPCNicki Bress, CPC-ANicole Clevenger, CPC-APam Wayman, CPC, CCCPrema Karthick, CPC-ARyan John Roberts, CPC, CIRCC, CANPCSarah Collinson, CPC, CPMA, CPCDSean Su, CRCSmitha Rachel John, CPC-AStacie Buck, CIRCCSteven Charles Dina, CPCSusan A Carbone, CPC, CPMA, CPC-ITonya Morgan, CPC-A

CPC®CPCCPCAbitha Venkatesan, CPC-PAdina Lopez, CPCAimee Kruger, CPCAkobundu Amuta, CPCAlice Anne Smith, CPCAlicia Arruda, CPCAlicia Evawn Robertson, CPCAlicia Roberts, CPCAllie Venhuizen, CPCAllison Colwell, COCAlma Morales, CPCAlvina Robinson, CPCAmanda Peryea, COC, CPCAmanda Ploeger, CPCAmey Johnson, CPCAmy Burg, CPCAmy Kalieta, CPC, CPC-PAmy Large, CPCAmy Tarr, CPCAndrea Lloyd, CPCAngel Hill, CPCAngel Romo-Rubalcaba, CPCAngela Flory, CPCAngela Tuck, CPC, CPPMAngela Ward, CPCAngelena Burks, CPCAnna Lorey, CPC-PAnnabel Luna Ruiz, CPCArmishia Handberry, CPCAshley A Titus, COC, CPCAshley Sewald, CPCAudrey Lynne Schaffran, CPC

Autumn Poland, CPCBarbara Redman, COCBonnie Smith, CPCBrad Smedley, CPCBrenda Winkler, CPCBrenda Cox, CPCBrianne Stephens, CPCBridget Haught, CPCBridgot Peters, CPCBritanny Davila, CPC, CGSCBrittany Frye, COC, CPCBrittany Goldstein, CPCBryce Jardine, CPCCandace Dos Santos, CPCCandace Mary Jordan, COCCara Cross, CPC, CPMACarol Bradley, CPCCarol Prince Penninger, COC, CPCCarolyn Bartholomew, CPCCaryn Kropf, CPCCatina Ann Tomlin, COC, CPCCesarina Stagno, CPCCharity Robinson, CPCChaunda Capers, CPCCherilyn Phillips, CPCCherita Turner, CPCChindanee Mam, CPCChrista Hendricks, CPCChristi Timbs, CPCChristine Fisk, CPCChristine Page, COC, CPCCindy Pennycuff, CPCCrystal A Torres, CPCCrystal Gardner, CPCCynthia Cochran, CPCCynthia Hogue, CPCDana Brett, CPCDana M Dunn, COC, CPCDani Compston, COCDaniel Cormier, CPCDarcy Petersen, CPCDeborah Kracl, COC, CPCDebra Knight, COC, CPCDe’Lyne Willis, CPCDena Childress, CPCDiana Brown, CPCDianne Lolley, CPC-PDolores Morris, CPCDonna M Gawel, COCDoris S. Salazar Sawyer, CPCDynanna N Bryant, CPCEbonie Griffin, CPCElizabeth Thornton, CPCFaith Finley, CPCFalecia Randolph, CPCFelicia Gilliland, CPCForrest Bleau, CPCFrances Benson, CPCFrancisca Longoria, CPCFrunscean Chisholm- West, CPCG Gail Stephenson, CPC, CPC-PGiovanni Flores, CPCGirija Reddy, COC, CPC, CIRCCGreta Bach, CPCGwendolyn Kay Miller, CPCHafidh Shihabuddin, CPCHeather Crosby, CPCHeather Lamberg, CPCHeather Matthias, CPCHeather Sorenson, CPCHeidi Whitesides, CPCHolly Christiansen, CPCInay Iriban, CPCJackie Wabaunsee, CPCJade Nichole Peterson, COC, CPCJamie Ashby, CPCJamie Reidhead, CPC

Jan McReynolds, CPCJane Gray, COC, CPC, CPC-PJane M Rapes, CPCJanie Loftis, CPCJean Marie Figlioti, COC, CPCJenna Lee Rice, COCJennifer Buzzelli, CPCJennifer Hendrix, CPCJennifer LaPiana, CPCJennifer Latva, COC, CPCJennifer Lynn Schneider-Lueken, CPCJennifer Moeller, CPCJennifer Nordlund, CPCJennifer Stamey Hannah, CPCJennifer Stamey Hannah, CPCJeremy Cox, CPCJeremy Cox, CPCJessica Hurless, CPCJill Jennings, COC, CPCJill Jorgensen, CPCJoan Clyne, CPC, CRCJoanna Welch, CPCJodi Johnson, CPCJoett Nicholson, CPCJohn Christopher Horst, CPCJose Ramon Rodriguez, CPCJose Raul Belen, CPCJoyce L Sole Reeves, CPCJulie Blanchfield, CPC, CPBJulie-Marie Ewell, CPCKaitlyn Leavens, CPCKalpita Masani, COC, CPCKandis Chestnut, COCKara Markle, COCKaren A Jones, CPCKaren C Kostecki, COC, CPCKaren Girard, CPCKaren McLaughlin, COC, CPCKaren Trammell, CPCKaren Wiedau, COC, CPC-PKarissa Shirts, CPCKatherine Comerford, CPCKathleen Alvarez, CPCKathleen Ann O’Hara, COC, CPCKathryn Crossman, CPCKathy Kirkendall, CPCKatie Cosby, CPCKatie Troup, CPCKeila Orozco, CPCKelli Anderson, CPCKelli J Squire, CPCKelli Timmons, CPCKelly Marie Kuehn, COC, CPCKelly McFadden, CPCKelly Sullivan, CPCKenrick Mui, COC, CPCKerry Hooley, CPCKevin Mansfield, CPCKim Godwin, CPCKim Norris, CPCKirk Grantham, CPC, CPMAKristen Hansmann, CPCKristen Ohm, CPCKristi Mathews, CPC, CGICKristie McDuffie, CPCKristin Layne, CPCKristyn Billings, CPCLadina Jones, CPCLakshmi Ramakrishnan, CPCLaureen Marie Conrad, CPCLeah Elise Matthew, CPCLeah Johnston, CPCLeann Lawson, CPCLeAnne Mace, COCLena Nicole Clark, CPCLenora Williams, CPCLeona Lutsch, CPC

Lessa Kimbrell, CPCLinda Lester, COC, CPCLiri Sheshi, COCLisa Mahlum, CPCLiudmyla Musiienko, CPCLori A Overton, CPCLori Guaraglia, CPCLori Neyens, CPCLouise J Hayes, COC, CPCLucretia Price, CPCMadea DeHaven, CPCMadelaine M Luces, CPCMargarite Scott, CPCMaria Dolores Casas, CPCMaria Grace Morabe, COCMaria Manolov, CPCMaria Robles, CPCMaribeth Durbin, CPCMarina Gonzalez, CPCMarjorie Bedsole, CPCMarlena Daughenbaugh, CPCMary Alexander, CPCMary Anderson, CPCMary Brasfield, CPC-PMary Cortez, CPCMary Duke, CPCMary Wackerle, CPCMarybeth K McCall, COC, CPCMaureen Frederick, CPCMaureen Landry, CPCMayra A Tapia, CPCMegan Gilliam, COCMegan Pfingsten, CPCMelanie Etter, CPCMelanie Prosser, COCMelissa Clements, CPCMelissa Colombo, CPCMelissa James, CPCMelissa Roaten, COCMelissa Thompson, CPCMichele Dawn Christopher, CPCMichelle Lopez, CPCMichelle Mckay, CPCMichelle Newsome, CPCMonita Phillips, COCMui Ngov, CPCMykeela L Hackett, CPCNancy Choi, CPCNancy Garcia, CPCNancy Louise Lucas, CPCNannette Mayo, CPCNatalie Arnold, CPCNatasha D Barrett, CPCNicole Calcanes, COC, CPCNicole Frantz, CPCNicole Moulden, CPCNora Hunter, COC, CPCPamela Lynn Graham, CPCPamela Medina, CPCPamela Schulman, CPCPat Hance LPN, CPCPatricia Brayton-Winter, CPCPatricia Nichting, COC, CPCPatti Kelley, CPCPaula Giovanetti, CPCPhyllis Baker, CPCPhyllis Pratt, CPCPrasanna Mary, CPCPrecy Lim, CPCRachel Ann Cristobal, COC, CPCRamona Lazenby, CPCRaul Reyes, CPCRebecca K Nelson, CPCRebecca Nieman, CPCRebecca Rios, CPCRegina Taylor, CPCRenae Wilson, COC

Reva Harris, CPCRhonda G Crouch, CPC, CHONCRhonda Rappe, CPCRoberta Burkhart, CPCRobin Griffin, COCRohan Sasmal, CPCRonna Foster, CPCRose M Garcia, COCRustie Elkins, CPCRuth Anderson, CPCRuth Hancock, CPCSabrina McDowell, CPC, CPC-PSabrina Smith, CPCSamantha D. Ulery, COCSandi Miller, CPCSandra R Talada, CPCSandra Thompson, CPCSandy Mclynch, CPCSarah Burnham, CPCSarah Lindahl, CPCShannon M Schwartz, COCShannon Ramirez, CPCShannon Smith, CPCShareef Sabree, COC, CPCSharon Babin, CPCSharon Britian, CPCSharon Juguilon, CPCShayla D. Gowers, CPCSheetal Bhutani, CPCSheila Ayers, CPCSheila Cornwell, CPCShellee Barbour, CPCShelley Hutchinson, CPCSherry Sroka, COC, CPCShervonne L Walker, CPCShoshana Espin, CPCSommer Williams, CPCSonia M Magliocchetti, COC, CPC, CPMA, CEMC

Stacey Lynn Rudd, CPCStacy Stasiewicz, CPCStephanie Love Jones, COC, CPCStephanie Michaelson, CPCStephen Swisher, COC, CPCSule Mohammed, COC, CPCSummer Burns, CPCSusan Beeman, CPCSushma M S, CPCSuzzeatte Wisdom, CPCTammy Comfort, CPCTammy J Arlt, CPCTammy Story, CPCTara Megee, CPCTaylor Thompson, CPCTeresa Striley, CPCTerry Goodman, CPCTetyana Shlyakhova, CPCTheresa Johnson, CPCTina Grech, CPCTina Reiter, CPCTonya A Miller, CPCTonya Vike, CPCTracey Morehart, COC, CPCTraci Chrisman, CPCTracie Van Wyngarden, CPCTracy Fillies, CPCTrisha Mullins, CPCTyna Miller, CPCValerie Alvarado, CPCVicki Vargas, CPCVictoria Basile, CPCVictoria Hubbard, COC, CPCVirginia Anderson, CPCVirginia Banatt, CPCWayne Greenwood, CPCWendy R Lawrence, CPCWendy S Rowe, COC, CPC, CPMA


NEWLY CREDENTIALED MEMBERSWendy Sowa-Maldarelli, CPCWendy W Knight, CPCWhitney Loss, CPCYasmin Mejia, CPCYolonda Ray, CPC

ApprenticeApprenticeApprenticeA. Deepthi, CPC-AAaron Collard, CPC-AAarti Singh, CPC-AAbbey Morin, CPC-AAbdul Hafeez Salam, COC-AAbinaya Vidyashankar, CPC-AAfrica Bulbula, CPC-AAgnieszka Piqueras, CPC-AAileen Boucher, CPC-AAkash Chauda Gupta, COC-AAlayna Reagor, CPC-AAlejandra C Martinez, CPC-AAlejandra Troconis, CPC-AAlekhya Bollina, COC-AAlexander Pait, CPC-AAlexandra Fancher, CPC-AAlicia J Olmeda, CPC-AAlicia Aamoth, CPC-AAlicia Bellante, CPC-AAlicia Clardy, CPC-AAlicia Pride, CPC-AAlicia Ripa, COC-A, CPC-AAlison Hatt, CPC-AAlison Simmons, CPC-AAlissa Bradburn, CPC-AAllison Blair, CPC-AAllison Davis, CPC-AAllison Klosky, CPC-AAllison Troxell, CPC-AAllu Naresh Kumar, CPC-AAllyson Hafner, CPC-AAlthea Mathews, CPC-AAlwyn Fong, CPC-AAlyssa Ditzler Ethridge, CPC-P-AAlyssa Norton, CPC-AAmanda R Brown, CPC-AAmanda Boronda, CPC-AAmanda Bullis, CPC-AAmanda Costabile, CPC-AAmanda Figel, CPC-AAmanda Frazier, CPC-AAmanda Harvey, CPC-AAmanda Perkins, CPC-AAmanda Sauls, CPC-AAmanda Swords, CPC-AAmarnath Arjunan, COC-A, CPC-AAmber DeAtley, CPC-AAmber Gay, CPC-AAmber Green, CPC-AAmber Kashyap, CPC-AAmber Kean, CPC-AAmber Mayhew, CPC-AAmber Mitchell-Gamber, CPC-AAmber O’Daniel, CPC-AAmber Orchowski, CPC-AAmber Ramsey, CPC-AAmber Schmidt, CPC-AAmber Thornton, CPC-AAmelia Rogers, CPC-AAmudhavalli D, CPC-AAmy Bunyard, CPC-AAmy Coyle, CPC-AAmy L Ramadhan, COC-A, CPC-AAmy Plante, CPC-AAna Bernal-Martinez, CPC-AAna Katherine James, CPC-AAncy Kurumkulam Peter, CPC-AAndrea Dow, COC-A

Andrea Howard, CPC-AAndrea Ketelhut, COC-AAndrea Koberlein, CPC-AAndrea Leann Strauch, COC-AAndrea Pearson, CPC-AAndrew Cobbs, COC-A, CPC-AAndrew David Martin, CPC-AAndrew Yurkosky, CPC-AAndria Riley, CPC-AAngel M Dauzat, CPC-AAngel Musgrave, COC-A, CPC-AAngela Allen, CPC-AAngela Blythe, CPC-AAngela Gieling, CPC-AAngela Tunstall, CPC-AAngela Wilson, CPC-AAngelia Brown, CPC-AAngie C Flaherty, CPC-AAnil Pandey, CPC-AAnila Lakshmanan, CPC-AAnish Thomas, CPC-AAnita Hahner, CPC-AAnitha Kanagarajan, CPC-AAnju Suresh, COC-AAnn Mia Haning, CPC-AAnna Miller, CPC-AAnnamarie Forcella, CPC-AAnne Ardath Stakkeland, CPC-AAnne Winchell, CPC-AAnnette Cleveland, CPC-AAnnie Fettig, CPC-AAnnie Houser, CPC-AAnnMarie O’Neill, COC-AAnns Jacob, CPC-AAnnu Agrawal, CPC-AAnnu Kumari, COC-AAntomary Bincy.J, CPC-AAnu Varghese, CPC-AAnumol Krishnankutty, CPC-AAparna Gopireddy, CPC-AAparna Piraji Jadhav, CPC-AApril Bouchie, CPC-AApril Euteneuer, CPC-AApril Evans, CPC-AApril King, CPC-AApril Morin, CPC-AApril Sayers, CPC-AAprille Ruiz, CPC-AArchana Hole, COC-AArchana KishorKumar, CPC-AArchana Srinivasan, CPC-AArdenia Lowry, CPC-AArlene Edwards, CPC-AArshkara Khan, COC-AArunkumar Jagadesan, CPC-AArvind Singh Kaira, CPC-AAseem Arora, CPC-AAsha Irine Monis, CPC-AAshanti Hadley, CPC-AAshley Care, CPC-AAshley Dixon, CPC-AAshley Hall, CPC-AAshley Hillestad, CPC-AAshley Mayers, CPC-AAshley Porter, CPC-AAshley Wollaber, CPC-AAshok Gundabathina, COC-AAshwini Dhopte, COC-AAshwini Raja, COC-AAswathy Madathil Rajappan Nair, CPC-AAzarudheen Tajudheen, CPC-AB.K. Jayalakshmi, CPC-ABahoran Singh, CPC-ABala Murali, CPC-ABandi Shankar, COC-ABandi Shilpa, CPC-ABangaru Pavani Teja, CPC-A

Bao Vang, CPC-ABarbara Clavier, CPC-ABarbara McCray, COC-ABarbara O’Neil, CPC-P-A, CPBBarbara Pascarella, CPC-ABarbara Robson, CPC-ABeatrice A Santos, CPC-ABelinda Interior Gonzalvo, CPC-ABenjamin Whitt, CPC-ABenzy Ann Mathew, CPC-ABestha Chandra Sekhar, COC-ABeth King, CPC-ABeth Shelton, CPC-ABetsy Johnson, CPC-ABetty Duncan, CPC-ABeverly Gagnon Miller, CPC-A, CPBBhavya Ravikumar, CPC-ABhimrao Chandrakant Gawade, CPC-ABhumika Patel, CPC-ABhuvaneshwari Rajan, CPC-ABhuvaneshwari Thirumoorthy, CPC-ABhuvaneswari M Sivakumar, CPC-ABillie Jo Robbins, CPC-ABinoy Thomas, CPC-ABirgit Williams, CPC-ABisher Changaranchola, CPC-ABlessy Nishanthi, CPC-ABobbi Such, CPC-A, CPBBobby Lowe, CPC-ABojarajan Kumarasamy, COC-ABonita Garshnick, CPC-ABonthala Ramesh, CPC-ABrad Schwarck, CPC-ABrandi Brown, CPC-ABrandy Zurcher, CPC-ABreanna Salamone, CPC-ABrenda Johnson, CPC-ABrenda Jones, CPC-ABrenda L Lass, CPC-ABrenda Marcum, CPC-ABrennan Mainers, CPC-ABrittany Adams, CPC-ABrittney McClafferty, CPC-ABroncy Rose Joseph, CPC-ABryan Jefferson Icban, CPC-ACamille Sewell, CPC-ACandace Jolene Harmer, CPC-ACandace Sizemore, CPC-ACandice Waples, CPC-ACarie McCormick, CPC-ACarla Rose, CPC-ACarly Ziev, CPC-ACarmela Mendoza-Baltazar, CPC-ACarmen Garcia, CPC-ACarol Swedensky, CPC-ACarolyn Carr, CPC-ACarolyn Michele Shaw, CPC-ACarrie Flood, CPC-ACarrie Scholl, CPC-ACarrie Stubbs, CPC-ACassandra Rogers, CPC-ACassie A Burkholder, CPC-ACassie Parker, COC-A, CPC-ACassie Rainwater, CPC-ACatherine Santiago, CPC-ACathy Maniatakos, CPC-ACeleste Misbah, CPC-ACh. Amrutha, CPC-AChalla Sindhu, CPC-AChandra Weekley, CPC-AChandrashekhar Puyed, CPC-AChannon Stout, CPC-ACharles Grant, CPC-ACharlie Flores, CPC-ACharlotte Dunkle, COC-A, CPC-ACharlotte Jean, CPC-AChelsea Moody, CPC-A

Chelsea Pederson, CPC-ACherie Ann Nickles, CPC-ACheryl Moser, CPC-ACheyanne Andersen, CPC-AChiluveru Manogna, COC-AChindam Rajesh, CPC-AChitipothu Shruthi, CPC-AChitra Nellaiappan, CPC-AChitra Sekar, COC-AChris Faber, CPC-AChris Voutas, CPC-AChrista Clagon, CPC-AChristina Franks, CPC-AChristopher Boc, CPC-AChristopher Nicolaison, CPC-AChristopher Steven Hayes, CPC-ACindy Jackson, CPC-ACindy Sue Arnold, COC-A, CPC-AClaire Meehan, CPC-AClifford Chen, CPC-AColleen Kobe, COC-AConnie Mucci, CPC-AConnie Ward, CPC-AConstance Duff, CPC-ACorina Diaz, CPC-ACorinne Weckherlin, CPC-ACorissa Mclean, CPC-ACorrie Nave, CPC-ACourtney Crookshanks, CPC-ACristina Hebert, CPC-ACrystal Gonzales, CPC-ACrystal Thompson, CPC-ACrystal Thompson, CPC-ACrystal Watkins, CPC-ACymantha Martinez, CPC-ACynthia Cox, CPC-ACynthia Howell, CPC-ADale Spencer, CPC-ADan Hughes, CPC-ADandu Swathi, CPC-ADaniel Criswell, CPC-ADaniel Toledo, CPC-ADanielle Arcadi, CPC-ADanielle Emerson, CPC-ADanielle Garvey, CPC-ADanielle Papa, CPC-ADanielle Scholten, CPC-ADavette Malufka, CPC-ADavid Hurst, CPC-ADavid McElfresh, CPC-ADawn Elford, CPC-ADawn Loser, CPC-ADawna Alphonse, CPC-ADeann Reed, CPC-ADebby Waddle, CPC-ADeborah Brookover, CPC-ADeborah Cramer, CPC-ADeborah McGhee, CPC-ADeborah Wodhanil, CPC-ADebra Granger, CPC-ADeena Barton, CPC-ADeepa Muthusamy, CPC-ADeepthi Ghanta, CPC-ADellareese M Lowe, CPC-ADelphin Joseph, COC-ADenise Inman, CPC-ADenise Bostic, CPC-ADenise Faulkner, CPC-ADenise Kline, COC-ADenise M Kelley, CPC-ADenise M Kelley, CPC-ADephanie Hogan Begay, CPC-ADeShara Shells, CPC-ADesiree Elekwa-Izuakor, CPC-ADesiree Schwartz, CPC-ADhivya Prabha Palanisamy, CPC-ADiamela Valdes, CPC-A

Diana Neatrour, CPC-ADiane Carpenter, CPC-ADiguvapati Naga Lingeswara Reddy, CPC-A

Dina O’Reilly, CPC-ADinesh Chauhan, CPC-ADivya Gurusekaran, CPC-ADivya Palanisamy, CPC-ADivyaa Doguparthi, COC-ADolmaya Thogra, COC-ADolores Ratay, CPC-ADominic Bethel II, CPC-ADoneice Honeycutt, CPC-ADonica Marie Collier, CPC-ADonna Bougher, CPC-ADonna Corbani, CPC-ADonna Houghton, CPC-ADonna Moore, CPC-ADonna Sestito, CPC-ADoreen Melear, CPC-ADorene Thorgesen, CPC-ADottie Sue Davis, CPC-ADwight Jackson, CPC-AEarl T. Burris III, CPC-AEden Cabalu, CPC-AEdmee Vale, CPC-AEileen Maca, CPC-AElena Long, CPC-AElisha Somers, CPC-AElizabeth Ann White, CPC-AElizabeth Boden, CPC-AElizabeth Cardenas, CPC-AElizabeth Parsons, CPC-AElizabeth Tressler, CPC-AElizabeth Watts, CPC-AElla Uma Devi, CPC-AEllenmarie Caisse, CPC-AEmily Bernhardt, CPC-AEmily Jones, CPC-AEmily Long, CPC-AEmily Lovelace, CPC-AEnosh Saka, COC-AErica Griffin, CPC-AErica Ramirez, CPC-AErik Geissal, CPC-AErin Ash, CPC-AErin Aune, CPC-AErin Becker, CPC-AErin Lynn Jehle, CPC-AErin Thunder, CPC-AErrer ‘Dena’ Jackson, CPC-AEsther Leal, CPC-AEtta Smalley, CPC-AEva Janice Gauthier, CPC-AEvelyn Aguirre, COC-AEvelyn Harr, CPC-AFahida Moinudheen, CPC-AFalon Stone, COC-AFawn L Lueck, CPC-AFaye Halbur, COC-AFrances Ellaine Roc, CPC-AFrances Michelle Strickland, CPC-AGade Mallikarjuna Rao, COC-AGail Clizbe, CPC-AGail Quinn, CPC-AGayathri Pugalanthi, CPC-AGayle Farha, CPC-AGelisa Stafford, CPC-AGenevieve Kellogg, CPC-AGeorge Esguerra, COC-A, CPC-A, CPBGerardo Vela, CPC-AGeri Smith, CPC-AGia Jacquet, CPC-AGinger Persinger, CPC-AGinger Walsh, CPC-AGiuliano Edmund Fabian, CPC-AGivenchy Costar, CPC-A


NEWLY CREDENTIALED MEMBERSGlenda Werkmeister, CPC-AGloria Beverly, CPC-AGloria D Durham, CPC-AGloria Myllykangas, CPC-AGomathi Palanisamy, CPC-AGouse Mohiddin Sayyad, CPC-AGrace Anne Tudan, CPC-AGreg Killian, CPC-AGregory Thompson, COC-A, CPC-AGretchen Bender, CPC-AGricel Rivera, CPC-AGuinevere Shapiola, CPC-AGunasekar Ramaiah, COC-AGurpreet Matharu, CPC-AGurrapu Naveen, CPC-AHanna Marie Langley, CPC-AHari Priya Balasubramaniam, CPC-AHaris Rahman, CPC-AHarold Moran, COC-AHeather Harvey, CPC-AHeather Nelson, CPC-AHeather Orza, CPC-AHeather Perry, CPC-AHeidi Hughes, CPC-AHeidi Marie Whiteman, CPC-AHeidi Smith, CPC-AHenry Algarin, CPC-AHillary True, CPC-AHimabindu Yampati, COC-AHolli Peifer, CPC-AHolly Brock, CPC-AHolly Gillingham, CPC-AHumaira Shah, CPC-AInbaraj Chandran, COC-AIracema Hernandez, CPC-AIsrar Saifi, CPC-AJackannette Drisko, CPC-AJackie LeClair, CPC-AJacob Robinson, CPC-AJacqueline Krueger, CPC-AJacqueline Skahan, CPC-AJaime Moore, CPC-AJalpa Parmar, CPC-AJamell Richmond, CPC-AJamie Lee Geronimo Staples, CPC-AJamie Petricich, CPC-AJamie Tauferner, CPC-AJan Edward Julian, CPC-AJan Ingram, CPC-AJana Martin, CPC-AJana Sanderson, CPC-AJane Mattison, CPC-AJane McKenzie, CPC-AJanelle Crahan, CPC-AJanet Egessah, CPC-AJanet Varathan, CPC-AJanice Newman, CPC-AJanice Wilson, CPC-AJanine Mills, CPC-AJanine Skwarczynski, CPC-AJaqueline Da Silva, CPC-AJaro Mayda, CPC-AJasmil Fabiano, CPC-AJavier Cavazos, CPC-AJayalakshmi Y, CPC-AJayalakshmi Yadav Guthi, CPC-AJayme Uhrig, CPC-AJayme Yoshida, CPC-P-AJé DeVance, CPC-AJean Stackpoole, CPC-AJean Szurgot, CPC-AJeanette Bueno Bautista, CPC-AJeanette Springer, COC-AJeanie Ogle, COC-AJeannie Scott, CPC-AJeni Danielak, CPC-AJenifer Tobin, CPC-A

Jenna Brown, CPC-AJennetta R Parker, CPC-AJennie Alvarado, CPC-AJennie Rowland, CPC-AJennifer Birkbeck, CPC-AJennifer Bodie, CPC-AJennifer Braunschweig, CPC-AJennifer Burris, CPC-AJennifer Chaffin, CPC-AJennifer Fenger, CPC-AJennifer Gray, CPC-AJennifer Knolton, CPC-AJennifer Kunz, CPC-AJennifer Maciej, CPC-AJennifer Manella, CPC-AJennifer Painter, CPC-AJennifer Reddick, CPC-AJennifer Schmid, CPC-AJennifer Torres, CPC-AJenny Noel, CPC-AJessica Giffin, CPC-AJessica Bowen, CPC-A, CPBJessica Erin Harris, COC-A, CPC-AJessica Gonzalez, CPC-AJessica Gonzalez, CPC-AJessica Helfrich, CPC-AJessica Kerbs, CPC-AJessica L McKenzie, CPC-AJessica Lynn Bixby, CPC-AJessica Swenson Nelson, CPC-AJessica Thomas, CPC-AJessica Williams, CPC-P-AJeydaliz Ruiz, CPC-AJho Mhar De Chavez Malinao, CPC-AJijitha Hareendran, CPC-AJill Benson, CPC-AJill Dunton, CPC-AJill Headley, CPC-AJill Huston, CPC-AJill Manca, CPC-AJill Miyagawa, CPC-AJillian Kelly, CPC-AJim Dimartino, CPC-AJim Kim, CPC-AJinoy Mathew, CPC-AJoAnn Reed, CPC-AJoanne Anheuser, CPC-AJoanne Ching, CPC-AJoanne Graham, CPC-AJoanne McGraw, COC-AJodi Atwood, CPC-AJody A Hubbard, CPC-AJoey Sandoval, CPC-AJohn Henry Caranto, CPC-AJohn Paquette, CPC-AJolene Riesselman, COC-AJolynn Ortiz, CPC-AJonathan Haney, CPC-AJonathan Torres, CPC-AJonida Murati, CPC-AJordan Stacey, COC-AJosephine Mcgonagle, CPC-AJoshua Martin, CPC-AJoy Meharg, CPC-AJoy Stearns, CPC-AJoyce Esther Rani, CPC-AJoyce Weis, CPC-AJoyce Willettte, CPC-AJulia Donohue, CPC-AJulia Mink, CPC-AJulie Worch, CPC-AJune Martin, CPC-AJuney Jose, CPC-AJustine Gaumond, CPC-AJyotir Kulmacz, CPC-AK. Madhavi, CPC-AK. Vinutna, CPC-A

Kacey Dodenhoff, CPC-AKaitlin Tatro, CPC-AKaitlin Wilhalme, CPC-AKalika Colquhoun, CPC-AKalpana Nagar, CPC-AKalpana Premkumar, CPC-AKalpana Ragala, CPC-AKalyana Sundaram Nataraj, CPC-AKamal Saini, CPC-AKanaka Spandan, COC-AKandula Lakshmi Chandana, CPC-AKandy Olsen, CPC-AKannan S, COC-AKannan Thonthi, COC-AKara Masters, CPC-AKara McConniel, CPC-AKara Shaver, CPC-AKaren Brautigam, CPC-AKaren Case, CPC-AKaren Garofano, COC-AKaren King, COC-A, CPC-AKaren M Hanson, COC-AKaren Mandt, CPC-AKaren Marosz, CPC-AKaren McCulloch, COC-AKaren McEuen, COC-AKaren Mohler, CPC-AKaren Phipps, CPC-AKaren Richter, CPC-AKaren Sutley, CPC-AKaren Thomas, CPC-AKari Christopherson, CPC-AKari Jackson, CPC-AKari Johnson, CPC-AKari Stordahl, CPC-AKarl Olson, CPC-AKarolina Majerczak, CPC-AKarra Cubellis, CPC-AKarri Kavitha, CPC-AKarthikeyan Duraisamy, COC-AKaryn Sweeney, CPC-AKasey Boehmann, CPC-AKatelyn Delorm, CPC-AKatherine Ingram, CPC-AKathleen Carroll, CPC-AKathleen Gione, COC-AKathleen Lazar, CPC-AKathleen Loera, CPC-AKathryn C Smith, CPC-AKathryn Klingenberg, CPC-AKathy Ude, CPC-AKatrina Boldt, CPC-AKavitha Aarthiga Kalyana Sundaram, CPC-AKavitha Prakash, CPC-AKavitha Subbiah, CPC-AKayalvizhi P, CPC-AKayla M Beachler, CPC-AKayla Miller, CPC-AKayla Rivera, CPC-AKay-lee Alaspa, CPC-AKayleigh Frazier, CPC-AKeely Geffre, CPC-AKelli Beck, COC-AKellie Koop, CPC-AKelly Brogan, CPC-AKelly Conner, CPC-AKelly L Carter, CPC-AKelly Moody, CPC-AKelly Sarratt, CPC-AKelsey Apodaca, CPC-AKelsey Ellis, CPC-AKelsey Ellis, CPC-AKelsi Noteboom, CPC-AKenzi Brooks, COC-A, CPC-AKevin Sherar, CPC-AKiarra Harris, CPC-AKim Ford, CPC-A

Kim Iles, CPC-AKimberley Stoner, CPC-AKimberly Ehlert, CPC-AKimberly Noble, CPC-AKiruthika Mohan, CPC-AKlnrr Deepika, CPC-AKolla Jaipal Reddy, CPC-AKomal Bhumkar, COC-AKonda Sravanthi, CPC-AKori E Frank, CPC-AKourtney Wright, CPC-AKrishan Gopal, CPC-AKrishnaveni PV, CPC-AKristen Driver, CPC-AKristi Truscott, CPC-AKristin Fessick, CPC-AKristina Dawson, COC-AKristy Parker, CPC-AKshama Nagaraj, COC-A, CPC-A, CPBL. Rakesh Reddy, CPC-ALacey Nally, CPC-ALacey Rosson, CPC-ALakmini Prematillake, CPC-ALana Lamas-Nicholson, CPC-ALane Mayhew, CPC-ALaneta Kay Watts, CPC-ALanka Ravi Kiran, CPC-ALarissa Amundson-Keller, CPC-ALaShanda Wilks, CPC-ALaura Davy, CPC-ALaura Lacy, CPC-ALaura Liu, CPC-ALaura Route, CPC-ALaurel Frudd, CPC-ALauren Ariane McCloskey, CPC-ALauren Calhoun, CPC-ALauren Creager, COC-ALauren Davis, CPC-ALauren Hartigan, CPC-ALaurena Laughlin, CPC-ALaurie Schrader, CPC-ALaurilee Eades, CPC-ALavina Edward Joseph, COC-ALayla Abdirahman, CPC-ALeah Corbett, CPC-ALeeann OByrne, CPC-ALeigh Harold, CPC-ALeighanne Truelove, CPC-ALendi Kinsaul Watkins, CPC-ALeslie Eysler, CPC-ALeticia Bellantoni, CPC-ALija George, CPC-ALilli Thorsell, CPC-ALily Pennell, CPC-ALinda Bugdanowitz, CPC-ALinda Luxo, COC-ALinda Morse, CPC-ALindsay Carlson, CPC-ALindsay Sobczak, CPC-ALindsey Cleek, CPC-ALindsey Smith, CPC-A, CPBLindsey Voorhies, CPC-ALindy Aven, CPC-ALisa Baker, CPC-ALisa Clugston, CPC-ALisa Colbert, CPC-ALisa Creech, CPC-ALisa Davis, CPC-ALisa Harvey, COC-ALisa Hembree, CPC-ALisa Jones, CPC-ALisa Ketsenburg, CPC-ALisa Kindig, CPC-ALisa Lange, CPC-ALisa McLeod, CPC-ALisa Melanson, CPC-ALisa Mills, CPC-A

Lisa Spohn, CPC-ALisa Walsh, CPC-ALisdey Silverio Castillo, CPC-ALoogeswary Thiruvengadam, COC-ALoretha Davis, CPC-ALori Bloom, CPC-ALori Gomez, CPC-ALori Krueger, PharmD, CPC-ALori L Mauel, CPC-ALori Scarafile, CPC-ALorraine Marshall, CPC-ALouise Kauppinen, CPC-ALuida Rieche, CPC-ALukaiah Guduri, COC-ALydiaRathna Sugunaraj, CPC-ALynda Beamish, CPC-ALynsey Hersley, CPC-AM Swapna Latha, CPC-AM. Shekar goud, CPC-AMackenzie Pennington, CPC-AMadison Kelly, CPC-AMakesha Lynn Pettit, CPC-AMalisa Jokbengboon, CPC-AMallory Reefer, CPC-AMamta Kapoor, CPC-AManasi Maji, CPC-AMandati Shanthi Sree, CPC-AManikandan Sekar, COC-AManoj S, COC-AMarci Dusseault, CPC-AMarcia Cornele, COC-AMareena Susan Roy, CPC-AMargaret Rogers, CPC-AMargorie Bartley, CPC-AMaria A Hershberger, CPC-AMaria Bilbao, CPC-AMaria Rosetto, CPC-AMaria Teresa Gonzalez, CPC-AMariah Mikula, CPC-AMaricel Borges, CPC-AMarie Agnes Holliday, CPC-AMarie Johnson, CPC-P-AMarilyn Jaskowiak, CPC-AMarilyn Wheat, CPC-AMarissa Macri, CPC-AMartin Richards, CPC-AMary Dominique G Deato, CPC-AMary Grace Reyes, CPC-AMary Hogan, CPC-AMary Kay Bross, CPC-AMary Nancy Gnanasekaran, CPC-AMary Pavithra, CPC-AMary Quinn, CPC-AMary Roland, COC-AMary Surber, COC-AMary Wilson, CPC-P-AMaurice Mankowski, CPC-AMazen Zakeria, CPC-AMeagan Taylor, CPC-AMegan Allen, COC-A, CPC-AMegan Barnes, CPC-AMegan Drake, CPC-AMegan Guymon, CPC-AMegan Heusinkveld, CPC-AMegan Kincade, CPC-AMegan Potter, CPC-AMegan Stafford, CPC-AMegha Dhanesh, CPC-AMelanie Brame, CPC-AMelanie Brown, CPC-AMelanie Javier, CPC-AMelanie Mathis, CPC-AMelannie Phillips, CPC-AMelinda DeVries, CPC-AMelissa Archie, CPC-AMelissa Ballester, CPC-AMelissa Cox, CPC-A


NEWLY CREDENTIALED MEMBERSMelissa Daniels, CPC-AMelissa Douglas, CPC-AMelissa Edwards, CPC-AMelissa Fischer, CPC-AMelissa Grainger-Harry, CPC-AMelissa Hollar, CPC-AMelissa Rhodes, CPC-AMelissa S Bundren, CPC-AMenaka Baskaran, CPC-AMichael Chastain, CPC-AMichele deJong, CPC-AMichele Krieg, CPC-AMichele Weir, CPC-AMichele Yanes, CPC-AMichelle Gregorius, CPC-AMichelle Hastedt, CPC-AMichelle Hutton, CPC-AMichelle Marie Pajimula, CPC-AMichelle Othot, CPC-AMichelle Spivey, COC-AMichelle Wolfe, CPC-AMindy Gislason, CPC-AMiranda Morgan, CPC-AMiri Hayner, CPC-AMiriam Priscilla Morales, CPC-AMiriam Semendy, CPC-AMisti Spiering, CPC-AMithlesh Verma, CPC-AMohammed Shafeeque, COC-AMohd Anees Mohd Haneef, CPC-AMonika Balan, CPC-AMousamy T.M, CPC-AMukesh Jha, CPC-AMunmi Saikia Matlotia, COC-AMuralimohan Reddy, COC-AMustafa Shariff, CPC-AMylene Almoite, CPC-AMyvizhi Deenadhayalan, CPC-AN. Lokesh, CPC-ANadezhda Shotropa, CPC-ANaeem Parveen, CPC-ANagadurgaprasad Bodapati, COC-ANakia Young, CPC-ANamdev Kadam, CPC-ANancy A Galvin, CPC-ANancy Anderson, CPC-ANancy Dougherty, CPC-ANancy Gulley, CPC-ANancy Hochu-Oliveira, CPC-ANandhini Madheswaran, CPC-ANandini Sekar, CPC-ANatalie Anderson, COC-A, CPC-ANatalie Jury, CPC-ANatalie Norris, CPC-ANatalie Russell, CPC-ANaTasha Ross, CPC-ANate Evans, CPC-ANathan Bushlow, CPC-ANatraj Adla, COC-ANaveen Kumar, CPC-ANeelam Malumphy, COC-ANereida Bruno, CPC-ANezyl Mante, CPC-ANichol Wilson, CPC-ANicole Bokanoski, CPC-ANicole Litterio, CPC-ANicole M Ball, CPC-ANicole Shafer, CPC-ANicole Ward, CPC-ANiharika Dhusia, CPC-ANikki Wanger, CPC-ANikki Trahan, CPC-ANikkie Suveerachaimontian Phukunhaphan, CPC-A

Nilofar Hakim, CPC-ANina Newman, CPC-ANina Sonin, CPC-A

Nirmala Devi Rodda, CPC-ANirmala Dharmalingam, CPC-ANishanth Purushothaman, COC-ANivas Raj Ganesan, CPC-ANkiru Ogbogu, CPC-ANnaemeka Morah, CPC-ANoor Aaysha Nasrin Mohamed Sadiq, CPC-A

Norazimah Sabree, CPC-ANuseba Abdul Khader, CPC-ANydia Davila, CPC-AOdapally Srinivas, CPC-AOdette Alonso, COC-AOlive Carlos, CPC-AOlivia Wiltse, CPC-AOlivia Wong, CPC-AOlyvia Freeman, CPC-AOmar Emil Monet, COC-AP. Swetha, CPC-APadma Vaddi, CPC-APadmalatha Pilli, CPC-APaige Haase, CPC-APam Chitwood, CPC-APamela J Branch, CPC-APamela Jean Brandt, CPC-APamela Reaser, CPC-APamela Sanford, CPC-APamela Stark, CPC-AParimala Mamillapalli, CPC-AParisa Coffman, CPC-APathula Sravani, CPC-APatrice Simpkins, CPC-APatrice Vary, CPC-APatricia A Ward, CPC-APatricia Curtis, CPC-APatricia Easley, CPC-APatricia Fowler, CPC-APatricia Gutierrez, CPC-APatricia Mathison, CPC-APatricia Possenriede, CPC-APaula-Kay Magda, CPC-APaulette Palmer, CPC-APaulette Viney, CPC-APawan Sharma, COC-APeggy Klocke, COC-APeggy Trujillo, CPC-APenumaka BabyRajitha, CPC-APhyllis Ann Zyglewyz, CPC-APillalamarri Kalyani, CPC-APolinaidu Bonu, COC-APooja Pandey, CPC-APoonam Nigam, CPC-APoonam Vilas Wankhade, COC-APrachi Dhobale, CPC-APramit Kumar, CPC-APrasad K, CPC-APrashanth Kukkala, CPC-APrashanthi Dharmaraj, CPC-APrathima Badrinarayanan, COC-APriya B, CPC-APriya Krishnan, CPC-APriyanka Mekala, COC-APriyanka Patil, COC-APrudhvi Vani Yerram Setti, CPC-APugazholi Parthiban, CPC-AQuiana Petteway, CPC-AR. Sirisha Reddy, CPC-ARachael Hoyez, CPC-ARachel Bannick, CPC-ARachel Kile, CPC-ARachell Nye, CPC-ARaghunandhan Awari, COC-ARajesh Sampath, COC-ARajeswari Nagarajan, CPC-ARajitha Mudike, COC-ARajkamal Jagadeesan, COC-ARajshekhar S Kabanuri, CPC-A

Raju Aloopady Padmanabhan, CPC-ARamprasad Dussa, COC-ARamya Parthasarathy, CPC-A, CPBRamya Devi, COC-ARandi Hillebrandt, CPC-ARaquel Kenley, CPC-ARaquel Rodriguez, CPC-ARashedha Banu Mohammed Abubackar, CPC-A

Ravi Kishore Yadav Romala, COC-ARavi Tripathi, CPC-ARavindar Reddy D, CPC-ARebecca Broome, CPC-ARebecca Jasse, CPC-ARebecca Kraynak, CPC-ARebecca Mullins, CPC-ARebecca Snowberger, CPC-ARebecca Young, CPC-AReeja Mary Raju, CPC-ARegina Balch, CPC-ARegina Driscoll, COC-ARegupriya Madhavan, CPC-ARejithamol Anjilithottathil Manoharan, CPC-A

Reka Jayakumar, CPC-ARekha Agarwal, CPC-ARenata Rambo, CPC-ARenee Knutsen Phay, CPC-ARenee Wilkins, COC-AReshma Garule, CPC-AResmy George, CPC-ARevathi Sekar, CPC-ARhonda M Mowry, COC-A, CEDCRhonda Olt, CPC-ARhonda Pepper, CPC-ARichard Shorter, CPC-ARisvana Jaibunisha, CPC-ARiyas Mohamed Saleem.I, CPC-ARobert Palmer, CPC-ARoberta Phillips, CPC-ARobin B Stewart, CPC-ARobin Clark, CPC-ARobin Cox, CPC-ARobyn Roche, CPC-ARobynn Denise Cochran, CPC-ARohan Brizan, CPC-ARohan Pardeshi, CPC-ARohini Patil, COC-ARonda Lister, CPC-ARoni Lynch, CPC-ARosa Lee Trompeter, CPC-ARosaelia Samaniego, CPC-ARose Wakefield, CPC-ARoselinJannet AbrahamMani, CPC-ARosely Arugolanu, CPC-ARoshni Rai, CPC-ARoslyn Bouchikas, COC-ARozalia Arguello, CPC-ARupali Gupta, COC-A, CPC-ARuth Zinken, CPC-ARyan Boyle, CPC-ARyan S Dischner, CPC-ARyan Williams, CPC-AS. Arun Kumar, CPC-ASabitha Kethineedi, COC-ASabrenia Johnson, CPC-ASachin Kumar, CPC-ASachin Sharma, CPC-ASadananda Behera, CPC-ASailendra Koka, CPC-ASajana K Badusha, CPC-ASalla Shiva Krishna Reddy, CPC-ASamantha Blair, CPC-ASamantha Danielle Hursey, CPC-ASamar S Shaqqoura, CPC-ASameena Ishrath, CPC-ASameer Abhiman Aher, COC-A, CPC-P-ASami Staley, CPC-A

Samudrala Naresh, COC-ASamuel Richardson, CPC-ASandhya Dumpa, COC-ASandhya Lahu Dhuri, COC-ASandra Garrett, CPC-ASandra Zanos, CPC-ASangeetha Chinnarasu, COC-A, CPC-ASara Acevedo, CPC-ASara Burnette, CPC-ASara Jordan, CPC-ASara Shader, CPC-ASarah Bridgeman, CPC-ASarah Buonano, CPC-ASarah Cole, COC-A, CPC-ASarah Malin, CPC-ASarah Mcclellan, CPC-ASarah McQueen, CPC-ASarah Rios, CPC-ASarah Watt, CPC-ASaraswathy Harichandran, CPC-ASaritha Veerasamy, CPC-ASatish Kumar Ponna, CPC-ASatyanarayana Kalavala, COC-ASatyawathi Anantha Karedla, CPC-ASayeeda Begum, CPC-ASerphina Nez, CPC-AShahanaz Fathima Akbar Basha, CPC-AShaik Khadar Vali, CPC-AShail Bala Anne, CPC-AShalan Beasley, CPC-AShalimar Patricia Clayton, COC-AShanika McDaniel, CPC-AShanila PS, COC-AShankar Bobbili, CPC-AShanmuga Bharathi Kesava Moorthi, CPC-A

Shannon Nielsen, CPC-AShannon Saunders, CPC-AShannon Strickland, CPC-AShannon Suezann Cobb, CPC-AShari Floyd, CPC-ASharon Jackson, CPC-ASharon Maike, CPC-AShashi Kant Patel, COC-AShauna Lemay, COC-AShawn Weaver, CPC-ASheba Sushma, CPC-ASheilene Simon, CPC-AShelby Matsuoka, CPC-AShelley Bojalad, CPC-AShemia Joseph, CPC-ASheneika Green, CPC-ASheri Davis, CPC-ASherri Barnes, CPC-ASherry Mitchell, CPC-ASheryl Houser, CPC-AShirish Shrikrishna Patil, CPC-AShivalore Swarna latha, CPC-AShraddha Singh, CPC-ASierra Bunting, CPC-ASilpa V E, CPC-ASilva Sarian, CPC-ASiranjeevi Chandran, CPC-ASivapriya Sugumar, CPC-ASoibam Sotindro Singh, CPC-ASomesh Bhatt, CPC-ASompalli Seshadri, CPC-ASonja Maria Powell, CPC-ASony Yellapu, CPC-ASoujanya Rupner, CPC-ASoumya Mohanan Nair, CPC-ASoumya Vasam, COC-ASowmya Kandula, COC-ASreejith C, CPC-ASreenivasaReddy ChinnaMuntala, CPC-ASrinivas Chowdary Bandla, CPC-ASrinivas Reddy Pulugu, COC-A

Stacey Amick, CPC-AStacey Benson, CPC-AStacey Brewer, COC-AStaci Ertzberger, CPC-AStaci Wortzman, CPC-AStacie Ann Parker, CPC-AStacy Cable, CPC-AStacy Escobedo, CPC-AStacy Fitzgerald, CPC-AStacy Norton, CPC-AStacy Webb, CPC-AStarlet Verhovec, CPC-AStephanie Allen, CPC-AStephanie Anderson, CPC-AStephanie Davis, CPC-AStephanie Fox, CPC-AStephanie Grice, COC-AStephanie Guynn, CPC-AStephanie Hespe, CPC-AStephanie Shelp, CPC-AStephanie Steig, CPC-AStephanie Thorsell, CPC-AStephany LaRue, CPC-ASteven R Brennan, CPC-ASubi Anil, CPC-ASudhir Babaji Gunjal, CPC-ASujitha Mathew, CPC-ASundae Richason, CPC-ASunil Kumar Santha, CPC-ASunilkumar Thurram, COC-ASunitha Bolabanda, CPC-ASuraj Anand, CPC-ASure Laxmi Sirisha, CPC-ASurekha Degala, CPC-ASuresh Babu Banda, COC-ASusan Aszmann, CPC-ASusan Balcom, CPC-ASusan Bunch, CPC-ASusan Ferrara, CPC-ASusan Langley, COC-ASusan Shuman, CPC-ASusan Vanessa Titus-Davies, CPC-ASusan Whitehall, CPC-ASushma Somisetty, CPC-ASuvarna Salunke, CPC-ASuvidha Sangaraju, CPC-ASuvila Samuvel, CPC-ASuzanne Hernandez, CPC-ASuzanne Paglino, CPC-ASwarnalatha R, COC-ASydney Perez-Means, CPC-ASydney Salazar, CPC-ATabitha Williams, CPC-ATacheima Bien-Aime, COC-A, CPC-ATaelor Wright, CPC-ATami Randall, CPC-ATami Wilson, CPC-ATamila Emerick, CPC-ATammi Seger, CPC-ATammy Dreves, CPC-ATammy Warren, CPC-ATangala Malone, CPC-ATaniqua M. Alexander, CPC-ATanura Marcheline Moss, COC-ATanya Philip, CPC-ATara Goedken, CPC-ATara R Lyons, CPC-ATara Rocklin, CPC-ATara Spence, CPC-ATara Williams, CPC-ATarisa DeSalvo, CPC-ATawna Johnson, CPC-ATeresa Cochran, CPC-ATerri McKernon, CPC-ATetyana Doolittle, CPC-AThangaraj Jayabalan, COC-AThea Sierra, CPC-A


NEWLY CREDENTIALED MEMBERSTheresa Brown, CPC-ATheresa Couture, CPC-ATheresa Insinga, CPC-ATiana Stewart, CPC-ATierra Cummings, CPC-ATiffany Padilla, COC-ATiffany Plumber, CPC-ATimothy Wise, CPC-AT’Kara Jones, CPC-ATom Sweeney, COC-ATonya Scott, CPC-ATorri Clark, CPC-ATracy Marinaro, CPC-ATracy Norman, CPC-ATracy Peters, CPC-ATracy Port, CPC-ATracy Wells, CPC-ATrisha Moore, CPC-ATuesday McCauley, CPC-AUmamageswari Prithiviraj, CPC-AUpasana Rangrez, CPC-AUrmi Saha, CPC-AV N Bhushanam Tallapudi, CPC-AVaishali Chauhan, CPC-AVaishnavi Krishnamurthy, CPC-AValeria E Williams, CPC-AValeria Smith, CPC-AValerie James, CPC-AValerie Mirabella, CPC-AValorae Stressman, CPC-AVanaja Bathini, CPC-AVanessa Lopez, CPC-AVantessa Morgan, CPC-AVanya Maury, CPC-AVarun Sulodia, CPC-AVeena Pulakanti, CPC-AVeronica Herrera, CPC-AVeronica Kapp, CPC-AVicki L Rohrer, CPC-AVicki Summerlin, CPC-AVicky Anderson, CPC-AVicky Huyhnh, CPC-AVicky Taylor, CPC-AVidhya Sivasubramanian, CPC-AVidya Kunreddy, CPC-AVignesh Muruganandham, CPC-AVijay Jawahar Londhe, CPC-AVijaya Dharshini Dharmarajan, CPC-AVijaya Priya Bakthavachalu, CPC-AVikash Prakash, CPC-AVimalsundar Marimuthu, COC-AVinayan Ponnully Kizhakethil, CPC-AVinessa Tafoya, CPC-AVinodhini Gandhi, CPC-AVinoth Kumar Lawrence, COC-AVirginia Hawley, CPC-AVirginia Prevost, COC-AVisalakshi Dhevarajan, CPC-AVishnu Balachander, CPC-AVita Jaunmaize, CPC-AWill Sailors, CPC-AWinsome Boykin, CPC-AY. Ganga Parvathi, CPC-AYakasiri Ramesh, CPC-AYanet Triana Moya, CPC-AYarrabothu Parameshwari, CPC-AYazmin Rodriguez De Welsh, CPC-AYemme Sreekanth Reddy, COC-AYerenso Martinez, CPC-AYerrabadu Ummar Basha, COC-AYmelda Lewis, CPC-AYolanda Rivera, CPC-AYuvaraj Sanjeevi, CPC-AZina Pape, COC-A, CPC-AZuleyma Garrido, CPC-AZulma Quinones, CPC-A

SpecialtiesSpecialtiesSpecialtiesAbigail Erlandson, CPC, CEMC, COBGCAbigail Pipkin, CPC, CENTCAbirami Mayandi, CPC, CPMAAdianet Rivero, CPC, CPMAAdriana Carrillo, CPC-A, COSCAdriana Lara, CPC, CGSC, CIMC, CPEDCAdriana Lara, CPC, CGSC, CIMC, CPEDCAida Fadhil Ali, CPMAAimie Ellen Maston, CPC-A, CEMCAjovin Vijay, CICAlejandro Gerardo Suarez Fernandez, CPC, CPMA

Alexandra Chrisler, COC, CPMA, CRCAlicia Renae Waddell, CPC, CRCAlma Acosta, CPC, CRCAlres Dinnall, RN, M.Ed., CPC, CRCAmanda Armstrong, COC-A, CPC-A, CRCAmanda B Feaser, CPC, CRCAmanda Brooks, CPC, CPMAAmanda Donoho, CPC, CRCAmanda Harvey, CPPMAmanda J Andrews, CPC, CEMCAmanda San Roman, COC, CPC-P, CPMA, CIC

Amarendar Gajjela, CPMAAmber Lewis, CPBAmy Louise Lanoue, CPC, CIMC, COBGCAmy Louise Lanoue, CPC, CIMC, COBGCAmy Marie deClairville, CPC, CRHCAmy Marie Young, CPC, CRCAmy Stanley, CPC, CHONCAmy Walker, COC, CPC, CPB, CEDC, CRCAna Liza M Cruz, CPC, CPMA, CEMC, COBGC

Anabela Antunes, CPPM, COSCAnastasha Brashears, CPC, CPMAAndre Anderson, CPC, CUCAndrea Lise McClure, CPC, CGSC, COBGCAndrew Struse, CPC, CPBAngela Lynch, CPC, CRCAngela Redding, CPC, CGSCAngie Williams, CPBAngie Wilson, B.A., CPC, CRCAnita Fitterer, CPC, CICAnna McAdam, COC, CPC, CPC-P, CCC, CEMC

Anna McAdam, COC, CPC, CPC-P, CCC, CEMC

Anne Garcia, CRCAnne Jablonski, CPMAAnnette Daniels, CPC, CRCAnnette M Coffey, CPC, CRCAnnie Daniel, CPC, CPMAAnny Lee, CPC-A, CGSCAnusha K, CICApril M Rigdon, CPC, CPMAAprilan Woolworth, CPC, CRCArlene H Putnam, CPBArun R L, CICAshish Chauhan, CPC-A, CICAshley Coleman, CPC, CPMAAshley Connor, CRHCAshley Fleischer, CPBAurelia de los Reyes, CRCAurora Monica Garcia, CPC, CGIC, CUCAurora Monica Garcia, CPC, CGIC, CUCBambi S Barnes, COC, CPC, CEMC, CRCBarbara (Betsy) Moore, CPPMBarbara A Wilson, CPC, CRCBarbara Armenteros, CPC, CPMABarbara Hays, CPC, CPMA, CPC-I, CEMC, CFPC

Barbara Ryan Fortson, CPC, CPMA

Beatriz Hernandez, CPC, CPMA, CRCBecky Mora, CRHCBelgica Moreno, CPC-A, CPMABen Burton, CRCBeth Rochelle Shelton, CPC, CENTC, COSC

Betty L Fumar, CPC, COBGC, CPEDCBibi Z Chowrimootoo, CPC, CPBBlair M Ortega, CPC, CCCBonnie Rapchak, CPMABonnie Sue Connors, CPC, CCC, CEMCBoy Gerald Flores, CRCBrandi Aydelott Barton, CPC, CPMABrandi Hicks, CPC, CGIC, CUCBrandi L Earl, CPC, COBGCBrandy Wright, CPC, CGSC, CIMC, CPEDCBrenda Danielle Terry, CPC, CPMABrenda Duell, CPBBrenda Ellis, CPBBrenda Kempf, COC, CRCBrenda Roos, CPC, CRCBrindha Ramadhas, CICBrittany Kristine Reiber, CPC, CRCBrittney S Woolard, CPC, COSCCaitlin Connors, CPBCandace M Sexton, CPC, CPMA, CRCCara L Crawford, CPC, CPMACaramie Perry, CPC, CENTC, COSC, CPEDCCaramie Perry, CPC, CENTC, COSC, CPEDCCaridad Martinez, CPC-A, CPMACarla J Townsend, CPC, CPB, CPPMCarlin Ki Krhut, CPC, CCCCarol Davis, CPC, CRCCarolyn Ann King, CPC, CRCCarrie Holstrom, CGICCasey Pittman, CPC, CPMA, CHONCCassandra Cartwright, CPC, CRCCatherine Bishai, CPC, CRCCatherine Paul, CPC, CGSCCathy Hentz, CPPMCathy R Davis, COC, CPC, CPMA, CHONCCharleen Johnson, CPC, CASCCCharlene C James, CPC, CCCChelsi Trout, CPC, CPMACherie Jeannine Simpson, CPC, CRCCheryl Barnaby, CPC, CPMAChoo Hooi (Janice) Khoo, CRHCChristi McMinn, CPC-A, CANPCChristina Banaka, CPBChristina Becker, CPC, CICChristina Myers, CPC, CPB, CPMAChristine Gomez, CRCChristine L Mitchell, CPC, CPB, CANPCChristine R Carbonaro, CPC, CPC-P, CPMA, CRC

Cindy Brempong, CPC, CRCCindy Stothers, CPC, CEMCClayton Howard, CPPMCrystal Hornbuckle, COBGCCynthia C Duat, CPC-A, CIMC, CPEDCCynthia Louise Brown, COC, CPC, CRCDamarys Ayala, CRCDanette Ingland, CPBDanielle Ingle, CPBDarlene Britton, CPC, CPMA, CPC-I, CEDCDarlfene Abano, CPC-A, CEDCDarsha Harper, CANPCDawn Richey, CPCODeanna Obiedzinski, CRCDebbie Camden, CPC, CPMA, CRCDebbie Culberson, CPBDebbie Solti, CPC, CRCDeborah L Groves, CPC, CPBDebra Ann Duguid, CPC, CPMADebra J Garcia, CPC, CRCDebra L Love, CPC, CPMADeidre Jandeska, CCCDeidre Jandeska, CCC

Deirdra A Nehf, CPC, CPMADeitra Dee Payne, CPC, CPMA, CRCDelly Parham, CPC, CPMADemetria Bonner Woodson, CPC, CRCDenise Dobbin, COC, CPC, CRCDenise Schery, CRHCDiana Lynn Davis, CPC, CUCDiane Hyler, CPC, CPMADiane Benskin, COC, CIRCCDiane Fulton, CPPMDianne Lenhardt, CPC, CPMADonna Becker, COC, CRCDonna Gray, CPC, CRHCDonna L Reddick, CPC, CIMC, COBGC, CPEDC

Donna Louise Heleniak, CPC, CGIC, CUCDonna M Carlson RN,, CPC, CRCDorene Kelsey, CPC, CPMADoret Lyn DeBarros, CPC, CEMCDunia Aljure, COC, CPMAEdmund Kowalski, CRCEdward Cartledge, CRCEdward Leone, CPC, CPC-P, CPMA, COSCEdwin Moon, CPC-A, CRCEileen J Costigan, CPC, CEMCEilene Louie, CPC, COBGCElizabeth Ann Freiberg, COC, CPC, CRCElizabeth Facundo, CPC, CPB, CHONCElizabeth G Jackson, CPC, CPCDElizabeth M Moppins, CPC, CGSC, CIMCElizabeth M Moppins, CPC, CGSC, CIMCElizabeth McAllister, COC, CPC, CPC-I, CEMC, CRC

Elizabeth Perry, CRCElizabeth Wolfarth, CPC, CEMC, CUCErin Bristow, CPC, CRCErin M Spada, CPC, CGSCEstrella Matheu Morales, CPC, CPMA, CRCEtwaria R Singh Gillette, COC, CPMAEveleen G Gill, CRCFarine Faria Ali, CPC-A, CENTC, CIMC, COSCFaye Hogeland, CPC, CICFrances A Geltch, CPC, CPMA, CPC-IFrances Perez, CPCO, CPBFrederica Castellanos, CPC, CIMC, CPEDCFunke Giwa, CPPMGabriel Ruiz, CPC, CRCGabrielle Mizell, CPC, CUCGail Woytek, CRCGeneva Fitzhugh Bryan, CPC, CPB, CPMAGenevieve E Francisco, CPC, CIMC, COBGC, CPEDC

Geraldine O Reggeti, CPC, CPMAGwen Hucker, CPC, CRCGwendolyn A VanHeest, CPC, CPCO, CPEDC

H Patricia Haller, CPC, CEDC, CEMCHaley Dodd, CPC-A, CENTCHeidi Ann Cantermen, CPC, CRCHeidi Ann Husman, CPC-A, CGIC, CIMC, CPEDC, CUC

Heidi Ann Husman, CPC-A, CGIC, CIMC, CPEDC, CUC

Heidi Marie Botts, CPC, CGIC, CUCHeidi Marie Botts, CPC, CGIC, CUCHilda Frenes Torres, CPBInes D Bibiano, CPC, CIMC, COBGCInes D Bibiano, CPC, CIMC, COBGCIsis Farlow, CPBIvy Lynn Thompson, CPC, CRCJackie Prado, CPC, CRCJacob Swartzwelder, CPC, CEMC, CRCJacqueline Morris, CPC, CRCJacqueline Sparks, CPC, COBGCJacquelyn Starns, CPC, CPCO, CPMAJaime L. R. Benn, CPC, CGICJames Harold Holmes, CPC, CIRCCJames John Pacifico, CPC, CRC

Jamie Ortega-Silva, CPC, CEDCJana Caulk, CPC, CRCJanet Cavanzo, CPC, CPMA, CRCJanet Skurski, CPC, CPCO, CPMAJanet Woolley, CPC, CPMAJanie A. Van Noy, CPC, CPMA, CANPCJarris Scollick, CPPMJasmine Ensley, CPC, CPPMJean I Thomas, CPC, CRCJeanne M Alwardt, CPMAJeffrey Sullivan, COC-A, CPBJenifer Smith, CRCJennifer Ann Theien, CPC, CPMA, CRCJennifer DeLong, CPC, CEDCJennifer Dipasquale, CPC, CEMCJennifer Lyman, CPC, CEMCJennifer Norton, COC, CPC, CPMA, CEMC, COSC

Jennifer Oskolkoff-Miller, CPC, CPBJennifer Pena, CPPMJennifer Valiton, CPC, CPMAJennilee Ortega, CPC, CPMA, CRCJessica J Franzese, CPC, CPMAJill Barnes, CGSCJill Denyse Kaminski, CPC, CGSCJill M Tom, COC, CPC, CPMA, CPC-IJill Reynolds, CPC, CRCJodi DiBiasi, CPC, CPCO, CPB, CPMA, CEMC

Jody Bell, CPC-A, CPBJody Oaks, COC, CPC, CPCO, CICJohn Sunderland, CPC-A, CPMAJohnna Sharon Derain, COBGC, CRCJolene M Ferrier, CPBJoni K Balch, CPC, CPMAJoshua Cronan, CPC, CEDCJoy Hipolito, CPBJoyce Anne Kilgore, CPC, CRCJudy K Holder, CPC, CPPMJudy Mayor-Davies, CPBJulee Shiley, CPC, CPMAJulia Allen, CPC, CPMAJulia Kenney-Hall, CPC, CCC, CEMCJulianne Johnson, CPC-A, CGICJulie H Price, CPC, CIRCC, CIMCJulie Painter, CPMA, CCVTCKadie Gibson-Karanikas, CPC, CPCO, CPPM, CCVTC

Kali Serrano, CPPMKara McVey, CPC-A, CPMAKara Snowman-Wulff, CRCKaren Ann Frank, CPC, CPPMKaren Downing, COC-A, CPB, CPMAKaren Lankisch, CPC-A, CPPMKaren M Tolbert, COC, CPC, COBGCKaren Stefanese, CPC, CPMA, CRCKaren Varnedoe, CPC, COSCKaren Y Marble, CPC, CPC-I, CCVTCKarla Calvet, CPC, CPMAKarla Grimwood, CPC, CPMA, CEMCKarla Hughes, CPC, COSCKasia Stasiak, CPC, CPMAKatharine E Hieber, CPC, CGSC, CIMCKatharine E Hieber, CPC, CGSC, CIMCKathi Hall, CGSCKathleen Ann Roza, COC, CPC, CICKathleen Ann Shera, CPC, CPBKathleen Forsman, CPPMKathrine Lowe, CPC-A, CFPCKathryn A Heimerman, CPC, CGIC, CGSCKathryn L Williams, CPC, CPMAKathy L Van Es, CPC, COBGCKathy W Gunnerson, CPC, CENTCKatrina Girard, CPC, CPMAKatrina Yvonne Taylor, CPC, CPMAKelly Schwartz, CPPMKelsey Williams, CPC, CRCKerri Corn, CPC, CGSC, CPEDC


NEWLY CREDENTIALED MEMBERSKerri Corn, CPC, CGSC, CPEDCKerry Beth Atkins, COC, CPC, CPCO, CPMA, CEMC, COBGC

Kerry Ducey, CPC, CPMAKim A Wells, CPC, CPMA, CEMCKim Breisch, CPPMKimberlee S Davis, CPC, CRCKimberley Ramsey, CPBKimberly Ann Bush, CPC, CPBKimberly Ann Shoemaker-Bias, CPC, CPMAKimberly Hoffman, CPC, CGSC, CIMCKimberly Hoffman, CPC, CGSC, CIMCKimberly Konopnicki, CPC, CPMAKimberly McDermott, CPC, CPMA, COBGCKing Sarino, CPC, CRCKirsty Marie Dela Cruz, CRCKolette Cotropia, CPC, CRCKristen Reed-Pearson, CRCKristen Worden, CPC, CANPC, CEMCKristi S Bartkowiak, CPC, CPMA, CHONCKristina Reyes, COC, CPC, CPMA, CRCKristine Finck, CPC, CRCKristine Johnson, CPC, CPBKyle Williams, CPC, CPMA, CICL Susan Stahl, CPC, CPMALahoma Brasfield, CPC, CICLa-Keisha Michelle White, CPC, CANPCLaura Beck, CPC, CPCOLaura G Bertke, CPC, CPMALaura Goodman, CPC, CRCLaura J Higdon, CPC, CPMALaura L Davis, CPC, CPMA, CENTC, COSCLauri Herbert, CPBLaurianne R Toney, CPC, CRCLaurie Lynn Kagels, CPC, CICLaurie Sierra, CPC, COBGCLavanya Bandollu, CICLeJeanne Harris, CPC, CPMALenier Danilo Delgado Diaz, CPC, CPMALesa Danelle Moore, CPC, CRCLesa Titus, CPC, CIMC, COBGC, CPEDCLeslie Marie Pitt, CPC, CRCLeslie Marie Pou, CPC, CEMC, CFPC, CRCLilit Martirosyan, CPC, CRCLinda Colangelo, COC, CPC, CPMALinda Huggins, CICLinda L Oakes, CPC, COSCLinda M. Danesi, CPC, CPBLinda Scott, CPC, CPMALindsay Ireland, CPC, CGSCLisa A Wyatt, COC, CEDCLisa Gebhardt, CPC, CPBLisa Hornick, CPC, CPMALisa K Shelton, CPC, CPPMLisa Marie Valentin, CUCLisa Nolan, CPC, CCCLisa Ratliff Mize, COC, CICLiset Estevez, CPC, CPMALissa B Singer, CPC, CPCO, CPC-ILola Nichole Elder, COC, CPC, COBGCLori J Sagide, CPC, CPC-P, CPMA, CPC-I, CRC

Lori Petrozza, CPC, CPB, CRCLori Renee Logan, CPC, CEMCLucina Gort, CHONCLydia Satterfield, CPC, CFPCLynda P Ingram, CASCCLynda P Ingram, CASCCLynn B Easley, CPC, CEDCLynn Graham, CPC, CPMA, CCVTCLynn Punturi, CPC, CRCMaggie Garner, CPBMai Kelley, CPC-A, CEMCMansi Parikh, CPC, CEMC, CHONCMaranda Goldsmith, CPC, COBGCMarcedita Acevedo-Feliciano, CPC-A, CPMA

Mari Vance, CPPM

Maria Brooks-Swims, CRCMaria Cristina Ladores Rolle, CPC, CRCMaria Elena Garcia, CGICMaria Licon, CPC, CRCMaria Linda V Devers, CPC, CRCMaria Soto, CPBMarianne Nykiel, CPC, CPBMaribel Moctezuma, CPC, CRCMarie Adler, CPEDCMarilyn Rundle Schwartz, CPC, CPMAMarissa R Cartagena, CPC-A, CRCMarjorie A Belanger, CPC, CPC-P, CRCMark Painter, CPMAMarriym Lateefah Lofton, CPC, CGIC, CUCMarsha McGraw, CPMA, CRHCMarsha Sporhase, CPC, CPMAMary A Wilson, CPC, CRCMary C Cripps, COC, CPC, CPC-P, CHONC, CRC, CRHC

Mary J Crawford, CPC, CGSC, CIMCMary J Crawford, CPC, CGSC, CIMCMary Kaleleihokuonalani Umeka Brookins, CPC, CRC

Mary Lovely Concepcion, CRCMary Savino, CPC, CEMCMary Typhair, CPC-A, CPMAMaryann C Palmeter, CPC, CPCO, CENTCMary-Ellen Johnson, CPMAMatthew Hobizal, CPCDMatthew Stein, CRCMayra A Lazo, CPC, CENTC, COSCMayra A Lazo, CPC, CENTC, COSCMeily Nodal, CPC, CPMAMelanie B Scott, CPC, CRHCMelanie McKee, CPC, CPPMMelissa Brown, CPC, CFPCMelissa Conyers, CPBMelissa French, CPC, CCVTCMelissa Gee, COC-A, CPBMelissa L Kulavic, CPC, CPMAMelodie L.R. Bauer, CPC, CIMC, COBGC, CPEDC

Mendy Pemberton, CEDCMercedes Sandoval, CPC, CPMAMey Saelee, CPCDMichael Alexander Martinez, CPC, CPMAMichael Atalia Cerbo, CPC-A, CPMAMichael M Sandoval, CPC-A, CIMC, COBGC, CPEDC

Michael M Sandoval, CPC-A, CIMC, COBGC, CPEDC

Michaelle Waters, CPC, CPMAMichelle Bassett, CPC, CPBMichelle Hildreth, CPC, CPMAMichelle Laubach, CPCOMichelle M O’Neil, CPC, CCCMichelle Mills, CPC, COSC, CSFACMichelle Morgan, CPC, CRCMichelle Zumbrun, COBGCMigdalia Martinez, CEDCMiranda Agosto, CPBMisty Tinch, CPC, CPMAMitzi McCallister, CPC, CPB, CPMA, COSCMolly Shumway, CPC, COBGCMona Nanavati, CPC-A, CPMAMonica A Lavergne Diaz, CPC, CPB, CRCMonica Cutino, CPC, CIMC, COBGC, CPEDC

Monica Lyn Edwards, CPC, CGSCMonica Pizana, CPC, CRCMonika Sanders, CPC, CPBMonique Boyd, CPC-A, CRCMownika Gandla, CICMylene L Sabile, CPC, CGIC, CUCMylene L Sabile, CPC, CGIC, CUCNancy Bass, CPBNancy Ramirez, CRCNancy Walker, CPB

Nancy Zizelman, CPC, CPBNathan Monroe, CPC-A, CPMA, CEMCNera Kathleen Benton, CPC, CPB, CPMANichole Fournier, CPMANicole DeBien, CPBNicole Kiggans, CEMCNicole Morgan Ready, CGSCNorma Iris Fellows, CPC, COSCOkezie D Iroz-Nnanta, CPC, CCVTCPam Gould, CPC, CPBPamela Jacobson, CPC, CRCPamela Love, CPC, CPMAPamela Pietras, CPPMPatina L Green, CPC, CPMA, CRCPatricia A Basa, CPC, CPMA, CCVTC, CEMCPatricia A Lynch, CPC, CENTCPatricia Ball, CPC, CRCPatricia Demming, CPC, CEMCPatricia Heck, CPC, CPMA, CEMCPatricia Louise Dodge, CPC, COBGCPatti Daniels, CPCOPaul Bieser, CPBPaula C Salva, CPC, CPMAPaula Sauder, CPC, CPCO, CPMAPavan Kalyan Prattipati, CICPavel Dubrovka, CPC-A, CPMA, CANPCPenny C Allemand, CPC, CPPMPervina Annette Gilmer, COC, CRCPhillip B Talbert, CPC-A, CPBPhylicia Doty, CPC, CPMAPremanjali Kurumella, CICPriscilla Witwer, CPBPriyanka Kumari, CICRachel D Brunswick, CPC, CHONCRachel Gomez, CPBRadha Rai, CPC, CRCRadhakrishnan Annamalai, COC, CPC, CPC-P, CIRCC, CPMA, CANPC, CASCC, CEMC, CIC

Ramasubbu Subburayalu, COC, CPC, CPCO, CPC-P, CIRCC, CPB, CPMA, CPPM, CASCC, CCC, CCVTC, CEDC, CENTC, CFPC, CGIC, CGSC, CHONC, CIMC, COBGC, COSC, CPCD, CPEDC, CPRC, CRC, CRHC, CSFAC, CUC

Rana Sebai, CPC, CPPMRebecca Doll, CPC, CCC, CCVTCRebecca Elizabeth Simmers, CPC, CPMA, CRC

Rebecca Poff, CPC, CPMA, CHONC, CPCDRebecca R King, CPC, CPMAReGina Ford, CPC, CGICRegina Wells, CCCRenato Millama, CRCRene Lopez Roman, CPC-A, CRCRenetta Deanne Ruedemann, CPC, CRCReshma Sashittal, CPBRhonda F Schlesinger, CPC, CPMA, CCCRhonda Humphrey, CPC, CPB, CPPMRhonda S Holley, CPC, CPCO, CPPM, CSFAC

Rizwan Ali, CPC, CICRobin A. Lambert, CGSCRobin L Frey, CPC, CHONCRobin L Mason, CPC, CPPMRobin Norman, CPC, CPMA, CRCRobin Tucker, CRCRobyn Gutherless, CPC, CUCRoger L Hettinger, COC, CPC, CPCO, CPB, CPMA

Romulo Villanueva Jr., CPC, CRCRose Trevino, CFPCRoxanne Betton, CPC, CEMC, CFPCRuben Anthony Posada, CPC-A, CIMC, COBGC, CPEDC

Ruben Anthony Posada, CPC-A, CIMC, COBGC, CPEDC

Rupa Mehta, CPC, CPB

Sally Lyster, CRHCSamantha Daughtry, CPC, CCC, CCVTCSamantha Daughtry, CPC, CCC, CCVTCSamantha Lueck, CPBSamantha Reid, CPC, COBGCSamantha Summerlin, CPBSandra C Welsh, COC, CPC, CPMASandra Newstein, COC, CPC, CPC-P, CPMA, CEMC

Sandra P Carnaroli, CPC, CRCSanjana Sharma, CPC, CPMASantosh Kumar Meriyala, COC, CPC, CPC-P, CPB, CPMA, CASCC, CCVTC, CGSC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COSC, CPCD, CPEDC, CPRC, CRC, CRHC, CSFAC, CUC

Sara Burns, CPC, CPMASara Elliott, CPC, CPPM, CRCSara Klimkiewicz, COBGCSarah E Dunkin, CPC-A, CCVTC, CIMCSarah F Fair, CPC, CPMAScarlett DeMott, CPC, CRCScotisha Beckford, COC, CPC, CEDC, CEMC

Shalan Taylor Corlieto Natale, CPC, CGSCShanetta Laurice Bell, CPC, CRCShania Maqbool-Schwartz, CPC, CIMC, COBGC, CPEDC

Shania Maqbool-Schwartz, CPC, CIMC, COBGC, CPEDC

Shannon B Davis McGivern, CPC, CPBShannon N Jackson, COC, CPC, COSCShannon Reece, CIRCCShanon Ashley, CPCO, CPPMShantell Christian, CPPMShari L Irving, CPC, CRCSharon Davis, COC-A, CPMA, CEMCSharon Espanola, CICSharon McGue, COC, CCCShawneice N Smith, CPC, CGICSheila M Rozmirsky, CPC, CPMAShelley Howard, COBGCSheri Knight, CPBSheri L Rogan, CPC, CEMCSherrina M Hansen, CPC, CPCO, CPMASherry L Bryant, CANPCSherryle Givens, CPC, CPMAShirley Thompson, CPC, CPMA, CPC-IShobhit Malik, CPC, CICShujun Wang, COC, CPC, CGSCSiji G P, CICSilvia M Bosmenier, CPC-A, CPMASilvio R Martinez MD, CPC, CPMA, CRCSiva Chaitanya Pasupuleti, CICSiva Teja Kumar, CICSoledad Myers, CPC-A, COSCSonia Hernandez, CPC, CIMC, CPEDCSonya Denise Floyd, CPC, COBGCStaci Bell, COC, CEMCStacie Zimmerman, CPBStacy Leigh Blodgett, CPC, CRCStacy Lynn Ehret, CPC, CRCStephanie Carver, CPC, CASCCStephanie Mathis, CPC, CRCStephen Blatt, CPMASteve Lee, CPC, CRCStevie Calvert, CPC, CPMASuiQi Jiang, CPC, CPMASusan Jackson, CPC, CEDCSusan K Hunt, CPC, CRCSusan L Waterman, CPC, CRCSusan Lynne Irvin, CPC, CRCSusan Melo Dasilva, CPC, CEMC, CRCSusan Weimer, CCCSuzanne Jacobs, CPC, CRCSuzanne L Mucha, COC, CPC, CPMA, CCVTC, CEMC, CHONC

Syla Poy, CPC, CGSC, CIMCSyla Poy, CPC, CGSC, CIMCTamantha Young, CRCTamara Reed-Sims, CPC, CEMCTamela J Walker, CPC, COBGCTammy Lynn Atkins, CPC, CRCTammy Toll, CPC, CPMATamra H McLain, COC, CPC, CPB, CEMCTanya Citron, CPCO, CPMATara Jane Pease, CPC, CEMCTarndra Maduskuie, CPC, CGSCTeresa Jewell, CPMATeresa L Garner, COC, CPC, CHONCTerri Barry, CIRCCTerry Cronin, CPC, CPMA, CEMCTerry Ellen Tompkins, CPC, CEMCTheresa Almeroth, CPC, COSCTherese Jentz, CPC, CRCTiffany Buckley, CPBTiffany Lee Cribb, CPC, CPMA, CEMCTiffany Yuppa, CRCTimothy Buxton, COC, CPC, CIC, CRCTina Carr, CPPMTina Chyko, CPC, CRCTina Leslie, CPC, CPMATina Marie Palmer, CPC, CPMA, CPC-I, CRCTina Muela, CPC, CIRCC, CCC, CCVTC, CIMC

Toi S Taylor, CPC, CRCTorri Rubertus, CPC, CICTracy Dixson, CPB, CPEDCTracy Menosky, CPC, CASCCTracy R Johnson, CPC, CPMA, CRCTricia Lee Dicey, CPC, CENTCTridev Biswas, CICTrina F Neilson, CPC, CPMAUdaybhasker Akoju, CICVa Lee Lo, CPC, CGIC, CUCValarie Norman, CPC, CPCO, CPPMValerie Herrera, CPC, CGICValerie Silva, CRCVanessa Elizabeth Lowe, CPC, CPCOVanessa McCarthy, CPC, CGIC, CIMC, CPEDC, CUC

Vanessa McCarthy, CPC, CGIC, CIMC, CPEDC, CUC

Vanessa McCarthy, CPC, CGIC, CIMC, CPEDC, CUC

Vereen Watson CCS, CPC, CRCVicki Flores, COC, CPC, CPMAVickie Lytle, CPC, CCVTCVicky Diane Mansur, CPC, CICVictor Mee Teck Mo, CPC-A, CPPM, CRHCVictoria Benedict, CPC, CEMCVictoria Commons, CPC-A, CUCVivienne Broughton, CPC, CPMA, CEDCWendy A Miller, CPC, CRCWendy Anderson, CPC, CPMA, COBGC, CUC

Wendy L Cottrell, CPC, CPMAWendy L Del Real, CPC, CPC-P, CPMA, CGSCWendy Olson, CPC-A, CHONCWestley Garcia, CRCYadira I. Mendez, CRCYamila Pereiro, CPC, CPMAYamila Prendes, COC, CPC, CPMA, CRCYelena Slutskaya, CPC, CPPMYosley Carballosa, COC, CPC, CPMA, CRCYvonne Mendelson, CPC, CRCZoraida Diaz, CIC


At 16 I knew I wanted to work in the healthcare field. My first interest was sparked when my healthcare science teacher described her experiences in nursing school

and how the field of nursing had evolved since then. I had a class book, which list-ed a position profile for each member of the healthcare team. I was fascinated with this book and researched many positions to help me decide on a good fit.

Decisions, DecisionsWould I be a sonographer, a phlebotomist, or a registered nurse? Would I work in the business of healthcare? It was a tough choice. Finally, I chose to enroll in the Medical Office Administration program at my lo-cal community college. Out of all the business career options, medical billing and coding interested me most. Coding remained an elusive choice for me. I wanted to learn more about coding, but did not have the resources to train for certification. After graduating with an associate degree, I found an entry level job as a medical billing specialist. After much trial and error, I learned the steps for getting denied claims paid. I used payer contract knowledge to organize a process that minimizes billing errors and helps secure clean claims.

Diving Into the Science of CodingI gained experience working with insurance systems, but I also was interested in the science of medicine. I made the decision to use my savings to take a training course in coding. As I learned more about coding, I became fascinated with how the com-plexities of disease processes and medical treatments can be condensed into one system and re-organized in a way that allows the patient’s clinical picture to be ex-plained in a concise and logical manner on the claim form.

Staying Connected Is KeyThe biggest goal I have as a newly credentialed coder is to stay as keenly connected as possible to the issues underlying reimbursement. No one knows how proposed changes to reimbursement structure may affect the role of coders. I am not sure where this will lead me in my career, but I do know that I will embrace change. I feel very lucky to have found my niche and I am excited to begin my career as a coder in the midst of ICD-10, one of the most significant changes in healthcare history.

I Am AAPC

#IamAAPCHealthcare Business Monthly wants to know why you chose to be a healthcare business professional. Explain in less than 400 words why you chose your healthcare career, how you got to where you are, and your future career plans. Send your stories and a digital photo of yourself to Michelle Dick ([email protected]) or Brad Ericson ([email protected]).

ALLISON WEIR, CPC-A

I feel very lucky to have found my

niche and I am excited to begin

my career as a coder in the midst of

ICD-10, one of the most significant

changes in healthcare history.

#Ia

mA

AP

C

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