The Big Picture Contract Negotiations -...
52
Plus: HCC • Word on ICD-10 • Risk Adjustment • Ultrasounds • E/M Modifiers Marcia Brauchler, MPH, CPC, CPC-H, CPC-I, CPHQ The Big Picture of Contract Negotiations The Big Picture of Contract Negotiations August 2012
Transcript of The Big Picture Contract Negotiations -...
Plus: HCC • Word on ICD-10 • Risk Adjustment • Ultrasounds • E/M Modifiers
Marcia Brauchler, MPH, CPC, CPC-H, CPC-I, CPHQ
The Big Picture of Contract Negotiations
The Big Picture of Contract Negotiations
Aug
ust
20
12
NAMAS 4th Annual Auditing Conference
Conference held at Grove Park Inn, Asheville, NC December 3-4, 2012
“Hands-on” Specialty-Specific Auditing CPMA® Training Course Training for Effective Managed Care Negotiations
Conference Agenda Provides two tracks each day. During each session the attendee will chose from:
General topics relevant to all fields of auditing Specialty-specific auditing breakout sessions General Sessions relevant to all auditors and include speakers such as:
Shannon DeConda, President of NAMAS Sean Weiss, VP of Decision Health Kelly Custer a well-known Fraud & Stark Attorney Expert
For a complete listing of sessions, please visit our website www.NAMAS-
This month’s conference special is: Bring your physician for 1/2 Price! Purchase a ticket to the conference and bring your physician for only $495! Visit our website for more details!! www.NAMAS-Auditing.com or call 877-418-5564
This 4th Annual conference is being supported by:
HSM Customers should inquire with their Representative for additional conference discounts that may apply
The ONLY National Conference that is AUDITING SPECIFIC
Preconference Events Include:
www.aapc.com August 2012 3
[contents] 7 Letter from the Chairman and CEO
9 Letter from Member Leadership
10 Letters to the Editor
10 Kudos
13 Coding News
In Every Issue
18 Strengthen Your Diagnosis Coding for Risk Adjustment SerineA.Haugsness,CPC
20 Coding from EHRs: It’s Documented, but Did It Happen? ErinAndersen,CPC,CHC
22 Bedside Ultrasounds: Take a Closer Look SarahTodt,RN,CPC,CPMA,CEDC
24 Factor HCC with a Two-pronged Approach to Risk Adjustment HollyJ.Cassano,CPC
26 Practice Managers Succeed with Practical Know-how DixonDavis,MBA,MHSA,CPPM
29 The Big Picture of Contract Negotiations MarciaBrauchler,MPH,CPC,CPC-H,CPC-I,CPHQ
34 Identify the Correct Global Period E/M Modifier NancyClark,CPC,CPC-I
38 It’s Time to Re-evaluate Your E/M Coding SuzanBerman,CPC,CEMC,CEDC
On the Cover: Physicians’ Ally, Inc. is lined up at the box office of the Paramount Theatre in Denver, Colo. to see Marcia Brauchler’s big picture, “Payer Contract Negotiations.” Cover photo by Brian Kraft Photography (www.briankraft.com).
Special Features
Education
Coming Up
Contents
August2012
41
12 Quick Tips: Morton’s Neuroma, PMDD
16 Hot Topic: Wellness Visits
41 ICD-10 Roadmap: Word is …
50 Minute with a Member
14 AAPCCA: Chapter Speakers
15 Handbook Corner: Smartphones
45 A&P Quiz
47 Newly Credentialed Members
Online Test Yourself – Earn 1 CEUGo to: www.aapc.com/resources/ publications/coding-edge/archive.aspx
22
• PT/OT
• Surgical Modifiers
• Colonoscopy
• EHRs that Code
• Acronyms
Features29
18
Contract Negotiations
4 AAPCCodingEdge
Volume 23 Number 8 August 1, 2012
CodingEdge(ISSN:1941-5036)ispublishedmonthlybyAAPC,2480South3850West,SuiteB,SaltLakeCityUT84120-7208,foritspaidmembers.PeriodicalsPostagePaidatSaltLakeCityUTandatadditionalmailingoffice.POSTMASTER:Sendaddresschangesto:CodingEdgec/oAAPC,2480South3850West,SuiteB,SaltLakeCityUT84120-7208.
Serving 116,000 Members – Including You!
August2012
adve
rtis
ing
inde
x Advanced Career Solutions, LLC ..................17www.CodingCert.comwww.CodingConferences.com
American Medical Association .................... 40www.amabookstore.com
CaseCoder, LLC ............................................37www.casecoder.com
Coding Institute, LLC ....................................15www.SuperCoder.com
CodingWebU.com ......................................... 46www.CodingWebU.com
Contexo Media ..............................................33www.contexomedia.com
HealthcareBusinessOffice, LLC ....................27www.HealthcareBusinessOffice.com
Ingenix is now OptumInsightTM, ....................28partofOptumTMwww.optumcoding.com
MedAssets .......................................................5www.knowledgesourcepro.com/signup
Medicare Learning Network® (MLN) ..............8OfficialCMSInformationforMedicare Fee-For-Service Providers http://www.cms.gov/MLNGenInfo
NAMAS/DoctorsManagement ................. 2, 51www.NAMAS-auditing.com
ZHealth Publishing, LLC ...............................11www.zhealthpublishing.com
Be Green!Why should you sign up to receive Coding Edge 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 Coding Edge 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 house or office than paper issues.
Go into your Profile on www.aapc.com and make the change!
Chairman and CEOReedE.Pew
Vice President of Finance and Strategic PlanningKorbMatosich
Vice President of MarketingBevanErickson
Vice President of ICD-10 Education and TrainingRhondaBuckholtz,CPC,CPMA,CPC-I,CGSC,COBGC,CPEDC,CENTC
Directors, Pre-Certification Education and ExamsRaemarieJimenez,CPC,CPMA,CPC-I,CANPC,CRHC
[email protected],CPC,CPMA,CPC-I,CMRS
Director of Member ServicesDanielleMontgomery
Director of PublishingBradEricson,MPC,CPC,COSC
Managing EditorJohnVerhovshek,MA,CPC
Executive Editors MichelleA.Dick,BS ReneeDustman,BS [email protected] [email protected]
Production Artists TinaM.Smith,AAS ReneeDustman,BS [email protected] [email protected]
Advertising/Exhibiting Sales ManagerJamieZayach,BS
Addressallinquires,contributionsandchangeofaddressnoticesto:
Coding EdgePO Box 704004
Salt Lake City, UT 84170(800) 626-CODE (2633)
©2012AAPC,CodingEdge.Allrightsreserved.Reproductioninwholeorinpart,inanyform,withoutwrittenpermissionfromAAPCisprohibited.Contributionsarewelcome.CodingEdgeisapublicationformembersofAAPC.StatementsoffactoropinionaretheresponsibilityoftheauthorsaloneanddonotrepresentanopinionofAAPC,orsponsoringorganizations.Cur-rentProceduralTerminology(CPT®)iscopyright2011AmericanMedicalAssociation.AllRightsReserved.Nofeeschedules,basicunits,relativevaluesorrelatedlistingsareincludedinCPT®.TheAMAassumesnoliabilityforthedatacontainedherein.
CPC®,CPC-H®,CPC-P®,CPCOTM,CPMA®andCIRCC®areregisteredtrademarksofAAPC.
IDENTIFY missed revenue opportunities
REDUCE A/R days
RECEIVE accurate reimbursement
ACCESS up-to-date billing, coding and regulatory research tools
LEARN MORE ABOUT MEDASSETS KNOWLEDGESOURCE PRO AT: www.knowledgesourcepro.com/signup
MedAssets® is a registered trademark of MedAssets, Inc. © MedAssets 2012. All rights reserved.
improveFINANCIAL PERFORMANCE AND COMPLIANCE
MedAssets-KnowledgeSource-June2012-v2.indd 1 6/11/12 2:23 PM
In August, register for any specialty exam and...
study guide
practice exam
Get a
Get a
(a $99.95 value)
(a $59.95 value)
Learn more at: www.aapc.com/specialty
Considered Specialty Certification?
FREE
FREE
Have you...
Exam, Study Guide and Practice Exam - only $245!NOTE: Beginning October 1, 2012 specialty CEUs will count towards all core CEU requirements (excluding CPPM and CIRCC)
abc
CASCC
CANPC™
CCC™
CGSC™
CHONC™
CIMC™
CCVTC™
CCPC™
CPCD™
COBGC™
COSC™
CENTC™
CEDC™
CEMC™
CGIC™
CPEDC™
CPRC™
CRHC™
CUC™
CSFAC™
CFPC™
Ambulatory Surgical Center Evaluation and Management Orthopaedic Surgery
Anesthesia and Pain Management Family Practice Otolaryngology
Cardiology Gastroenterology Plastics and Reconstructive Surgery
Cardiovascular and Thoracic Surgery General Surgery Pediatrics
Chiropractic Hematology and Oncology Rheumatology
Dermatology Internal Medicine Surgical Foot and Ankle
Emergency Department Obstetrics and Gynecology Urology
www.aapc.com August 2012 7
As this Coding Edge goes to the print-er, the Supreme Court’s decision to uphold the 2010 Patient Protection
and Affordable Care Act (ACA) is only a couple of weeks old. Speculation about the ACA’s impact and future continue to fill our airways and hallways. Even though many provisions have already been enacted, most view the ACA the same way a boy regards his first suit: complicated, uncomfortable, and restrictive. Survival of the ACA is up in the air. The Su-preme Court’s ruling leaves the future of the act to the voters in November, and allows the Senate to overturn it by simple majori-ty, rather than 60 votes, to prevent a filibus-ter. By agreeing with the solicitor general’s argument that the individual mandate is a tax only manageable by Congress, the out-come of presidential and congressional elec-tions will determine the ACA’s future be-yond January 2013.
What the ACA Means for Health ProfessionalsCoders, billers, auditors, practice manag-ers, and payers are adapting to ACA chang-es already in effect, such as preventive ser-vices at no cost, access to coverage and care for those with chronic or pre-existing con-ditions, and simpler, standardized informa-tion for consumers. Upcoming rules, how-ever, for both physicians and employers still are not fully developed. The day after the Supreme Court decision, the U.S. Depart-ment of Health & Human Services (HHS) Secretary Kathleen Sebelius announced new funding opportunities for states im-plementing ACA’s health information ex-changes (HIEs). Other parts of the act on hold while awaiting the Supreme Court’s decision are being jump-started during the ACA’s guaranteed seven months of imple-mentation.Impacts on coding, billing, and practice management from the ACA and other re-cent events include:
• Billing changes resulting from the
new Version 5010 electronic data interchange (EDI) standard, effective last month
• Changes to coverage and reimbursement as self-paying patients evaporate and insurance rules are changed to meet ACA
• Additional payment-altering quality management guidelines and reporting
• Incentive programs to primary care physicians and others based on case mix and specialty that may improve or cut reimbursement
• Enhanced documentation requirements for new coding, quality, and payment regulations
• More stringent compliance efforts to meeting additional Health Insurance Portability and Accountability Act (HIPAA) regulation
• Revised physician reimbursement schedules and rates
• New Medicaid billing rules
Members, as Always, Adapt with SuccessAAPC members who code, bill, manage, audit, and adjudicate are no strangers to change and varying regulations. In many cases, it will be AAPC members who will successfully implement the ACA in their workplaces. This is because of members’ knowledge, f lexibility, networking, and courage.
Stay InformedAAPC is here to help. AAPC publications, workshops, webinars, online forums, and the expertise of your colleagues at local chapter meetings offer valuable support as the ACA is enacted. We are testifying on our members’ behalf before federal committees and working with lawmakers to assure no changes are made without important input. For example, Rhonda Buckholtz, CPC, CPMA, CPC-I, AAPC’s vice president of
ICD-10 Education and Training, testified in June on how the ICD-10 implementa-tion delay impacts providers and their staffs. AAPC staff, members of the National Ad-visory Board (NAB), and the AAPC Chap-ter Association (AAPCCA) Board of Direc-tors are visiting local chapters to help you understand what is happening and how it affects you. We share what we learn and hear from members during our visits with each other and department heads, adjust-ing our processes, rules, and benefits, so be-ing an AAPC member is always more valu-able than the day before.The ACA’s future and impact on health care and our jobs are still to be realized. Cod-ers, billers, auditors, managers, and pay-ers will all see different consequences, but our dedication and professionalism will get us through. AAPC and your member col-leagues are there for you.Sincerely,
Reed E. Pew AAPC Chairman and CEO
Find AAPC Support as ACA Unfolds
LetterfromtheChairmanandCEO
Official CMS Information forMedicare Fee-For-Service Providers
R
The Medicare Learning Network (MLN)It’s never been easier to understand Medicare Program enrollment, billing and coverage.
As you know, every business day can bring an avalanche of information
about new policies, regulations and procedures. The Evaluation and Management
Services Guide provides education on medical record documentation, evaluation and
management billing and coding considerations.
Learn more today. http://go.cms.gov/EvaluationManagement
DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Medicare & Medicaid Services
R
Evaluation and Management Services Guide
December 2010 / ICN: 006764
3 MLN AUG Coding Edge Magazine, FINAL PRESS.indd 1 6/15/12 1:03 PM
www.aapc.com August 2012 9
The past few years have brought a myr-iad of changes in health care, many of which have had a direct impact
on AAPC members. Among theses chang-es are health care reform, technological ad-vances in medicine, meaningful use of elec-tronic health records (EHRs), increased fed-eral and state regulations on documentation and coding requirements, and so on. While these changes present challenges for us all, they also provide a wealth of opportunity for those who are prepared, knowledgeable, and not afraid of change (and work).
Credentials Do MatterIn addition to the Medicare and Medic-aid EHR Incentive Programs, which pro-vide incentive payments to providers able to demonstrate meaningful use of a certi-fied EHR, the American Recovery and Re-investment Act of 2009 (ARRA) allocated funds for the federal government to wage a battle against health care fraud, waste, and abuse—making complete documentation and accurate coding, as well as regular au-diting, an even more important part of ev-ery health care entity.As our industry moves forward with elec-tronic data interchange (EDI), the role of medical coders will continue to evolve, as well. Adapting to these changes will re-quire strategic thinking and planning to steer the direction of our career. For many of our members, the EHR will necessitate a change from coding to auditing, which will provide opportunity and incentive for many coders to advance in their careers. To rise to the challenge of entering into the audit-ing realm, Deborah Grider, former AAPC president and CEO, says it best in her arti-cle “CPCs® Branch out into Medical Audit-ing” (Coding Edge, August 2010): “Coders who seek an auditing position should be ex-perienced in medical coding and hold cod-ing certification.”
Health Care Reform Will Bring New ChallengesCoding medical records has always been about payment and the search for statisti-cal outliers that may indicate problems in the billing and payment process. Health care reform and the 2010 Patient Protection and Affordable Care Act (ACA) add com-ponents that will require an even more crit-ical review of health insurance claims: risk management and quality reporting man-agement. These two components are in-tertwined and may involve changes to ex-isting, comfortable provider practices. For example, it will become essential under the proposed structure for providers to submit claims with the most specific diagnosis pos-sible, including a historical health status that doesn’t necessarily impact the current medical condition.
Our Membership Tells the StoryThere is a correlation between the rigor-ous process a person must go through to be-come a credentialed coder and/or auditor, and that person’s success in the field. This holds true for most professional occupa-tions. The evidence of this truth is easy to see when AAPC’s “continued growth ex-presses the value many physicians and out-patient practices have with our credentialed professionals,” according to Grider in a No-vember 2010 press release.
Best Wishes,
Cynthia Stewart, CPC, CPC-H, CPMA, CPC-I, CCS-PPresident, National Advisory Board
Weather the Storm
LetterfromMemberLeadership
10 AAPCCodingEdge
LetterstotheEditor
Kudos PleasesendyourKudosto:[email protected]
Pleasesendyourletterstotheeditorto:[email protected]
Surge of New Chapters Spread Coding CheerThank you new chapters for your hard work and dedication to our field. We congratulate these upcoming chapters:
Waterloo, IowaMorrilton, Ark.
Natchitoches, La.Corona, Calif.
Green Valley, Ariz.Midland, Texas
Selden, N.Y.Mount Juliet, Tenn.
Northbrook, Ill.Petersburg, Va.
Woodhaven, Mich.Chino Hills, Calif.
Carson, Calif.Blue Bell, Pa.
Poughkeepsie, N.Y.Orange Park, Fla.Statesville, N.C.Silverdale, Wash.Middletown, N.Y.Grants Pass, Ore.Haverhill, Mass.Watertown, Mass.Stockton, Calif.Spring Hill, Fla.Tampa Southeast, Fla.Pontiac, Mich.Jackson, Mich.
Susan Edwards, Awarded for ExcellenceCopley Health Systems honored Susan Edwards CPC, CEDC, of Vermont for her excellence during the organization’s annual Em-ployee Awards Banquet. According to a Copley Health Systems’ May 18 press release (http://copleyvt.org/interior.php/pid/67/sid/454/nid/119):
“Susan Edwards of Health Information Man-agement was honored with the Goddard Family Award, an award that recognizes ex-
cellence in a non-nursing position. Dr. Silver-stein shared how impressed the Medical Staff was
with how Sue tackled coding-related education this past year.”
Edwards began her career at Copley Hos-pital in Morrisville, Vt. in 2002 as a medical
transcriptionist and later discovered an interest in coding. She is now Copley’s coding special-
ist, Northeast region one representative for AAPCCA, secretary on the Board of Di-rectors, and a member of the AAPC Eth-ics Committee.
Code 93315, Not 99315On page 22 of July’s issue, the article “Documentation is Key for TEE and OLV” mistakenly referenced code 93315 Transesophageal echocar-diography for congenital cardiac anomalies; including probe placement, im-age acquisition, interpretation and report as 99315.Dana A. Chock, CPC-A
Advice on Separate E/M and Chiropractic ServicesI enjoyed your article about E/M coding in the June’s Coding Edge (“Be Aggressive with Same-day E/M and Office Procedure,” pages 14-15). I am a CPC® and a CCPC™, and this issue of evaluation and manage-ment (E/M) on the same day as a “minor procedure” is very common for chiropractors.Page F16 of the 2012 ChiroCode Deskbook suggests the following situa-tions qualify as “significant separately identifiable” (or “non-routine,” as it relates to chiropractic manipulative therapy (CMT) codes 98940-98942):
• Initial evaluation• Periodic reevaluation• Exacerbation or re-injury• Counseling (less than 50 percent face-to-face time)• Release/discharge from active care• Consultation (requested by an appropriate source)
When I teach coding seminars to other doctors of chiropractic (DCs), I encourage them to ask if one of these six scenarios applies before they bill an E/M code (and attach modifier 25 Significant, separately identifi-
able evaluation and management service by the same physician on the same day of the procedure or other service) during a visit where other services are rendered. I think that this can apply in other specialties, as well. I have not been able to find any Centers for Medicare & Medicaid Servic-es (CMS) or American Medical Association (AMA) guidelines that are this specific, but this general approach may be useful for your readers.Evan M. Gwilliam, DC, CPC, CCPC, NCICS, CCCPC
Clarification: Medicare Covers Spinal Manipulation Only for Chiropractors“Document Chiropractic Group and Individual Therapy Differences” (July 2012, pages 36-39) reviewed Medicare documentation and cod-ing requirements for individual and group therapy codes. Although in-surers may follow the Centers for Medicare & Medicaid Services (CMS) guidelines for documenting and coding therapy services, Medicare will not cover therapy services provided by a chiropractor. Chapter 15, section 30.5 of the Medicare Benefit Policy Manual states that coverage of chiropractor’s services “extends only to treatment by means of manual manipulation of the spine to correct a subluxation pro-vided such treatment is legal in the State where performed. All other ser-vices furnished or ordered by chiropractors are not covered.” CPT® 98940-98942 Chiropractic manipulative treatment (CMT) ... are the only codes covered by Medicare, when properly billed by a chiropractor and supported by documentation; therapy codes, therapeutic activities, and self-care training are not. For more information, see “Medicare Outpatient Therapy Billing” on the CMS website at: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/
MLNProducts/Downloads/Medicare_Outpatient_Therapy_Billing_ICN903663.pdf.
12 AAPCCodingEdge
phot
obyi
Stoc
kpho
to©
Erik
Reis
phot
obyi
Stoc
kpho
to©
EKen
neth
C.Z
irkel
QuickTips
Stand Up for Correct Morton’s Neuroma CodingByG.J.Verhovshek,MA,CPC
Morton’s neuroma (355.6 Lesion of plan-tar nerve)—also called Morton’s metatar-salgia or Morton’s neuralgia—is a benign growth of fibrous tissue occurring on the plantar nerve, most commonly between the third and fourth toes. Symptoms may include burning, numbness, tingling, and
shooting pains. Many patients describe the feeling as “having a peb-ble in my shoe.” The condition may develop from injuries or excess pressure (such as from tight-fitting shoes). Treatment for Morton’s neuroma commonly involves corticoste-roid injections into the affected tissue for pain relief. Report these injections using CPT® 64455 Injection(s), anesthetic agent and/or ste-roid, plantar common digital nerve(s) (eg, Morton’s neuroma). Less fre-quently, the physician may employ a neurolytic agent to destroy the plantar nerve. Injections of this type are reported using 64632 De-struction by neurolytic agent; plantar common digital nerve.Report either 64455 or 64632 only once per foot, regardless of the number of injections. Both codes are unilateral, however, so you may append modifier 50 Bilateral procedure to either code if the physician injects the plantar nerve on both feet.
Never report 64455 and 64632 together for the same foot. Per CPT® Assistant, January 2009, “Because the treatment therapies described by codes 64455 and 64632 are distinctly different, it would not be appropriate to report codes 64455 and 64632 for each of these ther-apies at the same session.”CPT® now bundles fluoroscopic guidance for needle placement with many injection procedures (for example, 64479-64484 and 64633-64636). This is not the case for 64455 and 64632, however. You may separately report 77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) for fluoroscop-ic guidance when provided and properly documented. Report the guidance code only once per session, regardless of the number of in-jections. Append modifier 26 Professional component for services in the facility setting, or if the physician performing the guidance does not own the equipment.In some cases, surgical excision may be necessary to remove the neu-roma. This is reported with CPT® 28080 Excision, interdigital (Mor-ton) neuroma, single, each. Per the code descriptor, you may report one unit of 28080 for each neuroma excised.
G.J. Verhovshek, MA, CPC, is managing editor at AAPC.
Know Symptoms and Code for Premenstrual Dysphoric DisorderBySusanM.Edwards,CPC,CEDC
Premenstrual dysphoric disorder (PMDD) is the current term for what previously was known as premenstrual tension syndrome, or premen-strual syndrome (PMS). Premenstrual dysphoric disorder affects 3-5 percent of menstruating women, and is characterized by severe mood and physical symptoms around a woman’s menstrual cycle. Until 2012, PMDD was not referenced in the ICD-9-CM code book. PMDD is now an inclusion term to code 625.4, as follows:625.4 Premenstrual tension syndromes Menstrual molimen Premenstrual dysphoric disorder Premenstrual syndrome Premenstrual tension NOSThe acronym PMDD is directly referenced in the alphabetic index. This update makes it clear that premenstrual tension syndrome and PMDD are related conditions coded the same; however, PMDD is technically more severe than PMS, with symptoms that can be debil-itating. The mood symptoms of PMDD predominate and can cause social impairment. According to the Mayo Clinic, PMDD symptoms occur during the week or two before the menstrual period and remit soon after the on-set of the menstrual period. Most sources agree that at least five or more specified symptoms must be present most of the time during each symptomatic phase. These symptoms include:
• Depressed mood• Mood swings• Irritability• Decreased interest in
usual activities • Difficulty concentrating• Lack of energy • Marked change in
appetite• Insomnia or
hypersomnia • Feeling overwhelmed• Physical symptoms, such
as breast tenderness or bloating
• Tension• Food cravings
Physicians now have a simple screening tool to help women identify whether they are suffering from PMS or PMDD.
Susan M. Edwards, CPC, CEDC, works at Copley Hospital in Morrisville, Vt. She is a member of the AAPC Chapter Association (AAPCCA) Board of Directors, Northeast Region 1, and is AAPC New-port, Vt. local chapter president.
www.aapc.com August 2012 13
CodingNews
Update Your esMD ProcessingThe Centers for Medicare & Medicaid Services (CMS) instructs review contractors in transmittal 426 on the process for handling late esMD.When a provider has failed to submit a response to an Additional Documentation Request (ADR) letter by the deadline, CMS says, Medicare administrative contractors (MACs) should use the esMD content transport services (CTS) receipt date as the date the docu-mentation was received. If the CTS receipt date is outside the con-tractor’s normal business hours, the following business day may be used as the receipt date.See CMS transmittal 42 for more information: www.cms.gov/
Regulations-and-Guidance/Guidance/Transmittals/Downloads/R426PI.pdf.
URL Change for OIG’s Compliance Guidelines The U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) is updating its website reference in Pub. 100-08 Medicare Program Integrity, section 1.3.9 for accessing compliance program guidelines and statistical sampling. OIG com-pliance program guidelines and statistical sampling can be found on the OIG website at http://oig.hhs.gov/authorities/docs/selfdisclosure.pdf.
Expect Tighter Controls for Diabetic Supply ClaimsAs a result of an OIG June 2012 report, expect increased scrutiny of high utilization claims for test strips and lancets. The OIG esti-mates contractors overpaid as much as $271 million for these types of claims in 2007.Medicare Part B covers home blood-glucose test strips and lancet that physicians prescribe for their diabetic patients. The National Coverage Determination (NCD) does not specify utilization guide-lines and documentation requirements; however, Local Coverage Determinations (LCDs) for the four durable medical equipment Medicare administrative contractors (DME MACs) reviewed by the OIG indicate coverage for up to 100 test strips and 100 lancets every month for insulin-treated diabetics, and 100 test strips and 100 lancets every three months for non-insulin-treated diabetics.Medicare considers 50 test strips as 1 unit and 100 lancets as 1 unit, so a standard claim for a patient’s monthly (or three-month) allot-ment of these supplies would be two units of A4253 Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips and 1 unit of A4259 Lancets, per box of 100.For complete details of the OIG review, see the June 2012 report, available at: http://oig.hhs.gov/oas/reports/region9/91102027.pdf.
CHICAGO | OCT. 25-27, 2012AAPC REGIONAL CONFERENCE
CHICAGO HYATT REGENCY3-Days | 14 CEUs | $350 $325
Early Bird Registration ExtendedThrough Aug. 24
Through Aug. 24
Come join us in Chicago!www.aapc.com/2012regional
2012 AAPC REGIONAL CONFERENCECHICAGO
14 AAPCCodingEdge
AAPCChapterAssociation
Help!INeedChapterMeetingSpeakersWhen you’ve exhausted your speaker pool, here’s where to look.
BySusanEdwards,CPC,CEDC
Finding speakers is a common problem many AAPC chapters face, but it isn’t because of a lack of candidates. There
are many speakers available to you, if you know where to look. In the medical field, almost anyone can be a resource and most people are willing to share what they know, if you just ask.As an education officer for my local chap-ter, I began my search for speakers with co-workers. When I asked a coworker to con-sider speaking at a chapter meeting, the ini-tial reaction was almost always the same: “I don’t know anything about teaching cod-ing,” my coworker would reply. Once I ex-plained what I was looking for in a speaker, however, I wasn’t turned down. I would ex-plain that our chapter doesn’t need to hear what he or she knows about coding, we’d just like to know more about his or her job. Learning about other health care jobs al-lows us to be better coders; and hearing how other medical professionals perform proce-dures, and the techniques they use, helps us understand the process more clearly and as-sign codes more accurately.
Tap into Your Professional ResourcesIn beginning your search for speakers, use resources around you and near your facili-ty. Don’t limit yourself to only physicians; reach out to other professionals. For ex-ample:
• Nurse practitioners and physician assistants
• Diabetic and nutritional counselors• Respiratory therapists• Radiology technicians
• Wellness nurses• Compliance officers• Local insurance carriers• Medical librarians• Local colleges • Professional Medical Coding
Curriculum (PMCC) instructors • State departments of banking and
insurance officials• County or state department of health
administrators and professionals• Medicare carriers’ provider training
and events centers (or your area provider)
• Regulatory agencies like the FBI or your Medicare fraud unit
• Associations for supporting patients and families dealing with diseases
• Your hospital speakers’ bureau• Manufacturers of medical products,
materials, and drugs
Look to Coders and AAPCDon’t forget to look to your fellow coders. They’re great resources as speakers and they are right next to you. Your regional representatives from AAPC boards, the National Advisory Board (NAB), and AAPCCA Chapter Associa-tion (AAPCCA) may be available to visit lo-cal chapter meetings. Official visits are ar-ranged through the Local Chapter Depart-ment and must be prescheduled. When pos-sible, board members make every effort to meet the needs of our local chapters.Another option for obtaining speakers is from your own membership. Chapter mem-bers can be creative, bringing variety to your
meetings. This, in turn, will help the speak-er feel more connected to his or her chapter.
Have Fun with Open Discussions or GamesInstead of finding a speaker, consider a Code-A-Round. Ask your members to bring the most difficult or confusing cases they have come across and conduct an open dis-cussion. Remember: All identifying patient information must be left out.Games are another great way to add friend-ly competition and excitement to a chapter meeting. Games to consider include Cod-ing Jeopardy, “Who Wants to Be a Million-aire?” Coding Bingo, Coder’s Feud, etc. More game suggestions can be found by searching the AAPC Chapter Officer fo-rum at www.aapc.com.
Our Website Is Full of Topics and PresentationsAAPC’s website and forums can be a meet-ing topic in itself. A chapter officer can pro-vide a demonstration on where and how to find information online. Have an instruc-tional meeting on using the forums. Under the Chapter Resources tab, your officers can also find PowerPoint presentations with au-dio recordings to use for your local chapter meetings.Look around you. If you think outside of the coders’ circle, you may be pleasantly sur-prised at the ideas you come up with.
Susan Edwards, CPC, CEDC, is a coding specialist at Copley Hospital in Morrisville, Vt. She is the president of the Newport, Vt. chap-ter, and teaches medical terminology at a local adult learning center. Ms. Edwards is North-east Region One representative for AAPCCA, and secretary on the Board of Directors. She is also on the AAPC Ethics Committee.
Don’t limit yourself to only physicians; reach out to other professionals.
www.aapc.com August 2012 15
AAPCCAHandbookCorner
Are Smartphones OK to Bring into an Exam?
ByErinAndersen,CPC,CHC
There has been discussion recently about whether smartphones should be allowed into an AAPC credentialing examination because it may increase opportunities for cheating or distraction. AAPC feels it is important for test takers to have access to phones in case of emergency. We trust coders and coders-to-be are ethical and would not actively seek ways to cheat or to intentionally disrupt oth-ers during the exam. Hearing “Ding Dong! The Witch Is Dead” when your mother-in-law calls during a test, (albeit amusing) may break someone’s concentra-tion.The proctoring instructions, referred to in the Lo-cal Chapter Handbook, allow “cell phones” to be brought into credentialing exams, but they need to be turned off and stowed away. The guidelines then state, “electronic devices capable of storing and retrieving texts, audio-books, etc. may not be brought into the exami-nation room.” This rule was written prior to advancements in cell phone technology (such as smartphones, which are capable of data storage). The Examination Department has since voiced their
intention to update the rule to allow smartphones into an examina-tion room, but they must be turned off and stowed away.If you are uncertain whether you may bring a particular item with
you to an exam, or if you have any other questions about the exam or exam etiquette, please con-
tact the Examination or Local Chapter De-partments at AAPC.
We trust that coders and
coders-to-be are ethical
and would not actively
seek ways to cheat or to
intentionally disrupt
others during the exam.
phot
obyi
Stoc
kpho
to©
Umbe
rtoPa
ntal
one
Be it breaking news from Part B Insider or essential compliance tools like Fee Schedules, LCDs CCI Edits Checker, and more, Part B Coder provides everything you need to ensure your Part B coding’s profitable and on track!
16 AAPCCodingEdge
HotTopic
CreateOrderfromWellnessVisitChaosLet your patients know what to expect from these visits.
ByJacquelineNashBloink,MBA,CPC-I,CHC
The Centers for Medicare & Medicaid Services (CMS) has begun a campaign
to educate Medicare beneficiaries about preventive services, including wellness vis-its, available to them. There is even a You-Tube clip to promote these visits. If CMS believes these visits are such a great service for the beneficiary, why do so many physi-cians cringe when they hear an appointment has been scheduled for such a service?
ManagePatientExpectationsBeneficiaries often expect a head to toe ex-amination during the wellness visit, but this is not what it delivers. Office staff must be-gin to educate the beneficiary that the well-ness visit is a plan of care. When the benefi-ciary understands the wellness visit was cre-ated to take a snap shot of his or her current health status, and the physician won’t be performing a physical examination, the sit-uation will be better controlled—meaning fewer angry beneficiaries and more physi-cians willing to perform the service.Staff should also inform beneficiaries they will not incur a co-pay for a wellness vis-it, but if another service is provided during the visit, there will be a co-pay for that por-tion of the visit.
CMS has many educational resources avail-able to physician offices to assist with ex-plaining wellness visits to patients, includ-ing a downloadable patient brochure, found at: www.cms.gov/Outreach-and-Education/Medi
care-Learning-Network-MLN/MLNProducts/down
loads/Annual_Wellness_Visit.pdf.
ThreeVisitTypes,ThreeSetsofRequirementsThere are three types of wellness visits, each of which has different requirements.1. G0402 Initial preventive physical exam-ination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment describes the “welcome to Medicare preventive visit.” The benefi-ciary can only receive this visit during the first year that he or she is eligible and en-rolled in Medicare. If the patient does not exercise his or her right to request this vis-it during that first year, he or she will never again have the chance to request it.During this visit, the beneficiary is eligible for a screening electrocardiograph (EKG) (G0403-G0405) and aortic aneurism ultra-sound (AAU), if he or she meets the follow-ing requirements:
• Patients may be eligible for the screening EKG if a referral is given during the welcome to Medicare preventive visit (G0402).
• AAU is provided as a one-time screening if the beneficiary gets a referral as a result of the welcome to Medicare preventive visit (G0402). Eligible patients are those who either have a family history of abdominal
aortic aneurysm or if the patient is male, aged 65-75, who has smoked at least 100 cigarettes during his lifetime, and the patient has never had an AAU paid for by Medicare during his or her lifetime.
For more detail on the EKG and AAU screenings, visit the CMS website: www.
medicare.gov/navigation/manage-your-health/pre
ventive-services/preventive-service-overview.aspx).2. After 11 full months have passed, the beneficiary is eligible for the next wellness visit. G0438 Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit describes the “initial Medicare wellness visit.” This visit can be performed at any point in the beneficiary’s life, but only once during his or her lifetime. This code was implemented by CMS in 2011.3. After 11 full months have passed since the initial wellness visit, the beneficiary is eligible for the “subsequent” wellness vis-it (G0439 Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit). A beneficiary can request this visit every year (after 11 full months have passed between visits), if so desired.You can find a summary of the requirements of all Medicare wellness visits on the CMS website: www.cms.gov/Outreach-and-Education/
Medicare-Learning-Network-MLN/MLNProducts/
downloads//MPS_QuickReferenceChart_1.pdf.
CreateaTemplatetoMakeDocumentationEasyIf the physician’s office combined all of the components of each of the three visits to-gether to create one master template, as shown in Example A, the beneficiary would get a few extra benefits each year, while making things easier for the physician.Items in red represent the services the physi-cian provided during the visit that may have not been needed during that particular vis-it, but were required in one of the other vis-its. If all 10 steps are performed during the
Takeaways:
• Wellness visits are a plan of care rather than a head-to-toe exam.
• There are three visit types with three sets of requirements.
• Ease visit for both providers and patients by developing a template for documentation.
phot
obyi
Stoc
kpho
to©
Patri
ckH
eagn
ey
www.aapc.com August 2012 17
HotTopic
G0402, G0439, or G0438 visit, the provid-er does need to stop and think which compo-nent he or she is missing, making life much easier for both physician and patient. By following a template for documenting wellness visits, the staff becomes familiar with the steps, and patients become accus-tomed to the questions and are prepared to answer them each year.The health care team at the office (medical assistant, licensed practical nurse, or regis-tered nurse) may be able to assist the health care professional (nurse practitioner or physi-cian assistant) in obtaining 75 percent of the information prior to the physician entering the room to talk with the patient. Each year,
the physician will have a written description of the beneficiary’s lifestyle and will be better prepared to address various risks that the pa-tient may face as he or she ages.With the wellness visit well-documented, all that remains is scheduling next year’s well-ness visit (remember: at least 11 full months after this visit).
Jacqueline Nash Bloink, MBA, CPC-I, CHC, lives in Tucson, Ariz. and is director of compli-ance for Arizona Community Physicians.
ExampleA:
10 Easy Steps to Document Medicare Wellness Visits1. Patient completes the required “Health
Risk Assessment Questionnaire” prior to the visit with the physician (this is new for 2012). Guidelines for creating a form with all of the necessary components can be found at the Centers for Disease Control and Prevention (CDC) website: http://prevent.org/data/files/news/healthriskassessmentscdcfinal.pdf.
2. Office staff documents the patient’s height, weight, blood pressure, body mass index (BMI), and visual acuity.
3. Patient’s medical history, family history, and social history are discussed and documented. Special attention is paid to past illnesses, surgeries, allergies, and injuries. Family history is pertinent with hopes of catching high-risk areas that may be modifiable or identified with special screening tools. The social history will be helpful in documentation of substance abuse such as smoking or alcohol.
4. Patient is queried about current or past events of depression. Make sure to list the type of depression tool used to determine the risk. Examples of such tools might include PQ1, PQ2, or Zing.
5. List all current medications, including vitamin supplements.
6. List all current providers and suppliers that the patient is seeing (specialists, diabetic suppliers, etc.).
7. Assessment of functional ability and safety: This must include:
• Hearing
• Daily living activities
• Risk of falling
• Safety/home life/risks
8. Cognitive impairment assessment and observation. Information may also be obtained from the patient’s family, care-givers, or friends.
9. End-of-life planning and advance direc-tives. Does the physician agree with this plan?
10. Written plan of preventive services that the patient is eligible for the next one to 10 years. The patient takes this plan when he or she leaves the office.
Beneficiaries often expect a head to toe examination during the wellness visit, but
this is not what it delivers.
Todiscussthisarticleortopic,gotowww.aapc.com
2013 Med ica l Cod ing Update and Re imbursement Confe rence
C DINGCON20126-8 DECEMBER 2012 ORLANDO FL
We're excitedly counting the months till we see you in Orlando, Florida for CodingCon’s 5th Annual 2013 Medical Coding Update and Reimbursement Conference happening on December 6-8, 2012 at the Buena Vista Palace, Orlando, Florida! This 2 ½ day event is the only multi-specialty conference that will equip you with the tools you need in correcting codes from the start, avoiding claim denials, maximizing your productivity and increasing your practice’s bottom-line. Call (866) 251-3060 or register at www.codingconferences.com today!
Type in AAPC195 as Promo Code to claim your exclusive $195 Price Off!
Featured Specialties • Anesthesia• Ambulatory Surgery• Billing and Collection• Ob-Gyn• Orthopaedic• Otolaryngology• Pain Management• Pathology and Clinical Lab• Pediatrics• Urology
Who Should Attend:• healthcare coding & billing professionals• coders• billing & compliance professionals• consultants• clinical documentation integrity professionals• physicians• industry leaders
Features • Specialty specific break-out sessions• All access pass to any specialty (main sessions)
Earn asmuch as16 CEUs!
18 AAPCCodingEdge
Feature
StrengthenYourDiagnosisCodingforRiskAdjustmentDo it for more accurate coding; do it for better patient care.
The concept of risk adjustment was “born” upon passage of the Balanced Budget Act of 1997 and refined by
the Beneficiary Improvement Act of 2000, which mandated that the Centers for Medi-care & Medicaid Services (CMS) imple-ment risk adjustment for Medicare Advan-tage organizations (MAOs) in 2004 and achieve 100 percent risk-adjusted payments by 2007. To achieve this, CMS uses the CMS-Hierarchical Condition Category (HCC) model. Risk adjustment has also been adopted by a number of states using other models, such as the Chronic Illness Disability Payment System (CDPS), Epi-sode Risk Groups (ERGs), Diagnostic Cost Group (DCG), and others—mainly be-cause state populations are more diverse than the rather narrow group of Medicare-eligible patients.
Why Should a Coder Care About Risk Adjustment?CMS requires accurate and complete di-agnosis coding, and for all coding to be done in accordance with official guidelines and CMS regulations. If that’s not a good enough reason, think of your patients.Great documentation and accurate diag-nosis data provides information for care management activities, trends in chronic illness among populations, and increased communication among specialists treating the same patient. Conversely, poor docu-mentation and diagnosis coding can lead to missed diagnoses (and lack of treatment), poor communication among treating phy-sicians (leading to duplicate or contradicto-ry treatment), and even incorrect diagno-ses (like coding a “rule-out” as a confirmed
condition). Incorrect diagnoses can follow a patient for the rest of his or her life and po-tentially exclude him or her from obtaining life or health insurance in the future.
How Can a Coder Keep Risk Adjustment Models Straight?Here’s the best news: You don’t have to!Coding supports all risk adjustment models while documentation and guidelines sup-port coding; but because payment general-ly revolves around CPT® and HCPCS Lev-el II coding, ICD-9-CM coding tends to be put on the back burner. CMS recogniz-es this and encourages MAOs to educate coders, physicians, and facilities about the need for correct and complete diagnosis in-formation. Here’s more good news: Becoming a better diagnosis coder NOW will help you in the transition to ICD-10-CM. The ICD-10-CM guidelines are similar to those for ICD-9-CM, so take advantage of the one-year de-lay to become a great diagnosis coder.Here’s how:1. Read the Official ICD-9-CM Guide-
lines for Coding and Reporting.
2. Skip the cheat sheets. Use the alpha-betic index AND tabular listing every time (even if you THINK you know the code), and follow all of the listed rules.
3. If you need clarification, go to the American Hospital Association’s AHA Coding Clinic for ICD-9-CM.
4. Learn or brush up on anatomy and physiology (A&P) to help you under-stand when something doesn’t make sense for the condition you’re coding. This will also help you determine when you need to ask the physician to pro-vide more clarity about the condition.
How Can Coders Help Pro-viders Document Dx Better?Providers who document well are a coder’s dream. Here are some things you can do to make that dream come true:
Make sure all of the required tech-nical elements are present in every prog-ress note. If required elements are not pres-ent, the auditor doesn’t have to go any fur-ther and can fail the note on a technicality. Required elements include:
• A legible signature with credentials• Patient name on each page• Date of service is evident• Note is complete and legible
(meaning someone coming in and auditing this note would not have to ask questions). You don’t want to fail an audit because the note cannot be deciphered.
BySerineA.Haugsness,CPC
Takeaways:
• The CMS-HCC Risk Adjustment Model requires all providers to submit accurate and complete diagnoses.
• Accurate diagnosis coding is important for disease monitoring and tracking, as well as risk adjustment.
• Teaching your providers to document fully and clearly will assist in the transition to ICD-10-CM.
www.aapc.com August 2012 19
Todiscussthisarticleortopic,gotowww.aapc.com Feature
Print out a few progress notes from your electronic health re-cord (EHR). In many cases, the note you see when you’re coding from the EHR is not the same as the note the auditor sees printed out from your EHR. Audit some notes from the printed version or what-ever version you provide to those who re-quest medical records. Look for contradic-tory information and laundry lists of codes dating back to when the patient was in ute-ro not supported in the documentation on that date of service. Use that information to provide feedback to physicians, managers, compliance officers, or whoever else might need to know in your organization.
Stress descriptive documentation. The Official ICD-9-CM Guidelines for Cod-ing and Reporting, section IV.K, instructs, “Code all documented conditions that co-exist at the time of the encounter/visit, and require or affect patient care treatment or management.” Remind physicians that sim-ply listing a condition in the progress note is not necessarily sufficient to support that the condition is current. The progress note must support the diagnoses by showing ev-idence they were monitored, addressed, as-sessed, treated, or evaluated. Providing this information not only allows you to cap-ture the diagnosis codes, it can help support medical necessity by showing what, how, and why the listed conditions affected the provider’s medical decision-making during that encounter.Pay attention also to generic diagnoses such as chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF),
pain, and others. Providers are creatures of habit and may default to a generic diagnosis when a more descriptive diagnosis may be more appropriate.
Introduce providers to the golden rule: “Document for others what you would have them document for you.” Remember that every patient they see has probably been seen by another provider at some point and will probably see another provider some time in the future. Just like receiving good documentation with a solid history from the patient’s previous provider is helpful in di-agnosing and treating the patient now, their good documentation will help another pro-vider give great patient care in the future.
History versus current condition. When a physician documents “history of,” he or she might mean a condition that is chronic and is being treated, but causing no symptoms. Unfortunately, “history of” to a coder (and an auditor) means the condition no longer exists.On the other end of the spectrum, many providers will document “breast cancer” to describe a patient who had a mastectomy in 1979 and has had no evidence of recur-rence. It would be incorrect to code 174.9 Malignant neoplasm of breast (female), un-specified because there is no evidence of cur-rent disease.
Teach providers to document the tim-ing of the disease process clearly so there is no question as to whether it is histori-cal or current.
Rule-outs are dangerous! Rule-outs, probable, or possible diagnoses are not to be coded per outpatient rules.
To avoid confusion and give coders some-thing to code, providers should document the symptoms or reason the test is being or-dered.
Remind your providers that COD-ERS MAY NEVER ASSUME. Everything coded needs to be spelled out and support-ed in the progress note for that date of ser-vice. Just because the provider knows the patient has a leg ulcer and that leg ulcer was caused by diabetes does not mean the coder can code it. Causality must be documented clearly in every note on every date of service (for example: “diabetic ulcer on the patient’s right heel”).
Give positive feedback when provid-ers get it right! Providers tend to be high achievers. They are often motivated to pro-vide excellent patient care by making their records complete and meaningful. We all like to receive credit for a job well done.
Serine A. Haugsness, CPC, is a coding ana-lyst at Buckeye Community Health Plan, with risk adjustment and coding education as a pri-mary responsibility. She holds an associate de-gree in medical billing and coding and has over 11 years of health care experience. Serine is pursuing a bachelor’s degree in health care management.
Becoming a better diagnosis coder now will
help you in the transition to ICD-10-CM.
20 AAPCCodingEdge
Feature
CodingfromEHRs:It’sDocumented,butDidItHappen?Help providers document appropriately by showing the pitfalls of EHR documentation habits.
But EHRs bring their own coding and compliance risks. These include:
� Using entries from another person or source (such as another provider, resident, or student) as their own documentation.
� Using documentation from a previous visit to document a current visit.
� Using templates that may not represent what happened at the current visit.
� Misrepresenting the nature of the visit by carrying forward past clinical data that does not apply to the current visit.
Look for Telltale Signs in the ChartHow do coders know when these things are occurring? A progress note should be an accurate reflection of what oc-curred at the current visit. Although you were not present in the room with the patient and provider to know what hap-pened, you can look for certain signs when reading chart notes. Examples include:
� Established outpatient or subsequent hospital visit documentation that includes one or more of the following:
à Long and detailed history of present illness (HPI) à Past medical, family, and social history (PFSH) à Allergies à Medication list à Comprehensive review of systems (ROS), either as a
detailed table or “otherwise negative” à Conflicting information (i.e., “Patient reports SOB”
in HPI, with “Resp: No SOB” in ROS.) à Same exam as previous visit(s), or same for every
patient, every visit
à Labs and/or radiology from weeks/months/years prior to visit
à Same assessment and plan as previous visit(s) à Same amount of time documented as previous
visit(s), or for every patient, every visit � Initial hospital visit (e.g., admits, history, and physicals
(H&Ps), consults) documentation is or has: à Abnormally long, given the usual documentation
habits of the provider à A comprehensive history documented for a patient
that is well known to the provider à A comprehensive history and exam stated as having
spent 10-20 minutes with the patient, given that over half was spent in counseling or coordination of care
� Procedure documentation is or has: à The same documentation for every patient, every
time it is performed à Conflicting information
Approach Providers TactfullyNow that you have identified certain providers who show these signs, how do you approach them in a way that does not offend them? Try these seven tactics:1. Set up a time to meet with the provider in person. Talk-
ing with a provider about his or her documentation can be a touchy subject, and nonverbal cues are essential for avoiding confusion and misunderstandings.
2. Be prepared with examples of the provider’s documen-tation illustrating your areas of concern. Have support-ing guidelines on hand to show the provider.
3. Offer positive feedback first. What does the provider do
ByErinAndersen,CPC,CHC
Takeaways:
• EHRs raise several new compliance issues.• Look for certain signs of misuse of EHRs in documentation.• Sit with your provider. Get more information and use the
meeting to educate the physician on proper documentation.• It’s documented, but did it happen?
The age of electronic health records (EHRs) has begun. The days of deciphering illegible chicken scratches, cajoling busy physicians to write more than 10 words, and extensive searches for missing charts
will one day be extinct. The EHR allows coders to work from home, promises a more complete record, timesaving templates and legible notes, and offers hope for better communication between health care providers.
www.aapc.com August 2012 21
Feature
Todiscussthisarticleortopic,gotowww.aapc.com
well? This sets an optimistic tone that will be the spoonful of sugar needed when you begin recommending changes.
4. Ask questions before you request changes. Get all the facts first to confirm your assumptions about what you are seeing. Perhaps this provider does ask about social history at each visit because the patient’s medication requires the patient to abstain from alcohol. You shouldn’t assume it was not asked.
Here are some specific questions you may wish to ask the provider: � When you are seeing an established patient, do you discuss
the patient’s PFSH at each visit? � I see that you have a detailed ROS table in all of your chart
notes. Are each of the questions asked for each system or is it part of your template?
� It looks like you always spend 25 minutes with each of your clinic patients. Is that an approximation of the time you spend? How do you count your time?
� When one of your patients is admitted to the hospital, do you re-obtain the history that is documented?
� I see you often bring the last five lab results into your notes. Are you discussing these results with the patient at the visit or do you bring them into the note for historical purposes?
5. Acknowledge, explain, suggest. Let the provider know you have listened. Explain why you are asking for a change to get his or her buy-in. Because most of us do not like to be told what to do, offer suggestions or recommendations rather than demand-ing a change. It is a gentler, more effective way to bring about compliance with your request. Suggestions to begin the conver-sation include:
� “I hear what you are saying about wanting to have a complete snapshot of the patient’s history in your chart note so you only need to look back at your last visit for all the needed information. It is fine to bring all of that information into your note but, as a coder, I need to be able to identify what happened at today’s visit, so I can determine the appropriate level of service. What if you were to label the historical data as ‘Previously Obtained?’”
� “When you are determining the amount of time you spend with your patients, you look at when your clinic started and
ended and divide the time by the number of patients. In looking at your clinic schedule, I can see that you are very busy and I’m sure it is difficult to determine how much time you spend with each individual patient. In coding, we may only bill for the time you spend face-to-face with the patient. Knowing this, what do you think is the best way for you to count your time more accurately? Some providers I’ve talked with like to print a copy of their schedule so they can note enter and exit times on it. Would that work for you?”
6. Overcome objections. Listen very carefully to what the pro-vider has told you. What is important to this provider? Time-saving documentation techniques? Billing at a higher level? Better patient care? Knowing your provider’s agenda is essen-tial to dissolving his or her objections. Here are some questions and suggestions to keep the conversation moving in a positive direction:
� “It sounds like adding ‘Previously Obtained’ to your notes each time would be too time-consuming to do for each patient visit. What if I were to create a template for you that already had everything labeled this way?”
� “In listening to you talk about your patients, it sounds like you might be grossly underestimating the time you spend with some of them. Because you are basing your level of service on the time you document, you might be under-billing for some of the patients. It sounds like it would be worth an extra moment of your time to note your enter and exit time so you can be accurately paid for your time.”
7. Thank the provider for his or her time. Providers are very busy and it is important to honor his or her participation in the meeting.
EHRs are a great tool in improving documentation when used re-sponsibly. Most providers want to document appropriately, but may not realize the pitfalls of certain documentation habits. Prior to EHRs, the old coder saying was, “If it wasn’t documented, it didn’t happen.” Now, we must ask, “It’s documented, but did it happen?”
Erin Andersen, CPC, CHC, has worked in coding and compliance since 2003 at Oregon Health & Science University performing chart audits and educating pro-viders, coders, and staff about coding and billing. Ms. Andersen is the education officer in the Rose City chapter in Portland, Ore. and she is one of the Region 8 rep-resentatives on the AAPCCA Board of Directors.
Although you were not present in the room with the patient and provider to know what happened, you
can look for certain signs when reading chart notes.
22 AAPCCodingEdge
Facility
BedsideUltrasounds:TakeaCloserLookAs handheld devices become more readily available, it’s important to know the procedure codes.
Takeaways:
• Ultrasound is performed more frequently at the patient’s bedside for guidance or diagnoses.
• CPT® codes reflect complete and limited ultrasounds.• Include anatomical locations and medical necessity for the
imaging in documentation.
BySarahTodt,RN,CPC,CPMA,CEDC
Ultrasound technology has evolved with recent changes allow-ing for these diagnostic studies to be performed at the patient’s bedside. The machines are more portable and affordable than
ever, which has led to increased use of services. Many residency pro-grams require training in the performance and interpretation of bed-side ultrasounds. Ultrasound services are not limited to radiologists, but may be performed by other specialties, such as emergency physi-cians and anesthesiologists.
Bedside Ultrasound DefinedUltrasound is a medical imaging technique using high frequency sound waves and their echoes to create an image for evaluation. Pro-viders may use ultrasound to evaluate the patient for a condition or to assist with a procedure. CPT® codes related to ultrasound are found in the radiology section. The codes are identified by the anatomical location evaluated, or by the diagnostic procedure performed with the assistance of ultrasound.The anatomical codes are further delineated by the detail amount of the study (complete or limited). A “complete” study represents an at-tempt to view and evaluate all of the major structures in an anatomi-cal location. For example, a complete abdominal ultrasound (76700 Ultrasound, abdominal, real time with image documentation; com-plete) would include evaluation of all the major abdominal organs, including the liver, gall bladder, bile duct, spleen, pancreas, kidneys, and major vessels, in addition to any abnormality.A “limited” study represents a directed evaluation of one or more or-gans for a suspected condition. For example, a provider performs a limited abdominal study to assess the presence of gallstones. This service would be reported with CPT® code 76705 Ultrasound, ab-dominal, real time with image documentation; limited (eg, single or-gan, quadrant, follow up).If a limited ultrasound is performed on an anatomical location for which there is no CPT® code for a limited study, the complete study may be reported with modifier 52 Reduced services to indicate the re-duced service. For example, there is no limited study code equiva-lent of 76817 Ultrasound, pregnant uterus, real time with image doc-umentation, transvaginal. To report such a limited study, you would claim 76817-52.
Bedside Ultrasound IndicationsBedside ultrasound may be used in support of another procedure. For instance, ultrasound guidance is frequently used for needle placement and vascular access. Ultrasound guidance used for nee-dle placement for procedures, such as needle biopsy or aspiration or injections, would be reported with CPT® 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization de-vice), imaging supervision and interpretation. The ultrasound is used to aid localization with a needle.Ultrasound guidance for central venous line placement would be re-ported with +76937 Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of select-ed vessel patency, concurrent realtime ultrasound visualization of vas-cular needle entry, with permanent recording and reporting (List sep-arately in addition to code for primary procedure). Ultrasound guid-ance codes should be reported in addition to the primary procedure. For example, a provider uses ultrasound guidance to place a subcla-vian central venous line. The central line would be reported 36556 Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older, with +76937. Bedside ultrasound may also be used to evaluate soft tissue for diag-nostic purposes. The codes for these ultrasounds depend on the lo-cation of what is being evaluated.
• Evaluation of an extremity (i.e., arm including axilla or leg (non-vascular)) would be reported with 76882 Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific.
• Evaluation of soft tissue of the neck would be reported with 76536 Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation.
• Chest wall and upper back would be reported with 76604
www.aapc.com August 2012 23
Facility
Bedside ultrasound may be used in support of another procedure. For instance, ultrasound guidance is frequently
used for needle placement and vascular access.
Ultrasound, chest (includes mediastinum), real time with image documentation.
• Lower back and abdominal wall would be reported with 76705.
• Soft tissue areas of the lower abdomen, pelvis, and buttocks would be reported with 76857 Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles).
Bedside ultrasounds are also used for diagnostic evaluations. In the emergency department (ED), providers may perform a Focused As-sessment Sonogram for Trauma (FAST) exam to evaluate for trau-matic injuries. FAST generally represents two distinct ultrasounds: a limited transthoracic echocardiogram (CPT® 93308 Echocardiogra-phy, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study) as well as a limited abdominal ultrasound (76705). Documentation require-ments must be met for both services to report them. There are many more indications for bedside ultrasounds for diag-nostic purposes. Retroperitoneal ultrasound (76775 Ultrasound, ret-roperitoneal (eg, renal, aorta, nodes), real time with image documen-tation; limited) would be used when evaluating for abdominal aor-tic aneurysm or for renal disease. Limited abdominal ultrasound (76705) may be used for the evaluation of biliary tract disease or oth-er abdominal pathology.
Pelvic Ultrasound Depends on Pregnancy StatusFemale pelvic and transvaginal ultrasounds code selection depends on whether the patient is known to be pregnant prior to the test. A limited pelvic ultrasound is reported with 76857 if the patient is not known to be pregnant prior to the study. If the patient is known to be pregnant prior to the study, 76815 Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses should be reported. The transvaginal ultrasound codes for non-pregnant (76830 Ultra-sound, transvaginal) and pregnant (76817) uterus do not have a se-lection for limited study. If you must report a limited study of this
type, append modifier 52 to either 76830 or 76817, as appropriate. For example, a provider performs a limited transvaginal ultrasound to assess for possible tubal pregnancy. You would report this service with 76817-52.
Required DocumentationBedside ultrasound documentation should include the anatomical location evaluated, and the reason for the test to show medical ne-cessity. The interpretation and report with findings should be re-corded in the patient’s record. The record should include an impres-sion and who performed the test. There is also a requirement of im-age retention. The image may be placed in the chart or stored in a re-trievable location.Ultrasound has become a useful modality in patient care and gives providers a powerful tool to aid in diagnoses and treatments. Be aware of the many types of ultrasounds and their documentation requirements. As technology advances and these handheld devices are more readily available, more of these services will be provided.
Sarah Todt, RN, CPC, CPMA, CEDC, is the director of Provider Education and Audit at LogixHealth, an ED-specialized provider of coding, billing, and end-to-end revenue cycle services for hospitals, office-based practices, and EDs nation-wide. Ms. Todt specializes in emergency medicine and critical care. She has served on the AAPC National Advisory Board (NAB) and the ED specialty exam steering committee, and she presents on ED reimbursement topics.
phot
obyi
Stoc
kpho
to©
zilli
24 AAPCCodingEdge
Feature
FactorHCCwithaTwo-prongedApproachtoRiskAdjustmentDon’t lose money due to under-reported HCC codes.
Proper hierarchal condition category (HCC) classification depends on a plan’s ability to obtain accurate diagnostic HCC information and report that information accurately to the Centers for Medicare
& Medicaid Services (CMS).If a plan focuses solely on disease management to decrease costs (neglect-ing to develop an effective HCC strategy), it runs the risk of losing money due to under-reported HCC codes. Although the plan may still save $150-$250 per member, it will be deficient if it does not factor HCC coding into its business model and work aggressively on a two-pronged approach that incorporates both prospective and retrospective HCC capture.
Prong No. 1: RetrospectiveA plan generally relies on algorithms (risk adjustment software) to search for unreported diagnosis codes via chart reviews. A plan’s coding staff, or a third-party vendor contracted by the plan, extracts large numbers of charts from network physician offices to capture chronic disease processes. After review, any previously unreported codes are submitted to CMS.
Prong No. 2: ProspectivePlans provide ongoing education to assist physicians in the process of devel-oping a complete and accurate member profile that resonates with all cur-rent ICD-9-CM codes identified at each encounter. Taking a prospective approach increases a plan’s ability to capture more accurate data.Providers must report all diagnoses that affect the patient’s evaluation, care, and treatment, including:
• Nature of the presenting problem
• All chronic conditions (such as atrial fibrillation, congestive heart failure (CHF), chronic kidney disease (CKD), rheumatoid arthritis, diabetes with manifestations, chronic obstruction pulmonary disease (COPD), all active cancers)
• History on any relevant past conditions
• V codes (factors that influence health/status codes)
• E codes (external causes of injury and poisoning)
HCC scores on individual members determine CMS reimbursement to the plan. Diagnosis and demographic information should be captured at each face-to-face encounter to obtain a health-based measure of that member’s future medical needs.
Knowledge = Recovered Reimbursement
Consider the following:• More than 50 percent of a plan’s revenue comes from captured HCC
codes.
• More than 30 percent of HCC codes do not pass the CMS validation process, due to lack of supporting documentation in the medical record.
• Providers do not report greater than 40 percent of active chronic conditions.
With those disturbing statistics, it is imperative that a plan employs certi-fied coders who have a thorough understanding of CMS’ HCC methodol-ogy and HCC coding process to ensure capture of all documented chron-ic conditions that risk adjust to HCCs. Coders must also be able to identi-fy documentation deficiencies and review with network providers for im-provement.HCC coding processes include:1. Assessments, plans, all active chronic conditions, and diagnosis codes
documented in charts annually.
2. Coding precision and specificity: Coders have the ability to conduct prospective chart reviews to capture missed chronic conditions that have been documented, but not submitted, by the provider or group.
3. The provider’s ability to submit at least eight diagnosis codes to max-imize HCC reporting to plans (CMS has accepted eight diagno-sis codes since 2007). You may claim 99080 Special reports such as in-surance forms, more than the information conveyed in the usual medical communications or standard reporting form for providers who submit to Medicare Advantage plans to report additional diagnosis codes for chronic conditions. Some providers who use an electronic health re-cord (EHR) may not have the ability within the EHR to submit more than four diagnosis codes to a plan. Code 99080 has no relative val-ue units (RVUs), and may be used as an adjunct to the evaluation and management (E/M) code to capture additional diagnosis codes with-out skewing the provider’s accounts receivable (A/R) report.
4. The plan sends to risk adjustment processing system (RAPS) diagno-sis codes that are converted to HCC codes.
5. CMS factors the plan’s risk adjustment.
ByHollyJ.Cassano,CPC
Coders must also be able to identify documentation deficiencies and
review with network providers for improvement.
www.aapc.com August 2012 25
Feature
Todiscussthisarticleortopic,gotowww.aapc.com
This process allows plans and providers to deliver better benefits and care. For example, at the plan level:
• CMS reimburses health plans on a risk-adjusted basis.
• The sicker a member is expected to be, the more CMS pays a plan.
• Diagnoses reported in one year affect payments for the next year.
• Increased reimbursement from CMS (due to better and accurate reporting from providers) allows the plan to provide richer benefits to members for the following year, and allows for bonuses and better reimbursement to providers for fee-for-service (FFS)/capitation models.
Providers also are better able to: • Completely and accurately assess member’s health status.
• Monitor and document all active diagnoses, past illnesses, and status conditions.
• Monitor readmissions to hospitals.
• Review medication.
• Identify potential new problems early.
• Reinforce self-care and prevention strategies.
Plans that implement a two-pronged approach (prospective AND retro-spective) to capture HCC codes will see increased revenue and cost con-tainment through better disease management by including a defined HCC coding initiative. A plan that combines both approaches can potentially in-crease revenue anywhere from $1,500-$2,500 per member.
The 411 on Third-party VendorsIf a plan chooses to work with a third-party vendor to aid in the retrospec-tive aspect of HCC capture, it should have a checklist clearly defining the plan’s expectations. A vendor’s ability to successfully conduct a majority of the retrospective coding initiatives (the first prong) is imperative, as it al-lows the plan to focus on prospective coding initiatives (the second prong). When a plan has a targeted approach to HCC capture, it can better identify high-risk members and channel them into an appropriate disease manage-ment program. At the end of the day, when a plan is successful at HCC cap-ture, it creates a win-win outcome for the plan, the providers, and ultimate-ly the members who are served.
Holly J. Cassano has worked in practice management, coding, auditing, teach-ing, and consulting for multiple specialties for the past 16 years. She served two terms as an AAPC local chapter officer, maintains an online column for Advance for Health Information Professionals, writes for Justcoding.com, and is the host blogger for: Coding Notes for Consumer Media Network (CMN) www.medicalbill -ingandcoding.org/blog/welcome-to-my-new-blog/. This past April, she pre-sented at the Third Annual HCC Best Practices for Proactive Medical Manage-
ment from Generalities to Interventions to Outcomes for Physician Groups and Health Plans, in Jacksonville, via Opal Events. She works for Preferred Care Partners as a CDI specialist, based out of The Villages, Fla and is the founder of ACCUCODE Consulting, LLC ([email protected]). You can reach her at [email protected] or follow her on Twitter @HollyCassano.
Understand HCC MethodologyHCC payment rationale was developed to mirror the individual health risk profile (HRP) of Medicare Advantage members, and uses ICD-9-CM information as the primary indicator to determine a member’s health status. Thousands of ICD-9-CM codes map to less than 100 HCCs, which are what ultimately drive risk adjustment factor (RAF) scores and per member per month (PMPM) premiums paid to a Medi-care Advantage plan.
Hereisachecklistofwhataplanshouldlookforinathird-partyvendortoassistinretrospectivereviews:
❏ Vendor has established relationships in physician network
❏ Current number of clients: Can the vendor handle your plan’s volume on time to scan appointments and minimize rescheduling?
❏ Ability to generate pursuits and set scan appointments
❏ Ability to identify what the extractions should or should not include (health care effectiveness data and information set (HEDIS) measures, special needs plan (SNP) forms, progress notes)
❏ Flexible chart retrieval services based on the specific needs of the plan
❏ Number of scan techs on staff: Does the geographic range and staff support the provider network area?
❏ Security and Health Insurance Portability and Accountability Act (HIPAA) compliance—equipment types (for example, flash drives, portable scanners, etc.): Do they bring paper if records have to be printed, so as not to use the provider’s resources?
❏ Diverse staff to meet different market needs: Excellent provider and plan relationship skills
❏ Ability to view the electronic images of all medical records
❏ Number of certified coders on staff (in-house and remote)
❏ Ability to generate accurate coding reports based on scans to minimize duplications and errors
❏ Ability to code each record using online magnetic resonance angiography (MRA) reporting, capture for diagnosis, or HCC codes
❏ Ability to accurately identify areas in the record that support HCC findings and risk adjustment data validation (RADV)
❏ Ability to identify provider deficiencies in documentation and coding, and report to the plan on results
❏ Annotate the electronically coded record with notes and report generation to assist the plan in targeting deficient providers
❏ Year-to-date, month-to-date, and real-time (within the past 30 days) report generation to identify low RAF score providers and providers whose HCC reporting is low in comparison to panel size
❏ Ability to identify members who have not had any HCC codes reported from a provider panel
❏ HEDIS reporting abilities to assist providers and plan to obtain four- and five-star ratings
❏ Pharmacy utilization and facility tracking
❏ Ability to identify members who have not been seen and are new to the provider panel within the past six months
❏ Turn-around time (TAT) from time of scan to coding, with report generation to the plan
A vendor also should provide the plan with a monthly accounting that identifies errors and generates corrective actions from all pursuits. The report should contain at the very least the following:
❏ A list of members charts scanned from provider or group
❏ A list of charts that were coded from provider or group
❏ A list of charts that weren’t coded from provider or group with logic to pursue with provider/group
❏ By member, a list of captured HCC or prescription drug hierarchical condition category (RxHCC) codes that can be submitted
❏ By member, a list of dropped HCC or RxHCC codes that need to be addressed with the provider or group
❏ By member, a list of reduced HCC or RxHCC codes that need to be addressed with the provider or group
❏ By member, a list of new HCC or RxHCC codes
26 AAPCCodingEdge
PracticeManagement
PracticeManagersSucceedwithPracticalKnow-howObtain the necessary skills to manage an exceptional practice.
ByDixonDavis,MBA,MHSA,CPPM
Health care provides opportunity to work in a variety of settings, from medical clinics to hospitals, and from long term
care centers to home health. Within this indus-try there are many exciting employment oppor-tunities. Physicians and other clinicians provide direct care to patients while the front office regis-ters patients and schedules appointments. Cod-ers and billers verify accurate and complete rev-enue flows, as auditors and compliance officers ensure the practice follows federal and state reg-ulations. And then, there’s the practice manager who oversees, organizes, and directs all of these efforts. Effective practice managers are increas-ing in demand. Most independent medical practices are owned by physicians who have very little, if any, train-ing in the business side of medicine; the majority of their education and training is on providing excellent clinical skills, not in running a busi-ness. A practice manager who can effectively or-ganize and manage a medical practice is crucial to the physician business owner.
ManagersAreEssentialtoaPractice’sSuccessSuccessfully managing a medical practice is one of the most challenging, yet rewarding, leader-ship opportunities in health care. The complex-ities of the revenue cycle and compliance regu-lations in our health care system, along with hu-man resource knowledge and general business and management skill requirements, make this an exciting and demanding profession. Success-ful managers are those who have the skill set and expertise to ensure the mission and goals of the practice are met.The industry places many demands on medi-cal clinics, such as advanced technology, a com-plex payment structure, federal and state reg-ulations, documentation and coding require-ments, laws prohibiting certain relationships, and health care reform. These demands create an increasing need for managers who not only understand the basics of practice management,
but who are able to apply these principles in real life situations. I have associated with managers who can talk about accounts receivable (A/R), denials, and even contract negotiations, but if they had to actually find a way to reduce A/R, to decrease denials, or to renegotiate a contract, they’d be in trouble.
Hands-onApproachReachesHigherSuccessLevelsAs with most positions, some practice manag-ers get by with mediocre performance while oth-ers dive in and really make a difference. Some managers struggle to keep the business afloat while others lead, directing successful medi-cal practices to provide quality services with financial strength. This is even more evident in small- to mid-sized clinics where the prac-tice manager must be directly involved in all as-pects of the clinic because there are no resourc-es for “extra” staff. Here are real scenarios to il-lustrate my point:Scenario One: This manager knows the basic theory of managing the financials of a practice, either through education or limited experience, and can talk about A/R and how the number of days in A/R needs to be kept low. When it comes time to meet with the billing supervisor or bill-ing staff, the manager explains that the days in A/R need to be lower and directs the billing de-partment to get the aging buckets in line with benchmarked numbers; however, the manager does it without providing specific direction or assistance. Without a practical understanding of how the A/R can be improved, the manager is only able to provide theories, not real life solu-tions, for the billers, which compromises finan-cial success, as well as the confidence the billing staff has in their manager. Scenario Two: This manager has received train-ing in the practical application of practice man-agement and not only understands the theo-ry of A/R, but also the practical application of how to manage it. This manager also has prac-tical skills, such as what tactics work to have
clean claims, collect money due, manage de-nied claims, and administer appropriate adjust-ment policies. When this manager sits with the billing staff, he or she is able to more effective-ly make specific goals and plans, provide specif-ic advice when needed, and get in and help out with specific functions when appropriate. When problems or shortfalls occur, this manager also can identify specific areas for correction and im-provement because he or she understands the mechanics of what is making the engine work.The principle of practical know-how illustrated in these scenarios also applies to many other du-ties of running a medical practice. Practice man-agers who possess the skills and practical know-how, as demonstrated in Scenario Two, can ef-fectively lead and manage medical practices to a higher level of success. In medical groups, we often see staff recognized at excelling in areas such as coding, billing, clin-ical skills, or customer service and are rewarded by career advancement—sometimes to a prac-tice management position. These individuals may work hard and still fall short because they are not proficient in the skills necessary for the new breadth of responsibilities handed to them. Other times, we see staff that is very bright and excelling in their current position, but their ca-reer advancement is limited because their skills are too specific to take on more responsibilities. Both of these groups may be able to succeed and be knowledgeable in a medical management po-sition if they can fill in that gap and learn the ad-ditional management skills necessary.
TrainingforPracticeManagementMany scholastic institutions offer management degrees, including bachelor’s and master’s de-grees in health care administration. I’m a propo-nent of education and believe it’s valuable to your career and your life in general. I understand, however, that a college degree is not an option for everyone and that simply understanding the high-level theory surrounding practice manage-ment—or business in general—is not going to
www.aapc.com August 2012 27
PracticeManagement
be enough to truly help a practice maximize rev-enue, minimize costs, stay in compliance, man-age staff and physicians, and prepare for the fu-ture of information technology (IT). Whether you are a coder, biller, college gradu-ate, high school graduate, or a manager looking to be more effective, it’s vital to understand the practical skills needed to effectively run a med-ical practice daily, and how to apply those skills for real success. It’s these basic skills people often either overlook or don’t know exist. Sometimes, so much time is spent learning high-level theory that the effectiveness in practicality is lost. Oth-
er times, experience and education is so focused that there is no opportunity to learn the neces-sary skills for effective management over sever-al business disciplines. By understanding these basics, you can find success and fulfillment in this position. Some say finding a great job opportunity in-volves a lot of luck. I believe luck is what happens when preparation meets opportunity. Opportu-nities in practice management are out there. Pre-pare yourself now to succeed in the opportuni-ties that come your way.
Dixon Davis, MBA, MHSA, CPPM, has held senior leader-ship positions in independent physician groups and integrated health systems. His operational experiences include the imple-mentation of EHRs, financial restructuring and improvement, acquisitions and divestitures of physician groups, managing several practice start-ups, and successfully leading organiza-tions through change management.
Successfully managing a medical practice is one of the most challenging, yet rewarding, leadership
opportunities in health care.
Be with the family and earn CEUs!
Continuing education. Any time. Any place. ℠
Need CEUs to renew your CPC®? Stay in town. At home. Use our CD-ROM courses anywhere, any time, any place. You won’t have to travel, and you can even work at home.
From the leading provider of interactive CD-ROM courses with preapproved CEUs
Finish at your own speed, quickly or leisurely Just 1 course earns as much as 18.0 CEUs Use any Windows® PC: home, office, laptop No Internet needed: no expiring passwords
Finish a CD in a couple of sittings, or take it a chapter a day — you choose. So visit our Web site to learn more about CEUs, the convenient way!
Our CD-ROM/CEU course line-up: E/M from A to Z (18 CEUs)
Primary Care Primer (18 CEUs) E/M Chart Auditing & Coding (16 CEUs) Demystifying the Modifiers (16 CEUs) Medical Coding Strategies (15 CEUs)
Walking Through the ASC Codes (15 CEUs) Elements of ED Coding (11 CEUs)
HealthcareBusinessOffice LLC: Toll free 800-515-3235 Email: [email protected] Web site: www.HealthcareBusinessOffice.com
Follow us on Twitter: twitter.com/hbollc
Easily affordable with EasyPayments! www.HealthcareBusinessOffice.com/easypay.htm
(Some courses also have CEU approval
from AHIMA. See our Web site.)
© 2012 Optum, Inc. | 12-28676 12080064
With so many changes in the industry, you can trust Ingenix, now
Optum, to provide the resources you need to improve coding accuracy
and speed reimbursements today and make a successful transition to
ICD-10 tomorrow. Choose from our ICD-9-CM, Current Procedural Coding Expert, HCPCS Level II and ICD-10-CM and -PCS draft code sets and mappings products.
Remember to mention source code 152872 to redeem your discount.
Strengthen your skills and save on the resources you need—today and tomorrow.
Order online at OptumCoding.com/AAPC and save 20 percent.
Call 800.464.3649, option 1, and save 20 percent.
Ingenix now OptumInsight, part of Optum—a leading health services business.
Strengthen today’s coding…and prepare for tomorrow’s.
© 2012 Optum, Inc. | 12-28676 12080064
12-28676 AAPC I-9_I-10 Coding Edge Print Ad Final-Rev.indd 1 6/8/12 12:31 PM
www.aapc.com August 2012 29
Cover:BillingandPracticeManagement
A focused effort on negotiating payer contracts can create much-needed money for any practice, and coders are uniquely qualified to facilitate these negotiations. This month, I’ll provide an overview of the contract negotia-tion process. In future months, we’ll discuss each step in greater detail to help you level the playing field with insurance companies.
ByMarciaBrauchler,MPH,CPC,CPC-H,CPC-I,CPHQ
TheBigPictureofContractNegotiationsFocus on preparing for and benefitting from the lengthy negotiation process.
30 AAPCCodingEdge
Cover
Ask for a Pay RaiseHealth plan contracts drive the majority of revenue in most medical practices. You’ll likely never get a rate increase unless you ask for it, but if you make such renegotiations a priority, you should succeed. You can’t negotiate mandated government fee schedules (Medicare, Medicaid, and TRICARE), so concentrate on commercial payer rates.Note: As payers get consolidated through mergers (such as United-Health Group’s acquisition of PacifiCare or CIGNA’s purchase of Great-West), you may find your fees dropping to match the lower of the two fee schedules. You can use this as a reason to renegotiate fees.
Define Your Payer MixPrioritize your payers to determine where you will gain the most ben-efit (see Chart A for example). In this example, Medicare is 22 per-cent of the practice’s business. The next four payers represent 70 per-cent of the practice’s income. Those four payers should be your pri-ority. Don’t waste hours negotiating a contract for a payer that might only be 1 percent of your business.
ChartA:RevenueBasedonPayers
Determine Contract ReimbursementDon’t try to negotiate rates without knowing where you stand. You might find, for instance, that a payer’s fee schedule results in pay-ments less than what Medicaid pays. This is a really good reason to ask that payer for a rate increase.Most commonly you’ll be told that your fee schedule is based on a percentage of a given year of the Medicare Resource Based Relative
Value Scale (RBRVS) (e.g., 120 percent of 2008 RBRVS). Find out if (and when) the payer updates its fees. Consider also what compo-nents of RBRVS the payer uses (e.g., geographic practice cost indi-ces (GPCI) adjustment, site of service differential, multiple proce-dure discounts, etc.).
Identify Often-used CodesCoders are uniquely qualified to identify those services/procedures billed most frequently. Gather the following:
• Superbill with CPT® and HCPCS Level II codes - HCPCS Level II codes are often neglected, but may constitute a significant monthly expense. If you don’t include them, they become a cost rather than a revenue center.
• Frequency count of CPT® and HCPCS Level II codes - Your billing system should generate a report to define which codes your practice uses, and how often. Realize that history is the best predictor of the future. If evaluation and management (E/M) constitutes 80 percent of what the practice does, one negotiation strategy would be to accept a lower reimbursement on procedures to increase reimbursement for E/M services.
• Fee schedule with charges for each code - Evaluate whether your charge is in excess of the current contract allowed amount. Often charges below the current allowed amounts are uncovered.
• Commonly used ICD-9 codes - Gathering this information will help you to define patient mix. For example, most payers consider dermatology an “elective specialty,” and may not prioritize a rate increase. The payer’s attitude may change, however, if the top diagnostic codes you report are for neoplasm treatment (an “essential” service).
Know the Contract Negotiation ProcessAfter you’ve determined your baseline utilization and current rates, you’re ready to begin negotiations. This will take time and energy. If you dive in naively with no idea of the scope and phases of the pro-cess, you’re bound to burn out and give up. Your apathy only bene-fits the payer.
You’ll likely never get a rate increase unless you ask for it, but if you make such renegotiations a priority, you should succeed.
www.aapc.com August 2012 31
Cover
Here’s a quick rundown of making progress toward your goal:
0 Percent: Identify Payer Contact Identify a specific person in charge of contracting for an entire net-work. Create a database for your contacts with as much information as possible (e.g., full name, title, phone number, address, and email address).
10 Percent: Draft and Send Health Plan Proposal LetterDrafting this letter helps you gather your thoughts, and literally gets you on the same page as physicians and other stakeholders at your practice. Include your demographic information (practice name, tax identification number, office address(es), and contact informa-tion). Spell out the strengths your practice brings to the payer and the market and state your rate request. For example, if your current contract is for 120 percent of current-year Medicare rates, and you’re requesting 140 percent, state that; and, provide a few reasons for the rate increase. The health plan proposal should be mailed and certified with a re-turn receipt requested. Be prepared to follow up. As a general rule, if letters are sent to 10 different health plans, one or two might respond without you having to make a follow-up call.
20 Percent: Follow Up with PayerThe health plan representative may have already told you during the initial phone call the typical fee schedule for physicians of your geo-graphic location and specialty. During the same call, you may be able to express what alternate rates would be acceptable. Save time by getting a verbal commitment from the payer that they’ll offer and send the agreed-upon, acceptable rates before they send out a fee schedule and contract to you.
30 Percent: Receive Offer from Payer When the offer of new rates is received (either as part of a contract or as a standalone fee schedule for preliminary approval), you’ll need to make the entire offer (rates and contract language) acceptable to the unique needs of the practice. As such, you should request the com-plete agreement for review. You may want to have certain codes carved out as fixed amounts. Check the fees for rates for in-office radiology, clinical labs, consul-tation codes, preventive exams, and unlisted procedures—anything that might cause future payment problems. These additional specif-ics about the fee schedule should be defined to your satisfaction in the offer under consideration.
40 Percent: Read Language and Draft Revisions Unless you’re desperate for the payer contract, review the language and fee schedule terms for acceptability. If you find areas of disagree-ment or concern over the language of the contract, prepare a letter or email specifically citing the problematic contract language, why you object, and the proposed alternate language you’d find accept-able. Go back and forth with the payer on requested language revi-sions, and review all contract drafts. The bulk of the work (the negotiations) is over. Now begins the ad-ministrative endurance test to confirm the contract terms get im-plemented.
50 Percent: Language and Rates Acceptable Initial each page of the contract. This will prevent anyone question-ing whether you overlooked a page of the agreement or an attach-ment. Even if the agreement drafts were redlined throughout the ne-gotiation, compare the final draft to the exact text you desire.
60 Percent: Signature on Contract Print the agreement provided by the health plan, if via email, and prepare the agreement by assembling it in the proper order, with all pages completed and exhibits/addenda attached. Have the physician sign all relevant areas. Fill in the other necessary information, such as adding the practice address to the “notice” section of the contract, the signature page, or any exhibits requiring demographic informa-tion such as the tax identification number, billing address, etc.
70 Percent: Credentialing Packet Complete and Submitted Generally, a new agreement comes with an associated credentialing packet. Complete the packet, providing copies of all requested docu-ments. Now is a great time to set up online payer log-ins, if you don’t already have them.
80 Percent: Contract Returned Correctly Send the agreement with a tracking number. Keep a hard copy of the partially executed documents, and follow up until you receive a fully executed (counter-signed) copy for your files. Save the agreement in an easy-to-locate place within the practice. Have a copy for your re-cords, in case you need to supply the payer with a copy.
90 Percent: Credentialing Approved When the plan gets the credentialing packet, the internal review by the payer starts. Be proactive, and find out when the credential-ing committee will review the applications. Respond quickly when asked for additional information.
Don’t try to negotiate rates without knowing where you stand.
32 AAPCCodingEdge
Cover
Todiscussthisarticleortopic,gotowww.aapc.com
100 Percent: Effective Date At this point, the credentials are approved and the contract is re-ceived by the plan. Now you wait for an effective date. Generally, a “welcome letter” stating the effective date is sent to the practice ad-dress. This often accompanies your fully executed agreement. If you are in need of an expedited effective date, you may be able to get one over the phone or via email by your payer contact.Having the effective date is the ultimate confirmation that you are done with the contracting process. Most practices we come across only have partially executed versions of their agreements, which are not legal documents.
Monitor for Continued SuccessWith the contract enacted, be sure to monitor payments and other terms to be certain that you are receiving the improvements you’ve worked to achieve. Summarize the agreement in fewer than two pag-es, with essential terms identified for all stakeholders. This cheat sheet will be the primary reference for everyone involved with the contract in the future. Ideally, the actual agreement will need to be referenced only for specific details on a rare occasion. Provide your front desk schedulers and pre-authorization coordina-tors with a list of payers the practice accepts and online payer log-ins. Share the effective date and new rates with the billing staff. Chart B is a format that is useful.
ChartB:ExampleofPayerMonitoring
Mark your calendar for a renegotiation in the future. If you have es-calators built in for your rates, mark those on the calendar, too, so you can be assured they will take effect. The value of staying organized throughout the contract negotiation process is essential. The aforementioned steps should help you pre-pare for—and endure—the lengthy negotiation process. Any rate increase should make the endurance test worthwhile.Stay tuned: We will provide additional tips and specifics to improve your success during contract negotiations.
Marcia Brauchler, MPH, CPC, CPC-H, CPC-I, CPHQ, is the founder and presi-dent of Physicians’ Ally, Inc., a health care consulting firm and concierge billing company for specialty physician practices in Denver. She works with physicians on managed care contracts, reimbursement, and practice administration. Her expe-rience includes hospital, health plan, and independent practice association admin-istration. Her firm sells updated Health Insurance Portability and Accountability Act (HIPAA) policies and procedures and online staff training. She is a published re-searcher and a frequent public speaker.
Physicians’Ally,Inc.(l-r):LynnHolmes,
LindseyH.Daly,MSHA,CPC,MarciaL.
Brauchler,MPH,CPC,CPC-H,
CPC-I,CPHQ,JohnWilliams,Crystal
Lytle,LynnHooper
Having the effective date is the ultimate confirmation that you are done with the contracting process.
2012 Best Practices for ICD-10-CM Documentation and Compliance
Understanding the new documentation requirements for ICD-10-CM is vital to a successful transition to ICD-10. ICD-10-CM requires more detailed documentation for assignment of the most specific diagnosis code(s).
The 2012 Best Practices for ICD-10-CM Documentation and Compliance addresses the documentation analysis phase of ICD-10-CM coding and provides all the tools required for an effective documentation analysis and a corrective action plan including:
• Comprehensive review of each ICD-9-CM chapter and the corresponding ICD-10-CM chapter or chapters with identification of diagnoses/conditions requiring additional documentation and discussion of the relevant coding guidelines and coding notes
• An ICD-9-CM to ICD-10-CM comparison of code categories and subcategories requiring more specific documentation
• A table with ICD-9-CM codes and the applicable ICD-10-CM codes for the same condition
• Checklists to identify the new documentation elements for categories, subcategories and/or codes in ICD-10-CM
• Scenarios showing required documentation in ICD-9-CM and ICD-10-CM with the additional documentation elements in ICD-10-CM highlighted
• Codes (ICD-9-CM and ICD-10-CM) and explanations including applicable guidelines for each scenario
• End of chapter quizzes including coding practice of conditions discussed in the chapter
• Specialty-specific checklists for documentation review of current records to help identify documentation deficiencies
• And more!
Regular Price: $159.95 Your Price: $127.96
Order your copy at www.codingbooks.com/documentation. Be sure to enter promo code AAPCDOC to receive your discount.
20296 4 Choke Cherry Road, 2nd Floor | Rockville, MD 20850 | www.codingbooks.com | Tel: 1-800-334-5724
NEW!
34 AAPCCodingEdge
FeaturedCoder
IdentifytheCorrectGlobalPeriodE/MModifierHere’s how to determine and append a modifier that best tells the story of the E/M claim.
ByNancyClark,CPC,CPC-I
Modifiers are crucial in telling the story of the claim by identifying procedures that have been altered in some way without changing the core meaning of the code(s) submitted. Let’s look at the modifiers that can be appended to evaluation and management (E/M) codes used within the global period.
The Global Surgical PackageUnderstanding global modifiers begins with a comprehension of the global surgical package. The CPT® surgical package definition indicates that for every surgical procedure, there are integral servic-es included that cannot be reported or billed separately, as indicat-ed in Example A.The Centers for Medicare & Medicaid Services (CMS) refers to the surgical package concept as the “global period.” In minor proce-dures, such as removal of skin lesions or endoscopies, a zero- to 10-day global period after the procedure applies. For major surgeries, the global period is extended to one day prior to and 90 days after the procedure. An example of a major surgery would be an appendecto-my. Note that commercial carriers may place different global peri-ods on procedure codes.One way to determine the global period for Medicare is by using the Medicare Physician Fee Schedule Database (MPFSDB). Global sur-gery status indicators are attached to each procedure code from the surgery section of CPT®, as shown in Example B.Modifiers 24, 25, and 57 (see descriptors below) can be appended to E/M codes, which include CPT® 99201-99499, and ophthalmolo-gy codes 92002-92014; the latter codes are found in the medicine section of CPT®.
Modifier 24Modifier 24 Unrelated evaluation and management service by the same physician during a postoperative period shows the E/M being billed is not part of the global surgical package and is separately reimburs-able. To further indicate the procedure is unrelated, we usually—al-though not necessarily—use a different diagnosis from that linked to the previous procedure. For example, on May 1, the patient undergoes an appendectomy for acute appendicitis. The appropriate coding based on this informa-tion is 44950 Appendectomy with 540.9 Acute appendicitis; without mention of peritonitis. On May 19, the patient presents to the same
operating surgeon with a new onset of right upper quadrant (RUQ) abdominal pain. At this visit, the surgeon examines the patient and suspects cholecystitis. He orders a complete blood count (CBC) and abdominal ultrasound, and documents an expanded problem-fo-cused history, expanded problem-focused exam, and medical deci-sion-making of low complexity.The appropriate coding on May 19 is 99213-24 Office or other outpa-tient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded prob-lem focused history; An expanded problem focused examination; Med-ical decision making of low complexity … with a diagnosis of 789.01 Abdominal pain; right upper quadrant. Modifier 24 is appended to in-dicate that this E/M is unrelated to the previous surgery. Notice the use of different diagnoses.In this next example, it is appropriate for the same diagnosis to be used for both the surgery and the subsequent E/M service: On June 1, the patient presents for a closed treatment of a single metacarpal fracture in his left hand. The appropriate coding is 26600-LT Closed treatment of metacarpal fracture, single; without manipulation, each bone, which has a 90-day global period. Modifier LT Left side is ap-pended to indicate location. The diagnosis is 815.03 Fracture of meta-carpal bone(s); closed; shaft of metacarpal bones(s).On July 1, the patient presents to the same operating surgeon, com-plaining of a possible fracture in his right hand. The physician per-forms an expanded problem-focused history and exam and his med-ical decision-making is of low complexity. After review of the X-rays, which may be separately billable, the physician identifies a new metacarpal shaft fracture. The appropriate coding is 99213-24, with 815.03. Note the use of the same diagnosis. Modifier RT Right side for the right hand would not be appropriate for the E/M code.
Takeaways
• The CPT® surgical package definition indicates that for every surgical procedure, there are integral services included that cannot be reported or billed separately.
• The Centers for Medicare & Medicaid Services (CMS) refers to the surgical package concept as the “global period.”
• Modifiers 24, 25, and 57 can be appended to E/M codes, includ-ing CPT® 99201-99499 and ophthalmology codes 92002-92014.
• The OIG is targeting claims where certain modifiers are appended to services performed during the global period.
www.aapc.com August 2012 35
FeaturedCoder
Modifier 25Append modifier 25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service to indicate that an E/M service is separate from what is normally required for a minor procedure. There must be a clearly documented, distinct, and significantly identifiable E/M service, above and beyond the usual preoperative and postoperative care associated with the procedure. The CPT® description of mod-ifier 25 specifies, “The E/M service may be prompted by the symp-tom or condition for which the procedure and/or service was provid-ed. As such, different diagnoses are not required for reporting of the E/M service on the same date.”
For example, an established patient presents to the office complaining of left eye pain and feel-ing as if sand is in his eye after doing some repair work around his house. The physician performs an examination, finds a wood splinter in the cor-nea, and removes it. He documents a problem-focused history and exam and straightforward medical decision-making. The appropriate cod-ing is 99212-25 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key com-ponents: A problem focused history; A problem fo-cused examination; Straightforward medical deci-sion making … and 65220-LT Removal of foreign
body, external eye; corneal, without slit lamp with 930.0 Cor-neal foreign body. Alternatively, for an eye examination, report 92012-25 Oph-thalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment pro-gram; intermediate, established patient and 65220-LT.
Modifier 25 for Combo Sick/Well VisitsModifier 25 also may be used when a preventive service (well visit) and a problem-oriented E/M (“sick visit”) occur dur-ing the same encounter. CMS instructs, “Medicare payment can be made for a significant, separately identifiable medi-cally necessary E/M service (Current Procedural Terminol-ogy codes 99201-99215) billed at the same visit as the Annu-al Wellness Visit (AWV) when billed with modifier -25. That
portion of the visit must be medically necessary to treat the benefi-ciary’s illness or injury, or to improve the functioning of a malformed body member.” (https://questions.cms.gov/)In this instance, be sure the documentation can substantiate two distinct E/M codes. One visit would be measured by the key com-ponents of history, examination, and medical decision-making (or, possibly the time component). The other service needs to indicate a full preventive care service. The modifier is appended to CPT® problem-based codes. Keep in mind that commercial payers’ poli-cies vary. Some will not pay for two E/Ms on one date of service and some payers may reduce the amount of the second E/M reimburse-
Example A
CPT® Surgical Package Definition
Pre-operative services, such as:
• Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia
• Subsequent to the decision for surgery, one related E/M encounter on the date immediately prior to, or on the date of, the procedure (including history and physical)
Intraoperative services that are normally a usual and necessary part of a surgical procedure
Post-operative services, such as:
• Immediate postoperative care, including dictating operative notes, talking with the family and other physicians
• Writing orders
• Evaluating the patient in the post-anesthesia recovery area
• Typical postoperative follow-up care
Source: CPT® 2012, American Medical Association (AMA), adapted
Example B
CMS Definition of Global Period
Minorprocedures: 0 to 10-day global period after procedure
Majorprocedures: 1 day prior and 90 days after procedure
000 = 0 global days
010 = 10 global days
090 = 90 global days
XXX = global concept does not apply
YYY = carrier determines global period
ZZZ = add-on codes
Global period calculator (MPFSDB): www.cms.hhs.gov/pfslookup/02_PFSsearch.asp
Source: Medicare Claims Processing Manual, chapter 12, section 40
Keep in mind that commercial payers’ policies vary. Some will not pay for two E/Ms on one date of service and some payers may reduce the amount of the second E/M reimbursement.
36 AAPCCodingEdge
FeaturedCoder
ment. It is important to check with the payer to verify both the coding policy and the pa-
tient’s benefits.For example, a 35-year-old es-tablished patient had previous-
ly scheduled an appointment for a routine examination. On the day of
the appointment she injures her ankle. The documentation of the visit supports a
problem-focused history related to the ankle injury, a problem-fo-cused examination of the ankle, and medical decision-making of straightforward complexity. The documentation also separately sup-ports a comprehensive preventive medicine E/M service.The appropriate coding of this service for a commercial payer is 99212-25, with a diagnosis of 845.00 Sprains and strains of ankle; unspecified site. You would also report 99395 Periodic comprehensive preventive medicine reevaluation and management of an individual in-cluding an age and gender appropriate history, examination, counsel-ing/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years with a diagnosis of V70.0 Routine general medical examination at a health care facility.For Medicare, there are several options for reporting the wellness exams:
• For a Medicare Initial Preventive Physical Exam (IPPE), use HCPCS Level II code G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment.
• For a Medicare AWV, use HCPCS Level II code G0438 Annual well visit; includes a personalized prevention plan of service (PPS), initial visit for a new patient or G0439 Annual well visit; includes a personalized prevention plan of service (PPS), subsequent visit for an established patient.
For clarification of the Medicare IPPE and AWV guidelines, see the Medicare Claims Processing Manual chapter 12, 30.6.1.1, “Ini-tial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV).”
Whether reporting to commercial payers or Medicare, the use of different diagnoses for sick and well visits further differentiates the services.
Modifier 57Modifier 57 Decision for surgery is similar to modifier 25, except that the surgical package includes one day prior to the procedure and usually has a 90-day global period after the procedure. Note: The CPT® description of the modifier does not actually indicate a glob-al period, but most payers’ guidelines indicate use for a major glob-al period. The E/M may be for the same or for a different diagnosis than the surgery.Remember CPT® surgical package guidelines include one related E/M encounter subsequent to the decision for surgery. So, if the op-erating physician performs an E/M on the day before a previous-ly scheduled surgery that includes normal preoperative care for the surgery, the E/M is not separately reportable because it is included in the global package. If the operating physician sees the patient the day before the surgery and at that visit decides to perform surgery, however, modifier 57 can be properly appended to indicate the E/M is not “bundled” into the surgery because a decision for surgery was made at this visit.For example, a non-Medicare patient presents to the emergency de-partment (ED) with acute right, lower-quadrant abdominal pain and fever. The ED physician requests a surgical consult. The con-sulting surgeon documents a level 3 outpatient consult and decides at that visit to perform an emergency appendectomy. The appropriate coding is 99243-57 Office consultation for a new or established patient … , 44950, and 540.9.Note: The global period of the performed procedure determines whether it is appropriate to append modifier 25 or modifier 57 to the E/M code.
Nancy Clark, CPC, CPC-I, is a member of the 2011-2013 AAPC National Advi-sory Board (NAB). She is director of the Healthcare Business Resource Center in New Jersey. She also She also is a PMCC-approved instructor and a health care consultant. Ms. Clark participates in the Novitas Medicare Provider Outreach and Education Advisory Group.
OIG Targets Use of Modifiers During the Global Surgery PeriodAs part of its 2012 Work Plan, the Office of Inspector General (OIG) “will review the appropriateness of the use of certain claims modifier codes during the global surgery period and determine whether Medicare payments for claims with modifiers used during the global surgery period were in accordance with Medicare requirements.” To stay clear of the OIG, remember, “visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a significant, separately identifiable service is also performed,” per the Medicare Claims Processing Manual, chapter 12, section 40.1.
For example, on March 1, a patient schedules removal of a skin lesion. On March 3, the patient presents to the office for removal of a benign skin lesion of the left arm, 1 cm, as measured by CPT® instructions. No other problems are discussed in detail. Appropriate billing on March 3 is 11401 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm. A significant, separate E/M service was not provided.
Spine Claims Auditing Technology to Revamp Your Revenue Cycle
www.casecoder.com888-337-8220 option 5
CaseCoderExtremeAd0112.indd 1 2/5/12 10:45 PM
38 AAPCCodingEdge
CodingCompass
It’sTimetoRe-evaluateYourE/MCodingBecause EHRs may affect your billing, verify that your evaluation and management levels remain compliant.
BySuzanBerman,CPC,CEMC,CEDC
OIG Does the Math: E/M Levels RisingIn May 2012, the Office of Inspector General (OIG) pub-lished “Coding Trends of Medicare Evaluation and Manage-ment Services,” illustrating a marked shift over time toward billing for higher-level evaluation and management (E/M) services. The OIG doesn’t directly blame EHR use for the trend in the report; however, it’s clear that the OIG is keenly aware of how EHRs can affect E/M billing.Details of the report show that between 2001 and 2010, Medicare increased the payment of E/M services from $22.7 billion to $33.5 billion. Dates of services toward the end of the survey period include a larger sample of electronically docu-mented records.The OIG concluded in the top three categories reviewed (sub-sequent hospital visits, established patient visits, and emer-gency room services), the “middle” code (e.g., level 3 for the established and emergency services) was the most often billed service; however, higher levels of service are being billed more frequently. A statistical comparison is made in Table A for es-tablished patient visits.Table A
Code 2001 2005 2010
99211 6% 5% 4%
99212 16% 12% 9%
99213 54% 52% 46%
99214 21% 28% 36%
99215 3% 3% 5%
Source: OIG analysis of 2001 and 2010 Part B Analytic Reports (PBAR) National Procedure Summary File (http://oig.hhs.gov/oei/reports/oei-04-10-00180.pdf), appendix C, page 21.
With regard to subsequent hospital services, 99232 Subse-quent hospital care, per day, for the evaluation and manage-ment of a patient, which requires at least 2 of these 3 key com-ponents; An expanded problem focused interval history; An ex-panded problem focused examination; Medical decision mak-ing of moderate complexity (mid-level code) is submitted most often. As you can see in Table B, however, there is a shift be-tween 99231 Subsequent hospital care, per day, for the evalu-ation and management of a patient, which requires at least 2 of these 3 key components; A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity and 99233 Subsequent hos-pital care, per day, for the evaluation and management of a pa-tient, which requires at least 2 of these 3 key components; A de-tailed interval history; A detailed examination ; Medical deci-sion making of high complexity from 2001-2010.
Table B
Code 2001 2005 2010
99231 31% 22% 15%
99232 53% 58% 59%
99233 16% 20% 25%
As shown in Table C on the next page, emergency service codes saw the biggest change between levels of service.
Takeaways
• The OIG finds E/M levels are rising and believes EHRs are the likely cause.
• Rising rates appear not to result from seeing sicker patients.
• CMS is identifying, auditing, and training providers whose E/M levels have risen.
With implementation of the electronic health record (EHR), it’s more important than ever to ensure documentation supports the individual level of service for each patient. Templates, smart phras-
es, easy text, and other shortcuts allow clinicians to document effortless-ly without taking medical necessity into account. This is troubling to pay-ers, and should be to the companies creating the records (as well as the pro-viders using them).
www.aapc.com August 2012 39
CodingCompass
Todiscussthisarticleortopic,gotowww.aapc.com
Table C
Code 2001 2005 2010
99281 2% 1% 0%
99282 9% 5% 3%
99283 31% 27% 20%
99284 32% 30% 29%
99285 27% 38% 48%
Specialties billing higher services more often were family practice, emergency medicine, and internal medicine, with obstetrics/gynecology (OB/GYN), showing the largest per-centage increase (4.3 percent, versus 1.9 percent overall) of physicians who billed only higher-level services. Geograph-ic location was not a factor in the results. Only three states didn’t have physicians who consistently billed higher service levels in 2010: Montana, Nebraska, and Wyoming. Physicians who bill higher levels of service might argue that they are seeing older patients, sicker patients, or patients with co-morbid conditions. OIG results didn’t support this theory. Patient populations were approximately the same age across the study, with the same diagnosis codes submitted, and the patients of those physicians consistently billing high-level ser-vices were, in aggregate, no sicker than average.
CMS Is Gunning for E/M UpcodersAs a result of this report, the OIG recommended the Centers for Medicare & Medicaid Services (CMS) continue to edu-cate the physician community on the appropriate application of documentation guidelines. This could include letters, in-person seminars, teleconferences, etc. Medicare carriers also will be reviewing a greater number of E/M services. The OIG has already provided CMS contractors with the names of physicians who it found to be consistently billing higher levels of services and, depending on a cost/benefit analysis, there will be more extensive reviews done for those physicians.EHRs are an amazing tool in the health care environment. When designed and used properly, they help to improve of-
fice flow, patient care, and the revenue stream. The higher levels of service the OIG found in its recent study might have been billed appropriately (The OIG says in the report that it “did not determine whether the services billed by physicians who consistently billed higher level E/M codes were inappro-priate or fraudulent.”), but without proper documentation in the medical record, there’s nothing to substantiate both the level of service and medical necessity.
Get Moving, Start EducatingThe provider community could view this report as a call to order. Documentation is becoming more robust and more transparent amongst agencies and other providers. It must be clear, clean, and relevant. The provider community must put in place appropriate documentation improvement plans—and not just in preparation for ICD-10-CM, but for cleaner claims, more appropriate billing, and clearer care plans that ultimately result in better outcomes for patients. Clinician education should be continual and timely. Phy-sicians should welcome the education and not feel over-whelmed, over-scrutinized, or threatened. Educators should be accommodating as to where and when education is done, and must understand the providers’ prospective. Training tools should be developed to deliver information in a vari-ety of ways. Meeting in small spans of times (taking a short break from patients or meeting early in the morning, for in-stance) might be appropriate alternatives to lengthy sessions. Weekend seminars and evening meetings with colleagues might also be great settings to provide billing and coding ed-ucation. Webinars and teleconferences are also very produc-tive ways to convey this information. The more the guide-lines are reviewed, the easier they are to adapt into the patient visit workflow.
Suzan Berman, CPC, CEMC, CEDC, is the senior director of Physi-cian Services for Health Revenue Assurance Associates. She serves on the OptumInsight Advisory Board and as Coding Institute Editorial Advisory Board member. She is a former AAPC National Advisory Board (NAB) and AAPC Chapter Association (AAPCCA) Board of Direc-tors member. She speaks nationally for organizations such as the Uni-versity of Pittsburgh, The Coding Institute, Advanced Career Solu-tions, AAPC, MGMA, and OptumInsight.
The OIG has already provided CMS contractors with the names of physicians who it found to be
consistently billing higher levels of services …
Learn what you need to know for 2013 from the source of CPT®—the AMA!
Back by popular demand!ICD-10-CM Chicago WorkshopNov. 13-14, 2012, directly preceding the Symposium
Visit ama-assn.org/go/symposia or call (800) 621-8335 to learn more and register!
Nov. 14-16, 2012Marriott Chicago Magnificent Mile
© 2012 Thinkstock
2013 CPT® and RBRVS Annual Symposium
See you in November!
Thepremiercoding and
reimbursement event
Register at ama-assn.org/go/symposia today!
www.aapc.com August 2012 41
ICD-10Roadmap
photobyiStockphoto©pialhovik
ProvidesICD-10-CMInsight
You have heard from many qualified, trained professionals in ICD-10-CM over the last several months, with some very informative ar-ticles on varying ICD-10-CM topics. As you prepare for the ICD-10-CM transition and implementation in your practice, you may benefit from hearing other health professionals speak on the topic of ICD-10-CM. I asked several individuals in key positions at differ-ent practices the question, “What is your biggest concern with ICD-10-CM implementation?”Their responses can offer you helpful insight as you continue to pre-pare for the transition to ICD-10-CM.
Medical Director“My main concern is that one of the stated advantages of ICD-10 is, ‘Specificity improves coding accuracy and depth of data for analysis.’ I say, ‘Garbage in, garbage out.’ For providers who are currently not using the specificity that exists with ICD-9, ICD-10 gives them more ‘garbage’ to choose from or to ignore. Also, as you know, you can only code what is documented in the record. I think lack of specificity will remain more of-ten the problem, rather than miscoding a specific diagnosis.”Kenneth W. Patric, MD, chief medical officer, The Little ClinicOne of the largest impacted areas will be the clinical documentation. Auditors and coders already struggle with this issue, and documenta-tion may become even more problematic with ICD-10-CM because it is data driven. If only unspecified codes are used in ICD-10-CM, we are no further in capturing the specific clinical picture of the pa-tient. In time, payers may not reimburse for unspecified codes when the documentation supports a more specific code. Solution: The best way to confront this issue is through monitor-ing and education. If you are not already performing documentation audits, begin now. Incorporate an ICD-10-CM readiness section in your audits or conduct a separate ICD-10-CM readiness review as a benchmark. Run a frequency report of the top diagnosis codes being used by the practice. Pull a sample of documentation for each pro-vider who represents these top codes. The auditor will assess the doc-umentation and determine:
1. Does the documentation support the diagnoses reported?
2. Will the documentation support an ICD-10-CM code?
The auditor must be familiar with the ICD-10-CM guidelines and codes to make this determination. After the audit has been conduct-ed and analyzed, the practice will have a good assessment of docu-mentation deficiencies and can develop a priority list of diagnoses re-quiring more detail. The audit will also identify providers who will benefit from focused ICD-10-CM training.Implement a documentation improvement program within the practice and monitor the documentation on an ongoing basis. This will ensure improvement and identify areas where providers are de-ficient and those who need more assistance and training. These au-dits should be conducted periodically to validate ICD-10-CM com-pliance. As with any audit, submit a report to senior management and the provider.If you do not have a trained Certified Professional Coder (CPC®) on staff to perform these audits, contact AAPC Physician Services to schedule a “ICD-10-CM Assessment: Documentation Readiness Evaluation” (www.aapcps.com/services/icd-10-assessment.aspx). Do not skip this step! This is a critical element as you begin the preparation and implementation process.
Physician“My biggest concern is the additional amount of time it will take me to look up codes. I am expecting that to really eat into my patient time. If you multiply an extra 30 to 60 seconds per patient, times 25 patients a day, you have effectively eliminated a 15 minute exam slot!”Stephen C. Spain, MD, FAAFP, CPC, CEO Doc-U-ChartThere will be a learning curve for physicians, as well as for coders.Solution: Consider developing a cheat sheet of the top 50 ICD-9-CM codes used in your practice. Have a trained CPC® convert the ICD-9 options to ICD-10. If you do not have anyone on staff that is trained to make the conversions, or just don’t have the time, AAPC offers laminated double-sided cards by specialty to make it easy.
ByKathyRowland,CPC,CEMC,CPC-I,CHC
Wordont
heStree
t
42 AAPCCodingEdge
ICD-10Roadmap
AAPC lists the Fast Forward Top 50 ICD-9 Codes Crosswalked to ICD-10 (by specialty) for $14.95 for members (www.aapc.com/icd-10/
crosswalks/index.aspx).Be resourceful and begin talking with your information technol-ogy (IT) system staff/vendor to evaluate what tools will be avail-able. Codes provided by a system may be crosswalked to unspecified codes via a matrix or general equivalency mappings (GEMs) file. Do not select the final code for the visit without validating it is the most specific diagnosis code supported by the documentation.An “ICD-10-CM Assessment: Documentation Readiness Evalua-tion” will help in this area, as well, by providing specific documen-tation feedback and education, and familiarizing everyone with the most frequently used codes in your practice.
Administrator“My biggest concerns are electronic implementation and making sure we do not lose revenue by missing things or ‘miscoding.’”Marianna D. Forsythe, MBA, chief operating officer/Vice Pres-ident of administraton, The Heart & Vascular Center of West Tenn./Delta Convenient Care, PCSolution: To address a possible short-term, adverse impact on rev-enue stream, consider increasing your practice’s cash reserve and/or securing an increased line of credit. This will ensure the practice can continue to meet its expenses should there be any delays in re-imbursement.Strategic planning and anticipation of productivity issues can help a practice minimize any hurdles. Begin by developing an ICD-10-CM steering committee or implementation committee that will help identify any areas of impact for the practice. This may be a commit-tee of one or two staff members in a smaller practice or a cross-sec-tion of billers, coders, IT staff, managers, physicians, administrators, etc. in a larger practice.Get representation for each area of the practice and be sure every af-fected area is identified and explored. Involve physicians early on so they understand the importance of preparation as the migration to ICD-10-CM occurs. The team should meet initially to identify the elements necessary for a smooth transition, and then analyze what areas will be affected. The resulting information should be shared with providers and management.Set boundaries for this committee to avoid “project creep.” Keep a priority list of identifying what will be addressed, including antici-pated deadlines, to keep the efforts focused and on track. Any issues that do not directly affect the implementation can be put on anoth-er action list for follow up after priorities involving the ICD-10 tran-sition are addressed.
This planning effort will not only identify areas affected by the tran-sition, but also how communication will be handled, training needs and education plans, as well as coordination with vendors, business partners, and other providers.
Billing Manager“How do we ensure that currently certified coders are trained on ICD-10? Will this be a separate certification? Will they be tested? How long will it take someone to learn ICD-10? And, since this will be new to ev-eryone, is the industry really ready for this?”Deanna Allen, A/R consultantSecond only to system upgrades, training will be the biggest expense for the practice.Solution: Develop a separate education plan specifically for ICD-10-CM. Do the training in phases, beginning with the background and history, rationale for change, and final rule highlights, and con-tinue through guidelines and code set training. Measure the reten-tion of what you learn by conducting post testing.As you begin to evaluate the training needs of the practice, ask your-self:Who must receive training on the ICD-10 code set?All areas of your practice will need some degree of training in ICD-10 CM. On average, it is estimated that:
• Providers will require 8-16 hours• Nurses will require 6-10 hours• Ancillary staff will require 6-10 hours• Coders will require 20-40 hours, not counting recommended
A&P coursesWhat options are available to train staff? Look into training options such as onsite, vendor training, commu-nity courses, webinars, and certification courses. Check out AAPC’s plan for training on www.AAPC.com.Which training format(s) will work best for your staff?Consider classroom training, web-based training, or self-guided ma-terials to meet your staff needs. How much will the training cost?Develop a budget once your methods are determined.What resources will staff need after training to resolve ques-tions as they arise?Resources could include any available tools, manuals, or frequently asked questions (FAQ) lists.
Begin by developing an ICD-10-CM steering committee or implementation committee that will help identify any areas of impact for the practice.
Find a workshop location near you! www.aapc.com/pathophysiitis
1-800-626-CODE (2633)
Get physicians perspectives on the most common disease processes: diabetes, hypertension, coronary artery disease (CAD), and obesity. Learn their approach for primary through tertiary prevention and discover how these diseases affect other aspects of patient care. Most importantly, apply your now expanded knowledge to code faster and with greater accuracy.
Author: Glade Curtis, MD, MPH, FACOG, CPC, CPC-I, COBGC
Co-Author: Shelly Cronin, CPC, CPMA, CPC-I, CANPC, CGIC, CGSC
Understanding the Disease ProcessDiabetes, Hypertension, CAD, and Obesity
AUGUST WORKSHOP
Suffering from
Treatment: Attend our 4-hour workshop this August and cure yourself of this debilitating syndrome plaguing thousands of coders.
Pathophysi-itis?Pathophysi-itis [path-oh-fiz-ee-ahy-tis]: A syndrome affecting coders whose confidence and efficiency are greatly hindered due to a lack of understanding of disease processes (Pathophysiology).
Up to 6 CEUs
40+ Cities
$149.95
Symptoms: · Irritability when deciphering clinical documentation· Confusion about the disease process· Lack of confidence when speaking to clinical staff· Overuse of search engines to research answers· Loss of productivity when coding· Denials as a result of coding inaccuracies
44 AAPCCodingEdge
ICD-10Roadmap
Will this be a separate certification?A separate certification will not be required for coders; however, to ensure certified coders maintain their ability to accurately code the code sets, AAPC certified members will have two years to pass an open-book, online, unproctored assessment. Due to the clinical na-ture of ICD-10-CM, a strong understanding of anatomy and patho-physiology (A&P) is recommended. AAPC offers “ICD-10 Anato-my and Pathophysiology Training” that covers all body systems in 14 modules (www.aapc.com/ICD-10/anatomy-pathophysiology.aspx). The cur-riculum blends online multimedia presentations (www.aapc.com/ICD-
10/sample/sample.html) with downloadable manuals (http://static.aapc.
com/ppdf/sample1.pdf) and evaluation quizzes to ensure your compre-hension of the material. At minimum, a refreshers course in A&P will be necessary to code using ICD-10-CM.Is the industry really ready for this? The ICD-9-CM system is more than 30 years old. Think of how much medicine has changed in 30 years. The ICD-9-CM catego-ries are full and do not represent contemporary medicine. Although the extended proposed implementation date (Oct. 1, 2014) provides more time to prepare, you should begin now. Create a list of your practice’s electronic systems and work flow pro-cesses using ICD-9 codes, both clinical and administrative—in-cluding payers, contractors, clearing houses and vendors. If you’re not sure if your circle of vendors, contractors, payers, clearing hous-es, and billing companies are ready, ask.Begin by communicating to all of your vendors and contracted pay-ers to get an idea of where they are in regard to ICD-10 readiness. De-termine which existing vendors will be affected by the ICD-10 tran-sition. Define requirements you will need from vendors to support your ICD-10 implementation. Determine if systems vendors and/or clearinghouses/billing services will support changes to systems, supply a timeline and cost estimate for implementation changes, and identify when testing will occur. Determine the anticipated testing time and a schedule. Put everything in writing. Begin testing four to six months before the live date to assess glitches that may affect payment. Identify crosswalk capabilities with your system for operating in ICD-9-CM and ICD-10-CM. Workers com-pensation carriers are not considered covered entities under Health Insurance Portability and Accountability Act (HIPAA) and are not required to make the transition to ICD-10-CM. If you are contract-ed with these carriers, contact them and ask them if they will be con-verting to the ICD-10-CM system.
Explore “Plan B” options in case your vendor does not progress fast enough, including operational workarounds and vendor replace-ment alternatives.
Coder“My main concern is getting clinical staff – especially doctors – on board for the transition. I do not see doctors changing their habits to become more specific. Coding will take twice as long, if not longer, by having to dissect every word into pulling out the perfect diagnosis when the doc-tor or provider could have provided the needed information all along.”Coding Staff of Calypso Enterprises, LLCUnspecified diagnoses will affect the revenue cycle, as well as the possibility of increased denials, because of incomplete or inaccurate translations of existing policies, benefits, and payment rules in pay-er systems as they attempt to transfer these rules to ICD-10-CM. Payments delays due to challenges in claim processing in the ICD-10 environment will include:
• Can the system maintain both ICD-9-CM and ICD-10 CM for a time?
• Can the database support so many codes?• Can it distinguish ICD-9-CM and ICD-10-CM code?• How will the code set updates be managed?
Solution: Explore these areas with your staff, vendors, and clear-ing houses. Planning and implementing ICD-10-CM must include communication and significant collaboration on IT, finance, edu-cation, and problem solving.Knowing whether clinician documentation is specific enough can be determined using the aforementioned AAPC Physician Services “ICD-10-CM Assessment: Documentation Readiness Evaluation.” Regardless of the size of your practice, steps toward implementation must begin now. As Winston Churchill said, “He who fails to plan is planning to fail.”
Kathy Rowland, CPC, CPC-I, CEMC, CHC, of Integrity Compliance, LLC, has over 25 years in the areas of health care administration and management. Nine years were spent specifically in the development and implementation of practice-based compli-ance plans, auditing documentation, and litigation support. She holds certifications in evaluation and management coding, compliance, and as an AAPC instructor. Ms. Rowland is also an ICD-10 trainer for AAPC.
Resources: 1. Centers for Medicare & Medicaid Services (CMS):
www.cms.gov/Medicare/Coding/ICD10/downloads/ICD10SmallandMediumPractices508.pdf2. AAPC:
www.aapc.com/icd-10/index.aspx
Todiscussthisarticleortopic,gotowww.aapc.com
Begin by communicating to all of your vendors and contracted payers to get an idea of where they are in regard to ICD-10 readiness.
www.aapc.com August 2012 45
A&PQuiz
Think You Know A&P? Let’s See …
ByRhondaBuckholtz,CPC,CPMA,CPC-I,CENTC,CGSC,COBGC,CPEDC
Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, is vice president of ICD-10 Training and Education at AAPC.
For arthritis patients, the two clinical clues most helpful for diagno-sis are the joint pattern and the presence or absence of extra-articu-lar manifestations. The joint pattern is identified by the answers to three questions: 1. Is inflammation present?
2. How many joints are involved?
3. What joints are affected?
Joint inflammation manifests as redness, warmth, swelling, and morning stiffness lasting at least 30 minutes. Both the number of affected joints and the specific sites of involvement affect the differ-ential diagnosis. Some diseases, such as gout, are characteristical-ly monarticular (affecting one joint), whereas other diseases, such as rheumatoid arthritis, are usually polyarticular (affecting many joints). The location of joint involvement can also be distinctive. Only two
diseases frequently cause prominent involvement of the DIP joint: osteoarthritis and psoriatic arthritis. Extra-articular manifestations, such as fever, rash, nodules, or neuropathy, narrow the differential diagnosis further.
TestYourselfAnswer this question to find out where your A&P skills rank.
What does the acronym DIP stand for?A. Diabetic insipid polyarthropathy
B. Distalinterphalangeal joint
C. Dormantinterphalangeal joint
D. Distal intra-articular joint
You will find the answer to this question on page 49.
2013 CODE BOOKS
Pre-Order Today!www.aapc.com/2013codebooks1-800-626-CODE (2633)
Physician Bundle 3 ICD-9 1 & 2 • HCPCS • Procedural Coding Expert
$304.85$124.95
Physician Bundle 1 ICD-9 1 & 2 • CPT® • HCPCS Level II
$304.85$169.95
Hospital Bundle 1 ICD-9 1-3 • CPT® • HCPCS Level II
$308.85$179.95
Physician Bundle 2 ICD-9 1 & 2 • HCPCS • CPT® • Procedural Coding Expert
$414.80$209.95
Hospital Bundle 2 ICD-9 1-3 • HCPCS • CPT® • Procedural Coding Expert
$418.80$219.95
Our Best Value!
LowestPrices
Anywhere
(484) 433-0495 www.CodingWebU.com
Tired of CD-Rom Courses that are out-of-date as soon as you take them?Tired of Audio Conferences where you cannot learn at your own pace?Tired of Online Courses you go through once and cannot access again?
If so, CodingWebU.com is your answer!We are the only program that provides interactive training incorporating audio, text and graphics to ensure you comprehend the information being taught. You will receive live updates as codes change and content is added.
You always have access to the most current information, even if you purchased the course three years ago.
We offer group discounts and reporting for larger customers.We can also create or host custom courses for your employees.
2012 Coding Scenarios ARE NOW AVAILABLE!!!2011 Annual CEU Coding Scenarios are also Available
Providing Quality Education at Affordable Prices
™CodingWebU.com
Over 60 Courses Approved for CEUs starting @ $30Pain Management Injections Emergency Department Coding Interventional RadiologyBurns, Lesions, and LacerationsBilling & ReimbursementGeneral Surgery CodingPhys. Pract. Revenue Mgm’tAdvanced Beneficiary Notices
AnatomyMedical TerminologyPhysicologyICD-10Chart AuditingRACCPT® & ICD-9 UpdatesE/M and OB/GYN
Specialty Coding ModifiersSleep DisordersMeaningful UseCompliance E|M CodingEHR...and more
CALL NOW to order your 2013 Coding Books!
www.aapc.com August 2012 47
AbbyJMiles, CPC
AdnerisQuinonez, CPC-H
AdriaSampson, CPC
AdrianaRuiz, CPC
AdrieneColesEllis, CPC
AlinaDiaz, CPC
AllisonJ.Hogan, CPC
AlmaSalcedo, CPC
AmandaAPierson, CPC
AmandaCSolon, CPC
AmandaLynnMartin, CPC-H
AmyRose, CPC
AmyKohlmann, CPC
AmyPhillips, CPC
AmyPurdy, CPC
AnaWagner, CPC
AngelaBlackwell, CPC
AngelaLynnGalea, CPC
AngellaGrim, CPC
AniDamatian, CPC
AnnAllison, CPC
AnneMorris, CPC
ArvellaOglesby, CPC
AshleyCThomas, CPC
AshleyRyall, CPC
AshleyYawn, CPC
BarbaraGentilini, CPC
BeckyDAlston,CPC, CPC-H
BelindaVasquez, CPC
BethAnnBuchanan, CPC
BethWWest, CPC-H
BettyGoolsby, CPC
BonnieAldrich, CPC
BrendaCooper, CPC-H
BrittanyMLemmons, CPC
CandaceGriffin, CPC
CandiceBrown, CPC
CarolAFarnsworth, CPC
CarolDison, CPC
CarolFisher, CPC
CarolSRoss, CPC
CarolWilson, CPC
CaroleLynnSharp, CPC
CarrieMann, CPC
CathyLChipman, CPC
ChelseaElizabethRing, CPC
CherylFliszar, CPC
CherylLynnValdez, CPC
CherylPosey, CPC
CheryllLynnArthur, CPC
ChristaWilliams, CPC
ChristinaGee, CPC
ChristineRuthMiller, CPC
ChristineVarner, CPC
ChristopherWest, CPC
ClariceCote, CPC
ColeenLissaMiller, CPC
ConnieCurtis, CPC
ConnieLeaBray, CPC
CostinelaBreahna, CPC
CouralisaLittle, CPC
CraigMoural, CPC
CrestaChristensen, CPC
CynthiaGunera, CPC
CynthiaMTrudeau, CPC-H
CynthiaMurdock, CPC
DanaMCruttenden, CPC
DarleneJohnsonLovett,CPC, CPC-H,CPCO,
CPMA
DarylLeeNache,CPC, CPC-H,CPMA
DawnMarieMailloux, CPC
DawnPruitt, CPC,CPEDC
DeannaEKwak, CPC
DeborahALondon,CPC, CPC-H
DeborahBroyles, CPC
DeborahRTerry, CPC
DebraEsham, CPC
DebraABaker, CPC
DebraFarley, CPC-H
DeeAnnSpringfield,CPC,CPC-H, CPC-P,CUC
DenaMTerry, CPC-H
DesireeBernadetteJohns, CPC
DesireeDeirdreMcCann,CPC, CPC-H,CPMA
DianaAnaValdez, CPC
DianaDavis, CPC
DiannaGilmore, CPC
DiedraMallory, CPC
DonnaStuber, CPC
EdithCardiff, CPC
ElenaRodriguez, CPC
ElizabethChapman, CPC
ElizabethPField, CPC
ElizabethRodriguez, CPC
EmileeAnnCatelo, CPC
EmilyMiller, CPC
EricaBrownawell, CPC
ErikaLambright, CPC
ErinAlanaBarnette, CPC
EugeneDefrees, CPC
FayeSkrdla, CPC
FrankLouisUngvary, CPC
GabrielaVazquez, CPC
GailDSchilling, CPC
GailParravicini,CPC, CPC-H
GiginaLMoran, CPC
GinaUSingson, CPC
HaileyReneeBaxter, CPC-H
HeatherDiaz, CPC
HeatherDunlap, CPC
HeatherMGales, CPC
HeatherMichelleWillis, CPC
HeatherTadlock, CPC
HeidiAnnSummerlin, CPC
HelenLe, CPC
HelenMLarkins, CPC
HollySheetz, CPC
HopeSConner, CPC
IrisSuarez, CPC
JacquelineDJoyner, CPC
JacquelynFerguson, CPC
JamieWerts, CPC-H
JanMattson, CPC
JanMoses, CPC
JaneilAddison, CPC
JanetSeymour, CPC
JanetMariePollard, CPC
JanetSHodgdon, CPC
JeanneannMTalasazan, CPC-H
JeffKrider, CPC
JenniferGrippando, CPC-H
JenniferFenstermaker, CPC
JenniferLynnHeuer, CPC
JenniferLysaKelley, CPC
JenniferStrouth, CPC
JennyYLopez, CPC
JesseeNicholeSnow, CPC
JillWard, CPC
JohnChau, CPC-H
JoyceDalton, CPC
JudyLynnNaples, CPC
JudybethFernandez,CPC, CPC-P
JulieAnneRezendes, CPC
JulieLynnEavenson, CPC
JulieMaffetone, CPC
JulieZick, CPC
KahlynnLawrence, CPC
KarenLynnStanley, CPC
KatherinePaguioMagpantay,CPC, CPC-H
KathleenLouiseWhitley, CPC
KathrynERiley, CPC
KathyASchnautz,CPC, CPC-H
KathyASmith, CPC
KathyRaymer, CPC
KatrinaBell, CPC
KatyPegorsch, CPC
KeishaAllmond, CPC
KellyEMayo,CPC, CPC-H
KellyJackson, CPC
KerriLHewitt, CPC
KerryAllen, CPC
KerrySkolnick, CPC
KimVasarab, CPC
KimberlyDMorgan, CPC
KimberlyHaas, CPC
KimberlySteele, CPC
KizzyLashonWilliams, CPC
KrisLLang, CPC,COSC
KrisSmith, CPC
KristaKEdwards, CPC
KristiElliott, CPC
KristinBrace, CPC
KristinEPiccolo, CPC
KristinJoySeara, CPC
LaceySpringer, CPC
LaraAiken, CPC
LauraHicks, CPC
LaurieAnneTanner, CPC
LeiannaGladden, CPC
LesaApplegateSmiley, CPC
LindaSScarlett, CPC
LindsayChriss, CPC
LindseyHoffman, CPC-H
LisaMPoitra, CPC
LisaMRice, CPC-H
LisaMariaArcher, CPC
LizzyRandleman, CPC-P
LolitaJoyce, CPC
LorettaMVittoria, CPC
LoriGibbs, CPC
LoriLeeSnyder,CPC, CPC-H
LoriMStapel, CPC
LorindaBolton, CPC
LudmilaYanishak, CPC
LyndaEileenJimenez,CPC, CPC-P,CPMA,CEMC
MagdaRodriguez, CPCMaraLynnHudock, CPC
MargretWunsch, CPC
MargueriteMarsh, CPC
MarianaCLalloz, CPC
MarilynMartinus, CPC
MarneLLasky, CPC
MartaMoscicka-Tecza, CPC
MarthaVeronicaRangel, CPC
MaryCatherineBlevins, CPC-H
MaryDax, CPC-P
MayaKrishanaJinwright, CPC
MeganHelenFoley, CPC
MeganSkeans, CPC
MelanieAmeliaMclin, CPC
MelissaAnnBorgel, CPC,CEDC
MelissaFrancis, CPC
MichaelShawnHammond,CPC, CPC-H
MicheleAnneRacioppi, CPC
MichelleKorbisch, CPC
MichikoUyeke-Esmeria, CPC
MonaLPratt, CPC
NancyRosales, CPC
NancySalas, CPC
NicoleAndreaWaryn, CPC
NicoleLEllis, CPC
OfeliaUrbina, CPC
OliviaDeterling, CPC
PamelaDropik, CPC
PamelaJHanna, CPC
PatriciaBarta, CPC
PatriciaGomez, CPC
PennyGaines, CPC
PrasanthKumarThudukurthi,CPC, CPC-P
RachelJarmon, CPC
RavikumarJayaraj,CPC, CPC-P
ReginaVWilliams, CPC
RhondaBirkner, CPC
RicHanna, CPC
RochelleORoberts, CPC
RodicaMoga,CPC,CPC-H, CPC-P
SandraGamboa, CPC
SaraMichelleStoll, CPC
SeerojnieRamgobind, CPC
ShandaNicoleMunoz, CPC
ShannonSwiderskiProvenza, CPC
ShaynaLeighDecker, CPC
SheenaLBooher, CPC
SheriJensen, CPC
StaceyAKerkache, CPC
StacyLynnMonell, CPC
StephanieAHolland, CPC
StephanieDHenslee, CPC
StephanieEast, CPC
SuePruden, CPC
SusanPope, CPC
SusanElainePringle, CPC
SusanKSmith, CPC
SusanMMathews, CPC
SusanMorris, CPC
SuzanNeel, CPC
SuzanneCEdin, CPC
SuzanneElizabethCarballo-Martinez, CPC
SylviaARuffin-Cuffee, CPC
TamaraLLucus,CPC, CPC-H,CPMA,CPC-I
TammieWomack, CPC
TammyYMossman,CPC, CPC-H
TaraChilders, CPC
TauraWay, CPC
TejalPatel, CPC
TeneshaBryan, CPC
TenoyaDBennett-Toyryla, CPC
TeresaRaymond, CPC
TeressaCupil, CPC-H
TinaMoore, CPC
TonyaLJustice, CPC
TraceyDenisePierce, CPC
TracieAnnHenry, CPC
VickiLizotte, CPC
VictoriaLPashia,CPC, CPC-H
VictoriaRentrop, CPC
VictoriaSloanOrr, CPC
VinothRamdass,CPC, CPC-P
WandaGarcia, CPC
WendyGonzalez, CPC
WendyShope, CPC
ApprenticesAbbeyGearhart, CPC-A
AbigailErlandson, CPC-A
AdamMask, CPC-A
AfroditiKaranikola, CPC-A
AizaAmorsolo, CPC-A
AlanaFrench, CPC-A
AlbertaLaws, CPC-A
AlejandraLetic, CPC-A
AlexandraKristineLuna, CPC-A
AlexisWard, CPC-A
AliciaDawnMoseley, CPC-A
AliciaHerman, CPC-A
AliciaThorpe, CPC-A
AlishaAbel, CPC-A
AllysonBrown, CPC-A
AmandaCluck, CPC-H-A
AmandaGPearce, CPC-A
AmandaGailMorris, CPC-A
AmandaJTenEyck, CPC-A
AmandaKerr, CPC-A
AmandaMarieYankah, CPC-A
AmandaRaeRasmussen, CPC-A
AmandaReneeSchuchardt, CPC-A
AmandaRichards, CPC-A
AmandaRichards, CPC-A
AmandaTate, CPC-A
AmaraSmith, CPC-A
AmberRashid, CPC-A
AmieAdeleOrsland, CPC-A
AmoryTolbert, CPC-A
AmritaRaja, CPC-A
AmyCooper, CPC-A
AmyGarrett, CPC-A
AmyGoldstein, CPC-H-A
AmyLynnClark, CPC-A
AmyMcArdle, CPC-A
AmyRoss, CPC-A
AnastashaJett, CPC-A
AndreaHall, CPC-A
AndrewWBaker, CPC-A
AndyWelch, CPC-A
AngelaGregorio, CPC-A
AngelaReid, CPC-A
AnithaAnandan, CPC-A
AnnCrary, CPC-A
AnnaCreech, CPC-A
AnnieRandall, CPC-A
AprilMichelleRigdon, CPC-A
AshleyBates, CPC-A
AshleyHall, CPC-A
AshleyHollon, CPC-A
AshleyRocha, CPC-A
AubreyAntiojo, CPC-A
AubreyBulaonAblir, CPC-A
AvaElizabethHall, CPC-A
BaileyNicoleVincent, CPC-A
BarbaraHetzel, CPC-A
BarbaraNoble, CPC-H-A
BarbaraScaboo, CPC-A
BeatrizA.Gonzalez, CPC-A
BeckyZhang, CPC-A
BethanyStarliper, CPC-A
BettyLogan, CPC-A
BeverlyEllenMurphey, CPC-A
BobbiKegler, CPC-A
BrandiGlasscock, CPC-A
BrandonEdwardKoller, CPC-A
BrandyBell, CPC-A
newly credentialed members
48 AAPCCodingEdge
NewlyCredentialedMembers
BrendaLMooneyham, CPC-A
BrigitteFagan, CPC-A
BrittanyDull, CPC-A
BrittneyWinn, CPC-A
BrookeAnneAlsup, CPC-A
BrookeStamm, CPC-A
CaitlinBrianneClemons, CPC-A
CaitlinCarroll, CPC-A
CameronMasaoka, CPC-A
CammyReneeDuvall, CPC-A
CandiceCarter, CPC-A
CandiceGilliard, CPC-A
CarissaStark, CPC-A
CarlaCornwell, CPC-A
CarmenAnieceReed, CPC-A
CarolBabson, CPC-A
CarolMeade, CPC-A
CaroleLudwig, CPC-A
CarolynAxthelm, CPC-A
CarolynEBeers, CPC-A
CarrieAnnSorensen, CPC-A
CarrieCook, CPC-A
CarrieFillar, CPC-A
CarrieNohel, CPC-A
CarriePennybacker, CPC-A
CarrieSmallwood, CPC-A
CarynSlackMD, CPC-P-A
CaseyGowers, CPC-A
CaseyNicoleHorning, CPC-A
CaseySmith, CPC-A
CassandraBugbee, CPC-A
CelesteKotowski, CPC-A
ChanelDavenport, CPC-A
ChantaAdams, CPC-A
CharleenRemedios, CPC-A
CharleneBaase, CPC-A
CharleneWilbur, CPC-A
ChelseaFrank, CPC-A
ChelseaHuff, CPC-A
CherrylCaladesDeAsis, CPC-A
CherylASutherland, CPC-A
CherylCastaneda, CPC-A
ChrisRouff, CPC-A
ChristieHickman, CPC-A
ChristineAJones, CPC-A
CindiRBrashear, CPC-A
ConnieJClarke, CPC-A
ConnieMDixon, CPC-A
ConnorManning, CPC-A
CorinaGarcia, CPC-A
CortneyTNettles, CPC-A
CourtneyLaneRobinson, CPC-A
CrissyBurns, CPC-A
CynthiaAHarris, CPC-A
CynthiaDeniseWood, CPC-A
CynthiaJohnson, CPC-A
CynthiaMarieCraig, CPC-A
DanGriffith, CPC-A
DanaChock, CPC-A
DanielaPlourde, CPC-A
DanielleLeeEckstein, CPC-A
DanielleThompson, CPC-A
DanitaBryant, CPC-A
DarleneKJacobs, CPC-A
DarleneMHubbard, CPC-A
DarrylBowers, CPC-A
DarshanRattenahalliSomashekaraiah, CPC-A
DavidAlexanderLeClair, CPC-A
DavidElkins, CPC-H-A
DavidMMalecki, CPC-A
DavidWestcott, CPC-A
DawnDavenport, CPC-A
DeborahAnnWoods, CPC-A
DeborahLadd, CPC-A
DeborahMcClure, CPC-A
DeborahRhoads, CPC-A
DebraMulliken, CPC-A
DeedriaJohnson, CPC-A
DeinnaCervera, CPC-A
DemetriaJackson, CPC-A
DenetteSlafter, CPC-A
DeniseCox, CPC-A
DeniseMOlszewski, CPC-A
DianeBorrego, CPC-A
DianneGrant, CPC-A
DonnaEnste, CPC-A
DonnaFortenberry, CPC-A
DonnaLane, CPC-A
DorothyMillerBateman, CPC-A
EdenElizabethGusewelle, CPC-A
EileenRachelleLarroza, CPC-A
ElaineAHarbold, CPC-H-A
ElaineBeaupied, CPC-A
ElisaWilkerson, CPC-A
ElizabethDavis, CPC-A
ElizabethHillVedder, CPC-A
ElizabethWeber, CPC-A
EllenSilverman, CPC-A
EllisonDavidElizaga, CPC-A
ElviraCastelluzzo, CPC-A
EmilyMoore, CPC-A
EmmanuelIgnacioAlmeda, CPC-A
EricPound, CPC-A
EricaStahl, CPC-A
EricaCommedo, CPC-A
EricaDeza, CPC-A
ErinCantiberry, CPC-A
ErinWilliams, CPC-A
FaeLPrice, CPC-A
FlorDiaz, CPC-A
FrancisPaulaParriett, CPC-A
GabrielaYep, CPC-A
GailStoops, CPC-A
GeneMciver, CPC-A
GinaRouse, CPC-A
GinnyEdge, CPC-A
GirirajParthasarathy, CPC-A
GlennClarkEasterling, CPC-A
GwendolynPfeiferAdmire, CPC-A
HarinderKaur, CPC-A,CPC-H-A
HariniKatam, CPC-A
HarriettMarieSoumah, CPC-P-A,CPMA
HeatherPayne, CPC-H-A
HeatherRGoldsby, CPC-A
HollyGeller, CPC-A
ImaiyanvanVaruthappan, CPC-A
InnaVerbitskaya, CPC-A
JackieEngleson, CPC-A
JacobMarcSonkin, CPC-A
JacquelineMLaires, CPC-A
JacquelineSLai, CPC-A
JamiePerucca, CPC-A
JanelWilson, CPC-A
JanetHowell, CPC-A
JanetSueFike, CPC-H-A
JasonDenson, CPC-A
JeanBoyer, CPC-A
JeanMPage, CPC-A
JeanelleSmith, CPC-A
JeanineSGallagher, CPC-A
JeanmarieMorse, CPC-H-A
JenniferAileenAlvara, CPC-A
JenniferBurke, CPC-A
JenniferEzzell, CPC-A
JenniferGould, CPC-A
JenniferHart, CPC-A
JenniferHeiser, CPC-A
JenniferJJohnson, CPC-A
JenniferLeep, CPC-A
JenniferMichelleStJohn, CPC-A
JenniferParks, CPC-A
JenniferPaynter, CPC-H-A
JenniferReed, CPC-A
JenniferRumble, CPC-A
JenniferSShepegi, CPC-A
JenniferSnodgrass, CPC-A
JennipherWioskowski, CPC-A
JessicaBryant, CPC-A
JessicaLynnMcKenna, CPC-A
JessicaNoelRodrigues, CPC-A
JillSparr, CPC-A
JillTracyPorter, CPC-A
JoSwanston, CPC-A
JoanMSestili, CPC-A
JoelleThomas, CPC-A
JoeyFleury, CPC-A
JohannaJohnson, CPC-A
JohnPatrickAtienza, CPC-A
JohnRuzelBalagtasUrrutia, CPC-A
JoleenSomers, CPC-A
JomielynRafanan, CPC-A
JonnaDavis, CPC-A
JoseManuelFernandez, CPC-A
JoseRafaelFernandez, CPC-A
JoyceHolt, CPC-A
JoyceSmith, CPC-A
JudithRPlaza, CPC-A
JudithSponkowski, CPC-A
JuleahRyder, CPC-A
JuliaAWahler, CPC-A
JulieMace, CPC-A
JunauferPonce, CPC-A
KaitlinMarieBrown, CPC-A
KalavaRajyalakshmi, CPC-A
KalpanaMunagala, CPC-A
KarenAnneHutton, CPC-A
KarenClarke, CPC-A
KarenJSharrah, CPC-A
KarenJones, CPC-A
KarenKRasmussen, CPC-A
KarenYOwens, CPC-A
KarieWessling, CPC-A
KarlySadkovich, CPC-A
KarmaSanchez-Garcia, CPC-A
KatelynnKHill, CPC-A
KatherineMelendez, CPC-A
KathleenKleinbauer, CPC-A
KathleenMcCorkle, CPC-A
KathleenSTuinstra, CPC-A
KathrynDanielleWhitney, CPC-A
KathrynGraceScott, CPC-A
KathyGunderson, CPC-A
KathyLephart, CPC-A
KathyMarkham, CPC-A
KatieAnnReed, CPC-A
KatieMalone, CPC-A
KaylaMBeachler, CPC-A
KaylaMFisher, CPC-A
KellyMeeksChilds, CPC-A
KellyRaeCentazzo, CPC-A
KelsieMarieJohnson, CPC-A
KeriCasper, CPC-A
KevinGarciaFajardo, CPC-A
KimClark-Scott, CPC-A
KimJoMcCollum, CPC-A
KimKeller, CPC-A
KimOswalt, CPC-A
KimTillery, CPC-A
KimberlyRodriguez, CPC-A
KimberlyAnnKading, CPC-A
KimberlyJones, CPC-A
KimberlyLynnRobeson, CPC-A
KimberlyMBanter, CPC-A
KimberlyMarieCox, CPC-A
KimberlySStamp, CPC-A
KimberlySmith, CPC-A
KimberlySmith, CPC-A
KimyattaBivens-Little, CPC-A
KrishaRayneKines, CPC-A
KristenLynnGoodnight, CPC-A
KristenStreet, CPC-A
KristiDeAnnBoyd, CPC-A
KristiElzy, CPC-A
KristiEricksonWilken, CPC-A
KristiRiendeau, CPC-H-A
KristieLRiches, CPC-A
KristiePruitt, CPC-A
KrystalWynter, CPC-A
KyleCole,CPC-A,CPCO, CPC-P-A
KymCarson, CPC-A
La’ShannaCorineGoodwin, CPC-A
LaceyWilliamson, CPC-A
LachelleRobinson-Mason, CPC-A
LacindaWiles, CPC-A
LaDondaGonsalves, CPC-A
LauraBurden, CPC-A
LauraGibbs, CPC-A
LaurenStiller, CPC-A
LaurettaCarter, CPC-A
LaurieCatherineNorris, CPC-A
LaurieLBrown, CPC-A
LavanyaAnumala, CPC-A
LawrencePaoloBautista, CPC-A
LeeAnnaArleneFlint, CPC-A
LenoreCioffi, CPC-A
LeslieAVanTilburg, CPC-A
LeslieKAleck, CPC-A
LethaLee, CPC-A
LexiHolder, CPC-H-A
LianetteCampos, CPC-A
LilianaSuarez, CPC-A
LindaCase, CPC-A
LindaLeeAiken, CPC-A
LindaPerryDavis, CPC-A
LindseyMarieAustin, CPC-A
LindyLogue, CPC-A
LisaAnnChamberlin, CPC-A
LisaBailey, CPC-A
LisaDePietro, CPC-H-A
LisaJSeslar-Lamont, CPC-A
LisaLopez, CPC-A
LisaStephens, CPC-A
LisetteKatrinaCota, CPC-A
LizMcCready, CPC-A
LoraDisbro, CPC-A
LoriLaClair, CPC-A
LoriBolesta, CPC-A
LoriCurtis, CPC-A
LorvelineArviolaPenus, CPC-A
LouizaSarkisyan, CPC-A
LourdesAyala, CPC-A
LusineBarseghyan, CPC-A
LykaAnneAngeles, CPC-A
LynetteAnnNagy, CPC-A
LynnMLeist, CPC-A
LynnVaughan, CPC-A
MaTheresaMarpa, CPC-A
MagdahReynoso, CPC-A
MaggieDziubek, CPC-A
MaheshKoppachari, CPC-A
MandyScheiderman, CPC-A
ManjuNair, CPC-A
MarcyLLinke, CPC-A
MargaretBehrmann, CPC-A
MargaretWoodcock, CPC-A
MargieKayAlderman, CPC-A
MariaLaou, CPC-A
MariaCarmelaBautista, CPC-A
MariaCartagena, CPC-H-A
MariaOrtiz, CPC-A
MariaSiennaFeOchavePamintuan, CPC-A
MariaTeresaGinezContreras, CPC-A
MariahMBanks, CPC-A
MarieFarrell, CPC-A
MarietteElizee, CPC-A
MarilynPacheco, CPC-A
MarilynRadtke, CPC-A
MarinaSpektor, CPC-A
MarkaleneFEarles, CPC-A
MarloRainDeLeon, CPC-A
MarthaASkidmore, CPC-A
MartiMcCall, CPC-A
MarvareeBailey, CPC-A
MaryLPoole, CPC-A
MaryMSherrod, CPC-A
MaryWCaporale, CPC-A
MaryWClarke, CPC-A
MaryWaninger, CPC-A
MaryAnnThompson, CPC-A
MarylineMedina, CPC-A
MarylouTammaro, CPC-A
MatthewPyer, CPC-A
MeganPodrez, CPC-A
MelindaMaeYoung, CPC-A
MelissaBodvar, CPC-A
MelissaRoberts, CPC-A
MelissaHardy, CPC-A
MelissaJaneKurtz, CPC-A
MelissaVanNieulande, CPC-A
MercyPriyadarsini, CPC-A
MichaelaMichelleHensley, CPC-A
MicheleLGruntz, CPC-A
MicheleStone, CPC-A
MichelleJohnson, CPC-A
MichelleLoera, CPC-A
MindyRuble, CPC-A
MireyaCoria, CPC-A
MistySparkman, CPC-A
MohammadAzharHussain, CPC-A
MonicaEdwards, CPC-A
MonicaShatnawi, CPC-A
MumthasYoosuf, CPC-A
NancyAnnFeisel, CPC-A
NancyCMak-Tse, CPC-A
NancyLBingham, CPC-A
NancyMoreau, CPC-H-A
NaomiJones, CPC-A
NatalieAWaddle, CPC-A
NatashiaReneeHubbard, CPC-A
NicholeLear, CPC-A
NicoleBarcellos, CPC-A
NicoleCHaller, CPC-P-A
NicoleMOliver,CPC-A, CPC-H-A
NicoleWilliams, CPC-P-A
NikkiDeGregorio, CPC-A
NikkiReal, CPC-A
NuriaDolan, CPC-A
OliviaPace, CPC-A
OpheliaMalagayo, CPC-A
PamGould, CPC-A
PamelaBarker, CPC-A
PaolaTaborda, CPC-A
PatriciaAWilson, CPC-A
PatriciaFox, CPC-A
PaulJohnAbboud, CPC-A
PaulMora, CPC-A
PaulaAFolts, CPC-A
PaulaBWhetstone, CPC-A
PaulaKayDyck, CPC-A
PaulaRandall, CPC-A
PaulaVBurklow, CPC-A
PennyGeary, CPC-A
PennyWaterman, CPC-A
PlamenaElenski, CPC-A
PraveenKumarPolepaka, CPC-A
www.aapc.com August 2012 49
NewlyCredentialedMembers
QuentonLMyhand, CPC-A
RachelDBrunswick, CPC-A
RachelSanchez, CPC-A
RachelleBonghanoy, CPC-A
RadhikaNakirikanti, CPC-A
RafaelAntoniodelaVega, CPC-A
RajithaKandimalla, CPC-A
RamonGonzalez, CPC-A
RamonaMarieVickrey, CPC-H-A
RamonaGrow, CPC-A
RandeeMoore, CPC-A
RaveendraChagantipati, CPC-A
RebeccaAWallace, CPC-A
RebeccaChatham, CPC-A
RebeccaJaggernauth, CPC-A
RebeccaJewelBrouillette, CPC-A
RebeccaNorris, CPC-H-A
RebeccaReneeConnors, CPC-A
RebeccaWCrytser, CPC-A
RedaleenDevibarGarcia, CPC-A
ReginaGallagher, CPC-A
ReneaRMoore, CPC-A
ReneeHuddleston, CPC-A
ReneeReno, CPC-A
RhondaGraf, CPC-A
RhondaLorenz, CPC-A
RhondaSimonian, CPC-A
RhondaSphon, CPC-A
RobinStewart, CPC-A
RobinDMccoy, CPC-A
RobinFeldman, CPC-A
RodneyFSheets, CPC-A
RogerRamos, CPC-A
RonHamiter, CPC-A
RonaldLeeMcKeown, Jr.,CPC-A
RondaDay, CPC-A
RuthFlowersGodwin, CPC-A
RuthLauer, CPC-A
RuthSSheets, CPC-A
RyanAlmero, CPC-A
SabrinaFoster, CPC-A
SabrinaLeighFoy, CPC-A
SalehMarette, CPC-A
SamJohnson, CPC-A
SamanthaAlisonMehne, CPC-A
SamanthaStidham, CPC-A
SandraRyen, CPC-A
SandraScarberry, CPC-A
SandyElftman, CPC-A
SandyWatkins, CPC-A
SaraEllenHuffine, CPC-A
SaraShafer, CPC-A
SarahLMitchell, CPC-A
SarahLewis, CPC-A
SarahOrtiz, CPC-A
SarinaKMayer, CPC-A
SathiyaSeelan, CPC-A
SeanGroves, CPC-A
ShameliaPerdue, CPC-A
ShannaRoseLeonardo, CPC-A
ShannonDearborn, CPC-A
ShannonJohnson, CPC-A
ShannonWildenberg, CPC-A
SharonLoeffler, CPC-A
SharonManiaci, CPC-A
SharonNolf, CPC-A
ShashidharAmeenpur, CPC-A
ShawnGass, CPC-A
ShawntayMichelleNichols, CPC-A
SheaGoodwin, CPC-A
SheejaKR, CPC-A
ShejilBabuPadincharethil, CPC-A
ShelbyBockman, CPC-A
SherriRHughes, CPC-A
SherrieRyan, CPC-A
SherrvonneJones, CPC-A
SherryWhitfield, CPC-A
SherynPayton, CPC-A
ShilpaLaggeri, CPC-A
ShwethaKasturi, CPC-A
SimoneWilliams, CPC-A
SireenaDeFazio, CPC-A
SirpaLepisto, CPC-A
SoniaLopez, CPC-A
SonyaGetchell, CPC-A
SonyaPage, CPC-A
SonyaRamsey, CPC-A
StaceyThomas, CPC-A
StacyGogel, CPC-A
StefaniBelew, CPC-A
StefanieOsborne, CPC-A
StephanieAnnStines, CPC-A
StephanieDianeLopez, CPC-A
StephanieObenour, CPC-A
StephanieReneeMcIver, CPC-A
StephanieSmart, CPC-A
StephanieSmith, CPC-A
StephenHirst, CPC-A
SueMcNamara, CPC-A
SunniAMunoz, CPC-A
SupriyaVendidandi, CPC-A
SureshBabu, CPC-A
SusanA.Boose, CPC-A
SusanBagis, CPC-A
SusanBurbank, CPC-A
SusanClark, CPC-A
SusanElizabethAlterman, CPC-A
SusanHawkins, CPC-A
SusanLute, CPC-A
SusanWitzke, CPC-A
SusanneLischer, CPC-H-A
SuzanneHonor, CPC-A
SuzieSawyer, CPC-A
SwethaChada, CPC-A
SylwiaStruk, CPC-A
TamaraRenaeMarkle, CPC-A
TamiHammond, CPC-A
TammiePMcClendon, CPC-A
TammyJeanWilson, CPC-A
TaraStallwood, CPC-A
TaraBlazakis, CPC-A
TaraMaurineBratcher, CPC-A
TaraMichelleSecco, CPC-A
TeannaStrahin, CPC-A
TeddieKirk, CPC-A
TeriParrish, CPC-A
TerriThompson, CPC-A
TerriGibbs, CPC-A
TerrieLynnJackson, CPC-A
TerryJames, CPC-H-A,CIRCC
TheresaArdelean, CPC-A
TheresaClay, CPC-A
ThereseFEspiritu, CPC-A
TiffannieLaurenCastle, CPC-A
TiffanyNSmith, CPC-A
TiffanyPruitt, CPC-A
TimothyRayBaker, CPC-A
TinaMarieMartin, CPC-A
TonyaLToney, CPC-A
TonyaReeves, CPC-A
TracyAnnHughes, CPC-A
TracyAnnWright, CPC-A
TracyJoSchreiner, CPC-A
TrishaChing, CPC-A
TrishaNicoleHand, CPC-A
TrishelleDeCoite, CPC-A
TristaMiller, CPC-A
TristaShoemaker, CPC-A
TwilaDykstra, CPC-A
UdayaKumarGonuguntla, CPC-A
ValerieJoRosati, CPC-A
ValeriePachak, CPC-H-A
VanessaMason, CPC-A
VeronicaJeanWoolfolk, CPC-A
VeronicaLaMeshaMoss, CPC-A
VeronicaLeeJackson, CPC-A
VickiCaudill, CPC-A
VictoriaCarpenter, CPC-A
ViniceLDuring, CPC-A
VirginiaMHall, CPC-A
WendyGrove, CPC-A
WhasookPark, CPC-A
WilliamJarredForrester, CPC-A
WinifredYaaEkeh, CPC-A
YulianaTeresaLagarda, CPC-A
SpecialtiesAlyssaKayOwens,CPC-A, CANPC
AmyDebenham,CPC, CPEDC
AmyKMorgan,CPC, CPMA,CEMC,CGSC
AnaParrotta,CPC, CANPC
AngelaBrown, CPCO
AngelaKaySmith,CPC,CFPC, COBGC
AnilaPrasad,CPC, CPMA
AnnaBWeaver,CPC, CPMA,CEMC
AnnaMMorissette,CPC, CGIC,CGSC
AnnetteLewis,CPC, CPMA
AnnMarieCharles,CPC, CPMA,CUC
ArianneEchemendia,CPC, CPMA
BelindaCopeland,CPC, CEMC
BevCallow, CCC
BrendaKMook, CCC
CarmelaHeshike,CPC, CPMA
CarolAnnBrinson,CPC, CPMA
CarynSmith,CPC, CRHC
CatherineEArment,CPC, COSC
ChayaHoward,CPC, CIRCC,CCC
ChequitaABattle,CPC, COSC
ChristinaLeeWagner,CPC,CPC-H, CGIC
ChristinaNicholaOlson, CPMA
CliffordCSumner,CPC, CIRCC
ColleenLennon,CPCO
CynthiaCSmith,CPC, CPMA
CynthiaHartline,CPC, CPMA
DamaysiBGonzalez,CPC, CPMA
DaniHolmes, CGIC
DanieyiMartinez,CPC, CPMA
DebbieLHayes,CPC, CPMA
DeeKelly,CPC, CPCO,CPMA,CPCD
DeirdreAnnReid-Fighera, CRHC
DeniseLSullivan,CPC, CGSC
DorisEberhardt,CPC, CUC
ElizabethAkopyan,CPC, CPMA
ElizabethGeiss, CRHC
ElizabethHorricks, COBGC
EllenMDixon,CPC, CPMA
FriedaRoshto,CPC, CPC-H,CPMA,CPC-I
GeraldineValdez, CUC
GuadalupeValdepena, CEDC
HarrietThomas-Fryer,CPC-H,CPC-P, CPMA
HelenPark, CRHC
IzelSilva, CPC,CPMA
JamieLBoltz,CPC,CPC-H, CPC-P,CPMA,CEMC
JaneClay, CPMA
JaneSusanWilson,CPC, CEMC
JanelMcDaniel,CPC, CPMA
JeannieDavis,CPC, CANPC
JenniferBorngraber,CPC, CGIC
JenniferMayeaux,CPC-A, CEMC
JoannaFernandez,CPC-A, CPMA
JuliaLima,CPC, CEMC
JulieWilson,CGSC, COBGC
JulieAnneFuhriman,CPC, CEMC
JulieEllenRoa,CPC, CPMA
JulieParks,CPC-A, CANPC
KanmaniSenthilkumar,CPC, CPMA
KarenSilva,CPC, CPMA
KarenSueConnors,CPC, CPMA
KarenWKelly,CPC, CPMA
KathrynAHeimerman,CPC, CGSC
KatieWells,CPC, CPMA
KelliLeAnnThompson,CPC, CEMC
KimReneeButts,CPC, CPMA
KristaLenig,CPC-P, CPMA
LaurenAnneBurdick,CPC-A, CPMA
LaurieAWilson,CPC, CPMA
LeslieWalden,CPC, COSC
LeticiaMarrero,CPC, CPMA
LilaHalverson,CPC, CPMA
LindaHuey,CPC, CGSC
LindseyLara,CPC, CPMA
LisaDonahue,CPC, CPMA
LisaVanLaan,CPC, CPMA
LisbehtBarrientos,CPC-A, CPMA
LiubaQuevedo,CPC-A, CPMA
LoriMahan,CPC, CPMA
LuciaMenendez,CPC, CIRCC
MaikoLindblom,CPC, CPMA
ManishaDNaik,CRHC
MaraMendez,CPC, CPMA
MareaLAspillaga,CPC,CPC-H, CPMA
MariaGabrielaTardencilla,CPC, CPMA
MarianneEUrtel,CPC, CEMC
MarleneDiaz,CPC, CPMA
MarthaChristieCallaghan,CPC, CPMA,CEMC,
COSC
MarthaLGaviria,CPC, CPMA
MatthewChristopher, CCPC
MelissaRusso,CPC-A, CIRCC
MicheleRCook,CPC, CPMA
MichelleAnneGenck, COBGC
MichelleLevis, CRHC
MichelleMiller, CCC
MichelleReneeRowell,CPC, CGIC
NathanMcNew, CPMA
NykiaAnnCabral,CPC, CEMC
PolinaEshkol, CPMA
RaisyMartinez,CPC-A, CPMA
ReneeSuzanneMorgan,CPC, CPMA
ReneeWhite,CPC, CPMA
RobinSharryScott,CPC, CEMC
RoseanneBrown,CPC, CIRCC
SandraTroade,CPC, CPMA
SandyVanDyke,CPC-H, COSC
SedonaMariaKirby,CPC-H, CPMA
SherylAnnetteHuffman,CPC, CPMA
SiddharthShah, CGIC
StaceyLynnHarper,CPC, CPMA
StacieLHawkins,RHIA, CPC,CEMC
SuharmyJimenez,CPC, CPMA
SusanDeBaugh, CFPC
SylviaDoggette, CPMA
TammyKramlinger,CPC, CANPC
TaniaGCruz,CPC, CPMA
TaniaLopez,CPC-A, CPMA
TeresaLThomas,CPC,CPC-H, CPMA
TeresaPearce,CPC, CIMC
TheresaAllen, CENTC
TheresaFischer,CPC, CPMA
TinaMCarr,CPC, CEMC
ToniJHodge, COBGC
TracieLeahHughes,CPC, CEDC
TracyMOlsten,CPC,CPMA, CPC-I
VennilaInba, CRHC
WandaMPrada,CPC, COSC
WandaMinnix,CPC, CPMA
WendyBMarchessault,CPC, CCC
YamilaPrendes,CPC,CPC-H, CPMA
YelinaDiaz,CPC, CPMA
YunaidesGonzalez,CPC, CPMA
Magna Cum LaudeAiledGonzalezTrujillo, CPC
AliciaMeadows, CPC
AmandaAles, CPC
AmandaNaulty, CPC
AngelaMBenkis, CPC-A
CamilleMorel, CPC-A
ChristinaCox, CPC-H
HeatherStokes, CPC-A
HosseinAMaleki,CPC, CIRCC
JeanneViloria, CPC-A
JenniferGibsonBlankenship, CPC-A
JenniferHayes, CPC-A
JoanSpalletta, CPC-A
KatherineMeyer-Cushing, CPC-A
KathyJMcClenahan, CPC-A
KimberlyGoode, CPC
LauraAGrieb, CPC-A
LindaPearl,CPC, CPMA
LisaMarieSuarez, CPC-A
LoriAnnMitchell,CPC, CPMA
LucretiaJMiller, CPC
MichaelaLandseerSeadale, CPC-A
PatriciaBouchard-Case, CPC
RanchielieRitarita, CPC-A
SalonicaGray, CPC-A
ShaneSindlinger, CIRCC
SindhumathiAnanthasayanam, CPC-A
StephanieColeman, CPC-A
SvitlanaHanson, CPC-H-A
TanyaLyons, CPC
VictoriaLKoontz, CPC-A
A&P Quiz AnswerThe correct answer is D. DIP is an acronym for distal intra-articular joint.
50 AAPCCodingEdge
Tell us a little bit about your coding career.
About 30 years ago, I was working in a prison hospital. The in-mates’ health care was contracted by the state, so we were re-quired to keep certain statistics using ICD-9 coding. My super-
visor offered to teach me coding and I gladly accepted. I went to college for medical office management and clinical arts, thinking eventually of a career in nursing. After learning coding, I took a detour and haven’t looked back. My career has included all aspects of coding, billing, office management, mainly in the physician and outpatient settings, with my previous position being senior reimbursement coding manager/consul-tant at a national orthopedic consulting firm. I am the ICD-10 educa-tor at the Medical University of South Carolina, and I also do indepen-dent coding consulting and teaching.
What is your involvement with your local AAPC chapter?I am a member of the Charleston, S.C. chapter. I was the chapter found-er and served as president of the Washington, D.C. chapter; I served as
president of another Charleston, S.C. chapter; and was a founder and secretary of the Hagerstown, Md. chapter. I have created a basic sem-inar, striving to keep costs down for maximum continuing education units (CEUs). I have mentored new members and happily report that some of them found employment through our networking.
What AAPC benefits do you like the most?I love networking with people all over the country. I have met many peo-ple at AAPC events and I’ve become good friends with some. Help is only a phone call or email away. My biggest AAPC benefit has been finding my position as a coding manager and consultant through my chapter in Washington, D.C. My boss was looking to fill a coding manager position and called the chap-ter officers from the officers’ list on AAPC’s website. He spoke with me and asked to let our members know about the position. I did as he re-quested, but after talking with him more about the position, I became very interested myself. I submitted my resume, we spoke again a couple of days later, and he asked me to meet the rest of the staff. I met with the staff the following week and was hired on the spot. If it weren’t for my local chapter, I would have never known about the position because he did not advertise it. I’ve since moved back to South Carolina, but I con-tinue to work for the company as an independent consultant.
What has been your biggest challenge as a coder?One challenge is explaining coding and reimbursement limitations to someone who wants reimbursement for a device and/or procedure when there is no coding for that particular situation. It is also a challenge hav-ing to explain that it’s not OK to code for a particular service or item just because it’s payable by insurance. Another challenge is finding the time to read and learn more about coding. Some days I want to know it all!
How is your organization preparing for ICD-10?We have an ICD-10 steering committee, made up with people from health information systems, information technology, finance, and many other departments, and we meet regularly. Our coders are work-ing on Procedure Classification System training and will follow that with Clinical Modification in the fall. We have also gone to comput-er-assisted coding in preparation for ICD-10 documentation require-ments.
If you could do any other job, what would it be?Sports management! I love sports.
How do you spend your spare time? I have a 24-year-old son, Lucas, and between us we have three dogs. I enjoy reading and cross-stitching. I love being outside, especially at the ocean. I am very involved as a volunteer with sea turtle rescue and nest-ing season on the beach.
MinutewithaMember
MachelleMorningstar,CPC,CPC-H,CEMC,COSC
Educator, Medical University of South Carolina, and Consultant
Unsure of what direction to take in preparing for the CPMA® exam?
Let NAMAS Help!
Log onto www.NAMASinfo.com and take the SELF ASSESSMENT TEST
This test will suggest the training that is best suited for you based on your current auditing knowledge. Training suggestions may include: ◊ You are ready! Take the exam ◊ Self Study Guide only
◊ AAPC Online Training Program ◊ Live NAMAS Training Event
NAMAS proudly offers CPMA® training as well as additional educational opportunities.
Visit our website and check our calendar to see all of the exciting places NAMAS will be visiting!
NAMAS wants to help coders and auditors “Enhance Your Career Through Education”
We want to help make your auditing career propel to the next level! Attend a NAMAS Training session in 2012 and you will be registered for the:
Auditor’s Career Kit
This kit will include: ◊ 2013 CPT®/ICD-9/HCPCS books ◊ 2013 Coding Updates Book ◊ NAMAS and AAPC paid memberships for 2013 ◊ Paid Admission to the NAMAS 5th Annual Auditing Conference ◊ Paid Admission to the 2013 AAPC Annual Conference ◊ A Tablet for making you mobile and on the go EVERY educational session you attend increases your chances of winning this auditors career kit!
www.NAMASinfo.com 877-418-5564
You’re In DemandModern practices are looking for individuals who can roll up their sleeves and effectively manage the business side of medicine. The practice manager role of today is complex and practical experience is essential. With responsibilities including finding and fixing the core problems of denials, negotiating insurance contracts, and ensuring compliant and efficient processes, experienced coders and billers are poised to succeed in this exciting career.
91% of the physicians we’ve surveyed put importanceon certification for practice managers. AAPC’s practice management training and certification can fill in your knowledge gaps and validate the skills you already have to meet this demand.
CPPMCPPM®
Get trained and certified today:www.aapc.com/cppm
1-800-626-2633
Certified Physician Practice Manager®
PAYROLL
![July 2011 - Amazon Web Servicesaapcperfect.s3.amazonaws.com/5548A1AF-4C9F-49A2-BFE0-BFA... · 2011-06-08 · July 2011 3 [contents] 7 Letter from the Chairman and CEO 8 Coding News](https://static.fdocuments.us/doc/165x107/5e9fd39d88ad2465c54bb2f6/july-2011-amazon-web-servicesaapcperfects3-2011-06-08-july-2011-3-contents.jpg)
![July 2011 - AAPCstatic.aapc.com/5548A1AF-4C9F-49A2-BFE0-BFA7D2344700/... July 2011 3 [contents] 7 Letter from the Chairman and CEO 8 Coding News 11 Letter from Member Leadership 12](https://static.fdocuments.us/doc/165x107/5b0b925e7f8b9a0c4b8e0bac/july-2011-july-2011-3-contents-7-letter-from-the-chairman-and-ceo-8-coding-news.jpg)
