Coding/Billing
March 2018 www.aapc.com
Nail the Internal Investigation Process: 16 Favorable outcomes for complaints require a plan Find the Lost Art of Customer Service: 38 To provide excellent service, ask yourself “WWAD?” Watchful Waiting of Newborns: 52 Sometimes conditions only require a watchful eye www.aapc.com March 2018 1 Looking to get certified?
AAPC Distance Learning
Students that complete our For more information or courses are TWICE AS LIKELY to enroll visit: aapc.com/exam-prep to pass the certification exam. CPC COC CIC CRC CPB CPMA CPPM CPCO Healthcare Business Monthly | March 2018
COVER | Coding/Billing | 30 Give Your Provider a Risk Adjustment PEP Talk By Meera Mohanakrishnan, MS, CPC, COC, CPC-P, CRC, CPC-I, CCS, PAHM [contents] ■ Coding/Billing ■ Auditing/Compliance ■ Practice Management
20 Fortify Your Understanding 16 Establish Best Practices 38 Rediscover the Lost of Bone Marrow Coding for Conducting Internal Art of Customer Service Artemio B. Castillejos, CPC, CPMA, Investigations Chelle Johnson, CPC, CPMA, CPPM, CCVTC, CCS, CL6SGB Erica Lindsay, PharmD, MBA, Esq. CPCO, CEMC, AAPC Fellow [continued on next page]
www.aapc.com March 2018 3 Healthcare Business Monthly | March 2018 | contents
14 ■ Added Edge 14 5 Tips to Get a Job Melissa L. Kirshner, MPH, CPC, CRC, CPC-I, AAPC Fellow 50 Remote Coding/Billing: Is It Right for You? Robin Moore, CPC, CCMA
■ Coding/Billing 22 New vs. Established Patients: Who’s New to You? Lori Cox, MBA, CPC, CPMA, CPC-I, CEMC, CHONC, AAPC Fellow
40 24 Send a Comprehensive Patient Statement for Collecting Payment Tameka J. Duncan, CPC, CPB, CPPM 26 Bariatric Surgery: A Personal Perspective Wanda Battle, CPC, CANPC, AAPC Fellow All-in-one 42 Clarify Mitral and Aortic Valve Coding Confusion Debra Mariani, CPC, CGSC Compliance For All. 44 Documenting Opioid Dependence and Abuse Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, CRC 46 When Sleep Tests Are Covered 42 Cindy Harms, CPC, CPC-I, CPPM 48 2018 Brings New Focus to E/M Services Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CEDO, CANPC, CASCC, CEDC, CRC, CCS, ICDCT-CM/PCS 52 Watchful Waiting: Collecting Newborn Information Jeanne Yoder, RHIA, CPC, CCS-P
■ Practice Management 40 HIM: Work Inside or Outside of the Box? Jen B. Flohr, RHIT, COC, CPMA, CPCO, CDIP, CCS, CAPM, ICD-10 Certified Trainer
COMING UP: DEPARTMENTS 66 Minute with a Member •• G Codes 7 Letter from Membership Leader EDUCATION •• NAB 2018-2021 9 HBM Feedback 59 Newly Credentialed Members •• Hyberbaric Oxygen Therapy 9 Healthcare Business News •• Endovascular 10 AAPC National Advisory Board We reinvented compliance management through a complete, flexible solution •• Scribes 12 AAPC Chapter Association that complies with all seven OIG recommendations to ensure you’re compliant, 13 Chapter News even when audited. On the Cover: Meera Mohanakrishnan, MS, CPC, COC, CPC-P, CRC, 34 I am AAPC Online Test Yourself – Earn 1 CEU CPC-I, CCS, PAHM, explains why it’s important to initiate a physician 35 Quick Tip education program (PEP) talk to explain compliant documentation and better https://www.aapc.com/resources/publications/ record-keeping. Cover design by Mahfooz Alam. 56 Member Experience healthcare-business-monthly/archive.aspx HEALTHICITY.COM/COMPLIANCEMANAGER 4 Healthcare Business Monthly All-in-one Compliance For All. AAPC Healthicity
We reinvented compliance management through a complete, flexible solution that complies with all seven OIG recommendations to ensure you’re compliant, even when audited.
HEALTHICITY.COM/COMPLIANCEMANAGER Serving 172,000 Members – Including You! Go Green! HEALTHCARE Why should you sign up to receive Healthcare Business Monthly in digital format? BUSINESS MONTHLY Coding Billing Auditing Compliance Practice Management Here are some great reasons: March 2018 • You will save a few trees. Director of Publishing • You won’t have to wait for issues to come in the mail. Brad Ericson, MPC, CPC, COS • You can read Healthcare Business Monthly on your computer, tablet, or [email protected] other mobile device—anywhere, anytime. Managing Editor • You will always know where your issues are. John Verhovshek, MA, CPC • Digital issues take up a lot less room in your home or office than paper [email protected] issues. Executive Editors Go into your Profile on www.aapc.com and make the change! Michelle A. Dick, BS [email protected] Renee Dustman, BS, AAPC MACRA Proficient HealthcareBusinessOffice, LLC...... 35, 65 [email protected] www.HealthcareBusinessOffice.com Graphic Design The Coding Institute...... 45 Mahfooz Alam www.codinginstitute.com/csg2018 Advertising Sales ZHealth ...... 41 Corey Stilson www.zhealthpublishing.com [email protected] (385) 207-2322
AdvertiserIndex Address all inquires, contributions, and change of address notices to: Healthcare Business Monthly PO Box 704004 Salt Lake City, UT 84170 (800) 626-2633 ©2018 Healthcare Business Monthly. All rights reserved. Reproduction in whole or in part, in any form, without written permission from AAPC® is prohibited. Contributions are welcome. www.aapc.com/medical-coding-jobs/project-xtern/ Healthcare Business Monthly is a publication for members of AAPC. Statements of fact or opinion are the responsibility of the authors alone and do not represent an opinion of AAPC, or sponsoring organizations. CPT® copyright 2017 American Medical Association. All rights reserved. Need Help? Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The Visit our Frequently Asked Questions (FAQ) page at AMA does not directly or indirectly practice medicine or dispense medical services. The AMA www.aapc.com/master-faq.aspx. assumes no liability for data contained or not contained herein. FAQs are categorized under the following topics: The responsibility for the content of any “National Correct Coding Policy” included in this • Membership • ICD-10 Training • Project Xtern product is with the Centers for Medicare and Medicaid Services and no endorsement • Certification Exams • CEUs • Forums by the AMA is intended or should be implied. The AMA disclaims responsibility for any • Training • CEU Vendors • Books consequences or liability attributable to or related to any use, nonuse or interpretation of • ICD-10 • HEALTHCON • Practicode information contained in this product. CPT® is a registered trademark of the American Medical Association. Still not finding what you’re looking for? Search our entire database of FAQs (http://aapc.force.com/knowledgebase). Volume 5 Number 3 March 1, 2018 For coding questions, please use our forums (www.aapc.com/memberarea/ Healthcare Business Monthly (ISSN: 23327499) is published monthly by AAPC, 2233 South Presidents Drive, Suites F-C, Salt Lake City UT 84120-7240, for its paid members. Periodicals Postage Paid forums/) or Ask an AAPC Expert service (www.aapc.com/resources/ask-an- at Salt Lake City UT and at additional mailing office. POSTMASTER: Send address changes to: expert/ask-an-expert-purchase.aspx). Healthcare Business Monthly c/o AAPC, 2233 South Presidents Drive, Suites F-C, Salt Lake City UT 84120-7240.
6 Healthcare Business Monthly Letter from Membership Leader
GOALS, TEAMWORK, AND DEDICATION SUM UP OUR PAST THREE YEARS t is hard to believe this will be my last article • Angela Clements CPC, CPC-I, Ifor Healthcare Business Monthly as president CEMC, CGSC, COSC, CCS, AAPC of AAPC’s National Advisory Board (NAB). Fellow – member relations I want to reflect on the past three years and The officers and myself relied heavily on the thank the membership for taking the time expertise of the board members to bring new to read these articles and for supporting the ideas and vision to the table. We asked them mission of AAPC. Most importantly, I want to report on how AAPC members would to express my gratitude to the individuals react to changes, and what changes the mem- who have served and worked with me over bership would like to see in the future. The the last three years. NAB and AAPC representatives addressed these issues and formed committees to delve Set Goals with Membership in Mind deeper into the topics. The energy, thoughts, When I accepted the position three years and guidance provided by the NAB has been • Angela Jordan CPC, COBGC, overwhelming. ago at HEALTHCON 2015, I addressed the AAPC Fellow – *NAB Awareness, membership and called on each member to Let’s recognize each one of our 2015-2018 Thought Leadership, Exam look inside themselves to determine how far NAB members and thank them for their • Lori Cox, MBA, CPC, CPMA, they wanted to go in their healthcare career. hard work and invested time over the past CPC-I, CEMC, CHONC, AAPC I urged each member to make that change three years (*indicates they are chair for that Fellow – NAB Awareness, *Specialty to achieve their goals. My commitment was committee): Credential, *Exam to work with the NAB and AAPC to provide • Colleen Gianatasio, CPC, CPC-P, • Angela (Annie) Boynton, MSJ, each member with the best products and ser- CPMA, CRC, CPC-I, AAPC Fellow vices to help them along the path to their goal. RHIT, CPC, COC, CPCO, CPC-P, – Hospital, *Thought Leadership CPC-I, CCS, CCS-P – *Social Media, It Takes Teamwork to Be Successful • Ellen Maura Wood, CPME, CPC, Thought Leadership, Military, *Exam CPMA – Hospital, Member of the Kimberly Reid, CPC, CPMA, I’m extremely fortunate to have had the • Year, Military, Exam CPC-I, CEDC, CEMC, COPC privilege of working alongside incredible • Christina LaRosse, CPC, AAPC – *Mentorship officers who shared the vision to recognize Fellow – Member of the Year, Exam what members needed to reach their goals. • Glenda Hamilton, CPC, COC, The NAB would not have accomplished • Sharlene Scott, RHIT, CPC, CPC-P, CPMA, CEMC, MCS-P, so many projects and tasks had it not been COC, CPC-I, CPMA, CDEO AAPC Fellow – NAB Awareness, Exam for hard-working individuals. The officers CCS-P, CCP-P – Hospital, Specialty • Angelica Stephens, COC, CPC, provided oversight to all our committees and Credential CPMA, CPC-I, CIMC, COSC, provided support and guidance to me as I • Brian Boyce, BSHS, CPC, CPC-I, AAPC Fellow – NAB Awareness, struggled with decisions and direction. CRC, CTPRP – Military, Social Media Mentorship Each NAB officer made a tremendous con- • Caren Swartz, CPC, COC, CPC-I, • Boyd Murayama, CPC, CPC-I – tribution to both the NAB and the organiza- CPMA, CPB, CRC – Thought Specialty Credential, Mentorship tion we represent; and for that, I owe special Leadership, Mentorship, *Military, • Jonnie Massey, CPC, CPC-P, thanks to: Exam CPMA, CPC-I – NAB Awareness • Michael Miscoe, JD, CPC, CASCC, • Leonta (Lee) Williams RHIT, CUC, CCPC, CPCO, CPMA, CPCO, CCDS, CCS, CPC, CEMC, So Much to Do, So Little Time CEMA, AAPC Fellow – president CHONC – *Hospital, Specialty Many issues we identified over the last three elect Exam, Military, Exam- years do not have a simple answer, not all • Ann Bina, CPC, COC, CPC-I, • Shelley Garrett, CPC – *Advocacy, items on our extensive “To Do” list had a COPC, AAPC Fellow – secretary Military, Social Media conclusion. Many issues that were addressed
www.aapc.com March 2018 7 Letter from Membership Leader will carry forward to the next NAB term. Realize that we have worked hard on the following projects over the last three years. It is an amazing list! 1. Helped with and presented at three HEALTHCON events and provided solid feedback to the conference committee 2. Spoke at and helped with more than six AAPC Regional Conferences 20. Provided input — with the assistance • Executive Assistant Rachel Momeni 3. Recognized a Member of the Year for of the Advocacy Committee — to help • Director of Events Melanie Mestas write a letter as comment to proposed two years, and formed committee to • Director of Publishing Brad Ericson, changes of documentation guide- update policy MPC, CPC, COSC 4. Provided many articles for Healthcare lines by the Centers for Medicare & Medicaid Services (CMS). • Senior Marketing Communications Business Monthly through our NAB Manager Alex McKinley (AAPC Alex) awareness committee 21. Discussed: A special thank you goes to Rhonda 5. Recognized the need to create • Use of Professional Medical Buckholtz. CPC, CDEO, CPMA, CRC, an easier way to verify member’s Coding Curriculum (PMCC) CPC-I, CENTC, COBCG, COPC, credentials when the member ID is outside of identified scope CPEDC, who volunteered her time and ex- not available • AAPC’s international presence pertise to the NAB, long after it was expected. 6. Prompted a Hospital Committee and 22. Supported local chapters by being I extend a huge thank you to Michelle A. Dick brought awareness of the credential guest speakers and the editorial team at Healthcare Business Monthly. They took my words, cleaned them 7. Created a Military Committee 23. Fostered Mentorship program up, and made them presentable. Thank you 8. Assisted in making decisions about 24. Explored new ways to improve our ICD-10 proficiency testing also to the AAPC Chapter Association for testing methods and content through working with the NAB on many projects. 9. Held many discussions to find a resolu- our Exam Committee. Together we reached many members and had tion for members with the “A-status.” 25. Attended three retreats to provide a lot of fun along the way. 10. Recognized the need for more AAPC with feedback on issues oversight for social media. of interest to various internal The Torch Is Passed 11. Formed a Social Media Committee to departments to the 2018-2021 NAB recognize potential areas of concern, 26. Helped with AAPC Coder It’s been an incredible adventure and I’ve such as how to improve social media improvements absolutely loved all of it! Keep believing in use and use it more effectively. 27. Helped with PMCC accreditation yourself. Only you can make the changes 12. Reviewed specialty exams. Provided 28. Helped with international coding necessary to reach your goals. feedback. Sunset some specialty exams. education 13. Provided educational ideas for Healthcare Business Monthly, work- Accolades to Our Friends Take care, shops, and webinars in the National Office 14. Updated meeting frequencies The board would not have direction if it were 15. Updated responsibilities for officers not for the individuals at AAPC who guided 16. Helped contribute many ideas us and provided support to our committees. for AAPC through the Thought Thank you for leading us and helping the Jaci Johnson Kipreos, CPC, COC, CPMA, Leadership Committee. NAB accomplish so many goals: CPC-I, CEMC, AAPC Fellow 17. Provided input and feedback on cur- • CEO Jason VandenAkker President, NAB rent and potential products. • President Bevan Erickson 18. Provided input and feedback on the • VP, Member and Certification recognition program Development Raemarie Jimenez, 19. Provided input for suggestions on CPC, CDEO, CPB, CPMA, CPPM, next healthcare system…the good/ CPC-I, CANPC, CRHC, CCS, bad of Affordable Care Act. AAPC Fellow
8 Healthcare Business Monthly HBM FEEDBACK ■ 3 Ways to Contribute to Healthcare Business Monthly
ll AAPC members receive Healthcare Sharing your expertise helps others; ABusiness Monthly exclusively, and it’s being published can advance your always been a publication by and for mem- career; and it’s an economical way February 2018 www.aapc.com bership. Our goal is to publish articles and to earn CEUs. You don’t have to other content that will make your career be an English major; we’ll make and membership journey more successful sure you put your best foot forward and satisfying. But we can’t do it without while sharing your knowledge and you. Here are three ways you can help: experience. Go to www.aapc.com/ • Take our survey: Go to www. resources/publications/healthcare-business- surveymonkey.com/r/HBM-survey and tell us monthly/contribute.aspx to find out how to what you think about the magazine. contribute. • Comment: Send feedback Healthcare Business Monthly helps you stay about the articles we publish to in touch with what’s happening in the [email protected]. You industry while connecting you with AAPC can also email any of the editorial and our members. Reach out and help us staff listed on page 6. We’re always make the magazine your best resource. Break the Cycle: 14 Putting an end to poor documentation starts with you glad to hear from you. Help Fight the Opioid Crisis: 42 Raise red flags when patient abuse is present Win at Your Audit Proposal: 52 • Submit an article: Writing for Map a course for compliance and healthy revenue www.aapc.com February 2018 1 the magazine is very rewarding.
HBM_Feb2018.indd 1 11/01/18 2:34 PM Healthcare Business News
OIG Creates an Active, More Transparent Work Plan You can use the items listed on their Work Plan as an auditing tool to compare and review your own pro- If you are wondering why Healthcare Business Monthly hasn’t pub- vider billing activities and compliance plans. The Active lished articles about 2018’s Office of Inspector General (OIG) Work Work Plan items added in January under investigation Plan this year, it’s because the U.S. Department of Health and for Centers for Medicare & Medicaid Services (CMS) Human Services (HHS) announced in June 2017 that it would are: update the OIG Work Plan monthly as an Active Work Plan to enhance transparency. • Financial Impact of Health Risk Assessments and Chart Reviews on Risk Scores in Medicare Here is summary of the purpose of the OIG Work Plan, according Advantage to their website: • OIG Toolkit to Identify Patients at Risk of The OIG Work Plan sets forth various projects including OIG Opioid Misuse audits and evaluations that are underway or planned to be ad- • Potential Abuse and Neglect of Medicare dressed during the fiscal year and beyond by OIG’s Office
Beneficiaries NEWS of Audit Services and Office of Evaluation and Inspections. Projects listed in the Work Plan span the Department and in- • Questionable Billing for Off-the-Shelf Orthotic clude the Centers for Medicare & Medicaid Services (CMS), Devices public health agencies such as the Centers for Disease Control • Status Update on States’ Efforts on Medicaid-Provider and Prevention (CDC) and National Institutes of Health Enrollment (NIH), and human resources agencies such as Administration • Hospitals Billing for Severe Malnutrition on Medicare Claims for Children and Families (ACF) and the Administration on You can view the OIG Work Plan archives and monthly updates all the Community Living (ACL). OIG also plans work related to is- way back to 1997 at: https://oig.hhs.gov/reports-and-publications/archives/workplan/ sues that cut across departmental programs, including state index.asp. Be sure to check the site monthly to find the most recent OIG and local governments’ use of federal funds, as well as the func- targets that apply to your practice (https://oig.hhs.gov/reports-and-publications/ tional areas of the Office of the Secretary of Health & Human workplan/active-item-table.asp). Services (HHS). Some Work Plan items reflect work that is stat- utorily required. www.aapc.com March 2018 9 ■ AAPC NATIONAL ADVISORY BOARD By Angela Jordan, CPC, COBGC, AAPC Fellow
Reflections from the Former National Advisory Board Lasting friendships, personal growth, accomplishment, and satisfaction are the legacy they leave to our next leaders.
his year’s HEALTHCON will be bittersweet for those who have ideas. It’s not often that you get the opportunity to sit around a table Tserved on the National Advisory Board (NAB). It is a transition with people who work in a facility, payer system, education, legal year, when we welcome new members and say goodbye to those field, and consulting and range from CEOs, administrators, auditors, completing their term. There is so much that goes into serving and educators. I highly recommend it and encourage you to consider
AAPC and our members while in the NAB. The knowledge gained, applying for the NAB the next time nominations are open. iStockphotogianliguori / the new skills developed, the personal growth spurred by working If you have a few years under your belt and experience, share it! with a diverse group, and the friendships built along the way are all We each have a responsibility to help those who want to make this invaluable. profession their chosen career. Pay it forward; you won’t regret it. I Some NAB members, including myself, took a moment to share also hope you take advantage of all the tools, resources, education, sentiments about their experiences on the NAB. and local chapter opportunities AAPC offers.
ANGELA JORDAN ANGELA (ANNIE) BOYNTON CPC, COBGC, AAPC FELLOW MSJ, RHIT, CPC, COC, CPCO, CPC-P, CPC-I, CCS, CCS-P I look back on the past three years with My experience on the NAB has been one amazement. Opportunities, such as of the most positive professional experi- participating in HEALTHCON, speak- ences in my career. I love the joy and sat- ing at regional conference, visiting local isfaction of giving back to my profession chapters, and attending other organiza- and the unique opportunity to explore tion meetings, have allowed me to meet avenues of healthcare growth and profes- so many members and make new friend- sional development that might not other- ships . The stories shared, the tears shed wise have been afforded to me. I am over accomplishments, and the calls re- amazed at the wealth of talent and ceived when a member needed a little knowledge that surrounds me as a mem- encouragement and support have left a ber of the NAB. It’s a privilege and an permanent impression on my heart. honor to collaborate with such amazing Thank you for all you’ve shared. professionals. Every meeting, confer- The phenomenal, diverse group of professionals I’ve been honored to ence, and NAB conference call presents another opportunity to learn serve alongside made for an excellent collaborative environment for something new from these talented professionals.
10 Healthcare Business Monthly Reflections
ANGELA CLEMENTS ELLEN MAURA WOOD CPC, CPC-I, CEMC, CGSC, COSC, CCS, AAPC FELLOW CPME, CPC, CPMA As I reflect on the last five years as a I didn’t know what to expect when I NAB member, I think about all of the applied for the NAB. I just wanted to amazing AAPC members I’ve met. I give back to an organization that has
made many new NAB friends while given me a lot. That might sound corny, NAB AAPC serving two terms. I also made new but it’s true. I’ve been an AAPC mem- friends attending HEALTHCON, re- ber for many years and it’s because of gional conferences, and local chapter my certification that I have felt valued, meetings. I have had the opportunity to important, and respected. All that present at several local chapter meet- AAPC offers — regional and national ings that I probably would not have at- conferences, local chapter events and tended, otherwise. The members were meetings, continuing education unit amazing. I enjoyed speaking with ev- opportunities, networking, and educa- eryone who crossed my path. I appreci- tion galore — is over and above what ate the positive stories and opportunities members shared with me most organizations offer their membership. Being on the NAB has that I brought back to the board on their behalf. I am grateful for been icing on the cake for me. being given the opportunity to represent AAPC membership. I en- I learned that the people who serve on the NAB are just like you and courage you to get involved in your local chapter, and then look to me: They represent various regsions of the United States; they have get involved at the national level. incredible experience and insight; and they are all accomplished I am grateful for the members who welcomed me into their network professionals. I learned that my opinion matters. And I learned that circle. Healthcare is so topsy-turvy, no one can survive it alone, AAPC directors and corporate executives truly care about the coder which is why networking is such a huge part of our profession. To in the trenches and want to help each succeed. expand your network circle, attend your local chapter meetings. I walk away from this experience with lifelong friends and a sense One day a month is worth the investment in your growth. If there of real accomplishment with my participation. I’m sad to see it end. is another local chapter within driving distance, attend once a year Many thanks for allowing me to participate and represent Region and expand your circle even more. 1 - Northeast. It’s been a real pleasure. Thank you for the opportunity to serve. My term is up, but I’m sticking around so I can continue to expand my network circle. I walk away from this experience with
GLENDA HAMILTON lifelong friends and a sense of real CPC, COC, CPC-P, CPMA, CEMC, MCS-P, AAPC FELLOW accomplishment with my participation. When I was appointed to the NAB in 2015, I didn’t know what to expect. Much to my surprise, these three years brought me fantastic new friendships, which will continue long after our ten- ure on the NAB. The other members who shared a wealth of knowledge and professional ideas are always there for support and willing to give uncondi- tionally of themselves. Being able to interact with AAPC staff members, who can’t do enough and always have a smile on their face, makes me proud to Angela Jordan, CPC, COBGC, AAPC Fellow, is senior managing consultant at Soerries be part of this organization. I am thankful that the AAPC gave me Coding and Billing Institute. Her 25 years’ experience includes coding and compliance management for a large physician network, and coding auditor for a nationwide hospital the opportunity to meet and work side by side with such a wonderful management organization. Jordan speaks at regional and national AAPC conferences, writes group of professionals. for coding publications, and develops coding workshops. She is a member of AAPC’s NAB, has Have a blessed new year. served on the AAPC Chapter Association, and was the 2012 chair. She is a member and past president of the Kansas City, Mo., local chapter.
www.aapc.com March 2018 11 AAPC Chapter Association By Lance Smith, MPA, RHIT, COC, CPMA, CEMC, CHC, CCS-P
Explore the Other Side of HIPAA in Your Newsletter
A local chapter shares the importance of the HIPAA Security Rule to help healthcare organizations. iStockphotoNicoElNino /
monthly newsletter is an excellent tool Safeguards Overview is flood-proof along with other protec- A many local chapters use to provide their Administrative safeguards refer to a tions. If your paper records are still members with area healthcare news, chapter covered entity’s policies and procedures stored in a cabinet or on shelves, they are events, job postings, and announcements. that address the security of ePHI. These subject to the physical safeguards under The New Windsor, N.Y., local chapter went can be anything from documentation of the Security Rule, as well. A covered en- one step further in the January edition of software that protects the information, tity should review these safeguards regu- their newsletter by incorporating an educa- to the risk management policies that larly and update them as they upgrade tional article on HIPAA security. address reviewing and maintaining this their electronic health record systems. In security. What constitutes a violation doing this, you can feel secure knowing The Other Side of HIPAA of these security standards and the that compliance with the Security Rule While most of us think of privacy when consequences of such actions are also is maintained in your office. we hear the acronym HIPAA, that is examples of administrative safeguards. only half the story. There is the Privacy Technical safeguards refer to the protec- Stop the Presses! Rule that is (hopefully) near and dear to tions put in place to protect ePHI. These A monthly newsletter is a great way to share all healthcare professionals’ hearts, but include tools we use every day, such as tidbits of healthcare business professional there is another side to HIPAA that ad- complicated passwords we must change expertise that runs rampant within your lo- dresses the security of protected health every 30 to 90 days, firewalls, and data cal chapter. Encourage officers and members information (PHI). The Security Rule encryptions. Controls are also part of to submit content for your local chapter was enacted in 2005 to protect the then- these technical safeguards, such as setting newsletter. You never know: It may prompt a growing field of electronic PHI (ePHI). up users to access only certain data to discussion at your next chapter meeting. There are three major areas of safeguards perform their tasks. Although this is dis- a covered entity must ensure are in place cussed in the Privacy Rule, the means to Lance Smith, MPA, RHIT, COC, CPMA, CEMC, CHC, to comply with the Security Rule. These CCS-P, is the director of HIM at HealthAlliance Hospital accomplish this is a technical safeguard. in Kingston, N.Y. He has spent 20 years in healthcare are administrative, technical, and physi- Physical safeguards refer to the physical functions, including HIM, compliance, revenue integrity cal safeguards. safety of all types of PHI. Computers audits, hospital and physician practice coding, and should be locked in a safe space that third-party billing. Smith has taught coding classes and medical terminology. He is the former secretary of the Ellenville, N.Y., local chapter.
12 Healthcare Business Monthly Chapter News By Marcia Maar, COC, CPC, CRC, AAPC Fellow Flower City Professional Coders Raise $4K for Project AAPC n 2010, the AAPC Chapter Association Coders' members and the 2017 officers who helped make it happen: I(AAPCCA) created a charity to help • Marcia Maar, COC, CPC, CRC AAPC Fellow, MACRA victims of catastrophic disasters. The Proficient – president AAPCCA continues to challenge local • Debra J. O'Connell, COC, CPC – vice president/secretary chapters to collect monetary donations in creative ways to benefit worthy causes. • Georgia A. Schmidt, CPC-A – treasurer This year, during the Fall Into Coding • Kristine Seely, CPC – membership development officer conference in Rochester, N.Y., my chap- • Trina F. Haggerton, CPC – education officer ter held a silent auction and collected Project AAPC is an inspiration; and our chapter is delighted to over $1,000. Each officer created two or not only support it, but to also spread the word about how AAPC iStockphoto / ipopba / iStockphoto more baskets to be auctioned off to the empowers members to reach out and help others. highest bidder. Due to the turn out, we We hope our contribution provides hurricane disaster relief and helps also passed around a collection bucket and collected several hundreds those in need to restore faith, home, and security. of dollars from members in attendance. It was also decided, due to such success, that the chapter would match the donations. Learn how your chapter can participate in Project AAPC at: www.aapc. com/memberarea/chapters/projectaapc.aspx. In total, the Flower City Professional Coders of Rochester, N.Y., is donating $4,000 to Project AAPC. For a chapter who regularly has Marcia A. Maar, COC, CPC, CRC, AAPC Fellow, works in risk adjustment for a local not-for-profit health between 40-50 attendees at meetings, this amount is something our insurance company in Rochester, N.Y. She is the president of the Flower City Professional Coders, Rochester, N.Y., chapter is very proud of. Thanks to the Flower City Professional local chapter.
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www.aapc.com March 2018 13 ■ ADDED EDGE By Melissa L. Kirshner, MPH, CPC, CRC, CPC-I, AAPC Fellow iStockphotoRawpixel/ With a little persistence and a lot of networking, that dream coding job could be yours. ou spend months studying and taking notes, preparing for the doesn’t mean you must run out and hire a professional photographer, YCertified Professional Coder (CPC®) exam. You spend 5 hours but ensure your photos reflect your professional self in all social and 40 minutes taking the exam. And then, it happens. After hitting media. Keep the selfies, pictures of your kids, pets, and party photos refresh on the AAPC website about one hundred times, your results private. Wear a suit and be well groomed. are finally here. And, you PASSED! Now what? “Hiring managers have turned down people who present themselves Here are the next five steps to help you find a job, with advice from an online looking unkempt,” Bidwell continued. “Who are you and expert in job placement, Account Executive Stephanie Bidwell for what do you want? Are you looking to impress people who you want Arrow Strategies, a nationwide talent acquisition agency. to date or are you looking to impress a hiring manager? We have aggressively gone after candidates who present themselves profession- ally when looking for work.” MAKE YOUR ONLINE 1 PRESENCE PROFESSIONAL TAKE ADVANTAGE OF “Many times, we are not able to set up a face-to-face meeting with 2 AAPC LOCAL CHAPTER BENEFITS candidates we are interviewing. In those cases, we turn to social me- dia: Facebook, Google, LinkedIn. We have disqualified candidates AAPC members can attend chapter meetings anywhere; you are not due to their Facebook photos,” Bidwell says. limited to only your chapter. Attend as many chapter meetings as you Most hiring managers turn to social media to vet who you are before can before and after certification. Every time you go, you’ll gain edu- they ever interview you. Decide in advance how you want them to see cation for which you might earn continued education units. Meetings you. For example, your profile picture should be professional. This are also opportunities to network with the others in attendance.
14 Healthcare Business Monthly Get a Job
Most hiring managers turn to social media to vet who you are before they ever interview you. Decide in advance how you want them to see you. 4 GET YOUR FOOT IN THE DOOR
At one of my recent chapter meetings, a person was chatting with her Entry-level, part-time, and seasonal jobs in any setting are great places friend about an open position in her company. An officer overheard to start. the conversation and made an introduction to someone who recently “There are many remote coding opportunities available for coders earned her CPC® and was looking for work. Fast-forward three weeks: in HEDIS season, which runs from January to May every year,” said The Certified Professional Coder-Apprentice (CPC-A®) was hired at Bidwell. “Every insurance company looks for coders for these five the company and is on her way to a new career. months for full-time work doing record extraction and data entry. I Local chapters are also great resources for finding available positions like these positions for newer coders because the team is larger and in your local area. My chapter frequently notifies its members of new led by seasoned coders and nurses who help to guide the newer coder.” positions in the area via email and through the local chapter forums Most companies hire from within. Getting your foot in the door, on AAPC’s website. learning the business, and proving you are hard-working and dedi- cated may be your opportunity to land a permanent coding job down the road. 3 MAKE THE RIGHT CONNECTIONS
Many chapters have developed relationships with local employment 5 GAIN EXPERIENCE WITH AN EXTERNSHIP agencies such as Arrow Strategies. Recruiters can help job seekers in so many ways. My chapter has done several events with Arrow. Their A great way to get your foot in the door and earn experience is to take focus with our members has been on interviewing techniques and advantage of AAPC’s Project Xtern (www.aapc.com/medical-coding-jobs/ resume writing. Bidwell said, “I look at a resume for about 5 seconds. project-xtern/). Many newly certified CPCs® report they are unable How do you make an impact in 5 seconds? Does your resume read to land that first job due to their lack of experience. Project Xtern correctly?” Coordinator Ashlyn McGlone reports there are now more than 300 Recruiters can help you to polish your resume, as well as prepare project sites located across the United States. you for the interview. When you do get the interview, be prepared. “The program provides our members valuable work experience that Research the company and have a few questions ready. The candidate can be applied to resumes and toward the removal of apprentice status who has no questions will not likely get a call back, according to [Project Xtern alone will not remove the apprentice designation from Bidwell. Questions about the company show that you are interested your credential],” McGlone said. “The experience also aids members and invested in the company already. Before you leave, ask the in- with finding employment. Project Xtern is an ideal way to get your terviewer what the next steps are. And always ask the interviewer for first taste of real-world knowledge and experience in the medical their business card. Email a thank you note that same day. Do not coding field and gives potential employers an opportunity to see make the interviewer wait for “snail mail” to arrive. you in action. It builds confidence and improves your research and Bidwell advises, “Do not be afraid to follow up. As a recruiter, the ones analytical skills.” who follow up with me regularly are the ones I remember and will There are plenty of opportunities and possibilities for finding em- likely recommend for a position.” ployment after you have earned your certification.
Melissa Kirshner, CPC, CRC, CPC-I, AAPC Fellow, is executive director of a physician organization in Southeast Michigan. She has more than 30 years of healthcare experience in billing, coding, compliance, education, and software development. As a certified PMCC instructor, she teaches billing and coding classes to prepare students for the CPC® exam. Kirshner is a founding member of the Novi, Mich., local chapter, and serves as treasurer.
www.aapc.com March 2018 15 ■ AUDITING/COMPLIANCE By Erica Lindsay, PharmD, MBA, Esq. Establish Best Practices for Conducting Internal Investigations
Favorable outcomes require a Evaluate the Need for an Investigation The first step is to establish a complaint review policy. This will bring
plan for gathering information, consistency to the way in which complaints are handled in your iStockphotonyul/ conducting interviews, and organization. An internal investigation usually starts when an employee makes bringing in legal counsel. a verbal or written complaint to management or the compliance department, or irregular activity is discovered. Complaints should be reviewed and prioritized based on severity, complexity, and resources available. After reviewing the complaint, if it is determined that a policy breach or unlawful behavior has occurred, conduct a timely investigation. o maintain effective compliance, healthcare entities may have Tto conduct internal investigations. To ensure efficiency in the Acting quickly to secure information and evidence will improve process and consistency in the results, you’ll need a solid and enforce- the results of the investigation and the facility’s credibility with law able company policy for compliance. Let’s review the process of an enforcement and government agencies. internal investigation from start to finish, and consider best practices If the complaint is unfounded or frivolous, the investigation may be you might incorporate into your organization’s plan. closed. ■ ■ ■ 16 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Investigation
Your healthcare organization should create a customized
investigation plan that contains an outline of the issue, a AUDITING/COMPLIANCE witness list, and sources for information and evidence.
Initiating an Investigation • Should not have a personal relationship with the involved parties. If an investigation is determined to be appropriate, there are key questions that need to be addressed, including: • Should be able to build a rapport and be perceived as non-biased. • What is the issue (e.g., unlawful conduct, noncompliance, abnormal activity)? • Should be open minded and make decisions based on presented facts — not jump to conclusions prior to • Who should conduct the investigation (e.g., legal, completing the investigation. compliance, third party, outside department, management)? There should be at least two people present to conduct • Should know when to involve legal counsel. interviews, one being the interviewer. Legal counsel should always be notified of an issue. They can • Where should the meetings take place (e.g., conference room, help to determine if they should conduct the investigation, if they off site)? should delegate someone to conduct the investigation, etc. If legal counsel conducts or delegates the investigation, there are legal • Who should be interviewed? Identify all persons involved, protections — including attorney/client privilege and work-product including witnesses. immunity — that can be implemented to protect the entity. • How should the investigation be conducted (e.g., in person Your healthcare organization should create a customized investiga- [preferred], phone, conference)? tion plan containing an outline of the issue, a witness list, and The Society for Human Resource Management recommends in sources for information and evidence. The interviewer should “How to Conduct a Workplace Investigation,” the following seven follow a documentation process that’s consistent throughout the steps: organization. Goals of the interviewers include: 1 Ensure Confidentiality • Contacting all witnesses; • Providing details regarding the complaint to the accused; The employee disclosing the information should be protected; and however, there may be extreme circumstances where an individual’s • Allowing the accused the opportunity to respond before identity may be revealed during the investigation. The investigator issuing discipline. should aim to protect the identity of the discloser as much as possible. The interviewer should create questions prior to the interview based on the type of information required. The Association of 2 Provide Interim Protection International Certified Professional Accountants (AICPA) explains in “Conducting Effective Interviews” (Forensic and Valuation If unlawful behavior is occurring, discuss with human resources Services Section), the different types of interview questions: the need to immediately remove the employee from the premises to prevent further criminal activity and to reduce the risk to the • Informational questions are non-confrontational, designed organization. When the investigation is completed, and the find- to gather information, and should be non-biased. ings are confirmed, the employee, if cleared, can return to work, or • Open-ended questions are best (e.g., who, what, when, other arrangements may be made through human resources. where, how?). Open-ended questions require the responder to elaborate, which can uncover many facts from the 3 Organize and Collect Information incident. Selecting a neutral investigator is key to a successful investigation. • Closed-ended questions may not be as revealing. They Important factors weigh into the decision of who in your organiza- usually require a “yes” or “no” answer, and can be used to tion should be chosen. Most important, the investigator: confirm previously answered facts.
www.aapc.com March 2018 17 Discuss this article or topic in a forum at Investigation www.aapc.com
• Leading questions provide an answer as part of the • Interview the accused. When interviewing the accused, question. These types of questions are used when the facts are the objective is to allow them to respond to allegations and already known, and are used for confirmation. to obtain their version of the events. Do not interrogate • Double-negative questions should be avoided because they the accused; allow them to discuss the facts in an open can be confusing and lead to inaccurate information (e.g., the environment. The accused may respond in either oral or results are not inconclusive). written form and may also have legal counsel present. If legal counsel is present, establish the role of the attorney before the • Attitude questions are when the interviewer interjects their interview. opinion, which can be interpreted as biased, into the question. • Interview all witnesses until complete. If an additional day is • Admission-seeking questions are when the interviewer needed, immediately schedule the interviews for the next day. uses direct accusations in a statement as a definitive fact, not as a question. Do not use this approach unless there is actual TIP: Consider starting the interview process either on a Monday or Tuesday. If interviews start on evidence of the wrongdoing (e.g., a recording of the drug Friday, the investigation may lose momentum by waiting until Monday to schedule an additional day. diversion from the pharmacy). • Between each interview, review and complete notes and AUDITING/COMPLIANCE 4 Conduct Interviews prepare for the next interview. This allows questions to evolve Reserve a conference or meeting room to conduct interviews. It’s so the interviewer can capture the most information. best to have at least two interviewers present: one to ask questions, • When all witnesses are interviewed, review all notes and the other to take notes. This allows for multiple witnesses, which evidence. If a witness needs to be questioned again for is especially important if the accused admits to wrongdoing. All clarification, conduct the subsequent interview immediately. interviews should be documented in writing, including an admis- sion to wrongdoing. Audio or video recording of the interview is an 5 Collect all information and analyze option; however, it requires reliable equipment and chain of custody Prepare a report for upper management with a final resolution. for the recording to ensure it’s not tampered with. Spread out the interviews with time in between and have inter- 6 Conclude viewees leave promptly when finished. This will help to ensure Determine an outcome resulting from the evidence. Determine interviewees leaving the meeting room do not have an opportunity disciplinary actions, warnings, or memos with the assistance of to interact with other interviewees entering the meeting room. human resources. Hold separate meetings with the reporter and the Consider holding the interviews on the same day, if possible. The accuser, providing them with the results of the investigation. interview should be held in a logical order and should begin as soon as possible to avoid prejudice and evidence or witness loss. For example, the order of an interview process may be: 7 Close and Document • Interview the person who reported the incident. This will Lastly, you must: allow the interviewer to identify the issue, clarify facts, • Close the investigation; identify and gather evidence, and identify additional • Prepare an investigation report; and witnesses. • Present it to the appropriate personnel.
Erica Lindsay, PharmD, MBA, Esq., is a healthcare attorney practicing in Chicago at 10 Investigation Errors to Avoid Lindsay Law, Chicago. She specializes in contract and qui tam cases. Lindsay is an instructor Ten common investigation mistakes, according to the Society for Human Resource for the University of Wyoming School of Pharmacy and has recently published Protect and Empower: The Career Survival Guide for Healthcare Professionals. She can be contacted at Management (“How to Conduct a Workplace Investigation”) are: [email protected]. 1. Failing to plan (you should already have an investigation procedure in place) 2. Ignoring complaints 3. Delaying investigations 4. Losing objectivity 5. Being distracted during interviews 6. Using overly aggressive interview tactics Resources 7. Not conducting a thorough investigation 8. Failing to reach a conclusion Society for Human Resource Management, “How to Conduct a Workplace Investigation:” 9. Failing to create a written report www.shrm.org/hr-today/news/hr-magazine/pages/1214-workplace-investigations.aspx 10. Failing to follow up with those involved Conducting Effective Interviews: AICPA – Forensic and Valuation Services Section
18 Healthcare Business Monthly AAPC Webinars ■ CODING/BILLING By Artemio B. Castillejos, CPC, CPMA, CCVTC, CCS, CL6SGB Fortify Your Understanding of BONE MARROW CODING Reimbursement for aspiration and biopsy and harvesting of bone marrow rely on knowing current CPT®, Medicare, and NCCI guidance.
s of Jan. 1, health information professionals may select specific Example 1: The donor for a 50-year-old patient with aplastic Acodes for bone marrow aspiration based on purpose. Here’s what anemia was brought to the operating room and general anesthesia you need to know to apply these codes correctly. was provided. To collect bone marrow from the posterior iliac crest, the provider administered approximately 400 needle sticks. After Be Aware of 2018 Code Changes the marrow was aspirated, the needle was removed immediately. To reflect standard of care changes, CPT® code descriptors for 38220 Blood was given to the donor as support, and as needed. At the end Diagnostic bone marrow; aspiration(s) and 38221 Diagnostic bone of the procedure the donor was transferred to the recovery room. marrow; biopsy(ies) were revised, and new codes 38222 Diagnostic In this example, it is appropriate to report CPT® code 38230 Bone bone marrow; biopsy(ies) and aspiration(s) and +20939 Bone marrow marrow harvesting for transplantation; allogeneic. You would not aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure) were created to describe services more accurately. Per the Centers for Medicare & Medicaid Services (CMS), the deletion of HCPCS Level II code G0364 is final. Instead of reporting 38221 and G0364 for bone marrow aspiration and biopsy, you should report 38222 Diagnostic bone marrow; biopsy(ies) and aspiration(s). Code 2018 Changes Remarks +20939 Bone marrow aspiration for bone grafting, spine surgery only, Added code through separate skin or fascial incision (List separately in addition to code for primary procedure) 38220 BoneDiagnostic bone marrow; aspiration only(s) Revised code 38221 BoneDiagnostic bone marrow; biopsy, needle or trocar(ies) Revised code 38222 Diagnostic bone marrow; biopsy(ies) and aspiration(s) Added code G0364 Bone marrow aspiration performed with bone marrow biopsy Deleted code through the same incision on the same date of service.
Let’s look at coding rules and patient scenarios to better understand how to apply these codes correctly. Understand Bundling Rules for Testing Bone marrow aspiration and biopsy often are performed together at the same surgical site. Obtaining bone marrow by aspiration or sampling, described by 38220 and 38221, is for testing only, and does not include transplant purposes. When harvesting bone marrow for transplantation is done at the same time as the aspiration and biopsy, the code for bone marrow aspiration and biopsy are not separately reportable. iStockphotoShidlovski /
■ ■ ■ 20 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Discuss this article or topic in a forum at www.aapc.com Bone Marrow
report the bone marrow aspiration, described by CPT® code 38220, Differentiate Separate Incisions concurrently with 38230. Aspiration and biopsy may be reported together only when they are performed in different bones, via a separate skin incision for the NCCI Rules for Procedures Performed Alone same bone, or at a separate patient encounter by the same physician Report 38220 when bone marrow aspiration is performed alone, on the same date of service. Modifier 59 Distinct procedural service CODING/BILLING and 38221 when bone marrow biopsy is performed alone. According indicates that the physician aspirated or took samples from separate to National Correct Coding Initiative (NCCI) Policy Manual for sites. Medicare Services, Chapter 5, Section E1, codes 38220 and 38221 Example 3: The provider performs a bone aspiration and bone are reported one time only, even if the provider performs multiple biopsy on a 45-year-old male patient. After informed consent, a aspirations or scrapings at the same insertion site. bone marrow is aspirated to the posterior iliac and sent for analysis. The provider performs a bone marrow sampling in the sternum, which is sent for analysis. Because the bone marrow aspiration and bone marrow biopsy are performed at different sites on the same date of service, report 38221 and 38220, and append modifier 59 to identify the procedure is separate and distinct from the primary procedure. According to an excerpt in the NCCI Policy Manual for Medicare Service, Chapter 5, Section E1, “CPT codes 38220 and 38221 may only be reported together if the two procedures are performed at separate sites or at separate patient encounters. Separate sites include bone marrow aspiration and biopsy in different bones or two separate skin incisions over the same bone.” Use 38222 for Same Bone, Same Incision When a sequenced bone marrow biopsy (38221) and bone marrow aspiration (38220) are performed through the same bone or the same skin incision over the same bone, report 38222. Example 4: A provider performs a bone marrow biopsy and aspira- tion for a 77-year-old patient. Code 38222 represents the bone marrow aspiration procedure with a bone marrow biopsy through the same incision, in the same bone, on the same date of service.
Artemio Castillejos, CPC, CPMA, CCVTC, CCS, CL6SGB, is a healthcare information management professional, a license financial consultant, and an AHIMA World Congress Board Member with more than four years of experience in outsourced or offshored projects. He is a medical coding trainer at UST Global Manila Philippines. Castillejos is specialized in cardiology, cardiothoracic and vascular, evaluation and management, and surgical coding. He is a member of the Makati, Philippines, local chapter.
Resources Federal Register - The Daily Journal of the United States Government - A rule by CMS, Nov. Example 2: A 50-year-old male patient with history of leukemia 15, 2017, “Medicare Program, Revision to Payment Policies Under the Physician Fee Schedule presents to the facility and Dr. Smith performs a bone marrow and Other Revision to Part B for CY 2018; Medicare Share Savings Program Requirements; and aspiration in the left side posterior iliac crest. At the completion Medicare Diabetes Prevention Program.” https://federalregister.gov/d/2017-23053 of the procedure, the specimen is sent for analysis. The patient Decision Health Part B News [online]. Breaking news: returns one week later and Dr. Smith performs a bone marrow CPT® 2018 update delivers 4 new E/M codes, mass revisions and updates: core biopsy in the left posterior iliac crest. https://pbn.decisionhealth.com/Blogs/Detail.aspx?id=200623 Report the first visit using 38220 for bone marrow aspiration NCCI Policy Manual for Medicare Services, Effective Jan. 1, 2016, Chapter 5, §E1 performed alone. Report the second visit using 38221 for bone American Medical Association, 2018 CPT® Professional Edition marrow biopsy.
www.aapc.com March 2018 21 ■ CODING/BILLING By Lori Cox, MBA, CPC, CPMA, CPC-I, CEMC, CHONC, AAPC Fellow New vs. Established Patients: WHO’S NEW TO YOU? Billing for new patients requires three key elements and a thorough knowledge of the rules.
persistent concern when reporting evaluation and management sional or another physician/ A(E/M) services is determining whether a patient is new or estab- qualified health care pro- lished to the practice. New patient codes carry higher relative value fessional of the exact same units (RVUs), and for that reason are consistently under the watchful specialty and subspecial- eye of payers, who are quick to deny unsubstantiated claims. Here ty who belongs to the same are some guidelines that will ensure your E/M coding holds up to group practice, within the claims review. past three years. In addition to this definition, Be Sure New vs. Established Applies the Centers for Medicare & Not all E/M codes fall under the new vs. established categories. For Medicaid Services (CMS) example, in the emergency department (ED), the patient is always adds in Medicare Claims new and the provider is always expected to get the patient’s history to Processing Manual, Chapter diagnose a problem. 12 - Physicians/Nonphysician In the office setting, patients see their provider routinely. The pro- Practitioners (30.6.7): vider knows (or can quickly obtain from the medical record) the An interpretation of a diagnostic test, reading an X-ray or patient’s history to manage their chronic conditions, as well as make EKG etc., in the absence of an E/M service or other face-to- medical decisions on new problems. face service with the patient does not affect the designation A provider seeing a new patient may not have the benefit of knowing of a new patient. the patient’s history. Even if the provider can access the patient’s medical record, they will probably ask more questions. Define “New” Let’s break down the three key components that make up the new What’s New? patient definition: The definition of a new patient is listed in the CPT® code book: Professional Service: When physician coders see this, we automati- A new patient is one who has not received any profession- cally think of modifier 26 Professional services. This leads us to think al services from the physician/qualified health care profes- that if the provider bills a claim for radiology or labs, and sees the patient face to face, an established patient office visit must be billed. This is not true, per the aforementioned CMS guidance. If the provider has never seen the patient face to face, a new patient code should be billed. The general rule to determine if the Example: A patient presents to the ED with chest pain. The ED phy- sician orders an electrocardiogram (EKG), which is interpreted by the patient is “new” is that a previous, cardiologist on call. The cardiologist bills 93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only. The face-to-face service (if any) must have patient is sent home and asked to follow up with the cardiologist next week for coronary artery disease. At that visit, the cardiologist bills occurred at least three years from the a new patient visit because he only interpreted the EKG, but did not see the patient face to face. date of service. ■ ■ ■ 22 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Discuss this article or topic in a forum at www.aapc.com New vs. Established
matter. The provider has already seen these patients and has established a history. He cannot bill a new patient code just because he’s billing in a different group. • If a doctor of medicine (MD) or doctor of osteopathy sends a
patient to a mid-level provider (i.e., nurse practitioner (NP) CODING/BILLING or physician assistant (PA)) and the visit does not fall under incident-to, the NP or PA could bill a new patient code if they are a different specialty with different taxonomy codes. If the MD is a family practice provider and the NP sees hematology patients, for example, the specialty is different and a new patient code can be billed. But if the NP is also considered family practice, it would not be appropriate to bill a new patient code. • If one provider is covering for another, the covering provider must bill the same code category that the “regular” provider would have billed, even if they are a different specialty. For example, a patient’s regular physician is on vacation, so she sees the internal medicine provider who is covering for the family practice doctor. The internist must bill an established patient code because that is what the family practice doctor would have billed. Know the Exceptions There are some exceptions to the rules. For example: • Some Medicaid plans require obstetric providers to bill an Three-year rule: The general rule to determine if a patient is “new” initial prenatal visit with a new patient code, even if they have is that a previous, face-to-face service (if any) must have occurred seen the patient for years prior to her becoming pregnant. at least three years from the date of service. Some payers may have • Medicare considers hospitalists and internal medicine different guidelines, such as using the month of their previous visit, providers the same specialty, even though they have different taxonomy numbers.
iStockphoto / megaflopp / iStockphoto instead of the day. Example: A patient is seen on Nov. 1, 2014. He moves away, but returns to see the provider on Nov. 2, 2017. Because it has been three Know When to Appeal years since the date of service, the provider can bill a new patient If a new patient claim is denied, look at the medical record to see if E/M code. the patient has been seen in the past three years by your group. If so, Different specialty/subspecialty within the same group: This check to see if the patient was seen by the same provider or a provider area causes the most confusion. For Medicare patients, you can use of the same specialty. Confirm your findings by checking the NPI the National Provider Identifier (NPI) registry to see what specialty website to see if the providers are registered with the same taxonomy the physician’s taxonomy is registered under. For payers, this usually ID. If it’s a commercial insurance plan, check with the credentialing is determined by the way the provider was credentialed. department, or call the payer, to see how the provider is registered. If your research doesn’t substantiate the denial, send an appeal. Those who are part of the credentialing process must understand how important it is to get the provider enrolled with the payer Lori Cox, MBA, CPC, CPMA, CPC-I, CEMC, CHONC, AAPC Fellow, is regional director for correctly. Denials will ensue if this is not done correctly. Healthicity Audit Services. She has 20 years of experience in multiple areas of healthcare including auditing and compliance. Cox has been certified since 2002 and is a member of the New to Whom? Quincy, Ill./Hannibal, Mo., local chapter. She is the Region 5 AAPC National Advisory Board representative. Problems begin when doctors switch practices, send patients to mid-levels, and cross-cover for each other. Here are some examples of these situations: Resource • If a doctor changes practices and takes his patients with Medicare Claims Processing Manual, Chapter 12 - Physicians/Nonphysician Practitioners (30.6.7): him, the provider may want to bill the patient as new based www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf on the “new” tax ID. This is incorrect. The tax ID does not
www.aapc.com March 2018 23 ■ CODING/BILLING By Tameka J. Duncan, CPC, CPB, CPPM Send a COMPREHENSIVE PATIENT STATEMENT for Collecting Payment Clear and precise patient statements will get you paid faster.
ccounts receivable collections on patient balances are vital to Athe sustainability of any physician’s office. Although it’s best practice to collect co-pays, co-insurance, deductibles, and self- pay payments up front — either during the check-in or check-out process — practices rarely collect all money due. When patients are not able to pay in full, or the front desk clerk does not collect payments in full, the office must send out billing statements. Whether your office collects payment via this method depends on if your billing statement has all the elements it needs, and if it is easy for your patients to understand. Generally, if patients understand what they owe and why, they will pay. For best results, make sure to include the following information on your billing statements: 1. A clear title such as: “Statement,” “Patient Statement,” “Statement of Account.” It should be clear that this is a bill. 2. Date the statement was printed and payment due date 3. Office information that includes: • Name of the office 12. Amount due or pending by the insurance company or third- party payer • Physical and mailing address 13. Current and/or past due amounts
• Phone and fax number iStockphotosturti/ • E-mail and web address 14. Types of payment accepted at the practice 4. Name and mailing address of the payment guarantor 15. Date further action will be taken if the balance is not paid and what that action will be 5. Name of the physician or other qualified health professional who provided the service 16. Note of thanks to the patient for “prompt payment” and encouragement to contact the practice with questions or 6. Name of the patient who received the service concerns 7. Date(s) of service, a brief description of the service provided, When your patients are clear about what they owe and why, they will and the charge amount be more likely to make payments in full, or at least set up a payment 8. Date(s), amount, and payment(s) previously made by patient agreement (if your office offers this option). If you’re spending a lot 9. Adjustments made by the practice, including the description of time and money mailing patients numerous statements, or losing and amount 20 to 40 percent to collection agencies, it’s time to take action. Take a better look at your billing statement. 10. Payment amounts made by the insurance company or third- party payer Tameka J. Duncan, CPC, CPB, CPPM, has over 10 years of medical billing experience, and is passionate about a healthy patient-physician relationship. As a member of AAPC, she wants to 11. Notes from the insurance company or third-party payer such start a local chapter in the U.S. Virgin Islands. Duncan works in an obstetrics/gynecology office, as the deductible amounts, coverage termination, coordina- and has plans to start a medical billing practice and become a patient advocate. tion of benefits needed, etc. ■ ■ ■ 24 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Accurate Coding Results. Best Encoder Value.
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Get Your Free 14-Day Trial at www.aapc.com/coder ■ CODING/BILLING By Wanda Battle, CPC, CANPC, AAPC Fellow Coder’s Voice BARIATRIC SURGERY: A PERSONAL PERSPECTIVE Gain compassion for patients by understanding the choices they make. decided to have a laparoscopic vertical sleeve gastrectomy (VSG) • Ulcer, gallstones, bowel obstruction, and reflux Iafter going in for a routine check of my blood pressure. I was told Risks and disadvantages associated with VSG may include: I was pre-diabetic. My grandmother became diabetic later in life • Bleeding, infection, and blood clots and died of diabetic complications. I was 50-years-old and possibly looking at the same fate. Although my high blood pressure was under • Stomach leakage along the stapled edge control, I battled with my weight. I had tried every diet I could find: • Nonreversible pills, shakes, Weight Watchers®, Jenny Craig®, Nutrisystem®, etc. • Might not be covered by certain insurance companies because Some helped me to lose weight, but then I’d gain it back. My doctor it’s considered investigational or experimental told me to just stop eating. Really! Because I had high blood pressure, obstructive sleep apnea, hiatal hernia, polycystic ovary syndrome, and knee pain, my insurance A Tough Choice agreed to cover the procedure after six months on a physician- I researched both the gastric sleeve and bypass bariatric surgery supervised diet. options. Even though both have risks, the bypass was more invasive and had a few more risks than the sleeve. Positive Outcome Risks and disadvantages associated with gastric bypass may include: The vertical gastric sleeve was the best thing I’ve ever done. I’m happier, • Bleeding, infection, and blood clots healthier, and more confident and self-aware than I’ve ever been. When • Stomach leakage along the stapled line I want to indulge, I think about my husband and my sons and being around for my future grandchildren. I am so proud of how far I’ve come • Complex, invasive surgical procedure and I don’t let momentary lapses get me down and keep me from my • Dumping syndrome goals. This is a lifelong journey, not a race to the finish line. I learned in • Potential nutritional deficiency the support groups that they fix your stomach, not your head. iStockphotobearsky23 / ■ ■ ■ 26 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Discuss this article or topic in a forum at www.aapc.com Gastric Sleeve
My journey has inspired several others to look in to the procedures and make a lifestyle change for their health. CODING/BILLING
The weight loss has been slow, and there are times when I feel Wanda H. Battle, CPC, CANPC, AAPC Fellow, has over 20 years’ experience in the medical frustrated. At those times, I remind myself the surgery was not field, from patient registration, to account representative, to case management. She became about size; it was about me, and changing a lifetime of bad eating certified in 2004 and earned her specialty credential and AAPC Fellow recognition in 2017. habits. No matter what you do, people always judge you and have She works for Children’s Healthcare of Atlanta. Battle served as vice president of the Marietta, Ga., local chapter in 2017. something to say. Whatever you do, do it for you and no one else. I’ve lost 50 pounds so far! My journey has inspired several others Resource to look in to the procedures and make a lifestyle change for their http://guidedoc.com/gastric-sleeve-vs-gastric-bypass-surgery health. #LOVE YOURSELF
Coding Laparoscopic placed in the right upper quadrant to work with and a 12 mm trocar was inserted left upper quadrant and an additional 5 mm port was placed in the left abdomen. A subxiphoid incision Vertical Sleeve Gastrectomy was made through which the Nathanson retractor was inserted, elevating the left lateral This is the operative report from Wanda Battle’s surgery. Can you code it properly? Go segment of the liver to the anterior abdominal wall. We inspected her hiatus and she did online (www.aapc.com/resources/publications/healthcare-business-monthly) and take have a hiatal hernia. It was 2-3 cm. We mobilized the hiatus anteriorly. The hiatus was re- the Healthcare Business Monthly Test Yourself quiz for this issue to find out. You’ll earn one approximate with a single figure of eight suture using 0-silk. The closure was not too tight, continuing education unit for your effort. as we could easily pass out instruments between the closure and the esophagus with the EGD scope down. We then turned our attention to the sleeve gastrectomy. The short gastric Operative Report arteries were divided using Ligasure starting along the greater curve, working proximally Procedure: for some distance. We then worked back toward the pylorus. All the short gastrics were 1. Laparoscopic sleeve gastrectomy. divided. We measured approximately 4 cm from the pylorus itself and then began the 2. Hiatal hernia repair (2 cm anterior mobilization and repair with 0-silk xl). sleeve gastrectomy by firing an angled green staple load toward the lesser curvature. All 3. Upper endoscopy to rule out leak (negative). staple loads in this case were reinforced with Gore Seamguard for staple line reinforcement. We ensured that this was not too tight by examining anteriorly and posteriorly. A second Aesthesia: GETA green load stapler was then applied to the stomach along the lesser curve. I then adjusted Estimated Blood Loss: <10 mL our staple load to make the sleeve gastrectomy at the appropriate size based on the bougie. Specimen: Sleeve stomach The endoscope is 32F, so we did not hug it tightly, aiming for bougie size of 40F. It tool Drains: None approximately 6 firings of the stapler to reach the angle of His (2 green, 2 gold, 2 blue). Indications for Procedure: The patient has been evaluated during the bariatric preoperative We placed the stomach in the lower abdomen and observed the staple line. The endoscope process for surgery. The patient has preoperative co-morbidities and BMI indications was then used to evaluate both for bleeding and a leak. Fluid was instilled in the abdomen as documented in the chart. They understand the inherent risks of this procedure as along the staple line to observe for bubbles. None were seen. We were advanced the scope documented in detail in the clinic chart. through the sleeve gastrectomy and visualize the pylorus. There was no active bleeding within the gastric pouch. There was a small ooze from the proximal stomach posteriorly and Procedure in Detail: The patient was given Ancef 3 g and Flagyl 500 mg 20 minutes before this was clipped. No other pathology was noted in the abdomen. the incision and SCD boots were placed for the DVT prophylaxis bilaterally. After induction of general anesthesia, the abdomen was prepped and draped in sterile fashion. Pt was The omentum was draped over the staple line to cover it. The liver retractor was removed. strapped and secured to the table in multiple locations. A footboard was also used. The A 15 mm endocatch bag was inserted after enlarging it a little bit with a Kelly clamp. endoscope was then inserted into the stomach and towards the pylorus to serve as a The remnant stomach was then pulled through this port and sent to pathology. The bougie. The cap was taken off to emit the insufflation and decompress the stomach. The right upper quadrant port site was closed with an interrupted 0 Vicryl suture placed in a scope was turned off. figure-of-eight fashion with the suture-passing device. The abdomen was inspected and We made an incision 18 cm down from the xiphoid, left of the midline. A radially dilating no other pathology was noted. The ports were removed from the abdomen. The abdomen trocar was inserted in the abdomen under direct vision and the abdomen was inspected. No was desufflated of air and the skin incisions were closed with running 4-0 monocryl sutures. abnormal pathology was noted. Three additional trocars were then placed. A 15 mm was Dermabond was applied.
www.aapc.com March 2018 27 Too busy to get Everything done?
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ind o t ore t aa . o 1 k ■ CODING/BILLING By Meera Mohanakrishnan, MS, CPC, COC, CPC-P, CRC, CPC-I, CCS, PAHM
Encourage physicians to value proper documentation and help them fulfill risk adjustment requirements and HEDIS scores.
he medical record is evidence of a patient’s past and present health RADV, HEDIS, and the Importance Tstatus and medical treatment. Quality documentation is necessary of Provider Documentation for accurate coding and billing. More significantly, it’s essential to deliver quality healthcare. For these reasons, it’s important to initiate The Centers for Medicare & Medicaid Services (CMS) collects data a physician education program (PEP) talk to explain compliant to rate the quality of care physicians deliver. This data relates to the documentation and encourage provider buy-in of better medical diagnoses documented by the rendering physician. As such, every record-keeping. physician should be aware of the risk adjustment data validation (RADV) process for Medicare patients.
■ ■ ■ 30 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management PEP Talk
Upcoding or changing diagnoses to obtain higher reimbursement without supporting source documents is fraud. CODING/BILLING RADV is the process of verifying that chronic diagnosis codes and quality patient outcomes. The medical record chronologically submitted for payment by the Medicare Advantage organization documents patient care, and is an important element contributing are supported by medical record documentation for the patient. to high quality care. Physicians should know that CMS likely will audit their patients’ Provide physicians with educational materials and forms to assist medical records, at some time. Upcoding or changing diagnoses to them to improve their documentation, such as shown in the Sample obtain higher reimbursement without supporting source documents Checklist. This allows for improved HEDIS and risk adjustment is fraud. Data validation certifies that both the documentation and factor (RAF) performance. coding are appropriate. Physicians know the medical decision-making process. As such, Providers are the main source of information driving the documen- they are the best choice to capture accurate information from tation of chronic conditions, as well as Healthcare Effectiveness a clinic or hospital visit — not only for better documentation Data and Information Set (HEDIS) scores. This means that for purposes, but also for accurate coding and billing. You can look at every visit a coder/educator has with your physician, it’s an opportu- the exam and tally the necessary elements to get an evaluation and nity to reiterate the importance of documenting chronic conditions management (E/M) code, but the physician has a true handle on the and HEDIS measures. A big challenge in provider engagement is medical component and should select the E/M code. getting them to understand the alignment of HEDIS measures Be sure your physicians are aware that lab results or radiological imaging diagnoses results are not codable unless the clinician brings Sample Checklist: the information into the medical office visit or progress note. Checklist Yes / No Patient ID Record the Right Documentation Patient full name Here are points you should make for your PEP talk: DOB • Documentation should be accurate, valid, and complete. Sex - female /male • Handwritten medical records must be legible. DOS • The medical record must include the physician signature Medical record number with full name and credentials. Physician full name and credential • Rendering physicians must sign the record. PCP full name and credential • EHR should be authenticated (e.g., signed by, electronically Location and contact details of the physician office signed by, authenticated by), followed by the provider’ss name and credential. Chief complaint/subjective • Some EHR settings that automatically fill in the full history, HPI full exam, and full review of systems info for all patients Appropriate medical, social, and family history and/or for every patient visit. These systems require the Review of systems provider to manually uncheck a box to delete the services not Physical examination provided, often resulting in overbilling. Lab or other ordered test(s) • Document every active chronic condition and HEDIS Working diagnosis consistent with findings measures with detailed documentation to support it in the medical record, because you never know if or when the Final assessment patient will be back to the doctor for that year. Plan of action consistent with diagnosis • Include current medication list. Documentation and supporting chronic condition • Clinical evaluation and findings are documented for each in each visit visit. Document HEDIS/quality codes • Document every chronic condition and support every CMS accepted signature chronic diagnosis by monitored, evaluated, assessed, or Physician credential treated (MEAT) criteria.
www.aapc.com March 2018 31 PEP Talk
Common Missed Opportunities for Physician Education
SCENARIO 1 EXAMPLE SCENARIO 1 (incomplete documentation): A patient Missing visits the physician for fever and nausea. The patient physician name, has a history of chronic conditions including hyper- credential and signature lipidemia, hyperthyroidism, neuropathy, depression etc. The diagnosis in Scenario 1 Example cannot be sub- mitted due to an incomplete record. The objective, No Chronic condition documented assessment, and plan are not documented. The MA plan would not be reimbursed for the highlighted CODING/BILLING Patient is on chronic condition. medications like Simvastatin, Losartan, but no chronic conditions documented
SCENARIO 2 EXAMPLE
Rendering Physician is different from Signed Physician
SCENARIO 2 (Rendering physician is different from signed physician): This is common when a group of doctors works in a shared institution/clinic, but may lead to legal issues. The staff/physician should select the correct physician name and correct authentication name in the electronic health record (EHR).
SCENARIO 3 (missing signature or chart not closed): The physician a printed signature below the illegible signature, this may be should know that if there is no signature in the record, the record accepted, as well. is incomplete and CMS will not accept it. If the signature is illegible, CMS example for an attestation letter: Medicare will consider evidence in a signature log or an attestation statement to determine the author of the medical record entry. I, _____[print full name of the physician/practitioner]_____, If signatures are missing or illegible, providers may submit an hereby attest that the medical record entry for _____[date attestation statement. of service]_____ accurately reflects signatures/notations A signature log or attestation statement would support the that I made in my capacity as _____[insert provider identity of the illegible signature. If the original record contains credentials, e.g., M.D.]_____ when I treated/diagnosed the
32 Healthcare Business Monthly Discuss this article or topic in a forum at www.aapc.com PEP Talk
SCENARIO 3 EXAMPLE above listed Medicare beneficiary. I do hereby attest that this information is true, accurate, and complete to the best of my knowledge, and I understand that any falsification,
Susan Young MD omission, or concealment of material fact may subject me CODING/BILLING to administrative, civil, or criminal liability. The following handwritten signature examples meet the Chart not closed Fever and uneasy Missing provider’s signature requirement: • Legible full signature • Legible first initial and last name 71 in • Illegible signature over a typed or printed name
SCENARIO 4 (chronic condition not documented): The record shown in Scenario 4 Example documents the patient is on drugs that support the diagnoses of diabetes mellitus, hypothyroid- ism, hyperlipidemia, etc.; but the physician has not documented chronic diagnosis in the medical record. The doctors should be educated in documenting chronic condi- tions in every visit, as we never know if the patient will return to the physician during the same year. In such scenarios, the RAF for the patient is affected and the MA plan would not recognize the correct revenue, affecting the patient's quality of care.
SCENARIO 4 EXAMPLE
Mark Reynaldo MD
Patient on medications like Incomplete documentation Metformin (medication for Diabetes), Synthroid ( medication for Hypothyroid, Goiter ,Thyroid cancer etc), and Atorvastatin (Medication for Heart failure · High cholesterol · Hypertriglyceridemia · Hyperlipidaemia, but no chronic conditions are documented
• Document disease to highest level of specificity (for example, Meera Mohanakrishnan, MS, CPC, COC, CPC-P, CRC, CPC-I, CCS, PAHM, is a Certified ICD- if the patient has diabetes mellitus type II with neuropathy, 10 Consultant and director of Medical Coding Operations at IntegraNet Health and dean of document the same and just not diabetes mellitus II). IntegraNet Coding Academy in Houston, Texas (mmohanakrishnan@ integranethealth.com). She has a Master’s degree in Biochemistry and is a member of • Code to the highest specificity. the Houston, Texas, local chapter. Help your doctors to help their practice and patients more effectually by getting them to pay attention to the details with a PEP talk.
www.aapc.com March 2018 33 I Am AAPC
ANNE KUCHAN, CPC-A y decision to pursue a path in healthcare started the moment of Mheartbreak when my husband told me he was leaving me, soon after our second child was born. Feelings of loss and shock evolved into planning and decision-making. It was now up to me to provide a stable future for myself and two young children. I originally went to school to develop my art talent, but now I needed to develop a skill in a field I respected: healthcare. I began taking online classes towards a degree in medical coding and reimbursement. Putting Determination and Skills to the Test When I started the degree program, I thought medical coding simply involved selecting codes for procedures and diagnoses. I quickly learned it was a lot more complicated than that. It was daunting at first, but I chose this field with purpose and I was determined to do well. I sought help and asked questions from teachers and advisors, and I
#IamAAPC joined AAPC. I made use of my artistic skills by drawing anatomical diagrams of body systems to help me understand what I was coding. I balanced my studies with a home care job and the needs of a baby and toddler.
I made use of my artistic Patience Is a Virtue I was proud to graduate in under two years. My focus then turned to skills by drawing anatomical the Certified Professional Coder (CPC®) exam. After taking AAPC practice exams, I was ready to test everything I learned. The hardest diagrams of body systems to part after taking the exam was waiting for the confirmation of passing, but I did it and it felt so good. My certification will help me get started help me understand what I in an entry level position, and I’ll grow from there. was coding. Turn Adversity into Success I attend local AAPC meetings and earn continuing education units (CEUs), and I plan to take AAPC practicum coding modules to get my apprentice designation removed. I also continue to study anatomy and codes, and read Healthcare Business Monthly. It’s possible to turn shock and heartbreak into success and accomplish- ment. I’m proud of how far I’ve come, and will continue to seek opportunities in the healthcare field with the resolve that started my journey.
34 Healthcare Business Monthly Quick Tip By Deborah Palmer, CPC, CRC
P = Have a positive attitude. A = Always respect a clinician’s time. If you must ap- EMPATHY proach a clinician with a coding question or docu- mentation dilemma, begin by asking, “Is this a good time to talk about documentation and coding?” Improves Coder/ Remember that patients come first. Disrupting the clinician could sidetrack their train of thought. T = Thank the clinician for the opportunity to share Clinician Relationships coding and documentation tips. To cultivate an effective, professional relationship with your clini- H = Host an educational webinar, a WebEx meeting, cians, you must have EMPATHY. or face-to-face session for clinicians and/or coders. E = Educate yourself. Stay current on coding guidelines, read Y = Yes, you should acknowledge and applaud any Healthcare Business Monthly, forums, etc. If you have current documentation improvement success your clinicians QUICK TIP information and are up to date with changes, your clinicians will have. have more faith in your abilities. Deborah Palmer, CPC, CRC, has worked in the business of healthcare since the early 1980s. M = Make introductions. In other words, network and share knowl- She is a coding and documentation specialist for Holy Redeemer Health Systems in Huntingdon edge with your peers. Get to know your billing staff, outpatient Valley, Pa. Palmer provides education to clinicians and staff regarding proper coding and coders, inpatient coders, etc. Shadow your clinicians and be documentation. She is a member of the Blue Bell, Pa., local chapter. willing to share what you know.
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www.aapc.com March 2018 35 Thank You! To our 2018 HEALTHCON Sponsors and Exhibitors.
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Ӏ 3M Health Information Systems Ӏ Hushmail Ӏ Addison Group Ӏ Knack Global Ӏ Alliance HIM Ӏ LexiCode, Now Part of Exela Thank You! Ӏ American Health Information Management Ӏ Maxim Health Information Services To our 2018 HEALTHCON Sponsors and Exhibitors. Association (AHIMA) Ӏ McGraw-Hill Education Ӏ Alpha II Ӏ Medical Audit Resource Services, Inc Ӏ Altegra Health MedKoder PLATINUM Sponsors Ӏ Ӏ American Medical Association Ӏ MedLearn Publishing Ӏ Aviacode, Inc. Ӏ National Alliance of Medical Auditing Ӏ Charter Oak State College Specialists Ӏ CodingAID Ӏ National Healthcareer Association Ӏ Coding Network, LLC (The) Ӏ Optum360 GOLD Sponsors Ӏ Columbia Southern University Ӏ PatientKeeper Ӏ DecisionHealth AAPC ExhibitorsӀ QualCode, Inc Ӏ DuvaSawko Ӏ RCM Health Care Services Ӏ Elsevier Ӏ ReadyMed Ӏ Expo Enterprise Ӏ Streamline Health SILVER Sponsors Ӏ F.A. Davis Company Ӏ TCI (The Coding Institute, LLC) Ӏ Find-A-Code Ӏ The College of St. Scholastica Ӏ HCA Physician Services Group Ӏ The HIPAA E-Tool Ӏ Health Information Associates Ӏ Ultimate Medical Academy Ӏ Healthcare Cost Solutions Ӏ Wolters Kluwer BRONZE Sponsors Ӏ Healthicity Ӏ ZHealth Publishing Ӏ Healthpac Computer Systems, Inc
Register by March 9 at: www.HEALTHCON.com ■ PRACTICE MANAGEMENT By Chelle Johnson, CPC, CPMA, CPPM, CPCO, CEMC, AAPC Fellow REDISCOVER THE LOST ART OF CUSTOMER SERVICE Ask “WWAD?” and then apply these tips to patient and colleague interactions.
he medical world is still an arena where, regardless of how Tmuch technology is available, face-to-face communication still dominates. As such, customer service is key. To provide excellent service, ask yourself: What Would AAPC Do? (WWAD?) WWAD? AAPC professionals pride ourselves on being the best at what we do — whether that is coding and billing, auditing and compliance, practice management, or one of the many other career opportunities in the business of healthcare. Being able to express our knowledge and expertise in a manner that opens the line of communication and understanding is a win-win. So when we ask, “What Would AAPC Do?” we are asking, how would the “best in the business” approach excellent customer service. Here are some tips. Practice Patience Being calm in the face of an irate patient or an annoyed colleague can be intimidating. The ability to remain relaxed and focused will help to defuse a sticky situation. One way to do this is to depersonalize the situation. Rather than defending, explaining, justifying, or excusing a behavior or action, talk about the situation from a dissociated place. For example, “I understand there’s a concern about the service provided by this office at your last appointment, as it did not meet your needs. I would appreciate you sharing your thoughts, so I can address this issue now and for future patients.” Often the patient or co-worker is venting and not upset with you personally. Remembering you’re the representative of your practice will help you to keep the situation in perspective. Active listening, such as taking notes and focusing on problem resolution, will help to keep everyone calm. Sometimes, just keeping in mind that you are not personally responsible for the other person’s frustra- tion or anger helps to depersonalize the situation. iStockphotoTommL / ■ ■ ■ 38 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management To discuss this article or topic, go to www.aapc.com Customer Service
To provide excellent service, ask yourself: What Would AAPC Do? (WWAD?) PRACTICE MANAGEMENT PRACTICE
Convey Clear, Non-confrontational Communication Nothing is more embarrassing for your staff than a patient receiving conflicting information from two different employees. It’s not just what you say, but how you say it that puts you on the road to a successful conversation. Eliminate “you” comments such A well-trained staff, conveying the same information in the same as, “You should have completed this form.” Using “you” comments positive and professional manner is a wonderful united front. automatically puts the other person in an argumentative position. Ensuring your policies are clear and your staff is well educated will Rephrasing your statement so it’s less confrontational will ruffle less go a long way in providing excellent customer service. feathers. For example, “It appears the form was not completed. I’m happy to assist with that now.” Manage Time Wisely Ask questions and listen fully to the answers before you reply. Using Adhering to good time management skills allows you to quickly the 1-2-3 trick is a good option in these cases — mentally counting research and resolve the concerns and issues of your customers. to three before replying allows for a calm and thoughtful response. Show you have a well-oiled and organized office by using your time wisely and meeting all deadlines for patient communication. Be Honest Poor time management gives the impression of an unorganized and incompetently run office. “Say what you mean. Mean what you say” is a time-honored phrase and still very true. Communicate the truth in all situations. Although hedging or telling “little white lies” can stave off an initial Add a Little of You confrontation, it leads to mistrust in the long run. Be honest and The most unique talent you can bring to your communications is convey the facts as clearly and concisely as possible. a little bit of you. Each of us has a unique personality. Our natural ability to represent the office in a professional competent manner Handle Surprises with Grace is a great skill. Letting personality flavor your interactions with customers adds an extra special touch. Often during a conversation, we are surprised by some information communicated to us. Not getting rattled is essential for excellent Add your personal touch by getting to know your patients and customer service. Remain calm so you can accurately process the co-workers. Chat about things that interest them. Often, you’ll new information. Kneejerk responses and panicked answers are find common ground and interests. It’s easier to bridge situations not helpful, and often need to be amended. It’s better to note the that arise when you already have a friendly relationship built on information and inform the other person that you’ll look in to the common ground issue and then provide an appropriate response. They’ll appreciate one full, clear answer. Learn from Feedback Getting immediate feedback allows you to address concerns before Show Empathy they escalate. Always ask if you have answered all a patient’s ques- The ability to understand and share the feelings of another is a tions or concerns before moving on. Getting immediate feedback is strong tool in customer service. The importance of empathy is a great learning tool and an excellent measure to determine if your conveyed perfectly in the 1991 movie “The Doctor,” in which an communication was sufficient. uncompassionate heart surgeon gets sick and becomes the patient. Learn from your mistakes. If you did not meet the customer’s needs Seeing the medical world from the patient’s perspective was an eye this time, use it as an opportunity to change your approach for the opener for the surgeon in this movie, and ultimately changed the next time. way he worked with his patients. Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow, has over 25 years’ We’ve all been in a patient’s or co-worker’s position; applying experience in the medical field. She has worked on both sides of the aisle with work history sensitivity and being aware of how they are feeling is invaluable. The covering the insurance carriers as well as the facility and providers. Johnson specializes in medical world is a confusing and scary place, and empathy can go a FQHC, family practice, public health, compliance, obstetrics/gynecology, and pediatrics. Her long way toward a successful encounter. past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif. She is a member of the Modesto Calif., local chapter. Be Consistent Consistency requires strong policies and procedures, and the ability to recall and apply these policies when interacting with patients.
www.aapc.com March 2018 39 ■ PRACTICE MANAGEMENT By Jen B. Flohr, RHIT, COC, CPMA, CPCO, CDIP, CCS, CAPM, ICD-10 Certified Trainer HIM: Work Inside or Outside of the Box? Explore and weigh your options to determine what work environment iStockphotoSIphotography / is best for you.
ver the years, more healthcare organiza- Otions have chosen to outsource some, if not all, of their health information manage- ment (HIM) roles to staffing companies, career. Remember: It’s not always what you allowed to work weekends or evenings if that eliminating plenty of direct-hire positions. know, but who you know! fits your schedule better. Due to the high demand for healthcare pro- Compensation: Traditionally, a vendor is C fessionals, there are many staffing companies Working for a Vendor able to offer a slightly higher hourly rate than specializing in HIM support. How do you (Out of the Box) a healthcare facility; however, both typically M decide if working in HIM for a healthcare Familiarity with Multiple Electronic require an initial and/or quarterly perfor- Y facility or as a vendor is right for you? Here Health Record (EHR) Software: When mance review, and hold annual reviews with CM are some things to consider. possible pay increases. you work for a staffing company, you are MY
often able to work on several different EHR CY Working for a Healthcare Facility programs and encoders, depending on Weigh the Benefits CMY (Inside the Box) what the clients use. It’s beneficial to have As far as benefits go, both options are K Stability and Security: Being employed experience with as many kinds of healthcare comparable and competitive. Some staffing directly through a healthcare organization or software as possible, and this is a great op- companies and facilities offer a bonus struc- facility provides a sense of job security and sta- portunity to do so. ture for high-performers, have a wellness/ bility. You get to know your co-workers; work Diversity of Healthcare Specialties/ fitness reimbursement program, and will pay collaboratively in a team environment; stay Service Lines: Vendors work with all types annual dues for one healthcare association informed of events or engagements that the of healthcare facilities, from physician prac- membership such as AAPC. hospital/facility sponsors; and feel as if you’re tices to ambulatory surgical centers (ASCs) If you are a student, new to the HIM field, part of something bigger in the community. to multi-hospital healthcare delivery systems. or simply ready for a change, explore all the Opportunity for Growth: Most organiza- Depending on your experience, assignment, prospects, weigh the pros and cons, and then tions prefer to hire from within, whenever and assignment length, you’ll have the poten- decide which is best for you. tial to work for various medical specialties, possible. Being on the inside allows you to Jen Flohr, RHIT, COC, CPMA, CPCO, CCS, CAPM, learn of job openings as they become available. inpatient, outpatient, or professional-fee ICD-10 Certified Trainer, has 20+ years in the These positions may mean a promotion from services. healthcare industry. She is the owner of JBF Healthcare your current role, or an opportunity to use Continuing Education Unit (CEU) Consulting, LLC, specializing in consulting and interim your expertise in a new and challenging way. Opportunities: Most vendors offer their management assignments in the areas of revenue cycle management, HIM, and clinical documentation improvement. Flohr has Develop Professional Relationships: employees free monthly webinars so they can an associate degree in HIM from Hodges University, and she is a member Although healthcare facilities are increas- continue with professional development while of the Haverhill, Mass., local chapter. ingly encouraging their HIM professionals earning AAPC or AHIMA CEUs to maintain to work remotely, many still prefer their their credentials. This is a definite perk! employees to be onsite. Working onsite al- Flexibility: Most employees work from Remember: It’s not lows you to develop rewarding professional home; although, it’s entirely contingent on relationships with management, physicians, the client’s needs. The working hours tend to always what you know, and other healthcare providers. These rela- be flexible and not your typical 8:30 a.m. to tionships may prove advantageous in your 5:00 p.m., as well. For example, you may be but who you know! WWW.ZHEALTHPUBLISHING.COM ■ ■ ■ 40 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management C
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WWW.ZHEALTHPUBLISHING.COM ■ CODING/BILLING By Debra Mariani, CPC, CGSC
93460, 93461, 93530, 93531, 93532, Correct procedural coding 93533) with TMVI codes when using: relies on deciphering similar • Contrast injections, angiography, road-mapping, terminology and acronyms. and/or fluoroscopic guidance for the TMVI ue largely to the confusingly similar terminology used to describe • Left ventricular angiography Dvarious valve procedures, they can be a challenge to document and to assess or confirm valve report. Let’s review common terms and coding guidelines to reduce positioning and function the confusion. • Right and left catheterization for hemodynamic First Things First: Know Your Terms measurements before, There are several types of valve procedures that are better known by during, and after TMVI for their acronyms: guidance of TMVI • Transcatheter aortic valve implantation (TAVI) Example: If the physician must • Transcatheter aortic valve replacement (TAVR) access the patient’s hemodynamics • Transcatheter mitral valve implantation/replacement (TMVI) (left heart catheterization) while per- forming the TMVI, do not code both • Transcatheter mitral valve repair (TMVR) a TMVI and a left heart catheterization • Transcatheter pulmonary valve implantation (TPVI) because the catheterization is bundled It’s important to understand the differences in these procedures to into the TMVI procedure. correctly apply their corresponding CPT® codes. Right and left heart catheterization codes (93451, 93452, 93453, 93456, 93457, 93458, New Category III Codes Describe TMVI 93459, 93460, 93461, 93530, 93531, 93532, CPT® 2018 introduces two new Category III codes to report TMVI. 93533) may be reported during the same session as This procedure is generally performed for mitral regurgitation, TMVI only if: mitral stenosis, and complication of a previously placed mitral valve • No prior study is available and a full diagnostic study prosthesis: is performed. 0483T Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve; percutaneous • A prior study is available, but as documented in the medical approach, including transseptal puncture, when performed record: 0484T transthoracic exposure (eg, thoracotomy, transapical) °° There is inadequate visualization of the anatomy and/or The procedures include vascular access, catheterization, balloon pathology; or valvuloplasty, valve deployment and (as needed) repositioning, tem- °° The patient’s condition with respect to the clinical porary pacemaker insertion for rapid pacing, and access site closure. indication has changed since the prior study or there is a clinical change during the procedure that requires new Heart Catheterization with TMVI evaluation. Per CPT® guidelines, do not bill diagnostic right and left heart cath- Example: The physician may perform a diagnostic catheterization eterization codes (93451, 93452, 93453, 93456, 93457, 93458, 93459, on the same day during the same session as a TMVI if the patient de- ■ ■ ■ 42 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Discuss this article or topic in a forum at www.aapc.com Valve Coding
TEE usually is performed with transcatheter valve procedures. This service is performed by a echocardiographer, who reports the service separately. iStockphotoHYWARDS / velops a significantly clinical change during the was performed with TMVI. For the full guidelines, see your 2018 CODING/BILLING procedure, which requires a new evaluation. CPT® code book. In this case, report a TMVI (0483T) and the diagnostic catheterization code with TAVR/TAVI Coding modifier 59 Distinct procedural service The TAVR/TAVI codes (CPT® 33361-33366) have been in place appended. since 2013, and their use is fairly straightforward; however, you Diagnostic coronary angiography may have questions about how to code for transcatheter aortic valve (93454 - 93564) performed during in valve procedures. The answer is, use the TAVR/TAVI procedure the same session as TMVI may be codes with modifier 22 Increase procedural service appended, with reported for right and left catheter- adequate documentation of the procedure. ization for the same reasons, stated Example: A patient has a failed bioprosthetic valve. The surgeon above. determines the patient is not a candidate for another open heart pro- Example: The provider performs cedure, and would benefit from a valve in valve TAVR procedure. a coronary angiogram prior to The interventional cardiologist performs the TAVR. Report TAVR TMVI because the patient had a (33361–33366, as appropriate) and append modifier 22 to indicate prior coronary angiogram of inad- an increased procedural service. equate diagnostic quality. In this case, report TMVI and a coronary Mitral Valve Procedures angiogram with modifier 59 ap- TMVR describes repair only, and is reported using 33418 pended to indicate a separate and Transcatheter mitral valve repair, percutaneous approach, including distinct procedure. transseptal puncture when performed; initial prosthesis and, when Angiography, radiological supervi- appropriate, +33419 Transcatheter mitral valve repair, percutaneous sion and interpretation, intrapro- approach, including transseptal puncture when performed; additional cedural road mapping to guide the prosthesis(es) during same session (List separately in addition to code for TMVI, left ventriculography, and primary procedure). These codes describe TMVR, not implantation completion angiography are included (i.e., 0483T is for TMVI, not repair; 0484T is for transthoracic in 0483T and 0484T. When right and exposure). left catheterization and/or angiography Transesophageal echocardiography (TEE) usually is performed are performed during the same session/ with transcatheter valve procedures. This service is performed by a same day, append modifier 59 to indicate echocardiographer, who reports the service separately. that a separate and distinct procedural service Report TMVR via the coronary sinus using 0345T Transcatheter mitral valve repair percutaneous approach via the coronary sinus. TPVI Report TPVI using 33477 Transcatheter pulmonary valve implan- tation, percutaneous approach, including pre-stenting of the valve delivery site, when performed. Example: A patient may have a history of a tetralogy of Fallot repair, and has developed shortness of breath and extreme weakness upon exertion. The patient is believed to have a failing pulmonary conduit. After imaging confirmation of pulmonary regurgitation, the patient undergoes TPVI. Report using 33477.
Debra Mariani, CPC, CGSC, is a coding and physician reimbursement associate with the American College of Cardiology. She has participated in her local chapters for the past 17 years, and has served in several officer roles. Mariani is a member of the Frederick, Md., local
iStockphotojack0m/ chapter.
www.aapc.com March 2018 43 ■ CODING/BILLING By Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, CRC Documenting Opioid Dependence and Abuse New metrics and quality measures call for improved documentation to track this growing problem. iStockphotoMegan/ Miks pioid dependence and overdose are at crisis levels. Healthcare • Use of Opioids from Multiple Providers: This measure assesses Oprofessionals have a front row seat to this epidemic, and we have the rate of health plan members 18 years and older who receive a responsibility to know coding and documentation requirements opioids from multiple prescribers and multiple pharmacies. for such cases. In implementing these metrics, the NCQA is adding health plans to the list of those responsible for stemming the opioid problem. In Opioid Use Becomes a Quality Measure addition to the NCQA’s efforts, opioid use is tracked closely by many According to the Centers for Disease Control and Prevention (CDC), value-based reimbursement and quality outcome payment models. 91 Americans die every day from an opioid overdose. Prescription drugs play a significant role in this statistic. According to the ICD-10 Coding National Committee for Quality Assurance (NCQA), the amount Opioid use is defined in ICD-10-CM under the category F11 Opioid of prescription opioids sold to pharmacies, hospitals, and physicians related disorders, which is further categorized by patterns of use, almost quadrupled from 1999 to 2010. Deaths from prescription abuse, and dependence. As with other drug use and dependency opioids have also quadrupled in the same time (NCQA, 2017). codes, these codes may specify “with intoxication,” “with induced In response to this growing problem, the NCQA introduced two psychotic disorder,” and “with other induced disorder.” new Healthcare Effectiveness Data and Information Set (HEDIS) Rely on documentation in the medical record to assign the most metrics: accurate code for the encounter. Clinicians typically turn to the • Use of Opioids at High Dosage: This measure assesses the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), rate of health plan members 18 years and older who receive published by the American Psychiatric Association, for diagnostic long-term opioids at high dosage (average morphine equivalent protocol. The DSM-5 criteria for Opioid Use Disorder are: dose >120 mg). The diagnosis of Opioid Use Disorder can be applied to someone who has a problematic pattern of opioid use lead- ing to clinically significant impairment or distress, as man- ifested by at least two of the following, occurring within a Related Reading 12-month period: For more information on the U.S. opioid epidemic, ways to spot abuse, 2018 ICD-10 • Taking more opioid drugs than intended. codes, and government response, read the article, “Help Combat the Opioid Crisis by Fol- lowing Guidelines and State Rules,” in the February issue of Healthcare Business Monthly. • Wanting or trying to control opioid drug use without success. For more information on HEDIS, read “HEDIS: Improving Healthcare Quality and Patient • Spending a lot of time obtaining, taking, or recovering Outcomes,” in the October 2016 issue of Healthcare Business Monthly. from the effects of opioid drugs. Articles published in Healthcare Business Monthly are available online at the • Cravings opioids. Knowledge Center on AAPC's website. • Failing to carry out important roles at home, work, or school because of opioid use. ■ ■ ■ 44 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Discuss this article or topic in a forum at www.aapc.com Opioid
According to the NCQA, the amount of prescription opioids sold to pharmacies, hospitals, and physicians has almost quadrupled from 1999 to 2010. CODING/BILLING • Continuing to use opioids, despite use of the drug causing Note: If you or someone you care about is struggling with opioid dependency or addiction, relationship or social problems. help is available. For information, go to www.samhsa.gov/find-help/national-helpline or call 1-800-662-HELP (4357). • Giving up or reducing other activities because of opioid use.
• Using opioids even when it is physically unsafe. Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, CRC, has 18 years of experience in health • Knowing that opioid use is causing a physical or insurance customer service, claims, quality, and coding. As risk adjustment quality and psychological problem, but continuing to take the drug education program manager for Capital District Physician’s Health Plan (CDPHP), Gianatasio’s primary responsibilities are provider engagement and clinical documentation improvement. anyway. She specializes in developing coding curriculum and instruction to support compliance with • Tolerance for opioids. federal guidelines and appropriate reimbursement processes. Gianatasio teaches coding, documentation, and auditing classes; serves as president of the Albany, N.Y., local chapter; and is a member of the AAPC National • Withdrawal symptoms when opioids are not taken. Advisory Board. Note: Not everyone who uses opioids has an opioid use disorder. The above list is not applicable if the individual is experiencing these symptoms under appropriate medical supervision. Resource American Psychiatric Association, DSM-5TM, 2013. According to the CDC, the majority of drug overdose deaths (more than six out of 10) involve an opioid. Documentation improvement NCQA Blog: Features and Announcements. (n.d.). Dec. 1, 2017, from www.ncqa.org/ aides coding specificity and allows stakeholders to generate quality Opioid Overdose. (2017, August 30). Oct. 23, 2017, from data that could potentially save lives. www.cdc.gov/drugoverdose/epidemic/index.html
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www.aapc.com March 2018 45 ■ CODING/BILLING By Cindy Harms, CPC, CPC-I, CPPM When Sleep Tests Are Covered Whether patients test for sleep issues in a lab or in the comfort of their home, Medicare reimbursement hinges on following protocol.
leep studies performed in certified sleep labs have long been Scovered by Medicare. But many patients find it hard to relax in a strange place, hooked up to electrodes, which makes it difficult to obtain accurate test results based on a normal night’s sleep. A home sleep test (HST) is a calmer and often more reliable alternative. Many third-party payers reimburse unattended sleep tests performed in the privacy of a patient’s home. Reimbursement is a nightmare, however, if provider qualifications, as well as medical necessity, documenta- tion, and billing requirements, aren’t met. Let’s look at both certified sleep lab tests and HSTs to see if your coding and billing practices will get your claims paid. Not All Sleep Tests Are Created Equal An HST involves connecting the patient to a portable monitor approximately the size of a large cellular phone. Before going to bed, the patient attaches sensors to their body. The device records such parameters as airflow through the mouth and nose, breathing, and blood oxygen levels. The next day, the device is returned to the certified sleep physician for data collection, analyzation, and interpretation. An HST is an unattended study: A qualified sleep technologist is not physically present to respond to emergencies, patient needs, or technical problems during the recording session. These tests are not generally covered for patients under 18 years of age. HSTs are also known as type II, type III, and type IV studies, depend- ing on the device used: • A type II device measures seven different channels, including electroencephalogram (EEG), electrooculogram (EOG), chin These are “quantity physician” and “quantity hospital” codes, mean- electromyogram (EMG), airflow, respiratory effort, oxygen ing there is a maximum allowable number of units of service, per day, saturation, sleep staging, and electrocardiogram (ECG). per patient. • A type III device measures four different channels, including fmajor / iStockphoto ECG/heart rate, two channels for respiratory effort and/or PSGs Are Not Performed at Home airflow. A polysomnogram (PSG) is a type I study, which must take place in • A type IV device measures three channels: airflow, oxygen a certified sleep lab attended by a technologist or qualified health saturation, and peripheral arterial tone. professional. Patients of all ages may be tested in this setting. CPT® codes used to bill for PSG include: Use these HCPCS Level II codes to bill Medicare for HST: 95800 Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis G0398 Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, (eg. by airflow or peripheral arterial tone), and sleep time. EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation 95801 minimum heart rate, oxygen saturation, and respiratory analysis (eg. by airflow or G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 peripheral arterial tone) respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation 95806 Sleep study, unattended, simultaneous recording of heart rate, oxygen saturation, respiratory G0400 Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels airflow, and respiratory effort (eg. thoracoabdominal movement). ■ ■ ■ 46 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Discuss this article or topic in a forum at www.aapc.com Sleep Tests
Apply Modifiers Correctly are covered for testing a patient for the diagnosis of SA, insomnia with SA, hypersomnia with SA, or sleep-related hypoventilation/ When only the technical component of the procedure is provided, hypoxemia. append modifier TC Technical component to the appropriate sleep study code, billed with the date the sleep study device was used. If Medicare will cover a HST only for patients with a high pretest the HST device is shipped to the patient’s home with a follow-up probability of moderate to severe obstructive sleep apnea (OSA). If CODING/BILLING call to overview the instructions, the place of service (POS) code is the patient does not have OSA, the home study test will not be able 12 Home, and the billing date is the date of the call. to test for, or determine, what other sleep disorder(s) may be present. If billing for HST interpretation only, HSTs are not covered for Medicare patients with: append modifier 26 Professional services to • Comorbidities (moderate to severe pulmonary disease, specify the professional component of the neuromuscular disease, or congestive heart failure); service, only. In this case, the date of service • Other sleep disorders (central SA, periodic limb movement is when the test was interpreted. The POS disorder, insomnia, parasomnias, circadian rhythm disorders code reflects where the physician analyzed or narcolepsy); or the results. • For screening asymptomatic persons. If a diagnosis is not established based on the results of the testing, Time Counts perhaps because of inadequate results, the provider can code the For accurate coding, 95800, 95801, and patient’s signs and symptoms that prompted the order for the 95806 must include six hours of recording test. If the insurance company rejects the claim, an appeal can be time. If fewer than six hours is obtained, submitted based on documentation in the medical record that was or oxygen saturation is inadequate for in- obtained prior to testing. terpretation, append modifier 52 Reduced services to the code to indicate a reduced Documentation Requirements service with subsequent reimbursement Documentation must show that the HST was performed with a reduction. comprehensive face-to-face sleep evaluation and a prescription from Example: A patient has a diagnosis of a physician. The HST must be performed with an approved device sleep-related hypoventilation, excessive and the recordings must be interpreted by a physician or other daytime sleepiness, and sleep apnea qualified health professional who has sufficient training in sleep (SA). His attending referred him to an medicine and polysomnograms. The test report should include accredited sleep center for evaluation. The a description of the monitored channels, total sleep time, sleep sleep medicine board-certified physician efficiency, and number/duration of awakenings. performed a comprehensive face-to-face Because Medicare contractor and commercial payer billing re- sleep evaluation and provided the patient quirements constantly change, check with your carrier’s coverage with a type IV portable monitoring device guidelines before submitting the claim. Prior authorization may be with instruction on applying the probes needed. and setting up the device. The patient returned the device to the sleep center a Cindy Harms, CPC, CPC-I, CPPM, has been in the medical field for 40 years, and has taught medical billing, few days later, and the physician analyzed and reported his findings. coding, and practice management for 27 years. She is a member of the Albany, N.Y., local chapter. The provider should bill G0400 or 95801, POS 15 Independent diagnostic testing facility, depending on the carrier and if the test was performed at home or in a lab. Resources According to Noridian HealthCare Solutions, March 2016, some Medicare administrator contractors do not pay for either the global, Sleep Study CPT codes list 95806, 95810, 95811, 95807: professional, or technical components with POS 11 Office. www.medicarepaymentandreimbursement.com/2011/08/polysomnography-and-sleep- studies-cpt.html Note also that many third-party payers state that even if two or Sleep Review, 4 Steps to Correct Coding for Home Sleep Apnea Testing: www.sleepreviewmag. three nights of study are performed, reimbursement is for only one com/2015/04/4-steps-correct-coding-home-sleep-apnea-testing/ April 19, 2015. night of study. CMS Manual Pub 100-03 Medicare National Coverage Determination (NCD), CMS Decision Memo Local Coverage Determination (LCD): Polysomnography and Other Sleep Studies Meet Medical Necessity Requirements (L36861), for services performed on or after June 5, 2017. Many insurance plans, including Medicare Part B, cover home sleep Noridian HealthCare Solutions, Polysomnography and Other Sleep Studies, March 2016 tests for eligible patients. The physician services related to HSTs
www.aapc.com March 2018 47 ■ CODING/BILLING By Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CEDO, CANPC, CASCC, CEDC, CRC, CCS, ICDCT-CM/PCS
2018 Brings New Focus to E/M Services
CPT® code and guideline New! Psychiatric CoCM Services Three new codes (99492-99494) report initial and subsequent psy- changes show a shift towards chiatric CoCM. Per the American Psychiatric Association, CoCM services:
collaborative care and behavioral iStockphotopixelfusion3d / …typically [are] provided by a primary care team consisting of health management. a primary care physician and a care manager who work in col- laboration with a psychiatric consultant, such as a psychiatrist. Care is directed by the primary care team and includes struc- ith the release of CPT® 2018, we see major changes in coding tured care management with regular assessments of clinical sta- Wthroughout the Evaluation and Management (E/M) section. tus using validated tools and modification of treatment as ap- New codes and chapters were added for collaborative care manage- propriate. The psychiatric consultant provides regular consul- ment (CoCM) and behavioral health management. Let’s review these tations to the primary care team to review the clinical status complex changes, which went into effect Jan. 1. and care of patients and to make recommendations. New! Cognitive Assessment and Care Plan Services To report CoCM, all bulleted items must be performed and docu- mented, and the time threshold must be met, as demonstrated in New code 99483 Assessment of and care planning for a patient with Table A. Do not report 99492 Initial psychiatric collaborative care cognitive impairment, requiring an independent historian, in the of- management, first 70 minutes in the first calendar month of behavioral fice or other outpatient, home or domiciliary or rest home replaces health care manager activities with 99493 Subsequent psychiatric col- deleted HCPCS Level II code G0505. With code 99483, typically laborative care management, first 60 minutes in a subsequent month of 50 minutes are spent face-to-face with the patient and/or family or behavioral health care manager activities in the same month. caregiver. Cognitive assessment and care plan services are provided when a comprehensive evaluation of a new or existing patient, who exhibits signs and/or symptoms of cognitive impairment, is required New! General Behavioral Health to establish or confirm a diagnosis, etiology, and severity for the Integration Care Management condition. This service includes a thorough evaluation of medical and New code 99484 Care management services for behavioral health con- psychosocial factors, potentially contributing to increased morbidity. ditions, at least 20 minutes of clinical staff time, directed by a physician Do not report cognitive assessment and care plan services if any of the or other qualified health care professional, per calendar month replaces required elements are not performed or are deemed unnecessary for HCPCS Level II code G0507 to report general behavioral health the patient’s condition. For these services, see the appropriate E/M integration (BHI) services, which incorporate principles associated code. Cognitive assessment and care planning may be reported every with collaborative care. To report these services, all bulleted items 180 days, but not with other E/M services. listed in the code descriptor must be performed and documented, and ■ ■ ■ 48 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Discuss this article or topic in a forum at www.aapc.com E/M Changes
Table A Cognitive assessment and care Type of Service Total Duration of Collaborative Care Code(s) Management Over a Calendar Month planning may be reported every 180
Initial- 70 minutes Less than 36 minutes Not reported CODING/BILLING 36-85 minutes separately days, but not with other E/M services. (36 minutes- 1 hour 25 minutes) 99492
Initial plus each additional 86-116 minutes 99492 x 1 AND initiation of observation status, supervision of the care plan increment up to 30 minutes (1 hour 26 minutes- 1 hour 56 minutes) 99494 x 1 for the observation, and performance of periodic reassess- Subsequent 60 minutes Less than 31 minutes Not reported ments. For observation encounters by other physicians, see of- 31-75 minutes separately fice or other outpatient consultation codes (99241-99245) or (31 minutes - 1 hour 15 minutes 99493 subsequent observation care (99224-99226) as appropriate. Subsequent plus each 76-105 minutes 99493 x 1 AND The term “outpatient hospital” was added to code descriptors to additional increment up to (1 hour 16 minutes- 1 hour 45 minutes) 99494 x 1 clarify that observation services (including 99217 Observation care 30 minutes discharge day management) are specific to outpatient status (POS 22 On campus-outpatient hospital). Do not report observation for the time threshold (in this case, at least 20 minutes) must be met. Do patients admitted to the hospital. not report 99484 with 99492, 99493, +99494 Initial or subsequent There are several important changes to the E/M guidelines and psychiatric collaborative care management, each additional 30 minutes parenthetical instructions. in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating New guidelines clarify that prolonged service codes 99354-99357 physician or other qualified health care professional (List separately in involve direct patient contact, beyond the usual service, in either addition to code for primary procedure) in the same month. the inpatient or outpatient setting. The guidelines define direct patient contact as “face-to-face,” but further include “additional Revised! Guidelines for Initial non-face-to-face services on the patient’s floor or unit in the hospital Observation Care and More or nursing facility during the same session.” New guidelines explain that telephone services codes 99441-99443 New text clarifies that initial observation codes 99218-99220: are not reported with 93792, 93793 for home and outpatient INR … report the encounter(s) by the supervising physician or oth- monitoring. er qualified healthcare professional with the patient when des- Revised guidelines clarify that time-based critical care services (99291 ignated as a hospital “observation status.” This refers to the Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes and +99292 Critical care, evalua- Anticoagulation Management tion and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary Gets an Overhaul service)) may not be reported by the same individual (or a different Codes 99363 and 99364 for anticoagulation management are deleted and replaced by new individual of the same specialty or group) when reporting neonatal (Medicine section) codes: or pediatric critical care services (99468-99476) for the same patient 93792 Patient/caregiver training for initiation of home international normalized ratio (INR) monitor- on the same day, but may be reported by an individual of a different ing under the direction of a physician or other qualified health care professional, face-to-face, specialty (from either the same or different group) on the same day as including use and care of the INR monitor, obtaining blood sample, instructions for reporting home INR test results, and documentation of patient’s/caregiver’s ability to perform testing neonatal or pediatric critical care services. and report results Per CPT®, “Critical care interfacility transport face-to-face (99466, 93793 Anticoagulant management for a patient taking warfarin, must include review and interpreta- 99467) or supervisory (99485, 99486) services may be reported tion of a new home, office, or lab international normalized ratio (INR) test result, patient instruc- by the same or different individual of the same specialty and same tions, dosage adjustment (as needed), and scheduling of additional test(s), when performed group, when neonatal or pediatric critical care services (99468- Due to the critical nature of thinning blood or reducing its clotting factor, patients on warfarin 99476) are reported for the same patient on the same day.” require constant oversight and international normalized ration (INR) testing. The medication is adjusted, as needed, to provide the best level of anticoagulation in the blood. The patient Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CEDO, CANPC, CASCC, CEDC, CRC, CCS, is reminded of the specific dietary needs, and observed for possible bruising. Anticoagulation ICDCT-CM/PCS, has been a coder for over 25 years. She works at Change Healthcare as the management codes are used to report this oversight, which includes ordering, reviewing, Facility Coding Services line manager. She also serves as an interim instructor in her and interpreting the INR testing, communicating with the patient, and adjusting dosage, hometown of Mobile, Ala. Pritchett owned and operated the medical billing and coding company, Gulf Coast HIM Solutions. She shares her expertise in publications and as a lecturer as necessary. Code 93792 reports the education for the patient or caregiver for home INR at conferences such as HEALTHCON and Coding-Con. She has served as the president, vice president, and monitoring; 93793 reports the provider’s management and oversight. member development and education officers for the Mobile, Ala., local chapter.
www.aapc.com March 2018 49 ■ ADDED EDGE By Robin Moore, CPC, CCMA Remote Coding/Billing: IS IT RIGHT FOR YOU? iStockphoto / monkeybusinessimages / iStockphoto Know the type of work and requirements, and debunk the myths surrounding coding/billing from home.
ou see jobs for remote coding and billing leave or are terminated. As such, you are last less than three months. Usually no Yadvertised everywhere: schools promote required to clock in and out and comply taxes are taken out of your pay, and you are it, recruiters tempt you with it, and your with company policy. paid at the end of the project. If the project coworkers says it’s their dream to work 2. You work for a staffing company, and spans several months, however, you may be from home. It sounds great, but is working projects may be short term or long term, paid monthly. When one contract ends, it’s remotely right for you? Before you throw out depending on how long the client needs up to you to find another. all those business suits, take a reality check. you. Sometimes projects take longer than Something to consider: Most companies will anticipated or you’re asked to stay on lon- supply their remote employees with either a What’s Your Type? ger. You might accrue time off, be offered laptop or a desktop computer. Non-employee There are different three main types of health insurance benefits, or have taxes workers, however, usually must purchase their remote work descriptions: taken out of your check (if you don’t have own computers, software, and office supplies. 1. You are an employee of a company with taxes taken out of your check, you must If the company does not provide tech sup- all the benefits that every employee of that still report your income to the IRS). port, you may also want to hire a company company has, but you work from home. 3. You work from home, under contract, for to help you when you need a computer geek. You accrue time off, are offered insurance, specific projects. You agree on a pay rate Just remember to adhere to HIPAA when and you’re at the job until you decide to and you know the end date. Projects often hiring third parties to do your techy work!
50 Healthcare Business Monthly Remote Coding
Do You Have What It Takes? The last thing to think about is whether you can you be alone all day, every day. It gets Fact or Fiction? Most remote coding/billing positions require lonely. People prefer to do business interac- I can skimp on a babysitter. a Certified Professional Coder (CPC®) or tions via email, rather than on the phone. You Fiction: Watching children is impossible when there are Certified Professional Biller (CPB™) cre- may long to hear a live voice. Social media is strict production standards you must adhere to. When dential, with at least three years’ experience your personal interaction, your outside con- working at home, you’re watched closely on meeting working in a medical office or facility. numbers. nection. There are no more potlucks, Friday Many new coders ask why onsite experience pizza parties, or holiday parties. The good I can work whenever and wherever I want. is a requirement. When starting out, working news is there is no office gossip or traffic on Fiction: There are some projects that can be worked on closely with other coders and under direct your commute — unless you count tripping whenever you feel like it, as long as you complete it by a supervision will help with your success. Most given deadline. Often you can set your work time; once set, over the cat on your way to the office. entry-level coders work better onsite until though, you need to stick to working those hours. they become proficient in coding processes Robin Moore, CPC, CCMA, is a physician revenue cycle You must have a designated office space. It’s easier to tune and are confident at working independently. coding and documentation auditor for Mercy Health and out distractions while you work if you have separate space a remote coder for Himagine Solutions, Inc. She serves with a door you can shut. Coding is an art that is fine-tuned over the as the president of the Toledo, Ohio, local chapter, and years. The more you work with the codes, the she has held other officer positions. I can work in my pajamas. better you are at applying their descriptions. Fact: You can work in your pajamas most of the time (unless you have a Skype meeting that day), but it gets old. You’ll An important thing you need to ask yourself realize you need to at least throw on some jeans and a is, “Do I have the commitment?” It takes a t-shirt. It’s hard to get in the mood to work if you leave dedicated employee to tune out house sur- your pajamas on all day. It wears on your constitution and roundings and work all day. You can’t stop You may long self-image. work to wash those dishes piled up in the sink, finish the laundry, or watch the kids. to hear a live voice.
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www.aapc.com March 2018 51 ■ CODING/BILLING By Jeanne Yoder, RHIA, CPC, CCS-P WATCHFUL WAITING: COLLECTING NEWBORN INFORMATION Know when to code newborn conditions that only require a watchful eye.
uring an initial Note: These perinatal guidelines are the same as the general coding Dnewborn evalua- guidelines for “additional diagnoses,” except for the final point tion, watchful wait- regarding implications for future healthcare needs. Assign codes ing conditions are for conditions that have been specified by the provider as having findings that usu- implications for future healthcare needs. ally resolve without For instance, abnormal findings on screenings — for example, medical interven- newborn hearing screening or lab screenings — are not coded in the iStockphotoSvetlana_Smirnova / tion in a few weeks inpatient record, unless: to a few years. Some • There was diagnostic testing or a specialty inpatient consult; or watchful waiting is- sues require continued • The pediatrician notes the abnormal results have implications outpatient evaluation until for future healthcare. resolution. Let’s review which condi- This is not the same as for professional services coding, where the tions should be reported and when. first-listed diagnosis is the reason for the encounter. In that case, other conditions can be coded if they were involved in medical decision- Coding Watchful Waiting Conditions making, or otherwise affected the episode of care. Watchful waiting conditions usually are not coded by hospital Here are several watchful waiting findings to consider. inpatient coders because the conditions do not use significant hos- pital resources and do not affect newborn hospitalization. Per the Inconclusive Newborn Hearing Screening ICD-10-PCS Official Guidelines for Coding and Reporting, only The longer the newborn has before an auditory function screening, clinically significant conditions are reported. the greater the chance of a successful screening. Screening is usu- For inpatient hospital coding, a condition is clinically significant if ally done as close as possible to inpatient discharge for this reason. it requires: Depending on the study, 2 to 10 percent of newborns have inconclu- • Clinical evaluation (e.g., specialty consult during the sive results at discharge (e.g., there may be fluid in the middle ear; the hospitalization); newborn may be fussy; one ear might pass, but the other does not). • Therapeutic treatment (e.g., bili lights for clinically significant Report an inclusive screening finding (R94.120 Abnormal audi- neonatal jaundice); tory function study) in the professional record so the newborn can be retested at the well-baby checks. There is no CPT® code because these • Diagnostic procedures (e.g., ultrasound due to sacral dimple); hospital screenings are usually done by hospital staff who are trained • Extended length of hospital stay (e.g., beyond the average for by an audiologist. Because it is a screening (not diagnostic), the test the MS-DRG); does not meet the definition of a “diagnostic procedure or therapeutic • Increased nursing care and/or monitoring (e.g., neonatal treatment” for a clinically significant condition. intensive care unit); or If the screening must be done during the well-baby check, possible • There are implications for future healthcare needs (e.g., having CPT® codes to collect the screening are: a specialty consult ordered prior to discharge). ■ ■ ■ 52 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Newborns
Identify Watchful Waiting Conditions Some watchful waiting conditions include: Some conditions happen more frequently in premature newborns such as cryptorchidism and • Failing the newborn hearing screening • Umbilical hernia umbilical hernias. Sometimes issues heal without interventions, such as minor hematomas from the birth process and laceration from the fetal monitoring electrode. And immature • Eye issues due to immaturity or from the • Clicking hip(s) CODING/BILLING ointment applied to the newborn’s eyes • Fractured clavicle lacrimal glands mature, hydroceles close, and hip joint motion usually improves without need for intervention. • Congenital hydrocele • Hematomas from the birth process • Cryptorchidism (undescended testicle(s)) • Neonatal jaundice
92586 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous • Involve significant costs (e.g., use of the operating room, system, limited more expensive diagnostic imaging types, such as computed 92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or tomography and magnetic resonance imaging); transient evoked otoacoustic emissions), automated analysis • Are risky (e.g., bedside spinal taps, epidural/regional/general anesthesia); Immature Lacrimal Ducts • Are diagnostic or therapeutic; or Lacrimal ducts are the drainage system for fluid that lubricates • Increase the length of stay. the eye. With time, the lacrimal ducts mature and the membrane Low-cost, low-risk screening and prevention procedures usually are covering the nasolacrimal ducts open. Until the lacrimal ducts drain not coded. Hospitals typically decide the data provided by 3E0CX2 spontaneously, the pediatrician can show the parents a massage is not coded because it takes time to collect, clutters the rest of the technique to use between the bridge of the nose and the inside data, and does not provide information to improve patient care corner of the affected eye. or efficiency. For the same reason, subcutaneous vaccine admin- Immaturity is not congenital absence, agenesis, stenosis, stricture, istration (3E0134Z Introduction of serum, toxoid and vaccine into or malformation. Because this is a normal condition, there is no subcutaneous tissue, percutaneous approach) usually is not coded. code for it. Do not report Q10.3 - Q10.6 or any of the H04 Disorders Sometimes, a parent declines prophylactic services such as the of lacrimal system for immaturity of the lacrimal ducts. Inpatient eye ointment and vaccinations. Although declining the inpatient coders do not code immature lacrimal ducts because the condition prophylactic services is not reportable by inpatient hospital coders does not use additional resources. Usually, the time spent teaching (because it does not affect the hospitalization), outpatient physician parents how to care for the newborn’s eyes until the lacrimal ducts office coders can and should use Z28 Immunization not carried out mature is not significant. If time is not significant, and it does not and under immunization status codes when provider-recommended impact medical decision-making, it does not meet the definition of immunizations are not administered. an additional professional encounter diagnosis. Inflammation Due to Prophylactic Antibiotic Ointment Most newborns have ointment administered at birth, or soon after the initial bonding with the mother. Although inflammation occurs less frequently now than in the past because the medication used has changed, it may occur. This is not a reportable inpatient condition. The ointment is administered by the hospital staff, so there is no professional component to the service. Even if it meets the technical meaning of conjunctivitis (inflammation of the conjunctiva), it isn’t contagious; it’s self-limiting and does not affect medical decision-making, so it cannot be coded on the pediatrician’s encounter. To determine if the administration of the anti-infective (e.g., eryth- romycin) externally to the eye (3E0CX2 Introduction of oxazolidi- nones into eye, external approach) is coded, check if your hospital has a policy on inpatient procedure collection. Each payer can develop
iStockphotoSpekkak / its own diagnosis-related group. Usually, procedures coded:
www.aapc.com March 2018 53 Newborns
Congenital Hydrocele move around in the depression and sometimes move out of the ac- etabulum. Usually, “clicking hips” lead to no findings but are noted Testicles develop in the abdomen. Usually prior to birth, the testicles so other providers know there is not issue. When the observation descend into the scrotum. The lining of the abdomen “pouches” into of “hip click” does not lead to diagnostic testing (e.g., ultrasound), the scrotum to surround the testicle. Sometimes, fluid builds up therapeutic treatment (e.g., parental training in the use of, and inside the lining, causing a hydrocele. If the lining closes and the fluid discharged with, a Pavlik harness), an inpatient specialty consult, has nowhere to go, it’s a noncommunicating hydrocele. Swelling in neonatal intensive care, or a scheduled outpatient specialty consult, such a hydrocele is uniform, over time, until the fluid is absorbed by it is not coded by inpatient coders. When there is a diagnostic study, the body. If the lining still has an opening into the abdomen, the fluid such as an ultrasound with no diagnosis, the justification for the can move in and out of the lining surrounding the testicle. For these diagnostic study is coded with R29.4 Clicking hip. hydroceles, the swelling will become greater and decrease. When newborns are discharged with the Pavlik harness, code for Do not code the condition as part of the newborn hospitalization the placement of an immobilization device, external, limiting unless it requires a consult, diagnostic or therapeutic services, the movement of the upper right leg with 2W3NXYZ CODING/BILLING prolonged length of stay, increased nursing services, or there is Immobilization of right upper leg using other device and documentation by the provider for future healthcare needs. In those upper left leg with 2W3PXYZ Immobilization of (uncommon) circumstances, report P83.5 Congenital hydrocele. left upper leg using other device. This is usually Unless there are issues, congenital hydroceles also are not coded on associated with one of the codes from Q65 the well-baby checks. Congenital deformities of the hip. Cryptorchidism Clicking hips may develop into dysplasia of the hip. Approximately one in 1,000 This generally refers to an undescended or maldescended testis. children have congenital developmen- The condition affects 3 percent of term male infants, and 1 percent tal dysplasia of the hip, which is coded of male infants at one year. Incidence is as high as 30 percent in Q65.89 Other specified congenital premature male neonates. Spontaneous descent after one year is deformities of hip. Usually, hip clicks uncommon. Expect to see this monitored; usually there is a consult/ involve watchful waiting, with the referral around six months of age for newborns with undescended tendons and muscles continuing to testicle(s). Typically, no extra resources are required during the develop until the click is no longer felt. newborn hospitalization, so do not code the condition. The pe- diatrician will spend time evaluating the condition, and at some Fractured Clavicle point, a code in the Q53 Undescended and ectopic testicle range will be used. The provider should document whether the testis is ectopic Sometimes, a newborn’s clavicle is frac- (e.g., in the superficial inguinal pouch) or abdominal. Although an tured during a vaginal delivery. Fractured undescended testicle usually is described as palpable or impalpable, clavicles are usually noted by the pediatrician also get the location, if you can. on the newborn evaluation, but do not meet the definition of clinical significance. Usually, the Umbilical Hernia nurses pin the sleeve of the affected arm to the body of the newborn’s t-shirt. With the sleeve pinned to the t-shirt, Approximately 10 to 20 percent of newborn’s have an umbilical her- the newborn has restricted arm movement, and the clavicle heals nia. This is caused by a small opening in the abdominal muscles that without intervention. abdominal contents (e.g., fluid, abdominal lining) spill through. If the fractured clavicle does not use additional resources during These usually heal and resolve on their own. Otherwise, at 3 to 4 the hospitalization (a safety pin is not additional resources), do years of age, the hernia will be surgically repaired. not code the condition on the hospital encounter. If the condition Do not code this condition for the newborn inpatient encounter, involves a diagnostic study, however, it is coded. The pediatrician unless additional resources are used. At the well-baby check, report will wait watchfully and check the clavicle until it’s healed. On the K42.9 Umbilical hernia without obstruction or gangrene if the condi- pediatrician’s encounter, code P13.4 Fracture of clavicle due to birth tion is addressed (not merely noted in the documentation). injury because it involved medical decision-making. Do not use S42.0- Fracture of clavicle for the initial encounter or subsequent Clicking Hips without Diagnostic professional encounters. Imaging or Brace at Discharge The “ball” at the proximal end of the femur is supposed to fit Hematoma from the Birth Process snuggly into the acetabulum (the cup-shaped depression in the For most newborns, hematomas from the birth process resolve pelvis). When the depression is too shallow, the femoral head may spontaneously. All that is needed is watchful waiting. When no
54 Healthcare Business Monthly Discuss this article or topic in a forum at www.aapc.com Newborns
additional resources are used, this is not coded on the inpatient a significant finding for the newborn, do not code it on the inpatient record, and is part of the pediatrician’s well-baby check. When the hospital record. hematoma is extensive or combined with other issues that cause Numerous skin findings may be noted, but are not coded in the excessive hemolysis, involving additional resources, look to P58 inpatient record unless they are clinically significant. When the
Neonatal jaundice due to other excessive hemolysis. pediatrician spends additional time explaining the skin condition, CODING/BILLING and the findings affect the episode of care, it should be coded on Newborn Jaundice professional encounters. A fetus’ blood is different than an adult’s. The fetal blood is designed An example is hemangiomas (e.g., strawberry hemangiomas), which to attract oxygen from the mother’s blood. After the newborn begins do not impinge on vital structures and are not located in the to breath on his own, the fetal blood is destroyed and replaced with periorbital area, lip, neck, or sacral region. More commonly seen in blood that works with lungs. Newborn jaundice happens when the documentation are: the newborn’s liver and sunshine on the newborn’s skin don’t • Infantile acne • Diaper dermatitis remove the fetal blood components in an efficient man- • Melanin • Neonatal erytherma ner. Two hundred years ago, newborns would have hyperpigmentation toxicum been placed on blankets in the sun for newborn jaundice. Now, newborns are checked with a • Disorders of pigmentation • Seborrhea capitis transcutaneous bilirubinometer, and the • Vitiligo • Local infection of skin pediatrician reviews standard laboratory • Other hypertropic • Milia (including Bohn blood screenings. These are not “addi- disorders of skin nodules on the gum and tional resources.” Blood testing done as • Café au lait spots Epstein pearls on the a diagnostic test, however, meets the palate) requirements for coding the jaundice. If the newborn jaundice is excessive, Abnormal Results of Routine Screenings hospitals use “bili” lights. Without a diagnosis, abnormal results of routine screenings should The ICD-10-PCS code for light not be coded unless the pediatrician states the abnormal results treatment of the skin is 6A600ZZ have implications for future healthcare. If the abnormal results lead Phototherapy of skin, single for a single to diagnostic testing, they should be coded on an inpatient record. treatment. Multiple treatments is Inpatient coders don’t collect watchful waiting conditions. A condi- coded 6A601ZZ Phototherapy of skin, tion does not need to be coded on the inpatient hospital encounter multiple. Do not confuse light treatment to be coded on the pediatrician’s hospital encounter. Understanding with ultraviolet light therapy, which is usu- why a pediatrician documents a finding enables you to determine if ally used for skin conditions such as psoriasis. it should be coded. When the newborn jaundice requires additional resources, the correct diagnosis is usually found under Jeanne Yoder, RHIA, CPC, CCS-P, is a data analyst supporting the Defense Health Agency. P58 Neonatal jaundice due to other excessive hemolysis or P59 She has been a speaker at national meetings as well as many local chapter meetings. Yoder is a member of the Baltimore East, Md., local chapter. Neonatal jaundice from other and unspecified causes codes. Mothers typically are counseled on newborn jaundice signs and when to bring the newborn in. For most newborns, the transition from fetal to newborn blood simply involves watchful waiting. iStockphotostockce /
Stigma Resources Stigma (plural stigmata) is a finding that may indicate an abnormal For more information about blocked lacrimal ducts, visit: condition, such as a sacral dimple without a visible floor being aao.org/eye-health/diseases/treatment-blocked-tear-duct. stigma for occult spina bifida. Sacral dimples without diagnostic For more information about cryptorchidism, visit: ncbi.nlm.nih.gov/pubmed/10932966. services, such as diagnostic imaging, are not coded on inpatient For more information about congenital hydrocele, visit: records. There is a new code for sacral dimples, Q82.6 Congenital www.webmd.com/parenting/baby/tc/congenital-hydrocele-topic-overview#1. sacral dimple, which can be coded in the professional encounter if www.hkjpaed.org/pdf/2007%3B12%3B93-95.pdf sacral dimple they affect care, such as when an ultrasound is ordered and there is www.stanfordchildrens.org/en/topic/default?id=developmental-dysplasia-of-the-hip- no finding of occult spina bifida. ddh-90-P02755 hip dysplasia Malpresentations are almost always noted on the inpatient record. Cincinnati Children’s, umbilical hernia: www.cincinnatichildrens.org/health/u/umbilical-hernia But unless the breech presentation or other malpresentation caused
www.aapc.com March 2018 55 Member Experience By David Blackmer, MSC
TIME FOR OUR CHECKUP! iStockphoto1001Love / Be honest; let us know what’s working and what needs fixing.
tatistics show that preventive healthcare exams save lives and educational events, online courses, and AAPC in general. You will Sincrease life expectancy. Even though the patient sometimes sched- also get an indication of the kinds of forthcoming projects AAPC is ules and shows up at these appointments begrudgingly, nobody who considering or embracing. works in this industry should need to be convinced of the importance of an annual checkup. What We Learned Last Time AAPC feels the same way about administrative evaluations. We Here are a few highlights about our respondents from the last time need to have our collective pulse taken regularly to determine what’s you helped us conduct research: working well and what needs improvement. As healthcare evolves, so too does our membership. As we continually expand to offer new • 30 percent were AAPC members for more than six years. services and products in a variety of related fields, our membership Another 34 percent were members three to six years. becomes more diversified, as well. These changes provide great • 64 percent held one AAPC credential. The remainder were opportunities for everyone. evenly split between being non-certified or holding multiple AAPC credentials. We Want to Hear from You • Females accounted for 91 percent of the responses. We recently launched a membership survey. Participation is open • 44 percent indicated coding was their primary job online at www.aapc.com/checkup through the end of March. responsibility. In 10 minutes, you can share with us your thoughts about member benefits, certification, continuing education units (CEUs), appren- • In rating work challenges, the top three were: tice designations, customer service, social media, local chapters, live °° Obtaining management skills
56 Healthcare Business Monthly Checkup
As we continually expand to offer new services and products in a variety of related fields, our membership becomes more diversified, as well.
° Getting definitive coding answers Props to Our ° Learning advanced coding skills Customer Service Representatives We appreciate feedback from members about their experiences with AAPC’s customer Tools to Tackle Work Challenges service; we especially love receiving props! Here’s what a few members said recently about With regards to the work challenges, AAPC heard you and has their customer service experiences: created resources to assist. We now have a Professional Development “John was very helpful and patient with me. I appreciated his kind customer service. Course Library, which you can subscribe to for one year when you Keep up the great work John!!!” renew your membership (or by calling us at 800-626-2633 and “Lori was very helpful and answered all my questions. I had questions removing the ‘A’ ordering separately). This library contains more than 180 online status and emailed her the required information. She addressed and processed it by the courses, most of which are specifically designed to teach leadership end of the day to my surprise.” and management techniques. The catalog of courses includes coach- John and Lori receive special recognition regularly; they’ve both been here 15-plus years! ing a workplace team to perform better, communicating effectively, These two pioneers of our Customer Service Department know a staggering amount of improving presentation skills, understanding body language, quick information about AAPC past and present. tips for leaders, and many others. With regards to apprentice removal, keep in mind that letters of recommendation must: Tap into AAPC Experts • Show proof of relevant on-the-job experience, and specify for how long We now offer “Ask an AAPC Expert,” where our seasoned pro- • Be on company letterhead and signed fessionals reply to your tough coding, billing, auditing, practice • Include at least one letter from an employer management, or compliance questions in one to two business days. Apprentice removal can also be accomplished through a combination of experience and We’ve also updated our free member discussion forums to ensure education or our digital experience tool, Practicode (www.aapc.com/practicode/). their usefulness. “[Jennifer] corrected several errors on my account ... she is AWESOME!” We Cater to Your Needs Our representatives often request that you verify contact information to ensure our records are up to date. You can check your account details regularly by logging into www.aapc. We continually improve upon our webinars, conference sessions, and com, hovering your mouse pointer over “My AAPC” in the upper right corner, and clicking other educational offerings to focus on specialty-specific subjects and on “Profile/Preferences.” provide advanced training for those who seek it. At HEALTHCON To nominate an AAPC employee for excellent service you received, send an email to next month, we’re launching a new pre-conference event: the Lean [email protected]. Six Sigma White Belt program. We develop our future based on your valuable input. This is your membership organization. after all; you have a say in the direction we go. Please share your opinion at www.aapc.com/checkup.
David Blackmer, MSC, is the director of member experience at AAPC. He is a member of the Salt Lake South Valley, Utah, local chapter.
www.aapc.com March 2018 57 Smart Design. Intelligent Auditing. AAPC Healthicity
C om m m o oc . m o audit process by merging audit workflow, management, and reporting c o o o w o o .
HEALTHICITY.COM/AUDITMANAGER NEWLY CREDENTIALED MEMBERS
Can’t find your name? It takes Amanda Neary, CPC Felicia Evans, CPC Mohan Palanisamy, CPC Trameika Jackson, CPC about three months after you Amber Lingerfelt, CPC Florence Emmanuelle Auza, CPC Monica Romero, CPC Trena Mcclemons, CPC pass the exam before your Amber St Baptiste, CPC Gabriela Mejia, CPC Murali Krishna Yeligeti, CPC Trisha Teague-Munoz, CPC name appears in Healthcare Amelia France, CPB, CPC Gabriela Mejia, CPC Muthuselvi Muthusamy, CPC Tya Kent, CPC Business Monthly. 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Lynn Mickleson MD, CPC Lisa L Gonzales, COC, CPC Sheena Ver Taguba, CPC Aleah Karsh, CPC-A Shaquavia Inman, CPC-A Dayanara Dioses, CPC Lorna Schwartz, CPC Sheera A Creese, CPC Alec Zapata, CPC-A Sharon Douglas, CPC-A Debbie Roberts-Felix, COC, CPC Lourdes Orellana, CPC Shelia Minor, CPC Alejandro Centeno, CPC-A Sheril Johnson, CPC-A Debora Funnell, CPC Lucretia Read, CPC Sherry Dowell, CPC Alena Samoilenka, CPC-A Sindhuja Sivanantharaja, CPC-A Debora Perez, CPC Mai Do, CPC Siva Krishnan Gunnamraju Venkata, Alex Ortiz, CPC-A Surekha Velineni, CPC-A Deborah Artis, CPC Margaret (Peggy) Woodruff, CPC CPC Alexandria Law, CPC-A Swathi Gundala, CPC-A Deborah Battice, CPC Maria Bernhardt, CPC Smita Patil, CPC Alfonsina Fraschilla, CPC-A Talia Beard, CPC-A Demari Winston, CPC Maribel Sanchez, CPC Solanki Saxena, CPC Alfonso Wilson, CPC-A Tina McDonald, CPC-A Denise Butterfield,CPC Maricruz Olivarez, CPC Sravani Chittari Uddanti, CPC Alicia Grady, CPC-A Denise Nagy, CPC Marie Elizabeth Houston, CPC Sree keerthi Yerraballi, CPC Alicia Shelton, CPC-A Diab Rizk, CPC Marquetisha Curry, CPC Stacei R Stanford, CPC Aliesha Shank, CPC-A ® Diana Nelson, CPC Marquita Monique Glenn, CPC Stacey Gladden, CPC Alisia Romero, CPC-A CPC Diana Walp, CPC Martina Denny, CPPM, CPC Stacy Carlile, CPC Alison Weaver, CPC-A CPC Dipika Subash Yadav, CPC, COC Mary Black, CPC Stacy Davis, CPC Alissa Cookman, CPC-A Abigail Sarokin, CPC Edna Palmieri, CPC Mary Deborah Welch, CPC Stephan Tong, COC Alma Calloway, CPC-A Abraham Quintero, CPC Elisangela Silva, CPC Mary Johnson, CPC Stephanie Kling, CPB, CPC Alphonse Ligoriya Mary Joseph, CPC-A Abraham Quintero, CPC Elizabeth Cable, CPC Matthew Hartwick, CPC Suganya James, CPC Althea Baker, CPC-A Aina A Lawal, CPC Elizabeth Kerr, COC, CPC Mauleen Cruickshank, CPC Suzanne Lawrence, CPC Amal C A, CPC-A Alecia Maes, CPC Elizabeth Moore, CPC Megan Reddall, CPC Sylvia Morales, CPC, COC Amal Ghannam, CPC-A Alison Jacobsen, CPC Elizabeth Moss, CPC Melissa Zuniga, CPC Tammy Nevoraski, CPC Amanda Dowlin, CPC-A Alison Kolanovic, CPC Emeyra Dejesus, CPC Michaun Henry, CPC Tasha Canfield,CPC Amanda Johnson, CPC-A Allison Jolly, CPC Emily Dupont, COC, CPC Michelle Budnik, CPC Theresa Ozbirn, CPC Amanda Miller, CPC-A Allison Orphy, CPC Esther Walker, CPB, CPC Michelle C Marold, CPC Thoa Huynh, CPC, COC Amanda Mullins, CPC-A Alyssa Moore, CPC Ethan Densley, CPC Michelle Katherine North, CPC Tina Elder-Cadoree, COBGC, CPC Amanda Quinn, CPC-A Amanda Brakebill, CPC Eumi Vilarino, CPC Miguel Angel Terrazas, CPC, COC Tracey Tuller, CPC Amanda Sumner, CPC-A Evelyn Bobo, CPC Mitzi Martin, CPC, COC Tracy Beltman, CPC Amanda Trevino, CPC-A
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Madhan Mohan, CPC-A Carol Desrochers, CPC-A Colleen Connors, CPC-A Delina D’souza, CPC-A Angela Williams, CPC-A B. Navaneetha, CPC-A Carol Kupfner, CPC-A Colleen McCarthy, CPC-A Delores Creasy, CPC-A Angellette Simms, CPC-A Babu Rajendran, CPC-A Caroline Dietz-Carlson, CPC-A Colleen Rhoads, CPC-A Delphine Mary Gopal, CPC-A Angelo Marciano, CPC-A Backiya Lakshmi Anbumani, CPC-A Caroline Masse, CPC-A Colleen Soop, CPC-A Denean Marsh, CPC-A Anil Kumar Routa, CPC-A Bailey Komm, CPC-A Carolyn Jamie Wisecarver, CPC-A Connie Puryear, CPC-A Denisse Rodriguez, CPC-A Anilkumar K, CPC-A Balaji Mathiyazhagan, CPC-A Carrie Cole, CPC-A Conrado III Tanyag, CPC-A Devendra Sairam Thota, CRC, CPC-A Anirudh Udatha, CPC-A Balaji Ramu, CPC-A Carrie Hansen, CPC-A Constance Phillips, CPC-A Devika P, CPC-A Anita Agarwala, CPC-A Banda Shiva, CPC-A Carrie Kowalski, CPC-A Corie Estrella, CPC-A Dhanalakota Mahendra Varma, CPC-A Anita Hewett, CPC-A Bandi Neethu Shalini, CPC-A Carryle Sheene De Cardo Pucan, Corina Cuevas, CPC-A Dhanalakshmi D, CPC-A Anitha A, CPC-A Barbara Burt, CPC-A CPC-A Corinne Bronson, CPC-A Dhanana Mohan, CPC-A Anitha B, CPC-A Barbara Cobb, CPC-A Casseciella Scott, CPC-A Courtney Battle, CPC-A Dhanapal Arumugasamy, CRC, CPC-A Anitha Channarayanahalli, CPC-A Barbara Diane Haggblom, CPC-A Cas-sha Jackson, CPC-A Courtney Brady, CPC-A Dhaniyalakshmi Sakthivel, CPC-A Anitha N, CPC-A Barbara Vanlandingham, CPC-A Cassie Lee Smith, CPC-A Courtney Stelmack, CPC-A Dhanya maria Sebastian, CPC-A Anitha Shankar, CPC-A Bayli Chapman, CPC-A Cassie Osborne, CPC-A Courtney Utley, CPC-A Dhritiman Bhattacharya, CPC-A Anithamol Nirappil cherian, CPC-A Becky Stines, CPC-A Castillo Gerald Shahani, CPC-A Cristy Plaisted, CPC-A Dhruvi Panchal, CPC-A Anjali Bhanderi, CPC-A Becky Amodei, CPC-A Catherine Corl-Cox, CPC-A Crystal Addington, CPC-A Diana Lat, CPC-A Anjali Devi, CPC-A Becky Townsend, CPC-A Catherine Huizenga, CPC-A Crystal Allen, CPC-A Diane Belford, CPC-A Anjana Vijayan, CPC-A Belinda Coleman, CPC-A Cathrin Indra G, CPC-A Crystal Ault, CPC-A Dianne Hayden Belen, CPC-A Anju Issac, CPC-A Belinda Young, CPC-A Cecil Avila, CPC-A Crystal Kerby, CPC-A Digna A Oviedo, CPC-A Anju Raphel, CPC-A Benedict Vincent Benette Noble Revilla, Celeste Ancayan Dipon, CPC-A Crystal LaMar, CPC-A Dileep G, CPC-A Ankam Swetha, CPC-A CPC-A Chad Paulin, CPC-A Crystal Mason, CPC-A Dilip kumar Velde, CPC-A Ankita Amuloju, CPC-A Benny Kevin Kesterson, CPC-A Challa Rakesh, CPC-A Cydnee Dutton, CPC-A Dillon Williams, CPC-A Ankita Chakrabortty, CPC-A Bernia Blount, CPC-A Chanchal Sharma, CPC-A Cynthia A Stasieluk, CPC-A Dilshida Sherin A, CPC-A Ankita Srivastava, CPC-A Beth Koch, CPC-A Chandrika1 Venkatanarayana, CPC-A Cynthia Acosta, CPC-A Disha Jain, CPC-A Ann Hightower, CPC-A Betsy Cromer, CPC-A Chanelle Stanley, CPC-A Cynthia Fredrick, CPC-A Disha Sunil Davey, CPC-A Ann Kidd, CPC-A Betty Pollard, CPC-A Chareena Wrobel, CPC-A Cynthia Jackson, CPC-A Divya Ganapathi, CPC-A Ann Truex, CPC-A Beverly Ann Brown, CPC-A Charity Johnson, CPC-A Cynthia Jones, CPC-A Divya Krishnan K, CPC-A Anna Gostylo, CPC-A Beverly Henry, CPC-A Charlene Michelle Ellzey-Scott, CPC-A Cynthia Russett, CPC-A Divya Kurada, CPC-A Anna Mae Melchiorre, CPC-A Beverly June Edwards, CPC-A Charlotte Jennifer Saberola Sagalongos, D Chandrashekar, CPC-A Divya Mohan, CPC-A Anne Marie Diaz, COC-A Beverly Ojongtambia, CPC-A CPC-A Dadda Damodhara Rao, CPC-A Divya Musham, CPC-A Annelice Reyes, CPC-A Bharkath Rahman, CPC-A Charls Paul, CPC-A, CPMA, COC-A Daina Morris, CPC-A Divya Raj, CPC-A Anthony Guardamondo, CPC-A Bhaskar Nedunuri, CPC-A Charmaine Benjamin, CPC-A Dana Parker, CPC-A Divya Rayapudi, CPC-A Antonette Rante, CPC-A Bhaskaran Mani, CPC-A Chau Marihart, CPC-A Daniel J Vestboe, CPC-A Divya Vellaisamy, CPC-A Anupama Sathyan, CPC-A Bhawna Khetani, CPC-A Chavala. Veeranjaneyulu, CPC-A Daniel Owens, CPC-A Divya Venil, CPC-A Anusha Bollineni, CPC-A Bhusa Prasad, CPC-A Cheri Verrinder, CPC-A Danielle Norton, CPC-A DivyaPriya C, CPC-A April Cooper, CPC-A Bincy Philip, CPC-A Cherry Fernando, CPC-A, COC-A Dantuluri Achuta Ramaraju, CPC-A Divyapriya Nagaraj, CPC-A April D Roberts, CPC-A Bobbi Glade, CPC-A Cheryl Curtis, CPC-A, CPMA, COC-A Danyiel McComb, CPC-A Dolly Gulati, CPC-A April La Rocque, CPC-A Boda Raj kumari, CPC-A Cheryl Hausmann, CPC-A Dapeng Zheng, CPC-A Doney Jose, CPC-A
60 Healthcare Business Monthly NEWLY CREDENTIALED MEMBERS
Donna Anderson, CPC-A Frazier Lewis, CPC-A Irene Brewer, CPC-A Jeri Ann Newton, CPC-A Kartiki Kushwaha, CPC-A Donna Lara, CPC-A, CPMA, CPPM, COC-A Fritz G Gourdet, CPC-A Irving Julius Pace Hilay, CPC-A Jerilyn Butterfield,CPC-A Karunkumar Beeravolu, CPC-A Donna O’Prandy, CPC-A G Naina Mohamed, CPC-A Iryna Demedenko, CPC-A Jesmy Raju, CPC-A Kasey Shrader, CPC-A Donna Summers, CPC-A G. Rajeshwar Reddy, CPC-A Itha Vijay, CPC-A Jessa Flores, CPC-A Katakam Sudarshan, CPC-A Doreen Rock, CPC-A Gaayathri Rajagopalan, CPC-A Ivorie Anna-Stacia Ustanny, CPC-A Jesse Zepeda, CPC-A Katare Sailesh Kumar, CPC-A Doris Olivares, CPC-A Gabrianna Johnson, CPC-A J. Prasanna Kumari, CPC-A Jessica Beatty, CPC-A Kate Davis, CPC-A Dr.Krishna Satheesh, CPC-A Gabriel Coles, CPC-A Jackelyn Noemi Torres, CPC-A Jessica Calkins, CPC-A Katherine Davis Wise, CPC-A Dr.NABILA Rajib, CPC-A Gabriel Espino, CPC-A Jaclyn Meyers, CPC-A Jessica Lazzaro, CPC-A Katherine Mitchell, CPC-A Dragana Pantelic, CPC-A GadhamSetty Saikrishna, CPC-A Jacquel Stinson, CPC-A Jessica Mahler, CPC-A Kathleen Alves, CPC-A Durgadevi Amirthalingam, CPC-A Gail Iriks, CPC-A Jacqueline Alexander, CPC-A Jessica Rehe, CPC-A Kathleen Bacis, CPC-A Dustin Evans, CPC-A Ganesh Kumar, CPC-A Jacqueline Pennington, CPC-A Jessie Bair, CPC-A Kathleen Bateman, CPC-A Dustin Reed, CPC-A Ganeshdas Cholayil, CPC-A Jacqueline Reller-Kalloo, CPC-A Jhansi Rani. R, CPC-A Kathleen DiPietro, CPC-A, COC-A Earl Gregory Atienza Mendoza, CPC-A Gangaraju Sabbarapu, CPC-A Jacqueline Traiteur, CPC-A Jill Browne, CPC-A Kathleen Mcclernon, CPC-A Easwari M, CPC-A Ganta Ramana Reddy, CPC-A Jacquelyn Harrison, CPC-A Jill Gilbertson, CPC-A Kathleen Scarlett Keener, CPC-A Eden Geneva Rose Espina, CPC-A Gattegari Praneeth, CPC-A Jagadeesh Kumar Marripati, CPC-A Jill Holt, CPC-A Kathrine Holley, CPC-A Edgar Nunez, CPC-A Gauri Kulkarni, CPC-A Jaiganesh Subramanian, CPC-A Jill Wolko, CRC, CPC-A Kathryn Denise Dimiceli, CPC-A Edgar Savella, CPC-A Geetha Rani Pulimi, CPC-A James Thomas, CPC-A Jisha Mapranathukaran, CPC-A Kathryn Davis, COC-A Edward Acosta, CPC-A Gemella J Colson, CPC-A Jamie Brewer, CPC-A Jisna James, CPC-A Kathryn Payne, CPC-A Ekta Jain, CPC-A Gerard Schley, COC-A, CPC-A Jamie Cole, CPC-A Jitendra Jatav, CPC-A Kathryn Schlesier, CPC-A Elanchezhian Balu, CPC-A Ghia Mariz Cuales, CPC-A Jamie Samuelson, CPC-A Joan Rothenberg, CPC-A Kathryn Tamm, CPC-A Elisabeth Mathew, CPC-A Gilmy George, CPC-A Jamie Wempren, CPC-A Joann Macdonald, CPC-A Kathy Caldwell, CPC-A Elizabeth Germain, CPC-A Gina Brenneman, CPC-A Jamshi Mohamed Salim, CPC-A Joanne Dagal, CPC-A Kathy Kukowski, CPC-A Elizabeth A Cashion, CPC-A Gina Green, CPC-A Jana Krocak, CPC-A Jocelyn Ann Hoover, CPC-A Kathy Walter, CPC-A Elizabeth Devliegher, CPC-A Gina M Bardol, CPC-A Janampeta Narasimha, CPC-A Jodi Busse, CPC-A Katie Morrison, CPC-A Elizabeth Hampton, CPC-A Ginger Nuttall, CPC-A Janardhan KulzhandhaiPerumal, CPC-A Jody Petty, CPC-A Katie O’Connell, CPC-A Elizabeth Medina, CPC-A Giselle Garcia, CPC-A Jane Johns, CPC-A Joey Cris Sevillaga, CPC-A Katie Pattin, CPC-A Elizabeth Micieli-Mattingly, CPC-A Goddeti Naresh, CPC-A Janelle Giardino, CPC-A John Michael Dufale Miraflor,CPC-A Katrina Fleming, CPC-A Elizabeth Milam, CPC-A Gottimukkala Julia Angel Grace, CPC-A Janelle Nord, CPC-A John Reyes, CPC-A Katrina Lyn Luche, CPC-A Elizabeth Perez Lozano, CPC-A Goutham Dannaram, CPC-A Janet A Beck, CPC-A Jones Tamilarasi, CPC-A Katrina Smith, CPC-A Elizabeth Rydberg, CPC-A Grace D Muthiah, CPC-A Janet Gomba, CPC-A Jonicka Washington, CPC-A Kavita Kumari, CPC-A Elizabeth Stefanczuk, CPC-A Grace Sheeba John wesley loganathan, Janet Williamson, CPC-A Jonnada Padmaja, CPC-A Kavitha Muthukrishnan, CPC-A Elizabeth Tracey, CPC-A CPC-A Janice Dohnert, CPC-A Jose Bueno, CPC-A Kavitha P, CPC-A Ella Mcduffie,COC-A Grace Vedambal, CPC-A Janine Jones, CPC-A Josephine Nastor, CPC-A Kaye Matthews, CPC-A Elmita Marcelon, CPC-A Graham Stevens, CPC-A Janova Varghese, CPC-A Joshua Share, CPC-A Kaylah Lambert, CPC-A Ema Chandran, CPC-A Greeshma M, CPC-A Jasmin N Hansz, CPC-A Joy Thompson, CPC-A Keerthana B, CPC-A Eman Baker, CPC-A Gurav Kalpana Maruti, CPC-A Jasmine Taylor, CPC-A Joyce Jose, CPC-A Keerthana Subramanian, CPC-A Emilene Rose Bautista, CPC-A Guruvignesh Murugadoss, CPC-A Javier Perez, CPC-A Juanita Porter, CPC-A Keerthika Babu, CPC-A Emily Dee, CPC-A Guvvala Naga Sreedevi, CPC-A Jayabharathi Govindaraj, CPC-A Judith Perez, CPC-A Keisha Karol Rose, CPC-A Emily K Wickens, CPC-A Gwendolyn Wallace, CPC-A Jayanthi SenthilKumar, CPC-A Judy C Ocon, CPC-A Keishina Francis, CPC-A Emily Parduhn, CPC-A Haley Glanville, CPC-A Jayasankari Sankaran, CPC-A Julia Pringle, COC-A, CPC-A Kelley Perrien, CPC-A Emily Schaad, CPC-A Hannah Lewis, CPC-A Jaycea Menard, CPC-A Julian Bell, CPC-A Kellie Lynn Batshon, CPC-A Emily Webster, CPC-A Hardai Ganesh, CPC-A Jayne Sereneck, CPC-A Juliana Dail, CPC-A Kelly L Stork, CPC-A Emmeline Alaconis, CPC-A Haripriya Thummapudi, CPC-A Jeanese Riley, CPC-A Julie Brooke, CPC-A Kelly Smallwood, CPC-A Encar Garber, CPC-A Harish Haregoppada Virupakshappa, Jeanna Small, CPC-A Julie Fritzner, CPC-A Kelly Wood, CPC-A Endia Holmes, CPC-A CPC-A Jeanne Nicolosi, CPC-A Julie Goodin, CPC-A Kenda Rae Moore, CPC-A Eric Leonel Chavarria, CPC-A Haritha Rani Pokam, CPC-A Jeannette Marie Williams, CPC-A Julie Jessen, CPC-A Kennedy Blaire Mayo, CPC-A Eric Nelson, CPC-A Harold Combess, CPC-A Jeannie Giles, CPC-A Julie Krabbenhoft, CPC-A Kenneth Argueza, CPC-A Eric Preston Avondet, CPC-A Harold Garlando, CPC-A Jedi Pradeep, CPC-A Julie Mooney, CPC-A Kenth Geoffrey Manalo, CPC-A Ericka Ward, CPC-A Harry Glen Ramos Constantino, CPC-A Jeeja K, CPC-A Julie Singco, CPC-A Kenya Fugit, CPC-A Erika Gordon-Wallae, CPC-A Haseena Faizal, CPC-A Jeena Madathil, CPC-A Julie Thompson, CPC-A Keri A Fedderman, CPC-A Erika LaTonia Isabel, CPC-A Hasiba Shanavaz, CPC-A Jeeva Jothi Parivallal, CPC-A June Verrie Valentin Pascual, CPC-A Keri Littlejohn, CPC-A Erika Lynch, CPC-A Haya Qadri, CPC-A Jegatheeswaran Rajendiran, CPC-A Justin Jan Mercader Aldana, CPC-A Keri Staley, CPC-A Erika Maxie, CPC-A Heather Balmain, CPC-A Jen Crum, CPC-A Justin McLean, CPC-A Keshari Chand Panwar, CPC-A Erin Cutts, CPC-A Heather Hinson, CPC-A Jenifer Mascarenhas, CPC-A Justin Philip, CPC-A Keshia Heidelberg, CPC-A Erin Heard Broussard, CPC-A Heather Kemery, CPC-A Jenilin Elizabeth Joy, CPC-A Jyothi G, CPC-A Keshia Ramey, CPC-A Erin James, CPC-A Heather Kiser, CPC-A Jenna Dwyer, CPC-A Jyothi Gavini, CPC-A Keva Clay, CPC-A Erin Kline, CPC-A Heather Sean, CPC-A Jennalisa Lopez, CPC-A K Suhasini, CPC-A Kevin Salvador Bestoton Tamkin, CPC-A Erin Kresha Naval Zablan, COC-A Heather Watkins, CPC-A Jennie Jackson, CPC-A K. Naga Sravani Purnima, CPC-A Khan Shahansha Khan, CPC-A Erin Michelle Somers, CPC-A Heather Wells, CPC-A Jennifer A Morarend, CPC-A Kailee Mae Fleming, CPC-A Khatija Saira, CPC-A Erin Smith, CPC-A Helen Edgington, CPC-A Jennifer Ashmore, CPC-A Kali Sedlak, CPC-A Khrizel Pareño, CPC-A Erra Prashanthi, CPC-A Hema Deshmukh, CPC-A Jennifer Atterberry, CPC-A Kalin Elise Dunning, CPC-A Kieara Woodfin,CPC-A Esther Jasmine Sivasankara Narayanan, Hemalatha Subramaniam, CPC-A Jennifer B Vance, CPC-A Kalpana Rath, CPC-A Kieta Z Fonville, CPC-A CPC-A Hilalul Haque M C, CPC-A Jennifer Cecil, CPC-A Kalyani Vayilla, CPC-A Kim Conrad, CPC-A Etika Sravan, CPC-A Himani Mohapatra, CPC-A Jennifer Childers, CPC-A Kamalapriya C, CPC-A Kim Wingerson, CPC-A Eugene William Cooper, CPC-A Hina Patel, CPC-A Jennifer Conway, CPC-A Kamila Sushanth Kamila Sagar, CPC-A Kimberley Martin, CPC-A Eunice Y Lee, CPC-A Hope Marriah McNiel, CPC-A Jennifer Eisenhauer, CPC-A Kanaka Durga Noudu, CPC-A Kimberly Ann Huffman, CPC-A Evangeline Marie Sargent, CPC-A Hyacinth Amion, CPC-A Jennifer Freeman, CPC-A Kandimalla Sravanthi, CPC-A Kimberly Anne Jacobs, CPC-A Ezequiel Rudy, CPC-A Ian M Pagay, CPC-A Jennifer Gallen, CPC-A Kani Prathap, CPC-A Kimberly Ejbeh, CPC-A Ezhilarasi PanneerSelvam, CPC-A Ibelis Ferro Bermudes, CPC-A Jennifer M Kritz, CPC-A-P Kannan Venkateswaran, CPC-A Kimberly Louise Ogden, CPC-A Fabrienne Castro, CPC-A Icika Andrews, CPC-A Jennifer McGuire, CPC-A Kara Hosch, CPC-A Kimberly McKinley, CPC-A Falesha Anderson, CPC-A Idiga - Saritha, CPC-A Jennifer Murphy, CPC-A Kara Little, CPC-A Kimberly Mirabella, CPC-A Farah Miguel, CPC-A Ifrath Saidalu, CPC-A Jennifer Ong, CPC-A Kara Owens, CPC-A Kimberly Roth, CPC-A Farwah Fatima, CPC-A Ilango Shanmugam, CPC-A Jennifer Poynor, CPC-A Karaggouni Naga Prathyusha, CPC-A Kimberly Wannemacher, CPC-A Fatima Nasreen Mohamed Nizar, CPC-A Imelda Daludado, CPC-A Jennifer Stiffler,CPC-A Karen Allison, CPC-A Kiran Joshi, CPC-A Fekla Martushev, CPC-A Indhumathi Nagesh, CPC-A Jennifer Stivers, CPC-A Karen Perry Callahan, CPC-A Kiranmai Amrutham, CPC-A Femi Oshisanya, CPC-A Indira Daniels, COC-A Jennifer Woodall, CPC-A Karla K Westbrook, CPC-A Kirti Chawla, COC-A Frances Shero, CPC-A Indira Prriyadarshini, CPC-A Jenny Rose Nieves, CPC-A Karlee Read, CPC-A Kodiganti Vijaykanth, CPC-A Francis Simon Cruz Villanueva, CPC-A Indubai Patil, CPC-A Jenny Sin, CPC-A Karolyn Kishelle Terry, CPC-A Kohila Rajendran, CPC-A Francisca Lynn Schreck, CPC-A Indupuri Vijaya Mohani, CPC-A Jepsy Jerin, CPC-A Karthick S, CPC-A Kokatam Sujatha, CPC-A
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Kokila Manivannan, CPC-A Lisa Mckinney, CPC-A Mariel Benfit,CPC-A Miranda J Munoz, CPC-A Nisha Deepak, CPC-A Koteswaramma Yannamsetti, COC-A, Lisa Mcnulty, CPC-A Marissa Signore, CPC-A Miranda Speer, CPC-A Nishana Velu, CPC-A CPC-A Lisa Wilson, COC-A Marjorie Cooperman, CPC-A Mohamed Ali Ahamed Kutty, CPC-A Nithya G, CPC-A Kresondra Hales, CPC-A Lisandra Gonzalez Cedeno, CPC-A Mark Simpson, CPC-A Mohamed Maged Hamrah, CPC-A Nivedha Jacob Nixon, CPC-A Krisha Bridges, CPC-A Lisette Palacios, CPC-A Marlin Martinez, COC-A Mohammad Azeem, CPC-A Noell Wickersham, CPC-A Krishna Etikanolu, CPC-A Liubetsys Nunez, CPC-A Marnelli Acilo Borja, CPC-A Mohammad Mohsin, CPC-A Nordy Fernandez Fraginals, CPC-A Krishna Pavani Mutya, CPC-A Liz Giannasca, CPC-A Marta Navarro, CPC-A Mohammed Abdul Farooq, CPC-A Norkie Mota, CPC-A Krishnabhrathbehara NL, CPC-A Liz Urdahl, CPC-A Martha C Wong, CPC-A Mohammed Faseem A, CPC-A Norma Angélica Loera, CPC-A Krisie Fae Ngilangil, CPC-A Lokesh Reddy, CPC-A Martha Molina, CPC-A Mohammed Idrees Ajmal Khan, CPC-A Norma Wholley, CPC-A Krista Rath, CPC-A Lora Jackie Fouts, CPC-A, CPMA, COC-A Mary Ann Carlos, CPC-A Mohd Hasim Khan, CPC-A Nou Lee-Welsh, CPC-A Kristen Coates Payne, CPC-A Lori Barr, CPC-A Mary Ann Lorraine Arriesgado, CPC-A Molly Grawe, CPC-A Nune Babao Balgomera, CPC-A Kristen Henry, CPC-A Lori Kane, CPC-A Mary Ann Santos, CPC-A Monica Gattorno Narciandi, CPC-A Obineni Vijaya Lakshmi, CPC-A Kristi Hobbs, CPC-A Lori Newton Anspach, CPC-A Mary Anne Lycel Brua Reyes, CPC-A Monique M Farfan, CPB, CPC-A Odalys de Armas, CPC-A Kristian Cappelmann, CPC-A Lourdes B Diaz, CPC-A Mary Berrios, CPC-A Monique Newson, CPC-A Olesya Blazhko, CPC-A Kristin Foerch, CPC-A Lourdes Garcia, CPC-A Mary Case, CPC-A Mothukuri Ashwini, CPC-A Olga Chepurko, CPC-A Kristin Beddick, CPC-A Loveena Joseph, CPC-A Mary Greene, CPC-A Mounika Abbagoni, CPC-A Olga Maksimenko, CPC-A Kristina Moore, CPC-A Luba Bushuyev, CPC-A Mary Hentry, CPC-A Mounika Barla, CPC-A Olga Rosenblum, CPC-A Kristine Brown, CPC-A Lydia Nance, CPC-A Mary Kangas, CPC-A Mubeena Rasheeth, CPC-A Oluwadamilola Akinbunmi, CPC-A Kristine Knox, CPC-A Lyndsie Steckelberg, CPC-A Mary Lloyd, CPC-A Muhammed Haneefa E, CPC-A Oruganti. Nagajyothi, CPC-A Kristy Gann, CPC-A Lynn Campain, CPC-A Mary Morgan, CPC-A Muhammed Nasarudheen K, CPC-A P. Durga Bhavani, CPC-A Kristy Reeves, CPC-A Lynne Brown, COC-A Mary Robert Fish, CPC-A Mukesh Lakshminarayanan, CPC-A Padee Lor, CPC-A Krystal Stewart, CPC-A M Ganesh, CPC-A Marycris Reyes, CPC-A Mukkera Sravanthi Reddy, CPC-A Padma Sridhar Rajasekaran, CPC-A Kshema Renju, CPC-A M Ranjith Reddy, CPC-A Maryse Dionne, CPC-A Mukunda Navuru, CPC-A Pakkirgandla Madhavi, CPC-A Kunam Bharathi, CPC-A M. Obulamma, CPC-A Maryum Vonique Millen, CPC-A Muneer M S, CPC-A Palem Nagamani, CPC-A Kundeti Sridhar, CRC, CPC-A Ma Eliza Geron, CPC-A Mateti Preethi, CPC-A Mutharasan Sundarapandian, CPC-A Pallapu Aishwarya, CPC-A Kusuma Kumari Meka, CPC-A Machelle Balland, CPC-A Matthew Myers, CPC-A Muthoju Vaibhav, CPC-A Palvinder Kaur, CPC-A Kyla A Jastorff, CPC-A Machugari Nishitha, CPC-A Mayuli Pino Hernandez, CPC-A Muthu Subramanian, CPC-A Pamela Boland, CPC-A L Keerthi Chandrika, CPC-A Macmillan Morcoso, CPC-A Mayvelyn Laino, CPC-A Muthukrishnan Vaithiyanathan, CPC-A Pamela Little, CPC-A Lakshay Shadija, CPC-A Madhavi K, CPC-A Meagan Abramo, CPC-A Muthuvel M, CPC-A Pamela Sposato, CPC-A Lakshmi Praba Ponraj, CPC-A Madhavi Pradeep, CPC-A Meagan Monahan, CPC-A MyrLynn Hill, CPC-A Pandiri Dasharatham, CPC-A Lakshmi Prasanna Kolasani, CPC-A Madhavi Senapati Lata, CPC-A Meagan Williford, CPC-A Myweshia Edwards, CPC-A Panga SivaSankarReddy, CPC-A Lalaine Balleta Garcia, CPC-A Madhu Tiwary, CPC-A Meenakshi Velayudham, CPC-A Naga Mallika Kode, CPC-A Pankajam Thangavel, CPC-A Lamiya Denise Norris, CPC-A Madhuri Mekala, CPC-A Meenakshi Velmurugan, CPC-A Naga Mounika Kanneti, CPC-A Paola Orellana, CPC-A Lan Do, CPC-A Maegan T Ator, CPC-A Meera Sekar, CPC-A Nagabhushana B, CPC-A Parkavi Arunachalam, CPC-A Lanier Richmond, CPC-A Maelis Gonzalez, CPC-A Meera Suvarna, CPC-A Nagarajan Kumaran, CPC-A Patel Anushri, CPC-A Lanora Collins, CPC-A Mahalakshmi Ravichandran, CPC-A Megan Eckles, CPC-A Nagendar Goli, CPC-A Patil Srikanth, CPC-A Larissa Luckel, CPC-A Mahamood Mahammad, CPC-A Megan Forcum, CPC-A Nagendramma A, CPC-A Patrice Gable, CPC-A Larry Cleland, CPC-A Mahendranath Kottala, CPC-A Megan Maertz, CPC-A Nakethlyn Lykle Fulton, CPC-A Patrice Isham, CPC-A Latasha Pate, CPC-A Mahesh Mallarapu, CPC-A Melanie Walsh, CPC-A Nalini J Jeganathan, CPC-A Patrice Newman, CPC-A Latisha Ilion, CPC-A MaheshKumar Manohar Rao Sirigiri, Meleanie Jackson, CPC-A Nancy Childers, CPC-A Patricia A Morrell, CPC-A Latonya Carter, CPC-A CPC-A Melida Short, CPC-A Nandhakumar Krishnasamy, CPC-A Patricia Duarte, CPC-A Laura Kelchen, CPC-A Maheswaran A, CPC-A Melisia Scott, CPC-A Nandhini Selvamoorthy, CPC-A Patricia M Montoya, CPC-A Laura Perry, CPC-A Mahitha Rajesh, CPC-A Melissa Acierto, CPC-A Nanditha Krishna S K, CPC-A Patricia Wright, CPC-A Laura Phillips, CPC-A Mai Shoua Her, CPC-A Melissa Benton, CPC-A Naomi Counts, CPC-A Patti Chapman, CPC-A Laura Wilson, CPC-A Maia Bhirud, CPC-A Melissa Braddam, CPC-A Naresh Vemula, CPC-A Patti VanHoesen, CPC-A Lauran Sellers, CPC-A Maili Marin, CPC-A Melissa Dumont, CPC-A Natalia Quake, CPC-A Paula Buckley, CPC-A Laurie Shultz, CPC-A Malathi Palanisamy, CPC-A Melissa Fagan, CPC-A Natalie Berry, CPC-A Paula C Crawford, CPC-A Lavanya Devulapally, CPC-A Mamidala Srinivas, CPC-A Melissa Fogarty, CPC-A Natalie Pearl, CPC-A Paula Defnall, CPC-A Laxmi Prasad, CPC-A Man Ho Yuen, CPC-A Melissa L Cameron, CPC-A Natalie Porter, CPC-A Paula Murphy, CPC-A Leaetta Templeton, CPC-A Manaswitha Laddipalli, CPC-A Melissa Middlebrooks, CPC-A Natasha Harris, CPC-A Pavani CH, CPC-A Leah Molke, CPC-A Mandy Bowen, CPC-A Melissa Schneider, CPC-A Natasha Hunt, CPC-A Pavani Meka, CPC-A Leea Templeton, CPC-A Mandy Corr, CPC-A Melody Asunto Curitana, CPC-A Natasha Jackson, COC-A Payton Schmidt, CPC-A Leenus A, CPC-A Manikandan Babu, CPC-A Mercedes Lynn Darrow, CPC-A Natasha Kapler, CPC-A Peggy Stewart, CPC-A Legi R, CPC-A Manikandan D, CPC-A Meri Beth Blake, CPC-A Nathesa West, CPC-A Pendem Rajendra Prasad, CPC-A Leidy Rivera, CPC-A Manikandan Dhamotharan, CPC-A Merri Mullins, CPC-A Natraj Puppala, CPC-A Peter F Dougherty, CPC-A Leila Kochis, CPC-A Manikandan Murugesan, CPC-A Meyver Perez Leon, CPC-A Nazema Farheen, CPC-A Phani Sai Babu Palem, CPC-A Lekshmi Das, CPC-A Manikandan Ponraj, CPC-A Michael B Guevara, CPC-A Neeharika P, CPC-A Philip Noel Ramos, CPC-A Lenica Guizzagan, CPC-A Manimegalai Gunasekaran, CPC-A Michael Conley, CPC-A Neena Jose, CPC-A Philip Silva, CPC-A Leo Joseph, CPC-A Manjeera Palagummi, CPC-A Michael Royer, CPC-A Neenu Eldho, CPC-A Phillisha Jackson, CPC-A Leona Marie Bender, CPC-A Manjula Mukunda Shivalingaiah, CPC-A Michael Smith, CPC-A Neenu Varghese, CPC-A Pilar Vazquez, CPC-A Leopoldo Lim Duenas, CPC-A Manoj Basha Shaik, CPC-A Michele Beck, CPC-A Neenumol Mathew, CPC-A Pittala Srinivas, CPC-A Lesley Kastner, CPC-A Manuella Carter, CPC-A Michele Fouts, CPC-A Neethu CS, CPC-A Podium Naveen, CRC, CPC-A Leslie Ann Brundrett, CPC-A Marcia Brown, CPC-A Michele Mullins, CPC-A Neethu Vinod P M, CPC-A Ponkarthic Chandran, CPC-A Leslie Durofchalk, CPC-A Marcia L Mcallister, CPC-A Michele Persiani, CPC-A Neha Reddy Ponagandla, CPC-A Pooja Chaudhary, CPC-A Leslie Harkness, CPC-A Margaret Berumez, CPC-A Michelle Brock, CPC-A Neville Elaine Joyce Evangelista Jacinto, Poovizhi Sakthivel, CPC-A Leslie Squires, CPC-A Margaret Hartman, CPC-A Michelle Burns, CPC-A CPC-A Pothumudi Sowmya, CPC-A Leticia Padron, CPC-A Maria Bolden, CPC-A Michelle Hernaez, CCC, CPC-A Nicole Daniel, COC-A, CASCC, CPC-A Prabhakaran Ganesan, CPC-A Lilith James, CPC-A Maria Eliza Bondoc Magat, CPC-A Michelle Langley, CPC-A Nicole Mendes, CPC-A Prabhakaran M, CPC-A Lincy ML, CPC-A Maria Giambanis, CPC-A Michelle Lee Killian, CPC-A, COC-A Nicole Steinke, CPC-A Prabhavathi Ammasi, CPC-A Linda Giovinazzo, CPC-A Maria Montgomery, CPC-A Michelle Mills, CPC-A Nicosia Watts, CPC-A Pradeep Dsouza, CPC-A Linda Luong-Andres, CPC-A Maria Raquel White-Josiah, CPC-A Michelle Moura, CPC-A Nida Etienne, CPC-A Pradeep Kommineni, CPC-A Linda Moore, CPC-A Marianne Rico Denunno, CPC-A Michelle Shearn, CPC-A Nidhi Rawat, CPC-A Pradeep Kumar, CPC-A Linda Sowa, CPC-A Marie Nichols, CPC-A Michelle Smith, CPC-A Niharika Janyaula, CPC-A Prakash Ravi, CRC, CPC-A Lindora Green, CPC-A Marie Catherine Baron, CPC-A Michelle Wiltshire, CPC-A Nikhija G Krishnan, CPC-A Prasanth Andavan, CPC-A Lindsay McMillan, CPC-A Marie Jezzelle Montalbo, CPC-A Michileu Stimpson, CPC-A Nikolina Suzic, CPC-A Prashanth Bhasker, COC-A Lindy Hornbuckle, CPC-A Marie Kathleen Dianne Barola, CPC-A Mikhail Paul Morgan, CPC-A Nimmy Maria Varghese, CPC-A Prashanth Thallapalli, CPC-A Linet Luisa Aldana Cabrera, CPC-A Marie Raphael, CPC-A Mila Pekarek, CPC-A Nina Mary Abraham, CPC-A Preetha Francis, CPC-A Lisa Couto, CPC-A Marie Wendy Bautista, CPC-A Milan B.N, CPC-A Nino Jarrod Gonzaga, CPC-A Premalatha Thiruvengadam Valarpuram, Lisa Granados, CPC-A Mariegayz Suniga, CPC-A Minnette Durano Ceniza, CPC-A Nirmal Antony, CPC-A CPC-A
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CPC, CEDC Judy E Fields, COC, CPC, CRC, CPMA Udhayavani Srinivasan, CPC-A William Murray, CPC-A CDEO Divya Maneesh, CPC-A, CPMA Julia Merriman, CPC-A, CRC
64 Healthcare Business Monthly NEWLY CREDENTIALED MEMBERS
Julissa Tuya, CPC-A, CRC, CPMA Marianne Grace Asplen, CPC, CPMA Rose Voss, CPC, CRC Stephanie Makahon, CPC, CPMA Venkatesan Jeevanantham, CPC, CPMA Karen Ann Leahey-Betten, CRC Marie Doucette, CPC, CRC Ryan John Roberts, CPC, CIRCC, Stephanie Marilynn Moyeno, COC-A, Venugopal Kolanu, CPC, CPMA Karen Craib, CPC, CEMC, CPMA Marierlin Jimenez, CPC-A, CRC CANPC, CRC CPC-A, CPMA Veronica Mejia, CPB Karen Swann, CPC-A, CRC Marionette Stark-Hickey, CPC, CRC Samantha Blair, CPC, CPB, CRC Steve N Murray, CPMA, CPCO Vicki Brock, CPB Kasey Kerr, CPCO Marisa Leigh Elliott, CPC, CHONC, Samantha Denice Stokes, CPC, CPMA Suman Dongala, CPMA Vicki L Devine, CPC, CRC Katherina Bailey, CPB CDEO Samantha Venegas, CPC-A, CPB Susan Carson, CPB Vickie Marie Dimond-Lopez, CPC, CRC Kathleen M Pirro, CPC, CPMA, CFPC, Martha P Lorenzo, CRC Samitria Beasley, CPC, CRC Susan Haiko, CPC, CRC Vinh Rocker, CRC CGIC, CEMC Martine Heriveaux, CRC Samoya Skeete, CPC, CPMA, CPC-I, Taiwo Awoyomi, CRC Virginia Antonelli, CPC, CPMA Kathleen M Pirro, CPC, CPMA, CEMC, Mary Beth Zuziak, CPC, CCVTC CEMC, CRC Tamara Barril, CPC, CPMA, CRC, CDEO Vishanthini Palanisamy, CPC, CPMA CGIC, CFPC Mary C. Medina, CPPM Sandra Ann Delgado, CPC, CPMA, Tamara Garcia Diaz, CPC, CRC Wendy J Horton, CPC, CIRCC Kathleen M Szabo, CPC-A, CPMA Mary Claire Juntado, CPMA CEMC Tamerria Jackson, CPB Wendy Thompson, CPC, CPB, CPPM Kathleen Watson, CPB Mary Ellen E Reardon, CPC, CRC Sandra Delgado, CPC, CRC Tammy L Lee, COC, CPC, CPMA, Xiaoxia Qi, CHONC, CPB Katleen Rose Plaza, CPMA Mary White, CPC-A, CRC Sandra Lynn Vermillion, CPC, CPMA CEMC Yanet Triana Moya, CPC-A, CRC, CPMA Katrina M Geis, CPC, CPMA Maurice Jackson, CPC-A, CPMA, CRC Sarah R Trent, CHONC Tana Turner, CRC Yara Romain, CPC, CPMA, CDEO Kelli Cortessis, COBGC Mayelin Aguilera Sifontes, CRC Sarika Jain, CPC, COSC Tawana Johnson McIver, COC, CPC, Yendry Milian, CRC Kelly D Vanderford, CPC, CGSC Melissa Gurganus, CPB Scott Munsterman, CPCO CPC-P, CIC, CPC-I, CPB Ying Zhao, CPC, CPMA Kelly M Anastasio, COC, CPC, CPC-I, Melissa Ward, CIRCC Seema Bapat, COC, CPC, CRC Tawanna L Louis-Jeune, CRC Zatania Strain, CPC, CPMA CPCO Melody M Ongenae, CPC, CPMA Shalina Chellathurai, CIRCC Telisa N Buffer, CRC Zusel Granados Galvez, CPC-A, CRC Kelly Maczuga, CPC, CRC Melva Palacios, CRC Sharlane Hensarling, CPC, CEMC Teresa Ann Treon, CPC, CPMA Keoca Acker, CPC, CRC Meredith Short, CPC-A, CRC Sheri Fowler, CPB Teresa Hardee, CRC Kerrie M Shulund, CPC, CPMA Michelle Sanders, CPC, CPMA Sherri Lewis, CPB Terrie Lasticly, CPC, CPMA Kevin Anderson, CRC Mick Miller, CPB Sherry A. Steines, CPC, CPCO, CPB, Tharani Kumar, CPC, CPMA Kimberly A Thompson, COC, CPC, Milaydis Sanchez Matos, CPC-A, CRC CPPM Thelma Catrice Brantley, CPC, CPMA CPMA Missy Avison, CPC, CGSC Sheryllbeth Manacsa, CPC-A, CPMA Timothy Shane Wakefield,CPCO Kimberly I Pope, CPC, CPMA Mistery Santiago, CPC-A, CPB Shifra Gross, CPC, CPPM Tina Horgan, CRC Kirsten Levy, CPC, CRC, CPMA Modisty Kennedy, CPC, CPB Shweta Jha, CPC-A, CPMA Tina Rachel Thomas, CGIC Krishnaveni Thangavel, CIRCC Monicue Mitchell, CPB Silvia Rosado, CPC, CPMA, CRC, CDEO Tracy Devino, CPB Krista Holland, CPC, CRC Monique Parker, CPC, CPMA Sonya Blankenship, CPC, CPB Tricia De Leon, COC, CPC, CPMA Kristen Hunter, CANPC Nageshwari Karunai Ramanujam, Srimukhi Chigurupati, CPC-A, CPB Tricia M Packer, CPC, COPC, CPMA Kristen Lynn Metzke, CPC, CGIC, CGSC CPC-A, CPMA Staci Grayson, CPC, CPMA Trina L Knight, CPC, CPMA Kristen M Jimenez, CPB Nancy Bell, CPC, CANPC Stacia C Whetstone, COC, CPC, CPMA Usha Pandiyan, CPC, CIC, CEDC Kristin Martinez, CPC, CEMC Nancy Huang, CRC Starla N Anderson, CPC, CFPC Vanessa Manuel, CPB Kristina Phares, CPC, CRC Nancy McCarty, COC-A, CPC-A, CPB, Stephanie Cron, CPMA Venita Alvarez, CPC, CPB Krystal Janneth Rodriguez-Martinez, CPMA, CRC CPC-A, CPB Natalia Valle, CRC Kulsoom Shaikh, CPC-A, CRC Nicole Squillace, CPC-A, CPMA Lacy Bethany, CPC, CEDC Nikki Whitley, CPC, CRC Lasonne Arceneaux, CPB Noah Timothy Tyler Richards, CPB Latique Auguster, CPC, CEMC Noopur Naik, CPC-A, CIC, CPMA Latorria S Freeman, CPC, CRC, COBGC, Noreen Razak, COC-A, CPC-A, CPMA CEMC Oghenetega Nedderman, CPC, CRC Laura Bowen, CPC, CRC Omar Diaz, CPC-A, CRC Laura Wheeler, CPMA, CRC, Osleidys Perez, CPC, CPMA CDEO CEUs. Lauren Gardner, CRC Osmer Puerto Arias, CRC Lauren M Walsh, CPC, CCC, CCVTC Oxana Alvarez, CPC, CRC, CPMA Laurie Peris, CRC Patricia Anne Little, COC, CPC, CRC Get ‘em. Leah Phirakhong, CPC, CEMC Patricia Louise Dodge, CPC, COBGC, Leonie Esselbach, CPC, CRC, CDEO CPB Leslie McGee Henderson, CPC, CPPM, Pauline Epie Etta, CPC, CPCO CPB Penny Caudill, CPC, CPB Got ‘em. Leslie Tomlinson Jordan, CPC, CRC Princess Short, CPC, CRC Leticia Lopez, CRC Priya Agrawal, CPC-A, CPMA Lianet Triana Moya, CRC, CPMA Raja kumar Natarajan, CPC, CEMC Linda Hammontree, CPC, CRC, CDEO Rakan Ahmad Damaso Al Hanaki, COC, Linda OConnell, CPMA CPC, CPCO, CPC-P, CDEO, CIC, CPB, HBO Ad Linda Prince, CPB CPMA, CPPM, CRC, CPC-I, CEDC, Done Lisa Noone, CRC CEMC, CENTC, CGIC, CHONC, Liurka Rodriguez Morales, CPC, CPMA, COBGC, COPC, COSC, CPCD, CRC, CDEO CPEDC, CUC with ‘em. Lori Patrick, CPC, CPMA Ramiro Exposito Valdes, CPC, CRC Lorna Ombawa, COC, CPC, CIC, CPB, Ramya Kathiresan, CIRCC CRC, CPC-I, CPEDC Rebecca Hodges, CPB Lovely Joseph, CPC-A, CPMA Rebecca Marrocchio, CPC-A, CRC Lyndsay Webb, CPC, COBGC Redtfeldt Heidi, CPB Lynn Feltner, CPC, CRC, CPMA Reisson Tulabot, CEDC M Chandana MD, CPMA Renetta Hollingsworth, CPC, CEMC Madelyn Bender, CPB Reynier Velazquez, CRC Madhavi Maruthan, CPC-A, CIRCC Ria Collins, CPC, CPMA, CRC Madiha Ali, CRC Ricardo Jose Perez, CPC, CPMA, CRC, Manuel Moquete, CRC CGSC Margaret Rose Brann, CPB Ricardo San Pedro, CPC, CRC Maria “Lorena” Bermudez, CEDC Rita Fae Aulbach, CPC, CPCD Maria Alejos, CPC, CRC Robin Oldham, CPC, CRC Visit us at: Maria Colomar, CPC-A, CDEO Ronald Suhumskie, CPC-A, CCC Maria Gabriela Tardencilla, CPC, CPMA, Rose Ann Cajayon Bayan, CPMA www.HealthcareBusinessOffice.com CRC, CPC-I, CDEO Rose Ann Schoedel, CPC-A, CPB
www.aapc.com March 2018 65 Minute with a Member
HAZEL M. MILLER, LPN, CPC-I, COC, CPC, CPC-P, CPMA, CMBS, AAPC FELLOW AAPC Expert ICD-10 Trainer and Consultant, Rochester, N.Y.
employees. I also began teaching at universi- applying for. Is it something you want to do ties in the Rochester, N.Y., area. or is it a foot-in-the-door job? Don’t discount Over the years, I have obtained many more the job just because it isn’t exactly what you certifications, and today I own my own want. It may provide you with the experi- consulting firm. ence to move into the job of your dreams. If you are a CPC-A®, get coding experience by HBM: What is your involvement with your doing something such as billing or taking an local AAPC chapter? internship. Think outside the box because I have served as the 2005 presenting presi- coding has unlimited opportunities. dent and the 2006 and 2015 president for the HBM: What has been your biggest chal- Flower City Professional Coders (FCPC) in lenge as a coder? Rochester, N.Y. I attend meetings as I am Getting the Rochester, N.Y., area employers HBM: Tell us a little bit about how you got able. The FCPC started small, with three to understand that CPCs® are phenom- into coding, what you’ve done during your or four people who cared about coding and enal coders and worth their weight in gold. coding career, and where you work now. had a vision, which grew with the help of Bryant & Stratton College. Great members Employers should take a chance on CPCs® I was working for a Medicare administrative and officers have grown the chapter into because they know coding rules, regula- contractor as senior clinical professional re- what it is today. I am proud to be part of this tions, and guidelines. They get employers lations staff when the Centers for Medicare phenomenal group of people. extra dollars in the door. & Medicaid Services (CMS) asked for Certified Professional Coders (CPCs®) HBM: What AAPC benefits do you like the HBM: If you could do any other job, what to be on site. I was told to locate a CPC® most? would it be? coding class, enroll, attend, and pass the I love the discounts we receive for so many There is no other job I would want to do. I certification exam. While taking the class, different venues. I love, love, love the confer- love coding and Medicare, and putting the I discovered I was actually a facility coder, ences. I learn so much, have a great time, two together equals heaven. but I remained in the class and took the and get to put faces with the voices I hear on CPC® exam. HBM: How do you spend your spare time? the phone at AAPC. Tell us about your hobbies, family, etc. During this time, I was part of the educa- tion team training the CMS Outpatient HBM: How has your certification helped you? I have a wonderful, caring husband of Prospective Payment System. I was living Certification validates for an employer my 46 years, a daughter, and grandchildren between two states and traveling more than knowledge base, along with my work and who live about six houses away from me. I was home. I did my homework on planes, education experience. Employers know Between cheerleading, football, lacrosse, trains, car drives, and in hotel rooms. It was certification exams are difficult; and when basketball, and horse riding competitions, one of the best experiences of my life! you pass the exam, that means you have I am busy. I love spending time with my After I passed the exam, I was asked to take extensive knowledge of coding, including family on vacation; traveling the world; the Certified Outpatient Coder (COC®) the rules and regulations. CPCs hit the going to Manhattan with my family to see exam. My friend and former CPC® instruc- ground running and help employers find the Thanksgiving Day parade, grabbing a tor at Bryant & Stratton, Melissa Rector, revenue opportunities. hot dog from a street vendor, and visiting all CPC, CPC-I, suggested I become a CPC® the sites. I also enjoy gardening, the colors instructor, as well. She gave me a job lead HBM: Do you have any advice for those of the four seasons, morning walks with at Excellus BlueCross BlueShield. I sat for new to coding and/or those looking for my friend, having lunch with my neighbors the Certified Professional Coder-Payer jobs in the field? once a month, and working when it feels (CPC-P®) exam and went on to develop in- As an AAPC certified instructor, I suggest right. ternal CPC® and COC® classes for Excellus you learn something about the job you are
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