Code FESS with a Clear Head 18 Get Paid for Virtual Check-Ins 48

January 2020 www.aapc.com

Code FESS With a Clear Head 18 Guidance leads to proper payment Get Paid for Virtual Check-Ins 48 Be aware of conditions for coverage Top 12 CPC® Exam Tips 64 Tried and true secrets to success www.aapc.com January 2020 1 on the table? Over the course of your career, if you don't earn another credential, it could cost you as much as $300,000?

Visit: aapc.com/next AAPC Exams Healthcare Business Monthly | January 2020

COVER | Added Edge | 30 New Year, New You A Coder’s Roadmap to Career Pathing Leonta Williams, MBA, RHIA, CCS, CCDS, CPC, CPCO, CRC, CEMC, CHONC

[contents] ■ Coding/Billing ■ Coding/Billing ■ Added Edge

18 Code FESS With a Clear Head 48 Get Paid for Virtual Check-Ins 64 Top CPC® Exam Tips Winda F. Hampton, RHIA, CPMA, Terry Fletcher, CPC, CCC, CEMC, Meagan Williford, MA, BA, CPC-A CCS-P CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMCRC, QMGC [continued on next page]

www.aapc.com January 2020 3 Healthcare Business Monthly | January 2020 | contents

14 ■ Member Feature 14 Coding Superstars Take AAPC’s Mentorship Program by Storm Michelle A. Dick, BS

■ Coding/Billing 22 Use Medicare Summary Notices as an Opportunity to Educate Patients LeAndrea Mack, CPC, CRCS-I, NR-CMA 25 4 Steps for Improved Excision Coding Stacy Chaplain, MD, CPC 22 28 Anatomy of an Operative Report Jessica G. Kibbe, COC, CPC, CASCC 43 Coding Social Determinants of Health Toni Elhoms, CPC, CRC, CCS, AHIMA-Approved ICD-10-CM/PCS Trainer 44 Fortify Your Understanding of Medical Necessity Artemio B. Castillejos, CPC, CPMA, CCVTC, CPC-I, CCS, CL6SGB 52 From Registration to Claims Billing, Overcome Gender Identity Barriers Danielle Erickson, CPC, CCS Litriana (Lee) Shimano, CPC, CMDP, CCP, PCS, 44 AHIMA Approved ICD-10-CM/PCS Trainer

■ Added Edge 56 Feedback Rules for Better Communication Michael Warner, DO, CPC, CPCO, CPMA, AAPC Fellow

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

COMING UP: DEPARTMENTS 66 Minute with a Member • Cloned Notes • Employee Retention 7 Letter from Membership Leader • Annual Wellness Visit 8 Knowledge Center EDUCATION • Knee Arthroscopy 9 I Am AAPC 58 Newly Credentialed Members • Medicare Revalidation 10 AAPC Chapter Association Online Test Yourself – Earn 1 CEU 11 Chapter News www.aapc.com/resources/publications/ On the Cover: Leonta Williams, MBA, RHIA, CCS, CCDS, CPC, CPCO, 12 Hardship Relief healthcare-business-monthly/archive.aspx CRC, CEMC, CHONC, maps out pathways for coders striving for career Or try it on your My AAPC application. growth and continued success. Cover design by Mahfooz Alam. 13 Local Chapter Spotlight Availability expires 1 year after publication date. Photo from Getty Images.

4 Healthcare Business Monthly FIND EVERYTHING YOUR BUSINESS NEEDS WITH AAPC BUSINESS SOLUTIONS

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Learn more at aapc.com/business Go Green! HEALTHCARE Why should you sign up to receive Healthcare Business Monthly in digital format? BUSINESS MONTHLY Co Compac racc Maam Here are some great reasons: January 2020 • You will save a few trees. • You won’t have to wait for issues to come in the mail. Head of Publishing, Editorial & Technology • You can read Healthcare Business Monthly on your computer, tablet, or Leesa A. Israel, BA, CPC, CUC, CEMC, CPPM, CMBS other mobile device—anywhere, anytime. [email protected] • You will always know where your issues are. Executive Editors • Digital issues take up a lot less room in your home or office than paper Michelle A. Dick, BS issues. [email protected] Go into your Profile on www.aapc.com and make the change! Renee Dustman, BS, AAPC MACRA Proficient [email protected] Advertiser Index Stacy Chaplain, MD, CPC AT&T Dealer...... 51 [email protected] www.freephonesnow.com/hcbmonthly Healthcare Business Office, LLC ...... 23, 33 Graphic Design www.HealthcareBusinessOffice.com Mahfooz Alam NAMAS ...... 50 www.namasconference.com Advertising Sales Physicians Mutual Insurance Company...... 12 Mark Sherwood www.dental50plus.com/healthcare [email protected] Project Resume...... 23 Address all inquires, contributions, and change of address notices to: www.ProjectResume.net YMT Vacations...... 17 Healthcare Business Monthly www.ymtvacations.com PO Box 704004 ZHealth ...... 24 Salt Lake City, UT 84170 www.zhealthpublishing.com (800) 626-2633 ©2020 Healthcare Business Monthly. All rights reserved. Reproduction in whole or in part, in any form, without written permission from AAPC® is prohibited. Contributions are welcome. Healthcare Business Monthly is a publication for members of AAPC. Statements of fact or Healthcare Business Monthly opinion are the responsibility of the authors alone and do not represent an opinion of AAPC, or sponsoring organizations.

® When you advertise in CPT copyright 2019 American Medical Association. All rights reserved. Healthcare Business Monthly, Fee schedules, relative value units, conversion factors and/or related components are not www.aapc.com March 2019 you’ll reach the largest and assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The most engaged audience AMA does not directly or indirectly practice medicine or dispense medical services. The AMA ARD M W OD assumes no liability for data contained or not contained herein. R E of medical coders, billers, FO R T A H T G E I auditors, compliance officers, A The responsibility for the content of any “National Correct Coding Policy” included in this R T

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THINK ABOUT consequences or liability attributable to or related to any use, nonuse or interpretation of MDM SCORING IN THE HBM reaches more than EMERGENCY DEPARTMENT information contained in this product.

What’s in Store for 2019 OPPS? 18 180,000 AAPC members ® Hint: More site-of-service payment equalization CPT is a registered trademark of the American Medical Association. Be Specific with National Drug Codes: 38 How to report “what’s in the box” 1 March 2019 every month who read both Make Artificial Intelligence Your Friend: 51 www.aapc.com Will the robot next to you affect your coding career? 08/02/19 1:14 PM the proprietary content in HBM_Mar2019.indd 1 Volume 7 Number 1 January 1, 2020 realtime and archived past Healthcare Business Monthly (ISSN: 23327499) is published monthly by AAPC, 2233 South Presidents issues as a valuable reference. Drive, Suites F-C, Salt Lake City UT 84120-7240, for its paid members. Periodicals Postage Paid To get in front of our audience, contact Mark Sherwood, Advertising Manager at Salt Lake City UT and at additional mailing office. POSTMASTER: Send address changes to: Healthcare Business Monthly c/o AAPC, 2233 South Presidents Drive, Suites F-C, Salt Lake @ (661) 542-2255 or [email protected]. City UT 84120-7240.

6 Healthcare Business Monthly Letter from a Membership Leader

Recap the Rewards of AAPC Membership

any purchases and start saving money with Career Advancement: The Career these valuable offers! Advancement Committee continues to focus on providing you with suitable Products and Services: The Product and tools and resources to advance your Services Committee had a very busy year current skill set, and also develop skills for evaluating dozens of AAPC and partner adjacent, advanced, and emerging roles publications to ensure materials are current within the industry. AAPC’s Mentorship and accurate. This included a review of Program was launched this year using AAPC code books and submissions of sug- a proprietary mentor-mentee matching nce again, a new year is upon us! I sin- gestions and feedback for implementation platform called MentorCity. For those Ocerely hope you all have a joyous and in future editions. Please continue to share interested in participating, go to www.aapc. prosperous year. With the new year comes your ideas and suggestions for improving com/resources/mentor.aspx. Please review the new codes, new rules, and the opportunity AAPC products and services. information for both mentors and mentees to stay ahead of the curve by digging in and so that you understand the obligations of mastering all the changes. Certification and Training: Everyone each role, which are vital in making the Last year I focused on restructuring the should tip their hats to the Certification mentor-mentee relationship successful and AAPC National Advisory Board (NAB) and Training Committee because these rewarding for everyone involved. Moving standing committees to better assist AAPC in folks take AAPC exams for sport! More forward, this committee is working on supporting its members. These committees specifically, they take the exams to ensure developing career progression tools that will have done exceptional work. Here is a recap each adequately evaluates competency in allow you to evaluate career path options of what they’ve been doing to strengthen the the subject area. They also ensure that the when you are ready to level up. value of AAPC membership, as well as the educational programs associated with each The NAB is also getting ready for recognition and value of your credentials. exam appropriately prepare test-takers. This HEALTHCON 2020 (#HCON2020), work is ongoing; if you have any thoughts which will be held April 5-8 at the ever-pop- Membership: The Membership Committee or suggestions after taking an exam, please ular Disney’s Coronado Springs Resort and has worked hard to educate members on the share them! Conference Center at Walt Disney World in many benefits AAPC membership provides. Orlando, Florida. HEALTHCON provides All member benefits have been consolidated Networking and Awareness: The attendees with excellent networking op- on the AAPC website under Membership/ Networking and Awareness Committee has portunities and a chance to meet colleagues Member Benefits. Here you will find access been focused on improving AAPC forums by from across the country who work in a wide to local chapter, regional, and national driving queries into specialty-specific areas. variety of industry sectors. Add top-tier conference learning events, networking As a new feature, forum responses are being speakers and subject matter experts offering opportunities through these events and the crowdsource-rated and reviewed by subject a broad spectrum of education, along with online forums, and educational offerings on matter experts to ensure the answers you find the magic of Disney, and you have the recipe almost every topic of potential interest. On on AAPC’s forums are accurate and reliable. for an event you can’t afford to miss. I hope this page, under Career Resources, you will to meet each of you at either a conference or find job postings from across the country, chapter event this year. including remote positions. Don’t forget to check out the Members’ Only Savings I hope to meet each Happy New Year! Center, where you can find low-cost and free continuing education unit (CEU) of you at either a Sincerely, opportunities; discount health, life, liability, and accident insurance offerings; and access conference or chapter to exclusive AAPC member savings through our Discounts and Deals program. Check event this year. Michael D. Miscoe, JD, CPC, CASCC, the member Savings Center for discounts on CUC, CCPC, CPCO, CPMA, CEMA, a myriad of goods and services before making AAPC Fellow

www.aapc.com January 2020 7 ■ KNOWLEDGE CENTER By Nikki Taylor, MBA, COC, CPC, CPMA, CRC CPT® and RBRVS 2020 Annual Symposium Wrap-Up

The American Medical Association (AMA) Tips for Conference Success • Bring business cards. Ensure that you held its CPT® and RBRVS 2020 Annual AMA’s Symposiums are well worth the cost; don’t miss a networking opportunity Symposium in Chicago, Illinois, Nov. 20- the amount of information attendees leave because you are unprepared. 22, 2019, on the Magnificent Mile. The with and the connections they make are • Check out the scenery. It’s not all symposium is a chance to gain valuable invaluable. Here are some tips for making work! After the day ends, take time information on the CPT® updates and RVS the most of these events: to see the sights or meet up with Update Committee (RUC) rationale from • When you arrive at the Symposium, some of the people you’ve met at the those who either worked on the code set or register for the event. There will Symposium. those who work within the specialty. These be a nametag for you, along with sessions provide the why for the updates that materials that were included in the Plan Ahead you don’t normally learn from the CPT® registration fee such as books and Stay tuned to the AMA events page to learn code book. handouts. You’ll need these to jot more about the Symposium and to get details down notes from the presentations. on other 2020 events. Highlights of the AMA Symposium Although the slides contain great Nikki Taylor, MBA, CPC, COC, CPMA, CRC, is a senior The highlight for most was the Evaluation information, the speaker’s input is development editor for TCI SuperCoder where she and Management (E/M) 2020 session on vital, and oftentimes key information develops content for SuperCoder.com. She also Wednesday and the E/M Office Visits 2021 is discussed that you’ll never hear if develops content for webinars and books. Taylor is a session on Friday. you aren’t in attendance. member of the Greenville, N.C., local chapter. Other equally informative sessions fo- • Dress in professional yet comfortable cused on ophthalmology, general surgery, attire. You never know who you may cardiovascular medicine, behavioral health, have the pleasure of meeting, and first urology, and much more. impressions are always important.

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8 Healthcare Business Monthly I Am AAPC

SILVIO R. MARTÍNEZ RUIZ, MD, CPC, CDEO, CPMA, CRC am a doctor, and my medical practice focuses on primary care and preventive Imedicine, in addition to inpatient management. To keep up with the constant changes in the healthcare industry, government, and insurer requirements, it was necessary for me to learn more about the business side of healthcare.

My CPC® Opened New Doors In 2011, I took a preparatory coding course with an AAPC-certified instructor with the objective of becoming AAPC certified. I then took and passed the Certified Professional Coder (CPC®) exam. This certification helped me to apply guidelines, rules, and conventions to document more accurately and assign codes with the highest level of specificity. Wearing both doctor and coder hats is a challenge, but it has honed and increased my skills and knowledge, which has allowed me to lecture at different events for the purposes of educating other professionals, including my doctor colleagues. As an active member of AAPC and having had a very good experience as a coding professional, I decided to acquire more certifications. #IamAAPC

“As an active member MY CPMA® Improved My Claims Payment The second certification I obtained was the Certified Professional Medical Auditor of AAPC and having (CPMA®). This certification has helped me both in my outpatient and hospital practices. Health insurance companies perform different audits during the year, had a very good and with my experience as an auditor, I have been able to adequately document in the medical file to avoid adverse remarks and results during these audits. experience as a coding professional, I decided MY CRC™ Improved My Risk Adjustment Coding The third certification I acquired was the Certified Risk Adjustment Coder to acquire more (CRC™). This AAPC credential has allowed me to understand the risk adjustment model and the importance of assigning specific codes to chronic conditions. certifications.” My CDEO® Improved My Documentation The fourth certification I obtained was the Certified Documentation Expert - Outpatient (CDEO®). The knowledge I gained while preparing to sit for this certification has allowed me to understand the importance of thorough documentation in the outpatient setting. Everything starts with proper documentation.

I’m Not Done Yet #IamAAPC I plan to sit for my Certified Inpatient Coder (CIC™) and Certified Professional Healthcare Business Monthly wants to know Compliance Officer (CPCO™) credentials to continue improving the quality of why you chose to be a healthcare business my work. Thank you, AAPC! professional. Explain in less than 400 words why you chose your healthcare career, how you got to where you are, and your future career plans. Send your story and a digital photo of yourself to ([email protected]).

www.aapc.com January 2020 9 ■ AAPC Chapter Association By Brenda Stevens, COC, CPC, CDEO, CPMA, CRC, CPC-I, CMC, CMIS, CMOM Learn What It Takes to be Chapter Secretary Take inventory and see if your strengths align with the key skills and traits needed to succeed as chapter secretary. gettyimagesizusek/

he duties of an AAPC local chapter secretary include maintaining a Competencies of a good secretary include: Tlist of active chapter members and publishing the chapter meeting • Excellent communication skills; able to communicate clearly minutes within 10 days of the meeting. The secretary should also • Ability to take accurate notes at meetings encourage members to update their contact information on AAPC’s • Responsiveness; deals promptly with correspondence website. Accomplishing these duties requires a person with certain • Makes sure members receive and bring with them to skill sets. meetings all necessary materials • Tech-savvy; computer skills, such as typing, scanning, What Makes a Great Secretary? printing, utilization of software programs and internet browsers The best secretaries possess a combination of certain characteristics and professional hard and soft skills. Do you have what it takes to serve as secretary for your local Characteristics of a good secretary include: chapter? If so, please consider stepping up to the challenge! • Detail-oriented and well organized Brenda Stevens, COC, CPC, CDEO, CPMA, CRC, CPC-I, CMC, CMIS, CMOM, is lead coder at • Professional; demonstrates politeness and respect in all Medkoder, with 20 years of experience working on the business side of medicine. She has a dealings with colleagues passion for teaching students at the college level on accurate and ethical coding for a successful • Dependable and accountable career in medical coding and billing. Stevens is Region 2 representative of the AAPC Chapter • Able to multi-task Association and has held many local chapter offices for the Eastern Shore Coders in Salisbury, • Good under pressure; able to meet deadlines Md., local chapter.

10 Healthcare Business Monthly Chapter News By Rik Salomon, CPC, CRC, CEDC, CEMA, CMCS Speaker’s Bureau: Enhance Chapter Meetings with Virtual Events

s we enter 2020, AAPC local chapters are planning a year filled The Speaker’s Bureau ensures local chapters have at their disposal Awith incredible education and learning. We know AAPC members high-quality, diverse educational presentations on a robust list of thrive on fresh, interesting topics and material. As local chapter topics and specialties. officers, our goal is to provide our members with plenty of top-notch To take advantage of this wonderful resource, or for other inquiries information and educational materials. regarding the Speaker’s Bureau, reach out to Lynda Wetter, CPC, CPB, CPMA, CEMC, CGSC, at [email protected]. A Solution to a Problem Rik Salomon, CPC, CRC, CEDC, CEMA, CMCS, has more than 25 years of health information management experience as a coder, auditor, educator, and documentation specialist. Salomon One of our biggest challenges is finding speakers to share their exper- is a frequent speaker and is nationally published. Salomon has served in many officer roles for tise at each of our chapter meetings. The AAPCCA has found a great the Carolina Coders Charlotte, N.C., local chapter and is a Region IV AAPC Chapter Association way to help: The Speaker’s Bureau is an amazing opportunity for our Board of Directors representative. local chapters to connect and learn from outstanding educators from across the country. These speakers are available to present virtually at on-site chapter meetings and educational events.

AAPC Workshops

www.aapc.com January 2020 11 ■ Hardship Relief By Judy A. Wilson, CPC, COC, CPCO, CDEO, CPPM, CPB, CPC-P, CANPC, AAPC Approved Instructor

Here is an excerpt of a letter from a member who received help from the Hardship Fund: “My name is K.C., and I’m penning this letter to express my gratitude for the payment of my AAPC membership. I thank you from the bottom of my heart for this award. It has had the honor of announcing the Hardship Fund at AAPC’s 2012 been a BIG help to me. Thanks, thanks, thanks.” INational Conference in Las Vegas. I, along with so many others, have since been committed to helping this cause succeed. We hope Your donations are needed and appreciated. The Hardship to always have enough money to help any AAPC member who has Committee assures you that the donations are being used to help found themselves in need of assistance. members in need. The next time you are at a chapter meeting and see the Hardship Where Do Your Donations Go? Fund collection jar, a lap quilt being raffled off, or a 50/50 drawing, you should feel good about giving to the Hardship Fund and knowing This year the Hardship Fund made it possible for over 179 members it’s all about members helping members. to keep their credentials and maintain AAPC membership by paying Judy A. Wilson, CPC, COC, CPCO, CDEO, CPPM, CPB, CPC-P, CANPC, AAPC Approved their renewal fees. The fund has purchased code books for several Instructor, has 38 years’ experience in medical coding/billing including 26 years as the members who would not otherwise have had the means to study for business administrator for Anesthesia Specialists, a group of eleven cardiac anesthesiologists their exam or even do their job. The fund has even paid for a couple who practice at Sentara Heart Hospital. Wilson is now self-employed doing education training of exams in cases where extreme hardship was demonstrated. These and auditing. Wilson served on the AAPCCA Board of Directors from 2010- 2014 and served awards have totaled over $33,282. Thank you to all the members who again from 2015 - 2017. Wilson has presented at several AAPC regional and national conferences and is a regular contributor to AAPC’s Healthcare Business Monthly and Knowledge Center. have donated to the Hardship Fund and helped make this possible. gettyimages PeopleImages / Dental Insurance Physicians Mutual Insurance Company

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12 Healthcare Business Monthly Local Chapter Spotlight ■ By Rik Salomon, CPC, CRC, CEDC, CEMA, CMCA Ginger Hancock-Walden CPC, CRC, Pensacola, Fla., Local Chapter

additional skills, and hearing from speakers who teach about different areas in the medical field.

Prior to moving to Pensacola and becoming her local chapter’s president, Hancock-Walden was the member development officer for the Festus, Missouri, local chapter in 2014. “I love being involved with my local chapter! It helps to develop my leadership skills and fosters a sense of unity, networking, and learning experiences for our membership,” Hancock-Waldon said. Hancock-Walden also makes sure to attend conferences. She attended HEALTHCON 2019 and thoroughly enjoyed the experience. “Networking, leadership development, and a wide variety of learning experiences made it worth the trip. I would love to work my way into being on the National Advisory Board and continue to teach and mentor others,” she said. Hancock-Walden plans to obtain her Certified Professional Medical Auditor (CPMA®) credential in 2020. With her decades of experience in this field, she is sure to succeed at whatever she does.

Rik Salomon, CPC, CRC, CEDC, CEMA, CMCS, has more than 25 years of health information management experience as a coder, auditor, educator, and documentation specialist. Salomon is a frequent speaker and is nationally published. Salomon has served in many officer roles for his month, the spotlight shines on Ginger Hancock-Waldon, the Carolina Coders Charlotte, N.C., local chapter and is a Region IV AAPC Chapter Association TCPC, CRC — the 2020 president of AAPC’s Pensacola, Florida, Board of Directors representative. local chapter. Having years of experience in the health information management field, Hancock-Waldon has held many positions over the years. She said: I started out as a claims processor in 1992, and throughout the years, I have worked my way up to the coding side of medical records as an auditor. I have been through different areas of the medical coding field over the years, which has allowed me to be a well-rounded professional, from my knowledge of coding from the beginning of the provider charting to the end claims payment.

Hancock-Waldon became an AAPC member to start her coding career. “I always wanted to see how the chart got coded to a claim, so I pursued the necessary education and took the certification classes. I became a member in 2012,” she said. Attending chapter meetings is extremely important to Hancock- Waldon. She said: The meetings are very informative. They also help with networking and building my self-esteem in my profession. What I like most about chapter meetings is that they help in obtaining

www.aapc.com January 2020 13 ■ MEMBER FEATURE By Michelle A. Dick, BS Coding Superstars Take AAPC’s Mentorship Program by Storm

gettyimages / erhui1979

Learn why joining our dedicated to mentoring and hear the benefits everyone receives from it. But first, we’ll explain a little bit about how the program began program’s pioneers will prove and its purpose. to be beneficial for everyone. Why a Mentorship Program? AAPC’s National Advisory Board (NAB) President Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA, CEMA, AAPC Fellow, said that the NAB formed a Career Development Committee with AAPC and recently launched the Mentorship Program to assist members in fostering a positive attitude for learning. It creates a way for mentors and mentees to identify each other APC’s Mentorship Program has started with success, with many and develop productive relationships. Amembers actively engaged in the new program. Seasoned and Miscoe has been both a mentee and a mentor, and each role has subject matter expert (SME) members have stepped up in a mentoring helped him maintain an attitude focused on achieving and suc- role to nurture others’ careers. They have taken students new to medi- ceeding. He said, “As a mentee, I’ve been inspired by the success and cal coding, revenue management, and compliance under their wing professional achievements of my mentors. As a mentor, I’m motivated to help ensure success in the field. Because they have done wonderful by the positive attitudes and quest for knowledge of my mentees.” things, let’s highlight just a few of the AAPC superstars who are

14 Healthcare Business Monthly Mentoring

“Mentoring creates a way for mentors and mentees to identify each other and develop productive relationships.”

Mentors Say It’s a Win/Win new to be sure you really know the answer. Most of the time, mentees Three members — key players in the program — stepped up and do [know the answer]; they just need that reinforcement. agreed to a Healthcare Business Monthly interview about their mentor- Members should just try the program. I think AAPC members ing experience, its benefits, and why others should follow suit to help think that, as a mentor, you need to know the answer to everything more AAPC members succeed. and have it right at your fingertips, which is not true at all. The truth is you know more than you think you do. Mentoring builds Rebecca S. Coltrane, CPC, confidence for yourself, too. I have one particular mentee who could/ CPMA, CPPM, CRC should be a mentor, too — it’s all about encouragement and showing One benefit I get from men- her what her value is. I will get her to mentor someday! toring is that I get to meet new people — hear about Lori Sobral, CPC, CPPM, their experiences. I learn the CPMA different things that members The main benefit I get out do in the coding world and of mentoring is the satisfac- what they are hoping to get tion of being able to help out of membership. I also like other people in their educa- being helpful, and I remem- tional and career endeavors. ber how overwhelming the I embrace any opportunity beginning was. There seems to make a difference in the to be so much to learn, and lives of those trying to better it all seems so complicated themselves and advance both and overwhelming. When I personally and profession- help people break it down and ally. An added benefit is the simplify it or give them additional resources, it feels good. I also like chance to meet great people giving back to AAPC, too. I think mentoring online takes some of the with whom I wouldn’t other- shyness out of it. People feel free to ask questions that may be hard to wise come in contact. AAPC ask directly to a stranger. members involved in this I see many benefits that mentees are getting out of the Mentorship program live in all areas of the country, and it is interesting to hear Program. I serve as an additional resource for them — and a cheer- their experiences and different perspectives. I feel we can learn from leader, too. I try to help boost their confidence. It’s hard when you are each other, not just as coders, but as people. Another benefit comes

“I have one particular mentee who “I certainly don’t have all the could/should be a mentor, too — it’s all answers, but I like to give some about encouragement and showing her direction as to where the answers what her value is.” can be found.”

www.aapc.com January 2020 15 Mentoring

“As experienced coders, we all have different areas of strength and expertise that can help newer members either break into the industry or expand their horizons.”

in the challenge of being able to answer questions appropriately and It Takes a Village keeping current on my coding knowledge. I certainly don’t have all A special thanks goes out to the NAB’s Career Development the answers, but I like to give some direction as to where the answers Committee, member Carla Monique Sexton, COC, CPC, and can be found. Sometimes in addressing an issue or concern new to countless other devoted AAPC members for your dedication to this me, I can research information and obtain new knowledge that is of program and help in making it a success. use to me as well. The benefits I have seen mentees getting out of the Mentorship You, Too, Can Take Mentoring by Storm Program include receiving extra help to pass certification exams and obtaining useful resources for information to advance them in To learn more about AAPC’s Mentorship Program and its benefits, their careers. Every experienced coder has insight and tips that can read the article, “Behold the Power of Two” by David Blackmer, be shared, so why not use that to aid in achieving your goals? My MSC, on page 64 of the September 2019 issue of Healthcare Business mentees have also built up confidence with our interactions, not only Monthly. You also can go to AAPC’s website at www.aapc.com/resources/ in realizing they can reach their short- and long-term goals, but also mentor.aspx to explore the requirements, discover more benefits, and that support and guidance is available in this ever-changing and often find answers to questions you may have in the FAQ at the bottom of ambiguous industry. the page. I encourage other AAPC members to become mentors to help cre- Michelle A. Dick, BS, is an executive editor at AAPC and a member of the Flower City ate a culture of collaboration between coders, which is much needed Professional Coders local chapter in Rochester, N.Y. in our field. As experienced coders, we all have different areas of strength and expertise that can help newer members either break into the industry or expand their horizons. It’s also a great way to network, perfect your own skills, and give back to our coding community.

Tammy Kerkstra, CPC, CHONC I have benefited from the AAPC Mentoring Program because I have built relationships with other coders while being able to share what I’ve learned in my coding to help them in their coding journey. My mentees have found an opportunity to learn and grow in their coding skills “It’s a great way for both mentor while discovering where they can go with their coding and mentee to learn from each careers. I recommend other members try the program. It’s a great way for both mentor and mentee other while fostering relationships to learn from each other while fostering relationships with fellow coders. Both can learn a lot from each other. with fellow coders.”

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TM Promo code N7017 CALL 1-844-446-4183 *Prices are per person based on double occupancy plus up to $299 in taxes & fees. Cruise pricing based on lowest cabin category after Instant Rebate is applied. Single supplement and season surcharges may apply. Add-on airfare available. Onboard Credit requires purchase of Ocean View or Balcony Cabin. For Hawaiian Islands Cruise & Tour, Free Internet and Free Beverage Package offers vary based on cabin category purchased. Additional service charges are required and payable to YMT with final balance for select Set Sail offers. For full Set Sail terms and conditions ask your Travel Consultant. Offers apply to new bookings only made by 12/31/19. Other terms & conditions may apply. www.aapc.com January 2020 17 ■ CODING/BILLING By Winda F. Hampton, RHIA, CPMA, CCS-P Code FESS With a Clear Head gettyimagesRossHelen / Consider anatomy and coding Sinus Anatomy There are four separate sinus cavities (jointly, the paranasal sinuses) guidance to put things into on each side of the face. They are: • Maxillary (antrum). These air-filled sinuses are located perspective. below the eye, behind the cheek. • Ethmoid. The ethmoid sinuses are between the eye and the nasal cavity. The concha bullosa is an extension of the unctional endoscopic sinus surgery (FESS) is a surgical procedure ethmoid sinus located in the middle turbinate. Fperformed endoscopically on the nasal/sinus cavities. The purpose • Sphenoid. The sphenoid is a wedge-shaped bone in the of the surgery is to reduce the symptoms of chronic sinusitis such as middle of the skull that contains the sphenoid sinuses. It is congestion, drainage, post-nasal drip, headaches, and facial pain. located between the back of the nasal space and the cranial Coding FESS can be unnerving because there are multiple codes cavity. Just lateral or beside the sphenoid sinus are the optic associated with the surgery. Reviewing sinus anatomy and coding nerves and the intracranial portion of the carotid arteries. guidance for FESS will help you keep a clear head when coding these • Frontal. These sinus cavities are located above the eye in the claims. forehead region.

18 Healthcare Business Monthly ■ Coding/Billing ■ Auditing/Compliance ■ Practice Management FESS

“According to the CPT® code book, diagnostic endoscopy and sinusotomy (the incising of a sinus) are included in

the surgical sinus endoscopy codes 31237-31298.” CODING/BILLING

Diagnoses That May Require FESS According to the CPT® code book, diagnostic endoscopy and The most common indications for endoscopic nasal/sinus surgery sinusotomy (the incising of a sinus) are included in the surgical are rhinosinusitis (sinusitis), polyp, cyst, neoplasm, and polypoid sinus endoscopy codes 31237-31298. Diagnostic codes 31231- sinus degeneration. Common diagnoses and associated ICD-10- 31235 are not reported separately with surgical codes 31237-31298. CM codes include: Additionally, according to the CPT® code book, “To report these • Chronic pansinusitis (J32.4) — when all four sinus cavities services when all of the elements are not fully examined (eg, judged have chronic sinusitis. If coded individually: maxillary not clinically pertinent), or because the clinical situation precludes (J32.0), frontal (J32.1), ethmoid (J32.2), and sphenoid such exam (eg, technically unable, altered anatomy), append modi- (J32.3). fier 52 if repeat examination is not planned, or modifier 53 if repeat • Other chronic sinusitis (J32.8) — when more than one examination is planned.” sinus cavity has chronic sinusitis. Procedure codes 31233-31294 are unilateral. When performed • Acute, recurrent pansinusitis (J01.41) — when all four sinus on both the right and left sinus cavity, append modifier 50 Bilateral cavities have acute, recurrent sinusitis. (Per ICD-10-CM, as procedure to the procedure code. CPT® code 31231 is listed as it relates to sinusitis, the term “recurrent” is associated with unilateral or bilateral, making it inappropriate to append modifier acute, not chronic.) 50 to this code. • Other acute, recurrent sinusitis (J01.81) • Polyps (J33.8) FESS Coding Guidance • Cyst and mucocele of nose and nasal sinus (J34.1) • Polypoid sinus degeneration (J33.1) To select the correct code, read the body of the operative report to • Other specified disorders of nose and nasal sinuses (J34.89) ensure that documentation supports the procedure listed under the Procedures heading. Specific terminology or a sufficient description Coding FESS Procedures of the procedure must be documented. Here are examples of the work involved in specific procedure codes: During surgery, the surgeon will perform diagnostics on the in- Endoscopic Maxillary Antrostomy — Vignette for Code 31256 ternal anatomy of the nasal/sinus cavities with the assistance of (CPT® Assistant, January 1997) an endoscope for increased visualization and magnification. The The maxillary sinus ostium is palpated and visually iden- surgeon inspects the interior nasal cavity, the middle and superior tified. Residual inferior bony uncinate remnants are re- meatuses, the turbinates, and the sphenoethmoid recess. This diag- moved, and the ostium enlarged posteriorly, inferiorly, nostic portion of the surgery is reported using the appropriate code and anteriorly as indicated. Bony partitions, as between from CPT® code range 31231-31235. the natural maxillary sinus ostium and a Haller cell above, may require removal to relieve the obstruction. Hemostasis with topical agents or sponge insertion may be required.

If the description in the body of the operative report does not indicate that the ostium was violated, it may not be appropriate to code the procedure. Best practice is to query the provider when in doubt. Endoscopic Maxillary Antrostomy with Tissue Removal for Code 31267 (Coders’ Desk Reference for Procedures 2019) Code 31267 has all the elements of 31256. In 31267, the gettyimagesPeterHermesFurian / maxillary sinus may be opened, and the mucosa removed.

We’ve got more great articles on the Knowledge Center at: www.aapc.com/blog/. www.aapc.com January 2020 19 FESS

“If diseased or abnormal tissue is present within the frontal sinus, a scalpel or biting forceps is introduced parallel to the endoscope and is used to remove the tissue.”

Endoscopic Total Ethmoidectomy — Vignette for Code 31255 ….” This implies there may not be diseased or abnormal (CPT® Assistant, January 1997) tissue within the frontal sinuses. The surgery begins with complete uncinate process remov- CODING/BILLING al. The anterior ethmoid cells are removed, and the medial Endoscopic Sphenoid Sinus for Code 31287-31288 (Coders’ Desk orbital wall identified and skeletonized under endoscopic Reference for Procedures 2019) visualization. The middle turbinate ground lamella is pen- The sphenoid can be explored with direct access or through etrated and removed, and the posterior ethmoid cells are the posterior ethmoid sinus. The isolated access to the removed back to the anterior sphenoid wall, which is fol- sphenoid sinus is through dilation of the sphenoid osti- lowed up to the skull base. The skull base is then skeleton- um. The middle turbinate may be fractured or partially ized and followed forward to the frontal recess at the ante- removed for access. The ostium is cannulated and dilat- rior ethmoid artery. ed. The physician uses forceps or a sphenoid punch to open the sinus cavity. Additionally, diseased mucosa or tissue is Endoscopic Frontal Sinus Exploration for Code 31276 (Coders’ removed in 31288. Desk Reference for Procedures 2019) A sinusotomy of the frontal sinus ostium is performed. If Combination codes 31253, 31257, 31259 (Total Ethmoidectomy diseased or abnormal tissue is present within the frontal si- with Frontal Sinus Exploration or Total Ethmoidectomy with a nus, a scalpel or biting forceps is introduced parallel to the Sphenoid Sinusotomy, or with a Sphenoidotomy and Removal of endoscope and is used to remove the tissue. This procedure Tissue) – CPT® Assistant, April 2018 includes polypectomy, debridement, or biopsy of the fron- Code 31253 includes the work of codes 31255 and 31276. tal sinus tissue when performed. Electrocautery may be Code 31253 is reported when a complete/total ethmoidec- used for hemostasis. The nasal cavity may be packed with tomy is performed with frontal sinus exploration. If only a Telfa or gauze. partial ethmoidectomy is performed in conjunction with a frontal sinus exploration, report codes 31254 and 31276. There does not have to be tissue removed from the frontal sinus cavity to code for this procedure. The surgeon Code 31257 includes the work of both codes 31255 and may explore the cavity. Also, the Coders’ Desk Reference for 31287. Code 31257 is reported when a complete/total eth- Procedures states, “If diseased or abnormal tissue is present moidectomy is performed with a sphenoidotomy (sphenoid sinusotomy). If only a partial ethmoidectomy is performed in conjunction with a sphenoidotomy, report codes 31254 and 31287.

Code 31259 includes the work of codes 31255 and 31288. Code 31259 is reported when a complete/total ethmoidectomy is performed with a sphenoidotomy and removal of tissue from the sphenoid sinus. If only a partial ethmoidectomy is performed in conjunction with a sphenoidotomy and removal of tissue from the sphenoid sinus, report codes 31254 and 31288.

Coding Separate Procedures Within the endoscopic sinus surgery codes, there are two separate

gettyimagesTharakorn / procedure designated codes: 31231 Nasal endoscopy, diagnostic, unilat-

20 Healthcare Business Monthly Discuss this article or topic in a forum at www.aapc.com FESS

“When an otolaryngology surgeon performs the approach of a procedure, and a neurosurgeon performs the resection on that same patient for a cranial

mass or tumor, both surgeons may require the use of the navigation system.” CODING/BILLING

eral or bilateral (separate procedure) and 31237 Nasal/sinus endoscopy, • “Image guidance was placed on the patient and calibrated.” surgical; with biopsy, polypectomy or debridement (separate procedure). According to National Correct Coding Initiative (NCCI): “A The surgeon’s documentation should also describe the area in procedure designated by the CPT code descriptor as a ‘separate which the system was used. For example: procedure’ is not separately reportable if performed in a region • “Surgical navigation was used to confirm the position of the anatomically related to the other procedure(s) through the same lamina papyracea (i.e., medial orbital wall), skull base, and skin incision, orifice, or surgical approach.” frontal recess cells.” In other words, when performed on the same side (ipsilateral), it would be incorrect to bill 31231 or 31237 with the endoscopic When an otolaryngology surgeon performs the approach of a surgical codes (31238-31294). However, because there are two procedure, and a neurosurgeon performs the resection on that same orifices (right and left nasal cavities), when performing a diagnostic patient for a cranial mass or tumor, both surgeons may require the procedure on the right side and a surgical procedure on the left side, use of the navigation system. However, only one MUE is allowed both procedures may be reported. Modifier 59 Distinct procedural per day for the navigation system, and the CPT® code does not allow service may be required with 31231 and 31237. for co-surgery (modifier 62). The CPT® code does, however, allow for an assistant surgeon (modifier 82) (see the Medicare Physician Coding the Stereotactic Fee Schedule); therefore, if the documentation supports its use, the neurosurgeon may bill for the navigation system appending Computer-Assisted Navigation System modifier 82 to the CPT® code. According to CPT® code book, the Brainlab navigation system Additionally, when a neurosurgeon is involved, the CPT® code may be used to facilitate the performance of endoscopic sinus may be 61781 Stereotactic computer-assisted (navigational) procedure; surgery, and is reported with 61782 Stereotactic computer-assisted cranial, intradural (List separately in addition to code for primary (navigational) procedure; cranial, extradural (List separately in addi- procedure) for an intradural cranial procedure, rather than 61782 tion to code for primary procedure) when the procedure is performed (extradural). Why 61781 instead of 61782? If a neurosurgeon is in conjunction with endoscopic sinus surgery. involved, the surgical target may be intradural. Therefore, regard- One explanation for use of this system is that the paranasal sinuses less of whether the otolaryngology surgeon’s work is performed share a common thin wall with the eye socket (or orbit) and cranial extradural (outside the dura), the code is driven by the location of cavity. When performing surgery in a highly delicate region, the the surgical target. surgeon relies on the system to navigate the area through the identifi- Winda F. Hampton, RHIA, CPMA, CCS-P, has more than four years’ experience as an cation of anatomical landmarks. The ethmoid, for example, is a facial outpatient surgical coder. She attended the University of Alabama at Birmingham, where she bone located between the eyes whose upper portion lies just below received a Bachelor of Science in Health Information Management. Hampton is a member of the cranial cavity. According to the Cleveland Clinic, “All operations the Durham, N.C., local chapter. on the ethmoid sinus carry a rare chance of creating a leak of cerebral sinus fluid (CSF).” The risk of CSF leak is potentially reduced because the endoscope allows for improved visualization. Nevertheless, a CSF leak could lead to an infection, potentially resulting in meningitis. Resources When coding the navigation system, the surgeon’s documenta- Optum360. Coding Companion. ENT/Allergy/Pulmonology. 2018 tion should describe the setup. Examples include: Optum360. Coders’ Desk Reference for Procedures. 2018 • “The surgical navigation system was set up and found to be American Medical Association. CPT® Assistant. Jan. 1997 accurate after registration.” Centers for Medicare & Medicaid Services, National Correct Coding Initiatives. July 16, 2019. Web. • “The registration sticker for the Medtronic image guidance Sept. 1, 2019 system was placed on the forehead. The face was registered with good correlation. Landmarks were checked with the probe, Cleveland Clinic, n.d. “Sinus Surgery.” Sept. 25, 2019. https://my.clevelandclinic.org/health/ treatments/17478-sinus-surgery which showed satisfactory accuracy.”

www.aapc.com January 2020 21 ■ CODING/BILLING By LeAndrea Mack, CPC, CRCS-I, NR-CMA Use Medicare Summary Notices as an Opportunity to Educate Patients gettyimagesAntonioGuillem / Use this tool to inform patients of What is a Medicare Summary Notice? An MSN is a document that Medicare patients receive after visiting their benefits and clarify billing their physician or other healthcare provider for Part A or Part B services and durable medical equipment (DME). This document questions. is intended to help patients remember the physicians, specialties, supplies, and services involved in their care. Understanding the information contained in an MSN can minimize the frustration often felt by both patients and providers trying to grasp benefit coverage. hile calling Medicare to explain a patient’s benefits is sometimes For patients enrolled in original Medicare, an MSN is mailed out Wbetter, this is not always the first phone call the patient makes. every three months (if any claims were submitted to Medicare during More likely, the patient calls the provider’s office with questions about that period). Medicare also makes this notice available online at their medical bills. Here’s how your practice can use the Medicare Medicare.gov. Summary Notice (MSN) to help educate all parties involved on The MSN is similar to the explanation of benefits (EOB) state- Medicare benefits. ment, which itemizes everything billed to Medicare, including what

22 Healthcare Business Monthly ■ Coding/Billing ■ Auditing/Compliance ■ Practice Management Discuss this article or topic in a forum at www.aapc.com MSN

services were charged, what Medicare paid for, and what the patient B for medium- to high-risk patients, but for low-risk patients, it’s still may owe their providers. There are separate notices for Part covered under Medicare Part D.

A, Part B, and DME, but each notice provides the same type of CODING/BILLING information. Use Phone Calls as an Opportunity to Educate Patients Why Do Patients Call With Use the MSN to educate patients when they call about a procedure Questions About Their MSN? they don’t recall receiving. Chances are they are not aware of the Medicare encourages beneficiaries to compare claim details on their formal medical terminology of the procedure they received. MSNs with the bills they receive from their providers, including For example, perhaps the patient sees on the MSN CPT® 20610 verifying provider name, date of service, billing code(s), and descrip- Arthrocentesis, aspiration, and/or injection, major joint or bursa (eg, tions. Patients often call questioning a service that shows up on their shoulder, hip, knee, subacromial bursa); without ultrasound guid- MSN when they do not recognize it or remember receiving it. ance and does not believe they had such a complicated-sounding While the charges are usually accurate and fair, patients do not al- procedure performed during their visit. A quick explanation that ways have a clear understanding of the services they received and the this is the cortisone shot they received will ease their concern about coverage parameters for those services. Although these calls can be any fraud or abuse, and now they know the name of the procedure daunting and quite tedious in a busy office, consider the call an for cortisone injections. opportunity to educate the patient and, sometimes, the physician, Finally, although “This is not a bill” is printed on every MSN, too. patients sometimes mistake the MSN for a bill. Usually, this error For example, services like the hepatitis B vaccine may need to can be cleared up by asking the patient to read the title of the first be explained to patients, or a friendly reminder may need to go out page of the document, which states “Medicare Summary Notice.” to the providers in your office, regarding coverage. This service is For an example of a MSN, visit www.cms.gov/Medicare/Medicare-General- confusing because immunization is covered under Medicare Part Information/MSN/Downloads/Sample-Part-B-Medicare-Summary-Notice.pdf.

LeAndrea Mack, CPC, CRCS-I, NR-CMA, is a clinical coding investigator for UnitedHealthcare/Optum through Healthcare Support Staffing. She has a degree in healthcare and over 16 years of healthcare experience, starting as a medical assistant and moving into coding for multi-specialty practices in 2015. She is a member of the Overland Park, Kan., local chapter. CEUs. Resources https://www.medicare.gov/coverage/hepatitis-b-shots Get ‘em. https://www.medicare.gov/forms-help-resources/mail-you-get-about-medicare/medicare- Got ‘em. summary-notice-msn DoneHBO Ad with ‘em. PR Ad

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We’ve got more great articles on the Knowledge Center at: www.aapc.com/blog/. www.aapc.com January 2020 23 ZHealth CODING/BILLING ■ By Stacy Chaplain, MD, CPC

Steps for Improved Excision Coding

gettyimages / Liderina Editor’s note: This article is the second part of a three-part series based on the presentation given by Melissa Caperton, RHIA, CPC, CPMA, CPPM, CFPC, Approved Instructor, at HEALTHCON 2019. We began this series last month by breaking down the Part 2: Consider skin lesion type, complexities of skin procedure coding in the article “Explore in Depth the Complexities of location, and excised diameter. Skin Procedures.”

onsideration of several factors, such as the type of removal, le- Skin excision coding may seem complex at first, but you can easily Csion size and location, pathologic results, intent, etc., are key to master it in four steps: accurately coding dermatological lesion removal procedures. Let’s review the codes and guidelines for lesion removal by excision and 1 Check the pathology report. how to avoid common mistakes when coding these skin procedures. Skin excision codes are first classified based on information extracted Excision - Benign/Malignant Lesions (11400-11646) from the pathology report on whether the lesion is benign (non- cancerous) or malignant (cancerous). Do not code the lesion type Excision involves the cutting and full-thickness removal of a lesion, based on “suspected” or “probable.” Base your code selection on with extension through the dermis into the subcutis. Skin lesion the pathology report, even if it means waiting a few days before excisions include the surrounding tissue or margins. To accurately submitting the claim. code lesion excisions, review the documentation for details regarding If the report describes a benign lesion or one of uncertain behavior whether the lesion is benign or malignant, the location, and the (for example, indications of atypia or dysplasia), assign a benign lesion excised diameter. code (11400-11446).

■ Coding/Billing ■ Auditing/Compliance ■ Practice Management www.aapc.com January 2020 25 Skin Lesion Excision

“Do not code the lesion type based on “suspected” or “probable.” Base your code selection on the pathology report, even if it means waiting a few days before submitting the claim.” CODING/BILLING If pathology confirms malignancy, assign a malignant lesion code 2 Location matters. (11600-11646). Malignancies can be further classified into: Knowing whether the lesion was benign or malignant will help you • Carcinoma in-situ – precancerous cells that have not select the code that also identifies the anatomic location from which spread beyond the primary site; may evolve into an invasive the lesion was excised. malignancy Benign lesion • Primary site – the original, or first, tumor in the body Trunk, arms, legs – 11400-11406 growing at the anatomical site where tumor progression Scalp, neck, hands, feet, genitalia – 11420-11426 began Face, ears, eyelids, nose, lips, mucous membrane – 11440-11446 • Secondary (metastatic) site – cancer cells that have spread Malignant lesion from the primary site to other parts of the body and formed Trunk, arms, legs – 11600-11606 secondary tumors Scalp, neck, hands, feet, genitalia – 11620-11626 Face, ears, eyelids (skin only), nose, lips – 11640-11646 Without a pathology report to confirm the diagnosis, you must assign an unspecified diagnosis and a benign lesion excision code 3 Calculate excision size. (11400-11471). Code selection is determined by the size of the excision, not the size of the lesion. Excision size includes the size of the lesion plus the width of the excised margins (the area surrounding the lesion that is also removed). To calculate the excision size, measure the diameter of the lesion at its longest point (greatest clinical diameter) plus two times the narrowest margin appropriate for removing the entire lesion (the margin on both sides of the lesion).

Note: The rule of thumb is to measure first; cut second. The provider should measure the lesion and margins preoperatively because the lesion tissue generally changes shape or shrinks once removed and placed in formalin.

4 Consider the circumstances. Before you code, make sure to evaluate for the presence of special circumstances such as removal of multiple lesions, re-excision, and bundling concerns. • Report each lesion separately; multiple excisions require a modifier. When the provider removes multiple lesions in a single © MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH, ALL RIGHT RESERVED. visit, code each lesion separately, assigning

26 Healthcare Business Monthly Discuss this article or topic in a forum at www.aapc.com Skin Lesion Excision

specific CPT® and ICD-10-CM codes for every lesion • Be on the lookout for bundling issues. According treated, and report the most complex lesion first. Append to CPT® guidelines, all lesion excision codes include modifier 59 Distinct procedural service to the second and local anesthesia and simple wound closure. Repair by all subsequent codes describing lesion excision in the same intermediate or complex closure should be reported

anatomic location. separately. CODING/BILLING • Re-excision necessitates special consideration. The provider may revisit a previous excision to remove In such cases, report intermediate (12031-12057) and complex additional tissue if pathology shows malignancy in the (13100-13153) repairs or reconstructive closure (15002-15261, margins. Proper reporting of this re-excision depends on 15570-15770) in addition to lesion excision (11440-11446). Note, the timing of the follow-up excision. however, payers who follow the National Correct Coding Initiative If re-excision is performed during the same session as the (NCCI) edits will bundle intermediate and complex repairs into initial excision, report one code based on the final widest excision of benign lesions of 0.5 cm or less (11400, 11420, and margin. This should describe the greatest area removed. For 11440). example, if the first excision measures 2.0 cm with margins, Next month, in the final installment of this three-part series, we’ll and the second excision increases the margins by 1.0 cm on review coding tips for wound repair (closure) procedures. all sides, code for a 4.0 cm excision. Do not report a 2.0 cm Stacy Chaplain, MD, CPC, is an executive editor at AAPC. She has worked in medicine for excision and a 4.0 cm excision. almost 20 years and has more than four years’ experience in medical writing and editing. Prior If the re-excision is performed during a subsequent to AAPC, she led a compliance team as director of clinical coding quality for a multispecialty session, code based on the diameter of the new excision and group practice. Chaplain received her Bachelor of Arts in Biology from The University of Texas append modifier 58 Staged or related procedure or service by at Austin and her Medical Doctorate from The University of Texas Medical Branch in Galveston. the same physician during the postoperative period because the She is a member of the Beaverton, Ore., local chapter. re-excision occurred during the global period of the initial excision.

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www.aapc.com January 2020 27 ■ CODING/BILLING By Jessica G. Kibbe, COC, CPC, CASCC Anatomy of an Operative Report

It’s your first line of defense for coding and claims payment.

he operative report is perhaps the single • Surgery Information – Name of Tmost important document in a surgical the primary surgeon, co-surgeons, chart. It is the official document that cap- residents, and/or surgical assistants; tures what transpired in the operating room. type of anesthesia; name of It must support the medical necessity for anesthesiologist/CRNA; use of treating the patient, describe each part of the special equipment (microscope, surgical procedure(s), and reveal the results robotics, etc.) and/or implants; of the surgery. The operative report is the complications; and estimated blood document used most to reimburse claims for loss. the surgeon, surgical team, and the facility. • Pre-operative and Post-operative Auditors and payers use the operative report Diagnoses – List of all applicable to verify that the documentation supports all diagnoses to support medical codes reported on the claim. Let’s breakdown necessity. the four basic sections of an operative report • Procedure(s) Performed – A and their requirements. comprehensive list of the surgery or surgeries. What’s in an Op Report? The History/Indications for Surgery The operative report consists of: section of the op report describes why the • Heading surgery is needed and the actions preced-

• History/Indications for Surgery ing the surgery, if applicable. The surgeon gettyimages andresr / • Body explains how the illness or injury occurred, • Findings and Follow-Up the occurrence date or duration, the patient’s Heading. If performed unilaterally, the cor- past medical history pertinent to the proce- rect side must be documented. The Heading of an operative report contains: dure, the patient’s family history pertinent to The following should be documented • Facility Information – Name the procedure, past or failed treatments, etc. as well: the approach (whether open or en- and address of the facility and the The Body of the operative report doscopic); implantation of the implants or patient’s medical record number for contains: devices previously listed in the Heading; use that facility. Description of the Procedure(s) – All of robotic or microscopic assistance previ- • Patient Information – Patient’s procedures from the beginning (prepping) ously listed in the Heading; any specimens full legal name, date of birth/age, to the end (closure and dressings) MUST be collected or frozen sections performed; and sex. Some procedures are sex-/ documented in this section. If the procedure intraoperative monitoring or testing; and age-specific. was performed bilaterally, then both sides any portions performed by another surgeon. • Date of Service – Date the surgery must be documented here in some fashion, Description of the Procedure(s) is the was performed. even if it is already stated as such in the most important part of the operative report.

28 Healthcare Business Monthly ■ Coding/Billing ■ Auditing/Compliance ■ Practice Management Discuss this article or topic in a forum at www.aapc.com Op Report Anatomy

“If the coder finds a procedure is omitted,

missing bilateral CODING/BILLING documentation, or any other discrepancies between the heading and the body, the surgeon should be queried immediately for verification and possible correction.”

• Follow-Up Treatment or Future Procedures – The surgeon should document any future (staged) procedures for proper modifier assignment. Follow up or repeat screening indications should be documented here as well.

Other Considerations In certain instances, more definitive, reportable diagnoses or complications may be found in the History/Indications for Surgery section and Body of the operative report than what may be listed the Heading. In the case of co-surgeons, each surgeon should provide an operative report for their portion of the surgery. And for discontinued procedures, the reason for discontinuing the This is where the basic principle of a coder’s a procedure is omitted, missing bilateral procedure must be documented. mantra “NOT DOCUMENTED, NOT documentation, or any other discrepancies A coder’s job is to read the entire report DONE” applies. If a procedure is not docu- between the heading and the body, the from start to finish to capture all billable mented here, auditors/payers will either surgeon should be queried immediately for services and be the first line of defense not reimburse for the missing procedure or verification and possible correction. against any errors or discrepancies before recoup a previous payment for the missing The Findings and Follow-Up should the claim is submitted. procedure. contain: Jessica G. Kibbe, COC, CPC, CASCC, is an ASC It is vital to code from this section and • Summary of Findings – coding specialist with Acadiana Coding Services. She not code just from the procedure listings Summarize the findings of the has 19 years’ experience specializing in ASC coding in the Heading. The procedures listed in surgery. and billing for multiple specialties. She also provides the Heading should only give the coder a • Complications – Any complications auditing, consulting, and on-site education services checklist of what to look for in the body or absence of complications should for ASCs and surgeons. She is the 2020 president-elect for the Lafayette, La., local chapter. of the operative report. If the coder finds be documented here.

We’ve got more great articles on the Knowledge Center at: www.aapc.com/blog/. www.aapc.com January 2020 29 ■ ADDED EDGE By Leonta Williams, MBA, RHIA, CCS, CCDS, CPC, CPCO, CRC, CEMC, CHONC

Follow this guide for mapping out a clear path to career success and personal fulfillment.

30 Healthcare Business Monthly New Year, New You

“It is important to remain steadfast in your employment pursuits, but it is equally important to be flexible and open to opportunities that will get you in the door.”

he first step to advancing your career as a healthcare business Entry-Level Positions Tprofessional is determining where you want to go next. Success Newly credentialed coders entering the industry sometimes encoun- means different things to different people, so you must be able to ter difficulty landing their first medical coding position due to lack define what success means to you. Once you have identified what role of experience. It is important to remain steadfast in your employment you wish to attain, the next step is to chart a course for getting there. pursuits, but it is equally important to be flexible and open to op- Your roadmap should include goals, timelines, and action items portunities that will get you in the door. For beginner or entry-level needed to reach your desired level of success. Depending on how medical coders, employment may include non-coding roles closely far you want to take your career, you may need to acquire additional associated with billing or insurance claim processing. When you do education, training, and skills along the way. land your first coding position, it will most likely not be a remote position. Coders are directly responsible for the financial health of Chart a Course for Career Advancement an organization; your employer will want to build some trust before authorizing you to work from home, absent of direct supervision. As you plan your next career move, think about your strengths and AAPC’s core credentials will give you a leg up in securing an weaknesses, and what you most enjoy doing. Also, consider the cur- entry-level position. Such positions typically do not require a degree rent industry trends in healthcare, and whether there are any growth but may require some experience. If you are new to the industry, opportunities at your current place of employment. think about any skills you may have that can be applied to your new Your career path plan should include a list of activities needed to role. Review the job description you are interested in, paying close reach your goal, along with resources to support achieving it. AAPC attention to terms such as “required” and “preferred.” has an array of credentialing opportunities for many of the diverse professional healthcare business roles available today. Identify which TIP: After reviewing the job description, tailor your resume (based on your skills and experience) to meet the employer’s expectations. certification(s) will best support your desired role. Your plan should also include any potential obstacles or challenges that may keep you from achieving your goal, or at minimum, slow the process. Address Entry-Level Core Credentials challenges by having a documented response action for each. • Certified Professional Coder (CPC®) Be realistic about your goals and allow yourself enough time to • Certified Outpatient Coder (COC™) get there. It also helps to share your aspirations with someone who • Certified Risk Adjustment Coder (CRC™) will provide encouragement, but also hold you accountable. • Certified Professional Biller (CPB™) If you have a good working relationship with your employer, communicate your goals to your manager (many of us do this Entry-Level Positions in performance reviews). Use this process to identify your • Physician Coder strengths and weaknesses, and to discuss opportunities for • Risk Adjustment Coder growth or improvement. Employers may be instrumental in • Ancillary Coder helping you to achieve your goals, as employee retention and • Claims Edit Specialist succession are important to organizations. • Collection Specialist

www.aapc.com January 2020 31 New Year, New You

• Insurance Claims Specialist Mid-Level Credentials • Medical Records Clerk • Certified Inpatient Coder (CIC™) • Payment Poster • Certified Documentation Expert Outpatient (CDEO®) • Certified Professional Medical Auditor (CPMA®) Intermediate-Level Positions • Certified Physician Practice Manager (CPPM®) If you have been a medical coder for a few years and are looking to Mid-Level Positions advance your career, the good news is there are many opportuni- • Coder II and up ties available. The role of a coder is transforming, with continued • Inpatient Coder technological advancements, value-based payment methodologies, • Speciality Coder and artificial intelligence (AI) creating many new opportunities. • Coding Educator At the intermediate level, seek to attain additional credentials and • Coding Auditor perhaps even a collegiate degree to reinforce your technical coding • Validation Specialist skills and bolster your critical, analytical, and management skills. • Coding Supervisor Think about ALL the responsibilities you have in your current role • Practice Manager and make note of them. You probably do much more than what was outlined in your job description upon hire, but that’s okay because Advanced-Level Positions those additional activities can help you land your next position. Managers will tell you a large percentage of their time is allocated to TIP: Hone and develop your soft skills. Soft skills are crucial in any role, but especially important if your staff development, training, and coaching. There are many respon- ultimate career path leads to management. For more information, read “Short on Experience? Soft Skills sibilities, expectations, and deadlines associated with management May Get You the Job” in AAPC’s Knowledge Center (Gianatasio, October 2019). positions. If your career path includes a position in leadership, know

32 Healthcare Business Monthly New Year, New You

that higher education (for example, bachelor’s degree) may be a neces- “Whatever your aspiration, know sity depending on the position and employer. Add AAPC’s Certified Professional Compliance Officer (CPCO™) credential to validate your that you can accomplish it with understanding of the importance of healthcare compliance and how it affects your day-to-day decisions. You do not need to be an expert in hard work, smart planning, and all things; you should, however, be able to perform at a high level and effectively execute the roles and responsibilities related to your position. continual investment in YOU.“ Whatever your aspiration, know that you can accomplish it with hard work, smart planning, and continual investment in YOU. TIP: A mentor can provide invaluable feedback and guidance in your career path initiatives. Find Master-Level Positions someone who is ethical, experienced, and willing to help guide you. To find a mentor, consider using AAPC’s Mentorship Program (www.aapc.com/resources/mentor.aspx). You are headed to the top! You have put in the time and have the required technical and soft skills needed to become proficient not Advanced-Level Positions only in medical coding, but other associated functional areas such as • Coding Manager revenue cycle management, compliance, and process improvement. • Consultant For these positions, typically, employers look for someone with 5 • Revenue Cycle Manager to 10 years of experience, with a number of those years spent in direct • Performance Improvement management. Employers may also require or prefer an individual who • HIM Manager has a master’s degree. • Compliance Auditor Also, at this level, whether you are working for an organization or • Fraud/Waste Investigator working for yourself, you should have excellent communication and • Regional Manager interpersonal skills. To achieve this level, your career path planning

Don’t go! Stay with the family and earn CEUs! Need CEUs to renew your CPC®? Stay in town. Don’t leave. Use our CD courses anywhere, any time, any place. You won’t have to travel, and you can even work on ’em at home.

• From the leading provider of computer-based interactive CD courses with preapproved CEUs • Take it at your own speed, quickly or leisurely • Apple® Mac support with our Cloud-CD™ option HBO• AdWindows® support with CD-ROM or Cloud-CD™ Our coding courses with AAPC CEUs: • CD-ROM — best option if Internet access in your • CPT for Mental/Behavioral Health (10 CEUs) area is slow or not reliable (requires CD/DVD drive) • Care Management — CPT Coding (10 CEUs) • Cloud-CD™ — lower cost, immediate Web access • • Add’l user licenses — great value for groups Prime Time: ICD-10-CM for Primary Care (11 CEUs) • Primary Care Primer — CPT Coding (18 CEUs) Finish a CD in a couple of sittings, or take it a • E/M from A to Z (18 CEUs) chapter a day — you choose. So visit our Web site to • Dive Into ICD-10 (18 CEUs) learn more about CEUs, the convenient way! • Charting E/M Audits (11 CEUs) See our remodeled website for our best sellers • The Where’s and When’s of ICD-10 (16 CEUs) like: Primary Care Primer, E/M from A to Z • Walking Through the ASC Codes (15 CEUs) (All courses with AAPC CEUs • Coding with Heart — Cardiology (12 CEUs) can also earn CEUs with AHIMA. HealthcareBusinessOffice LLC: Toll free 800-515-3235 See our Web site.) Email: [email protected] Web site: www.HealthcareBusinessOffice.com Continuing education. Any time. Any place. ℠

www.aapc.com January 2020 33 New Year, New You

gettyimages / Cn0ra will need to include activities for developing business, relational, and to reach your destination. Take advantage of the many resources clinical acumen so that you are able to understand all the intricacies AAPC offers on their website (many are free to members, such as necessary to collaborate with team members, providers, and company those found at www.aapc.com/medical-coding-education/help/low-cost-ceus.aspx). executives. Be smart and strategic in your career path planning, involving only those who offer some benefit to you. Finally, work hard to TIP: When you reach this level, chances are someone helped you along the way. Be sure to give back remain humble, embrace change, and always be ready for that next by being a mentor to those who are working to get to where you are now and sharing your experience opportunity! and subject matter knowledge with AAPC local chapters. Lee Williams, MBA, RHIA, CCS, CCDS, CPC, CPCO, CRC, CEMC, CHONC, has more than 15 years of combined health information management experience as a consultant, coding director, Master-Level Positions educator, trainer, and practice manager. She is the founder and past president of the Covington, • Coding Director Ga., local chapter and serves as secretary on AAPC’s National Advisory Board. • Compliance Officer • HIM Director • Project Management • College Professor • VP Coding • Operations Director Resources • Consultant (CEO) AAPC. (2019) “Medical Coding Certification.” Retrieved from www.aapc.com/certification/medical-coding-certification.aspx Make It a Great Year Career Innovation. (2019). “Unlock Career Potential.” Retrieved from www.careerinnovation.com/tools-and-services/be-bold-in-your-career-course/ This is the year you commit to investing in your career advancement. Indeed. (2019). “Find Jobs.” Retrieved from www.indeed.com/ Identify the credentials, skills, competencies, and education you need

34 Healthcare Business Monthly Orlando | April 5 - 8 | Coronado Springs

The Business of Healthcare Meets Here

3K 90+ 75+

Attendees Educational Sessions Exhibitors www.HEALTHCON.com | Orlando

G Invitation from Bevan Erickson

Dear AAPC Members: I look forward to seeing you at HEALTHCON 2020, April 5 - 8 at Coronado Springs. This year, choose from more than 90 educational sessions, including A New Way of Thinking - E/M. Attend HEALTHCON for more facility-related education than ever, like the Facility Expo along with our always-popular Anatomy Expo. Coding, billing, compliance, management and career growth and more will be covered. Make time to attend panel sessions like Legal Trends and Issues and Revenue Cycle Management. Plan on networking with your peers, sharing experience and knowledge, while having fun at events like our Networking Breakfast. Make and renew friendships, expand your career opportunities, and leave as a more knowledgeable and valuable healthcare professional. We’ll see you there!

Bevan Erickson | CEO, AAPC

G Event Details Dates April 5 - 8, 2020

Location Coronado Springs 1000 West Lake Buena Vista Orlando, Florida 32830

Registration $975 (through January 12)

G Travel Coronado Springs Resort Single/Double Rooms: $255**/night Triple Rooms: $280**/person/night Quad Rooms: $305**/person/night

Gran Destino Tower Room Rates Single/Double Rooms: $315**/night Triple Rooms: $340**/person/night Quad Rooms: $365**/person/night

Airfare We’ve arranged a discount airfare with Delta for most cities. Visit www.HEALTHCON.com to see your savings. www.HEALTHCON.com

G Keynote Ӏ Gloria A. Wilder, M.D., M.P.H. Gloria A. Wilder is a respected champion in providing care to underserved communities. A leader in using entrepreneurship to not only make care accessible but better as well, she is a sought-after public speaker with an inspiring and game-changing message for healthcare.

Gloria A. Wilder, M.D., MPH is a nationally recognized pediatrician, entrepreneur, public speaker and expert on poverty and social justice. Dr. Wilder formerly served as the Chair of Mobile Health Programs at Georgetown University and Children’s National Medical Center in Washington, D.C. From 2009-2011, Dr. Wilder joined the leadership of United Medical Center as the Executive Vice President of Physician Integration and Strategic Alliances.

In 2005, Dr. Wilder used her business expertise to found Core Health, a health and wellness company dedicated to assisting underserved communities in improving access to quality holistic healthcare services.

In 2007, Dr. Wilder was selected by Michael Neidorff CEO of Centene Corporation to be one of the founding members of the Centene Health Advisory Council where she continues to serve to this day. In 2017, Dr. Wilder accepted the role of VP, Innovation and Preventive Health at Centene Corporation. Centene Corporation, a Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government-sponsored healthcare programs, focusing on under-insured and uninsured individuals.

In 2005, Dr. Wilder was awarded the National Caring Award for exceptional generosity and commitment to service. In 2004, she was named Physician Humanitarian of the Year by George Washington University. She was also inducted into the prestigious Gold Humanism in Medicine Honor Society and has been awarded the Oprah Winfrey Use Your Life Award. A nationally recognized speaker and expert on poverty and economic segregation in healthcare, Dr. Wilder Braithwaite’s work has been featured on the Oprah Winfrey show, CBS’ 48 Hours and NBC’s Dateline.

BROUGHT TO YOU BY AAPC | Orlando

G General Sessions Ӏ Legal Trends and Issues the definitions to the medical practice. From helping physicians document appropriately to AAPC Legal Advisory Board supporting, why they did what they did to - This panel discussion, led by AAPC’s Legal assigning the right codes and modifiers to Advisory Committee, offers insights into today appealing to receive the payment deserved – and tomorrow’s – most pressing legal concerns for medical practices and facilities Mastering Anatomy and Physiology, Part 1: Digestive, facing increased financial scrutiny and -Biliary, and Urinary Systems regulation. Join us for this perennial favorite! Presenter: Christopher Chandler, MHA, MBA, CPC, CGSC A New Way of Thinking - E/M To become a master of coding, you need to Presenter: Raemarie Jimenez, CPC, CDEO, CPB, - know more than just coding. It is vital to have CPMA, CPPM, CPC-I, CRHC a knowledge of the anatomy and physiology of Learn about the big changes for New and the body in order to better understand surgical Established E/M. This session will discuss the notes, medical necessity of treatments, and the degree of risk upcoming changes to the E/M Documentation involved with treating certain illness/injuries. As part 1 of a 3 Guidelines going into effect January 1, 2021. part series of presentations, this course will cover detailed and We will review case examples and determine how overall code advanced anatomy and physiology for the digestive, biliary, selection will be impacted applying changes to the guidelines. and urinary systems in addition to common diseases, illnesses, We will discuss best practices to be ready for this change. This treatments, and surgeries. is over 20 years in the making. Come learn about the exciting coding we have in store. Ӏ Coding Specialty G Breakout Sessions Mastering Orthopedic CPT Coding - Presenter: Nate Felt, CPC, ATC, PTA Ӏ Coding General This presentation will dive into common orthopedic coding concerns. This will include Hospitalist, and Surgeons, and Consulting Provers- OH MY! a review of CPT, NCCI and AAOS guidelines to Presenter: Shannon O’Tyson DeConda, CPC, - help you more accurately code for orthopedic CPMA, CPC-I, CEMC surgeries. This presentation will also give you a Inpatient Pro-Fee services oftentimes collide clinical perspective of orthopedic coding that will better prepare with multiple providers and specialties caring you for working with orthopedic surgeons. for the same patient. Many times, we find hospital protocols are taking precedence over Outpatient CDI for Oncology and Hematology Services the need for medical necessity, and we all know that ALL services - Presenter: Leonta Williams, CPC, CPCO, CRC, CEMC, must be medically reasonable, indicated, and that we must prove CHONC each is medically necessary. During this session we will discuss Learn methods of exploring strategies for open complexities associated with a multiple provider approach to communication and partnership between care, global bundling concerns, concurrent care, critical care, provider, coder and CDI specialist. Identify split-shared services, and of course discharges. Case studies will common diagnosis related denials for those be presented for a hands-on learning opportunity. specialties and how improved documentation can reduce those denials. Learn how to handle documentation conflicts between Medical Necessity - Defining, Documenting, and Defending the inpatient and outpatient setting and explore ways to use SOI Presenter: Kimberly Garner Huey, COC, CPC, CPCO - and ROM to validate the necessity of codumenting and coding / Sandra Kay Giangreco Brown, RHIT, COC, CPC, to the highest degree of specificity and the relationships of CPC-I, COBGC comorbidities. Learn how to best navigate the clinical coding Definitions of medical necessity vary – ambiguities surrounding “history of” versus “active” disease. Learn depending on who you are – physician, coder, how documentation impacts research initiatives, reimbursement, biller, payer. This session will explore and apply readmission rates, quality measures, risk adjustment, and physician profiles. Review of the most common diagnosis queries and missed diagnoses in Oncology and Hematology. Visit www.HEALTHCON.com for a full list of our sessions

G Breakout Sessions (Continued) Risk Coding for Pediatrics Importance of Accurate Documentation & Coding; A - Presenter: Trinity Schrieber, CPC /Mary Wood, CPC, -Physician’s Perspective CRC, CPC-I Presenter: Dr. Rae Godsey , CPC-A This presentation will cover acute and chronic In the ever changing healthcare landscape, Pediatric HCCs. It will cover the age breakdown with more administrative burden being placed for the various conditions and tiers. By the end on physicians, it is even more important for of the presentation you will know why it coders to have a collaborative relationship with is important for a practice to monitor Pediatric their clinical staff. Dr. Godsey will provide a HCCs, watch for acute vs chronic, and physician’s perspective on complete documentation and coding understand chronic conditions. and tips on how to create that partnership. Ӏ Auditing Ӏ Outpatient Facility Auditing Mental Health Services Navigating the Magical World of Modifier - Presenter: Stephanie Lynn Allard, CPC, CEMA, - Presenter: Amy Lee Smith, COC, CPC, CPMA RHIT Modifiers for facility services can be pretty During this session we will identify the many tricky. This session will introduce the most- types of mental health services and work used and most-abused modifiers in acute through the code categories to determine facilities, including tips on proper application/ what services to bill in different,,m and work required documentation. We will discuss billing through the code categories to determine what services to bill implications of incorrect modifier application, and tips on how in different, scenarios. We will breakdown the documentation to remain compliant with guidelines.. requirements and identify the provider, type and/or employee that is allowed to render billable serivces. Coding the Silent Wounds of War for Veterans: PTSD and -AUD When to Call a Friend...Friendly Lawyer Presenter: Karen Kostick, RHIT,CCS, CCS-P - Presenter: Jaci J. Kipreos, COC, CPC, CDEO, CPMA, It is critical for health information professionals CPC-I, CEMC / Kathleen Michele Rowland, BSN, RN, CHC, CPC, to educate clinicians on complete and accurate CPC-I, CEMC documentation requirements for Post- Recognize when there is a need to consult with Traumatic Stress Disorder (PTSD) and Alcohol legal counsel before, during or after an audit, Use Disorder (AUD). Health information coding Discuss what is meant by attorney professional ethics are needed now more than ever to ensure client privilege and understand when it is the clinical data integrity conversation begins between the beneficial, Explain the regulations surrounding provider and patient; and the health record is documented to self-reporting and paybacks. the fullest on behalf of the veteran.

Ӏ Inpatient Facility The Evolution of HIPAA Compliance and Cyber Risk in Healthcare Emerging Payment Models and the Effect on Hospitals - Presenter: Jeff Mongelli - Presenter: Marianne Durling , MHA, RHIA, CCS, What does the constantly changing landscape CDIP, CPC, CPCO, CIC, Approved-Instructor of HIPAA compliance and cyber risk look like This session will focus on emerging payment today and how do you stay protected. Cyber models in healthcare and their impact on threats are evolving and becoming more hospital coding and billing. We will review difficult to detect and more dangerous, and value based care, population health, ACO’s and healthcare organizations remain one of their top targets. At quality metrics and trending. We will review the impact these the same time, HIPAA enforcement is adapting, but are these have on RCM, CDI and compliance and how all these areas must new changes actually better for healthcare organizations? work together for improved patient outcomes and appropriate We’ll explore what’s new on the cyber-attack front and what reimbursement. organizations need to do to stay secure and HIPAA compliant.

BROUGHT TO YOU BY AAPC | Orlando

G Breakout Sessions (Continued) Ӏ Billing Ӏ Compliance Deep Dive – The Incident-To Rule – Common Anatomy of the OIG and Investigations of BIlling/Coding -Misconceptions and Fraud Liability - Presenter: Eric Rubenstein Presenter: Michael D Miscoe , Esq, CPC, CPCO, Attendees will learn about how the OIG CPMA, CASCC, CCPC, CUC fits into the world of healthcare billing This advanced interactive session will outline, and coding. From a compliance, legal and through common examples, the more practical perspective, attendees will hear about problematic elements of the CMS incident-to investigations where billing and coding were at rule, which is applicable to outpatient services. the heart of fraud activities, and how billers and coders have This program will address the compliance risks associated with a duty to ensure that their work is accurate and correct. An reporting services under this rule. Attendees will be asked to understanding of the lifecycle of a healthcare fraud investigation work through a number of common scenarios to “operationalize” will be discussed, and attendees will gain insight into what their understanding of some of the more commonly problematic triggers healthcare fraud investigations involving fraud, waste components of the rule, which include: and abuse. • What it means to establish that care is “integral although incidental” to the physician’s professional service Physician Practice Compliance Pitfalls — Cases of • How licensure issues impact compliance with the Incident-to -Compliance Gone Wrong rule under the auxiliary person definition. Presenter: CJ Wolf, MD, CHC, CCEP, CIA, COC, CPC • How or if the rule applies to care supervised by non- The headlines of compliance settlements for physician practitioners physician practices seem to be more and more frequent. But when you look a little closer, the Decrease Payer Denials for Increased Revenue same themes seem to become apparent. This - Presenter: Stephanie M Sjogren , CCS, HCAFA, session will focus on cases of “compliance gone CPC, CDEO, CPMA, CPC-I wrong” in physician practices. Learn what mistakes not to make. Whether you are a large organization or a small single provider practice, the number of Medical Marijuana from a Federal/State Regulatory and denied claims can be overwhelming and cost -Reimbursement Perspective a staggering amount of money. To manage Presenter: Christopher Adam Parrella, JD, CHC, this can be a scary prospect — but fear not, we are here to CPC, CPCO help. This presentation is designed to help you prevent denials This primer session will review the legality of as work those AR reports in an efficient manner. Sometimes medical marijuana from a federal and state small changes to your protocol can go a long way. Additionally, regulatory perspective to include the official we will go over payer contracting, policies and editing tips and positions of the Food and Drug Administration, tricks and how you can make the most of your time. the medicare and medicaid programs and the state boards of medicine. Denial Ain’t Just a River in Egypt - Presenter: Chad Benjamin Peterson, MBA, CPC, Ӏ Practice Management CEMC Building your Team with Six Sigma Principals and Strategy We become better coders when we - Presenter: Rhonda Buckholtz, CPC, CDEO, CPMA, understand the entire process of managing a CRC, CENTC, CGSC, COBGC, COPC, CPEDC, Approved-Instructor claim. I will explain the difference between an Running a practice in today’s healthcare EOB and remittance advice, as well as CARC environment is messy at best. Most often we and RARC codes and what goes on behind the scenes at the are stuck in the weeds just trying to make it insurance company. I will advise on how to know when to call through the day. By learning how use lean the insurance and which questions to ask. I will also teach how six sigma practices to best benchmark key deliverables in our to research payer policies. practices we can begin to tie that into system reports to get the best gains and to show the value behind those gains in order to influence all stakeholders through data. www.HEALTHCON.com

G Breakout Sessions (Continued) 5 Step Leadership System Ӏ Facility Expo - Presenter: Dixon Davis, MBA, MHSA This course teaches managers how to apply the Five-Step Leadership System, which helps diagnose and correct employee concerns to achieve better performance. Attendees will also learn how to teach their staff the five corresponding steps of employee responsibility.

G Additional Events Learn more about a dynamic and progressive business at our Anatomy Expo Ӏ AAPC Facility Expo. See the future and learn from the best of the present. You might learn the latest in documentation, coding, billing, electronic medical records, compensation, and many other things.

Whether you are a facility veteran or an interested observer, so much is happening, you will be enthralled. The Facility Expo promises a mix of new information and fun.

Ӏ Teach the Teacher | $195 | 8 CEUs/CTUs Celebrate the wonders of human anatomy at our very popular AAPC Anatomy Expo. This event offers an in-depth look into Saturday, April 4 | 8 am – 4 pm the complex machine we call the human body. Physicians from This workshop provides certified instructors with tools to improve a variety of specialties will use anatomical models, devices, their teaching and communication skills. This is also a great and videos to provide an insider’s look at the anatomic and opportunity to network with other instructors. Earn 8 CTUs or physiologic nuances of the body. Novice and expert alike will 8 CEUs for participation in this workshop. find this session fun, informative, and exhilarating.

BROUGHT TO YOU BY AAPC g Additional Events (Continued)

| Orlando

G Additional Events (Continued) Ӏ Examination | Prices vary by certification Ӏ Networking Breakfast Saturday, April 4 | 8 am – 1:40 pm AAPC certifications are the gold standard for the business of healthcare and are held by more than 107,000 professionals. Those who obtain these credentials are critical to compliant and profitable medical practices/facilities. These credentialed individuals also typically earn 20% more than non-certified employees. AAPC credentials increase your chances of being hired and retained in a competitive job market. Be sure to register for this event at HEALTHCON.com. Ӏ Local Chapter Officer Leadership Training Don’t miss one of the best parts of HEALTHCON! Join us as Free | 2 CEUs we recognize professionals who serve, in a light-hearted, entertaining way. Visit with new friends and old, and network Saturday, April 27 | 5:30 pm – 8:30 pm with your fellow healthcare professionals. What a great way to All officers and prospective officers are invited to meet with end this great event! members of the AAPC Chapter Association on Saturday, April 27 from 5:30 pm to 8:30 pm. It’s a great way to kick off HEALTHCON Discounted Disney World Theme Park Tickets 2019 and we will have all the information you need to govern Ӏ your chapter successfully in 2019. Don’t let the fun stop at HEALTHCON. As an attendee, you get discounted prices on Disney World tickets. Network with 75+ Exhibitors Ӏ After you’re done rubbing shoulders with industry leaders and featuring their latest products & services learning the latest in healthcare business, get ready for the 4/5 | Welcome Reception magic of Disney. 4/6 | Coffee, Lunch and Break Learn more at www.mydisneygroup.com/healthcon2020 4/7 | Coffee, Lunch and Break

CODING/BILLING ■ By Toni Elhoms, CPC, CRC, CCS, AHIMA-Approved ICD-10-CM/PCS Trainer Coding Social Determinants of Health

here is a lot of buzz in the healthcare industry recently about social Coding SDOH Tdeterminants of health (SDOH) and their impact on society at SDOH codes are represented in ICD-10-CM code categories large. With the expansion and updates to ICD-10-CM and the Z55-Z65 to describe conditions such as poverty, homelessness, abuse, Diagnostic and Statistical Manual of Mental Disorders (DSM-5), neglect, etc. Payers often deny the SDOH codes as primary diagnoses the new approach is to medicalize social problems. National claims because they are classified in ICD-10-CM as “Unacceptable Principal data shows us that most healthcare providers don’t code for SDOH. Diagnosis” codes. This designation has historically been exclusive to facility billing, but many outpatient claims are denied every year for What Are Social Determinants of Health? the same reason. There has also been a lot of controversy surrounding who can The Centers for Disease Control and Prevention (CDC) defines capture SDOH data and the context for which it can be used for SDOH as “societal and environmental conditions such as food, coding and reporting purposes. These additional hassles tend to housing, transportation, education, experiences, social support and disincentivize providers from assigning diagnosis codes to patients employment that can affect a person’s health. Numerous studies have with SDOH factors. demonstrated a link between economic status, social factors and physical environment as key influencers in health outcomes.” Official Guidelines Change Things Up Hospitals across the United States are filled with SDOH patients. For example, a homeless man is admitted to the observation unit for According to the ICD-10-CM Official Guidelines for Coding and chest pain of unknown origin. After a comprehensive workup, there is Reporting FY 2019, “For social determinants of health, code assign- no medical diagnosis concluded, and the patient is discharged. How ment may be based on medical record documentation from clinicians do you code for this encounter and get reimbursed? involved in the care of the patient who are not the patient’s provider since this information represents social information, rather than medical diagnoses.” This update is a game-changer, as most of the patient-specific SDOH information is captured by ancillary staff supporting the physicians.

SDOH Affect Everyone The SDOH codes are very powerful tools in capturing the complexity of patient populations. These additional factors affecting a patient’s health can justify higher levels of evaluation and management services, risk adjustment payment methodologies, prolonged services, extended monitoring, etc. An additional consideration is the lack of continuity of care for SDOH patients because their access to stable phone and mailing resources are often limited. SDOH diagnosis codes are one of the few tools we share collectively to measure and evaluate SDOH on a national scale. Medical coders across the country can have a huge impact on this public health issue by aligning their training efforts to educate healthcare providers about the importance of comprehensive clinical documentation and capturing accurate code assignment for SDOH.

Toni Elhoms, CPC, CRC, CCS, AHIMA-Approved ICD-10-CM/PCS Trainer, is a nationally known speaker and writer on medical coding, reimbursement, and revenue cycle management. She is the president of the Orlando, Fla., local chapter. gettyimagesvaeenma /

■ Coding/Billing ■ Auditing/Compliance ■ Practice Management www.aapc.com January 2020 43 ■ CODING/BILLING By Artemio B. Castillejos, CPC, CPMA, CCVTC, CPC-I, CCS, CL6SGB Fortify Your Understanding of Medical Necessity

The quality of evaluation and management documentation is paramount for clinician reimbursement. gettyimages / Chinnapong

valuation and management (E/M) services are the most vulnerable The American Medical Association (AMA) defines medical neces- Eto billing errors because it is complicated to select the proper code sity as: for the level of service captured in the documentation. A firm grasp Healthcare services that a prudent physician would provide of the differences between medical decision making (MDM) and to a patient for the purpose of preventing, diagnosing, treat- medical necessity can improve your claims payment rate, as well as ing or rehabilitating an illness, injury, disease or its associ- make the external audit process much easier, should an audit occur. ated symptoms, impairments or functional limitations in a manner that is: (a) in accordance with generally accepted Medical Decision Making vs. Medical Necessity standards or medical practice; (b) clinically appropriate in terms of type, frequency, extent, site and duration; and (c) MDM is a key component of an E/M service, in addition to history not primarily for the convenience of the patient, physician, and physical exam. MDM specifically refers to the complexity of or other health care provider. establishing a diagnosis and/or selecting a management option. Medical necessity refers to the appropriateness of the service pro- The Centers for Medicare & Medicaid Services (CMS) Internet vided for a certain condition. Medical necessity determines whether Only Manual (IOM) Medicare Claims Processing Manual, the service will get reimbursed. Publication 100-04, Chapter 12, Section 30.6.1, states: Problems arise when MDM and medical necessity are used inter- Medical necessity of a service is the overarching crite- changeably, or when practices and payers define medical necessity rion for payment in addition to the individual require- differently. ments of a CPT code. It would not be medically neces- Title XVII of the Social Security Act, Section 1862[a][1][a] states: sary or appropriate to bill a higher level of evaluation and No payment may be made under Part A or Part B for ex- management service when a lower level service is warrant- penses incurred for items and services which are not rea- ed. The volume of documentation should not be the pri- sonable and necessary for the diagnosis or treatment of ill- mary influence upon which a specific level of service is ness or injury or to improve the functioning of a malformed billed. Documentation should support the level of service body member. reported.

44 Healthcare Business Monthly ■ Coding/Billing ■ Auditing/Compliance ■ Practice Management Medical Necessity CODING/BILLING “To justify an E/M code level, the history, exam, and MDM must be medically appropriate and necessary.”

Medical Necessity Drives Code Selection If a physician performs a detailed history and a detailed exam for Medical necessity drives the final level of E/M code choice — not an established patient, can the auditor, coder, or payer determine the the MDM alone. For every encounter, documentation must show level performed wasn’t appropriate and necessary? that the levels of history, exam, and MDM performed were all The justification for reporting a low-level code for a visit despite medically appropriate and necessary. This includes documenting the history and exam supporting a higher level of service is based the medical necessity for any ancillary studies and therapeutic on the excerpt from the Medicare Claims Processing Manual that interventions ordered or performed. states medical necessity, not the volume of the documentation, is the When auditors and coders apply the definition of medical ne- overarching criterion in choosing the final level of service. cessity, how do they ascertain what level of history and exam is CMS and AMA jointly developed a documentation guideline medically necessary for a presenting diagnosis or chief compliant, that states that an established patient encounter (or any other office and therefore choose the appropriate E/M code level? or outpatient visit) requires two of the three key components to be There are no published regulations that define the medical neces- met to arrive at a final E/M service code. Neither AMA nor CMS sity criteria for performing a certain level of history and exam for a mentions that the MDM must be one of the key components in given chief complaint. The auditor and coder must use their clinical determining the final E/M code. The Medicare Claims Processing knowledge to determine the severity of a patient’s presenting problem, Manual excerpt states that medical necessity is the overarching but must not make a judgment or question the provider’s thought criterion for the level of service and not the MDM and that MDM process for workup decisions such as ordering imaging, medication, should not be used as a reserve for medical necessity. etc. to diagnose and treat a patient condition. Only the clinician can determine the medical appropriateness and necessity of each case reviewed and account for the standard of care in the community, the clinical training and experience of the provider, and medico-legal consideration for the local area, the state, and the country.

Beware of Consistent Over-Documenting You may see that provider documentation is always detailed, and levels of history and examination seem to always be high. This can be a problem with electronic medical records (EMRs), which make it easier to document, or can be because the provider’s standard of care includes a thorough history and exam. That means you need to be careful coding services, such as established patient visits, that only require two out of three key components for a code level. Your payer can easily determine if you rendered an E/M service when you bill for it but determining whether medical necessity supports the level of service you coded is the next step. A payer can make the medical necessity judgment and either deny or adjust your gettyimages / shansekala E/M levels based on their medical necessity determination.

www.aapc.com January 2020 45 Discuss this article or topic in a forum at Medical Necessity www.aapc.com

the etiology of the patient’s condition is CODING/BILLING unknown, sound medical practice would merit that a complete physical exam be performed to guide the provider towards a definitive diagnosis and treatment plan. Therefore, the medically necessary detailed history and detailed or com- gettyimages / DjelicS prehensive exam would support coding 99214 Office or other outpatient visit for the Documenting Medical Necessity evaluation and management of an established patient, which requires To justify an E/M code level, the history, exam, and MDM must be at least 2 of these 3 key components: a detailed history; a detailed medically appropriate and necessary. If your clinician documents no examination; medical decision making of moderate complexity … solid evidence of medical necessity, you cannot report a higher level or 99215 … a comprehensive history; a comprehensive examination; of service — such a claim will not be reimbursed regardless of how medical decision making of high complexity … for this encounter. severe the patient’s condition is or how complicated the provider’s When the same patient returns to the office for a follow-up visit thought process was. after their coronary artery bypass surgery with no specific concerns, Best practice is to consider each element of the history and exam the provider may find it hard to justify doing either a complete as a distinct thought process that must be performed only if there is history or exam. The information obtained for a complete history a medical reason at that visit. Because coders can only code based or exam would be clinically informative and not within the realm on the provider documentation they review, your best bet if it of medical necessity. Therefore, you would report a lower level seems like documentation doesn’t support medical necessity for a established patient office visit code for this encounter. high-level visit, even though history and exam technically allow the Artemio Castillejos, CPC, CPMA, CCVTC, CPC-I, CCS, CL6SGB, is a healthcare revenue higher code, query the provider. professional, Approved-AAPC CEU Education Provider, and an AHIMA World Congress Board Member with five years’ extensive experience in compliance, auditing, training, and coding both American and Australian Coding Classification System. He is a training manager in the Clinical Example for Medical Necessity medical coding department at PMAX Global, Philippines. An established patient comes in complaining of intermittent chest pain. It would be medically necessary to perform a comprehensive his- Resources tory to address this issue. First, the provider would take an extensive history of present illness describing the location, severity, duration, Title XVIII of the Social Security Act, Section 1862 [a] [1] [a], www.ssa.gov/OP_Home/ssact/ modifying factors, and any associated signs and symptoms related title18/1862.htm to the patient’s chest pain. The provider would then review and Center for Medicare & Medicaid Services Internet Only Manual Medicare Claims Processing Manual, confirm the patient’s past medical history to identify any potential Publication 100-04, Chapter 12, Section 30.6.1, www.cms.gov/Regulations-and-Guidance/ risk factors for coronary artery disease such as hypertension or Guidance/Manuals/Downloads/clm104c12.pdf dyslipidemia. The physician would also ask about a family history American Medical Association, Medical Necessity, www.nationalacademies.org/hmd/~/media/ of cardiovascular disease and perform a social history to determine 8D03963CAEB24450947C1AEC0CAECD85.ashx if the patient is a smoker or has a sedentary lifestyle. ACEP Reimbursement Committee 2016, Preparing for Payer Audits, www.acep.org/globalassets/ Finally, because of the clinical spectrum for diagnosing chest sites/acep/media/reimbursement/preparing-for-payer-audits.pdf pain is broad, the provider performing a complete review of systems Family Practice Medicine, A Refresher on Medical Necessity, www.aafp.org/fpm/2006/0700/p28.pdf is justified to uncover any clue that may point to a diagnosis. As

46 Healthcare Business Monthly BETTER TOGETHER

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Coders' Specialty Guides now available on AAPC.com/SpecialtyGuides ■ CODING/BILLING By Terry Fletcher, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMCRC, QMGC

Get Paid for Virtual Check-Ins

medical practice can now bill and collect Apayment for certain non-face-to-face services without the strict telehealth rules Medicare’s new of the originating sites being outside of the communication Metropolitan Statistical Area (MSA) or in a Health Professional Shortage Area (HSPA) technology-based service located in a rural census tract. Of course, there are requirements that must be met — policies have several six, to be exact. The rules for virtual check-ins and remote conditions for coverage. evaluations of recorded video and/or images are simple: 1. The patient must be established to the practice. 2. Five to 10 minutes of medical discussion must be documented. 3. If the service originates from a related evaluation and management (E/M) service provided within the previous seven days by the same physician or other qualified healthcare professional, the service is bundled into the E/M service. 4. If the service leads to an E/M service or procedure within the next 24 hours or soonest available appointment, the service is bundled into the E/M service. 5. Verbal consent must be noted in the medical record for each service. 6. The physician must document in the medical record that the patient does not need to come in for a follow-up visit unless there is a problem. gettyimages / KatarzynaBialasiewicz

48 Healthcare Business Monthly ■ Coding/Billing ■ Auditing/Compliance ■ Practice Management Virtual Check-Ins

“I would also recommend that CODING/BILLING practices hold these claims for at least 14 days, or a specific time period, to avoid refunding money.”

Use G Codes to Report G2010 example: the past seven days, or if that contact leads to Communication-Based An established patient came into the orthope- a visit in the following 24 hours or “soonest Technology dist to be evaluated for a knee injury. She fell available appointment.” and hurt her left knee during a game of beach Keeping track of the dates may be one Medicare introduced two new HCPCS volleyball. She was told to ice and rest her of the biggest challenges for practices, Level II codes in 2019 for these professional knee and given Tylenol. Ten days after this mainly because the Centers for Medicare services: G2012 and G2010. visit, the patient calls the office complain- & Medicaid Services (CMS) is vague about G2012 Brief communication technology-based service, e.g. ing of red bumps on her left side. She takes the definition of the “soonest available virtual check-in, by a physician or other qualified health a few pictures on her cell phone and sends appointment.” care professional who can report evaluation and manage- them to her physician through the practice’s If your practice plans to offer these remote ment services, provided to an established patient, not secure patient portal. The doctor looks at the visits, you will need to plan for the following originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure pictures and calls the patient back the next situations: within the next 24 hours or soonest available appointment; day. After a brief conversation, the doctor Patient consent: The patient will need to 5-10 minutes of medical discussion decides the patient may have a reaction to the sign a consent form when they receive a ser- G2010 Remote evaluation of recorded video and/or images sand, but she doesn’t need to come in unless vice, and this should be documented in the submitted by an established patient [store and forward], the rash gets worse or she develops a fever. patient record or by way of a “virtual sign-in including interpretation with follow-up with the patient sheet.” Alert patients that this is new because within 24 business hours, not originating from a related Note: It would not be appropriate to report G2010 if the patient some patients may be used to calling the E/M service provided with the previous 7 days nor leading called to discuss continued swelling of the knee. to an E/M service or procedure within the next 24-hours or practice for advice without being charged. soonest available appointment Billing concerns: A billing office point person is advisable to ensure that the service G2012 example: Virtual Check-In is not bundled into a previous visit (within An established patient of your family prac- Problems and Solutions the last seven days), or the next available tice clinic has been coming in for a variety appointment, or within 24-hours post of illnesses off and on for a few years. The Virtual check-ins are going to be tough to virtual contact. I would also recommend patient was seen about three months ago and track because they can’t be billed when a that practices hold these claims for at least six months prior for a urinary tract infection patient contacts the practice about a related 14 days, or a specific time period, to avoid (UTI) and was treated with the antibiotic problem from a visit that took place within refunding money. Cipro successfully. The patient calls today and says she feels another UTI coming on; she speaks to the nurse practitioner (NP) under the physician’s direct supervision. The NP documents the patient’s related symptoms in the medical record, docu- CPT® Definition of Established Patient ments 10 minutes spent with the patient, Because virtual check-ins and image/video evaluations are limited to established patients, it’s necessary to identify patients and calls in a script for Cipro. as such prior to rendering these services. According to the CPT® code book, “An established patient is someone who has received professional services from the physician/qualified health care professional or another physician/qualified health Note: It would not be appropriate to report G2012 if the patient care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past was told by the physician to come in at the next available three years.” appointment for follow up.

www.aapc.com January 2020 49 Discuss this article or topic in a forum at Virtual Check-Ins www.aapc.com

Collecting fees: Patients need to know Medicare Advances that Medicare does allow payment for these Virtual Care Coverage in 2019 services, but they will have a copay. Coverage Provisions in the Calendar Year 2019 Physician Fee Schedule added access to care using telecommunications technology by: will be hit or miss for commercial plans. Make sure the coverage is verified before • Paying clinicians for virtual check-ins (G2012); charging for it. Also, practices that offer • Paying clinicians for evaluation of patient-submitted video/photos (G2010); and remote visits and decide to wait until the • Expanding Medicare-covered telehealth services to include prolonged preventive services (HCPCS Level II codes G0513 patient’s next visit to collect a copay need to and G0514). be prepared to deal with patients who may • Paying separately for new coding describing chronic care remote physiologic monitoring (CPT® codes 99453, 99454, tell you they don’t remember the call and and 99457) and interprofessional internet consultation (CPT® codes 99451, 99452, 99446, and 99447) won’t pay two copays. • Expanding the use of telehealth services for the treatment of opioid use disorder and other substance use disorders. Terry Fletcher CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMCRC, QMGC, is a CODING/BILLING • Adding renal dialysis facilities and the homes of patients with end-stage renal disease (ESRD) receiving home dialysis healthcare coding and reimbursement consultant, as originating sites, and not applying originating site geographic requirements for hospital-based or critical access educator, and auditor based in California with over 30 hospital-based renal dialysis centers, renal dialysis facilities, ESRD patients’ homes for the purposes of furnishing the years industry experience. She is an Editorial Board home dialysis monthly ESRD-related clinical assessments. Member for ICD10Monitor.com and a coding educator for McVey • Adding mobile stroke units as originating sites and not applying originating site type or geographic requirements Seminars, MGMA, AAPC, AHIMA, ICD10Monitor, Medlearn, and MMI. Her company, Terry Fletcher Consulting, Inc., teaches over 100 specialty for telehealth services furnished for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke. coding seminars and webinars every year. Fletcher is also a CDI, ICD-10- • Paying for medical discussions or remote evaluations of conditions not related to a Rural Health Clinic or Federally CM, and CPT® coding auditor for many medical practices and hospitals Qualified Health Center service provided within the previous seven days, or within the next 24 hours, or at the soonest around the country. You can listen to Fletcher every Tuesday discuss the available appointment, billable with HCPCS Level II code G0071. business of medicine on her CodeCast® Podcast on all downloadable platforms.

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© 2019 AT&T Intellectual Property. All rights reserved. AT&T and the Globe logo are registered trademarks of AT&T Intellectual Property. All other marks are the property of their respective owners. NRO SF T 0319 1529 E ■ CODING/BILLING By Danielle Erickson, CPC, CCS, and Litriana (Lee) Shimano, CPC, CMDP, CCP, PCS, AHIMA Approved ICD-10-CM/PCS Trainer From Registration to Claims Billing, Overcome Gender Identity Barriers Part 2: Know the codes and documentation to help prove medical necessity for gender-related surgical procedures.

gettyimages / ronniechua

atients with gender conflict have stereotyping and depression DSM-5 Helps Eliminate “Disorder” Labels Pto overcome; don’t let staff and billing be another obstacle they Part of removing stigma is choosing the right words with which to must face when getting medical care. Last month in this gender describe the condition. DSM-5 replaced the diagnostic name “gender identity series we discussed how you can help these patients overcome identity disorder” with “gender dysphoria,” and made other impor- challenges by knowing the limitations of electronic medical records tant clarifications in the designation criteria. Replacing “disorder” (EMRs) and the importance of good data collection and registration. with “dysphoria” in the diagnostic label is not only more appropriate In this second installment, we explain how the Diagnostic and and consistent with familiar clinical sexology terminology, it also Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) removes the connotation that the patient is “disordered.” helps to remove gender identity stigma, how to apply proper coding The DSM-5 diagnosis adds a post-transition specifier for people to medical claims, and how to prove medical necessity. who are living full time as the desired gender (with or without legal

52 Healthcare Business Monthly ■ Coding/Billing ■ Auditing/Compliance ■ Practice Management Gender Identity sanction of the gender change). This ensures treatment access for “A patient’s self-assessment and individuals who continue to undergo hormone therapy, related surgery, or psychotherapy or counseling to support their gender desire for sex reassignment cannot transition. Gender dysphoria has its own chapter in DSM-5 and is separated from “Sexual Dysfunctions and Paraphilic Disorders.” be viewed as reliable indicators CODING/BILLING To be diagnosed with gender dysphoria, there must be a notable difference between the patient’s expressed gender and experienced of gender dysphoria.” gender, and it must continue for six months.

Get Familiar With ICD-10-CM Codes Pay Attention to F64.0 Transsexualism Documentation Required by Insurance Transsexualism is also referred to as transgender, which is a type Gender reassignment surgery is intended to be a permanent change of gender dysphoria that can manifest as early as 2 years of age. between an individual’s gender identity and physical appearance A transsexual person experiences a gender identity that is not — it is not easily reversible. A careful and accurate diagnosis is consistent with their biological sex, causing the transsexual person essential for treatment and can be made only as part of a long-term significant distress that impairs their ability to function. A person diagnostic process involving a multidisciplinary specialty approach with transsexualism may feel so strongly that they belong to the that includes: opposite sex that they will undergo sexual reassignment therapy. • An extensive case history; Sexual reassignment almost always involves surgery, in addition to • Gynecological, endocrine, and urological examination; and hormone therapy. • A clinical psychiatric/psychological examination. F64.1 Dual role transvestism Note: A patient’s self-assessment and desire for sex reassignment cannot be viewed as reliable Use additional code to identify sex reassignment status (Z87.890) indicators of gender dysphoria. Excludes1: gender identity disorder in childhood (F64.2) Excludes2: fetishistic transvestism (F65.1) The behavioral health professional’s role is essential in providing Transvestism is also referred to as cross-dressing. Dual role transves- documentation about medical necessity for gender reassignment. tism has three distinct criteria: After the individual is professionally assessed, the provider’s docu- • An individual wants to dress like the opposite sex; mentation and formal recommendation are sent to medical and • The motivation is not a sexual desire to be the opposite sex; and surgical specialists. Documentation recommending hormonal or • The individual does not wish to permanently change their surgical treatment should be comprehensive and include ALL the assigned sex. following: • Individual’s general identifying characteristics A dual role transvestite lives in both worlds: the gender to which • Initial and evolving gender, and sexual and psychiatric their physical sex coincides and the gender opposite of their physical diagnoses sex. Although the latter is what the individual identifies with more, • Details regarding the type and duration of received the need to be this sex is not a debilitating obsession. psychotherapy or evaluation F64.2 Gender identity disorder of childhood • Extent to which eligibility criteria have been met • Mental health professional’s rationale for hormone therapy Gender dysphoria in children or surgery Excludes1: gender identity disorder in adolescence and adulthood (F64.0) • Degree to which the individual has followed the standards Excludes2: sexual maturation disorder (F66) of care and the likelihood of continued compliance F64.8 Other gender identity disorders • Whether the mental health professional is a part of a gender team F64.9 Gender identity disorder, unspecified Gender identity disorder encompasses several conditions that are Coverage Depends on the State, characterized by a disparity between the individual’s biological sex and their perceived sexual identity. Another term for this condition Insurance, and Documentation is gender incongruity. The Affordable Care Act includes a nondiscrimination provision To be classified as a gender identity disorder, this mismatch (Section 1557) that is very detailed and specifically prohibits dis- between biological and perceived gender must be accompanied by crimination based on gender identity, but it does not require health significant emotional distress and impair the individual’s ability to insurance policies to “cover any particular procedure or treatment function in daily life. for transition-related care.”

www.aapc.com January 2020 53 Gender Identity

Depending on the state, insurance, and documentation, health There are also surgical-specific procedure documentation req- plan coverage may be offered if ALL the following are documented: uirements. • The patient is 18 years of age or older. • The patient has a definitive diagnosis of persistent gender FTM Gender Reassignment and Documentation dysphoria that has been documented by a qualified licensed mental health professional, such as a psychiatrist, Documentation requirements vary depending on the procedure. psychologist, or other licensed physician experienced in the For example: field. Breast surgery (such as initial mastectomy, breast reduction) • The patient has received continuous hormone therapy for requires one letter of support from a qualified mental health 12 months or more under the supervision of a physician. professional. • The patient has lived as their reassigned gender full time for Hysterectomy and salpingo-oophorectomy require that 12 months or more. BOTH of the following additional criteria are met: • The patient’s medical and mental health providers • Documentation of at least 12 months of continuous CODING/BILLING document there are no contraindications to the planned hormonal sex reassignment therapy. surgery and agree with the plan (within three months of the • Recommendation of sex reassignment surgery (genital prior authorization request). surgery) by two qualified mental health professionals with written documentation submitted to the physician performing the genital surgery. At least one letter should be a comprehensive report. Two separate letters or one letter with two signatures is acceptable. One letter from a master’s Common ICD-10-CM Codes for FTM degree mental health professional is acceptable if the second The following codes are commonly found on female-to-male (FTM) charts; the letter is from a psychiatrist or Ph.D. clinical psychologist. insurance company still lists the patient as female: E28.9 Ovarian dysfunction, unspecified Vaginectomy requires ALL the following criteria are met: • Documentation of at least 12 months of continuous N94.9 Unspecified condition associated with female genital organs and menstrual cycle hormonal sex reassignment therapy (may be simultaneous N91.5 Oligomenorrhea, unspecified [scanty or infrequent menstruation] with real-life experience). N95.0 Postmenopausal bleeding [primary absence of menstruation] • Individual has lived within the desired gender role for N91.2 Amenorrhea, unspecified [secondary absence of menstruation] at least 12 continuous months, which includes a wide N94.10 Unspecified dyspareunia range of life experiences and events (for example, family events, holidays, vacations, season-specific work, or school N94.11 Superficial (introital) dyspareunia experiences), including notification to partners, family, N94.12 Deep dyspareunia friends, and community members (for example, at school, N94.19 Other specified dyspareunia work, other settings) of their identified gender. N94.819 Vulvodynia, unspecified • Recommendation of sex reassignment surgery (genital N90.89 Other specified noninflammatory disorders of vulva and perineum surgery) by two qualified mental health professionals with written documentation submitted to the physician Q52.6 Congenital malformation of clitoris performing the genital surgery. At least one letter should be N64.4 Mastodynia a comprehensive report. Two separate letters or one letter E28.2 Polycystic ovarian syndrome with two signatures is acceptable. One letter from a master’s degree mental health professional is acceptable if the second Common ICD-10-CM Codes: MTF letter is from a psychiatrist or Ph.D. clinical psychologist. The following codes are commonly found on male-to-female (MTF) charts; the insurance company still lists the patient as male: MTF Gender Reassignment and Documentation N50.0 Atrophy of testis Orchiectomy requires BOTH of the following additional criteria N50.9 Disorder of male genital organs, unspecified are met: N62 Hypertrophy of breast • Documentation of at least 12 months of continuous E89.5 Postprocedural testicular hypofunction [post procedural/post-ablative testicular hormonal sex reassignment therapy. hypofunction] • Recommendation for sex reassignment surgery (genital E29.1 Testicular hypofunction surgery) by two qualified mental health professionals with written documentation submitted to the physician

54 Healthcare Business Monthly Discuss this article or topic in a forum at www.aapc.com Gender Identity

performing the genital surgery. At least one letter should A letter of medical necessity is needed to support the patient’s be a comprehensive report. Two separate letters or one wish to pursue surgery. The letter should indicate the patient has: letter with two signatures is acceptable. One letter from • A persistent and well-documented case of gender dysphoria a master’s degree mental health professional is acceptable and the procedure is medically necessary to treat the

if the second letter is from a psychiatrist or Ph.D. clinical patient’s gender dysphoria; CODING/BILLING psychologist. • Lived for at least a year in the gender role that matches their gender identity; What Is NOT Considered Medically Necessary • Received mental health counseling or psychotherapy, as deemed necessary; Cryopreservation or storage of embryo and sperm and cosmetic • No medical or mental health conditions that would make procedures often are not considered medically necessary as part of the procedure medically inappropriate, or has medical gender reassignment and are not covered by insurance. or mental health conditions that are reasonably well- Cosmetic, noncovered services include: controlled prior to the procedure; • The cognition and capacity to make a fully informed Abdominoplasty Neck tightening decision and to consent to the treatment; AND Blepharoplasty Nipple/Areola reconstruction • Received hormone therapy for 12-24 months, depending on the patient and procedure (or describe why hormone Breast enlargement procedures, including Pectoral implants therapy is not medically appropriate for them). augmentation mammoplasty, implants, and Removal of redundant skin silicone injections of the breast Replacement of tissue expander with When to Use Modifiers 45 and KX Calf implants permanent prosthesis testicular insertion Cheek/malar implants Rhinoplasty When submitting claims for gender reassignment for facility Chin/nose implants claims, administrators are encouraged to report condition code Scrotoplasty 45 Ambiguous gender category with an inpatient or outpatient Collagen injections Second stage phalloplasty gender-specific service. For professional claims, physicians and Electrolysis Skin resurfacing (for example, dermabra- other healthcare professionals are encouraged to include modifier Face/forehead lift sion, chemical peels) KX Requirements specified in the medical policy have been met with a Brow lift Surgical correction of hydraulic abnormality procedure code that is gender-specific. Hair removal/hair transplantation of inflatable (multi-component) prosthesis including pump and/or cylinders and/or Get Past Insurance Barriers Penile prosthesis (noninflatable/inflatable) reservoir Testicular expanders Testicular prostheses Next month, our last article of this gender identity series will discuss insurance barriers, what your facility can do to help create a safe Jaw shortening/sculpturing/facial bone Trachea shave/reduction thyroid environment for patients, and the key takeaways from this series. reduction chondroplasty If you missed the first article of this gender identity series, go to Laryngoplasty Voice modification surgery pages 46-49 of the December issue of Healthcare Business Monthly Lip reduction/enhancement Voice therapy/voice lessons to read “Part 1: Know the limitations of EMRs and the importance Liposuction of quality data collection.” This article is also available online in AAPC’s Knowledge Center. Mastopexy Danielle Erickson, CPC, CCS, is a health information management educator with Optum360 with 15 years’ experience in auditing, education, and revenue management. She holds an Associate of Applied Science in Medical Billing and Coding from Northland College Professionals Must Attest to Medical Necessity East Grand Forks, Minn. Erickson is a member of the Fargo, N.D., local chapter. Some payers and states require two letters of medical necessity from any of the following: Litriana (Lee) Shimano, CPC, CMDP, CCP, PCS, AHIMA Approved ICD-10-CM/PCS Trainer, is an educator with a 30-year background in the healthcare industry. She has had • A licensed psychiatrist, psychologist, psychiatric nurse management roles in physician-based services in multiple settings, including private practitioner, or clinical social worker who has treated the practice, academic health systems, and managed care companies. Shimano has extensive patient for a minimum of 12 months experience leading coding departments, development and delivery of coding education • Physician, psychiatrist, psychologist, psychiatric nurse training for all audiences, quality audits for internal staff and external clients, workflow improvement, coding practitioner, or clinical social worker who has evaluated the and billing support, and revenue cycle management. She is a member of the Loma Linda, Calif., local chapter. patient • Primary care provider of the patient

www.aapc.com January 2020 55 ■ ADDED EDGE By Michael Warner, DO, CPC, CPCO, CPMA, AAPC Fellow Feedback Rules for Better Communication

Learn the art of constructive criticism to improve office morale and productivity.

veryone wants feedback, but we don’t always like it. Feedback can Ego quickly astray if there is a mismatch in communication styles between two parties. For example:

Style 1: The Putdown You put together a draft plan on how to implement a new policy. Hoping for encouragement, you reach out to a colleague, to which you get the response, “This will not work, so you should do it another way.” As a result, you feel dejected and withdrawn.

Style 2: The Flatterer Rearranging your plan to account for intended and unintended consequences, you want to know where you stand. You reach out to another colleague looking for an evaluation and get the response, “Great to see you working hard!” You helplessly wonder, “Really? I gettyimages / Pollyana Ventura wanted details, not a pat on the back!” In the book “Thanks for the Feedback,” authors Douglas Stone and Evaluation Sheila Heen describe three forms of feedback: appreciation, coaching, Evaluation feedback is given as a scoring metric, which might com- and evaluation. They emphasize, “Know what you want, and know pare your new plan to existing or other proposed plans. “Evaluations what you’re getting” because “the match matters.” (p. 19) align expectations, clarify consequences, and inform decision making,” write Stone and Heen. (p. 33) Appreciation As an exercise among family members or professional co-workers, discuss the various forms of feedback. Explore examples of how Appreciation conveys gratitude, awareness, and validation. When matching feedback expectations can result in better performance and you drafted your new plan, you were initially seeking encouragement healthy relationships. In contrast, showcase examples of how feed- to fuel your passion for describing a new implementation process. back mismatch can undermine productivity and damage interaction. When appropriately given and received, this form of feedback can With a little practice, both feedback receivers and givers will be able motivate higher levels of performance. to establish ground rules. To best test the exercise, try framing your needs for giving and receiving feedback in the style of appreciation, Coaching coaching, or evaluation. What happens when someone offers feedback, and you are not able Coaching guides toward gaining additional skills and knowledge. to control the format? The authors recommend listening and “pull- In response to your detailed plan, for example, coaching feedback ing” information out of the giver. Often, when someone gives critical could alert you to new and relevant final rules published in the feedback, our initial reaction is to defend ourselves by injecting a Federal Register. Incorporating this knowledge could result in better supportive statement. To “pull” information, listen with the intent of accommodation and compliance, thus improving your plan. understanding and not with the intent of responding.

56 Healthcare Business Monthly Feedback

“To ‘pull’ information, listen with the intent of understanding and not with the intent of responding.”

For example, hearing your proposal, another colleague offers, asking, “Help me evaluate this plan. How does it compare to our “I completely disagree with your plan.” The reviewer goes on to current standard or other proposals?” explain three points to support his disapproval. Listening and not As a giver of feedback, consider framing your responses with the responding, you focus your mind on the information. Of interest, type of advice given. You could report, “I really appreciate your work you’ve never considered the third consequence and gain important and believe it is important. Do you want me to give any coaching information. After the conversation, you realize that all concerns and/or evaluation feedback?” For the person seeking coaching or can be addressed with additional accommodation. If you had im- evaluation, you’ve opened the door. This type of exchange is less likely mediately responded defensively to the person’s statement, you would to cause misunderstandings that may damage relationships. have deprived yourself of deeper learning. Introduce a feedback conversation at home and at work. Use examples of matching and mismatching expectations. This Feedback is a 3-Step Process exercise promises to improve what you do while strengthening relationships. Imagine reaching out to your colleague for a first draft review Michael Warner, DO, CPC, CPCO, CPMA, AAPC Fellow, is an associate professor at Touro stating, “Can you please give me some appreciation form of University California, an AAPC National Advisory Board Member, and president of non-profit feedback so I can further develop my concepts?” This will help Patient Advocacy Initiatives. prompt your reviewer to better address your needs. Your colleague’s response may acknowledge the credibility of your work and support you to continue. Once your report gains detail, you reach out with, Resource “I’d like some coaching here. Can you please review this plan and Stone, D., Heen, S. “Thanks for the Feedback,” Penguin Books, ©2014 tell me what more I need to know or do?” Finally, you may reach out

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Kimberly Clark, CPC-A Maliea Weaver, CPC-A Michelle Nash, CPC-A Hunsila A, CPC-A Jinzy Jaleel, CPC-A Kimberly Gordon, CPC-A Malla Lavanya Spandana, CPC-A Michelle Petit-Michel, CPC-A Irena Ruseni, CPC-A Jo Strack, CPC-A Kimberly Mcintyre, CPC-A Mallem Sukanya, CPC-A Michelle Skidmore, CPC-A Iris Chong, CPC-A Joann Beltz, CPC-A Kimberly S Hester, CPC-A Mallory Nicole Gibbs, CPC-A Midde Immanuel Wincent Sharath Irish S Jonale, CPC-A Joby Kurian, CPC-A Kimberly Schaffer, CPC-A Mamidala Srikanth, CPC-A Kumar, CPC-A Iryna Kravchenko, CPC-A Jodi Burdick, CPC-A Kimberly Silvia-Pare, CPC-A Manasi Shidhaye, CPC-A Midhila Devan, CPC-A Iswarya Manoharan, CPC-A Jody Duhaime, CPC-A Kimberly Warrick, CPC-A Manda Mounika, CPC-A Minal Maldikar, CPC-A Iulia Tent, CPC-A Jody Mann, CPC-A Kimi Martin, CPC-A Mandala Sravani, CPC-A Mindy G Speck, CPC-A Izabela Fiorelli, CPC-A John House, CPC-A Kitty Reese, CPC-A Mandy Deeben, CPC-A Miranda L Banks, CPC-A Jacqueline Riordan, CPC-A Johnna Kopah, CPC-A Kogila Gopi, CPC-A Manimala Karikolraj, CPC-A MirzaSaifulla Baig, CPC-A Jaimie Renae Speer, CPC-A Joice George, CPC-A Komakula Ramadevi, CPC-A Manish Chaurasia, CPC-A Mitchell L Repatacodo, CPC-A James Guskiewicz, CPC-A Joni Kingsbury, COC-A Konda Shravani, CPC-A Manish Jha, CPC-A Mithileshchandra Kulkarni, CPC-A Jami Crone, CPC-A Jovina Cabalza, CPC-A Kristen Higginbotham, CPC-A Manju Sunny, CPC-A Mogili Swetha, CPC-A Jamie Griffin,CPC-A Joy Guerechit, CPC-A Kristen Rosales, CPC-A Manjula J, CPC-A Mohammad Abdul Fazal, CPC-A Jamie Tooke, CPC-A Juby George, CPC-A Kristen Schreibeis, CPC-A Maram Prakash, CPC-A Mohammed Nadeemuddin, CPC-A Jamise J Jackson, CPC-A Judith Cooperrider, CPC-A Kristin Ricciardo, CPC-A Maranda Eaton, CPC-A Mohammed Nather Batcha Jancy John, CPC-A Julia Ann Carr, CPC-A Kristine Weitekemper, CPC-A Marcela Arroyo, CPC-A Mugaitheen, CPC-A Janelle K Francis, CPC-A Julia Wirfel, CPC-A Kriston Lowe, CPC-A Margaret Roberts, CPC-A Mohanie Game, CPC-A Janelle Phillips, CPPM, CPC Juliann Chaparro, CPC-A Lacon Sweet, CPC-A Maria Barbosa, CPC-A Mohd Idris, CPC-A Janet Estrada, CPC-A Julie Main, CPC-A Ladonna Griffin,CPC-A Maria Concepcion Agbulos, CPC-A Mohd Sanaullah, CPC-A Janet Harris, CPC-A Julie Miller, CPC-A Ladonna Lee Tatar, CPC-A Maria G Chairez, CPC-A Mona Shah, CPC-A Jangati Prasanna Lakshmi, CPC-A Julius Patrick S Valencia, CPC-A Lakisha Isaacs, CPC-A Mariah Miller, CPC-A Monica Landry, CPC-A Janine Cruz, CPC-A Juvy Asuncion Altea, CPC-A Lalio Vanessa, CPC-A Maribel Najera Alonso, CPC-A Monya Foxe, CPC-A Jansi N, CPC-A Kaitlyn Cullen, CPC-A Larry Russell Preston, CPC-A Maricel Wight, CPC-A Morampudi Sreeramya, CPC-A Jasmin Arling, CPC-A Kalob Valle, CPC-A LaTierra Watson, CPC-A Marie Schram, CPC-A Morgan Jones, CPC-A Jaya Priyanka S P, CPC-A Kanchan Nath, CRC, CPC Laurel Johnson, CPC-A Marie Stephanie Z Santos, CPC-A Muhammed Shibas, CPC-A Jayalakshmi Sendamarai Cannane, Kara Griffin,CPC-A Lauren Brady, CPC-A Marilene G Xavier, CPC-A Mukkamalla Venkata Rajeswari, CPC-A Karen Denise Boone, CPC-A Laurie Mineo, CPC-A Marilyn Alexandre, CPC-A CPC-A Jayasri Madhavan, CPC-A Karen Ferrell, COC-A LeAnn Bradley, CPC-A Mariselda Trejo-Villareal, CPC-A Mukund Vishnu Wable, CPC-A Jean Fisher, CPC-A Karen Horn, CPC-A Leena Sara Thomas, CPC-A Mark Anthony G Belmonte , CPC-A Nabeela Khan, CPC-A Jeanne Marie Pavia, CPC-A Karen Schmeltzer, CPC-A Lesley A Mulderick, CPC-A Mark Xuereb, CPC-A Naga V Rekha Danduboyina, Jeanne Toy, CPC-A Kari Brown, CPC-A Lesley Mergenthaler, CPC-A Marla Perez, CPC-A CPC-A Jeannie Miller, CPC-A Karin Allen, CPC-A Leslie Carter, CPC-A Marlee Callender, CPC-A Nainala Divya, CPC-A Jeannie Quigley, CPC-A Karla Bossman, CPC-A Linda Hurley, CPC-A Marquetta Quick, CPC-A Nancy Diaz, CPC-A Jeelakarra Prabhavathi, CPC-A Karla Denise Rodriguez, CPC-A Linda Mikos, CPC-A Martha Knox, CPC-A Nancy Eckerman, CPC-A Jeevana Latha Sesham, CPC-A Karla Martinez, CPC-A Linda Morgan, CPC-A Marwa Ibrahim, CPC-A Nandhini Karthikeyan, CPC-A Jenna Mcclelland, CPC-A Katherine Grigsby, CPC-A Linda Spencer, CPC-A Mary Ann C Reyes, CPC-A Narayanan B, CPC-A Jennelyn A Oraliza, CPC-A Kathi Dorvee, CPC-A Linda Sue Helton, CPC-A Mary Ann E. Secapuri , CPC-A Natalie Gillespie, CPC-A Jennifer Barrera, CPC-A Kathleen Burke-Sabean, CPC-A Lindsay Eaton, CPC-A Mary Asbell, CPC-A Natasha Dubuque, CPC-A Jennifer Benefiel,CPC-A Kathleen Pittler, CPC-A Line W Berndt, CPC-A Mary Copus, CPC-A Nathi Amani, CPC-A Jennifer Carlson, CPC-A Kathryn Messer, CPC-A Linh Bui, CPC-A Mary Moody, CPC-A Naveen Kumar N S, CPC-A

60 Healthcare Business Monthly NEWLY CREDENTIALED MEMBERS

Neena Kumar, CPC-A Ramya V M, CPC-A Shaun Harper, CPC-A Tangela Allen, CPC-A Vinodhini Viswanathan, CPC-A Nelson Anto, CPC-A Randell Cadawas Avelino, CPC-A Shawn Newton, CPC-A Tanisa Verduzco, CPC-A Vintra Jayaseelan, CPC-A Nemalla Chandrakala, CPC-A Randolph John Borromeo, CPC-A Shawn Hill, CPC-A Tanya E Johnson-Haye, CPC-A Vishakha Alpe, CPC-A Nichole Zimmerman, CPC-A Rashida Saheedali, CPC-A Shawnee Morgan, CPC-A Tara Flint, CPC-A Vivian Madison, CPC-A Nicole Bertsch, CPC-A Raven Simone Preston, CPC-A Shayna Mumby, CPC-A Tara Reed, CPC-A Vivian Vicente Camero, CPC-A Nicole Lea Payne, CPC-A Rebecca J Conner, CPC-A Sheaun S Perry, CPC-A Tara Thompson, CPC-A Wendy Regan, CPC-A Nicole Michelle Elmore, CPC-A Rebecca Rathbone, CPC-A Sheena Maria Love, CPC-A Tasha Soward, CPC-A Whitney Ashby, CPC-A Nicole S Ingrasci, CPC-A Reddy Gari Sujitha, CPC-A Shelby Bennett, CPC-A Tatiana Badillo, CPC-A Whitney McDermott, CPC-A Nicole Seagreaves, CPC-A Regina Gonzalez, CPC-A Shelia Estes, CPC-A Tawie Bayer, CPC-A Whitney Reeves, CPC-A Nina Rozell Digueno, CPC-A Regina McClain, CPC-A Shelley A Segura, CPC-A Taylor Coston, CPC-A William Walser, CPC-A Nirja Regmi, CPC-A Rekhamsa Rachuru, CPC-A Shelley Braxton, CPC-A Tejaswi Sali, CPC-A Wrushal Suryawanshi, CPC-A Nirmala Adla, CPC-A Rhonda Renee Drobiazgiewicz, Shelley Goebel, CPC-A Teresa Bennett, CPC-A Yamuna Shankar, CPC-A Nivedha Gunasekar, CPC-A CPC-A Shenerika Braddy, CPC-A Thanmai Saride, CPC-A Yanci Zavala, CPC-A Nivetha Arjunan, CPC-A Rhose Deldoc Panganiban , CPC-A Sheree Petty, CPC-A Thea Iris Baluyot, CPC-A Yania Corria, CPC-A Nolimar Tabaranza Zamora, CPC-A Rincy Abraham, CPC-A Sherrie Park, CPC-A Thelma Diaz, CPC-A Ybelize Ramirez, COC-A Nunna Yateesh, CPC-A Rincy C P, CPC-A Shin Man Tina Cheung, CPC-A Thenmozhi Muthusamy, CPC-A Yedurudona Nithin Babu, CPC-A Odelkis Torres Lopez, CPC-A Rita Gonzalez, CPC-A Shweta Patil, CPC-A Theresa Bombardier, CPC-A Yi Lai, CPC-A Olga Goldman, CPC-A Rivitha Prathaban, CPC-A Shwetha C V, CPC-A Theresa Trost, CPC-A Yoganandhan Kumaresan, CPC-A Olivia Ann Herring, CPC-A Robert Caesar Ponce, CPC-A Siddhi Dhirendra Purohit, CPC-A Tiera Watson, CPC-A Yolanda Clark, CPC-A Olivia Bario, CPC-A Robinette Harleaux, CPC-A Silvia Aguilera, CPC-A Tiffany Ann Bowman, CPC-A Yuxuan Qi, CPC-A Olivia Rodriguez, CPC-A Ronald Collins, CPC-A Sindhu Anbuchelian, CPC-A Tiffany Anthony, CPC-A Yvette James-Trotman, CPC-A Olutayo A Clarke, CPC-A Ronald Dewey, CPC-A Sindu Chenampara, CPC-A Tiffany Deepe, CPC-A Yvonne Rios, CPC-A Oma Ramdeen, CPC-A Ronie Jabile Gedo Cruz, CPC-A Sirjana Basnet Pandey, CPC-A Tiffany Hammond, CPC-A Zahily Vazquez Castellanos, CPC-A Onyinye C Akuchie, CPC-A Rory Chatriand, CPC-A Siva Sivaraj, CPC-A Tiffany Kintzley, CPC-A P N B Lakshmi, CPC-A Ruby Carole Carter, CPC-A Sivashankar R, CPC-A Tiffney Ann Means, CPC-A Paladi Priyanka, CPC-A Ruff Cael Jean, CPC-A Skylar Diane Kever, CPC-A Tina Denise Mack, CPC-A Pallavi Channegowda, CPC-A Rushikesh Bharatsing Patil, CPC-A Sneha Ravindra Kumar Rathod, Tonya Douthitt, CPC-A Specialties Pam Barber, CPC-A S M Saraswathi, CPC-A CPC-A Toreal Jackson, CPC-A Pam Floyd, CRC, CPC S Pon Priyanka, CPC-A Snober Rifat, CPC-A Tracie Keator, CPC-A Abdul Fasid Syed Sulaiman, CRC Pamela J Sunstrom, CPC-A Sadula Ravali, CPC-A Sonam Bagal, CPC-A Tracy Bennett, CPC-A Adrienne M Diaz, CPC, CPMA, Pamela Simpkins, CPC-A Sahiti K, CPC-A Sonya Ramdarass, CPC-A Tracy Tullercash, CPC-A CRC, CDEO Parvathy Soman Sreeraj, CPC-A Salla Rajitha, CPC-A Sook Cadwell, CPC-A Travis McMurray, CPC-A Ajith Mathi, CRC Patheparapu Hanumantha Rao, Sally Castellini, CPC-A Sowmiya Ramakrishnan, CPC-A Treasa Kuppandicherry Xaviour, Akash Kishor Jadhav, CPC-A, CPC-A Sally Cortez, CPC-A Spencer Chiu, CPC-A CPC-A CEDC Patil Jyothi Reddy, CPC-A Samanth Prasad Tiwari, CPC-A Srinivasan Muthusamy, CPC-A Treylan Loftis, CPC-A Alex Pandian John Kennady, CRC Patricia Alber, CPC-A Samantha Strange, CPC-A Stacy Ciccone, CPC-A Tulasiram Payyavula, CPC-A Alexandra Jay Gialanze, CPC, Paula Driver, CPC-A Samreen Taj Ibrahim, CPC-A Steffani Mitchell, COC-A Ty Oudanonh, CPC-A CPMA Paula Mae S Maranan, CPC-A Sandhya Aousarmal, CPC-A Stephanie Brewer, CPC-A Tycie Wright, CPC-A Allison Dabler, CPC, CPMA Pavithra Murugesan, CPC-A Sandhya Nair, CPC-A Stephanie Pierce, CPC-A Uditya Pant, CPC-A Allison Wallace, CRC Payton Wilson, CPC-A Sandhya Palla, CPC-A Stuart S Huie Jr, CPC-A Ummay Mohammadi Siddique, Alyssa Smitley, CPC-A, CPB Paytsar Serkisian, CPC-A Sandi Rex, CPC-A Subashini M, CPC-A CPC-A Amanda Aguilera, CRC Peiyuan Tang, CPC-A Sandra Buntin, CPC-A Sudheer G, CPC-A Vadapalli Nageswara Rao, CPC-A Amanda D Lawrence, CPC, CRC Pennie Aitken, CPC-A Sandra Ramlakan, CPC-A, COC Suganthi Dillibabu, CPC-A Vaibhavi Dabral, CPC-A Amanda Dieterle, CPC, COBGC Pooja Patil, CPC-A Sandra Ruscha, CPC-A Suganya Muthukrishnan, CPC-A Valipalli Moti Raviteja, CPC-A Amandeep Gill, CPC, CRC Poornima Marimuthu, CPC-A Sandra Williams, CPC-A Suganya R, CPC-A Vanessa Paris, CPC-A Amarilis Marrero, CPC, CRC Poornima Muthukumarasamy, Sara Byer, CPC-A Sumi Ignatious, CPC-A Vani Macha, CPC-A Amber Bryant, CPC, CPB CPC-A Sara Hardtarfer, CPC-A Summer Greene, CPC-A Vanmathi Venkatesan, CPC-A Amber Holfelder, COC, CPC, Pramod Aghav, CPC-A Sarah Bjornstedt, CPC-A Sunit Thakur, CPC-A Veasna Nuon, CPC-A CDEO, CPB, CPMA, CEMC, Pratap Mocherla, CPC-A Sarah Dooly, CPC-A Sunny Razdan, CPC-A Velmurugan Dhayalan, CPC-A COPC, CEDC Pratiksha Bhat, CPC-A Sarah Francisco, CPC-A Surabhi Shukla, CPC-A Venkatesan V, CPC-A AminalBeevi AbdulJabbar, CRC Praveen Murugan, CPC-A Sarah Hutto, CPC-A Suriakala Shanthakumar, CPC-A Veronica Panebouef, CPC-A Amy G Tulip, CPC, CPB, CHONC, Precious Jewel Rances, CPC-A Sarah Long, CPC-A Susan Brown, CPC-A Veronika Nikol Ramirez, CPC-A CRC Priscilla Matthewganesan, CPC-A Sarah Shirley Raja Ibrahim, CPC-A Susan Elizabeth Paquette, CPC-A Vicki Jones, CPC-A Andra McConnell, CPC, CPMA Priyanka Basu, CPC-A Saranya Saseendran, CPC-A Susan Johnson, CPC-A Vicki Lee, CPC-A Angela A Hudson, COC, CPC, Priyanka Lakh House, CPC-A Saravanan Murugananthan, CPC-A Susan Kiely, CPC-A Vicki Sue Hart, CPC-A CPC-P, CPMA, CRC, CDEO Priyanka Repalle, CPC-A Sarin Rose, CPC-A Sushma Potluri, CPC-A Victoria Tuck, CPC-A Angela Boulet, CPC, CRC Racheal Brafford, CPC-A Sathyapriya Ramamoorthy, CPC-A Swapnarani Sriramoju, CPC-A Victoria Young, CPC-A Angela Fay Jarrett, CPC, CRC Ragavendra K, CPC-A Sathyashri Palanisamy, CPC-A Swati Gupta, MD, CPC-A Vijayalakshmi K, CPC-A Angela Michelle Moultrie, CPC, Raina Nieves, CPC-A Savaii Mislang-Darden, CPC-A Sydney Kirksey, CPC-A Vijayalaxmi Seran, CPC-A CPB Rajani P R, CPC-A Savitha Tomy, CPC-A Syed Mohammed Zeeshan, CPC-A Vijetha CA, CPC-A Anita Mangalore, COC, CPC, CRC, Rajashree Radhakrishnan, CPC-A Selena Baker, CPC-A Tamala Swift, CPC-A Vijitha Kizhakkekalam Vijayakumar, CPMA Rajat Sharma, CPC-A Sham Nijanth J, CPC-A Tamara Johnson, COC-A CPC-A Anitha P Prabhakaran, CRC Rajula Abdul Rafeek, CPC-A Shamna Salam, CPC-A Tamilbharathi Iyyappan, CPC-A Vinalee Vinayak Khedekar, CPC-A Ann Marie Grant, CPC, CRC Rakesh Kasukurthi, CPC-A Shanmugapriya A, CPC-A Tammy Hayhurst, CPC-A Vincent T A, CPC-A Anna M McGregor, CPC, CPMA, Rakesh Singh Tomar, CPC-A Shannon Dallas, CPC-A Tammy Kipf, CPC-A Vineeta Rajesh Nair, CPC-A CEMC, CPCO Ramani Ramgopal, CPC-A Shantha Murty Swamy M, CPC-A Tammy Lynn Bossio, CPC-A Vineetha Madasu, CPC-A Anna Simpson-Cruz, CPC, COBGC Ramesh M, CPC-A Shaquana Bynoe, CPC-A Tamra Hilton, CPC-A Vinitha Ushakumari Ramachandran, Annadale S Collins, CPC, CRC Ramesh R, CPC-A Sharon Grant, CPC-A Tanean Phillips, CPC-A CPC-A Annamaria DiGisi, CPC, CPMA, CRC

www.aapc.com January 2020 61 NEWLY CREDENTIALED MEMBERS

Anne Gilliam, CPC, CCC Cody Lisa Payne, CPC, CIC, CEMC, Haojie Jessica Hu, COC, CPC, Jessica Hayes, CPB, CPEDC Kimberly M Hamilton, CPC, CIC Anne Nitti, CRC CRC CPMA, CRC, CPC-I, CDEO Jessica Hondal, CPPM, CPCO Kimberly Millette, CPC, CRC Annette J Graham, CPC, CPMA, Colleen Carnara, CRC Harinee Viswanathan, CRC Jessica Somohano, CPPM Kimberly Oates, CEMC CRC Colleen Kolbeck, COC, CPC, Harish Karthikeyan, CRC Jessyka Burke, CPC, COSC, Kimberly Pearson, CPPM Antoine Mansour, CPMA CPMA, CEDC Haritharani Dharmaraj, CRC CASCC Kimberly R. Pottmeyer, CPC, Anusuya Rajan, CRC Courtney Nohava, CPC-A, CPB Harivignesh Durairaj, CRC Joanie Howard, CPC, CRC CPMA April Gum, CPB Cristina Garcia, CPPM Harshini Jagadeesh, CRC Joanna Otero, CPC, CRC Kimberly Staten, COC, CPC, April VanMetre, CPC, CFPC Crystal Behnke, CEMC Haven Sferrazza, CPC, CPMA Jodi Peters, CPC, CPB COSC Aravindh Rajamanickam, CRC Crystal Irish U Delima, CRC Hayat Chaalan-Ali, CPC, CPMA John Valentin, CPB Kondapaturi Venkatesh, CRC Aris Govjian, CPCO Cynthia Noel Wagner, CPC, CPCO Heather A Anderson, CPC, CRC Joyce Burton, CPC, CPMA, CEMC Kowsalya Rajendran, CRC Arlene Eccles, COC-A, CPMA, CRC Dammira Hsu, CPC-A, CRC Heather M Dominguez, CFPC, Judi Lynch, CPB Kowsalya Sivasubramaniyan, CRC Arlyne Rose Pacis, CRC Dana Jeanne Stewart, CPC, CEMC, CPCO Judith Klobutcher, CPC, CPMA Kris Carl T Tiangson, CRC Arunkumar Paulraj, CRC CRC Heather Marie Thompson, CPC, Julia Freire, CPC, CRC Kristel P Bagabaldo, CRC Arunrasu Selvaraj, CRC Daniel Robert Peters, CPC, CIRCC CGSC, COSC, CGIC Julie Ann Dragoo, CRC, CPMA Kristen Abrantes, COPC, CPB Ashley Elizabeth Hacker, CPC, Daniel Pascuas, CPC-A, CPB, CIC Heidi Kay Thomsen, CPC, COBGC Julie Wieneke, CPC, CEMC Kristin Mccracken, CRC CPMA Darcel Wilson Young, CPC, CPMA Hemalatha Appasamy, CRC Justine Louis Escober Del Rosario, Kristine M Gronhagen, CPC, Audrey Rene Jackson, CPC, CRC Dawn Lett, CPC, CPMA, CPEDC, Hilary C Crosby, CPC, CPPM CIC CPMA Awilda Harden, CPB CDEO Hodda M El-Iskandarani, COC, Juville F Floresca, CRC Kristine Nicholas, CPC-A, CRC Azeeza Fathima Syed Mukthar, Debbie Handt, CPC, CRC CPC, CDEO Kaitlin Hall, CPC, CRC Kristy A Gamble, CRC CRC Deborah Leah Marg, CPC, CRC Holly Dunning, CPC, CRC Karen Barry, CPMA Kshama Sanjay Gharat, CRC Bebin Ashokkumar, CRC Deborah Woods, CPC, CRC, CPC-I, Holly Steinman, COC, CPC, CRC, Karen Dunham, CPC, CANPC Kuralarasan Panneerselvam, CRC Becky Jean Joiner, CPC, CPMA CPMA COBGC Karen Elisabeth Senst, CPC-P, CIC Kyra Crutchfield, COC, CPC, Benjamin Cronze, CPC-A, CPMA Debra Johnson, CPC-A, CPCO, Ian Mattis, CPC, CEMC, COPC, Karen Ewald, CPPM CASCC, CCVTC Berlimol Thottupurathu CPMA, CRC, CDEO CPMA Kari Cindia, CPC, CANPC Lakshminarayanan Ravi, CRC Baby Mathew, CRC Debra Lynn Conard, CPC, CRC Idoneris Villalona, CPC, CPCO, Karina Annette Johnson, Esq, COC, Laura K Futch, CPC-A, CRC Beverly Gillot, CPCO Deepa Mallesh Dhotre, CRC CPMA CPC, CPCO, CDEO, CIC, CPB, Laura Lara, CPC, CPCD Bokka Praveen Kumar Ramaiah, Deicy Sahraie, CPB Ilene Zanchelli, CPC, CRC, CEMC, CPMA, CPPM, CPC-I, CANPC, Lauri Benson, CPB CRC Dena Bynum, CPB CPMA CCC, CCVTC, CGSC, CHONC, Laurie Seelinger, CPC, CASCC Bonnie Amber Perkins, CPC, Denice Craven, CPC, CGIC Iris Yvette Bonet, CPC-A, CRC COBGC, COSC, CPCD, CEMC Leah Wall, CPC, CGSC, CPMA CGSC Denise M Bolyard, CPC, CANPC Jaime Morton, CPC, CASCC, Karpagalakshmi Eswaran, CPC-A, Lee Ann Dangelo, CRC Bonnie Smallidge, CPC, CEMC, Devanesan Lourduswamy, CRC CANPC CRC Leslie Nikkole Hudson, CPC, CRC CUC, CPEDC Dhanamjaya Ramanaiah, CRC Jaithoun Bivi Mohamed, CRC Karthikeyan Subramaniyan, CRC Linda Alane Atherton, CPC, CEMC, Brandi Grosser, CPC, CPB, Dharani Sambasivam, CRC James W Bailey, CPC, CRC Karunasree Vabanagiri, CRC COPC COBGC, CPMA Dhivya Devarasu, CRC Jamie Myers, CPC, CPCO Katherine Romano Brown, COC, Linda Anderson, CRC Brandon Dumlao, COC, CPC, Diana Russell, CPCO Janani Murugappan, CRC CPC, CGSC, CHONC, CCVTC Linda Martien, COC, CPC, CPMA, CDEO, CPB, CPMA, CCC Dianne M Hamel, CPC, CRC Jane LaPlante, COC, CIC, CEDC, Kathleen Edge, CPC, CPCO CRC Caitline Summers, CPC-A, CPB, Donna Malone, CPC, CRC, CPMA Kathleen Jean Plemel-Dibble, CPC, Lindsay Walraven, CPC-A, CFPC CPCO Approved-Instructor, CRC-I Janelle Wilson, CPC, CPCO CDEO Lindsey Lane, CPC, CPMA, CPCO Carol Soto, CPB Ebony Fisher, CPB Ja’Net Hollins, CRC Kathleen Kirk, CRC Lindsey M A Kelly, CPC, CPMA Carrie Crossen, CPC, CRC Eileen Ferrini, CPC-A, CRC Janine O’Brien Smith, COC, CPC, Kathleen M Skolnick, COC, CPC, Lindsey Taylor Hannan, CPC, Catherine A Hagen, COC, CPC, Eileen Wiedemann, CPC, CRC CPCO, CPMA, CRC, CASCC, CPCO, CDEO, CPB, CPMA, CEDC, CEMC CPMA, CEMC, CIMC, CHONC Elena Cetola, CPB CEMC, CENTC, CHONC, COPC, CPPM, CRC, CPC-I, CEMC, Linu Maria John, CPMA Catherine FU, CPEDC Elizabeth A Strain, CPC, CPMA CDEO CEDC Lisa Annette Miller, COC, CPC, Cathy Doreen Fiermonti, CPC, Ellen M Lynch, CPC, CRC, CPMA Janine Valentine, CPC, CRC, Kathleen Stoddard, CPC, CDEO CIC, CPB, CANPC, COSC, CPMA, CRC, CDEO Elyse Cortez, CPC, CPB COBGC Kathy J Washburn, CPC, CDEO CPMA Celine Burke, CPC, CIC Emmanuel S Delas Alas, CRC Jawana Marie Lucas, CPC, CPMA, Kathy McCalley, CPMA Lisa Dobson, CRC Chanda Colwell, CPC, CPMA Erick Mariano, COC-A, CPC-A, CPCO Katie Cooper, CRC Lisa Lampkin, COC, CPC, CIC, Chandrasekar Varanamuthu, CRC CPCD, CPMA Jeannette Lajara, CPB Katie Lynch, CPC, CPMA CPMA, CANPC Chandrika Chandrasekaran, CRC Ernest Styles, CPC-A, CPMA Jenipha Augustin, CRC Kauionalani Hai, CPB Lisa MacLellan, CPC-A, CRC Chantale Lisa Krzanowski, CPC, Eswar Arunkumar Sivakumar, CRC Jennifer Cornwall, CPB Kavineshwar Sankaradas, CRC Lisa Miller, CPC, CRC COBGC, CPMA Eunice F Nazarro, CRC Jennifer D Vybiral, CPC, CRC, Kaviyarasan Chinnakannan, CRC Lisa Perkins, CPB Chantel Carter, CPC-A, CPB Faith El Zayin Vallejos, CIC Keerthana Krishnamurthy, CRC Liza Marie C Garcia, Charlotte Janusik, CPB CPPM CRC Fanooss Khajehnoori, CPC-A, CRC Jennifer Harris, CPC, CRC, Keisa R Newburry, CPC, Lora Hofer, CPC-A, Charlotte Tharp, CPC, CRC CPMA CIRCC COSC Fortunato Teodoro Ledesma, Keisha Wilson, CPC, CPMA, Cheresse D Santiago, CRC CIC Jennifer L Martinez, CPC, CRC CRC Lora Ramer, CPC, CRC Cherie Felkner, CPC, CPB, CGIC, Frances Pileggi, CPC, CRC Jennifer Lauren Jones, CPC, CRC Keli Randolph, CPB Louise F Metz, CPC, CPMA CGSC, COBGC, CPCD Gaayathri Rajagopalan, CPC, Jennifer M Connell, COC, CPC, Kelli Crooks, CPC, CRC Louise Sexton, CRC Cheryl Lynn Valdez, CPC, CRC CPMA CPCO, CPC-P, CPB, CPMA, Kelli 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Jessica Brown, CPC, CRC Kimberly Hill, CPC, CRC Madonna L Davis, CDEO

62 Healthcare Business Monthly NEWLY CREDENTIALED MEMBERS

Maggie Pavelek, CPCO Nicole Bulochnik, CRC Rose Laur, CPC, CPB, CPMA Subashchandra Bose Shankar, CRC Vignesh Thanikasalam, CRC Mai Vo, CPB Nicole Marie Gendreau, CPC, CEDC Roshni Chandralal Ahuja, CPC-A, Sugan Subramaniyan, CRC Vigneshwara Reddy Vuyyuru, CRC Mantu Kumar, CRC Nicole McGhee, CPC, CPMA, CRC CEDC Suganya Damodaran, CRC Vijay Shirsath, CPC-A, CEDC Marco Unzueta, CPC, CIC, CDEO Nirubha Subbukannu, CRC Ross Alan Hendricks, CPC, CRC Suganya Mohan, CRC Viktoriya Rebrik, CPC, CPMA, Marcy Jaramillo, CPC, CPB Nitesh Ashok Zagade, CRC Rowell Desosa Dela Cruz, CIC Sujithamary Sankar, CRC COBGC Maria Victoria L Landingin, CIC Nivedha Palanisamy, CRC Rubini Kumaravel, CRC Suman Mahadev, CPB Vinayak Shinde, CEDC Marianne Genii O Tinga, CRC Nora Smith, CPC, CPMA Rupali Balu Jagtap, CRC Suman Shreyaah, COC, CPC, Vincy Vincent, CRC Maricar Lopez Bosshard, CIC Noreen Hilton, CRC Ryan Alberto Lazona, CIC CDEO, CPB, CPMA, CRC, CGSC Xinni Guo, CPC, CPCO MariKristy Hasinski, CPC, Paige Slowik, COC, CPC, CRC Sadhana Natarajan, CRC Sunitha Nagarajan, CRC Yenise Oms, CPC, CRC, CPMA Approved-Instructor, CRC Pamela Jill Settles, CPC, CRC, Safeera Ibrahim, CPC-A, CPMA Sureka Yolanda Moore, CPC, CRC Yenisleidys Gonzalez Perez, CRC Marojin Subirjeth Mani, CRC CDEO Salma Baig, CEDC Surya R Ravi, CRC Yesenia Nettles, CPC, COSC, Mary Claire M Insigne, CRC Pamela McLean, CPCO Samantha J Parham, CPC, CRC Susan Kuhn, CPC-A, CRC CPMA Mary Edleen Ona, CPB Parkavi Bharathi, CRC Sandra M Caron, CPC, CEMC, Susan Sirocka, CPC, CPMA, CDEO Yvette Solis, CPC, CRC Mary Fitzgerald, CPC, CRC Paso L Yang, CPC, CUC, CCC CRC Susan Speicher, CPC, CPMA Mary Gauthier, CPC, CEMC Pauline Niquette, CPC, CRC Sangeethalakshmi Gowthaman, Susan Young, CPC, CRC Mary Grace Estomago, CIC Pavithra Dhamodaran, CRC CRC Sushma Balakrishnan, CRC Mary J Carver, COC, CPC, CRC Pavithra Rishivasan, CRC Santhosh Sekar, CRC Suvetha Vaiyapuri, CRC Maryrose M Valencia, CIC Penny Riser, CPC, CRC Sara Speece, CPC, CRC Suzanne Sloop, COC-A, CPC-A, May Rachel H Lamprea, CPC-A, Penny Walker, CPC, CHONC Sarah L Petty, CPC, CRC, CPMA CRC Current and CPCO Peter Conticelli, CRC Sarah Newman, CPB Suzette M Obermeier, CPC, CRC Comprehensive Meagan McCoy, CPCO Phoebe Zuromski, CRC Sarah Otto, CPB Synthia Fernandes, CPC, CRC Megan M Spahic, CPC, CPB Pina Crawley, CPC, CPMA Sarah Peddle, CPC, CCC Tahleel Atatreh, CPMA - 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www.aapc.com January 2020 63 ■ ADDED EDGE By Meagan Williford, MA, BA, CPC-A Top CPC ® Exam Tips Part 2: 12 tips help you to be ready on exam day.

gettyimages / skynesher

ast month I shared steps you can take before the Certified TIP 2: Arrive Early LProfessional Coder (CPC®) exam to help you prepare. But what Arrive to the exam at least 30 minutes before the test starts. This will should you do when test day arrives? give you time to sign in, get settled, and use the restroom. I was very nervous the day I took the CPC® exam. I remember sitting in the exam room, with a million thoughts racing through TIP 3: Believe in Yourself my head: This is really difficult. What if I don’t pass? What is that question even asking? I am running out of time. I’m not going to finish Yes, the CPC® exam is challenging and long. Honestly, I considered the test! giving up about halfway through the exam because everything was so Although anxiety almost got the best of me that day, I was able to overwhelming and it felt as though time kept zooming by. But then power through and pass the exam on my first attempt. With a solid I stopped for a few seconds, took deep breaths, and gave myself a pep test-taking strategy and good time management skills, I believe you, talk. Taking that moment to gather my thoughts eased my panic and too, can set yourself up for success on exam day. helped me to focus. And remember, if you don’t pass the exam on the first try, you can TIP 1: Leave Electronics Behind retake it — for free! Don’t beat yourself up if you fail; stay positive and determined. If passing the exam is something you really want, don’t Leave your phone and other electronic devices in your car. give up.

64 Healthcare Business Monthly Exam Tips

“Taking that moment to gather my thoughts eased my panic and helped me to focus.”

TIP 4: Wear Layers about. In the first part of the test, I let the time mess with my mind. You never know how cold or hot it will be in the testing room; wearing I had difficulty concentrating on the actual questions because I was layers allows you to adjust to the room’s temperature accordingly. afraid I was going to run out of time. Also, give yourself time at the end of the exam to go back and TIP 5: Bring Plenty of No. 2 Pencils answer the questions you skipped. Don’t leave any question blank. You won’t be penalized for guessing wrong; it’s in your best interest Have plenty of sharpened No. 2 pencils, in case the one you are using to answer every question. For anything you answer, you have a 25 breaks. There’s no time to sharpen pencils. Be sure the pencils have percent chance of guessing correctly, but for anything you leave blank good erasers or bring a separate eraser. You may also want to bring a you have a 100 percent chance of getting it wrong. highlighter (see tip #10). Important: Although you can take bathroom breaks during the exam, the clock will not stop during these breaks, so use your time TIP 6: Take Snacks and Water wisely (see tip #2). If you’re hungry, you might have difficulty concentrating on the TIP 10: Don’t Get Psyched Out by the Long Questions test. Bring snacks and water, but make sure your snacks can be eaten quietly. Crunchy snacks, such as carrot sticks and chips, can make For longer questions, such as the operative reports, highlight and it hard for other test-takers to concentrate. Considering opening all underline the relevant information. This will help you to focus on the packages before the exam starts to minimize additional noise. information you need to answer the question correctly, and not get distracted by all the nonessential information. TIP 7: Follow all Proctor Instructions The longer questions are worth the same points as the shorter questions. If you find yourself spending too much time on a longer Proctor-to-examinee instructions can be found at http://static.aapc.com/ question, move on and go back to it later. If you still can’t figure it out, aapc/documents/proctor-to-examinee.pdf if you want to know what is expected guess! ahead of time. Proctors will read these aloud the day of the exam. Pay attention — you don’t want all of your hard work to be for naught if you TIP 11: Look at the Answers and Think seal your test booklet incorrectly or fill out the answer sheet incorrectly. About How They Relate to the Questions TIP 8: Form a Test-Taking Strategy Use the process of elimination to remove any answer you know is wrong. For example, if the question relates to an evaluation and at the Beginning of the Exam management (E/M) services code, but one of the answers is not an If there is a section of the exam you think might be easier for you, E/M services code, then you can confidently eliminate that choice. such as the compliance questions, then answer those first. Consider If you can’t choose between two codes, select one but put a question skipping long questions until the end. But if you do skip around, mark by that question. If you have time remaining after answering make sure to fill out the correct bubbles on the answer key. You do not every question, revisit the questions you marked. want to get off track on your answer sheet. TIP 12: Clearly Document Skipped Questions TIP 9: Keep an eye on the Time If you need to skip a question, make sure to clearly mark any answer You have five hours and 40 minutes to finish the 150-question exam. choices you already eliminated and jot down any notes you want That gives you just over two minutes per question. Some questions to remember later. This way, five hours later, when you go back to will take less time and others will take more time. Consider crunching the question, you won’t have to remember why you were debating numbers and figuring out about where you should be at what time. between codes. For example, if your exam starts at 8 a.m., at 9 a.m. you should be Meagan Williford, BA, MA, CPC-A, is the editor for TCI’s newsletters Cardiology Coding Alert, around question 27 and by noon you should be at about question 109. Podiatry Coding and Billing Alert, and Neurosurgery Coding Alert. Wear a watch because you don’t know where the clock will be in the room. But don’t get so obsessed with the time that it’s all you think

www.aapc.com January 2020 65 Minute With a Member

Seema Bapat, CPC, COC, CRC Risk Adjustment Coder, Aviacode

Tell us a little bit about how you got into coding, what have you done during your coding career, and where you work now? I am a hotel management graduate from India. After getting married, I came to the United States with my husband and started living in Michigan. I raised my three kids first and then became serious about my career. I always had an interest in the medical field and started exploring what I could pick up in that area. I came to know about medical coding and decided to pursue it. I completed an online course and passed the Certified Professional Coder (CPC®) exam in 2012. Then, I completed the Certified Outpatient Coder (COC™) and Certified Risk Adjustment Coder (CRC™) certifications. Today I work remotely as a risk adjustment auditor.

What AAPC benefits do you like the most? I like chapter meetings the most. It is a great way to meet and network with others in the world of coding. The speakers inform us about various topics that help keep our coding knowledge current. Also, AAPC’s Healthcare Business Monthly magazine is a wonderful resource for coding tips and compliance guidelines. It highlights motivational and success stories of other coders.

Do you have any advice for those new to coding and/or for those looking for a job in this field? “I would say, don’t I would say, don’t give up, work hard, and trust yourself. Believe that there are good things out there for you. Be prepared and ready when opportunity knocks. I got my first job at a give up, work hard, place that was 80 miles from my home, but I took it and got used to the daily commute. That work experience helped me get to the next level. and trust yourself. What has been your biggest challenge as a coder? Believe that there are Getting my first job after completing the certification was very challenging. Without work experience, it is very difficult to get a job. It took me eight months to get my first job good things out there after my certification. I am grateful to Pamela Pulley, who believed in me and offered me a contract position. I am also thankful to Tammy Allen, who motivated me to pursue my for you. Be prepared CRC™. and ready when How do you spend your spare time? Tell us about your hobbies, family, etc. My family keeps me busy. I have three kids ranging from 13 to 21 years old. My husband opportunity knocks.” and I enjoy spending time with the family, cooking, and yoga.

GOT A MINUTE? If you are an AAPC member who strives to advance in the business of healthcare, we want to know about it! Please submit your answers to the above questions to [email protected].

66 Healthcare Business Monthly t's not too late seie the opportunity er the course o your career i you dont earn another credential it could cost you as uch as .

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