Families Who Code Together Stay Together 50 Test Yourself Members Confess That Their Passion for Coding Doesn’T Stay at the Office

June 2008

(clockwise) Clifton L. Jones, CPC, CCP Joyce L. Jones CPC, CPC-H, CCS-P, CPC-ASC, CNT Traci Linn, CPC Families Who Beth Wolf, BA, CPC Code Together Stay Together

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9 33 47 June 2008

In Every Issue

[contents] 5 Letter From the Vice President

7 Letter From the NAB President

12 Letters to the Editor

15 Coding News

23 Kudos 24 42 Extreme Coding Features 8 ABN: Shift Responsibility to Patients the Correct Way Belinda S. Frisch, CPC, gives you information on Advanced Beneficiary Notice of Non-coverage (ABN) to correctly notify beneficiaries that Medicare is not likely to Education cover specific services. 16 Top 10 Reasons for Employers 18 Stay Current with April 2008 Medicare Physician Fee Schedule Updates to Participate in Project Xtern MPFS changes quarterly, tugged in various directions by several initiatives. Jean Acevedo, LHRM, CPC, CHC, brings us up to speed on the latest changes. 31 Examination Dates 24 Families Who Code Together Stay Together 50 Test Yourself Members confess that their passion for coding doesn’t stay at the office. The enthusi- asm for coding has found its way into the hearts of loved ones to become a favorite family pastime. Senior Editor Michelle Dick reports. 32 What Hat Do You Wear? People We learned from our Work of a Coder survey that coders wear plenty of hats, but physi- 38 Newly Credentialed Members cians often see us as firefighters or police officers. Sheri Bernard CPC, CPC-H, CPC-P, writes about hats and other surprising results. 44 Understand Carrier Medical Policy and the Long Denial Process Do you understand the process behind how a provider develops medical policy? Next Month Few really do. Jonnie Massey, AHFI, CPC, CPC-P, CPC-I, reveals what goes into the decisions that affect your reimbursement. Art of Negotiating 47 RACs Are Coming to Your Town Books to Buy The new federal Recovery Audit Contractor (RAC) program is coming to city near you. How can you prepare for the review? Good coding is your best protection says CAC Solutions Brad Ericson, CPC, CPC-ORTHO. Coding Books

On the Cover: It’s no secret that the Jones family is passionate about coding. Joyce L. Consultants Jones, CPC, CPC-H, CCS-P CPC-ASC, CNT, and husband, Clifton L. Jones, CPC, CCP, pose on their porch with daughters, Beth Wolf, BA, CPC, and Traci Linn, CPC. Cover photo by Neil Brake of Vanderbilt Medical Center. www.aapc.com June 2008 3 Targeting the AAPC Audience The membership of AAPC, and subsequently the readership of Coding Edge, is quite varied. To ensure we are providing education to each segment of our audience, in every issue we will publish at least one article on each of three levels: apprentice, June 2008 professional and expert. The articles will be identified with a small bar denoting CEO and President knowledge level: Reed E. Pew Beginning coding with common technologies, basic anatomy and [email protected] APPRENTICE physiology, and using standard code guidelines and regulations. Vice President of eMarketing Bevan Erickson More sophisticated issues including code sequencing, modifier [email protected] PROFESSIONAL use, and new technologies. Vice President of Member Services Advanced anatomy and physiology, procedures and disorders Stephanie L. Jones, CPC, CPC-E/M EXPERT [email protected] for which codes or official rules do not exist, appeals, and payer specific variables. Vice President of Member Relations Sheri Poe Bernard, CPC, CPC-H, CPC-P [email protected] Vice President of Education Nancy Reading, BS, RN, CPC [email protected] AAPC Code of Ethics Director of Publications Brad Ericson, BA, MPC, CPC, CPC-ORTHO [email protected] Members of the American Academy of Professional Coders Senior Editor (AAPC) shall be dedicated to providing the highest standard of Michelle A. Dick, BS professional coding and billing services to employers, clients, [email protected] and patients. Professional and personal behavior of AAPC Production Staff members must be exemplary. Tina M. Smith, AAS Graphics zz AAPC members shall maintain the highest standard [email protected] of personal and professional conduct. Members shall Display Advertising respect the rights of patients, clients, employers, and all other colleagues. Raemarie Jimenez, CPC zz Members shall use only legal and ethical means in all 877-642-9909 professional dealings, and shall refuse to cooperate with, [email protected] or condone by silence, the actions of those who engage in Address all inquires, contributions and fraudulent, deceptive, or illegal acts. change of address notices to: zz Members shall respect and adhere to the laws and regulations of the land, and uphold the mission statement of the AAPC. Coding Edge PO Box 704004 zz Members shall pursue excellence through continuing education in all areas applicable to their profession. Salt Lake City, UT 84170 zz Members shall strive to maintain and enhance the dignity, (800) 626-CODE (2633) status, competence, and standards of coding for professional services. © 2008 American Academy of Professional Coders, Coding Edge. All rights reserved. zz Members shall not exploit professional relationships with Reproduction in whole or in part, in any form, without written permission from the AAPC patients, employees, clients, or employers for personal gain. is prohibited. Contributions are welcome. Coding Edge is a publication for members of the American Academy of Professional Coders. Statements of fact or opinion are the responsibility of the authors alone and do not imply an opinion of the AAPC, or sponsoring This code of ethical standards for members of the AAPC strives ® to promote and maintain the highest standard of professional organizations. Current Procedural Terminology (CPT ) is copyright 2007 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related service and conduct among its members. Adherence to these listings are included in CPT®. The AMA assumes no liability for the data contained herein. standards assures public confidence in the integrity and service of professional coders who are members of the AAPC. CPC®, CPC-H®, and CPC-P® are registered trademarks of the American Academy of Professional Coders. Failure to adhere to these standards, as determined by AAPC, will result in the loss of credentials and membership with the American Academy of Professional Coders. Volume 19 Number 6 June 1, 2008 Coding Edge (ISSN: 1941-5036) is published monthly by the American Academy of Professional Coders, 2480 South 3840 West, Suite B. Salt Lake City, Utah, 84120, for its paid members. Periodical postage paid at the Mendota, IL. 61342 mailing office. POSTMASTER: Send address changes to Coding Edge c/o AAPC, 2480 South 3840 West, Suite B, Salt Lake City, UT., 84120.

4 AAPC Coding Edge letter from the vice president Vice President’s Message Last year, our leader, Reed E. Pew, requested that the AAPC national office focus on one priority: improving our performance by delivering world class, member-focused service. Our talented and committed department heads stepped up to the plate and augmented our service staff by recruit- ing health care professionals. Now, we are delighted that many of our staff members are also CPCs®. The result of our focus is improved service quality, including: improved telephone hold times, faster service through better technology and staff training, and increased overall member satisfaction levels through personalized service. We continue to improve our service. We have aggressively expanded your member benefits to provide you with increased membership value, by providing the following: zz Health and life insurance at affordable individual plans zz Savings connection with quality dis- counts from the world’s best brands. ll Up to 50 percent off at more than 200 nationwide retailers (Target, Barnes and Nobles, Lands’ End, Lane Bryant, Office Depot, etc.) To move forward and help our members continue to look for services that support ll BIG savings on hotels, rental cars, compete in today’s rapidly evolving business high standards of accuracy and productivity, airfare, and cruises environment, we’ve added member services and give our members a competitive edge. ll Up to 30 percent off movie tickets focused on providing time-friendly educa- Most importantly, we continue to look for at over 11,000 theaters nationwide tion and training. We’ve created many new every opportunity to provide world class, ll Factory-direct savings of up to 50 “on-demand” tools to help members file member focused service. percent below manufacturer suggested and log CEUs with the CEUTracker, and to As we enter the summer of 2008, the AAPC retail price (MSRP) on electronics, register for workshops and exams instantly. stands tall with a highly qualified staff of clothing, jewelry, appliances, and more CEUs earned from AAPC’s live and audio talented individuals with your needs our top workshop exercises, Coding Edge, and priority. Our commitment to service means I’ve been a CPC® for 11 years and your vice EdgeBlast emails are now available online your interactions with us are based on value, president of member service for almost a instantly graded and automatically popu- superior service, and a positive experience. year and a half. Like many of you, I’ve seen a lated for credit in the AAPC CEUTracker. Please feel free to contact me directly by sharp and positive turn in what it means to We added interactive online practice exams calling 800-626-2633 to let me know how be a CPC® today. I believe we have made the for members to test their areas of strength we are doing and how we can continue to right kind of changes in our member service, and weakness before committing to a certi- best serve you! and I am proud to say we have grown into fication examination date. Sincerely, the nation’s largest member organization for Our members represent some of the finest professional coders, leading our industry in coders in the industry and deserve the best providing quality education and training pro- there is to offer. In this time of positive Stephanie L. Jones CPC, CPC-? grams, and valuable certifications. change and ongoing improvement, we will Vice President of Member Services

www.aapc.com June 2008 5 Get Your Coding Edge CEUs Online And get your EdgeBlast CEUs, as CEU Stories well. Test Yourself is now online at www.aapc.com/test/yourself/. You - Tell us about novel ways and can take the test, grade yourself, cor places where you’ve earned rect mistakes, and have your CEUs your CEUs. automatically added to your CEU Share ways you’ve saved Tracker for submission. money. Contact us through [email protected]. Tell Us Your Questions or Concerns AAPC Website Newly Do you have a question regarding Designed for You information found in Coding Edge? Check out the newly designed Or maybe you have a difference AAPC website. We've made it in opinion that you would like to more intuitive and easier to use share? Write us at for you, with easier access to [email protected]. the information you need and to your colleagues. Go to www.aapc.com/.

Have a job that pays for CEUs? Does your employer pay for your CEUs? If so, we’d love to here about

As you come across unusual or confounding operative - it. Send an email telling how your notes, decode them and e-mail copies to us at extreme [email protected] or by mail to Extreme Coding AAPC, employer helps you obtain CEUs to: P.O. Box 704004, Salt Lake City, Utah, 84170. We will [email protected] consider them for inclusion in this regular feature.

6 AAPC Coding Edge letter from member leadership

Unleash the Possibilities Recently, my five-year-old granddaughter but became passionate and enthusiastic along reminded me of what a magical time child- the way. It doesn’t matter if you are a coder, hood is. She is an energetic and beautiful biller, consultant, physician, attorney, etc., little darling, filled with light and promise. it is the passion and possibilities you bring She believes she is a princess and believes in into your life that is important. Once you fairy tales—what child doesn’t? At one time think something is possible, set your mind or another we have wished for a fairy god- in believing it, and it can happen. We live mother to wave her magic wand and grant in a world of evolving possibilities. We have our wishes upon request. To be a child again the potential to change our life with every and believe in fairy tales is wishful thinking decision we make, good or bad. The bad that may not be far from the truth. decisions are not always as bad as we think. We see lucky people: not just people who Sometimes a bad decision or mistake is good, win reality game shows or the lottery, but as a painful lesson can help us gain strength those who seem to glide from one success in and realize possibilities. life to another. We know lucky people: not Altering the way you think could change just the wealthy, but the blessed, healthy, your life. Ban negative thoughts from your happy, fortunate people who seem content in mind and reach for positive thoughts. Posi- whatever they do. Nothing seems to go awry tive thoughts attract positive experiences. in their life. What’s their secret? What if we Focus on the good things in life whether could have a fairy godmother wave a magic personal or professional. You may realize wand and our lives would be perfect like what you thought you wanted, is not really their lives? what you wanted at all. Back to reality: our lives are filled with When I was a child, I used the word “can’t” trials and tribulations. Although, we are quite often; for example, I can’t tie my shoe, surrounded by daily struggles, we all have I can’t eat my broccoli, I can’t understand a little of that fairy tale magic in us. Every this math problem, etc. One day, my father one has the ability and power to grant there had enough with the word “can’t.” My father own wishes. The energy we use to grant our scolded me and said, “Can’t never did any- wishes is not magic or mysterious; it is a thing, and that horrible word is banned from vital part of who we are. The Universal Law our home.” That day has stuck in my mind of Attraction is a way to realize our hidden for many years. Each time I feel like things potential by making things happen and are impossible, I hear my father say “Can’t creating magic. There are powerful forces never did anything.” It strengthens me to say within us that shape and form our life expe- “I know I can.” Ralph Waldo Emerson said, riences in the world. “What lies behind us and what lies before us are tiny matters, compared with what lies Deborah Grider, Finish this sentence: “To fulfill my poten- CPC, CPC-E/M, CPC-H, CPC-P, CCS-P tial I must ______.” Ultimately, to fulfill within us and when we bring what is within National Advisory Board President one’s potential is our life-long goal. You may out into the world, miracles happen.” have all the money and power in world, but Miracles, magic, and wishes come from at the end of the day, you might feel like inside us. Unlock the magic in you and real- something is missing. Most of us started our ize the wonderful possibilities. careers with the “it’s just my job” mentality, Until next month …

www.aapc.com June 2008 7 feature

Advanced Beneficiary Notice: Shift Responsibility to Patients the Correct Way by Belinda S. Frisch, CPC

An Advanced Beneficiary Notice of Non-coverage (ABN) is 6. Complete all blanks, including estimated cost, and the a form for Medicare beneficiaries to notify them that Medi- patient’s signature. Give a copy of the form to the ben- care is not likely to cover specific services. It is not used for eficiary and retain the original in the patient’s file. Medicare Choice beneficiaries or non-Medicare patients. What Reasons Should I Put on an ABN? A new form, CMS-R-131, was created to blend together Clearly state on the ABN why Medicare may not pay for former ABN-L and ABN-G forms. The form contains the services. Reasons may include (but are not limited to) several new fields, including cost estimate, and must be the following: used by providers no later than Sept. 1, 2008. zz Medicare does not pay for these tests for your condition What Does an ABN Do? zz Medicare does not pay for these tests as often as this The ABN serves two purposes: (denied as too frequent) zz It encourages Medicare beneficiaries to make zz Medicare does not pay for experimental or research informed consumer decisions about their medical use tests care. It provides beneficiaries the chance to opt out of zz Medicare does not consider these services to be rea- non-covered services and informs them of their finan- sonable or medically necessary cial responsibility should Medicare deny payment. PROFESSIONAL zz It shifts payment responsibility from the provider Modifier GA and ABNs to the patient. Delivering an ABN-covered service Use modifier GA to report a waiver of liability, or ABN, without a signed ABN and appropriate modifier on file. will cause Medicare to deny the services as the pro- Append GA to the line item which the beneficiary signs vider responsibility (PR) aka a write-off. Obtaining for EVERY TIME an ABN is signed. Failure to do so, the ABN and billing the line item with modifier results in Medicare inappropriately determining PR GA Waiver of liability statement on file generates a PR (write off) for the denied charge. denial which allows the patient to be billed and lists If the modifier GA is present, Medicare notifies the the charge as their responsibility on their OWN copy patient of their financial responsibility and the provider of the Explanation of Medicare Benefits. can legally bill the beneficiary for the balance due. How is it Delivered? More Information: CMS is very clear about how and when to deliver an ABN. If a patient needs help understanding the ABN process, 1. Verbally review the ABN with the beneficiary or the new ABN form includes the telephone number 1-800- their representative and answer any questions before MEDICARE under the “additional information” section. the ABN is signed. Providers can find a complete guide, including CMS 2. Do not change the ABN forms from the Office of instructions and forms, at: Management and Budget (OMB)-approved format www.cms.hhs.gov/BNI/02_ABNGABNL.asp#TopOfPage except for where allowed by customizable fields. OMB-approved forms are available at: www.cms.hhs.gov/BNI. 3. Deliver an ABN with enough time before the service Belinda S. Frisch, CPC, is author of rendered for the beneficiary to consider and make an Correct Coding for Medicare, Com- informed consumer decision. pliance, and Reimbursement, and resides in upstate New York. 4. Never use ABNs in emergency or urgent care situations. She can be reached at 5. Reproduce ABNs on a single page. [email protected].

8 AAPC Coding Edge feature

PT Coding

Sometimes Requires a Group Hug APPRENTICE Brad Ericson, CPC, CPC-ORTHO

Once a patient is evaluated by a physical therapist CMS to additionally clarify the situation. The key (PT), reporting outpatient therapy can become sticky. is code 97150 in different situations. In one, the PT The reason is twofold: PT modality coding is largely treats two or more patients whose condition or ther- based on 15 minute units, and a patient might receive apy has a common, unifying element. The patients a mix and match of massage, gait training, and myo- might all be post-low back surgery or attending pool fascial release in the same hour, The other reason is therapy. The clinician may provide some instruction that therapists sometimes treat patients individually and remain in attendance for the session for which and in a group at the same time. 97150 is billed. Mixed Patients Add Complexity In another situation, however, two or more patients may not have unifying elements and receive diverse When do you charge for the modality separately and therapies, but never at the same time. The PT is in when do you charge group therapy? The AMA CPT® constant attendance and the patients may perform exer- code 97150 Therapeutic procedures(s), group (2 or more cises developed for individual diagnoses and plans of individuals) can be reported for each member of a care. They are, however, in the clinic at the same time group. AMA guidelines for code 97150 say “Group with the same therapist, prompting the use of 97150. therapy procedures involve constant attendance of the physician or therapist, but by definition require Mix and Match one-on-one patient contract by the physician or thera- You can assign one-on-one codes along with the 97150 pist.” The Centers for Medicare and Medicaid Services for those units when the therapist provides individual (CMS) also defines group therapy in publication care. For example, while there are a number of patients 100-2, Chapter 15: 230, saying patients can be, but in the facility receiving therapy following knee surgery, don’t need to be, performing the same activity. The one patient may require neuromuscular reeducation physician or therapist involved in group therapy ser- of movement while another may require 15 minutes vices must be in constant attendance, but one-on-one of gait training. In addition to 97150, the first patient patient contact isn’t required. would receive two units of 97112 Therapeutic procedure, Here is where the clarity ends. What happens if you one or more areas, each 15 minutes; neuromuscular reeduca- have a group of Medicare patients coming in and out tion of movement, balance, coordination, kinesthetic sense, who are treated by the same modality during one posture, and/or proprioception for sitting and/or standing unit of their time in the clinic by the same clini- activities and the other would have one unit of 97116 cian but not at exactly the same time? And what Therapeutic procedure, one or more areas, each 15 minutes; happens if you have a bunch of patients in a therapy gait training (includes stair climbing) along with 97150. pool? Rarely are pool patients performing the same The duration of the group session for the applied code exercises in unison. Do you report 97150 or 97113 should be sufficient to ensure that professional ser- Therapeutic procedure, one or more areas, each 15 minutes; vices are provided. Because code 97150 is not broken aquatic therapy with therapeutic exercises? into timed units, it can be used with other interven- The Solution is Mixed, Too tions provided on the same day of services, although Brad Ericson, CPC, CPC- modifiers may be required. Guidance is found thanks to the American Physical ORTHO, is the director of publications at AAPC. Therapy Association (APTA), which is working with

www.aapc.com June 2008 9

meet the AAPC staff

Design & Layout, Publishing Department Meet theTina AAPC M. Smith Staff

I have come a long way from the six years I lived in Maui and Kauai, Hawaii. I knew I had an interest in the visual arts, so I explored my artistic side by creating small paintings mixed with found objects from the ocean, mostly sea urchin body pieces ground by the sand and waves to soft purples and greens. My art always turned out looking very simple and graphic but, I didn’t realize that I wanted a career in graphic arts until I moved back to Salt Lake City and went to college. I was inspired by great design I saw that was possible for print media, particularly book interiors and book cover design. I decided this would be my focus. One day while looking for work, the AAPC called me in for an interview. They hired me and immediately I went to work on the many books we publish. Talk about divine intervention. I had no idea that the AAPC published books when I went in for the interview. So I have been doing what I love for them ever since. Last September, I was asked to design and layout Coding Edge. I was reluctant at first, but took on the Up Close and Personal challenge; and, with the help of the great people I work with, I think the magazine is looking and reading better than ever. How do you spend your spare time? I really enjoy being outdoors. If I had my way, I Coding Edge has come a long way since its humble would be on a permanent camping trip, traveling beginnings of stick figure clip art and sparse articles. the western United States: exploring, rock climb- One of the most satisfying aspects of editorial design ing, and hiking with my boyfriend. Unfortunately, to me is solving the magazine’s problems every month. I have little time so I often settle for a movie or a My job is to visually present the article so you know night out with friends. what the article is about before you read it. This is challenging when you think of the often dry subject If you could do any other job what would it be? matter of the medical coding world. I solve a problem I’ve always wanted to be a garden designer. I’ve one article at a time, giving each piece a distinct per- never been more at peace than when I’m in a sonality, which I hope draws you into it. beautiful garden.

www.aapc.com June 2008 11 letters to the editor

Letters to the Editor

How Do You Interpret that level of service, even though it might help the Fifth Commandment? steer the physician during the visit. Dear Coding Edge, 3. Finally, CPT®/AMA is clear in the CPT® 2008 (pages 10-11) on how to assign an established I disagree with a portion of the article “The Ten patient level of service. Under these guidelines, Commandments of E/M Coding” by Dr. Stephen the MDM need not match the overall level of Spain. Dr. Spain’s Commandment Five is headlined service. The guidelines, as listed under each by the title “Medical Decision Making (MDM) code, state that only two of the three components Must Match Service Level.” This is wrong for three need support the level billed. Nowhere do I find important reasons. a rule indicating the MDM component should 1. Dr. Spain appears to draw a strict parallel match the overall level of service. These guide- between “medical necessity” and “medical deci- lines alone contrast with Dr. Spain’s article. sion making” in his explanation referring to the To sum it all up: The level of service warranted Medicare Claims Processing Manual, Chapter does not solely rely on just the MDM or the medi- 12, Section 30.6.1 (page 31). I don’t think his cal necessity in any way under the current guide- interpretation is substantiated by any CMS lines, and to state as such in a national publication literature that I have come across. These two is largely misguided. Rather, each level of service are related, but are definitely not the same. is determined by the three E/M components which Nor should one be substituted for the other. in turn should be driven by the appropriateness of Dr. Spain’s article implies that MDM somehow those services rendered (medical necessity), according carries more weight than the other two com- to the patient’s condition. ponents, which it does not, according to the guidelines. Dr. Spain defers to the individual Medicare intermediary’s criteria for the evaluation of MDM levels. 2. Secondly, CMS uses the term “overarching cri- But then why print this as a concrete rule if that terion for payment” when describing medical is the eventual course of action coders are to take? necessity. But it also goes on to say “in addition I believe the AAPC and the Coding Edge should to the individual requirements of the CPT® heavily consider publishing an additional article in code.” Dr. Spain indicates this CMS guidance an upcoming issue that clarifies this concept. Not supports his claim that the MDM must match doing so has the potential consequence of steering the level of service, which it again does not. many members, including providers, in the wrong CMS’s guidance also states that the “volume” direction when both are documenting and/or coding or sheer quantity of documentation should not their respective services going forward. be the primary influence on the level of service chosen. Volume doesn’t equate to the qualita- Troy Bagnall, CPC tive character of the documentation (where the Dear Mr. Bagnall, elements go in an audit form). CMS is simply stating here that the totality of verbiage should Unfortunately, you are not alone in following this logic, not be reason to code a level of service higher as I frequently encounter providers who exploit this than what is appropriate. This means the crite- argument as a loophole in the E/M coding system. ria for establishing the level of service should be Whether two or three elements are needed to deter- the type of elements included, not the number mine the level of service, the 2008 CPT® manual of elements, further supporting that the three says the components “must meet or exceed the stated documentation components (history, exam, requirements to qualify for a particular level of E/M MDM) should be the driving criteria for assign- service.” Using the CPT® manual instructions, by ing level of service. MDM alone does not drive default, whenever MDM is one of the required ele-

12 AAPC Coding Edge ments, it must meet or exceed the level appropriate as saying “The carriers are well aware that a physician for the billed level of service. Since you quoted the intent on upcoding can increase the level of the his- CPT® manual in support of your argument, I will tory and physical very easily. Medical decision making assume that you will rely upon it as an authoritative is something else entirely. This is where they’re going source in this regard. to be looking.” Dr. Eugene Winter, the medical direc- Having dispensed with any situation where MDM tor of Florida’s Medicare Fiscal Intermediary, First is used to determine the level of service, let’s turn to Coast Service Options, recently wrote providers that the circumstances where you say necessity (or MDM) the, “medical reasonableness and necessity standard does not play a role. As you stated, your argu- is the overarching criterion for the payment for all ment would only apply for the subset of established services billed to Medicare. Providers frequently ‘over patients where the provider or coder is relying upon document’ and consequently select and bill for a the History and Exam elements to rationalize the higher level E/M code than medically reasonable and billed level of service. As I understand your reason- necessary.” ing, it is your opinion that, in this circumstance, In conclusion, your assertion that MDM or the med- MDM or medical necessity does not come into play. ical necessity standard does not apply to some billed However, this is simply not the case. services is wholly outside the realm of accepted and Let’s use Medicare as the model. As stated in the published opinion and policy, and would pervert the Medicare Provider’s Manual, medical necessity is the principle of providing, billing, and being paid for overarching criterion for all payment. This is not only those services medically necessary. just Medicare Policy, it is the law (section 1862(a)(1) Stephen C. Spain, MD, FAAFP, CPC (A) of the Social Security Act). Calculation of MDM [email protected] is a tool used by providers and payers to quantify medical necessity. On Medicare’s end, a medical Dear Coding Edge Readers, necessity test is applied to every claim, even if the submitter of the claim is relying on only the history We’ll explore this controversial topic further in a and exam portions (remember, the law that charters future issue. the Medicare and Medicaid programs requires them Please use the AAPC online forums at www.aapc. to apply a medical necessity test to every payment com/memberarea/forums/index.php to post a thread they make). If you look at the “bullets” Medicare regarding Dr. Spain’s “The Ten Commandments of uses to assess the medical necessity of a service, you E/M Coding” article. will see that they match, almost completely, the Coding Edge components used to assess MDM. You should read an article that appeared recently in Please send your letters to the editor to: the AAFP Family Practice Management Journal written [email protected]. by Robert Edsall and Kent Moore, titled “Think- ing On Paper: Guidelines for Documenting Medi- cal Decision Making.” In the article, Dr. Pat Price, medical director for Medicare Part B in Kansas and Nebraska, is quoted as writing, “It should be the complexity of the medical decision making process and the medical problem which is the most heavily weighted factor determining the E/M service level.” In the same article, Dr. Charles Calodney, MD, who represents the American Academy of Family Practice on the AMA CPT® Advisory Committee, is quoted

www.aapc.com June 2008 13 All the coding educational resources you need from the authors of CPT®

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08-0334:pdf:4/08 brs coding news coding news by Michelle A. Dick and Sheri Poe Bernard, CPC, CPC-H, CPC-P Most ICD-9-CM Changes independent laboratories), physicians, prac- in Decade Proposed titioners, and suppliers. This ABN replaces the existing ABN-G (form CMS-R-131G), Centers for Medicare and Medicaid Services ABN-L (form CMS-R-131L), and NEMB (CMS) announced April 15 its proposed (form CMS-20007). changes to ICD-9-CM for 2009, and the number of new codes this year is the most CMS allows a six-month transition period in more than a decade. More than 330 new from the date of implementation, March 3, diagnosis codes are proposed and will be 2008, to use the revised form and instruc- posted in an upcoming Federal Register. tions. Providers and suppliers should use the revised ABN (CMS-R-131) no later than Included are codes classifying carcinoid Sept. 1, 2008. tumors by site; secondary diabetes mellitus in its own category 249; more than two For downloadable ABN forms, instruc- dozen new headache codes; retinopathy of tions, and FAQs, go to: www.cms.hhs.gov/ prematurity codes by stage; pressure ulcers by BNI/02_ABNGABNL.asp stage; and newborn necrotizing enterocolitis To learn more on ABNs, read the article by stage. More than a dozen codes associated “ABN: Shift Responsibility to Patients the with Pap smears and HPV and 25 obstetrics Correct Way” in this issue of Coding Edge. and gynecology codes were also added. Expanded Ways to In addition to the 330 proposed diagnosis Participate in PQRI codes, another set of more than 120 diag- On April 15, CMS announced new options nosis codes was presented in April to CMS under the PQRI program to make it easier with the request they be ‘fast tracked’ for to participate. inclusion in the new code set for 2009. The decision on whether those codes will be part New options in the PQRI law allows CMS of the 2009 changes will not be known until to offer: the Final Rule, expected to be published in • Reporting approaches that give you more options the Federal Register. in August. Along with to successfully participate. the new diagnosis codes more than 40 new • Alternate reporting periods to allow you to begin procedure codes for inpatient reporting were reporting on July 1, 2008, and still receive an incentive payment (1.5 percent of allowable charges proposed. All new 2009 ICD-9-CM codes for services provided from July 1 through Dec. 31). will become effective Oct. 1. • More options for submitting quality measures You can download a list of the proposed data to CMS through a qualified, established changes, at: www.aapc.com/documents/I- clinical data registry, in which you may already be 9ChangesfromCMS-1390-P.pdf participating. • Removal of the limit (cap) on your incentive for Use New ABN Forms the 2008 reporting period. CMS posted a revised Advanced Beneficiary For more on new PQRI reporting options, Notice of Non-coverage (ABN) for use when go to: www.cms.hhs.gov/PQRI/. Medicare payment denial is expected. The revised ABN is for providers (including

www.aapc.com June 2008 15 TOP Reasons for Employers to Participate10 in Project Xtern 10. Receive one free audio conference each year your facility participates with the Project Xtern program. 9. Be a mentor to a new coder. We each have so much knowledge to share. 8. Evaluate the extern’s work ethic prior to an employment offer. 7. Evaluate the extern’s skills and abilities prior to an employment offer. 6. Decrease initial employment costs. You have 90 days to preview an extern’s performance prior to making a job offer. 5. Train the extern your way. New coders are eager to learn. 4. Eliminate backlog with the use of additional staff at no extra cost. 3. Interview the candidates prior to externship placement and select the extern of your choice. 2. Select from qualified candidates in your area. 1. Eliminate recruitment costs. There is no fee to be listed as an Xtern facility.

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Stay Current with April 2008 Medicare Physician Fee Schedule Updates by Jean Acevedo, LHRM, CPC, CHC

18 AAPC Coding Edge hot topic

The added measures expand the practitioner’s program participation, potentially earning a 1.5 percent bonus based on the practitioner’s total Medicare allowed payments during the reporting period by including measures for back pain, mammography, and others.

ust when you thought you’d understood and The May 14, 2007, CMS Memorandum from the Jimplemented the Medicare Physician Fee Sched- Medicare Drug Benefit Group states “…if a vac- ule (MPFS) and HCPCS Level II updates from late cine is administered out-of-network in a physician’s last year, they’ve changed again. office, the physician would provide the vaccine and These updates occur each year as the Centers for its administration and then bill the beneficiary for Medicare and Medicaid Services (CMS) issues the entire charge, including all components. The technical directives to its contractors to ensure beneficiary would, in turn, submit a paper claim to contractors implement the appropriate logic for the the Part D sponsor for reimbursement for both the current year’s changes, as it clarifies the payment vaccine ingredient cost and administration fee.” If a rules and creates new HCPCS Level II codes. These patient comes to the doctor’s office for Zostavax (a “technical directives” usually publish in the first shingles vaccine), it’s expected the patient will pay half of the year. The April change request updates out-of-pocket for both the vaccine and its adminis- some payment files and includes new and revised tration. The practice should provide the Medicare codes for the Physician Quality Reporting Initia- beneficiary with a 1500 form showing charges for ® tive (PQRI). While the change request is published both the Zostavax (CPT 90736 Zoster (shingles) in April, the effective date for some of the changes vaccine, live, for subcutaneous injection) and its admin- ® is retroactive to Jan. 1 according to CMS Manual istration (CPT 90471 Immunization administration System, Pub. 100-04 Medicare Claims Processing, (includes percutaneous, intradermal, subcutaneous, or Transmittal 1482. intramuscular injections); one vaccine (single or combina- tion vaccine/toxoid)) for submission to the beneficiary’s Administration of Part D-Covered Drugs/Vaccines Part D drug plan. There will be instances where Since Medicare Part D (the prescription drug pro- the physician does not stock the vaccine and the gram) pays for certain vaccines, CMS created a patient picks the drug up from a pharmacy, or the HCPCS Level II code (G0377) for physicians to bill pharmacy delivers the vaccine, for administration in Part B for vaccine administration covered under Part the doctor’s office. Again, the patient is financially D. The ability to bill Part B for a Part D covered responsible for the physician’s vaccine administration drug no longer exists, so CMS deleted G0377 from and a 1500 form should be submitted to his or her the database effective Dec. 31. In the Tax Relief and Part D plan for reimbursement. Health Care Act of 2006, Congress modified the definition of a Part D “drug” to include its adminis- PQRI and Other Changes tration. CMS interpreted the act to mean the negoti- Almost 30 new performance measurement codes are ated price for a Part D covered drug included the included, and some existing PQRI code descriptions cost of administering the drug. CMS believes both were revised. The added measures expand the prac- the drug and its administration should be billed on titioner’s program participation, potentially earning one claim as a way to prevent fraudulent claims of a 1.5 percent bonus based on the practitioner’s total drug administration that was never given. Medicare allowed payments during the reporting

www.aapc.com June 2008 19 hot topic

period by including measures for back pain, mammography, and others. A number of other CPT® and HCPCS Level II codes were modified to reflect revised bilateral indicators, relative value unit (RVU) revisions, or procedure status changes retroactive J7613 Albuterol, inhalation solution, FDA-approved to Jan. 1. A number of J Codes (J7611–J7614) were final product, non-compounded, adminis- reinstated and the reinstated codes were effective for tered through DME, unit dose, 1 mg dates of service on or after April 1. J7614 Levalbuterol, inhalation solution, FDA- April HCPCS Level II Code Update approved final product, non-compounded, administered through DME, unit dose, 0.5 mg CMS has also published an update to the 2008 HCPCS Level II codes, MLN Matters number: MM5981. CMS Q4098 Injection, iron dextran, 50 mg updates the HCPCS Level II codes on a quarterly basis. The April update is particularly important if your IVIG Administration practice or organization provides inhalation therapy Along with a new HCPCS Level II code for intrave- with Albuterol or IVIG administration. nous immunoglobulin IVIG (Q4097 Injection IVIG Effective for claims with dates of service on or after Privigen, 500 mg), the April update includes revised April 1the following HCPCS Level II codes will billing instructions drawn from Change Request no longer be payable for Medicare: J7602 Albuterol, (CR) 5981 to ensure payment for G0332 Services for all formulations including separated isomers, inhalation intravenous infusion of immunoglobulin prior to admin- solution, FDA-approved final product, non-compounded, istration (this service is to be billed in conjunction with administered through DME, concentrated form, per 1 administration of immunoglobulin) to pay for additional mg (Albuterol) or per 0.5 mg (Levalbuterol) and J7603 pre-administration-related services where there may Albuterol, all formulations including separated isomers, be potential market issues when using Q4097. inhalation solution, FDA-approved final product, non- Effective April 1, the following codes are affected: compounded, administered through DME, unit dose, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol), J1751 Injec- J1561 Injection, immune globulin, (Gamunex), intra- tion, iron dextran 165, 50 mg and J1752 Injection, iron venous, non-lyophilized (e.g. liquid), 500 mg dextran 267, 50 mg. J1566 Injection, immune globulin, intravenous, lyophilized (e.g. powder), not otherwise speci- In their places are the fied, 500 mg following HCPCS Level II codes: J1568 Injection, immune globulin, (Octagam), intra- J7611 Albuterol, inhalation solution, FDA-approved venous, non-lyophilized (e.g. liquid), 500 mg final product, non-compounded, adminis- J1569 Injection, immune globulin, (Gammagard tered through DME, concentrated form, 1 mg liquid), intravenous, non-lyophilized, (e.g. J7612 Levalbuterol, inhalation solution, FDA- liquid), 500 mg approved final product, non-compounded, J1572 Injection, immune globulin, (Flebogamma), intra- administered through DME, concentrated venous, non-lyophilized (e.g. liquid), 500 mg form, 0.5 mg

20 AAPC Coding Edge hot topic

Medicare contractors will only pay a claim for If you don’t follow these billing rules the claim is pre-administration-related services (G0332) associ- denied with a message such as M67 “Missing other ated with IVIG administration if G0332, the drug procedure codes” or 16 “Claim/service lacks informa- (IVIG, HCPCS codes: J1561, J1566, J1568, J1569, tion.” The reason explanation of benefits codes often J1572 and/or Q4097), and the drug administration merely state something for claims adjudication was service are all billed on the same claim for the same missing but don’t tell you what. In the case of IVIG Jean Acevedo, LHRM, date of service; billing, you should check to see if guidelines noted CPC, CHC, President & Senior Consultant of Returned institutional claims for G0332 to the were followed. If not, then the specific information prompting either of these reason codes will be Acevedo Consulting Incor- provider if: porated, is President of the apparent. zz J1561, J1566, J1568, J1569, J1572 and/or AAPC Palm Beach County For more changes, check out Change Request chapter. She is a member zz Q4097 and (CR) 5980, issued to your carrier, FI, and A/B of the Editorial Advisory Boards of zz A drug administration service are not also billed MAC which may be viewed at www.cms.hhs.gov/ Medical Office for the same date of service on the same claim Billing and Collection Transmittals/downloads/R1482CP.pdf on the CMS Alert, Physical Therapy & zz Rejected professional claims as unprocessable for website. And, the April HCPCS update is found at Rehab Alert, and Internal G0332 if J1561, J1566, J1568, J1569, J1572 and/or www.cms.hhs.gov/transmittals/downloads/R1492CP.pdf. Medicine Coding Alert, national newsletters zz Q4097 and a drug administration service are not published by The Coding billed for the same date of service on the same claim Institute.

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www.aapc.com June 2008 21 minute with a member

Peggy A. Stilley, HSC, CPC, CPC-OGS, ACS-OB

Coding Edge (CE): Tell us a little bit about CE: What do you advise other coders to your career—how you got into coding, do if they disagree with the way a physi- what you’ve done during your coding cian has coded his chart? career, what you’re doing now, etc.? Stilley: My personal experience shows that Stilley: My health care career started in college physicians really want to do the right thing: working in a small town clinic where I col- they want the best care for their patients, and lected urine samples, ran EKGs, and cleaned up they want to be available for their family. after barium enema procedures. Soon I decided They are pulled in many different directions. to take on a more glamorous side of medicine Physicians rely on their staff for education by performing venipuncture at the local blood regarding new codes and regulations, and plasma donor center where we processed hun- they want coders to tell them when they are dreds of specimens each week. not “making the grade.” With that being Since then, I have worked for private physicians said, I have three suggestions: as a medical assistant, later moving into the 1. Be professional and courteous; earn their billing and coding side. In 1996, The Univer- respect and trust. sity of Oklahoma, Tulsa offered me the clinic 2. Ask for a time to discuss a specific issue. manager position for the obstetric-gynecology If they prefer, send an email, make quick department where I attended a coding class notes on a progress note, or ask for time in under the tutelage of Gay Boughton-Barnes. a staff or faculty meeting to go over tick- After several months of taking classes, reading, ets and errors. attending lectures, and having study sessions 3. Remember that when a provider is busy, over coffee, I took the CPC® test and passed it. your timing is critical! At the time, I didn’t know about the AAPC or what a certified coder represented. I hadn’t real- CE: If you could have any other job, ized the opportunities that they bring and the what would it be? people that I would meet and share experiences Stilley: Is there a market for a person over 50 with. I have been fortunate to have mentors to who is content watching peppers and toma- encourage me and become lifetime friends. toes grow, and making salsa with them when CE: What is your involvement level with they are ripe? your local AAPC chapter? CE: How do you spend your spare time? Stilley: Four years ago, I served as president. Tell us about your hobbies, family, etc. Prior to my presidency, I was responsible for our Stilley: I have three great kids. (I can say that local chapter newsletter. Currently, I serve as the now because they don’t live with me!) They education officer. We have an annual fall confer- blessed us with nine beautiful grandchildren. ence where the entire chapter is involved—this is A perfect weekend is when they all come the high-point of our year! Saturday for dinner and they all go home CE: What has been your biggest chal- Sunday afternoon. lenge as a coder? In the words of, George Carlin, “Surround Stilley: My newest endeavor is chairing a task yourself with what you love, whether it’s force of coders/billers in our clinic to examine family, friends, pets, keepsakes, music, plants, current work flow, identify common issues, hobbies, whatever. Your home is your refuge.” and recognize how charges are captured. We I love planting a vegetable garden and can- hope this helps us identify ways to standard- ning the fruits of my labor, reading a good ize procedures for the University, educate book, and watching movies that have a plot. residents and providers to become proficient at I love the ocean—my husband and I traveled coding, and extend the jobs of coders and bill- to Kauai for our 35th anniversary and we ers beyond that of scrubbing and correcting had the time of our lives. errors. I love a challenge!

22 AAPC Coding Edge kudos

Let’s Give Three Cheers! Raemarie Jimenez, CPC, and Jeri Leong, RN, CPC, CPC-H, Kudos to Marti Geron, CPC, CMA, CM, reimbursement manager, were recently highlighted in Advance for HIM’s March 24 issue as department of pediatrics at the University of Texas, Southwestern two of its Top 10 in HIM. Medical Center at Dallas, for the past 10 years. Birdette Bean, RN, Raemarie received honors as Top Pathfinder for her work expand- CPC-I, president of the Scottsdale, Ariz. local chapter, said, “Marti ing the Project Xtern program and presenting career experience has accepted a position as an auditor with the University of Texas’ opportunities to new coders. Advance billing/institutional compliance office. She was my coding instructor said Raemarie doubled the number at the University of Texas, Arlington, of Project Xtern sites from 80 to 167. and I’ll always be thankful for the Raemarie is also responsible for the coding foundation I gained in that Coding Edge’s advertising. class! Marti has been a successful reimbursement manager and coding Jeri, a former National Advisory instructor—a great accomplishment, Board (NAB) president and a tireless and now I congratulate her and give coding evangelist, was named Top her ‘Kudos’ for her newest achieve- Trailblazer for virtually establishing ment—a position as an auditor!” coding as a profession in the state of Hawaii, the only state that requires certified coders for medical bill review. Jeri began by hold- ing chapter meetings around a kitchen table—now, the state has more than 400 members! Kudos to you both from Coding Edge!

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www.aapc.com June 2008 23 cover

Families Who Code Together Stay Together by Michelle A. Dick, Senior Editor

Photo by Nathan Crowley Hoofer Sisters: Coding has kept us close, traveling, and working together Four Texas Sisters Toni says “We have been very blessed with the jobs Toni J. Hoofer CPC, PMCC, ERCS, emergency room we have now. We are emergency room coders and we coder, elected to speak on behalf of the four coding sisters. work from home. We are employed by a company in Okla. In 2006, we moved our parents down closer to Toni started coding in 1998 after working 15 years us due to health problems. Our father is on hospice in long term care. Toni answered an ad in the paper because of heart problems and this has made it easier for a coder at a billing company. She said, “I was to help take care of him. This profession has helped given a chance and, as they say, the rest is history. us deal with doctors, hospital, pharmacy, etc.” This billing company has at one time or another, since 1998, employed all of my sisters.” Toni became Coding Challenges certified in 1999, and her sisters followed suit soon The biggest challenge in coding for the four sisters after: Tammy Bellamy in 2003, Tina Myers in 2004, is the amount of knowledge that is needed and how and Terri Stone in 2005. it grows and changes daily. Keeping up with the

24 AAPC Coding Edge cover

“In 2006, we moved our parents down closer to us due to health problems. Our father is on hospice because of heart problems and this has made it easier to help take care of him. This profession has helped us deal with doctors, hospital, pharmacy, etc.”

changes is exciting. Toni said, “We are all active ticipate in with mom, and we do win. Taking care of members in the San Antonio Chapter of AAPC. the family is very important to all of us and our jobs Networking, attending conferences, and meeting have made this possible. We are truly blessed. Our new people has helped and we do this together.” parents have done a wonderful job and now it is our turn. We are a very proud family.” Family Get-togethers Tina agrees with Toni that family is important and When Toni reflects on how coding has affected her coding helps tie them together when she said, “My family, she said, “We have a relationship that many sisters and I have always been close. We all had sepa- people are envious of—growing up in the mili- rate careers and families, and we always stay in touch. tary sometimes you only have each other. Coding has kept us close, traveling together, and working When we all became certified and started coding together. We have two younger brothers (not in together, I learned a new respect for all my sisters. coding), but our sister-in-law, Cindy Hoofer, was We talk constantly, answer questions, just bounce trying to decide on a career change; she studied on things off of each other, and are never too busy to her own and in 2007 she passed the CPC exam in St help each other. My sisters are the greatest and I can Louis, Mo. We really do have a family affair!” not imagine my life without them.” The sisters have yearly family reunions that their After a long day at the office where all you do is father started several years ago. Toni said, “Get- live and breathe medical coding, imagine yourself ting together is like the ‘Family Tradition,’ Hank plopped on the couch relaxing, feet up. You try hard Williams Jr. song. The conversation always comes to forget the E/M claims that were denied earlier around to coding and the other members just roll today. Slowly, the denials slip from your head, and their eyes and give us a few laughs. There are many then you hear a voice say, “Did you hear that the medical questions that come up and of course we new ICD-9-CM codes might be released?” This sce- have to put our two cents in.” nario is familiar to many AAPC members: the passion for coding doesn’t stop at the office and it has We Are Family: I Got All My Sisters and Me found a haven in the family household. Toni, when referring to her sisters’ families said, We interviewed four very different families with one “I am the only single one in the bunch (good or common thread—coding. These four members tell bad), my spare time is with the Sci-Fi Channel and Coding Edge how coding not only affects them, but attending Red Hat meetings with friends. My sisters how it affects their families. What these individuals have husbands and grown children and pets that have in common is they aren’t the only member in keep them busy. BINGO is a pasttime we all par- their families who are passionate about coding.

www.aapc.com June 2008 25 cover

“How many times do you call your coding mentor, who in my case is my mother, and end the call with ‘I love you, see you soon!’ I’m sure when I first started working in my office, people had to think I make personal phone calls all the time, but even though I am talking to family, it really IS work related!”

Family Relationships and Coding Coding has affected Beth’s family relationships in a positive way, as she frequently calls her mother from work with coding questions. Beth said, “How many times do you call your coding mentor, who in my case is my mother, and end the call with ‘I love you, see you soon!’ I’m sure when I first started working in my office, people had to think I make personal phone calls all the time, but even though I am talking to family, it really IS work related!” Since there are four coders in the family, it can sometimes be difficult to have a family gathering without discussing coding. Beth said, “My dad and I made a pact a long time ago that we weren’t going Jones family: Ending calls to talk about coding at the dinner table, but sometimes we have to remind my mom. She just giggles to your mentor with “I love you” when we do.” As for how coding has affected non-coders in the Two Sisters, Mom, and Dad family, Beth says, “I don’t think it has affected relationships with the non-coder family members. At different Beth Wolf, BA, CPC, coding consultant for HCA work- points, we have had uncles, aunts, cousins, etc., thinking with Regulatory Compliance, shares with us her ing about a career in coding—but so far, it’s just me, coding family members’ story. mom, my dad, and sister. If we get any more family Beth’s mother, Joyce L. Jones, CPC, CPC-H, CCS-P involved, we will have to start our own chapter!” CPC-ASC, CNT, director of business operations at AmSurg, is her family’s coding inspiration. She’s Family Get-togethers the coding inspiration for Beth; her dad, Clifton L. It’s easy for Beth’s family to get together for family Jones, CPC, CCP, lead physician education special- functions as they all live relatively close to each ist at Community Health Systems; and sister, Traci other in the Nashville, Tenn. area. She said, “With Linn, CPC, partner and manager of business opera- the size of our family, we usually have a birthday or tions at Evergreen Healthcare Solutions. holiday to celebrate each month, as well as cookouts Joyce helped Beth and Traci find jobs after school. or bonfires. The women in my family have a tradi- Beth worked in a coding department while Traci tion of making chocolate candies every Christmas. worked in a doctor’s office. Cliff, on the other hand, It’s a tradition we started in honor of my grand- would listen to Joyce while teaching the AAPC mother (my mother’s mom).” Coding Curriculum. Before and after Joyce’s lessons, Beth’s spare time is spent training for a half mara- she had a long way to walk and Cliff wanted to be thon. She enjoys reading, cooking, and art. She is sure she was safe. He would sit and wait for her, and married to her best friend, Jason. They have two eventually, he learned how to code. cats: Belle and Max.

26 AAPC Coding Edge cover

“Coding together as a family can actually become quite passionate, at times. Instead of playing Monopoly or Texas Hold’em like other families when they get together, I find we will often bring up the coding challenges we have encountered during the work week.”

Mom, Dad, and Daughter Jo-Anne Sheehan, CPC, founder of Lomar Associates, tells us about her coding family. Jo-Anne’s company provides medical billing, coding, and consulting services in the New England area. She has been featured in Working Women magazine and National Electronic Biller’s Alliance newsletter and has acted as a medical billing expert in highly profiled insurance fraud cases in Boston. Jo-Anne’s husband, Thomas Sheehan, DC, CPC, has had a successful chi- ropractic practice since 1988. He joined Jo-Anne in 1993 to help her manage her growing company, and assists employees and clients who need help in coding or billing. Tom is working with Jo-Anne as an approved AAPC “in house” vendor, training Lomar’s staff for their CPC®. Dianna Lomasney, their daughter, attended Salve Regina University and is training under her parents to be a CPC®. Sheehan Family: Coding: Fun for the Family Coding replaces Monopoly and poker Coding has affected Jo-Anne’s relationship with other family coders in a positive way. She said, “Coding members, she said, “My son, Steven, attempted together as a family can actually become quite pas- coding and billing for my company last year, but sionate, at times. Instead of playing Monopoly or Texas decided he liked automobiles better. He now is Hold’em like other families when they get together, studying to be an automotive technician at Uni- I find we will often bring up the coding challenges versal Technical Institute (UTI). He had a difficult we have encountered during the work week. We then time understanding why coding rules varied among review tough operative notes together that require payers. He didn’t like the fact that coding was not different approaches and solutions. Tom, my husband, black and white. ‘Too many gray areas,’ he said. I is truly a teacher of anatomy and physiology, and his have to agree with him. You either adapt and fit the approach to coding strategies is based on that knowl- mold for this job or find a different career path. His edge, where Dianna and I approach it from a coding girlfriend, Jessica, now works for me and is anxiously ethics point of view: bundling and unbundling, modi- preparing for the CPC® exam.” fier usage, insurance carrier rules, etc.” Jo-Anne’s 14-year-old daughter, Mary Kate, tolerates Jo-Anne feels coding together has definitely brought all the coding discussions. She wants to have fun when her family closer. She said, “The simple fact that my the family gathers. If there are serious discussions to husband and I relocated our businesses to be together be had, they should be about Hanna Montana or the for my staff and to work together truly says it all. I Jonas Brothers. As of right now, Mary Kate is defi- also enjoy taking a day off from the office with Dianna nitely not interested in a coding career. “Of course, to attend seminars about coding. The seminars com- time will tell ... Dianna wanted nothing to do with bine family time with education—lots of fun!” coding when she was in high-school or college but Coding May Not be for Everyone somehow she has managed to work for Lomar Associ- When referring to Jo-Anne’s non-coding family ates, and she is truly my shining star!”

www.aapc.com June 2008 27 cover

“We get together at family gatherings and laugh at some of the funny situations we have encountered. The rest of the family kind of looks at us like, ‘What’s so funny?’ It makes it even more fun between us.” The Halls and Teels Family: Coding brings laughter at family gatherings

Mother and Daughter-in-law said, “They mostly hate it when we start ‘talking Rena G. Hall, CPC, and Amanda Teel, CPC, share shop,’ but all in all, there hasn’t been any major con- their family coding relationship flict because of it.” Amanda said, “Sometimes when we ‘talk shop’ the rest of the family just looks at us Rena fell into coding while working as a reception- as if we are speaking a foreign language!” ist. She was offered a position in the billing and coding department in 1988. Since Rena started, she Talking about coding can lighten-up the atmosphere has worked many roles in the claims process. She has at family functions. Rena said, “We get together at worked in billing and collection, coded, researched family gatherings and laugh at some of the funny claims, and followed-up, audited, and appealed. She situations we have encountered. The rest of the now bills insurance for KC Neurosurgery. Rena’s family kind of looks at us like, ‘What’s so funny?’ daughter-in-law, Amanda, was introduced to medi- It makes it even more fun between us.” Amanda is cal coding and billing when she worked as a unit thankful that she married into a family where she clerk at an area hospital. She works for an insurance can honestly say “I love” about her in-laws. “Not a company in customer service, and is training in data holiday goes by that we are not all together.” entry, which places her closer to coding. She recalls, What Free Time? “When my supervisor left to work for a Medicaid Rena’s spare time is spent singing and playing hand HMO, she recruited me to come along and do the bells at her church. She enjoys taking Spanish les- inpatient authorizations … the rest is history!” sons. Rena said Spanish, “Another challenge, but I Rena and Amanda both agree that coding can be a thrive on challenges!” Amanda has three children challenge. Rena said “My biggest challenge is trans- who are actively involved with sports and church lating the doctors’ terminology into the terminology activities, which takes up most of her free time. ® used in the CPT and ICD-9-CM books!” Amanda Amanda said, “When I do have a free moment, I declared “I would have to agree with Rena!” love paper crafting and quilting.” Together Rena and Family Relationships and Coding Amanda enjoy making flavored coffees and cocoas and sharing recipes. As for how coding has affected their relationship, Rena said “Amanda and I have always been pretty close. This career just gives us one more thing in Michelle A. Dick holds a BS in graphic common.” Amanda agrees, “Rena and I have always design from Buffalo State College. She been close, but it is nice to have someone who under- has been editor-in-chief for six graphic design tutorial publications, editor for stands when you have had a frustrating day and why!” the Coding Institute’s Part B Survival When referring to the non-coders in the family’s Guide, and is now engulfed in the reaction to their common passion for coding, Rena world of medical coding

28 AAPC Coding Edge cover

More Families Who Love to Code

Coding Edge received an overwhelming response to our Bulletin Board’s call for coding families. Although we couldn’t include everyone’s comments, here are some coder family stories we received from members. I had to laugh when I saw your inquiry on this month’s a director of business operations for a private practice bulletin board regarding coding families. Mine is such specializing in mental health for seniors. that when I was pregnant with my son, my friends We constantly have coding conversations at family tried for months to get me to name him ‘Codey!’ gatherings and everyone looks at us as if we are speak- I’ve been in the field for about 15 years now. My ing a foreign language! When the three of us get husband, Russell D. Skow, CPC, and I were mar- together the topics are ICD-9-CM and CPT® codes. ried seven years ago, and at that time he was work- Angela R. Roberts, BBA, CPC ing as an electronics technician. Day after day, I would come home from work regaling tales of fas- I began working in an HIM department about 12 cinating operative sessions, legal compliance chal- years ago, but not in coding. Within a few months, lenges, and the latest on the OIG Work Plan. My I learned and worked in coding. I thrived in coding husband would just look at me and roll his eyes. and in 2002 passed the CPC-H® exam. When my A few months later, I started teaching medical daughter, Melissa Tweedie, CPC-H was in high coding and reimbursement at a local allied health school she started volunteering at our hospital in college. I encouraged him to audit my night “Intro- the HIM department where she filed and pulled duction to Medical Coding” course. My husband records. Eventually, she was hired to do part-time caught on quickly. I was surprised at how well he work while still in high school. We are very close seemed to grasp the material (maybe I was just really and this brought us even closer together. that good of a teacher). He continued in the associate When the time came for Melissa to choose a course degree program (with other instructors), and went on of study, she decided to apply at Alfred State Col- ® to earn his CPC certification shortly after. lege, in the two year health information technology/ Contrary to popular belief, we don’t sit around the medical records associate degree online program. dinner table every night discussing coding. We didn’t She was also interested in coding and decided to end up naming our son ‘Codey,’ or teach him num- take the coding and reimbursement specialist cer- bers using CPT® codes. However, there are times, tification at the same time. I had always wanted when the mood and lighting are just right, that a to go to college and earn a degree, but the timing little HPI or ROS talk really makes an evening! was never right. Melissa convinced me that I should Heather J. Skow, CPC, Area Reimbursement also enroll. We were both accepted to Alfred State Manager, South Region Critical Care Systems College and graduated two years later. Melissa and I worked for the same HIM department full time; I am a CPC®, and have two sisters-in-law in the myself as a coder and Melissa as a HIM clerk, while business as well. Cynthia M. Roberts, MA, RHIA, pursuing degrees full time. I furthered my creden- the eldest of the three of us has a master’s degree in tials and passed both my RHIT and CCS exams. healthcare information management (HIM) and is an Recently, Melissa passed the CPC-H exam. HIM director. Charlene E. Young, CCS, is the middle Linda Benson, RHIT, CCS, CPC-H sister and is an inpatient coder for a university medical center. I am the youngest of the three and I work as

www.aapc.com June 2008 29 Want to know more about health coverage Relax. for individuals? For a free quote or to apply visit us at www.AAPC.com We can help you choose the health Member Beneﬁts Section insurance coverage that’s right for you of Your Member Area

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Choice: Aetna‡ has a wide range Just a call away: Our Member Assistance of affordable health insurance plans, Program provides telephone access to including coverage for children only. licensed clinicians for consultation and Immunizations are covered 100 percent. referrals to community services 24 hours a day, 7 days a week. Access: Benefit from our national network of physicians, hospitals and dentists. Health Savings Account (HSA) Compatible plans available: No waiting period: No waiting period to You can pay for qualified medical access preventive health (routine physicals) expenses with tax-advantaged funds. or annual routine GYN exam coverage. Please consult your independent Locked-in rates: Your rates can be financial advisor before opening an modified from the time in which you HSA or making an investment selection. got your quote, however rates from the effective date are guaranteed not to increase for 12 months in most states.

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In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans. Coverage through the AAPC program are not guaranteed issue, however you may be eligible under HIPPA for guaranteed issue plan. Information subject to change. Plans may be subject to medical underwriting. H ealth insurance plans contain exclusions and limitations. Investment services are independently oered through JPMorgan Institutional Investors, Inc., a subsidiary of JPMorgan Chase Bank. ©2008 Aetna Inc. 13.03.385.1-AAPC (4/08) Changes to Coding Edge

You’ll see some changes to Coding Edge in the next few months we Eventually, we’ll replace Test Yourself in the Coding Edge with more feel will make your be a member easier and more satisfying. We’re good information by members. You’ll still be able to take the tests responding to your requests for more information and better access and get the CEU through the Member Area on our Web site. to what you need not only to maintain your membership, but zz Exam Dates Another change you’ll notice beginning with improve your stature as a coder. this issue is the removal of the Exam Dates. These are posted Some of the changes include the following: on www.aapc.com on the main page under Certification. Go to zz Test Yourself is now online at www.aapc.com. Sign in to the Exams and note your state. A complete list updated in real time Member Area and go to Resources. Open the Coding Edge and lets you know where and how to apply for the next exam closest you’ll see electronic copies of past issues. Since April you’ve been to you. able to complete the test on-line. zz The limitations of space and the magazine’s monthly sched- zz How? Select the Test Yourself to the right of the magazine. ule prevented us from bringing you all or the latest scheduled Take the exam while reading the magazine or open the elec- exams. We’re excited to be able to dedicate that space to another tronic copy. Search for the answers and fill in the button. If coding article, helping you do your work while the AAPC Web you’re wrong, you can try again until you’re correct. This helps site helps you pursue your certifications. you understand what answer coincides with each story. We’re anxious to serve you. Please let us know what else we can zz When finished with a correct test, select “Grade” and you’ll see do with Coding Edge to make your work a little easier, your career a your certificate and the CEU will be automatically posted in little more full, and the magazine more useful. your CEU tracker. Brad Ericson, CPC, CPC-ORTHO Director of Publications

www.aapc.com June 2008 31 member survey

The Work of a Coder: Survey Tells Us Who We Are

More than 12,000 of you responded all, 31 percent of respondents said they work at in January to the Work of a Coder survey. It revealed home some of the time, and 8 percent said they some surprising results, further defining us as a pro- worked at home full-time. The highest number fession and helping to debunk some stereotypes. of telecommuters is found among billers; 39 The survey, made available online through a Web percent work at home some of the time and 13 link, was open to responses for six weeks. It gar- percent work at home full-time. Only half said nered 12,068 respondents, of which 93.5 percent professional coders review EOBs and handle were professional coders certified through AAPC. appeals at their office. The survey collected demographic information zz Six out of 10 said their physicians have a solid regarding work environment and credentials, and knowledge of coding and compliance, and seven included 40 questions specific to work and work- out of 10 say their physicians comply with ing relationships. Completing the exam were 8,975 coding documentation requirements. coders, or 74.4 percent of participants. The data zz Most (93 percent) say they are provided with aggregation engine for the survey was provided by necessary resources and that their employers pay SurveyMonkey.com. for their CEUs (71 percent). Only 62 percent of The results found in the Members area of the AAPC employers pay for membership dues. Web site, were completed by coders in all walks of zz Fifty-six percent of respondents said their physi- life. Half work in physician practices. Billing com- cians perform coding duties in their practice. pany employees comprise 11.8 percent of responses, Of those physicians who code, 71 percent do so and outpatient hospital employees, 9.8 percent. The regularly or all the time. Of those who code, weight of the numbers in physician practices is three out of four do so using cheat sheets or reflective of AAPC membership. The survey goes EMR pick lists. further into the actual tasks performed in the office. zz Most physicians, however, don’t have formal But that’s where the ho-hum part of the survey coding education while their coders do. ends. Here are some of the interesting results: zz Most of those surveyed (92 percent) felt relation- This exhaustive survey by the Academy helps ships between providers and payers are positive. confirm the role of the coder while clarifying mis- zz Respondents like the idea of working from conceptions in a profession that continues to grow home, and frequently mentioned noise in the and change. For a more specific look, check out the office as a problem affecting productivity. In Members area of the AAPC Web site.

32 AAPC Coding Edge member survey

The relationship between my practice and payers is positive. 7,073 responses

80% 70% 60% 50% Quotes from the Survey 40% “I am very lucky. I work for a physician that understands 30% coding and the importance of proper coding and compli- 20% ance. He helps me keep informed on changes and also helps me with my education and CEUs.” 10% 0% “My employer understands & appreciates the value I bring Strongly agree Agree Disagree Strongly to the company. I also have taken on an unofficial role as Disagree an educator and compliance officer to inform our company about coding changes and compliance issues. I am very fortunate to be working for a company like this one.”

“In the past, they were content in coding everything as pain and only providing one Dx per claim. I have proven that by being creative and using specific Dxs and different Dxs for different tests, reimbursement for these services To see this information have increased with fewer appeals and more, go to the necessary. Yes, I have made a differ- Resources tab in the ence in their practice.” Members area of the AAPC Web site. “I love my physicians but sometimes I think that they think the coders are the bad guys because we give them My employer pays for CEUs back charts to dictate as well as needing more information. to keep my knowledge current. 8,414 respondents We don’t have the same relationship as the other admin- istrators in our office. Everybody is laughing and having 45% great relationships with everybody else, except for us. We have to be in an office together (3 coders) and trudge away 40% coding, trying to make ends meet at the end of the month, 35% while it seems like everybody else isn’t even working. The coders put in a ton of hours. Sometimes I wish I could be 30% the one out there building relationships with the physicians 25% to let them know that we do have a personality and that we’re not the bad guys.” 20% 15% “The coding department is always the ones to blame when revenue isn’t being generated fast enough.” 10%

“When the coders go to classes and return with informa- 5% tion, the providers do not always accept what we have 0% learned as accurate.” Strongly agree Agree Disagree Strongly Disagree

www.aapc.com June 2008 33 member survey

Work of a Coder: Which Hat Do You Wear? AAPC Survey Reveals Coders Can Be Enforcers or Rescuers by Sheri Poe Bernard, CPC, CPC-H, CPC-P

Sorting through the thousands of responses to If you are a firefighter, bravo! You’re part of a team AAPC’s The Work of a Coder survey, it is clear that with common goals and mutual respect. Your physi- coders love coding. cian may see you as a firefighter because of your own But for coders working in physician offices or clin- communication skills and team-building activities, ics, a strong division arises between those who love or you may be benefitting from groundwork laid by coding and love their jobs, and those who love your predecessor. It’s also possible that you work for coding but are downright miserable in the work- a provider who independently figured out your role. place. How do we account for the difference? Count yourself lucky, as this survey respondent does: It may boil down to something as simple as percep- “The relationship between coders and physi- tion. Consider this analogy: We all, intellectually, cians is collaborative, and communication is appreciate the fact that our neighborhoods and our essential to compliance and reimbursement. families are kept safe by police and firefighters, We are the “business side” to the medical either of whom would risk their life to protect you office and we are valued as “equal partners” from harm’s way. Emotionally, however, each creates in the success of our practice. My employer a very different response in us. generously provides resources and training When we think about an encounter with a police (including conferences) for the coders in equal officer, what images do we conjure? We think of measure to other members of the practice someone who demands that we slow down, or some- (medical staff & providers).” one who waits to give us a ticket. The police officer If you are a seen by your providers as a police officer, is seen as an obstacle between us and our goals. He work to change your hat. Consider new communica- may have public safety as his goal, but to us, he’s an tion tactics and work approaches. The fact that you unwelcome enforcer. are perceived as an enforcer is not necessarily your When we think about an encounter with a fire- fault. It could be that your physician doesn’t appreci- fighter, what images do we conjure? We think of ate impediments to his clinical calendar, even when someone saving a cat in a tree, or rescuing a sleeping they lead to higher reimbursements. Or it could be family from a house fire. The firefighter is seen as that a previous coder employee warped the physician’s someone who makes himself an obstacle between us view on the value of coders. What can you do to help and certain danger. His goal is public safety, and we your physician see you differently? We may find some look upon him as our lifesaver. answers if we look at the activities of firefighters: When your physician sees you heading his way, Prevent and educate. The best fire is the one that who does he see: the police officer or the fire- is prevented. Work with your physician to reduce fighter? An obstacle and enforcer or a welcome future errors by ensuring he or she understands the lifesaver? The answer will correlate directly to your problem. Bring documentation or examples to illus- own job satisfaction. trate your case, and keep your explanation as concise as possible.

34 AAPC Coding Edge member survey

Never forget you and your physician are on the same team. Firefighters work in large teams and each player has a critical role. In teamwork, there is no right or wrong. Instead, everyone is committed to mutual success.

Remember: is dependent upon devising a plan and following it zz Don’t fan the flames. Keep your voice level and through. Do your homework before each encounter unemotional. Don’t use “hot button” words like with the physician team. Have copies of coding or “always,” “never,” or “wrong.” Once a physician is compliance rules you plan to cite. Be organized in put on the defensive, communication suffers. your written and verbal communications, and link your concerns to the “vital signs” ($$$) of the busi- zz Speak in positive tones. Many people only ness. How is this going to safeguard the practice point out what is wrong; be sure to praise what and increase revenues? is right. Outline steps to improve the rest. Put dollar amounts to your suggestions to move your Foster teamwork. Never forget you and your physi- image from “enforcer” to “money-maker.” cian are on the same team. Firefighters work in large teams and each player has a critical role. In team- Size up the problem. Before firefighters enter a work, there is no right or wrong. Instead, everyone is building or climb their ladders, they assess the situ- committed to mutual success. If your language and ation to determine which approach will be most attitude communicate self-righteousness, teamwork effective. Coders seeking information from their pro- is doomed. A team culture in which everyone is viders should do the same. Ask neutral, introductory chasing mutual goals is what you seek. Look at how questions, and agree where you can. An emphatic everyone suffers in this survey respondent’s office: nod accompanied by “Absolutely!” or “So true!” can get frank answers to your follow-up questions. “I have been met with resistance and outright Follow-up questions can help you sort feelings from anger when I have asked the physicians to cor- facts. Wear down resistance with good humor and rect, complete or comply with whatever would an earnest desire to fix the problem. Leave your ego be necessary to warrant the code they wish to at the door. be sent on to the insurance company. Now I Preserve and control. Do what you can to diffuse just down-code the fee ticket if it is not docu- the heat. The best way is to remain emotionally neu- mented it was not done.” Sheri Poe Bernard, CPC, tral yourself, even when faced with a confrontational Many times, we make the mistake of thinking our CPC-H, CPC-P, is vice pres- doctor. Don’t respond to aggressive or angry ques- coding abilities are enough. But it is human nature ident of member relations to value trust more than competence. Earn your pro- has been a National Advi- tions with an answer. When you answer an angry sory Board member for six question, it sends a message that the question’s tone viders’ trust, and they will see your competence. Use years, serving four years as is appropriate and you are the rightful recipient facts, data, and coding and compliance rules to allow the board’s executive team of anger. Instead, ask another question, or make a your physicians to make their own analyses. Don’t secretary before being comment acknowledging the physician’s concern: “I feel their need to validate. The facts are a reflec- elected president-elect. She tion of your abilities. Trust is developed over time, worked at Ingenix for 15 know exactly how you feel—this is so frustrating!” years before joining AAPC. Not only will this help to cool the situation, but it and they will eventually be comfortable with your She is a frequent speaker also results in you gaining a reputation as an even- presentation of the facts without having to inves- at national coding events tempered professional. tigate the issue themselves. When that happens, and has published several you’ll know you’ve changed hats and are a bona fide medical coding and reim- Search and rescue. Successful search and rescue coding firefighter. bursement articles.

www.aapc.com June 2008 35 2008 Audio Conferences Get all remaining 2008 $ $ audio conferences for: 699 399 And your entire o ce can listen in!

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06/11/08 Top Ten Claim Submission Errors & How to Avoid Them Linda Farrington 06/18/08 Orthopedic Guru: The Nuts & Bolts of Coding For Orthopedic Surgeries Lynn Anderanin 06/25/08 E ectively Using the Internet & Other Tools to Find Coders & Coding Jobs Bevan Erikson 07/09/08 The Basic Anatomy of an E/M Code: Selecting the Right Level of Service Marsha Diamond 07/16/08 OB-GYN Guru: Coding & Billing OB-GYN Services Arlene J. Smith 07/23/08 Climbing the Coding Ladder: How to Move Your Career to the Next Level Lynn Anderanin 08/06/08 Risk Assessment: How Internal E/M Audits Can Hurt & Help Your Practice Marsha Diamond 08/13/08 Pediatric Guru: Coding & Billing Pediatric Services Lisa Jensen 08/20/08 5 Things You Need to Know About Consumer Directed Healthcare & Your Practice Linda Farrington 09/10/08 Commercial Payer Audits: Providers, Payers & E/M Visits- Preparation and Readiness Stephanie Jones 09/17/08 Pay For Performance in the Private Payer Marketplace Linda Farrington 09/24/08 Cardiology Guru: Coding & Billing in Cardiology Terry Fletcher 09/26/08 2009 ICD-9-CM Update John Bishop 10/08/08 Stop Lost Revenue! Commonly Un-coded Services Missed With Your OV Marsha Diamond 10/15/08 Interventional Radiology Guru: Coding & Billing For Interventional Radiology Services Sandy Giangreco 10/22/08 Ancillary Services: What You Need To Know When Adding New Physician Services to Practice Jonnie Massey 11/05/08 Medical Informatics Principles – Coding, Data Mapping & the CPC Annette Grady 11/12/08 2009 AMA CPT-4® Update John Bishop 11/19/08 2009 Specialty Specic Update – Orthopedics Lynn Anderanin 11/26/08 2009 Specialty Specic Update – Anesthesia Raemarie Jimenez 12/03/08 2009 Specialty Specic Update – Pediatrics Lisa Jensen 12/16/08 2009 Specialty Specic Update – Radiology Jean Acevedo 12/17/08 2009 Specialty Specic Update – Cardiology Terry Fletcher 12/18/08 2009 Specialty Specic Update – Internal Medicine John Bishop And More! * Audio conferences are subject to change All audio conferences begin at 1 p.m. EST.

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For a Limited Time 2008 Audio Subscription subscribers may purchase individual CD recordings of each live conference for $39.95. When an individual audio conference is purchased ($149.95) a CD will be included for free. newly credentialed members newly credentialed members

Denise Loraine Thompson, CPC Flint MI Kavitha Velumani, CPC Ricardo M. Bautista, CPC-A Chula Vista CA Olga L. Gutierrez, CPC-A, CPC-H-A Torrance CA Chantle Ames, CPC-A Huntington UT Southeast Ronda L Davidson, CPC Kentwood MI Chennai Tamil Nadu Hideki Yoshikawa, CPC-A Chula Vista CA Milagros Suello Pidazo, CPC-A Tustin CA Valarie Farnsworth, CPC-A Huntington UT Katie Lynn Johnson, CPC, Danville, AL Michele Lynn Curtis, CPC Leslie MI Magee Xavier, CPC Chennai Tamil Nadu Barbra L Comunale, CPC-A Claremont CA Alicia Beverly, CPC-A Vallejo CA Branda Bird, CPC-A Kearns UT Pamela Fenoff, CPC Crestview FL Traci Ann Cook, CPC Saginaw MI Renuka Karuppannan, CPC Martha H Robledo, CPC-A Commerce CA Mia M Garbes, CPC-A Van Nuys CA Joleen Strunk, CPC-A Kearns UT Paula Leigh Royal, CPC Daytona Beach FL Amanda Alice Snyder, CPC Sterling Heights MI Comibatore Tamil Nadu Jacklyn Ann Kirk, CPC-A Discovery Bay CA Peggy P Shadkamian, CPC-A Woodland Hills CA Kari S Huts, CPC-A LaSal UT Sandra Kay Ball, CPC-H Milton FL Janet Katherine Schneid, CPC, CPC-H Avon OH Sureshnivaas Seethapathy Selvaraj, CPC Bertha L Pineda, CPC-A Downey CA Lisa Yuriko Ohara, CPC-A Aiea HI Heather Hansen, CPC-A Midvale UT Kimberly Espinosa, CPC Naples FL Tiffany Anne Gautreaux, CPC Columbus OH Madurai Tamil Nadu Jere L Cassidy, CPC-A El Dorado Hills CA Twaila K Yamashita, CPC-A Aiea HI Margaret Griffith, CPC-A Moab UT Kathy Dorceant, CPC Alpharetta GA Heather Christine Hilliard, CPC Lima OH Musphirabanu Abdulsherif, CPC Jennifer C Rabner, CPC-A Escondido CA Florence A Guillermo, CPC-A Honolulu HI Chelsey Hiemes, CPC-A Moab UT Teresa Lynn Galaviz, CPC Dalton GA Denise E Horvath, CPC Massillon OH Chennai Tamilnadu Clarizza Erazo Ortega, CPC-A Fontana CA Chanel Mililani Nelias, CPC-A Kapolei HI Lindsey K Jackson, CPC-A Moab UT Kimberly Black, CPC Evans GA Gail R Epperly, CPC Mentor On The Lake OH Shunmugapriya Durairaj, CPC Maria Guadaupe Contreras, CPC-A Gardena CA Jennifer S Au Hoy, CPC-A Pearl City HI Jeanne McGann, CPC-A Moab UT Valerie Burson Roberson, CPC Villa Rica GA Cheryl Anne Olinger, CPC New Philadelphia OH Chennai Tamilnadu Alicia De La Torre, CPC-A Gilroy CA Jensina S Carter, CPC-A Eugene OR Vida Frost, CPC-A Monticello UT Jennifer A Wagner, CPC Henderson TN Nancy Nalepa, CPC Willowick OH Subashini Ganesan, CPC Travyon L Woods, CPC-A Hercules CA Debra Jean Kramer, CPC-A Eugene OR Sheila Rae Wells, CPC-A Monticello UT John M Yuill, MD, CPC Hendersonville TN Zaklina Novkovic, CPC Willowick OH Chennai Tamilnadu Tracy A. Brown-Hanson, CPC-A Hesperia CA Teresa Turrentine, CPC-A Lebanon OR Jillian Mafileo, CPC-A Murray UT Kelley G Minton, CPC Kingsport TN Prem Kumar Mahalingam, CPC Alka Tyagi, CPC-A Irvine CA Unkyung Bae, CPC-A Portland OR Kimberly Palmer, CPC-A North Salt Lake UT Angela Griffin Elgin, CPC Knoxville TN Chennai Tamilnadu Patricia J. Smith, CPC-A Laguna Niguel CA Jessica Sienkiewicz, CPC-A Portland OR Janie Katherine Tippit, CPC-A Ogden UT Erin M Hudson, CPC Knoxville TN Mid-Atlantic Nikole Babb, CPC Murray KY Gayathri Natarajan, CPC Sally A Nemeth, CPC-A Lathrop CA Marybeth Taylor, CPC-A Algona WA Mallory Gwen Twitchell, CPC-A Ogden UT Richard Kevin Townsend, CPC Knoxville TN Anabell Diaz, CPC Greensboro NC Chennai Tamilnadu Mai Thi Nguyen, CPC-A Long Beach CA Deborah A Roberts, CPC-A Bonney Lake WA Amanda D Lake, CPC-A Orangeville UT Angela F Newton, CPC Memphis TN Sandra Fleri, CPC Shepherdstown WV Hemalatha R, CPC Chennai Tamilnadu Jason M. Freeman, CPC-A Los Alamitos CA Sharon E Smith, CPC-A Olympia WA Amy Gail Houskeeper, CPC-A Price UT Miranda Gayl Jones, CPC Nashville TN Jayashree Sridharan, CPC James J. Agcaoili, CPC-A Los Angeles CA Kathleen Ann Baker, CPC-A Seattle WA Gayla M Houskeeper, CPC-A Price UT Lynda R Wright, CPC Portland TN Chennai Tamilnadu Denice Francez Abel Garcia, CPC-A Los Isaac H Gribben, CPC-H-A Seattle WA Sunny R. Houskeeper, CPC-A Price UT April Nicole Leach, CPC Strawberry Plains TN Atlantic Renganayaki Srinivasan, CPC Angeles CA Angela Larsen, CPC-A Price UT Vanessa Cunningham, CPC Gaithersburg MD Suriayani Raip, CPC-A Spokane WA CHENNAI Tamilnadu Anthony C. Hammond, CPC-A Los Angeles CA Amber Marie Leonard, CPC-A Price UT Dawn Crawford, CPC Prospect Park NJ Vita V Prisyazhnyuk, CPC-A Tacoma WA Kaladevi Thangappan, CPC Trudes C. Manalang, CPC-A Los Angeles CA Carrie Lee Brooks, CPC-A Salt Lake City Southwest Virginia Rae Sevin, CPC Ambridge PA Kylie Jean Corriveau, CPC Conway AR Chennai Tamilnadu Nadine Marshall, CPC-A Los Angeles CA Troy A. Johnson, CPC-A Salt Lake City Sandi Brown, CPC Leesport PA Mountain/Plains Chrissy Lister, CPC Heber Springs AR Kavitha Manoaharan, CPC Erika Martin, CPC-A Los Angeles CA Jennifer I. Nomann, CPC-A Salt Lake City Tammera Lyn Cunningham, CPC New Steven Hooper, CPC-A Broomfield CO Patricia Lea Freeman, CPC Overland Park KS Chennai-53 Tamilnadu Katy Rubinov, CPC-A Los Angeles CA Danna M Walton, CPC-A Salt Lake City Castle PA Linda M Adams, CPC-A Boise ID Teahnee Kincaid-Fremen, CPC Ama LA Muthuramalingam Ramasubramanian, CPC Florencia M Siman, CPC-A Los Angeles CA Kathlien Barnhart, CPC-A Sandy UT Karen E Devitto, CPC New Castle PA Andrew Heisler, CPC-A Boise ID Gail D Boutin, CPC New Iberia LA Coimbatore Tamilnadu Romina Veronica S Toyama, CPC-A Los Karla M Nielson, CPC-A South Jordan UT Alma Mae Grauso, CPC New Castle PA Bridgette Estlick, CPC-A Star ID Gere Harmon, CPC, CPC-H Ashland MO Rashmi Joy John, CPC Angeles CA Joan Soucie, CPC-A Syracuse UT Lynda Ann Kusnierz, CPC New Castle PA Hallie R. Hernandez, CPC-A Avondale AZ Misty Dawn McCrackin, CPC Cape Namakkal Tamilnadu Lindsey K. Barr, CPC-A Mission Viejo CA Malory K. Ericksen, CPC-A Taylorsville UT Renee Marie Llewellyn, CPC New Castle PA Kay Jean M Poulson, CPC-A Flagstaff AZ Girardeau MO Sangeethapreetha Chinnathambi, CPC Elodie Mealares, CPC-A Mission Viejo CA Stacey Hollis, CPC-A West Jordan UT Kathleen R McGonigle, CPC New Castle PA Ronald James Morrison, CPC-A Mesa AZ Meagan Kendra Kessler, CPC Chaffee MO Saidapet, Chennai Tamilnadu Luba Dub, CPC-A Modesto CA Orlandra M. Smith, CPC-A West Valley City UT Marlene Jane Mitcheltree, CPC New Castle PA Kathren L Dresen, CPC-A Phoenix AZ Kim Marie Miller, CPC Kearney MO Ravikumar Karunanidhi, CPC Danielle E. Aguilar, CPC-A Moreno Valley CA Michelle A Reiter, CPC New Castle PA Jason W. McDaniel, CPC-A, CPC-H-A Phoenix AZ Donna K Stephens, CPC Peculiar MO Tanjore Tamilnadu Cindy C Balvaneda, CPC-A Moreno Valley CA Laurie L Seaborn, CPC New Castle PA Cyntha Marie Jakobs, CPC-A Tucson AZ Northeast Alyce Renee Spiriti, CPC-H Ocean Springs MS Anand Babu M, CPC Candice M. Machado, CPC-A Moreno Valley CA Suzanne Bruno, CPC New Wilmington PA Traci Kim Maes, CPC-A Cortez CO Kathleen M Edwards, CPC-A Branford CT Linda Elley, CPC Scottsbluff NE Thiruverkaddu Tamilnadu Cristina S. Arcinue, CPC-A Murrieta CA Beth Ann Palisin, CPC Sharon PA Elsie Whitehorse Walck, CPC-A Cortez CO Lisa Z Castelli, CPC-A North Haven CT Leona Darlene Nix, CPC Denison TX Saurabh Banerjee, CPC Noida UP Maria Coral Vallido, CPC-A Murrieta CA Craig M Yaros, CPC-A Denver CO Stacey Malin, CPC-A West Haven CT Wendy Annette Deranger, CPC Houston TX Nandan Chawla, CPC Noida UP Maria Victoria Llamido, CPC-A Newark CA Pamela L Brezonick, CPC-A Egnar CO Terry Thompson Cutshall, CPC-A Bangor ME Lisa F Lewis, CPC Lubbock TX International Brajesh Choubisa, CPC-H Noida UP Katherine Ross, CPC-A Norco CA Jessica B Cesare, CPC-A Greeley CO Karen Sue Connors, CPC-A Derry NH Mohammad Ali Hadi, CPC-H Allison McClain, CPC Lubbock TX Kulvinder Kaur, CPC Noida UP Maria Theresa Grace C Riley, CPC-A North Jenny Marie Jones, CPC-A Greeley CO Kathleen Anker, CPC-A Amherst NY Dodhpur Aligarh Kim L Edmonsond, CPC Pearland TX Jyoti Rao, CPC Noida UP Hollywood CA Barbara E. Kaumeier, CPC-A Littleton CO Kellie Pfalzer, CPC-A Amherst NY Soupaty Vanila Varunika, CPC Christiana Smith, CPC Rosharon TX Rashmi Gupta, CPC-H NOIDA UP Gisele Johnson, CPC-A Northridge CA Penny Elaine Sheeler, CPC-A Littleton CO Karolina Hodil, CPC-A Buffalo NY Hyderebad Andhra Pradesh Somit Hazra, CPC Asansol, West Bengal WB Ingrid Ioana Edwards, CPC-A Norwalk CA Laurie J Nally, CPC-A Windsor CO Leslie M Brogan, CPC-A Cheektowaga NY Chitti Karuna Devi, CPC Anusuya Pattabiraman, CPC Chennai Lorena A Gastelo, CPC-A Norwalk CA Cathrine R. Shannon, CPC-A Windsor CO Dawn Marie Fiorella, CPC-A Depew NY Mountain/Plains Secunderabad Andhra Pradesh Cynthia Nelson, CPC Prescott AZ Precilla Ramya, CPC Rosemarie Romero, CPC-A Norwalk CA Kimberly S Krizek, CPC-H-A Cedar City IA Arlene Glowacki, CPC-A Drpew NY Ssoma Rajetha, CPC Tabitha D Batty, CPC Prescott Valley AZ Finger Post, Ooty Thenilgiris Linda C Brown, CPC-A Oak Park CA Jennifer L Poyer, CPC-H-A Cedar Rapids IA Terri Stonebraker, CPC-A Lancaster NY Secunderabad Andhra Pradesh Tamara Lynn Martinez, CPC Aurora CO Pankaj Arora, CPC New Delhi Marsha Lewis, CPC-A Oakley CA Rosanne H. Staniford, CPC-A Council Bluffs IA Lisa M Kropp, CPC-A Lockport NY Sundaramma Durgempudi, CPC Nancy J Lott, CPC Fort Collins CO Vaishali Gupta, CPC New Delhi Susan Lopez, CPC-A Orange CA Kelli Dawn Tilbury, CPC-A Council Bluffs IA Adam Daniel Wilson, CPC-A N Tonewanda NY Hyderabad Andhrapradesh Ann Treanor, CPC Boise ID Shuchi Khanor, CPC New Delhi Ada Vasquez, CPC-A Orange CA Anita Lynn Amrine, CPC-A Fairfield IA Cynthia LaValle, CPC-P-A Patchogue NY Sadiq Pasha Shaiq Abdul, CPC Aurora J Sparks, CPC NAMPA ID Hemant Kumar, CPC New Delhi Catalina Zaragoza, CPC-A Pacoima CA Katherine K Fitzgerald, CPC-A Glenwood IA Susan M Smarz, CPC-A Ansonia CT Hyderabad AP Ruth C Cambra, CPC North Salt Lake UT Jyoti Sengar, CPC New Delhi Vanessa L. Adams, CPC-A Placerville CA Ramona Rubendall, CPC-A Marion IA Elizabeth Lee, CPC-A, CPC-H-A Bridgeport CT Shakeel Ahmed, CPC Hyderabad AP Jaswant Singh, CPC New Delhi Aimee B. Dunkle, CPC-A Rancho Santa Deborah K Smith, CPC-H-A Pleasant Hill IA Izabela Olekszyk, CPC-A Bristol CT Sushma Kallur, CPC Hyderabad AP Rahul Srivastava, CPC New Delhi Margarita CA Shannon Lorraine Baisden, CPC-A Boise ID Shari Beth Millen, CPC-A Cheshire CT West Mahesh Kumar Pampari, CPC Hyderabad AP Karyn Michelle Leonard, CPC-A Rancho Jennifer Lynn Thompson, CPC-A Boise ID Bernadette Dennis, CPC-A Danbury CT Dustie Denise Hathcoat, CPC Waterford CA K Vijayasree, CPC Hyderabad AP Santa Margarita CA Cristina Lea Briolet, CPC-A Meridian ID Damary Rosario-Ali, CPC-A Danbury CT Claudia Kernaghan, CPC Henderson NV Dr. Santosh Kumar Guptha, CPC, CPC-P Apprentices Emily M Sindoni, CPC-A Rancho Santa Niver Katja Natasha, CPC-A Meridian ID Jill Privee, CPC-A Dayville CT Jennifer Estes, CPC Las Vegas NV Hyderabad andhra pradesh AP Margarita CA Christy Jolene Stone, CPC-A Meridian ID Angela M DellaCamera, CPC-A East Donna Harn, CPC Sparks NV Thyagarajan Munuswamy, CPC Near West Christine M. Hannigan, CPC-A Richmond CA Chris M Dadey, CPC-A Post Falls ID Haven CT Jeri L Barker, CPC La Grande OR FoodWorld, Ameerpet, Hyderabad AP Janet Brown, CPC-A Modesto CA Victor A King, CPC-A Riverside CA Dana M Fox, CPC-A Twin Falls ID Tara A Vanacore, CPC-A East Haven CT Gina Denise Black, CPC, CPC-H Roseburg OR Shereen Vadivel, CPC Diane M Ferrell, CPC-A Modesto CA Patricia Y Singleton, CPC-A Riverside CA Wanda Hammett Sauter, CPC-A Billings MT Deborah S Amato, CPC-A Madison CT Cynthia A Egbert, CPC Sedro Woolley WA Murugespalya Bangalore Kimberly Ann Hill, CPC-A Milwaukie OR Cindy A Diaz, CPC-A Romoland CA Sherri A Olson, CPC-A Judith Gap MT Cheryl A Belletti, CPC-A Meriden CT Barbara Gilcrease, CPC Vancouver WA Vidhyalakshmi Balasubramanian, CPC Catherine Perisich, CPC-A Portland OR Meichelle Stoddard, CPC-A San Bernardino CA Michael B. McFadden, CPC-A Missoula MT Nancy Ege, CPC-A Middletown CT Denise Michelle Wright, CPC Vancouver WA Ambattur Chennai Dawn Renae Brown, CPC-A Anchorage AK Sheryl Aimee Lorenzo Cawagas, CPC-A Diane R Zeller, CPC-A Mandan ND Melissa Beardsley, CPC-A Naugatuck CT Saravanan Subramanian, CPC Charlene E. Chamberlain, CPC-A Anchorage AK San Diego CA Erin L Argo, CPC-A Omaha NE Lisa M Bunting, CPC-A Naugatuck CT Northeast Thoraipakkam Chennai Jennifer Edora, CPC-A Anchorage AK Rosalina Celis, CPC-A San Diego CA Lisa Janell Fouts, CPC-A Omaha NE Maureen J O’Sullivan-Best, CPC-A New Jennifer L Ansaldo, CPC North Haven CT Ravi Kumar Malik, CPC, CPC-P Crystal Helmericks, CPC-A Anchorage AK Jesus D Del Fierro, CPC-A San Diego CA Tamera L Sona, CPC-A Omaha NE Haven CT Beverly Ann Nickols, CPC Sherman CT Opp Sarita Vihar DL Gia D Janvrin, CPC-A Anchorage AK Anjali Koul, CPC-A San Diego CA Jennifer L White, CPC-A Omaha NE Kelli M. Sullivan, CPC-A New Haven CT Kristie Ann Sargeant, CPC Bucksport ME Padmashree Murali, CPC Pamela Irene Link, CPC-A Anchorage AK Denise Maile Rhodes, CPC-A San Diego CA Kathleen F. McKnight, CPC-A Picacho NM Barbara J. Buzynski, CPC-A New Milford CT Thomas Maher, CPC East Amherst NY Bangalore Karnataka Jamie Leigh Twombley, CPC-A Anchorage AK Kory Stetina, CPC-A San Diego CA Kela Kaye Fellows, CPC-A Rapid City SD Kathryn A. Wroblewski, CPC-A Niantic CT Janaki Vetcha Kishore, CPC Lisa Ann Wright, CPC-A Anchorage AK Krishna V. Rallabhandi, CPC-A San Dimas CA Michelle Jayne Begay, CPC-A Blanding UT Ann B Webb, CPC-A Pine Meadow CT Mumbai Maharashida Great Lakes Judy DeVries, CPC-A Eagle River AK Darlene Y Mercer, CPC-A San Marcos CA Rona Flannery, CPC-A Blanding UT Joyce Ann Panilaitis, CPC-A Plymouth CT Jayaprada Bhamidipati, CPC Shauna Lynn Galvin, CPC-H Shelbyville IL Meachelle Renee Ross-Trostle, CPC-A Jessica A. Duenas, CPC-A Santa Ana CA Jeannie Hutchins, CPC-A Blanding UT Bertha A Couchman, CPC-A Preston CT Navi Mumbai Maharastra Kimberly A Smith, CPC-H Shelbyville IL Elmendorf Afb AK Celia G Enriquez, CPC-A Santa Ana CA Jackie L Jeppson, CPC-A Blanding UT Sandra Lynn Butch, CPC-A Southington CT Bhanu Pratap Singh Mehta, CPC-H Jodie A Coil, CPC Albion IN Sharlon Sharell Smith, CPC-A Alameda CA Sunitha Penny, CPC-A Santa Clara CA William Lewis Olderog, CPC-A Blanding UT Aida L. Crespo-McCray, CPC-A Stratford CT Sarojini Nagar New Delhi Christina Lyons, CPC Fort Wayne IN Ritaben Nitinkumar Patel, CPC-A Anaheim CA Wilmore A Nagares, CPC-A Santa Clarita CA William Lewis Olderog, CPC-A Blanding UT Elizabeth Homes, CPC-A Waterford CT Lokesh Anbazhagan, CPC-P Jean A Bookout, CPC Ft Wayne IN Sherri Johnson-Kelly, CPC-A Burbank CA Stephanie Lynn Gonia, CPC-A Santee CA Tiffany Lee Palmer, CPC-A Blanding UT AnnMarie Kleban, CPC-A Watertown CT Chennai Tamil Nadu Diane L Farlee, CPC Ft Wayne IN Leanne M Agpaoa, CPC-A, CPC-H-A Brian M Perez, CPC-A Stockton CA Christa Lynn Monsen, CPC-A Bluff UT Danielle C Michener, CPC-A Woodbury CT Rajalakshmi Gopalakrishnan, CPC Angela Nicole Henry, CPC Ft Wayne IN Carson CA Ontiveros A. Calderon, CPC-A Sun City CA Elizabeth A. McAlister, CPC-A Bountiful UT Christine Green, CPC-A Bear DE Chennai Tamil Nadu Rhonda Kaye Forde, CPC Indianapolis IN Ana Catalan, CPC-A Carson CA Sedie Hamidi, CPC-A Tarzana CA Shelley D. Brown, CPC-A Castle Dale UT Leslie Renee Spera, CPC-A Chelsea MA Kannan Kamala, CPC Chennai Tamil Nadu Allison Luallen, CPC Sellersburg IN Denise Catalan, CPC-A Carson CA Fabiola A Talavera, CPC-A Tarzana CA Rylie Lyn Stevens, CPC-A Draper UT Joyce Laura Merriman, CPC-A Ludlow MA Lakshmanan Pudur Samiappan, CPC Madhuri Dimple Vardhiboiyena, CPC-H Kandy J Paredes, CPC-A Carson CA Nancy Cho, CPC-A Torrance CA Alana Stewart, CPC-A Holladay UT Christine M. Gauvin, CPC-A N. Dartmouth MA Farmington MI Chennai Tamil Nadu Priya Sarju Vora, CPC-A Cerritos CA

38 AAPC Coding Edge newly credentialed members

Tara Facchiano, CPC-A Plymouth MA Jennifer A Goodman, CPC-A Bayville NJ Irene J Shanley, CPC-A Fort Pierce FL Kristin Scarcella, CPC-A Ann Arbor MI Joanne M Kastle, CPC-A Redford MI Kristin Wilson, CPC-A Coffeyville KS Lisa A Clark, CPC-A West Yarmouth MA Paulette K. Purchla, CPC-H-A Bayville NJ Meko D. Stafford, CPC-A Jacksonville FL Julianne Jondro, CPC-A Monroe MI Annie Kennedy, CPC-A Redford MI Ashley Leeann Henton, CPC-A De Soto KS Kelly A Godbout, CPC-A Wilbraham MA Joseph R Wilchinsky, CPC-A Brick NJ Autumn S. Abbott, CPC-A Lake Worth FL Jessica Lynn Leja, CPC-A Northville MI Barbara Ann Knudsen, CPC-A Redford MI Veronica Lea-Ann Ames, CPC-A Dearing KS Dean S. Thomas, CPC-A Farmington ME Diane M Roberts, CPC-A Cherry Hill NJ Patricia Ann Wayne, CPC-A Lake Worth FL Candace M Flek, CPC-A Westland MI Theresa D Shepler, CPC-A Royal Oak MI Ranae D. Ann Hedges, CPC-A Leawood KS Deena Moreau, CPC-A Jay ME Kathleen M Wright, CPC-A Hazlet NJ Mary Beth Bridges, CPC-A Lakeland FL Jacqueline D Kula, CPC-A Brinkhaven OH Donnetta Bell-Bryan, CPC-A Southfield MI Marcia Vaun Hillman, CPC-A Leawood KS Marilyn Ann Armstrong, CPC-A Hanover NH Denise A DelleChiaie, CPC-A Howell NJ Donna Garcia, CPC-A Lakeland FL Linda Lee Gatian, CPC-A Canal Fulton OH Yevette Moss, CPC-A Southfield MI Meredith Louise Kerr, CPC-A Lenexa KS Robin T Shea, CPC-A Hudson NH Jacqueline Redington, CPC-A Howell NJ Terri Diann Grigsby, CPC-A Lehigh Acres FL Jacqueline Marie Kerr, CPC-A Eastlake OH Kelly L Campeau, CPC-H-A Taylor MI Debra Joy Prunty, CPC-A Lenexa KS Daniel R. Danjou, CPC-A Manchester NH Karen Marie Washington, CPC-A Howell NJ Amy A. Sterling, CPC-A Lighthouse Point FL Linda E Atherton, CPC-A Garfield Heights OH Pamela Ann Zybach, CPC-A Taylor MI Shanna Michelle Walker, CPC-A Olathe KS Dawn M Garbino-Flinkfelt, CPC-A Kenneth R Bruce, CPC-A Jackson NJ Jose Bichara Abinader, CPC-A Miami FL Kristen M Higgins, CPC-A Orrville OH Paula J Hayes, CPC-A Tustin MI Shannon S. Adams, CPC-A Overland Park KS Manchester NH Maria P Sanchez, CPC-A Jackson NJ Janet Camji, CPC-A Miami FL Amy M Gonzales, CPC-A Orrville OH Rebecca L. Schafnitz, CPC-A Washington MI Marjorie J. Cabansag, CPC-A Overland Park KS Lisa Marie Howe, CPC-A Manchester NH Nicole M. Garman, CPC-A Lumberton NJ Jacqueline A Gomez, CPC-A Miami FL Michelle D Lax, CPC-A Orrville OH Tara Lynn Miller, CPC-A Waterford MI Kathleen R. Prittie, CPC-A Overland Park KS Jessica Lynn Troisi, CPC-A Manchester NH Suching L Chou, CPC-A Middletown NJ Alexandra M. Rogers, CPC-A Miami FL Michelle Gail Holston, CPC-A Shreve OH Janice Lee Nierzwick, CPC-A Waterford MI Selena S. Tjardes, CPC-A Overland Park KS Laurie Marie Reihms, CPC-A Nashua NH Jeanne M Pleban, CPC-A Millstone Gail Anne Silversmith, CPC-A Miami FL Annette M Kranz, CPC-A Wooster OH Jason T. Prichard, CPC-A White Lake MI Deborah L Cox, CPC-A Shawnee KS Holly C. Drummond, CPC-A Pembroke NH Township NJ Jasmine Brown, CPC-A Oldsmar FL Kathryn E Sears, CPC-A Wooster OH Victoria Jane Leparskas, CPC-A Wixom MI Christine Renee Yingling, CPC-A Topeka KS Debra J Rodgers, CPC-A Springfield NH Margaret A Cosgrove, CPC-A Mount Tritia L Donley, CPC-A Orlando FL Allan Dale Williams, CPC-A Alhambra IL Sarah Ann Begin, CPC-A Crystal MN Jaime Allison Brown, CPC-A Wichita KS Elaine M Jenkins, CPC-A Stratham NH Ephraim NJ Margaret Jennifer Felix, CPC-A Orlando FL Monica C Ross, CPC-A Alorton IL Cindy L Hoppe, CPC-A, CPC-H-A Shakopee MN Tammy M. Delgado, CPC-A Wichita KS Precious Tilley, CPC-A Bellport NY Kimberly L Ezell, CPC-A Pine Hill NJ Faith Abigail Loennig, CPC-A Orlando FL Kimberly Ann Plaza, CPC-A Arlington Hts IL Brook J Farmer, CPC-A Akron OH Andrea M Fletcher, CPC-A Wichita KS Jackie S Lavelle, CPC-A Brewster NY Mary Ann Knier, CPC-A Sea Girt NJ Elizabeth C. DePirro, CPC-A Palm Harbor FL Amy D Geyer, CPC-A Belleville IL Billie Shoemaker, CPC-A Akron OH Porshia Yvonne Mitchell, CPC-A Wichita KS Amanda M Ranellone, CPC-A Brewster NY Cynthia L Grater, CPC-A Sewell NJ Kathleen N. Fischer, CPC-A Pensacola FL Lisa Eastham, CPC-A Bloomington IL Linda D Saurer, CPC-A Apple Creek OH Lisa Marie Paulk, CPC-A Wichita KS Elizabeth Lora-McRae, CPC-A Bronx NY Donna A Breese, CPC-A Somerset NJ Stacey A. Smithline, CPC-A Port Saint Lucie FL Debbie Deprest, CPC-A Bourbonnais IL Kim A Saffle, CPC-A Brunswick OH Tammy Perry Hass, CPC-A Metairie LA Rachel Ann Platon Reynes, CPC-A Bronx NY Penny Hamilton, CPC-A Spring Lake Heights NJ Alicia D. Daniels, CPC-A Saint Lucie West FL Sherri Combs, CPC-A Carpentersville IL Marsha M Holtsberry, CPC-A Buckeye Lake OH Artimease Deloch, CPC-A Zachary LA Fabiola Alexandre, CPC-A Brooklyn NY Caren M Schank, CPC-A Swedesboro NJ Anne Nielsen, CPC-A Saint Petersburg FL Rose Bielat, CPC-A Chicago IL Jennifer Renee Allen, CPC-A Cleveland OH Dendra C Harrell, CPC-A Belton MO Irina Chpitalnik, CPC-A Brooklyn NY Christine B Hollingsworth, CPC-A Tinton Falls NJ Sandra M. Sickler, CPC-A Saint Petersburg FL LaTrevia Broomfield, CPC-A Chicago IL Beverly A Ford, CPC-A Cleveland Heights OH Clarissa M. Moore, CPC-A Blue Springs MO LaBretia Daise, CPC-A Brooklyn NY Diane M Manno, CPC-A Toms River NJ Jennifer O Murphy, CPC-A Sebastian FL Alla Nadoyan, CPC-A Chicago IL Polly A Kapronica, CPC-A Elyria OH Sara Quinones, CPC-A Brookline Station MO Marcus A Francis, CPC-A Brooklyn NY Sarah J Steele, CPC-A Toms River NJ Lisa J Sargent, CPC-A Sebastian FL Barbara Schneider, CPC-A Chicago IL Beverly J Caldwell, CPC-A Euclid OH Debra M. Schafer, CPC-A Cape Girardeau MO Terri Marie Cooper, CPC-A Camillus NY Sarah J Steele, CPC-A Toms River NJ Rebecca L Forrester, CPC-A Tampa FL Jeffrey Wagner, CPC-A Chicago IL Amanda Leigh Gilbert, CPC-A Huron OH Arddeenia V. Davis, CPC-A Columbia MO Joseph C. Gonsalves, CPC-A Cheektowaga NY Daiva Trzepizur, CPC-A Toms River NJ Demitra Freeman, CPC-A Tampa FL Deborah Y Moses, CPC-A Collinsville IL Deborah A Arms, CPC-A Ironton OH Brooke Moore, CPC-A Columbia MO Adriele J Novellano, CPC-A Davenport NY Deborah A Hopp, CPC-A Villas NJ Kristen Marie Larose, CPC-A Tampa FL Ann Thomas, CPC-A Collinsville IL Regina Ann Monnig, CPC-A Ironton OH Pamela J Samuels, CPC-A Columbia MO Cheryl Lee Bennigsohn, CPC-A Fairport NY Geri Stevenson, CPC-A W Belmar NJ Carrie Helen Dowd, CPC-A Vero Beach FL Veronica Enciso, CPC-A Crystal Lake IL David R Allen, CPC-A Liberty Twp OH Kristin J Lyons, CPC-A Florissant MO Siby A. Joseph, CPC-A Floral Park NY Susan Calsetta, CPC-A Whiting NJ Shari M Horne, CPC-A Vero Beach FL Barbara Langley, CPC-A East Peoria IL Denice A. Popovich, CPC-H-A Louisville OH Lori A Rivolta, CPC-A Foristell MO Latoya N Spencer, CPC-A Highland NY Christina Marie Weyand, CPC-A Airville PA Ambrosia D McAdams, CPC-A Vero Beach FL Sonia Acevedo, CPC-A Elgin IL Jill Catherine Schabell, CPC-A Loveland OH Debi Bailey, CPC-A Grandview MO Veronica R Ruffin, CPC-A Jamaica NY Patricia A Jones, CPC-A Alburtis PA Tara Yvonne Hunter, CPC-A Wellington FL Linda Herman, CPC-A Elgin IL Melinda M Goss, CPC-A Massillon OH Amanda S Coller, CPC-A Hazelwood MO Ana Martinez, CPC-A Kew Gardens NY Michael Harry Leister, CPC-A Annville PA Dominique Wright, CPC-A Acworth GA Franziska Pickerell, CPC-A Granite City IL Carmen Herzfeld, CPC-A Medina OH April Lynn Fry, CPC-A Kansas City MO Donna V Harmon, CPC-A Le Roy NY Mary Catherine Nolan, CPC-A Bensalem PA Yasmir Cobb, CPC-A Atlanta GA Nancy J Stidham, CPC-A Granite City IL Lois A. 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Saunders, CPC-A Ellenwood GA Becki Denning, CPC-A Neoga IL Jacqueline A McGinnis, CPC-A Holmen WI Janet C Davis, CPC-A Broken Arrow OK Thomas D Fish, CPC-A Valatie NY Andrea Steber, CPC-A Nazareth PA Tina Marie Hill, CPC-A Grovetown GA Amy Suzanne Adams, CPC-A Peoria IL Susan S Steinborn, CPC-A Janesville WI Allison Sales, CPC-A, CPC-H-A Chickasha OK Vanessa C Campbell, CPC-A West Seneca NY Erica Graziosi, CPC-A New Freedom PA Diahann M Logan, CPC-A Lawrenceville GA Barbara Ann Abram, CPC-A Rantoul IL Barbara E Kreilkamp, CPC-A Kansasville WI Michele Burke, CPC-A Tulsa OK Elizabeth R. Durnan, CPC-A Charlestown RI Elinor C Schneider, CPC-A Philadelphia PA Jenny Huang Shorter, CPC-A Lilburn GA Geri Moritz, CPC-A Saint Charles IL Jessica R. Gunderson, CPC-A La Crosse WI Johanna Dean Eastwood, CPC-A Tulsa OK Linda M Peterson-Saravo, CPC-A No Judi Birch, CPC-A Reading PA LaTonia L Tyler, CPC-A Lithonia GA Amanda C. Fulgenico, CPC-A Shorewood IL Lindsay Renee Mikkola, CPC-A Madison WI Russell Thomas O’Brien, CPC-A Tulsa OK Providence RI Jessica M Runk, CPC-A Spring Grove PA San D Edwards, CPC-A Rex GA Susan Persinger, CPC-A Sparland IL Caralee Larson, CPC-A Menomonie WI Sandra Kay Webb, CPC-A Tulsa OK Darin George Fortin, CPC-A Irasburg VT Catrina Allen, CPC-A Upper Darby PA Twyla Michelle Hooks, CPC-A Riverdale GA Linzy N Beauchamp, CPC-A Springfield IL Raynesia K. Johnson, CPC-A Milwaukee WI Michelle Evette Rodriguez, CPC-A Austin TX Jamie L Klymn, CPC-A Wilder VT Wanda J. Reichard, CPC-A Walnutport PA Melissa C Orosco, CPC-A Stockbridge GA Danielle J Wethington, CPC-A Springfield IL Charlene R Ricks, CPC-A Milwaukee WI Jennifer L Waldrop, CPC-H-A Austin TX Hou-Ming Cai, CPC-A Wexford PA Misty Quinton, CPC-A Talking Rock GA Denise R McDonald, CPC-A St Charles IL Cathy Schroeder, CPC-A Milwaukee WI Irene Viernes Gariby, CPC-A Galveston TX Atlantic Deirdre Kohr, CPC-A York PA Sheryl Newkirk, CPC-A Toccoa GA Kristy Ann Pfalzgraf, CPC-A Staunton IL Erica H. Cervantes, CPC-A South Milwaukee WI Aurelia L. Johnson, CPC-A Galveston TX Lorraine Spradley, CPC-A New Castle DE Ellen Elaine Leisher, CPC-A York PA Latonya S Bryant, CPC-A Union City GA Judy Marie Ottensmeier, CPC-A Trenton IL Cheryl L Hansen, CPC-A Sun Prairie WI Audrey Ann Salinas, CPC-A Galveston TX Cynthia M Hill, CPC-A Hagerstown MD Letitia Anne Stout, CPC-A York PA Danelle Jessica Hughes, CPC-A Antioch TN Paula Ann Dean, CPC-A Clarksville IN Alicia Irene Aros, CPC-A Wausau WI Leticia Adame, CPC-A Houston TX Cheryl Newton, CPC-A Jefferson MD Misty Dawn Forte, CPC-A Ashland City TN Michelle Rene Stimpson, CPC-A Decatur IN Stacey Lynn Dallman, CPC-A Wausau WI Darla Comeaux, CPC-A Houston TX Mary Bernhard, CPC-A Ortley Beach NJ Southeast Glenda Kay Ross, CPC-A Birchwood TN Janet Maye Lazdins, CPC-A Indianapolis IN Bill Hamann, CPC-A Wausau WI Cynthia Inez French, CPC-A Houston TX Banumathi Parthasarathy, CPC-A Spotswood NJ Denise M Blaine, CPC-A Coral Gables FL Ryan Francis Winn, CPC-A Brentwood TN Kelly M Ryan, CPC-A Jeffersonville IN Jennifer Lynn Klumpyan, CPC-A Wausau WI Karen Bosscher, CPC-A Lubbock TX Margaret E. Anderson, CPC-H-A Camp Hill PA Ruth B Hite, CPC-A Longwood FL Donna Kay Jiga, CPC-A Caryville TN Karen Nelson, CPC-A Lebanon IN Eric J Olson, CPC-A Wausau WI Deana Shae Perry, CPC-A Lubbock TX Susan R Bogush, CPC-H-A Camp Hill PA Marsha B Dowell, CPC-A Middleburg FL Dinah Cox, CPC-A Cleveland TN Shelby Leann Hublar, CPC-A New Albany IN Carol Rich, CPC-A Weston WI Rosemary Piersall, CPC-A Lubbock TX Kristina L Reifsnyder, CPC-H-A Camp Hill PA Patricia Scott, CPC-A Appling GA Lia Whitmire, CPC-A Collierville TN Julie Valco, CPC-A Saint John IN Jamailah C Lowe, CPC-A Missouri City TX Tina L Swartz, CPC-H-A Camp Hill PA Penny P Tuttle, CPC-A Warner Robins GA Sandra Green, CPC-A Cookeville TN Cora Kulik, CPC-A Whiting IN Southwest Vicki D Wells, CPC-A Pearsall TX Ami Zumkhawala-Cook, CPC-H-A Camp Hill PA Teresa Ann Trevathan, CPC-A Gleason TN Phyllis E Harper, CPC-A Cordova TN Linda F Flynn, CPC-A Allegan MI Glennda Lee DeRousse, CPC-A Louisburg KS Michael B Gambill, CPC-A Plano TX Donna Rae Roth, CPC-A Duncannon PA Heather M King, CPC-A Jackson TN Sonya Cannon, CPC-A Crossville TN Tonia A Monk, CPC-A Bancroft MI Debra Ann Irwin, CPC-A Overland Park KS Victoria Lynn Mazak, CPC-A San Antonio TX Barbara E Seifrit, CPC-H-A Etters PA Kara Thurman, CPC-A Jefferson City TN Juanita Z Rincon, CPC-A Lebanon TN Diane Marie Gadsby, CPC-A Belleville MI Chris Guyer, CPC-A Belton MO Janet Ann Thornton, CPC-A Spicewood TX Nancy A Teter, CPC-H-A Harrisburg PA Susan Fisher, CPC-A Memphis TN Mary A Lucas, CPC-A Memphis TN Mark D. Hellekjaer, CPC-A Beverly Hills MI Nesha D Park, CPC-A Hamilton MO Bonniebelle Spencer, CPC-A Spring TX James Lloyd Jones, CPC-H-A New Freedom PA LaShundra Scott, CPC-A Bessemer AL Brittany M Gore, CPC-A Nashville TN Anne E. Jones, CPC-A Beverly Hills MI Shelby Myers, CPC-A House Springs MO Lindsey Janee Vela, CPC-A Texas City TX Sei-Youn Song Park, CPC-A Abingdon MD Mary B. Dillingham, CPC-A Birmingham AL Jasmine L. Hathaway, CPC-A Nashville TN Ruth A Harrison, CPC-A Cedar Springs MI Brenna D. Hewins, CPC-A Independence MO Staci Jane Thomas, CPC-A Wolfforth TX Angelina D. Poulin, CPC-A Baltimore MD Jamila Marshall, CPC-A Birmingham AL Chiquita Lou Knight, CPC-A Nashville TN Roxanne L Johnson, CPC-A East Grand Jessica A Rice, CPC-A Independence MO Michele Lynn Stanton, CPC-A Baltimore MD Pamla S Tarver, CPC-A Birmingham AL Jessica D. Etherton, CPC-A Strawberry Plains TN Rapids MI Christine Ann McElroy, CPC-A Kansas City MO Mid-Atlantic Theresa Jones, CPC-A Bowie MD Stacey Renee Gibson, CPC-A Brewton AL Malina Desiree Taylor, CPC-A White Bluff TN Barbara J. Gearhart, CPC-A Fair Haven MI Melanie Kay Sloan, CPC-A Kansas City MO Kelly Coggins, CPC-A Monroe NC Shauna Ransom, CPC-A Columbia MD Mims Hackett III, CPC-A Dothan AL Zita F Lane, CPC-A Flint MI Shawn Wolpert, CPC-A Kearney MO Shannon L. Clodfelter, CPC-A Wilmington NC Gbemisola V. Adebayo, CPC-A District Debra K Mullis, CPC-A Dothan AL Great Lakes Jillian E Breece, CPC-A Flushing MI Corey E. Ward, CPC-A Lees Summit MO Jessica L Carroll, CPC-A North Augusta SC Heights MD Karen M Fancher, M.D., CPC-A Guntersville AL Mary Beth Lindauer, CPC-A Chicago IL Renee C Venturi, CPC-H-A Garden City MI Rebecca Kay Saling, CPC-A Lee’s Summit MO Aja Trammel, CPC-A Sterling VA Karen Marie Bolling, CPC-A Edgewood MD Suzann M Rupp, CPC-A Hoover AL Lisa Malmstrom, CPC-A Elmwood Park IL Stacey L. Romanowski, CPC-A Grand Blanc MI Cindy L Caddell, CPC-A Lone Jack MO Kimberly Wyatt, CPC-A Catlettsburg KY Bonnie April Pasino, CPC-A Elkton MD Sonya LaBreeska Dyess, CPC-A Opp AL Rodney Tyrone Hodge, CPC-A Springfield IL Stacy M. Nickelson, CPC-A Grand Rapids MI Lori Sherman Jeffries, CPC-A Slater MO Letecia Dianna Brown, CPC-A Danville KY Mary Alana Owens-Fox, CPC-A Ellicott MD Tammie R Johns, CPC-A Opp AL Jamie L Reinewald, CPC-A Auburn IN Diane Elizabeth Clay, CPC-A Kalamazoo MI Maranda B. Reddoch, CPC-A Amarillo TX Carrie M Stanley, CPC-A Elizabethtown KY Jacqueline S. Frommelt, CPC-A Glen Helen Kelley, CPC-A Pelham AL Michelle Elaine Lambert, CPC-A Fort Wayne IN Janna Kosters, CPC-A Kentwood MI LaTorya S Tatmon, CPC-A Houston TX Judy Ann Gault, CPC-A Elsmere KY Burnie MD Shirley Dodd Batson, CPC-A Sylacauga AL Kathleen Susan Westhoff, CPC-A Fort Patricia Ann Brown, CPC-A Lansing MI Heather Genelle Martin, CPC-A Lubbock TX Ceciley Marie McCoy, CPC-A Fairdale KY Candace Vines, CPC-A Landover MD Deidre L Spencer, CPC-A Trussville AL Wayne IN Rhonda Harrison, CPC-A Lincoln Park MI Veronica S. Munoz, CPC-A San Antonio TX Anthony Dale Stroud, CPC-A Fairdale KY Sonya Renee Lewis, CPC-A Laurel MD Jenevie P Brown, CPC-A Brandon FL Carrie Elizabeth Hamman, CPC-A Ft Yolanda M Bernier, CPC-A Livonia MI Brenda Y. Johnson, CPC-A Texas City TX Diane Fields, CPC-A Georgetown KY Liz Troutman, CPC-A North Potomac MD Ella-Jayne Melton, CPC-A Cape Coral FL Wayne IN Shelly E. Skladzien, CPC-A Livonia MI Richard D Sills, CPC-A Clarkridge AR Christopher Eric Gentry, CPC-A Lebanon Janell J. Moore, CPC-A Pikesville MD Dottie S Ogaz, CPC-A Cape Coral FL Jennifer G Kelly, CPC-A Indianapolis IN Tanya Ann Scrivo, CPC-A Macomb MI Linda S Agnew, CPC-A Gamaliel AR Junction KY Stephanie Eaton, CPC-A Randallstown MD Anna Leah Myers, CPC-A Delray Beach FL Donna L Harju, CPC-A, CPC-H-A Kokomo IN Anita Marie Wiley, CPC-A Marcellus MI Sara J Stewart, CPC-A Humphrey AR Cindy Lynn Cook, CPC-A Lexington KY Jennifer M. Hahn, CPC-A Millington MI

www.aapc.com June 2008 39 newly credentialed members

Terry Paulus, CPC-A Lexington KY Stephanie R. Todd, CPC-A Pfafftown NC Meredith S Howell, CPC-A Richmond VA Dharmatej Gangadhar, CPC-A Joselito Yecla Urian, CPC-A Quezon City PHI Sarah Michelle Staggs, CPC-A Lexington KY Sharon Carol Bryan, CPC-H-A Raleigh NC Connie L. Joyce, CPC-A Stony Creek VA Murugespalya Bangalore Juan Alonso-Echanove, CPC-A Hato Rey PR Beverly Morton Tucker, CPC-A Lexington KY Gladys K. Bowser, CPC-A Roanoke Rapids NC Barbie A W Roundtree, CPC-A Stony Creek VA Lakshmi Priya Gurusamy, CPC-A Sivakumar Arasu, CPC-A, CPC-H-A Lori Ann Brown, CPC-A Louisville KY Marion Miles, CPC-A Roanoke Rapids NC Kershundra Y. Clinton, CPC-A Virginia Beach Murugespalya Bangalore Chennai Tamil Nadu Sherrita Denise Brown, CPC-A Louisville KY Alexis W. Winstead, CPC-A Rougemont NC Christina L. Greyhat, CPC-A Virginia Beach Nayeem Riswana J, CPC-A Thulasi Chandrasekaran, CPC-A Lori Ann Daniel, CPC-A Louisville KY Kelly L Rogers, CPC-A Timberlake NC Tammy L Stoddard, CPC-A Virginia Beach Murugespalya Bangalore Chennai Tamil Nadu Madelynn M. George, CPC-A Louisville KY Deena M Kilgo, CPC-A Waxhaw NC Quinda N. Taylor, CPC-A Virginia Beach Jaisudha Jayaprakash, CPC-A Baratii Cinnamani, CPC-A Chennai Tamil Nadu Danger M. Giselle, CPC-A Louisville KY Crystal G. Billings, CPC-A Winston-Salem NC Deborah Molaschi, CPC-A Williamsburg VA Murugespalya Bangalore Mohanasundari Dhananjeyan, CPC-A Nancy Kristine Graser, CPC-A Louisville KY April Poteat, CPC-A Winston-Salem NC Wendie M. Davis, CPC-A Buckhannon WV Subathra Kanniappan, CPC-A Chennai Tamil Nadu Heather Marie Grider, CPC-A Louisville KY Rebecca McSwain, CPC-H-A Aiken SC Gina Marie Gillispie, CPC-A Given WV Murugespalya Bangalore Grace Mary Jerome, CPC-A Chennai Tamil Nadu Tameeka D. Holsey, CPC-A Louisville KY Ashley Newton, CPC-A Clemson SC Dorothy Mae Davis, CPC-A Nutter Fort WV Rina Kumari, CPC-A Murugespalya Bangalore Biji John, CPC-A Chennai Tamil Nadu Jillian Marie Jones, CPC-A Louisville KY Debbie K Kolbus, CPC-A Florence SC Charlotte G. Workman, CPC-A Weston WV Viswanathan Munirathinam, CPC-A Shirley Bala Rachel, CPC-A Chennai Tamil Nadu Stacey Delaine Jones, CPC-A Louisville KY Sandra H. Humphries, CPC-A Lugoff SC Murugespalya Bangalore Anitha Radhakrishnan, CPC-A Chennai Tamil Nadu Reba Mishelle Liddick, CPC-A Louisville KY Joy Dicks, CPC-A New Ellenton SC International Chitra Nagarajan, CPC-A Murugespalya Bangalore Dhanalakshmi Rajendran, CPC-A Tina Mitchell, CPC-A Louisville KY Patty Lynn Wood, CPC-A Bedford VA Sushma Chawa, CPC-A Hyderabad AP Kalaivani R, CPC-A Murugespalya Bangalore Chennai Tamil Nadu Kelly Jo Rich, CPC-A Louisville KY Stephanie E. Griffith, CPC-A Charlottesville VA Shailaja Hanumadla, CPC-A Hyderabad AP Durga Devi Radhakrishnan, CPC-A Muthukumar Ramakrishnan, CPC-A Eboni K. Sayonkon, CPC-A Louisville KY Cheryl L. Alvarado, CPC-A Chesapeake VA Yamini Sarika Jennila, CPC-A Hyderabad AP Murugespalya Bangalore Chennai Tamil Nadu Patricia J Vaughn, CPC-A Louisville KY Cynthia C. Cochran, CPC-A Chesapeake VA Srikanth Naidu Perisetty, CPC-A Hyderabad AP Sathya Rajendran, CPC-A Murugespalya Bangalore Rathnakumar Ramasamy, CPC-A Michelle Lane Ward, CPC-A Louisville KY Elizabeth Abbitt-Kirk Lilley, CPC-A Chesapeake VA Chidambaram sawri Rajan, CPC-A Hyderabad AP Rajkumar Ramalingam, CPC-A Chennai Tamil Nadu Erin Lee Lloyd, CPC-A Madisonville KY Sheila Oglesby, CPC-A Chesapeake VA Rajyalaxmi Vanga, CPC-A Hyderabad AP Murugespalya Bangalore Lakshmiprabha Sekaran, CPC-A Carrie Lynn Wyatt, CPC-A Madisonville KY Julie Carroll Powell, CPC-A Chesapeake VA M Arokia Vinolya, CPC-A Hyderabad AP Satish Ramamurthy, CPC-A Chennai Tamil Nadu Shannon Ann Tirey, CPC-A Nortonville KY Sharon J Dardoufas, CPC-A Chesterfield VA Senthil Kumar Ethirajan, CPC-A Murugespalya Bangalore Savitha Karpagavalli Thiruvengadam, CPC-A Sabine Else Bellinger, CPC-A Radcliff KY Cheryl Moreland, CPC-A from Chesapeake, Va. Adambakkam Chennai Veeresh Vishwanath Rayakodi, CPC-A Chennai Tamil Nadu Jason W Donnelly, CPC-A Richmond KY Beverly T. Ghany, CPC-A Emporia VA Haribabu Narasimhalu, CPC-A Avadi Chennai Murugespalya Bangalore Satheesh TV, CPC-A Chennai Tamil Nadu Nicole M Bibelhauser, CPC-A Shepherdsville KY Virgie M Jones, CPC-A Freeman VA Rajaram Chandrasekaran, CPC-A Sathiya Priya Sarangapani, CPC-A Rajkumar Kuppuraj, CPC-A Chennai Tamilnadu Marsha A. Jones, CPC-A Shepherdsville KY Janice Rebecca Clyburn, CPC-A Fries VA Chrompet Chennai Murugespalya Bangalore V. Janet Ebenezer Mary, CPC-A Chennai Tamilnadu Charleen S Shinkle, CPC-A Shepherdsville KY Tamara Lynn Hicks, CPC-A Hampton VA Manikkavalli Karuppaiah, CPC-A Guindy Chennai Yogeetha Sigamani, CPC-A Iyyappan Muthupandian, CPC-A Julia Lynn Whited, CPC-A Shepherdsville KY Katrina Justine Mason, CPC-A Hampton VA Sivarangabas Arumugam, CPC-A Kolathur Chennai Murugespalya Bangalore Chennai Tamilnadu Allison Nicole Crews, CPC-A Taylorsville KY Jane-Marie J. Massey, CPC-A Hampton VA Arunkumar Chokkalingam, CPC-A Emmanuel Suganand, CPC-A Balaji Suresh Ravi Narayanan, CPC-A Theresa A Hahn, CPC-A Union KY Nancy Neidig, CPC-A Mechanicsville VA MKB Nagar Chennai Murugespalya Bangalore Chennai Tamilnadu Loretta J Vines, CPC-A Fayetteville NC Linda H Sivertsen, CPC-A Middletown VA Srividhya Padmanaban, CPC-A Sembium Chennai Amit Kumar Thakur, CPC-A Jaisheela Padmanabhan, CPC-A Cathy Crowl, CPC-A Fuquay Varina NC Susan C Elder, CPC-A Midlothian VA Neelima Komeravelli, CPC-A Ameerpet, Hyderabad AP Murugespalya Bangalore Chennai Tamilnadu Kimberly M Ramsey, CPC-A Gastonia NC Joyce A Koolhaas, CPC-A Midlothian VA Anitha Anandan, CPC-A Murugespalya Bangalore Chitra Venkata Ramani, CPC-A Chitrakala Ramamoorthi, CPC-A Ashley Paige Meacham, CPC-A Graham NC Gloria M Russell, CPC-A Midlothian VA Shilpa B G, CPC-A Murugespalya Bangalore Murugespalya Bangalore Chennai Tamilnadu Nadine D. O’Neill, CPC-A Hillsborough NC Thedora Brooks-Cole, CPC-A Newport News VA Mekhala C M, CPC-A Murugespalya Bangalore Dr.Eshwarchandra Vidyasagar Boora, CPC-A Mansi Girish Shah, CPC-A Mumbai Niya N Staten, CPC-A Kinston NC Sandra H. McConnell, CPC-A Newport News VA Yeshomathi Kariyanapalya Chandrasekhar, CPC-A Somatiguda Hyderabad Bhargav Shrikant Thakkar, CPC-A, CPC-H-A Lucy E Richardson, CPC-A Macon NC Megan J. Zubrzycki, CPC-A Newport News VA Murugespalya Bangalore Josie Duazo Mananes, CPC-A Quezon City MM Mumbai Johnetta E. Hunter-Leslie, CPC-A Matthews NC Nicole Gail Baumgardner, CPC-A Norfolk VA Madhumitha Elango, CPC-A Eric Descalso Evangelista, CPC-A Antipolo City PH Rachana Virnodkar, CPC-A Mumbai Carol Aplin Wiley, CPC-A Matthews NC Danielle A VanNes, CPC-A Norfolk VA Murugespalya Bangalore Cesar Jr Villegas Trinidad, CPC-A Manila PHI Shalini Sarkar, CPC-A Murugespalya Shirley Anderson, CPC-A Oak Island NC Deborah M Sweetman, CPC-A Portsmouth VA Suananda Tatoy Mariano, CPC-A Quezon City PHI

40 AAPC Coding Edge AAPC Ad:AAPC Print Ad 3/28/08 1:17 PM Page 1

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Code: AAPC2008 www.healthcare.delmar.cengage.com A Complicated Nephrectomy

In April, we presented a case of a patient presenting with acute renal failure. Her left kidney had succumbed to an arterial occlusion and was to be removed. Complicating the procedure was a difficult repair of the superior mesenteric artery, the celiac axis, and supporting tissues. We asked Nancy Reading, vice president of education at the AAPC, to take a look. Here’s her take: First let’s look at the clinical picture. This is an interesting case physiologically. Renal blood flow (RBF) is regulated by a large number of factors to keep flow steady and in turn to keep the filtration of plasma through the glomerulus (glomerular filtration rate or GFR) steady. Remember blood flows into the kidney through the renal artery and then the plasma portion is filtered through the glomerulus and sent on to Bowman’s capsule. The hormonal control of RBF is due to the renin-angiotensin system. Renin is secreted in response to hypotension or hypovolemia to preserve the renal blood pressure by stimulating the cleavage of angiotensin I to angiontensin II. Ultimately, angiotensin II stimulates the release of adlosterone, a potent vasopressor, which increases systemic aterial pressure. Due to the deceased arterial perfusion of the kidney secondary to the stenosis of the celiac artery the body released rennin in response to poor blood flow to the kidney. This caused hypertension in the patient, necessitating the removal of the atrophied kidney and arterial bypass surgery. ICD-9-CM code 447.4 Other disorders of arteries and arterioles: celiac artery compression syndrome indicates there is celiac artery disease. if you look up stenosis\artery\celiac in the Index, 447.4 is the code listed. Hypertension is secondary to the renal hypotension—not renal disease or cardiac disease, which takes the coder to 405.91 Secondary hypertension; renovascular. It would be inappropriate to code 403.X Hypertensive chronic kidney disease as the “excludes” lists renovascular hypertension, or 405.XX. The acute renal failure is also excluded with 403.X. Since the renal failure and renal atrophy are symptoms of the arterial stenosis and induced hypertension it is not necessary to code them. CPT® codes are 35631 (53.06 RVU) 50220 -51 (28.26 RVU), and 38102. CPT® code 35631 Bypass graft, with other than vein; aortoceliac, aortomesenteric, aortorenal is for the arterial bypass graft from the supraceliac (above the take off of the celiac artery) portion of the aorta to the superior mesenteric artery (SMA). The dissection of the kidney was poorly documented for the work done to the ureter, since no bladder cuff was noted 50220 Nephrectomy, including partial ureterectomy, any open approach including rib resection; seems the best fit for the nephrectomy. Code 38102 Splenectomy; total, en bloc for extensive disease, in conjunction with other procedure (List in addition to code for primary procedure) is reported as a result of an iatrogenic injury that could not be repaired, probably due to the 6,000 units of heparin, a potent anticoagulant. There are a variety of schools of thought as to whether you should report the repair of the iatrogenic injury. It was added here for the sake of example. Nancy Reading, BS, RN, CPC, CPC-I Vice President of Education Have You Gone to Extremes?

Have you got a challenging scenario you’d like to see discussed in this forum? Send your op report to [email protected]. Before forwarding it to us, please safeguard the patient’s personal information by changing dates and removing unique identifiers. 42 AAPC Coding Edge extreme coding Can You Code This Note? Faced With a Reconstructive Nightmare This is a case of a very rare malignant growth commonly facial excision the reconstructive surgeon repairs the patient’s occurring in the head, neck, or breast. Removal usually skull base. How would you code this? requires reconstructive surgery. In this case, after the cranio-

Diagnosis: Adenocystic carcinoma status post craniofacial excision Operative Procedure: Skull base reconstruction with bone graft, split calvarial, orbital reconstructions with mesh, nasal reconstruction with cantilever bone graft, palatal reconstruction with plated split-thickness calvarial bone graft rectus, myocutaneous free flap. Placement of Alloderm 16 X 4 cm and split-thickness skin graft 7.5 X 10 cm. Indications: The tumor was misdiagnosed for six months requiring removal by a team of physicians, including a neck extirpative surgeon, a neurosurgeon, and myself. The patient will need additional surgery after planned radiotherapy. - Procedure: A significant defect remained in the skull base when I arrived. The neuro surgeons placed a pericranial flap and the entire inner table of the frontal bone flap.- One of the pieces fit perfectly, covering the supraorbital roofs and part of the cribri form area, and was sealed with Hydrocet. The bone flap was placed back on, closing her- bicoronal, leaving the facial defect. Mesh plates were fashioned, attached, and cantile vered off the lateral orbital rim to create a new orbital floor, inferior orbital rim, and medial wall of the eye. The eyes appeared symmetrical despite significant swelling. I cut a piece of inner table of calvarium to fashion a cantilever bone graft, which was placed in the glabellar area with a multidimensional plate using 1.7 mm screws. This allows nasal dorsal support and tip protection. The patient’s palate had a maxillectomy defect. A mandibular plate was fashioned off the zygoma/linear orbital rim providing upper alveolus and nasal spine support and reducing risk of retropulsion of her flap, compromising the airway. Remaining split cover grafts were cut into one cm wide strips and placed around the cavity areas with screws. After checking the positioning on the model and sterilizing, the flap was harvested. The plate was placed with bone chips within the fat of the rectus myocutaneous flap. The rectus abdominis flap was harvested and designed over the right rectus muscle (a PEG tube was placed previously). The proposed skin panel was cut through the fat with a Bovie cautery and outlined in the skin pad of the anterior rectus sheath. We removed the skin and fat to leave only muscle, and the skin graft was placed Intracostal nerves and blood were Ligaclipped and divided proximally down to the pedicle. In the right neck, the otolaryngologist had already dissected the facial artery and vein and a tunnel was made between it and the cheek subcutaneously. The pedicle was divided. The abdomen was closed with multiple interrupted braided sutures, and a piece of Alloderm was sutured. Dressing was placed on the abdomen after the skin was stapled. A 19-French Blake was placed and sutured with nylon in the groin. - After removing the upper portion of the skin and fat in the head and neck, we posi tioned the pedicle for anastomosis with a single suture to the cut edge of the anterior soft palate, laterally to the buccal mucosa and the inner mucosa of the lip. The lip was closed in three layers. Sutures were also used to lateralize the right base of the nasal tip. We found multiple dermal flaps while cutting the artery and a good location with excellent blood flow. The facial and deep inferior epigastric arteries were cleaned and anastomosed using microsurgical techniques. The vena comitans and facial vein were cleaned and anastomosed using a 3-mm couple system. The neck was closed with a single Penrose and sutured. After the lip reconstruction, the distal muscle was wrapped around the cantilever bone graft and sutured laterally. The subciliary incisions were closed using gut, although buried sutures were used to close deeply. Sixteen 7.5 X 10 cm split-thickness “pie- crusted” skin grafts were placed onto the muscle overlying our cantilever bone graft using multiple interrupted fast absorbing gut. The neurosurgeon took the pins out,out; the endotracheal tube was replaced by a number eight Shiley.

www.aapc.com June 2008 43 feature

Understand Carrier Medical Policy and the Long Denial Process by Jonnie Massey, AHFI, CPC, CPC-P, CPC-I

EXPERT When a service is provided to a patient with insur- The scientific evidence must permit conclusions ance, it should be paid for, right? That’s what we as concerning the effect of the technology on health patients, providers, or consumers like to believe—if outcomes; and it were only that simple. Generally speaking, when jj The technology must improve the net health services are provided, one expects compensation. outcome; and This may not be the case, if the service provided is jj The technology must be as beneficial as any impacted by medical policy. established alternatives; and Let’s explore medical policy and the process behind jj The improvement must be attainable outside developing and reviewing carrier medical policy. investigational settings. Carriers have medical policy that sets coverage guidelines for specific procedures, equipment, and Keep the TEC criteria in mind when submitting services. To provide for you a better understanding data for consideration to a carrier-related to medical of why service compensation may be denied by carri- policy. Thorough research will be conducted. ers, we’ll review the common process used for deter- Embedded in this evidence-based review process mining carrier medical policy. is also a rigorous quality review of published studies following nationally recognized standards for How Medical Policies are Made assessing scientific literature. Once the evidence is Medical policies are determined via an evidence- reviewed, policy drafts are submitted for external based review process that may be reviewed in more review by practicing physicians with expertise in the detail by accessing the individual carrier medical associated technology fields. Examples may include policy development and review process. You can orthopedic surgeons, primary care physicians, and usually review this online or ask for a copy. Please physical medicine specialists as appropriate to the review your carrier’s website or contact them directly reviewed policy. It is within this context that the for details. Published scientific literature is reviewed submitted evidence is reviewed in its entirety by the against technology evaluation criteria (TEC), all of medical policy department. which must be met for the technology to be consid- Things to consider when submitting data to a carrier ered medically necessary. See the twelve programs for a medical policy review or research: the Agency for Healthcare Research and Quality (AHRQ) has designated as evidence-based practice jj Clinical trials: Small-sized clinical trials may centers. not be powerful enough to establish the outcomes’ significance. Considering the prevalence The TEC are defined as follows: of conditions, are sufficiently powered clinical jj The technology must have final approval from the trials expected? appropriate government regulatory bodies; and

44 AAPC Coding Edge Keep in mind, medical policy application is subject to state and federal laws, and specific instructions from plan sponsors and self-insured groups. jj Randomization: Were methods of randomization described in the articles submitted? Few may be considered anecdotal evidence not meeting randomization methods can truly be considered the national standards for scientific literature. The randomized (e.g., computer-generated, coin benefits reported in anecdotal evidence often are toss). Without a description of the used method, not seen when tested in randomized clinical trials. patient selection bias cannot be ruled out. Patient surveys such as requests for personal experi- jj Follow-up period: Is the length of follow-up ence reports included within submitted patient let- too short? When determining safety and efficacy ters tend to be answered by the patients who have of a service, longer-term outcomes are considered positive experiences. This evidence cannot be con- a measured primary outcome. For example, the sidered unbiased. The submitted anecdotal evidence short-term benefits such as a reduction in the will not be included in the critical appraisal of the use of opiates or better initial range of motion published literature. often do not significantly impact the length of If there isn’t new data in the published literature, the recovery period or the success of a surgery in the current medical policy usually remains in place. improving symptoms and functional levels for Medical policy staff continue to monitor the peer-re- these patients. viewed, published literature on a regular basis. If the jj Inconsistency: Check for inconsistencies between literature changes and the five technology assessment studies in the measured outcomes and the mea- criteria are met, the medical policy will be updated. surement tools used. This does not permit comparison between most of the available studies. What Medical Policy Doesn’t Do Medical policy does not determine the schedule jj Mixed results: Have there been mixed results in of benefits, but rather, it dictates the process that the reviewed studies? Does the submitted mate- determines if the services will be paid by the carrier. rial consist of only articles documenting positive Keep in mind, medical policy application is subject outcomes? Would a literature search reveal other to state and federal laws, and specific instructions studies not supporting these outcomes? from plan sponsors and self-insured groups. A search of the MEDLINE database may be con- Medical policy is not medical advice. Questions and ducted in addition to the submitted articles. This concerns about treatment should always be directed search may include reviews of random trials. When to the health care provider. Should a provider or providing data to carrier-related medical policy, it is Jonnie Massey, AHFI, CPC, patient use a service or device not allowed by car- CPC-P, CPC-I, is a senior beneficial to include information about random trials rier Medical Policy, a waiver clearing indicating the investigator in the External specific to your service in the data packet you send service must be signed prior by the patient before Audit and Investigation for review. Department of Regence, receiving the service. Other areas of review may include: a search of the in Portland, Ore., a com- If you are unclear on the medical policy or you have pany that oversees the National Guidelines Clearinghouse database and concerns about a service you provide and how the operation of BlueCross research of the clinical practice guidelines and posi- policy applies, contact your carrier and explore avail- BlueShield plans in four tion statements. western states. She also able options. As always, check with your carriers If you feel it’s necessary to send patient or physician serves on the National prior to providing a service or device that may be Advisory Board of the letters to support your position, know that letters addressed by medical policy. AAPC, in Salt Lake City.

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RACs Are Coming to YOUR Town How Can You Prepare for the Review? Brad Ericson, CPC, CPC-ORTHO

A new federal auditing program is coming to city How Does RAC Work? near you. In the RAC program, it’s all about the money. Audi- The Recovery Audit Contractor (RAC) program, tors aren’t looking for perpetrators of fraud; they’re created in 2004 through the Medicare Moderniza- reviewing claims to uncover errors in code selection Act (MMA) to safeguard the Medicare Trust tion or medical necessity requirements. Contractors Fund, identifies Medicare and Medicaid overpay- working in the RAC program run Medicare claims ments and requests repayments from facilities, physi- through proprietary editors that identify practices cian practices, and DME providers. A demonstration where coding and billing errors occur or practices project begun three years ago in Ariz., Calif., Fla., with high frequencies of procedures targeted by the Mass., N.Y., and S.C. recovered $357.2 million in Office of Inspector General (OIG). In either case, the overpayments for the six states in the federal govern- targeted practices are required to respond to RAC ment’s 2007 fiscal year. requests for patient records and other information. CMS is delighted with the success of its pilot pro- For facilities, the RACs review medical records for gram, which identified and collected overpayments which diagnosis-related groups (DRGs) were reported. not previously caught by Medicare Affiliated Con- For providers, the RACs inspect medical records filed tractors (MACs). The cost to the government is 22 under Part B. For most Medicare Part A and B situa- cents for each dollar returned to the Medicare pro- tions, the RAC sends a request to the provider or facil- gram, a worthwhile payoff by anyone’s standard. The ity for a photocopy of the entire medical record for the hope is that by recovering these costs, short-term encounter and payment in question. gains will be followed by long-term cost savings for A recipient of the letter shouldn’t redact the Medicare providers and members alike. “We need requested records, as RACs are authorized by CMS to ensure accurate payments for services to Medicare to view this information. A response to the RAC beneficiaries and by taking this important step, request must be delivered within 45 days. The RAC people with Medicare can be assured they are being has 60 days to review the record and notify the pro- charged correctly for their share of their health care vider of the outcome of the review. A request may services,” acting CMS administrator Kerry Weems ask for one specific record or multiple records. It’s PROFESSIONAL said recently. critical that the record is photocopied in its entirety CMS announced in March that the RAC program for the RAC, as incomplete records could result in will be operational in 2009 and will name four additional findings of insufficient documentation. regional RACs this spring. The RACs will be private In some cases, the contractor’s data mining systems companies equipped with proprietary Medicare edit determine claims that clearly don’t meet the require- systems, and they will earn a percentage of collected ments of Medicare policies and don’t require medi- refunds. The only states exempt from participation cal records because it is so obvious an overpayment will be those undergoing a Medicare Administrative occurred. CMS reviews a percentage of these determi- Contractor (MAC) transition, and they will be exempt nations before the letters are sent. only during the transition period. RAC isn’t the same as Medicare’s Comprehensive Good Coding is the Best Prevention Error Rate Testing (CERT) program that was imple- CMS says bad coding is the biggest cause of the mented in 2003. In CERT, Medicare contractors’ problem, even though the error rate determined work is evaluated for their ability to detect errors. through CERT has dropped from 14.2 percent in CERT evaluates program performance while RAC 1996 to 3.9 percent in 2007. evaluates individual provider compliance. CERT During the pilot program, almost half of repay- continues to operate as a parallel program as RAC ments resulted from incorrect coding. According to ramps up. a press release from CMS, the types of inadvertent

www.aapc.com June 2008 47 feature

It’s all about the money. Auditors aren’t looking for perpetrators of fraud; they’re reviewing claims to uncover errors in code selection or medical necessity requirements.

errors leading to improper payments found by the and professionalism certified coders will bring to RACs include the following examples: your office. zz A health care provider billed Medicare for con- Pick a single RAC point person. Your office ducting three colonoscopies on the same patient should have one person charged with managing on the same day; any RAC queries when they come. This person will zz Payments were made for services that were coded document all correspondence, perform concurrent incorrectly—for example, Medicare was billed review of records that are sent to RAC, and keep for a certain procedure but the medical record management apprised. shows that a different procedure was actually Keep one for each of you. Be sure to keep a copy provided; of every page you turn over to the RAC; and, while zz A health care provider was paid twice because you can’t amend or change the records, you can the provider submitted duplicate claims; submit an addendum explaining why something was billed a particular way. zz A claim was paid using an outdated fee schedule. Study the 2008 OIG Work Plan. Many of the In these examples, the RAC would issue a repay- targets for RACs are taken directly from the OIG ment request for the amount paid for the extra Work Plan, which can be downloaded at www.oig. service or the incorrect coding. If the beneficiary hhs.gov/publications/docs/workplan/2008/Work_ paid wrong copayment amounts, the health care pro- Plan_FY_2008.pdf. Some of the issues in the 2008 vider would need to reimburse the patient for those work plan include the following: copayments. “Incident to” services provided by non-physician How Can You Prepare? practitioners. Medicare has very specific rules regard- What can you do to prepare before you receive a ing reporting services provided by physician assistants letter from your RAC? (PA) or nurse practitioners (NP). A PA or NP can be Assess the situation. Perform your own retrospective paid at 100 percent of the physician rate if the physi- audit, going back as much as three years to see what cian establishes a treatment plan for the patient and is you uncover. Don’t focus on E/M leveling, as this is a in the office at the time of the encounter. Otherwise, topic that has temporarily been excluded from RACs the PA or NP is reimbursed for services at 85 percent as CMS considers an AMA proposal to change the of the rate paid to a physician. Not adhering to these way these services are reviewed. However, the auditors rules can be very expensive if your practice is audited will still look at duplicate billings, global rules, and and you are found noncompliant. procedures on the same day as an E/M, new vs. estab- Check place of service codes. If you perform lished patients, and consultation issues. surgery in an ambulatory surgical center (ASC) or Educate your team about RAC. Who opens the outpatient hospital, ensure that you are reporting mail at your practice or facility? If a letter from the correct place of service code for these surgeries. RAC isn’t immediately identified, precious time If you report these surgeries with the code for your could be wasted, hobbling your response. The mail own office rather than an ASC or outpatient hospi- room, front office, back office, finance team, recep- tal, you will be overpaid for the services. tionist, or unlucky intern should all be aware of the Observe global periods. Ensure you aren’t bill- RAC program and alert to any RAC correspondence. ing for follow-up office visits occurring within the Employ certified coders. CMS is requiring RACs global period of the surgery. These visits are consid- to use certified professional coders in their reviews. ered part of the surgical package and shouldn’t be If you aren’t using certified coders, consider hiring separately reported. some, or certifying those you have. Certified coders Watch unbundling of procedures. Keep current can talk peer-to-peer, which is an advantage to use with the National Correct Coding Initiative (NCCI) during an audit. The other plus is the knowledge to ensure your office isn’t billing for more procedures

48 AAPC Coding Edge feature than is appropriate. For example, if during a diagnos- ago, and providers were told to bill one unit of the tic colonoscopy the physician removes some polyps HCPCS Level II code for each vial of drug delivered. by snare, the code for the colonoscopy with snare Because the cost of one vial of pegfilgrastim costs retrieval of polyps is the only code reported. The more than $2,000, recovery from misreporting of diagnostic colonoscopy is bundled into the primary administration of this drug was significant. procedure. Know Medicare rules. RAC contractors will be Assure Medical necessity. Ensure that the services monitored by CMS, but it’s always possible that a provided to the patient meet the medical neces- contractor will misinterpret the local and national sity requirements found in the National Coverage coverage decisions regulating how you bill for a par- Determinations (NCDs) accessed on the Medicare ticular service. You can help the RAC contractors— website and Local Coverage Determinations (LCDs) and yourself—by clarifying particular situations. approved by the MACs. Ensure the diagnosis is ade- Knowledge is power. quately documented in your medical record for the patient. “Rule out” diagnoses are never acceptable When Will You See It? diagnoses and be sure coders can find a “real” diag- If you’re not in one of the demonstration states, you nosis in the record. For example, “rule out pneumo- have time to prepare. nia” may be a reason for a chest X-ray, but the chart While CMS admits the dates are flexible and that should describe why pneumonia was suspected. some states may not see RACs if they’re undergoing Fever, cough, and chest pain all can be coded and all a MAC transition, they expect the following states What do you think of meet the medical necessity rules for the chest x-ray; to begin RAC this spring. In addition to the dem- RAC? Are you ready? “rule out pneumonia” cannot and does not. onstration states (save for Calif.): Ariz. Mont., Wyo., Log on to the AAPC Confirm units of service. From x-ray services to N.D., S.D., Minn., Colo., N.M., Ind., Mich., N.H., Medical Coding & pharmaceutical injections, ensure that the correct R.I., and Maine. States looking at fall implementa- Billing Forums at unit number is reported in the claim. One of the tion include Calif., Hawaii, Nev., Okla., and Texas. www.aapc.com/ common errors cited in the RAC report involved The rest will see RAC in 2009 at the very latest. memberarea/ billing for pegfilgrastim. In the past, one unit of the For more information on the RAC program and to forums/index.php HCPCS Level II code for pegfilgrastim was reported view the FY 2007 Status Document, visit: http:// and let us know. for each milligram of drug delivered, but CMS www.cms.hhs.gov/RAC changed the fee schedule and rules several years

www.aapc.com June 2008 49 test yourself GetGet Certified.Certified. GetGet Ahead!Ahead! Tests Your Knowledge Join us at a Coding Edge location near YOU! 1. What federal program plays heavily into the Medicare physician fee schedule this year? June 2008 a. CERT b. RAC c. PQRI d. OPPS 2. What code is used when several patients are being treated in a PT clinic and have a common, unifying element? a. 97010 b. 97001 c. 97150 d. 97113 3. An ABN is given to a Medicare beneficiary for what purpose? a. When the copay is waived b. When the test results are all but normal Look For Your Conference Specialty Below! c. When the service is likely not to be covered Join us for CodingCert.com’s three-day CPC® Training Camps starting this June, and gain the tools you d. When the practice is being audited by OIG need to master the AAPC’s Coder Certification Exam! 4. For 2009, CMS has proposed what for ICD-9-CM? a. FewestFor changes more in a decade information call us toll-free Earning the gold-standard CPC® certification means more expertise, more money, more career oppor- b. Removal at of (866)the V codes 251-3060 and mention code c. Most changes in a decade tunities, and more professional recognition for coders, billers, and other health care professionals. The d. Addition of sectionVCEDG308 for alternative therapiesor visit us online at results of the AAPC’s recent Salary Survey revealed:

5. Payer medical policywww.codingconferences.com is determined via what? a. High level meetings of insurance executives, physicians, and lawyers  Certified Coders earn an average of 17 % more than their non-certified counterparts. b. Application to state insurance commissions  42 % said that Certification was required for employment at their current positions. c. Evidence-based review process  41% of coding positions are closed to non-certified coders. Recent search of d. Annual meetings of payer actuaries Monster.com revealed 310 available medical coding positions, 128 of which 6. Use what modifier to report a waiver of liability or ABN on file? required certification. a. 59 b. CC So find a way to take 3 days — just 3 days — out of your busy job and personal life, and we’ll deliver c. GA exactly what you need to pass the CPC® exam and reap benefits that last your entire career. Learn d. 52 Starting in June... from a master instructor, and get to know other health care professionals who are striving for the 7. When a RAC requests records, you should do what? Sponsored By: same goal. a. Provide redacted claims only to avoid HIPAA violations b. Provide only summaries of each record Index: CE06002008A Earn AAPC Approved c. Make complete copies of each record for the RAC andCEUs! you You can earn up to Starting in June... Get One CEU d. Amend the records to correct any mistakes 16 CEUs per conference! These questions are answered in articles throughout this news magazine. For answer- 8. Which federal program is similar to, but not the same as the RAC? ing all questions correctly, you will receive one a. MPFS CPC® Training Camps are coming to CEU at the time of your renewal. These CEUs b. ABN are awarded in addition to the CEUs avail- c. CERT 22 states and 28 cities! able annually for submitting summaries from d. PQRI Coding Edge. Please do not submit until your To find the CPC® Training Camp nearest you, visit us at renewal date. 9. You have how many months to implement the new ABN forms? Test Yourself Online a. Three months from March 3 www.CodingCert.com or call us at 866-251-3060. These same questions can be accessed online at b. One year from July 1 Full Page www.aapc.com/testyourself/. Once you go there c. Six months from March 3 Live area: 7.625” x 10.125” and take the test, you can automatically grade d. Six months from July 1 your answers, correct any mistakes and have your CEUs automatically added to your CEU 10. ICD-9-CM may have a dozen codes dealing with what current issue? CodingCert.com Tracker for submission. a. Teen drinking Note: Beginning this month (June), all Test b. Closed head injuries Get Certified. Get Ahead! Yourself questions can be accessed online. c. Pap smears and HPV d. Post traumatic stress disorder 50 AAPC Coding Edge GetGet Certified.Certified. GetGet Ahead!Ahead! Join us at a location near YOU!

Look For Your Conference Specialty Below! Join us for CodingCert.com’s three-day CPC® Training Camps starting this June, and gain the tools you need to master the AAPC’s Coder Certification Exam!

For more information call us toll-free Earning the gold-standard CPC® certification means more expertise, more money, more career oppor- at (866) 251-3060 and mention code tunities, and more professional recognition for coders, billers, and other health care professionals. The VCEDG308 or visit us online at results of the AAPC’s recent Salary Survey revealed: www.codingconferences.com  Certified Coders earn an average of 17 % more than their non-certified counterparts.  42 % said that Certification was required for employment at their current positions.  41% of coding positions are closed to non-certified coders. Recent search of Monster.com revealed 310 available medical coding positions, 128 of which required certification.

So find a way to take 3 days — just 3 days — out of your busy job and personal life, and we’ll deliver exactly what you need to pass the CPC® exam and reap benefits that last your entire career. Learn Starting in June... from a master instructor, and get to know other health care professionals who are striving for the Sponsored By: same goal.

Earn AAPC Approved CEUs! You can earn up to 16 CEUs per conference! Starting in June... CPC® Training Camps are coming to 22 states and 28 cities! To find the CPC® Training Camp nearest you, visit us at www.CodingCert.com or call us at 866-251-3060. Full Page Live area: 7.625” x 10.125” CodingCert.com Get Certified. Get Ahead!