HEALTHCARE BUSINESS MONTHLY July 2016 www.aapc.com Coding | Billing | Auditing | Compliance | Practice Management
Get Paid for Smoking Cessation: 22 Don’t give up on reimbursement: Verify coverage
Exude Confidence as an Auditor: 52 Ditch the emotional baggage and gain respect
Tips to Improve HEDIS Scores: 60 Enhance quality of care and reduce costs Smart Design. Intelligent Auditing. Healthicity - 1
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HEALTHICITY.COM/AUDITMANAGER Healthcare Business Monthly | July 2016
COVER | Coding/Billing | 38 Secrets of Successful Coders Apply 14 strategies to help you climb your way to coding success. Smart Design. By Stephanie Cecchini, CPC, CEMC, CHISP Intelligent Auditing. Healthicity - 1 [contents] ■ Coding/Billing ■ Added Edge ■ Practice Management
Customize, manage, train and simplify your audit process. We streamlined your audit process by merging audit workflow, management, and reporting 22 Get Paid for Smoking Cessation 52 Ditch the Emotional Baggage to 56 Manage Hospital capabilities into one easy-to-use, web-based solution. Kasandra Bolzenius, CPC Become a Respected Auditor Staff Cellphone Distractions Holly Pettigrew, COC, CPC, CHC Michelle A. Dick
HEALTHICITY.COM/AUDITMANAGER [continued on next page] www.aapc.com July 2016 3 Healthcare Business Monthly | July 2016 | contents
16 ■ Member Feature 14 Emory Physician Group Practice Celebrates and Prepares Its Coders Donna Beaulieu, CRC, C-CDIS, CPC-I, CPMA, CPC, CEMC, CEDC, CFPC, CCP-P, CRP Hasan Zaidi, MPH, CPC, CEDC, CSPPM
■ Coding/Billing 16 MACRA FAQs Renee Dustman 20 Think Twice Before Sticking It in Your Ear Maryann C. Palmeter, CPC, CENTC, CPCO, CHC 24 Providers vs. Payers: Collaboration is the Best Medicine 24 Susanne Myler, COC 28 Cut Costs with Quality Transitional Care Management Stephen Canon, MD 32 Combat Common Denials in Orthopedic Coding Michael Strong, MSHCA, MBA, CPC, CEMC 42 Soothe the Sting of 2016 Paravertebral Block Changes Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CANPC, CASCC, CEDC, CRC, ICDCT-CM/PCS 44 ICD-10 Restricts Same-day Sick and Well Visits Debra Mitchell, MSPH, COC 48 WHO Winds Its Gears for ICD-11 50 Brad Ericson, MPC, CPC, COSC 50 The Latest on Multianalyte Assays with Algorithmic Analyses John Verhovshek, MA, CPC
■ Auditing/Compliance 54 Guard PHI with Sensitivity Andy Rusch, CPC
■ Practice Management 60 HEDIS: Manage Your Healthcare Outcomes Lynn Stuckert, LPN, CPC, CPMA COMING UP: DEPARTMENTS 66 Minute with a Member •• Cardiac Cath Reports 7 Letter from Member Leadership •• Officer Nominations EDUCATION 8 Letters to the Editor •• Audit Defense 62 Newly Credentialed Members 9 I Am AAPC •• Medical Device Credits 10 AAPC Chapter Association •• ICD-10 Best Practices 11 AAPC National Advisory Board On the Cover: Stephanie Cecchini, CPC, CEMC, CHISP, reveals 14 Online Test Yourself – Earn 1 CEU secret strategies that will help you climb your way to coding success. 12 Chapter News www.aapc.com/resources/publications/ Cover photo by Rachel Momeni. 47 Dear John healthcare-business-monthly/archive.aspx
4 Healthcare Business Monthly Page 5_HBM-July-2016 edits02_ALAM.pdf 1 13/06/16 4:51 pm
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Visit o CPCOn neRe e or call on of our academic advisors at Serving 156,000 Members – Including You! Go Green! HEALTHCARE Why should you sign up to receive Healthcare Business Monthly in digital format? BUSINESS MONTHLY Coding | Billing | Auditing | Compliance | Practice Management Here are some great reasons: July 2016 • You will save a few trees. • You won’t have to wait for issues to come in the mail. Publisher Brad Ericson, MPC, CPC, COSC • You can read Healthcare Business Monthly on your computer, tablet, or [email protected] other mobile device—anywhere, anytime. • You will always know where your issues are. Managing Editor John Verhovshek, MA, CPC • Digital issues take up a lot less room in your home or office than paper [email protected] issues. Go into your Profile on www.aapc.com and make the change! Editorial Michelle A. Dick, BS Renee Dustman, BS HealthcareBusinessOffice, LLC...... 31 Graphic Design www.HealthcareBusinessOffice.com Mahfooz Alam ionHealthcare...... 58 www.ionHealthcare.com Advertising Ohana Healthcare, LLC...... 65 Jon Valderama www.ohanahc.com [email protected] Optum360...... 8 vendor index vendor Address all inquires, contributions, and change of address notices to: www.optum360coding.com/transition Healthcare Business Monthly Superbill Consulting Services, LLC...... 65 www.superbillconsulting.com PO Box 704004 Salt Lake City, UT 84170 The Coding Institute, LLC...... 47 www.codinginstitute.com/books (800) 626-2633 ©2016 Healthcare Business Monthly. All rights reserved. Reproduction in whole or in part, in The HIPAA Institute...... 65 any form, without written permission from AAPC® is prohibited. Contributions are welcome. www.hipaainstitute.com Healthcare Business Monthly is a publication for members of AAPC. Statements of fact or ZHealth Publishing, LLC...... 27 opinion are the responsibility of the authors alone and do not represent an opinion of AAPC, www.zhealthpublishing.com or sponsoring organizations. CPT® copyright 2015 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not as- Ask the Legal Advisory Board signed by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA is not recommending their use. The AMA does not directly or indirectly practice medi- From HIPAA’s Privacy Rule and anti-kickback statute, to compliant coding, cine or dispense medical services. The AMA assumes no liability for data contained or not to fraud and abuse, there are a lot of legal ramifications to working in contained herein. healthcare. You almost need a lawyer on call 24/7 just to help you make sense of all the new guidelines. As luck would have it, you do! AAPC’s Legal The responsibility for the content of any “National Correct Coding Policy” included in this Advisory Board (LAB) is ready, willing, and able to answer your legal ques- product is with the Centers for Medicare and Medicaid Services and no endorsement by the tions. Simply send your health law questions to [email protected] and let AMA is intended or should be implied. The AMA disclaims responsibility for any consequenc- the legal professionals hash out the answers. Select Q&As will be published es or liability attributable to or related to any use, nonuse or interpretation of information con- in Healthcare Business Monthly. tained in this product. CPT® is a registered trademark of the American Medical Association. Medical Coding Legal Advisory Committee: ® TM ® TM ® ® Timothy P. Blanchard, JD, MHA, FHFMA CPC , COC , CPC-P , CPCO , CPMA , and CIRCC are registered trademarks of AAPC. Julie E. Chicoine, JD, RN, CPC Volume 3 Number 7 July 1, 2016 Michael D. Miscoe, JD, CPC, CPCO, CPMA, CASCC, CCPC, CUC Healthcare Business Monthly (ISSN: 23327499) is published monthly by AAPC, 2233 South Presidents Christopher A. Parrella, JD, CPC, CHC Drive, Suites F-C, Salt Lake City UT 84120-7240, for its paid members. Periodicals Postage Paid Robert A. Pelaia, Esq., CPC at Salt Lake City UT and at additional mailing office. POSTMASTER: Send address changes to: Stacy Harper, JD, MHSA, CPC Healthcare Business Monthly c/o AAPC, 2233 South Presidents Drive, Suites F-C, Salt Lake City UT 84120-7240.
6 Healthcare Business Monthly Letter from Member Leadership
Two Unique-to-AAPC Resources Have Unsurpassed Value
s I glanced at the table of contents for this Amonth’s Healthcare Business Monthly two things immediately came to mind. My first thought is how fortunate we are to have a monthly publication that provides us with so much valuable information. The topics are current, varied, and answer the needs of members for each of our specialties, jobs, and responsibilities. My second thought is how valuable our local chapters are to members. Local Chapters Bring You the Best at May MAYnia Looking at all the topics that were presented across the country for this year’s May MAYnia, I’m impressed at how the local chapters went all out to provide members with some incredible educational dream jobs because of connections made at Nothing compares opportunities. The topics were just as varied chapter meetings. as the ones presented in this magazine. The only sadness I have in regards to local to seeing members Chapter officers worked hard to make the chapters is how many of my own local meetings successful. Some held all-day chapter meetings I cannot attend due to my show up at a meeting events, others combined May MAYnia into traveling schedule. their regular monthly meeting, adding prizes and watching the and giveaways, and encouraging members Dive into Your Valuable Resources to bring guests. The photos, posts, and networking that starts updates kept “AAPC Alex” very busy on the I hope you enjoy this month’s edition of AAPC Facebook page. The excitement was Healthcare Business Monthly. Find your immediately. contagious. favorite article and discuss it with peers at your next chapter meeting. Better yet, think Take the typical excitement you find at a of an article you want to write for Healthcare normal chapter meeting and step it up a Business Monthly or a topic you’d like to notch or two and you have the fever that present at your local chapter. Have no fear! is May MAYnia. I was both fortunate You’ll be among friends who appreciate your and honored to be the speaker at the expertise. Indianapolis, Indiana, local chapter’s May MAYnia. The spirit of the event stayed with me for many days. Take care, I Love Local Chapter Meetings! Nothing compares to seeing members show up at a meeting and watching the networking that starts immediately. Some Jaci Johnson Kipreos, CPC, COC, CPMA, members have made lifelong friends at their CPC-I, CEMC chapter meetings. Others have found their President, National Advisory Board
www.aapc.com July 2016 7 Please send your letters to the editor to: Letters to the Editor [email protected]
Failure to Report a witnessed a murder could be charged for not Example: A patient has an existing Crime Is Not a Crime reporting what he or she saw to police. nephrostomy catheter. Diagnostic A coder’s liability under the False Claims nephrostogram is performed (50431), “Are Auditors, Billers, and Coders Liable Act only arises when he or she is an active demonstrating a mid-ureteral stenosis. for False Claims?” (May 2016, pages 48-49) participant in the misconduct (this may Ureteroplasty is performed (+50706). The contained an inaccurate statement: “Having have been the unstated presumption of the nephrostomy tube is removed and not knowledge and being aware of a person or statement cited from the article). In such replaced at the end of the procedure (50389). entity generating fraudulent claims is a crime.” cases, a coder might face direct and/or To clarify, no person has an affirmative duty to conspiracy liability. Additionally, a coder Biliary Coding Example report a crime or to report fraudulent conduct could be held liable for obstruction if he or Needs Clarification such that failure to do so is, in itself, a crime. she assisted in efforts to conceal the crime Coders do not need to fear that they will be The article “Percutaneous Biliary by destroying or altering records in response Interventional Coding” (April 2016, pages liable for the misconduct of others, especially to a government investigation. when they are instructed to code or bill in a 28-31) included an example on page 29 (top manner they are not comfortable with. Michael D. Miscoe, Esq., CPC, CASCC, right), which should have specified: CUC, CCPC, CPCO, CPMA Although coders have an ethical duty to Example: A patient has an existing external advise a provider or entity of what they biliary drainage catheter. Diagnostic perceive to be inappropriate coding or Proper Codes for cholangiogram is performed (47531), billing practices, they have no legal duty Nephrostomy Tube Removal demonstrating a distal common bile duct stenosis. Cholangioplasty is performed to do so, and have no legal duty or AAPC An example in “CPT® 2016: Urinary (+47542). No tubes are left in place at the Code of Ethics duty to report such conduct Interventional Coding” (March 2016, end of the procedure (add 47537 for tube to law enforcement. A coder could not be page 19) did not list the proper coding for removal and delete 47531 as bundled with charged with a crime for failing to report nephrostomy tube removal. The example tube removal). misconduct no more than a person who should have specified:
Thank you TO THOSE OF YOU THAT VISITED US AT AAPC HEALTHCON 2016.
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8 Healthcare Business Monthly I Am AAPC
TIERNEY DAVIS HOGAN, RN, MBA, CPC
fter a couple years in clinical nursing, I was drawn to the business side Aof healthcare. Originally, I thought that meant I would be working as a utilization review nurse for a health plan. After a couple of years in medical management for health plans, including utilization review and case management, I discovered my true interest was in medical claims review. That gradually led to an interest in reviewing claims not only for medical necessity but for all guidelines pertaining to coding and billing healthcare services. Solidifying Knowledge on the Business Side of Healthcare I went on to earn my Certified Professional Coder (CPC®) credential in 2007. I now work for a large health plan, where I transitioned from medi- cal claims review to coding specialist project lead on a team responsible for health plan benefits coding configuration. My primary work focuses on ensuring that procedure and diagnosis cod-
ing configurations of health plan benefits are aligned with state and feder- #IamAAPC al mandates, especially related to preventive care benefits mandated by the Affordable Care Act. It is interesting and challenging work. I have learned so much about After a couple of U.S. Preventive Service Task Force guidelines, Bright Futures guidelines, Health Resources and Services Administration Women’s Preventive Ser- years in medical vices Guidelines, the Centers for Medicare & Medicaid Services FAQs re- management lated to preventive services, and state mandates related to preventive care. for health plans, Front- and Back-end Coders Working to Meet Standards I work on the “back end” with health plan medical directors, ensuring that including utilization coding of insurance benefits align with current standards of practice, as well as state and federal mandates. My work has led me to greatly respect coders review and case who work on “the front line” with their physicians, ancillary providers, and facilities. management, I discovered my true interest was in medical claims review.
#IamAAPC
www.aapc.com July 2016 9 AAPC Chapter Association By Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC Validate Your Expertise with a Specialty Credential Show employers that you have coding, reimbursement, and compliance know-how in a unique area of healthcare.
ealth facilities of all A complete list of specialty credentials is listed on the AAPC Hsizes rely on medical specialty credentials website: www.aapc.com/certification/specialty-credentials. coders, compliance aspx, as shown in Figure A. Which certifications are right for you? officers, practice managers, Find out at www.aapc.com/certification/medical-coding-certification.aspx. etc., to protect their livelihood by obtaining proper reimbursement from Figure A: AAPC offers 22 specialty credentials. payers and patients for services rendered by providers on staff. As such, these positions have a high degree of responsibility, and employers are sometimes reluctant to hire new staff unless they can prove competence in a specific area. Specialty certifications prove istock.com/Casanowe you have what it takes to get the job done right. Prove to Employers You Mean Business Employers today are looking for applicants with a solid academic foundation and relevant experience in particular areas of healthcare. As the industry becomes more demanding, complex, and competitive, certification gives you a distinct advantage among other, less qualified job applicants. Certification shows you are proficient in your specialty area Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, specializes in dermatology coding. A national speaker on coding and regulatory issues, she presents at American Academy of and committed to quality healthcare. Employers understand Dermatology annual and summer meetings, AAPC regional conferences, and several other the importance of certification, which is why it’s one of the first venues. McNicholas has a wide range of experience in various medical specialties and practice qualifications they look for when scanning for potential candidates. settings. She is also a certified and approved ICD-10-CM/PCS expert and trainer, a former You’ll find it’s also an asset when you’re negotiating salary. member of the AAPC Chapter Association, and has served office for the Des Plaines, Ill., local chapter. Choose Your Specialty AAPC offers 22 specialty credentials you can earn to demonstrate a superior level of expertise in your respective specialty disciplines. That means they are standalone certifications with no requirement to obtain the Certified Professional Coder (CPC®) credential. As the industry becomes more Popular core credentials include: CPMA® Certified Professional Medical Auditor demanding, complex, and CPCO® Certified Professional Compliance Officer CPPM® Certified Physician Practice Manager competitive, certification gives CIRCC® Certified Interventional Radiology and Cardiovascular Coder you a distinct advantage among CPB® Certified Professional Biller CRC® Certified Risk Adjustment Coder other job applicants.
10 Healthcare Business Monthly AAPC NATIONAL ADVISORY BOARD ■ By Angela Jordan, CPC NAB Regional Spotlight: Region 6 – Great Lakes Two representatives team up to promote, serve, and support AAPC and its Region 6 members. he National Advisory Board (NAB) is meetings and conferences. You have probably and Development, at which time she was Tturning the spotlight this month to Region read her many articles in this publication over mentored by Rhonda Buckholtz, CPC, 6 – Great Lakes and its representatives. The the years. She was featured on the cover of the CPCI, CPMA, CRC, CHPSE, CENTC, Great Lakes region is comprised of Wisconsin, October 2010 edition of AAPC’s Coding Edge CGSC, CPEDC, COBGYN. Minnesota, Illinois, Indiana, Michigan, and for her expertise on 5010 transaction prior When traveling became too difficult with a Ohio. The six states of Region 6 cover 388,306 to ICD-10 adoption. Boynton is an active young son, Reid went back to work for UVM square miles. This region is home to 21,511 member of the Worchester, Massachusetts, Medical Center. But when she confessed to AAPC members and 77 local chapters. local chapter. Buckholtz that she missed the camaraderie Angela (Annie) Boynton, RHIT, CPC, Outside of work, Boynton is savvy with she felt at AAPC, her mentor suggested she COC, CPCO, CPC-P, CPC-I, CCS, genealogy. While working on her family tree, apply to be on the NAB. She did, and the rest CCS-P, of Shrewsbury, Massachusetts, and she discovered she was related to another NAB is history. Kimberly Reid, CPC, CPMA, CPC-I, member, Chandra Stephenson, CPC, COC, “AAPC has been an incredibly positive CEMC, of Burlington, Vermont, are the two CPB, CPCO, CPMA, CPC-I, CIC, CCS, influence in my life. My coding credentials NAB representatives who promote, serve, and CANPC, CEMC, CFPC, CGSC, CIMC, have given me the opportunity to grow in a support AAPC and its Region 6 members. COSC. She traced her lineage back six or way that I never thought was possible,” Reid seven generations to the same family in the said. “Being part of the NAB allows me to Annie Boynton, RHIT, same little town in Tennessee. It’s impressive meet other coders and help them understand CPC, COC, CPCO, CPC-P, for two relatives to have honored AAPC with the value of what we do every day.” NAB service. CPC-I, CCS, CCS-P Reid has lived in Burlington, Vermont, for the Boynton has served in Kimberly Reid, CPC, past 15 years. Although Reid loves Vermont, the health information she still has strong roots in Michigan, and management field for 15 CPMA, CPC-I, CEMC proudly displays her Michigander spirit; she years in provider, payer, Reid has worked in the especially loves the Red Wings. and educational capacities. She is principal of medical field for 28 years. Boynton Healthcare Management Solutions, She began as receptionist Making Region 6 Stronger specializing in practice and payer consulting, for a walk-in clinic near Both Boynton and Reid have a passion for our compliance, and education. Boynton holds Detroit, Michigan. Reid profession, and they are dedicated to acting several certifications in coding, as well as recalls, “All I had to do was smile, pull charts as a voice to see us through the changes as degrees in health information technology and and chat it up with the patients. I loved it! healthcare evolves. We encourage you to reach healthcare management, and she is pursuing Everything about that job was fascinating, out to them; they would enjoy hearing from graduate work in health, hospital, and except when they taught me how to draw you. You can reach Boynton at Annie.Boynton@ pharmaceutical law at Seton Hall University. blood. That’s when I knew the coding part of aapcnab.com and Reid at [email protected]. the medical field was where I belonged.” The The past few years, Boynton has traveled If you want to be part of something that can sight of blood made her faint. the country teaching ICD-10 and other change people’s lives and provide you with workshops for AAPC. She has also spoken Reid worked hard to gain experience in billing exceptional personal growth, we encourage at several national and regional AAPC and coding, and later took a position as you to submit an application to serve on the conferences, in addition to numerous chapter coding educator at the University of Vermont NAB. It will be an experience you’ll never (UVM) Medical Center. When the Medical forget! Center asked her to teach the Certified Great Lakes Region Fun Fact Professional Coder (CPC®) class, she figured Angela Jordan, CPC, is managing consultant at Med- it was high time she became credentialed. ical Revenue Solutions, LLC, with more than 25 years of With a name like “Great Lakes” you’d expect a lot of experience in the healthcare field, and has been a mem- water. According to the U.S. Geological Survey Water Reid also got involved in the Burlington, ber of AAPC for 15 years. Her career path has taken her Science School, Michigan is covered with the highest Vermont, local chapter, and worked her way from a small family practice, radiology, large physician services group to a percentage of water at 41.50 percent. Minnesota, up the ranks to become president. AAPC managing consultant. Jordan is on the AAPC NAB and has held many offic- known as “the land of 10,000 lakes,” is covered by later chose her to become an expert ICD- es in the Kansas City, Mo., local chapter, including president. In 2009, she 8.4 percent water. 10 trainer, and eventually offered her the served on the AAPC Chapter Association board of directors and was chair- woman in 2012. position of director of ICD-10 Training
www.aapc.com July 2016 11 Chapter News By Michelle A. Dick May MAYnia: Fun and Education Overload Chapters turn up the value for this annual event.
very year AAPC local chapters celebrate May MAYnia, which is a of Clearwater’s officers smoked a pork butt all day, so members could Efun way to provide members with quality education, draw in new enjoy pulled pork sandwiches. In addition to the goodies AAPC sent, members, and promote networking with colleagues. Four chapters they raffled off a gardening basket and a tote bag filled with beach share how they ramped up participation at their monthly meetings essentials. They also gave out dozens of “beachy” door prizes. As for last May. coding education, Laureen Jandroep, COC, CPC, CPPM, CPC-I, CEO of Certification Coaching Organization, gave a presentation Clearwater Gulf to Bay, Florida on modifiers. The Clearwater Gulf to Bay, Florida, local chapter chose a beach The newest member of the Clearwater chapter, Terry Paulus, CPC, a theme for their May MAYnia celebration, complete with sand transplant from Kentucky, said, “The Clearwater Gulf to Bay AAPC toys, flip-flops, and seashells. They named the foods to correspond local chapter May MAYnia was the best I have ever experienced in the 10 years of attending local chapter meetings. The food, fun, and fabulous raffle items were over the top. Good job Sandi Webb, Christine Cornforth, and Cindy Lewis. You guys are the best!” Webb said, “The best part was a larger-than-usual turnout and the fellowship we all enjoyed that evening.” Big Stone Gap, Virginia May was filled with positive activities for the Big Stone Gap, Virginia, local chapter. On May 1, several members participated in the Mountain Empire Older Citizens Walkathon. The proceeds from each walkathon benefited the Emergency Fuel Fund for the Elderly and assisted senior citizens with home heating-related emergencies during the winter months. The chapter raised $550. To top off the chapter’s good deeds, on May 13, six of Big Stone Gap’s Clearwater’s “Beach Rules” helped members come out of their shell at May MAYnia. students and AAPC members (five are Certified Professional Coders (CPCs®)) earned their associate degree in Health Information with the beach theme: “Spinach dip was seaweed dip, pretzel sticks Management. were driftwood, blue punch was gulf water, and we had a cake with a shoreline motif on top, as well as Nutter Butter flip-flops,” said Sabrina Ward, CPC, CCA, CEHRS, CBCS, said, “We are a small chapter Vice President Sandi Webb, BA, CPC. The husband of one chapter — but thanks to the involvement of our students, we are
Nutter Butter flip-flops and shoreline Big Stone Gap and their families join Mountain Empire cake were a big hit at Clearwater’s beach-themed May MAYnia. Community College for a walkathon to benefit senior citizens.
12 Healthcare Business Monthly Chapter News
Cynthia Brigg’s PAC Family Trivia game was a big success in Petersburg.
codebooks as door prizes and two new coders each won an AAPC The Big Stone Gap HIM graduates are a proud group. Coder subscription. Briggs said, “All of them wanted me to pass along their appreciation for the prizes!” seeing a growth in our meetings and looking forward to what’s to come!” Toledo, Ohio The Toledo, Ohio, local chapter knows how to pack in a crowd at Petersburg, Virginia May MAYnia. President Robin Moore, CPC, proudly announced May MAYnia was a success for the Petersburg, Virginia, local that, “87 members were in attendance, up from 45 last year.” Pizza, chapter. Keisha Sutton, CPC, from The American Congress of salad, and cake were served; Obstetricians and Gynecologists, or ACOG, spoke for two hours and Janet Cullum, CPC, on defining the obstetrics/gynecology global package. After her gave a presentation on presentation, members played a trivia game that Petersburg President documentation. Cynthia Briggs, CPC, CPMA, created called PAC Family Trivia. Moore said, “Our seminar If you are interested in incorporating the game at your next chapter was such a success last meeting, here’s how it’s played: month, so we wanted to • Each table has 25 cards containing coding-related questions This cake says it all. Nice job Toledo, Ohio! give back to our members.” facing down in the middle of the table. Toledo offered two • Members take turns reading the questions, and the remaining continuing education units to members for only $1, and they gave members at the table try to be the first to answer each question away prizes galore: books, gift cards, shirts, and lots of other AAPC correctly. chapter goodies, according to Moore. • The member who answers correctly first gets the card. If no one answers the question correctly the reader keeps the card. • Whomever has the most cards at the end of the game wins! Petersburg had over 30 members attend, which is up from last year. AAPC’s giveaways were a big hit: Two members won ICD-10-CM
It’s a full house listening to Janet Cullum’s presentation at Toledo’s May MAYnia.
No doubt these chapters will see a return on their invested efforts. Great job officers! For more May MAYnia celebrations, check out the AAPC Group on Facebook, www.facebook.com/groups/21496405430/.
Michelle A. Dick is executive editor at AAPC and a member of the Flower City Coders, Rochester, N.Y., local chapter. Keisha Sutton explains the obstetrics/gynecology global package at Petersburg’s May MAYnia.
www.aapc.com July 2016 13 ■ MEMBER FEATURE By Donna Beaulieu, CRC, C-CDIS, CPC-I, CPMA, CPC, CEMC, CEDC, CFPC, CCP-P, CRP, and Hasan Zaidi, MPH, CPC, CEDC, CSPPM Emory Physician Group Practice Celebrates and Prepares Its Coders Georgia’s largest healthcare system embraces the new face of healthcare and prepares its staff for change.
Emory Physician Group Practice coders celebrate Medical Coders Day.
Establishing Georgia Medical Coder’s Day Emory’s Coding Education Department worked with Governor Nathan Deal’s office to designate May 19, 2016, as Georgia’s Medical Coders Day. Emory was thrilled to receive proclamation from the governor, recognizing coders across the state of Georgia for their invaluable support to physicians, care teams, insurance payers, and patients. Bridging the Provider - Coder Gap mory Physician Group Practice (Emory) encompasses 2,000 Eproviders, more than 39 specialties at more than 80 locations, six Emory’s Coding Education Department strives to create a strong hospitals, and at least 130 medical coders. This healthcare system partnership among providers, coders, and clinical departments by supports its medical coding professionals, and is leading its clinical and serving four key functions: business staff into healthcare’s future: the value-based payment model. 1. Coding to capture true patient acuity Let’s look at how they honor their coding professionals and help them 2. Documentation improvement prepare for an evolving healthcare industry. 3. Strategic initiatives 4. Education engagements
14 Healthcare Business Monthly Member Feature
... they have focused on faculty physicians from Emory School of Medicine. Coders who attend earn free continuing education units from design, development, and AAPC.
Emory Coding University is deployed. This is an online MEMBER FEATURE integration of future healthcare platform of coding- and documentation-related webinars created by the Coding Education Department (short videos: reimbursement models. 10-15 minutes). 2016: The Provider Shadowing Initiative is initiated for continued ICD-10 support. Coding educators observe provider workflow to ensure services rendered are documented and coded accurately. Since its inception in 2013, the department Weekly coding lab sessions are initiated to partner front has supported multi-specialty service lines end (operations) and back end (account receivables) coders ranging from primary care to surgical with coding educators to resolve coding-related denials at a services. Service lines were created patient account level. to standardize revenue cycle processes by allocating designated resources for The Coding Education Department is redesigned to prepare success: Coding Educator and Revenue for the Ambulatory Clinical Documentation Improvement Cycle Analyst. initiative while partnering with physicians and care teams. Since the inception of the Coding Education Department, they have focused Leading Clinicians and on design, development, and integration of Coders into New Payment Models future healthcare reimbursement models. With the movement towards value-based reimbursement models and a strong emphasis towards better population health management, the A Timeline to Help Coding Education Department has partnered with their physicians, Revenue and Patient Care care teams, coders, and care coordination centers to assist with patient acuity capture. In only a few years, Emory has launched programs and educational improvements to help employees The Ambulatory Clinical Documentation Improvement initiative transition through healthcare changes. Here are highlights of what was launched to ensure accurate coding/documentation and they have accomplished for coding and healthcare professionals: predictive analytics around population health management. Emory instills the following guiding principles for patient acuity capture: 2013: The Coding Education Department is created to assist providers, 1. Clinical Care – to capture pertinent diseases of each patient coders, and clinical departments with coding/documentation needs. 2. Patient Stratification – to identify high-risk and high-cost patients 2014: 3. Care Protocols – to generate care plans to match patient Professional Medical Coding Curriculum (PMCC) is launched healthcare needs under guidance and leadership of Donna Beaulieu, CRC, C-CDIS, CPC-I, CPMA, CPC, CEMC, CEDC, CFPC, CCP-P, CRP. To By capturing true patient acuity, Emory will be able to improve date, 175 students have successfully completed the coding course, patient health outcomes while optimizing revenue streams — which is offered at no cost to Emory healthcare employees as part of ensuring a win-win-win situation for their patients, providers, and their professional development. payers. 2015: Donna Beaulieu, CRC, C-CDIS, CPC-I, CPMA, CPC, CEMC, CEDC, CFPC, CCP-P, CRP, is Specialty-specific ICD-10 readiness documents are created and assistant director at Emory Physician Group Practice. She is a member of the Atlanta. Ga., lo- deployed to providers via faculty meetings and published on Emory’s cal chapter. website. A successful transition to ICD-10 was realized with no loss in physician and coder productivity. Hasan Zaidi, MPH, CPC, CEDC, CSPPM, is senior manager at Emory Physician Group Prac- The Coder Development Program is launched to enable tice. He is a member of the Atlanta, Ga., local chapter. coders to become highly specialized in multiple specialties and reduce the need for external coders. This monthly program brings in keynote speakers who are world-renowned
www.aapc.com July 2016 15 ■ HOT TOPIC By Renee Dustman istock.com/StockFinland Get answers to questions about the affect 2015 legislation will have on Medicare Part B reimbursement. he Medicare Access and CHIP Reauthorization Act of 2015 A proposed rule published in the Federal Register (FR Vol. 81, No. T(MACRA) repealed the sustainable growth rate (SGR) formula 89) on May 9 outlines CMS’ intentions for establishing these two — used since 1997 to determine Medicare payment updates — and components of the Quality Payment Program. established an annual 0.5 percent update to the Medicare Physician Note: To determine whether clinicians met the requirements for the Fee Schedule (MPFS) through 2018. But what happens after that? Advanced APM track, all clinicians will report through MIPS in Inquiring minds want to know. the first year.
Get to Know What MACRA Has in Store for You Q: What is MIPS? Q: What else does MACRA have in store for clinicians? A: In 2019, MIPS will replace the Physician Quality Reporting System, the Medicare Electronic Health Record (EHR) Incentive A: MACRA also requires the Centers for Medicare & Medicaid Program, and the Value-based Payment Modifier with a more Services (CMS) to create a new, streamlined system for straightforward approach to quality and value reporting. incentivizing clinicians to provide quality care: the Quality Payment Program. The program allows eligible clinicians to choose Eligible clinicians will be evaluated based on their performance one of two paths for quality reporting: scores in four categories: 1. A Merit-based Incentive Payment System (MIPS); or Cost – This category replaces the cost component of the Medicare Physician Value Modifier Program. Scores will be based on 2. Incentive payments for participation in an Alternative Medicare claims, so there are no reporting requirements for Payment Model (APM). clinicians.
16 Healthcare Business Monthly MACRA FAQ
MACRA doesn’t change how existing APMs function or reward value; it rewards participation.
Clinical Practice Improvement Activities – This category Table B: MIPS-adjusted Medicare Part B Payments rewards activities that benefit patients, such as those focused on care Year Maximum Adjustment coordination, patient engagement, and patient safety. 2019 +/- 4% Advancing Care Information – This category replaces the 2020 +/- 5% Medicare EHR Incentive Program, or Meaningful Use, for 2021 +/- 7% physicians. 2022 +/- 9% Quality – This category replaces the PQRS and the quality component of the Medicare Physician Value Modifier Program. In the first year, negative adjustments can be no more than -4 percent. According to the proposed rule, clinicians will be able to choose the The positive adjustments will be scaled to achieve budget neutrality, activities and measures that are most relevant to their practice. so the maximum positive adjustment could be as much as 4 percent. Each category will be weighted and worth up to a specified number In the first five payment years, MACRA allows CMS to reward of points, as shown in Table A. exceptional performance. Exceptional performers could earn as Table A: MIPS Performance Categories for 2017 much as an additional 10 percent without a budget neutrality adjustment. Category Max points Weight CMS has not mentioned a cap on the maximum adjustment after Quality 80-90 (based on size) 50% 2022, but it’s clear that eligible clinicians stand to lose or gain quite Advancing Care Information 100 25% a bit of money under MIPS. Clinical Practice Improvement Activities 60 15% Cost (Resource Use) Average score 10% Q: Who are MIPS eligible clinicians? A: In 2019-2020, MIPS eligible clinicians include: The MIPS score measures clinicians’ overall care delivery; reporting • Physicians (medical doctor/doctor of osteopathy and doctor of is not limited to care provided to Medicare beneficiaries. dental surgery/doctor of dental medicine) Note: CMS proposes to make clinicians’ MIPS scores and APM • Physician assistants performance public on the Physician Compare website. • Nurse practitioners Q: How will MIPS affect Medicare reimbursement? • Clinical nurse specialists A: A MIPS-eligible clinician’s composite performance score (CPS) • Certified registered nurses anesthetists will result in a positive, negative, or neutral payment adjustment In subsequent years, the definition of “eligible clinician” may beginning in 2019. A clinician’s CPS for 2019 will be based on 2017 expand to include other qualified healthcare professionals. performance data in the aforementioned categories. Table B shows Exempt from MIPS are clinicians in their first year of Medicare the proposed adjustments to Medicare Part B payments for eligible Part B participation; clinicians who bill Medicare up to $10,000 clinicians based on their CPS. and provide care for 100 or fewer Medicare patients in one year; and qualifying participants in Advanced APMs.
www.aapc.com July 2016 17 MACRA FAQ
Q: What is an APM? Note: MACRA doesn’t change how existing APMs function or A: As defined by MACRA, APMs include: reward value; it rewards participation. • CMS Innovation Center models Q: What are the advantages of participating in an Advanced APM? • Medicare Shared Savings Program A: Qualifying APM participants (QPs) are excluded from MIPS • A demonstration under the Health Care Quality and receive a 5 percent lump sum bonus in 2019-2024. Beginning Demonstration Program in 2026, QPs will get a 0.75 percent update to the fee schedule • A demonstration required by federal law conversion factor each year, compared to 0.25 percent for non-QPs. MACRA defines Advanced APMs as those using certified EHR The APM bonus payment will be based on the estimated aggregate technology; basing payment on quality measures comparable to payments for professional services furnished the year prior to the those in MIPS; and either bearing more than nominal financial payment year. risk for monetary losses or participating in a Medical Home model According to Blue Ocean Performance Solutions CEO Chris expanded under the authority of a CMS Innovation Center model. Sawyer, “These changes are going to drastically increase physician According to the proposed rule, models considered Advanced ACO participation around the country.” APMs for 2017 include: CMS thinks so, too. “We expect that the number of clinicians who • Comprehensive End-stage Renal Disease Care Model qualify for the incentive payments from participating in Advanced • Comprehensive Primary Care Plus APMs will grow as the program matures and as physicians take advantage of the intermediate tracks of the Quality Payment • Medicare Shared Savings Program (Tracks 2 and 3) Program to experiment with participation in APMs,” writes CMS • Next Generation Accountable Care Organization in a MACRA Quality Payment Program FAQ.
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18 Healthcare Business Monthly MACRA FAQ
Q: How can clinicians qualify for incentive payments Final Rule for participation in Advanced APMs? Although this information is based on a proposed A: Eligible clinicians must meet certain thresholds rule, it’s safe to say these changes are in our future. It’s to be considered QPs and qualify for incentive a very near future, so the time to act is now. Clinicians payments. CMS will calculate a percentage threshold who submit Medicare Part B claims should be ready score for each Advanced APM entity using two for the 2017 performance period to ensure future methods — payment amount and patient count — revenue. and compare it to the corresponding QP threshold. Those who reach the threshold are rewarded. Renee Dustman is executive editor for AAPC, and a member of the Flower City Coders, In 2019 and 2020, QPs must have 25 percent of their Rochester, N.Y., local chapter. payments or 20 percent of their patients come through an Advanced APM. In 2021 and 2022, QPs must have 50 percent of their payments or 35 percent of their patients come through an Advanced APM. And in Resources 2023 and beyond, the threshold goes up to 75 percent Quality Payment Program slides: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ for the payment amount method or 50 percent for the Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-MACRA-NPRM-Slides.pdf patient count method. Quality Payment Program fact sheet: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ As with MIPS, the QP performance period for the Value-Based-Programs/MACRA-MIPS-and-APMs/NPRM-QPP-Fact-Sheet.pdf 2019 incentive begins in 2017. Physician Compare website: www.medicare.gov/physiciancompare/search.html “MACRA in 4 Minutes” (www.youtube.com/watch?v=UXLvu_eop8k)
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800-626-2633 Advancing the Business of Healthcare 800-626-2633 Advancing the Business of Healthcare ?www.aapc.com July 2016 19 ■ CODING/BILLING By Maryann C. Palmeter, CPC, CENTC, CPCO, CHC Think TWICE Before Sticking It in Your EAR Although removing foreign bodies from the ear is an otolaryngological pain, coding it doesn’t have to be.
s curious kids, the sage advice “Don’t put anything in your ear report 69205 Removal foreign body from external auditory canal; with Asmaller than your elbow” didn’t stop my friends or me from general anesthesia. This procedure is also unilateral. putting many things into our ears (and mouths and noses) that weren’t Code 92502 Otolaryngologic examination under general anesthesia is intended to go there. As a (sensible adult) coder, now when an object considered a standard of medical/surgical practice when performed istock.com/Vicgmyr ends up in an ear, I need to determine whether it’s there by way of with the removal of a foreign body. As such, do not report it separately nature or some other manner, as well as how the object was removed. if the examination is performed on the same ear and during the same encounter as the foreign body removal. Removal of Foreign Object Removal of a broken cotton swab, an insect, or a Cocoa Puff™ from Removal of Cerumen an ear qualifies as the removal of a foreign body. Removal of a foreign Impacted cerumen (ear wax) is typically extremely hard and dry and body from the external auditory canal without general anesthesia accompanied by pain and itching. Impacted cerumen obstructing is coded 69200 Removal foreign body from external auditory canal; the external auditory canal and tympanic membrane can lead to without general anesthesia. This code is unilateral, so if the patient hearing loss. There are two different methods for removing impacted sticks a Cocoa Puff™ in both ears, report 69200 on a single claim cerumen. (For cerumen removal that is not impacted, refer to detail line and append modifier 50 Bilateral procedure. evaluation and management codes.) Note: Individual payers may have different rules on billing unilateral procedures performed bilaterally, and may prefer that the procedure Cerumen Removal: Instrumentation code be billed on two separate line items, appended with modifier RT Report 69210 Removal impacted cerumen requiring instrumentation, Right side or LT Left side. unilateral if instrumentation is used to remove impacted cerumen. The type of removal described by 69200 is performed under direct Code 69210 captures the direct method of impacted earwax removal visualization with an otoscope. Forceps, a cerumen spoon, or suction using curettes, hooks, forceps, and suction. is used to remove the foreign body. In the case of a live insect, mineral CPT® considers this procedure to be unilateral, stating, “For bilateral oil is usually dropped into the ear to immobilize the insect before it procedure, report 69210 with modifier 50.” The Centers for Medicare is removed. & Medicaid Services (CMS) sees things differently. In the 2014 If the patient cannot tolerate the procedure while awake, general Medicare Physician Fee Schedule, CMS stated its opinion that the anesthesia may be used. This may also be the case if the foreign body procedure will typically be done on both ears at the same encounter is so large that an incision is made into the external meatus to enlarge because “the physiologic processes that create cerumen impaction the opening before the foreign body can be extracted. In this instance, likely would affect both ears.” CMS also said, “Given this, we will
■ ■ ■ 20 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management To discuss this article or topic, go to www.aapc.com In Your Ear
Medicare will pay the same amount for 69210 whether it is
Think TWICE Before performed on one ear or two, even though the CPT® descriptor CODING/BILLING Sticking It in Your EAR stipulates it is unilateral. Other payer policies may differ from Medicare’s. Although removing foreign bodies from the ear is an continue to allow only one unit of CPT 69210 to be billed when Cerumen Removal with Audiologist Service furnished bilaterally.” The Medicare Physician Fee Schedule Look- HCPCS Level II code G0268 Removal of impacted cerumen (one or otolaryngological up Tool on the CMS website lists procedure code 69210 as bilateral; both ears) by physician on same date of service as audiologic function appending modifier 50 is unnecessary. pain, coding it testing was created to allow payment to a physician who removes Bottom line: Medicare will pay the same amount for 69210 impacted cerumen on the same date a contracted or employed doesn’t have to be. whether it is performed on one ear or two, even though the CPT® audiologist performs audiologic function testing. descriptor stipulates it is unilateral. Other payer policies may differ CMS does not separately reimburse audiologists for removal of from Medicare’s. cerumen because this is considered inherent in the audiologic function test. If a physician removes the impacted cerumen on the same day Cerumen Removal: Irrigation as the audiologic function testing, however, the physician (or other New procedure code 69209 Removal impacted cerumen using qualified healthcare practitioner) may separately report G0268. irrigation/lavage, unilateral describes an indirect and less invasive The moral of this story is: The next time you’re thinking about method of cerumen removal. The creation of this code for CPT® sticking something in your ear to remove some bothersome earwax, 2016 was warranted to differentiate between direct and indirect think twice. approaches of removing impacted cerumen performed or supervised by physicians or other qualified healthcare professionals. Maryann C. Palmeter, CPC, CENTC, CPCO, CHC, is employed with the University of Flor- Report 69209 when the removal of impacted cerumen does ida Jacksonville Healthcare, Inc. as the director of physician billing compliance where she pro- vides professional direction and oversight to the billing compliance program of the Universi- not require instrumentation. Irrigation/lavage involves using a ty of Florida College of Medicine – Jacksonville and its practice plan. She has over 30 years of continuous low pressure flow of liquid (e.g., saline solution) to experience in federal and state government billing and compliance regulations gained gently loosen impacted cerumen and flush it out, with or without through working on both the physician billing and government contractor sides of the healthcare industry. Pal- the use of a cerumen softening agent (e.g., cerumenolytic), which meter served on the National Advisory Board from 2011-2013 and served as the board’s secretary from 2013- may be administered days prior to, or at the time of, the procedure. 2015. She is the education officer for the Jacksonville, Fla., local chapter. Palmeter received AAPC’s “Member of the Year” award in 2010. Only one method of impacted cerumen removal (i.e., either 69209 or 69210) may be reported when both are performed on the same day, on the same ear. Procedure code 69209 is unilateral. If performed bilaterally, report 69209 on a single claim detail line with modifier 50 appended. Note: Individual payers may have different rules on billing unilateral procedures performed bilaterally and may prefer the procedure codes to be billed as separate line items with modifiers RT and LT for the right and left ears, respectively. Resources 2014 Medicare Physician Fee Schedule: www.cms.gov/medicare/medicare-fee-for-service- Tip: Don’t confuse procedure code 69020 Drainage external auditory canal, abscess with the payment/physicianfeesched/pfs-federal-regulation-notices-items/cms-1600-fc.html service described by procedure code 69209. Although both describe a method of irrigation/ lavage and/or drainage, 69209 is specific to impacted cerumen and 69020 is specific to Medicare Physician Fee Schedule Look-up Tool: www.cms.gov/apps/physician-fee-schedule/ abscesses. search/search-criteria.aspx
www.aapc.com July 2016 21 ■ CODING/BILLING By Kasandra Bolzenius, CPC Get Paid for Smoking Cessation Proper documentation and verifying coverage criteria prior to claim submission can improve your chances for reimbursement. istock.com/JoeBelanger
any healthcare providers perform tobacco use counseling daily, 2. Who are competent and alert at the time counseling is provided; Mbut they may not be documenting or reporting it appropriately. and Reliable guidance is needed to ensure all performed services are 3. Who receive counseling furnished by a qualified physician or claimed and supported by complete documentation. other Medicare-recognized practitioner. Where Opportunity Knocks Each payer may have its own restrictions for coverage, so inquire about a patient’s benefits prior to claim submission. The Centers for Disease Control and Prevention (CDC) has produced evidence supporting that tobacco use remains the single largest preventable cause of death and disease in the United States. A Documentation May Determine Payment study in 2010 indicated that seven out of 10 adult smokers wished to As with any time-based evaluation and management (E/M) service, quit; however, studies also indicate that only an estimated 4 percent documentation must include sufficient detail to support the claim. to 7 percent of people are able to quit smoking on any given attempt Proper documentation for tobacco-use cessation counseling should without medicines or other help. Counseling and other types of include the total time spent face to face with the patient, and what was support can increase success rates better than medications alone. discussed. The patient’s desire or need to quit tobacco use, cessation techniques and resources, estimated quit date, and planned follow Medical Necessity up should be noted within the patient’s medical record. Without this information, medical necessity for coverage may be questioned, The Centers for Medicare & Medicaid Services (CMS) set a standard which could result in denied or delayed payment. for coverage (which commercial payers may not follow). Per MLN Matters® article MM7133, CMS will cover tobacco cessation Without documentation of significant and separately identifiable counseling for beneficiaries: work, the payment for smoking cessation counseling may be included in the payment for the primary E/M service. 1. Who use tobacco (regardless of whether they have signs or symptoms of tobacco-related disease); ■ ■ ■ 22 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management To discuss this article or topic, go to www.aapc.com Smoking Cessation
As with any time-based evaluation and management (E/M) service, documentation must
include sufficient detail to support the claim. CODING/BILLING
Examples of incomplete documentation: pack of cigarettes per day after several failed attempts at quitting. • “I have counseled the patient again to quit smoking. The Approximately 15 minutes were spent counseling the patient patient verbalized understanding, but is not ready to quit in cessation techniques. He understands continuing to smoke smoking.” could lead to stroke and death. The benefits of stopping were also presented to him. The patient has verbalized his desire to “give it • “>3 minutes spent counseling patient on tobacco use.” another try.” He has set his own goal of 30 days to be completely Proper Billing Means Prompt Reimbursement smoke-free. We will follow up in two weeks to check progress. CPT® coding: Private payers may follow CMS’ direction when it comes to billing 99407 requirements for these services; however, it’s important to know your patient’s insurance benefits. ICD-10-CM coding: Medicare will cover two cessation attempts per year. Each F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders attempt may include a maximum of four intermediate or intensive J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation counseling sessions. The total annual benefit covers up to eight smoking and tobacco- Know Your Patient Coverage use cessation counseling sessions in a 12-month period. The beneficiary may receive another eight counseling sessions during If your clinic is just beginning to provide these services to your a second or subsequent year after 11 months have passed since the patient population, it’s best to verify coverage criteria prior to claim first Medicare covered cessation counseling session was performed. submission. For instance, Preventive Medicine Services guidelines in the CPT® codebook state, “Codes 99381-99397 include counseling/ Example: The beneficiary received the first of eight covered sessions anticipatory guidance/risk factor reduction interventions which in January 2011. The count starts beginning February 2011. The are provided at the time of the initial or periodic comprehensive beneficiary is eligible to receive a second series of eight sessions preventive medicine examination.” Many payers group tobacco use in January 2012. Medicare’s prescription drug benefit also covers cessation counseling under this umbrella and will not reimburse it smoking and tobacco-use cessation agents prescribed by a physician. separately. Knowledge of potential reimbursement errors keeps the CMS specifies symptomatic patient criteria as beneficiaries “who denial rate low and provider-patient relationships strong. use tobacco and have been diagnosed with a recognized tobacco- related disease or who exhibit symptoms consistent with tobacco Kasandra Bolzenius, CPC, is a senior compliance specialist with a large healthcare system related disease.” in the Midwest. She regularly provides guidance to healthcare providers, administration, and medical staff on billing and coding standards, government policy, and internal revenue op- CPT® descriptions: portunities. Bolzenius is a member of the Saint Louis West, Mo., local chapter. 99406 Smoking and tobacco cessation counseling visit for the symptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes 99407 intensive, greater than 10 minutes G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes Resources G0437 intensive, greater than 10 minutes www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS- QuickReferenceChart-1TextOnly.pdf These counseling services must be submitted with appropriate diagnosis coding to support medical necessity. The claim and www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ documented encounter should include tobacco use status and MLNMattersArticles/downloads/MM7133.pdf confirmed tobacco-related diseases, as appropriate. www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/ Example: A 67-year-old male Medicare patient presents with www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to- exacerbated COPD on oxygen. This patient continues to smoke one quitting-smoking-success-rates
www.aapc.com July 2016 23 ■ CODING/BILLING By Susanne Myler, COC PROVIDERS vs. PAYERS Collaboration is the Best Medicine istock.com/daizuoxin
f you are a coder who works for a large payer organization, your day-to-day work looks different Ithan that of a coder working for a provider. I’ve worked for both the provider and payer sides, and I’ve been on both sides of a medical record request. It’s no fun for anyone. To come to a favorable resolution, it’s important to understand how to navigate these scenarios and to see the payer’s When providers point of view. and payers work The Roles on Both Sides of the Fence together, claims Provider coders — whether physician, facility, or ancillary (such as home health, lab, ambulance, etc.) — translate what the provider has documented in the patient record into a claim that will be payment issues paid by a third party or payer. Challenges for provider coders include everything from meeting productivity quotas, to managing the revenue cycle, and more. get resolved. Payer coders have a completely different experience. The coding (and clinical) staff isn’t able to speak face to face with the provider submitting claims because, rather than working with a few providers, the staff is working with thousands of them. The provider’s submission (the claim and subsequent documentation) is all that is available for basing decisions regarding reimbursement, review, denial, or recoupment. ■ ■ ■ 24 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Providers vs. Payers
Contracts between providers and payers generally specify the length of time in which reviews (prior to payment and
after) can take place, as well as other stipulations. CODING/BILLING
Medical Records Request What to Do when Requests Are Received Payers requesting medical records for claims that have already been Payers have an address to which payments are sent, and sometimes paid typically send a letter to the provider’s correspondence address. a different address for correspondence. When a request for medical The letter generally dictates what types of records are needed (e.g., records has been issued (either by letter or PRA), the time clock lab reports, radiology reports, etc.). If the request involves supplies starts for the payer to receive the documentation. Payers typically or durable medical equipment, a proof of delivery, Certificate of reach out to providers after certain time markers to ensure requested Medical Necessity, written order, etc., are necessary. Requests for documents have been received to avoid a denial based on non-receipt claims that are pending or held prior to payment for review usually of records. are part of the provider remittance advice (PRA). A letter could also A common complaint payers hear from providers is that the letter/ be generated for prior-to-payment requests. PRA in which the request is made gets transferred from department Payers can also use vendors to perform reviews. Vendors must sign a to department so by the time the right person gets the request, it’s business associate agreement with the payer if they are performing a too late and the denial for non-receipt has happened. Payers strive to review. A letter disclosing this agreement may be sent to the provider have the right mailing addresses, but with thousands of providers of just prior to a request for medical records. This announcement all types throughout the country, this can be a daunting task. letter usually requires no action on the part of the provider unless When a request is received, the provider’s team should: it is accompanied by an actual request for specific patient records. • Check the date of the letter. If it’s more than a month old, Receipt of an announcement letter does not mean the provider has chances are it has traveled from department to department. been targeted for the review — only that the provider falls within the scope of claims or providers eligible for review. • If you are responsible for sending the requested documentation, contact the payer by phone or email using If you receive a request from a payer for a patient’s medical records, the information on the letter and explain the situation. Any it’s usually in response to: contact by the provider generally will prolong or restart the • A general review for all providers claiming a particular service time frame for receipt. Find out the payer’s specific protocols or combination of services/diagnosis(es) for documentation receipt. Payers want to work with • A review for certain providers based on peer-to-peer providers; they don’t only want to deny claims. performance (higher utilization of a particular code when • If you are not the correct person to respond to a reviewed next to claims from peers of the same specialty) documentation request, and depending on your directives • A review of all providers under a particular tax identification from your leadership, make sure it gets to the right person. number (TIN) based an external request (such as from the When the responsible person receives the request, they should Centers for Medicare & Medicaid Services (CMS), Office of contact the payer immediately, as above. Inspector General (OIG), or a state agency) • When contacting the payer, request additions or changes to • A review of a certain provider based on an external request the address (such as an attention line, etc.) to avoid future (such as CMS, OIG, state agency, or member appeal) issues. There are other reasons for medical record reviews, but this list covers • Review the type of documentation requested, and send those 99 percent of requests. Reviews may be performed either prior to documents. Completeness and legibility of documentation payment or after payment has been made, depending on the contract is paramount. Incomplete records, or records that cannot be language between the provider and the payer (if a contract exists). read, are of no use to reviewers trying to determine whether Contracts between providers and payers generally specify the length services billed as rendered meet the necessary documentation of time in which reviews (prior to payment and after) can take place, requirements. For example: For evaluation and management as well as other stipulations. If there is no contract, the review time codes, if there isn’t a clearly defined review of systems, but the frame in a particular scenario is at the payer’s discretion. history and medical decision-making are clear, the service
www.aapc.com July 2016 25 To discuss this article or topic, go to Providers vs. Payers www.aapc.com
Communication with the payer is important because, although payers are similar, each has its own specific procedures for each step in the process.
could be either denied or recouped based on lack of documentation. • Contact the payer with questions using the CODING/BILLING information on the request, as necessary.
Relevance matters: Do not send a 400-page record istock.com/zest_marina unless every page is pertinent to the request. Keep in mind that a fellow coder likely will be responsible to decipher the material (at least at first). Sending records with random pages upside down, multiple pages containing only a single sentence, or records that are not pertinent to the request causes extra work for the person receiving the documentation, who did not put the review in place. There’s no reason to shoot the messenger. If you’ve missed the deadline, and the claim is either fully denied or is in the process of recoupment due to non-receipt of documentation, contact the payer immediately. Many payers are happy to review the documentation, and may reverse the denial or recoupment without resubmission of the claim if the Typically, a letter is sent with the review outcome (the findings letter) submitted documentation meets necessary criteria. that narrates the reasons why the payer feels the documentation does not support the claim as billed. Every provider has some The payer will have multiple avenues to receive documentation, such level of reconsideration and appeal rights; check with the payer as as postal services, secure fax, secure email, and in some cases a secure to what they offer if you disagree regarding the findings. Usually, FTP site for quick transfer. Whichever method you choose, follow instruction is given in the letter as to reconsideration and/or appeal. up to ensure the payer received the documentation. Providers who are contracted with the payer often have a “provider advocate” assigned to their group; you may contact this advocate at After the Documentation Is Submitted any time for questions regarding correspondence from the payer. Upon receipt of the requested records, the payer clinical team begins Communication with the payer is important because, although to review the documentation. It takes time to ensure the entire payers are similar, each has its own specific procedures for each step claim case is reviewed. Sometimes the payer clinical team may ask in the process. for clarification of documentation or additional documentation Payers, like providers, are an important piece of the healthcare if it appears something is missing. The payer clinical team makes puzzle. Together, we can reach a favorable outcome. multiple efforts to reimburse the provider, rather than to pursue denial or recoupment. But it’s common not to receive feedback if the Susanne Myler, COC, has more than 25 years’ experience in the healthcare industry from documentation sent substantiates the service billed (i.e., no news is claims biller to executive management. She attended Stephen F. Austin State University in good news). Nacogdoches, Texas, and is employed by a large healthcare payer organization. Myler is a member of the Abilene, Texas, local chapter. If every attempt is made to substantiate the service using the documentation submitted, but it cannot be reconciled (and depending on the scope of the review), a denial or recoupment takes place. This could mean the entire claim is denied/recouped, or only a line item from the claim.
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CMY
K ■ CODING/BILLING By Stephen Canon, MD
Cut Costs with Quality Transitional Care Management istock.com/KatarzynaBialasiewicz Understand the CCM interface and the 2016 fee schedule to get a handle on avoidable mistakes. lthough patients going home from the hospital are usually on the Since the rollout of the TCM codes in CPT® 2013, the Centers for Aroad to recovery, many are not functioning at 100 percent, and Medicare & Medicaid Services (CMS) has incentivized providers to often do not know how to get better. Perhaps even worse, primary care lower readmissions and improve care by allowing increased revenue for providers may be uninformed about a patient’s hospital admission, or these non-face-to-face activities. An additional $70-$100 of revenue how to help the patient return to health after discharge. This lack of is possible for each patient discharge, if the provider accomplishes the coordination (a.k.a., transitional care management (TCM)) between metrics outlined by CMS for performing an appropriate transition acute care facilities and primary care providers is a huge problem. of care. Nearly one in five patients is readmitted to the hospital within 30 days after hospital discharge, leading to a cost of $24 billion each year. TCM Requirements The original TCM service requirements from January 2013 included (see Figure 1 on the next page): Transitional Care Management CPT® Codes • Initial communication within two business days 99495 Transitional Care Management Services with the following required elements: Communication • Face-to-face visit in seven (high complexity) or 14 (moderate (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days complexity) calendar days of discharge; Medical decision making of at least moderate complexity during the service period; Face-to-face visit, within 14 calendar days of discharge • Date of service on the 30th calendar day, with day one being the date of discharge (from January 2013 through December 2015) 99496 Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days Medical decision-making (MDM) of at least moderate complexity of discharge; Medical decision making of high complexity during the service period; Face-to- during the service period, and completion of medicine reconciliation face visit, within 7 calendar days of discharge on or before the date of the face-to-face visit, also are TCM requirements. ■ ■ ■ 28 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management To discuss this article or topic, go to www.aapc.com TCM
Figure 1 Transitional Care Management Timeline DAY 1 DAY 2 Patient High Discharged Complexity DAY 30 from Face-to-Face TCM CODING/BILLING Hospital Visit Due Complete
Check that Make patient has not Initial Contact Schedule/Conduct Face-to-Face Visit been readmitted
2 BUSINESS DAY 14 DAYS Moderate Initial Complexity Contact Face-to-Face Deadline Visit Due
Providers eligible for TCM billing include primary care providers, either in a hospital system with a unified inpatient and outpatient specialists, advanced practitioners, and physician assistants. TCM EHR or through an integrated inpatient and ambulatory solution service settings include acute care facilities such as inpatient acute with automated integration or a manual process. care hospitals (including observation admissions and psychiatric Mistake 2: Failure to understand the metrics and requirements facilities), long-term care hospitals, and skilled nursing facilities. of TCM. Providers may consider the TCM requirements complicated, For example: A 52-year-old man is admitted for an acute myocardial especially because workflows do not exist in electronic health infarction, undergoes cardiac catheterization and stent placement, records (EHRs). In addition, CMS recently modified the TCM and is discharged on Friday, May 27. Awareness that the ambulatory requirements in the 2016 Physician Fee Schedule (PFS), limiting practice has two business days to finish the initial communication TCM billing with the new chronic care management (CCM) code is imperative for TCM completion. Because Monday, May 30, is a and further complicating when and how to bill TCM. Common holiday, the practice has until Wednesday, June 1, to complete the mistakes prevent practices from receiving the extra reimbursement. initial communication. Knowing the five biggest mistakes of TCM can benefit practices Mistake 3: Failure to correctly identify TCM candidates. leveraging (or considering) this opportunity. For example: A 22-year-old G1P0 otherwise healthy woman delivers Five TCM Mistakes to Avoid a healthy baby by cesarean section and is discharged two days later. The patient does not qualify for TCM because the required MDM Mistake 1: No discharge notification from the primary care physician is lower than the required moderate complexity needed for TCM. or specialty provider caring for the patient after discharge. Mistake 4: Failure to schedule the face-to-face visit within the correct This is largely a system problem due to lack of integration between time frame. the acute care setting and the ambulatory setting. Solutions exist The Upside of TCM Approximately 1.8 million of the 9 million Medicare patients and Quality’s (AHRQ) Healthcare Cost and Utilization Project Only three studies included all elements of TCM outlined by discharged from a hospital annually are readmitted, leading to Statistical Brief #172, April 2014. CMS: two quality improvement studies and one observational potentially preventable recurrent illness and unnecessary cost. To test whether TCM metrics reduce hospital readmissions study. All three noted reduced readmission rates, with Some conditions with the highest rates of hospital readmission — and, if so, whether the effort justifiably improves patient varying success between 1.8 percent and 19.9 percent for the include congestive heart failure, septicemia, pneumonia, outcomes — the University of Kentucky investigated the ambulatory practices performing TCM. Other metrics (such as congestive obstructive pulmonary disease (COPD), and cardiac effectiveness of TCM, as outlined by Medicare in 2013, by mortality, quality of life, and functional status change) were dysrhythmias. More than half of patients who are readmitted conducting a meta-analysis of studies. The resulting not assessed. The conclusion was that completing TCM metrics are covered by Medicare (58.2 percent), with Medicaid and literature, “Systematic Review of Ambulatory Transitional Care does make a difference in reducing hospital readmissions, but commercial insurance patients comprising a much smaller Management (TCM) Visits on Hospital 30-Day Readmission that more information is needed. percentage, according to the Agency for Healthcare Research Rates,” is telling.
www.aapc.com July 2016 29 TCM
For example: An 80-year- old woman with COPD and HTN is admitted for pneumonia and is ready for CODING/BILLING discharge three days later after appropriate treatment and with continued outpatient antibiotic therapy. Her face-to-face visit needs to occur within 14 days after hospital discharge to stay on track
for TCM billing. This istock.com/michaeljung timing — coupled with a timely initial communication, moderate MDM, and medicine health and lower hospital admissions. With the potential revenue reconciliation — permits billing for TCM. available through CCM, there has been significant interest in this opportunity. Mistake 5: Billing the wrong date of service. Medicare and CPT® specify that CCM and TCM cannot be This issue has been exacerbated by the 2016 PFS. In 2013, Medicare billed during the same month. You may bill 99490 Chronic care mandated that the date of service be reported as the 30th day after management services, at least 20 minutes of clinical staff time directed hospital discharge. Effective January 1, 2016, CMS changed the by a physician or other qualified health care professional, per calendar date of service requirement to the date of the face-to-face visit within month, with the following required elements: Multiple (two or more) seven to 14 days following hospital discharge. With this change, chronic conditions expected to last at least 12 months, or until the CMS will allow (but not require) submission of the claim when the death of the patient, Chronic conditions place the patient at significant face-to-face visit is completed, consistent with global surgery and risk of death, acute exacerbation/decompensation, or functional bundling rules under the PFS. decline, Comprehensive care plan established, implemented, revised, Although this may seem to allow for an easier billing process within or monitored during the same month as TCM if the TCM service the current evaluation and management (E/M) framework, CMS period ends before the end of a given month and at least 20 minutes still requires a single TCM bill to be submitted per service period. of qualifying CCM services are subsequently provided during that Practices may submit the bill by the seventh or 14th day, but they also month. CMS expects, however, that the “majority of the time, CCM must verify that the patient remains well for the full 30-day service and TCM will not be billed during the same calendar month.” (CMS period, so as not to conflict with another potential TCM event. TCM FAQ, March 17, 2016). For example: A 64-year-old woman with hypertension and How CCM Affects TCM Billing diabetes mellitus is discharged from the hospital on January 20 The rollout of the CCM opportunity in January 2015 created after management of an episode of diabetic ketoacidosis. After another complication for TCM billing. With CCM, Medicare completing the metrics for TCM, she remains healthy and out of the encourages non-face-to-face services for patients with chronic hospital until the service period is completed on February 18. CCM medical conditions who have not been hospitalized within the is resumed on February 19, and greater than 20 minutes of clinical past 30 days. Requirements for CCM include maintenance of a staff time is directed toward optimization of her insulin regimen comprehensive healthcare plan with 20 minutes of clinical staff before the end of February. Because the MDM for her TCM episode time per month, to justify approximately $42 of reimbursement per was moderate in complexity, and because the metrics for CCM were Medicare patient per month. Through this initiative, CMS hopes met before the end of the month, both 99495 and 99490 codes were to encourage maintenance of chronically ill patients to improve billed in February.
30 Healthcare Business Monthly To discuss this article or topic, go to www.aapc.com TCM
Approximately 1.8 million of the 9 million Medicare patients discharged annually are readmitted to the hospital, leading to
potentially preventable recurrent illness and unnecessary cost. CODING/BILLING
Simplify the Process Resources Discharging patients need not be a complicated process. Timely communication AHRQ, “Conditions with the Largest Number of Adult Hospital Readmissions and detailed instructions should be forwarded to the individuals assuming care by Payer, 2011,” Anika L. Hines, PhD, MPH, et. al., Healthcare Cost and after discharge to ensure the patient’s return to health. Leveraging the TCM Utilization Project Statistical Brief #172, April 2014: www.hcup-us.ahrq. opportunity correctly will increase revenue and incentivize improvement in gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.pdf transitioning patients from the hospital to their home environment, with no repeat University of Kentucky’s UK Knowledge, “Systematic Review of Ambulatory performances. Transitional Care Management (TCM) Visits on Hospital 30-Day Readmission Rates,” Roper, Karen L., et. al., 2016: http://uknowledge.uky.edu/ Stephen J. Canon, MD, is a board certified urologist and associate professor at the University of Arkansas for Med- familymedicine_facpub/3/ ical Sciences (UAMS). He also is chief of pediatric urology at Arkansas Children’s Hospital (ACH), program director of the UAMS Department of Urology, and the 2010 inaugural recipient of the ACH Auxiliary and John F. Redman, M.D., Frequently Asked Questions about Billing the Medicare Physician Endowed Chair in Pediatric Urology. Canon received his medical degree from the University of Texas Medical Branch Fee Schedule for Transitional Care Management Services, March 17, and completed a Pediatric Urology Fellowship in Columbus, Ohio. He also is chief medical officer and co-founder of Phyzit TCM™, a 2016: www.cms.gov/medicare/medicare-fee-for-service-payment/ cloud-based software application which streamlines the TCM process with lowered readmissions and increased revenue. physicianfeesched/downloads/faq-tcms.pdf Be with the family and earn CEUs! Need CEUs to renew your CPC®? Stay in town. At home. Use our CD courses anywhere, any time, any place. You won’t have to travel, and you can even work at home.
• From the leading provider of computer-based interactive CD courses with preapproved CEUs • Take it at your own speed, quickly or leisurely • Just 1 course can earn as many as 18.0 CEUs • Apple® Mac support with our Cloud-CD™ option HBO• AdWindows® support with CD-ROM or Cloud-CD™ • Cloud-CD™ — lower cost, immediate Web access Our coding courses with AAPC CEUs: • Add’l user licenses — great value for groups • The Where’s and When’s of ICD-10 (16 CEUs) • Dive Into ICD-10 (18 CEUs) Finish a CD in a couple of sittings, or take it a • E/M from A to Z (18 CEUs) chapter a day — you choose. So visit our Web site to learn more about CEUs, the convenient way! • Primary Care Primer (18 CEUs) • E/M Chart Auditing & Coding (16 CEUs) • Demystifying the Modifiers (16 CEUs) ® Check out our website for our latest course, • Medical Coding Strategies: CPT O’view (15 C’s) The Where’s and When’s of ICD-10! • Walking Through the ASC Codes (15 CEUs) (All courses with • AAPC CEUs Coding with Heart — Cardiology (12 CEUs) also earn CEUs with AHIMA. HealthcareBusinessOffice LLC: Toll free 800-515-3235 See our Web site.) Email: [email protected] Web site: www.HealthcareBusinessOffice.com Continuing education. Any time. Any place. ℠
www.aapc.com July 2016 31 ■ CODING/BILLING By Michael Strong, MSHCA, MBA, CPC, CEMC Combat Common Denials in Orthopedic Coding istock.com/humonia Part 1: Arm yourself with bundling rules and medical policy knowledge.
ost control and denials are common in orthopedic care. Over Before you report both an injection and E/M service appended Cthe next two months, we’ll review common mistakes that lead to with modifier 25 Significant, separately identifiable evaluation and orthopedic claims denials and provide tips to avoid those mistakes. management service by the same physician or other qualified health care This month, we’ll discuss unbundling and medical policies. professional on the same day of the procedure or other service, answer the Next month, we’ll discuss up-coding and missing or insufficient following questions: documentation. • Is this a new injury/problem? Note: Although this article uses orthopedic examples, much of the • Is this an exacerbation of a previous injury/problem? information is applicable in any outpatient setting. • Is this an unanticipated change in the condition? Unbundling • Is there a change in the treatment plan? For example, if pain returns but the provider does not perform a new Unbundling of services is among the most common reasons for work-up to assess the pain, the E/M service may not be warranted. denials, particularly in light of National Correct Coding Initiative Documentation should indicate the causal relationship to the pain if (NCCI) edits, American Medical Association (AMA) CPT® coding attempting to use exacerbation or a new injury to support a separate rules, and other specialty or payer requirements. E/M service with modifier 25. E/M Services with Injection Remember: Every surgical procedure (Yes, an injection is a surgical procedure listed in the Surgery section of the CPT® codebook) In orthopedic practice, serial injections frequently prompt unbundling includes an inherent E/M component as part of the global surgical errors. Over time, the effects of the injection often fades and pain package. Performing a history and exam is standard care to assess for returns, which my require another injection in the series. If the patient contraindications or reasons not to perform the procedure. returns for another injection as part of a series, standard of care, or treatment plan, do not report a separate evaluation and management The American Academy of Orthopedic Surgeons (AAOS) addresses (E/M) service. Even if three months pass between the injections, do reporting injections and E/M services together in AAOS Now (April not report an E/M service if there is no significant patient work-up. 2013 and October 2009). Per AAOS, if a patient returns to the office ■ ■ ■ 32 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Orthopedic Coding
In orthopedic practice, serial injections frequently prompt unbundling errors. CODING/BILLING
in three months requiring no imaging or additional assessment, to report 29876 with other arthroscopic knee procedures in the the repeat injection does not warrant a separate E/M service. If same compartment with clear documentation of medical necessity. new imaging studies are performed with additional assessment, Providers should check with payers regarding the three-compartment however, a separate E/M service appended with modifier 25 may be rule and bundling edits (i.e., 29876 with 29880). warranted. Both AAOS articles provide in-depth E/M examples and analysis on this particular subject matter. Shoulder Bundles Reporting E/M services based on time (rather than components Shoulders are a different story. Neither CMS nor AAOS agree of history, exam, and medical decision-making) should be the on the areas of the shoulder. CMS considers the shoulder a single exception, not the rule. Counseling and/or coordinating care on a anatomic area or one joint, as affirmed in the NCCI manual. NCCI repeated basis for the same patient and same treatment plan may call edits are adopted nationally for Medicare and Medicaid and many into question the medical necessity of the services. commercial carriers have some form of NCCI policy in their policies. Consequently, denials for services performed on the same shoulder Knee Bundles with modifier 59 (or X{EPSU} modifiers) are common. Some Other common unbundling errors involve shoulder and knee providers and staff attempt to contest these bundling edits due to the procedure coding. Claim denials of this nature can be avoided when differences between AAOS and CMS interpretation on the shoulder. you understand the payer’s definition of “compartment.” Example 2: Under CMS rules, 29822 Arthroscopy, shoulder, surgical; Both the Centers for Medicare & Medicaid Services (CMS) and the debridement, limited and 29827 Arthroscopy, shoulder, surgical; with AAOS recognize three compartments of the knee: medial, lateral, rotator cuff repair should never be reported together, unless 29822 and suprapatellar. It’s inappropriate to append modifier 59 Distinct was performed on the contralateral shoulder. procedural service or one of the X{EPSU} modifiers to unbundle AAOS and CMS continue to engage, which has resulted in a surgical procedures performed in the same compartment(s). suggested change to the NCCI edits effective July 1, 2016, with Example 1: Never report both CPT® 29880 Arthroscopy, knee, policy manual changes slated for December 2016. surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage Fracture Care (chondroplasty), same or separate compartment(s), when performed Denials in fracture care are rising. One bone of contention is when and 29876 Arthroscopy, synovectomy, major, 2 or more compartments providers report an E/M service with the casting and strapping (eg, medial or lateral), per the NCCI manual. Each code represents codes when using a pre-fabricated or off-the-shelf splint or brace. the same two compartments of the knee. Because a knee only has Instead, the provider should report the appropriate E/M code with three compartments, one or both compartments involved in each the appropriate L-series HCPCS Level II code. Refer to the casting procedure may overlap. and strapping codes only when the provider custom fabricates the For instance, if 29876 was performed on the same compartments as cast and/or splint using fiberglass, plaster, etc. The supplies used for 29880, report only 29880. But if the provider performed the services custom castings are generally reported with Q codes. in the suprapatellar compartment and either the medial or lateral compartment, report 29880 and 29875 Arthroscopy, knee, surgical; Modifiers 25 and 59 synovectomy, limited (eg, plica or shelf resection) (separate procedure) The Office of Inspector General (OIG) released two reports in 2005 with modifier 59 appended. Modifier 59 is necessary because the on modifiers 25 and 59. According to those reports, modifier 25 suprapatellar compartment is a separate compartment/structure is incorrectly reported approximately 35 percent of the time, and from the medial and lateral compartments of the same knee. (Note modifier 59 is reported incorrectly approximately 40 percent of the that CMS has indicated that separate compartments of the knee do time. The percentages for both modifiers exceeds the FBI’s definition not qualify as a separate structure for modifier XS Separate structure). of fraud, waste, and abuse. Example 1 does not apply to all situations, as it may be possible
www.aapc.com July 2016 33 To discuss this article or topic, go to Orthopedic Coding www.aapc.com
Denials in fracture care are rising. Providers should not report an E/M service with the casting and strapping codes when using a pre-fabricated or off-the-shelf splint or brace.
Medical Policies Chiropractic Treatment
CODING/BILLING CMS creates policies on a national level (national coverage Chiropractic treatment is always under OIG scrutiny. Most payers, determinations) and Medicare administrative contractors (MACs) including workers’ compensation states with treatment parameters, may create their own medical policies on a local level (local coverage are likely to deny maintenance chiropractic treatment or excessive determinations). Although LCD denials may not be upheld at the treatment. Often, chiropractors must complete a back or neck appeal level for an administrative law judge, MACs apply them for index on patients to obtain authorization for treatment. Many denials. LCDs that seem to trip up the most providers are those for carriers will deny extra-spinal adjustments; however, extra-spinal manipulations under anesthesia (MUA), chiropractic treatment, adjustments are often payable in workers’ compensation, personal and total joint replacements. injury, and auto claims. Knowing that most payers deny extra- spinal adjustments (98943 Chiropractic manipulative treatment MUA (CMT); extraspinal, 1 or more regions), some unethical chiropractors Most payers rarely cover MUA. Unique situations for coverage will falsely report a higher-level spinal adjustment code (98941 may include frozen shoulder or knee arthrofibrosis. Many policies Chiropractic manipulative treatment (CMT); spinal, 3-4 regions or consider MUA to be investigational for the spine or other joints. 98942 Chiropractic manipulative treatment (CMT); spinal, 5 regions), Appealing these services is difficult because few Medicare payers which triggers audits for up-coding and medical necessity. see the medical necessity of these services. Workers’ compensation, personal injury, and auto insurance carriers, however, may offer ABNs and Other Disclosures greater opportunities for reimbursement. Because there are so many medical and reimbursement policies, practices should be pro-active in verifying their patients’ benefits Imaging Guidance and coverage. This includes obtaining necessary prior authorization Payers often focus on imaging guidance use with injections. As of and copies of policies. When it’s clear the services are not covered, January 1, 2015, the following CPT® codes include ultrasound providers should ask the patient to sign an Advanced Beneficiary guidance: Notice (ABN). An ABN will inform patients of their financial responsibilities for any services they receive. 20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting Michael Strong, MSHCA, MBA, CPC, CEMC, is the bill review technical specialist at SFM Mutual Insurance Company. He is a former senior fraud investigator with years of experience 20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, performing investigations into fraud and abuse. Strong also is a former EMT-B and college acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with professor of health law and communications. He is a member of the St. Paul, Minn., local permanent recording and reporting chapter, and can be contacted at [email protected]. 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting Many payers require documentation for imaging guidance necessity. For example, they want to see documentation that the initial attempt failed, the patient’s condition and/or weight would not allow the Resources injection to be performed without the imaging guidance, or the AAOS Now, April 2013 and October 2009: www.aaos.org/AAOSNow/ provider performed aspiration for a Baker’s cyst. Imaging guidance is rarely covered for small joints such as toes or fingers. Two 2005 OIG reports on modifiers 25 and 59: Payers will also deny injections performed too frequently. Most Use of Modifier 59 to Bypass Medicare’s National Correct Coding Initiative Edits: http://oig.hhs. gov/oei/reports/oei-03-02-00771.pdf injected drugs work for weeks or months, so repeat injections may Use of Modifier 25: http://oig.hhs.gov/oei/reports/oei-07-03-00470.pdf be denied if they are administered in a short time span.
34 Healthcare Business Monthly Atlantic City, NJ
Anaheim, CA AAPC - Regional Conf.
Anaheim CA Atlantic Cit September 19-21 October 6-8
CEU thru ul 31st
Great education featuring, auditing, billing, compliance, coding, facility and practice management. Re er To ! Log on to aapc com/con erences A N A H E I M 2 0 1 6
Anaheim CA September 19-21 12 CE s | 695 445 thru July 31st
Anaheim, CA
Session Highlights AAPC - Regional Conf. Hot Buttons for Payers E/M Capture in the Hospital Outpatient onnie Massey, CPC, CPC-P, CPMA, CPC-I Department inda Martien, COC, CPC, CPMA Bullet-Proof Your Documentation renda dwards, CPC, CPB, CPMA, CPC-I, CEMC, CRC How to Analyze Denials and Rejections vonne ailey, CPC, CP , CPC I How to Build an Audit Tool Resources for E/M Auditing Panel aci . ipreos, COC, CPC, CPMA, CPC-I, CEMC Michael Miscoe, Esq, CPC, CPCO, CPMA, CASCC, CCPC, CUC
Physician Documentation Improvement for Coding Chronic Conditions ICD-10-CM renda dwards, CPC, CPB, CPMA, CPC-I, CEMC, CRC Rhonda ollars, COC, CPC ICD-10-CM Code Updates Risk Adjustment Rhonda uckholt , CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, rian R oyce, CPC, CPC-I, CRC CPEDC, CRC
Find all sessions and conference details at aapc com/con erences
Hotel (Includes taxes and fees) Disneyland® Hotel Disney’s Grand Starting at 28 /night Californian Hotel Spa Starting at 3 /night ATLANTIC CITY 2 0 1 6
Atlantic Cit October 6-8 12 CE s | 695 445 thru July 31st
Atlantic City, NJ
Session Highlights AAPC - Regional Conf. Unlocking ICD-10 Combination Codes E/M Capture in the Hospital Outpatient rian R oyce, CPC, CPC-I, CRC Department inda Martien, COC, CPC, CPMA Bullet-Proof Your Documentation renda dwards, CPC, CPB, CPMA, CPC-I, CEMC, CRC Future of Value-Based Healthcare an Schwebach, MHA, CPPM Deep Dive: The Incident - To Rule Michael Miscoe, Esq, CPC, CPCO, CPMA, CASCC, CCPC, CUC How to Analyze Denials and Rejections vonne ailey, CPC, CPB, CPC-I
NCCI and Modi er 59, X{EPSU} Coding Chronic Conditions Angela Clements, CPC, CPC-I, CEMC, COSC renda dwards, CPC, CPB, CPMA, CPC-I, CEMC, CRC
Risk Adjustment ICD-10-CM Code Updates rian R oyce, CPC, CPC-I, CRC Rhonda uckholt , CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, CRC
Visit aapc com/con erences to see all the sessions and conference details
Hotel (Includes taxes and fees) Harrah's Resort Starting at $225/night ■ CODING/BILLING By Stephanie Cecchini, CPC, CEMC, CHISP
Apply 14 strategies to help you climb your way to coding success.
There are more than 120,000 certified medical coders in the United States. Some coders define their success by income; some by credentials; some by title; some by their responsibility; and some by many other benchmarks. How did those coders achieve their definition of success? A study and countless interviews uncovered a remarkable pattern of traits among them: These coders strategized their way to the top. Here are 14 “secrets” of successful coders you can use to climb the ladder to success.
■ ■ ■ 38 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Secrets of Success Photos by Rachel Momeni. NO. 1 Visualize Your Goal CODING/BILLING A 2010 Princeton study concluded the ideal income for true happiness is $75,000 per household, per year. That poses the question: Do you need to earn six figures? To help answer that, ask yourself: • Am I hungry enough to succeed? • Does experience or belongings bring me happiness? • What work/life balance do I need? (Earning a high salary often means working longer hours.) • What income is necessary to achieve the things most important to me? Write down what you believe will define your success. Studies show writing it down allows you to visualize the goal and increase your odds of reaching that goal.
NO. 2 Start (and Do Not Stop)! A problem many of us face when we decide to start something new is that the beginning looks and feels a lot like failure. For example, when you go to the gym for the first time, it might be weeks before you see the results from the exercise you are doing, but you will immediately begin to feel pain in your muscles. It’s important to work through a slow start, and to stick with your conviction to reach your goal.
NO. 3 Master What You Have Many people have all kinds of resources at their disposal, yet don’t take the time to master any of them. Instead of sitting back and complaining, “If only I had …,” focus on the resources to which you already have access, and improvise to overcome your obstacles. Learn to use the tools you have better than anyone imagined possible. If you waste time lamenting on what you don’t have, you’ll miss an important opportunity to master what you do have.
www.aapc.com July 2016 39 Secrets of Success NO. 4 NO. 7 Do What You Love Have a Sense of Urgency When you love something, you put tremendous energy into The most successful coders share an extreme sense of urgency. it. Someone who does not feel passionate about what they do This is a Zen-like conviction to get the job done better than cannot have the same easy commitment and dedication as anyone else can. Urgency comes from understanding why someone who does. For many coders, this will happen in an you are motivated to do something. What gets you up in the area of specialization, such as coding for particular medical morning? What is your destiny? What will keep you pushing specialty, coding facility versus professional fees, surgical claims, toward your goals no matter what obstacles you face? Look or evaluation and management (E/M) claims. For others, it inside yourself and define your “why.” If you do not know what might be working in management, consulting, or teaching. your “why” is, and your “why” is not strong, you will find it
CODING/BILLING When you do what you love, you’ll have an enthusiasm that leads difficult to fight for success and win. to advanced opportunities. NO. 8 NO. 5 Develop Business Acumen Professional coders are smart, hardworking, committed, Outwork Them trustworthy, and resilient. They are committed to their ongoing An important shift is happening within our workforce. professionalism, and they constantly hone their subject matter Approximately 30 percent of us are Millennials (people born skills. They seek out education to become more assertive and between 1985 and 1996). Studies show that younger workers confident. They learn how to self-promote, get a mentor, and desire more personal time, which makes them less likely to work effectively network. Successful coders also understand the extended hours. Those of you willing to put in extended time financials of their business. They understand costs; revenue; will stand out in a sea of coders who are otherwise committed to working capital; earnings before interest, taxes, depreciation, family and friends. A powerful work ethic and commitment to and amortization (EBITDA); and working within a budget. career will set you apart from other employees and demonstrate They are able to scan their active environment for opportunities that you mean business. and risks affecting their practice’s bottom line. Gain these skills and you’ll climb a couple of rungs up the career ladder. NO. 6 NO. 9 Get Creative Have Confidence We are often told to “think outside of the box.” Scientists have It’s surprising to me how many coders fall into the trap of proven, however, that abstractly thinking about something self-doubt. Even successful coders reportedly struggle with without some kind of context is exceedingly difficult. Instead, insecurity. Why? As coders, we must deal with daily criticism, think about things in different boxes. To do this, successful rejection, arrogance, and pressure. Self-talk is incredibly coders ask questions — specifically open-ended questions for important in dealing with all that negativity. which there are no right or wrong answers. For example, instead Repeat after me: You are a person of worth. of asking, “Doctor, how many review of systems are required for Start each day with a positive affirmation that focuses on your a 99202?” ask, “Doctor, how do you feel about documenting strengths. Be optimistic. Relax. And remember that you have E/M services?” This allows for a more creative and customized purpose. discussion, which can lead to a more successful outcome.
40 Healthcare Business Monthly To discuss this article or topic, go to www.aapc.com Secrets of Success NO. 10 NO. 13 Don’t Apologize Embrace Change CODING/BILLING “I’m sorry! I bumped into you when you stepped out in front What you know is less valuable than your ability to learn and of me!” adapt. Change is necessary to avoid becoming obsolete. One coder I spoke with earns $225,000 per year. Despite her salary, “I’m sorry that the CMS compliance rules are so frustrating!” she told me the one thing that sets her apart is her ability to “I’m so sorry to bug you.” stay current with change. Rather than looking at change as How many times a day do you say, “I’m sorry?” How many something to overcome, she chooses to run directly into it. times do you actually mean it? Many of us use the words to soften our message before it leaves our mouth. It’s a word we use out of politeness. But what it actually does is undermine your leadership ability and authority, which is more of a career killer NO. 14 than being disliked. Don’t say, “I am sorry you have to learn these coding rules.” Instead, say, “These rules are difficult, but I can Don’t Wait help you make sense of them.” Do not wait to be happy. The only thing that we have, for sure, is the current moment. If you do not allow yourself to be happy in the moment you are in, you lose a beautiful gift. Do not put off going to the park with your kids, or trying the newest things that interest you. Do not wait to be happy until you are “successful.” NO. 11 You already may be there.
Tolerate Risk Stephanie Cecchini, CPC, CEMC, CHISP, is an ICD-10 trainer, a medical coding expert, public speaker, and ex- To get ahead, a certain amount of career experimentation is ecutive who has been serving the healthcare community for more than 20 years. She is a member of the Salt Lake usually necessary. This can be scary. In a phenomenon known as City, Utah, local chapter. negativity bias (also known as the negativity effect), we tend to overestimate the risk associated with a change and underestimate the overall opportunity. Go ahead and take the leap. Ships may be safest in the harbor, but they are built to be at sea. When the learning curve is straight up, your salary will often follow.
NO. 12 Practice Humility Documentation used for coding can be frustratingly subjective. In an effort to create a reproducible audit result, coders tend to create black and white philosophies that help us in our decision-making. For coders not yet humbled by E/M coding interpretations, for example, it might be difficult to ask for help, or even to ask for forgiveness. Remaining open-minded and collaborative is a common trait among most successful coders. Be the impetus for creating a coding community where we demonstrate more patience, respect, gratitude, humility, and forgiveness with each other.
www.aapc.com July 2016 41 ■ CODING/BILLING By Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CANPC, CASCC, CEDC, CRC, ICDCT-CM/PCS Soothe the Sting of 2016 istock.com/Marccophoto Paravertebral Block Changes When you know the bundling rules and how to report additional sites, coding is no longer a pain.
or 2016, there are several additions to CPT® codes relating to space of the thoracic spine (e.g., to attach a drug delivery system) for Fparavertebral blocks (PVB): continuous infusion of drugs such as anesthetics, steroids, or opioids. 64461 Paravertebral block (PVB) (paraspinous block) thoracic; single injection site (includes imaging Example: A patient presents to the pain management clinic guidance, when performed) for insertion of a pain pump within the paravertebral space for continuous infusion of Demerol® for his lung metastasis and chronic +64462 second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary procedure) pain due to neoplasm. The physician inserts the catheter tip within the area of T4 and attaches this to the pain pump for delivery of pain 64463 continuous infusion by catheter (includes imaging guidance, when performed) medication and pain management. Per their descriptors, all PVB codes bundle imaging guidance; CPT® When coding PVBs, remember: specifically instructs us not report the radiology (i.e., computed • This block is used most common for analgesia/anesthesia for tomography or fluoroscopy) separately. postoperative pain management. Call on 64462 for Additional Sites • Blocks may be necessary for pain management following certain types of surgery, such as breast surgery or thoracotomy, Report an initial PVB injection in the thoracic spinal area with or for patients with rib fractures. These necessary blocks may 64461. Report additional thoracic PVB sites with add-on code be separately reportable if the physician documents the block 64462. as separate from the procedure. Example: A 46-year-old male presents with severe thoracic pain due to lung metastasis. He is to undergo PVB injections at T3- Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CANPC, CASCC, CEDC, CRC, ICDCT-CM/PCS, T6. Injections were performed, with additional injections to each has been a coder for over 20 years with her most recent position being held at Change Health- care as a quality analyst/educator. She has many years of experience in several different areas of additional space. coding and serves as an interim instructor in her hometown of Mobile, Ala. Pritchett owns and Based on the documentation, the correct coding for this scenario is: operates her own medical billing and coding company, Gulf Coast HIM Solutions located in Mobile, Ala. She shares 64461 (first level, T3), 64462 x 3 for the three additional levels (T4, her expertise in publications and as a lecturer at conferences such as Coding-Con for The Coding Institute. She has T6, and T6). served as the president and vice president of the Mobile, Ala., local chapter. Use 64493 for Continuous Infusion Code 64463 reports placement of a catheter tip in the paravertebral ■ ■ ■ 42 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management CODING/BILLING ■ By Oby Egbunike, CPC, COC, CPC-I, CCS-P
ICD-10 coding relies on Ease the Pressure of documentation that includes stage, location, Decubitus Ulcer Coding and sometimes laterality.
ecubitus ulcers — also known as bedsores extend up to, but not through, deep severe pressure ulcer first. ICD-10 includes Dor pressure ulcers — develop as a result of fascia. a note with category L89 Pressure ulcer to compromised circulation to tissues of the • Stage 4: Necrosis of the soft tissue “code first any associated gangrene (I96).” skin. For example, when a patient stays in extending to muscle, tendons, joints, For example, the physician documents one position too long, the weight of the and/or bone. an unstageable pressure ulcer on the right bones against the skin inhibits circulation • Unspecified stage: There is no hip covered in eschar. The appropriate and causes ulceration. This usually occurs provider documentation specifying coding is L89.210 Pressure ulcer of right hip, at the heaviest bones, such as the buttocks, the stage of the ulcer. unstageable. hips, and heels. • Unstageable ulcer: The provider In a second example, a patient is diagnosed Appropriate coding of a pressure ulcer cannot clinically determine the depth with a stage 3 pressure ulcer of the left heel. requires documentation of the location (site), of the ulcer, due to eschar or slough Proper coding is L89.623 Pressure ulcer of laterality (if applicable), and stage of the covering the ulcer. left heel, stage 3. ulcer. ICD-10-CM pressure ulcer codes are combination codes that identify the location When multiple ulcer sites are documented, Reference (site) of the ulcer, as well as the stage. code for each anatomic site and stage. Sequencing is based on the pressure ulcer 2016 ICD-10-CM Expert for Physicians Pressure ulcer stage is classified based on the being treated. If all the pressure ulcers are severity: stages 1-4, unspecified stage, and treated, sequence the code for the most Oby Egbunike, CPC, COC, CPC-I, CCS-P, is a li- unstageable. censed ICD-10-CM instructor for AAPC. She has a • Stage 1: Redness that does not turn Bachelor of Arts in Business Administration with con- When multiple ulcer centration in Health Information Management from pale when pressed and released with a Northeastern University Boston. Egbunike has more than 10 years of ex- fingertip (persistent focal erythema). sites are documented, perience in healthcare management, coding, billing, and revenue cycle. • Stage 2: Partial thickness skin loss She is associate director of professional coding and education at Lahey involving epidermis, dermis, or both. code for each anatomic Health. Egbunike is a member of the Boston, Mass., local chapter. • Stage 3: Full thickness ulceration into subcutaneous fat, which may site and stage. istock.com/Solar22
■ ■ ■ Coding/Billing Auditing/Compliance Practice Management www.aapc.com July 2016 43 ■ CODING/BILLING By Debra Mitchell, MSPH, COC ICD-10 Restricts Same-day Sick and Well Visits istock.com/dolgachov
CD-10-CM strictly limits the circumstances under which a provider Imay report a preventive visit and a sick visit for the same patient on the same day. If the patient is symptomatic on arrival for a preventive visit, per ICD-10-CM guidelines, the visit no longer qualifies as a preventive encounter. A sick visit may be billed, but the preventive Diagnosis code visit should be rescheduled. descriptions don’t ICD-10 Changes the Rules Billing a sick visit with a wellness visit (sometimes called “split allow split billing for billing”) has been common practice. I contend that the adoption of ICD-10-CM last October has changed the rules, however, making sick patients who are split billing rarely appropriate. The reason lies in the descriptors for at your office for a codes used to report preventive encounters. Codes describing preventive encounters are found in categories Z00 preventative exam. Encounter for general examination without complaint, suspected or reported diagnosis and Z01 Encounter for other special examination without complaint, suspected or reported diagnosis. The codes necessarily include the category designation within their full descriptors. For example: Z00.0- Encounter for general examination without complaint, suspected or reported diagnosis; Encounter for general adult medical examination ■ ■ ■ 44 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Same-day Visits
The payer may accept the claim, but that doesn’t mean it’s coded correctly. CODING/BILLING
Z00.1- Encounter for general examination without complaint, suspected or reported diagnosis; Encounter 24 of the form. The payer may accept the claim, but that doesn’t for newborn, infant and child health examinations mean it’s coded correctly. A payer is not allowed to override the Z01.4- Encounter for other special examination without complaint, suspected or reported diagnosis; Excludes1 edits; only the World Health Organization (WHO), Encounter for gynecological examination which maintains the ICD-10 code set, has that authority. If the category descriptor does not apply, neither can the individual WHO has investigated complaints regarding some Excludes1 edits, code in that category. By properly including the category designation and they published interim advice in October 2015 through the into the descriptors, Z00.0-, Z00.1-, and Z01.4- are not appropriate Centers for Disease Control and Prevention (CDC): if the patient has a current complaint, or a suspected or reported diagnosis. In other words, you cannot report a wellness encounter if Updated October 26, 2015 (Original posting October 19, the patient is sick. 2015) There are circumstances that have been identified where some conditions included in Excludes1 notes should Excludes Notes Strengthen the Rule be allowed to both be coded, and thus might be more appropriate for an Excludes2 note. However, due to the To reinforce this guideline, ICD-10-CM specifies an Excludes1 partial code freeze, no changes to Excludes notes or revisions note to prevent reporting Z00.0- or Z01 in addition to signs and to the official coding guidelines can be made until October symptoms: 1, 2016. This new guidance concerning Excludes1 notes is Z00.0- intended to allow conditions to be reported together when Type 1 Excludes: appropriate even though they may currently be subject to encounter for examination of sign or symptom – code to sign or symptom an Excludes1 note. This coding advice has been approved by the four Cooperating Parties—the American Health Z01 Information Management Association (AHIMA), the Type 1 Excludes: American Hospital Association (AHA), the Centers encounter for laboratory, radiologic and imaging examinations for sign(s) and symptom(s) ̶ code to the sign(s) or symptom(s) for Medicare and Medicaid Services (CMS), and the National Center for Health Statistics (NCHS). This Note: The pediatric well visit codes do not have an Excludes1 note advice will also be published in the 4th Quarter 2015 for signs and symptoms, but do carry the category description issue of Coding Clinic for ICD-10-CM and ICD-10- for each selection, “Encounter for general examination without PCS. complaint, suspected or reported diagnosis.” ICD-10-CM defines an Excludes1: Question: We have received several questions regarding the A type 1 Excludes note is a pure excludes note. It means interpretation of Excludes1 notes in ICD-10-CM when the “NOT CODED HERE!” An Excludes1 note indicates conditions are unrelated to one another. How should this that the code excluded should never be used at the same be handled? time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such Answer: as a congenital form versus an acquired form of the same condition. If the two conditions are not related to one another, it is permissible to report both codes despite the presence The Excludes1 notation means you may not list the affected Z00/ of an Excludes1 note. For example, the Excludes1 note Z01 codes with signs or symptoms codes in field 21 of the claim at code range R40-R46, states that symptoms and signs form, even if you link the diagnoses to different line items in field constituting part of a pattern of mental disorder (F01-F99)
www.aapc.com July 2016 45 To discuss this article or topic, go to Same-day Visits www.aapc.com
Although you can have a patient who is both bipolar and experiencing (unrelated) dizziness, a patient cannot be both well and sick at the same time.
cannot be assigned with the R40-R46 codes. However, if dizziness (R42) is not a component of the mental health
CODING/BILLING condition (e.g., dizziness is unrelated to bipolar disorder), then separate codes may be assigned for both dizziness and the mental health condition. In another example, code istock.com/AlexRaths range I60-I69 (Cerebrovascular Diseases) has an Excludes1 note for traumatic intracranial hemorrhage (S06.-). Codes in I60-I69 should not be used for a diagnosis of traumatic intracranial hemorrhage. However, if the patient has both a current traumatic intracranial hemorrhage and sequela from a previous stroke, then it would be appropriate to assign both a code from S06- and I69-.
The statement, “If the two conditions are not related to one another ...” does not allow reporting of same-day well and sick encounters. Although you can have a patient who is both bipolar and experiencing (unrelated) dizziness, a patient cannot be both well and Look to Patient Scenarios for Clarity sick at the same time. Example 1: A patient is scheduled for a well visit. He arrives and is asymptomatic with no specific complaint, but during the course CPT® Guidelines Allow Some Exceptions of the well visit a problem is discovered. Assuming documentation CPT® guidelines do allow for same-day sick and preventive visits: is complete, code for the well visit with abnormal findings. Also code an E/M service (if it was significant) to address the problem, If an abnormality is encountered or a preexisting problem and append modifier 25. Code the signs and symptoms, unless a is addressed in the process of performing this preventive definitive diagnosis is documented. medicine evaluation and management service, and if the Example 2: A patient scheduled for a well visit is symptomatic when problem or abnormality is significant enough to require he arrives. For dates of service on or after October 1, 2016, you may additional work to perform the problem oriented E/M not code a well visit, per ICD-10-CM. You must report a sick visit, service, then the appropriate Office/Outpatient code and report the signs and symptoms, or (if confirmed) a definitive 99201-99215 should also be reported. Modifier 25 diagnosis. should be added to the Office/Outpatient code to indicate that a significant, separately identifiable evaluation and Debra Mitchell, MSPH, COC, is a coding and compliance consultant and auditor, as well as a professional in- management service was provided on the same day as the structor in coding, billing, and medical terminology. She has developed several courses for adult education programs preventive medicine service. The appropriate preventive in medical coding and billing, and has contributed to the development of a coding certification program. Mitchell medicine service is additionally reported. was recently named to the Biltmore’s Who’s Who in America’s Professional Women. She is a member of the Colum- bia, Mo., local chapter. Notice, however, that this instruction does not address the patient who presents for a well visit with symptomatic concerns; rather, it narrowly addresses a visit with abnormal findings or a pre-existing condition that requires additional workup. In these cases, you may report an office visit with the preventive visit, as long as there is Resources documentation of an abnormal finding in the notes (a presenting WHO interim advice on excluded, CDC, October 2015: www.cdc.gov/nchs/data/icd/Interim_ symptom is not an abnormal finding). You must be sure to append advice_updated_final.pdf modifier 25 to the office visit.
46 Healthcare Business Monthly ■ DEAR JOHN
Have a Coding Quandary? Ask John Do I Use 25 or 59 for Same-day Assessment and E/M? Can you advise on the appropriate modifier usage not normally reported together, but are appropriate under for billing an emergency department evaluation and the circumstances.” management (E/M), such as 99284, with G0396 to avoid In this case, the only (non-E/M) service provided is the alcohol/ Q bundling edits? Should the physician apply modifier 25 on substance abuse assessment; therefore, modifier 59 is not the E/M? Should she apply 59 on G0396? Or should she both apply appropriate. To report the significant, separately identifiable 25 to the E/M and 59 to G0396? E/M service on the same day as the assessment, proper coding is G0396 Alcohol and/or substance (other than tobacco) abuse Append modifier 25 Significant, separately identifiable structured assessment (e.g., audit, dast), and brief intervention 15 evaluation and management service by the same physician to 30 minutes and 99284-25 Emergency department visit for the or other qualified health care professional on the same evaluation and management of a patient, which requires these 3 day of the procedure or other service to the appropriate key components: A detailed history; A detailed examination; and AE/M service code when the provider performs “a significant, Medical decision making of moderate complexity. separately identifiable E/M above and beyond the other service Although not required, it’s helpful to document the E/M service provided, or beyond the usual preoperative and postoperative separately in the note. This helps to illustrate the separate nature care associated with the procedure that was performed” (CPT® of the E/M. The E/M and other procedure or service may be Appendix A: Modifiers). related (i.e., the reason for the E/M also may be the reason for By contrast, modifier 59 Distinct procedural service “is used to the other procedure or service), but the work of the E/M service identify procedure/services other than E/M services, that are must meet all requirements of the chosen level of service.
TCI # 1
www.aapc.com July 2016 47 ■ CODING/BILLING By Brad Ericson, MPC, CPC, COSC
WHOWHO WindsWinds ItsIts GearsGears forfor ICD-11ICD-11 istock.com/© radiuoz istock.com/© ICD-11 is in the works, but you can bet your favorite watch there’s plenty of time before it comes to fruition.
hat’s happening with ICD-11? As ICD-10 implementation According to Donna Pickett, MPH, RHIA, the chief of classification Wloomed last summer, many who were opposed to it argued we and public health data standards at the National Committee for should wait until ICD-11 was available. It would give us time to Health Statistics (NCHS), ICD-11 will be an electronic-only tool, implement true interoperability, and avoid the localized disruptions supporting electronic health records (EHRs) and information ICD-10 would no doubt bring, naysayers contended. systems. Like ICD-10, ICD-11 is touted as being a data-rich resource, But the ICD-10 implementation happened, and by most accounts it making work easier for public health efforts, payers, policy makers, has been less painful than feared. ICD-11 has been forgotten on this and providers. side of the Atlantic, at least. Much of the WHO’s work has been marrying its Family of Classifications with the Standardized Nomenclature of Medicine Swiss Precision – Clinical Terms (SNOMED CT) to link terminologies and In Switzerland, the World Health Organization (WHO) is crafting classifications. “In the era of information and electronic health the new code set like a watch, projecting a 2018 release. Member records,” Pickett told the NCHS’ Coordination and Maintenance nations like the United States will then adapt it for their needs, which Committee, “it represents a major achievement.” That major will take at least a couple of years. Then the implementation process achievement includes using terminology common to all member begins. But don’t panic about the implementation just yet; it took 17 nations and more forcefully steers the industry toward electronic years to implement ICD-10-CM after it was released by the federal assignment. government. ■ ■ ■ 48 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management To discuss this article or topic, go to www.aapc.com ICD-11
Like ICD-10, ICD-11 is touted as being a data-rich CODING/BILLING resource, making work easier for public health efforts, payers, policy makers, and providers.
What Does it Look Like? as the stem code is the main condition, or was present on admission. ICD-11 will be quite different from ICD-10, and last year’s proponents may find it as daunting as ICD-10 seemed. The Centers • Type III codes indicate when the associated stem code is used for Medicare & Medicaid Services (CMS) cautions, however, that as a reference, such as in documentation of a patient’s family ICD-10-CM is an essential building block for the implementation history. of ICD-11. ICD-11 has five new chapters: Try It On • Chapter 3 - Diseases of the Blood and Blood-forming Organs There is a lot more to ICD-11 than we can inspect here, and a lot of it is still being tested and discussed. You can access a beta version • Chapter 4 - Disorders of the Immune System and make comments through the WHO’s website. You also can • Chapter 6 - Conditions Related to Sexual Health learn more about their efforts to assure universal ease-of-use and • Chapter 8 - Sleep-Wake Disorders comprehensive input, which have included the participation of • Chapter 26 - Extension codes Topic Advisory Groups (TAGs), newsletters, and other outreach. The WHO has developed a coding tool that helps you better use • Chapter 27 - Traditional Medicine and understand the code set. Using their official process, you The new code set also has a new coding scheme. For example, can make proposals for change and help build the code set you chapter numbers will be Arabic rather than Roman. Codes will have eventually may use. Go to www.who.int/classifications/icd/en/ to see what’s an additional letter in the second character, differentiating it from coming in your future. ICD-10. The first character always relates to the chapter number. Codes will be different, too. The foundation of the code — the stem Brad Ericson, MPC, CPC, COSC, is publisher at AAPC and a member of the Salt Lake City, Utah, chapter. code — will be in the index. In Pickett’s example, type 1 diabetic mellitus (DM) is the stem code and appended with another code to describe the disease. Example: Patient with type 1 DM with diabetic retinopathy 6A10 Type 1 diabetes mellitus
MG45 Diabetic retinopathy
6110/MG45 Type 1 DM with diabetic retinopathy Resources In addition to a new format for the codes, which will be provided ICD-11 at WHO: www.who.int/classifications/icd/revision/en/ in both long and short descriptions, further clarity is added by the TAG information: www.who.int/classifications/icd/TAGs/en/ Section X codes. There are three types of Section X extension codes: NCVHS, Status of ICD-11, Pickett, Donna: www.ncvhs.hhs.gov/wp-content/uploads/2016/01/ • Type I codes add additional detail that accommodates Pickett-Status-of-ICD-11-v2-feb-17-2016-revised.pdf further medical detail for the stem code, such as laterality or severity. Transitioning to ICD-10. CMS Press Release, Feb. 25, 2015: www.cms.gov/Newsroom/ MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-02-25.html • Type II codes add administrative and other usage data, such
www.aapc.com July 2016 49 ■ CODING/BILLING By John Verhovshek, MA, CPC The Latest on Multianalyte Assays with Algorithmic Analyses Look to brand names and parenthetical instructions when coding these procedures.
• Disease type • Specimen type and analyzed materials • Methodology
• A report, such as a probability index or istock.com/Shironosov risk score For example, the descriptor for 81500 Oncology (ovarian), biochemical assays of two proteins (CA-125 and HE4), utilizing serum, with menopausal status, algorithm reported as a risk score tells us the disease type (ovarian), the specimen/materials analyzed (proteins CA-125 and HE4, utilizing serum), and the type of report (algorithm reported as a risk score). When to Turn to Appendix O Several MAAA tests are proprietary to a single clinical laboratory or manufacturer, and are commonly referred to by brand name (e.g., hen coding for multianalyte assays with For example, CPT® Changes 2016: An ROMA™, Harmony™, ScoliScore™) rather Walgorithmic analyses (MAAA), it may Insider’s View tells us that 81490 Autoimmune than by the details listed in the individual help to know the brand name of the test(s) (rheumatoid arthritis), analysis of 12 CPT® code descriptors. To aid in proper code performed; and when applying the MAAA biomarkers using immunoassays, utilizing assignment, CPT® Appendix O Multianalyte codes (CPT® 81490-81599), be careful to serum, prognostic algorithm reported as a Assays with Algorithmic Analyses lists heed all CPT® parenthetical instructions. disease activity score (a new code in 2016), a number of MAAA tests by brand name “may be performed in adults with rheumatoid and lab/manufacturer, matching them to Decipher MAAA Codes arthritis to quantify disease activity. The the appropriate CPT® code. In this way, for An analyte is “a chemical substance that is result, a disease-activity score, may help example, you can quickly determine proper the subject of a chemical analysis,” and an predict risk for subsequent joint damage in coding for AlloMap® is 81595 Cardiology assay is “analysis (as of an ore or drug) to patients with arthritis.” (heart transplant), mRNA, gene expression determine the presence, absence, or quantity In the Pathology and Laboratory section profiling by real-time quantitative PCR of 20 of one or more components” (per Merriam- of CPT®, guidelines under subsection genes (11 content and 9 housekeeping), utilizing Webster). MAAA involves the analysis of Multianalyte Assays with Algorithmic subfraction of peripheral blood, algorithm various materials, the results of which are Analyses define and explain the MAAA reported as a rejection risk score. used to assign a numeric value. That value codes at length. As the CPT® codebook A number of tests listed in Appendix O are measures, for instance, the activity of a given explains, the MAAA code descriptors provide reported using a four-digit number followed disease or a patient’s risk of a particular important details about the procedures they by the letter M, rather than a CPT® Category disease. represent, such as: I code (e.g., 0004M Scoliosis, DNA analysis of
■ ■ ■ 50 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management To discuss this article or topic, go to www.aapc.com MAAA
53 single nucleotide polymorphisms (SNPs), algorithmic analysis itself.” For example, Even if you are able to assign using saliva, prognostic algorithm reported you would not separately report technical a code by referencing a brand as a risk score, which describes ScoliScore™, lab tests, such as 86140 C-reactive protein, in Tansgenomic, Inc.). addition to an MAAA code because MAAA name using Appendix O, be sure CODING/BILLING Whether assigning a Category I code or an codes always include the underlying lab to check the full code listing in tests. MAAA codes also include cell lysis M code, the test being billed “must fulfill the Pathology and Laboratory the code descriptor and, if proprietary, must (using an agent or substance to break down be the test represented by the proprietary cells into their components), but CPT® rules section of CPT®. name listed in Appendix O,” per CPT® allow you to separately report procedures instructions. that are required prior to cell lysis, such this case, there are no further parenthetical as microdissection (88380 Microdissection directions to guide code application. In other words: You must make an exact (ie, sample preparation of microscopically match to assign a specific code. “Close Example 3: The patient undergoes a test identified target); laser capture and 88381 enough” doesn’t count. Instead, CPT® tells that meets the descriptor requirements for Microdissection (ie, sample preparation of us, “When a specific MAAA procedure 81503 Oncology (ovarian), biochemical assays microscopically identified target); manual). is not included in either [Appendix O] or of five proteins (CA-125, apolipoprotein A1, in the Category I MAAA section, report Note, as well, that some payers may pay beta-2 microglobulin, transferrin, and pre- the analysis using the Category I MAAA separately for collection of specimens albumin), utilizing serum, algorithm reported unlisted code (81599),” and “When an (e.g., 36415 Collection of venous blood by as a risk score, but the test is not OVA1™ analysis is performed that may potentially venipuncture). by Vermillion, Inc. Per CPT® instruction, fall within a specific descriptor, however “When an analysis is performed that may the proprietary name is not included in Coding Examples potentially fall within a specific descriptor, however the proprietary name is not [Appendix O], the MAAA unlisted code The following examples assume the payer included in [Appendix O], the MAAA (81599) should be used” (see also CPT® follows CPT® guidelines: Assistant, January 2015). unlisted code (81599) should be used.” In Example 1: CPT® Changes 2016 offers this case, 81599 Unlisted multianalyte assay Appendix O is not an exhaustive list of the following example of 81525 Oncology with algorithmic analysis is appropriate. brand-name MAAA procedures; in some (colon), mRNA, gene expression profiling by cases, you must code solely from the CPT® real-time RT-PCR of 12 genes (7 content and Medicare Doesn’t code listings, based on the code descriptors. 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported Accept MAAA Codes Don’t Overlook as a recurrence score: On a final note, Medicare doesn’t accept Parenthetical Instructions the MAAA codes, and (in defiance of A 60-year-old female with stage CPT® rules) instead instructs you to bill the Even if you are able to assign a code by T3 mismatching repair (MMR) underlying test codes. referencing a brand name using Appendix positive colonic adenocarcinoma O, be sure to check the full code listing in the visits her oncologists two weeks When reporting to Medicare, the situation Pathology and Laboratory section of CPT®. A after surgery. The oncologist orders is more complex and may require some majority of the 20+ MAAA Category I codes an assay to analyze the expression research. For example, Medicare does not listings include parenthetical guidelines of 12 genes, including an algorithm pay for MAAA 81538 Oncology (lung), mass that are crucial for proper code application. which provides a recurrence score. spectrometric 8-protein signature, including For example, the complete listing for 81512 The recurrence score predicts the risk amyloid A, utilizing serum, prognostic and Fetal congenital abnormalities, biochemical of colon cancer recurrence for the predictive algorithm reported as good versus assays of five analytes (AFP, uE3, total hCG, patient and is used to help inform poor overall survival, and instead instructs hyperglycosylated hCG, DIA) utilizing adjuvant treatment decisions. you (via the 2016 Clinical Laboratory Fee maternal serum, algorithm reported as a Schedule final determinations) to report Example 2: The patient is subject to Corus® risk score tells us, “Do not report 81512 in 83789 Mass spectrometry and tandem mass CAD test. In Appendix O, this cross- conjunction with 82105, 82677, 84702, spectrometry (eg, MS, MS/MS, MALDI, references to CPT® 81493 Coronary artery 86336.” MS-TOF, QTOF), non-drug analyte(s) disease, mRNA, gene expression profiling by not elsewhere specified, qualitative or real-time RT-PCR of 23 genes, utilizing whole quantitative, each specimen x 8 units. What’s Included? peripheral blood, algorithm reported as a risk The MAAA codes “encompass all analytical score. Be sure to check the code listing in John Verhovshek, MA, CPC, is managing editor at AAPC and a services required … in addition to the the Pathology and Laboratory section; in member of the Hendersonville-Asheville, N.C., local chapter.
www.aapc.com July 2016 51 ■ ADDED EDGE By Holly Pettigrew, COC, CPC, CHC Ditch the Emotional Baggage to Become a Respected Auditor Experience shows that as confidence builds, value grows.
hen I accepted the position of physician coding auditor for a large such as “bean counting” for evaluation and management code leveling. Whealthcare organization, I was excited and optimistic. The title When dealing with colleagues and those I was auditing, I considered “auditor” carries a certain sense of power or prestige, but on the flipside myself a pretty good conversationalist and negotiator, and I was it also brings to mind negative images of someone who is not welcome. confident I could deal with emotional responses quite well. I studied I imagined myself with a hard edge in a blue or black dress suit, plain courses on how to become a better presenter, and I knew I needed to pump shoes, very little makeup, and hair pulled back tightly with a become a better listener. Ultimately, I found that beyond academic furrowed brow and briefcase in tow. But in the back of my mind was knowledge, it takes a mentally strong my softer side with an optimistic glimmer — I just knew I could person with unwavering ethics change the organization’s perception of an auditor. I wanted to be a good auditor. to be someone who was seen as helpful, valuable, and essential. Sliding into the Auditing Role I began rigorous training. I had more than 20 years’ experience in the medical field with extensive medical terminology knowledge, so I thought it would be fairly easy to slide into the auditor role. That was not the case. As part of my training, every detail of my preliminary audits were carefully scrutinized, and I became an expert on concepts istock.com/Sudowoodo Now when I enter a clinic door, people are glad to see me. “Compliance” and “ethics” are no longer scary words.
52 Healthcare Business Monthly Respected Auditor
Here I was, a Certified Professional Coder (CPC®), telling a provider with at least an MD or DO behind his name how to correct his documentation as I was pointing out his errors.
Anxiety Levels Take a Steady Climb because it seemed like she “always told us what we could not code/ bill and not what we could.” I took this to heart. I searched for missed Just finding the way to clinics in a giant metroplex is intimidating in items that were documented and could be billed in his specialty. itself. The worst part of the job, however, was the dreaded “failing” of a provider and needing to rebill. Here I was, a Certified Professional I find it also helps to: Coder (CPC®), telling a provider with at least an MD or DO behind • Collect teaching tools from every source you can get your hands his name how to correct his documentation as I was pointing out his on. errors. Giving negative news can be emotionally draining because • Create your own tools based on feedback from the providers. generally people like to get along with others. It seemed unnatural • Keep up to date with new technologies. to me at first. I watched the look on the provider’s face as I informed him that the score on the audit did not meet the necessary level and I • Share with providers relevant news released by the Centers for detailed the process for correction. It was a horrible feeling, and I know Medicare & Medicaid Services and Office of Inspector General. he saw it in my eyes. But I was assured by others in my department Once providers see your intentions are genuinely in their best interest, it would get better, and that I needed to focus on how much good it you will gain their respect and rapport. This is what I did, and now would bring to the company by correcting the coding issues. when I enter a clinic, people are glad to see me. “Compliance” and As the first few months went on, my anxiety level increased. I would “ethics” are no longer scary words. not sleep the night before an audit when there was a possibility a doctor would not pass. Was it tempting to alter a detail to pass a physician? Let Ethical Integrity Guide You Absolutely, but what kind of auditor would I be? Obviously, not one Companies that are more ethical actually have greater stability to with integrity, so I pushed through and did the right thing. those that are not. According to a Bloomberg.com article, “Why Be an Ethical Company? They’re Stronger and Last Longer:” Raise Emotional IQ to Demand Respect When a company’s ethical compass is pointing true north, I took steps to become more comfortable with auditing, strengthen my everything else falls into line. This isn’t to say that companies ethical integrity, and alleviate anxiety. If you find yourself in a similar with great ethics don’t fail. But it does seem to indicate that situation as an auditor and want to become more confident, here is companies without good ethics are far more likely to fail due my advice: to their inability to sustain or hear an inner voice to guide • Practice breathing exercises while you are waiting in the lobby them through the dark times to the light. to be called into an audit meeting. Push on auditors. You have a valued place in the medical field. • Mentally walk through a meeting, visualizing a genuine, warm smile as you present your findings. Holly Pettigrew, COC, CPC, CHC, began her career with Baylor Scott & White Health in 1994. She has held several positions with her company, from medical transcriptionist to her current • Practice delivering both good and bad news, while encouraging position as physician coding auditor for the Health Texas Provider Network. Pettigrew holds a providers to improve their documentation. Bachelor of Science degree in Business Management and earned her CPC® in 2012. She is a mem- • Become skilled at disarming emotional physicians who do not ber of the Fort Worth, Texas, local chapter. take criticism well. • Learn how to read people, so you can connect with them in some way before the auditing meeting ends. Resources In short, raise your emotional IQ. Bloomberg. “Why Be an Ethical Company? They’re Stronger and Last Longer.” Wadhwa, V. (August Listening is also a very important part of auditing. At a meeting, a 16, 2009): www.bloomberg.com/news/articles/2009-08-17/why-be-an-ethical-company- provider expressed to me that he was not happy with the past auditor theyre-stronger-and-last-longer
www.aapc.com July 2016 53 ■ AUDITING/COMPLIANCE By Andy Rusch, CPC Guard PHI with Sensitivity Be aware of your surroundings when discussing a patient’s private medical information.
ontrary to the opinion of others, a coder’s job is never boring. We Otherwise, they may be reluctant to work with the team, which can Chave the privilege of reading provider notes, which are always cause communication issues. Misuse of PHI may also cause a loss of interesting. Sometimes they’re even funny or absurd. As professionals, revenue for the practice. Patients who feel their personal information however, we must remember that we are working with sensitive is not being kept private or safeguarded may be inclined to seek care information and need to treat it as such. Patients rightly expect the elsewhere. healthcare team to protect their private information. A quick review of HIPAA requirements serves as a good reminder of that, and reinforces Precautionary Steps to Shield PHI our ability to guard patients’ protected health information (PHI). To instill faith in your patients and providers, take precautions when accessing patient information vital to daily tasks, such as coding, Confidentiality Is Key when Handling PHI insurance denials, and working within the patient record. For example: Best practices for handling patient information and keeping medical • Access patient information only when it’s necessary to fulfill job record integrity include: duties; • Ensuring the data is accurate within the documentation; • Speak softly when discussing patients among co-workers • Preventing unnecessary access to the patient information; and (which you should only do for job-related purposes); and • Understanding when it’s appropriate to discuss a patient record • Use security measures such as passwords on computers, locking with colleagues. mechanisms on paper records, and automatic lock screens on Inappropriate uses of patient information include: laptops. • Discussing patient information within earshot of other patients It’s Not Just the Law or visitors In addition to meeting requirements under law, there is a moral and • Discussing patient information in public areas (cafeterias, ethical standpoint to consider when accessing patient records. Suppose elevators, hallways, etc.) you discover a funny situation in a patient record — for example, due • Sharing information with other healthcare associates when not to an amusing situation or a dictation error — and you share that required for duties information with other associates. Morally, you should consider this • Accessing information of close relatives or people you know scenario from the patient’s point of view. How would you feel if you were • Discussing patient information with those who are not a part of the patient? Would you think sharing the information was acceptable? the organization’s healthcare team Health information professionals must remember that, although you are most often working with medical records, numbers, and dollar amounts, Integrity Goes Beyond Compliance you are also working indirectly with human patients. Consider whether Although incidental exposure to patient information may occur within using the patient information is in the patient’s best interest. There will an organization without serious repercussions, outside exposure must always be a risk when sharing patient information, but you must protect be kept to a minimum to protect patients’ privacy. it to the best of your ability. Demonstrating a high level of integrity and respect for patients is the best way to care for them. The HIPAA Privacy Rule demonstrates times when discussing patient information cannot be avoided and is necessary to the roles of the Andy Rusch, CPC, is a coding professional for Ministry Health Care in Wisconsin. He graduated in healthcare team. When disclosure of patient PHI is necessary, there are 2012 with an associate degree in Biomedical Informatics and has been working as a coding special- measures you can take to minimize the exposure. For example: ist for the past four years. Rusch is a member of the Wausau, Wisc., local chapter. • Try not to reveal patient identification information; • Keep the discussion to a minimum; and Resources • Move to a more private location, if possible. www.hhs.gov/hipaa/for-professionals/privacy/guidance/incidental-uses-and-disclosures/ Handling PHI appropriately goes beyond HIPAA compliance. For index.html example, providers need to know they can count on the coding and www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ health information team to work professionally with patient records. downloads/SE0726FactSheet.pdf ■ ■ ■ 54 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management All-in-one Compliance For All Healthicity - 2
We reinvented compliance management through a complete, flexible solution that complies with all seven OIG recommendations to ensure you’re compliant, even when audited.
H H C C C P C ■ PRACTICE MANAGEMENT By Michelle A. Dick
Manage Hospital Staff Cellphone
Distractions istock.com/Neustockimages inpatient attending rounds, which is when supervising staff discuss Without enforcing a policy and make decisions about patient care with residents. According to The Doctor’s Tablet blog, “Setting Boundaries on Smartphone Use for when it’s acceptable for in Hospitals,” a study conducted by the Albert Einstein College of healthcare professionals to Medicine: … found that 57% of residents and 28% of faculty reported use cellphones, a patient’s using smartphones regularly during these rounds. As we expected, the clear majority of smartphone use was to access life could be at risk. medical references and resources, but team members also used their phones for personal texts and e-mails, and 15% of residents acknowledged using their phones for non-patient et’s face it: We have become a society tied to our cellphones. They care uses (such as web-surfing). Lconnect us to friends and family, games, directions, events, photos, business transactions, and even patient emails in an instant. They are You may have heard the story in December 2011 of a 56-year-old our lifeline to the world’s information. Healthcare professionals use male patient with dementia who was harmed because a resident them to access encrypted messages and secured medical records, and became distracted while on a smartphone. The patient needed a to converse with colleagues; however, those same phones can become replacement percutaneous endoscopic gastrostomy (PEG) tube a life-threatening distraction when misused in a hospital. and the procedure was successful. Three days after the procedure, the patient was supposed to stop anticoagulation medication. The Smartphones Are Making the Rounds attending physician asked the resident to use her cellphone to enter the medication data into the hospital’s computer system. Just as the Without clear rules and policies for smartphone use, the device can resident began entering the order into her smartphone to stop the become a problem for hospital staff. This is especially true during ■ ■ ■ 56 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Smartphones
Because smartphones and other mobile devices may be necessary
for hospital communication between healthcare professionals, MANAGEMENT PRACTICE especially doctors, they can’t be restricted all together.
medication, she received a text message from a friend regarding an they call patients, each other, etc.” The hospital system discourages upcoming party, and she replied through text messaging. She never personal internet/Facebook use by blocking the sites. The WNY entered the information and the healthcare professionals moved on nurse said, “If you try to log onto Facebook, for example, you will get to the next patient. The patient suffered spontaneous bleeding into an error message, and an “ACCESS DENIED” message.” the pericardium from the dose error, which cost him an extra three Aside from the provision for doctors, the WNY hospital is more weeks in the hospital. stringent on their cellphone use, and employees are encouraged to not use their phones on the premises even when their shift is over. Poor Policy Can Put Your Hospital at Risk The WNY nurse said, “Like, if you’re leaving and want to call your To avoid incidents such as social notifications interrupting patient husband to tell him you’re on your way home or whatnot, they care, hospitals are taking action; however, the policies aren’t always encourage you to wait until you’re in your car to call.” The hospital enforced. A nurse in a hospital in North Carolina told Healthcare feels the sight of an employee on a cellphone sends a message to Business Monthly that her hospital’s policy says personal phones visitors that the employee is “unavailable” to help them if they’re lost, while at work are not allowed except for breaks. “We are allowed unsure of where to go, etc. to check our work email, but not supposed to check personal email (which they end up blocking, so you can’t get into it from a work Implement Staff Smartphone Policy and Stick to It computer),” she said. The nurse also said that social media is blocked Because smartphones and other mobile devices may be necessary for and staff isn’t allowed on social media during work. “There can be hospital communication between healthcare professionals, especially disciplinary action for what you post on social media if management doctors, they can’t be restricted all together. To avoid healthcare staff or higher ups find out, especially if it violates HIPAA,” she said. As misusing smartphones for non-work related functions that may for doctors at the hospital in North Carolina, they are able to check compromise patient care, there are policies you can implement. personal email while working. According to U.S. National Library of Medicine research, these are When it comes to enforcing staff policy, however, the nurse revealed: some solutions to deter healthcare staff from inappropriately using smartphones: Even though the policies state no one is supposed to use their cellphone, everyone does, and I’ve never seen any • Create specific Wi-Fi hotspot zones for smartphone use. disciplinary action for it. Nurses leave their phones right out This will minimize their use in sensitive and restricted areas. on the desk. And doctors, nurse practitioners, or physician These zones can be in cafés or break rooms where healthcare assistants use cellphones for pretty much all communication professionals are not tending to work-related activities. from what I see when they are on the unit. • Create no-phone zones in sensitive areas such as intensive care units (ICUs), operating rooms, and critical care units. The policy does state that for “extenuating circumstances” • Have staff personal devices out of reach and use hospital- or emergencies you can have your phone out during work if provided devices that contain preinstalled job-specific approved by management. functions and apps. Are cellphones a problem in your workplace? A good indicator is • Set up to-do checklists in every room where work-related “when there are people sitting on their phones when you need help, tasks are performed to remind healthcare providers of what or call bells are going off and stuff needs to be done,” the nurse said. needs to be done. This also helps to decrease errors due to smartphone distraction and related multitasking. Stringent Policies Are Key • Set up an intra-company social network for staff to Another nurse who works at a hospital system in Western New York communicate and exchange information in a secure fashion. (WNY) said her hospital’s cellphone policy is in the “Dress Code” • Have voice-function capabilities integrated into all health- section of the employee manual. The Dress Code policy “prohibits related apps used at the workplace, allowing staff to cell phone use during working hours. This applies to everyone, but communicate hands-free when necessary. doctors carry their cell phones everywhere and use them because
www.aapc.com July 2016 57 To discuss this article or topic, go to Smartphones www.aapc.com
• Have staff create a “high alert” list of important phone numbers, messages, and emails on their phones. These numbers would be permitted to alert the healthcare professional during work. All other numbers and emails would not alert the user and/or go into “do not disturb” mode. As for keeping protected health information (PHI) secure on hospital staff smartphones, the U.S. National Library of Medicine suggests these best practices: • Ensure all digital data is appropriately encrypted, and network and devices associated with the network are password- protected. • Limit high-risk share interfaces such as Bluetooth and Infrared. • Set up required security patches and permission to access PRACTICE MANAGEMENT company networks/intranets on personal devices. • Generate security alerts/warning messages if a compromised or unauthorized device is used on the network. • Generate security messages to users who access unscrupulous or potentially unauthorized websites. • Establish strict regulations for taking pictures and videos via smartphones. istock.com/Wavebreakmedia
• Provide staff with periodic and relevant training in ethics and conflicts of interest. • Ensure prior permission is obtained before taking photos and videos at work. While taking photos and videos, all must adhere to organizational ethics and conflict-of- interest policies. In an upcoming article, we’ll cover how to manage smartphone distractions and HIPAA violations of patients.
Michelle A. Dick is executive editor at AAPC and a member of the Flower City Coders, Rochester, N.Y., local ION chapter. Resources Rachel J. Katz, MD, The Doctor’s Tablet, “Setting Boundaries on Smartphone Use in Hospitals” (December 24, 2013): http://blogs.einstein.yu.edu/setting-boundaries-on-smartphone- use-in-hospitals/ Rachel J. Katz, MD, The Doctor’s Tablet, “Smartphones, Millennials and Policy on Hospital Rounds” (February 20, 2014): http://blogs.einstein.yu.edu/smartphones-millennials-and- policy-on-hospital-rounds/ Agency for Healthcare Research & Quality, “Order Interrupted by Text: Multitasking Mishap” (December 2011): https://psnet.ahrq.gov/webmm/case/257 U.S. National Library of Medicine, National Institutes of Health “Distraction: an assessment of smartphone usage in health care work settings,” August 27, 2012: www.ncbi.nlm.nih.gov/pmc/articles/PMC3437811/
58 Healthcare Business Monthly Over 7000 ICD-10 Co e Chan es
AAPC Code Books
Visit aapc.com/medical-coding-books or call on of our academic advisors at 800-626-2633 ■ PRACTICE MANAGEMENT By Lynn Stuckert, LPN, CPC, CPMA HEDIS: Manage Your Healthcare Outcomes Aim to enhance quality of care and reduce costs by meeting performance measures and three criteria.
he Healthcare Effectiveness Data and Information Set (HEDIS) Tconsists of a set of performance measures developed by the National Committee for Quality Assurance (NCQA), and is used by more than 90 percent of American health plans to compare how well a plan performs in these areas: • Quality of care • Access to care • Member satisfaction with the health plan and doctors HEDIS reporting is required for NCQA accreditation and the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Programs, and is used for Consumer Reports health insurance ranking. HEDIS allows for measurement; standardized reporting; and accurate, objective, side-by-side comparison of health insurance company’s ability to improve preventive health outreach plan outcomes. to its members. How HEDIS Measures Are Created These ratings serve as a basis for physician quality incentives programs, such as pay-for-performance and quality bonus funds. A NCQA’s Committee on Performance Measurement — a broad- provider’s individual scoring based on these programs pays increased based group representing employers, consumers, health plans, and premiums using quality indicators, such as those used in HEDIS. istock.com/greenwatermelon others — debates and collectively decides on the content of HEDIS. HEDIS measures must meet three key criteria: relevance, soundness, HEDIS Calendar and feasibility. NCQA has a set deadline of May 15 for health plans to gather all Why HEDIS Is Important to Physicians HEDIS data. Results are analyzed and reported to NCQA in June, and the NCQA releases Quality Compass results nationwide in HEDIS measures track a health plan’s and physician’s ability to July (commercial edition) and September/October (Medicaid and manage health outcomes. Strong HEDIS performance reflects Medicare editions). enhanced quality of care. With proactive population management, physicians can monitor care to improve quality, while reducing costs. Patient Privacy and Data Security Participation in a quality incentive program also improves HEDIS performance and increases a practice’s earning potential. All plans and physicians must comply with all applicable federal and state laws and regulations regarding health plan member privacy The Value of HEDIS to Your Patients and data security, including HIPAA, the Standards for Privacy of Individually Identifiable Health Information, and the HIPAA HEDIS helps consumers receive optimal preventive and quality care. Security Rule as outlined in the Code of Federal Regulations Title 45. It allows them to review and compare health plans’ scores, helping them to make informed healthcare choices. Under the HIPAA Privacy Rule, data collection for HEDIS is permitted, and the release of this information requires no special How HEDIS Scores Are Used patient consent or authorization. Abstraction of data falls under treatment, payment, and healthcare operations. As the healthcare industry moves toward quality, both state and Three ways HEDIS data is collected: federal governments are using HEDIS ratings not only for health plans, but also for individual providers. Physician-specific scores are 1. Administrative data – obtained from claims data evidence of preventive care at primary care practices. State purchasers • Essential for measuring and monitoring quality, service aggregate HEDIS rates to evaluate the effectiveness of a health utilization, and differences in members’ healthcare needs
■ ■ ■ 60 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management To discuss this article or topic, go to www.aapc.com HEDIS
As the healthcare industry moves toward quality, both MANAGEMENT PRACTICE state and federal governments are using HEDIS ratings not only for health plans, but also for individual providers.
how well Medicare Advantage organizations manage the physical and mental health of its members at the beginning and the end of a two-year period. Scores are categorized and percentages reported as: better, same, or worse than expected. For example: monitoring physical activity, the member discussed exercise with their doctor or other health provider in the last year and was advised to increase or maintain physical activity. The survey question would ask, “Did you talk with a doctor or other health provider about your level of exercise or physical activity?” Tips to Improve HEDIS Scores • Submit claims with the proper ICD-10 or CPT® Category II codes that count toward measures. • Correct coding of claims is very important: If claims are not • Avoid missed opportunities. Many patients may not return coded correctly the data may not be captured for HEDIS and to the office for preventive care, so make every visit count. may not reflect accurate quality scores. • Complete outreach calls to noncompliant members. 2. Hybrid data – obtained from claims data and medical record • Review and update your Patient Assessment form. This form reviews should yield very useful data over the short and long term. • Medical record requests are sent to providers. • Order labs at the beginning of the year and prior to a patient’s 3. Survey data – obtained from member and provider surveys appointment. Repeat lab tests for patients who are not at their goal, and adjust medication if necessary. Key Terms to Know • Educate patients to take medications as prescribed. Denominator: Target population. • Chart documentation must reflect services billed. Numerator: The portion of the target population that had evidence • Take advantage of your electronic health record (EHR). of appropriate (or inappropriate) care. If you have an EHR, try to build care gap “alerts” within Provider specialty: Certain measures must be provided by a specific the system. Paper chart users should develop standardized provider specialty. documentation templates. Anchor date: The specific date the member must be enrolled to be Lynn Stuckert, LPN, CPC, CPMA, has 30 years of experience in large multi-specialty clin- eligible for a measure. ics and hospital systems as a nurse, chart auditor, educator, compliance manager, and medi- Member experience measures: Represents members’ perspectives cal writer. Stuckert has held offices for the City of Palms (Fort Myers, Fla.) local chapter and about the care received. Example: being able to obtain appointments the Health Management Association of Southwest Florida. quickly. Resources Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey: CAHPS® surveys represent an effort to accurately and reliably www.ncqa.org capture information from consumers about their experiences with NCQA’s Quality Compass: www.ncqa.org/hedis-quality-measurement/quality-measurement- healthcare services. Health plans report survey results to NCQA products/quality-compass who use the results to make accreditation decisions and create Consumer Reports health insurance ranking: www.consumerreports.org/cro/health/health- national benchmarks for care and services. Example question: Have insurance/index.htm you had a flu shot since July 1, 2015? CAHPS® surveys: www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/ Medicare Health Outcome Survey: Provides a general indication of Medicare Health Outcomes Survey website: www.hosonline.org/
www.aapc.com July 2016 61 NEWLY CREDENTIALED MEMBERS
Can’t find your name? It takes about Eileen Goldin, CPC Shannon Nolen, CPC Asha.G Gandhi.K, COC-A Dana McDermott, CPC-A three months after you pass before your Evangelia Plakias, CPC Shaqueena Diana Sturdivant, CPC Ashif Thoduvil, CPC-A Dana Roper, CPC-A name appears in Healthcare Business Fanny Santos, CPC Sher Stiller, CPC Ashley Brown-Pacheco, CPC-A Dana Sadoff, CPC-A Monthly. Faris Wheatley, CPC Sheri Denise Byrd, CPC Ashley Coonhead, CPC-A Danica Padre Palad, CPC-A Francesca Valerio, CPC Sherri Lash, CPC Ashley Guzman, CPC-A Daniel Larocco, CPC-A Gertrudes Miciano, CPC Sherrie Mosher, CPC Ashley Whitmore, CPC-A Daniel Swanson, CPC-A Harmony Kmieciak, CPC Sheryl L Danner, CPC Audra Bevins, CPC-A Daniela Stoyova, CPC-A Magna Cum Laude Heather Smith, COC Sonya Edgar, CPC Aysha Iqbal, COC-A Danielle Dionne, CPC-A Jamie Dunlap, CPC Spring Rhodes, CPC Aysha Salam Afsal, CPC-A Danielle Popik, CPC-A Jamie Forster, CPC Stacey Winters, CPC, CPC-P Azarudeen Abdulkalam, COC-A Danielle Ratliff, CPC-A Amy Buxton, CPC-A Jan Vroman, CPC Steffany J Vargas, COC, CPC Baliram Eknath Nivilkar, COC-A Danyelle Kittrell, CPC-A Angela Hadlock, CIRCC Janet D Fuller, COC, CPC Stephen Holmes, CPC Bambi Feaster, CPC-A Dara Ramesh, CPC-A Austin Earl Zamora Paz, CPC-A Janet Rose, CPC Tammy Knaub, CPC Barbara Christa Benito Sarmiento, CPC-A Darryl Keith Ceniza Cabatingan, CPC-A Cathy Jeanne Arceña, CPC-A Jerie May Villanueva, CPC Tammy S McKnight, COC, CPC Barbara J Doremire, CPC-A Dartagnan Warnke, CPC-A Christer John Maquirang Curaraton, CPC-A Jessica Gina Capone-Arias, CPC Tara Keller, CPC Baskaran K, CPC-A David Gross, CPC-A Christina Heck, CPC-A Jill M Petrusic, COC, CPC, CPMA Teneil Osullivan, CPC Benjamin Giorgio Vera Cruz, CPC-A Dawn Ertilus, CPC-A Cleopatra May Tamayo, CPC-A John Settlemyer, CPC Theresa Crumb, CPC Benjamin Joe R, CPC-A Dawn I Peterson, CPC-A Courtney Hawbaker, CPC-A Joris Y Santiago, CPC, CRC Tiffany Osborn, CPC Benjamin Seth Talavera Dizon, CPC-A Dawn Kuhl, CPC-A Daikel Martinez Tuero, CPC Joy Evans, CPC Tiffany Swicegood, CPC Benson Thomas Alexander, CPC-A Dawn Suttle, CPC-A Debbie Rose Colisao Dela Torre, CPC-A Julie Jarl, CPC Tracey Sexton, CPC Beverly Rokes, CPC-A Dawn Taylor, CPC-A, CPB Frank Chen, CPC-A Julieann Sarah Goguen, CPC Tracie Baker, CPC Bhavna Kanhere, CPC-A Deana Gray, CPC-A Haley Randol, CPC-A Juvilee Allaga, CPC Trina Josette Hough, CPC Bhavya Bandari, CPC-A Deb Noone, CPC-A Hemalatha Avudaiyappan Muthiah, CPC-A Kaliope Spieler, CPC Vance Shelton, CPC Bobbi Smochek, COC-A Deb Solan, CPC-A Janet Grensten, CPC-A Karen L Goulet, CPC Varunkumar Sugumar, CPC BoseEarnest Philipose, CPC-A Deborah Geiman, CPC-A Jennifer Bassett, CPC-A Karen Acoba, CPC Violet Toledo, CPC Brad Steinagel, CPC-A Debra Barnhart, CPC-A Judith Kiss, CPC-A Karen Mathews, CPC Virginia Chatham, CPC Bradeep Sudharshan, CPC-A Debra Green, CPC-A Karla Krystle Dimaculangan, CPC-A Karen Whipple, COC, CPC Yanet Palmer, COC, CPC, CPMA Brandi Bidwell, CPC-A Debra Kay Woodruff, CPC-A Kathleen L Cali, COC, CPC, CPMA Karlene Dittrich, CPC, CPMA Yanisleiki Rodriguez, COC, CPC, CPMA Brandon Ford, COC-A Debra Lollar, CPC-A Kathreen Dawn Ramos, CPC-A Kayla Lee, CPC BreeAnn Albers, CPC-A Dee Dee Barnes, CPC-A Kathy Konop, CPC-A Kelly Andrews, CPC Brenda Fallos, COC-A Deepika Degala, CPC-A Kevin Ranyll Tan, CPC-A Kenisha L Moore, CPC Brenda Fry, CPC-A Denetha Coe, CPC-A Marvie Anne Abing, CPC-A Kerry Maguire, CPC Apprentice Brenda Kelly, CPC-A Denise England, CPC-A Michelle Voight-Martin, COC-A Kimberly Carrigan, CPC Brenna Dick, CPC-A Denise Juarez, CPC-A Nicole Heighton, CPC-A Kindra Godines, COC, CPC Brianna Martinez, COC-A Denise Mikulas, CPC-A Nikhitha A, CPC-A Kristen R Lieber, COC, CPC, COSC A Shalini Preethi, CPC-A Bridget Aul, CPC-A Denise Yeich, CPC-A Nina Hua, CPC-A Kristina Len Roberts, COC, CPC Abigail Tanieca Gapusan, CPC-A Brittany Haley, CPC-A Desiree Warren, CPC-A Princess Roschelle Limson, CPC-A Kristy Meyer, CPC Ade Guzman, CPC-A Brittany N Billings, CPC-A Dexacilyn Fink, CPC-A Ratoni Barrows, CPC-A LaShonda Williams, COC, CPCO, CPMA, Aika Allelyn Banaag, CPC-A Brooke Ellett, COC-A Dhanashree Tilekar, CPC-A Rychelle Julia Alesna, CPC-A CEMC Aileen Villanueva, CPC-A Byri Pradeepa, CPC-A Dhanya Nair, COC-A Shovaun Marler, CPC-A Lashuna Cooper, CPC Ajay Nandkumar Lotake, CPC-A Caitlin Sheridan, CPC-A Dhivya Priya JP, CPC-A Shyrene Canosa, CPC-A Laura A Stanford, CPC Ajay Padmam, COC-A Calvert E Bennett, CPC-A Diana Sinclair, CPC-A Svetlana Robinson, CPC-A Laura Finlay, COC Ajesh Kuriakose, COC-A Candace Chapman, CPC-A Diana Marie Andreasen, CPC-A Sylwin Seno, CPC-A Laura Spicer, CPC Akhil K Nair, COC-A Candice Fitt, CPC-A Diane Marx, CPC-A Tara Angela Pandac, CPC-A Lauren Smith, CPC Alaina Hall, CPC-A Candice Moore, CPC-A Diane Prestwich, CPC-A Tiffannie Ramos, CPC-A Lindsay Morro, CPC Aleta LaGree, CPC-A Carey Hughes, CPC-A Dipali Naik, CPC-A Yamila Lopez Moreira, CPC Lisa Bigbey, COC, CPC Alexandra S Woods, CPC-A Carl Irwin Maurice Cardenas Patangan, Dipali Rameshrao Kokare, CPC-A Lisa Loomis, CPC Alia Claire El-Azem, CPC-A CPC-A Divya Krishnakumar, CPC-A Lisbet Rodriguez Lazo, CPC Alicia Carolina Gutierrez, CPC-A Carol Brake, CPC-A DJ Song, CPC-A ® Lori Caldwell, CPC Alicia Scala, CPC-A Carol Myers, CPC-A Dodda Manasa, CPC-A CPC Lori Hofmann, COC, CPC Allison Hillyer, CPC-A Carrie Danheim, CPC-A Donald Feliciano, CPC-A Lori McVay, CPC Allison Scala, CPC-A Carrie Stephens, CPC-A Donna Cross, CPC-A Lucinda S Neville, COC, CPC Amanda Basquez, CPC-A Cassandra Johnson, CPC-A Donna Ryan, CPC-A Adam Snyder, CPC Marcy Moore, CPC Amanda Silva, CPC-A Cedie Barca, CPC-A Donna Shiffert, CPC-A Aida Barredo, CPC Maria Escobar, CPC Amber Edler, CPC-A Chanchal Chauhan, CPC-A Doretha Mclaurin, CPC-A Alicia Jason, COC, CPC Marindy Harris, CPC Amber Feaver, CPC-A Chantelle Heet, CPC-A Dubose Stephens, CPC-A Alisha Galaviz, COC Marjorie S Buchanan, CPC Amber Krueger, CPC-A Chareese Brust, CPC-A Ebony Singleton, CPC-A Allison Larroquette, CPC Marlo Ibarra, CPC Amber Surrena, CPC-A Charive Canonigo Carino, CPC-A Edcel Lyra Reyes Hernandez, CPC-A Amanda Neely, CPC Marni Berger, CPC Ambra Fey, CPC-A Charlene Howard, CPC-A Edison Ray Boglosa Garciano, CPC-A Amanda White, CPC Mary Hicks, COC, CPC Amie Broschat, CPC-A Charlene Sol Mena, CPC-A Edu Ryan Tradio Cayme, CPC-A Amber Glomah, CPC Mary Lou Reese, COC Amina Mendiola Gabriel, CPC-A Charles E McGlathery Jr Jr., CPC-A Ehrin G Taylor, CPC-A Amber Shoemaker, CPC Melanie Murphy, CPC Amit Parashar, CPC-A Charrie Jane Bayson Villarampa, CPC-A Elane Wiggins, CPC-A Amy J Hanson, CPC Melissa Dawn Shields, CPC Amy Eighmy, CPC-A Cheryl Cluck, CPC-A Elena Tarnovetskyy, CPC-A Andrea Kristen Roberson, COC Melissa Ghiozzi, CPC Amy Gee, CPC-A Cheryl Eckman, CPC-A Eliana Cabrera-Acosta, CPC-A Angela Gottbreht, CPC Melissa Marea Snyder, CPC Amy Nelson, CPC-A Cheryl Moore, CPC-A Elisa Romeo, CPC-A Anna Gruba, CPC Michelle Lynn Higley, CPC Amy Peterson, CPC-A Cheryl Snyder, CPC-A Elizabeth Alia, CPC-A Araseli Bachmann, COC, CPC-P Nan Andrena Tolbert, CPC Amy Tausend, CPC-A Chiu-Ming Nguyen, CPC-A Elizabeth Hanna, CPC-A Ashlee Heath, CPC Nancy Edwards, CPC Andrew Pritchard, CPC-A Christi Elaine Smart, CPC-A Elizabeth Hernandez, CPC-A Ashley Kauzlarich, CPC Nancy Hulewicz, CPC Andy Dominguez, CPC-A Christina Fischer, CPC-A Elizabeth Robeson, CPC-A Ashley Roske, CPC Nani Williams, CPC Angela M Ferro, CPC-A Christina Holder, CPC-A Elson Samuel, COC-A Barbara Olney, CPC Natalie Barron Dhawan, CPC Angela Marie Franklund, CPC-A Christina San Pedro, CPC-A Emilee Garrett, COC-A Barbara Whitfield,CPC Neree Ambursly, CPC Angela Rose Bacigalupo, CPC-A Christine McBain, CPC-A Emma Eberwien, CPC-A Bethany Wical-Roberts, CPC Nichole Glass, CPC Angela Wilson, CPC-A Christine Pletcher, CPC-A Erica Clark, CPC-A Brandi Grosser, CPC Nicole Lemm, CPC Angelo Perdiguez, CPC-A Christopher Brooks, CPC-A Erica Rhodin, CPC-A Brenda Balsness, CPC Nikki Hardy, CPC Anil Kumar, COC-A Christopher DiOrio, CPC-A Erica Wade, CPC-A Carla Williamson, CPC On Wong, COC, CPC, CPMA Anita Rajaraman, CPC-A Christopher John Lanario Santiago, CPC-A Erico Paolo Cuenta Arcigal, CPC-A Caroline Riley, CPC, CPC-P, CPB Pam Hanna, CPC Ankireddy Divyasree, CPC-A Christy Tate, CPC-A Erika Hawk, CPC-A Cherlyn Miller, CPC Pamela D Kornitsky, CPC Ann Margaret Harlow, CPC-A Cindy Armes, CPC-A Erin Al-Hammami, CPC-A Cheryl Dunlap, CPC Paquita Hart, CPC Anna Bump, CPC-A Claire Grisham, CPC-A Erin Wright, CPC-A Christin Brodrick, COC, CPC, CIC Patricia Sickler, CPC Anna Christalyne Cansino, CPC-A Clarissa Ma. Lao, CPC-A Esperanza Magboo, CPC-A Christina Kesler, CPC Paula Gormley, CPC Anna Kharitonov, CPC-A Clyre Fea Jude Eguia, CPC-A Esteban Garcia, CPC-A Christy Becker, CPC Paulita Bradley, CPC Anna Kim, CPC-A Colleen Wood, CPC-A Eva Barton, CPC-A Christy Best, CPC Peggy Moser, CPC Anna Page, CPC-A Connie Kent, CPC-A Everla Magdangal, CPC-A Chrystal West, CPC Rena Donald, CPC Anne M Hartman, CPC-A Corina Valdez, CPC-A Fairooz Al-Hasnawi, CPC-A Claudia E Villalobos, CPC Roberto Leon, COC, CPC, CPMA Annette Graunke, CPC-A Cory Gerstenschlager, CPC-A Farhana Begum, CPC-A Crystal Braddock, CPC Robin Beatty, CPC Annieska Bautes, CPC-A Courtney Chartrand, COC-A Farzana Islam, CPC-A Cynthia Bussard, COC Robin Ogle, CPC Antonneth Ferrer, CPC-A Courtney M Daubenspeck, CPC-A Faye MacClellan, CPC-A Danielle Chalker, CPC Robin Shuttleworth, CPC Anupriya Chintala, CPC-A Crystal A Reuer, CPC-A Felicia Sumner, CPC-A Danielle L Sherman, CPC Roger Heusner, CPC April Fields, CPC-A Crystal Arroyo, CPC-A Franch Mabelle Serna, CPC-A Darcel Wilson Young, CPC Ronnie Arevalo, CPC Aravinda Malleboina, CPC-A Crystal Ridings, CPC-A Francia Geller, CPC-A Dawn M Harrison, CPC Sabrina Butera, CPC Archana Thakur, CPC-A Cyndi Sue Owen, CPC-A Franz Berry Azarcon, CPC-A Dawntaya Auston, CPC Samantha Hiller, CPC Arihant Sethi, CPC-A Dacia Z Clark, CPC-A Frieda Davis, CPC-A Deborah Bedard, CPC Sarah Maison, CPC Arlo Perez, CPC-A Dadasaheb Hanumant Magar, COC-A Gabrielle J Gordon, CPC-A Debra Fiore, CPC Sarah Schiro, COC Arnel Alcazaren, CPC-A Dakotah Sorenson, CPC-A Gaeya Spencer, CPC-A Donna M Watson, COC, CPC, CPMA Selma Cokic, COC, CPC Arnie Cristine Cruz Ocampo, CPC-A Dalitza Vasquez, CPC-A Gail Moorehead, CPC-A Donna Pimental, CPC Shannon Bufford, CPC Aruna Thummala, CPC-A Dana Gunthorpe, CPC-A Gale Walker, CPC-A Dorothy Adiba Alexander, CPC Shannon M Agin, CPC Arunima Ghosh, CPC-A Dana Marcus, CPC-A Gandhasari Rameshbabu, CPC-A
62 Healthcare Business Monthly NEWLY CREDENTIALED MEMBERS
Gaurav Rawat, CPC-A Jennifer Jaramillo, CPC-A Kimberly Stremel, CPC-A Maria Romano, CPC-A Noelle Adrian Marcelo, CPC-A Gayle Stephens, CPC-A Jennifer Marie Beck, CPC-A Kogila Gopu, CPC-A Maria Rossana Vicenta De Jesus, CPC-A Noemi Magsino Villafranca, CPC-A Geetanjali Dilip Bhuvad, CPC-A Jennifer Moreshead, CPC-A Kotte Madhavi, CPC-A Maria Sigg, CPC-A Norene Leavey, CPC-A Genesis Hairston, CPC-A Jennifer Simpson, CPC-A Kranti Eknath Durgade, CPC-A Marie France Delos Santos Rellosa, CPC-A Nungshitombi Oinam, CPC-A Genevieve Ward, CPC-A Jennifer Sneen, CPC-A Kremena Saam, CPC-A Marifi Del Mar Dacillo,CPC-A Odde Madhukar, CPC-A Genny Ann Parcon Gepes, CPC-A Jennifer Wilson, CPC-A Krishnapriya Krishnamachari, CPC-A Maritoni Kohls, CPC-A Odemaris Ivy, CPC-A Gladys D Garcia, COC-A Jenny Chambers, CPC-A Krista Beckwith, CPC-A Martha Abby Panghulan, CPC-A Olga Mokhova, CPC-A Gloria Varela, CPC-A Jenny White, CPC-A Kristian Cef Manimbo, CPC-A Martha Harris, CPC-A Omayra Pagan, CPC-A GLoria Yawn, CPC-A Jeoffray Jm Rimando, CPC-A Kristin Donnellan, CPC-A Martha Taylor, CPC-A Paarul Sharma, CPC-A Gokila Palaniappan, CPC-A Jessi Molder, CPC-A Kristin Slack, CPC-A Marvetta Cunningham, CPC-A Pamela Green, CPC-A Grace Garland, CPC-A Jessica Barraza, CPC-A Kristina Compton, CPC-A Mary Annette Mendonca, CPC-A Panchami Appukuttan, COC-A Grant Michael Baldwin, CPC-A Jessica Blair, CPC-A Kristine Gray-Jurgens, CPC-A Mary Blair, CPC-A Pankaj Satyawan More, CPC-A Grishma Kundalia, CPC-A Jessica Brooks, CPC-A Kristine Kramer, CPC-A Mary E Macbeth, CPC-A Paola Andrea Biares Bayona, CPC-A Gunni Vinyasa, CPC-A Jessica Campfield,CPC-A Kristy Perkins, CPC-A Mary Escoto, CPC-A Parbati Swain, COC-A Gurkirat Virk, CPC-A Jessica Coffman, CPC-A Krutika Vijay Golatkar, CPC-A Mary Jane Tulabot, CPC-A Parveen Kumar, CPC-A Gurrala Nirosha, CPC-A Jessica Egan, CPC-A Krystal Ybarra, CPC-A Mary Joyce Englis, CPC-A Parvej Mukadam, CPC-A Gwen Elmquist, CPC-A Jessica Hannans, CPC-A Krystina Pena, CPC-A Mary M Reyes, CPC-A Patricia Sierra, CPC-A Gypsy Boy Saldivia, CPC-A Jessica Jones, CPC-A Kulsoom Shaikh, CPC-A Mary McGuiness-Smith, CPC-A Patricia Urban, CPC-A Haley Norris, CPC-A Jessica Marilyn Giron, CPC-A Kurumurthy Laxman Koli, COC-A Matthew H Kamien, CPC-A Patrick Moorman, CPC-A Haley Wire, CPC-A Jessica Renneke, CPC-A Kymberly Van Loon, CPC-A Matthew Larson, CPC-A Pavithra Rajendran, CPC-A Halima Antoo, CPC-A Jigeth Leyba Bustamante, CPC-A Laarni D Marquez, CPC-A Matthew Staup, CPC-A Phoebe Delos Reyes, CPC-A Hannah McCarthy, CPC-A Jill Alison Drews, CPC-A Laarni Dames, CPC-A Maureen Gamayon, CPC-A Pia Jennica Marie Acas, CPC-A Harsh Makkar, COC-A Jill Jonette Cornstubble, CPC-A Lacey Engelmann, CPC-A Maurice Nichols, CPC-A Pinki Das, CPC-A Hayley Ireland, CPC-A Jim Gerhardt, CPC-A Lakshmi Adusumilli, CPC-A Mayur Pol, CPC-A Pogaku Sandeep, CPC-A Heather Mullins, CPC-A Joanna Marie Padilla, CPC-A Lalitha Dhulipala, CPC-A Meenu Agarwal, CPC-A Pooja Kottanadan Paul, CPC-A Heather Berning, CPC-A Joanne Jacquin, CPC-A Larissa Vargas, CPC-A Meera Surendran, COC-A Pooja Tikkisetty, CPC-A Heather Blocher, COC-A, CPC-A Jodi Surkis, CPC-A Latisha Samuels, CPC-A Megan Rizzo, CPC-A Prasad Nigade, CPC-A Heather G Bosen, CPC-A John Angelo Cabauatan, CPC-A Laura Conlan, CPC-A Megha Nair, COC-A Prashanth Kumar Manchi Balaraj, CPC-A Heather Gruber, CPC-A John Mabon, CPC-A Laura Lewis, CPC-A Meghna Gupta, CPC-A Prathyusha B, CPC-A Heather Lynn Bryngelson, CPC-A John Neil Coyoca Punay, CPC-A Laurel Wilhelm, CPC-A Melchelle Mirasol, CPC-A Proven Dumagpi, CPC-A Heather Williamson, CPC-A Johnston Busi, CPC-A Lauren Kellett, CPC-A Melinda Frisch, CPC-A Rachel Hall, CPC-A Heidi Breshears, CPC-A Jonathan Quiki, CPC-A Lauren M Kailian, CPC-A Melissa Baer, CPC-A Rachel Born, CPC-A Heidi Hicks, CPC-A Joshua Linn, COC-A Lauren McGhee, CPC-A Melissa Eurit, CPC-A Radhika Krishnamurthy, CPC-A Heidi Milmoe, CPC-A Joshua McCarty, CPC-A Lauren Pilarski, CPC-A Melissa Hackett, CPC-A Rahul Goyal, CPC-A Heidi Moore, CPC-A Juliann Chun, CPC-A Lauren Ramey, CPC-A Melissa Steien, CPC-A Rajendar Goud Kass, CPC-A Hemalakshmi Shruthi Vempati, CPC-A Julie Ann Patent, CPC-A Laurie DeBuhr, CPC-A Melissa Turner, CPC-A Rajiver Merca, CPC-A Hemalatha Govindarajan, CPC-A Julie Davis, CPC-A Lavanya Arudra, CPC-A Meredith Harrington, CPC-A Rakisha Sherrill, CPC-A Heziel Joy Par, CPC-A Julie Lotz, CPC-A Lawanda N Graves, CPC-A Meredith Parker, CPC-A Ramanjinamma Kuruba, CPC-A Himanshu Singh, CPC-A Julie Ripley, CPC-A Leanne Munger, CPC-A Merita Praveen, CPC-A Rameshreddy Samala, COC-A Holly Baker, CPC-A Julie Zoldos, CPC-A Lekshmi Sukumaran, COC-A Merlin Thanga Suba, CPC-A Ramya Gunasekaran, CPC-A Honorio Lua, CPC-A Jumde Sharada, CPC-A Lella Pavani, CPC-A Michael Henderson Graves Jr, CPC-A Ramya Nettikopula, CPC-A Ia Anne Noelle Burla, CPC-A Jussein Vitug Mallare, CPC-A Lenore Faith Macmillan, CPC-A Michele Dursteler, CPC-A Rashanda Moye, CPC-A Ibidun McKiver, CPC-A Justin Peacock, CPC-A Leslie Canty, CPC-A Michele Tutton, CPC-A Rasmitha Gorre, CPC-A Ileen Howard, CPC-A Jyosthna B Vennapusa, CPC-A Leslie Hewitt, CPC-A Michelle C Dutton, CPC-A Ravi Pandu, CPC-A Ilse Andreas Parcon Acupan, CPC-A Jyoti Kadam, COC-A Leslie Lewis, CPC-A Michelle D Burks, CPC-A Rayabarapu Haritha, CPC-A Imran Khan Shaik, CPC-A K V N Sreenikhila, CPC-A Leslie Mitchell, CPC-A Michelle De Castro Guevarra, CPC-A Realiza Pernis, CPC-A India Burdine, CPC-A Kaitlyn M Altenhoff, CPC-A Letitia Prather, CPC-A Michelle Hammerberg, CPC-A Rebecca Baker, CPC-A Indira Pillas Aranzanso, CPC-A Kalyan Mandagadda, CPC-A Liezel Guillermo, CPC-A Michelle Haynie Spruit, CPC-A Rebecca Dawn Bates, CPC-A Insiya Choilawala, CPC-A Kamille Jovette Salvatierra, CPC-A Liliana Colina, CPC-A Michelle Lackey, CPC-A Rebecca Ferraro, CPC-A Iona Torres, CPC-A Kammi Lauck, CPC-A Lillian Herrera, CPC-A, CPMA Michelle Lafata, CPC-A Rebecca L Breitkreutz, CPC-A Iragavarapu Bharathi, CPC-A Kapil Baburao Suryawanshi, COC-A Linda Folkerts-Beute, CPC-A Michelle Lande, CPC-A Regina Mandelblatt, CPC-A Irene M True, CPC-A Karen Brounstein, CPC-A Linda Kay Gifford, CPC-A Michelle Sese, CPC-A Regina Turner, CPC-A Irene Torok, CPC-A Karen D Zuppinger, CPC-A Linda Tracey, CPC-A Michelle Wetzel, CPC-A Regine Pesino, CPC-A Irene Weimer, CPC-A Karen Gold, CPC-A Lindsay Alzamora-Cook, CPC-A Minh Vo, CPC-A Rekha Murali, COC-A Iryna Ries, CPC-A Karen McCartney, CPC-A Lindsey Danielle Anderson, CPC-A Miranda Ruuth, CPC-A Rena Vue, CPC-A Isabel Ferrer, CPC-A Karen Mercado, CPC-A Lindsey Howard, CPC-A Mirtha Luz Sulca, CPC-A Renee Johnson, CPC-A Isabel Guidi, CPC-A Karen Presha, CPC-A Lindsey Norman Marshall, CPC-A Mona Richardson, CPC-A Revathy Govindankutty Nair, CPC-A Ivy Rajan, COC-A Kari Nettesheim, CPC-A Lisa Cobb, CPC-A Monica Kocjan, CPC-A Rhonda Welch, CPC-A J S Saritha, CPC-A Karina Freschlin, CPC-A Lisa Gordon, CPC-A Monica Nandkumar Marathe, CPC-A Rigel Marasigan, CPC-A Jack Matney, CPC-A Kasturi Dudhane, CPC-A Lisa S Freeman, CPC-A Monika Porch, CPC-A Rijo Thomas, CPC-A Jacqueline Walker, CPC-A Katha Wewe, CPC-A Liza M Colon Gonzalez, CPC-A Morgan Renae Rayburn, CPC-A Robert Croutcher, CPC-A Jagruthi Golusu, CPC-A Katherine Duffie,CPC-A Lora Johnston, CPC-A Mrudula Vijayarao, CPC-A Robert Desormeaux, CPC-A Jaime Paulson, CPC-A Katherine Lockridge, CPC-A Lora Paige Wood, CPC-A Mrunali Pralhad Bhosale, CPC-A Robert Vincent Lenart, CPC-A Jaime Thomas, CPC-A Kathleen Austria Jagmis, CPC-A Lori Cavazos, CPC-A Muvva Nagendra Babu, CPC-A Roberta Morrow, CPC-A James Andrew Yamba, CPC-A Kathleen Selgado, CPC-A Lori Monten, CPC-A Myrna B Pinillos, CPC-A Robin Michelle Guffey, CPC-A Jami Yount, CPC-A Kathryn Tutunjian, CPC-A Lori Ruby, CPC-A Myrna Ordonez, CPC-A Robin Zenon, CPC-A Jamie Hanmer, CPC-A Kathryn Hartman, CPC-A Lorie Lineback, CPC-A Nagini Sorna Aravintha Losanan, CPC-A Robyn George, CPC-A Jamie Harvey, CPC-A Kathryn O’Malley, CPC-A Lorita M Cassell, CPC-A Nagula Manasa, CPC-A Rochelle Mae Calape, CPC-A Jan Bozzone, CPC-A Kathy Kindschi, CPC-A Lorrie Hyde, CPC-A Nagulapally Suresh Kumar, COC-A Rochelle McLemore, CPC-A Jan Luong, CPC-A Katie Scherer, CPC-A Louise Denlea, CPC-A Nagunuri Rani, CPC-A Rocio Almeida, CPC-A Jana Calhoun, CPC-A Katrina Leanne Bunnell, CPC-A Luisa Ortiz, CPC-A Namrata Jadhav, CPC-A Rocio Corbin, CPC-A Jane L Bakalian, CPC-A Kayla Kristine Woodring, CPC-A Lydia Ramos, CPC-A Nandhini Kothandan, CPC-A Rohit Chaudhary, CPC-A Janetta Mcgahagin, CPC-A Kayla Rose, CPC-A Lynelle Fay Jimenez, CPC-A Naritha Galosmo, CPC-A Rommel Velasquez Colina, CPC-A Janice Herron, CPC-A Kelly Marie Schreiner, CPC-A Ma Angelica Pascual Garcia, CPC-A Narmatha Dhanasekaran, CPC-A Romona Elizabeth Ghanie, CPC-A Janiecia Queen, CPC-A Kelly Michel, CPC-A Ma Angelica Pascual Garcia, CPC-A Natalie Mae Malig, CPC-A Ron Kristian Timosa, CPC-A Janis Hall, CPC-A Kelly S Johnson, CPC-A Ma. Monica Felix, CPC-A Naveen Shanmuganathan, CPC-A Rona Abella Balbuena, CPC-A Janna Beckmann, CPC-A Kendra Hulkonen, CPC-A Ma. Nina Krystel Bona, CPC-A Nazia Hameed, CPC-A Ronda Black, CPC-A Jasmine Fouts, CPC-A Kendra Nacole Biggs, CPC-A Ma. Sonica Supang, CPC-A Nea L Carter, CPC-A Rose Tippy, CPC-A Jasmine Ricks, CPC-A Kendra Nelson, CPC-A Maakani Sameera, COC-A Neelam Hawaibam, CPC-A Roselle Garlejo Bambico, CPC-A Jason Campbell, CPC-A Kenneth Viray, CPC-A Macey Perkins, CPC-A Neena Juliet Robert, CPC-A Rosetta Miles, CPC-A Jay G. Cooke, CPC-A Kerrie Smith, CPC-A Madhavarapu Gayathri, CPC-A Neha Rajani, CPC-A Roshni Jaya, COC-A Jayanthi Mohan, CPC-A Kevin Rogers, CPC-A Madhavi Bhukya, CPC-A Neha Vashishtha, CPC-A Ross Louiege Mendoza, CPC-A Jayanthi Selvaraj, COC-A Kevin Rogers, CPC-A Mahesh Abbili, CPC-A Neil Andrew Salenga, CPC-A Rucha Jadhav, CPC-A Jayme Kraynak, CPC-A Kiana Hill, CPC-A Maheswari Anand, CPC-A Nela Priyanka, CPC-A Ruth Jones, CPC-A Jean Andrick, CPC-A Kim Sayam, CPC-A Malikanti Manohar, CPC-A Nicholas Zosky, CPC-A Rydal Igat, CPC-A Jeanette L Mitchell, CPC-A Kim Zandro Gozo, CPC-A Malladi Rohan Teja, CPC-A Nichole Olson-Hanks, CPC-A Sahera Banu, CPC-A, CIC Jeffrey Clarke, CPC-A Kimberly A McElfresh, CPC-A Mamatha Bottu Sethu, CPC-A Nicole Carino, CPC-A Sai Priyanka Malisetty, CPC-A Jen Babcock, CPC-A Kimberly Bonnaure, CPC-A Mamatha Thummala, CPC-A Nicole Marie Elnicki, CPC-A Saikumar Gokulam, COC-A Jenila Rubavathy Jeyaraj, CPC-A Kimberly Brand, CPC-A Manali Pathak, CPC-A Nicole Preto, CPC-A Sajan Cherian Mathew, COC-A Jenna Burt, CPC-A Kimberly Gromer, CPC-A Manjusha Dasamalla, CPC-A Nikhil Tyagi, CPC-A Salman Hudud, CPC-A Jennefer Moody, CPC-A Kimberly Kimble, CPC-A Manjushri Ramakrishna Rao, CPC-A Niki Mehta, CPC-A Samantha Suzanne Diaz, CPC-A Jenni Dennis, CPC-A Kimberly Lemonde, CPC-A Manohar Alla, COC-A Nilanka Rodrigo, CPC-A Samarateja Gundu, COC-A Jennibeth Marquez, CPC-A Kimberly McCraine, CPC-A Marci Penner, CPC-A Ninfa Webb, CPC-A Sameer Khan, CPC-A Jennifer Cruz, CPC-A Kimberly Morris, CPC-A Marcia Oliveira, CPC-A Nireesha Kampa, CPC-A Sandeep Shivaji Gole, COC-A Jennifer Gentzlinger, CPC-A Kimberly Mulford-Rambis, CPC-A Margarette Bauer, CPC-A Nisha Viswanathan, COC-A Sandra P Salazar, CPC-A Jennifer Hackett, CPC-A Kimberly Smith, CPC-A Maria (Lulu) Mireles, CPC-A, CEMC Niyati Y Patel, CPC-A Sandy Liao, CPC-A
www.aapc.com July 2016 63 NEWLY CREDENTIALED MEMBERS
Sandy Martin, CPC-A Teresa Marshall, CPC-A Brenda Venezia, CPC, CUC Jean Marie Darnell, CPC, CPB Nadine Gosine, CRC Sandy Rogers, CPC-A Teri Culp, CPC-A Bridget C Brown, CPC, CPMA Jennifer Councilor, CPC, CPMA, CEMC Nakai Kanoyangwa, CPC-A, CIC Santoshi Pandit, COC-A Tesah Linton-Carnes, CPC-A Bridgette Lawrence, CPC, CPMA Jennifer E Baukus, CPC, CEMC Nancy Rios-Avila, CPC, CPMA, COSC, CUC Sara Clark, CPC-A Thasleena Banu, CPC-A Brooke Anne Buckley, CPC, CPMA, CEMC Jennifer Harris, CPC, CRC Nanette Noprada, CPC-9-A Sara Hackwelder, CPC-A Tiffany Jacobs, CPC-A Caitlin Adams, CPC, CPCO Jennifer Janczuk, CPC, CHONC Nichole Cihak, CPCO Sara Harrison, CPC-A Tina Heinen-Smith, CPC-A Camille Beauchamp, CPB Jennifer Jean Guindon, CPC, CPB Nicole Howells, CPC-A, CPMA Sara Milano, CPC-A Tina Herron, CPC-A Candace Duncan, CPC, CPMA Jennifer Leppek, CPC, CRC Nicole Pine, CPMA Sarah Baumann, CPC-A Tina Hildreth, CPC-A Candace Elaine McCormick, CPC, CPCO Jennifer M Hynes, CPC, CCC Nidhi Singh, CPC, CPMA Sarah Campos, CPC-A Tina Marie Caipilan, CPC-A Candace L Omija, CPC, CPMA, CANPC Jennifer Purk, CPC, CEMC Noble Anu John, CPC-9-A Sarah J Nies, CPC-A Tonya Bailey, CPC-A Candace Winters, CPC-A, CPB, CPMA Jerri C Hinch, CPC, CRC Odelis Lopez, CPC, CRC Sarah Redden, CPC-A Tonya Moretz, CPC-A Candi Hume, CPC, CIRCC, CPMA Jessica Chen, CRC O’Shanda Y Pablo, CPC, CRC Saranya M, CPC-A Tonyah Cole, CPC-A Caridad J Trujillo, CPC, CRC Jessica Gielow, CPC-A, CPB Pamela Ediger, CPC, CPMA Sarath Thekkedath, CPC-A Tori Li Toda, CPC-A Carol Skelton, CPC, CPMA Jessica McHugh, CRC Patricia Claybaugh, CPC, CPMA Sasikala Murugesan, COC-A Tracey Stamey, CPC-A Carolyn D Francis, CPC, CRC Jessica Roisin Moore, CPC, CRC Paulo Sugawara, CPC, CPMA, CRC Savannah Thompson, CPC-A Tracie Dorton, CPC-A Casandra Steinhaus, CPC-A, CEDC, CEMC Jessica Williams, CPC, CGIC Peggy A Johnson, CPC, CPMA Sayli Sutar, CPC-A Travis Soyars, CPC-A Cathy Reid, CHONC Jill Lynn McPheron, CPC, CPMA Pui Fung Tsang, CPB Seema Yadav, COC-A Trixie Mariel Araune, CPC-A Chandra Lynn Stephenson, COC, CPC, JoAnna Long, CPC, CGSC Rachel D Bates, CPC, CUC Shampa Rahman, CPC-A Trupti Dattatray Jambhale, CPC-A CPCO, CPB, CPMA, CPPM, CPC-I, Joaquin Cutino, CPC, CRC Rachel Steiger, COC-A, CPC-A, CPMA Shan-Chuin Kong, CPC-A Tushar Arjun Mahadik, COC-A CANPC, CCC, CEMC, CFPC, CGSC, CIC, John Ferrara, CPCO Rachelle Denis, CPC, CPPM Shannon Carlisle, CPC-A Tyshawna Murray, CPC-A CIMC, COSC, CRC John Methgen, CPC-A, CPB Rafaela Gallo, CPC, CPMA, CRC Shannon Church, CPC-A Uma Sankaran Chathapuram, CPC-A Chareva L Reyes, CPC, CPMA Johnna Porter, CPC-A, CRC Rayshelle Aparicio, CPC, CRC Shannon McShane, CPC-A Uppula Sathish, CPC-A Cheala Hopkins, CPB Jolene Kappes-Lillquist, CPC, CPCO Rebecca Cashman, CPC, CPMA Shannon Schmidlin, CPC-A V S Pavan Kumar Chinni, CPC-A Chelsea Barry, CPC, CEMC Joshua Martin, CPC-A, CRC Rebecca Ledvina, CPC, CRC Shanu Varkey, COC-A Vaishali Patel, CPC-A Cherice Nicole Witter CCS, COC, CPC, CPC-P, Joy L Tolzman, CPC, CRC Rhonda Lynn VanTeeffelen, CPC, CPPM, Sharad Kumar Sharma, CPC-A Valisha Gorman, CPC-A CPC-I, CRC Joyce Patterson, CPC-A, CRC CGIC Sharee Black, CPC-A Vallapu Sousheel, CPC-A Christina Henson, CIMC Judy Linda Castonguay, CPC, CEMC Richard Spaeth, CPC, CPMA Shawna Wood, CPC-A Vanessa Perez, CPC-A Christina Joy McFann, CPC, CIRCC, CCVTC Judy Michael, CPB Rita Antonelli, CPC, CPMA Shelly Clarke, CPC-A Vanitha Thankarajan, CPC-A Christine Marie Hernandez, COC, CPC, CHONC Julia Macdougall, CASCC Ruby Jeanne Weber, CPC, CPMA Shenitra Davis, CPC-A Vanmathi Sundar, CPC-A Christine Theiss, CPB Juliana Maria Vallarino-Negron, CPC, CPMA Sabrina Suder, CPC, CPMA Shermeikia Jones, CPC-A Vasudeo Subhash Chaudhari, COC-A Cinthia Serna, CPC, CCVTC Julie King, CPPM Sajonia E. Diaz Velazquez, CPC, CPMA Sherry Baldwin, CPC-A Vasundhara Dantuluri, CPC-A Claire Ann Flores, CPC-9-A Julie McNally, CPPM Sally Khan, CEMC Shiela Marie Guiquing, CPC-A Veronica Franco, CPC-A Connie Cofer, CPC, CIRCC, CPMA Kala Nichols, CPB Sally Kolman, CPC, CPMA, CPPM, CEMC Shiju Mohamed, CPC-A Vetrivel Mani, CPC-A Corina Bucsi, CPC, CPB, CGSC Karen Roslie, CPPM Samantha Webster, CPC, CHONC Shilpa Avinash Deshpande, CPC-A Vicki Wiehebrink, CPC-A Corinne Weckherlin, CPC-A, CPB Karen Smith, CPMA Sandra Garrett, CPC-A, CPB Shirin Fan, CPC-A Vickie L Sanders, COC-A, CPC-A Courtenay J Obert, CPC, CRC Kathleen Christopherson, CPC-A, CPB, CFPC Sandra Margarita Lazo, CPC, CRC Shirley Mantuano Catoner, CPC-A Victoria Kidwell, CPC-A Cristina Maria Alvarez, CRC Kathleen Marshall, CPC, CEMC, CGSC Sangili Murugan Palanivel, COC, CPC, CPMA Shirlisa Banks, CPC-A Victoria Leabo, CPC-A Crystal Anica Junious-Green, CPC, CPMA Kathryn Lindsley, CPMA, CEMC Santhiya Balaguru, CPC-A, CIC Shital Khedkar, COC-A Vidya Shivaji Patil, CPC-A Cynthia Tillman, CRC Kathy Stapleton, CPC, CPMA Sara Frischer, COC, CPC, CEDC, CRC Shravan Kumar Kandi, COC-A Vijaylaxmi Vishal Jadhav, COC-A Cynthia Ellis, CPPM Katrina DeBruhl-Covan, CPC, CPB Sarah Collinson, CPC, CPMA, CEMC, CPCD, Shweta Bhegade, CPC-A Vinh Hoang, CPC-A Dale R Constantino, CPC, CRC Kelly D Hall, CPC, CPB, CPMA, CEMC CPRC, CRC Shweta Mane, COC-A Vipin Babysarojam, COC-A Dana Petras, CPC, CPMA Kelly Sherrill, COC, CRC Sarah Dargis, CPCD Siddharth Gangawane, CPC-A Virgie Crouch, CPC-A Daniela Saito, CPB Kim Emmons, CEDC Sarah E Fox, CPC, CRC Siman Joseph Dsouza, CPC-A Vishal Ramesh Gaikwad, COC-A Danielle Irwin, CPMA, CEMC Kimberly K Olson, CPC-A, CPEDC Sarah Ramsey, CPC, CRC Sivali Boddu, CPC-A Vladimir Cortez, CPC-A Danielle Mills, CPC, CEDC Kimberly Krebs, CPEDC Saravanan Rajentheran, CPC, CPMA Sneha B, CPC-A Warren Wilkinson, CPC-A Dawn Wittke , CCS-P, CPC, CPMA, CPC-I, CRC Kimberly Lillis, COC, CPC, CPPM, CEMC, Shana Windover, CPC, CPCO Sneha Mable, COC-A Wendy Karyle Ramirez, CPC-A Dayana Ivon Perez-Sanchez, CPC, CPMA, CRC CHONC Shane Lawson, COC-A, CPMA Sonal Prakash Phalle, CPC-A Whitney A Hayes, CPC-A Debbie Dawson, CPC, CRC Kimberly Thomas, CPC, CPEDC Sheila Rodriguez, CPC-A, CEMC Sonali Ramdas Jadhav, COC-A Whitney N Folsom-Lecouffe, CPC-A Debbie J Peterson, COC, CPMA Kimberly Timko, CPC, CPMA, CEMC Shelby Jensen, CHONC Soumya Naiki, CPC-A William Moy, CPC-A Deborah Smith, CPC, CRC Kori Sawyer, CPC, CPCO Silvana Fischman, CRC Sravani Raikoti, CPC-A William P Douglas, CPC-A Debra P Faust, CPC, CPMA Kripa Anitha Krishnankutty, CPC-9-A Siran Deng, CRC Sreedhanya K, CPC-A Yahira Colon, CPC-A Debra K Rhea, CPC, CPB, CEMC Kristin Pamela Young, CPCO Sonia Cavazos, CPC, CPMA, CPPM Sridath Jituri, CPC-A Yoel Lovelle, CPC-A Denise Suskie, CPC, CPMA, CCVTC Kristin Romero, CRC Sonja D Moon, CPC, CPMA Srikkumaran Thaamotharhan, CPC-A Yogesh Vishnu, CPC-A Deva Kiran, CPC-A, CPMA Lanette Collins, CPC, CPMA Sonya Martin, CFPC Srinivas Gundeti, COC-A Yogita Gonnade, CPC-A Diana L Pirtle, CPC, CPMA Larissa Tamayo, CPB Steven Ovens, CPC, CRC Stacey Maurice, CPC-A Yoliana Carralero, CPC-A Diane Bryand, CPC, CPMA LaShonda Williams, COC, CPCO, CPMA, CEMC Suharmy Jimenez, CPC, CPMA, CRC Stacey Romanenko, CPC-A Zak Bartels, CPC-A Dianne Sibal, CPC, CIRCC, CEMC Laura Wheeler, CPMA Sumamol Thomas, CPC-9-A Stephanie D Brooks, CPC-A, CRC Diaren Rodriguez, CPC, CPMA Leigh Cyr, CPC, CUC Susan Csikos, CPC, CRC Stephanie Harry, CPC-A Dolmaya Thogra, COC-A, CIRCC, CPB, CPMA, Leslee Marie Allen, COC, CPC, CIRCC Susan L Baldwin, COC, CPC, CPMA Stephanie Matney, CPC-A CCVTC Leslie Palmer, CPC, CANPC, CHONC Susan M Murphy, CPC, CPB Stephanie Nasalroad, CPC-A Specialties Dominique Zapata, CPC, CPMA, CRC Leslie Michelle Pickens, CPC, COSC Susan Wilkinson, CRC Stephanie Ramoutar, CPC-A Domonique Perkins, CPC, CEMC, COBGC Lily C Garcia, CPC, CRC Susanne M Westmoreland, CPC, CPMA, CRC Stephanie Simmons Johnson, CPC-A Aarthy Sooryanarayanan, CPC-A, COSC Donnine E Day, CPC, CPMA, CEMC, CENTC Linda Heissenberg, CPPM Suzanne Estes, CRC Subash Sisupalan, COC-A Abigail Erlandson, CPC, CEMC, COBGC, CPCD Doret Lyn DeBarros, CPC, CPMA, CEDC, CEMC Linda Prentice, CPB Suzanne Winn, CPB Suma George, COC-A Abigail Pipkin, CPC, CENTC, CPCD Earlene Kincaid, CPPM Lindsey Pileika, CRC Syed Zaidi, CPC, CEDC Sumit Shukla, CPC-A Agnieszka Balnis, CPPM Ebone Nicole Fleming, CPC, CRC Lindsey Vitez, COC, CPC, CPCO Tami Baker, CPC, CEDC Surepalli Nagalakshmi, CPC-A Aileen Magracia Dario, CPC-9-A Elena Castaneda, CRC Lindsey Webb Lyle, COC, CPC, CIC Tamrisia Braddy, CPC, CEMC Sureshbabu V Eerisetty, CPC-A Alecia Johnson, CPB Elisa Grisel Torres, CPC, CRC Lisa Harding, CPC, CPB, CPMA Temiko M Holmes, CPC, CEMC Susan Bohaski, CPC-A Alyshia Baker, CPC, CPMA Elizabeth Napoles, CPC-A, CPMA Lisa Jane Harris, CPC, CPC-I, CRC Tena S Brown, CPC, CEMC Susan McCarthy, CPC-A Alyson Rodgerson, CPC, CGSC Ellen Risotti-Hinkle, CPC, CPMA, CPC-I, Lisa Janell Fouts, CPC, CPMA, CANPC Tennison Yu, CRC Suswetha Kothapalle, CPC-A Amaechi Lawrence Ofunne, CPC, CPMA, CEMC, CFPC, CIMC, CRC Lisa Morris, CPC, CEMC Teresa S Brown, CPC, CPB Suzette Valdez, CPC-A CEMC, CENTC, CGSC, CPRC Erica Marie Marshall, CPC, CENTC, CPRC Lissa Topham, CPC-A, CPB Terri L Minotti, COC, CPC, CPB Swapnagandha Bhoite, CPC-A Amanda Proctor, CPC, CPMA, CRC Erica S Brownawell, CPC, CCC Lorena Rodriguez, CPMA Tiffany Bustle, CPCO, CPPM Swapnali Gawade, COC-A Amber Long, CPC, CCC Erica Toth, CPC, CPB Lori Gomez, CPC, CPB Tina Hopkins, CPC, CRC Sybil Norman, CPC-A Amy Beecher, CRC Fernando Campos, CRC Lori L Koetje, CPC, CEDC, CPRC Tina Marie Lange, CPC, CPMA Sylvia Duplantier, CPC-A, CPMA Ana Armstrong, CPC, CPMA, CANPC Gina M Schirato, CPCO, CPB, CPMA Lynda Gail Detmers, CPC, CHONC Tina R Wadkins, CPC, CPCO, CPMA, CPPM, CRC Sylvia Hatley, CPC-A Ana Arnold, CPC-A, CHONC Girlie A Gamboa, CPC, CRC Madeline Maceda-Hernandez, CPC, CPMA, Tong Parngs, CPC-A, CPCO, CPMA Tabitha Lichtenwalner, CPC-A Ana Yanez-Marrero, COC, CPC, CPMA, Giselle Pastrana, CPC, CRC CRC Tracey Louise, CPC, CPC-I, CRC Tache Vaughn, CPC-A CPC-I, CRC Hailey Walker, CPC, CIRCC Maggie Toyos, CPC, CRC Tracy Bettis, CRC Takia Sands, CPC-A Andrea Hefner, CPC, CPB, CPPM Heather Bollman, CPC, CPB, CPC-I Maranda Goldsmith, CPC, CPMA, COBGC Tracy Marshall, CPB Tamara Gessell, CPC-A Andrea Smith, CPC, CPMA Heather Leigh Mashburn, CPC, CIRCC Marcia Tracey, CRC Tracy Swaim, CPB Tamara Kelly, CPC-A Andrew Myers, CPC-A, CPB Heather Vaughn, COC, CPC, CRC Maria D Nunez, CPC, CPMA, CRC Tricia Owsley, CPMA Tamara Turpin, CPC-A Angela Paine, COC, CPMA, CPC-I, CEMC, CRHC Hildolidia Rodriguez, CPC, CPMA María de los Angeles Gongora Iglesias, Vania Johnson, CPC-A, CPMA Tamekia Staton, CPC-A Angelia Puckett, CPC, CPMA, CEMC, CGIC Holli A Lancaster, CPMA, CRC CPC, CRC Vicki Rittenhouse, CPB Taminka Blue, CPC-A Ania Rivero, CPC, CPMA Ilene Flaherty, CPC, CPMA Maria Victoria Goguen, COC, CPC, CPB, Vilma Smith, CPC, CRC Tammie Lynn Diddens, CPC-A Anna Krizel Esguerra, CPC-9-A Indira Olazabal, CPC, CPMA, CRC CPPM Vishnu Shanam, CIC Tammy Kenny, CPC-A Anna Marie Grimes, CPC, CPC-P, CRC Irene Pinto, CPC-A, CPMA Marisol Garcia, COC, CPC, CHONC Wendy Mcallister, CPB Tammy Michelle Kersey, CPC-A Anton Arbatov, CPCO Isbelys C De Armas, CPC, CPMA, CRC Mary E Kinney, CPC, CENTC Wenona Lynn Mason Goc, CPC-A, CPMA Tammy Wilson, CPC-A Aprille Ruiz, CPC, CPB, CGSC Jaime Sarten, CPC, CRC Maureen Schultz, CRC Yan Jiang, CPC, CPMA Tanvi Zagade, CPC-A Beth Helsel, CPC, CRC James Gleason, CPPM Max Jeevin Maria, CPC, CPMA YI Yu, CRC Tanya Bush-Townsend, CPC-A Beth Reynek, CRC Jan Rafael Reyes, CPC-9-A Maydolis Gutierrez, CPC, CPMA, CRC Zakiyyah Wagerle, CPC, CRC Tatiana Hockett, CPC-A Beth Schaub, CPC, CPMA Janell Dawn Kangas, CPC, CPMA, CPPM Mayrelis Ramos Gonzalez, CPC, CPMA, CRC Tawn Lynn Hubbard, CPC-A Beverly Jean Maniscalco, CPC, CPCO Janet Bennett, CRC Meghana Mohan, CPC-9-A Taylor Robinson, CPC-A Bobette L Haley, CPC, CPMA Janet Marie Wright, CPC, CPB Melissa Susan Threadgill, CPC, CPMA Taylor Thoren, CPC-A Brenda A McManemy, CPC, CCC Janeth Fernandez RN, CPC, CPCO Melody Villegas Estrella, CPC-9-A Teal Leroy, CPC-A Brenda Dominski, CIRCC Janie Loftis, CPC, CPMA Michelle Nadolny, CPC, CPMA Telidevara Sai Anusha, CPC-A Brenda Lor, CPC, COSC Jasmin Johnson, CPC, CPB, CEDC Morgan Jones, CPC, COBGC, CPRC
64 Healthcare Business Monthly TCI # 2
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www.aapc.com July 2016 65 Minute with a Member
Marg M. Strein Scranton/Wilkes-Barre, Pennsylvania
the AAPC ICD-10 proficiency test, read every issue of Healthcare Business Monthly and all the CMS updates, and code every
quiz I can find. istock.com/klenger
What advice do you have for new coders? My advice to anyone seeking employment in the field of coding is to “be true to thyself.” Be a trailblazer when needed, and do not give up when work is challenging or the path gets rough.
If you could do any other job, what would it be? My main goal is to land a job in the coding industry. I like coding and working with records very much. Although coding is my main career choice, I have a Bachelor of Arts in Sociology and consulting experience to support me. Tell us a little bit about how you got into to get better acquainted with CPT®, coding, what you’ve done during your HCPCS Level II, and ICD-9-CM codes, How do you spend your spare time? Tell coding career, and where you work now. and explore general surgery. I relied on us about your hobbies, family, etc. While attending an online medical coding my background, determination, skills, I am a vegetarian and enjoy cooking program online, I also worked full time and AAPC to succeed; and as a result, Asian, Indian, and French cuisine. I am as a lead merchandiser. I am the sole I achieved the coding quality scores an adventurous spirit: I dabble in outdoor supporter of my household, but I managed required. The position was short term, activities and I search for quests to conquer. to dedicate time to learning medical however, so I am presently seeking a In my spare time, I enjoy family, drawing,
coding guidelines, anatomy, and medical position in medical records or coding. yoga, dancing, hiking, and organic terminology. gardening. What AAPC benefits do you like the most? In 2014, I completed the program with honors. I knew finding a place in the I rely on AAPC’s Healthcare Business coding field would be a challenge, but I Monthly for coding information, was determined. education, and inspiration. I enjoy and benefit from the coding exercises, articles, In 2015, I was employed in a facility, and inspirational stories from professional coding outpatient same-day surgery coders, especially those who have charts. It afforded me the opportunity experienced difficulties along their paths to success. GOT A MINUTE? I am extremely grateful for the Hardship If you are an AAPC member who strives to advance Scholarship Fund, and I hope to the business of healthcare, we want to know about it! reciprocate to other members in need when Please contact Michelle Dick, executive editor, at I can. While job seeking, I continue my [email protected], to learn how to be featured. coding education in many ways: I passed
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