IR-DRG and You Reaches a Rock? of Course Not

Your connection to medical coding and documentation compliance

"Does running

water stop when it IR-DRG and You reaches a rock? Of course not. It In today’s fast-paced world where comfort breeds for-Service payment model and has been utilized turns either left or complacency, it is essential that we take the within Abu Dhabi since 2011. initiative to engage in continuous learning as a right, and IR-DRGs have estimated length of stay and relative means to sharpen our saw. This will ensure more continues its weight based on the presentation of patient’s success in our chosen field. So how do we go about way. Likewise, a disease condition and plan of care. Variations may in enriching our knowledge? The media, books, positive person is happen depending on the progress of the patient, events such as AAPC meetings, for instance, are confident that no some of the ways to learn, Rachel Coon, AAPC President and Sandra Chamberlin, the IR-DRG speaker for the AAPC March challenge will to grow, to socialize and Local Event. stand in the way of meet other professionals, achieving his or and to be proactive her goal" outside of work. His Highness AAPC meetings intend to Sheikh Mohammed provide an avenue for bin Rashid al learning in-depth Maktoum information on critical topics, led by experts in the field and imparted by selected knowledgeable AAPC Event presenters. The IR-DRG for Reminder instance was tackled Next Event during the March 21st AAPC meeting, presented Saturday June 20th by a specialist in the DRG arising complications, and comorbidities that 10:30am coding field Ms. Sandra Chamberlin. Ms. Sandra warrants additional care. Since IR-DRGs might be Managing Procedure Chamberlin is a holder of various certifications such affected by the patient’s secondary diagnoses, Denials as RHIA, CCS, CPC and a Certified trainer for ICD- complete and concise documentation by the 10; she is also the Executive and Chief Clinical physician is of utmost importance to reflect an Speaker: Coding Officer for Gulf-HRA and an expert in (to accurate DRG assignment and with it an optimal Dr. Mohammad Balochi mention a few) Coding & Supervision, Clinical reimbursement for the facility. Payment is calculated Documentation Improvement, and Coding by multiplying the base weight (the AED amount Training. With her long experience in the coding that stays consistent) by the individual IR-DRG Inside this issue: arena, there is no other expert who can explain to relative weight, this results in the expected us better the importance of IR-DRG. reimbursement to the facility. IR-DRG serves a two ICD-9 CODING way purpose of measuring the quality of physician AREA: So, what is IR-DRG? IR-DRG which stands for 2 –4 services and as reimbursement tool for facilities thus Cardiovascular International Refined - Disease Related Groups, is a System it is important that as HIM professionals we system that classifies patients into different understand how IR-DRGs can impact our work. REFRESHING CPT: categories based on their condition/diagnosis, Cardiovascular 5-7 treatment modalities, age and sex. IR-DRGs are One’s knowledge and understanding of the System primarily driven by the principal diagnosis but can importance and implication of IR-DRGs cannot be Meet the AAPC be affected by a patient’s secondary diagnosis. IR- understated. With this, I quote the influential Albert 8 Officers DRGs encompass all the procedures, services, Einstein, “Wisdom is not a product of schooling but Answer Me This 9 products and devices utilized during the single of the lifelong attempt to acquire it.” Regularly inpatient encounter. The IR-DRGs replaced the Fee- improve your skills. Continuously seek knowledge. Gulf –HRA 10 Accelerate your career.

Volume 3. Page 1 GULF-HRA | 2015 ICD-9 CODING AREA Circulatory System by: Eric Tayag Chapter 7 of ICD-9-CM pertains to diseases of the Circulatory System with codes ranging from 390 to 459. Listed below are the commonly applied guidelines that must be known by every coder.

HYPERTENSION  NOTE: Late effect has no time frame, it can occur any time after the resolution of the infarction state.  Do not use either.0 (malignant) or .1 (benign) unless medical record  History of TIA/CVA with NO RESIDUAL DEFICITS documentation supports such a identified is coded to V12.54. designation.

 Hypertension and Heart Disease: A direct relationship of hypertension ACUTE MYOCARDIAL and heart condition must be documented by the INFARCTION physician (i.e. “due to” or implied hypertensive) If no  An AMI documented as non-trans causal relationship stated, hypertension and heart mural /sub endocardial/ NSTEMI condition should be coded separately. with a provided site is still coded as a NSTEMI.  Hypertension and Chronic Kidney Disease: A direct causal relationship is presumed. A secondary code  If NSTEMI evolves to STEMI, assign the STEMI code. from 585 code category can be used to identify the CKD stage along with the 403 code category.  If STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI.  Hypertensive Heart and Chronic Kidney Disease: Category code 404 can be used when both hypertensive kidney disease and hypertensive heart CODING TIPS! disease are stated in the diagnosis. Additional codes Medical coding is a dynamic process. from code categories 428 and 585 can be used to What you’ve known in the past may identify heart failure (if patient has) and CKD stage. not be suitable in the current trend. In order to become a proficient coder,  Code 796.2 is used for elevated blood pressure if no YOU NEED TO CONTINUALLY READ, prior diagnosis of hypertension. COMPREHEND and most importantly, BE UPDATED! Basic knowledge on concepts of anatomy and CEREBROVASCULAR ACCIDENT physiology is a MUST! This will help you to learn the disease process, the necessity of  The terms stroke, cerebral interventions and be guided with the details of infarction and CVA are all indexed the operative report itself. to 434.91. To be able to assign the most appropriate code:  Postoperative cerebrovascular  Specific chapter guidelines must be read accident: A cause and effect prior to assigning a code. relationship between the  Always check the Tabular section after intervention done and occurrence checking the index section. There are some of CVA must be specifically instructional notes listed in this section documented by the physician. A secondary code that can direct you to a more appropriate should also be used to identify the type of code. haemorrhage or infarct.  Read code descriptions to avoid unbundling.  Late Effects of Cerebrovascular disease (Category  Check the Coder Desk Reference for a 438): Specific residual must be documented as due more elaborated procedural code. If the to the previous attack of CVA. Codes from category details of the OP report do not match on 438 may be assigned with an active infarction code what is stated in the CDR, your assigned provided that the patient has a current CVA and code might be inappropriate. deficits from an old CVA.  Be mindful of medical necessity of the procedure done.

Volume 3. Page 2 GULF-HRA | 2015 ICD-9 CODING AREA Circulatory System SITUATIONAL CODING was concluded that the report have showed multi-vessel coronary artery disease. Physician discharged the patient CODING SCENARIO: week after the admission with the following diagnosis: A 76 year old male patient was discharged following a  Acute Anteroseptal wall myocardial Infarction Non ST-elevation myocardial infarction. 2 weeks later, he  Multi-vessel coronary disease developed severe dyspnea and chest Code the diagnosis in this scenario. pain and decided to go to ER for check-up. Patient noticed to have bi- Answer: Assign code 410.11 as principal diagnosis and lobar crackles upon auscultation with 414.01 as secondary. significant increased in his vital signs. Rationale: As previously stated in the previous example, After due workups, he was diagnosed with cause of occasioning the patient for admission is due to questionable congestive heart failure and subsequently myocardial infarction. As per Coding Clinic, Third admitted. Cardiology consultation was made on his 2nd Quarter 2009 Page 10; Assign MI code as the principal stay in the hospital and confirmed the diagnosis of diagnosis since the MI is still being treated, 414.01 can Severe CHF along with episode of chest pain due to his be added as a secondary diagnosis. Myocardial previous NSTEMI. Pharmaco-management was initiated infarction is a more life threatening event in comparison and patient gradually improved. No new infarction to CAD making it more applicable to be placed as the noted during admission. Patient discharged on 4th day principal diagnosis. Although there’s a facility to facility with the following diagnosis: transfer in this scenario, subsequent episode of care is  Severe CHF still not applicable since acute treatment is still being initiated in patient’s condition.  Chest pain due to previous MI, no new infarction ICD 10 CODING: I21.09, I25.10 Code the diagnosis in this scenario. Answer: Assign code 428.0 as principal diagnosis and 410.72 as secondary. ICD-10 HINT!! Rationale: As per Coding Clinic Third quarter 1997 Page: In contrary to 8-week period in ICD-9, ICD 10 only 10;assign 428.0 as principal diagnosis and subsequent considers MI as active in a span of 4weeks. As per Section E of the ICD-10-CM Draft Code Set (2012), MI code as secondary. As per HAAD Coding Manual “For encounters occurring while the myocardial (2011), is defined as the condition, after study, which infarction is equal to, or less than, four weeks old, occasioned the admission to the hospital. In this including transfers to another acute setting or a post- instance, the CHF is the main reason for admitting the acute setting, and the patient requires continued care patient. Since the patient is still on the 8-week period of for the myocardial infarction, codes from category I21 his myocardial infarction, 410.72 shall be coded to may continue to be reported. For encounters after the identify the subsequent episode of care as no new 4 week time frame and the patient is still receiving care related to the myocardial infarction, the infarction noted on this admission. appropriate aftercare code should be assigned, rather ICD 1O CODING: I50.9 (CHF), I21.4 than the code from category I21.For old or healed myocardial infarctions not requiring further care, code A 56-year old lady was admitted in 125.2, old myocardial infarction may be assigned” Hospital A (a secondary hospital) due to severe chest pain, workup done which revealed elevated A 45 year old male patient was troponins and diagnosed as Acute admitted in ER due to severe high anteroseptal wall myocardial blood pressure. Initial reading of infarction. The hospital cannot 240/120 mmHg was recorded and optimize the provision of care due to started immediately with sublingual unavailability of some resources so a decision was Capoten, after 15 minutes of urgently made to transfer the patient to a tertiary observation second reading was hospital (Hospital B). In Hospital B, patient continually done but no changes noted on her received therapeutic regimen to her acute MI. Attending blood pressure. The physician ordered intravenous cardiologist decided to do coronary angiogram which labetalol drip which subsequently lowered the reading have fully agreed by the patient. After the procedure, it to 220/100 mmHg. The patient was diagnosed to have

Volume 3. Page 3 GULF-HRA | 2015 ICD-9 CODING AREA Circulatory System accelerated hypertension. What is the appropriate stenting done on LAD and angioplasty on RCA and diagnosis code in this encounter? patient gradually improved. Patient was discharged with Answer: Assign code 401.0; malignant hypertension the following diagnosis: Rationale: Accelerated hypertension can be indexed in 1. Accelerated Angina the alphabetic section of the ICD 9CM, it is synonymous 2. Angina due to multi-vessel disease. to malignant hypertension. Code the diagnosis alone in this scenario. ICD 10 CODING: I10 Answer: Assign code 414.01, Coronary artery disease, In ICD 10 CM, hypertension is no longer native artery as principal and 411.1, accelerated angina classified as to benign, essential or as secondary diagnosis. malignant. Rationale: As per Coding Clinic, First Quarter 2003 Page: Patient was rushed in the emergency 12 to 13 Effective with discharges: April 30, 2003, department due to severe sweating, accelerated angina is synonymous to unstable angina. As tachycardia and unbearable chest pain. per Coding Clinic Second Quarter 2004 Page: 3 to 4 Due to patient’s instability, decision for admission was Effective with discharges: August 10,2004, assign 411.1 made for further diagnosis workup and medical as a secondary code and 414.01 as principal since it is management. A Coronary angiogram with left heart stated that the cause of patient’s angina is the CAD. cardiac catheterization was done and showed 99% ICD 10 CODING: I25.110 stenosis of LAD and 55% stenosis of RCA. Drug-eluting

ICD 10 CM’s (Complete Coding Draft Code-set 2012) page 13 of Chapter 9 section b: “ICD10 CM has a combination codes for atherosclerotic heart disease with angina pectoris. The subcategories for these codes are I25.11, Atherosclerotic heart disease of native coronary artery with angina pectoris and I25.7, Atherosclerosis of coronary artery bypass graft(s) and coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris. When using one of these combination codes it is not necessary to use an additional code for angina pectoris. A causal relationship can be assumed in a patient with both atherosclerosis and angina pectoris, unless the documentation indicates the angina is due to something other than the atherosclerosis. If a patient with CAD is admitted due to an acute myocardial infarction (AMI), the AMI should be sequenced before the coronary artery disease”

ICD 10 is fast approaching. Listed below are some of the changes made in the cardiology section:

TOPIC ICD 9 ICD 10 Hypertension Classified as benign, malignant, Only once code assigned regardless unspecified (401.x) whether benign, malignant or unspecified (I10) Acute Myocardial Equal to or less than 8 weeks Equal to or less than 4 weeks Infarction time frame Atherosclerotic 2 codes assigned, 1 for the Not necessary to use an additional code Coronary Artery CAD and 1 for the angina for angina, there's a combination code for Disease and Angina CAD and angina

REFERENCES: HAAD Coding Manual: For Hospitals and Other Healthcare Institutions by Clinical Coding Steering Committee (2011) Coding Clinic, First Quarter 2003 Page: 12 to 13 Effective with discharges: April 30, 2003 Coding Clinic Second Quarter 2004 Page: 3 to 4 Effective with discharges: August 10,2004 ICD-10-CM: The Complete Official Draft Code Set by Ingenix (2012) Coding Clinic Third quarter 1997 Page: 10 Effective with discharges: August 1, 1997 Coding Clinic, Third Quarter 2009 Page 10: Effective with discharges: September 15, 2009

Volume 3. Page 4 GULF-HRA | 2015 REFRESHING CPT CARDIAC CATHETERIZATION (Non Congenital) Coronary artery disease is one of the documented causes of acute myocardial infarction. Before leading to death of cardiac tissues, interventions are being done to abort this thing to happen. A coronary angiography is usually done to visualize the coronary circulation and to identify any stenosis or narrowing. A decision is made whether to do a cardiac catheterization or not depending on the discretion of the performing physician.

Here are some key points in understanding a cardiac (93503) in conjunction with other diagnostic catheterization procedure: cardiac catheterization codes unless it is solely done for hemodynamic purposes monitoring.  Entry Point: Artery for Left Heart visualization; Vein for Right Heart visualization.  Catheter placement in coronary artery for coronary angiography with right and left heart  Do not be confused with right and left coronary catheterization is coded to 93460 but if a bypass angiography to right and left cardiac graft angiography was performed as well code to catheterization. 93461.  Right cardiac catheterization involves the QUESTION: introduction of the catheter into the venous system towards the right heart chambers and Avoidance for unbundling of codes is one of the pulmonary artery. Right chambers angiography, important things that a coder must know. This will not supravalvular aortography, pulmonary only prevent claim denial but also provide a more angiography are some that are usually coded accurate coding practice. In reference to code 93458, separately when performed. what is not included in the code description and can be coded separately if actually done?  Left cardiac catheterization involves the introduction of the catheter into the arterial A. Coronary Angiogram system towards the left heart chambers and B. Injection for guidance includes injection for guidance, left ventricular/ left atrial angiography, imaging supervision, C. Left Ventriculography interpretation, and report. D. Injection of a pharmacologic agent  Catheterization that passes through the aortic ANSWER: D valve into the left ventricle with coronary Rationale: Injection of a pharmacologic agent is an add angiography is reported to 93458. If the catheter -on code and has an instructional note in code 93463 DID NOT pass through the aortic valve and to code first (93451-93453, 93456-93461, 93530- coronary angiography is performed, code 93454. 93533). Choices A to C are all bundled in the 93458  Do not report insertion of a Swan-Ganz catheter code. PERCUTANEOUS CORONARY INTERVENTION Percutaneous Coronary Intervention is usually performed once a diseased artery is found. In reporting this procedure, one must be guided by the following rules:

 ONLY 1 coronary intervention can be reported for a single MAJOR coronary artery vessel and it’s BRANCH (Interventions in the branch vessels

are considered a part of the intervention in the major vessel and are not reported separately.) SITUATIONAL CODING HIEARCHY RULE FOR A SINGLE MAJOR VESSEL Patient was rushed in the emergency department  ONLY 1 Initial therapeutic procedure can be due to severe sweating, tachycardia and unbearable reported; any other therapeutic coronary artery chest pain. Due to patient’s instability, decision for procedures in different vessels are reported admission was made for further diagnosis workup using the "each additional vessel" code. and medical management. A Coronary angiogram

Volume 3. Page 5 GULF-HRA | 2015 REFRESHING CPT

PERCUTANEOUS CORONARY INTERVENTION with left heart cardiac catheterization was done and RATIONALE: As per CPT Assistant, December 1996 showed 99% stenosis of LAD and 55% stenosis of Page: 10 Category Angioplasty w/intracoronary RCA. Drug-eluting Stenting done on LAD and stent insertion: The initial vessel procedure that angioplasty on RCA and patient gradually improved. included the angioplasty and the subsequent stent Patient was discharged with the following diagnosis: placement would be reported with code 92980. To  Accelerated Angina report additional vessels treated only by angioplasty during the same session, use code 92984. This  Angina due to multi-vessel disease. information applies similarly to atherectomy Code the CPT procedure codes in this scenario. procedures. CPT CODES: 92980, 92984

CODING EXAMPLES FOR PTCA AND STENT INSERTION: If the physician places a stent in the left circumflex and performs an angioplasty in the obtuse marginal 1 (which is a branch of the circumflex), only the stenting should be reported (92980) PRINCIPLE: HIEARCHY RULE FOR a SINGLE MAJOR VESSEL (STENTING supersedes ATHERECTOMY supersedes ANGIOPLASTY. Stenting of the right coronary artery and left circumflex coronary artery. Codes: 92980 and 92981 PRINCIPLE: Any other therapeutic coronary artery procedures in different vessels are reported using the "each additional vessel" code. Placement of three stents in the proximal, mid and distal portions of LAD. Code 92980 PRINCIPLE: if multiple stents were placed side by side in a single vessel, the stent code would be reported only once; one procedure only per major coronary vessel. Angioplasty and stenting in the RCA. Code: 92980 PRINCIPLE: HIEARCHY RULE FOR a SINGLE MAJOR VESSEL (STENTING supersedes ATHERECTOMY supersedes ANGIOPLASTY. Stenting of RCA and angioplasty of the obtuse marginal 1 (which is a branch of the circumflex) Code: 92980, 92984 PRINCIPLE: Any other therapeutic coronary artery procedures (ex, angioplasty or athrectomy) in different vessels are reported using the "each additional vessel" code.

CORONARY ARTERY BYPASS GRAFT Coronary artery bypass graft (CABG) is a surgical procedure done in patients with severe ischemic cardiac diseases such as coronary artery disease (CAD). The aim of the procedure is to provide adequate blood flow (using a graft) to the heart when its coronary arteries are diseased.

In reporting a CABG procedure, one MUST: CABG with combined venous and arterial grafts  Identify the graft used (Vein Only, Artery Only, or  Includes harvesting of saphenous vein graft and Combined Vein and Artery). artery graft, except: CABG with venous grafts only (33510 – 33516)  35500 – Upper extremity vein  Includes harvesting of saphenous vein graft  35572 – Femoral-popliteal vein  Separately reportable harvesting;  35600 – Upper Extremity Artery  35500 – Upper extremity vein  Two codes are reported:  35572 – Femoral-popliteal vein  Sequence the Arterial Graft first (33533 – CABG with arterial grafts only (33533 – 33536) 33536) followed by the combined venous and arterial grafts (+33517 - +33523)  Includes harvesting of arterial graft, excluding ***33517-33523 are Additional Codes and  35600 – Upper Extremity Artery (e.g. Radial cannot be reported alone. Artery)

Volume 3. Page 6 GULF-HRA | 2015 REFRESHING CPT CORONARY ARTERY BYPASS GRAFT

CABG procedure was discussed to patient and his relatives to prevent a myocardial infarction to happen. After signing of the consent for procedure, patient was urgently transferred to Hospital B which is a highly specialized cardiology hospital for the CABG procedure. CABG report dictates the use of combination of two saphenous veins and an internal mammary artery graft. After the procedure, patient was transferred back to Hospital A for continuity of care. How will you code the CABG procedure in Hospital B? ANSWER: Assign code 33533 and 33518. SITUATIONAL CODING RATIONALE: To report combined arterial and venous A 55-year old male patient was admitted to Hospital A grafts, it is necessary to report 2 codes: due to severe chest pain. Coronary angiogram showed  The appropriate arterial graft severe Multi-vessel coronary artery stenosis. Proposed  The appropriate combined arterial-venous graft

Which procedures are considered primary procedures that may be reported with add-on CPT code 33530, Reoperation, coronary artery bypass procedure or valve procedure, more than one month after original operation (List separately in addition to code for primary procedure)? a. 33400-33496 c. 33863 b. 33510-33536 d. All of the above

ANSWER: D: All of the above Reference: CPT Assistant, February 2005 Pages: 13,14 Category: Coding Consultation

REFERENCE CPT Reference Guide for Cardiovascular Coding by AMA (2011) Current Procedural Terminology: Professional Edition by American Medical Association (2011) Current Procedural Coding Expert by Ingenix (2011) CPT Assistant, December 1996 Page: 10 Category Angioplasty w/intracoronary stent insertion CPT Assistant, February 2005 Pages: 13,14 Category: Coding Consultation Blausen.com staff. "Blausen gallery 2014". Wikiversity Journal of Medicine. "Blausen 0152 CABG All" by BruceBlaus. http:// commons.wikimedia.org/wiki/File:Blausen_0152_CABG_All.png#/media/File:Blausen_0152_CABG_All.png

Coding for ICD-10

ICD-10-CM Primary Procedure Code: 00PV4MZ (Removal of neurostimulator lead from spinal cord, percutaneous endoscopic approach) Diagnosis: 00HV4MZ (Insertion of neurostimulator lead into spinal cord, percutaneous endoscopic approach) T85.112A To Locate: (Breakdown T85.112A: Index > Complication > electronic stimulator device > spinal cord > mechanical > [mechanical] of breakdown implanted M96.1: since the term “ failed back syndrome” does not exist in the ICD-10 index use “post laminectomy syndrome” in the Index. electronic neurostim ulator [electrode] of 00PV4MZ: Px index > Removal of device from > building the code: spinal cord, initial spinal cord > 00PV > go to table 00P and go 00HV4MZ: Px index > Insertion of device in > across encounter) spinal the row cord > Secondary Dx: to 00HV M96.1 – post finish > go to Laminectomy table Syndrome (NOS) 00H and go ICD-9-CM PDx: 996.2 across the

Volume 3. Page 7 GULF-HRA | 2015 Meet the AAPC Officers

Sunil Raj, CPC, CIMC

Vice-President of AAPC UAE Chapter

We sat down and had a chat with one of the cornerstones of coding here in UAE, Mr.Sunil Raj who has been in the UAE coding business for years. Having been a part of the HAAD CCSC Voting Committee he had a hand in developing the new guidelines for HAAD. In the last 4 years has been involved in activities that helped improve the coding and billing market. We will find out how coding started here in UAE and find out what he thinks about coding.

How did you start coding? I had my post Noor. In 2011 Daman graduate in microbiology. I am MS Microbiology. offered me a job and I joined them that year. Back then I I started my career as a microbiologist, then I was in the medical strategy went to teaching. I was a college lecturer for six department which main The good thing {about coding} is, coding is years. I was in my hometown in India, functions are to make always changing, it’s always challenging, Telantrum, there was a company named guidelines, rules and train people in Daman. I stayed everyday new things are coming, and your “Revenue Med”, the same Revenue Med that is there for two years and got to active here (UAE). So Revenue Med has US talk to different departments. brain will always be shocked if you are a coder. operation and they wanted to start an Indian While in Daman I had the operation for coding in our town, they needed opportunity to be in contact with the people who made some people to start the operation so I and 13 the guidelines in HAAD, those who were Every step was a challenge, we had to do our people started the Indian operation for Revenue involved in the health system finance and financial studies, we needed to train the doctors, Med. Slowly we were introduced to ICD coding those in the quality management department. we needed to train the coders, we had to make We made a lot of proposals based on our and then also gradually learned CPT coding. We sure it was profitable, everything, everything was observation on the billings we see from the started doing some outpatient clinic’s files. New providers, we had a good relationship with a challenge for us. In two years of my career projects started coming like E.R. And we were Daman, which has made coding and billing when I was in Al Noor we saw a lot of things, doing comfortably well for the next two years. market better. the introduction of E&M, Per-Diem Coding, and Until that time inpatient was not outsourced in What are your experiences in AAPC? DRG coding. All these things occurred within a India and then there was a thought “Why can’t The idea of a local chapter is excellent, span of two years’ time that was a great we try inpatient an inpatient (coding) to be because the issues here in UAE are we don’t challenge. Every step of the way was very started in India?” During that time, normally have enough low cost training available, that is challenging. when it comes to inpatient people would go a major issue here. UAE coding market is a We have created a lot of milestones, from from India to the United States to study then little different from the US market. You can 2009 to 2015 in the span of six years we saw a come back but we cannot send that much get a lot of information on coding in the US lot of changes. With a small market and very people, so what we did was we made a core from the internet but not much about what is few people I think we can only achieve this in group, and with an instructor, Andrea Faber, we happening in the UAE, billing wise it is a little UAE. created a curriculum of inpatient coding in India bit different, you need peer experts to explain If you were given a chance to change and we started learning inpatient DRG coding in clearly what is really happening in the US careers what do you think it would be? India. That is when we started getting new coding market, and they could share their I started my career as a microbiologist, I have clients, and slowly we got a lot of business in experiences. Another issue is that coders here been in marketing, and then I’ve been teaching inpatient. Our core business then moved from have little opportunity for networking. Local then moved to coding. And the longest I have outpatient to inpatient very soon, because chapters also give coders a lot of opportunity been in is coding, coding has been very inpatient is a big business area. to network for their career growth and they interesting. The good thing is, coding is always When I was left the company I was the can share their questions with their peer changing, it’s always challenging, everyday new Manager for Quality and Compliance. That time members. So the local chapter is a very things are coming, and your brain will always be UAE coding was just starting. Michelea Peech, important organization that has been shocked if you are a coder. the director for medical coding for Al Noor at introduced to UAE. What do you do in your spare time? I that time, who is the CCSC chair now, came to As a coder what was the greatest am a family person. I always spend my free India because she needed more people in UAE challenge you have faced? When I came time with my family. All my hobbies are with my and recruited five of us to Al Noor. to UAE there was only ICD-9-CM coding. I family. I enjoy my family life. In what year did you come here in the was part of UAE’s transition from Fee-for- UAE? I came here in 2009 working for Al Service to Per-Diem billing to DRG billing.

Volume 3. Page 8 GULF-HRA | 2015 Answer Me This

Fill in the box with the correct letters that will complete the word that corresponds to the given ICD 9 diagnosis codes.

ICD 9 CM Diagnosis Codes Word Search Puzzle Answer C - 429.3 S - 414.10 A - 416.9 Y - 425.4 R - 427.31 S - 428.20

D - 414.9 T - 401.9

I - 427.89 E - 423.9 O - 428.0 M - 410.90 V - 424.90 A - 413.9 S - 424.0 C - 423.0 U - 398.0 L - 426.6

A - 427.2 R - 429.83

Answers will be released next issue. For any questions or queries regarding this section please email - [email protected]

Volume 3. Page 9 GULF-HRA | 2015 GULF HRA

The conversion from ICD-9-CM to ICD-10-CM, will affect AHIMA instructors, Gulf-HRA combines expertise with every department across the entire health care local knowledge. continuum. In order to transition smoothly, Gulf-HRA Four stage implementation plans (Planning, are offering a variety of opportunities to allow you to Communicating, Comprehensive Training and Testing) establish your implementation plan and successfully ensure all stakeholders are prepared and the transition is transition to ICD-10-CM. a success.

Providing face to face sessions with licensed AAPC and Client + Gulf-HRA = Client Success

Instructor Profiles

Sandra Chamberlin Rachel Coon [email protected] [email protected] Chief Clinical Coding Officer, Gulf- Director of Clinical Coding, Gulf-HRA HRA CCS-P, CPC, CPC-P, CPMA, CPPM, CPC RHIA, CCS, CPC, C|PC-I, ICD 10- -I, CEMC, ICD-10-CM AAPC and CM AHIMA Approved Certified AHIMA Approved Certified Trainer. Instructor

As a founding member of Gulf-HRA Sandy Certified from AAPC, AHIMA, and NAMAS as a embodies the vision of the company and brings with coder, auditor and instructor for medical coding and her a vast experience in the healthcare industry. In the billing. Rachel excels in resolving employer challenges past Sandy has served as a Director, Clinical Coding & to increase efficiency, customer satisfaction, and the HIM; ICD-10 Program Lead, Health Information bottom line by compliant Documentation training. Technology Adjunct Instructor, HIM Director and Data Dedicated and technically skilled business professional

Quality Manager.

Gulf-HRA AAPC Coding Certification Training

ICD –10—CM Approved AHIMA and AAPC Trainers Certified Professional Coder (CPC) Certified Professional Medical Auditor (CPMA) Certified Professional Practice Manager (CPPM) Certified Professional Coder—Payer (CPC-P) Certified Evaluation and Management Coder (CEMC) Contact: [email protected]

Contributors: Want To Suggest a Topic? Or do Violeta Galang you have a coding or coding Florina April Galang Jake James Fidel compliance topic that seems Michelle Mendoza Rejoyce Dizon confusing? Send it to us so we can Marie Joy Feliciano share questions and solutions to all Eric Tayag coders.

Volume 3. Page 10 GULF-HRA | 2015