HEALTHCARE BUSINESS MONTHLY December 2015 Coding | Billing | Auditing | Compliance | Practice Management

HEALTHCARE BUSINESS MONTHLY December 2015 www.aapc.com Coding | Billing | Auditing | Compliance | Practice Management

Let Blood Transfusion Payment Flow: 25 Keep revenue roads clear of denial roadblocks

Watch Out for Identity Thieves: 42 Protect patients from losing their medical identities

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800-626-2633 Advancing the Business of Healthcare www.aapc.com/medical-coding-books Healthcare Business Monthly | December 2015

COVER | Coding/Billing | 29 Sneak a Peek at 2016 CPT® Changes G.J. Verhovshek, MA, CPC, and Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC

[contents] ■ Coding/Billing ■ Auditing/Compliance ■ Practice Management

40 Make the Most of HCCs 42 Nobody Is Immune 50 The Medical Scribe: Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I to Medical Identity Theft A Hot Commodity Jonnie Massey, CPC, CPC-P, CPC-I, Renee Dustman CPMA, AHFI [continued on next page]

www.aapc.com December 2015 3 Healthcare Business Monthly | December 2015 | contents

12 ■ Code of Ethics ■ Facility 10 Ethics Update Strengthens 25 Blood Transfusions: Document AAPC Membership Properly for ICD-10-PCS AAPC Ethics Committee Diana H. Williams, BS, CPC, CCS-P, CCS, CPMA

■ AAPC Chapter ■ Added Edge Association 36 Distance Learning: 12 Make Your Chapter a Success Choose Wisely Faith C.M. McNicholas, RHIT, CPC, CPCD, Dawn Moreno, PhD, CPC, CBCS, CMAA, PCS, CDC MTC, CPL, CLT

■ 22 ■ Added Edge Auditing/Compliance 14 How a Credential Is Born 44 Handling PHI Glenda Hamilton, CPC, COC, CPMA, CEMC, Disclosure for Genealogists CPC-P Joseph de Beauchamp, PhD

■ Coding/Billing ■ Practice Management 16 Medicare Primary Care 47 Boost Your Immune Center Exception Update System with Office Yoga Maryann C. Palmeter, CPC, CENTC, CPCO Bridget Toomey, CPC, CPB, CRCR, RYT-200 20 Claim All Your Pennies for 54 Onboarding Employees Discontinued Procedures in a Small Office Ellen M. Wood, CPC, CMPE 54 Sarah W. Sebikari, MHA, CPC 22 Specimen Validity Testing ■ Member Feature Frank Mesaros, MPA, MT (ASCP), CPC 56 Military Members: Trained for Success 26 Coding that Brings You to Your Knees Michelle A. Dick Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P

COMING UP: •• 2015 Salary Survey •• 2016 OPPS DEPARTMENTS EDUCATION •• OIG Work Plan 7 Letter from CEO 60 Newly Credentialed Members •• Pediatric Vaccination 8 Letters to the Editor •• 36415 Venipuncture 9 Healthcare Business News Online Test Yourself – Earn 1 CEU 10 Code of Ethics On the Cover: John Verhovshek, MA, CPC, and Raemarie Jimenez, www.aapc.com/resources/publications/ CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, give you a sneak peek into 66 I Am AAPC healthcare-business-monthly/archive.aspx what changes are in store for CPT® 2016. Cover design by Kamal Sarkar.

4 Healthcare Business Monthly ZHealth Publishing, LLC C M www.zhealthpublishing.com Y

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K Serving 153,000 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: December 2015 • You will save a few trees. • You won’t have to wait for issues to come in the mail. Director of Publishing 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 ...... 39 Designer www.HealthcareBusinessOffice.com Mahfooz Alam Optum360TM A leading health services business ...... 67 Kamal Sarkar www.optumcoding.com Advertising Jon Valderama Supercoder, LLC...... 8 www.SuperCoder.com Address all inquires, contributions, and change of address notices to: ZHealth Publishing, LLC ...... 5 Healthcare Business Monthly PO Box 704004 www.zhealthpublishing.com Salt Lake City, UT 84170 (800) 626-2633 vendor index vendor ©2015 Healthcare Business Monthly. All rights reserved. Reproduction in whole or in part, in any form, without written permission from AAPC® is prohibited. Contributions are welcome. Healthcare Business Monthly is a publication for members of AAPC. Statements of fact or opinion are the responsibility of the authors alone and do not represent an opinion of AAPC, 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 assigned 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 medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The responsibility for the content of any “National Correct Coding Policy” included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information con- Ask the Legal Advisory Board tained in this product. CPT® is a registered trademark of the American Medical Association. From HIPAA’s Privacy Rule and anti-kickback statute, to compliant coding, to fraud and abuse, there are a lot of legal ramifications to working in healthcare. You almost CPC®, COCTM, CPC-P®, CPCOTM, CPMA®, and CIRCC® are registered trademarks of AAPC. 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 Advisory Board (LAB) is ready, willing, and Volume 2 Number 12 December 1, 2015 able to answer your legal questions. Simply send your health law questions to LAB@ Healthcare Business Monthly (ISSN: 23327499) is published monthly by AAPC, 2233 South Presidents aapc.com and let the legal professionals hash out the answers. Select Q&As will be Drive, Suites F-C, Salt Lake City UT 84120-7240, for its paid members. Periodicals Postage Paid at Salt Lake City UT and at additional mailing office. POSTMASTER: Send address changes to: published in Healthcare Business Monthly. 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 CEO

Work Worth Doing

s I reflect on the past year, I am remind- Certified Inpatient Coder (CIC™) and Certi- A ed of something Theodore Roosevelt said: fied Risk Coder (CRC™) credentials and cur- “Far and away the best prize that life has to of- riculum. New online education modules help fer is the chance to work hard at work worth members of all disciplines. Look for more doing.” Events outside AAPC and your re- training and credential opportunities in 2016 quests provided many challenges and oppor- to keep current with the business of health- tunities we resolved to address. Our drive to care. serve members prompted several accomplish- Improved, Less Expensive Codebooks – ments this year, and I’m grateful to be part of AAPC responded quickly to member feed- an organization that achieved the following: back surrounding our AAPC codebooks. We 150,000th Member – We welcomed Ele- made a number of adjustments that will make na Kuklina, PhD, as our 150,000th mem- the books easier to use as coding and educa- ber this year. The Centers for Disease Control tion tools. The low priced books continue to and Prevention (CDC) health scientist and help practicing coders and students. Emory University adjunct professor joined HEALTHCON – We had record-breaking AAPC to seek training and certifications that attendance at AAPC national conference this would help her in her obstetrics and gynecol- year. We hope you enjoyed all of the new ogy research. tracks and sessions we added to better meet ICD-10 Implementation –AAPC members your needs. AAPC members and and staff were instrumental in making this AAPC continues to augment its impact as we year’s long-awaited ICD-10 implementation serve members through meaningful certifi- staff were instrumental go smoothly. AAPC members served as ed- cation, education, and service. We have com- ucators, coordinators, and leaders in the in- pleted a great deal but have a lot more hard in making this year’s dustry as the country transitioned from ICD- work worth doing. AAPC will continue to 9 to the new diagnosis code set. AAPC will serve members through meaningful certifica- long-awaited ICD-10 continue to support you with advanced train- tion, education, and service. — and that’s our ing opportunities, based on what you’ve told prize as we find ways to better serve you and implementation go us you want to learn about this new code set the organizations for which you work. and its use. Here’s to a successful 2016! smoothly. Code of Ethics – The National Advisory Board’s Ethics Committee released an updated Code of Ethics to better respond to mem- Sincerely, bers’ changing work environments. Simpli- fied and meaningful, the Code of Ethics holds members to the highest standard. Adherence to these ethical standards instills public confidence in the integrity and professionalism of AAPC members. More Customer Service Staff – To help serve Jason J. VandenAkker you better and reduce wait times, we more CEO than doubled AAPC’s Service Center staff since the beginning of the year. We also added Online Chat as another way for you to reach an AAPC customer service professional. New Certifications and Products – As part of AAPC’s effort to support your requests and emerging opportunities, we developed the

www.aapc.com December 2015 7 Please send your letters to the editor to: Letters to the Editor [email protected]

One Inhalation Treatment per Patient Encounter HEALTHCARE BUSINESS MONTHLY September 2015 www.aapc.com “Don’t Leave Money on the Nebulizer Table” (September 2015, pages 24-27) indicated that pay- Coding | Billing | Auditing | Compliance | Practice Management ers may allow you to report multiple units of CPT® 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device). Since January 2014, Medicare is not among these payers. The January 2014 National Cor- rect Coding Initiative update, chapter XI, section J, states: CPT code 94640 should only be reported once during a single patient encounter regardless of the number of separate inhalation treatments that are administered. If CPT code 94640 is used for treatment of acute airway obstruction, spirometry measurements before and/or after the treatment(s) should not be reported separately.

Take the Teaching Physician Quiz: 38 Get schooled in teaching hospitals’ physician guidelines

Put a Cork in Revenue Leakage: 44 Get to the root cause by resolving communication issues Ken Camilleis, CPC, CPC, CPC-I, COSC, CMRS, CCS-P, CCS-P Directors: Take Compliance Seriously: 56 Know what you’re supposed to oversee

September2015_HBM.indd 1 12/08/15 9:11 pm

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TCI-1

8 Healthcare Business Monthly Healthcare Business News

growth of AAPC as well as recognizes the importance and contribu- AMA Asks HHS to Make AAPC an ICD-10 Partner tion of its members,” she said. In a letter to U.S. Department of Health & Human Services (HHS) Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COB- Secretary Sylvia Burwell, American Medical Association (AMA) Ex- GC, CPEDC, vice president of strategic development for AAPC, said, ecutive Vice President and CEO James L. Madara asked the agen- “With payment reforms and changes in the coding system, it is now vi- cy to add AAPC as a Cooperating Party for the ICD-10 Coordina- tal for the cooperating parties to contain inclusion of physician coding tion and Maintenance Committee. AAPC has the necessary exper- representation, and AAPC is the best equipped to do that.” tise, experience and can serve as the voice of physicians lacking in to- Read the complete article on news.aapc.com. day’s Cooperating Parties. Parties making up the ICD-10 Coordination and Maintenance Com- mittee include the Centers for Disease Control and Prevention’s Na- New Year Payment Releases tional Center for Health Statistics; the American Hospital Association The Centers for Medicare & Medicaid Services released final rules (AHA); and the American Health Information Association (AHIMA). October 10, 2015, detailing how the agency will pay for physician ser- The parties are responsible for the development and maintenance of the vices provided in 2016 to patients covered under Medicare. Among International Classification of Diseases (ICD) code set mandated for the key policies finalized in the 2016 payment rules are: use in the United States. • Finalizing the Home Health Value-Based Purchasing model “AAPC’s 141,000 [now 153,000] members represent the highest lev- • Finalizing updates to the “Two-Midnight” rule el of expertise in the industry in the areas of medical coding, medical • Finalizing the End-Stage Renal Disease Quality Incentive Program billing, medical auditing, compliance, and practice management,” Madara said in the letter. • Beginning the new physician payment system post the Sustainable Growth Rate formula, and supporting patient- Being made a partner would help the committee, as well as AAPC and family-centered care members, Jaci Johnson Kipreos, CPC, COC, CPMA, CPC-I, CEMC, president of the organization’s National Advisory Board, • Finalizing a provision to empower patients and their families said. Representation at coordination and maintenance meetings will regarding advance care planning help coders better contribute to the development of the codes they use Read all about it on the CMS website at: www.cms.gov/Newsroom/MediaRe- to establish medical necessity. “This represents a huge success in the leaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-30-2.html.

AAPC - Coder

www.aapc.com December 2015 9 ■ Code of Ethics By AAPC Ethics Committee

Ethics Update Part 3: Foster the ethical principles of commitment Strengthens AAPC and competence. Membership here are six ethical principles of professional conduct: integrity, respect, commitment, competence, fairness, and T responsibility. In previous issues, we’ve discussed ethical responsibilities of AAPC members, the impact of negative conduct, and how to maintain integrity and respect. This month, we’ll focus on being committed and competent. Commitment According to the Urban Dictionary’s top definition, “Commit- ment is what transforms the promise into reality. It is the words that speak boldly of your intentions. And the actions which speak louder than words. It is making the time when there is none. Coming through time after time after time, year after year after year. Commitment is the stuff character is made of; the power to change the face of things. It is the daily triumph of integrity over skepticism.” Before you make a commitment, consider carefully the possible outcomes of your decision. A commitment obligates you to do something. Some commitments, like marriage, can be life altering. When you take a job, you’re making a commitment to show up and do the job well — whether it’s a paid position and your employer has committed to compensate you, or it’s a volunteer effort. Volunteering for your AAPC local chapter shows commitment to your professional growth and the development of chapter members. When we commit to AAPC membership, we commit to “upholding a higher standard,” which includes the responsibility to continually increase our level of professional competence. We commit to the AAPC Code of Ethics and the AAPC Chapter Association Code of Ethics, as well. Adherence to standards, like commitment, ensures public confidence in the integrity and service of medical coding, auditing, compliance, and practice management professionals who are AAPC members. AAPC Chapter Association board members work with local chapter officers and members, as do the local chapter represen- tatives at AAPC headquarters in Salt Lake City, Utah. In doing image by iStockphoto franckreporter by © image

10 Healthcare Business Monthly Code of Ethics

Competence, as defined by the Business Dictionary, is “A cluster of related abilities, commitments, knowledge, and skills that enable so, we see commitment demonstrated consistently by local chapter officers and members, the people who volunteer their time and ener- a person (or an organization) to act gy to strengthening local chapters. They are committed to the vision and mission of AAPC. They are committed to advancing the work effectively in a job or situation.” of those who are involved in the business of healthcare by teaching, mentoring, proctoring, and supporting local chapter members. Sim- ilarly, AAPC advisory board members, such as the National Advisory problems and treatment, and from the payer that the codes submit- Board, Ethics Committee, and Legal Advisory Board, make a com- ted for payment correlate with the provider’s documentation and the mitment to serve AAPC members. Without these committed mem- patient’s condition. bers and staff, AAPC could not function effectively. Competency cannot be emphasized enough. AAPC’s Ethics Com- The commitment you express to yourself, AAPC, and employers in- mittee occasionally encounters disputes involving competency. Such cludes an obligation to comply with standards that exist in every pro- issues rarely involve actual knowledge and skill, but instead involve fessional discipline. Without these standards, we cannot represent member conduct, where a coder knew or should have known his or ourselves as a professional discipline. As you consider your commit- her actions deviated from generally accepted standards and practices. ment to professional conduct, think about your willingness to en- Taking shortcuts, not engaging in due diligence, failing to adhere to hance and improve your professional image, and the image of health- the “rules of the road,” and engaging in inappropriate behavior can care professionals across the globe. lead to review before the AAPC Ethics Committee panel. For example, coders should question circumstances where the quantity of Competence claims processed is more important than ensuring the codes on the claims are correct. AAPC’s commitment to core values includes competence, which ad- heres to: If elected to represent a local chapter, it’s necessary to become ac- quainted with AAPC’s Local Chapter Handbook, which covers • Developing and achieving a skill set that fosters high quality, roles, expectations, and general guidance regarding chapter financ- effective work product and work process; es. If designated to proctor an AAPC certification exam, it’s im- • Maintaining credentials and coding expertise through portant to remember that AAPC credentials (your credentials) are ongoing continuing education, networking, and professional highly regarded in the healthcare industry. They are earned based development; and on merit. Test-takers must achieve credential(s) on their own, with- • Maintaining a strong knowledgebase of key principles, out the help of others. No one would seek care from a physician or including an awareness and understanding of applicable advanced practice professional who cuts corners. Similarly, no one laws and regulations surrounding ethical and competent, would want someone who is unprincipled to be responsible for cod- professional coding. ing their claims. Competence, as defined by the Business Dictionary, is “A cluster of The coding profession’s role in healthcare is becoming more impor- related abilities, commitments, knowledge, and skills that enable a tant with the transition to ICD-10 and the shift from fee-for-service person (or an organization) to act effectively in a job or situation.” In to value-based compensation. Such importance is reflected by the in- medical coding, competence requires more than memorizing codes creased discussion surrounding these transformative changes. or understanding physician office habits; it requires professional cod- AAPC seeks to ensure membership reflects the very best of compe- ers to describe the physician/patient encounter sufficiently to the pay- tent and trustworthy professionals who are relied on to help physi- er for reimbursement on behalf of the provider. cians and other providers be properly compensated for their services. Coding is the last link in the chain of the physician/patient interac- The AAPC Code of Ethics should serve as a road map to all who nav- tion. It tells the payer why the patient presented for care, what hap- igate the business of healthcare. pened, and when. This step requires a high level of trust from the physician that the coder comprehends the note describing the patient’s AAPC Ethics Committee

www.aapc.com December 2015 11 AAPC Chapter Association By Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC Make Your Chapter a SUCCESS Tips to help officers advance the business side of healthcare.

his is the season of giving, being We congratulate newly-elected officers and want you to know you are not Tthankful, and new beginnings. As alone. Officers rotating out have plenty of knowledge and experience to I think of AAPC local chapters, I can’t help you get a jumpstart on achieving a thriving chapter through the com- help but recognize how our local chap- ing year. And you can always ask for assistance from your AAPC Chapter As- ter officers are selfless individuals who sociation regional representative, too. give freely of their time, knowledge, and wisdom to help all AAPC members excel Officers Promote Member Success in their careers. As a chapter officer, you play an essential role in promoting AAPC’s mission statement, “Advancing the business side of healthcare.” Part of your role is to provide an educational forum for AAPC members to: • Receive low or no cost continuing education units (CEUs); image by iStockphoto © CamiloTorres

Happy Holidays from the AAPC Chapter Association The AAPC Chapter Association board of directors encourages every officer and member to take time for family and friends during this holiday season. Stop, relax, and enjoy each other’s company. We often are so involved with our daily activities that we forget to enjoy the time. Best wishes to all of you and your families this season, and in the coming new year.

12 Healthcare Business Monthly AAPC Chapter Association

• Network and establishing an environment where less àà AAPC is allowed to post the officers’ names and contact experienced members may interact, learn, and be mentored by information on the AAPC website for each chapter those with more experience; and member’s access; and • Make regular AAPC’s certification examinations available àà All elected officers must maintain current AAPC throughout the country. membership. Without your assistance, AAPC could not fully advance the business Meetings: side of healthcare, and local chapters could not function effectively. • Hold officers’ meetings routinely and distribute the minutes of Because your role is so important, AAPC offers several tools to sup- these meetings to chapter officers and other meeting attendees port your leadership for a successful term. Everything you need to op- in a timely manner by uploading a PDF copy to the chapter’s erate your local chapter is available at www.aapc.com/memberarea/default.aspx, online library. after you log into your AAPC membership account. • Hold at least six chapter meetings and four exams per year, in a friendly and professional manner. Chapter officers must share Tips to Start the Year Right responsibility to proctor all chapter-sponsored exams. A few items you’ll need to check off for a successful and exciting start àà Encourage all officers to participate in the planning of are: events such as May MAYnia, chapter seminars/conferences, 1. Download and review the 2016 AAPC Local Chapter Handbook fundraisers, etc. – Most of the answers to your questions have been addressed in àà Encourage and include chapter members to participate the soon-to-be-released 2016 AAPC Local Chapter Handbook. through committees. Officers must abide by the guidelines and check for changes, effective October 1. Finances: • Retain all financial and non-financial chapter records and 2. Attend the Local Chapter Officer Training – Offered by AAPC documents. Chapter Association and the AAPC Local Chapter Depart- ment, this is in-depth training to help you understand what • Comply with all requirements related to the use of local it takes to operate a successful AAPC local chapter, as well as chapter funds, including the submission of the monthly Profit AAPC’s expectations of all its officers. The training provides and Loss Statement no later than the fifth of each month and additional resources available on AAPC’s website and how to for the end of the year by December 31. find officer-related information. A leadership training session is • Ensure you have a minimum of two signatures on the local available at AAPC HEALTHCON and additional sessions are chapter checking account and are authorized to sign each offered around the country throughout the year. These officer check drawn from the local chapter bank account. training sessions are four hours, and well worth your time. • Ensure appropriate use of chapter funds, as outlined in the 3. Abide by the following chapter officer expectations: Local Chapter Handbook. • Submit all required paperwork and agreements. Officer elections: Above all, remember you serve voluntarily to represent your chap- • Ensure the roles of president, vice president, secretary, and ter members and AAPC, and are expected to act ethically and with treasurer have been filled. integrity. Ensure you promote AAPC and its mission on a local lev- àà Chapters with average attendance of fewer than 40 el and communicate all local concerns to AAPC in a timely manner. members at local chapter meetings can combine the positions of secretary and treasurer into one position. Officers Stay Dedicated and True Blue àà Chapters with an average attendance of 40 or more The commitment of our volunteer officers is seen in all areas of our members at meetings are encouraged to elect an education profession. I am impressed by the dedication of everyone involved in and member development officer in addition to the four carrying out the AAPC mission statement, during challenging and main positions above. rewarding times. Thank you for your service to our members. Your • Submit online election verification to AAPC, which includes commitment moves us forward and demonstrates integrity, account- the names of the newly elected officers, city, state, and contact ability, dignity, and respect. information within 10 days of elections. à Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, specializes in dermatology coding. A à All elected chapter officers must agree to the terms in the national speaker on coding and regulatory issues, she presents at American Academy of Derma- Chapter Officer Agreement, indicating their promise to tology annual and summer meetings, AAPC regional conferences, and several other venues. Mc- serve as officers for one year; Nicholas has a wide range of experience in various medical specialties and practice settings. She is also a certified and approved ICD-10-CM/PCS expert and trainer, a member of the AAPC Chap- ter Association, and has served office for the Des Plaines, Ill., local chapter.

www.aapc.com December 2015 13 ■ ADDED EDGE By Glenda Hamilton, CPC, COC, CPMA, CEMC, CPC-P HowHow aa CredentialCredential IsIs BornBorn Understand the process of expanding specialty credential options. image by iStockphoto © shuttertop hen I first became certified, AAPC offered only Certified Pro- pops up, select your specialty or, if it isn’t listed, enter it. Then, Wfessional Coder (CPC®) and Certified Outpatient Coding click “Done.” (COC®, formerly CPC-H) credentials. The Certified Professional Here begins the possibility of a new credential. But the process is Coder-Payer (CPC-P®) was added next. Soon after, a beta-test was complicated. If there is a large response requesting the same field of offered to chapters for the Certified Evaluation and Management expertise, the process moves forward. Coder (CEMC™) credential. These core credential certifications re- Medical societies are contacted to make sure competing credentials quired equal continuing education units (CEUs). with similar requirements are not being duplicated. It’s also neces- As AAPC grew, members requested a greater range of specialty cre- sary to determine whether the credential is needed in the industry, dentials. Coders who worked in a single specialty found the CPC® and whether it will meet industry standards. or COC® credential difficult to earn because the exams tested on When a credential is determined to be necessary, a test committee is multiple specialties. AAPC decided to redesign the specialty exams formed. The committee is made up of five experts, with at least two to stand alone, so a core credential was no longer mandatory to sit years’ experience in the specialty. AAPC staff runs the committee. for a specialty exam. Work on the exam committee includes the following steps: If you have worked in a specialty practice for years and want to vali- • Competencies needed to perform the job are determined. date your expertise in that specialty, then acquiring a specialty certification is the way to go. • Competencies are vetted by employers. • AAPC oversees the development, review, and vetting of The Birthing Process all questions based on the determined competencies. The question bank includes questions used for the certification If you don’t see a certification for your specialty on the AAPC exam and test preparation materials (study guides and website, you can request that it be added. Go to the “Specialty practice tests). Medical Coding Certification” webpage at www.aapc.com/certification/ specialty-credentials.aspx, and click the link at the bottom right corner Most coding exams include: that says, “Don’t see your specialty? Tell us.” When the survey • Anatomy and physiology

14 Healthcare Business Monthly Credential

If you don’t see your specialty certification on the AAPC website, you can request it to be added. ADDED EDGE

• Medical terminology on performance for each question. These statistics are used to vet • Coding concepts for the specialty the accuracy of each test question. Beta testers also complete a survey to determine whether all competencies were covered, the diffi- • Medical record abstraction of office notes and procedures, if culty level of the exam was appropriate, and the proper amount of applicable time was allotted. • Evaluation and management (1995 and 1997 Only after all of the steps and statistics in the process are complete is Documentation Guidelines for Evaluation and Management a decision made whether to offer the certification exam. Then, just Services) maybe, we witness the birth of a credential! • Compliance • Payment methodologies Glenda L. Hamilton, CPC, COC, CPMA, CEMC, CPC-P, brings over 25 years of experience to practice management, coding, reimbursement, education, and consulting as a business owner. She joined Cooper University Hospital in 2005 as clinical documentation educator. Beta Testing Ensures a Thorough Exam Hamilton is now senior compliance auditor at Cooper. She has held many officer positions over A question bank for the certification exam is developed next. Ques- the past 10 years at the Cherry Hill, N.J., local chapter. Hamilton started multiple charitable tions are pulled for a beta exam, which is used to gather statistics projects in the chapter and believes in paying it forward. for question performance. Expert coders in the field are evaluated

Need an official answer? Ask an AAPC Expert

Visit aapc.com/ask-an-expert to get expert answers to your healthcare questions.

Whether you are settling a coding dispute or need a response from a reputable source, AAPC Ask an Expert provides the answers you need. Post a coding, billing, auditing, practice management or compliance question and receive a response from an AAPC Expert within one business day. The AAPC Expert team includes professionals from all facets of the business of healthcare. Get answers to tough questions from a source you can trust.

www.aapc.com December 2015 15

Need an official answer? Ask an AAPC Expert

Visit aapc.com/ask-an-expert to get expert answers to your healthcare questions.

MedicareMedicare image by iStockphoto © ivanastar Clarify the rules, PrimaryPrimary and understand documentation requirements CareCare CenterCenter and limitations when reporting ExceptionException services. UpdateUpdate

■ ■ ■ 16 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Primary Care

The primary care center exception CODING/BILLING is not limited to primary care or family practice residency programs.

he final rule for teaching physician presence and documentation Trequirements under Medicare Part B has been in effect since July 1, 1996. Over the years, the Centers for Medicare & Medicaid Ser- vices (CMS) has revised and clarified the rule. Let’s assess the current regulations to see how they affect coding and billing in your medical practice. Billing Guidelines Generally, to bill Medicare Part B for services involving residents, the teaching physician must personally perform the service, or at least be physically present during the critical or key portions of the service. Only specified services performed by residents under a “primary care exception” (within an approved Graduate Medical Edu- cation Program) may be billed to Medicare Part B under the teaching physician’s provider number without the teaching physician there to perform the service. The primary care center exception is not limited to primary care or family practice residency programs. Per CMS, the exception could apply to any residency program with requirements that are incom- patible with the teaching physician physical presence requirement. Residency programs most likely to qualify for the exception include family practice, general internal medicine, geriatrics, pediatrics, and obstetrics/gynecology. Attest in Writing For the exception to apply, the center must attest in writing to the Medicare administrative contractor (MAC) that the following conditions have been met: 1. The services are performed in a center located in an outpatient department of a hospital or another ambulatory care entity in which the time spent by the residents in patient care activities is included in determining Medicare Part A pay- ments to the hospital. 2. The residents involved have completed more than six months of a residency program. 3. The teaching physician directs the care of no more than four residents at a time, and directs the care from such proximity as to constitute immediate availability.

www.aapc.com December 2015 17 Primary Care

Under the exception, residents may provide reasonable and neces- CODING/BILLING sary, low- to mid-level evaluation and management (E/M) services, and other specified services, without the presence of a teaching

physician. Specific procedure codes that may be billed under the ex- image by iStockphoto © sshepard ception include: CPT® Codes New patient office or other outpatient visit: 99201, 99202, and 99203 Established patient office or other outpatient visit: 99211, 99212, and 99213 HCPCS Level II Codes G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment

G0438 Annual wellness visit, includes a personalized prevention plan of service (PPPS), first visit

G0439 Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent 4. The teaching physician has no other responsibilities at the visit time (including the supervision of other personnel) and man- For services other than those listed above, the general teaching phy- ages responsibility for those patients seen by the residents. sician policy applies. 5. The patients seen are an identifiable group who consider the center to be the continuing source of their healthcare, and Append Modifiers Properly are cognizant that residents under the medical direction of Modifier GE This service has been performed by a resident without the teaching physicians furnish services. The residents follow presence of a teaching physician under the primary care exception must the same group of patients throughout the course of their be appended to services billed under the exception. Services that residency program. do not meet the requirements for an exception revert to the gener- Centers exercising the exception do not need to obtain prior approv- al teaching physician guidelines, and claims must include modifier al, but they must maintain records demonstrating that they quali- GC This service has been performed in part by a resident under the di- fy for the exception. rection of a teaching physician. Services Included Under the Exception Follow 4-to-1 Ratio Rules The range of services residents may furnish under the exception in- A teaching physician may not supervise more than four residents at cludes: any given time, and only residents who have completed more than six months of an approved GME program may furnish billable pa- • Acute care for undifferentiated problems or chronic care for tient care without the teaching physician’s physical presence. Al- ongoing conditions, including chronic mental illness though residents with less than six months in an approved GME • Coordination of care furnished by other physicians and program do not qualify for the exception, they are counted among providers the four residents under supervision of the teaching physician. See • Comprehensive care not limited by organ system or diagnosis the following chart for scenarios of how the 4:1 ratio affects billing.

18 Healthcare Business Monthly To discuss this article or topic, go to www.aapc.com Primary Care CODING/BILLING

Sample Scenarios with 4-to-1 Ratio Resident with six Resident with more Resident with more than Resident with more Exception applies to old Apply modifier GC to charge months or less in than six months in six months in residency than six months in residents B, C, and D, but not to for new resident A. residency program. residency program. program. residency program. new resident A. Follow general Apply modifier GE to charges New resident A Old resident B Old resident C Old resident D teaching physician rules for for residents B, C, and D. new resident A.

Resident with six Resident with more Resident with more than Resident with more Resident with more Exception does not apply to Apply modifier GC to charges months or less in than six months in six months in residency than six months in than six months in ANY residents because the for ALL residents. residency program. residency program. program. residency program. residency program. 4-to-1 ratio is exceeded. Follow New resident A Old resident B Old resident C Old resident D Old resident E general teaching physician rules for ALL residents.

Resident with six Resident with six Resident with more than Resident with more Exception applies to old Apply modifier GC to charges months or less in months or less in six months in residency than six months in residents C and D, but not to for new residents A and B. residency program. residency program. program. residency program. new residents A and B. Follow Apply modifier GE to charges New resident A New resident B Old resident C Old resident D general teaching physician for old residents C and D. rules for new residents A and B.

Documentation Requirements Resources To qualify for the exception, the teaching physician must document the extent of his or her participation in the review and direction of “Guidelines for Teaching Physicians, Interns, and Residents,” www.cms.gov/Outreach- the services furnished to each patient. and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Teaching- Physicians-Fact-Sheet-ICN006437.pdf Good Teaching Physician Note Example Medicare Claims Processing Manual, Pub. 100-04, chapter 12, www.cms.gov/Regulations-and- I have reviewed with the resident Jane Doe’s medical history, phys- Guidance/Guidance/Manuals/Downloads/clm104c12.pdf ical examination, diagnosis, and results of tests and treatments and agree with the patient’s care as documented in the resident’s note. Maryann C. Palmeter, CPC, CENTC, CPCO, is director of physician billing compliance with This is a good teaching physician note because it specifies that the University of Florida Jacksonville Healthcare, Inc., where she provides professional direc- the teaching physician reviewed and discussed the history, phys- tion and oversight to the billing compliance program of the University of Florida College of ical examination, assessment, and plan provided by the resident, Medicine-Jacksonville. Her extensive experience in federal and state government payer bill- and it supports the teaching physician’s agreement with the plan ing and compliance regulations has been gained through executive level positions on both the physician billing and government contractor sides of the healthcare industry. Palmeter served as a Nation- of care for the patient. al Advisory Board member from 2011-2013 and as secretary from 2013-2015. She was named AAPC’s 2010 Poor Teaching Physician Note Example “Member of the Year” and is a member of the Jacksonville, Fla., local chapter. I have discussed the case with the resident. This note is poor because it does not specify what was discussed with the resident, nor does it support the teaching physician’s direction of the services furnished to the patient.

www.aapc.com December 2015 19 ■ CODING/BILLING By Sarah W. Sebikari, MHA, CPC Claim All Your Pennies for Discontinued Procedures When a procedure is cut short due to complications or risks, be sure to meet payer reporting criteria.

it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding modifier 53 to the code reported

by the individual for the discontinued procedure. image by iStockphoto © Chris_Elwell The American Medical Association (AMA) created modifier 53 in 1997 to distinguish between services discontinued at the provider’s discretion, and those discontinued as a result of extenuating circumstances that cause a risk to the patient. Supporting Documentation Requirements To append modifier 53, certain documentation criteria must be met, and that documentation must be available for payer review. Documentation must substantiate the discontinued procedure and support medical necessity. Specifically: • The operative report must indicate anesthesia was induced and the procedure started. Anesthesia may include local, regional block, moderate/conscious sedation, deep sedation, or general anesthesia. • If a scope was used, documentation must support that a scope was introduced prior to termination of the procedure. discontinued procedure is one that is halted prior to completion • Documentation must indicate in detail the reason the Abut after anesthesia has been induced, usually because the pa- procedure was discontinued. The more detail, the easier it is tient’s health is at risk. Modifier 53 Discontinued procedure is ap- for the payer to manually adjust the claim, rather than hold pended to the procedure code to indicate such an occurrence. Used it for further review (held claims delay reimbursement and improperly, modifier 53 can get you in hot water. Let’s consider the subsequently affect operations). proper use of this modifier in a physician setting. Examples of documentation that would warrant use of modifier 53 include: Modifier 53 Defined • The patient encountered difficulty breathing during the Modifier 53 is used to denote a discontinued surgical or diagnostic procedure; therefore, the procedure was terminated. procedure, and indicates that the provider aborted the procedure as • As a result of extensive hemorrhaging, the procedure was a result of an unexpected event or a complication that put the pa- discontinued. tient’s welfare at risk. Per CPT® instruction: • The patient suffered continued arrhythmia, so the procedure Under certain circumstances the physician or other qual- had to be aborted. ified health care professional may elect to terminate a sur- • An adverse reaction to anesthesia caused the patient to gical or diagnostic procedure. Due to extenuating circum- convulse, prompting a discontinuation of the procedure. stances, or those that threaten the well-being of the patient,

■ ■ ■ 20 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Discontinued Procedures CODING/BILLING To append modifier 53, certain documentation criteria must be met, and it must be available for payer review.

• The patient was unable to tolerate the procedure as a result of sterile fashion, general anesthesia is administered, and a flexible morbid obesity. bronchoscopy under fluoroscopic guidance is inserted through In addition to operative notes, the Center for Medicare & Medic- the oropharynx to the trachea. On visualization, a lung mass is aid Services (CMS) requires documentation stating the percentage noted. Biopsy forceps are inserted to obtain a biopsy and the pa- of the procedure performed; however, most commercial payers will tient starts to bleed uncontrollably. At this point, Dr. Bronco de- determine the percentage of the procedure completed based on doc- cides to terminate the procedure after controlling the bleeding, umentation in the operative report. as this caused evident risk to the patient’s life. The appropriate procedure code 31628 Bronchoscopy, rigid or flexi- Reimbursement ble, including fluoroscopic guidance, when performed; with transbron- Reimbursement for procedures billed with modifier 53 is based on chial lung biopsy(s), single lobe is billed with modifier 53 appended how much of the procedure was performed, as documented in the to signify the procedure was started and discontinued by the phy- operative report. This shows the significance of clear and concise sician, since the risks of continuing the procedure would be high. documentation detailing the extent of the procedure. The CMS Physician Fee Schedule Relative Value Files list a sepa- Example 2 rate Relative Value Unit (RVU) for some codes based on modifi- A patient who has been experiencing severe headaches for the er 53. For example, CPT® 45378-53 Colonoscopy, flexible, proximal past two month is scheduled for a spinal tap. On arrival, the pa- to splenic flexure; diagnostic, with or without collection of specimen(s) tient is prepped and sedated. While performing the spinal tap, by brushing or washing, with or without colon decompression (separate Dr. Tap realizes the patient is experiencing difficulty breathing procedure) has already been reduced on the fee schedule. Typically, and is moving and twisting in pain. Dr. Tap notes that the pa- however, payers manually price procedures billed with modifier 53. tient’s well-being is at risk, and decides to immediately halt the procedure. Tips: Code 62270 Spinal puncture, lumbar, diagnostic is billed with mod- • Send an operative report with the claim so the payer will ifier 53 appended to alert the payer that the procedure was discon- determine reimbursement. Expect a reduced reimbursement tinued. By appending modifier 53 in this instance, you also poten- rate, so do not reduce your fee in advance. tially avoid a denial for duplicate billing if the procedure is complet- • Do not report elective cancellation of a procedure prior to ed successfully in the future. anesthesia with modifier 53. • Do not report evaluation and management or time-based Risk Management Reminder services with modifier 53. When a discontinued procedure is aborted as the result of potential • Only append modifier 53 to physician services. risk to a patient’s life, risk management must be notified. • Do not append modifier 53 to laparoscopic or endoscopic procedures converted to an open procedure, or when a Resources: procedure is converted to a more extensive procedure. AMA, 2015 CPT® Professional Edition CMS Medicare Claims Processing Manual, chapter 4, section 20.6.4 Example 1 A patient with pneumonia of an unspecified nature was sched- Sarah W. Sebikari, MHA, CPC, is employed by Summit Health Management a Physician uled by Dr. Bronco’s office for a surgical bronchoscopy with bi- Practice Management Organization in New Jersey as a coding compliance education lead for opsy. On checking in at the endoscopy suite, the patient signs an their Coding Compliance department. She has been in the healthcare field for over 12 years, with experience spanning from multiple-specialty physician to outpatient coding and reim- informed consent. The patient is prepped and draped in normal bursement.

www.aapc.com December 2015 21 ■ CODING/BILLING By Frank Mesaros, MPA, MT (ASCP), CPC Specimen Validity Testing Determine coverage and be sure to maintain documentation. image by iStockphoto © nikesidoroff

ou may know it as adulteration, specimen validity, or specimen in- normally found in urine, or that normally is found, but is in abnor- Ytegrity testing; regardless of terminology, Medicare does not cov- mal concentrations. Adulterants work by interfering with immuno- er it, but other insurance plans do. The key to reimbursement is to assay and/or confirmatory assay function, or they convert the target understand the tests, determine if they are medically necessary, re- drug into compounds not detected by the test. view payer policies for coverage parameters, and be sure your physi- Synthetic urine products can be submitted when urine specimen cian’s documentation is supportive. collection is not observed; however, more commonly, water or sa- line solution is substituted. Diluting the urine sample to the point Urine Evaluation and Report where the targeted drug is below the cutoff concentration is a way Understanding how to evaluate urine drug screens for adulterations, to get a negative result. (Substance Abuse and Mental Health Ser- substitutions, and potential false results is complex, but vital to in- vices Administration) terpreting their results. A detailed medication history — includ- The National Correct Coding Initiative (NCCI) manual (chapter ing prescription, nonprescription and herbal medications — and 10, section E) says: proper knowledge of medications that cross-react with urine drug screens are essential for assessing cross reactivity that may affect re- Providers performing validity testing on urine specimens sults. (Moeller 2008) utilized for drug testing should not separately bill the validity testing. For example, if a laboratory performs a urinary Urine tests can appear in a report as adulterated, substituted, or di- pH, specific gravity, creatinine, nitrates, oxidants, or oth- lute. An adulterated urine specimen contains a substance that is not ■ ■ ■ 22 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Validity Test

Specimen validity testing is typically ordered by treating clinicians who use the results to make therapeutic decisions

regarding specific medical problems of their patient, CODING/BILLING including those related to medication and illicit drug use.

er tests to confirm that a urine specimen is not adulterated, Similarly, Florida Medicare administrative contractor First Coast this testing is not separately billed. … [a] laboratory test is a Service Options does not cover specimen validity testing including, covered benefit only if the test result is utilized for manage- but not limited to pH, specific gravity, oxidants, and creatinine. ment of the beneficiary’s specific medical problem. Testing (First Coast Service Options, Inc., 2014) to confirm that a urine specimen is unadulterated is an in- Cigna coverage policy 0512 regarding drug testing indicates rou- ternal control process that is not separately reportable. tine tests to confirm specimen integrity are not covered because they are not considered medically necessary. (Cigna 2015) Because the Medical Necessity phrase “routine tests” is used, you can argue that although routine Treating physicians typically order specimen validity testing to integrity testing is not covered, integrity testing when specifically make patient-specific therapeutic decisions, including those relat- requested may be covered. ed to medication compliance and illicit drug use. In the absence of A federal employee health benefit plan for mail handlers (Mail Han- this validity testing, a patient may succeed in deceiving a physician dlers Benefit Plan) on urine drug testing specifically indicates CPT® through the submission of an adulterated urine specimen. This may codes 81002 Urinalysis, by dip stick or tablet reagent for bilirubin, glu- have the unintentional effect of masking the presence of some un- cose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific grav- derlying medical conditions by providing misleading urine drug ity, urobilinogen, any number of these constituents; non-automated, test results. (Kirsh 2015) without microscopy; 81003 Urinalysis, by dip stick or tablet reagent for Concerns of drug abuse and noncompliance are considerations pain bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, management physicians routinely assess. Specimen validity testing specific gravity, urobilinogen, any number of these constituents; auto- provides evidence that, when taken into consideration with oth- mated, without microscopy; and 82570 Creatinine; other source as ad- er indicators (e.g., incorrect pill counts, suspicious behaviors, clini- ditional tests that may be appropriate to verify a urine sample was cal symptoms), may assist the medical management of the patient, not adulterated when specifically ordered by the authorized request- including the initiation of a conversation regarding potential drug ing provider. Coventry Health Care, an Aetna company, has a urine abuse, mismanagement of medications, or diversion of prescribed drug testing policy with the same coverage wording. drugs. (Ko 2013) In a document published on the Anthem Blue Cross Blue Shield website titled “Urine Drug Screening – A Practical Guide for Cli- Coverage Varies, but Is a No for Medicare nicians,” laboratory tests are specifically specified, indicating con- tamination should be considered if test results for pH, specific grav- Palmetto Government Benefits Administrator states their position ity, urine creatinine, or urine nitrite levels are outside predetermined in policy M00024, consistent with the NCCI manual: levels. (CARES Alliance 2010) … a diagnostic laboratory test must be ordered by the treat- Specimen validity testing is mandatory for the Department of Trans- ing physician and the test results must be used in the man- portation workplace drug and alcohol testing programs. (Section agement of the beneficiary’s specific medical problem. Al- 40.89(b) 2008) The U.S. Department of Health & Human Services though some laboratory requisitions allow the ordering drug testing standards were first published in 1988. In 2004, signifi- physician to designate specimen validity testing (e.g., creat- cant revisions requiring specimen validity testing on federal employ- inine, oxidant, pH, specific gravity) to ensure that a patient ee donor urine specimens were included. (Bush 2008) specimen has not been adulterated, the results of this testing Although specimen validity testing is arguably medically necessary, are not used in the management of the beneficiary’s medi- routine use fits into Medicare’s definition. This does not, however, cal problem. Therefore, Palmetto GBA has determined that take into account conditions where there may be medical value in the specimen validity testing is a statutorily excluded service. tests. Check the relevant coverage policies to determine whether this testing is covered and what documentation to maintain.

www.aapc.com December 2015 23 To discuss this article or topic, go to Validity Test www.aapc.com

Resources Kenneth L. Kirsh, Christo, P.J., Heit, H., Steffel, K., and Passik, S.D., “Specimen validity testing in Bush, Donna M., “The U.S. Mandatory Guidelines for Federal Workplace Drug Testing Programs: urine drug monitoring of medications and illicit drugs: Clinical implications,” Journal of Opioid Current status and future considerations,” Forensic Science International 174 (2-3): 111-119, 2008. Management, 11 (1): 53-59. CARES Alliance, “Urine Drug Screening - A Practical Guide for Clinicians,” 2010: Mail Handlers Benefit Plan, “FEHBP Urine Drug Testing.” www.mhbp.com/web/groups/ www.anthem.com/painmanagement/documents/Urine_Drug_Screening.pdf. public/@cvty_mailhandlers_mhbp/documents/document/c075890.pdf Center for Substance Abuse Treatment, “Medication-Assisted Treatment for Opioid Mancia Ko, Merritt, P., and Dawson, E., “Specimen Validity Testing - Focus on Screens looks at Addiction in Opioid Treatment Programs,” Treatment Improvement Protocol (TIP) Series interpreting urine drug assay results.” Practical Pain Management. June 1, 2013: 43 (Substance Abuse and Mental Health Services Administration): www.practicalpainmanagement.com/resources/diagnostic-tests/specimen-validity-testing. http://buprenorphine.samhsa.gov/tip43_curriculum.pdf Palmetto GBA, “Specimen Validity Testing (M00024),” MolDX. September 4, 2014. Cigna, “Cigna Medical Coverage Policy - Drug Testing,” October 15, 2015: Section 40.89(b), 49 CFR, June 25, 2008. https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0513_ Substance Abuse and Mental Health Services Administration, “Clinical Drug Testing in Primary coveragepositioncriteria_drug_test.pdf. Care (TAP 32),” chapter 4, page 43.

CODING/BILLING The Centers for Medicare & Medicaid Services (CMS), NCCI Policy Manual for Medicare Services, Substance Abuse and Mental Health Services Administration, “Clinical Drug Testing in Primary chapter 10, section E. Care (Technical Assistance Publication Series - TAP 32),” chapter 5, pages 52-54. Coventry Health Care, “Urine Drug Testing Coverage,” American Foreign Service Protective Tellioglu, Tahir, “The Use of Urine Drug Testing To Monitor Patients Receiving Chronic Opioid Therapy Association: www.afspa.org/home/pdfs/FEHBP-Urine-Drug-Testing-Coverage.pdf. for Persistent Pain Conditions,” Medicine and Health Rhode Island 91 (9), pages 279-80, 282. First Coast Service Options, Inc., “Controlled Substance Monitoring and Drugs of Abuse Testing,” First Coast Service Options. November 15, 2014: Frank Mesaros, MPA, MT(ASCP), CPC, is CEO of Trusent Solutions, LLC, a management www.medicare.fcso.com/Fee_lookup/LCDDisplay.asp?id=DL35654 consulting firm specializing in the laboratory industry. Trusent provides revenue stream in- K.E. Moeller, Lee, K.C., and Kissack, J.C., “Urine Drug Screening: Practical Guide for Clinicians.” tegrity services to regional laboratories, hospital based laboratories, and physician office Mayo Clinic Proceedings 83 (1): 66-76. based laboratories. He is a member of the Harrisburg, Pa., local chapter.

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24 Healthcare Business Monthly FACILITY ■ By Diana H. Williams, BS, CPC, CCS-P, CCS, CPMA TRANSFUSIONS Document Properly for ICD-10-PCS Assign correct characters and keep the revenue road clear of denial roadblocks.

imely documentation reviews can help you to find problematic time this is a peripheral vein, but it should be documented as such. Tcoding. With ICD-10 implementation, blood transfusion facility You don’t want your documentation to fall short for coding purpos- coding is one area you may want to check for medical record deficien- es. Conducting a review can be very helpful here. cies. The first step to ensuring your physician documentation is suf- Character 4 of the seven character code for the transfusion must be: ficient is knowing what you must look for. 3 Peripheral Vein; 4 Central Vein; 5 Peripheral Artery; or 6 Central Ar- tery. Assign the Right Characters For the 5th character, Approach, you must select either 0 Open or 3 Blood transfusions can be found in the Administration section of Percutaneous. Check your documentation and, if necessary, reach out ICD-10-PCS with the first character 3, meaning procedures to put to your providers to ensure this information is captured and present in or on a therapeutic, prophylactic, protective, diagnostic, nutrition- in the medical record. al, or physiologic substance. The second character for a blood trans- The final two characters necessary to complete the code are character fusion is a 0 Circulatory (system), and the third character is 2 Transfu- 6 Substance, and character 7 Qualifier. There are many choices for sion (putting in blood or blood products). This brings you to the ICD- character 6, and some pertinent are: H Whole Blood, K Frozen Plas- 10-PCS table that begins with 302. See the following excerpt from ma, L Fresh Plasma, N Red Blood Cells, P Frozen Red Cells, Q White Table 302 for reference: Cells, and R Platelets. Section - 3 Administration Operation - 2 Transfusion: Putting in blood or blood products Character 7 Qualifier has two options: 0 Autologous and 1 Nonau- Body System - 0 Circulatory tologous. Body System/Region Approach Substance Qualifier Following these steps, for example, the correct code in ICD-10-PCS 3 Peripheral Vein 0 Open G Bone Marrow 0 Autologous for a red blood cell transfusion accessing a percutaneous peripheral 4 Central Vein 3 Percutaneous H Whole Blood 1 Nonautologous vein using nonautologous cells is 3023N1. 5 Peripheral Artery J Serum Albumin 6 Central Artery K Frozen Plasma Documentation Is Key L Fresh Plasma M Plasma Cryoprecipitate Find out how many of these procedures are performed a day in your N Red Blood Cells facility. Be sure you can locate proper documentation in each patient’s P Frozen Red Cells medical record. When you find the documentation, ensure it holds Q White Cells up for coding and possible review. R Platelets Timely reviews can assist you and your organization to answer these S Globulin important questions. Ensure that you can document and code blood T Fibrinogen transfusions correctly, and keep the revenue road clear of prevent- V Antihemophilic Factors able roadblocks. W Factor IX X Stem Cells, Cord Blood Y Stem Cells, Hematopoietic Resources ICD-10-PCS Introduction, Administration Section Character 4 specifies the body system/region and identifies the site where the substance is administered — not the site where the sub- Diana H. Williams, BS, CPC, CCS-P, CCS, CPMA, has over 30 years of experience in healthcare as a consul- stance administered takes effect. The body systems/regions for ar- tant, coder, educator, auditor, manager, and medical insurance professional. She is a multi-specialty surgical teries and veins are peripheral artery, central artery, peripheral vein coder, specializes in evaluation and management audits and works in clinical documentation improvement. You and central vein. can reach Williams at [email protected]. She is a member of the Pensacola, Fla., local chapter. Locate where this is documented in the medical record and, specifically, if an artery or vein was accessed for the transfusion. Most of the ■ ■ ■ Coding/Billing Auditing/Compliance Practice Management www.aapc.com December 2015 25 ■ CODING/BILLING By Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P Coding that Brings You to Your Knees Part 2: Open surgical procedures

and non-operative procedures image by iStockphoto © Maridav

ing (total knee arthroplasty) is an inpatient procedure (POS 21). The most common diagnosis to justify a TKA is severe osteoarthritis (ICD-10 M17.- or ICD-9 715.26/715.36). Know the Lingo To verify TKA procedural notes, watch for words such as medial, lateral, patellofemoral, and tibial. Progress notes should confirm the osteoarthritis is so severe there is bone-on-bone encroachment. (Payers may want to see a copy of the dictated notes.) For a TKA revision (27486 Revision of total knee arthroplasty, with or without allograft; 1 component and 27487 Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component), watch for key words such as “removal and replacement of polyetheline liner” or “poly exchange,” and determine whether both the femoral and tibial components were removed. If only the liner was removed and replaced, report 27486 with modifier 52 Re- duced services. Don’t Get Tripped Up By Common Errors A common error is failing to document or code a tendon transfer, which can be reported separately with 27396 Transplant or transfer (with muscle redirection or rerouting), thigh (eg, extensor to flexor); single tendon. The tendon repair codes also can easily be confused with 27437 Arthroplasty, patella; without prosthesis, which refers to a bone/joint repair rather than a tendon repair. This is a classic example of how important it is to read the entire report and to understand exactly what type of tissue is being repaired, as well as to account ast month, we discussed coding arthroscopic knee procedures. for all procedures performed during the operative session (some of LNow, let’s address coding open knee procedures, as well as non- which may not be included in a primary procedure and would not operative services, including injections and fracture care. trigger National Correct Coding Initiative edits). Open Procedures More Tricks of the Trade There is a wide range of CPT® codes (27301-27599) that covers the • Fracture/dislocation care coding (27500-27566) depends gamut of open knee services, such as incision, excision, repair/revi- on the specific anatomic site, type of fracture, and approach sion/reconstruction, fracture/dislocation treatment, etc. (closed, open, percutaneous). Manipulation of the knee joint 27570 Manipulation of knee joint un- • Report a bone graft (e.g., 20902 Bone graft, any donor area; der general anesthesia (includes application of traction or other fixation major or large) if the graft is harvested from a non-adjacent devices) usually is bundled into a surgical procedure, and is rarely site (i.e., through a separate incision), and when the graft is paid unless it’s done alone. not included in the CPT® descriptor for the surgery. Because of the anticipated recovery time of a few days, total knee • You might be able to report multiple units of 27403 arthroplasty (TKA), 27447 Arthroplasty, knee, condyle and plateau; Arthrotomy with meniscus repair, knee (possibly with modifier medial AND lateral compartments with or without patella resurfac- 59 Distinct procedural service/XS Separate structure) if the

■ ■ ■ 26 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management To discuss this article or topic, go to www.aapc.com Open Knee

open meniscus repair is done on both the medial and lateral Needle access into compartments. Check your specific payer’s guidelines, and fluid filled knee joint be sure there is adequate supporting documentation in the

• Coding for patella surgeries can be tricky. A relatively Patella (kneecap) CODING/BILLING common procedure is a patellar tendon repair, coded as Fluid-filled 27380 Suture of infrapatellar tendon; primary or 27381 Suture joint capsule of infrapatellar tendon; secondary reconstruction, including fascial or tendon graft. The latter includes obtaining and using a fascia or tendon graft. Tibia

Non-operative Knee Treatments Knee replacement Services to treat early osteoarthritis and other chronic or acute knee conditions include steroid or nonsteroidal anti-inflammatory drug (NSAID) injections, and various non-operative fracture treatments. Condyle These are just temporary alternatives to surgery. component Illustration 2015 © Optum360 © 2015 Illustration If the provider performs an appropriately documented and med- Femur ically necessary exam prior to injection, you may report the sup- ported evaluation and management (E/M) service with modifier 25 Significant, separately identifiable evaluation and management Prosthesis Patella service by the same physician or other qualified health care professional on the same day of the procedure or other service appended, as well as Plateau 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa Tibia component (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance or 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound Patellar aspiration guidance, with permanent recording and reporting. Sometimes, depending on the recommended medication, an injec- in the treatment. These visits are reported using 99024 Postopera- tion regime is planned to cover more than one session. In such a case, tive follow-up visit, normally included in the surgical package, to indi- there is no separately identifiable E/M service after the initial ses- cate that an evaluation and management service was performed during sion. You may also report the HCPCS Level II code for any medica- a postoperative period for a reason(s) related to the original procedure, tion injected in the doctor’s office (e.g., Euflexxa® J7323 Hyaluronan which is a zero-charge postoperative visit. or derivative, euflexxa, for intra-articular injection, per dose or Syn- If the physician determines at such an encounter that the patient failed visc® J7325 Hyaluronan or derivative, synvisc or synvisc-one, for in- non-operative treatment (e.g., still experiencing pain caused by the tra-articular injection, 1 mg); however, it’s important to read the pa- fracture) and decides to perform surgery within 48 hours, you may tient’s chart notes and to understand contractual arrangements with report an E/M code with modifier 57 Decision for surgery appended. local payers. If the medication is supplied by pharmacy script (as is If a new problem (including the same condition on the contralater- often the case), reporting the supply is double-dipping. al knee) is discovered during this 90-day period, you may report the Another type of nonsurgical knee treatment consists of fitting the appropriate E/M code with modifier 24 Unrelated evaluation and patient to an orthosis, such as a splint or cast in the event of a frac- management service by the same physician or other qualified health care ture. Such a service is reported as “closed treatment without manip- professional during a postoperative period appended. ulation” and any of the following might apply: Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P, is an educational consultant and PMCC in- 27508 Closed treatment of femoral fracture, distal end, medial or lateral condyle, without manipulation structor. He is also a professional coder for Signature Healthcare, a health system covering 27516 Closed treatment of distal femoral epiphyseal separation; without manipulation much of southeastern Massachusetts. Camilleis’ primary coding specialty is orthopedics. He 27520 Closed treatment of patellar fracture, without manipulation is a member of the Hyannis, Mass., Cape Coders local chapter. 27530 Closed treatment of tibial fracture, proximal (plateau); without manipulation 27538 Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee, with or without manipulation Although nonsurgical, these treatments have a 90-day global period; therefore, any related office visits during this time are included

www.aapc.com December 2015 27 HBM-Sep-2016-Advance-Your-Career-Full-Page-1.1-Print-Ready3.pdf 1 9/11/2015 1:14:04 PM Wanting to Advance Your Career?

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Visit aapc.com/compare 28 Healthcare Business Monthly and discover which credential is right for you. CODING/BILLING ■ By John Verhovshek, MA, CPC, and Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC image by iStockphoto © PeopleImages Sneak a Peek at CPT® 2016 Changes See what procedural coding changes will affect you most.

he release of the 2016 CPT® codebook brings us approximate- Time counted toward +99415 and +99416 does not have to be contin- Tly 350 new, revised, or deleted codes, as well as many new guide- uous; however, time spent by clinical staff performing other, separate- lines, coding tips, and parenthetical instructions. Here are some ly reported services does not count toward prolonged services time. highlights. Note that facilities may not report +99415 and +99416. What’s New for Prolonged Clinical Staff Services New for 2016 are two, time-based, add-on evaluation and manage- No News Is Good News? ment (E/M) codes to describe prolonged clinical staff services provided with direct patient contact: There are no changes to CPT® modifiers this year. Anesthesia coders can rest easy, as well: There are no CPT® code changes for anesthesia +99415 Prolonged clinical staff service (the service beyond the typical service time) during an evaluation services in 2016. and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Manage- ment service) +99416 each additional 30 minutes (List separately in addition to code for prolonged service) Endobronchial Ultrasound Gains Codes Services must be directly supervised by the physician or qualified Endobronchial ultrasound (EBUS) combines ultrasound with healthcare professional. As defined at 42 CFR 413.65, “direct su- bronchoscope to visualize the airway wall and adjacent structures. pervision” means that the physician or nonphysician practitioner The technique allows surgeons to obtain sample tissue from the must be present on the same campus where the services are being lungs and nearby lymph nodes; for example, to diagnose and stage furnished. lung cancer, detect infections, and identify other lung conditions.

■ ■ ■ Coding/Billing Auditing/Compliance Practice Management www.aapc.com December 2015 29 CPT® 2016

Over the past several years, radiological supervision and interpretation (S&I) increasingly has become an included component of many procedures. The trend continues in 2016.

CODING/BILLING Code 31620 (which previously reported EBUS) is deleted and re- New Urinary Imaging Procedures placed by three new codes: CPT® 2016 introduces 50430 and 50431 for antegrade nephrosto- 31652 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with en- gram and ureterogram (imaging procedures for diagnostic assess- dobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, ment of the urinary system), and designates revised and replacement aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures codes for urinary catheter procedures. 31653 with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchi- For example, 50433 Placement of nephroureteral catheter, percutane- al sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph ous, including diagnostic nephrostogram and/or ureterogram when per- node stations or structures formed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all 31654 with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnos- associated radiological supervision and interpretation, new access de- tic or therapeutic intervention(s) for peripheral lesion(s) (List separately in addition to scribes percutaneous nephrostomy to place a nephroureteral cathe- code for primary procedure[s]) ter that drains internally and/or externally (via new access). Report a single unit of 50433 for each renal collecting system/ureter ac- Intravascular Ultrasound cessed (e.g., 50433 x 2, if both renal collecting systems/ureters are Now Includes Radiological S&I accessed.). The procedure includes diagnostic nephrostogram and/ Over the past several years, radiological supervision and interpreta- or ureterogram (when performed), as well as imaging guidance and tion (S&I) increasingly has become an included component of many all associated radiological S&I. procedures. The trend continues in 2016. Additional codes are added to describe percutaneous conversion For example, non-coronary intravascular ultrasound codes 37250 of a nephrostomy catheter to nephroureteral catheter (50434), and 37251 (which did NOT include radiological S&I) are deleted, to be replaced by two new add-on codes that describe identical procedures, but now include radiological S&I. The codes are: 37252 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure)

37253 each additional noncoronary vessel (List separately in addition to code for primary procedure) Cholangiography-related Codes Get an Overhaul Cholangiography is visualization of the bile ducts using an injected contrast medium to locate obstruction(s). Cholangiography codes 47531–47541 are deleted and replaced by a new set of codes describing injection of the contrast medium (47531, existing access and 47532, new access), placement/revision/removal of biliary drainage catheter (47533-47537), stent placement (47538-47540), access for rendezvous procedure (47541), removal of stones from the biliary ducts (+47544), and more. image by iStockphoto © decade3d

30 Healthcare Business Monthly CPT® 2016 CODING/BILLING

and removal and replacement of an existing nephrostomy catheter (50435). Intracranial Thrombolysis Gains a Code image by iStockphoto © budgetstockphoto Thrombolysis is the breakdown of blood clots. For 2016, you’ll report this service with CPT® 61645 Percutaneous arterial translumi- nal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s) for thrombolysis for intracranial arteries using mechanical thrombectomy (clot removal) or infusion. Diagnostic angiography, fluoroscopic guidance, selective catheter- ization and thrombolytic injection(s) are included, although you may separately report diagnostic angiography of a non-treated vas- Radiologic Exam Codes Get More Precise cular territory. Also included are neurologic and hemodynamic New codes describing radiologic exam of the spine now provide monitoring of the patient, and closure by manual pressure, arterial greater specificity as to the number of views. For example: closure device, or suture. You may report 61645 once per intracrani- 72081 Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral al territory treated. The intracranial territories include right carotid spine if performed (eg, scoliosis evaluation); one view circulation, left carotid circulation, and vertebro-basilar circulation. 72082 2 or 3 views There are also new codes for prolonged administration of pharmacologic agent(s) in any intracranial artery, for any reason other than 72083 4 or 5 views thrombolysis: 72084 minimum of 6 views 61650 Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory Earwax Removal by +61651 each additional vascular territory (List separately in addition to code for primary procedure). Lavage Now a Distinct Service Impacted cerumen (ear wax) can cause symptoms including pain, dizziness, and loss of hearing. In years past, removal of impacted cerumen not requiring instrumentation has been reported Three New Codes for Paravertebral Block using an appropriate evaluation and management (E/M) code. The American Medical Associa- A paraspinous block completely desensitizes the affected spinal seg- tion (AMA) added a parenthetical note to CPT® 2014 instructing, “For cerumen removal that is ment (generally for pain relief). CPT® 2016 adds three codes to re- not impacted [see above] or does not require instrumentation, eg, by irrigation only, see E/M port thoracic paravertebral block (PVB) by injection (single and ad- service code, which may include new or established patient office or other outpatient services ditional) or continuous infusion: ….” The AMA also revised the CPT® descriptor for 69210 to specify “requiring instrumentation.” For 2016, the rules have changed. You may still report 69210 Removal impacted cerumen requir- 64461 Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging ing instrumentation, unilateral for removal of cerumen requiring instrumentation; however, guidance, when performed) removal by lavage now has its own code, 69209 Removal impacted cerumen using irrigation/ +64462 second and any additional injection site(s) (includes imaging guidance, when per- lavage, unilateral, and no longer is reported as an E/M service. CPT® 2016 now instructs, “for formed) (List separately in addition to code for primary procedure) cerumen removal that is not impacted, see E/M service code….” 64463 continuous infusion by catheter (includes imaging guidance, when performed) Note that both 69209 and 69210 are unilateral procedures; for removal of impacted cerumen from both ears, append modifier 50 Bilateral procedure to the appropriate code.

www.aapc.com December 2015 31 CPT® 2016

The new codes replace several now-deleted codes, such as 72069 and 72090.

CODING/BILLING Similar changes affect codes describing radiologic exam of the hip(s) and pelvis. Two examples include: 73502 Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views

73523 Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views Clinical Brachytherapy Revised Many codes describing services related to clinical brachytherapy are deleted and replaced, while several other codes are revised. For example, deleted codes 77785 and 77786 are replaced by the following: 77770 Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel

77771 2-12 channels

77772 over 12 channels Also added are new codes for skin surface brachytherapy, 77767- 77768.

Pathology and Laboratory: cine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramus- Refining Test Methods and More cular use, but code use does not change. There have been many changes to the Pathology and Laboratory In a few cases, revisions are more substantial. For example, the de- chapter for 2016, most of which are based on methods used to per- scriptor for 90647 Haemophilus influenzae type B vaccine (Hib), image by iStockphoto © mediaphotos form various tests. For example, a new code was created to report PRP-OMP conjugate, 3 dose schedule, for intramuscular use is revised an obstetric panel with HIV testing: 80081 Obstetric panel (includ- to delete “3-dose schedule,” and to change the vaccine to “Hae- ing HIV testing). mophilus influenzae type” B. Also added is 90625 Cholera vaccine, Ten new codes are added to the Multianalyte Assays with Algorith- live, adult dosage, 1 dose schedule, for oral use and two codes for me- mic Analyses (MAAA) section to report risk scores for rheumatoid ningococcal recombinant protein and outer membrane vesicle vac- arthritis, coronary artery disease, heart transplant rejection, and on- cine (90620, 90621). cology (including colon, colorectal, gynecologic, lung, and thyroid). Special Otorhinolaryngologic Services Cleaning Up the Vaccine Codes Caloric vestibular testing is used to evaluate the vestibular nerve. There are over 60 revisions to vaccine codes for 2016, almost all of For 2016, the former code for caloric vestibular testing (92543) is which are minor “housekeeping” changes. Many obsolete vaccines deleted and replaced by two new codes: are deleted (for example, 90645 and 90646); and many vaccine de- 92537 Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in scriptors are revised to provide greater clarity, with no affect on code each ear for a total of four irrigations) application. For example, the abbreviation “HepA” is added after 92538 monothermal (ie, one irrigation in each ear for a total of two irrigations), which more the name of the vaccine in the descriptor for 90634 Hepatitis A vac- precisely define the test protocol.

32 Healthcare Business Monthly To discuss this article or topic, go to www.aapc.com CPT® 2016

There have been many CODING/BILLING changes to the Pathology and Laboratory chapter for 2016, most of which are based on methods used to perform various tests.

Special Dermatological Procedures No Time for Electronic A new series of codes (96931-96936) now describes reflectance confocal microscopy for cellular and sub-cellular imaging of Analysis of Neurostimulator skin. The technique allows for imaging of skin lesions in vivo (no Pulse Generator System biopsy is necessary). In prior years, electronic analysis of implanted neurostimulator pulse generator system was a time- More information is available in AAPC’s December workshop, based service. For 2016, that’s no longer the case. Code 95972 Electronic analysis of implanted neuro- “New Year, New Updates,” in several cities December 2-14. stimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, Check out the Education section on AAPC’s website for more battery status, electrode selectability, output modulation, cycling, impedance and patient compliance information. measurements); complex spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent pro- John Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Hendersonville-Ashe- gramming has been revised to eliminate the time element “up to one hour,” while 95973 (previously ville, N.C., local chapter. used to report each additional 30 minutes beyond the first hour) has been deleted. Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, is vice president, Member and Certification Development and a member of the Weston, Fla., local chapter.

www.aapc.com December 2015 33 ICD-10 is Here! Advance Your Skills Now. ICD-10-CM General Code Set Training Updated training methods for ICD-10

Now the most comprehensive and affordable methods to prepare for ICD-10 will also allow coders to demonstrate their proficiency at their own pace and with unlimited attempts. AAPC - Rhonda Buckholtz, CPC,ICD-10 CPMA, CPC-I, CGSC, CPEDC, CENTC Available September 2012 AAPC Vice President, ICD-10 Training and Education

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For more information, call 800-626-2633 www.aapc.comor visit: aapc.com/icd10December 2015 35 ■ ADDED EDGE By Dawn Moreno, PhD, CPC, CBCS, CMAA, MTC, CPL, CLT

Selecting a comprehensive coding and billing curriculum will help you to land your first industry job.

36 Healthcare Business Monthly Distance Learning

When you talk to potential schools, be sure you (and not

just your tuition money) are important to them. ADDED EDGE

dvanced curriculum and training is necessary to a medical cod- New graduates with subpar training may miss out on job opportu- Aer’s or biller’s success. Not all online programs are equal, howev- nities because they can’t pass an employer’s test, or because they sim- er. The reality is that there are subpar schools on the Internet. You ply do not have the skills to perform the job. Their money has been must do your homework before you buy in. spent, and they are often left “high and dry,” without any support. A scaled down education doesn’t generally offer monetary savings Detect Subpar Schooling — subpar schools often charge nearly the same as the really good There are a few ways to spot a subpar school or curriculum right schools — and may end up costing you more in lost opportunities. away: If you scale down your education, you are also scaling down your potential success in the industry. • The school offers only its “own,” proprietary reference materials. Schools that do not use the gold-standard Curriculum Aimed at Success textbooks in teaching medical coding/billing may create their own texts to reduce supply costs. Proprietary training is A comprehensive and advanced curriculum is necessary to your suc- OK, with professional textbook backup. cess as a new medical coder/biller. Regardless of what anyone tells you, medical coding is not easy to learn. It takes a lot of practice to • Course hours are skimpy compared to schools and build your skill set to an employable level. A comprehensive pro- curriculums that offer comprehensive training gram includes, at least: programs. Subpar training covers only the basics; the credit or course hours are low and the foundational knowledge • Professionally written textbooks by credible sources. is brief. Medical coding requires a skill that is developed • Access to a qualified and certified instructor. A good over time, requiring much practice, working closely with instructor will answer questions within 24 hours and grade a qualified, certified instructor to hone your skill set to an exams within 48 hours throughout your training. employable level. • Lack of one-on-one assistance. Very large schools that do not have enough instructors will resort to tactics such as telling students to contact the instructor only via email. The student may wait a week or more for exam results or to have a simple question answered. A good school will require instructors to answer student questions within 24 hours and to have exams graded and back to students within 48 hours. Anything else is shortchanging the student. • They usually cost the same or more than quality education programs. This is because profit is the first priority. A good school balances the desire to make a fair profit with the desire for an excellent reputation in the industry, gained by helping students. • They try to enroll you without making sure it is a good career fit for you. A good school will enroll students that it feels are apt to be successful. If a prospective student says she dislikes working on the computer all day, it’s obvious that she will not enjoy coding or billing.

www.aapc.com December 2015 37 Distance Learning

Your future success starts with choosing a program that is advanced in nature, that has many hours of practice, and that offers career guidance. ADDED EDGE ADDED

• A minimum of 800-1,000 hours of coursework to give the student enough knowledge and practice to excel in the workplace. • ICD-10-CM training in addition to CPT® and HCPCS Level II. Medical coders and billers use all three codes sets and must understand them, thoroughly. • Comprehensive foundational training in medical terminology, anatomy, physiology, and in the anatomy and terminology of each medical specialty. If a student does not have this detailed training, there is no way he or she will pass the AAPC’s Certified Professional Coder (CPC®) Face the Truth and Shop Around examination. Your future success starts with choosing a program that is advanced • Plenty of hands-on practice, rather than just reading a in nature, has many hours of practice, and offers career guidance. computer screen and taking online quizzes. There should be Here’s a list of questions you should ask any school before you enroll: textbooks and coding/billing scenarios with which to practice. • Can I contact my instructor by phone and email? Is there a • Excellent post-graduate support to assist students with time frame in which he or she is supposed to respond? resumes and guide them on where and how to land a job. • What textbooks do you use? Good schools teach and encourage members to join the industry’s • Do you discuss the software used for medical coding/billing professional association, AAPC. They also encourage students to in the industry? test for AAPC’s CPC(R) credential after graduation, and provide • Are your materials proprietary, or do you use professionally guidance and assitance. They provide externships so students get written and widely accepted textbooks in your program? hands on experience in the industry and to remove apprentice status from their credentials. • How many credit or course hours is your program? Similarly, new medical billers should obtain AAPC’s Certified Pro- • Do you assist with my resume and give me guidance on how fessional Biller (CPB™) credential to prove expertise in medical bill- to land my first job? ing. Certification and AAPC membership promotes professional- • May I speak to one or two graduates of your program? ism, documents proven skills to an employer, and allows the new • How long have you been in business? graduate to shine above others who are not certified. • Are you a member of the Better Business Bureau (BBB)? In the job market, new graduates are competing against older, more (Check the BBB website to see if there are multiple experienced coders and billers; new medical coders and billers must complaints against the school.) possess a stellar skill set to compete. They must score well on em- • How much hands-on practice do I get in your program? ployment tests and interviews. They must have comprehensive knowledge of all medical specialties, terminology, and anatomy to • Are there any other possible fees I may incur after enrolling? earn AAPC’s Certified Professional Coder - Apprentice (CPC-A®) (Hidden fees are common among subpar schools.) entry-level status. Having this credential assists new coders in get- When you talk to potential schools, be sure you (and not just your ting his or her foot in the door, and opens up industry networking tuition money) are important to them. Are they asking the right opportunities. questions to determine whether you are a good fit for medical cod-

38 Healthcare Business Monthly Distance Learning

ing/billing? Are they trying to rush you off the phone after five minutes, or trying to get you to sign an enrollment agreement before you ADDED EDGE feel comfortable? Medical coding/billing is a great career choice — being part of the medical field can be interesting, rewarding, and financially lucra- tive — but becoming a medical coder or biller is not easy. The training time usually takes six months, or more (although a very motivated student working through a course full-time can finish faster). Finishing quickly is not the priority. Learning the material of an advanced, detailed, in-depth curriculum is your goal.

Dawn Moreno, PhD, CPC, CBCS, CMAA, MTC, CPL, CLT, is the admissions manager of Medical-Technical-Administrative Career Center (MTACC) and has worked in the online adult education industry as a content writer, instructor, and director in medical coding, medical billing, medical office management, and medical transcription. She has written for national industry publications such as Healthcare Business Monthly, NCRAs Journal of Court Reporting, BC Advantage magazine, and industry blogs and publications. Moreno’s passion is in helping adults learn new career skills to change their lives for the better, and her motto is that one is never too old to learn something new. She is a member of the Albuquerque, N.M., local chapter. 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 HBO ® • Apple Mac support with our Cloud-CD™ option • Windows® support with CD-ROM or Cloud-CD™ Our coding courses with AAPC CEUs: • Cloud-CD™ — lower cost, immediate Web access • Dive Into ICD-10 (18 CEUs) • Add’l user licenses — great value for groups • E/M from A to Z (18 CEUs) • Primary Care Primer (18 CEUs) Finish a CD in a couple of sittings, or take it a • E/M Chart Auditing & Coding (16 CEUs) chapter a day — you choose. So visit our Web site • Demystifying the Modifiers (16 CEUs) to learn more about CEUs, the convenient way! • Medical Coding Strategies: CPT® O’view (15 C’s) Check our website for our newest course, Walking Through the ASC Codes (15 CEUs) • The Where’s and When’s of ICD-10! • Coding with Heart — Cardiology (12 CEUs) (All courses with • The Where’s and When’s of ICD-10 AAPC CEUs also earn CEUs HealthcareBusinessOffice LLC: Toll free 800-515-3235 with AHIMA. See our Web site.) Email: [email protected] Web site: www.HealthcareBusinessOffice.com Continuing education. Any time. Any place. ℠

www.aapc.com December 2015 39 ■ CODING/BILLING By Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I Make the Most of HCCs Part 1: Bolster documentation for commonly under-coded conditions.

ccuracy and specificity in diagnosis coding and Amedical documentation are critical in risk adjustment payment models. Over the next few months, we’ll look at several commonly under-coded conditions in the Medicare hierarchical condition category (HCC) model diagnosis code categories and discuss strategies for improving documentation. COPD HCC 111 in Medicare 2014* CMS HCC Model Category The category of chronic obstructive pulmonary disease (COPD) includes many different respiratory conditions. The word “chronic” provides very important information in this category. If the provider is defaulting to an unspecified asthma or bronchitis code, the patient will not be considered in this measure. The documentation should specify the condition (e.g., chronic obstructive asthma, emphysema, or chronic obstructive bronchitis): for example, “Chronic bronchitis with cough, patient advised to quit smoking.” There are several pulmonary conditions associated with this HCC. In patients with pulmonary disease, it’s also important to document and code, when present, hypoxemia and or acute/chronic respiratory failure. If your patient is oxygen dependent, the doctor must document the reason for the oxygen. You cannot assume the relationship. *HCC risk coding is retrospective. The 2014 model is the most recent one being used. CHF HCC 85 in Medicare 2014 CMS HCC Model Category Chronic heart failure (CHF) is one of multiple cardio- vascular conditions associated with this HCC. Multi- ple codes specify heart failure by type and acuity. The HCC also includes cardiomyopathies and pulmonary hypertension, which should be specified by type. Re- member: You cannot assign a diagnosis from findings on a chest X-ray, echocardiogram, electrocardio- gram, etc. The provider must interpret and document his findings.

■ ■ ■ 40 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management To discuss this article or topic, go to www.aapc.com HCCs

Diabetes is one of the most frequently under-coded conditions in risk adjustment. CODING/BILLING

Many patients with these conditions are stable on medication. In this case, it’s very important for the provider to link the med- Risk-adjusted ication use to the disease it’s used to treat (e.g., “chronic diastolic CHF, stable on Lasix”). Payment: What’s at Stake? image by iStockphoto greenwatermelon by © image As healthcare moves from fee-for-service to focusing on risk adjustment, you must pay close atten- Angina Pectoris tion to providers’ documentation. In a risk-adjusted payment model, the more severe or complex a HCC 88 in Medicare 2014 CMS HCC Model Category diagnosis, the higher the risk value assigned to it. A risk adjustment value is assigned to each diagnosis code that falls into the payment model. Codes are then grouped into a hierarchical condition “Chest pain” and “angina” are not interchangeable for coding. category (HCC). Chest pain is not a risk adjusted diagnosis because chest pain can be caused by many non-cardiac conditions. The provider should Hospital and physician claims are the main sources of data that drive the risk adjustment model. Pro- specify the type of angina, when known. Angina that is controlled viders in the outpatient setting have been paid on a fee-for-service model for so long, many neglect on medication should be documented and coded (e.g., “Angina their diagnosis code documentation and reporting. If medical documentation lacks the accuracy and specificity needed to assign the most appropriate diagnosis code, providers face the possibility of stable on Isordil”). reduced payment in a performance-based payment model. Diabetes with Complications HCC 18 in Medicare 2014 CMS HCC Model Category Diabetes is one of the most frequently under-coded conditions in risk adjustment. Many providers default to diabetes without complications due to habit or because of how their electronic health record is set up. Correct coding requires the type and method of control to be documented. The provider needs to establish a direct correlation when a patient with diabetes has a complication or manifestation. Documenting statements such as “due to,” “caused by,” or “secondary to” are sufficient to make the link between the diabetes and the documented complication (e.g., “stage IV chronic kidney disease due to diabetes - GFR 20; considering dialysis”). The Big Picture These are just a few of the categories in the Medicare HCC model. There is great opportunity for outpatient coders to have a very positive affect in their practice, as well as in our industry. Focus- ing on a few, simple documentation improvement strategies at a time will help to illustrate patients’ true severity of illness. Cor- rectly documenting and coding diagnoses will ensure better patient care, as patients are more easily identified for care management by Medicare and other health plans. This data ultimately serves to provide the industry with financial forecasting and planning, which drives the cost of care.

Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, is a risk coding and education specialist for Capital District Physician’s Health Plan. She enjoys teaching PMCC, auditing, and ICD-10 classes. Gianatasio is president of the Albany, N.Y., local chapter and a member of the National Advisory Board.

www.aapc.com December 2015 41 ■ AUDITING/COMPLIANCE By Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI image by iStockphoto © duckycards

Nobody Is Immune to Medical Identity Theft

any forms of identity theft may stem from a medical record breach. Thieves may use someone else’s identity to seek medical care, open new utility accounts, receive cred- Mit cards, conduct online transactions, apply for home loans, buy cars, get a job, commit crimes, or file for fraudulent government benefits. Medical records contain a plethora of information all in one place. This is a jackpot for thieves. Medical identity theft poses a risk even greater than financial breaches. Consider Take steps to someone claiming to be you and seeking medical care. Perhaps he or she has a serious medical condition that you do not have. Now this condition is on your permanent record. What protect your if the thief is a drug addict, has a terminal illness, or a different blood type? Now, the thief’s medical profile is part of yours. Often, thieves will visit emergency rooms and leave the bal- practice and its ance of the medical bill to the “real” person to pay. Unpaid bills go to collection agencies and patients from affect credit ratings. The provider, also a victim, is left with unpaid services. being victimized. The Devastation of Medical Identity Theft Consider the true case of the drug-addicted, pregnant woman who delivered a baby using a stolen health insurance card. The baby was born addicted to drugs and with other serious health concerns. The mother abandoned the baby the next day. The real insurance cardholder was visited by authorities and had her children taken into protective custody. She was a suburban housewife with no history of drug use. Fortunately, she was able to get her kids back later the same day, but she had to prove she had not delivered a drug-addicted baby the day before. ■ ■ ■ 42 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management Identity Theft

Consumers expect healthcare Identity Theft: A Serious Problem providers to be proactive in AUDITING/COMPLIANCE According to the Ponemon Institute, 2.3 million Americans were victims of medical identity preventing and detecting theft in 2014. Victims will tell you, medical identity theft is one of the most expensive and time-consuming types of identity theft to resolve. Protected health information (PHI) breaches affect not just patients, but also providers and health plans. In 2010, Ponemon Institute con- medical identity theft. ducted a survey that concluded the average cost incurred to resolve a medical data breach is more than $20,000, or $211 per record. More than 50 percent of victims are not aware their identity has been stolen for a year, or more. Victims may become aware of a breach when they are turned down for credit. Often, collection agency letters and phone calls are the first indication identity has been stolen or breached. In another case, a college student signed up to donate blood, but was Medical identity theft victims might also suffer embarrassment from disclosure of sensitive told she could not donate because she was HIV positive. It was many personal health conditions. years and thousands of dollars later before she was able to correct her medical record and reclaim her identity. • File a complaint with the FTC at www.ftccomplaintassistant.gov The ramifications of a medical identity theft don’t end there. A false or by phone at 1-877-ID-THEFT (1-877-438-4338); TTY: medical profile can be devastating emotionally and financially: Vic- 1-866-653-4261; and see info at www.ftc.gov/idtheft. tims may be denied life insurance, fired from their job, or even re- • File a report with local police, and send copies of the ceive death threats. report to their health plan’s investigations or privacy department, their healthcare provider(s), and the three Medical Devices nationwide credit reporting companies: Equifax, Experian, Other medical identity theft risks include medical alert devices, and TransUnion. Information on how to file a police implanted defibrillators, continuous positive airway pressure ma- report and reach the credit reporting companies is at chines, and insulin pumps. These devices connect to networks. So- www.ftc.gov/idtheft/consumers/defend.html. phisticated hackers can intercept the data and access these devices • Look for signs of other misuses of personal information by and the personal information associated with them. If a device has reviewing credit reports. The law requires each of three major a signal that can be hacked, the user is at risk. Consumers can con- nationwide credit-reporting companies to give people a free tact the device manufacturer to determine how the data is protect- copy of their credit report each year if they ask for it, at ed and how the company responds to data breaches. www.AnnualCreditReport.com or 1-877-322-8228. • Inaccurate or fraudulent information can be reported at Takeaways www.ftc.gov/idtheft. You can also learn how to get inaccurate Consumers expect healthcare providers to be proactive in prevent- information corrected or removed. ing and detecting medical identity theft. According to a recent Po- Medical identity theft is serious business, and should be acted on neman study, 48 percent of respondents surveyed said they would immediately to help mitigate risk. Many employers and insurance consider changing healthcare providers if their medical records were companies offer credit protection and monitoring services. Some lost or stolen. If a breach occurs, 40 percent expect prompt notifica- companies also offer medical identity fraud alert systems. Everyone tion to come from the responsible organization. should look at options and take necessary precautions. Everyone who touches a medical record must be hyper vigilant. The U.S. Federal Trade Commission’s Red Flags Rule requires business- Sources: es and organizations to develop and implement procedures to de- Ponemon Institute© Research Report, Fifth Annual Study on tect suspicious activities or patterns of behavior that suggest identi- Medical Identity Theft, February 2015: ty theft. Some of the measures are as simple as asking for photo iden- http://medidfraud.org/wp-content/uploads/2015/02/2014_Medical_ID_Theft_Study1.pdf tification. Providers should ask for photo ID (government issued is Experian, “Combating the Rising Tide of Medical Identity Theft”: preferred) and maintain a photo in the chart. Patients should pro- www.experian.com/assets/data-breach/white-papers/medical-fraud-resolution.pdf tect their information, including their health insurance ID card.

Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI, is director of the Blue Shield of Califor- Tips and Resources nia, Special Investigations Unit. Her specialties include healthcare fraud investigation, pre- Victims can take advantage of their rights under the HIPAA Priva- vention, and resolution. Massey has extensive experience in health insurance plans and management and trains on healthcare fraud, coding, and ICD-10. She is on AAPC’s National Advi- cy Rule. To learn more about medical identity theft and how to pro- sory Board, and also served from 2007-2009. Massey is a member of the Sacramento, Calif., tect yourself, check out these tips and resources: local chapter.

www.aapc.com December 2015 43 ■ AUDITING/COMPLIANCE By Joseph de Beauchamp, PhD Disclosure fo PHI r Gen ing ea dl log an is H ts image by iStockphoto © johnwoodcock

Awareness of your responsibility for protecting client and family medical information is essential.

eritage societies and genealogists often request access to personal to jail for it. When you understand the ramifications of the HIPAA Hhealth information (PHI) of patients and the deceased and are, security and privacy rules and PHI breaches, you can avoid breach- therefore, subject to HIPAA privacy and security rules. To prevent a es and the consequences that come with them. HIPAA compliance breach that could lead to possible jail time and a lofty fine, it’s important to know what heritage society researchers Ensure Clients’ Identity and Intentions and genealogists do, how they handle PHI, and your role in disclo- The first critical point of engagement should be for the researcher to sure of information for their research. identify the client and his or her intentions. Proper client identification is important because certain documents might be discovered Experience Speaks Volumes to which the “purposed” client is not entitled, such as in the case of When I was young, I was an idealist. I thought, “What you don’t heritage or estate matters. know, won’t hurt you.” Now that I have grown up and have over 40 Heritage societies use a notary to detect false identification. Nota- years of career experience under my belt, I know ignorance can in- ries are critical in the discovery process for heritage matters because deed hurt you. It’s no excuse in the eyes of the law, and you can go they are licensed to investigate the identities and to check for false

■ ■ ■ 44 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management PHI Disclosure

When a heritage society is asked to obtain records for

osur AUDITING/COMPLIANCE I Discl e for G a person, it might include health records such as birth PH en certificates, death certificates, and even DNA results. ing ea dl log n is a t identification proofs, such as government photo identification and Inspector General and the Department of Justice have the s Social Security cards. The use of a false Social Security card, birth right to check your safeguards at any time during this period. H certificate, or drivers’ licenses is punishable up to 15 years in jail, Occupational Safety and Health Administration also has the with no statute of limitations. (Justice, August 30, 2012) right to investigate and arrest you for any reason stated or not A genealogist or historian must identify the applicant or client be- stated at any time. fore engagement; not knowing your applicant or client is not a le- gitimate excuse that will keep you out of jail if a HIPAA breach oc- Remember Who You Are curs. Not properly checking the identification of the person can You are a member of a professional organization, and know what lead to her or him fraudulently obtaining health records and oth- your code of ethics dictates you to do. If you volunteer for a non- er financial information. There are cases where people are serving profit organization, such as a heritage group or first response orga- 45 years in jail, and have received fines as much as $158 million for nization, never avoid the duties and responsibilities of protecting such offenses. client information. Recently there has been a wave of interest in DNA tracking and pub- How Medical Records for Research Affect You lishing of this information; avoid retaining and accepting this in- When a heritage society is asked to obtain records for a person, it formation. When handling PHI, please advise your clients to care- might include health records such as birth certificates, death certif- fully review the disclosures with their attorneys before they under- icates, and even DNA results. These records fall under HIPAA, and go any DNA testing. You have a responsibility to your clients/pa- should never be copied, scanned, or sent over the Internet via email. tients to make them aware of the possible consequences. If you send Genealogists also should never hold these records in their care be- any documents, disclose this to your client, even if you are volun- cause the risk is too high. Violations of healthcare records carry pen- teering without pay. alties of 20 years imprisonment and million dollar fines. (American Helping people to discover their roots is very rewarding, but it Medical Association, February 17, 2009) comes with much responsibility. Pay attention to those around you If you mail medical record documents to a heritage society, you must and their intentions. Knowing the heritage society, genealogist, and be clear in your disclosures that these places of business are beyond customer, and what you can legally do to help them, is a critical part your control. If you don’t know what a genealogist or heritage society of your responsibility. What you don’t know can hurt you. is doing with the documents, make sure this is disclosed to the client. The information discovered may affect estate or title of property Resources documents. They might also assist in property settlements with di- American Medical Association, HIPAA Violations and Enforcement, AMA and 42 USC 132o-5, 1-3; vorce or annulment. To leverage risk, make sure: February 17, 2009. • The client is entitled to see the documents. Disclose in all Dictionary, B. L., Ignorantia juris non excusat, St. Paul: Black’s Law Dictionary, 2014. cases to every client what and how you will retain the files. Justice, 9. C.-A, False Identification, 18 USC 1028 (a) (7), Department of Justice, August 30, 2012). • You have permission for sending or copying documents. AMA, HIPAA Violations and Enforcement, 42 USC 1320-5, 1-3; February 17, 2009. • You know where you are sending documents. Over 83 Justice, O., Office of Public Affairs; Harris County, Texas: Justice News, September 15, 2015. percent of medical facilities and financial institutions George J. Annas, J. M., The New England Journal of Medicine, “HIPAA Regulations - A New Era of holding files of persons are breached. Medical Records Privacy?” 5120 et, seq., April 10, 2003. • You know to whom you are sending documents and what they are doing with those documents. You bear the Joseph de Beauchamp, PhD, carries Doctorates of Philosophy in Theology, Finance, and full responsibility of the law for sending and storage of Psychology. He runs a Medical Level I secured facility enforced under HIPAA, works as a recov- information belonging to the client. ery agent for government payers, and serves hospice patients in heritage and genealogical societies as both a chaplain and advisor. He has helped over 70,000 families and patients in a ca- • You safeguard this information for five years. The Office of reer spanning over 40 years. De Beauchamp is a member of the Las Vegas, Nev., local chapter.

www.aapc.com December 2015 45 Healthicity Smart Design. Intelligent Auditing.

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46 Healthcare Business Monthly PRACTICE MANAGEMENT ■ By Bridget Toomey, CPC, CPB, CRCR, RYT-200 Photo by Stephanie Photography. Knutson

s the winter months begin, so does the cold and flu season. AWhen a staff member is sick, the germs spread quickly and Stay healthy at before you know it the absence list is a mile long. We can all take precautions to help stay healthy this winter. Being bound your desk by using to a desk or office space is no longer an excuse not to move your body throughout the day. Here are some office yoga postures postures that that specifically work to boost your immune system. stimulate immunity.

■ ■ ■ Coding/Billing Auditing/Compliance Practice Management www.aapc.com December 2015 47 Office Wellness

Back Posture: Sit comfortably at the front of the chair. Keep your feet flat on the floor, about hip distance apart. Technique: Place your hands on your thighs. Inhale, expand the chest forward, driving the rib cage out and up by push- ing back the shoulders. Exhale, bring the shoulders in front and retract the chest in. Keep the chin level with the floor during all movements. Continue for 10 repetitions. Benefits: • Helps to break up knots in the PRACTICE MANAGEMENT shoulder blades. • Encourages blood flow to the upper torso. Photos by Stephanie Knutson Photography.

Arms Being bound to a desk Posture: Sit comfortably with a straight spine, either at the front of the chair or all the way to the back. Keep your feet flat on the floor, about hip distance apart. or office space is no Technique: Bring your hands to chest level, interlock your fingers, and turn your palms outward. Inhale, stretch both arms forward. Exhale, raise both arms over your head with the palms up to- longer an excuse not wards the ceiling. Inhale, bring the arms back down out in front of the body with the palms out. Exhale, bring the hands back to the center of the chest. Repeat 10 times. to move your body Benefits: throughout the day. • Improves blood circulation in the arms. • Expands lung capacity.

48 Healthcare Business Monthly To discuss this article or topic, go to www.aapc.com Office Wellness

Chest

Posture: Sit comfortably with a straight spine, ei- MANAGEMENT PRACTICE ther at the front of the chair or all the way to the back. Keep your feet flat on the floor, about hip distance apart. Technique: Grip the fingertips of both hands together and bring them to chest level with the fore- arms parallel to the ground. Inhale. Suspend the breath and, without separating the hands, try and pull the hands apart. Exhale. Inhale and pull again. Repeat 10 times. Benefits: • Opens up the heart center and chest. • Stimulates the thymus gland.

Shoulders Posture: Sit comfortably with a straight spine, either at the front of the chair or all the way to the back. Keep your feet flat on the floor, about hip distance apart. Technique: Interlock the fingers and bring the arms up over the head. Bend the head, arms, and torso to the left, stretching the right side of the body. Hold this posture with long deep breathing for 10 seconds. Then bend the head, arms, and torso to the right and feel the stretch on the left side of the body. Hold with long deep breathing for 10 seconds. Repeat 10 times. Benefits: • Opens up the lungs and enhances breathing. • Helps to circulate clean air throughout the body, keeping the body energized.

References: Akhar, Shameem. Yoga in the Workplace, Chenni: Westland Ltd, 2010. Bhajan, Yogi. The Aquarian Teacher, Santa Cruz: The Teachings of Yogi Bhajan, 2010. Thakur, Bharat. Desktop Yoga, New Delhi: Wisdom Tree, 2007.

Bridget Toomey, CPC, CPB, CRCR, RYT-200, teaches Kundalini yoga at Heartland Yoga in Iowa City, Iowa. She is certified by the Kundalini Research Institute as a Kundalini yoga teacher and is a member of the International Kundalini Yoga Teachers Association. Toomey works for the University of Iowa Hospitals and Clinics in Patient Financial Services as a revenue cycle co- ordinator, where she supervises staff on the physician Iowa Medicaid team. She is a member of the Iowa City, Iowa, local chapter.

www.aapc.com December 2015 49 ■ PRACTICE MANAGEMENT By Renee Dustman THE MEDICAL SCRIBE: A Hot Commodity image by iStockphoto © shironosov

They streamline the documentation process so physicians can concentrate on healing patients.

IPAA regulations, ICD-10 documentation requirements, elec- Although there are no prevailing federal regulations concerning the Htronic health records (EHRs), and quality initiatives, among oth- use of scribes in the healthcare setting, there are plenty of opinions er things, have put a lot of demands on physicians’ time. To regain for what a scribe may do. focus on healing people, many physicians and hospitals are hiring The Joint Commission takes the stand that a scribe “does not and medical scribes to delegate administrative tasks. may not act independently” but can document the physician’s or practitioner’s dictation and/or activities. The healthcare certifying The Role of the Medical Scribe organization goes further to say that scribes may assist practitioners For centuries, scribes have been documenting important events for in navigating EHRs and in locating information such as test results recordkeeping. It’s been a natural progression for scribes to enter the and lab results. healthcare industry. Their usefulness for capturing accurate and de- Medicare administrative contractors (MACs) also may have some- tailed documentation (handwritten, electronic, or otherwise) of the thing to say on the matter. Cahaba GBA, for example, published physician/patient encounter is undeniable. guidance in the form of a local coverage article (A52695), in which ■ ■ ■ 50 Healthcare Business Monthly Coding/Billing Practice Management Auditing/Compliance Scribes

A scribe’s responsibilities are ultimately controlled by the

regulatory requirements and policies established by the MANAGEMENT PRACTICE provider, and the level of risk an employer is willing to accept.

it reiterates The Joint Commission’s opinion and adds, “The physi- A scribe’s responsibilities are ultimately controlled by the regulatory cian who receives the payment for the services is expected to be the requirements and policies established by the provider, and the level person delivering the services and creating the record, which is sim- of risk an employer is willing to accept. ply ‘scribed’ by another person.” The Jurisdiction J MAC further states that when a scribe indepen- Legal Ramifications dently records the past, family and social history and the review of As with any employee or contractor who has access to patient re- systems (ROS) for an evaluation and management (E/M) service — cords, a scribe must abide by HIPAA and HITECH regulations. in as far as the scribe is simply documenting the physician’s words Compliance with the Record of Care and Provision of Care stan- and activities during the visit — the physician may count that work dards also apply. It is important to be certain that the scribe’s servic- toward the final level of service billed. es are used and documented appropriately, and that the documen- Examples of information entered by a scribe into the EHR or chart tation is present in the medical record to support that the physician may include: actually performed the service. • History of the patient’s present illness For example: • ROS and physical examination • The scribe must sign (name and title), date, and time stamp • Vital signs and lab values all entries into the medical record — electronic or manual. • Results of imaging studies • The role and signature of the scribe must be clearly • Progress notes identifiable and distinguishable from that of the physician or licensed independent practitioner or other staff. • Continued care plan and medication lists The scribe cannot enter the date and time for the physician or prac- Scribes are generally not credentialed medical personnel and, there- titioner. Although allowed in other situations, a physician or practi- fore, rarely qualify to enter computerized physician order entry tioner signature stamp is not permitted for use in the authentication (CPOE) in the EHR to meet meaningful use requirements. The of scribed entries; the physician or practitioner must actually sign or Centers for Medicare & Medicaid Services (CMS) realizes there authenticate through the clinical information system, and do so be- are exceptions: fore the physician or practitioner and scribe leave the patient care area. If a staff member of the eligible provider is appropriately cre- The provider’s note should indicate: dentialed and performs similar assistive services as a med- • Affirmation of the provider’s presence during the time the ical assistant but carries a more specific title due to either encounter was recorded specialization of their duties or to the specialty of the med- • Verification that the provider reviewed the information ical professional they assist, he or she can use the CPOE function of CEHRT [certified EHR technology] and have • Verification of information accuracy it count towards the measure. This determination must be • Any additional information needed made by the eligible provider based on individual workflow • Authentication, including date and time and the duties performed by the staff member in question. It’s The Joint Commission’s stand that scribes may not make inde- A scribe might also be responsible for expediting patient flow pendent decisions or translations while capturing or entering infor- through surgery under direction of the medical doctor or other mation into the health record beyond what is directed by the pro- qualified healthcare provider, and facilitating patient flow by assist- vider; nor does the agency support scribes entering orders for physi- ing the provider in navigating through electronic documentation cians or practitioners. including entering orders, reviewing lab/test results, post-op notes, As the use of scribes becomes more prevalent, the potential for ex- medication reconciliation, and discharge summaries. panded legal guidance and direction grows. Physicians using scribes

www.aapc.com December 2015 51 To discuss this article or topic, go to Scribes www.aapc.com

must monitor federal and state regulatory changes to ensure their practices consistently meet compliance standards. Cer- tified scribes will become in high demand, as their credentials will negate much of that liability. Becoming a Medical Scribe PRACTICE MANAGEMENT Working as a medical scribe requires more than just good pen- manship and computer skills. A qualified, employable scribe comes equipped with a broad range of skills, such as: • Knowledge of medical terminology and technical spelling • Basic anatomy Healthicity • Familiarization with HIPAA Privacy and Security Rules • Medico-legal risk mitigation All-in-One • An understanding of the essential elements of

documenting a physician-patient encounter and E/M image by iStockphoto © mkurtbas levels Compliance for All. • Knowledge of federal initiative requirements • General knowledge of the roles and responsibilities of Medical Scribes medical personnel and billing practices Improve Productivity • Strong interpersonal and communication skills ProScribe, a medical scribe employment service, collected and compared data from a five-hos- You will also need at least a high school diploma and at least one pital system over a three-year period to demonstrate the impact of scribe services on physician We reinvented compliance management through a complete, ﬂexible year of experience in the healthcare field. productivity, throughput metrics, and patient satisfaction. The results are impressive. solution that complies with all seven OIG recommendations to ensure As a scribe, you may find employment or contract work in var- ProScribe was also able to demonstrate a 20 percent increase in provider productivity after one ious settings, including physician practices, hospitals, emer- year of scribe services. The five-hospital system saw an increase of 40,000 patients from year 1 you’re compliant, even when audited. gency departments, long-term care facilities, long-term acute to year 3. care hospitals, public health clinics, and ambulatory surgery In ProScribe’s case study, there were demonstrated improvements in door-to-provider times centers. and door-to-discharge times, as well as a significant decrease in the number of patients who HEALTHICITY.COM/COMPLIANCE left without being seen. Resources Source: www.proscribemd.com/scribe-services/ www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFaqId =426&ProgramId=47 www.cms.gov/medicare-coverage-database www.healthit.gov/providers-professionals/meaningful-use-definition-objectives https://questions.cms.gov/faq.php?faqId=9058

Renee Dustman is an executive editor at AAPC.

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www.aapc.com December 2015 53 ■ PRACTICE MANAGEMENT By Ellen M. Wood, CPC, CMPE Onboarding Employees in a Small Office Invest in new employees and focus on the benefits small practices offer. image by iStockphoto © DMEPhotography

ringing new employees up to speed requires a significant invest- For example, important qualities for front desk staff are the ability Bment, which may be especially challenging in smaller offices to stay positive even if a patient is being unpleasant, and not to take lacking a formal training program or other dedicated resources. For patients’ negative comments personally. practice managers in small and growing offices (two to 10 practitio- The interview process lasts a long time, and involves several steps. ners), there are several ways to ease the process. When resources are tight, you can’t afford to hire the wrong person. During an initial interview, try to gauge the individual’s lev- First, Find a Match el of professionalism and seriousness about the job. You may want Successfully integrating a new employee into your office depends on to test the applicant’s skill or knowledge. When interviewing some- finding the right person for the job. one for a coding/billing position, for example, you might ask the ap- When writing a help wanted ad — and when conducting interviews plicant how he or she would handle a few real-life scenarios you’ve — name the exact qualities you are seeking in an employee and the had in your office (such as complaints about a wrong billing code). requirements of the job. Rather than saying, “must be motivated If you are impressed with a candidate after an initial interview, in- and willing to multi-task,” list the typical duties the job entails, and vite the person back to spend an hour observing the job he or she stress the specific skills an applicant must have. would be doing (have the individual sign a confidentiality agreement first). Do this on a busy day, so he or she can see what is expect-

■ ■ ■ 54 Healthcare Business Monthly Coding/Billing Practice Management Auditing/Compliance Onboarding

The smaller an office, the more everyone must work MANAGEMENT PRACTICE together and contribute to a positive environment.

ed. Some candidates may find they are not interested after they see check off items on the list as he or she is trained on each area. The what really goes on. list can also double as a reminder of regular tasks to be completed. The smaller an office, the more everyone must work together and You may want to ask experienced employees to create a three-ring contribute to a positive environment. You may want to bring your binder for each position that describes what needs to be done and top two or three candidates back for a group interview with exist- how to do it. For example, a binder might include instructions on ing staff. This gives staff a stake in the future employee’s success, how to order scans for each payer. and allows them to share the credit for new hires. Review staff questions for the candidate ahead of time to be sure they are appropriate. Keep Tabs, Get Feedback, and Improve Quality healthcare is a mission, not a job, and it takes a certain kind Assessments are useful to provide feedback to employees, but also of person to work in our industry. Throughout the interview pro- to ask for feedback. Conduct 90-day self-assessments of your new- cess, consider how an applicant’s personality will help (or hinder) hires to help answer these questions: his or her success. Employees must be resilient and even-tempered. • What tasks are you most comfortable doing? The busy, messy, day-to-day realities of a healthcare office may dis- appoint idealists or the faint of heart. • In what areas are you least comfortable? For example, general surgeons deal with life and death daily. They • What parts of your job do you like and not like? often treat trauma victims in the hospital, and occasionally must be • How can the practice help to make your job easier? the bearers of bad news. Patients are likely to be physically stressed Never punish an employee for his or her opinion; use the respons- and generally worried. Emotions run high and frustrations build. es as feedback to improve the overall practice. For example, a fresh Even the nicest people can snap when things aren’t going well. In set of eyes may recognize a more efficient way to complete a task, or addition to professional competence, healthcare workers must have may notice a weakness in training. One of the main advantages of a thick skin, humility, and patience. smaller practice is that you can adopt new processes fairly quickly, with a minimum of red tape. Training Tips to Boost Competency Self-assessments also help pinpoint and curtail employee problems When training new employees, get creative. For example, HIPAA before they escalate. You are better off hearing about and respond- and Occupational Safety & Health Administration (OSHA) training to a complaint before a disgruntled employee “poisons the well” ing videos (often with accompanying exams to test employee com- and turns other employees negative. For example, an employee who prehension) are widely available simply by searching online. Check is unhappy with your “earned time off” policy may be willing to with your professional colleagues (for example, at your next AAPC talk through the issue, so he or she no longer needs to complain to chapter meeting) and ask if they have effective resources they’d rec- other employees. ommend or share. You might also look to your vendors to provide Above all, at every step along the way, it’s important to have trans- low- or no-cost training. For instance, the service that collects used parency and to clearly define employee expectations. This contrib- sharps must offer OSHA training to its employees. As part of your utes to everyone’s peace of mind and satisfaction, which will im- contract with the company, ask that they share training materials prove employee morale. (such as binders or an instructional DVD) with your staff. If your internal systems include a training component, take advan- Ellen Wood, CPC, CMPE, has worked in the medical field for over 20 years and has been a certified coder for over 13 years. She is the practice manager for Seacoast General Surgery and tage of them. For example, some electronic health records (EHRs) an adjunct professor at a local community college. Wood’s experience includes employee include webinars to teach employees how to use the system. Have mentoring and oversight of meaningful use policies and objectives, PQRS, and ePrescribing employees view the webinars throughout their initial 90 days, and programs. She helped to start the first New Hampshire local chapter, Seacoast-Dover, and beyond, so they learn to become efficient in the system with less tri- served on its board. al and error. For each position, ask an experienced employee to make a check-off list of daily, weekly, and monthly responsibilities. The new-hire can

www.aapc.com December 2015 55 ■ MEMBER FEATURE By Michelle A. Dick

We are honored to have MILITARY MEMBERS the crème de la crème Trained for Success bettering our organization. ou may remember military slogans such as “Be all you can be,” Y(Army), “It’s not just a job; it’s an adventure,” (Navy), “Aim high” (Air Force), and “The few, the proud, the Marines.” They were concise, tough slogans that prompted pride and excitement for our country. Although powerful slogans, they don’t capture the true emotion of serving in the military and the discipline, unbreakable bonds, and life-long friendships soldiers experience. Our military personnel are a rare and beautiful breed that only a service member can truly understand, and we are honored to have them as AAPC members. The training and experience the military creates produces excellence in the workplace and in life.

Let’s meet just a handful of AAPC’s military members: Caren J. Swartz (left) Rob J. Pachciarz Caren J. Swartz, CPC-I, CPMA, COC, CRC, CPB - served 1982- 1990 (1982-86 active duty, 1986-90 active reservist). Rank: petty officer 3rd class, Sub base Groton, Connecticut; operating room technician (scrub) active reservist at Willow Gove, Pennsylvania, naval air station, then Bethesda Naval, Bethesda, Maryland; hospital Corps school in Great Lakes, Illinois, then operating room (OR) school in Portsmouth, Virginia. Rob J. Pachciarz, CPC, COC, CIRCC, CASCC - served from 1987-1991 as a communications/computer systems operator at Eak- er Air Force Base (AFB) in Blytheville, Arkansas. Jeanne Yoder, RHIA, CPC, CPC-I, CCS-P - 27 years as a hospital administrator. Rank: 2nd lieutenant through lieutenant colo- nel. She spent 17 years as a medical logistics officer at Hill Air Force Base, Utah; Kadena Air Base, Okinawa, Japan; Altus AFB, Oklaho- ma; Brooks AFB, Texas; Philadelphia at Defense Personal Support Jeanne Yoder Sherry Blackwell Center; medical records at Sheppard AFB, Texas; billing for TRI- CARE Management Activity in Falls Church, Virginia; and data analysis at Bolling AFB in Washington, D.C. Sherry Blackwell, CPC - served in the Air Force Reserves from 1981-2014, retired with the rank of Master Sergeant (E-7). She was deployed in countries such as Germany, Spain, Egypt, Italy, and Panama. She served active duty for two years in 2003, Baghdad, Iraq, and then was deployed to Ali Al Salem Air Base, Kuwait in 2006 and 2010. Her last deployment was in 2012 to Manas Transit Center in Bishkek, Kyrgyzstan. Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA - served from 1979-1989. From 1979-1981, Pennsylva- nia Army National Guard, 1/103rd Armor Basic Non-Commis- Michael D. Miscoe

www.aapc.com December 2015 57 Military Members

The opportunities offered to me would have never been offered as a civilian.

sioned Officers Course (Distinguished Graduate), rank: Special- ist-4. From 1981-1985, United States Military Academy, West

MEMBER FEATURE MEMBER Spreading Smiles During War Point, New York, graduated with bachelor’s degree in Electrical En- gineering, rank: Cadet - Commissioned 2nd Lieutenant, Branch, Sherry Blackwell, CPC, served 33 years in the Air Force Reserves and retired with the Aviation. From 1985-1986, Fort Rucker, Alabama, Aviation Of- rank of Master Sergeant. During her service she enjoyed her deployments the most. She ficer Basic Course (Distinguished Graduate), Air Assault School, traveled to many countries such as Germany, Spain, Egypt, Italy, and Panama. After 911, Airborne School (Fort Benning, Georgia), Rotary Wing Aviator she was called to active duty in 2003 for 2 years, and was deployed to Baghdad, Iraq. Blackwell’s greatest joy during this time was trying to bring smiles to war zones. She Course (Distinguished Graduate), Attack Helicopter Qualifica- recalls the experience: tion Course, rank: 1st Lieutenant. From 1986-1989, 5/9 Air Caval- ry, 25th Infantry Division, Schofield Barracks, Hawaii. Current sta- While deployed I worked in a support function in which we worked with the troops tus: service disabled veteran. that were in-transit to Afghanistan, Iraq, and other countries within the Theater of Operations. Our job was to make sure the arrival to their deployment destination was as smooth as possible. This was a difficult job because most of the time I was Why Did They Choose Medical Coding? looking into the eyes of a scared 19-year-old who was heading into a war zone, not Swartz’s military OR experience led her to coding; she became in- knowing what to expect. If I could make them smile by greeting them with a smile, creasingly interested in the billing/practice management side of a pre-paid card to call home, or even a candy bar and soda, I felt like I had made his medicine. She said, “It was important to me to learn what drove pay- or her day a little better. That is what made me love my job! ment and why, since this was not something that was ever spoken about on active duty.” The more Swartz learned, the more she wanted to educate herself to ensure the best pay for physicians. “I need- Yoder became a coder because she had a degree in biology and needed to educate them based on payer policy as well as coding rules,” ed a job. She said, “A member of the northern Illinois fencing club, she said. where I fenced, recommended I get into the Medical Record Ad- ministration program at the University of Illinois Medical Center.” Blackwell started her coding career while working in the business She did, and the rest is coding history. office of a county hospital as a cashier. She said, “My interest was sparked from working side by side with the ER coders and listening Pachciarz chose coding simply “to be of better service to the phy- to them discuss cases when extracting codes.” Blackwell applied for sician practices [he] served by helping them with denials and oth- and accepted a Department of Radiology coding position. She has er coding needs.” been a coder since 1985 and is supervisor of anesthesia and surgical services coding for Medical University of South Carolina Phy- Applying Military Skills to Coding Work sicians. Yoder has applied to her coding career what she learned in the Miscoe went into coding as a result of developing a medical billing U.S. Air Force as a medical logistics officer, TRICARE manage- program. He said, “Curiosity led me to study coding, documen- ment, and a data analyst. She said to run a practice well, “you need tation, and billing rules, and I noted how they varied from payer good data that tells you who your patients are, the conditions they to payer.” This led Miscoe to steady progression of consulting and have, the level of health they want, and how much they are will- shortly thereafter, working as a forensic coding expert, and then ing to do to have that level of health.” You also need to know “what to health law and law school. Now he is AAPC’s National Adviso- can be done to help them, what you actually provide, and the re- ry Board president-elect, Legal Advisory Board member, and Eth- sources involved.” Yoder says coding tells the story, which she ics Committee chair, a compliance and health law expert, and le- learned throughout her coding career. “Standard code sets (e.g., gal consultant. ICD, CPT®/HCPCS Level II, NDC) … need to be maintained.

58 Healthcare Business Monthly Military Members

I was happy to pay back some small MEMBER FEATURE part of what this country provides.

I read as a coder, I learned from this training.” She constantly ques- Why Did You Join the Military? tioned the physicians, asked about disease, anatomy, and the procedures that took care of health issues, and she learned about different Some of our military members served to follow in family member’s footsteps. For others, specialties and procedures. Swartz said, “The opportunities offered it was American pride and giving themselves to our country. Here is why these members to me would have never been offered as a civilian.” served this great nation: “I always wanted to do something that contributed to society, and I felt there was no better Favorite Military Experiences way than defending the country I loved.” Reflecting on his experiences, Pachciarz said that “working and liv- - Sherry Blackwell, CPC ing alongside others with the same common goal of loving and pro- “I actually never thought about not joining the military. Everyone in my family served.” tecting our great country” was his favorite part of serving in the mil- - Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA itary. “My father served as an MP in the Air Force, my brother a crew chief in the Marine Corps. I Swartz cherishes the life-long friendships she has made. She said, knew I would get excellent training and really wanted to serve my country in some way.” “It’s a feeling that people in the civilian community cannot appre- - Caren J. Swartz, CPC-I, CPMA, COC, CRC, CPB ciate — bonds between people who have served. They understand “I love my country and many in my family served, as well.” what that truly means.” - Rob J. Pachciarz, CPC, COC, CIRCC, CASCC Miscoe’s fondest memories were of flying attack helicopters, and he “After backpacking around Europe during college, and seeing a variety of governments in action, loved the Cavalry mission. He said, “Beyond that, my favorite part I decided that although there may be problems in the USA, it was the best country around.” about serving was that it gave me the opportunity to earn the free- - Jeanne Yoder, RHIA, CPC, CPC-I, CCS-P doms that I enjoy, as well as the incredible opportunities that this country provides to those willing to work and take advantage of I’ve found that corrupting a code set to collect something for which them.” Miscoe recognizes the incredible investment that the coun- it was not intended is usually a mistake,” she said. Code sets need try made in his schooling and additional training. “Service to our to be easily collectable, well defined, and worth more than the re- country provided a way to balance the ledger,” he said. sources to collect. Yoder added to Miscoe’s assessment of military favorites and con- Miscoe said skills he brought from the military to his current work cluded, “I was happy to pay back some small part of what this coun- include “leadership fundamentals, problem-solving skills, confron- try provides.” tational tolerance, and knowledge that with effort, I can succeed at Thank you for your service military members. AAPC honors and any task.” salutes you. Pachciarz said what he carried to his coding career from his military Michelle A. Dick is executive editor at AAPC. experience is a “discipline to get where I need to be on time; respect for a chain of command; importance of functioning as a team; and attention to detail.” Blackwell agrees with Pachciarz about discipline being a skill she brings to her career. She also brings a deep respect for her fellow air- men that she said has been a great attribute in her civilian career. As for Swartz, everything she does today stems from her military training. She said, “All the anatomy and terminology in every note

www.aapc.com December 2015 59 NEWLY CREDENTIALED MEMBERS

Autumn Poland, CPC Jan McReynolds, CPC Lessa Kimbrell, CPC Reva Harris, CPC Magna Cum Laude Barbara Redman, COC Jane Gray, COC, CPC, CPC-P Linda Lester, COC, CPC Rhonda G Crouch, CPC, CHONC Bonnie Smith, CPC Jane M Rapes, CPC Liri Sheshi, COC Rhonda Rappe, CPC Brad Smedley, CPC Janie Loftis, CPC Lisa Mahlum, CPC Roberta Burkhart, CPC Amande Lee, CPC-A Brenda Winkler, CPC Jean Marie Figlioti, COC, CPC Liudmyla Musiienko, CPC Robin Griffin,COC Amruta Paranjape, CPC, CPMA, CEMC Brenda Cox, CPC Jenna Lee Rice, COC Lori A Overton, CPC Rohan Sasmal, CPC Anna Odor, CPC-A Brianne Stephens, CPC Jennifer Buzzelli, CPC Lori Guaraglia, CPC Ronna Foster, CPC Ashley Generallo, CPC Bridget Haught, CPC Jennifer Hendrix, CPC Lori Neyens, CPC Rose M Garcia, COC Barbara Michelle Bess, CPC Bridgot Peters, CPC Jennifer LaPiana, CPC Louise J Hayes, COC, CPC Rustie Elkins, CPC Christine Vienneau, CPC, CIRCC Britanny Davila, CPC, CGSC Jennifer Latva, COC, CPC Lucretia Price, CPC Ruth Anderson, CPC Christine Yost, CASCC Brittany Frye, COC, CPC Jennifer Lynn Schneider-Lueken, CPC Madea DeHaven, CPC Ruth Hancock, CPC Dawn James, CPC Brittany Goldstein, CPC Jennifer Moeller, CPC Madelaine M Luces, CPC Sabrina McDowell, CPC, CPC-P Donna Malone, CPC, CRC Bryce Jardine, CPC Jennifer Nordlund, CPC Margarite Scott, CPC Sabrina Smith, CPC Ellen Bryant, CPMA, CRC Candace Dos Santos, CPC Jennifer Stamey Hannah, CPC Maria Dolores Casas, CPC Samantha D. Ulery, COC Isabella Demedici, CPC-A Candace Mary Jordan, COC Jennifer Stamey Hannah, CPC Maria Grace Morabe, COC Sandi Miller, CPC Jennifer Wood, CPC-A Cara Cross, CPC, CPMA Jeremy Cox, CPC Maria Manolov, CPC Sandra R Talada, CPC Julia Santiago, CPC, CRC Carol Bradley, CPC Jeremy Cox, CPC Maria Robles, CPC Sandra Thompson, CPC Kathleen McKula, CPC, CPMA, CEMC Carol Prince Penninger, COC, CPC Jessica Hurless, CPC Maribeth Durbin, CPC Sandy Mclynch, CPC Kelli Rain, CPC, CPMA Carolyn Bartholomew, CPC Jill Jennings, COC, CPC Marina Gonzalez, CPC Sarah Burnham, CPC Kelly Lauer, COC-A, CPC-A Caryn Kropf, CPC Jill Jorgensen, CPC Marjorie Bedsole, CPC Sarah Lindahl, CPC Kristen Driver, CPC Catina Ann Tomlin, COC, CPC Joan Clyne, CPC, CRC Marlena Daughenbaugh, CPC Shannon M Schwartz, COC Kristin Colbert, CPC-A Cesarina Stagno, CPC Joanna Welch, CPC Mary Alexander, CPC Shannon Ramirez, CPC Laura E Sheriff, CPC, CRC Charity Robinson, CPC Jodi Johnson, CPC Mary Anderson, CPC Shannon Smith, CPC Madhura Malvankar, CPC-A Chaunda Capers, CPC Joett Nicholson, CPC Mary Brasfield,CPC-P Shareef Sabree, COC, CPC Mahathi Chadalavada, CPC-A Cherilyn Phillips, CPC John Christopher Horst, CPC Mary Cortez, CPC Sharon Babin, CPC Marla S Miller, COC, CPC Cherita Turner, CPC Jose Ramon Rodriguez, CPC Mary Duke, CPC Sharon Britian, CPC Mary C Grove, CPC, CIRCC Chindanee Mam, CPC Jose Raul Belen, CPC Mary Wackerle, CPC Sharon Juguilon, CPC Mary Peabody, CPC, CPMA Christa Hendricks, CPC Joyce L Sole Reeves, CPC Marybeth K McCall, COC, CPC Shayla D. Gowers, CPC Nicholas Massa, CPC Christi Timbs, CPC Julie Blanchfield,CPC, CPB Maureen Frederick, CPC Sheetal Bhutani, CPC Nicki Bress, CPC-A Christine Fisk, CPC Julie-Marie Ewell, CPC Maureen Landry, CPC Sheila Ayers, CPC Nicole Clevenger, CPC-A Christine Page, COC, CPC Kaitlyn Leavens, CPC Mayra A Tapia, CPC Sheila Cornwell, CPC Pam Wayman, CPC, CCC Cindy Pennycuff, CPC Kalpita Masani, COC, CPC Megan Gilliam, COC Shellee Barbour, CPC Prema Karthick, CPC-A Crystal A Torres, CPC Kandis Chestnut, COC Megan Pfingsten,CPC Shelley Hutchinson, CPC Ryan John Roberts, CPC, CIRCC, CANPC Crystal Gardner, CPC Kara Markle, COC Melanie Etter, CPC Sherry Sroka, COC, CPC Sarah Collinson, CPC, CPMA, CPCD Cynthia Cochran, CPC Karen A Jones, CPC Melanie Prosser, COC Shervonne L Walker, CPC Sean Su, CRC Cynthia Hogue, CPC Karen C Kostecki, COC, CPC Melissa Clements, CPC Shoshana Espin, CPC Smitha Rachel John, CPC-A Dana Brett, CPC Karen Girard, CPC Melissa Colombo, CPC Sommer Williams, CPC Stacie Buck, CIRCC Dana M Dunn, COC, CPC Karen McLaughlin, COC, CPC Melissa James, CPC Sonia M Magliocchetti, COC, CPC, CPMA, Steven Charles Dina, CPC Dani Compston, COC Karen Trammell, CPC Melissa Roaten, COC CEMC Susan A Carbone, CPC, CPMA, CPC-I Daniel Cormier, CPC Karen Wiedau, COC, CPC-P Melissa Thompson, CPC Stacey Lynn Rudd, CPC Tonya Morgan, CPC-A Darcy Petersen, CPC Karissa Shirts, CPC Michele Dawn Christopher, CPC Stacy Stasiewicz, CPC Deborah Kracl, COC, CPC Katherine Comerford, CPC Michelle Lopez, CPC Stephanie Love Jones, COC, CPC Debra Knight, COC, CPC Kathleen Alvarez, CPC Michelle Mckay, CPC Stephanie Michaelson, CPC ® De’Lyne Willis, CPC Kathleen Ann O’Hara, COC, CPC Michelle Newsome, CPC Stephen Swisher, COC, CPC CPC Dena Childress, CPC Kathryn Crossman, CPC Monita Phillips, COC Sule Mohammed, COC, CPC Diana Brown, CPC Kathy Kirkendall, CPC Mui Ngov, CPC Summer Burns, CPC Abitha Venkatesan, CPC-P Dianne Lolley, CPC-P Katie Cosby, CPC Mykeela L Hackett, CPC Susan Beeman, CPC Adina Lopez, CPC Dolores Morris, CPC Katie Troup, CPC Nancy Choi, CPC Sushma M S, CPC Aimee Kruger, CPC Donna M Gawel, COC Keila Orozco, CPC Nancy Garcia, CPC Suzzeatte Wisdom, CPC Akobundu Amuta, CPC Doris S. Salazar Sawyer, CPC Kelli Anderson, CPC Nancy Louise Lucas, CPC Tammy Comfort, CPC Alice Anne Smith, CPC Dynanna N Bryant, CPC Kelli J Squire, CPC Nannette Mayo, CPC Tammy J Arlt, CPC Alicia Arruda, CPC Ebonie Griffin,CPC Kelli Timmons, CPC Natalie Arnold, CPC Tammy Story, CPC Alicia Evawn Robertson, CPC Elizabeth Thornton, CPC Kelly Marie Kuehn, COC, CPC Natasha D Barrett, CPC Tara Megee, CPC Alicia Roberts, CPC Faith Finley, CPC Kelly McFadden, CPC Nicole Calcanes, COC, CPC Taylor Thompson, CPC Allie Venhuizen, CPC Falecia Randolph, CPC Kelly Sullivan, CPC Nicole Frantz, CPC Teresa Striley, CPC Allison Colwell, COC Felicia Gilliland, CPC Kenrick Mui, COC, CPC Nicole Moulden, CPC Terry Goodman, CPC Alma Morales, CPC Forrest Bleau, CPC Kerry Hooley, CPC Nora Hunter, COC, CPC Tetyana Shlyakhova, CPC Alvina Robinson, CPC Frances Benson, CPC Kevin Mansfield,CPC Pamela Lynn Graham, CPC Theresa Johnson, CPC Amanda Peryea, COC, CPC Francisca Longoria, CPC Kim Godwin, CPC Pamela Medina, CPC Tina Grech, CPC Amanda Ploeger, CPC Frunscean Chisholm- West, CPC Kim Norris, CPC Pamela Schulman, CPC Tina Reiter, CPC Amey Johnson, CPC G Gail Stephenson, CPC, CPC-P Kirk Grantham, CPC, CPMA Pat Hance LPN, CPC Tonya A Miller, CPC Amy Burg, CPC Giovanni Flores, CPC Kristen Hansmann, CPC Patricia Brayton-Winter, CPC Tonya Vike, CPC Amy Kalieta, CPC, CPC-P Girija Reddy, COC, CPC, CIRCC Kristen Ohm, CPC Patricia Nichting, COC, CPC Tracey Morehart, COC, CPC Amy Large, CPC Greta Bach, CPC Kristi Mathews, CPC, CGIC Patti Kelley, CPC Traci Chrisman, CPC Amy Tarr, CPC Gwendolyn Kay Miller, CPC Kristie McDuffie,CPC Paula Giovanetti, CPC Tracie Van Wyngarden, CPC Andrea Lloyd, CPC Hafidh Shihabuddin,CPC Kristin Layne, CPC Phyllis Baker, CPC Tracy Fillies, CPC Angel Hill, CPC Heather Crosby, CPC Kristyn Billings, CPC Phyllis Pratt, CPC Trisha Mullins, CPC Angel Romo-Rubalcaba, CPC Heather Lamberg, CPC Ladina Jones, CPC Prasanna Mary, CPC Tyna Miller, CPC Angela Flory, CPC Heather Matthias, CPC Lakshmi Ramakrishnan, CPC Precy Lim, CPC Valerie Alvarado, CPC Angela Tuck, CPC, CPPM Heather Sorenson, CPC Laureen Marie Conrad, CPC Rachel Ann Cristobal, COC, CPC Vicki Vargas, CPC Angela Ward, CPC Heidi Whitesides, CPC Leah Elise Matthew, CPC Ramona Lazenby, CPC Victoria Basile, CPC Angelena Burks, CPC Holly Christiansen, CPC Leah Johnston, CPC Raul Reyes, CPC Victoria Hubbard, COC, CPC Anna Lorey, CPC-P Inay Iriban, CPC Leann Lawson, CPC Rebecca K Nelson, CPC Virginia Anderson, CPC Annabel Luna Ruiz, CPC Jackie Wabaunsee, CPC LeAnne Mace, COC Rebecca Nieman, CPC Virginia Banatt, CPC Armishia Handberry, CPC Jade Nichole Peterson, COC, CPC Lena Nicole Clark, CPC Rebecca Rios, CPC Wayne Greenwood, CPC Ashley A Titus, COC, CPC Jamie Ashby, CPC Lenora Williams, CPC Regina Taylor, CPC Wendy R Lawrence, CPC Ashley Sewald, CPC Jamie Reidhead, CPC Leona Lutsch, CPC Renae Wilson, COC Wendy S Rowe, COC, CPC, CPMA Audrey Lynne Schaffran, CPC

60 Healthcare Business Monthly NEWLY CREDENTIALED MEMBERS

Wendy Sowa-Maldarelli, CPC Andrea Howard, CPC-A Bao Vang, CPC-A Chelsea Pederson, CPC-A Diana Neatrour, CPC-A Wendy W Knight, CPC Andrea Ketelhut, COC-A Barbara Clavier, CPC-A Cherie Ann Nickles, CPC-A Diane Carpenter, CPC-A Whitney Loss, CPC Andrea Koberlein, CPC-A Barbara McCray, COC-A Cheryl Moser, CPC-A Diguvapati Naga Lingeswara Reddy, Yasmin Mejia, CPC Andrea Leann Strauch, COC-A Barbara O’Neil, CPC-P-A, CPB Cheyanne Andersen, CPC-A CPC-A Yolonda Ray, CPC Andrea Pearson, CPC-A Barbara Pascarella, CPC-A Chiluveru Manogna, COC-A Dina O’Reilly, CPC-A Andrew Cobbs, COC-A, CPC-A Barbara Robson, CPC-A Chindam Rajesh, CPC-A Dinesh Chauhan, CPC-A Andrew David Martin, CPC-A Beatrice A Santos, CPC-A Chitipothu Shruthi, CPC-A Divya Gurusekaran, CPC-A Andrew Yurkosky, CPC-A Belinda Interior Gonzalvo, CPC-A Chitra Nellaiappan, CPC-A Divya Palanisamy, CPC-A Apprentice Andria Riley, CPC-A Benjamin Whitt, CPC-A Chitra Sekar, COC-A Divyaa Doguparthi, COC-A Angel M Dauzat, CPC-A Benzy Ann Mathew, CPC-A Chris Faber, CPC-A Dolmaya Thogra, COC-A A. Deepthi, CPC-A Angel Musgrave, COC-A, CPC-A Bestha Chandra Sekhar, COC-A Chris Voutas, CPC-A Dolores Ratay, CPC-A Aaron Collard, CPC-A Angela Allen, CPC-A Beth King, CPC-A Christa Clagon, CPC-A Dominic Bethel II, CPC-A Aarti Singh, CPC-A Angela Blythe, CPC-A Beth Shelton, CPC-A Christina Franks, CPC-A Doneice Honeycutt, CPC-A Abbey Morin, CPC-A Angela Gieling, CPC-A Betsy Johnson, CPC-A Christopher Boc, CPC-A Donica Marie Collier, CPC-A Abdul Hafeez Salam, COC-A Angela Tunstall, CPC-A Betty Duncan, CPC-A Christopher Nicolaison, CPC-A Donna Bougher, CPC-A Abinaya Vidyashankar, CPC-A Angela Wilson, CPC-A Beverly Gagnon Miller, CPC-A, CPB Christopher Steven Hayes, CPC-A Donna Corbani, CPC-A Africa Bulbula, CPC-A Angelia Brown, CPC-A Bhavya Ravikumar, CPC-A Cindy Jackson, CPC-A Donna Houghton, CPC-A Agnieszka Piqueras, CPC-A Angie C Flaherty, CPC-A Bhimrao Chandrakant Gawade, CPC-A Cindy Sue Arnold, COC-A, CPC-A Donna Moore, CPC-A Aileen Boucher, CPC-A Anil Pandey, CPC-A Bhumika Patel, CPC-A Claire Meehan, CPC-A Donna Sestito, CPC-A Akash Chauda Gupta, COC-A Anila Lakshmanan, CPC-A Bhuvaneshwari Rajan, CPC-A Clifford Chen, CPC-A Doreen Melear, CPC-A Alayna Reagor, CPC-A Anish Thomas, CPC-A Bhuvaneshwari Thirumoorthy, CPC-A Colleen Kobe, COC-A Dorene Thorgesen, CPC-A Alejandra C Martinez, CPC-A Anita Hahner, CPC-A Bhuvaneswari M Sivakumar, CPC-A Connie Mucci, CPC-A Dottie Sue Davis, CPC-A Alejandra Troconis, CPC-A Anitha Kanagarajan, CPC-A Billie Jo Robbins, CPC-A Connie Ward, CPC-A Dwight Jackson, CPC-A Alekhya Bollina, COC-A Anju Suresh, COC-A Binoy Thomas, CPC-A Constance Duff, CPC-A Earl T. Burris III, CPC-A Alexander Pait, CPC-A Ann Mia Haning, CPC-A Birgit Williams, CPC-A Corina Diaz, CPC-A Eden Cabalu, CPC-A Alexandra Fancher, CPC-A Anna Miller, CPC-A Bisher Changaranchola, CPC-A Corinne Weckherlin, CPC-A Edmee Vale, CPC-A Alicia J Olmeda, CPC-A Annamarie Forcella, CPC-A Blessy Nishanthi, CPC-A Corissa Mclean, CPC-A Eileen Maca, CPC-A Alicia Aamoth, CPC-A Anne Ardath Stakkeland, CPC-A Bobbi Such, CPC-A, CPB Corrie Nave, CPC-A Elena Long, CPC-A Alicia Bellante, CPC-A Anne Winchell, CPC-A Bobby Lowe, CPC-A Courtney Crookshanks, CPC-A Elisha Somers, CPC-A Alicia Clardy, CPC-A Annette Cleveland, CPC-A Bojarajan Kumarasamy, COC-A Cristina Hebert, CPC-A Elizabeth Ann White, CPC-A Alicia Pride, CPC-A Annie Fettig, CPC-A Bonita Garshnick, CPC-A Crystal Gonzales, CPC-A Elizabeth Boden, CPC-A Alicia Ripa, COC-A, CPC-A Annie Houser, CPC-A Bonthala Ramesh, CPC-A Crystal Thompson, CPC-A Elizabeth Cardenas, CPC-A Alison Hatt, CPC-A AnnMarie O’Neill, COC-A Brad Schwarck, CPC-A Crystal Thompson, CPC-A Elizabeth Parsons, CPC-A Alison Simmons, CPC-A Anns Jacob, CPC-A Brandi Brown, CPC-A Crystal Watkins, CPC-A Elizabeth Tressler, CPC-A Alissa Bradburn, CPC-A Annu Agrawal, CPC-A Brandy Zurcher, CPC-A Cymantha Martinez, CPC-A Elizabeth Watts, CPC-A Allison Blair, CPC-A Annu Kumari, COC-A Breanna Salamone, CPC-A Cynthia Cox, CPC-A Ella Uma Devi, CPC-A Allison Davis, CPC-A Antomary Bincy.J, CPC-A Brenda Johnson, CPC-A Cynthia Howell, CPC-A Ellenmarie Caisse, CPC-A Allison Klosky, CPC-A Anu Varghese, CPC-A Brenda Jones, CPC-A Dale Spencer, CPC-A Emily Bernhardt, CPC-A Allison Troxell, CPC-A Anumol Krishnankutty, CPC-A Brenda L Lass, CPC-A Dan Hughes, CPC-A Emily Jones, CPC-A Allu Naresh Kumar, CPC-A Aparna Gopireddy, CPC-A Brenda Marcum, CPC-A Dandu Swathi, CPC-A Emily Long, CPC-A Allyson Hafner, CPC-A Aparna Piraji Jadhav, CPC-A Brennan Mainers, CPC-A Daniel Criswell, CPC-A Emily Lovelace, CPC-A Althea Mathews, CPC-A April Bouchie, CPC-A Brittany Adams, CPC-A Daniel Toledo, CPC-A Enosh Saka, COC-A Alwyn Fong, CPC-A April Euteneuer, CPC-A Brittney McClafferty, CPC-A Danielle Arcadi, CPC-A Erica Griffin,CPC-A Alyssa Ditzler Ethridge, CPC-P-A April Evans, CPC-A Broncy Rose Joseph, CPC-A Danielle Emerson, CPC-A Erica Ramirez, CPC-A Alyssa Norton, CPC-A April King, CPC-A Bryan Jefferson Icban, CPC-A Danielle Garvey, CPC-A Erik Geissal, CPC-A Amanda R Brown, CPC-A April Morin, CPC-A Camille Sewell, CPC-A Danielle Papa, CPC-A Erin Ash, CPC-A Amanda Boronda, CPC-A April Sayers, CPC-A Candace Jolene Harmer, CPC-A Danielle Scholten, CPC-A Erin Aune, CPC-A Amanda Bullis, CPC-A Aprille Ruiz, CPC-A Candace Sizemore, CPC-A Davette Malufka, CPC-A Erin Becker, CPC-A Amanda Costabile, CPC-A Archana Hole, COC-A Candice Waples, CPC-A David Hurst, CPC-A Erin Lynn Jehle, CPC-A Amanda Figel, CPC-A Archana KishorKumar, CPC-A Carie McCormick, CPC-A David McElfresh, CPC-A Erin Thunder, CPC-A Amanda Frazier, CPC-A Archana Srinivasan, CPC-A Carla Rose, CPC-A Dawn Elford, CPC-A Errer ‘Dena’ Jackson, CPC-A Amanda Harvey, CPC-A Ardenia Lowry, CPC-A Carly Ziev, CPC-A Dawn Loser, CPC-A Esther Leal, CPC-A Amanda Perkins, CPC-A Arlene Edwards, CPC-A Carmela Mendoza-Baltazar, CPC-A Dawna Alphonse, CPC-A Etta Smalley, CPC-A Amanda Sauls, CPC-A Arshkara Khan, COC-A Carmen Garcia, CPC-A Deann Reed, CPC-A Eva Janice Gauthier, CPC-A Amanda Swords, CPC-A Arunkumar Jagadesan, CPC-A Carol Swedensky, CPC-A Debby Waddle, CPC-A Evelyn Aguirre, COC-A Amarnath Arjunan, COC-A, CPC-A Arvind Singh Kaira, CPC-A Carolyn Carr, CPC-A Deborah Brookover, CPC-A Evelyn Harr, CPC-A Amber DeAtley, CPC-A Aseem Arora, CPC-A Carolyn Michele Shaw, CPC-A Deborah Cramer, CPC-A Fahida Moinudheen, CPC-A Amber Gay, CPC-A Asha Irine Monis, CPC-A Carrie Flood, CPC-A Deborah McGhee, CPC-A Falon Stone, COC-A Amber Green, CPC-A Ashanti Hadley, CPC-A Carrie Scholl, CPC-A Deborah Wodhanil, CPC-A Fawn L Lueck, CPC-A Amber Kashyap, CPC-A Ashley Care, CPC-A Carrie Stubbs, CPC-A Debra Granger, CPC-A Faye Halbur, COC-A Amber Kean, CPC-A Ashley Dixon, CPC-A Cassandra Rogers, CPC-A Deena Barton, CPC-A Frances Ellaine Roc, CPC-A Amber Mayhew, CPC-A Ashley Hall, CPC-A Cassie A Burkholder, CPC-A Deepa Muthusamy, CPC-A Frances Michelle Strickland, CPC-A Amber Mitchell-Gamber, CPC-A Ashley Hillestad, CPC-A Cassie Parker, COC-A, CPC-A Deepthi Ghanta, CPC-A Gade Mallikarjuna Rao, COC-A Amber O’Daniel, CPC-A Ashley Mayers, CPC-A Cassie Rainwater, CPC-A Dellareese M Lowe, CPC-A Gail Clizbe, CPC-A Amber Orchowski, CPC-A Ashley Porter, CPC-A Catherine Santiago, CPC-A Delphin Joseph, COC-A Gail Quinn, CPC-A Amber Ramsey, CPC-A Ashley Wollaber, CPC-A Cathy Maniatakos, CPC-A Denise Inman, CPC-A Gayathri Pugalanthi, CPC-A Amber Schmidt, CPC-A Ashok Gundabathina, COC-A Celeste Misbah, CPC-A Denise Bostic, CPC-A Gayle Farha, CPC-A Amber Thornton, CPC-A Ashwini Dhopte, COC-A Ch. Amrutha, CPC-A Denise Faulkner, CPC-A Gelisa Stafford, CPC-A Amelia Rogers, CPC-A Ashwini Raja, COC-A Challa Sindhu, CPC-A Denise Kline, COC-A Genevieve Kellogg, CPC-A Amudhavalli D, CPC-A Aswathy Madathil Rajappan Nair, CPC-A Chandra Weekley, CPC-A Denise M Kelley, CPC-A George Esguerra, COC-A, CPC-A, CPB Amy Bunyard, CPC-A Azarudheen Tajudheen, CPC-A Chandrashekhar Puyed, CPC-A Denise M Kelley, CPC-A Gerardo Vela, CPC-A Amy Coyle, CPC-A B.K. Jayalakshmi, CPC-A Channon Stout, CPC-A Dephanie Hogan Begay, CPC-A Geri Smith, CPC-A Amy L Ramadhan, COC-A, CPC-A Bahoran Singh, CPC-A Charles Grant, CPC-A DeShara Shells, CPC-A Gia Jacquet, CPC-A Amy Plante, CPC-A Bala Murali, CPC-A Charlie Flores, CPC-A Desiree Elekwa-Izuakor, CPC-A Ginger Persinger, CPC-A Ana Bernal-Martinez, CPC-A Bandi Shankar, COC-A Charlotte Dunkle, COC-A, CPC-A Desiree Schwartz, CPC-A Ginger Walsh, CPC-A Ana Katherine James, CPC-A Bandi Shilpa, CPC-A Charlotte Jean, CPC-A Dhivya Prabha Palanisamy, CPC-A Giuliano Edmund Fabian, CPC-A Ancy Kurumkulam Peter, CPC-A Bangaru Pavani Teja, CPC-A Chelsea Moody, CPC-A Diamela Valdes, CPC-A Givenchy Costar, CPC-A Andrea Dow, COC-A

www.aapc.com December 2015 61 NEWLY CREDENTIALED MEMBERS

Glenda Werkmeister, CPC-A Jenna Brown, CPC-A Kacey Dodenhoff, CPC-A Kim Iles, CPC-A Lisa Spohn, CPC-A Gloria Beverly, CPC-A Jennetta R Parker, CPC-A Kaitlin Tatro, CPC-A Kimberley Stoner, CPC-A Lisa Walsh, CPC-A Gloria D Durham, CPC-A Jennie Alvarado, CPC-A Kaitlin Wilhalme, CPC-A Kimberly Ehlert, CPC-A Lisdey Silverio Castillo, CPC-A Gloria Myllykangas, CPC-A Jennie Rowland, CPC-A Kalika Colquhoun, CPC-A Kimberly Noble, CPC-A Loogeswary Thiruvengadam, COC-A Gomathi Palanisamy, CPC-A Jennifer Birkbeck, CPC-A Kalpana Nagar, CPC-A Kiruthika Mohan, CPC-A Loretha Davis, CPC-A Gouse Mohiddin Sayyad, CPC-A Jennifer Bodie, CPC-A Kalpana Premkumar, CPC-A Klnrr Deepika, CPC-A Lori Bloom, CPC-A Grace Anne Tudan, CPC-A Jennifer Braunschweig, CPC-A Kalpana Ragala, CPC-A Kolla Jaipal Reddy, CPC-A Lori Gomez, CPC-A Greg Killian, CPC-A Jennifer Burris, CPC-A Kalyana Sundaram Nataraj, CPC-A Komal Bhumkar, COC-A Lori Krueger, PharmD, CPC-A Gregory Thompson, COC-A, CPC-A Jennifer Chaffin,CPC-A Kamal Saini, CPC-A Konda Sravanthi, CPC-A Lori L Mauel, CPC-A Gretchen Bender, CPC-A Jennifer Fenger, CPC-A Kanaka Spandan, COC-A Kori E Frank, CPC-A Lori Scarafile,CPC-A Gricel Rivera, CPC-A Jennifer Gray, CPC-A Kandula Lakshmi Chandana, CPC-A Kourtney Wright, CPC-A Lorraine Marshall, CPC-A Guinevere Shapiola, CPC-A Jennifer Knolton, CPC-A Kandy Olsen, CPC-A Krishan Gopal, CPC-A Louise Kauppinen, CPC-A Gunasekar Ramaiah, COC-A Jennifer Kunz, CPC-A Kannan S, COC-A Krishnaveni PV, CPC-A Luida Rieche, CPC-A Gurpreet Matharu, CPC-A Jennifer Maciej, CPC-A Kannan Thonthi, COC-A Kristen Driver, CPC-A Lukaiah Guduri, COC-A Gurrapu Naveen, CPC-A Jennifer Manella, CPC-A Kara Masters, CPC-A Kristi Truscott, CPC-A LydiaRathna Sugunaraj, CPC-A Hanna Marie Langley, CPC-A Jennifer Painter, CPC-A Kara McConniel, CPC-A Kristin Fessick, CPC-A Lynda Beamish, CPC-A Hari Priya Balasubramaniam, CPC-A Jennifer Reddick, CPC-A Kara Shaver, CPC-A Kristina Dawson, COC-A Lynsey Hersley, CPC-A Haris Rahman, CPC-A Jennifer Schmid, CPC-A Karen Brautigam, CPC-A Kristy Parker, CPC-A M Swapna Latha, CPC-A Harold Moran, COC-A Jennifer Torres, CPC-A Karen Case, CPC-A Kshama Nagaraj, COC-A, CPC-A, CPB M. Shekar goud, CPC-A Heather Harvey, CPC-A Jenny Noel, CPC-A Karen Garofano, COC-A L. Rakesh Reddy, CPC-A Mackenzie Pennington, CPC-A Heather Nelson, CPC-A Jessica Giffin,CPC-A Karen King, COC-A, CPC-A Lacey Nally, CPC-A Madison Kelly, CPC-A Heather Orza, CPC-A Jessica Bowen, CPC-A, CPB Karen M Hanson, COC-A Lacey Rosson, CPC-A Makesha Lynn Pettit, CPC-A Heather Perry, CPC-A Jessica Erin Harris, COC-A, CPC-A Karen Mandt, CPC-A Lakmini Prematillake, CPC-A Malisa Jokbengboon, CPC-A Heidi Hughes, CPC-A Jessica Gonzalez, CPC-A Karen Marosz, CPC-A Lana Lamas-Nicholson, CPC-A Mallory Reefer, CPC-A Heidi Marie Whiteman, CPC-A Jessica Gonzalez, CPC-A Karen McCulloch, COC-A Lane Mayhew, CPC-A Mamta Kapoor, CPC-A Heidi Smith, CPC-A Jessica Helfrich, CPC-A Karen McEuen, COC-A Laneta Kay Watts, CPC-A Manasi Maji, CPC-A Henry Algarin, CPC-A Jessica Kerbs, CPC-A Karen Mohler, CPC-A Lanka Ravi Kiran, CPC-A Mandati Shanthi Sree, CPC-A Hillary True, CPC-A Jessica L McKenzie, CPC-A Karen Phipps, CPC-A Larissa Amundson-Keller, CPC-A Manikandan Sekar, COC-A Himabindu Yampati, COC-A Jessica Lynn Bixby, CPC-A Karen Richter, CPC-A LaShanda Wilks, CPC-A Manoj S, COC-A Holli Peifer, CPC-A Jessica Swenson Nelson, CPC-A Karen Sutley, CPC-A Laura Davy, CPC-A Marci Dusseault, CPC-A Holly Brock, CPC-A Jessica Thomas, CPC-A Karen Thomas, CPC-A Laura Lacy, CPC-A Marcia Cornele, COC-A Holly Gillingham, CPC-A Jessica Williams, CPC-P-A Kari Christopherson, CPC-A Laura Liu, CPC-A Mareena Susan Roy, CPC-A Humaira Shah, CPC-A Jeydaliz Ruiz, CPC-A Kari Jackson, CPC-A Laura Route, CPC-A Margaret Rogers, CPC-A Inbaraj Chandran, COC-A Jho Mhar De Chavez Malinao, CPC-A Kari Johnson, CPC-A Laurel Frudd, CPC-A Margorie Bartley, CPC-A Iracema Hernandez, CPC-A Jijitha Hareendran, CPC-A Kari Stordahl, CPC-A Lauren Ariane McCloskey, CPC-A Maria A Hershberger, CPC-A Israr Saifi,CPC-A Jill Benson, CPC-A Karl Olson, CPC-A Lauren Calhoun, CPC-A Maria Bilbao, CPC-A Jackannette Drisko, CPC-A Jill Dunton, CPC-A Karolina Majerczak, CPC-A Lauren Creager, COC-A Maria Rosetto, CPC-A Jackie LeClair, CPC-A Jill Headley, CPC-A Karra Cubellis, CPC-A Lauren Davis, CPC-A Maria Teresa Gonzalez, CPC-A Jacob Robinson, CPC-A Jill Huston, CPC-A Karri Kavitha, CPC-A Lauren Hartigan, CPC-A Mariah Mikula, CPC-A Jacqueline Krueger, CPC-A Jill Manca, CPC-A Karthikeyan Duraisamy, COC-A Laurena Laughlin, CPC-A Maricel Borges, CPC-A Jacqueline Skahan, CPC-A Jill Miyagawa, CPC-A Karyn Sweeney, CPC-A Laurie Schrader, CPC-A Marie Agnes Holliday, CPC-A Jaime Moore, CPC-A Jillian Kelly, CPC-A Kasey Boehmann, CPC-A Laurilee Eades, CPC-A Marie Johnson, CPC-P-A Jalpa Parmar, CPC-A Jim Dimartino, CPC-A Katelyn Delorm, CPC-A Lavina Edward Joseph, COC-A Marilyn Jaskowiak, CPC-A Jamell Richmond, CPC-A Jim Kim, CPC-A Katherine Ingram, CPC-A Layla Abdirahman, CPC-A Marilyn Wheat, CPC-A Jamie Lee Geronimo Staples, CPC-A Jinoy Mathew, CPC-A Kathleen Carroll, CPC-A Leah Corbett, CPC-A Marissa Macri, CPC-A Jamie Petricich, CPC-A JoAnn Reed, CPC-A Kathleen Gione, COC-A Leeann OByrne, CPC-A Martin Richards, CPC-A Jamie Tauferner, CPC-A Joanne Anheuser, CPC-A Kathleen Lazar, CPC-A Leigh Harold, CPC-A Mary Dominique G Deato, CPC-A Jan Edward Julian, CPC-A Joanne Ching, CPC-A Kathleen Loera, CPC-A Leighanne Truelove, CPC-A Mary Grace Reyes, CPC-A Jan Ingram, CPC-A Joanne Graham, CPC-A Kathryn C Smith, CPC-A Lendi Kinsaul Watkins, CPC-A Mary Hogan, CPC-A Jana Martin, CPC-A Joanne McGraw, COC-A Kathryn Klingenberg, CPC-A Leslie Eysler, CPC-A Mary Kay Bross, CPC-A Jana Sanderson, CPC-A Jodi Atwood, CPC-A Kathy Ude, CPC-A Leticia Bellantoni, CPC-A Mary Nancy Gnanasekaran, CPC-A Jane Mattison, CPC-A Jody A Hubbard, CPC-A Katrina Boldt, CPC-A Lija George, CPC-A Mary Pavithra, CPC-A Jane McKenzie, CPC-A Joey Sandoval, CPC-A Kavitha Aarthiga Kalyana Sundaram, CPC-A Lilli Thorsell, CPC-A Mary Quinn, CPC-A Janelle Crahan, CPC-A John Henry Caranto, CPC-A Kavitha Prakash, CPC-A Lily Pennell, CPC-A Mary Roland, COC-A Janet Egessah, CPC-A John Paquette, CPC-A Kavitha Subbiah, CPC-A Linda Bugdanowitz, CPC-A Mary Surber, COC-A Janet Varathan, CPC-A Jolene Riesselman, COC-A Kayalvizhi P, CPC-A Linda Luxo, COC-A Mary Wilson, CPC-P-A Janice Newman, CPC-A Jolynn Ortiz, CPC-A Kayla M Beachler, CPC-A Linda Morse, CPC-A Maurice Mankowski, CPC-A Janice Wilson, CPC-A Jonathan Haney, CPC-A Kayla Miller, CPC-A Lindsay Carlson, CPC-A Mazen Zakeria, CPC-A Janine Mills, CPC-A Jonathan Torres, CPC-A Kayla Rivera, CPC-A Lindsay Sobczak, CPC-A Meagan Taylor, CPC-A Janine Skwarczynski, CPC-A Jonida Murati, CPC-A Kay-lee Alaspa, CPC-A Lindsey Cleek, CPC-A Megan Allen, COC-A, CPC-A Jaqueline Da Silva, CPC-A Jordan Stacey, COC-A Kayleigh Frazier, CPC-A Lindsey Smith, CPC-A, CPB Megan Barnes, CPC-A Jaro Mayda, CPC-A Josephine Mcgonagle, CPC-A Keely Geffre, CPC-A Lindsey Voorhies, CPC-A Megan Drake, CPC-A Jasmil Fabiano, CPC-A Joshua Martin, CPC-A Kelli Beck, COC-A Lindy Aven, CPC-A Megan Guymon, CPC-A Javier Cavazos, CPC-A Joy Meharg, CPC-A Kellie Koop, CPC-A Lisa Baker, CPC-A Megan Heusinkveld, CPC-A Jayalakshmi Y, CPC-A Joy Stearns, CPC-A Kelly Brogan, CPC-A Lisa Clugston, CPC-A Megan Kincade, CPC-A Jayalakshmi Yadav Guthi, CPC-A Joyce Esther Rani, CPC-A Kelly Conner, CPC-A Lisa Colbert, CPC-A Megan Potter, CPC-A Jayme Uhrig, CPC-A Joyce Weis, CPC-A Kelly L Carter, CPC-A Lisa Creech, CPC-A Megan Stafford, CPC-A Jayme Yoshida, CPC-P-A Joyce Willettte, CPC-A Kelly Moody, CPC-A Lisa Davis, CPC-A Megha Dhanesh, CPC-A Jé DeVance, CPC-A Julia Donohue, CPC-A Kelly Sarratt, CPC-A Lisa Harvey, COC-A Melanie Brame, CPC-A Jean Stackpoole, CPC-A Julia Mink, CPC-A Kelsey Apodaca, CPC-A Lisa Hembree, CPC-A Melanie Brown, CPC-A Jean Szurgot, CPC-A Julie Worch, CPC-A Kelsey Ellis, CPC-A Lisa Jones, CPC-A Melanie Javier, CPC-A Jeanette Bueno Bautista, CPC-A June Martin, CPC-A Kelsey Ellis, CPC-A Lisa Ketsenburg, CPC-A Melanie Mathis, CPC-A Jeanette Springer, COC-A Juney Jose, CPC-A Kelsi Noteboom, CPC-A Lisa Kindig, CPC-A Melannie Phillips, CPC-A Jeanie Ogle, COC-A Justine Gaumond, CPC-A Kenzi Brooks, COC-A, CPC-A Lisa Lange, CPC-A Melinda DeVries, CPC-A Jeannie Scott, CPC-A Jyotir Kulmacz, CPC-A Kevin Sherar, CPC-A Lisa McLeod, CPC-A Melissa Archie, CPC-A Jeni Danielak, CPC-A K. Madhavi, CPC-A Kiarra Harris, CPC-A Lisa Melanson, CPC-A Melissa Ballester, CPC-A Jenifer Tobin, CPC-A K. Vinutna, CPC-A Kim Ford, CPC-A Lisa Mills, CPC-A Melissa Cox, CPC-A

62 Healthcare Business Monthly NEWLY CREDENTIALED MEMBERS

Melissa Daniels, CPC-A Nirmala Devi Rodda, CPC-A Raju Aloopady Padmanabhan, CPC-A Samudrala Naresh, COC-A Stacey Amick, CPC-A Melissa Douglas, CPC-A Nirmala Dharmalingam, CPC-A Ramprasad Dussa, COC-A Samuel Richardson, CPC-A Stacey Benson, CPC-A Melissa Edwards, CPC-A Nishanth Purushothaman, COC-A Ramya Parthasarathy, CPC-A, CPB Sandhya Dumpa, COC-A Stacey Brewer, COC-A Melissa Fischer, CPC-A Nivas Raj Ganesan, CPC-A Ramya Devi, COC-A Sandhya Lahu Dhuri, COC-A Staci Ertzberger, CPC-A Melissa Grainger-Harry, CPC-A Nkiru Ogbogu, CPC-A Randi Hillebrandt, CPC-A Sandra Garrett, CPC-A Staci Wortzman, CPC-A Melissa Hollar, CPC-A Nnaemeka Morah, CPC-A Raquel Kenley, CPC-A Sandra Zanos, CPC-A Stacie Ann Parker, CPC-A Melissa Rhodes, CPC-A Noor Aaysha Nasrin Mohamed Sadiq, Raquel Rodriguez, CPC-A Sangeetha Chinnarasu, COC-A, CPC-A Stacy Cable, CPC-A Melissa S Bundren, CPC-A CPC-A Rashedha Banu Mohammed Abubackar, Sara Acevedo, CPC-A Stacy Escobedo, CPC-A Menaka Baskaran, CPC-A Norazimah Sabree, CPC-A CPC-A Sara Burnette, CPC-A Stacy Fitzgerald, CPC-A Michael Chastain, CPC-A Nuseba Abdul Khader, CPC-A Ravi Kishore Yadav Romala, COC-A Sara Jordan, CPC-A Stacy Norton, CPC-A Michele deJong, CPC-A Nydia Davila, CPC-A Ravi Tripathi, CPC-A Sara Shader, CPC-A Stacy Webb, CPC-A Michele Krieg, CPC-A Odapally Srinivas, CPC-A Ravindar Reddy D, CPC-A Sarah Bridgeman, CPC-A Starlet Verhovec, CPC-A Michele Weir, CPC-A Odette Alonso, COC-A Rebecca Broome, CPC-A Sarah Buonano, CPC-A Stephanie Allen, CPC-A Michele Yanes, CPC-A Olive Carlos, CPC-A Rebecca Jasse, CPC-A Sarah Cole, COC-A, CPC-A Stephanie Anderson, CPC-A Michelle Gregorius, CPC-A Olivia Wiltse, CPC-A Rebecca Kraynak, CPC-A Sarah Malin, CPC-A Stephanie Davis, CPC-A Michelle Hastedt, CPC-A Olivia Wong, CPC-A Rebecca Mullins, CPC-A Sarah Mcclellan, CPC-A Stephanie Fox, CPC-A Michelle Hutton, CPC-A Olyvia Freeman, CPC-A Rebecca Snowberger, CPC-A Sarah McQueen, CPC-A Stephanie Grice, COC-A Michelle Marie Pajimula, CPC-A Omar Emil Monet, COC-A Rebecca Young, CPC-A Sarah Rios, CPC-A Stephanie Guynn, CPC-A Michelle Othot, CPC-A P. 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Lokesh, CPC-A Patricia Mathison, CPC-A Robert Palmer, CPC-A Shannon Strickland, CPC-A Susan Ferrara, CPC-A Nadezhda Shotropa, CPC-A Patricia Possenriede, CPC-A Roberta Phillips, CPC-A Shannon Suezann Cobb, CPC-A Susan Langley, COC-A Naeem Parveen, CPC-A Paula-Kay Magda, CPC-A Robin B Stewart, CPC-A Shari Floyd, CPC-A Susan Shuman, CPC-A Nagadurgaprasad Bodapati, COC-A Paulette Palmer, CPC-A Robin Clark, CPC-A Sharon Jackson, CPC-A Susan Vanessa Titus-Davies, CPC-A Nakia Young, CPC-A Paulette Viney, CPC-A Robin Cox, CPC-A Sharon Maike, CPC-A Susan Whitehall, CPC-A Namdev Kadam, CPC-A Pawan Sharma, COC-A Robyn Roche, CPC-A Shashi Kant Patel, COC-A Sushma Somisetty, CPC-A Nancy A Galvin, CPC-A Peggy Klocke, COC-A Robynn Denise Cochran, CPC-A Shauna Lemay, COC-A Suvarna Salunke, CPC-A Nancy Anderson, CPC-A Peggy Trujillo, CPC-A Rohan Brizan, CPC-A Shawn Weaver, CPC-A Suvidha Sangaraju, CPC-A Nancy Dougherty, CPC-A Penumaka BabyRajitha, CPC-A Rohan Pardeshi, CPC-A Sheba Sushma, CPC-A Suvila Samuvel, CPC-A Nancy Gulley, CPC-A Phyllis Ann Zyglewyz, CPC-A Rohini Patil, COC-A Sheilene Simon, CPC-A Suzanne Hernandez, CPC-A Nancy Hochu-Oliveira, CPC-A Pillalamarri Kalyani, CPC-A Ronda Lister, CPC-A Shelby Matsuoka, CPC-A Suzanne Paglino, CPC-A Nandhini Madheswaran, CPC-A Polinaidu Bonu, COC-A Roni Lynch, CPC-A Shelley Bojalad, CPC-A Swarnalatha R, COC-A Nandini Sekar, CPC-A Pooja Pandey, CPC-A Rosa Lee Trompeter, CPC-A Shemia Joseph, CPC-A Sydney Perez-Means, CPC-A Natalie Anderson, COC-A, CPC-A Poonam Nigam, CPC-A Rosaelia Samaniego, CPC-A Sheneika Green, CPC-A Sydney Salazar, CPC-A Natalie Jury, CPC-A Poonam Vilas Wankhade, COC-A Rose Wakefield,CPC-A Sheri Davis, CPC-A Tabitha Williams, CPC-A Natalie Norris, CPC-A Prachi Dhobale, CPC-A RoselinJannet AbrahamMani, CPC-A Sherri Barnes, CPC-A Tacheima Bien-Aime, COC-A, CPC-A Natalie Russell, CPC-A Pramit Kumar, CPC-A Rosely Arugolanu, CPC-A Sherry Mitchell, CPC-A Taelor Wright, CPC-A NaTasha Ross, CPC-A Prasad K, CPC-A Roshni Rai, CPC-A Sheryl Houser, CPC-A Tami Randall, CPC-A Nate Evans, CPC-A Prashanth Kukkala, CPC-A Roslyn Bouchikas, COC-A Shirish Shrikrishna Patil, CPC-A Tami Wilson, CPC-A Nathan Bushlow, CPC-A Prashanthi Dharmaraj, CPC-A Rozalia Arguello, CPC-A Shivalore Swarna latha, CPC-A Tamila Emerick, CPC-A Natraj Adla, COC-A Prathima Badrinarayanan, COC-A Rupali Gupta, COC-A, CPC-A Shraddha Singh, CPC-A Tammi Seger, CPC-A Naveen Kumar, CPC-A Priya B, CPC-A Ruth Zinken, CPC-A Sierra Bunting, CPC-A Tammy Dreves, CPC-A Neelam Malumphy, COC-A Priya Krishnan, CPC-A Ryan Boyle, CPC-A Silpa V E, CPC-A Tammy Warren, CPC-A Nereida Bruno, CPC-A Priyanka Mekala, COC-A Ryan S Dischner, CPC-A Silva Sarian, CPC-A Tangala Malone, CPC-A Nezyl Mante, CPC-A Priyanka Patil, COC-A Ryan Williams, CPC-A Siranjeevi Chandran, CPC-A Taniqua M. Alexander, CPC-A Nichol Wilson, CPC-A Prudhvi Vani Yerram Setti, CPC-A S. Arun Kumar, CPC-A Sivapriya Sugumar, CPC-A Tanura Marcheline Moss, COC-A Nicole Bokanoski, CPC-A Pugazholi Parthiban, CPC-A Sabitha Kethineedi, COC-A Soibam Sotindro Singh, CPC-A Tanya Philip, CPC-A Nicole Litterio, CPC-A Quiana Petteway, CPC-A Sabrenia Johnson, CPC-A Somesh Bhatt, CPC-A Tara Goedken, CPC-A Nicole M Ball, CPC-A R. 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www.aapc.com December 2015 65 I Am AAPC ALLISON WEIR, CPC-A t 16 I knew I wanted to work in the healthcare field. My first interest was sparked Awhen my healthcare science teacher described her experiences in nursing school and how the field of nursing had evolved since then. I had a class book, which listed a position profile for each member of the healthcare team. I was fascinated with this book and researched many positions to help me decide on a good fit. Decisions, Decisions Would I be a sonographer, a phlebotomist, or a registered nurse? Would I work in the business of healthcare? It was a tough choice. Finally, I chose to enroll in the Medical Office Administration program at my local community college. Out of all the business career options, medical billing and coding interested me most. Coding remained an elusive choice for me. I wanted to learn more about coding, but did not have the resources to train for certification. After graduating with an associate degree, I found an entry level job as a medical billing specialist. After much trial and error, I learned the steps for getting denied claims paid. I used payer contract knowledge to organize a process that minimizes billing errors and helps secure clean claims.

#IamAAPC I feel very lucky Diving Into the Science of Coding to have found my I gained experience working with insurance systems, but I also was interested in the science of medicine. I made the decision to use my savings to take a training course niche and I am in coding. As I learned more about coding, I became fascinated with how the com- plexities of disease processes and medical treatments can be condensed into one excited to begin system and re-organized in a way that allows the patient’s clinical picture to be ex- plained in a concise and logical manner on the claim form. my career as a coder Staying Connected Is Key in the midst of The biggest goal I have as a newly credentialed coder is to stay as keenly connected as possible to the issues underlying reimbursement. No one knows how proposed ICD-10, one of the changes to reimbursement structure may affect the role of coders. I am not sure where this will lead me in my career, but I do know that I will embrace change. I feel most significant very lucky to have found my niche and I am excited to begin my career as a coder in the midst of ICD-10, one of the most significant changes in healthcare history. changes in healthcare history.

#IamAAPC Healthcare Business Monthly wants to know why you chose to be a healthcare business professional. Explain in less than 400 words why you chose your healthcare career, how you got to where you are, and your future career plans. Send your stories and a digital photo of yourself to Michelle Dick ([email protected]) or Brad Ericson ([email protected]).

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