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

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

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COVER | ICD-10 Roadmap | 30 Solve the ICD-10 Pervasive Developmental Disorder Puzzle Chandra Stephenson, CPC, COC, CPB, CPCO, CPMA, CIC, CCS, CPC-I, CANPC, CEMC, CFPC, CGSC, CIMC, COSC

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

21 Radiation Oncology: 48 Prepare Your Practice for Disaster 54 Encourage Employees to Report Everything Old Is New Again Debra Cascardo, MA, MPA, CFP Compliance Violations Cindy C. Parman, CPC, COC, RCC Erica Lindsay, PharmD, MBA, JD

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

26 ■ Added Edge 40 Is Your Next Step Inpatient Coding? 10 Corporate Membership: A Smart, Money Saving Option Leonta Williams, RHIT, CPCO, CPC, CCS, CCDS Michelle A. Dick ■ Practice Management ■ AAPC Chapter Association 42 Think of Capturing Revenue as Spokes on a Wheel 13 All Great Achievements Require Time Michelle Stallings, CPC By Roxanne Thames, CPC, CEMC 46 Record It for Reference Joe Ascensio 46 ■ Member Feature 14 Members Overcome Odds ■ Auditing/Compliance Geanetta Johnson Agbona, CPC, CPC-I, CBCS 50 Building a HIPAA Toolbox Stacy Harper, JD, MHSA, CPC ■ Coding/Billing 53 When Does the Locum Tenens 26 Common Chiropractic Clock Start? Procedures Aren’t Always Michael D. Miscoe, JD, CPC, CASCC, CUC, Straightforward CCPC, CPCO Kristy Johnston, CPC 59 Risk Assessment High Priorities 28 Kidney Transplant Coding in Brief Marcia L. Brauchler, MPH, FACMPE, CPC, Amy C. Pritchett, CPC, CANPC, CASCC, COC, CPC-I, CPHQ 59 CEDC, CRC, CCS, CDMP, CMPM, ICDCT-CM, ICDCT-PCS, CMRS, C-AHI 36 Arthroscopic Shoulder Debridement Bundles Bicep Tenotomy G.J. Verhovshek, MA, CPC 38 78: The “Complications” Modifier G.J. Verhovshek, MA, CPC

COMING UP: •• Sepsis and SIRS DEPARTMENTS EDUCATION •• Prolonged Services 7 Letter from Member Leadership 62 Newly Credentialed Members •• Selfies and Social Media 8 Letters to the Editor •• Cuban Healthcare 9 I Am AAPC •• Immigrant Coders 11 Local Chapter News 33 A&P Tip Online Test Yourself – Earn 1 CEU On the Cover: Chandra Stephenson, CPC, COC, CPB, CPCO, CPMA, CIC, 37 ICD-10 Quiz CCS, CPC-I, CANPC, CEMC, CFPC, CGSC, CIMC, COSC, explains ICD-10 general www.aapc.com/resources/publications/ pervasive developmental disorder definitions and subcategories. 66 Minute with a Member healthcare-business-monthly/archive.aspx Cover design by Kamal Sarkar.

4 Healthcare Business Monthly ZHealth Publishing, LLC www.zhealthpublishing.com Serving 144,000 Members – Including You! Go Green! HEALTHCARE Why should you sign up to receive Healthcare Business Monthly in digital format? BUSINESS MONTHLY Coding | Billing | Auditing | Compliance | Practice Management Here are some great reasons: July 2015 • You will save a few trees. • You won’t have to wait for issues to come in the mail. Director of Publishing • You can read Healthcare Business Monthly on your computer, tablet, or Brad Ericson, MPC, CPC, COSC other mobile device—anywhere, anytime. [email protected] • You will always know where your issues are. Managing Editor • Digital issues take up a lot less room in your home or office than paper John Verhovshek, MA, CPC issues. [email protected] Go into your Profile on www.aapc.com and make the change! Editorial Michelle A. Dick, BS Renee Dustman, BS Designers Mahfooz Alam HealthcareBusinessOffice, LLC ...... 37 Kamal Sarkar www.HealthcareBusinessOffice.com Advertising Medical Group Management Association ...... 58 Jamie Zayach, BS [email protected] www.mgma.org Jon Valderrama [email protected] Optum360TM A leading health services business ...... 68 www.optumcoding.com Address all inquires, contributions, and change of address notices to: Healthcare Business Monthly Supercoder, LLC...... 52 PO Box 704004 vendor index vendor www.SuperCoder.com Salt Lake City, UT 84170 (800) 626-2633 The Coding Network...... 24 ©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. www.codingnetwork.com 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, ZHealth Publishing, LLC ...... 5 or sponsoring organizations. www.zhealthpublishing.com CPT® copyright 2014 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 Volume 2 Number 7 July 1, 2015 luck would have it, you do! AAPC’s Legal Advisory Board (LAB) is ready, willing, and Healthcare Business Monthly (ISSN: 23327499) is published monthly by AAPC, 2480 South 3850 able to answer your legal questions. Simply send your health law questions to LAB@ West, Suite B, Salt Lake City UT 84120-7208, for its paid members. Periodicals Postage Paid aapc.com and let the legal professionals hash out the answers. Select Q&As will be 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, 2480 South 3850 West, Suite B, Salt Lake City UT 84120-7208.

6 Healthcare Business Monthly Letter from Member Leadership Make a Change. Be the Change.

s healthcare business professionals, we tle changes, as well as big changes with sud- have come to anticipate change. New den impact (for example, the year we experi- Acodes, new guidelines, new laws — we enced the “new” evaluation and management expect these things to occur at least annual- code section in CPT®, and then the doc- ly, and we prepare for them, just as we are pre- umentation guidelines). Throughout each paring for ICD-10 implementation. of the updates and new challenges, the one But is just being ready enough? constant that has helped to lead the way and teach is AAPC and the resources member- At HEALTHCON in April, I appealed to ship affords us. This will not change. membership to “Make a Change. Be the Change.” Now, more than ever, we have an Just look at the wealth of information Health- incredible opportunity to be a part of the care Business Monthly provides to members changes taking place in our industry. every month. Every issue contains articles that address current practice management, Give It All You’ve Got audit and compliance, and billing and coding issues. In this issue, you’ll learn about If your job is evolving into a different area or Occupational Safety and Health Adminis- your responsibilities are shifting due to the tration, radiation oncology, and much more. way claim information is being obtained and retrieved, use this as an opportunity to learn, AAPC also offers members constant learning evolve, and help other members. through webinars, workshops, conferences, forums, blogs, coding books, and credential- Throughout each of Ask yourself: ing. And you’re not alone: Your local chapter • How can I be a part of this change? and the AAPC Chapter Association, the Na- the updates and new • How can I apply my new skills within tional Advisory Board (NAB) and the Legal AAPC membership? Advisory Board are here for you. challenges, the one • How can I share my knowledge with members? Reach Out to NAB constant that has helped • How can I challenge myself and take Reach out to your AAPC NAB represen- lead the way and teach is this further? tatives. Let us hear what you need, what is working, and what isn’t working. To be the change, you must take action. If AAPC and the resources you want to get more involved in compliance, We are one AAPC, and together we are the for example, obtain your Certified Profes- change. membership affords us. sional Compliance Officer (CPCO™). But don’t stop there: Share what you’ve Sincerely, learned by speaking at your local chapter, writing an article for Healthcare Busi- ness Monthly, or answering questions in the AAPC forums. Then, challenge yourself further by learning a new specialty, such as outpatient fa- Jaci Johnson Kipreos, CPC, COC, CPMA, cility coding (Certified Outpatient Coding CPC-I, CEMC (COC™)) or inpatient facility coding (Certi- President, National Advisory Board fied Inpatient Coder (CIC™)).

Tools for Change Are in Your Hands I look back over the past 27 years of my career and see how healthcare has experienced sub-

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

Anesthesia Time next season, they may plant oats. Residue from HEALTHCARE the wheat crop may be left in the field and BUSINESS MONTHLY May 2015 www.aapc.com could contaminate the oat crop during grow- Guidelines Vary by Payer Coding | Billing | Auditing | Compliance | Practice Management ing and harvesting. For this reason, most of us Regarding how to record and bill anesthesia with celiac disease choose to avoid oats unless time, “Top Tips for Tiptop Anesthesia Bill- they’re “certified gluten free,” thus assuring ing” (May 2015, pages 28-31) advises, “Anes- us that there has been no potential for cross- thesia is calculated at 15-minute intervals (15 x contamination with other “must-be-avoided” 4 = 60). Also, when a case runs over seven min- grains like wheat, barley, and rye. utes, guidelines state to round up to the next 15 minutes provided.” Becky Buegel, RHIA, CHP, CDIP, CHC Note that guidelines to calculate anesthesia time differ from payer to payer. For example, Tiptop Tips for Anesthesia: 28 Billing doesn’t have to be complicated or daunting Qualifying Circumstances Don’t CPT® guidelines follow the “round up if more Physicians: Make Friends with Coders: 48 Your coder gets claims paid and boosts revenue than half the time has passed” rule, but do not Orthopedic Up-coding and Harassment: 62 What to do when a physician crosses ethical lines Always Call for Separate Coding specifically mention the 15-minute interval for anesthesia units. The article “Top Tips for Tiptop Anesthesia May2015_HBM.indd 1 14/04/15 8:35 pm Billing” (May 2015, pages 28-31) uses an ex- The Centers for Medicare & Medicaid Ser- ample regarding a 3-month-old undergoing vices guidelines state that you should record the exact anesthesia hernia repair, and using +99100 Anesthesia for patient of extreme time documented. Per the Medicare Claims Processing Manual, age, younger than 1 year and older than 70 (List separately in addi- chapter 12, section 140.3.2, anesthesia time “starts when the qual- tion to code for primary anesthesia procedure) to gain an addition- ified nonphysician anesthetist begins to prepare the patient for an- al base unit. esthesia services in the operating room or an equivalent area and ends when the qualified nonphysician anesthetist is no longer fur- In this case, it is incorrect to add 99100 because anesthesia codes nishing anesthesia services to the patient, that is, when the patient 00834 Anesthesia for hernia repairs in the lower abdomen not other- may be placed safely under postoperative care.” Individual Medi- wise specified, younger than 1 year of age and 00836 Anesthesia for care payers will calculate payment based on the actual, document- hernia repairs in the lower abdomen not otherwise specified, infants ed anesthesia time. younger than 37 weeks gestational age at birth and younger than 50 weeks gestational age at time of surgery already take the patient’s age Bottom line: Do not assume you should round anesthesia time to into consideration in the base unit value assigned, per the 2015 Rel- 15-minute intervals. Verify with your specific payers how they de- ative Value Guide. fine time units for anesthesia, and how they would like that time reported. Vivienne Midla, CPC, CANPC, ACS-AN —Healthcare Business Monthly You are correct: Parenthetical references following the CPT® list- ings for 00834 and 00836 direct, “Do not report … in conjunc- Oats Don’t Have Gluten tion with 99100.” Because the codes already take patient age into As one who was diagnosed with celiac disease in 1999, I wanted to account, it’s inappropriate to additionally report the qualifying cir- point out a misleading statement in “Coding Celiac Disease: Then cumstance for age (99100). and Now” (May 2015, pages 24-25). —Healthcare Business Monthly The article states, “... gluten is a protein found naturally in the grain of wheat, rye, oats, and barley.” Although gluten is found in many grains, including corn, the article has seemingly lumped oats in with other grains that must be avoided by those of us with celiac disease. According to the University of Chicago Celiac Disease Center, oats do not contain gluten but do have a protein called avenin, which is unrelated to the glutens that cause celiac disease. Oats are not one Speak Up and Be Heard! of the grains that celiacs must avoid. Many of us avoid oats because Do you have a question regarding information found in Healthcare Business Monthly? of the cross-contamination that can occur during the growing (and Or maybe you have a difference in opinion you would like to share with your peers? harvesting) of oats. Farmers usually rotate crops when growing Write us at: [email protected]. grains: one growing season they may plant wheat in a field, and the

8 Healthcare Business Monthly I Am AAPC

efore beginning my career at the University of Iowa BHospitals and Clinics in Patient Financial Services (PFS), I completed my bachelor’s degree in Sociology and spent my first year out of college traveling and living in In- dia. I always knew I wanted to be part of something bigger and help people, but it wasn’t until landing my first job in PFS that I truly knew what that calling was. My first job was as a patient account representative, which introduced me to my future career. While in PFS, I also worked in Pa- tient Billing Services, and as a member of the “fire squad.” I dug into problem areas and helped teams that needed assistance. This is where I became interested in medical coding. Time for Certification I received my Certified Professional Coder (CPC®) credential in December 2012. Earning my CPC® allowed me to see the bigger picture of the revenue cycle, and the logical pro-

gression was to become an education coordinator — an in- #IamAAPC house trainer that focuses on new-hire staff and retraining current staff. I lead the physician billing new hire training and introduce new staff to the world of billing. In August 2014, I put my skills to the test and received Certified Profes- sional Biller (CPB™) status. Billing Know-how Becomes a Blessing Around the same time I received my CPB™, my mom was diagnosed with stage 3C ovarian cancer. She underwent surgery to remove as much of the disease as possible. Fol- lowing surgery, she began an intense chemotherapy regi- men. With a diagnosis like this, it’s easy to feel completely helpless and to want to do anything and everything possible to help. After the initial shock and despair, I realized there was something I could do for her. Even with the best insurance at the best facility, billing and coding can be confusing for a patient. I was there to explain to my mom how all of it worked, how to read her explanation of benefits, and to make sure everything pro- cessed correctly. In the billing and coding world, there can be mistakes. I helped identify those mistakes for smooth claims processing. She is still in treatment and I am still using my skills to help take some of the pressure off of her. I Am AAPC My knowledge of coding and billing has been a blessing Healthcare Business Monthly wants to know why you chose to be a health- throughout this experience. care business professional. Explain in less than 400 words why you chose your healthcare career, how you got to where you are, and your future As I train students, I tell them to think of every patient career plans. Send your stories and a digital photo of yourself to Michelle like family. It’s our job as billers and coders to put patients Dick ([email protected]) or Brad Ericson ([email protected]). first.

www.aapc.com July 2015 9 ■ ADDED EDGE By Michelle A. Dick Corporate Membership: A SMART, Money Saving Option image by iStockphoto © acilo For hospitals, facilities, payer, bill- al dues. Johns said, “Members covered under the corporate receive a Don’t let ing, and other healthcare compa- discount for online purchases including code books, continuing ed- nies, AAPC corporate membership ucation, training, etc.” (Exceptions include: membership, advertis- membership is a great option over purchasing in- ing, cancellation/late fees, and continuing education unit (CEU) dues add dividual memberships. If your orga- vendor fees.) nization wants coding staff, doctors, Coding Manager Pam Brooks, MHA, CPC, COC, has corporate up to be a and clinicians who are well versed membership for her employees at Wentworth-Douglass Hospital. in payer and government guidelines She said that pricing is the best feature. Brooks offers it as part of the big chunk and regulations, you’ll find corpo- hospital employees’ benefit package. “We’ve always provided AAPC rate membership to be a cost effec- membership to our employed coders as part of their employment of change tive solution that helps ensure billing package, primarily because coding certification is a job requirement,” for your compliance and proper reimburse- Brooks said. “But as my coding staff grew, it became clear that it was ment. more cost-effective to have a corporate membership.” organization. How Does It Work? Brooks discovered other benefits along the way. She said, “Anoth- er perk that I’ve discovered with my corporate membership is there Corporate membership is purchased are discounts on webinars, workshops, and certification preparation by your employer. AAPC Membership Manager Jamie Johns said, materials. Because Brooks has 20-plus coders on Wentworth-Dou- “The corporate membership saves money for companies covering glass Hospital’s corporate membership, she often gets better pricing membership dues for their employees.” The minimum number of em- for other products. “It’s a win-win for us,” said Brooks. ployees you can have is six. “If you have six or more employees who either are AAPC members or would like to be AAPC members, you’ll Costs save overall,” said Johns. The annual corporate membership fee is $750 for up to 10 spaces. Ad- The employer/organization designates one person as the corporate ditional spaces may be purchased at any time during the renewal year contact, who then represents all members on the corporate member- at a prorated cost. You may also purchase additional spaces (beyond ship and pays the dues for everyone. the initial 10) for $75, each, either at the time of renewal or when a Each corporate membership has 10 “spaces” allotted for members. new corporate membership is started. These spaces can be used to add or remove individuals from the corporate membership at any time during the renewal year. Johns said Find Out More that employers are not paying for individual members, but for spaces To find out more about corporate membership and how to sign up, go for members to occupy. This means that you can remove members as to: www.aapc.com/membership/corporate-membership-right-for-you.aspx. they leave employment and add members to open spaces. If you are confused as to how it would affect your current Win/Win for Employers and Members membership or CEUs, look to commonly asked questions: www.aapc.com/membership/faq.aspx. There is an average savings of 42 percent for corporate memberships when you have between six to 10 individuals, and a 58 percent sav- Michelle A. Dick is executive editor at AAPC. ings when you have more than 10, as compared to individual renew-

10 Healthcare Business Monthly Local Chapter News Get Excited for Local Chapters

More than 500 local chapters make up the backbone of AAPC. Our Stuart Sailfish unique local chapters are places to learn, network, and have fun. And Chapter, from bottom-left each chapter’s vitality is the product of its members. These chapters around the table are perfect examples. to bottom-right: Theresa Holmes, Toni Holmes, Diana South Denver, Colorado Wenrich, Angela Kudos to the South Denver, Colorado, local chapter for their gen- Humphrey, Kathy Pride, Teresa erosity in bringing canned goods to meetings for distribution to lo- Alexander, Leila cal food banks. Vice President Deborah M. Wightman, CPC, Bishop-Masterson CHONC, said, “We started the program at our first chapter meet- (standing), Angie Boore, Donna ing in February of this year and the response has been overwhelm- Juchnowski, ing at each meeting. Thanks to all our members for caring about oth- Monika Liddle, ers in need.” Madeline Conlon, K.C. Mosby Toledo, Ohio April’s Toledo, Ohio, seminar was a big success, with 78 attendees from all over Ohio and Michigan. Numerous vendors donated items to make the day special for members. Toledo’s local chapter President Robin Moore, CPC, gave two thumbs up for the “awesome snacks and lunch” provided. A special thanks goes to Mandy Flagg, CPC, chapter. The officers who attended were President Leila Bishop- CEMC, of the Flint, Michigan, local chapter for keeping everyone Masterson, CPC; Education Officer Kathy Pride, CPC; and involved. Member Development Officer Monika Liddle, CPC, CGSC. The chapter invited all nine new members from the first quarter of 2015. Also in attendance were coding students from Fortis Institute; nurses looking for new employment; and a few others asking about the CPC® exam and how to prepare. It was a great turnout; the chapter plans to hold their next Meet and Greet on July 25, 2015 at Panera Bread in Stuart, Florida.

Indianapolis, Indiana The Central Indiana Local Chapter has been busy making 2015 a fab- ulous year. The chapter participated in the Susan G. Komen Central Indiana Breast Cancer Walk. The event supported and honored those who lost their battle with breast cancer, are fighting the battle, and the survi- vors. Central Indiana chap- Members gathered from all over ter members were there Ohio and Michigan to enjoy April’s seminar in Toledo. to support survivor, sis- ter, friend, and Vice Presi- dent-elect Shannon Glass, Stuart Sailfish, Florida MBA, RN, CPC, COC. The Stuart Sailfish, Florida, local chapter held their first new member “Meet and Greet” on April 25, 2015 at Panera Bread in St. Lucie West, Florida. The goal of the meet and greet was to get to know Proud Central Indiana new members, to make them feel welcome, to answer any chapter officers at their Officer questions, and to explain how to become more involved in the Training meeting

www.aapc.com July 2015 11 Local Chapter News

CCS, spoke about the importance of documentation using ICD-10. She focused on the details coders need from providers so they can encourage better documentation using ICD-10. Participants had their fill of food and no one left empty handed; there were door prizes for all attendees. Treasurer Michael S. Resan, CPC, CPC-P, CPB, told Healthcare Business Monthly, “Typical meeting attendance is 20 to 30 members, but thanks to the hard work of chapter officers, 56 mem- The Central bers and seven guests attended the May MAYnia event held at Lord Indiana Fairfax Community College!” walks to help fight Winchester, Va., had a big turnout at breast their May Maynia event. cancer. Central Indiana also held a 2015 ICD-10 boot camp, at which AAPC Chapter Association board of directors region 6 representative Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, spoke on how members can be ICD-10-CM compliant in their organizations. The chapter also hosted an officer training with the National Ad- visory Board’s Chandra Stephensen, CPC, COC, CPB, CPCO, CPMA, CPC-I, CIC, CCS, CANPC, CEMC, CFPC, CGSC, CIMC, COSC, as the presenter. It was an excellent way to network, give feedback, incorporate new ideas, and share talent with other officers. A special thank you goes to May MAYnia Committee, Tracy Kel- logg, CPC; Janet Smith, CPC; Cassie Wright, CPC, CPEDC, Healthcare Business Monthly is spotlighting local chapters with photos and stories. If your CMA; and Kristen Mercer, CPC, COC, for your hard work at mak- chapter would like to be featured, please contact your AAPC Chapter Association regional ing this year’s event a memorable success. representative or send your information to [email protected]. In sharing what your chapter is doing, others will benefit. Winchester, Virginia We ask for your stories to be short and your photos to be high resolution and clear. Send us The Winchester, Virginia, local chapter held their May MAYnia highlights of what happened in your chapter recently. Spotlight your special events, coding event on May 13, 2015. Kari Keller, CPC, CPMA, CIRCC, CPC-I, training, special speakers, fundraising results, or honors bestowed on chapter members.

Quick Tip By Renee Dustman e are so pleased with the response from AAPC chapters to our request for you to send Healthcare Business Monthly Wnews of special events. It’s rewarding for chapters to receive recognition for all they do to help our industry excel; and it’s bene- ficial for other chapters to see what their colleagues are doing. Here are a few tips to ensure your chapter looks its best in this magazine. 3 Tips for Making Tip No. 1 Subject Matter Matters If you could only send one photo of your event, what would it be? Your Chapter Look Keep this in mind while snapping shots at your next event. Try to capture a moment that tells the whole story in a single image. For example, an animated photo of officers interacting with members during a game night is much more expressive than a photo of PICTURE PERFECT a room full of people staring at a screen, or an unattended raffle ticket jar. If you aren’t able to take pictures during an event, a simple group shot of your officers is always good.

12 HealthcareHealthcare Business Business Monthly Monthly AAPC Chapter Association By Roxanne Thames, CPC, CEMC All Great Achievements Require Time Don’t throw in the towel in a moment of weakness; you may be moments away from achieving a dream. Maya Angelou said it best: “All great achievements require time.” Passing your exam was a major Everyone is able to see a person’s success. What many do not see is the time and effort it took to achieve that success, or how many failed at- achievement, one that probably took tempts preceded it. Perseverance and knowing when to ask for help will unleash your potential. hours of class time, studying, practice Overcome Challenges exams, sweat, and sometimes tears. Think back to how many times you have overcome a challenge. Did you use that experience to strengthen your determination in achieving a goal, or did you let it beat you down? ter Handbook (www.aapc.com/documents/2015lc_handbook.pdf). It’s an infor- mative resource that will assist you in becoming the best officer you Passing your exam was a major achievement, one that probably took can be. But don’t stop there — speak with other officers in person or hours of class time, studying, practice exams, sweat, and sometimes online in the AAPC Local Chapter Forum. tears. In the end it was worthwhile, and you celebrated your achievement of becoming AAPC certified. We all run into challenges in our daily and professional lives. Face them head on. Graciously except help. And make those dreams come Ask for Help true!

If you are still on the path to obtaining certification, use this challeng- Roxanne Thames, CPC, CEMC, is medical coding educator/auditor for Central Penn Manage- ing time to bolster your determination, rather than weaken your re- ment Group and has worked in the medical billing and coding field for 20 years. She started her solve. You can make things easier by asking for help: Take a review class, career as a billing office clerk for a nursing home and later worked as a physician biller/coder for ask your chapter officers to recommend a mentor, or join a study group. a large internal medicine practice in Lemoyne, Pennsylvania. Thames has taught diagnosis coding at Harrisburg Area Community College, with areas of expertise in physician billing, coding and provider edu- If you are striving to become an excellent local chapter officer, one of cation, ICD-9-CM coding, accounts receivable, collections, evaluation and management auditing, and appeals. the best things you can do is familiarize yourself with the Local Chap- She has served as president-elect and president of the York, Pa., local chapter.

There is a big difference between displaying your images on a monitor verses printing them on paper. Tip No. 2 Consider the Source Tip No. 3 There’s a big difference between displaying your images on a monitor verses printing them on paper. Displaying an image on a monitor Shed Some Light only requires three colors (RGB) and a resolution of 72 ppi. In print, Adequate lighting is essential. Remember to select the proper scene an image requires four colors (CMYK) and a resolution of 300 ppi. setting on your digital camera, such as “Party” if you are inside or To ensure the integrity of your photos in print, set your digital camera “Bright Sun” if you are outside. The flash on your camera or cell phone for the highest resolution setting available. Do not use photo editing only highlights a few feet in front of you; don’t rely on it to brighten a software to adjust the size of your images or edit them in any way. We dark room. If you are indoors, make sure the room is well lit. have specially trained people to do that for you! Most consumer-rated Lastly, using a tripod will improve your images ten-fold — especially cameras automatically save images in JPEG format, which is perfect. if the people in your shot are moving and you are using a special scene For smartphone cameras, there are size options that pop up setting like “Sport.” when you send the photo(s) via email. Options are usually Small, We look forward to seeing the fruits of your labor. Medium, Large, or Actual Size. Choose Actual Size to send the best quality photos. Small- or Medium-sized photos will not print well. Renee Dustman is an executive editor at AAPC.

www.aapc.com July 2015 13 ■ MEMBER FEATURE By Geanetta Johnson Agbona, CPC, CPC-I, CBCS Members Overcome Odds Healthcare career achievement is open to all.

As a medical coding instructor, I train a variety of students. At journey begins. I have found, however, that looking to others who times, I have struggled to encourage students who are burdened have overcome similar circumstances for inspiration can help to lead with negative thoughts or experiences. A student who is a minority you on the path to success. Consider the experiences of the following and sincerely believes her nationality, age, or gender is a hindrance coders, who overcame challenges that could have smothered their to gaining employment, for instance, may fall behind before the opportunity to succeed.

Charlesetta Gittens, MHSA, GJA: How have you continued to overcome this MPA, RMA, CPC, CPT, CET, AH I challenge? CG: Charlesetta Gittens (CG) is originally Now that I am teaching, I encourage students to be from Liberia and has resided in the compassionate to those they encounter with accents. I United States for several years. remind them to listen carefully and trade thoughts with others who are different from them. I also focus on help- Geanetta Johnson Agbona (GJA): Describe your current ing others, and this distracts me from focusing on nega- job(s). tive thoughts or feelings. CG: I am teaching classes for the Medical Assist and GJA: Have you ever been discouraged regarding your Medical Office Administration programs at East Coast career path? What steps did you take to overcome the Having Polytechnic Institute (ECPI) University. discouragement? GJA: Why were you determined to become a coder? CG: No, I have not been discouraged in my career choice. an accent I continue to educate myself and encourage others to do CG: I felt it was a mystery and that was interesting to me. the same. has been a At the time, medical coding connected to my work as a medical assistant. GJA: How have you benefited from AAPC training? challenge GJA: Did you consider yourself to be a minority in the The local chapter meetings have been very helpful to me. industry? What challenges did you overcome? I appreciate the updates provided on the websites regard- to me. ing ICD-10 and other topics related to healthcare. CG: I felt it was going to be a great challenge, but I was hopeful my hard work would pay off. I never thought it GJA: What are your goals? wasn’t possible for me. I became educated and passed the CG: My goal is to complete my dissertation in my doctor- AAPC exam. It took time, but I was eventually able to al degree in Health Services Administration with a con- find employment that I enjoyed. centration in Health Politics. Having an accent has been a challenge to me. At times, people can become distracted by my accent, especially GJA: What would you say to other minorities interested if they do not make a conscience effort to listen. I don’t in this industry? want my pronunciation of terms to hinder my profession- CG: Don’t give up! Continue to fight for your dreams and al development; therefore, I speak slowly and clearly. This your happiness. has improved my professional relationships. I also have endured the stigma of being overeducated.

14 Healthcare Business Monthly Overcoming Odds MEMBER FEATURE

Even though I am now past retirement age, I don’t see my possibilities being limited. Knowledge is much more powerful than age!

Linda Richardson, CPC-A GJA: Describe your current job(s) and responsibilities. Linda Richardson (LR) changed LR: I am responsible for ensuring medical necessity, careers at a time when many ponder correct coding, and insurance compliance. Many times retirement. She was concerned I have to review the charts to be sure that the charges that her age may prevent her from are done correctly. I consider myself the “puzzle solv- gaining suitable employment. er.” My success is reflected in the fact that I have got- Neither age nor her Certified ten my practice’s denials below the goal percentages set Professional Coder – Apprentice by corporate. (CPC-A®) status has prevented her from achieving her goals. GJA: What are your goals? LR: I am concentrating on becoming more proficient GJA: Why did you become interested in the medical in pediatric medicine. I would consider becoming a re- coding? covery audit contractor. Even though I am now past re- LR: In 2010, I found myself among many in America tirement age, I don’t see my possibilities being limited. without a job. I thought there was little to no chance of Knowledge is much more powerful than age! finding a position due to my age. One day, a mailer ar- rived from South Piedmont Community College high- GJA: How have you benefited from the training you lighting two-week classes that were aimed for those who get from AAPC? were downsized. The classes were free. I decided to try LR: AAPC is a great organization. I appreciate the train- every one that seemed the least bit interesting. One of ing material. Being a member of the Monroe Master the courses was Medical Office Administration, which Codes local chapter has been a plus. The officers and really interested me. members have contributed a lot to my education and my comfort level in dealing with the changes that are on the GJA: Did you consider yourself to be a minority in the forefront of this industry. I have been fortunate to serve industry? Did you think it was not possible for you as a as an officer for three terms: treasurer (two years) and minority and what challenges did you overcome? vice president (one year). LR: At a time in my life when I should have been thinking about retirement, I was not sure what opportunities lay ahead. When I was able to secure my position with Carolinas Healthcare, I realized that my challenges were self-manufactured. In the medical industry, if you can prove you have value, age is not really a factor.

www.aapc.com July 2015 15 Overcoming Odds

The main challenge I had was thinking that I had to know everything to be effective.

Osmin Small, CPC, CGSC Their practice had multiple certified coders, and I was not certified, at the time. So when they had to make a choice, Osmin Small (OS) is an accomplished the company did what any good company does: They chose instructor at Southeastern Institute to give the coding jobs to their certified coders. I was devas-

MEMBER FEATURE MEMBER in Charlotte, North Carolina, and is tated. I thought the “perfect” job was slipping away. I over- program coordinator. came my feelings of discouragement and got certified. I now GJA: Why were you determined to become a coder? have two certifications: CPC® and Certified General Sur- gery Coder (CGSC™). OS: I was a stay-at-home mother for about seven years. I knew I would be going back to work, and wanted to do some- GJA: Describe your current responsibilities. thing that was both fulfilling and in demand. I researched OS: I recently received a promotion to program coordina- medical billing and coding. Immediately, I was drawn to tor for the Electronic Medical Billing and Coding Specialist coding. After going to school for about one week, I was program in Charlotte, North Carolina. I am an instructor in hooked. I enjoyed the medical terminology. I enjoyed read- the classroom, so I lecture, give tests, tutor, and perform oth- ing physician notes. I also liked being a part of the healthcare er responsibilities that help my students. I manage the pro- community and feeling that I chose a good profession that gram and maintain externship sites that will help to propel didn’t require years and years of schooling to be successful. the program and the students to success. GJA: Did you consider yourself to be a minority in the GJA: How have you benefited from AAPC training? industry? What challenges did you overcome? OS: I owe a lot to AAPC. I’ve learned much from my chap- OS: I certainly did. It was intimidating, at first. But, then I ter meetings, Healthcare Business Monthly, and AAPC study realized that if I worked hard enough, I could do anything. materials. I am thankful they continue to be a great resource Besides, everything I read about the field indicated it was for coders. growing and would continue to grow, for a long time. I knew that would open many doors. GJA: What are your goals? The main challenge I had was thinking that I had to know OS: I am in the process of getting ICD-10 certified. I would everything to be effective. That’s not possible. Being humble also like to get another certification. Right now, I want to and asking for help was important to my success. learn my job to the best of my ability so I can give students I’ve been fortunate. I have worked with some very good com- my best. panies and some very good managers. I’ve worked with people who took an interest in me and who trained me. GJA: What would you say to other minorities interested in this industry? GJA: Have you ever been discouraged regarding your OS: Don’t let the fact that you are a minority hold you back. career path? What steps did you take to overcome the Study hard and work hard. Apply yourself. Learn as much discouragement? as you can from reading and other more experienced cod- OS: There was a time in my life when I was discouraged. The ers, but stay humble. Be willing to give back. Don’t make company I was working for merged with another practice. excuses!

16 Healthcare Business Monthly Overcoming Odds

When I completed school and became certified, it was clear to me that there are not a lot men working as medical coders, at least not in my area. MEMBER FEATURE

Bryan Eagle, CPC ing jobs or anything that would get my foot inside the door. I knew that someone would eventually take a chance on me. Bryan Eagle (BE) of Living Arts Institute in Winston Salem, North Carolina, is a GJA: Have you ever been discouraged regarding your relative rarity among coders — he’s a man! career path? What steps did you take to overcome the discouragement? GJA: Describe your current job(s) and responsibilities? BE: The biggest discouragement was going to school, taking BE: I am a medical billing and coding instructor for the school the certification test, becoming certified — on the first try, I where I was once a student. I absolutely love it. What better might add — and still struggling to find a job in the field. I was feeling than to share what I have learned with students who hired part time from my externship, which lasted about two will be going through some of the same things I went through? months. Months went by with no job leads. Then, one day, We have both day and evening classes, with the day program I had a job interview for a company that handled respiratory lasting about 13 months and the evening classes lasting about products. I also had a job interview at the local hospital inven- 18 months. torying medical supplies for surgeries. I was on my way home GJA: Why were you determined to become a coder? from the last interview, when I was called by a temporary agency about a job interview with Blue Cross and Blue Shield. Hav- BE: I wanted to do something in the medical field, and I had ing patience and perseverance is what helped me to overcome already explored becoming a CNA in 2004. I found that kind the discouragement. of work wasn’t what I really wanted to do. A recruiter inquired about my educational interests. After considering my options, GJA: How have you benefited from AAPC training? I chose medical billing and coding because it was challeng- BE: It’s amazing how I have grown within the last four or five ing to me. years. I am the secretary for my local AAPC chapter. GJA: Did you consider yourself to be a minority in the GJA: What are your goals? industry? Did you think it was not possible for you as a minority? BE: My goals are to become an even stronger instructor. The more training and information I receive, the better I can pre- BE: When I completed school and became certified, it was clear pare my students for when they enter the job market. to me that there are not a lot men working as medical coders, at least not in my area. There were times when I thought that it GJA: What would you say to other men interested in this might not be possible. In life you have to learn to be patient and industry? not get discouraged when things don’t look possible. BE: If I had one thing to say to anyone who wanted to step into GJA: What challenges did you overcome in the medical the world of coding, it would be, “It’s not impossible to achieve coding industry? if you set your mind to it.” When I got into the field and started looking at the education aspect of it, I knew that I liked to BE: I had virtually no healthcare experience when I came into be challenged, and that’s what coding has done for me. Be pa- the industry. Every job I applied for was looking for a minimum tient. Things do not happen overnight. of two years’ experience. I never gave up. I would apply for bill-

www.aapc.com July 2015 17 Overcoming Odds

The industry is wide open and minorities are welcome. I am proof.

Colette Samuel, CPC I did the work and proved myself, over and over. I kept speaking and using other avenues to get my message out, and time and Colette Samuel (CS) works for UnitedHealth technology also helped with many of the challenges. Electronic Group, which has encouraged her growth, mail was the best invention. I could share updates to policies and and she speaks on a national level regarding reimbursement guidelines without being physically present. When coding. She and her co-worker, Tavian Crank, we were face to face, there was a face with a name, and the work inspired me when they spoke at my local performed and revenue received was undeniable. It demanded chapter in Monroe, North Carolina. MEMBER FEATURE MEMBER respect.

GJA: Why were you determined to become a coder? GJA: Have you ever been discouraged regarding your career CS: I entered the medical industry as a certified medical secretary path? What steps did you take to overcome the discouragement? who could only find a job as a receptionist. When I got my foot in CS: A co-worker who took the exam twice told me that I wouldn’t the door with a billing company, I was truly awestruck. There were pass because she had not. She had been coding for 15 years. I chose jobs I had never heard of. One day while delivering correspon- her as a study partner because of her experience and we both were dence, I met the team of coders and it peaked my curiosity. I want- sitting for the same exam on the same date. We studied together for ed to work in “that” room with “those” ladies. a few weeks and her attitude was laced with negativity. I couldn’t I asked if I could be trained and one of the coders told me that it handle it, so our study sessions ended. would be impossible for me get a job as a coder because I didn’t In hindsight, her attitude had very little to do with me and was have any experience or training, and because I was not certified. more about her own insecurities. I didn’t understand at the time, Not every coder was certified, but the company had just mandat- but it was definitely what I needed to propel myself. Although it ed they all become certified within six months. I saw the book they seemed like the world was against me, I mustered up strength to were studying, and I begged my director to approve me for train- prove them wrong. I studied with an intensity I never knew I had. ing. The company wouldn’t pay for me to go to school, but would I dedicated two hours each night and eight hours on Saturday and pay for my books, study guides, and a boot camp. I was certified Sunday. My family was really a lifeline for me during this time. within six months. GJA: Describe your current job(s) and responsibilities. GJA: Did you consider yourself to be a minority in the industry? CS: What challenges did you overcome? I have been with UnitedHealth Group since 2008. My career has transitioned over the years from senior training and development CS: There were not many people who looked like me in the indus- consultant to quality improvement lead and physician advocate try, so I was considered to be a minority. for Provider Relations for Florida. Both positions have provider After being told that I couldn’t be a coder by other coders, I as- education and training as a central focus. My responsibilities sumed it was impossible. It wasn’t really a possibility until my di- include provider education, development and training, creating rector became a CPC®. I say this because she was somebody who Lunch-and-Learn opportunities, and so much more. As we near looked like me who became certified. the implementation date for ICD-10-CM, more training and Very early in my career I believed that my skin color was a barrier to materials will be underway. being heard. I was an accounts receivable collector who knew how to code, appeal claims, and overturn denials after hearings. The GJA: How have you benefited from AAPC training? words leaving my lips didn’t seem to matter, but the message did! CS: I absolutely love the family feel and culture of AAPC. There I found other ways to distribute the information. The information are resources upon resources available. I have purchased books over had to come from someone else to have the desired outcome. It was the years that have helped me to do my job with excellence. Daily, very frustrating because I have always been a very outspoken person. we have access to exceptional coding books, or we can pose ques-

18 Healthcare Business Monthly Overcoming Odds MEMBER FEATURE tions to fellow coders or look up information in Healthcare Business Clearly, age, gender, or nationality is not what determines success. Monthly. I have personally learned a lot and attribute much of my Success is determined by the amount of patience and endurance career success to AAPC. you have. Whatever obstacle you’re battling, do not let it prevent you from achieving your goals. Be determined, work hard, be- GJA: What are your goals? come educated, and take advantage of any resources available. CS: I plan to pursue more clinical training. I also plan to obtain With time, you will overcome the odds! more specialty credentials. Geanetta Johnson Agbona, CPC, CPC-I, CBCS, ICD-10-CM trainer, has been a part of the medical industry since 1992. She teaches medical billing and coding at CGS Medical Bill- GJA: What would you say to other minorities interested in this ing Service (www.cgsbillingservice.com), which she co-owns with her spouse, Charles. Ag- industry? bona is a member of the Monroe, N.C., local chapter. CS: The industry is wide open and minorities are welcome. I am proof. Your first step is partnering with AAPC and obtaining your certification. I did not know the real value of my certification until it took me places I never thought possible. I also warn anyone entering this field to not despise small beginnings. We all have to start somewhere.

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For more information, call 800-626-2633 or visit: aapc.com/regionals CODING/BILLING ■ By Cindy C. Parman, CPC, COC, RCC RADIATIONTION OONCOLOGYNCOL DIA OGY EverythingRA ing OldOld IsIs NNewew Again yth Ag er ain Ev

Get an overall understanding of hospital and freestanding center radiation oncology payments.

he quote, “Change always comes bearing gifts,” by Price Pritchett, PhD, accu- Trately captures coders’ feelings when final regulations, code updates, and other reimbursement changes occur, each year. This year, radiation oncology has experienced some of the biggest coding changes since the procedure codes were first written. To sharpen your radiation oncology coding skills, take a look at the “gifts” born in 2015. image by iStockphoto © sudok1 ■ ■ ■ Coding/Billing Practice Management Auditing/Compliance www.aapc.com July 2015 21 Radiation Oncology

New and Revised Procedure Codes These codes define the levels for

CODING/BILLING The three 2014 codes for simple, intermediate, and complex tele- remote afterloading brachyther- therapy isodose plans (77305, 77310, and 77315) have been replaced apy in terms of channels, rather with two codes for simple and complex teletherapy isodose plans: than sources. Like the teletherapy isodose plan codes, these brachy- 77306 Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), in- therapy plan codes include basic cludes basic dosimetry calculation(s) dosimetry calculations. 77307 complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s) Treatment Delivery, Image Guidance, and 77306 and 77307 include basic dosimetry calculations, which means 77300 Basic radiation dosimetry calculation, central axis Motion Tracking depth dose calculation, TDF, NSD, gap calculation, off axis factor, tis- Although the new procedure sue inhomogeneity factors, calculation of non-ionizing radiation sur- codes for treatment planning are face and depth dose, as required during course of treatment, only when used in all practice settings (hos- prescribed by the treating physician is no longer reported in addition pitals, freestanding cancer treat- to the isodose plan. ment centers, or physician offices), The three 2014 codes for brachytherapy isodose plans (77326, there are different Medicare treat- 77327, and 77328) have also been replaced by new codes: ment delivery and image guidance codes for hospital and freestanding radiation centers in 2015. 77316 Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s) For hospital billing on the UB04 claim form, the existing intensity-modulated radiation therapy (IMRT) treatment delivery codes 77317 intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachythera- (77418, 0073T) have been replaced by two new codes (77385 and py, 2-12 channels), includes basic dosimetry calculation(s) 77386, see Table 1) for simple and complex treatment delivery, both 77318 complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, of which include image guidance and motion tracking (when per- over 12 channels), includes basic dosimetry calculation(s) formed). This means that image-guided radiation therapy (IGRT) — such as cone-beam computed tomography (CT), CT on rails, stereoscopic imaging or ultrasound (US) guidance, and intra-fraction motion tracking — is no longer separately reported by the hospital when IMRT treatment is performed. Table 1: Code Description 77385 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple Prostate, breast, and all sites using physical compensator-based IMRT 77386 complex All other sites, if not using physical compensator-based IMRT

The 2014 CPT® Category III code for intra-fraction localization and tracking (0197T), 77421, and 76950 were deleted effective Jan- image by iStockphoto © oonal

22 Healthcare Business Monthly Radiation Oncology

Physicians and freestanding centers … do not report

any of the new CPT® treatment delivery or image CODING/BILLING guidance procedure codes for Medicare patients.

uary 1. Instead, 77387 Guid- These codes have the same definitions as their CPT® counter- ance for localization of target parts (most of which have been deleted), as shown in Table 2. volume for delivery of radiation treatment delivery, in- Table 2: cludes intrafraction tracking, 2014 CPT® 2015 HCPCS Description when performed is reported Code Level II Code by the hospital when the pa- Ultrasonic guidance for placement of radiation ther- 76950 G6001 tient receives standard exter- apy fields nal beam therapy. Stereoscopic X-ray guidance for localization of target 77421 G6002 Remember: The technical volume for the delivery of radiation therapy component of 77387 is not 77402 G6003 Radiation treatment delivery, >1MeV; simple reported with IMRT treat- 77403 G6004 6-10 MeV ment. 77404 G6005 11-19 MeV Code 77387 includes all im- 77406 G6006 20 MeV or greater age-guidance modalities 77407 G6007 Radiation treatment delivery, >1 MeV; intermediate (CT, kV/kV, US, etc.) and all 77408 G6008 6-10 MeV motion tracking (e.g., gating, 77409 G6009 11-19 MeV 3D positional tracking, etc.). Although the technical component of IGRT is included in the 77411 G6010 20 MeV or greater new IMRT codes, you may continue to report the professional 77412 G6011 Radiation treatment delivery, >1 MeV; complex

image by iStockphoto © Mark Kostich component of image guidance, as long as all ordering and doc- 77413 G6012 6-10 MeV umentation criteria are met. 77414 G6013 11-19 MeV The radiation treatment delivery codes billed by the hospital 77416 G6014 20 MeV or greater also are restructured for 2015. There is still a single code for su- Intensity modulated treatment delivery, single or mul- perficial and orthovoltage treatment, but there are now only tiple fields/arcs, via narrow spatially and temporal- 77418 G6015 three codes for treatment delivery at any dose greater than or ly modulated beams, binary, dynamic MLC, per treat- equal to 1 MeV. Previously, there were 12 codes based on both ment session the complexity and the MeV. The revised treatment delivery Compensator-based beam modulation treatment delivery of inverse planed treatment using 3 or more high codes billed by the hospital are: 0073T G6016 resolution (milled or cast) compensator, convergent 77401 Radiation treatment delivery, superficial and/or orthovoltage, per day beam modulated fields, per treatment session

77402 Radiation treatment delivery, >1 MeV; simple Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (e.g., 0197T G6017 77407 intermediate 3D positional tracking, gating, 3D surface tracking), each fraction of treatment 77412 complex Remember: Although Medicare requires these HCPCS Level Physicians and freestanding centers (claims submitted on the II codes during 2015, physicians and freestanding office-based CMS-1500 form) do not report any of the new CPT® treatment cancer treatment centers may be required to report the new delivery or image guidance procedure codes for Medicare pa- CPT® procedure codes for other payers. tients. These entities report HCPCS Level II codes for 2015.

www.aapc.com July 2015 23 Radiation Oncology

Although the new procedure codes for treatment planning are used in all practice settings … there are different Medicare treatment delivery and image guidance codes for hospital and freestanding radiation centers in 2015.

Hospital Regulatory Issues Physician/Freestanding Center Regulatory Issues CODING/BILLING Since 1992, Medicare has paid for the services of physicians, non- Comprehensive APCs physician practitioners, and certain other qualified healthcare pro- To improve the accuracy and transparency of payment for certain fessionals under the Medicare Physician Fee Schedule (MPFS). The device-dependent services, the Centers for Medicare & Medicaid Estimated Impact Table that projects payment increases or decreas- Services (CMS) implemented a policy this year that establishes 28 es by specialty states that in 2015 radiation oncology physicians will comprehensive ambulatory payment classifications (APCs) to pay experience an estimated 1 percent increase in Medicare reimburse- prospectively for the most costly hospital outpatient device-depen- ment and that freestanding radiation oncology centers will have ap- dent services. A comprehensive APC, by definition, provides a sin- proximately the same reimbursement as in 2014. gle payment that includes the primary service and all adjunct services performed to support the delivery of the primary service, even if the components span several days. This means hospitals must continue to report procedure codes for all services performed on a single claim, and receive a single payment for the total service. For radiation oncology, single-fraction stereotactic radiosurgery codes 77371 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 based and 77372 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; linear ac- celerator based are reimbursed through a comprehensive-APC, and intraoperative radiation therapy codes 77424 Intraoperative radiation treatment delivery, x-ray, single treatment session and 77425 In- traoperative radiation treatment delivery, electrons, single treatment session are included in the payment for the surgical procedure. Proton Beam Therapy TCN CMS also finalized the APC proposals affecting the proton beam therapy services for 2015, resulting in the national reimbursement changes shown in Table 3. Table 3: CPT® 2014 2015 % Descriptor Code Final Rule Final Rule Change Proton treatment delivery; 77520 $872.37 $507.55 -41% simple, without compensation 77522 simple, with compensation $872.37 $1,071.95 21% 77523 intermediate $1,205.27 $1,071.95 -12% 77525 complex $1,205.27 $1,071.95 -12%

24 Healthcare Business Monthly To discuss this article or topic, go to www.aapc.com Radiation Oncology

Radiation Vault CMS did not finalize its proposal to remove the radiation treatment vault from the direct practice expense (PE) input and to treat it as part of the infrastruc- ture. CMS stated in the final rule that it understands the essential nature of the vault in the radiation therapy services provision and its uniqueness to a particu- CODING/BILLING lar piece of medical equipment, but is not convinced either of these factors con- cludes the vault should be considered medical equipment for purposes of PE methodology under the MPFS. CMS says in the final rule that it intends to further study the issues raised by the vault and how it relates to PE methodology.

Get the Full Extent of Changes To better understand the full extent of coding and reimbursement changes affecting radiation oncology, review your CPT® and payer guidance. Bookmark specialty society and college pages, and monitor industry publications to ensure you are current with reimbursement changes, as well. And make sure to review the 2016 proposed rules, which may be available for inspection as you read this article.

Cindy C. Parman, CPC, COC, RCC, is principal and co-founder of Coding Strategies, Inc., in Powder Springs, Ga. Her professional career in healthcare includes 20 years of commercial group health insurance experience, where she managed claims processing and customer service. Parman served as president of AAPC’s National Advisory Board, and is a member of the Dallas, Ga., local chapter. image by iStockphoto © bgpix

AAPC Webinars

www.aapc.com July 2015 25 ■ CODING/BILLING By Kristy Johnston, CPC Common Chiropractic Procedures Aren’t Always Straightforward

roper documentation and reimbursement requires all staff P— from the personnel in charge of authorizations, to the provider, to the coder/biller — to understand the chiropractic procedure and diagnosis codes most commonly used in the office.

Adjustment Codes: 9894X Although they may seem straightforward, chiropractic adjustment codes are often misunderstood. Staff in charge of authorizations must know the differences between these codes to ensure they are requesting authorization for the correct level of treatment. If an authorization is submitted for 98943 Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions, but the doctor provides and bills 98941 Chiropractic manipulative treatment (CMT); spinal, 3-4 regions, the claim will be denied. This will result in additional work to get the original authorization corrected, and a delay in payment. Providers: Are you capturing the appropriate code for the spinal regions you’re adjusting? If you’re adjusting only one region, but reporting 98941, you’re over-coding and subjecting your office to an audit. On the other hand, if you’re adjusting three regions, but reporting 98940 Chiropractic manipulative treatment (CMT); spinal, 1-2 regions, you’re under-coding and causing the practice to lose money. Example: The provider adjusts C3-C4, T1-T3, T10-T12, L1- L3, and S3-S5. Reporting 98942 is over-coding because not all five regions were adjusted — T1-T3 and T10-T12 are in the same region (thoracic). Proper coding is 98941. Billers: Do the diagnoses support the procedure code on the claim? Make sure there is a diagnosis for each region to support the number of regions billed. According to the CPT® codebook, Proper all five spinal regions include: cervical, thoracic, lumbar, sacral, reimbursement and pelvic. Example: A patient presents with pain in the cervical, thoracic, requires clinical and and lumbar regions of the spine. The patient also reports pain in his right knee due to an ice hockey injury. Upon examination, office staff to the provider reports the following findings: segmental dysfunction of the cervical, thoracic, and lumbar regions. There play by the rules. is sprain/strain of the right knee. The following treatment is performed: Manual spinal adjustment to C5-C7, T1-T3, and L1-L5, and extraspinal adjustment to the right knee. image by iStockphoto © AJ_Watt ■ ■ ■ 26 Healthcare Business Monthly Coding/Billing Practice Management Auditing/Compliance To discuss this article or topic, go to www.aapc.com Chiropractic

Make sure there is a diagnosis for each region to support the number of regions billed. CODING/BILLING

Proper coding for this visit is: Therapeutic Services (97110, 97112, 97124, 97140) 98941, with diagnosis codes: CPT® codes 97110, 97112, 97124, and 97140 are timed therapeu- 739.1 Nonallopathic lesions, cervical region 723.1 Cervicalgia tic services. The provider must document the exact amount of time spent performing these services one-on-one with the patient. 739.2 Nonallopathic lesions, thoracic region 724.1 Pain in thoracic spine 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop 739.3 Nonallopathic lesions, lumbar region 724.2 Lumbago strength and endurance, range of motion and flexibility

98943, with diagnosis codes: 97112 neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and /or proprioception for sitting and/or standing activities 844.9 Sprain and strains of unspecified site of knee and leg 97124 massage, including effleurage, petrissage and/or tapotement (stroking, compression, 719.46 Pain in joint, lower leg percussion) It’s important to link the correct diagnoses to the appropriate CPT® 97140 Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manu- code. al traction) 1 or more regions, each 15 minutes Research the insurance company’s policy to determine if 98943 is For any single CPT® code, bill a single 15-minute unit, as follows: a payable code and if the code requires a modifier, such as modifi- 1 unit = 8 minutes to < 23 minutes er 51 Multiple procedures or modifier 59 Distinct procedural service. 2 units = 23 minutes to < 38 minutes You should be able to find the answer on the carrier’s website or in 3 units = 38 minutes to < 53 minutes its billing guidelines. 4 units = 53 minutes to < 68 minutes If more than one CPT® code is reported for a single date of service, Modalities, Supervised vs. Constant the total number of units that can be reported is based on the total Attendance (i.e., 97014 and 97032) treatment time. What is the difference between 97014 Application of a modality to 1 Source: Independence Blue Cross, Chiropractic Billing Guide, or more areas; electrical stimulation (unattended) and 97032 Appli- www.ibx.com cation of a modality to 1 or more areas; electrical stimulation (manu- If the provider spends less than eight minutes performing a timed al), each 15 minutes? therapeutic service, the biller needs to append modifier 52 Reduced Supervised modalities (97010-97028) are therapeutic treatments re- services to the procedure code. Improper use of this modifier could quiring supervision of the provider. The provider is not required to result in a loss of revenue or reimbursement take-back. remain one-on-one with the patient during the treatment session. You may be able to separately bill a therapeutic service performed on This allows the provider to exit the treatment room and check in pe- a separate body region that is unrelated to the manipulation proce- riodically with the patient. dure. Documentation in the patient’s medical record must support Constant attendance modalities (97032-97033) require the pro- both medical and chiropractic necessity. Append modifier 59 to the vider or qualified healthcare professional to have direct one-on- separate and distinct service code. one patient contact during the entire encounter, according to CPT® Example: Dr. Smith performs seven minutes of manual therapy. guidelines. On the same patient, same visit, Dr. Smith works with the patient Note: A qualified healthcare professional is an individual who is for 15 minutes on strengthening exercises. Proper coding for these qualified by education, training, and licensure/regulation and/or services is 97140-52 and 97110-59. facility privileges. This does not include clinical/office staff. Chiropractic claims are always under scrutiny. Appropriate reim- Documentation must indicate the provider’s constant attendance, bursement can be obtained, however, if everyone on the team plays as well as the amount of time the provider spent performing the by the rules. treatment. Many insurance companies reimburse for the 97032, but not for Kristy Johnston, CPC, is chiropractic billing specialist for Advanced Medical Consulting & Billing, Inc. She be- 97014. These codes are not interchangeable based on what the pay- came a certified coder in 2009, and is focused on chiropractic billing and coding. Johnston credits her career and coding path to her mother, Patricia P. Wood, CPC. She is a member of the Holyoke, Mass., local chapter. er allows. Be aware of the patient’s insurance payment policy before you begin a treatment session.

www.aapc.com July 2015 27 ■ CODING/BILLING By Amy C. Pritchett, CPC, CANPC, CASCC, CEDC, CRC, CCS, CDMP, CMPM, ICDCT-CM, ICDCT-PCS, CMRS, C-AHI Kidney Transplant Coding in Brief Be sure medical necessity is proven and check payer requirements.

When reporting kidney transplant, documentation must substanti- ICD-9-CM Code ICD-10-CM Code ate medical necessity, including a covered diagnosis. 403.91 Hypertensive chronic kidney disease, un- I12.0 There are several factors that insurance companies specifically deem specified, with chronic kidney disease not medically necessary for a kidney transplant, including: stage V or end stage renal disease • Known history or current malignancy up to and including 581.81 Nephrotic syndrome in diseases classified N08 Glomerular disorders in diseases classified metastatic cancer elsewhere elsewhere • Recurrent malignancy with a high incidence of recurrence Code first the underlying disease. • Untreated systemic infection making immunosuppression 582.1 Chr onic glomerulonephritis, with lesion of N03.3 Chronic nephritic syndrome with diffuse membranous glomerulonephritis mesangial proliferative glomerulonephritis unsafe (i.e., chronic infection) Focal glomerulosclerosis • Other irreversible end-stage diseases that are not linked to the kidney disease 585.1 Chronic kidney disease, Stage I N18.1 Chronic kidney disease, stage 1 585.2 Chronic kidney disease, Stage 2 N18.2 Chronic kidney disease, stage 2 (mild) Covered Diagnosis Codes* 585.3 Chronic kidney disease, Stage 3 N18.3 Chronic kidney disease, stage 3 (moderate) ICD-9-CM Code ICD-10-CM Code 585.4 Chronic kidney disease, Stage 4 N18.4 Chronic kidney disease, stage 4 (severe) 250.40 Diabetes with renal manifestations, type II E11.29 Type 2 diabetes mellitus with other diabet- 585.5 Chronic kidney disease, Stage 5 N18.5 Chronic kidney disease, stage 5 or unspecified type, not stated as uncon- ic kidney complication trolled 585.6 End stage renal disease N18.6 End stage renal disease 250.41 Diabetes with renal manifestations, type I E10.29 Type 1 diabetes mellitus with other diabet- 585.9 Chronic kidney disease, unspecified N18.9 Chronic kidney disease, unspecified (juvenile type) not stated as uncontrolled ic kidney complication 753.12 Polycystic kidney, unspecified type Q61.3 Polycystic kidney, unspecified 250.42 Diabetes with renal manifestations, type II E11.65 Type 2 diabetes mellitus with hyperglyce- 753.13 Polycystic kidney, autosomal dominant Q61.2 Polycystic kidney, adult type or unspecified type, uncontrolled mia 250.43 Diabetes with renal manifestations, type I E10.65 Type 1 diabetes mellitus with hyperglyce- 753.14 Polycystic kidney, autosomal recessive Q61.19 Other polycystic kidney, infantile type (juvenile type), uncontrolled mia 996.81 Complications of transplanted kidney T86.10 Unspecified complication of kidney trans- 403.01 Hypertensive chronic kidney disease, ma- I12.0 Hypertensive chronic kidney disease with plant lignant, with chronic kidney disease stage stage 5 chronic kidney disease or end stage T86.11 Kidney transplant rejection V or end stage renal disease renal disease T86.12 Kidney transplant failure 403.11 Hypertensive chronic kidney disease, be- I12.0 nign, with chronic kidney disease stage V *This is not a comprehensive list of covered diagnosis codes, which may vary by or end stage renal disease payer. Check with your individual payer/contract for a complete listing. image by iStockphoto © Talaj ■ ■ ■ 28 Healthcare Business Monthly Coding/Billing Practice Management Auditing/Compliance To discuss this article or topic, go to www.aapc.com Kidney Transplant CODING/BILLING

Procedure Codes ICD-9-PCS Code ICD-10-PCS Code Procedure coding for kidney transplant varies depending on the in- 55.51 Nephroureterectomy 0TB00ZZ Excision of right kidney, open approach dividual case and the services involved. Kidney transplant-related 55.52 Nephrectomy of 0TB10ZZ Excision of left kidney, open approach remaining kidney CPT® codes include: 0TT00ZZ Resection of right kidney, open approach 55.53 Removal of transplanted CPT® Code Description 0TT10ZZ Resection of left kidney, open approach or rejected kidney 00868 Anesthe sia for exptraperitoneal procedures in lower abdomen, including urinary tract; 0TT20ZZ Resection of bilateral kidneys, 55.54 Bilateral nephrectomy renal transplant (recipient) percutaneous endoscopic approach 01990 Physiological support for harvesting of organ(s) from brain-dead patient 55.61 Renal autotransplantation 50300 Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bi- 55.69 Other kidney transplantation lateral 50320 Donor nephrectomy (including cold preservation); open, from living donor Coding Guidelines 50323 Backbench standard preparation of cadaver donor renal allograft prior to transplantation, Per CPT® instructions, do not report 50323 with 60540 Adrenalecto- including dissection and removal of perinephric fat, diaphragmatic and retroperitoneal at- my, partial or complete, or exploration of adrenal gland with or without tachments, excision of adrenal gland, and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary biopsy, transabdominal, lumbar or dorsal (separate procedure) or 60545 Adrenalectomy, partial or complete, or exploration of adrenal gland with 50325 Backbench standard preparation of living donor renal allograft (open or laparoscopic) pri- or to transplantation, including dissection and removal of perinephric fat and preparation or without biopsy; transabdominal, lumbar or dorsal (separate proce- of ureter(s), renal vein(s), and renal artery(s), ligating branches as necessary dure); with excision of adjacent retroperitoneal tumor. 50327 Backbench reconstruction of cadaver or living donor renal allograft prior to transplanta- When reporting bilateral procedures, append modifier 50 Bilateral tion; venous anastomosis (each vein) procedure to 50340 and 50365. 50328 Backbench reconstruction of cadaver or living donor renal allograft prior to transplanta- Example: The patient has bilateral kidney failure and is undergoing tion, arterial anastomosis (each) bilateral recipient transplantation. The surgeon must remove both 50329 Backbench reconstruction of cadaver or living donor renal allograft prior to transplanta- kidneys for the transplantation; append modifier 50 to 50340 to de- tion, ureteral anastomosis (each) scribe bilateral nephrectomy. 50340 Recipient nephrectomy (separate procedure) For renal autotransplantation extra-corporeal (bench) surgery, re- 50360 Renal allotransplantation; implementation of graft, excluding donor and recipient ne- port autotransplantation as the primary procedure and other pro- phrectomy (without recipient nephrectomy) cedures (i.e., partial nephrectomy, nephrolithotomy) as secondary 50365 Renal allotransplantation, implantation of graft; with recipient nephrectomy procedure(s). 50370 Removal of transplanted renal allograft Example: The patient is undergoing an autotransplantation of the 50380 Renal autotransplantation, reimplantation of kidney kidney (50380). The physician performs a nephrolithotomy (50340) at the same session because the patient has several stones located in ICD-9-PCS (or Volume III) codes for facility reporting of kidney the unaffected kidney. In this situation, the CPT® codebook directs transplant include: us to append modifier 51 Multiple procedures to the nephrolithotomy; however, many payers do not require the use of modifier 51. Check ICD-9-PCS Code ICD-10-PCS Code with your payer for specifics. 00.91 Transplant from live 0TY00Z0 Transplantation of right kidney, related donor allogeneic, open approach Amy C. Pritchett, CPC, CANPC, CASCC, CEDC, CRC, CCS, CDMP, CMPM, ICDCT-CM, 00.92 Transplant from live 0TY00Z1 Transplantation of right kidney, ICDCT-PCS, CMRS, C-AHI, is an outpatient educator/auditor for Himagine Solutions, Tampa, non-related donor syngeneic, open approach Florida. She also owns and operates her own coding/billing/and auditing company, Gulf Coast HIM Solutions, Mobile. Pritchett has been a medical coder for over 20 years. 00.93 Transplant from cadaver 0TY00Z2 Transplantation of right kidney, zooplastic, open approach 0TY10Z0 Transplantation of right kidney, allogeneic, open approach 0TY10Z1 Transplantation of right kidney, syngeneic, open approach OTY10Z2 Transplantation of right kidney, zooplastic, open approach

www.aapc.com July 2015 29 ■ ICD-10 ROADMAP By Chandra Stephenson, CPC, COC, CPB, CPCO, CPMA, CIC, CCS, CPC-I, CANPC, CEMC, CFPC, CGSC, CIMC, COSC

Refine Your Understanding of Pervasive Developmental Disorders ICD-10 expands general PDD definitions and subcategories. ccording to the National Institute of Neurological Disorders and Stroke, pervasive developmental disorder (PDD) represents Aa number of disorders characterized by delayed development of socialization and communication skills. The diagnostic term PDD was introduced as part of the Diagnostic and Statistical Manual of Mental Dis- orders, third edition (DSM-III) in 1980. PDD has been further defined and divided in subsequent iterations of the manual, based on additional research findings. Refinement and expansion of PDD categories is demonstrated in the newest iterations of both the DSM and the International Classification of Diseases (ICD).

ICD-9-CM In ICD-9-CM, all PDD categories require a fifth-digit. The fifth-digit options are either: • 0 for current or active state; or • 1 for residual state Although the “current or active state” option is easily interpreted (correctly) to mean the patient has the condition now, there is often confusion as to when to use the “residual state” option. The Handbook of Autism and Pervasive Developmental Disorders indicates the term “residual” was included to account for cases where the child once met the criteria for one of the PDD categories, but no longer does — which seems to imply the individual no longer has the PDD.

■ ■ ■ 30 Healthcare Business Monthly Coding/Billing Practice Management Auditing/Compliance Autism

… refinement actually goes much further and the subcategory may change completely for some disorders (e.g., childhood schizophrenia is reported CODING/BILLING using the unspecified PDD subcategory in ICD-9-CM, but is reported using the Asperger’s syndrome subcategory in ICD-10-CM).

In ICD-9-CM, category 299 represents all PDDs and is divided into er, there is a new instructional note to separately report any medical four subcategories: condition or intellectual disability associated with the PDD. 299.0- Autistic disorder PDD is reported using category F84 Autistic disorder. Category F84 299.1- Childhood disintegrative disorder reflects further refinement in the definition of certain PDDs, as childhood disintegrative disorder and other PDDs are further di- 299.8- Other specified pervasive developmental disorders vided and two new subcategories are created: Rett’s syndrome and 299.9- Unspecified pervasive developmental disorder Asperger’s syndrome.

ICD-10-CM Define PDD Subcategories In ICD-10-CM, the 0/1 subclassifications are removed and the It appears these new subcategories are simply distinguishing one concept of current or active vs. residual no longer applies. Howev- specific disorder from the more generalized terms used in ICD-9-CM

History of PDD Recognition in DSM Table gives the timeline of when each type of pervasive developmental disorder (PDD) was identified (including who identified each disorder), when these disorders were clinically recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and when ICD further divided them for reporting purposes.

1908 1944 1980 1994 2015 Theodor Heller Hans Asperger DSM-III DSM-IV further divides ICD-10 adds identi es demenita proposes the introduces the PDD to include new infantilis, later idea of autistic new diagnostic childhood disintegrative subcategories calles Heller’s psychopathy term “pervasive disorder, Asperger’s and for Rett’s syndrome or (Asperger’s developmental Rett’s syndrome which syndrome and childhood syndrome). disorder.” created a consesus Asperger’s disintegrative between ICD and DSM. syndrome. disorder (CDD).

Leo Kanner publishes Andreas Rett DSM-III-R the DSM-V replaces “Autistic Disturbances of observes and only example of Asperger’s and Aective Contact,” identi es an PDD (autism) is Rett’s syndrome which, combined with unusual added. with a the work of Hans developmental generalized Asperger the following disorder in girls category of year, created the basis (Rett’s sydnrome). Autism Spectrum for the modern study of Disorder based on autism (ASD and PDD). severity. 1943 1966 1987 2013

www.aapc.com July 2015 31

1908 1944 1980 1994 2015 Theodor Heller Hans Asperger DSM-III DSM-IV further divides ICD-10 adds identi es proposes the introduces the PDD to include new demenita infantili, idea of autistic new diagnostic childhood disintegrative subcategories later calles Heller’s psychopathy term “pervasive disorder, Asperger’s and for Rett’s syndrome or (Asperger’s developmental Rett’s syndrome which syndrome and childhood syndrome). disorder.” created a consesus Asperger’s disintegrative between ICD and DSM. syndrome. disorder (CDD).

To fully understand why some of the subcategory assignments changed and why new subcategories were created, first understand the general definitions associated with each PDD subcategory.

(e.g., Rett’s syndrome is a specific form of childhood disintegrative Table A: disorder); however, refinement actually goes much further and the subcategory may change completely for some disorders (e.g., ICD-9-CM ICD-10-CM

CODING/BILLING childhood schizophrenia is reported using the unspecified PDD The following fifth-digit subclassification Use additional code to identify any subcategory in ICD-9-CM, but is reported using the Asperger’s is for use with category 299: associated medical condition and syndrome subcategory in ICD-10-CM). To fully understand 0 Current or active state intellectual disabilities. why some of the subcategory assignments changed and why new 1 Residual state subcategories were created, first understand the general definitions associated with each PDD subcategory. 299.0- Autistic disorder F84.0 Autistic disorder Autism or autism spectrum disorder (ASD): Autism spectrum dis- Childhood autism Infantile autism order is characterized by persistent deficits in social communication Infantile psychosis Infantile psychosis and social interaction across multiple contexts, including deficits in Kanner’s syndrome Kanner’s syndrome social reciprocity, nonverbal communicative behaviors used for social 299.1- Childhood disintegrative F84.2 Rett’s syndrome interaction, and skills in developing, maintaining, and understand- disorder F84.3 Other childhood ing relationships. In addition to the social communication deficits, Heller’s syndrome the diagnosis of ASD requires the presence of restricted, repetitive pat- disintegrative disorder Use additional code to identify any Dementia infantilis terns of behavior, interests, or activities (DSM-V, page 31). associated neurological disorder Disintegrative psychosis Rett’s syndrome: An unusual developmental disorder in girls char- Heller’s syndrome acterized by a short period of normal development, followed by a Symbiotic psychosis multifaceted form of intellectual and motor deterioration (Hand- Use additional code to identify book*, page 8). any associated neurological Childhood disintegrative disorder or Heller’s syndrome: A con- condition dition in which children appear normal for a few years, and then suffer a profound regression in their functioning and a derailment of 299.8- Other specified pervasive F84.5 Asperger’s syndrome future development; originally known as dementia infantilis or dis- development disorder Asperger’s disorder integrative psychosis (Handbook*, page 8). Asperger’s disorder Autistic psychopathy Asperger’s syndrome: The diagnostic criteria for this condition are Atypical childhood psychosis Schizoid disorder of childhood Borderline psychosis of childhood still evolving; however, both ICD-10-CM and DSM-V distinguish F84.8 Other pervasive it from ASD primarily based on a relative preservation of linguistic developmental disorders and cognitive capacities in the first three years of life (Handbook*, Overactive disorder associated page 88). Basically, these individuals typically display the social in- with intellectual disabilities teraction and communication delays without any clinically signifi- and stereotyped movements cant delay in spoken or receptive language or cognitive development. 299.9- Unspecified pervasive F84.9 Pervasive developmental *Handbook refers to the Handbook of Autism and Pervasive Develop- development disorder disorder, unspecified mental Disorders, volume 1, Diagnosis, Development, Neurobiolo- Child psychosis NOS Atypical autism gy, and Behavior, third edition. Pervasive developmenta l disorder Review Instructional Notes NOS Schizophrenia, childhood type NOS When you have an understanding of the general definitions associ- Schizophrenia syndrome of ated with the subcategories of PDD, review both the instructional childhood NOS notes provided, as well as the conditions reassigned in ICD-10-CM.

32 Healthcare Business Monthly To discuss this article or topic, go to www.aapc.com Autism CODING/BILLING

In ICD-9-CM, Rett’s syndrome is reported using the childhood dis- As we move from ICD-9-CM to ICD-10-CM, the code options and integrative disorder subcategory, which includes an instructional instructions for PDD have — like many other conditions — under- note to, “Use an additional code to identify and associated neurolog- gone significant revisions to reflect more specificity in diagnosis and ical disorder.” In ICD-10-CM, this same instructional note appears associated illness. for the subcategory Other Childhood Disintegrative Disorder, but does not appear or apply to the subcategory for Rett’s syndrome. Chandra Stephenson, CPC, COC, CPB, CPCO, CPMA, CPC-I, CIC, CCS, CANPC, CEMC, CFPC, CGSC, CIMC, COSC, is a consultant who started out in healthcare over 10 years ago. In ICD-9-CM, both childhood-type schizophrenia not otherwise She has worked in a centralized billing office, a family practice office, a cardiology office, as a specified (NOS) and schizophrenic syndrome of childhood NOS billing and coding instructor at a local technical college, and as a coding and compliance au- are reported using the subcategory of unspecified PDD. In ICD-10- ditor. She enjoys conducting audits, researching coding and compliance issues, developing CM, these conditions are reported using the Asperger’s syndrome coding tools, and providing practitioner education. She is a member of the AAPC National Advisory Board and the Indianapolis local chapter. subcategory.

ICD-9-CM to ICD-10-CM Crosswalk Table A (on page 32) shows a comparison listing of the subcategories, including the conditions or disorders contained within each, as well as all applicable instructional notes.

A&P Tip By Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC Juvenile Arthritis Juvenile arthritis, which includes juve- Juvenile arthritis can also cause eye inflammation and growth nile rheumatoid arthritis and juvenile problems. Symptoms may get better or go away (remission) idiopathic arthritis, is the most com- and then return in full force (flare). This condition may last mon type of arthritis in children un- only a few months or a lifetime. der the age of 17. It occurs when the im- Diagnosis of juvenile arthritis is based on physical exam, lab mune system attacks its own cells and tests, and medical history. X-rays may also be ordered.

image by iStockphoto © sshepard tissues. It is considered an autoimmune ICD-10 classifies juvenile arthritis (M08) into three major disorder. Both heredity and environ- subtypes defined by symptoms present during the first six ment play a role, but the exact cause of months following onset: systemic onset, polyarticular onset, this disease is unknown. and pauciarticular onset. Juvenile arthritis can cause persistent pain and swelling of one or more joints, affecting mobility. Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, is vice Other signs include: president of ICD-10 Training and Education at AAPC. • Limping in the morning • Fever and rash because of a stiff leg joint • Swelling in lymph nodes

• Clumsiness Anatomy & Pathophysiology

www.aapc.com July 2015 33 AAPC ICD-10

34 Healthcare Business Monthly AAPC ICD-10

www.aapc.com July 2015 35 ■ DEAR JOHN

Have a Coding Quandary? Ask John Arthroscopic Shoulder Debridement Bundles Bicep Tenotomy

We recently (2014 charges) reported for a Medicare patient:

29827-LT Arthroscopy, shoulder, surgical; with rotator cuff repair-Left side

29823-59-LT Arthroscopy, shoulder, surgical; debridement, extensive-Distinct proce- Q dural service 29819-59-LT Arthroscopy, shoulder, surgical; with removal of loose body or foreign body

+29826-LT Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure)

29999 Unlisted procedure, arthroscopy Medicare denied the unlisted code (the bicep tenotomy) as non-covered. Should we have appended modifiers to 29999? CPT® advises that when arthroscopy is performed with arthrotomy, to add modifier 51 Multiple procedures. Or perhaps the tenotomy is a bundled procedure? — Kathleen Smith, CPC/ARII image by iStockphoto © Jovanmandic

Modifier application isn’t the issue. Your suspicion that Arthroscopy, shoulder, surgical; debridement, limited or the bicep tenotomy is a bundled procedure is correct. code 29823 Arthroscopy, shoulder, surgical; debridement, Specifically, the tenotomy is bundled to the debride- extensive, should be reported based on the extent of the A ment (29823). CPT® Assistant, September 2012 advises: service provided. Question: My physician performs an arthroscopic shoul- Although not separately billable, in this case 29999 is the cor- der procedure in which a tenotomy of the biceps is done to rect code choice to describe the arthroscopic bicep tenotomy. complete debridement. What code would I use to report A final note: Despite CPT® advice, many payers no longer re- this procedure? quire the use of modifier 51. Check with your payer for specifics.

Answer: From a CPT coding perspective, because the biceps are tenotomized at the time of the debridement, only the debridement should be reported. Code 29822

If you have a coding-related question for AAPC’s Healthcare Busi- ness Monthly, please contact Managing Editor John Verhovshek, CPC, at [email protected].

36 Healthcare Business Monthly ICD-10 Quiz By Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC Think You Know ICD-10? Let’s See …

The ICD-10-CM codes for juvenile arthritis are broken down by which documentation concepts? A. Anatomical site, laterality, type B. Laterality, type C. Type, severity, temporal factors D. Temporal factors, anatomical location, complications/manifestations

Check your answer on page 65.

Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, is vice president of ICD-10 Training and Education at AAPC. ICD-10 Quiz image by iStockphoto © stocknroll 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.

HealthcareBusinessOffice,• From the leading provider of computer-based LLC interactive CD courses with preapproved CEUs • Take it at your own speed, quickly or leisurely www.HealthcareBusinessOffice.com• Just 1 course can earn as many as 18.0 CEUs • 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) Easily affordable with EasyPayments! Walking Through the ASC Codes (15 CEUs) • http://bit.ly/hbollc-ezpay • Coding with Heart — Cardiology (12 CEUs) (All courses with • Elements of ED Coding (11 CEUs) 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 July 2015 37 ■ CODING/BILLING By G.J. Verhovshek, MA, CPC 78: The “Complications” Modifier image by iStockphoto © Squaredpixels

f the same provider returns a patient to the operating room (OR) during the glob- Ial period of a previous procedure to treat a complication of that earlier surgery, append modifier 78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period to the CPT® code describing the follow-up procedure. Be sure it’s a new Note: Under the Centers for Medicare & Medicaid Services’ (CMS) guidelines, condition and the “same physician or other qualified healthcare professional” includes providers within the same physician group. related to the The term “related procedure” in the modifier 78 descriptor means the follow-up procedure is related to the original surgery, not to the underlying condition that original surgery, prompted the original surgery. That is, the diagnosis linked to the follow-up procedure will describe a new condition (i.e., a complication of surgery) that will dif- not the underlying fer from the diagnosis linked to the initial surgery. condition. For example, a patient suffers from diabetes and severe peripheral vascular disease, which results in gangrene of the right lower extremity. August 19, the patient’s foot is amputated at midtarsal region, with the hope of saving the remainder of the limb. Three days later, the patient is brought back to the OR for postoperative infection with debridement of the bone measuring 16 sq cm. The appropriate coding is:

August 19: 28800-RT Amputation, foot; midtarsal (eg, Chopart type procedure)-Right side 250.70 Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled 785.4 Gangrene ■ ■ ■ 38 Healthcare Business Monthly Coding/Billing Practice Management Auditing/Compliance To discuss this article or topic, go to www.aapc.com Modifier 78 CODING/BILLING

Modifier 78 does not reset global days from the previous surgery; and, typically, you do not receive full reimbursement for the surgery to treat the complication.

August 22: Differentiate 78 from 58, 79 11044-78-RT Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fas- Don’t mix up modifiers 78 and 79 Unrelated procedure or service by cia, if performed); first 20 sq cm or less the same physician or other qualified health care professional during 998.59 Other postoperative infection the postoperative period. Both modifiers describe a return to the OR Notice the use of different diagnoses for the original and follow-up during the global period of another procedure, but modifier 79 in- procedures. dicates the subsequent procedure is unrelated to the initial surgery. In other words, the follow-up procedure is not a result of the initial Return to the OR Is Crucial surgery or the diagnosis that prompted it. When you append mod- CMS defines an OR “as a place of service specifically equipped and ifier 79 to a claim, a new global period begins and the subsequent staffed for the sole purpose of performing procedures. The term in- procedure is paid at 100 percent of the allowed amount, as deter- cludes a cardiac catheterization suite, a laser suite, and an endoscopy mined by the carrier. suite. It does not include a patient’s room, a minor treatment room, For example, a patient undergoes a total abdominal hysterectomy a recovery room, or an intensive care unit (unless the patient’s con- on April 10. At a post-operative checkup, the physician discovers a dition was so critical there would be insufficient time for transpor- Bartholin’s gland cyst, which she removes. tation to an OR).” April 10: To append modifier 78 appropriately, the patient must be returned to the OR. This is especially important for Medicare beneficiaries. 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s) If the provider is able to treat the complication without a return to the OR, Medicare will bundle the treatment into the initial proce- Follow-up: dure’s global surgical package. The Medicare Claims Processing 56440-79 Marsupialization of Bartholin’s gland cyst Manual, chapter 12, specifies, “… the global surgical package includes all medical and surgical services required of the surgeon dur- In some cases, modifier 58 Staged or related procedure or service by ing the postoperative period of the surgery to treat complications the same physician or other qualified health care professional during the that do not require return to the operating room.” postoperative period, rather than modifier 78, may properly describe a return to the OR during the global period. CMS policy (Medicare By contrast, the General Correct Coding Policies for National Cor- Claims Processing Manual, chapter 12, section 40.1.B) states, “If a rect Coding Initiative Policy Manual for Medicare Services, chap- less extensive procedure fails, and a more extensive procedure is re- ter 1, stresses, “Control of postoperative hemorrhage is … not sepa- quired, the second procedure is payable separately.” In such a case, rately reportable unless the patient must be returned to the operat- modifier 58 is appropriate. ing room for treatment. In the latter case, the control of hemorrhage may be separately reportable with modifier 78.” For more information on modifier 58, see “58: The ‘Goes Beyond’ Modifier” in the June 2015 issue of Healthcare Business Monthly.

78 Leads to Decreased Payment G.J. Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Asheville-Hendersonville, Modifier 78 does not reset global days from the previous surgery; North Carolina, local chapter. and, typically, you do not receive full reimbursement for the surgery to treat the complication. Many insurers reimburse only the intraoperative portion of the usual fee schedule payment (approximately 80 percent of the total).

www.aapc.com July 2015 39 ■ CODING/BILLING By Leonta Williams, RHIT, CPCO, CPC, CCS, CCDS

Is Your Next Step Inpatient Coding? Compare it with outpatient coding, and if the shoe fits, wear it.

he healthcare industry affords many wonderful opportunities for Physician/Outpatient Coding Facility/Inpatient Coding career transition and growth. There is a plethora of career choices T Utilizes ICD-9-CM volumes 1 and 2 Utilizes ICD-9-CM volumes 1 and 2 available, such as coding, billing, auditing, compliance, and prac- (ICD-10-CM) for diagnoses (ICD-10-CM) for diagnoses tice management. If you decide on coding, you will also need to determine your preference in the outpatient or inpatient setting. Many Coding for “probable,” “suspected,” or Coding for “probable,” “suspected,” or outpatient coders assign diagnosis and procedural codes for physi- “rule-out” conditions is not allowed “rule-out” conditions is allowed cian offices, ambulatory surgery centers, emergency department Utilizes CPT® and HCPCS Level II for Utilizes ICD-9-CM volume 3 (ICD-10-PCS) (ED) services, etc.; whereas, inpatient coders assign codes for ser- medical/surgical procedures for medical/surgical procedures vices provided during a hospital inpatient stay. Reimbursement primarily based on Reimbursement primarily based on the It’s always a good idea to stay current with employment trends, no physician fee schedule, insurance diagnosis-related group (DRG) matter what your profession. Healthcare is evolving, not only on the contracted rates, ambulatory surgical clinical side of medicine, but also on the side of business and con- center rates, etc. sumer awareness. With impending ICD-10 implementation and No hospital stay Requires a hospital stay (usually with coder shortages reported by many facilities, it makes sense to con- two-day minimum) sider inpatient coding as your next step. Code assignment is based on the Code assignment is based on the entire Weigh Your Inpatient Coding Options encounter/visit admission (length of stay) Recently, AAPC introduced the Certified Inpatient Coder (CIC™) Services are billed on CMS-1500 form Services are billed on UB-04 form credential (www.aapc.com/certification/cic/). This credential focuses on For some, inpatient coding may prove to be more challenging than coding for services in an inpatient (facility) setting. If you are won- physician coding. Besides assigning diagnosis codes to conditions, dering about the differences between outpatient and inpatient cod- you must determine the principal diagnosis (PDx) to assign the cor- ing, consider some examples:

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

With impending ICD-10 implementation and coder shortages reported by many CODING/BILLING facilities, it makes sense to consider inpatient coding as your next step.

rect diagnosis-related group (DRG) to the inpatient Industry Expectations stay. The principal diagnosis is defined as the condition, Coder productivity and accuracy are still the primary after testing, determined to be the reason for the admis- factors in tracking job performance. The length of stay sion. Selection of the principal diagnosis is not always for hospital admission varies based on patient condition easy when multiple conditions are present upon admis- and services needed: Some stays are short (minimum of sion and treated throughout the stay. Separate from two days), while others are longer. Due to the volume identifying the PDx, other factors that may influence of documentation to review (e.g., history and physical the DRG are major complication/comorbidity (MCC), exam, ED notes, consultation notes, diagnostic lab/ra- complication/comorbidity (CC), and (sometimes) the diology results, progress notes, operative notes, etc.), as type of surgical procedure performed. well as the complexity of inpatient coding, productivity requirements — in terms of the amount of accounts Become Familiar with CDI, DRGs, MCCs, and CCs coded per hour/day — are less than physician coding. Clinical documentation improvement (CDI) is invalu- Coders are expected to retain a 95 percent accuracy rate, able in the inpatient setting. Because present MCCs and which is standard in the industry. CCs may change a DRG, resulting in higher reimburse- Where you work mirrors outpatient coding. You may ment, it’s imperative for provider documentation to be be onsite at a hospital, or work remotely. Because many detailed, comprehensive, and supportive of diagnoses. hospitals outsource their production coding, there is an For instance, a general description of congestive heart abundance of remote opportunities available to the ex- failure (CHF) (ICD-9 code 428.0 Congestive heart fail- perienced coder. Some hospitals now offer an in-house ure, unspecified) will not change the DRG; however, coding transition or cross-training program, in which documentation or clinical indicators supporting acute outpatient coders can learn inpatient coding within on chronic systolic CHF (ICD-9 code 428.23 Acute on their facility. This serves as a great opportunity to take chronic systolic heart failure) will. your career to the next level. A provider may be queried if there is documentation or clinical indicators to assign a more specific code. De- Research, Plan, Study, and Get Certified pending on the facility, the inpatient coder may be re- If you’re ready for a new challenge, now is the time to sponsible for creating that query. Many hospitals now consider inpatient coding. First step: Research! Learn have a CDI program where the CDI specialist initiates as much as you can about the rules and guidelines sur- the query, or perhaps the process is collaborated be- rounding this specialty, as well as employment opportu- tween the CDI specialist and inpatient coder. nities, requirements, and salary potential. Plan, study, In addition to DRGs, MCCs, and CCs, the inpatient and get CIC™ certified. You will find inpatient coding coder also needs to become familiar with guidelines an area of limitless possibilities. unique to inpatient coding, such as present on admission (POA) indicators, hospital acquired conditions Leonta (Lee) Williams, RHIT, CPCO, CPC, CCS, CCDS, has more than 12 years of experience as a coding manager, auditor, educator, trainer, and (HAC), and discharge dispositions. There are tools practice manager. She is founder and past president of the Covington, available to assist in the coding process: AHA Coding local chapter. Clinic, for example, is heavily relied on by inpatient coders for guidance. Being efficient in the use of an encod-

er system is usually a requirement for inpatient coding. image by iStockphoto © Amanalang

www.aapc.com July 2015 41 ■ PRACTICE MANAGEMENT By Michelle Stallings, CPC

SPOKE Think of 1

Collect and Process Capturing Patient Information Revenue as

SPOKE

Handle Spokes on Accounts 2 Service with

SPOKE

Coding and Billing Manage Capture the Provided a Wheel Collections When your revenue functions are working SPOKE in unison, you’re in for 3 a smooth ride.

evenue capture in a medical practice can be compared to a wheel. quire reception to confirm the demographic and insurance infor- RThe wheel begins to turn the moment a patient calls for an ap- mation for any patient who has not been seen at the practice in the pointment, and stops only when the balance on the patient account last 30 days. is zero. Just as multiple spokes support a wheel, multiple revenue The more information you share with the patient prior to the ap- functions (workflow tasks that staff or providers must perform) sup- pointment, the better equipped he or she will be. For example, when port the overall revenue cycle. Unless each function is performed ef- a patient calls for an appointment, reception might say: fectively, the practice collapses. Mr. Jones, we need to confirm your address, phone number, When a revenue function fails to support the overall process, it’s of- and insurance information on file. Please have copies of your ten because the responsible party doesn’t understand his or her role. insurance and driver license when you check in. Communication and a list outlining required information and tasks Mr. Jones I see your insurance requires $25 co-pay. Please will ensure that metaphorical wheel keeps turning. have this ready when you check in to see Dr. Doe. Whatever your policy is, be sure to spell it out so there are no surpris- SPOKE 1 es for the patient. While you have the patient on the phone, explain Collect and Process Patient Information the practice’s policy. If your state allows the cost of collections to be passed on to the patient, and the practice wishes to do this, outline Patient registration is your front line for revenue collection. Gather it in the financial policy. the correct information from the patient prior to his or her time with the provider. Failing to verify coverage before an appointment may It’s essential that staff fully understands the importance of individ- cause payment delays and inhibit workflow down the road. ual roles. Simply telling the front desk, “Make sure you get the insurance card and driver’s license,” may not be enough. The staff may Develop a clear and concise workflow to help staff understand the get busy or feel uncomfortable asking for a license. Explaining, “We importance of collecting patient information. For example, re- ■ ■ ■ 42 Healthcare Business Monthly Coding/Billing Practice Management Auditing/Compliance Capturing Revenue PRACTICE MANAGEMENT PRACTICE

Patient registration is your front line for revenue collection.

are having denials for wrong insurance,” or “We have to con- • If the provider does not document sufficiently what is sider the increase in identity theft in healthcare,” solidifies the being billed, educate the provider as to what is needed importance of the policy. Similar explanations can soothe pa- and why. tients who balk at sharing personal information. Update and communicate changes about your policies when necessary (e.g., when new codes or coding guidelines are in- SPOKE 2 troduced). Ask staff affected by the policy for input and feedback. Coders and billers tend to be very detail-oriented and of- Capture the Provided Service ten can provide excellent suggestions to create effective poli- with Coding and Billing cies and procedures. Proper coding and billing is the next spoke in your wheel. Communication is crucial because insurance policies change SPOKE 3 frequently. Establish a written policy and workflow from the time the service is provided to the time you submit the charge Manage Collections for payment. Consider areas requiring special attention. For Managing collections can be difficult. Consistently following example: a stated financial policy is the best offense. • Append modifier AI Principal physician of record to Even for patients with excellent insurance, the cost of care is an claims for an initial inpatient service for Medicare important consideration. Patients expect to know their out-of- patients. Ask providers to submit charges no more than pocket expenses; the better you communicate those costs, the five days past the date of service to prevent timely filing more success you’ll have when collecting co-pays, co-insur- denials and to allow coders time to accurately code and ance, and deductibles. submit for payment. Some practices use a procedure/benefit form (see Sample Ben- • Check edits built into your billing system to catch efit Form on next page) to further facilitate collections and to certain items that may be cause for a denial. For manage patient expectations. For example, consider this work- example, if a referring physician is not listed on the flow process: claim, will the edit catch it? Do you have an edit in place 1. The scheduler or secretary fills out the procedure/bene- to prevent billing Medicare for consultations, which the fit form with a CPT® code of the expected surgery. Centers for Medicare & Medicaid Services (CMS) does not cover? 2. After the patient is scheduled for surgery and all instructions are given, introduce the patient to a financial • Some practices review appointment scheduling against staff member. all charge slips to ensure no revenue is missed. Most practice management systems can automate this process. 3. The financial advisor can go over all the financial de- If you do not use a missing charge report function, find tails, such as the cost for the professional portion of the out why and consider using one. surgery, and collect the money. The patient should receive a copy of the form. • Practices may hold superbills for a day or more to verify that documentation supports what is being billed, and Be sure to include a disclaimer explaining that the CPT® code to ensure everything documented is billed. This can on the benefit form is an estimate based on the surgeon’s deter- increase workloads, but will ensure revenue is not lost. mination of the service(s) to be provided, but that the service(s) could be different.

www.aapc.com July 2015 43 To discuss this article or topic, go to Capturing Revenue www.aapc.com

SAMPLE BENEFIT FORM

GENERAL SURGERY Benefits and Eligibility Verification (Estimation of Procedural Expenses)

Surgery Date: ______MEDICALLY NECESSARY - URGENT ___ MEDICALLY NECESSARY – NON-URGENT ___ ELECTIVE INPATIENT/OUTPATIENT Patient Name ______Account # ______Physician ______CPT Description CPT Description 47562 Laparoscopic cholecystectomy 36561 Power port placement 47563 Laparoscopic Chole w/ Grams 37609 Temporal artery biopsy 49505 Open Inguinal hernia repair +5 yrs 43235 EGD 49585 Open Umbilical hernia repair +5yrs 43280 Lap Nissen/Toupet Whatever your

PRACTICE MANAGEMENT 49650 Laparoscopic Inguinal hernia 49320 Diagnostic Laparoscopy 49652 Laparoscopic hernia incl. Ventral, 49565 Open hernia repair incl. Ventral & policy is, be Umbilical, Spigelian & Epigastric Incisional. RECURRENT 49654 Lap Incisional hernia repair 49560 Open hernia Ventral & Incisional sure to spell it 43260 ERCP 45378 Colonoscopy

Insurance Company out so there are Charge Amount $ Allowed Amount $ no surprises for Deductible $ Remaining Deductible $ Co-Insurance $ ( %) Co-payment $ the patient. Amount Due From Patient $ Information Source Date Amount due from Patient is an estimated figure based on information obtained from patient’s insurance provider. The information is not a guarantee of insurance payment or benefits. Benefits are subject to all contract limitations and the member’s eligibility status on the date of service. Any amount not paid by insurance provider, automatically becomes the patient’s responsibility. All unpaid amounts are due in full within thirty (30) days of insurance notice. If the unpaid balance cannot be paid in full, other arrangements must be made.

** Please contact 000-0000 for estimated hospital expenses. This is not included in the total above. I have read and understand the financial obligation above and agree to the terms as stated.

Signature ______Date ______Witness ______Date ______PATIENT CONTACT #’s 1) ______2) ______Revised February 17, 2015

Typically, everyone in a medical practice is busy and may juggle SPOKE 4 many tasks. Teamwork helps to ease the load, as does taking the time Handle Accounts to understand how each person on your team communicates. We all want the end result, which is better revenue for our practice and — Many practice management programs are available to assist your most of all — satisfaction for ourselves and the patients we serve. practice with this function to keep the wheel turning smoothly. Assigning work by insurer allows staff to grow familiar with indi- Michelle Stallings, CPC, began in healthcare 24 years ago. She has worked for Ferrell-Dun- vidual payers’ rules. Perform quality audits (once per quarter, for in- can Clinic, a multi-specialty clinic for 15 years. She served as member developmental officer stance) to monitor payments closely. Set up electronic reminders of the Springfield, Mo., local chapter the year it was named Chapter of the Year (2011). Stall- ings also has served as the chapter’s education officer and is a part-time consultant for Health for information requests and appeals to be sure they aren’t missed. Advances. Staff handling accounts after the payer has received the claim must communicate well with the billing and coding staff. This helps to resolve any trends in denials.

44 Healthcare Business Monthly Compliance without the Complications. Compliance can be a challenging endeavor. Not anymore. 7Atlis makes compliance management simple and intuitive for all. By addressing each of the seven OIG recommendations, you’ll have total confidence that your practice is compliant, trained, and fully protected.

7Altis Simple, Step-by- AAPC Training Total Compliance Affordable Plans Step Guidance and Education Management and Pricing

Get Compliant Today. Web: www.7atlis.net | Email: [email protected] | Phone: 877.835.2842July 2015 45 ■ PRACTICE MANAGEMENT By Joe Ascensio Record It for Reference Enhance training in your office through basic video technology.

hen you teach someone, do you wonder if he or she will retain Wthe information? Are you concerned when the individual does not take notes? Will he or she be able to perform that task when prompted to do so? You can remove these questions from your mind if you do what many schools and universities are doing — record the lesson. Using one or more technology tools, you can make video documentation before you reach for that next cup of coffee. There are several free and low-cost solutions to easily create digital reference material on your computer.

More to Come Many schools and universities have invested thousands of dollars in state-of-the-art recording technology. In an upcoming article, we’ll talk about reaching out to these institutions to use their technology to make even more professional looking recordings.

Reasons to Record You can videotape inner office training, cross training, onboarding of new employees, and more. Video is especially helpful for showing, rather than telling, employees how to resolve problems. And anyone who misses a meeting or training session can easily watch the video at a later date. If a picture is worth a thousand words, imagine how valuable it would be to have written documentation with links to actual record- ed videos that explain, systematically, a particular process. Many offices have existing standard operating procedures (SOPs), but think

of the value of having both video documentation and written SOPs. image by iStockphoto © pagadesign ■ ■ ■ 46 Healthcare Business Monthly Coding/Billing Practice Management Auditing/Compliance Record It

Video is especially helpful for showing, rather

than telling, employees how to resolve problems. MANAGEMENT PRACTICE

These two tools (and other, similar tools) allow you to use Power- Point slides (to which you may make minor markups), add voice narration, and click a button to create a movie from the slides. When image by iStockphoto © LDProd using Microsoft Mix, you need to find a place to house the video on the Internet so others can see it. With BrainShark, this feature is built in: A Web link is provided, as is a special code (HTML) if you want to embed the video in a webpage. Be sure to research “how to” videos to save countless hours of learning by trial and error. Additional Features If you want to do more than just record five minutes of material and your voice over a slide, TechSmith has a step-up product from Jing called Relay®, which offers lecture capture (www.techsmith.com). Do some research to make sure you pick a product that can fulfill your wish list. Free Video Documentation Jing® by TechSmith is a free tool that allows you to record still imag- Hints and Tips for Recording es of the computer screen or make a video of anything you can dis- • Create a best practices whitepaper for video recording. play on a computer monitor, with voice narration. Using an inex- • Record in a quiet room, turn off your cell phone, and quiet pensive microphone that you can purchase at any large retail store anything that makes noise. (I recommended using a headset to record, as it will greatly improve sound quality) and a quiet room, you can create functional video • Close your door and put a note on the outside asking for quiet documentation with ease. while you record. Jing will record up to five minutes: The on-screen timer will count • Run a quick test before each recording session to be sure the up to five minutes, and the numbers change to a red font at the four- settings are correct. minute mark to alert you that time is running short. If you need • Position your headset so the microphone is not picking up more time, simply make additional videos and label them “part 2,” breathing sounds. “part 3,” etc. Your videos can be downloaded from or uploaded to When a college professor records a lecture and students watch it pri- Jing’s partner at www.screencast.com. or to class, it’s called a “flipped” class. That means the students can Take some time to practice using the software. TechSmith has very watch the recordings outside of class (preferably prior to class) and helpful online videos. You might also search online (e.g., Google focus on hands-on learning activities and group work while in the or YouTube) for additional how-to videos. You can learn a lot from classroom with the instructor. If students are learning in this flipped others. environment, perhaps working professionals can, too. Give it a try! Review the features and then download Jing for free from the Tech- Jose “Joe” Ascensio lives in Kansas City, Mo, and works at Kansas University – Edwards www.techsmith.com/jing.html Smith website at . Campus as an instructional technologist. He is also an author and speaker on topics related to Other free solutions to create video documentation include Micro- self-improvement and technology. Ascensio holds a master’s degree in education with an soft Mix (https://mix.office.com/) and BrainShark® (www.brainshark.com/). emphasis in adult education. His bachelor’s degrees are in computer information systems. These tools are similar to Jing, and offer free, entry-level accounts. Ascensio’s passions in life are family, technology, and training. You can reach him via LinkedIn at www.linkedin.com/in/joeascensio.

www.aapc.com July 2015 47 ■ PRACTICE MANAGEMENT By Debra Cascardo, MA, MPA, CFP Prepare Your Practice for Disaster When there’s crisis, have a plan to ensure a swift return to normal operations.

eing prepared for a disaster can save lives, information, and your Tip: Experience is the best practice. A disaster preparedness plan (also called a business con- teacher. Speak to your vendors, tinuity plan) should be part of your practice’s written policies phone systems, billing services, B labs, electronic health record and procedures. The goals of the disaster preparedness plan is to as- (EHR) providers, accountants, and sure staff and patients are safely evacuated and/or treated, and to re- others about their own disaster store business operations as quickly as possible. As a healthcare busi- preparedness policies, and how they ness professional, you play a critical role in planning how your prac- have responded to previous events. tice can safeguard its records and restore business functions in the event of a disaster. Have Accessible Open Up Communication Lines and Secure Records During and after a disaster, communication is vital. Be sure several As a coder, biller, or com- key personnel have the phone numbers, email addresses, and home pliance office, you’re prob- addresses of all employees. They should also have names and phone ably most concerned with numbers of each employee’s family (emergency contacts), and con- how a loss of documents tact information and account numbers for insurance agents, vendors, will affect your work in the hospitals, colleagues, etc. This information should be easily accessi- practice. Patient records ble outside of the office. must be accessible and se- Establishing a phone tree allows you to disseminate information cure. Documents, both paper and electronic, can be lost due to fire, about the disaster, quickly. Appoint one person to organize the phone flood, computer malfunction, etc. It’s critical for you to have a check- tree. This person will collect contact information for all of the indi- list on hand, so panic doesn’t set in. viduals who should be included on the list. When necessary, the orga- On your checklist, have the answer to these questions: nizer starts the phone tree by calling two people at the top of the list; • Are there computer drives, cash boxes, or other easily removed those two people each call two people, and so on. items that should be taken with you in case of a fire during You also should be able to remotely access the practice’s appointment office hours? schedule in case the office is damaged to the point where patients can- • Is there a designated person (and back up) responsible for that? not be seen, and must be alerted and rescheduled or, ideally, directed • Are your patient records, accounting information, contacts, to a temporary office. and other data backed up and accessible off-site? To cut down on the calls you have to make, forward the office’s phone • Has someone been designated to communicate with the number to an answering service or other working number, with a insurance carriers, vendors, and other business associates? message informing callers of why the office is closed and how they can reach their physician and/or medical record. If there is an email list of patients, you can also send a mass notification (be sure to blind copy Recovering Data and Avoiding HIPAA Violations the names, so they are not revealed to everyone receiving the email). Data recovery is the most important thing you can do to ensure busi- If the practice has a website, promptly display a message on the site ness continuity following a disaster. Backing up patient and finan- providing options for patients to access a healthcare provider or their cial data is critical and should be done automatically. EHRs and vir- medical record. tual private networks can eliminate worries about the loss of patient records and other important practice data. image by iStockphoto © Stuartmiles99 ■ ■ ■ 48 Healthcare Business Monthly Coding/Billing Practice Management Auditing/Compliance Disaster Plan PRACTICE MANAGEMENT PRACTICE Data recovery is the most important thing you can do to ensure business continuity following a disaster.

support the key people in your facility and community who are responsible for managing recovery efforts. Name these people in your plan and the tasks for which they are responsible.

Tip: You might want to name and train backup recovery personnel for specific tasks in case someone cannot fulfill his or her duties.

Whether you can return to your office or need to set up a satel- lite office is irrelevant if you have arranged to have your patient records, accounting records, vendor contact information, and other data stored electronically off-site and remotely accessible. Have an “emergency kit” to keep the practice running if unable to return to the office. Keep basic forms, such as insurance and lab request forms, prescription pads, and staff and patient lists in the kit, stored electronically and offsite. Ideally, you should prearrange with a col- league to temporarily share office space in the event of a disaster that precludes a return to your office. Be Flexible, and Update Often For “small” disasters, such as losing a laptop, thumb drive, or smart A good disaster recovery plan includes contingency plans for mul- phone, it’s vital that your patients’ protected health information tiple scenarios: (PHI) is not accessible to anyone else. Be sure to have passwords, thumbprints, encryption, or other security measures in place to en- • What needs to be done immediately? sure no unauthorized person can access PHI. • What needs to be done within 24 hours? Work with your information technology systems management team • What needs to be done if the disaster will affect your business to be sure data is not lost or vulnerable in a disaster and that dis- for several days, a week, a month, or longer? rupted systems are quickly restored. All critical files should be se- If your organization has multiple offices, you may need to make cure, backed up, and accessible from anywhere. Assess your current more specific plans for individual locations. network structure, systems, and backup plans to make sure there’s A disaster resulting in a temporary cessation of practice operations a contingency plan if Internet service and/or power outages affect does not mean a permanent shut down — if you are prepared. With the entire area. Check to see if there are redundant power supplies a plan in place for data storage and retrieval and proper insurance on more critical equipment, such as firewalls/routers, switches, and coverage, you can meet and overcome a disaster. Patients can be seen file servers. and payers can be billed.

Post-disaster Recovery Debra Cascardo, MA, MPA, CFP, is the owner of The Cascardo Consulting Group, a Fellow After a disaster has been met and resolved, it’s time to get the prac- of the New York Academy of Medicine, and a healthcare journalist. tice back on track. This will happen more quickly if you have already determined who will contact staff, patients, vendors, insurance agents, etc., about your office’s status. All personnel must know and

www.aapc.com July 2015 49 ■ AUDITING/COMPLIANCE By Stacy Harper, JD, MHSA, CPC

Part 8: Building a Ensure medical HIPAA Toolbox record availability and integrity with a contingency plan.

Consider this: The hard drive containing your electronic health record (EHR) crashes, resulting in loss or corruption of all data. You contact your vendor to pull the backup data so it can be loaded as soon as the server is up and running. The vendor informs you that the last several full backups failed, and the most recent comprehensive backup is one month old. You thought your organization had a robust contingency plan in place. What should you do now? There may not be a way to recover the lost data, but there are steps you can take to prevent this sort of thing from happening again. image by iStockphoto © PixHouse

Compliance Implications of Missing Records To minimize the risk of data loss or compromise, your organization should implement a robust contingency plan. The Security Aside from the inevitable operational interruption, the loss of elec- Rule specifies five components to consider when developing a con- tronic data can have significant compliance implications for your tingency plan: practice. Health records provide evidence of medical necessity for services performed or ordered by the provider. Medicare and other 1.) Criticality analysis; 4.) Contingency operations; and payers not only require this information to be available, but require 2.) Data backup; 5.) Testing and revision. providers to be able to demonstrate the integrity of data in electron- 3.) Disaster recovery; ic form. A compromise or loss of data does not have to be complete Although criticality analysis, testing, and revision are considered to have compliance implications. Failure to maintain audit capabil- addressable components — as opposed to required components — ities or user authentication may invalidate key components of the their inclusion in the process significantly affects the required com- documentation necessary to support third-party billing. ponents, and should not be omitted. The majority of safeguards under the HIPAA regulations found at 45 CFR 164 Subpart C focus on the security of electronic protect- 1. Criticality Analysis ed health information (ePHI) and prevention of unauthorized ac- The performance of a criticality analysis is key in effective utiliza- cess, use, or disclosure of such information. Most compliance ef- tion of contingency planning resources. To perform a criticality forts under the Security Rule focus on encryption, segregation, user analysis, you must assess the relative criticality of specific applica- controls, and other safeguards that prevent unauthorized activity. tions and data (45 CFR 164.308(a)(7)(ii)(E)). Contingency planning efforts also can have a significant impact on an organization’s overall compliance, and should not be overlooked.

■ ■ ■ 50 Healthcare Business Monthly Coding/Billing Practice Management Auditing/Compliance Data Integrity

Medicare and other payers not only require information

to be available, but require providers to be able to AUDITING/COMPLIANCE demonstrate the integrity of data in electronic form.

Criticality analysis begins with identifying applications contain- The data restoration process should consider specific systems and ing ePHI. The criticality or importance of data contained in each IT structure of your organization. Disaster recovery documenta- of these systems is then prioritized. This prioritization can be used tion should include instructions on how to grant access to individ- by your organization to determine where resources available for uals as needed to perform restoration services. The restoration pro- contingency planning should be used. For instance, an application cess should include some form of validation or confirmation that all that interfaces with the EHR system for transmission purposes may data has been accurately restored. If data is missing, provide guide- contain only a copy of data from the EHR. As such, the resources lines as to how to manage the gap. needed to perform backups of the data within this application may be significantly less than the resources allotted to the EHR application itself. For more information on disaster recovery, see the article “Prepare Your Practice for Disaster” on pages 48-49 in this issue of Healthcare 2. Data Backup Plan Business Monthly. Unlike paper records, electronic systems provide the opportunity to maintain copies of data for restoration in the event of a disaster. Each organization should develop a plan to describe how these back- 4. Emergency Operations up files are created and maintained (45 CFR 164.308(a)(7)(ii)(A)). In the event of a data loss or compromise, focus your activities on This plan should identify included applications, the performance getting the system restored; however, consider also how the organi- frequency, and the extent of copied data. zation will operate, in the meantime (45 CFR 164.308(a)(7)(ii)(C)). For example, many backup plans will involve only a partial backup For most healthcare providers, simply closing the doors until sys- of changes to data daily, with a comprehensive backup on a week- tems are restored is not an option. Emergency mode operations ly or monthly basis. should describe how workforce members can access information, The backup plan also should consider the manner in which the data how records should be maintained, and how the interim operations is backed up (e.g., tape, external hard drive, off-site cloud storage, will be incorporated into the IT system once functionality is re- etc.). When possible, the backup plan should ensure storage of back- stored. For larger organizations, the emergency operation policies up data in a location physically separate from the primary system. may be customized at the department level to address variations in storage and use of data across the organization. 3. Disaster Recovery Most disaster recovery plans begin with contacting the organiza- 5. Testing and Revision tion’s information technology (IT) department or IT vendor. Know Just as healthcare providers engage in natural disaster drills, your who will coordinate the restoration process and be sure the plan in- organization should test its contingency plan and make modifica- cludes contact information for key individuals, location of neces- tions as necessary (45 CFR 164.308(a)(7)(ii)(D)). Testing may be in sary data, and a process to notify other affected staff. Give thought the form of verifying completion of each backup process and test- to the manner in which data is restored (45 CFR 164.308(a)(7)(ii) ing backup files to ensure data can be recovered. Testing should (B)). Expected response times may be described in the disaster re- also include workforce education and drills. It’s only through test- covery policy or a vendor agreement. These response times are fre- ing that an organization can determine the effectiveness of its con- quently based on prioritization of data, which should be consistent tingency plan. with your organization’s criticality analysis.

www.aapc.com July 2015 51 To discuss this article or topic, go to Data Integrity www.aapc.com

Testing may be in the form of verifying completion of each backup process and testing backup files to ensure data can be recovered.

With an effective contingency plan, your organization can improve • A thorough disaster recovery policy would’ve provided you the likelihood that data is maintained consistent with its record re- with a process to verify the restored data and resolve any tention policies and compliance obligations. If you are affected by missing information due to the time lag between backing up data loss or interruption, the plan can minimize down time and data files and disk failure. loss, and streamline the process for workforce members. Your department-specific emergency operation plan provides your Now, think back to the initial scenario: staff with the necessary resources to continue providing healthcare AUDITING/COMPLIANCE • A contingency plan with testing of the backup process services while you manage the recovery and restoration process. would’ve ensured more recent backup data would be Stacy Harper, JD, MHSA, CPC, is healthcare attorney with Lathrop & Gage LLP, serves on available for restoration. AAPC’s Legal Advisory Board, and is a previous member of AAPC’s National Advisory Board. • Performing a criticality analysis would’ve prioritized the She consults with healthcare providers around the country on matters of regulatory sensitivity of your EHR data, and a comprehensive backup of requirements such as HIPAA, data privacy and security, Stark Law, Anti-kickback Statute, this component would’ve been performed weekly instead of state licensure, and Medicare conditions of payment and participation. Harper is a member of the Kansas City, Mo., local chapter. monthly. ICD-10 Workflow Now Available for Your Specialty on Your Browser

The all new revolutionary pictorial coding workflow tool that guides you to the most specific ICD-10 codes. Fuels efficiency with ICD-10 rules, guidelines and documentation requirements in one place. Easy integration with yourTCI EHR and PMS promises that your coding and compliance productivity keeps percolating.

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52 Healthcare Business Monthly ASK THE LEGAL ADVISORY BOARD ■ By Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO When Does the Locum Tenens Clock Start? Vague guidance from CMS calls image by iStockphoto © Adv for clarification of 60-day rule.

Thank you for providing guidance at the Legal Trends general session at HEALTHCON. I briefly talked with you about locum tenens and when Qthe clock starts for counting 60 days. Can you share government directive regarding this topic?

The Centers for Medicare & Medicaid Services’ (CMS) by using multiple locum tenens physicians. While it’s not clear that the guidance is found in the IOM Pub. 100-04, Medicare period can be extended in a non-emergency circumstance, it’s impor- Claims Processing Manual, chapter 1, section §30.2.11, tant to note that regardless of the absence circumstances, the regular Physician Payment Under Locum Tenens Arrangements physician is expected to return to the practice. You cannot bill under the - Claims Submitted to Carriers. It states, “The substitute locum tenens rule indefinitely or use it to fill long term staffing voids physician does not provide the visit services to Medicare due to a retirement, death, or other permanent departure of a physician Apatients over a continuous period of longer than 60 days subject to from the practice. If the regular physician is not returning, you cannot the exception ...” use multiple locum tenens physicians to extend the 60-day period. For Although this does not expressly clarify the start date, the rule does groups looking for a temporary replacement of a physician who has left make clear that the period starts when the locum tenens physician ac- the practice (not returning), pending the hire of a new physician, you tually begins rendering services. get only one 60-day period, beginning with the first date that the locum tenens physician provides services. CMS has published the following guidance pertaining to emergen- cies in the “Medicare Fee-For-Service Emergency-Related Policies Regarding the guidance that states a physician can return for “a short and Procedures,” Medicare Fee-For-Service Questions and Answers: period” to reset the 60-day clock: CMS does not clarify what a short period is. It’s reasonable to assume it’s longer than a day, possibly as E-2 Question: Will the 60-day locum tenens limit be extended for those affected by the long as a week, or so. disaster? Some physicians in nearby States are going to the affected disaster areas to help out. In their absence, locum tenens physicians (i.e., temporary or substitute physicians) are substituting for the physicians leaving their medical practices to work in the disaster areas. Resources Answer: No, the 60-day limit for a locum tenens physician may not be extended. Claims Processing Manual, IOM Pub 100-4, chapter 1, §30.2.11, Physician Payment Under However, current Medicare policy allows physicians to cover absences of longer than Locum Tenens Arrangements - Claims Submitted to Carriers: www.cms.gov/Regulations- 60 days by hiring multiple substitute physicians. For example, if a physician needs to be and-Guidance/Guidance/Manuals/Downloads/clm104c01.pdf absent from his or her medical practice for 120 days, the absent physician may hire one “Medicare Fee-For-Service Emergency-Related Policies and Procedures,” Medicare locum tenens physician to work the first 60-day period and a different locum tenens Fee-For-Service Questions and Answers, E-2: www.cms.gov/About-CMS/Agency- physician to work the second 60-day period. As an alternative to hiring more than one Information/Emergency/downloads/consolidated_Medicare_FFS_emergency_qsas.pdf locum tenens physician, a physician could return to work in his or her practice for a short period of time to reset the 60-day clock. In addition, Medicare policy (for locum tenens billing) does not allow absent Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA, is president-elect of AAPC’s physicians to bill for substitute physicians for an indefinite period of absence, nor does National Advisory Board, serves on AAPC’s Legal Advisory Board, and is AAPC Ethics Committee Medicare policy allow physicians and other entities to bill for locum tenens personnel chair. He has over 20 years’ experience in healthcare coding and over 16 years’ as a compliance to fill staffing voids. The services of temporary personnel to fill staffing needs may be expert, forensic coding expert, and consultant. He has provided expert analysis and testimony billed using other methods. on coding and compliance issues in civil and criminal cases and his law practice concentrates on representing healthcare providers in post-payment audits and with responding to HIPAA OCR issues. He speaks on a national level, and is published in national publications on a variety of coding, compliance, and health law This makes clear the issue of the start date; it also confirms the ability topics. He is a member and president of the Johnstown, local chapter. of a provider (for certain in an emergency) to extend the 60-day period ■ ■ ■ Coding/Billing Practice Management Auditing/Compliance www.aapc.com July 2015 53 ■ AUDITING/COMPLIANCE By Erica Lindsay, PharmD, MBA, JD ENCOURAGE EMPLOYEES TO REPORT COMPLIANCE VIOLATIONS

View reporting as an improvement to your compliance process, potentially saving you hefty fines.

mployees are key resources for identifying and reporting compli- go-based hospital, Sacred Heart, closed immediately due to a feder- Eance and ethics violations in your organization. Encourage and al fraud probe. The chief financial officer and four doctors were ar- support reporting options for employees, including self-disclosure rested in connection with an alleged kickback scheme in which doc-

and anonymous reporting. The sooner a violation is identified and tors were bribed to admit Medicare patients. The closure was a di- image by iStockphoto © AndreyPopov resolved, the healthier your organization will be. rect result of Medicare deciding to suspend payments for 180 days. Hundreds of Sacred Heart employees lost their jobs. Catch Violations Early When violations are undiscovered over long periods, major dam- Obstacles to Compliance Reporting age may occur, leading to layoffs or lost jobs for hundreds of people, Employees often resist reporting because there is a perception that among other consequences. For example, on July 1, 2013, a Chica- those who speak up are “tattletales,” untrustworthy, or disloyal to

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

When violations are undiscovered over long periods,

major damage may occur, leading to layoffs or lost jobs AUDITING/COMPLIANCE for hundreds of people, among other consequences.

their company and coworkers. A “whistle- governance consistently, reporting will not be viewed negatively, blower” informs when a person or organi- but as an improvement to the overall process. zation is engaged in an illicit activity, yet the term often has a negative connotation. Open Communication Channels Employees also may fail to report noncom- Demonstrate from the executive management level that your orga- pliance because they fear retaliation. In a nization expects reporting of non-compliance actions. Your code of study conducted by the National Business conduct is a great tool to illustrate the importance of ethics reporting. Ethics Survey, 65 percent of employees re- Within the code, incorporate a message from your board of directors port violations, and 21 percent of those suf- or the CEO explaining ethical standards of the organization and the fered retaliation from their employer. In anti-retaliation policy. Encourage employees to report on incidenc- January 2015, the U.S. Office of Special es of misconduct to maintain a safe workplace, while protecting prof- Counsel reported that, since last April, it its and reputation. Highlight that everyone is held to the same stan- has offered relief to a total of 25 whistle- dard of professional and ethical conduct — including management. blowers who faced retaliation for exposing Employees need methods to report violations in a non-threatening, wrongdoing at Veteran Affairs facilities. non-retaliatory manner. Offer employees direct communication to Employees who suffer from retaliation re- the compliance department through mail (electronic or paper), ho- sulting from reporting may not be success- tline access, and in person. Employees who report should see that ful without the assistance of an attorney. the relayed information will be addressed in a professional, prompt Some employees decide to report after they manner and feel comfort that they did the right thing. have separated from the organization to avoid retaliation, but this prolongs the non- compliance violations. Tip: Up to 50 percent of calls to the compliance hotline are related to human resource Often, employees will say that when they (HR) issues. Avoid this by incorporating an HR prompt in the compliance hotline, directing report potential violations, nothing hap- employees to report HR issues directly to HR. If desired, have an option for anonymous HR pens. By failing to respond or to share res- reporting by the caller. olutions, the organization encourages employees to be complacent, adding to the organization’s compliance risk. When employees who report on a compliance hotline give incom- Employees want to feel they are doing the plete information, the ability of the compliance department to take right thing, and that they work in an environment that encourag- action is impeded. When the report is documented, encourage the es a positive culture of providing care in a safe, efficient manner. If caller to disclose as much information as he or she feels comfortable. the problems continue and an employee has exhausted other op- If there are gaps or missing information, encourage the employee tions, he or she may seek outside counsel. This is how qui tam cases to call back to continue the report. Anonymous reports can be re- evolve. Monetary gain is usually not the driving force behind a whis- trieved through the assigned report identification number. Inform tleblower action — vindication is. Despite potential negative pub- the caller that the more information he or she discloses, the more licity and the tedium of a qui tam case, some individuals file because likely the investigation can be efficiently pursued. they feel an injustice is being committed, and no one is listening. When issues potentially involve HIPAA, or Medicare or Medicaid Management should value disclosure of violations and praise em- fraud violations, you might also remind the caller of time sensitivity ployees who report. If an organization promotes good corporate in reporting. Under the Affordable Care Act (ACA), a deadline for

www.aapc.com July 2015 55 Violations

An employee should not be penalized if he performed duties under the supervision of management, and later files a complaint of non-compliance based on the duties assigned.

reporting and returning overpayments is either: (1) 60 days after the ployee participants from more than 500 organizations who where date on which the overpayment was identified; or (2) the date any asked, “What motivates you to excel and go the extra mile at your corresponding cost report is due (see CMS Voluntary Self-Referral organization?” Employees were given 10 answers from which to Disclosure Protocol in the accompanying Resources section). Un- choose (see the chart). Money and benefits ranked seventh. The

AUDITING/COMPLIANCE der HIPAA, covered entities must notify affected individuals and top three responses were: intrinsic desire to do a good job, feeling en- the secretary of U.S. Department of Health & Human Services fol- couraged and recognized, and camaraderie. These responses invoke lowing the discovery of a breach of unsecured protected health in- a positive feeling of performing well for self and others. formation within time limits, as well. For more information, see “New Study Answers: “What Motivates Employees To ‘Go The Extra Mile?’” in the accompanying Resourc- No News Is NOT Good News es section. Many compliance departments use email and hotlines to collect in- Recognition is a highly valuable motivator that few organizations formation from employees. If a compliance hotline has low report- utilize. When employees report violations, the compliance depart- ing, do not assume, “no news is good news.” If compliance does not ment can show appreciation through a quarterly newsletter or email use the information and data collected from the hotline to investi- circulation (that is, if the employee agrees to be acknowledged publi- gate or resolve every complaint effectively, the benefits of the com- cally). This type of communication demonstrates to employees that pliance department are negated greatly. Every organization has a re- the organization appreciates their work, and gives others the cour- sponsibility to both the employees and the public to act on report- age to disclose potential issues. ing, or risk adverse consequences. 2. Executive Recognition from the CEO or Board Member: Re- serve this for a significant breach or violation. An employee would Offer Motivational Perks to Report Noncompliance be most grateful if the CEO calls to congratulate him, or if the CEO Some ideas include: expresses her appreciation by showing up in person. The encoun- 1. Recognition/Attention: Many individuals may believe money is ter can allow both the executive and employee to establish a connec- the sole motivator for reporting (and the only reason anyone would tion that could lead to future success. This is a powerful tool. Over- file a qui tam case). But that isn’t true. use will diminish its value, however. A survey recently conducted by TINYpulse included 200,000 em- 3. Time Off: Employees may select time off over cash when given the choice. Evaluate on a quarter- What motivates you to excel and go the extra mile at your organization? ly basis reports or disclosures that were critical or of great benefit to Camaraderie, peer motivation the organization. Award the top three reporters personal time off, if 4% 9% 20% Intrinsic desire to do a good job 4% desired. Allow early dismissals, late Feeling encouraged and recongnized 7% arrivals, and extended lunch peri- Having a real impact ods, or additional breaks in 15- or 8% 17% Growing professionally 30-minute intervals. 4. Snack Days: These can moti- Meeting client/customer needs 8% vate people. Anticipation builds ex- 10% 13% Money and benefits citement, so advertise ahead of the Positive supervisor/senior management event. Pizzas, cookies, coffee/Dan- ish, or popcorn may do the trick. Believe in the company/product 5. Monetary Gifts: Violations re- Other ported to the Centers for Medicare

56 Healthcare Business Monthly To discuss this article or topic, go to www.aapc.com Violations

& Medicaid Services (CMS) can assess fines in the millions of dol- “Chicago hospital to close in wake of fraud investigation,” www.modernhealthcare.com/ AUDITING/COMPLIANCE lars. If an employee identifies a problem early in the process and re- article/20130701/INFO/307019990 Accessed February 3, 2015. ports it to the compliance department, a $1,000 reward to the em- National Business Ethics Survey®, www.ethics.org/downloads/2013NBESFinalWeb.pdf ployee might be well worth it. “VA settles 25 whistleblower complaints,” www.fiercehealthcare.com/node/125841/print These are ideas and awards to help generate quality reporting and engage the workforce. These samples should be adjusted to your or- CMS Voluntary Self-Referral Disclosure Protocol, www.cms.gov/Medicare/Fraud-and- ganization’s financial and workflow structure. Abuse/PhysicianSelfReferral/downloads/6409_srdp_protocol.pdf New Study Answers: What Motivates Employees To ‘Go The Extra Mile?’ www.forbes.com/ Never Penalize for Reporting sites/victorlipman/2014/11/04/what-motivates-employees-to-go-the-extra-mile-study- An employee should not be penalized if he performed duties under offers-surprising-answer/ the supervision of management, and later files a complaint of non- For ideas to motivate employees, see “20 ways to motivate your employees without raising compliance based on the duties assigned. If the employee created the their pay,” www.biztrain.com/motivation/stories/20ways.htm violation through his or her workflow, it should still be reported (but would not be eligible to receive compensation or awards). As long as Erica Lindsay, PharmD, MBA, JD, is an ethics and compliance attorney practicing in the every employee reports in good faith, he or she should not hesitate greater Chicago area. Lindsay has worked in pharmacy compliance for over 15 years and has to relay such information. developed, evaluated, and implemented corporate compliance plans for hospitals and clinics. She advises clients through complex pharmacy regulations and guidelines including 340B, Medicare/Medicaid billing, and HIPAA compliance. Connect with her via Resources Linkedin:www.linkedin.com/in/ericadlindsay. “Amid Probe, Sacred Heart Hospital Abruptly Closes,” www.nbcchicago.com/news/health/ sacred-heart-hospital-closure-213927351.html

AAPC Membership

www.aapc.com July 2015 57 Build your compliance plan in minutes

Invest in your current peace of mind and your practice’s long-term future MGMA

With the MGMA Compliance Plan Toolkit, a web-based “wizard,” and a few simple pieces of your practice’s information, you can create a customized compliance plan in minutes.

This compliance toolkit covers the seven elements of a small group or third-party billing company’s voluntary compliance plan, as outlined by the U.S. Department of Health and Human Services Office of the Inspector General in 2000.

Policies in the toolkit include:

• Code of conduct • Food and Drug • Non-retaliation • Compliance officer Administration • Nondiscrimination position description • Sunshine Act • Sexual harassment • Antitrust laws • Professional courtesy • Use of nonphysician providers • DEA certification • Dismissing a patient • And dozens more

Authors: Marcia Brauchler, MPH, FACMPE, CPC, CPC-H, CPC-I, CPHQ $299 for MGMA members Erika Riethmiller Bol, CHC, CIPP/US, CPHRM Amy Powers, JD Purchase your toolkit today. Christopher Varani, MSF, MBA, CPC Daryl T. Smith, FACMPE mgma.org/store-compliance ® Medical Group Management Association 58 Healthcare Business Monthly AUDITING/COMPLIANCE ■ Build your By Marcia L. Brauchler, MPH, FACMPE, CPC, COC, CPC-I, CPHQ compliance plan in minutes Risk Assessment Invest in your current peace of mind High and your practice’s Priorities long-term future SHA requires employers to provide a safe workplace for employ- Oees, and grants employees with the right to working conditions free from risk of serious harm. The burden of compliance depends on the industry you’re in. Min- ing, manufacturing, and maritime industries, for example, have to comply with a lot more OSHA standards than the average physician practice. There are three major OSHA standards affecting a physi- With the MGMA Compliance Plan Toolkit, a web-based “wizard,” cian practice (listed here in the order of their risk to the practice, with and a few simple pieces of your practice’s information, you can the first being the most common): create a customized compliance plan in minutes. 1. Bloodborne Pathogens Standard: There were 198 citations of this standard in 2013. Bloodborne Pathogens is the only OSHA standard specific to healthcare. According to OSHA, the definition of This compliance toolkit covers the seven elements of a small group or third-party bloodborne pathogens is any pathogenic microorganisms that are billing company’s voluntary compliance plan, as outlined by the U.S. Department of present in human blood and can cause disease in humans. Health and Human Services Office of the Inspector General in 2000. Note: “Bloodborne” may be too narrow of a term: Pathogens can be transmitted in other ways, such as by other bodily fluids besides blood, and by contact with mucous membranes, such as the eyes or Policies in the toolkit include: mouth. Some pathogens include hepatitis B virus and human immunodefi- • Code of conduct • Food and Drug • Non-retaliation ciency virus (HIV). Because of the nature of their work, healthcare Administration Part 3: workers are at much higher risk than other individuals of contract-

• Compliance officer • Nondiscrimination image by iStockphoto © Steve Debenport ing infectious diseases. position description • Sunshine Act • Sexual harassment Occupational The standard requires employers to protect workers who are reason- • Antitrust laws • Professional courtesy • Use of nonphysician providers Safety and ably anticipated to come into contact with blood or other potentially • DEA certification • Dismissing a patient • And dozens more infectious materials. Specifically, employers are required to: Health • Establish a written exposure control plan and update it Administration annually. Authors: • Identify and ensure work practice controls, such as hand- Marcia Brauchler, MPH, FACMPE, CPC, CPC-H, CPC-I, CPHQ $299 for MGMA members (OSHA) Act washing and engineering controls, such as sharps’ disposal Erika Riethmiller Bol, CHC, CIPP/US, CPHRM containers. Amy Powers, JD Purchase your toolkit today. • Implement use of universal precautions. Christopher Varani, MSF, MBA, CPC Daryl T. Smith, FACMPE mgma.org/store-compliance ® Medical Group Management Association ■ ■ ■ Coding/Billing Practice Management Auditing/Compliance www.aapc.com July 2015 59 OSHA

Because of the nature of their work, healthcare workers are at much higher risk than other individuals of contracting infectious diseases.

egress) are. Do you have an evacuation plan for your practice? It should be posted at your

AUDITING/COMPLIANCE practice location and describe the locations of the fire extinguishers. In addition, emer- image by iStockphoto © Robeo gency exit routes must remain unblocked at all times (no clutter in the hallways), and exit doors must be unlocked at all times. You should know what your role is in an emergency situation. If the fire alarm goes off, what do you do? Does everybody stare at each other? Do you evacuate? Before things go wrong and you’re evacuating, everyone at the practice should be familiar with the office’s fire prevention plan. Ac- cording to OSHA, there are three primary ways everyone can help • Provide personal protective equipment. prevent fires in your workplace: • Make hepatitis B vaccinations available. 1. Never store flammable materials near an open flame or heat • Make available post-exposure evaluation and follow up. source. • Provide information and training to workers. 2. Do not allow flammable and combustible waste materials to 2. Hazard Communication Standard: There were 63 citations of accumulate. this standard in 2013. Hazardous chemicals can create either a physical hazard or a health hazard. 3. Maintain regular maintenance on heat-producing equipment. A physical hazard includes things that are explosive, flammable, or Ionizing Radiation corrosive. Chemicals that create a health hazard are those that are toxic, irritate skin, eyes or lungs, or are carcinogenic. You need to Practices with X-ray equipment have an additional area of OSHA know the hazardous chemicals in your work area, appropriate pro- regulation with which to comply. tective measures, and how to obtain additional information. Your practice should have a hazard communication plan and program OSHA Staff Training and a safety data sheet for each hazardous chemical in your work- OSHA requires initial training upon hire on the plan for blood- place. borne pathogens. If there are changes to the plan, train your staff. 3. General Workplace Standard: There were 39 citations of this For example, if the office changes its location or expands, redo standard in 2013. This standard includes general workplace safe- OSHA training (with new emergency evacuation routes, for exam- ty issues, such as electrical wiring, respiratory protection, use of the ple). OSHA retraining also should be conducted prior to introduc- proper recordkeeping forms, design and construction of exit routes, ing a new hazardous chemical. Train the staff on the risks and how medical services and first aid, and general requirements for person- to deal with the chemical. al protective equipment. The first thing to know under General Workplace Standards is how Why Comply with OSHA? to stay safe in an emergency situation. Your employees should know OSHA is enforced regionally. There are approximately 2,200 how to escape, and what and where your exit routes (i.e., means of OSHA investigators who are responsible for the safety of approxi-

60 Healthcare Business Monthly To discuss this article or topic, go to www.aapc.com OSHA

An inspector can just show up at

your workplace without notice and AUDITING/COMPLIANCE perform an inspection.

mately 130 million workers employed at more than eight mil- Obtain More Information lion worksites throughout the country. An inspector can just This overview is a start to understanding OSHA compliance; show up at your workplace without notice and perform an in- make sure that you consult with your lawyers or other profes- spection. He or she can also conduct OSHA investigations by sional advisors for definitive information about how to imple- phone or fax. These folks have priorities, however, with employment OSHA policies tailored to your practice. Here are re- ees in imminent danger or who have just suffered a catastrophic sources where you can find more information about the pol- event most likely to receive immediate attention. icies: The federal OSHA law applies to all 50 states and private sec- • Regulation: www.osha.gov/law-regs.html tor workers. Half of the states have more stringent requirements www.OSHA.gov/publications/poster.html or expand the workforce to include state and local government • Required poster: workers who are otherwise not protected under OSHA. Check Marcia L. Brauchler, MPH, CMPE, CPC, COC, CPC-I, CPHQ, is president and to see if you’re in one of the more stringent states, and make sure founder of Physicians’ Ally, Inc. Brauchler and staff provide advice and counsel to phy- you know your state’s standards. Go to OSHA.gov to get more sicians and practice administrators, as well as education and assistance on how best information on these state standards. to negotiate managed care contracts, increase reimbursements, and stay in compliance with healthcare laws. Brauchler’s firm sells updated OSHA policies and proce- You can be fined if you don’t comply with OSHA requirements. dures as well as online OSHA staff training. Learn more at www.physicians-ally.com or at www.mgma. Originally, OSHA reserved the right to assess per-employee com. She is a member of the South Denver, Colo., local chapter. penalties for violations of any OSHA standard (sometimes re- ferred to as OSHA’s “egregious penalty” policy). For instance, if a practice failed to provide protective gloves to its 10 employees, the practice could be fined 10 x $7,000 ($70,000) if the violation was willful. In this series on compliance risk assessment, I refer back to the “Heat Map” created by my firm to assist physician practices in identifying where to focus their resources — time, money, This changed, however, after an employer was assessed per- manpower, and the attention of management, providers, and staff — most efficiently and employee with 11 penalties totaling more than $1.1 million effectively. for failure to provide respirators or protective clothing (among other things) and sought review of the penalty by the Occupa- tional Safety and Health Review Commission. The commission limited OSHA’s ability to assess per-employee penalties to cases where the cited standard clearly describes conduct that is unique and specific to individual employees. Per-employee penalties may be assessed for failure to make appropriate entries in OSHA injury and illness logs because each entry is specific to an individual employee. The commission determined that per-employee penalties are not appropriate where a standard addresses a single work practice to protect against the exposure of multiple employees to a single recognized hazard. In the example above, failure to provide protective gloves to 10 In Part 1 of “Risk Assessment High Priorities,” we covered the False Claims Act (May, pages employees from a single bloodborne pathogen hazard would re- 51-44). In Part 2, we covered the five major human resource laws (June, pages 48-50). sult in a single violation of $7,000.

www.aapc.com July 2015 61 NEWLY CREDENTIALED MEMBERS

Darcie A Best, COC, CPC, CEMC Kindra Ashley Johnson, CPC Sharon Hamlin, CPC Andrea Turner, CPC-A Magna Cum Laude Deb Monroe, CPC Kristen Humphrey, CPC Sheila Hattel, CPC Andrew David Coffey, CPC-A Magna Cum Laude Debbie Cheatham, CPC Kristi Miller, COC Sheila Mulka, CPC Angela Hottle, CPC-A Debbie Fryery, CPC Kristin Koehnke, COC, CPC-P Shelley Bull, CPC Angela K Prusse, CPC-A Barb Townsend, CPC, CPB Debbie Holter, CPC Kristine Waddill, COC Sheralyn Finlay Hulse, CPC Angela McGlumphy, CPC-A Bryn Woodward, COC-A Deborah A. Booth, CPC Kyra Erb, CPC Sheri Travers, CPC Angela Omer, CPC-A Charmaine May Lubay, CPC-A Dena Scott, CPC Laura Brower, CPC Sheryl P Miller, CPC, CCC Angelica Garcia, CPC-A Cheryl Wiggins, CPC-A Diana Espinoza, CPC Laura Heard, CPC Shital Patel, COC Angelina Speltz, CPC-A Cynthia Simpson, COC, CPC-P, CRC Diana L Pirtle, CPC Laura Kennedy, COC, CPC Sidney Noble, CPC Angelique Rivera, CPC-A Damaisy Diaz, CPC-A Diane Lew, CPC Laura Williams, CPC Sophia Antoinette Olsen, COC, CPC Angelique Stevens, CPC-A Diane Herbeck, CPC Dimple Arun, CPC Lauri Hammond, CPC Stacy M Brown, CPC Anhkim Nguyen, CPC-A Eric Theis, CPC Dolores A Garcia, COC Laurie Vella, CPC Stacy S Richards, CPC Anil Kasarla, COC-A Hanna Turcotte, CPC-A Donna Powelson, CPC Lea Harris, CPC Stephanie Bryant, CPC Anissa Silman, CPC-A Jerome Yann Barbier, CPC, CCC Dr. Mohammad Baloch, CPC, CPC-P Leslie Castellanos Ulloa, CPC Stephanie English, CPC, CPMA Anjaiah Kacharla, COC-A Jessie Gallegos, CPC Duke Dice, CPC Leslie Marie Houser, CPC Stephanie Moore, CPC Anjali Sura, COC-A Jhan Jester Solmoro, CPC-A Edward De La Rosa, CPC Lillian Garza, CPC Suganya Dhashnamurthy, CPC Ann Craig, CPC-A Judy Presson, CPC, COSC Eliza Vattaso, CPC Linda Wright, CPC Tamaria Gibson, CPC Ann Klonicki, CPC-A Kelly Link, CPC-A Emily S Stevens, COC, CPC, CSFAC Lindsey Allen, CPC Tammy JoAn Cameron, CPC Anna Beth Luze, CPC-A Maria Gornyitzka, CPC-A Errol S Jones Jr, COC, CPC, CPC-P, Lissette Barreira, CPC Tatyana Blinder, CPC Anna Ferrera-Fazzino, CPC-A Marian Angela Llera, CPC-A CANPC Liza Sims, CPC Terrica McGuinn, CPC AnnaLynn Kelly, CPC-A Mayank Jain, CPC-A Evangelina Salazar, CPC Lois Bohlen, CPC Tiffany Brown, CPC Annie Lasway, CPC-A Mery Isabel Jauregui, CPC Faith Helen Hawley, CPC Lori Frazier, CPC Tina Gould, CPC Ann-Marie Trombatore, CPC-A Michelle Garber, CPC Faith Mahaffey, CPC Lori Vallandingham, CPC Tracey Fredricks, CPC, CPCO, CCC Anthony Jerome Withers Jr, COC-A Rajani Reddy, COC-A Gae A Jackson, CPC Lynne Severn, COC, CPC, CPMA Tracy Dessaint, CPC April Hall, CPC-A Regina Grayson, CPC-A Geovanni Arbelo, CPC Maegan M Fucci, CPC Tracy Foster, CPC April Jackson, CPC-A Sanda Breitkreutz, RN, CPC, CPMA, CEMC Geraldine O Reggeti, CPC Malorie Maxwell, CPC Tracy Lodge Jones, CPC April Lee Rouse, CPC-A Saranya Murugan, CPC-A Gisele R Hilton, CPC Mane Chilingaryan, CPC Tracy Maricee Love, CPC Archie Roland Trangia Dayot, CPC-A Sherry Daugherty, COC-A Greg Needs, CPC Marcia Clardy, CPC Tresa Peck, CPC Arian Christian Medina, CPC-A Shonda Q McKinney, CPC, CPMA, Heather Colomb, CPC Maria Leonard, CPC Trina Springer, CPC Arielle Ridings, CPC-A CEDC, CEMC Heather G Jordan, CPC Maribel Rivera, CPC Victoria Zayicek, CPC Arun Gaddameedi, COC-A Valerie J Downs, CPC-A Heather M Hardison, CPC Marie Toffel, CPC Vivian Terry, CPC Ashley Carlson, CPC-A Vicki G Eddy, CPC, CRC Heidi A Peixinho, CPC Marsha Darden, CPC Wanda Michelle Breitenbach, CPC Ashley Diane Beck, CPC-A Heidi Wild, COC, CPC Martha Patchett, CPC Wendy Annette Deranger, COC, CPC, Ashley Erin Sievers, CPC-A ® Hien Thuy Pham, COC, CPC, CPMA Mary Hutchison, COC, CPC CPMA, CCC Ashley Havecker, CPC-A CPC Holli Robbins, CPC Medinat A Ogunlesi, CPC Wendy Gilmore, CPC Ashley Koschoff, CPC-A CPC Holly Richardson, CPC Megan Casarez, CPC Wisam Jamal Hmaidi, CPC Ashley LaTulip, CPC-A Hugo Octaviano, COC, CPC Melanie Leer, COC Zorichell Mas Ramos, CPC Ashley Leegard, CPC-A Afton Fernandez, COC Ilene Bianca Villanueva, CPC Melissa Moore, CPC Ashley Sexton, CPC-A Alison M Rosborough, CPC Jackie Cardwell, CPC Melissa Mottley, CPC Ashley Sutton, CPC-A Alison Pardy, CPC Jacklyn Barber, CPC Merlys Gutierrez Safonts, CPC Ashwini Mallinatha Matage, COC-A Allyson Bezy, CPC Apprentice Jamie L. Jines, CPC Michele Connolly, CPC Apprentice Asma Farhana, CPC-P-A Amanda Jordan, CPC Jane F Eggert, CPC Micheline Vermette, CPC Austin Henry, CPC-A Amy Anderson, COC Janice Ramella, CPC Michelle Bruner, CPC Abbey Whaley, CPC-A Avantika Lad, CPC-A Amy Burkhart, CPC Jeanne M Marinelli, CPC Michelle Caudill, CPC Abdul Inamdar, CPC-A Ayisha said Rafeek, CPC-A Ana Penn, CPC Jeannette Scanlon, CPC Michelle Richards, COC Abhijit Bhausaheb Gatkal, COC-A Aysha Farooq, CPC-A Andra McConnell, CPC Jenna Coseboom, CPC Michelle Taylor, CPC Abigail Dorsey, CPC-A Babe Charlene Ligaya Dimapilis, CPC-A Andrew Wampleman, CPC Jennifer Agnello, CPC Mona Elchorbagy, CPC Abner Tanedo, CPC-A Babitha Moidunny, CPC-A Angela Mobley, CPC, CGSC Jennifer Eades, CPC Monica Carbajal, COC Adrian Limbo, CPC-A Babu Etikala, COC-A Angelena Danielle Hutcherson, CPC Jennifer Eritano, CPC Monica Loflin, CPC Adrianne Metzger, CPC-A Babu Rajendran, CPC-A Bambi Charboneau, CPC Jennifer Schultz, CPC Monique Gooding, CPC Ailyn Banas Benignos, CPC-A Bailey Neuenschwander, CPC-A Beverley Rhen Eades, CPC Jennifer Terrell, CPC Montina Boggs, CPC Aisha Hollingsworth, CPC-A Barbara A Wilkins, CPC-A Beverly T Boyd, CPC Jennifer Woodruff, CPC Natalia Escalante Johnson, COC, CPC Alaina Mills, CPC-A Bassam Zahee Talib Al Bayati, CPC-P-A Brittany Oropeza, CPC Jessica Bell, CPC Nicole Russo, CPC Alex Meservey, CPC-A Bathula Bharadwaja, COC-A Candace Simmons, CPC Jessica Cline, CPC Nitin Chhabra, CPC Algie Magpayo, CPC-A Beata Neumann-Chrostowska, CPC-A Candis Brown, CPC Jessica Herod, CPC Noel Bradley, CPC Alicia Jenkins, CPC-A Becky Anne Farmer, CPC-A Candra W Hawkins, COC, CPC Jillian Thomas, COC Oksana Ostrovskiy, CPC Alicia Savastano, CPC-A Becky Elkins, CPC-A Cari Vargas, CPC JoAnne Sapaden, COC Porsha M Brown, CPC Alietty Hernandez, CPC-A Belinda Barnes, CPC-A Carina Huizar, CPC Jodi Riess, CPC Rachel Hawkins, CPC Alison Fjoslien, COC-A Belinda Kay Walker, CPC-A Carlina R Herdey, CPC Josue Rodriguez, CPC Raeven Oropeza, CPC Allison Moore, CPC-A Belinda Peltz, CPC-A Carrie Childs, CPC Joyce Owens, CPC, CPMA Rebecca Waldheim, CPC Allysa Dean, CPC-A Bernadette Lamb, CPC-A Catherine Purnell, CPC Julie Lanette Patrick, CPC Rebekah Canterbury, CPC Alvin Ong, CPC-A Bethany Hughes, CPC-A Catherine Stockton, CPC Jyoti Shah, COC, CPC Renee Lien, CPC Amanda Buonocore, CPC-A Betsy Bos, CPC-A Cathy Saul, CPC Karen Cheatwood, CPC, CPCD Reta Cantrell, CPC Amanda Fuller, COC-A Betty Jane Soledad Ramirez, CPC-A Cathy Wells, CPC Karol Campos, CPC Robin Ketkar, CPC Amanda George, CPC-A Betty Mahan, CPC-A Chanda Sartain, CPC Kassie Yukish, CPC Robin Koller-Allora, CPC Amanda Hertz, CPC-A Boddedakodanda Naidu, CPC-A Chelsea Perkins, CPC Kate Strumbly, CPC Rosa Rios, CPC Amanda Kay Scott, CPC-A Brady Fulks, COC-A Cheryl Marie Clarke, CPC Katelynn M Beach, CPC Rosalyn Polk, CPC Amanda Peterson, CPC-A Brandi Banks, CPC-A Christina Ann Isaac, COC, CPC Kathleen Wilbanks, CPC Rose Marie Mayer, COC, CPC Amanda Tessmer, COC-A, CPC-A Brandi Wynes, CPC-A Christina Botzis, CPC Kathleen Winans, CPC Rosemarie Brooks, CPC Amanda Umansky, CPC-A Brandy Heddles, COC-A Christina Pike, CPC Kathy Budrow, CPC Sachi Parikh, CPC Amar Suresh Chaudhari, CPC-A Brenna Berry, CPC-A Christy Dale, CPC Kathy Seda, CPC Samantha Cobb, CPC Amber Peluso, CPC-A Brooke Ann Fender, CPC-A Christy Delong, CPC Katie Purpur, COC, CPC Sandra Lee Nadeau, COC, CPC, CEMC Amber Vincelli, CPC-A Brooke Howell, CPC-A Cindy McCarter, CPC Kelli Donahue, CPC Sandy Sullivan, CPC Amel Shire, CPC-P-A Brooke Hullett, CPC-A Cindy S Basham, CPC Kelly Carmickle, CPC Sara F DiBlasio, CPC Amy Marie Hall, CPC-A Bryan Nicewonder, CPC-A Concetta Assante, CPC Kelly Green, CPC Scott Clarke Sr, CPC Amy Weinman, CPC-A Caitlin Ireland, CPC-A Crissie Phillips, CPC Kelly Langschultz, COC, CPC Sean Fleming, CPC Amy Wilson, CPC-A Caitlin McDonald, CPC-A Curtis Woodfolk, CPC Kerri Christian, CPC Shanequa Joiner, CPC Ana Lisa Pablo, CPC-A Camille Tucker, CPC-A Cynthia Collison, CPC, CPPM, CCC Khia O’Neal, CPC Shannon M Evertsen, CPC AnaRuth Aguillon, COC-A Cammylflor Oraya, CPC-A Dana Schneider, CPC Kimberly Jennings, COC, CPC Sharon E Richard, CPC Andrea Ellis, CPC-A Candace Moomau, CPC-A

62 Healthcare Business Monthly NEWLY CREDENTIALED MEMBERS

Carline Noel, COC-A Dolly Taylor, COC-A James Waggoner, CPC-A Kaitlyn McCoid, CPC-A Lisa Bishop, CPC-A Carmen Peters, CPC-A Dona Mariam Johny, CPC-A Jamie Cottam, CPC-A Kandice Goncheroski, CPC-A Lisa Foster, CPC-A Carmen West, CPC-A Donald Gene Hendrix, CPC-A Janani Kulandai Raj, CPC-A Kantekar Shiva, CPC-A Lisa J Andrews, CPC-A Carol Ann Keene, CPC-A Donald L Spangler, CPC-A Janavi Jeevarathinam, CPC-A Karen Joy Crosdale, CPC-A Lisa Marie Arredondo, CPC-A Carol MacMartin, CPC-A Donald Triche, CPC-A Jane E Miller, CPC-A Karen Lynn Malinowitz, CPC-A Lisa Michelle Kirkwood, CPC-A Carol Maher, CPC-A Donna White, COC-A Jane Santander, CPC-A Karen Menken, CPC-A Lisa Moore, COC-A Carolyn Calomeni, CPC-A Donna Wong-Gibbons, CPC-A Jane Sheedy, CPC-A Karen Provost, CPC-A Lisa Paris, CPC-A Carolyn Segura, CPC-A Dorian Loberg Beck, CPC-A Janet Dougherty, CPC-A Karen Renda, CPC-A Lisa Plassman, CPC-A Casandra Darlyn Raley, CPC-A Dorian Summerer, CPC-A Janice Meints, CPC-A Karin Justiniano, CPC-A Lisa Pruitt, CPC-A Casey Richardson, CPC-A Dorothy Ilena Correo, CPC-A Janine Mae Marcon, CPC-A Karthika Gandhi, CPC-A Lisa Swanson, COC-A, CPC-A Cassandra McClain, CPC-A Dorothy Stanton, CPC-A Janna Crockett, CPC-A Karthikeyan Sankar, CPC-A Lisa Thomas, CPC-A Catharine Beall-Dennell, COC-A Dr Nadira Yasmin, CPC-P-A Jayapushpha Sathiyamoorthy, CPC-A Kassandra Grice, CPC-A Lisa Walsh, CPC-A Cayla Jones, CPC-A Dr. Sapna Prasanna Chandran, CPC-A Jaycie Diane Robbins-Bogart, CPC-A Katherine Alcaino, CPC-A Lisa Wheeler, CPC-A Chakradhar Rao Patlolla, COC-A Edmarson Garel Suniga, CPC-A Jayesh Khot, CPC-A Katherine Cammuso, CPC-A Liz Olson, CPC-A Chante Lehman, COC-A Ejee Macaranas, CPC-A Jeana Kjos, CPC-A Katherine Thibeault, CPC-A Lizette Ramirez, CPC-A Char Phillips, CPC-A Elaine Thole, CPC-A Jeanna Davis, CPC-A Kathleen Emery, CPC-A Logalakshmi Ayyappan, CPC-A Charlene Carlos, CPC-A Elizabeth Burke, CPC-A Jeanne Leonard, CPC-A Kathy Blouin, CPC-A Lojain Jawdat Moussa, CPC-P-A Charli Derise, CPC-A Elizabeth Feltner, CPC-A Jeannette Papilla, COC-A Katie Dzubinski, CPC-A Loretta Wermerson, CPC-A Charlotte Vail, CPC-A Elizabeth Meeker, COC-A, CPC-A Jenilee C Gracey, CPC-A Katie Nahulu, CPC-A Lori Grisco, CPC-A Chasity Hayes, CPC-A Elizabeth Tejada, CPC-A Jennifer Fink, CPC-A Kavinkumar Ponnusamy, CPC-A Lori Holtzinger, CPC-A Chayla Maddox, CPC-A Emily Smith, COC-A Jennifer Floyd, CPC-A Kayla Stearns, CPC-A Lori Smith, CPC-A Chester Berson Terciano, CPC-A Emily Thomas, CPC-A Jennifer Fournier, CPC-A Kayleigh Jesme, CPC-A Lorilee Jones, CPC-A Christina Garza Gonzalez, CPC-A Emily Wende, CPC-A Jennifer Friend Aud, CPC-A Keely Nyeholt, CPC-A Lucy A Moulton, CPC-A Christina Hewitt, CPC-A Ephraim Dale Brosas, CPC-A Jennifer Garcia, CPC-A Keith Schwacha, CPC-A Lucy Garcia, CPC-A Christina Willig, CPC-A Eraj Arbab Muhammad Usman Dogar, Jennifer L. Barnard, CPC-A Kelley Stallings, CPC-A Lyla Lathum, CPC-A Christine Cotty, CPC-A CPC-P-A Jennifer L. Smith, CPC-A Kelli Williams, CPC-A Lynsey Santiago, CPC-A Chunson Choe, CPC-A Eric Dacanay, CPC-A Jennifer Moats, CPC-A Kelly Dodson, CPC-A Mackenzie Richey, CPC-A Cindy Carney, CPC-A Erica Staffen, CPC-A Jennifer Runyan, CPC-A Kelly Houa Yang, CPC-A Magaly Fernandez, CPC-A Cindy Donoghue, CPC-A Erickson Estacion, CPC-A Jennifer Shaver, CPC-A Kelsey Chapman, CPC-A Mahesh Kola, COC-A Cindy Johnson, CPC-A Erik Ebert, CPC-A Jennifer Turgeon, CPC-A Kenzie Vande Vegte, CPC-A Mahesh Mittapelly, COC-A Claire Burkart, COC-A Erik M Bell, CPC-A Jennifer Walsh, CPC-A Keri Rodgers, CPC-A Maheswari Sekar, CPC-A Claire O’Donnell, CPC-A Erin Teuton, CPC-A Jenny Silva, CPC-A Keshav Kumar Mishra, CPC-A Maisoon Husaif, CPC-A Cortney Shaw, CPC-A Erin Williams, COC-A Jeremiah Mamaril Bolneo, CPC-A Kim A Nadeau, CPC-A Mangesh Torane, COC-A Courtney Brock, CPC-A Esakkiraj Gopal, CPC-A Jesse James Dilag, CPC-A Kim D Barney, CPC-A Manjula Srinivasan, CPC-A Courtney Simmons, COC-A Essence Williams, CPC-A Jessica Beaton, CPC-A Kimberly A Barker, CPC-A Manpreet Hira, CPC-A Crystal Larimer, CPC-A Fabiola Higginbotham, CPC-A Jessica Howard, CPC-A Kimberly Morosko, CPC-A Manuel Jr Almonte, CPC-A Crystal Long, CPC-A Fayaz Basha Lalsahebgari, COC-A Jessica Kendrick, CPC-A Kimberly Tharp, CPC-A Marc DeVar, CPC-A Cynthia Garcia, CPC-A Faye Salvado, CPC-A Jessica Reid, CPC-A Kimberly Tibbens, CPC-A Marcia Rice, CPC-A Cynthia Marie Vazquez, CPC-A Firdous Hussain, CPC-A Jessica Romine, CPC-A Kishor Bodduna, COC-A Marcie Small, CPC-A Cyrill Elyssa Gutierrez, CPC-A Flori Anderson, CPC-A Jessie Manley, CPC-A Krislin Floyd, CPC-A Maree Stefanee Mangune Desiderio, Czarina Rose Garcia, CPC-A Francis E Garcia, CPC-A Ji-Hyun Ahn, CPC-A Krista Lordan, CPC-A CPC-A Daisy Jane Combong, CPC-A Franklin Ladiao, CPC-A Jill Mavie Stewart, CPC-A Kristin Marie Wing, CPC-A Margaret K Ucella, CPC-A Dana Robin Alberts, CPC-A Gail Cummings, COC-A Jillian McFarland, CPC-A Kristin Oakland, CPC-A Marguerita E Ruffin, CPC-A Dana Walker, CPC-A Gail Roemer, CPC-A Joanne Valerie Eugenio, CPC-A Kristin Rafferty, CPC-A Maria Concepcion Pasion, CPC-A Daniel Meeker, CPC-A Geetha Palapula, COC-A Jodi Haselden, CPC-A Kristin Ruvalcaba, CPC-A Maria Katrina Alimagno, CPC-A Daniel Sarmina, CPC-A Gianelli Go, CPC-A Jodi Rush, CPC-A Kundla Rajasekhar Reddy, COC-A Maria Konstantinou, CPC-A Danielle C Gray, CPC-A Gincy John, CPC-A Jody Jones, CPC-A Kylie Sasnett, CPC-A Maria Nicoletti, CPC-A Danielle Robichaud, CPC-A Gladys Buster, CPC-A Joffrey Adair Benward, COC-A Lacey Shefstad, CPC-A Maribeth Gavan, CPC-A Daphne Janik, COC-A Gloria Chiapetta, CPC-A Johanna Rojas, CPC-A Laila Jane Nene, CPC-A Marie Bartgis, CPC-A Darcy Tyler, CPC-A Gopalakrishnan Sankar, CPC-A John Calhoun, CPC-A Lakshmi Mandavilli, CPC-A Marie Lyman, CPC-A Daria Morris, CPC-A Gowsalya Thiruvengadaraj, CPC-A John Crescenti, COC-A Lakshmi Sowjanya Jayanthi, COC-A Marilou Yu, CPC-A Darlene Ransom, CPC-A Gowtham Balaji Kannan, COC-A John David Ramos, CPC-A Lana Kenyon, CPC-A Marilyn Scaff, CPC-A Daryl Schaedel, CPC-A Greg Jarboe, CPC-A John Krok, CPC-A Lashaun Becker, CPC-A Marilyn Carnahan, CPC-A David Meharg, CPC-A Hallie Gonder, CPC-A Johny Basha Sayyad, COC-A Laura Cronin, CPC-A Marinelle Manlugon, CPC-A Dawn M Smith, CPC-A Hani El-Abbasi, CPC-A Jolanta Bublewicz, CPC-A Laura Foster, CPC-A Mark Christian Caponpon Caasi, CPC-A Dawn Newbrough, CPC-A Harsha Vardhan Raj, COC-A Jon Davis, CPC-A Laura Lee, CPC-A Mark Domer Tapican Mostajo, CPC-A Deann DenHerder, CPC-A Hartanti Ash, CPC-A Jonah Balbalec, CPC-A Laura Marie Desmarais, CPC-A Mark MacDonald, CPC-A Deborah Han, CPC-A Heather Ellen Thomas, CPC-A Jorge Luis Florez, CPC-A Laura Robillard, CPC-A Mark Presti, CPC-A Deborah Hibbard, CPC-A Heather Odell, CPC-A Jose Enrico Sarausad Macaraeg, CPC-A Laura Robinson, CPC-A Marlenin Estevez, CPC-A Deborra Capuchino, CPC-A Heather Silva, CPC-A Joseph Vatti, COC-A Lauren Mary Papoccia, CPC-A Mars Oliver Prado, CPC-A Debra Anderson, CPC-A Heather Swenson, CPC-A Jossie Lubin, CPC-A Lauren O’Brien, CPC-A Marsha Meister, CPC-A Debra Gulbranson, CPC-A Heidi Forsman, CPC-A Juanita Chambers, CPC-A Laurice Lum, CPC-A Martha M Hamilton, COC-A, CPC-A Debra Klein, CPC-A Helen E Glinski, CPC-A Judy Henson, CPC-A Lea Cope, COC-A Mary Allan, CPC-A Debra Leggett, CPC-A Hemalatha Murugan, CPC-A Judy Lipp, CPC-A Lee Moua, CPC-A Mary Colleen McPherson, CPC-A Debra M Walker, CPC-A Himabindu Kasithatla, COC-A Jules Monteyne, CPC-A Leema Penta Lourdusamy, CPC-A Mary Jane Smith, CPC-A Deeksha Gupta, CPC-A Holly Elizabeth Bravo, CPC-A Julie A Smith, CPC-A Leena Prabhudesai, CPC-A Mary Kyle, CPC-A Denise Carr, CPC-A Holly Tidd, CPC-A Julie Anne Geren, CPC-A Leigh Anne Ricks, CPC-A Mary Lammers, CPC-A Denise Pokrywka, CPC-A Holly Timcoe, CPC-A Julie Bryson, CPC-A Leomise T Allen, CPC-A Mary Mathews, CPC-A Dennisse Jayne Salgado, CPC-A Hope Bradford, CPC-A Julie Conley, COC-A Leonor Quinones, COC-A Mary Naylor, CPC-A Dharmendiran Chandrasekaran, CPC-A Hope M Reid, CPC-A Julie Hahn, CPC-A Lesley Helton Wirt, CPC-A Mary Parker, CPC-A Dian L Balow, CPC-A Imogen Ronde, CPC-A Julie Taylor, CPC-A Leslie Moore, CPC-A Mary Rita Schwartz, CPC-A Diana Grace Uy, CPC-A Ingrid Burns, CPC-A Julio Lagrule, CPC-A Lhea Marie Mariano Trinidad, CPC-A Mary Schwemley, COC-A Diane Greenwood, CPC-A Ivan Romasanta, CPC-A Junita Briggs, CPC-A Lianqi Liu, CPC-A Mayank Parmar, CPC-A Diane Laflam, COC-A Ivana Woolfson, CPC-A Justine Rogers, CPC-A Linda Boyd, CPC-A Mayra Renderos, CPC-A Diane Scholz, CPC-A Jacinta Henderson, CPC-A Jyothi Munagala, COC-A Linda Harlow, CPC-A Mayuri Chaudhari, CPC-A Diane Wend, CPC-A Jaclyn Mazzone, COC-A Jyothsna Kothandaraman, CPC-A Linda Mueller, CPC-A Md Muneeruddin, CPC-A Diane Whitlock, CPC-A Jacqueline Abram, CPC-A Kacey Hadley, CPC-A Lindsay Edmonds, CPC-A Meaghan Gillespie, CPC-A Diane Xander, CPC-A Jacqueline Marie Gardner, CPC-A Kacy Conradi, CPC-A Lingaswamy Amme, COC-A Meena Sekar, CPC-A Divya Cherakupally, COC-A Jaganath Mishra, CPC-A Kaitlin Robinson, CPC-A Lisa Ann Campell, CPC-A Megan Abel, CPC-A

www.aapc.com July 2015 63 NEWLY CREDENTIALED MEMBERS

Megan Simons, CPC-A Nikki Hersrud, CPC-A Richie Zubiri, CPC-A Shirly Byju, CPC-A Trusha Patel, CPC-A Meghan Monroe, CPC-A Nimi John, CPC-A Robin Coley, CPC-A Shiva Rama Krishna Duddala, COC-A Tu-Uyen Tieng, CPC-A Melanie Magnuson, CPC-A Nina Fort, CPC-A Robyn Kaminsky-Rosauer, CPC-A Shivaraj Medipally, COC-A Umashankar Chinchinada, COC-A Melanie Mays, COC-A Nina Holmes, CPC-A Rocio Ricaldi, CPC-A, CPMA SibiRaj Boopathy, CPC-A Vadivel Devaraj, CPC-A Melanie Post, CPC-A Nitin Datar, CPC-A Rohini Jivbache, COC-A Silvia Castellanos, CPC-A Val Aristheo Hurboda, CPC-A Melanie Powell, CPC-A Noelle A Goff, CPC-A Rolando Padilla, CPC-A Sivaji Kandera, COC-A Valerie Dorr, COC-A Melanie Welch, COC-A Olga Vander Valk, CPC-A Romel Borja Redublo, CPC-A Sivaramakrishna Rambilli, COC-A Valerie McGargill, CPC-A Melinda Johnson, CPC-A Olivia Shapiro, CPC-A Ronaldo Manuntag Pineda Jr, CPC-A Sobha Kuttanampurath Sasi, CPC-P-A Valerie Tabler, CPC-A Melissa Gerena, CPC-A Paigambar Sayyad, COC-A Rose Picone, CPC-A, CEMC Somer Smith, CPC-A Vamshidhar Reddy Mandadi, COC-A Melissa A Klotz, CPC-A Palakonda V S Achari, COC-A Roxana Izadi, CPC-A Sona Patel, CPC-A Vamshimanoj Bandhu, COC-A Melissa Ann Sutton, CPC-A Palani Kothandaraman, CPC-A Rubilyn Baleriado, CPC-A Soniya Jahar Pradhan, COC-A Vanessa Ladaga, CPC-A Melissa Branford, CPC-A Pamela Abshire, CPC-A Sabari Aathimoolam, CPC-A Sonja Sniffen, CPC-A Varalaxmi Dontha, COC-A Melissa Esquilin, CPC-A Pamela Malcosky, CPC-A Sabine Champagne, CPC-A Sophia Lindemann, CPC-A Veena Kombathula, CPC-A Melissa Gould, CPC-A Pamela Zessin, CPC-A Sadia Rahman, CPC-A Sowmya Chikka, COC-A Venkata Mohan Kumar Pesala, COC-A Melissa Hanley, CPC-A Panagiota Kakkos, CPC-A Sairam Alugandula, COC-A Sravanthi Rasuri, COC-A Venkataiah Pasunoor, COC-A Melissa Jean Weiby, CPC-A Panduranga Jella, COC-A Sally Morris, CPC-A Sreshika Srivastava, CPC-A Venkatesh Gali, COC-A Melissa Judd, COC-A Pat Placke, CPC-A Samalla Nagaraju, COC-A Sridevi Mothukuri, CPC-A Venu Marathi, COC-A Melissa Kate Moore, CPC-A Patricia D’Ambrosia, CPC-A Samantha Dykes, CPC-A Sridhar Donthula, CPC-A Veronica Arteaga, CPC-A Melissa Kraus, CPC-A Patricia Distefano, CPC-A Samantha Gallow, CPC-A Srikanth Kasturi, COC-A Vickie Houston-Wilkerson, CPC-A Melissa Mannino, CPC-A Patricia Flood, CPC-A Samantha Leamons, CPC-A Srikanth Reddy Bonam, COC-A Vickie M Gray, COC-A Melissa N Ivanchenko, CPC-A Patricia Isom, CPC-A Sampath Keshavena, COC-A Srikar Nandigama, COC-A Victoria Walters, CPC-A Melissa Robinson, CPC-A Patricia Sullivan, CPC-A Sandeep Kumar Gauta, COC-A Srinivas Gonela, COC-A Vidhya Venu, CPC-A Melissa Sanders, CPC-A Patricia Volz, CPC-A Sandra Martin, COC-A Srinivas Mogili, COC-A Vigneshwaran Raghupathy, CPC-A Melissa Smith, CPC-A Patrick Grimley, CPC-A Sandy Pando, CPC-A Srinivas Rao Gandepalli, COC-A Vikram Jaiswal, COC-A Melissa Stark, CPC-A Paul Young, CPC-A Sanjay Kumar Merugu, COC-A Srinu Jatavath, COC-A Vilma Ivonne Jimenez, CPC-A Menella Ciara Yap Pagsuguiron, CPC-A Pauline Brown, CPC-A Sanjeev Ellandula, COC-A Stacey Bridenback, COC-A Vinil Kumar Ande, COC-A Meredith Rarus, CPC-A Penelope Kotarski, CPC-A Santhiya Balaguru, CPC-A Stacey Oney, CPC-A Vinodh Kumar Kusa, COC-A Michael David Simpson, CPC-A Penny Zvonik, CPC-A Sapan Patel, CPC-A Stacy Austin, CPC-A Vinoth Raj Mani, CPC-A Michael John Zabala Principio, CPC-P-A Phyllis Toner, CPC-A Sara Smith, CPC-A Stan Stephen Pons, CPC-A Virginia Smith, CPC-A Michael McCabe, CPC-A Pooja Kadhane, CPC-A Sarah Caldwell, CPC-A Stella Smith, CPC-A Vishnu Chakradhar Rao Kola, COC-A Michelle Gertz, CPC-A Prachi Borkar, CPC-A Sarah Duncan, CPC-A Stephanie Lynn Mclean, CPC-A VishnuPrasad Ramisetty, COC-A Michelle Komm, CPC-A Pradeep Kumar Muthineni, COC-A Sarah Smith, CPC-A Stephanie Tanner, CPC-A Vishweta Chauhan, CPC-A Michelle Massie, CPC-A Prajakta Ghadigaonkar, CPC-A Saranya Kalaimani, CPC-A Stephanie Vetovitz, CPC-A Vrushali Sudhakar Masirkar, COC-A Michelle Upton, CPC-A Prajna Shetty, CPC-A Saravanakumar Soundarapandian, Stephen McEndarfer, CPC-A Wayne Chu, CPC-A Mikala Chaffin, CPC-A Pramila S Shrivas, CPC-A CPC-A Subalakshmi Kanagasabai, CPC-A Wendy Olson, CPC-A MiKayla Johnson, CPC-A Pramod Kumbhar, COC-A Saravanan Selvaraj, CPC-A Subash Kathirvelu, COC-A Wenona Lynn Mason Goc, CPC-A Milan Patel, CPC-A Prasad Sambhaji Wadkar, COC-A Sarita Bhanudas Patil, COC-A Subrina Green, CPC-A William Samir Khoury, CPC-P-A Mildrey Hennig, CPC-A Prashanth Veeragani, COC-A Sarupriya Thiruganasampandam Mrs, Sudhansu Sekhar Rath, CPC-A Yadagiri Chetla, COC-A Millie Thelen, CPC-A Praveen Gadagoni, COC-A COC-A Sue Weaver, CPC-A Yojana Bhagwat, CPC-A Mimoza Dema, CPC-A Praveen Kumar Kandukuri, COC-A Sarwat Syed, CPC-A Suganya Susai Francis, CPC-A Yosef Balasaheb Waghmare, COC-A Miriam Jessop, CPC-A Preya Parekh, COC-A Sateesh Reddy Malle, COC-A Sujatha Latta, COC-A Yuvaraj Perumal, CPC-A Misti Hardy, CPC-A Priya Natarajan, CPC-A Sathish Boopalan, CPC-A Sujitha Selvam, CPC-A Zedrick Thaad Cruz, CPC-A MItzi Richard, CPC-A Pushkar V Patil, CPC-A Sathish Sekar, CPC-A Sunil Ramakrishnan, CPC-P-A Zibran Batliwala, CPC-A Mizhelle Tamayo, CPC-A R Robert Paul, CPC-A Sathyarosini Periyasamy, CPC-A Sunitha Korna, COC-A Zina Pape, CPC-A Mohamed Shaaban, CPC-P-A Rabih Nazif Choughari, CPC-P-A Satyasai Mandlem, CPC-A Suresh Boselli, COC-A Zofia Mashchak, CPC-A Mohammed Asif Kareem, CPC-A Rachel A Kalinyak, CPC-A Scott Kennedy, CPC-A Suresh Kumar Chinnasamy, CPC-A Mohammed Amin Othman Jassim Rajain Jaikaran, CPC-A Sean Egerstrom, COC-A Suresh Takwale, COC-A Alabota, CPC-P-A Rajashekar Barapata, COC-A Seetha Chidambaram, CPC-A Susan Boulden, CPC-A Specialties Molly Kelly, CPC-A Rajeev Thomas, CPC-A Shafiyullah Shahulhameed, CPC-A Susan F Bright, CPC-A Specialties Molly Ralston, CPC-A Rajesh Neelamehan, CPC-A Shakia Cummings, CPC-A Susan Joann Fischer, CPC-A Monet Harrell, CPC-A Raju Garvandula, COC-A Shakkeela Shyjas, CPC-A Susan Schriefer, CPC-A Adrienne Johnson, CPC, CEMC Monica Bates, CPC-A Rakesh Makthala, COC-A Shandy Garrison, CPC-A Suthimol Venu, CPC-A Alana Harris, COC, CPC, CPMA Morgan Holley Salo, CPC-A Rakesh Yemineni, CPC-A Shannon Lynch, CPC-A Swapna Aleti, COC-A Alberto Ostolaza, CPC, CIRCC Mounika Nerella, COC-A Rakhee Mohan, CPC-A Shannon Morgan Smith, CPC-A Swapna Dumbali, CPC-A Alicia Sass, CPC, CRC Muhammad Tayyab Ahmad, CPC-A Ramesh Cheripalli, COC-A Shannon Taylor, CPC-A Tabitha Cornett, CPC-A Allison Bradberry, CPC, CIRCC Murali Vajjiravel, COC-A Ramya Arokiyadoss, CPC-A Shanon Kowalski, CPC-A Tamara James, COC-A Allison D’Angelis, CPC, CRC Mustaque Hamid Momin, COC-A Ramya Govindaraj, CPC-A Shantanu Hemant Isankar, CPC-A Tamela Charles, CPC-A Ally Chadwick, CPPM Muthu Abraham, CPC-A Ramya Vaidya, COC-A Sharath Chandra Katikareddy, COC-A Tara Ellis, CPC-A Alma Veronica Coudriet, COC, CPC, Naga Venkatesh Bandi, COC-A Randi Mahoney, CPC-A Sharmin Nasher, CPC-A Tara Jernigan, CPC-A CPMA Nagendra Babu Mada, COC-A Rani Abdel Maksoud Hassan Harraz, Sharon Cullum, CPC-A Telitha Xavier, CPC-A Amanda Barruos, CPC, COSC Nageswara Rao Kastala, COC-A CPC-P-A Sharon Gooding, CPC-A Teresa Lambert, CPC-A Amanda Carlson, CPCO Nagi Reddy Katta, COC-A Rashmi Kumari, CPC-A Sharon Joy Toetschinger, CPC-A Teresa Sniezak, CPC-A Amanda Crystal Fulgencio, CPC, CPMA Nandakishore Puvvala, CPC-A Ravi Kanth Madduri, COC-A Sharon McGue, COC-A Teresa VanderVoort, CPC-A Amena Choudhury, CPB Narasimhulu Gudelli, COC-A Ravinder Gaini, COC-A Shatasha Latika Harmon, COC-A Theresa Flores, CPC-A Amie Marie Anderson, CPC, CPMA Narayana Mandapu, COC-A Ravindran Gnanasekaran, CPC-A Shatondra Surulere, CPC-A Theresa Joseph, CPC-A Amruta Paranjape, CPC, CEMC Naresh Babu Gurajapu, COC-A Raymond Gawlik, COC-A Shavali Shaik, COC-A Theresa Staats, CPC-A Amy Hrivnak, CPC, CPMA Natalie Hinger, CPC-A Raymond Ong, CPC-A Shawn E Pinto, CPC-A Therese Callahan, COC-A Amy Liu, CPC, CPMA, CPPM, CASCC, Natraj Chappa, COC-A Rebecca Renee Suarez, CPC-A Shawn Valentine, CPC-A Thomasina Lindsey, CPC-A COSC Navadeepa Krishnan, CPC-A Rebekah Easterly, CPC-A Shaymaa Foud Fawzy, CPC-P-A Thomasina Merkel, CPC-A Andrea Fenti, CPC, CPMA Naveen Kumar Dhara, COC-A Regina Kulandaisamy, CPC-A Shayne Alexa McCarty, CPC-A Tiana Easterling, CPC-A Angela Carmichael, CRC Naveen Lolam, COC-A Regina Tungpalan, CPC-A Sheeba David Premalatha, CPC-A Tiffany Davis, CPC-A Angela Spang Laughman, CPC, CPB, CANPC Nehamein Pay-Bayee, CPC-A Renne Jones, CPC-A Sheena Kate Sanidad Santiago, CPC-A Tiffany Greenfield, CPC-A Angelo Sto. Domingo Renales, Nicole Daniel, COC-A, CASCC Renuka Mukkidi, COC-A Sheila Carter, CPC-A Timothy Adkins, CPC-A CIC Angie R Mangum, CPC, CEMC Nicole Edwards, CPC-A Reny Annie Philips, CPC-P-A Shekhar Tappa, COC-A Tolley Colley, CPC-A CPB, Anielka Solis, CPC, Nicole Nelson, CPC-A Revathi Kannan, CPC-A Shelby Moore, CPC-A Tracie Mullen, CPC-A CPMA Ann Lewis, CPC, Nicole Newman, CPC-A Rhianna Barnett, CPC-A Shermarc Aguada, CPC-A Tracy Galligher, CPC-A CPMA Anne Brown, CPC, CPB, Nicole Parker, CPC-A Rhonda Marie Howard, CPC-A Shilpa Shrinivas Gawade, COC-A Tracy Herlofson, CPC-A CIMC Antonio Garfield Fraser, CPC, Nikhita Thallamudi, COC-A Rhonda Nordby, CPC-A Shirley Hiester, CPC-A Trisha Kriel, CPC-A CPMA, CEDC Nikita Sukhadev Bakhale, COC-A Ricardo Bodkin, CPC-A Shirley Platt, CPC-A Troy Mckenzie, CPC-A

64 Healthcare Business Monthly NEWLY CREDENTIALED MEMBERS

Antonio Torres Osuna, CIC Diana Kohn, CEMC Kelly Lure, CPC, COBGC Nancy Smith, CPC, CPMA, CEMC Stacy Lynn Shaw, CPC, CPMA April M Jourdan, CPC, CPMA, CEDC Diane Barton, CPC, CPMA, CRC Kennetrice W Broom, CPC, CANPC Napaporn Phommachanh, CPC, CCC Stephanie McBay, CPC, CPB, CEMC Arnil Gio Lanuza Santos, CIC Diane L Kuck, CPC, CPMA Kimberly Aguirre, CPB Natalie Richardson, CPC, CPB Stephanie Neuman, CPC, CPB Ashleigh Grooms, CPC, CRC Dianna Carole Cochran, CPB Kimberly C Cook, CPC, CPMA, CEMC Nicole Castro, CPC, CPB Stephne Lyn Allen, CPC, CPMA Ashley H Knox, CPC, CPMA Donna Cuervo, CPC, CCC Krista J Campbell, CPC, CPMA Nicole T Joyce, CPC, CRC Sue A. Cress, CPC-A, CPB Ashley Mabry, CPC-A, CPMA E. Patrick Magallanes, CPPM Kristen Davidson, CPC, CPMA, CCVTC Nora Colon, CPC, CPMA Sunita Patel, CPC, CPMA Ashley Wincher, CPPM EdithAnn M Faoro, CPC, CPMA Kristie Smith, CPC, CRC Olga Barglowski, CPB Susan Elaine Smith, CPC, CPMA Asokar Arasu, CPC, CPMA Eleanor Suesue, CPC, CPMA Kristin Roessler, CPC, CPB Pallas Buckley, CPC, CPMA, COSC Susan White, CPC, CPPM Becky Gaffney, CPB Elisa Jensen, CPB Lacie Skillings, CPC, CPPM Pamela Stevens, CPC-P, CPB, CPPM, Suzanne Loeb, CPC, CPB, CGSC Behrokh (Brook) Golshan, CPC, CRC Elisha Karsky, CPC, CPCO Lakishia Lawann Moncree, CPC, CPMA CEMC Sylvia Yvette Mack, CPC, CPRC Ben Strickland III, CPC, CPMA Emilie LaRocque, CPC, CPMA Laura Bahnmiller, CPB Pamita Ragland, CIC Talitha Mitchell, CPC, CPMA Betty Williams, COC, CRC Emily Browning, CPB Laura A Winger, CPC, CPMA, CEMC Parth Ghetia, CPPM Tammy Ann Antoncic, CPC, CPCO, CPMA Beverly Ann Lewis, CPC, CGSC, COBGC Erika Bertz-Madrigal, CPB Laura Dolchok, CPPM Patricia C French, CPC, CPMA Tammy Michelle Thornton, CPC, CPMA Beverly Ann Sassorossi, CPC, CHONC Erin Baugh, CPB Laura L Rodriguez, CPC, CPMA Patricia Christianson, CPC-P, CPMA Tammy Perry Hass, CPC, CPB Beverly Gagnon Miller, CPB Ervin Deduyo Batangoso, CIC Laura Millet, CPC-A, CPMA Patricia Lynn Elliott-Kashima, CPC, CPB, Tammy Rose, CPC-A, CEDC Bonnie K Dunn, CUC Eva Smith, CENTC Lauri Williams, CPC, CPMA, CEMC, CUC COSC Tammy Shepherd, CPC-A, CPB Bonnie Sawyer, CPB Evan Ramos, CIC Laurie Weeks, CHONC Patti Thompson, CPB Tammye Lynn Harber, COC, CPC, CPB Brandi Couret, CPC, CPB Fannie Dobson-Phillips, CPC, CPB LeChaunda Tatum-Williams, CPC, CPCO, Paul Beane, CPC, CPCO, CPMA, CPC-I, Tara Alexandra Russo, CPC, CPMA, CRC Brandon Davis, CPPM Farzaneh Riar, CPCO CPMA, CPC-I CCPC, CRC Tara Donnelly, CPC, CEMC Brandy Yvonne Romano, CPC-A, CPB Frances Spine, CPMA, CHONC Lekshmi Geethakumari, CIC Paul R Wickline, COC, CPC, CPMA, Temitope Olusanya, CPB Breanne Neumann, CPB Geri Howard, CPC, CPMA Lena Rodriguez, CPB CEMC Tera VanWieren, CPC, CPMA Brenda Beyer, CPB Gina Banks, CPB Lesa R Schafer, CPC, CPPM Paula Morris, CPC, CPMA, CGSC, COSC Teresa Puckett, CPC, CPCO Brenda G Krotje, CPC, CPMA, CRC Glenda Cook, CPC, CCC Leslie Marie Pou, CPC, CEMC, CFPC Paula Rohr, CPC-A, CPB Teresa Thornhill, CPC, CRC Brenda Marie Thompson, CPC, COSC Grace Herma Aydelotte, CPB Linda Lightner Griffith, CPC,CRC Qiana Pearson, CPB Teri Johnson, CPC, CCPC Brenda R Stevens, CPC, CPMA Guadalupe Hernandez, CPC, CPMA, CRC Lindsay Born, CPC, CPMA Rachel Antoinette Simon, CPC, CPMA Terrilyn Jones, CPB Brenda White, CPB Heather Lynn Cooper, CPC, CPB Lioubov Petrova, CPC, CPMA, CEMC, Rachel Cullen, CPB Tesha A Holso-Dahlenburg, CPC, CPMA, Caprice Ricketts, CPB Hoaly Nguyen, CPC, CANPC CHONC Rachel Davidson, CPC, CPMA CSFAC Carol Jeanine Self, CPC, CPPM Holly L Hadley, CPC, CPMA, CEMC Lisa Gibson, CPB Raquel H Garcia, CEMC Theresa Farrell, CPC, COSC Carrie Bowers, COC, CPC-P, CPMA Irene Simon Daos, CIC Lisa Nicole Hector, CPC, CASCC Rayla Durler, CPB Theresa Helene Smith, CPC, CPMA Casey Nowakowski, CPC, CEMC Jackie Forrette, CPMA, CPCD Lise Sperry, CPB Rayna P Calaro, CPC, CPMA, CFPC Timothy Buxton, COC, CPC, CRC Cassandra Rumes, CPC, CGIC Jamey L Miller, CPC, COSC Loren Hopper, CPCO Rene Hermes, CPPM Tina LaPointe, CPC-A, CGIC Catalina Theissen, CPC, CCC Jamie Addler, COC, CPMA Lynda M Cothard, CPC, CRC Renea Grantham, CPC, CPB Tina M Boecker, CPC, CPRC Catherine Marcano, CPB Jamie Caron, CPC, CPB Lynn Busby, CPC, CPC-I, CIC Renee M Cook, CPC, CPCO Tinika Shantell Reed, CPC, CPMA Catherine Niemiera, CPC, CPMA Jan Rae Larson, COC, CEMC Lynne Soco Duran, CIC Rhonda M Winder, CPC, CPMA Tonya Jones, CPB Cathy Sue Jarvis, CPC, CPMA, CPPM, Jane Brannen, CPC, CPC-P, CPMA Magesh Vanchimuthu, CPC, CPMA, Robert P Thomas, CPC, CPB Tracy Gamboa, CPB CPC-I, CEMC Jane LaPlante, COC, CIC CEMC Robin E Pichelmayer, CPC, CHONC Tracy Kermode, CFPC Cathy Uimari, CPB Janet Scherer, CPC, CPMA Malissa Adams, CPB, CSFAC Robin Miller, CPC, CPMA Tracy Martin, CPC, CIRCC Catina Ridler, CPC-A, CPB Jean K Egginson, CPC-A, CPB Marci Twist, CIRCC Robin Morris, CPB, CEMC Trinia Westcott, CPC, CPB Cedric Mendoza Manahan, CIC Jenifer Edelen, CPC, CPMA Margaret Bauserman, CPC-A, CPB Rocio Ricaldi, CPC-A, CPMA Udhayakumar Palani, CPC, CPMA Charlotte Treasa Tweed, CPC, CPMA Jenna Richardson Wyatt, CPC, CPMA Margherita Kuhn, CPPM Ronnah G. Hernandez, CPB Ursuline Sookhoo, COSC Charmaine Shim, CPC-A, CPMA Jennifer A Barba, CPC, CPMA, COBGC Maria Lozares, CPC, CPMA Rosalind Brook Burnett, CPC, CRC Vanessa C Hollingsworth, CPC, CENTC Chatrione Harris, CPC, CPMA, CPC-I Jennifer Bright, CPB, CPPM Mark Fritz Cordon Zaguirre, CPC, CPMA Rose-Marie Rosario, CPC, CPMA Veronica Reddy, CPC-A, CPB Cherie Chenel, CPC, CPRC Jennifer Crum, CPC, CCC Marlen Pages, CPC, CPMA Rosie L Moher, CPC, CEDC Vickey Martin, CPB, CPPM Cheryl McGeachy, CPB Jennifer Edmondson, CPC, CPCO Marsha S Diamond, COC, CPC, CPMA Roxana Bejinariu, CPC, CPMA Vishnu Sharma, CPC, CPMA Cheryl Boren, CPC-A, CPB Jennifer Lang, CPC, CPB Martha Johnson, COC, CPC, CEDC Roxanna Smith, CPB Vivian Umeh, CPB Cheryl Chatter, CPC, CPCO, CPMA Jennifer Reyez, CPC, CPMA Mary Anderson, CPC, CPPM Ruth Brosnahan, CPMA Wanda Lee Wahl, CPC, CPMA Cheyenne Langston, CPB Jennifer Swinnich, CPPM Mary B Freeman, CPC, CPCO, CEMC Salini Mathiyaru, CPC-A, CPMA Wendy S Smith, CPB Chris Villanueva Rosales, CIC Jennifer Tarabocchia, COC, CPMA Mary Beth Dolin, CEMC Samuel Ramjattan, CPC, CPC-I, CEDC, Wendy Willes, CEA, COC-A, CPC-A, CPB, Christina Esham, CPC, CHONC Jessica Bojan, CPC, CPB Mary Dacalaño Tan, CIC CEMC CPC-I, CIC Christina Nelson, CPMA Jessica Bowen, CPB Mary Gasca, CPB Sandra E McGlamery-Smith, CPC, Yadiris ONeill, COC, CPMA Clara Padro, CPC, CIRCC Jessica Short, CPC, CPMA, CIMC Mary Halvordson, CPC-A, CPB CANPC Yiliana Pena, CPMA Clarissa D Dowrich, CPC, CPC-P, CPMA, Jester Magana Antojado, CIC Mary Victoria McGhee, CPC, CPMA, Sandra Monsalve, CPC, CPC-P, CPMA Yolanda J Jones, CPC, CPMA CRC Jinky Cabanero, COC-A, CPC-A, CPMA, CEMC Sandra Yudy Uricochea, CPC, CGSC Yuli Ouyang, CPB Conor White, CRC CEDC Mary Vrablic, CPMA Sara Arci, CPC, CPMA Yves-Edouard Baron, CPC, CPMA Constance Rae Bennett, CIC Jodi Anne Hellman, CPC, CPMA, CEMC Mary-Ellen Blair, COC, CPC, CPMA, Sarah Comley, CPB Cori Bowmer, CPC, CPMA, CPPM, CFPC John Dantay Rosario, CIC CPPM Sarah Duell, CPC, CRC Crystal Kline, CPPM Joyce Lynn Philbin, CPC, CPB Mathew Doxey, CPC, CEMC Sarah Wellborn, CEMC Crystal Scott, CPC-A, CPMA Judith Renae Pinner, COC, CPC, CPMA, Maylyn Lunario, CIC Sathishkumar Jeyachandran, CPC, Cynthia Lopez, CPC, CPMA, CEMC CPC-I Meaghan Sordillo, CPC, COSC CEMC Cynthia Richardson, CPC, CPMA, CEMC Judy Roden, CPB Megan Huckaby, CPC, CPB Saul O Sanabria, CPC, CPMA, CGSC Dacey Hoffman, CPC, CPMA Juliana Wright, CPC, CPB, CEMC Megan K Bruce, CPC, CIRCC, CCC Shandolyn Moore, CPC, CPB Dana Covington, CPC, CPMA Julie A Rajala, CPMA, CEMC Melanie Chaput, CPC, CPMA Shannon Coleen Edwards, CPC, CPRC Dana Minton, CPB, CEMC Kandi Mardis, CPC, CHONC Melanie Martinez, CPMA Shannon Elaine Furnas, CPC, CPB Danielle Burke, CPB Kara Bertram, COBGC Melanie Medeiros, CPC, CPPM Sharon Michelle Appel, CPC, CPMA Danielle James, CPB Karen Marsano, CEDC Melany Tupper, CIRCC Sherri Noon, CPC, CPPM Danielle Joy Brosan, CPC, CPCO Karen Matarazzo, CIC Melissa Chappell, CPC, CPB, CPMA Sherrill Stratton, CPC, CPB Darla R Mcknight, CPC, CPB, CPMA, Kari Heath, CPC, CRC Melissa Lynch, CPPM Sherry A. Steines, CPC-A, CPB CEMC Karyn Sutton, CPC, CPMA, CCVTC, Melissa R Ussery, CPC, CCC Shiloh Gibson, CPB Darla R Mcknight, CPC, CPB, CPMA, CGIC, CGSC, COSC, CSFAC Melissa Scrivner, CPC, CUC Shimeka Johnson, CPCO, CPMA CEMC Kathleen A Diaz, CPC, CPMA Michael Adaikalam, CPC, CPMA Simone M Fishley-Ewan, MS, COC, CPC, ICD-10 Quiz Answer Debbie Zander, CPC, CPMA Kathleen Coulter, CPC, CRC Michele A Rohan, CPC, CPMA CIRCC (from page 37) Deborah Gallardo Quibrantos, CIC Kathy Strang, CPC-A, CPCO Michelle M Tulier, CPC, CPMA Sirisha Veeramachaneni, CPC, CEDC Deborah Lynn Forde, CPC, CPCO Katie Hazelbush, CPB Michelle Mary Watson, CPC, CEMC, Sivaramalingam Muniasamy, CPC, CPMA The correct answer is A. Correct Debra Jayne Syktich, CPC, CPB, CPPM Katie Monastiere, CPCO CGSC Sonia Guiterrez-Matha, CPC, CPMA Debra K Rhea, CPC, CPB Katti K Yang, CPC, CPMA Mindy Ledbetter, CFPC Stacey Ferguson, CPC, CPMA code assignment in ICD-10-CM Debra T Shelton, CPC, CPB, CEMC Katy Niemchick, CPC, CEDC Mirjana Sekulovski, CPC, CRC Stacey D Ruggles, CPC, CPMA depends on documentation of Deni Adams, CPC, CPB Kelly Buckley, CPPM Missy Beasley, CPB, CPPM Stacey Singer, CGSC the anatomical site, laterality, Denise Reckers, CPC, CPMA Kelly D Hall, CPC, CPMA, CEMC Monica V Cioflanc, CPC,CPMA Stacey Walters, CPC, CCC Diana Durcan, CPC, CPMA Kelly Jo Roberson, CPC, CPB, CEMC Myra Looney, CPC, CEMC, COBGC Staci M Garibaldi, CPC, CPPM and type.

www.aapc.com July 2015 65 Minute with a Member Michelle M. Mesley-Netoskie, CPC Reimbursement Specialist, Albany ENT & Allergy Services, PC

HBM: Tell us a little bit about how you got HBM: How is your organization preparing into coding, what you’ve done during your for ICD-10? coding career, and where you work now. My organization has invested in a certified I was a property and casualty and an acci- electronic health record/practice manage- dent, life, and health broker, which was a ment system and clearing house that, from a commission position with a lot of travel. I system standpoint, says we are on target for wanted a stable salary so a friend recom- ICD-10. From a billing standpoint, we are mended a position in the physician side of working with our providers and rolling out hospital billing. She thought my contracting concepts in layers so we are not overwhelmed experience could be helpful. I started work- in October. ing denied no fault and worker compensation claims. As my career progressed, I was HBM: If you could do any other job, what promoted contingent on obtaining my Cer- would it be? tified Professional Coder (CPC®) credential I am so passionate about my work; however, within a year. That was 11 years ago. For the part of me has always wanted to own my own last six years, I have worked at Albany ENT craft and floral store. Years ago, I did 26-plus & Allergy Services, PC. craft shows a year. Sometimes I miss that cre- ative energy. HBM: What is your involvement with your HBM: How has your certification helped you? local AAPC chapter? HBM: How do you spend your spare time? I am very involved in my local chapter and My certificate has opened many doors. Most Tell us about your hobbies, family, etc. recently, I was asked to contribute two chap- proud to be in the chapter that was award- I live in Colonie, New York, with my hus- ters on ear, nose, and throat (ENT) billing ed the 2014 Chapter of the Year. This is the band of 13 years, Ron. We enjoy cycling with a partner at Albany ENT & Allergy Ser- first year in the past five that I am not an of- along the Mohawk and Hudson River trails, vices, PC, Gavin Setzen, MD. To be pub- ficer; I have served as vice president and ed- playing the acoustic guitar together, and lished was one of my coding career goals. The ucation officer. I continue to volunteer at traveling (As I write this, I am at the Grand book is scheduled for release this summer. most monthly meetings, I make it point to Canyon.). I love to read an average six to 10 be a resource for officers and members; and HBM: Do you have any advice for those new books a month. I enjoy crafting and hand each year I make 30 gift baskets to be raffled sewing, and giving back to my community at our September dinner for New York State to coding and/or those looking for jobs in the field? through church, my local chapter, and oth- Coder’s Day. er organizations. I have three wonderful chil- Keep your mind open; coding tends to take dren: William, 30, Ashely, 24, and Alessan- HBM: What AAPC benefits do you like the you in many directions. Stay informed about dra, 19. I am expecting my first grandchild most? national and local trends because current in- in August. The AAPC benefit I like the most is the dis- formation is key to success in this evolving count to HEALTHCON for chapter offi- business. cers. I have been fortunate to attend five national conferences. Another benefit I enjoy is HBM: What has been your biggest Healthcare Business Monthly. Being in a small challenge as a coder? specialty, it keeps me informed about nation- Staying informed. Carrier rules can al and other specialty changes. Lastly, my lo- sometimes defy what we learn as GOT A MINUTE? cal chapter is a great resource and has net- coders. The real world of coding is a If you are an AAPC member who strives to advance the business of working opportunities that have helped me balancing act of what we are taught healthcare, we want to know about it! Please contact Michelle Dick, in my career over the last decade. verse what the carriers want. executive editor, at [email protected], to learn how to be featured.

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