June 2008 (clockwise) Clifton L. Jones, CPC, CCP Joyce L. Jones CPC, CPC-H, CCS-P, CPC-ASC, CNT Traci Linn, CPC Families Who Beth Wolf, BA, CPC Code Together Stay Together Plus: Work of a Coder Survey • MPFS • Medical Policy • RACs • Advanced Beneficiary Notices CodingWebU.comCodingWebU.com TheThe NewNew HomeHome ofof thethe AnnualAnnual CEUCEU CodingCoding ScenariosScenarios && thethe “Nuts“Nuts andand Bolts”Bolts” ofof E&ME&M CodingCoding SeriesSeries CPC® Part 1 $85 for 9 CEUs CPC® Part 2 $85 for 9 CEUs CPC-H® $75 for 7 CEUs CPC-P® $85 for 8 CEUs E&M $65 for 6 CEUs Orthopedics $75 for 7 CEUs 2008 and 2007 Versions are Currently Available Local Chapter Gifts CodingWebU.comCodingWebU.com willwill givegive eacheach chapterchapter giftgift certificatescertificates toto bebe usedused asas rafflesraffles oror givegive awayaway atat youryour locallocal oror regionalregional conferences.conferences. ContactContact CodingWebU.comCodingWebU.com forfor moremore details.details. CodingWebU.com™ Providing Quality Education at Affordable Prices (484) 433-0495 www.CodingWebU.com contents 9 33 47 June 2008 In Every Issue [contents] 5 Letter From the Vice President 7 Letter From the NAB President 12 Letters to the Editor 15 Coding News 23 Kudos 24 42 Extreme Coding Features 8 ABN: Shift Responsibility to Patients the Correct Way Belinda S. Frisch, CPC, gives you information on Advanced Beneficiary Notice of Non-coverage (ABN) to correctly notify beneficiaries that Medicare is not likely to Education cover specific services. 16 Top 10 Reasons for Employers 18 Stay Current with April 2008 Medicare Physician Fee Schedule Updates to Participate in Project Xtern MPFS changes quarterly, tugged in various directions by several initiatives. Jean Acevedo, LHRM, CPC, CHC, brings us up to speed on the latest changes. 31 Examination Dates 24 Families Who Code Together Stay Together 50 Test Yourself Members confess that their passion for coding doesn’t stay at the office. The enthusi- asm for coding has found its way into the hearts of loved ones to become a favorite family pastime. Senior Editor Michelle Dick reports. 32 What Hat Do You Wear? People We learned from our Work of a Coder survey that coders wear plenty of hats, but physi- 38 Newly Credentialed Members cians often see us as firefighters or police officers. Sheri Bernard CPC, CPC-H, CPC-P, writes about hats and other surprising results. 44 Understand Carrier Medical Policy and the Long Denial Process Do you understand the process behind how a provider develops medical policy? Next Month Few really do. Jonnie Massey, AHFI, CPC, CPC-P, CPC-I, reveals what goes into the decisions that affect your reimbursement. Art of Negotiating 47 RACs Are Coming to Your Town Books to Buy The new federal Recovery Audit Contractor (RAC) program is coming to city near you. How can you prepare for the review? Good coding is your best protection says CAC Solutions Brad Ericson, CPC, CPC-ORTHO. Coding Books On the Cover: It’s no secret that the Jones family is passionate about coding. Joyce L. Consultants Jones, CPC, CPC-H, CCS-P CPC-ASC, CNT, and husband, Clifton L. Jones, CPC, CCP, pose on their porch with daughters, Beth Wolf, BA, CPC, and Traci Linn, CPC. Cover photo by Neil Brake of Vanderbilt Medical Center. www.aapc.com June 2008 3 Targeting the AAPC Audience The membership of AAPC, and subsequently the readership of Coding Edge, is quite varied. To ensure we are providing education to each segment of our audience, in every issue we will publish at least one article on each of three levels: apprentice, June 2008 professional and expert. The articles will be identified with a small bar denoting CEO and President knowledge level: Reed E. Pew Beginning coding with common technologies, basic anatomy and [email protected] APPRENTICE physiology, and using standard code guidelines and regulations. Vice President of eMarketing Bevan Erickson More sophisticated issues including code sequencing, modifier [email protected] PROFESSIONAL use, and new technologies. Vice President of Member Services Advanced anatomy and physiology, procedures and disorders Stephanie L. Jones, CPC, CPC-E/M EXPERT [email protected] for which codes or official rules do not exist, appeals, and payer specific variables. Vice President of Member Relations Sheri Poe Bernard, CPC, CPC-H, CPC-P [email protected] Vice President of Education Nancy Reading, BS, RN, CPC [email protected] AAPC Code of Ethics Director of Publications Brad Ericson, BA, MPC, CPC, CPC-ORTHO [email protected] Members of the American Academy of Professional Coders Senior Editor (AAPC) shall be dedicated to providing the highest standard of Michelle A. Dick, BS professional coding and billing services to employers, clients, [email protected] and patients. Professional and personal behavior of AAPC Production Staff members must be exemplary. Tina M. Smith, AAS Graphics z AAPC members shall maintain the highest standard [email protected] of personal and professional conduct. Members shall Display Advertising respect the rights of patients, clients, employers, and all other colleagues. Raemarie Jimenez, CPC z Members shall use only legal and ethical means in all 877-642-9909 professional dealings, and shall refuse to cooperate with, [email protected] or condone by silence, the actions of those who engage in Address all inquires, contributions and fraudulent, deceptive, or illegal acts. change of address notices to: z Members shall respect and adhere to the laws and regulations of the land, and uphold the mission statement of the AAPC. Coding Edge PO Box 704004 z Members shall pursue excellence through continuing education in all areas applicable to their profession. Salt Lake City, UT 84170 z Members shall strive to maintain and enhance the dignity, (800) 626-CODE (2633) status, competence, and standards of coding for profes- sional services. © 2008 American Academy of Professional Coders, Coding Edge. All rights reserved. z Members shall not exploit professional relationships with Reproduction in whole or in part, in any form, without written permission from the AAPC patients, employees, clients, or employers for personal gain. is prohibited. Contributions are welcome. Coding Edge is a publication for members of the American Academy of Professional Coders. Statements of fact or opinion are the responsibility of the authors alone and do not imply an opinion of the AAPC, or sponsoring This code of ethical standards for members of the AAPC strives ® to promote and maintain the highest standard of professional organizations. Current Procedural Terminology (CPT ) is copyright 2007 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related service and conduct among its members. Adherence to these listings are included in CPT®. The AMA assumes no liability for the data contained herein. standards assures public confidence in the integrity and service of professional coders who are members of the AAPC. CPC®, CPC-H®, and CPC-P® are registered trademarks of the American Academy of Professional Coders. Failure to adhere to these standards, as determined by AAPC, will result in the loss of credentials and membership with the American Academy of Professional Coders. Volume 19 Number 6 June 1, 2008 Coding Edge (ISSN: 1941-5036) is published monthly by the American Academy of Professional Coders, 2480 South 3840 West, Suite B. Salt Lake City, Utah, 84120, for its paid members. Periodical postage paid at the Mendota, IL. 61342 mailing office. POSTMASTER: Send address changes to Coding Edge c/o AAPC, 2480 South 3840 West, Suite B, Salt Lake City, UT., 84120. 4 AAPC Coding Edge letter from the vice president Vice President’s Message Last year, our leader, Reed E. Pew, requested that the AAPC national office focus on one priority: improving our performance by delivering world class, member-focused service. Our talented and committed department heads stepped up to the plate and augmented our service staff by recruit- ing health care professionals. Now, we are delighted that many of our staff members are also CPCs®. The result of our focus is improved service quality, including: improved telephone hold times, faster ser- vice through better technology and staff training, and increased overall member sat- isfaction levels through personalized service. We continue to improve our service. We have aggressively expanded your member benefits to provide you with increased membership value, by providing the following: z Health and life insurance at affordable individual plans z Savings connection with quality dis- counts from the world’s best brands. z Up to 50 percent off at more than 200 nationwide retailers (Target, Barnes and Nobles, Lands’ End, Lane Bryant, Office Depot, etc.) To move forward and help our members continue to look for services that support z BIG savings on hotels, rental cars, compete in today’s rapidly evolving business high standards of accuracy and productivity, airfare, and cruises environment, we’ve added member services and give our members a competitive edge. z Up to 30 percent off movie tickets focused on providing time-friendly educa- Most importantly, we continue to look for at over 11,000 theaters nationwide tion and training. We’ve created many new every opportunity to provide world class, z Factory-direct savings of up to 50 “on-demand” tools to help members file member focused service. percent below manufacturer suggested and log CEUs with the CEUTracker, and to As we enter the summer of 2008, the AAPC retail price (MSRP) on electronics, register for workshops and exams instantly. stands tall with a highly qualified staff of clothing, jewelry, appliances, and more CEUs earned from AAPC’s live and audio talented individuals with your needs our top workshop exercises, Coding Edge, and priority. Our commitment to service means I’ve been a CPC® for 11 years and your vice EdgeBlast emails are now available online your interactions with us are based on value, president of member service for almost a instantly graded and automatically popu- superior service, and a positive experience.