Focus on

March 2009
Focus on
Ophthalmology
Sue Vicchrilli, COT, OCS, Salt Lake City, Utah (left)
Kim Ross, CPC, OCS, Novato, Calif. (right)
Plus: Liver Transplants • Modifier 25 • 2009 OIG Hospital Plan • HIEs • Professional Tune-ups
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contents
12
16
36
[contents]
March 2009
In Every Issue
5 Letter From the Vice President
7 Letter From Member Leadership
10 Letters to the Editor
11 Coding News
26
44 Extreme Coding
Features
12 Code for Success When a Damaged Liver Needs Transplantation
Featured coder, Shelly Bauguss, CPC, CGSC, CANPC, CGIC, provides insight into
coding liver transplantation, a common treatment for patients diagnosed with alcoholic liver disease.
Education
16 HIE: Promoting Quality Care, Efficient Growth, and Improved Functionality
46 Road Map to ICD-10-CM
Kevin B. Shields, CPC, CPC-H, CPC-P, CCS, CCS-P, RCC, CCP-P, sheds light on
how Health Information Exchanges (HIEs) promise transformation in the way medical professionals and patients swap records.
50 Test Yourself
21 Correctly Code Patient Counseling
People
Use sign, symptom, or condition to prevent confusion with Preventive Medicine
Counseling codes (99401-99404), by William P. Galvin, CPC.
22 Five for Modifier 25
G. John Verhovshek, MA, CPC, says five steps is all you need for modifier 25 claim
success.
26 Focus on Ophthalmology
Get a clear picture on ophthalmology coding, from A-scans to YAG, with Kim Ross,
CPC, OCS, and Sue Vicchrilli, COT, OCS.
30 Managing Hospital Compliance
Jillian Harrington, MHA, CPC, CPC-I, CCS-P, explains why hospitals would do well
to monitor their compliance plan using the 2009 OIG Work Plan.
9 Local Chapters— Need a Professional Tune-up?
38 Newly Credentialed Members
42 Minute with a Member
Coming Up
NAB President
32 Complete Spinal Fusion Coding Includes Grafting and More
Mohs Micrographic Surgery
Spinal fusion involves multiple steps. G. John Verhovshek, MA, CPC, takes us
beyond those described by arthrodesis codes 22532-22632.
Colonoscopy
On the Cover: Kim Ross, CPC, OCS, coding specialist at American Academy of
Ophthalmology and Sue Vicchrilli, COT, OCS, coding executive at American Academy
of Ophthalmology, give us a close look at the ophthalmic procedures they see daily.
Cover photos taken by Bernhardt Mair. Photo Illustration by Tina M Smith.
Sepsis Confusion
Disaster Relief
www.aapc.com
March 2009
3
Serving 74,000 Members – Including You
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,
professional and expert. The articles will be identified with a small bar denoting
knowledge level:
APPRENTICE
Beginning coding with common technologies, basic anatomy and
physiology, and using standard code guidelines and regulations.
PROFESSIONAL
More sophisticated issues including code sequencing, modifier
use, and new technologies.
EXPERT
Advanced anatomy and physiology, procedures and disorders
for which codes or official rules do not exist, appeals, and payer
specific variables.
March 2009
CEO and President
Reed E. Pew
[email protected]
Vice President of Clinical Coding Content
Sheri Poe Bernard, CPC, CPC-H, CPC-P
[email protected]
Vice President of Product Management
Stephanie L. Jones, CPC, CEMC
[email protected]
Vice President of Marketing
Bevan Erickson
[email protected]
Director of Business and Member Development
Rhonda Buckholtz, CPC, CPC-I
[email protected]
(814) 673-7178
AAPC Code of Ethics
Director of Clinical Communications
John Verhovshek, MA, CPC
[email protected]
Members of the American Academy of Professional Coders
(AAPC) shall be dedicated to providing the highest standard of
professional coding and billing services to employers, clients,
and patients. Professional and personal behavior of AAPC
members must be exemplary.
zz AAPC members shall maintain the highest standard
of personal and professional conduct. Members shall
respect the rights of patients, clients, employers, and all
other colleagues.
zz Members shall use only legal and ethical means in all
professional dealings, and shall refuse to cooperate with,
or condone by silence, the actions of those who engage in
fraudulent, deceptive, or illegal acts.
zz Members shall respect and adhere to the laws and regulations
of the land, and uphold the mission statement of the AAPC.
zz Members shall pursue excellence through continuing
education in all areas applicable to their profession.
zz Members shall strive to maintain and enhance the dignity,
status, competence, and standards of coding for professional services.
zz Members shall not exploit professional relationships with
patients, employees, clients, or employers for personal gain.
This code of ethical standards for members of the AAPC strives
to promote and maintain the highest standard of professional
service and conduct among its members. Adherence to these
standards assures public confidence in the integrity and service
of professional coders who are members of the AAPC.
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.
Director of Member Services
Danielle Fenochietti
[email protected]
Director of Publications
Brad Ericson, MPC, CPC, COSC
[email protected]
Senior Editors
Michelle A. Dick, BS
[email protected]
Renee Dustman, BS
[email protected]
Production Staff
Tina M. Smith, AAS Graphics
[email protected]
Display Advertising
Julia Bond
[email protected]
Address all inquires, contributions and
change of address notices to:
Coding Edge
PO Box 704004
Salt Lake City, UT 84170
(800) 626-CODE (2633)
© 2008 American Academy of Professional Coders, Coding Edge. All rights reserved.
Reproduction in whole or in part, in any form, without written permission from the AAPC 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 represent an opinion of the AAPC, or sponsoring
organizations. Current Procedural Terminology (CPT®) is copyright 2008 American Medical
Association. All Rights Reserved. No fee schedules, basic units, relative values or related
listings are included in CPT®. The AMA assumes no liability for the data contained herein.
CPC®, CPC-H®, and CPC-P® are registered trademarks of the
American Academy of Professional Coders.
Volume 20 Number 3
March 1, 2009
Coding Edge (ISSN: 1941-5036) is published monthly by the American Academy of
4
AAPC Coding Edge
Professional Coders, 2480 South 3850 West, Suite B. Salt Lake City, Utah, 84120, for its
paid members. Periodical postage paid at the Salt Lake City mailing office and others.
POSTMASTER: Send address changes to Coding Edge c/o AAPC, 2480 South 3850
West, Suite B, Salt Lake City, UT., 84120.
letter from the vice president
Choose CEUs
to Stretch Skill Levels
In 2007, AAPC made it easier to report
CEUs by requiring documentation every 24
months instead of every 12 months. We also
doubled the number of free CEUs available
to members.
In 2008, we made it easier to record CEUs
by activating our online reporting system,
CEU Tracker.
But to hear at least one vendor tell it, for
2009 we’ve made CEUs much harder to
obtain: “Attention Certified Coders: CEU
Rules get stricter in 2009. It won’t be as
easy to earn CEUs for your CPC certification this year…” blazed across the bottom of
some Coder’s Pink Sheets earlier this year.
The note caught us by surprise; but then
we realized it is at least partly true. AAPC
has modified its CEU policy a bit, and has
implemented a mission statement for CEUs.
This statement holds us to a standard that
may, in fact, make it “harder” for some who
haven’t focused on continuing education.
AAPC CEU Mission
All members and business associates of
AAPC must “Uphold a Higher Standard”
in education. AAPC certified coders must
choose continuing education that stretches
their skill levels. Vendors and local chapters
must provide quality in curriculum. AAPC’s
national office must develop a comprehensive list of CEU opportunities and provide
vendors and local chapters with timely and
consistent CEU approvals.
For members, this means opportunities to
earn 5 CEUs in 60 minutes should be a
thing of the past. Members instead “must
stretch their skill levels” — meaning we
must choose CEUs that truly enhance our
professional knowledge and keep us up-todate with changes in the medical marketplace. Plan ahead and expect to expend an
hour for each CEU earned.
For vendors and local chapters, this means
focusing on what to teach, building it, and
then seeking CEUs is the new standard.
Don’t begin a project by determining its
L to R back: Darrelyn Rodman, CPC-A, Angela Abu-Khamseen, CPC-A, Bronwyn Swope, CPC-A,
Sheri Poe Bernard, CPC, CPC-H, CPC-P. In front: Wendy Atkinson, CPC-A
CEU count. That’s the tail wagging the dog.
If the education is there, the CEUs will be
there, too. AAPC products must meet the
same standards as our vendors’ products.
For AAPC’s CEU analysts, this means more
scrutiny to ensure certified members are
getting an hour’s worth of curriculum with
each CEU granted. It also means analysts
must be diligent so vendors receive quick
responses and members have a wide variety
of CEUs from which to choose. It’s a tough
job, which is why AAPC’s vendor analysts
are all certified coders.
CEUs awarded by AAPC analysts can be as
little as 0.5 or as much as 40. The CEUs can
be free to members or pricey. It’s important
for members to seek out CEUs that match
their needs and pocketbooks.
One of the best CEU values members will
find in 2009 is the AAPC National Conference in Las Vegas, April 5-8. The curriculum has something for everyone; and this
year, an eight-station anatomy lab staffed
by physicians provides a unique, hands-on
experience. Some of the best parts of the
conference are not tied to CEUs: discussing
specific coding issues, face-to-face encounters with expert faculty; networking with
coders in your specialty from all over the
country; and witnessing just how diverse
and professional the many faces of AAPC
are. We hope to see you at the Rio!
Sincerely,
Sheri Poe Bernard, CPC, CPC-H, CPC-P
Vice President of Clinical Coding Content
www.aapc.com
March 2009
5
letter from member leadership
Build Strong Bridges
Have you ever thought about how many
people and resources it takes to build a
bridge? There are more than half a million bridges in the United States today, and
we rely on them to cross obstacles, such
as rivers, oceans, railroad tracks, and canyons. When engineers design bridges, they
consider many factors that influence the
design. For example, the spanning distance
and available materials must be considered
before determining the size, shape, and
appearance. A bridge is typically constructed
with beams supported at the end by piers.
The weight of the beams pushes straight
down on the piers. The farther apart the
piers, the weaker the beams become. It can
take years to build a bridge strong enough
to withstand the test of time.
Physicians and medical coders also need to
build a bridge strong enough to last a lifetime. The spanning distance may seem great,
but the only materials required are respect
and understanding. These materials are the
foundation for binding together solid teams,
partnerships, and managing relationships.
Bridge the Gap
The first step in building a strong bridge
is identifying areas of contention. Many
people see things as right or wrong—they’re
right and you’re wrong. When a situation is
viewed through this lens, a power struggle
ensues. When an opposing situation is seen
as simply opinion and not fact, however,
cooperation is possible. Identifying and
understanding our differences allows for
compromise and negotiation.
A Team Approach
The AAPC has concentrated efforts for the
past couple of years on building a strong
bridge between the professional coding community and medical societies. The Academy
has reached out and supported numerous
medical societies and in turn has obtained
support from the provider community. The
positive strides made over just the past few
months have developed a team approach for
specialty credentials and exams. Various specialty societies have partnered with AAPC
to ensure our specialty credentials remain
the gold standard for certification. Many
organizations have specialty credentials, but
AAPC has taken them a step further by
making certain our specialty coders are the
best in the industry.
Developing strong relationships with the
medical societies has strengthened the
bridge between physicians and other AAPC
members and enabled the AAPC to reinvent specialty exams. Specialty committees
were formed with members and society
experts to develop specialty examinations
that incorporate real-world cases. This takes
our organization and credentials to the next
level of expertise. By certifying multi-specialty coders, the new credentials give other
specialty coders skill validation. This does
not devalue the core CPC® credential—it
strengthens it.
Not only will our specialty credentials
become an industry force, but the AAPC
and specialty societies’ collaboration will
achieve a level of mutual respect that fosters
education and sharing. This affords us the
opportunity to learn from physicians and
their societies. We can provide physicians
with a path to follow that partners with and
employs qualified certified coders working
together to make the health care industry
stronger. Keeping good relationships intact
will position the AAPC for future success.
Remember that when our organization wins,
we all win. Lend a hand in building the
bridge. We can assist and encourage health
care industry professionals to get involved
and form partnerships to build a strong and
long-lasting bridge.
“Teamwork is the ability to work together toward
a common vision. The ability to direct individual
accomplishments toward organizational objectives.
It is the fuel that allows common people to attain
uncommon results.” Andrew Carnegie
Until next month…
Deborah Grider,
CPC, CPC-H, CPC-P, CEMC, CPC-I,
CCS, CCS-P
National Advisory Board President
www.aapc.com
March 2009
7
Good News!
You’ve known us as The Medical Management Institute.
Get to know us as
.
Over the past year, we have been asking you to get to know us by a new
name, Contexo Media. Our customers and students have relied on us for
over 20 years to provide elegant solutions for coding, reimbursement and
compliance. While our name has changed, we haven’t changed our core
belief that medical professionals need affordable and easy-to-use tools
to do their jobs more effectively.
This year, we are building on our strong tradition by publishing several
best-in-class tools for coding reference, including the all-new 2009
Procedural Coding Professional. We are also committed to delivering our
unique blend of tools and training through new technology, including
E-learning, webinars, and other distance learning platforms. This will
allow us to deliver more timely and relevant information than ever before.
Plus, we will continue to partner with the American Medical Association
to bring you the hugely popular regional CPT® Changes seminars.
Our books, software and online education offerings are all designed with
input from medical professionals from across the nation, and offer a
trustworthy, independent source of information and insight. This helps
us ensure our products meet vigorous expectations – yours.
© 2009 Contexo Media
CPT® is a registered trademark of the American Medical Assciation
Tools and Training for the
Healthcare Professional
800.334.5724 | www.codingbooks.com
Visit us at Booth #300.
local chapters
Need a Professional Tune-up?
Local chapters provide resources
for jump-starting your career.
By Terry A. Fletcher,
CPC, CCC, CEMS, CCS-P, CCS, CMSCS, CMC
S
pring time is upon us. After such a cold winter with
more rain and snow than we care to remember, it’s
time to look at the new beginnings, new codes, new ways
to keep ourselves educated, and our local chapters in a
new light.
Many of us are so busy coding and billing, educating on
coding, and working full time we forget one of the best
resources for this is our local chapters. Our local chapters
can provide the professional tune-up we need to remind
us why we love what we do. Local chapter meetings can
involve education, networking, and an opportunity to
make great new friends. It can be a place to network, to
find employment opportunities, and to share experiences
in your specialty with fellow coders. For most of us, our
families aren’t excited to hear about how something is
coded or about a success story in coding education when
we get home from work or a seminar. When we attend
local chapter meetings, we can share these stories, ask for
expertise on other specialties, or offer expertise to fellow
local chapter members. This can turn into a great networking forum and also a great education session.
As many of us plan for our personal tune-up—for
example, going to a movie, attending a church service,
having dinner with friends, or traveling on vacation—we
forget that we should also treat ourselves to professional
tune-ups. Reflect on how contributing to the AAPC and
what attending a local chapter meeting can mean for you
personally and professionally.
Attending a local chapter meeting can be the most
rewarding and affordable way to listen to quality speakers and receive CEUs at a minimal cost. Networking opportunities are in abundance. The best way to
talk about coding solutions, to look for CPCs to hire,
to obtain those last few CEUs, and to learn of code
changes in a timely fashion is to attend your next local
chapter meeting.
AAPCCA Gears Up for Vegas
Next month we are gearing up for the National Conference in Las Vegas, and the AAPCCA is very excited. We
currently have 16 members on our board who have served
For most of us, our families aren’t excited to hear
about how something is coded or about a success
story in coding education when we get home from
work or a seminar. When we attend local chapter
meetings, we can share these stories, ask for
expertise on other specialties, or offer expertise to
fellow local chapter members.
you and your local chapters diligently over the past
two years. As in the last two national conferences, the
AAPCCA will be very visible. We will attend Sunday’s
local chapter events, as well as the “Get to Know Your
Local Chapter” booths.
Changing of the Guard
On a sad note, we have eight current AAPCCA members
who will be rotating off the board come conference. We
appreciate their hard work and time put into our board
over the past two years. The good news is that we have
eight new members rotating on the board. On behalf
of the entire Board of Directors, we could not be more
excited about our local chapters’ future and how the new
board will continue to assist them in their success. We
will be wearing our purple AAPCCA board of directors’
shirts at conference. Please make sure you stop one of us
and say “Hi!” We may have a treat for you!
I want to take this opportunity to thank all of the local
chapters and local chapter officers who email us personally
to let us know you appreciate what we are doing for our
local chapters. We thank you for your hard work and effort
to make local chapters a success. See you in Vegas!
Terry A. Fletcher,
AAPCCA Executive
Chair, CPC, CCC,
CEMS, CCS, CCS-P,
CMSCS, CMC
www.aapc.com
March 2009
9
letters to the editor
Please send your letters to the editor to:
[email protected].
Letters to the Editor
One Digit Makes a Difference
Dear Coding Edge,
In the January 2009 issue of Coding Edge, I noticed an
incorrect code in the article “Road Map to ICD-10-CM.”
It is on page 23 at the top-left for History of tobacco use. For
the ICD-9-CM code, the article has V15.52, but the code
should be V15.82.
Thanks,
Kathy Giem, CPC, CASCC
Grand Valley Surgical Center
Dear Kathy,
Thanks for catching our typo. It’s nice to know nothing gets
past a coding professional’s radar.
Sincerely,
Coding Edge
Do Not Report Surgical Aftercare
with an Acute Injury Code
Dear Coding Edge,
I have a comment regarding the article “Reporting the Surgical Relay” in the January issue (pages 26-27) with respect to
the use of modifiers 54, 55, and 56. Under the sub-heading
Consider Low-Level E/M, the author states that as an alternative to modifier 55 Postoperative management only, an office
could use procedure code 99212 Office or other outpatient visit
for the evaluation and management of an established patient, which
requires at least two of these three key components: a problem focused
history; a problem focused examination; straightforward medical
decision making. Counseling and/or coordination of care with other
10 AAPC Coding Edge
providers or agencies are provided consistent with the nature of the
problem(s) and the patient’s and/or family’s needs. Usually, the
presenting problem(s) are self limited or minor. Physicians typically
spend 10 minutes face-to-face with the patient and/or family. For the
primary diagnosis, use V58.3x Encounter for other and unspecified
procedures and aftercare; attention to surgical dressings and sutures,
with a secondary diagnosis of 884.0 Multiple and unspecified
open wound of upper limb, without mention of complication.
Code 884.0 is not appropriate for this scenario as this is no
longer an open wound, and the correct coding guidelines
specify that after the wound has been treated/healed, we do
not report the surgical aftercare with an acute injury code.
The correct way to report suture removal would be with
V58.43 Aftercare following surgery for injury and trauma and
V58.32 Encounter for removal of sutures.
Thank you,
Debra A. Mitchell, MSPH, CPC-H
Dear Debra,
You’re right. The better code choice would be V58.43, along
with the V code for suture removal (V58.32).
Many thanks for your help with this!
Coding Edge
coding news
coding news
By senior editors Renee Dustman and Michelle Dick
CCI Edits V.14.3 Exclude
New Drug Admin Codes
In case you haven’t noticed, the National
Correct Coding Initiatives (CCI) edits, Version 14.3, effective Jan. 1 through March
30, includes the 2008 CPT® codes for drug
administration, not the 2009 CPT® codes.
Hospital CCI edits lag one quarter behind
physician CCI edits. The new CPT® codes
for drug administration services won’t be
available in CCI edits until Version 15.0,
which will be released April 1.
To ensure reliable claims submission, carefully review 2009 first quarter Medicare
outpatient claims containing drug administration codes for any bundling policies that
apply but aren’t included in the CCI edits.
New Nuclear Medicine
Category II Codes
New for 2009, nuclear medicine professionals have nuclear medicine specific Category
II codes available; however, you won’t find
these codes listed in the 2009 CPT® book.
The following quality measures became
effective Oct. 1, 2008.
CPT® Code Long Description
3570FFinal report for bone scintigraphy
study includes correlation with existing relevant imaging studies (eg,
X-ray, MRI, CT) corresponding to the
same anatomical region in question
(NUC_MED)
3572FPatient considered to be potentially
at risk for fracture in a weight-bearing site (NUC_MED)
3573FPatient not considered to be poten-
tially at risk for fracture in a weightbearing site (NUC_MED)
Code 3570F may be used to report a documented correlation between bone scintigraphy and existing relevant imaging studies
(eg, X-ray, MRI, CT) corresponding to the
same anatomical region. Codes 3572F and
3573F may be used to report to a payer the
potential fracture risk and the communications to referring physicians with modifiers.
These new codes will appear in the 2010
CPT® book.
Insurers Overcharge
Beneficiaries Billions for Drugs
Since the Medicare Part D prescription program began in 2006, private health insurers
with plans under the Medicare prescription
drug benefit have overcharged beneficiaries and the program by billions of dollars.
Because of required audit failure, according to
a Department of Health and Human Services
(HHS) Office of Inspector General (OIG)
report, the Centers for Medicare & Medicaid Services (CMS) will not know the total
impact. In 2006, 80 percent of health insurers with Medicare prescription drug benefit
operating plans overcharged the program by
about $4.4 billion. The report found CMS
should have conducted 165 audits for 2006,
instead it has begun seven as of April 2007
and CMS probably won’t address the 2006
audit problems before 2010.
www.aapc.com
March 2009
11
featured coder
CODE FOR SUCCESS
When a Damaged Liver Needs Transplantation
PROFESSIONAL
By Shelly Bauguss, CPC, CGSC, CANPC, CGIC
St. Patrick’s Day became
a custom in America in
1737, the first year that
St. Patrick’s Day was
publically celebrated in
Boston. Today, people
celebrate the day
watching parades,
wearing green
clothes, and drinking beer.
Drinking beer
or any alcoholic
beverage in
moderation
is acceptable
to most, but
for others it
is an addiction that, over time, can result in severe liver
disease, most notably cirrhosis. Even for people who stop
drinking alcohol, the effects are still evident in the body
many years later.
Alcoholic cirrhosis is the most serious type of alcoholinduced liver disease. Cirrhosis is the replacement of
normal liver tissue with scar tissue. According to the
American Liver Foundation, www.liverfoundation.org,
between 10 and 20 percent of heavy drinkers develop
cirrhosis, usually after 10 or more years of drinking.
The damage from cirrhosis is not reversible, and it is a
life-threatening disease. The risk is particularly high for
people who drink heavily and have another chronic liver
disease, such as viral hepatitis C.
Liver transplantation is a common treatment for patients
with alcoholic liver disease diagnoses in North America
and Europe. The criterion for selecting a patient for liver
transplantation with alcoholic cirrhosis is the patient
must abstain from alcohol for six months. This has been
referred to as the six month rule, and is used to predict
future abstinence. An optimistic view about the salutary
effects of transplantation on alcoholic relapse came from
12 AAPC Coding Edge
Thomas Starzl, who coined the aphorism, “liver transplantation was the ultimate sobering experience.”
All prospective liver recipients have the same consultation process and multi-disciplinary team conferences
regardless of the patient’s diagnosis. As a transplant
coder, the initial patient consultation is the first coding
assignment. After the patient is placed on the transplant list with the United Network for Organ Sharing
(UNOS), the search and the wait begins to find an appropriate donor organ for the recipient.
The Procurement Process
The organ placement process is outlined on the UNOS
Web site (www.unos.org) as a complex organ matching
process for potential recipients based on ranking, policy
criteria, and organ offers. Calls are made in succession
to multiple recipients transplant centers to expedite the
placement process. When the organ is accepted for a
recipient, the donor is taken to the operating room (OR)
for organ harvest.
The procedure begins with donor brain death declaration,
which is noted in the chart along with consent from an
appropriate family member. The Ingenix Coders’ Desk Reference for Procedures 2009 outlines the procurement process
with code 47133 Donor hepatectomy (including cold preservation), from cadaver donor as:
The physician performs a donor hepatectomy by removing the liver from a cadaver donor for transplantation into
another recipient. The physician accesses the liver, which is
mobilized from its attachments. The blood supply and bile
ducts to the liver are dissected free and isolated. The liver
is removed with its attached blood vessels and bile ducts
and perfused with a cold preservation solution and removed
from the operative field. The liver is preserved for transplantation into the recipient. The organ remains under refrigeration, specially packed in a sealable container with some
preserving solution and kept on ice in a suitable carrier.
This code includes the graft, harvesting, and the cold
preservation. When billing for the procurement, most
guidelines state that documentation must include what
featured coder
It is important to make sure that the physician’s
documentation indicates what form of backbench
was performed.
type of organ preservation solution was used, e.g. custodial histidine-tryptophan-ketoglutarate (HTK). After
the organ is procured, it is sent to the recipient’s surgical
facility for the transplant.
Transplantation Process
The recipient’s transplantation process begins after the
organ is accepted from the transplant center. The patient
is brought to the OR and all standard practices of prepping, draping, and placing lines are performed.
The liver graft is brought to the operating room and the
backbench procedures begin. The CPT® manual has six
standard backbench codes for this portion of the transplantation process. These codes are:
47140Donor hepatectomy (including cold preservation),
from living donor; left lateral segment only (segments II and III)
47141Donor hepatectomy (including cold preservation),
from living donor; total left lobectomy (segments II,
III and IV)
47142Donor hepatectomy (including cold preservation),
from living donor; total right lobectomy (segments
V, VI, VII and VIII)
47143Backbench standard preparation of cadaver donor
whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection
and removal of surrounding soft tissues to prepare
the vena cava, portal vein, hepatic artery, and
common bile duct for implantation; without trisegment or lobe split
47144Backbench standard preparation of cadaver donor
whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection
and removal of surrounding soft tissues to prepare
the vena cava, portal vein, hepatic artery, and
common bile duct for implantation; with trisegment
split of whole liver graft into two partial liver grafts
(ie, left lateral segment (segments II and III) and
right trisegment (segments I and IV through VIII))
47145Backbench standard preparation of cadaver donor
whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection
and removal of surrounding soft tissues to prepare
the vena cava, portal vein, hepatic artery, and
common bile duct for implantation; with lobe split
of whole liver graft into two partial liver grafts (ie,
left lobe (segments II, III, and IV) and right lobe
(segments I and V through VIII)).
The main differences in these codes are whether the liver
graft was obtained from a living or cadaver donor, and
if the liver is split or not. It is important to make sure
that the physician’s documentation indicates what form
of backbench was performed. There are two backbench
reconstruction codes to use when the liver graft requires
venous or arterial reconstruction. Previously procured
iliac veins from the donor are anastomosed to the veins or
arteries of the donor liver graft. These codes are:
47146Backbench reconstruction of cadaver or living
donor liver graft prior to allotransplantation; venous
anastomosis, each
47147Backbench reconstruction of cadaver or living
donor liver graft prior to allotransplantation; arterial
anastomosis, each
Use these codes for each anastomosis performed during
donor vessel reconstruction.
Aortic conduit creation is another reconstruction that can
be performed and is used for extremely complex cases
where the recipient’s vascular anatomy would not support
liver graft placement or if the graft does not lend itself
to standard transplantation placement. The procedure is
performed by using the iliac artery procured from the
donor, which consists of a common iliac artery, an external iliac artery, and an internal iliac artery. To join the
vessels together to make the graft longer the physician
uses anastomoses.
As a solution to this coding challenge it was determined
in our facility that to bill appropriately for this procedure, the unlisted code 37799 Unlisted procedure, vascular
surgery is reported and compared to the code 47147, and
assigning one unit per anastomosis required to create the
graft. The rationale for coding this way is because the
procedure is performed on the backbench and separate
from the donor graft itself, so the standard reconstruction
codes do not apply for this procedure.
Prior to the donor graft placement, the recipient’s liver
must be removed and the abdomen prepared for graft
placement. In preparing the abdomen, a temporary
portacaval shunt is performed by partially occluding the
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vena cava and performing an end to side portacaval shunt
using sutures. Even though this is a temporary shunt, the
full procedure is performed per the CPT® definition of
code 37140 Venous anastomosis, open; portocaval. It is billable in addition to the transplant codes themselves.
The standard liver transplantation codes are:
47135Liver allotransplantation; orthotopic, partial or
whole, from cadaver or living donor, any age
47136Liver allotransplantation; heterotopic, partial or
whole, from cadaver or living donor, any age
Orthotopic is graft placement in the same anatomical
location as the original organ. Heterotopic is graft placement in an abnormal anatomical location. Since it is most
common for the liver graft to be placed in the normal
anatomic location in the recipient, code 47135 is the most
commonly used code. Due to the history of poor outcomes with heterotopic placement the practice has all but
been abandoned. The transplant surgeon should indicate
which type of transplant occurs, if the information is not
clearly indicated in the documentation of the anatomic
position the liver graft was placed, for example, in the
abdomen or the pelvis, then clarification is needed from
the surgeon. Codes 47135 and 47136 include the partial
or whole recipient hepatectomy, partial or whole transplantation of the allograft and the recipient care.
Additional Procedures
During transplantation, additional procedures maybe
performed. For example, a Roux-en-Y procedure may be
performed due to anatomic variances in the graft, the
recipient, or both. The procedure can be of the extrahepatic biliary ducts or of the intrahepatic biliary ducts.
The CPT® codes available for these procedures are:
47780Anastomosis, Roux-en-Y, of extrahepatic biliary
ducts and gastrointestinal tract
47785Anastomosis, Roux-en-Y, of intrahepatic biliary
ducts and gastrointestinal tract
If an aortic conduit is created and placed in the patient
(an additional procedure as well), this may be billed with
the code 37799, depending on where the conduit was
placed and what vessels were attached to the conduit. If
there is, a code for the anastomosis performed with the
conduit the code range will be 35631–35636 because the
graft is created using arteries from the donor and not
from the recipient.
These codes, in addition to the code 37140, would have
a modifier 51 Multiple procedures added to indicate these
are multiple procedures in addition to the base transplant
14 AAPC Coding Edge
codes depending on the payer. Most payers have software
to recognize these instances automatically and would not
require the coder to apply modifier 51.
Immunosuppression Therapy
After the procedure is complete, the patient will need
to be monitored and immunosuppression therapeutic
medications will be adjusted by the transplant surgeon
throughout the patient’s stay. These subsequent hospital
visits are billable per CMS guidelines as long as they are
truly significantly, separately-identifiable from a standard
postoperative visit and indicated by the use of modifier
24. To know if the visit would be billable under this
guideline, for example, check if the documentation outlines the immunosuppression drugs used, any side-effects
caused by the therapy, and/or if any modifications are
required. The note should not include any references to
wound checks or other standard post-operative care plans.
For the best outcome, the coder might suggest using two
notes, one for the immunosuppression and a separate note
for the post-operative follow-up note.
Liver Transplant Awareness
There are currently 100,665 people on the waiting list for
organ transplant; every 11 minutes a name is added to
the national transplant waiting list. To learn more about
organ donation or to sign up to become a donor please
visit www.donatelife.net.
Sources:
American Liver Foundation
(www.liverfoundation.org/education/info/alcohol/)
United Network for Organ Sharing
(http://unos.org/whatWeDo/organCenter.asp)
Coders’ Desk Reference for Procedures; 2009; published by Ingenix
Special thanks for clinical assistance to: William Chapman, MD, professor
of surgery in the Division of General Surgery, and chief of the Abdominal
Transplantation Section for Washington University Medical School in St.
Louis, Mo. and also to Christopher Anderson, MD, assistant professor of
the Surgery Division of General Surgery Section of Transplant Surgery for
Washington University Medical School in St. Louis, Mo.
Shelly Bauguss, CPC, CGSC, CANPC, CGIC,
is employed at the Abdominal Transplant Section of Washington University Medical School
in St. Louis, Mo. and is an adjunct instructor
at Sanford Brown College in Fenton, Mo. She
is the president of the St. Louis East Local
Chapter and an upcoming AAPCCA Board
Member with eight years of coding experience with special focus in general surgery coding.
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HIE:
HIEs promise
transformation
in the way medical professionals
and patients swap
records.
Promoting Quality Care,
Efficient Growth, and
Improved Functionality
Health Information Exchanges (HIEs)—and their larger
counterparts, regional health information organizations
(RHIOs)—allow payer, provider, and patient to retrieve,
view, and enter information on conditions, encounters,
payments, etc. This vital data exchange with increased
security and robust viability is a health IT dream.
HIEs are focused on building and maintaining electronic
information architecture. The design of these electronic
record “warehouses” allows users (patients) and participants (hospitals, providers, and payers) various access and
control over patient medical record content.
EXPERT
Immediate Access
An insurance company must request copies of a medical
record when reviewing treatment necessity. Very soon,
access to that same record may be available as soon as
the provider completes, enters, and authenticates the
note. If this same visit requires consultation elsewhere,
little or no paperwork would be required for the consultant to access a comprehensive patient history.
For patients, transferring records easily, maintaining a
personal health transcript, and granting access improves
the customer service experience. For providers and hospitals, HIEs solve workflow and broken information
trail problems; clinical benefits result from care delivery and continuity. Payers must find opportunities to
connect fragmented patient data and draw upon a full
range of clinical opinions.
The revenue cycle also gains from HIE’s mediation of
health data needs by driving down the moving information costs between one another, permitting quicker
turnaround times with denial management, claims
submission, and payment. Automation allows re-routing
staff time from return on investment (ROI) and claims
submission to other areas in the revenue cycle. HIEs
empower patients to readily participate in the revenue
cycle process and encourage practices to excel in collection efforts.
Opportunities Abound
In the framework of HIEs, coders will likely see duties
take place in real time. Revenue cycle functions will
move forward, making us pioneers in this process.
In that leadership role, coders become responsible for
developing HIEs’ usefulness in mining data and querying for information in that network system. This role
will encourage coders to become data quality experts
for their employers. Others’ roles, including QA management, and quality control, will emerge.
Ideally, HIEs would permit end users to tap into
embedded knowledge resources and share clinical,
coding, and billing related tools, information, and
products. This host of information would improve daily
coding processes and allow smaller practices to access
resources that might otherwise be off limits due to
expense.
Staff in coding areas, especially, will become experts on
key points of the HIE adoption. Foremost, our understanding of sharing information related to billing will
give us a strong foothold over the HIE. Our current
understanding of medical records easily translates into
working the HIE as a research tool for the practice—not
only on coding-related issues, but in sharing patient data
or information within our organizations. Coders should
also have a keen understanding of HIE privacy and security issues in the ever-changing health care business.
HIEs also promise to make strides in the accuracy of
diagnostic coding for provider-based services. With
clinical laboratory results and documentation available
shortly after completion of a test, coders may be able to
By Kevin B. Shields, CPC, CPC-H, CPC-P, CCS, CCS-P, RCC, CCP-P
16 AAPC Coding Edge
added edge
By envisioning the future benefits of HIE, we can see how disjointed the current system is and look to streamlining the system.
use the information to capture more specific codes for
claims. Insurers, similarly, could easily trace the provider’s purpose of ordering additional services related to
lab test results.
A Promising Future
Realistically, HIEs cannot mend all the woes of our
health care system; however, the less time spent volleying redundant tasks and more time spent establishing
patient care is a step in the right direction. At the base
of an HIE is a fundamental electronic health record for
each participating entity. Linking to an HIE can easily
remove the human error in facilities exchanging patient
information. Finally, HIE promotes quality improvement by scattering reviews to all aspects of health care,
rather than limiting the scope to immediate view.
As more providers and insurers use the interchange
system, it will become necessary for their counterparts
to participate in order to maintain existing business
relationships. With coders embracing this technology
and comprehending the mushrooming effect in practicality, HIEs can proliferate locally. By making ourselves
available to help refine HIE projects, even as volunteers,
we give voice to our unique industry knowledge and
ensure continued validation as stakeholders in HIEs.
Streamlining health information knocks out existing barriers between patient, payer, and provider. In
acknowledging the patient as our consumer, we cultivate the way we exchange health records and as a result
upgrade their care.
Kevin Shields is HIMS supervisor at
the VA Medical Center in Louisville, Ky.
and a member of the Ingenix Coding
& Referential Advisory Board Network
and the AHIMA Action Community for
e-HIM Excellence (ACE). He has also
participated in stakeholder focus groups
for a local HIE and is studying health
information technology at Weber State University. Kevin
may be reached at [email protected].
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feature
By William P. Galvin, CPC
Correctly Code Patient Counseling
Use sign, symptom, or condition to prevent confusion
with Preventive Medicine Counseling codes (99401-99404).
New Patients
Established Patients
Consultations
99201–10 minutes
99211–5 minutes
99241–15 minutes
99202–20 minutes
99212–10 minutes
99242–30 minutes
99203–30 minutes
99213–15 minutes
99243–40 minutes
99204–45 minutes
99214–25 minutes
99244–60 minutes
99205–60 minutes
99215–40 minutes
99245–80 minutes
CPT® 2009 states, “When counseling and/or coordination of
care dominates (more than 50%) the physician/patient and/or
family encounter (face-to-face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), then time may be considered the key or controlling factor
to qualify for a particular level of E/M services. This includes
time spent with parties who have assumed responsibility for the
care of the patient or decision making whether or not they are
family members (eg, foster parents, person acting in loco parentis, legal guardian). The extent of counseling and/or coordination of care must be documented in the medical record.”
For example, Monday, an established patient with diabetes
Type 2 (ICD-9-CM: 250.00 Diabetes mellitus without mention of
complication; type II or unspecified type, not stated as uncontrolled)
presents for a follow-up visit. The provider performs and
documents a detailed history, detailed exam and moderate
medical decision-making (MDM).
Using history, exam, and MDM as the key components, the
CPT® code selection should be 99214 Office or other outpatient
visit for the evaluation and management of an established patient,
which requires at least two of these three key components: a detailed
history; a detailed examination; medical decision making of moderate complexity. Counseling and/or coordination of care with other
providers or agencies are provided consistent with the nature of the
problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typi-
cally spend 25 minutes face-to-face with the patient and/or family.
As part of the MDM, the provider instructs the patient to go to
the lab for an A1C, CPT® 83036 Hemoglobin; glycosylated (A1C)
blood (except reagent strip). The patient complies and goes to the
lab on Wednesday for the blood work. When the results come
back, the provider reviews the results and schedules a face-to-face
visit with the patient to discuss the results and to set a course of
action for treating the patient’s medical condition.
Note: Lab results and counseling via phone does not constitute the use of telephone E/M codes because the phone call is
the result of a sign, symptom, or condition addressed within
the last seven days of an E/M visit.
Friday, the established patient returns. Because the patient
was just seen Monday, only a problem focused history,
problem focused exam, and moderate MDM are performed
and documented. In the progress note’s documentation, the
provider states, “Spent approximately 25 minutes, of which
50 percent of the time was spent counseling (describe the
counseling or coordination of care) the patient on the risks of
diabetes, how to eat healthy, the use of home glucose testing,
how to begin or expand on a exercise regiment, and prescription drug management if needed, etc.”
Using history, exam and MDM as the key components for this
E/M visit, the CPT® code selection should be 99212 Office or
other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components:
a problem focused history; a problem focused examination; straightforward medical decision making. Counseling and/or coordination of care
with other providers or agencies are provided consistent with the nature
of the problem(s) and the patient’s and/or family’s needs. Usually, the
presenting problem(s) are self limited or minor. Physicians typically
spend 10 minutes face-to-face with the patient and/or family.
If you use time (25 minutes) as the key controlling factor for
this E/M visit, however, your code selection could be 99214
for this visit as well.
APPRENTICE
A patient’s status—new, established, or consultation—isn’t
the only element you should consider when coding an evaluation and management (E/M) office or other outpatient service.
You also need to match the usual time associated with the
E/M codes with the documented time spent counseling the
patient for her sign, symptom, or condition.
The usual time associated with E/M office or other outpatient
clinic visit codes are shown in Table A.
Table A. When choosing an E/M code, consider the time element in addition to the patient’s status.
William Galvin, CPC, is the physician practice
coding director for Hallmark Health System
in Massachusetts. In his 12 plus years as a
coder, Bill has been fortunate to work in worldclass hospitals in and around the greater
Boston area. He is an AAPC member who
received his CPC® credential in 2004.
www.aapc.com
March 2009
21
Five
feature
for Modifier 25
[By G. John Verhovshek, MA, CPC]
Five steps is all you need for modifier 25 claim success.
M
isuse of modifier 25 Significant, separately identifiable evaluation and management service
by the same physician on the same day of the procedure or other service is among the most
common coding mistakes, costing medical practices millions each year in missed reimbursement
opportunities and costing insurers millions each year in improper payments. You can improve your
chances for modifier 25 success if your claims meet the following five criteria.
PROFESSIONAL
1. The physician must provide an evaluation and
management (E/M) service and a separate
procedure or service for the same patient on
the same day.
Do not apply modifier 25 if the physician performs an
E/M service only.
For example, a neurologist examines a patient experiencing upper-extremity weakness and pain. After a thorough
examination, the physician schedules the patient for a
diagnostic electromyography (EMG) exam to follow several days later.
In this case, you would report an appropriate outpatient E/M code, such as 99203 Office or other outpatient
visit for the evaluation and management of a new patient,
which requires these three key components: a detailed history;
a detailed examination; and medical decision making of low
complexity. . Counseling and/or coordination of care with other
providers or agencies are provided consistent with the nature of
the problem(s) and the patient’s and/or family’s needs. Usually,
the presenting problem(s) are of moderate severity. Physicians
typically spend 30 minutes face-to-face with the patient and/
or family, depending on the documented service level.
Because the neurologist provideds only the E/M service
on the initial service date, modifier 25 is not appropriate.
For electrodiagnostic testing on a later service date, you
would report the appropriate EMG code, such as 95861
Needle electromyography; two extremities with or without
related paraspinal areas. Unless the patient experiences a
significant worsening of symptoms or a new complaint
requiring a separate evaluation, you would not report
another E/M service for this later encounter.
Note that all physicians who bill under the same
22 AAPC Coding Edge
National Provider Number (NPI) (such as physicians
sharing an NPI in group practice) are considered, from a
coding perspective, the same provider.
2. The same-day E/M service must be significant and separately identifiable.
According to CPT® and the Centers for Medicare &
Medicaid Services (CMS) guidelines, all procedures and
services—no matter how minor—include an inherent E/M
component. Any E/M service you report separately must
exceed the minimal evaluation that normally accompanies any other same day service(s) or procedure(s).
CMS Transmittal 954 (Medlearn Matters MM5025,
Change Request 5025, May 19, 2006) states specifically
you should apply modifier 25 only for “a significant,
separately identifiable E/M service that is above and beyond
the usual pre- and post-operative work for the service.”
A significant, separately identifiable E/M service might
occur on the same day as another procedure or service when:
1.The provider sees a new patient, or
2.The provider sees an established patient with a new
complaint or a change in status.
In either case, a separate E/M service is essential to determine the need for any same-day procedure(s) or service(s)
that follow.
For example, an orthopedist sees a new patient for knee
pain evaluation. The orthopedist diagnoses the patient
with osteoarthritis of the knee and discusses options for
management, then injects a steroid such as Depo-Medrol
(J1020 Injection, methylprednisolone acetate, 20 mg or J1030
Injection, methylprednisolone acetate, 40 mg) to provide
patient relief.
feature
Physicians can help highlight a separate E/M service by separating the E/M service documentation from any
other same-day procedure(s) or service(s) documentation. That is, the provider should document the history,
exam, and MDM in the patient’s chart, and record the procedure notes on a different sheet attached to the
chart or in a different section within the electronic medical record.
You may report both the aspiration and the same-day
E/M in this case using 90772 Therapeutic, prophylactic or
diagnostic injection (specify substance or drug); subcutaneous or
intramuscular and 99201-99205, as appropriate to the documented E/M service level, with modifier 25 appended.
You may also report the drug supply. Only after completing an E/M service would the surgeon make a decision to
perform an additional procedure (the injection).
In a second example, a consult patient visits a cardiologist complaining of palpitations (785.1 Symptoms involving
cardiovascular system; palpitations) and light-headedness
(780.4 General symptoms; dizziness and giddiness). The physicians performs a complete cardiac workup (for example,
99243 Office consultation for a new or established patient,
which requires these three key components: a detailed history;
a detailed examination; and medical decision making of low
complexity. Counseling and/or coordination of care with other
providers or agencies are provided consistent with the nature of
the problem(s) and the patient’s and/or family’s needs. Usually,
the presenting problem(s) are of moderate severity. Physicians
typically spend 40 minutes face-to-face with the patient and/or
family) and orders a same-day, in-office echocardiogram.
You may report both the echocardiogram and the sameday E/M in this case, using 93307 Echocardiography,
transthoracic, real-time with image documentation (2D) with
or without M-mode recording; complete and 99243-25. You
might also report additional codes, such as +93320 Doppler echocardiography, pulsed wave and/or continuous wave with
spectral display; complete (list separately in addition to codes for
echocardiographic imaging) or +93325 Doppler echocardiography color flow velocity mapping (list separately in addition
to codes for echocardiography), depending on the equipment
and the images the physician obtained. Only after completing an E/M service would the physician make a decision to perform additional procedures (in this case, the
echocardiography).
If the provider sees the patient for a previously-scheduled
procedure or service, you would not normally report a
separate, same-day E/M service. “Visits by the same physician on the same day as a minor surgery or endoscopy
are included in the payment for the procedure, unless
a significant, separately identifiable service is also performed,” confirms the Medicare Claims Processing Manual
(Chapter 12, Section 40.1).
In our first example, the orthopedist would not claim an
E/M service on the same day as the previously-scheduled
injection. Remember: The physician has already evaluated the patient for the same problem during the earlier
E/M visit. The orthopedist may provide a cursory exam
immediately prior to the injection, but such an evaluation
is neither significant nor separately identifiable. Rather, it
is an inherent component of the injection itself.
Even if the physician provides an assessment and plan,
you probably should not report a separate E/M service
unless the patient has a new, unrelated complaint, or has
experienced a worsening of symptoms that prompt a new
history, exam, and medical decision-making (MDM).
Documentation should support unambiguously any separately-reported E/M service. Explanatory text for modifier
25 in the CPT® manual stresses “a significant, separately
identifiable E/M service is defined or substantiated by
documentation that satisfies the relevant criteria for the
respective E/M service” you choose to report. CMS rules
also stress that the provider must “appropriately and sufficiently” document medical necessity for both the E/M
service and the other service or procedure. Although you
don’t need to submit this documentation with the claim,
it must be available upon payer request.
Physicians can help highlight a separate E/M service by
separating the E/M service documentation from any other
same-day procedure(s) or service(s) documentation. That
is, the provider should document the history, exam, and
MDM in the patient’s chart, and record the procedure
notes on a different sheet attached to the chart or in a
different section within the electronic medical record.
This demonstrates to the payer and the coding staff the
distinct nature of the E/M service.
At a minimum, providers should document same-day
E/M services as well as if they had not provided any other
procedure(s) or service(s).
3. The E/M service doesn’t take place during a
global period.
All related, follow-up examinations by the same physician during a previous procedure’s global period—such as
those to evaluate the patient’s recovery—are included in
the global surgical package of the previous procedure.
www.aapc.com
March 2009
23
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For an unrelated E/M service during a previous procedure’s global period, you may report an appropriate E/M
code with modifier 24 Unrelated evaluation and management service by the same physician during a postoperative period
appended. This would require that the E/M service is for
a new problem not connected to the patient’s previous
complaint or procedure.
4. The same-day procedure(s) or service(s) does
not have a 90-day global period.
You should append modifier 57 Decision for surgery—not
modifier 25—to a separately identifiable E/M service
occurring on the same day, or on the day before a major
surgical procedure, and resulting in the physician’s decision to perform the surgery, according to the Medicare
Claims Processing Manual, section 40.2.
A major surgical procedure is any procedure or service
with a 90-day global period. Note that the global period
for a major surgical procedure begins one day prior to the
actual procedure.
For example, a neurosurgeon in the ED examines a
patient with a closed-in head injury due to a fall. Upon
full evaluation, the surgeon admits the patient and
immediately operates to evacuate a subdural hematoma
(61108 Twist drill hole for subdural or ventricular puncture;
for evacuation and/or drainage of subdural hematoma).
In this case, you should report both the surgical procedure (61108) and the examination that led to the decision
to perform the surgery (such as 99284, Emergency department visit for the evaluation and management of a patient,
which requires these three key components: a detailed history; a
detailed examination; and medical decision making of moderate
complexity. Counseling and/or coordination of care with other
providers or agencies are provided consistent with the nature of
the problem(s) and the patient’s and/or family’s needs. Usually,
the presenting problem(s) are of high severity, and require urgent
evaluation by the physician but do not pose an immediate significant threat to life or physiologic function. ).
Because the evacuation is a major procedure (it has a 90-day
global period), you should append modifier 57 to 61108.
The available documentation should note specifically that
the E/M service resulted in the decision for surgery.
You can find global periods for all CPT® procedure codes
by consulting Medicare’s Physician Fee Schedule relative
value file (MPFS RVU), which you may download from
the CMS Web site at www.cms.hhs.gov/PhysicianFee
Sched/PFSRVF/list.asp#TopOfPage.
24 AAPC Coding Edge
Be sure to select the most recent file for download as it is
updated quarterly.
To determine the global period for a particular procedure, simply look to the fee schedule’s “GLOB DAYS”
column. You will find several categories, including 000
(zero), 010, 090, XXX, ZZZ, YYY, and MMM (for
maternity codes).
Note that carriers may classify as “major” some procedures with a “YYY” global period. Check with your
carrier before reporting an E/M service modifier with
these procedures.
5. Provide a diagnosis for the E/M
You do not need a separate diagnosis to justify a sameday E/M service with modifier 25. CPT® specifically
states, “The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not
required for reporting of the E/M services on the same
date.” CMS guidelines, as articulated by Transmittal 954,
uphold this instruction.
For example, a new consult patient visits a general surgeon with a complaint of intense heartburn and abdominal pain. The surgeon takes a complete history and
performs an extensive exam. She then performs diagnostic endoscopy to check for reflux disease.
In this case, you will report the endoscopy with 43200
Esophagoscopy, rigid or flexible; diagnostic, with or without
collection of specimen(s) by brushing or washing (separate procedure). Separate documentation will also support a levelthree outpatient consult, with modifier 25 appended
(99243-25).
You should link the signs and symptoms that prompted
the exam (787.1 Heartburn and 789.00 Abdominal pain;
unspecified site) to the E/M code. You can link the same
signs-and-symptoms diagnoses to the endoscopy. Or, if
the surgeon finds verifiable evidence of reflux disease
(530.xx), you would report that diagnosis as primary.
If you can cite a different diagnosis for the E/M service,
such as when a patient arrives for a scheduled procedure
but the physician must provide E/M for a new, unrelated
problem, be sure to link a separate diagnosis to the E/M
service, to show it is an independent service.
[
]
G. John Verhovshek, MA, CPC, is AAPC’s
director of clinical coding communications.
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Focus on
Ophthalmology
Coding
From A-scans to YAG.
PROFESSIONAL
By Kim Ross, CPC, OCS,
and Sue Vicchrilli, COT, OCS
Remember the pirate’s often-lost wooden eye in
“Pirates of the Caribbean?” Or Tom Cruises’ eye
transplant in “Minority Report?” Movies showing
eye injuries intrigue us. Although it is a challenge
to code these incidents, an even greater challenge
is correctly coding the ophthalmic procedures we
see daily. Our focus is to highlight key points in
coding the services most frequently performed in
ophthalmology.
A-scan Ultrasound for
Intraocular Lens Calculations
CPT® codes 76519 Ophthalmic biometry by ultrasound
echography A-scan; with intraocular lens power calculation and CPT® code 92136 Ophthalmic biometry by
partial coherence interferometry with intraocular lens
power calculation
Report this code for use of the IOL Master, which
allow measurements of eye length and surface curvature, necessary for cataract surgery.
Medicare rules differ from non-Medicare payers.
For Medicare, these codes have one global technical component (modifier TC Technical component) and
a professional component (modifier 26 Professional
component) for each eye. Because non-Medicare payers
typically do not recognize these modifiers, only the
RT Right side or LT Left side modifiers should be
appended to 76519 or 92136.
26 AAPC Coding Edge
Argon Laser Trabeculoplasty (ALT)
CPT® code 65855 Trabeculoplasty by laser surgery, 1 or
more sessions (defined treatment series).
Medicare has assigned a 10-day global period to
this code selective laser trabeculoplasty (SLT). This
means that when a separately identifiable exam is
performed the same day, modifier 25 Significant,
separately identifiable evaluation and management service
by the same physician on the same day of the procedure or
other service should be appended to the appropriate
level of exam. Because some non-Medicare payers
recognize a 90-day global period for 65855, modifier 57 Decision for surgery should be appended to the
evaluation and management (E/M) code describing
the exam that determines the need for surgery when
the laser is performed on the same day. Beginning
January 2008, this procedure became payable in an
ambulatory surgical center (ASC).
Benign Skin Lesions
Medicare and non-Medicare payers will cover benign
skin lesion removal with appropriate documentation. The chief complaint should contain words such
as red, increasing in size, oozing, and/or itching. A
photo for documentation purposes is helpful. As
with any procedure that may be considered cosmetic,
it is best to obtain an Advance Beneficiary Notice
(ABN) from the patient. Append modifier GA
cover
One key component often missing in chart
documentation for functional claims is the
lack of a visual complaint from the patient.
Waiver of liability statement on file to the claim indicating an ABN is on file.
Blepharoplasty
CPT® code 15822 Blepharoplasty, upper eyelid and
CPT® code 15823 Blepharoplasty, upper eyelid; with
excessive skin weighting down lid
Most Medicare payers have a Local Coverage Determination (LCD) indicating specific preoperative
documentation requirements to distinguish cosmetic
vs. functional blepharoplasty. CPT® code 15822 is
typically considered cosmetic. By appending modifier GY Item or service statutorily excluded or does not
meet the definition of any Medicare benefit, offices indicate as such.
CPT® code 15823 is typically submitted for functional claims. One key component often missing in
chart documentation for functional claims is the
lack of a visual complaint from the patient. Too
often the chart might state, “Patient complains of
excessive baggy upper lid skin,” which does not provide medical justification for a functional claim.
Cataract Extraction
CPT® code 66984 Extracapsular cataract removal with
insertion of intraocular lens prosthesis (1 stage procedure),
manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification)
Extracapsular cataract removal is the number one
procedure performed in ASCs. Contrary to what
many physicians and coders think, there isn’t a
national policy with a visual acuity requirement.
Coverage varies by payer. The best documentation
indicates the impact the reduced vision has on the
patient’s daily living activities.
Complex Cataract Extraction
CPT® code 66982 Extracapsular cataract removal with
insertion of intraocular lens prosthesis (one stage procedure),
manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices
or techniques not generally used in routine cataract surgery
(eg, iris expansion device, suture support for intraocular
lens, or primary posterior capsulorrhexis) or performed on
patients in the amblyogenic developmental stage
It’s important to note that this CPT® code is not for:
Complications that occur during surgery
Vitrectomy performed at the time of surgery
Piggyback or multi-focal IOLs
Specific viscoelastic like Healon 5 or Healon GV
Complex cases that take longer than usual

Diagnosis of floppy iris syndrome or use of
Sugarcaine intraoperatively

Extraordinary services performed in routine
cataract surgery
Note: Payers who have coverage policies also allow
coverage for mature white cataract requiring dye for
capsulorrhexis, which is the making of a continuous
circular tear in the anterior capsule during cataract surgery to allow evacuation by pressure of the
nucleus of the lens.
Fluorescein Angiography
CPT® code 92235 Fluorescein angiography (includes
multiframe imaging) with interpretation and report
This test has unilateral payment, which means 100
percent of the allowable fee is payable per eye when
medically indicated. It is inappropriate to submit a
claim for the eye that does not have pathology. Claims
may be submitted as a single line item (eg, 92235-50)
or a two-line item with the RT and LT modifiers (eg,
92235-RT, 92235-LT), depending on payer preference.
Cost of the dye is not separately payable.
Fundus Photography
CPT® code 92250 Fundus photography with interpretation and report
This code is inherently bilateral. Payment is the
same whether one or both eyes are photographed.
The National Correct Coding Initiative (NCCI)
bundles fundus photography with CPT® code 92135
Scanning computerized ophthalmic diagnostic imaging, posterior segment, (eg, scanning laser) with interpretation and
report, unilateral
www.aapc.com
March 2009
27
cover
65755Keratoplasty (corneal transplant); penetrat-
ing (in pseudophakia)
 65756 Keratoplasty (corneal transplant); endothelial
+65757Backbench preparation of corneal endothelial allograft prior to transplantation (List
separately in addition to code for primary
procedure)
Lacrimal Punctal Plugs
Retinal detachment
Foreign Body
CPT® code 65222 Removal of foreign body, external eye;
corneal, with slit lamp
This code has a zero-day global period, which means
when the physician sees the patient a few days later, it
is a billable exam. The procedure is payable per eye,
not per foreign body. And in the event a rust ring
develops, 65222 is the appropriate code to use again.
Keratoplasty
Since Jan. 1, there are four options for transplanted
cornea. A  indicates a change in the CPT® description. A  indicates a new CPT® code. The following
new procedures have already received ASC approval:
65710Keratoplasty (corneal transplant); anterior
lamellar
65730Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia)
65750Keratoplasty (corneal transplant); penetrating (in aphakia)
28 AAPC Coding Edge
CPT® code 68761 Closure of the lacrimal punctum; by
plug, each
This is the only lacrimal procedure where payment is
per puncta, not per eye. The code is the same whether
using temporary (collagen) or permanent (silicone)
plugs. Typically, it is not necessary to distinguish the
difference to the payer. In 2002, Medicare bundled
the supply of the plug(s) with the insertion. NonMedicare payers may pay separately for the supply of
the plug with HCPCS Level II codes A4262 Temporary, absorbable lacrimal duct implant, each for collagen,
A4263 Permanent, long term, non-dissolvable lacrimal
duct implant, each for silicone, or CPT® code 99070
Supplies and materials (except spectacles), provided by the
physician over and above those usually included with the
office visit or other services rendered (List drugs, trays, supplies, or materials provided).
Patient complaint should document dryness, burning,
itching, excessive tears, and/or photophobia. Documentation should indicate other methods of treatment
have been tried and proven unsuccessful before plug
insertion. This could include artificial tears, ointments, humidifier, etc.
Optic Nerve Scan
CPT® code 92135 Scanning computerized ophthalmic
diagnostic imaging, posterior segment, (eg, scanning laser)
with interpretation and report, unilateral
In 2006, this service was billed more than five million times to Medicare. One hundred percent of the
allowable is paid per eye when medical necessity
exists. Contact your intermediary to confirm medical necessity.
Ophthalmoscopy
CPT® codes 92225 Ophthalmoscopy, extended with
retinal drawing (eg, for retinal detachment, melanoma),
with interpretation and report; initial and 92226 Ophthalmoscopy, extended with retinal drawing (eg, for retinal
detachment, melanoma), with interpretation and report;
subsequent
As with other procedures that have unilateral payment, 100 percent of the allowable is paid per eye
cover
To discuss this article
or topic, go to member
http://forums.aapc.com
when medical necessity exists. Payment is for the
detailed drawing, not for viewing. The drawing
should be detailed, but payers no longer require a
colored drawing.
Pachymetry
CPT® code 76514 Ophthalmic ultrasound, diagnostic;
corneal pachymetry, unilateral or bilateral (determination
of corneal thickness)
Payment for 76514 is the same whether testing one
or both eyes. This procedure is covered by Medicare
as a one-time basis for glaucoma usually, but also as
indicated in the progression of corneal disease.
Pterygium
CPT® codes 65420 Excision or transposition of pterygium; without graft and 65426 Excision or transposition
of pterygium; with graft
No matter the source of the graft, it is bundled
with the surgical code (65426). Amniotic membrane
transplant is not separately billable per CCI.
Suture Removal
CPT® codes 15850 Removal of sutures under anesthesia
(other than local), same surgeon and 15851 Removal of
sutures under anesthesia (other than local), other surgeon.
Aside from these two codes, suture removal is never
separately payable. It is part of the global surgical
fee or any E/M or eye code billed if you were not the
surgeon or if the patient is out of the global period.
Never report suture removal as a corneal foreign
body. Laser suture lysis is considered suture removal.
It is inappropriate to code 66250 Revision or repair
of operative wound of anterior segment, any type, early or
late, major or minor procedure for this service.
Topography
CPT® code 92025 Computerized corneal topography,
unilateral or bilateral, with interpretation and report
This was a new code in 2007. Payment is the same
whether one or both eyes are tested. Do not report
92025 with any corneal transplant code after the
decision for surgery has been made, and until the
end of the global period. This helps to maintain
the value of the surgical code.
Visual Fields
CPT® code 92081 Visual field examination, unilateral or bilateral, with interpretation and report; limited
examination (eg, tangent screen, Autoplot, arc perimeter, or
single stimulus level automated test, such as Octopus 3 or 7
equivalent), 92082 Visual field examination, unilateral
or bilateral, with interpretation and report; intermedi-
ate examination (eg, at least 2 isopters on Goldmann
perimeter, or semiquantitative, automated suprathreshold
screening program, Humphrey suprathreshold automatic
diagnostic test, Octopus program 33), and 92083 Visual
field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, Goldmann
visual fields with at least 3 isopters plotted and static
determination within the central 30 degrees, or quantitative, automated threshold perimetry, Octopus program G-1,
32 or 42, Humphrey visual field analyzer full threshold
programs 30-2, 24-2, or 30/60-2).
Payment for these codes is the same whether one or
both eyes are tested. CPT® code 92081 or 92082 is
appropriate for documentation prior to blepharoplasty.
YAG Laser Capsulotomy
CPT® code 66821 Discission of secondary membranous
cataract (opacified posterior lens capsule and/or anterior
hyaloid); laser surgery (eg, YAG laser) (1 or more stages)
Typical LCD indicates documentation should reflect:
Vision loss due to decreased light transmission (visual acuity of 20/30 or worse after other
acuity loss causes have been ruled out).
Increased glare. Test results must show decrease
in two lines of visual acuity in glare tester.
Indication of the impact the reduced vision has
on the patient’s daily activities.
Medicare payers do not expect to see this procedure performed regularly within the cataract global
period, and may request documentation.
Sue Vicchrilli, COT, OCS, is an American
Academy of Ophthalmology coding executive. Sue’s 26-year ophthalmic background includes all aspects of coding,
reimbursement, practice management,
and clinic and surgical assistance. Sue
is the Academy’s coding executive, the
author of EyeNet’s Savvy Coder, AAOE’s
Coding Bulletin, the Ophthalmic Coding Coach, Ophthalmic Coding Module Series, and “Code This Case.”
Kim Ross, OCS, CPC, is an American Academy of Ophthalmology coding
specialist. Kim has been in the field of
ophthalmology since 1975. The past 13
years were in a multi-specialty academic
setting at the University of California,
San Francisco (UCSF). Since 2004, she
managed departmental revenue and
compliance, coding and reimbursement, as well as OR
utilization for the 20-surgeon faculty at UCSF.
www.aapc.com
March 2009
29
coding compass
Managing
Hospital
EXPERT
Hospitals would do
well to monitor their plan
using the 2009 OIG Work Plan.
Compliance
By Jillian Harrington,
MHA, CPC, CPC-I, CCS-P
In the January issue of Coding Edge, we looked at the
2009 Office of Inspector General (OIG) Work Plan as
it pertains to physician practices. We would be remiss,
however, if we didn’t look at the items relating to hospitals, and how hospitals can best use this information to
create a compliance work plan.
Each October, the Department of Health and Human
Services (DHHS) OIG gives us a bit of insight into what
the upcoming year will bring. Their annual Work Plan
describes the activities within each office of the OIG for
the upcoming federal fiscal year. Some items are added,
some are removed, and some carry on. By examining
this plan, you can see what the federal government feels
are hospital sector concerns and use this information to
devise an auditing and monitoring plan for the year.
Provider-Based Status for
Inpatient and Outpatient Facilities
The Hospital Work Plan
In a different approach to a provider-based status review,
the OIG will look at Medicare reimbursement appropriateness for hospital-owned physician practices with
the provider-based designation. Hospital requirements
to obtain provider-based status for purchased physician
practices were revised by CMS in 2005. The revisions
address issues like patient population served, practice
location, and the hospital’s control level and governance
over the physician practice. If your hospital-owned physician practices are operated as provider-based clinics, now
is a great time to determine if you meet the criteria to
attain the provider-based designation.
Additional Part A Medicare Capital Payments for
Extraordinary Circumstances
The Centers for Medicare & Medicaid Services (CMS) has
a program where hospitals can request additional capital
payments be made to them under extraordinary circumstances. Eligibility for additional capital payments requires
unanticipated capital expenditures in excess of $5 million for circumstances beyond the facility’s control, such
as floods, fires, and earthquakes. Certain criteria must be
met and reviewed to determine whether a facility should
receive these payments. You are at a risk for not meeting
the criteria, for example, if the unanticipated expenditure
doesn’t exceed $5 million after net proceeds from any other
payment sources, such as, insurance, or local, state or federal government funding programs. If you are a recipient
of such a payment, take a look at your replacement capital
funding to be sure you still meet the federal criteria following receipt of all other payment sources.
30 AAPC Coding Edge
For several years, a provider-based status item has
appeared on the OIG’s Work Plan. This item is slightly
different than in past years, and should be noted as
such. Hospitals with provider-based facilities can receive
enhanced reimbursement, and are often a target of government inquiry. This review is aimed at facilities with
cost reports claiming provider-based status to determine
the potential impact on the Medicare program for those
facilities that improperly claim provider-based status. If
you are a facility claiming provider-based status for any
of your sites, check that you meet all criteria laid out in
the guidelines originally set in 2001 and revised in 2005.
Hospital Ownership of Physician Practices
Reliability of Hospital-Reported Quality Measure Data
Within the last few years, quality data reporting has gone
from simply a statistical task to one that can effect reimbursement. The advent of consumer tools like the Hospital
Compare Web site (www.hospitalcompare.hhs.gov)
make it more important for quality data submitted to
CMS to be accurate and complete. This year, the OIG
coding compass
Eligibility for additional capital payments requires unanticipated
capital expenditures in excess of $5 million for circumstances
beyond the facility’s control, such as floods, fires, and earthquakes. Certain criteria must be met and reviewed to determine
whether a facility should receive these payments.
will look at the quality data submitted by hospitals to
ensure they have implemented sufficient controls for creating a valid data set.
Who submits quality data for your facility? Review
the process for putting this data together, and verify if
appropriate quality assurance checks are occurring on
this data prior to submission. Also, do you have similar
submissions due for other entities, such as State Health
Departments or benchmark projects you are involved in?
If so, maximize your efforts toward gathering by creating
efficiencies in data collections for all quality measures.
Coding and Documentation Changes Under Medicare
Severity Diagnosis Related Group (MS-DRG) System
In October of 2007, MS-DRGs were implemented to
help recognize illness severity in the Medicare inpatient
reimbursement system. The OIG has quickly decided to
review this new system through coding trends and patterns to determine its vulnerability to potential upcoding. The key to accuracy in coding under MS-DRGs
is high-quality clinical documentation. To review your
compliance with this new system, a three part review is
essential:
1.Look at your clinical documentation process. Have
you implemented a documentation improvement
team, or concurrent coding processes?
2.Have your finance department review the financial impact of MS-DRGs. Are there any areas of
increased reimbursement that will serve as red flags
for government reviewers? If so, take the time to
review those claims.
3.Provide continuing education for coders on MSDRGs, inpatient coding, and improving clinical
documentation for the new system’s coding side.
Serious Medical Errors (Never Events)
CMS issued a rule in 2007 aligning patient safety, quality, and payment methodology aimed at denying payment
for certain hospital acquired conditions through coding of
present on admission (POA) indicators. At the same time,
legislation was passed requiring the OIG to study serious
medical errors known as Never Events, examining the
types of events and what payments are being made by any
party in these instances. The review that appears in the
Work Plan this year pertains to this legislation, as well as
a review of hospitals’ compliance with the new Present on
Admission coding requirements. Some state governments
are also moving forward with mandated never event and
hospital acquired condition (HAC) denials. Now is the
time to examine your adverse event reporting process, and
get finance, risk management, quality assurance, HIM,
coding, and administration all on the same page with
regard to billing and coding for both serious medical errors
and hospital acquired conditions.
Many of this year’s OIG Work Plan items continue from
the previous year’s plan. Some of these items include:
 Part A Hospital Capital Payments
Part A Inpatient Prospective Payment System
Wage Indices
 Payments to Organ Procurement Organizations
 Inpatient Hospital Payments for New Technologies
 Critical Access Hospitals
 Medicare Disproportionate Share Payments
Inpatient Psychiatric Facility Emergency
Department Adjustments
 Provider Bad Debts
 Medicare Secondary Payer
Payments for Diagnostic X-rays in Hospital
Emergency Departments
Jillian Harrington, MHA, CPC, CPC-I, CCS-P,
is the president/CEO of ComplyCode, a health
care compliance consulting and education firm
in upstate New York. She holds a Masters in
Health Administration from the Rochester Institute of Technology, and is a former member of
the AAPC National Advisory Board.
www.aapc.com
March 2009
31
feature
Part 2 in spinal series
Complete
Spinal Fusion Coding
Includes Grafting and More
By G. John Verhovshek, MA, CPC
Spinal fusion involves multiple steps beyond
those described by arthrodesis codes 2253222632, including bone grafting (20930-20938)
and instrumentation placement (22840-22851).
For complete coding, you should report these
additional procedures separately. When extensive
decompression accompanies arthrodesis, you may
report the procedures independently.
PROFESSIONAL
Three Questions Discern
Spinal Bone Graft Codes
32 AAPC Coding Edge
To select an appropriate spinal bone graft code,
the available documentation must allow you to
answer at most three questions:
1.Was the graft taken from the patient’s
body (an autograft) or from another source
(allograft)? If documentation includes bone
harvesting, an autograft code is appropriate.
Allografts include all prepared grafts, such
as Cornerstone or Medtronic Verte-Stack, or
tissue taken from a bone bank.
2.If the graft was taken from the patient’s body,
did the surgeon have to create a new incision
to remove the donor tissue? Bone tissue taken
from the ribs, spinous process, or laminar
fragments is “local.”
3.Was the graft a single piece of bone (structural), or did it consist of several—or many—
smaller pieces (morselized)? For example,
along with posterior cervical laminectomy,
the surgeon may pack morselized bone in
open areas on either side of the spine and in
the facet joint spaces to promote new bone
growth.
These three questions help you easily discern
among the spinal bone graft codes.
Spinal Bone Grafts
Auto or Allo graft
local or separate incision
structural/morselized
local
unspecified
20936
structural
20938
morselized
20937
structural
20931
morselized
20930
code
Autograft
separate incision
Allograft
Threaded bone
dowel (allograft)
N/A (surgeon does not
harvest graft)
N/A (surgeon does not
harvest graft)
N/A
22851
For example, suppose the surgeon performs a
posterior lumbar interbody fusion (PLIF) for
stenosis (724.02 Spinal stenosis; lumbar region) and
spondylolisthesis (738.4 Acquired spondylolisthesis) at
L1-L2 and L2-L3. She harvests bone from the iliac
crest, via a separate incision, to prepare and place a
morselized graft at each interspace.
You would report 22630 Arthrodesis, posterior
interbody technique, including laminectomy and/or discectomy to prepare interspace [other than for decompression], single interspace; lumbar for arthrodesis at the
first interspace, and +22632 Arthrodesis, posterior
interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each additional interspace (List
separately in addition to code for primary procedure) for
the additional interspace.
You would report +20937 Autograft for spine surgery
only (includes harvesting the graft); morselized (through
separate skin or fascial incision) (List separately in
addition to code for primary procedure) for the har-
feature
As with spinal bone grafts, all codes describing
instrumentation placement are exempt from multipleprocedure (modifier 51) adjustments, according to CPT®.
vest, preparation, and placement of the morselized
graft. You should report any spinal graft code only
once per procedure, regardless of how many areas the
surgeon treats with that same type of graft.
Note that all spinal bone grafting codes 2093020938 include graft shaping or preparation, when
required, and all autograft codes include graft harvesting. You would not code separately for either of
these services.
According to the 2009 National Physician Fee Schedule Relative Value File, you may not append modifier
50 Bilateral procedure, or modifiers 62 Two surgeons,
80 Assistant surgeon, 81 Minimum assistant surgeon or
82 Assistant surgeon (when qualified resident surgeon not
available) to spinal graft codes 20930-20938.
CPT® designates spinal bone graft codes as modifier 51 Multiple procedures exempt, meaning they
should be paid at the full fee schedule amount
when reported as additional procedures. Be aware,
however, that Medicare designates graft procedures
+20930 Allograft for spine surgery only; morselized
(List separately in addition to code for primary procedure
and +20936 Autograft for spine surgery only (includes
harvesting the graft); local (e.g., ribs, spinous process, or
laminar fragments) obtained from same incision (List
separately in addition to code for primary procedure) as
status “B” codes. As such, Medicare payers will
always bundle these codes into payment for other
services. Third party insurers do not necessarily
follow this convention.
Look to Surgical Approach When Reporting
Spinal Instrumentation
As with bone grafts, separately billable instrumentation placement generally accompanies arthrodesis.
For instance, in the aforementioned PLIF with
morselized autograft example, the surgeon also may
have fixed pedicle screws at two points to stabilize
the spine further.
If the surgeon places a metal cage or other prosthetic
device, such as a threaded bone dowel, in the intervertebral space, you will report +22851 Application
of intervertebral biomechanical device(s) (e.g., synthetic
cage(s), threaded bone dowel(s), methylmethacrylate) to
vertebral defect or interspace (List separately in addition to
code for primary procedure).
You should report only a single unit of 22851, regardless of how many devices the surgeon places at a
single level. If the surgeon places devices on multiple
spinal levels, however, you may report multiple units
of 22851 (one unit for each individual spinal level).
When coding for instrumentation that spans across
several vertebral segments using rods, cages, plates,
wires and/or other mechanical devices, you must
determine whether the device is anterior (attached to
the front of the spine or vertebral segment, facing the
front of the body) or posterior (attached to the back
of the spine or vertebral segment, facing the back of
the body). Anterior instrumentation usually involves
application of plates screwed directly onto the vertebrae, whereas posterior instrumentation involves
placement of rods or other apparatus that grip the
lamina or are screwed into the pedicles. Generally, the
type of instrumentation will correspond to the surgical approach (anterior or posterior) the surgeon selects.
You will claim placement of anterior instrumentation using +22845 Anterior instrumentation; 2 to 3
vertebral segments, 22846 Anterior instrumentation; 4 to
7 vertebral segments (List separately in addition to code
for primary procedure) and +22847 Anterior instrumentation; 8 or more vertebral segments (List separately in
addition to code for primary procedure), depending on
the number of vertebral segments spanned.
If the surgeon places posterior instrumentation,
you must further determine whether the device is
segmental (22842-22844) or nonsegmental (+22840
Posterior non-segmental instrumentation (e.g., Harrington
rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring
at C1, facet screw fixation) (List separately in addition to
code for primary procedure)).
Nonsegmental posterior instrumentation attaches
to the spine at two points only—the proximal and
distal portions (top and bottom) of the rod or other
device. You may report placement of nonsegmental
posterior instrumentation using +22840.
Segmental posterior instrumentation attaches to the
spine at three or more points, including the proximal and distal portions of the rod or other device.
You may describe placement of segmental posterior
instrumentation using +22842 Posterior segmental
instrumentation (eg, pedicle fixation, dual rods with
multiple hooks and sublaminar wires); 3 to 6 vertebral
segments (List separately in addition to code for primary
procedure), +22843 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks
and sublaminar wires); 7 to 12 vertebral segments) (List
separately in addition to code for primary procedure), or
www.aapc.com
March 2009
33
feature
To discuss this article
or topic, go to member
http://forums.aapc.com
+22844 Posterior segmental instrumentation (eg, pedicle
fixation, dual rods with multiple hooks and sublaminar
wires); 13 or more vertebral segments (List separately in
addition to code for primary procedure), according to the
number of vertebral segments spanned.
Be cautious when counting vertebral segments, keeping in mind that a single interspace lies between two
vertebral segments. For instance, the span C6-T2
contains four vertebral segments (C6, C7, T1, and T2)
and three vertebral interspaces (C6/C7/C7/T1, and T1/
T2). To report anterior instrumentation across this
span, you would choose 22846, which describes four
to seven vertebral segments, rather than 22845, which
describes two to three vertebral segments.
Spinal Instrumentation
Anterior
spanning 2 to 3 segments
22845
spanning 4 to 7 segments
22846
spanning 8 or more segments
22847
Posterior
spanning 3 to 6 segments
segmental
22842
spanning 7 to 12 segments
22843
spanning 13 or more segments
22844
non-segmental
22840
Cage, threaded bone dowel, methylmethacrylate, etc.
22851
CPT® defines spinal instrumentation procedures as
inherently bilateral, so you should not apply modifier 50 to any spinal instrumentation codes. As with
spinal bone grafts, all codes describing instrumentation placement are exempt from multiple-procedure
(modifier 51) adjustments, according to CPT®.
For example, a complete spinal fusion might include:
L4/L5 Discectomy
L5/S1 Discectomy
L4/L5 Transforaminal interbody fusion,
posterior interbody technique
L5/S1 Transforaminal interbody fusion,
posterior interbody technique
Morselized autograft, obtained from local
incision
L4/L5 Interbody cage placement
L5/S1 Interbody cage placement
L4, L5, S1 Bilateral pedicle screw instrumentation
You would report the arthrodesis at two interspaces
using 22630 Arthrodesis, posterior interbody technique,
including laminectomy and/or discectomy to prepare inter34 AAPC Coding Edge
space (other than for decompression), single interspace;
lumbar and +22632 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare
interspace (other than for decompression), single interspace;
each additional interspace (List separately in addition to
code for primary procedure).
In this case, the discectomy to prepare the interspaces at L4/L5 and L5/S1 is included in the arthrodesis, although a more extensive discectomy could be
separately coded, when justified (see below for more
information).
For the morselized autograft, you would report
20937.
For placement of the interbody cage at the first
level, you would report 22851. Because cage placement occurs at a second level, you may also report a
second unit of 22851 with modifier 59 Distinct procedural service appended. Modifier 59 shows the payer
that you addressed separate levels.
For the pedicle screw instrumentation, you should
report 22842. Remember, even though the instrumentation was bilateral, you would not append
modifier 50.
Code Separately More Than
Minimal Decompression Services
Arthrodesis may include related procedures such
as minimal laminectomy and/or discectomy to prepare the interspace, as indicated in the individual
arthrodesis code descriptors. Codes 22554-22585 and
22630-22632 describe scrapping away of the disk
just enough to make room for graft material.
In some cases, the surgeon may perform a more
than minimal (more extensive than usually associated with arthrodesis) discectomy or laminectomy.
In these cases, separate coding for the decompression (for instance, 63047, Laminectomy, facetectomy and
foraminotomy (unilateral or bilateral with decompression
of spinal cord, cauda equina and/or nerve root(s) (spinal
or lateral recess stenosis)), single vertebral segment; lumbar)
with modifier 59 may be justified.
To support a separate service, the surgeon’s documentation should highlight decompression of neural
elements and removal of fibrovascular scar tissue
over the dura (for instance, the posterior longitudinal
ligament), removal of disc material on the far lateral
sides, with foraminotomy, and/or necessary removal
of osteophytes (bone spurs).
[
]
G. John Verhovshek, MA, CPC, is AAPC’s
director of clinical coding communications.
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added edge
CEU costs got you down? While there are low or
When Employers
Pay for CEUs,
Everyone Wins
By Michelle A. Dick, senior editor
36 AAPC Coding Edge
no cost opportunities available, CEUs and the valuable
education they represent still can cost money. Employers are finding that helping coders with their continuing
education is paying off with money-saving accurate, compliant coding.
Kreeta Haffner, business office manager, Boulder Medical Center, said when asked why she pays for her employees, clinic coder Lisa Curtis’, CPC, CPC-E/M, CEUs,
“It is a win-win for the clinic.” Haffner added, “We pay
$150 annually towards membership costs.” Although
both Boulder Medical Center and Lisa benefit from the
decision to pay for CEUs, Haffner said, “I cannot dictate
what other clinics’ employee benefits should be, but providing additional education helps our clinic.”
When Curtis was hired she inquired if Boulder Medical
Center paid for CEUs and was told that they did. “It is
not something I had to request,” Curtis said. “Each year
we figure out a budget for this. They haven’t told me
‘No’ yet.”
Because Boulder Medical Center pays for Curtis to attend
workshops and conferences, she said, “I find there is a lot
more to learn by attending workshops than just reading
and doing (free) tests, although those are useful too; reading and doing the tests doesn’t always mean the information will stick. Interaction with other coders is very
important. It’s an opportunity to meet and network with
other coders in person that you wouldn’t normally meet,
and learn about their experiences. I’m looking forward to
going to the conference in Las Vegas!”
Billing Manager Jennifer L. Sprague, CPC, of Nephrology
Associates of Syracuse, P.C. is also an employee who has
her CEUs paid by her employer. When asked about it, she
said, “I do work for an organization that pays for CEUs.
It’s wonderful! Our practice, Nephrology Associates of
Syracuse, P.C. believes in educating staff and managers to
keep up with the ever-changing health care community.
Our practice recently paid for me to take my CPC® exam.
Not only did they pay for the exam, they also paid for a
Boot Camp in Boston, Mass. to prepare me for the exam.
They are an excellent company to work for.”
Lahey Clinic in Burlington, Mass. also pays for employees’ CEUs. Robin M. Serrentino, professional coding
department administrative assistant at Lahey said, “My
department pays for our coder’s membership, all audio
conferences and seminars. This way they are able to earn
their CEUs. We believe in educating the coders who
work in this department. It takes a lot of pressure off the
coder to know that they can receive education merely at
added edge
the tip of there fingers. As long as they work at Lahey
their memberships are paid for by Lahey. You would say
it’s one of Lahey’s perks.”
It’s not only the coding professional who benefits when
CEUs are paid for. Many employers reimburse coders for
their continuing education expenses because they know it
will pay off in the long run with accurate coding, ensuring proper reimbursement for medical services. Curtis
said, “It’s a tremendous benefit to the employers to keep
their coders up-to-date. The providers have a lot on their
plates focusing on patient care. Someone needs to keep
up with the ever-changing coding world.” What better
way to ensure current coding practices than providing
the means for continuing education.
By paying for employees’ CEUs the employer also helps
to safeguard their practice from potentially damaging
liability by proving they took measures to stay up-todate with compliant coding practices. According to
Julie E. Chicoine, Esq., RN, CPC, of the AAPC’s Legal
Advisory Board, if false claim litigation arises, “paying
for coders’ CEUs can help prove that the provider took
steps to stay current and on top of federal health care
program requirements.” Legal Advisory Board member
Michael Miscoe, Esq., CPC, CHCC, agrees. “Doctors are
ultimately responsible for the accuracy of their claims.
Whether trained in coding or not, they are expected to
report services accurately. Taking affirmative steps, such
as hiring certified coders as well as providing appropriate ongoing continuing education, demonstrates a commitment to compliance, which is essential to avoiding
allegations of gross negligence—a key factor in civil false
claims act liability.”
Earn CEUs in an Economy Slump
Free CEU Options
AAPC News Sources Earn You Free CEUs
If you aren’t fortunate enough to have CEUs paid for you,
please take advantage of AAPC’s free or low cost CEU
options. To find out more about these options, see the
accompanying sidebar “Earn CEUs in an Economy Slump.”
Hang This Up
If you need more CEUs than our free options offer,
approach your employer to help compensate for the
expenses. If you aren’t comfortable with that, hang this
article on your wall where it can be seen and possibly
provoke a conversation about the benefits of employers
supporting CEU costs.
[Michelle Dick is senior editor of
Coding Edge
]
Both student members and newly certified members always ask me how
to earn CEUs for free or at a very low cost. I am always taken aback
by this question because seasoned members know the answer to this
question and it is in the student member’s best interest to know the
answer also.
Edge–sidebar
Coding
How to Convince Your Employer
Attend Local Chapter Meetings
A free or low cost CEU option is to attend local chapter meetings. At
recent chapter meetings, there was concern about the economy and how
members will continue to pay to keep memberships current and obtain
CEUs during a time when many employers don’t pay to send employees
to conferences and workshops.
I feel now is the perfect time to remind everyone that we can earn CEUs
for free by supporting our local chapters. Most local chapter meetings
offer one or two CEUs per meeting and most meetings are free to members. Although members are assigned to a specific local chapter, you are
welcome and encouraged to network with and attend other local chapters, allowing you the opportunity to earn additional CEUs.
Chapters offering exam reviews may also offer CEUs to both non-certified and certified members. If you are a certified member and want to
attend a review, you may earn CEUs for free or at little cost.
Members can also offer presentations to fellow chapter members during
local chapter meetings and earn CEUs for their time. Presenting at a local
chapter is a wonderful way to earn additional CEUs while helping others
obtain CEUs as well.
There is no better time than now to come out and support the AAPC and
your local chapter! It can be fun, informative, free-of-charge and you are
afforded the opportunity to network with your peers. New chapters are
popping up all the time—look for a location near you.
The AAPC’s monthly Coding Edge magazine and the electronically sent
bi-monthly EdgeBlast allow you to earn additional CEUs at no cost.
You can earn CEUs by taking the Coding Edge Test Yourself quizzes
at www.aapc.com/MemberArea/resources/coding-edge/index.aspx and
the EdgeBlast quizzes at www.aapc.com/memberarea/resources/Edge
Blast_Archive.aspx.
We all have the opportunity to obtain the minimum requirement of 18
CEUs per year simply by participating in local chapter meetings, learning
in exam reviews, and completing the questionnaires in Coding Edge and
EdgeBlast.
I assure you that I have never paid to obtain CEUs as I take full advantage
of the benefits afforded to me as part of my AAPC membership.
[By Trina Cuppett, CPC, CPC-H]
www.aapc.com
March 2009
37
newly credentialed members
newly credentialed members
Maria Teresa Manuel Dagdag, CPC
Anchorage AK
Caroline R Etuckmelra, CPC, CPC-H
Anchorage AK
Jody Gretzke, CPC Anchorage AK
Karen Louise Stout, CPC Anchorage AK
Barbara A Hall, CPC Chugiak AK
Cheryl Skiffington, CPC Eagle River AK
Amy Levinson, CPC Palmer AK
Dana L Blackman, CPC Birmingham AL
Allison Singer, CPC Birmingham AL
Riley Leann Weir, CPC Birmingham AL
Edna Carol Hurt, CPC Brilliant AL
Lissette Lopez, CPC-H Calera AL
Phillip Stanley Powell, CPC Dothan AL
Jennifer Pate, CPC-H Florence AL
Rita H Ledbetter, CPC Lincoln AL
Ronya J Martin, CPC Mount Olive AL
Pamela Sue Brand, CPC Oneonta AL
Mary Ellen Fitzgerald, CPC Tuscumbia AL
Charlotte Adcox, CPC Woodstock AL
Carol McRoberts, CPC Fayetteville AR
Phyllis Cheshier, CPC Jonesboro AR
Donna Hollis, CPC Jonesboro AR
Shonna Slater, CPC Jonesboro AR
Jennifer Haddock, CPC Little Rock AR
Rhonda D Flowers, CPC-H Mtn. Home AR
Cassandra P Farmer, CPC West Memphis AR
Amber M Stevenson, CPC Avondale AZ
Candis Ashlee Thompson, CPC Benson AZ
Suzanne Denz, CPC Chino Valley AZ
Lois Scale, CPC Glendale AZ
Julie Coll, CPC Hereford AZ
Kati L Telliard, CPC Lake Havasu City AZ
Rebecca Jean Kozell, CPC Mesa AZ
Kathleen Cava, CPC, CPC-H Phoenix AZ
Robert Wenzl, CPC Phoenix AZ
Rebecca Marie Lane, CPC Sierra Vista AZ
Penny Young, CPC Snowflake AZ
Karissa Jones, CPC Tempe AZ
Mark Cormier, CPC Tucson AZ
Diane Susan Ramirez, CPC Tucson AZ
Dorine Geske-Butler, CCS, CPC, CPC-H
Vernon AZ
Maudy Sherer, CPC-H Alturas CA
Taylor Ho, CPC Anaheim CA
Monica Gonzales, CPC Bakersfield CA
Marty Shannon, CPC, CPC-P Bakersfield CA
Margoschis Vedamuthu, CPC Bakersfield CA
Thao Trang Thi Dang, CPC Baldwin Park CA
Chi Young Chung, CPC Brea CA
William John Wang, CPC Brea CA
Randolph A Stein, CPC Burlingame CA
Michael Driskill, CPC Cerritos CA
Mandy Felton, CPC Chatsworth CA
Kiet Van Lieu, CPC Chino Hills CA
Manish Jayaut Patel, CPC Corona CA
Vicki Lynne Cordts, CPC Cudahy CA
Robert Louis Escalera, CPC Cudahy CA
Jegathesan Krishnamurthy, CPC Delano CA
Zakeya A Warner, CPC Dixon CA
Gareth S Dulai, CPC Downey CA
Jennifer L Hackett, CPC El Sobrante CA
Rosemary Lopez Ramirez, CPC Fairfield CA
Antony Lin, CPC Fontana CA
Janley Kwan-Wah Hsiao, CPC Foster City CA
Kathleen M Aguiar, CPC Freemont CA
Suzanne R Peterson, CPC Garden Grove CA
Doris T Waldron, CPC Glendale CA
Edward K Yang, CPC Harbor City CA
Keisha Lynn McQueen, CPC Hayward CA
Heather Marie Swift, CPC-H Hesperia CA
Barbara C Deaton, CPC Hollister CA
Vicki Sue Ewing, CPC Huntington Beach CA
John P Russell, CPC Huntington Beach CA
Lucita F Vartanian, CPC La Mirada CA
Lana Tate, CPC Lake City CA
Lourdes Naluz Trinidad, CPC Lakewood CA
Connie Greer, CPC Lancaster CA
Akira Kugaya, CPC Lomita CA
38 AAPC Coding Edge
Saadallah Elsolh, CPC Los Angeles CA
Fariborz Mazdisnian, CPC Los Angeles CA
Sheryl Peralta, CPC Los Angeles CA
Julie F Romias, CPC MB CA
Erin Mendoza, CPC Mill Valley CA
April Nelson, CPC Mill Valley CA
June Weller, CPC Millbrae CA
George Austin, CPC Mission Viejo CA
Stephanie Barker, CPC Modesto CA
Evelyn L Espadera, CPC-H Newark CA
Ana Vazquez, CPC Oakdale CA
Amy Kane, CPC Oakland CA
Mary A Balderas Dabu, CPC Oceanside CA
Andy J Yang, CPC Orange CA
Samir G Tejwani, CPC Pasadena CA
Kenneth Hon Hing Wong, CPC Pasadena CA
Ron Anderson, CPC Rancho Palos Verdes CA
Lisa Reed, CPC Redding CA
Noel S Victor, CPC Redlands CA
Cassandra Stone, CPC Riverbank CA
Kristina L Benjamin, CPC Sacramento CA
Leslee M Allen, CPC, CPC-H San Diego CA
Jennifer Chaidez, CPC San Diego CA
Aline J Cezanne, CPC San Francisco CA
Josephine A Manuele, CPC San Francisco CA
Michelle R Martin, CPC San Francisco CA
Marivic Pinto, CPC San Francisco CA
Marlene Valle, CPC San Francisco CA
Jennifer L Wong, CPC San Francisco CA
Bijal Shah, CPC San Fransisco CA
Parmjit K Sidhu, CPC San Jose CA
Linda Greenberg, CPC San Marcos CA
Judy L Rosario, CPC San Pablo CA
Jamie Lee Bangs, CPC Santa Barbara CA
Faye Luu, CPC Santa Clara CA
Stephanie A Sutton, CPC, CPC-H Santa Cruz CA
Debbie Acton, CPC Santa Rosa CA
Cynthia J Sherlock, CPC Santee CA
Sandra J Richardson, CPC Simi Valley CA
Tiffany Thuy Thanh Pham, CPC Sunnyvale CA
Chiara E Conrado, CPC Tarzana CA
Nancy R Gonzalez, CPC Temple City CA
Michael Allen Medeiros, CPC Ukiah CA
Boris Prusa, CPC Upland CA
Stephanie Fraire, CPC Vallejo CA
Noemi Deneef, CPC Vista CA
Tracy L Von Winckelmann, CPC Vista CA
Barbara A McCullough, CPC Walnut Creek CA
Denise Von Schell, CPC-H Watsonville CA
Erin G Stone, CPC West Hills CA
Ethel B Kerr, CPC Westminster CA
Tamara L Downs, CPC Yucaipa CA
Amy Arnott, CPC Fort Collins CO
Bethanie D Sanchez, CPC Grand Junction CO
Debora Ann Ruttman, CPC Greeley CO
Linda A Tomasek, CPC, CPC-H Johnstown CO
Ann Filchak, CPC Littleton CO
Tammi R Fredekind, CPC Loveland CO
Melody Rose Lidmila, CPC Loveland CO
Wendy M Moul, CPC, CPC-H Loveland CO
Sandra Dohlman, CPC-H Mead CO
Jason M Pitts, CPC Pueblo West CO
Maria Magana, CPC Silt CO
Suzanne Marie Kurtoglu, CPC Bethel CT
Laura E Stephens, CPC Bethel CT
Shana L West, CPC Bridgeport CT
Patricia O’Connell-Campbell, CPC
Brookfield CT
Patricia Githmark, CPC Cheshire CT
Dawn M Willette, CPC-P Meriden CT
Christina D Alicea, CPC Naugatuck CT
Jean Douglas Betancourt, CPC New
Fairfield CT
Barbara Krueger, CPC Newington CT
Debra Wiedenheft, CPC-H Norwich CT
Marisa Cyr, CPC Plantsville CT
Marilyn P Rose, CPC Ridgefield CT
Krista Marie DelGais, CPC Shelton CT
Elaine Barbara O’Brien, CPC Southbury CT
Lori Jean Jacobs, CPC Stratford CT
Karen A Carbone, CPC, CPC-H Wallingford CT
Karen McLean, CPC Wallingford CT
Lois L Avery, CPC, CPC-P Waterbury CT
Sebeat M Rizvani, CPC Watertown CT
Dwight C Williams, CPC West Hartford CT
Karen Ann Frank, CPC West Haven CT
Renita Patterson Ellis, CPC-P Washington DC
David Trippi, CPC Bradenton FL
Lillie M Brown, CPC Brandon FL
Pamela Sue Keen, CPC Callahan FL
Jodi Abbey, CPC Clearwater FL
Miriam A.L. Reid-Smith, CPC Coral Springs FL
Barbara Tarbotton, CPC Edgewater FL
Patricia Stover-Jones, CPC Fruitland Park FL
Brandy Lin Cahill, CPC Gainesville FL
Julia D Dolhay, CPC Gainesville FL
Maura Kearney Jacob, CPC Gainesville FL
Carissa L Mitchell, CPC Gainesville FL
Nicole Renee Musgrave, CPC Gainesville FL
Shawn Michael Palmer, CPC Gainesville FL
Claudia J Partridge, CPC Gainesville FL
Pablo Rios, CPC Gainesville FL
Megan Victoria Rivera, CPC Gainesville FL
Pamela B Roberts, CPC Gainesville FL
Arlene Stanley, CPC Gainesville FL
Rolando San Pedro, CPC Hialeah FL
Nancy L Leasure, CPC High Springs FL
Janet S Batten, CPC Jacksonville FL
Darleen Patricia Green, CPC Jacksonville FL
Debra Parker, CPC Jacksonville FL
Jasmine Relova, CPC Jacksonville FL
Colleen J Rodriguez, CPC Jacksonville FL
Betsy A Westra, CPC Keystone Heights FL
Alma Marsden, CPC, CPC-H Lakeland FL
Ashlea Jinell Fike, CPC Lakeland FL
Shelly Feeney, CPC Largo FL
Lavora A Jones, CPC North Lauderdale FL
Maria Elizabeth Campbell, CPC Orlando FL
Clarissa D Dowrich, CPC, CPC-P Orlando FL
Karen Ann Smith, CPC Orlando FL
Stacie Wilson, CPC Orlando FL
Kimberly Hare, CPC Palm Bay FL
Amy Lambert, CPC, CPC-H Palm Harbor FL
Amy S Bittorf, CPC Pinecrest FL
Scott D Mesick, CPC Riverview FL
Leila Bishop Masterson, CPC Stuart FL
Grace Mary Schoedinger, CPC Sunrise FL
Corrine D Graham-Garner, CPC Tamarac FL
Patricia M Young, CPC Tamarac FL
Cristina Kmiotek, CPC Tampa FL
Lisa Elaine Tanner, CPC, CPC-P Tampa FL
Sheila Ward, CPC Tampa FL
Melissa Dawn Bates, CPC Albany GA
Sonya McMillan, CPC, CPC-H Alpharetta GA
Maria Cristina Ramos, CPC Braselton GA
John Russell Insco, CPC, CPC-H Buford GA
Vivian Hedden Taylor, CPC Buford GA
Bernice D Laferriere, CPC Clarkesville GA
Staci B Stringer, CPC Clermont GA
Carolyn Hines, CPC Dawsonville GA
Judy K Mullinax, CPC Dawsonville GA
Deborah Louise Cook, CPC Decatur GA
Tanya M Thompson, CPC Douglasville GA
Shawn M T Phillips, CPC, CPC-H Dunwoody GA
Nicole D Lowe, CPC Ellenwood GA
Joyce L Clark, CPC Flowery Branch GA
Cathy Elaine Miller, CPC Flowery Branch GA
Rhonda Y Frazier, CPC Gainesville GA
Kathryn M Moya, CPC Gainesville GA
Candice Gail Shepard, CPC Gainesville GA
Sherinda L Watson, CPC Gainesville GA
Purvi Sekhda, CPC Grovetown GA
Robin H. Frankland, CPC Kennesaw GA
Thavia Hepburn, CPC Lawrenceville GA
Belinda K King, CPC, CPC-H Lawrenceville GA
Loriann T Allen, CPC, CPC-H Lithonia GA
Danita Marie Richey, CPC Marietta GA
Helen Royals, CPC Marietta GA
Jana Wilson, CPC Marietta GA
Tanya Francine Cochran, CPC Maysville GA
Tina Bargar, CPC Murrayville GA
Lisa M Williams, CPC Murrayville GA
Deborah Thrower Smith, CPC Norcross GA
Jackie M Martin, CPC Oakwood GA
Jennifer M Tinsley, CPC Peachtree City GA
Laura J Mullis, CPC Perry GA
Christopher R Worsham, CPC, CPC-H Roswell GA
Bernadette R Bryant, CPC Savannah GA
Katie A Helmly, CPC Savannah GA
Yvonne Michelle Dupree, CPC, CPC-H,
CPC-P Snellville GA
Edna Ellen Messer, CPC Warner Robins GA
Sonja M Tukes, CPC Warner Robins GA
Abigail Laura Miller, CPC Washington GA
Tara Natasha Johnson, CPC Winder GA
Pamela Lyn Amuro, CPC Honolulu HI
Adanette Michelle Weaver, CPC Kapolei HI
Sinalaua Kalea Tiolu, CPC Waianae HI
Kimberly Vegter, CPC Clinton IA
Kathy Castle, CPC Coeur D Alene ID
Karen L Story, CPC Burr Ridge IL
Jenito Delos Santos, CPC Chicago IL
Sandra Stonestreet, CPC Columbia IL
Pamela K Vormezeele, CPC, CPC-H
Durand IL
Cynthia Cassada, CPC East Carondelet IL
Kendra E Draksler, CPC East Peoria IL
Rogelia Aranda, CPC Elgin IL
Meena Rathod, CPC-H Glenview IL
Elaine Oberlander, CPC Highland Park IL
Bernadetta Rebidas, CPC Homer Glen IL
Misty Foster, CPC Loves Park IL
Diana Lynn Crombie, CPC, CPC-H
Machesney Park IL
Diane M Kielb, CPC, CPC-H Naperville IL
Kelley Copeland, CPC Peoria IL
Jessica A Robertson, CPC Peoria IL
Marcy Elizabeth Were, CPC Peoria IL
Melissa A Williams, CPC Peoria IL
Ann Danger, CPC Port Byron IL
Christine R Gray, CPC, CPC-H Roscoe IL
Diann M Docter, CPC, CPC-H Sycamore IL
Stacy Plocher, CPC Bedford IN
Tammy Todd, CPC Bloomington IN
Cindi Myers, CPC Bristol IN
Lisa Barker, CPC Carmel IN
Anthony Burns, CPC, CPC-H Daleville IN
Elizabeth Sanders, CPC Darlington IN
Tara Fanchon Smith, CPC Fishers IN
Dawn Mcgillivray, CPC-H Fort Wayne IN
Christina Chandler, CPC Indianapolis IN
Christine A Obergfell, CPC Indianapolis IN
Phillip Williams, CPC Indianapolis IN
Ryan J Fischer, CPC-H Kokomo IN
Jaime Lynn Baker, CPC Mishawaka IN
Kathy Hall Leap, CPC, CPC-H Mooresville IN
Sharman Lewis, CPC Solsberry IN
Craig F Levi, CPC Frontenac KS
Natalie Jo Comer, CPC Galena KS
Stacie N Pawlan, CPC Roeland Park KS
Elysia Cramer, CPC Wichita KS
Brenda Smith, CPC Wichita KS
Lori Ann Bell, CPC Clinton KY
Erin Wilcher, CPC Danville KY
Shara Johnson, CPC Fort Thomas KY
Leigh Ann Bright, CPC Glberstville KY
Allison Rafferty, CPC Lexington KY
Mary Abbott, CPC Louisville KY
Amy Hrivnak, CPC Louisville KY
Peggy Ann Kannapel, CPC Louisville KY
Mary A Stewart-Herman, CPC Louisville KY
Steven D Stevenson, CPC Somerset KY
Janette Henry, CPC, CPC-H Baton Rouge LA
Diane Baas Scofield, CPC Chalmette LA
Gina Benedict, CPC Geismar LA
Cherrie H Broekhoven, CPC La Place LA
Rebecca Fontana, CPC Metairie LA
Janet S White, CPC Ponchatoula LA
Cheri Bouche, CPC Slidell LA
Charlotte Newsome, CPC Slidell LA
Dianne M Hamel, CPC Arlington MA
Amy J Figueiredo-Graziosi, CPC Attleboro MA
Leila Imbrogna, CPC Boston MA
Darlene Marini, CPC Braintree MA
Helen Fatima Archer, CPC Fall River MA
Mary E Mackenzie, CPC Hanover MA
Nancy Newman, CPC-H Holbrook MA
Natalie Ratty, CPC Lowell MA
Christene Marie Pozzi, CPC Millis MA
Amy L Vasconcelos, CPC N Dartmouth MA
Sandra R Ribeiro, CPC Seekonk MA
Raymond Keith Perry, CPC Sturbridge MA
Andrea Diamant, CPC Swampscott MA
Stacy Laumann, CPC Balitmore MD
Ashley Wright, CPC Baltimore MD
Lizzie Hearman-Nichols, CPC Upper
Marlboro MD
Stefanie Rose Nadeau, CPC Augusta ME
Anne-Marie Carol Leask, CPC Bath ME
Sue-Anne M Higgins, CPC Cape Elizabeth ME
Lynn Hudson, CPC Plymouth ME
Suzanne Lyon, CPC, CPC-H Sanford ME
Eileen R Nunley, CPC South Portland ME
Elizabeth Grabow, CPC Alger MI
Earline T Shelton, CPC Bangor MI
Gail Louise Sprunger, CPC Bay City MI
Deena Krause, CPC Caro MI
Sondra I Neff, CPC Clawson MI
Pamela Brown, CPC Jackson MI
Linda Ginsberg, CPC Kalamazoo MI
Emily Anne Hanna, CPC Kalamazoo MI
Christene Oorbeck, CPC Kalamazoo MI
Barb Radosa, CPC Merrill MI
Betty Plumer, CPC Midland MI
Sheila Hurtubise, CPC Muskegon MI
Cherity Ann Cowels, CPC Plainwell MI
Jennifer Burkett, CPC Richland MI
Denise Garrett, CPC Saginaw MI
Gayle Beagle, CPC-H Sandusky MI
Deborah Jean Frizzle, CPC Sturgis MI
Tina Wright, CPC Apple Valley MN
Cynthia Bunce, CPC Eden Prairie MN
Theresa Lynn Dziuk, CPC Farmington MN
Becky Lynn Neve, CPC, CPC-H, CPC-P
Maplewood MN
Jennifer June Talbot, CPC Midland MN
Stephanie M Beadle, CPC Moose Lake MN
Jo Anne Russell, CPC Saint Paul MN
Gina Raybourn, CPC-H Appleton City MO
Tracy Sullivan, CPC Belton MO
Renee Whitman-Teeter, CPC-H Bolivar MO
Amy M Jackson, CPC Butler MO
Sharon E McCoy, CPC Columbia MO
Laura M Pratte, CPC Columbia MO
Cleta Fay Dake, CPC-H Forsyth MO
Amy J Wheeler, CPC Gower MO
Carole Kristine Thurman, CPC Jackson MO
Lacey J Morrison, CPC Joplin MO
Ronnie M Hoskins, CPC Kansas City MO
Dianne Joy Lockhart, CPC Kansas City MO
Tabitha Lynn Plante, CPC Kansas City MO
Mary Patricia Keens, CPC Kansas City MO
B Kathleen Slagle, CPC Maryville MO
Sandra G Cooley, CPC Mountain View MO
Eliese Woodall, CPC Nixa MO
Cynthia Weathers, CPC Saint Louis MO
Janice Marie Wegner, CPC-H Sparta MO
Katrina Lave, CPC Springfield MO
Michelle S Musielak, CPC St Louis MO
Linda Clark, CPC St. Joseph MO
Tawiana Lewis, CPC St.Louis MO
Betsy J Cole, CPC Weatherby Lake MO
Tammy McIlwain, CPC Meridian MS
Lisa D Stallmann, CPC Picayune MS
Mollie Fondren, CPC Starkville MS
Katrina Pipkins, CPC Veely MS
Cynthia Lee Ray, CPC Philipsburg MT
Sharron Arnold, CPC Boonville NC
Kathleen Bessler, CPC Carthage NC
Elizabeth C Giraldo, CPC-H Charlotte NC
Jennifer Byrd, CPC Durham NC
Sonja J Lassiter, CPC Durham NC
Deborah D Rowland, CPC Durham NC
Amy Tolentino, CPC Flat Rock NC
Sherry White Thomas, CPC Germanton NC
Kristine P Hutchens, CPC Gibsonville NC
Julie Woodruff, CPC Glade Valley NC
September Brummett, CPC Greensboro NC
Deborah Perdue, CPC Greensboro NC
Barbara Morrison Reynolds, CPC Hamlet NC
Sharon B King, CPC Haw River NC
Kristine M Spatafora, CPC High Point NC
Joyce M Ellis, CPC Kernersville NC
Lorna Kay Doyle, CPC King NC
Angela Kay Spainhour, CPC Lewisville NC
Vicky W Woody, CPC Mocksville NC
Gina Rene McAllister, CPC Pfafftown NC
Terrie Matthes, CPC Raleigh NC
Loretta Hunt Honeycutt, CPC Thomasville NC
Rose Marie Van Parys, CPC Walkertown NC
Lindsay Marie Tucker, CPC Whitsett NC
Linda-Carolyn B Turner, CPC Winston-Salem NC
Lorrie Ann Glass, CPC Bismarck ND
Susan M Poitra, CPC Dunseith ND
Penny Lee, CPC Fargo ND
Linda Darlene Neill, CPC Bellevue NE
Tesha Dacheli Williams, CPC Bellevue NE
Karen M Tolbert, CPC, CPC-H Blair NE
Cindy L Prucha, CPC-H Lincoln NE
Deborah Kracl, CPC Norfolk NE
Kerry Luebe, CPC Norfolk NE
Nancy J Barna, CPC, CPC-H Omaha NE
Michele Jean Bonge, CPC Omaha NE
Carolyn Kohler, CPC Omaha NE
Elizabeth Ann Krause, CPC Omaha NE
Elizabeth Jane Kumm, CPC O’Neill NE
Megan J Walz, CPC Papillion NE
M Abigail Aucella, CPC Barrington NH
Lauren Alyse Clifford, CPC Dover NH
Heather T Viray, CPC New Market NH
Miguel Felix Vasquez, CPC Bergenfield NJ
Kenyatta Yuen, CPC Camden NJ
Melissa A Franchville, CPC Cape May Court
House NJ
Jen Growney, CPC Haddon Heights NJ
Catherine Boyle, CPC Laurel Springs NJ
Timothy K Park, CPC-H Marlboro NJ
Grace Brusca, CPC Middletown NJ
Cindy Kennedy, CPC Rahway NJ
Sojung Kim, CPC Sayreville NJ
Marlyn M Panday, CPC, CPC-H Teaneck NJ
Dorota E Guzio, CPC Union NJ
James Wilhelm, CPC Albuquerque NM
Sandy Lowry, CPC Silver City NM
Charllene Norman, CPC Silver City NM
Jessica Maria Companey, CPC Fernley NV
Tami Keathley, CPC Henderson NV
Rosela Gozon, CPC Las Vegas NV
Antoinette Koshi, CPC N Las Vegas NV
Zheila M Smith, CPC, CPC-H Reno NV
Lynda Elmore, CPC Sparks NV
Alona B Isip, CPC Sparks NV
Josue D Laforest, CPC Bronx NY
Tracy Lynn Betterton, CPC Chelsea NY
Glenn J Smits, CPC Cragsmoor NY
Anderson Cuartas, CPC Forest Hills NY
Doreen Meditz, CPC Glendale NY
Henia Grodenchik, CPC, CPC-H Hopewell
Jct NY
Lori M Zigata, CPC Johnson City NY
Christina Marie Muller, CPC Middletown NY
Cheryl R Niswender, CPC New Windsor NY
Michael Lopez, CPC New York NY
Crystal J Grissom, CPC Newburgh NY
Deborah C Pittman, CPC Newburgh NY
Angela Rae Brown, CPC Wallkill NY
Monica B Littlejohn, CPC Washingtonville NY
Denise A Curry, CPC Weedsport NY
Jodi M Perusko, CPC Yorktown Heights NY
Cedriee Thomas, CPC Akron OH
newly credentialed members
Mary Ann Neff, CPC Austintown OH
Goldie Sylvia Boggs, CPC Barberton OH
Rebecca Busken, CPC Cincinnati OH
Nicole Cook, CPC Cincinnati OH
Page M Miller, CPC Cincinnati OH
Claudia Ann Repine, CPC Cleveland OH
Khristina Ann Dilallo, CPC Cortland OH
Janet M Smiddy, CPC Eastlake OH
Angela Palmer, CPC Girard OH
Tabitha Monique Howell, CPC Mason OH
Danelle Janas, CPC Parma OH
Carol Belle McFarland, CPC Pataskala OH
Eileen Roland, CPC Stow OH
Angela M Reynolds, CPC Trenton OH
Linda S Lender-Peroni, CPC Willoughby OH
Elizabeth Kerr, CPC-H Arkoma OK
Amanda Rhodes, CPC Muldrow OK
Katreece Lamour Tate, CPC Oklahoma OK
Marianna Burnett, CPC-H Pauls Valley OK
James K Stone, CPC Estacada OR
Tina Winder, CPC La Grande OR
Dena Christine Clawson, CPC Portland OR
Karen Jones, CPC Portland OR
Lori Anne Weber, CPC Portland OR
Debbie Boychuck, CPC Allentown PA
Stephanie Gross, CPC Allentown PA
Kimberly Horger, CPC Bristol PA
Carla S Kreischer, CPC Catawissa PA
Lynn M Yoder, CPC Douglassville PA
Denise Sheehy, CPC Easton PA
Sharon H Filson, CPC Glen Mills PA
Ellen Capone, CPC Glenside PA
Nicole C Hauck, CPC Hughesville PA
Patricia L Kelley, CPC Kunkletown PA
Annette Lynn Palo, CPC Lester PA
Deborah A Lang CPC, CPC Northampton PA
April McBride, CPC Philadelphia PA
Shaheedah A Pankey, CPC Philadelphia PA
Jeannine Falatek, CPC-H Plymouth Meeting PA
Loretta Ann King, CPC Red Lion PA
Kim Horvath, CPC Slatington PA
Teresa L Amorese, CPC Warwick PA
Barbara Coupe Bernal, CPC Yardley PA
Kathleen Durgin, CPC York PA
Therese Burke, CPC, CPC-H, CPC-I
Chepachet RI
Andrea A Genest, CPC Jamestown RI
Maria Shields, CPC Pawtucket RI
Marion Buxton Rinaldi, CPC, CPC-H Riverside RI
Carol S Muller, CPC West Greenwich RI
Aimie Benko, CPC Woonsocket RI
Kenna Fuller Nelson, CPC Anderson SC
Carrie Lynn Barfield, CPC Aynor SC
Vicki I Shaw, CPC Belton SC
Tonya Hobbs, CPC Boiling Springs SC
Lawrence H Overbaugh, CPC Columbia SC
Stephanie Coleman Woods, CPC Enoree SC
Melinda A Davis, CPC Greenville SC
Tana Partridge Herring, CPC Greenwood SC
Stacey Rudd, CPC Greer SC
Rebecca E Grady, CPC Lexington SC
Elizabeth Corley Key, CPC Lexington SC
Katherine M Lamunyon, CPC Marietta SC
Amanda Jean Ivie, CPC Piedmont SC
Melissa La Shana Prysock, CPC
Spartanburg SC
Christine I Kim, CPC Sumter SC
Jamile Anthony Dumit, CPC Taylors SC
Melissa Miller, CPC Taylors SC
Jacqueline C Roach, CPC Taylors SC
Gina R Thompson, CPC Travelers Best SC
Dorothy A DeWees, CPC Travelers Rest SC
Tammy Siebert, CPC York SC
Sheryl J Santjer, CPC Aberdeen SD
Alyson Heuer, CPC-H Harrisburg SD
Linnette Kay Albers, CPC-H Hartford SD
Teresa L Laleman, CPC Pierre SD
Leann C Olson, CPC Rapid City SD
Sharon E Timmermans, CPC Sioux Falls SD
Cathy Courtney, CPC Antioch TN
Mary Sharae Thomas, CPC Antioch TN
Teresa Shelton, CPC Bartlett TN
Ashley Martin Green, CPC, CPC-H Brentwood TN
Natasha Walker, CPC Christiana TN
Danielle Casey, CPC Clarksville TN
Kathryn Matthews Edwards, CPC Cordova TN
Marlene K Wright, CPC Cordova TN
Kelley L. Clark, CPC Decatur TN
Teresa S Golden, CPC Eads TN
Jamie S Nihiser, CPC, CPC-H Franklin TN
Deborah Hancock, CPC Gainesboro TN
Cheryl Denise Kestner, CPC Gray TN
Brandy K Wheeling, CPC Hendersonville TN
Tracey Lee Champion, CPC Hillsboro TN
Sarah Baker, CPC Humboldt TN
Brenda Nell Nguyen, CPC Jackson TN
Laurie M Sloan, CPC Kingston Springs TN
Trella M Davis, CPC Leoma TN
Kathy J Martin, CPC Limestone TN
James R Robb, CPC Lynnville TN
Demetrice D Averyhart, CPC Memphis TN
Giovonya T Cox, CPC, CPC-H Memphis TN
Vicki Mae Smith, CPC Monroe TN
Christie Coleman, CPC Newbern TN
Jo Ann Stanfill, CPC Oak Ridge TN
Amy K McClung, CPC, CPC-H Smyrna TN
Kaye Jackson, CPC Winchester TN
Toni Jolivet, CPC Austin TX
Sheri Lynn Nesloney, CPC-H Beeville TX
Audra M Roberts, CPC Canyon TX
Cecelia Michele Tisdell, CPC Cedar Hill TX
Ryann Marie Philpot, CPC Cedar Park TX
Deanna Witter, CPC Copperas Cove TX
Barbara R Daniels, CPC Dallas TX
Sandra Simmons, CPC Denison TX
Francisca S Barrientez, CPC-H Floresville TX
Bobbie Genese Walker, CPC Flugerville TX
Kimberly Kaye Coleman, CPC Irving TX
Amy L Willson, CPC Krum TX
Stephanie Yvonne Copeland, CPC Kyle TX
Barbara Ann Kersey, CPC-H Leander TX
Julie A DeMasellis, CPC Lewisville TX
Becky Parker, CPC-H Longview TX
Teresa Cantu, CPC Lubbock TX
Rebecca Winters, CPC Mesquite TX
Marilyn Dommell, CPC Pearland TX
Marci L Barnhart, CPC, CPC-H Perryton TX
Priya Dravekar, CPC Plano TX
Dana Short, CPC Round Rock TX
Donna Jean Smith, CPC Round Rock TX
Mary L Springs, CPC Schertz TX
Lisa Neisser, CPC Victoria TX
Suzanne Bennett, CPC Webster TX
Diane Rowley Williamson, CPC Provo UT
Teri Cipriano, CPC Salt Lake City UT
Elizabeth Langdon, CPC Burke VA
Nancy Rackley, CPC, CPC-H Fredericksburg VA
Janell B Tattersall, CPC Staunton VA
Doreen C Kilburn, CPC Fairfax VT
Emily P Dixon, CPC Aberdeen WA
Natale Warner, CPC Battle Ground WA
Michelle Barlow, CPC Cheney WA
Mei L Sturdivant, CPC-H, CPC-P Cosmopolis WA
Jennifer Lee, CPC Edmonds WA
Jolene Bell, CPC Everett WA
Jennifer H Roberts, CPC Marysville WA
Monica Nicole Pinette, CPC Puyallup WA
Susan McCrea, CPC Reardon WA
Ana L Maciel Hernandez, CPC Richland WA
Toni Eddington, CPC Ridgefield WA
Jennifer Chaffee, CPC Seattle WA
Adrienne R Green, CPC Seattle WA
Lizabeth Kay Flesher, CPC Spokane WA
Rebecca House, CPC Spokane WA
Kimberly Nichols, CPC Spokane WA
Kristin Olson, CPC Spokane WA
Marsha Schwartzenberger, CPC Spokane WA
Angie Marie Stilson, CPC Walla Walla WA
Sue A Reed, CPC Wenatchee WA
Vicki L Kell, CPC Grafton WI
Jennifer Lynn Ketola, CPC Maple WI
Vicky Hielsberg, CPC Oshkosh WI
Kristin Leach, CPC Wisconsin Rapids WI
Barbara Bennett, CPC Kearneysville WV
Kristie M Bowser, CPC, CPC-H Portsmouth
Apprentices
Cheri Hufford, CPC-A Anchorage AK
Pamela M Mack, CPC-A Wasilla AK
Denise Prince, CPC-A Birmingham AL
Laura P DeShazo, CPC-A Dothan AL
Peggy K Weiland, CPC-A Homewood AL
Diane Perez, CPC-A Mc Calla AL
Eugenia Rudolph, CPC-A Pinson AL
Betty Jean Kipena, CPC-A Glendale AZ
Brooke Stevenson, CPC-A Phoenix AZ
Lori J Ness, CPC-A Tucson AZ
Antero Cervantes Estrella, CPC-A Anaheim CA
Bettina C Bartha, CPC-A Buena Park CA
Jennifer S Ho, CPC-A Canyon Country CA
Hsiuchou Ke, CPC-A Cerritos CA
Maria Romeo, CPC-A Chula Vista CA
Mary Kennedy, CPC-A Clovis CA
Alison Dalusong Balucanag, CPC-A Corona CA
Maria Cristina Ladores Rolle, CPC-A Corona CA
Decelaine Paraiso, CPC-A Duarte CA
Holly Hubble, CPC-A Escondido CA
Leah Lao Cuisona, CPC-A Fontana CA
Nuvia Bernal, CPC-A Fresno CA
Temeka R Bond, CPC-H-A Fresno CA
Rana Dean, CPC-A Fresno CA
Kimberly J Garza, CPC-A Gardens Groove CA
Susana Pasay-Maggio, CPC-A Granada Hills CA
Raquel A Temporal, CPC-A Hacienda Heights CA
Melina Alvaran, CPC-A Hercules CA
Christina M K Kuse, CPC-A Huntington
Beach CA
Gina Sandajan, CPC-A La Puente CA
Valorie Carlin Verreaux, CPC-A Linden CA
Teresa Anguiano, CPC-A Long Beach CA
Ivy Francia Bautista, CPC-A Los Angeles CA
Ronald Gatchalian, CPC-A Los Angeles CA
Hazel Narvaez Ilagan, CPC-A Los Angeles CA
Liliana Sandu, CPC-A Los Angeles CA
Janine D Kikkert, CPC-A Martinez CA
Niki M Armbruster, CPC-A Mission Viejo CA
Ashley Bohland, CPC-A Modesto CA
Cielo Parrenas Ramos, CPC-A Monterey
Park CA
Gino Carlo Tahanlangit Pinero, CPC-A
Moreno Valley CA
Melva F Panga, CPC-A Norwalk CA
Eric Dakay, CPC-A Ontario CA
Valeriya Demicheva, CPC-A Pacifica CA
Ruth Loveless, CPC-A Palo Alto CA
Margiela Embudo, CPC-A Pittsburg CA
Manuela S Aquino, CPC-A Riverside CA
Gary Toribio Baculo, CPC-A Riverside CA
Dominador Pasaoa Bongato, CPC-A
Riverside CA
Jocelyn A Cruz, CPC-A Riverside CA
Susan Ellis, CPC-A Rohnert Park CA
Ann Charmina Gonzales, CPC-A
Rosemead CA
Christi-Faith A Cruz, CPC-A Rowland Heights CA
Reginaldo L Cruz, CPC-A Rowland Heights CA
Maria Theresa Estrella Jimenez, CPC-A
Rowland Heights CA
Mildred “Midge” Anderson, CPC-A San
Diego CA
Kelleen M Green, CPC-A San Diego CA
Kayla Sarvis, CPC-A San Diego CA
Dulce Ramirez Ayache, CPC-A San Dimas CA
Diana E Mendoza, CPC-A San Fernando CA
Patricia A Saddler, CPC-A San Francisco CA
Teresa Ellen Arnold, CPC-A San Pablo CA
Alma Alikadic, CPC-A Santa Clara CA
Tristan Gil Guanlao Guanzon, CPC-A
Temecula CA
Concepcion Santos, CPC-A Victorville CA
Raymond F Santos, CPC-A Victorville CA
Rowena Frehe, CPC-A Vista CA
Chandrareni Rimawati, CPC-A Walnut CA
Rosalyn R Buan, CPC-A West Covina CA
Maria Elma Lejos Mecate, CPC-A
Wilmington CA
Latisha Marie Lewis, CPC-A Berthoud CO
DeEtta Darlene Gray, CPC-A Byers CO
Misty Marie Jonas, CPC-A Fort Collins CO
Tammy Rene Euresti, CPC-A Greeley CO
Matthew Snesko d’Armand, CPC-A
Loveland CO
Crystal Matusiak, CPC-A Steamboat Springs CO
Pauline Rheaume, CPC-A Superior CO
Sandra Bauer Gonzalez, CPC-A Thornton CO
Leodivina A Salazar, CPC-A Brookfield CT
Kelly McNally, CPC-A Brooklyn CT
Maggie Vanasse, CPC-A East Lyme CT
Kelli Lynn Steullet, CPC-A Ellington CT
Joye R Wegryn, CPC-A Hartford CT
Tiffany James, CPC-A Meriden CT
Barbara J Butwell, CPC-A Naugatuck CT
Diane L Ferguson, CPC-A Naugatuck CT
Marcia L Matcheson, CPC-A Naugatuck CT
Rachelle M Mauriello, CPC-A Naugatuck CT
Katrina Richard, CPC-A Naugatuck CT
Maryna Voronkov, CPC-A New Britain CT
Adilah Rashid, CPC-A New Haven CT
Lindsay K Maine, CPC-A Newington CT
Mariola Oko, CPC-A Rocky Hill CT
Wendi-Jean O’Donnell, CPC-A Sherman CT
Matthew Huebner, CPC-A Simsbury CT
Shannon K Partiss, CPC-A Southington CT
Christine Kellas, CPC-A Thomaston CT
Michele McLellan, CPC-A Torrington CT
Christine Mirra, CPC-A Wallingford CT
Tracey Travis Parsons, CPC-A, CPC-P-A
Wallingford CT
Carmella J Patzlaff, CPC-A Waterbury CT
Lorraine Krampitz, CPC-A Wolcott CT
Victor N Moturi, CPC-A Washington DC
Tennille Ann Delves, CPC-A Clearwater FL
Ronnie Mercado, CPC-A Clearwater FL
Edwin Alan Tan, CPC-A Clearwater FL
Pamela L Warren, CPC-A Fort Lauderdale FL
Kimberly Y Collins, CPC-A Hawthorne FL
Sally Troiani, CPC-A Hobe Sound FL
Yvonne Gulbranson, CPC-A, CPC-H-A Holiday FL
Leslie D Alvarez, CPC-A Melrose FL
Kathryn A McCullough, CPC-A Palm Bay FL
Linda Dunn, CPC-A Plantation FL
Nancy Buddie, CPC-A Port St Lucie FL
Sharon A Rodney, CPC-A Port St Lucie FL
Donna R Walcott, CPC-A Port St Lucie FL
Sergio A Moreno, CPC-A Saint Petersburg FL
Malaria Rodriguez-Covert, CPC-A Sharpes FL
Judy Kay Brand, CPC-A St Petersburg FL
Lynn M Tillinghast, CPC-A St Petersburg FL
Mark Young, CPC-A St Petersburg FL
Elizabeth Casale, CPC-A Tampa FL
Julianne Porter, CPC-A Tampa FL
Jessica L Camacho, CPC-A Valrico FL
Vera Mcgregor, CPC-A Zephyrhills FL
Bertha C Okpareke, CPC-A Acworth GA
Latasha Ringgold, CPC-A Augusta GA
Patricia C Wilbanks, CPC-A Chatsworth GA
Angela R Tipton, CPC-A Covington GA
Debbie F Vaughn, CPC-A Dacula GA
Carole King, CPC-A Evans GA
Rebecca M Nagy, CPC-A Flowery Branch GA
Taquelia S Hopkins, CPC-A Gainesville GA
Paullette S Steinberg, CPC-A Gainesville GA
Ellen Thomas, CPC-A Hephzibah GA
Penny Hammers, CPC-A Jonesboro GA
Linda A Martin, CPC-A Kingsland GA
Jennifer A Zimmerman, CPC-A Macon GA
Patricia Jordan, CPC-A Powder Springs GA
Natalie Hammonds Long, CPC-H-A
Rockmart GA
Christy Hembree, CPC-A Rocmart GA
Kathleen Craven, CPC-A Savannah GA
Brenda Gail Fuqua, CPC-A Silver Creek GA
Sandra M Jackson, CPC-A Stone Mountain GA
Gina M Miletta, CPC-A Stone Mountain GA
Natsuko M Maurice, CPC-A Honolulu HI
Barbara Vasold, CPC-A Honolulu HI
Nancy Ann Newell, CPC-A Kailua HI
Krista Jo Halverson, CPC-A Cedar Rapids IA
Paulette M Thomas, CPC-A Co Bluffs IA
Brooke K Kelsey, CPC-A Hiawatha IA
Sandra Baxton, CPC-A Belleville IL
Christina M Reyes, CPC-A Burbank IL
Mary B Larue, CPC-A, CPC-H-A Byron IL
Sharon Stallings, CPC-A Carmi IL
Edwina Jaro LeBoeuf, CPC-A Chicago IL
Tina M Luga, CPC-A Chicago IL
Christie A Borchmann, CPC-A, CPC-H-A
Durand IL
Beth A Harbeck, CPC-A Gurnee IL
Renee E Reynen, CPC-A Gurnee IL
Tina M Takala, CPC-A Gurnee IL
Jennifer Sherrill, CPC-A Highland IL
Melissa A Gonzales, CPC-A Lake Villa IL
Antigone Moore, CPC-A Mokena IL
Shari White, CPC-A Palos Heights IL
Myra Burk, CPC-A, CPC-H-A Poplar Grove IL
Heather S Henry, CPC-A Rockford IL
Angela F Young, CPC-A, CPC-H-A Rockford IL
Marilyn Holley, CPC-A, CPC-H-A Roscoe IL
Margi Charleston, CPC-A South Holland IL
Mary M Thon, CPC-A Villa Park IL
Michelle T Harrington, CPC-A Carmel IN
Carol Lothamer, CPC-A Evansville IN
Julia Chapman, CPC-A Fort Wayne IN
Elizabeth Ivancic, CPC-A Greenfield IN
Melinda Johnson, CPC-A Greenwood IN
Erin Taylor, CPC-A Greenwood IN
Cassandra L Lamar, CPC-A Huntington IN
Linda R Thompson, CPC-A Indianapolis IN
Jill Edwards, CPC-A Jeffersonville IN
Angela Sneed, CPC-A Kendallville IN
Maryl Robinson, CPC-A Wingate IN
Valerie K Buell, CPC-A Manhattan KS
Jerri Smith, CPC-A Overland Park KS
Kathryn A Heimerman, CPC-A Wichita KS
Donna L Hutson, CPC-A Wichita KS
Ruby A Lozano, CPC-A Wichita KS
Marisa Lenae Manning, CPC-A Wichita KS
Lesley Kay Petersen, CPC-A Wichita KS
Bobbie Sue Helderman, CPC-A Alvaton KY
Leslie Coffey, CPC-A Louisville KY
Christina Marie Love, CPC-A Louisville KY
Rachel Maguire, CPC-A Louisville KY
Dianne James, CPC-A Baton Rouge LA
Shanin Simon, CPC-A Lafayette LA
Kim-Yen Thi Nguyen, CPC-A New Orleans LA
Mary Emily Grosch, CPC-A Bolton MA
Danielle M Gemelli, CPC-A Burlington MA
Michelle Dupre, CPC-A Fall River MA
Linda A Bacon, CPC-A Marlboro MA
Eli Ray Stark, CPC-A Northampton MA
Lee-Ann Fonseca, CPC-A Seekonk MA
Lee E Smith, CPC-A Shrewsbury MA
Beth Ann Polhemus, CPC-A Columbia MD
Lori Nocket, CPC-A Dickerson MD
Margarita Kleese, CPC-A Elkridge MD
Leslie Somers, CPC-A Ellicott City MD
Heather Million, CPC-A Joppa MD
Evelyn Gutierrez, CPC-A Laurel MD
Sandar Win, CPC-A Linthicum Heights MD
Theresa Malin, CPC-A North East MD
Jennifer Pierson, CPC-A Owings Mills MD
Andrea Bishop, CPC-A Pasadena MD
Olga Sarakhman, CPC-A Poolesville MD
Teresa Schwartz, CPC-A Severn MD
Shannon Nicole Shiffrin, CPC-A Severn MD
Carol Adolphsen, CPC-A Sykesville MD
Shaye Robinson, CPC-A Westminster MD
Angela Marie Robinson, CPC-A Dayton ME
www.aapc.com
Carolyn Jett, CPC-A Sanford ME
Deborah A Wentworth, CPC-A York Harbor ME
Marianne M Ploucha, CPC-A Flushing MI
Debra Ann Clouse, CPC-A Hastings MI
Deborra Jo Russell, CPC-A Otsego MI
Mary Jo Surma, CPC-H-A Saginaw MI
Carmen J Lobnitz, CPC-A Grand Rapids MN
Patricia R Tauscher, CPC-A La Crescent MN
Jennifer R Henke, CPC-A Belton MO
Julia C Benedict, CPC-A Columbia MO
Jennifer L Oehlschlaeger, CPC-A Grain Valley MO
Donna L Harris, LPN, CPC-A Lees Summit MO
Shauna Lynn Larimore, CPC-A Nevada MO
Dawn Pharr, CPC-A Salem MO
Taneil Adney, CPC-A Springfield MO
Linda A Malone, CPC-A St Louis MO
Yolanda Rena Patino, CPC-A Byhalia MS
Jessica Lee Fandrich, CPC-A Belgrade MT
Amy Marie Terrio, CPC-A East Helena MT
Stephanie Summers, CPC-A Clayton NC
Terry Ellen Knapp, CPC-A Greensboro NC
Phyllis Heisler, CPC-A Oxford NC
Jade Marie Lone, CPC-A Pinebluff NC
Anita Lucas, CPC-A Pittsboro NC
Adriane Jarvis, CPC-A Winston Salem NC
Melissa Muchow, CPC-A Fargo ND
Kimberly Truhlicka, CPC-A Fargo ND
Tamara Lynn Nelson, CPC-A Fargo ND
Laurie Ann Keller, CPC-A Grand Forks ND
Stacy L Cork, CPC-A Ames NE
Nicole Suzanne Clark, CPC-A Bellevue NE
Constance N Coleman, CPC-A Bellevue NE
Jenice Rae Looney, CPC-A Bellevue NE
Heidemarie Fostvedt, CPC-A Elkhorn NE
Marla Kay Sick, CPC-A Fremont NE
Donna E French, CPC-A Gretna NE
Angela R Jacobson, CPC-A Hooper NE
Tracey J Spiers, CPC-A La Vista NE
Lisa Ann Bishop, CPC-A Omaha NE
Jill Elise Butler, CPC-A Omaha NE
Angela C Callaghan, CPC-A Omaha NE
Melanie Laura Cencek, CPC-A Omaha NE
Leslie A Daugherty, CPC-A Omaha NE
Jill M Hansen, CPC-A Omaha NE
Lori L Hopkins, CPC-A Omaha NE
Kathleen Marie Knox, CPC-A Omaha NE
April S Nielson, CPC-A Omaha NE
Jean Patricia O’Connor, CPC-A Omaha NE
Samantha A Radda, CPC-A Omaha NE
Lori Ann Riggs, CPC-A Omaha NE
Marcia C Winingham, CPC-A Omaha NE
Ines Akouyovi Nouake Adandogou, CPC-A
Papillion NE
Noel D Donahue, CPC-A Papillion NE
Heather Hansen, CPC-A Scottsbluff NE
Maria T Mashek, CPC-A West Point NE
Deborah James, CPC-A Bloomfield NJ
Cathy L Bennett, CPC-A Bridgeton NJ
Samuel S Shaw, CPC-A Cedar Knolls NJ
Sherry L Havens, CPC-A, CPC-H-A
Highland Lakes NJ
John A Mydosh, CPC-A, CPC-H-A
Highland Lakes NJ
Shirlynn Shirley, CPC-A Hillside NJ
Elizabeth A Chevalier, CPC-A Manahawkin NJ
Michael Strong, CPC-A Whiting NJ
Connie Johnson, CPC-A Moriarty NM
Harriette Cartwright, CPC-A Nassau NP
Roshann Shenique Miller-Albury, CPC-A
Nassau NP
Latoya Patrice Mitchell, CPC-A Nassau NP
Rebecca L Lassiter, CPC-A Las Vegas NV
Nydia L Huggler, CPC-A, CPC-H-A Reno NV
Iybi James, CPC-A Brewster NY
Annelise Day, CPC-A Johnson City NY
April S Henderson, CPC-A New York NY
Bolinda Haggerty, CPC-A Waverly NY
Robert O Nevels, CPC-A, CPC-H-A
Boardman OH
Theresa Ann Bable, CPC-A Canton OH
March 2009
39
newly credentialed members
Stephanie Lynn Lenigar, CPC-A Canton OH
Rebecca E Miller, CPC-A Canton OH
Debra L Love, CPC-A Girard OH
Kellie Gentry, CPC-A Hamilton OH
Susan I Kilar, CPC-A Hubbard OH
Trease Lynn Abbott, CPC-A Massillon OH
Emily Shaffer, CPC-A Massillon OH
Teri Sholder, CPC-A Miamisburg OH
Ingrid L Green, CPC-A Navarre OH
Jodi L Saeed, CPC-A Orrville OH
Karen Sklodowski, CPC-A Parma OH
Renee E Weaver, CPC-A, CPC-H-A Poland OH
Elaine M Kissel, CPC-A Seven Hills OH
Helena Gale Cross, CPC-A Stillwater OK
Sallie Cogan-Mavor, CPC-A Beaverton OR
Janet Derfler, CPC-A Lake Oswego OR
Rebecca Libbey, CPC-A Milwaukie OR
Rosalie Young, CPC-A Portland OR
Janet Scamahorn, CPC-A Scappoose OR
Mary Lee Browning, CPC-A The Dalles OR
Kimberly A Craven, CPC-A Bensalem PA
Nawal Ayoub, CPC-A Broomall PA
Tamara Lynn Balliet, CPC-A Catasaqua PA
Denise Lee Feathers, CPC-A Ephrata PA
Kira Flick, CPC-A Ephrata PA
Kristy Cornwell, CPC-A Erie PA
Ashley Smith, CPC-A Felton PA
Ashley Nicole Statler, CPC-A Greencastle PA
George J Blake, CPC-A Gwynedd Valley PA
Shannon E Gottschall, CPC-A Jersey Shore PA
Melissa Pitsko, CPC-A Nazareth PA
Gloria Sacknoff, CPC-A Nazareth PA
Melissa Tyler, CPC-A Northampton PA
Denise Glebocki, CPC-A Philadelphia PA
Chandra M Myers, CPC-A Philadelphia PA
Maureen Shattuck, CPC-A Philadelphia PA
Rebecca Kesterson, CPC-A Red Lion PA
Dawn Marie Fountain, CPC-A, CPC-H-A
Shohola PA
Kathleen M Buckley, CPC-A N Kingstown RI
Holly R Hanna, CPC-A Belton SC
Nena Duncan Beaver, CPC-A Chapin SC
Angela Newton, CPC-A Clemson SC
Adell Dawson, CPC-A Florence SC
Gertrude Shiver, CPC-A, CPC-H-A Gadsden SC
Joan Burckhalter, CPC-A Lexington SC
Kristen Barfield, CPC-A Mount Pleasant SC
Deborah L Wetmore, CPC-A Myrtle Beach SC
Tonjia Itach, CPC-A Surfside Beach SC
Jennifer Mary Wentz, CPC-A Armour SD
Lindsey Ann McCaskell, CPC-A Huron SD
Crystal Frances Melstad, CPC-A Huron SD
Sarah Marie Hargens, CPC-A Miller SD
Brittany Danielle Herman, CPC-A Miller SD
Camie Lynn Quilt, CPC-A Miller SD
Charity Littleton, CPC-A Whitewood SD
Verna L Summerer, CPC-A Antioch TN
Mary Jo Maeder, CPC-A Arlington TN
Katherine (Katie) F Chesser, CPC-A Bluff City TN
Anissa Renee Swanson, CPC-A Burns TN
Tami Denton, CPC-A Cedar Grove TN
Deborah Wells, CPC-A Cedar Hill TN
Dorothy M Dodson, CPC-A Chapel Hill TN
Tammy Lee Ambrose, CPC-A Clarksville TN
Cathy Sue Dozier, CPC-A Clarksville TN
Danielle M Minton, CPC-A Clarksville TN
Rebecca Irene Neely, CPC-A Clarksville TN
Kele M Odom, CPC-A Clarksville TN
Rita Kimberly Ragin, CPC-A Clarksville TN
Tracy Lee Spescia, CPC-A Clarksville TN
Myriah E Poston, CPC-A Cookeville TN
Bernadette Lyons, CPC-A Crossville TN
Brandy Garrett, CPC-A Friendship TN
Debbie J Sheats, CPC-A Germantown TN
Rebecca Browder, CPC-A Huron TN
Cathy Dickey, CPC-A Jackson TN
Autumn Glosson, CPC-A Jackson TN
Vicki Lewis, CPC-A Jackson TN
Chitikia M Vance, CPC-A Lyles TN
Doris Kay Wilson, CPC-A Medina TN
Kelli Patterson, CPC-A Medina TN
Angela M Rainey, CPC-A Midleton TN
Karen Seifert, CPC-A Mt Juliet TN
Sara Renee Lee, CPC-A Murfreesboro TN
Demerice Harrison, CPC-A Nashville TN
Ava M Hayden, CPC-A Nashville TN
Cristina M Fastzkie, CPC-A Academy TX
Nila Barfield, CPC-A Austin TX
Myesha Turner, CPC-A Bryan TX
Sherri Pearce, CPC-A Dallas TX
Susan Dymond, CPC-A Dripping Springs TX
Danielle Fulkerson, CPC-A Killeen TX
Christy L Lynn, CPC-A Killeen TX
Sandra Aykes, CPC-A San Antonio TX
Ellie M Mendiola, CPC-A San Antonio TX
Alesia Mae Spruell, CPC-A San Antonio TX
Sandra Pierce, CPC-A Temple TX
Amy E Montoya, CPC-A Troy TX
Angela Davis, CPC-A Tyler TX
Milo Guinn, CPC-A Wylie TX
Corey Erickson, CPC-A Salt Lake City UT
Adelaide D Morgan, CPC-A Bristow VA
Laura D Boutchyard, CPC-A Fredericksburg VA
Amy Clark, CPC-A Fredericksburg VA
Lisa D Meredith, CPC-A Rural Retreat VA
Ginger O’Day, CPC-A Bellevue WA
Suzanne Byrum, CPC-A Everett WA
Tomoko Doi, CPC-A Mukilteo WA
Shawna Paul, CPC-A Omak WA
Rebecca Million, CPC-A Seattle WA
Katherine Andre, CPC-A Spokane WA
Katie Crawford, CPC-A Spokane WA
Jenny Ducharme, CPC-A Spokane WA
Rhonda Reeve, CPC-A Spokane WA
Melissa Lane Keith, CPC-A Vancouver WA
Gail Stifter, CPC-A Greenville WI
Brenda Sweere, CPC-A Hilbert WI
Kathye L Meyer, CPC-A Holmen WI
Patricia Randolph, CPC-A Holmen WI
Kara M Gonsowski, CPC-A Kenosna WI
Ruth Ann Breidel, CPC-A La Crosse WI
Carla Ann Mullins, CPC-A La Crosse WI
Amanda L Savin, CPC-A La Crosse WI
Lynnaus L Gilbertson, CPC-A Onalaska WI
Heather Lynn Liethen, CPC-A Onalaska WI
Karen J Staley, CPC-A Seymour WI
Melissa Kristine Huff, CPC-A Sparta WI
Melinda Moore, CPC-A Ripley WV
Specialties
Rachel A Lacy,
CPC, CEMC Anchorage AK
Suzanne Howell,
CPC, CGIC Pell City AL
Lori Brockinton,
CPC, CEMC Austin AR
Haley Marie Parker,
CPC, CEDC Benton AR
Christina J Thompson,
CPC, CGSC Benton AR
Hallie N McGinley,
CPC, CGSC Hensley AR
Ginger Hill,
CPC, CGSC N. Little Rock AR
Debra A Phillips,
CPC, CANPC Pine Bluff AR
Thomas James Mobley,
CPC, CPC-H, CIRCC, CEDC Gilbert AZ
David Nance,
CPC, CPC-H, CEMC Ceres CA
Rachele Francine Porter,
CPC, CEDC, CUC Hawthorne CA
Sharona Eliaszadeh,
CPC, CUC Los Angeles CA
Iris Geraldine Torres,
CPC, CUC Reseda CA
Jessica Ting Lin,
CPC, CEMC Saratoga CA
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40 AAPC Coding Edge
Katrin Tilk,
CPC, CEMC, CUC Valley Vlg CA
Vicki L Faris,
CPC, CEMC Durango CO
Linda K Peterson,
CCSP, CEMC Durango CO
Mary Bort,
CPC, COSC Englewood CO
Sharon Jeanine Mosset,
CPC, CASCC, COSC Grand Junction CO
Sally J Wadlington,
CPC, CEMC Windsor CO
Judith Ann Fekete,
CPC, CEMC Meriden CT
Greydis Maleta,
CPC, CGIC Pembroke Pines FL
Rachael Milley,
CPC, CEMC Port Saint Lucie FL
Monika A Liddle,
CPC, CGSC Port St Lucie FL
Juanita Marcus,
CPC-H, COBGC Atlanta GA
Stacy L Smith,
CPC, CEMC Byron GA
Lana Moshkovich,
CPC, CEMC Glenview IL
Kelly L Rieck,
CPC, CGSC Mattoon IL
Teresa M Boat,
CPC, CEMC, CFPC Lafayette IN
Susan A Cochran,
CPC, CEMC Plainfield IN
Karen R Cross,
CPC, CEMC Overland Park KS
Mary B Davis,
CPC, CEMC E. Longmeadow MA
Toni D Adriance,
CPC, CPC-H, CEMC Kittery ME
Irene L Craft,
CPC, CEMC Sanford ME
Stephany Renee Kelow,
CPC, CEDC, CEMC Raytown MO
Jeanette Ann Brown,
CPC, CEMC Saint Louis MO
Nancy Ann Stratton,
CIRCC Smithville MO
Cathy Cothran,
CPC, CEMC St Louis MO
Lindsay-Anne McDonald Jenkins,
CPC, CPC-H, CIRCC, CPC-I St. Louis MO
Karen A Howard,
CPC, CASCC Winfield MO
Beth ReAnne Gentry,
CPC, CEMC Poplarville MS
Carolee E Bryan,
CPC, CEMC Charlotte NC
Elektra S Covington,
CPC, CEMC Charlotte NC
Keyshia Monique DuBose,
CPC, CEMC Charlotte NC
Ferlymane H Geiss,
CPC, CEMC Charlotte NC
Marina A Gregory,
CPC, CEMC Charlotte NC
Jennifer L Pereira,
CPC, CEMC Charlotte NC
David P White,
CPC, CEMC Charlotte NC
Traci H Edwards,
CPC, CEMC Concord NC
Shayne A Hatfield,
CPC, CEMC Concord NC
Martha Kent Forrest,
CPC, CEMC Lexington NC
Nancy G Higgins,
CPC, CPC-I, CEMC Monroe NC
Tiffany Henderson Spencer,
CPC, CEMC Monroe NC
Joycelyn Harris,
CPC, CEMC Winston Salem NC
Christi Michelle Reid,
CPC, COSC Winston Salem NC
Rhonda Frans,
CPC, CEMC Gretna NE
Kathleen Hanlon,
CPC, CEMC Omaha NE
Doreen Miller,
CPC, CEMC Asbury NJ
Sucheta Herekar,
CPC, CEMC E. Windsor NJ
Vina Prakash Patel,
CPC, CEMC North Brunswick NJ
Romulo Del Rosario Malimban,
CPC, CIRCC Las Vegas NV
Christiana Oji,
CPC, CCC, CCVTC Queens Village NY
Dawn R Stiles,
CPC, CEMC Cincinnati OH
Sabrina M Isola,
CPC, CEDC, CFPC Florence OR
Jenny Lynn Quigley,
CPC, CEMC Salem OR
Stacy Henning,
CPC, CEMC Turner OR
Christina R Allen,
CPC, CEMC, COSC Dallastown PA
Renee Connor,
CPC, CPC-H, CPC-I, CCC Lititz PA
Nancy M Enos,
CPC, CPC-I, CEMC Warwick RI
Stephanie N Meetze,
CPC, CEMC Blythewood SC
Karen K Byrne,
CPC, CEMC Pawleys Island SC
Ingrid Weidman,
CPC, CEMC Summerville SC
Donna Lyn Nugteren,
CPC, CEMC Sioux Falls SD
Ingdia Dormeis Holt,
CPC, CEMC Hendersonville TN
Barbara Pross,
CPC, CPC-I, CEDC, CEMC Knoxville TN
Shannon O’Tyson Smith,
CPC, CPC-I, CEMC Knoxville TN
Lynn Keaton-Cockrell,
CPC, CPC-H, CPC-I, CEMC Summertown TN
Barbara J Schindler,
CPC, CUC Harker Heights TX
Lila L Harmon,
CPC, CUC Holland TX
Diane M Rozak,
CPC-H, CASCC, CGIC Longview TX
Natalie J Moya,
CPC, CPC-H, CPC-P, CPC-I, CEMC Pearland TX
Cynthia L Graham,
CPC, CEMC, CPEDC Moneta VA
Maria P Blanchette,
CPC, CEMC, COBGC So Burlington VT
Amy Elizabeth Petry,
CPC, CEMC Bothell WA
Gail R Osborn,
CPC, CIMC Kennewick WA
Sheila R Blair,
CPC, CEMC, COBGC Lynnwood WA
Laurie V Riches,
CPC, CCC Spokane WA
Christy Ann Robison,
CPC, CEMC Spokane WA
minute with a member
Trina Cuppett, CPC, CPC-H
President, Hickory Coding Specialist, Hickory, N.C.
Coding Edge (CE): Tell us a little bit about
your career—how you got into coding,
what you’ve done during your coding
career, what you’re doing now, etc.?
Trina: My first job was at the age of 18 in
a medical office working as an administrative assistant to the clinical director. One of
my duties was filing worker’s compensation
claims. I have also worked as a practice coordinator in a family practice and psychiatric
practice. Another medical job I had was
filing UB-92s for a hospital billing office
and conducting chart audits for outpatient
hospital services. Currently, I teach billing
and reimbursement issues and medical terminology and anatomy at a local community
college.
CE: What is your involvement level with
your local AAPC chapter?
Trina: I started with the Hickory Chapter at
its inception in 2004 and I am the president.
In the past, I have networked with the Statesville Coding Chapter and started the Mooresville Coding Chapter in Mooresville, N.C.
I have also mentored two previous chapter
presidents; and I am currently working with
Mooresville chapter President Marcia Kraus to
promote networking among our local chapters.
CE: What has been your biggest challenge as a coder?
Trina: My biggest challenge as a coder has
probably been implementing “mentoring” in
our area for students and new members. Most
of us forget that when we first got into the
field someone, somewhere helped us along
the way. I’m a firm believer in paying it forward. Recently, I had some seasoned members come into the classroom for mentoring
42 AAPC Coding Edge
with students and the students really appreciated our members giving them an hour of
their time. The mentors explained their ideas
on breaking into the coding field, landing a
first job in the medical field, and studying
tips for their upcoming CPC® exams.
CE: What do you advise other coders
to do if they disagree with the way
a physician has coded his chart? Do
you approach the physician, or have a
monthly meeting?
Trina: I have always approached the physician directly. In some environments it is
difficult to have regular monthly meetings
due to patient scheduling, rounds, and call
duties. I have found that most physicians
are extremely receptive to being approached
about coding issues. Compliance is such an
important issue that physicians want to make
sure they are aware of possible discrepancies.
CE: If you could have any other job,
what would it be?
Trina: I am blessed to be doing it. Teaching has afforded me the opportunity to
help implement classes, to be proactive for
change, and to help our local coding students
in school and through the chapter. I feel very
blessed to be doing what I enjoy.
CE: How do you spend your spare time?
Tell us about your hobbies, family, etc.
Trina: I am a student with a double major
in paralegal technology and middle grade
education, so I don’t have a lot of spare time.
I love to read, garden, and travel with my
family as much as we can. My children love
going to zoos, aquariums, water parks, the
mountains, and the beach.
Alert!
Buyers of
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that help you find the right code, faster.
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that the AMA has been purchasing it from us for the past 16 years and publishing it under
their book cover. But that will change this year. For 2010, the only way to guarantee you
receive the same content you’ve grown to rely on is to purchase the Ingenix product.
This time, you can judge a book by its cover. You might not know what to expect
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Make sure you’re getting the ICD-9-CM content you’ve come to rely on.
For more information, call us at (800) INGENIX (464-3649), option 1,
or visit www.shopingenix.com\ ICD9.
The Case of the Alphabetic Bowel
A double loop (Maydl) hernia, although rare, isn’t necessarily twice as difficult to code as a more typical hernia.
In this case, a 40-year-old male presented with a 48-hour history of colicky pain in the abdomen and pain in the left inguinal
region with vomiting and progressive abdominal distension. He had a lump in the left inguinal region that had not been tender
and easily reducible for 20 years.
During surgery, the hernial sac was found to have 250 ml of foul-smelling brownish fluids, which were removed. Exploration of
the sac revealed the hernia contained a segment of small bowel, the cecum, and the appendix, all of which were gangrenous.
The intra-abdominal section of small bowel was 1.5 meters long and also gangrenous. The physician performed a massive small
bowel resection and excision of the cecum and appendix, along with an ileocolic anastomosis.
In this case, ICD-9-CM coding is fairly straightforward, in spite of the uncommon nature of the patient’s condition. Code 550.0x
Inguinal hernia; with gangrene defines an inguinal hernia with gangrene, as is documented in this case, and includes obstruction. The hernia is a double loop, but that does not mean it is bilateral. The hernia is not specified as recurrent (although the
patient has exhibited an easily-reducible lump in the left inguinal region for many years). As such, a fifth digit of “0” unilateral
or unspecified (not specified as recurrent) is appropriate.
The primary procedure (the procedure with the highest number of relative value units) in this case is the excision and anastomosis of the small bowel, 44120 Enterectomy, resection of small intestine; single resection and anastomosis.
The operative report defines the anastomis as massive, but there is only one resection and anastomosis. Add-on code +44121
Enterectomy, resection of small intestine; each additional resection and anastomosis (List separately in addition to code for
primary procedure) is not appropriate. The documentation does not contain specific information (such as the time required
to perform this particular procedure vs. the time required for a more typical case) necessary to append modifier 22 Unusual
procedural services to 44120.
Code 44960 Appendectomy; for ruptured appendix with abscess or generalized peritonitis describes removal of the gangrenous
appendix, and should be reported separately in this case. Note that the National Correct Coding Initiative (CCI) bundles a standard appendectomy (44950 Appendectomy) into the small bowel resection (44120). In the absence of evidence for abscess or
generalized peritonitis, you would not report the appendectomy separately.
The final (lowest-valued) code in this case is for the hernia repair: 49507 Repair initial inguinal hernia, age 5 years or older,
incarcerated or strangulated. The patient’s age (40), location of the hernia (inguinal), initial vs. recurrent (initial), and clinical
presentation (strangulated) all factor in the code choice. Note that CPT® instructions preceding hernia repair codes 4949149590 specify, “the excision/repair of strangulated organs or structures such as testicle(s), intestine, ovaries are reported by
using the appropriate code for the excision/repair.” This is why we would report the enterectomy, 44120, separately.
44 AAPC Coding Edge
extreme coding
Can You Code This Note?
MALT Lymphoma Confined to Colon
Primary malignant lymphoma of the large intestine is rather
rare, accounting for only 0.2 percent of primary neoplasms
of the large intestine. Intestinal marginal zone B-Cell lymphoma (MZL) of mucosa-associated lymphoid tissue (MALT)
type is equally rare. Here, the patient has a MALT lymphoma involving only the colon, with no other evidence of
Non-Hodgkin’s lymphoma (NHL).
Can you code this?
ary care
ear-old female presented to her prim
Indications: An asymptomatic, 52-y
negative for
health exam. Review of systems was
physician’s office for a routine
on in bowel
t sweats, hematochezia, or alterati
weight loss, fatigue, chills, nigh
on digital
rkable for a rectal poly p palpable
function. Physical exam was rema
normal CBC,
negative, and lab studies revealed
rectal exam. Stool was hemoccult
function.
creatinine, calcium, and hepatic
a 0.5-cm
a routine colonoscopy that revealed
Procedure: The patient underwent
al poly p was
ke villous mass at 60 cm. The rect
rectal poly p and a 4 cm frond-li
ures. A subically demonstrated lymphoma feat
hyperplastic, and the mass histolog
nt with
iste
d. The surgical specimen was cons
sequent hemicolectomy was performe
lymphoma of MALT type.
extranodal marginal zone B-Cell
unctive chemothe resection and has finished conj
The patient recovers well after
scans shows no evidence of NHL.
therapy successfully. A repeat CT
Have You Gone to Extremes?
Have you got a challenging scenario you’d like to see discussed in
this forum? Send your op report to [email protected].
Before forwarding it to us, please safeguard the patient’s personal
information by changing dates and removing unique identifiers.
www.aapc.com
March 2009
45
road map
Walk Through Skin and Subcutaneous Tissue Crossovers
Walk Through Skin and Subcutaneous Tissue Crossovers
Road Map to ICD-10-CM
By Deborah Grider, CPC, CPC-H, CPC-P, CEMC, CPC-I, CCS, CCS-P
46 AAPC Coding Edge
Our journey using the ICD-10-CM roadmap leads
us to draft guidelines and coding issues focusing on
“Understanding the ICD-10-CM Draft Guidelines for
the Skin and Subcutaneous Tissue.” Consider the codes
for the Skin and Subcutaneous Tissue located in chapter 12 of ICD-10-CM.
In ICD-9-CM there are three subchapters in chapter 12:
680–686 Infections of skin and subcutaneous tissue
690–698Other inflammatory conditions of skin and
700–709
subcutaneous tissue
Other diseases of skin and subcutaneous tissue
These three subchapters were expanded in ICD-10-CM
chapter 12 to include blocks L00-L99, as follows:
L00–L08 Infections of the skin and subcutaneous tissue
L10–L14 Bullous disorders
L20–L30 Dermatitis and eczema
L40–L45 Papulosquamous disorders
L50–L54 Urticaria and erythema
L55–L59Radiation-related disorders of the skin and
subcutaneous tissue
L60–L75 Disorders of skin appendages
L76Intraoperative and postprocedural complications of
dermatologic procedures
L80–L99 Other disorders of the skin and subcutaneous tissue
Chapter 12 in ICD-10-CM was restructured to bring
together related disease groups. Nearly all of the categories and subcategories in ICD-10-CM were expanded to
either the fourth- or fifth-character level in this chapter.
ICD-10-CM includes a number of category and/or subcategory title changes to adequately reflect the content.
Diseases were grouped in either their own blocks or new
categories to identify specific disease types.
Codes in ICD-9-CM moved to chapter 12 in ICD-10-CM:
ICD-9-CM
ICD-10-CM
704.1 Hirsutism
L68
039.0 Erythrasma
L08.1 Erythrasma
136.0 Ainhum
L94.6 Ainhum
Hypertrichosis
The codes in categories L89 Decubitus ulcer and L97
Non-decubitus chronic ulcer of lower limb, not elsewhere classified contain a great deal of detail.

The fourth character delineates the anatomy
details (right versus left, upper versus lower).

The fifth character identifies the ulcer’s specific site.

The sixth character identifies ulcer depth.
For example: A physician is called by the nursing home
to treat a patient with bed sores on the left buttock.
After examining the patient, the physician documents
decubitus ulcer, left buttock, stage II.
Compare a pressure ulcer (decubitus ulcer) of the
left buttock:
ICD-9-CM
707.0 Chronic ulcer of skin
L89 Pressure Ulcer
707.0 Pressure ulcer
Bed sore
Decubitus ulcer
Plaster ulcer
Use addition code to identify pressure ulcer stage
Decubitus ulcers were also expanded in ICD-10-CM.
In ICD-9-CM, two codes are used to identify the decubitus ulcer and a secondary code is assigned to identify
the pressure ulcer stage. In ICD-10-CM, only one code
is needed to adequately describe the condition and the
ulcer’s stage.
Includes:
bed sore
decubitus ulcer
plaster ulcer
pressure area
pressure sore
707.02 Buttock
Code any association
gangrene (I96)
707.2 Pressure ulcer stages
L89.3Pressure ulcer of
Code first site of pressure
ulcer (707.00-707.09)
L89.32Pressure ulcer of
(707.20-707.25)
707.20Pressure ulcer,
unspecified stage
707.21Pressure ulcer
stage I
707.22Pressure ulcer
stage II
707.23Pressure ulcer
stage III
707.24Pressure ulcer
stage IV
707.25Pressure ulcer
unstageable
Decubitus Ulcers and
Non-decubitus Chronic Ulcers of Lower Limbs
ICD-10-CM
buttock
left buttock
L89.321Pressure ulcer of
left buttock stage I
L89.322Pressure ulcer of
left buttock, stage II
L89.323Pressure ulcer of
left buttock, stage III
L89.324Pressure ulcer of
left buttock, stage IV
L89.329Pressure ulcer
of left buttock,
unspecified stage
Using ICD-9-CM, two codes are necessary. The first
listed diagnosis identifies the decubitus ulcer’s location
and the secondary code describes the ulcer’s stage. In
ICD-10-CM, only one code is necessary to describe
both the pressure ulcer site and the ulcer’s stage. Notice
the level of specificity in ICD-10-CM.
road map
ICD-9-CM
ICD-10-CM
707.02Decubitus ulcer
L89.322Pressure ulcer of left
of the buttock
707.22Pressure ulcer
stage II
buttock stage II
When assigning a code for these ulcers using
ICD-10-CM, review the record thoroughly to verify
both the ulcer’s site and severity. For multiple ulcers of
the same site, it is only necessary to assign a code for
the most severe ulcer.
Any condition reducing blood flow to the legs may
cause a lower limb ulcer. The same condition may also
prevent an ulcer from healing, even with aggressive
treatment. When the underlying condition is known, it
should be sequenced before the ulcer.
Atherosclerosis of the lower extremities and diabetes
mellitus are common underlying conditions. Combination codes for atherosclerosis of the lower extremities
and diabetes mellitus include lower extremity ulcers.
The sequencing instructions at categories L89 and L97
differ slightly from the standard conventions, however.
A serious decubitus ulcer that does not respond to
treatment may be a reason for hospital admission. If
decubitus ulcer is the reason for admission, it should
be the principal, first-listed diagnosis. Secondary codes
for the other decubitus ulcer-associated health problems should also be assigned. Generally, an underlying
condition is responsible for a non-decubitus ulcer of the
lower limb (L97).
An L97 code should be used with the combination
code for the underlying condition to specify the ulcer’s
site and depth. In some cases, no underlying cause for
the ulcer is documented. In such cases, a code from
L97 may be listed first.
The instructional note at L97 indicates the “code first”
note is applicable only when an underlying condition is
documented.
For example: A patient is treated in the outpatient hospital wound care clinic for a severe non-healing ulcer of
the right midfoot and heel with bone necrosis due to
diabetes mellitus.
Compare ICD-9-CM and ICD-10-CM codes
ICD-9-CM
ICD-10-CM
250.81 Diabetes with other
E086.621 Diabetes mellitus due
specified manifestations, type I
[juvenile type], not
stated as uncontrolled
707.14 Ulcer of heel and
midfoot
to underlying condition with foot ulcer
L97.413Non-pressure
chronic ulcer of
right heel and midfoot with necrosis
of bone
Both decubitus and non-decubitus ulcers may become
so severe that gangrene (necrosis of the tissue) sets in
at the ulcer’s site. For gangrene cases resulting from a
skin ulcer, the gangrene should be sequenced first, followed by the code for the ulcer.
When gangrene is present, the primary focus of treatment is to remove the gangrene, usually with debridement or amputation of the affected area. The “code
first” note at categories L89 and L97 instructs that
gangrene should be sequenced before the ulcer. This
note applies only if gangrene is present.
For example: A patient with a gangrenous pressure
ulcer of the right ankle, with necrosis of the muscle
and bone is treated for debridement of the area.
Review the comparison:
ICD-9-CM
ICD-10-CM
707.06 Pressure ulcer, ankle
I96Gangrene, not else-
707.24 Pressure ulcer, stage IV
785.4 Gangrene
where classified
L89.514Pressure ulcer of
right ankle, stage IV
Using ICD-9-CM, gangrene of the lower extremities
instructional notes state to code first any associated
condition. In the example above, the pressure ulcer and
the ulcer’s stage are coded first and second, with the
gangrene as a tertiary diagnosis. In ICD-10-CM, the
instructional notes identifies that gangrene is coded
first, followed by the pressure ulcer. This differs from
ICD-9-CM instructions.
A secondary external cause code identifying the exposure’s source should be used when reporting categories
L56 Other acute skin changes due to ultraviolet radiation
and L57 Skin changes due to chronic exposure to non-ionizing
radiation.
For example: A female patient who uses a tanning bed
in her apartment daily is treated by a dermatologist for
multiple solar keratoses on her face due to overexposure
in the tanning bed.
Compare ICD-9-CM and ICD-10-CM:
ICD-9-CM
ICD-10-CM
702.0 Actinic keratoses
L57.0Actinic keratoses
E926.2Visible and ultraviolet
light sources
E849.0Place of occurrence,
home
(solar)
W89.1Exposure to
tanning bed
Y92.039Place of occur-
rence apartment
With both ICD-9-CM and ICD-10-CM, the condition followed by the external cause code is reported.
Because the location of the overexposure is known, it
can be reported as well. Notice in ICD-10-CM, the
place of occurrence states “apartment.”
www.aapc.com
March 2009
47
road map
To discuss this
article or topic, go to
http://forums.aapc.com/
The place of occurrence codes for home is sub-divided
to include apartment, boarding home, single family
residence, institution, nursing home, prison, reform
school dormitory, and mobile home. These categories are further divided to include areas of the home
including, bathroom, bedroom, driveway, garden,
kitchen, swimming pool, etc.
Compare ICD-9-CM and ICD-10-CM place of occurrence residential codes for an apartment and a single
family home:
L76.11Accidental puncture and laceration of skin and subcu-
taneous tissue during a dermatologic procedure
L76.12Accidental puncture and laceration of skin and subcu-
taneous tissue during other procedure
L76.2Postprocedural hemorrhage and hematoma of skin
and subcutaneous tissue following a procedure
L76.21Postprocedural hemorrhage and hematoma of skin
and subcutaneous tissue following a dermatologic
procedure
L76.22Postprocedural hemorrhage and hematoma of skin
and subcutaneous tissue following other procedure
ICD-9-CM
ICD-10-CM
Y92.00residence (non-
Y92.00residence (non-insti-
institutional)
(private)
tutional) (private)
Y92.019house, single family
Y92.039 apartment
Y92.010 kitchen
Y92.031 bathroom
Y92.011 dining room
Y92.032 bedroom
Y92.012 bathroom
Y92.030 kitchen
Y92.013 bedroom
Y92.038 specified NEC
Y92.014 driveway
Y92.015 garage
Y92.016 swimming pool
Y92.017 garden or yard
Y92.018 specified NEC
ICD-10-CM category L76 Intraoperative and postprocedural complications of dermatologic procedures is a new
subsection found in chapter 12 that is divided into
fourth and fifth characters:

Fourth character describes complications and con
ditions following surgery, such as hemorrhage and
hematoma

Fifth character further specifies the complication
Examples of postprocedural
complications in ICD-10-CM include:
L76Intraoperative and postprocedural complications of
skin and subcutaneous tissue
L76.0Intraoperative hemorrhage and hematoma of skin and
subcutaneous tissue complicating a procedure
Excludes: Intraoperative hemorrhage and hematoma of skin
and subcutaneous tissue due to accidental puncture
during a procedure (L76.1-)
L76.01Intraoperative hemorrhage and hematoma of skin and
subcutaneous complicating a Dermatologic procedure
L76.02Intraoperative hemorrhage and hematoma of skin and
subcutaneous complicating other procedure
L76.1Accidental puncture and laceration of skin and subcu-
taneous tissue during a procedure
48 AAPC Coding Edge
L76.8Other intraoperative and postprocedural complica-
tions of skin and subcutaneous tissue
Use additional code, if applicable to further specify disorder
L76.81Other intraoperative complications of skin and subcu-
taneous tissue
L76.82Other postprocedural complications of skin and sub-
cutaneous tissue
Some of the codes in chapter 12 of ICD-10-CM have
been expanded further to include notes directing the
coder to use an additional code:

Use additional code (B95–B97) to identify organism

Code first (T36–T65) to identify drug or substance

Code first underlying disease

Code first any associated
For example:
L00–L08 Infections of the skin and subcutaneous tissue
Use additional code (B95–B97) to identify infectious agent
L02 Cutaneous abscess, furuncle and carbuncle
Use additional code to identify organism (B95–B96)
L23 Allergic contact dermatitis
Code first (T36–T65) to identify drug or substance
Because ICD-10-CM codes are expansive compared
to ICD-9-CM codes, coding skin and subcutaneous
tissue will be challenging. Detail and specificity in
documentation are the key ingredients to successfully
coding ICD-10-CM skin and subcutaneous tissue.
Next up is “Diseases of the Musculoskeletal System
and Connective Tissue.”
Deborah Grider, CPC, CPC-H,
CPC-P, CEMC, CPC-I, CCS,
CCS-P, is the president of the
AAPC’s National Advisory Board.
She is also writing the ICD-10-CM
Implementation Guide, which will
be released in 2009.
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test yourself
Coding Edge Tests Your Knowledge
March 2009
Index: CE03002009A
1. The physician sees an established patient with a new diagnosis of diabetes. If the total visit lasts 25 minutes,
what is the minimum number of minutes the physician must spend on counseling and/or coordination and care
to code the visit using time—rather than history, exam, and medical decision-making—as the controlling factor
in selecting an E/M level?
a. 12 minutes
b. 13 minutes
c. 25 minutes
d. There is no minimum time requirement.
2. The physician sees a new patient in consultation for a total of 35 minutes. Using time as the key factor, what is
the correct code for this visit if 20 minutes are spent in counseling and coordination and care?
a. 99202
b. 99203
c. 99242
d. 99243
3. Under ICD-9-CM, you must use a minimum of two separate codes to describe what characteristics of a pressure ulcer?
a. location and depth
b. location and any associated diabetes
c. location and any associated gangrene
d. location and stage
4. ICD-10-CM category L76 describes intraoperative and postprocedural complications of dermatologic procedures. Which of the choices below best describes the information conveyed by the forth digit in this category?
a. complications and conditions following surgery
b. intra-operative hemorrhage and/or hematoma
c. post-operative hemorrhage and/or hematoma
d. accidental puncture and laceration of skin and subcutaneous tissue
5. Which modifier applies when the same physician performs an unrelated E/M service that occurs during the
global period of a previous procedure?
a. modifier 24
b. modifier 25
c. modifier 57
d. The same physician may never bill for an E/M service during another procedure’s global period.
6. Which of the choices below best describes the difference between modifiers 25 and 57?
a. Modifier 25 applies only to E/M services; modifier 57 applies only to surgical services.
b.Modifier 25 applies to E/M services separately provided with minor procedures (those with 0-day, 10-day, or no
global period); modifier 57 applies to E/M services that prompt a major (90 day global) procedure.
c.Modifier 25 applies only to a separate, distinct E/M service; modifier 57 applies to any E/M service provided immediately prior to surgery.
d.Modifier 25 requires a separate diagnosis for the E/M and same-day procedure; modifier 57 does not require
separate diagnoses for the E/M service and same-day procedure.
7.
8. In the office, the same ophthalmologist removes sutures during the global period of a previous surgery. How
would you report this service?
a. using an appropriate E/M code
b. 66250
c. The service is not separately billable.
d. 15850
9. Which code would you choose for backbench preparation of a liver for transplant taken from a cadaver, with
trisegment split of whole liver graft?
a. 47140
b. 47143
c. 47144
d. 47145
10. A CVA patient receives skilled treatment consisting of 20 minutes of therapeutic exercise (CPT® 97110) and
25 minutes of gait training (CPT® 97116). The total “Timed Code Treatment Minutes” documented will be 45
minutes. What is the proper coding?
a. 97110, 97116
b. 97110, 97116 x 2
c. 97110 x 2, 97716
d. 97110 x 2, 97716 x 2
Get One CEU
These questions are answered in articles
throughout this news magazine. For answering all questions correctly, you will receive one
CEU at the time of your renewal. These CEUs
are awarded in addition to the CEUs available annually for submitting summaries from
Coding Edge. Please do not submit until your
renewal date.
Test Yourself Online
These same questions can be accessed online at
www.aapc.com/testyourself/. Once you go there
and take the test, you can automatically grade
your answers, correct any mistakes and have
your CEUs automatically added to your CEU
Tracker for submission.
50 AAPC Coding Edge
How would you indicate a bilateral procedure for Fluorescein angiography, 92235?
a. 92235 x 2
b. 92235-50
c. 92235-LT, 92235-RT
d. Coding varies by payer preference.
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