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HEALTHCARE
BUSINESS MONTHLY
Coding | Billing | Auditing | Compliance | Practice Management
Get Paid for Smoking Cessation: 22
Don’t give up on reimbursement: Verify coverage
Exude Confidence as an Auditor: 52
Ditch the emotional baggage and gain respect
Tips to Improve HEDIS Scores: 60
Enhance quality of care and reduce costs
July 2016
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Healthcare Business Monthly | July 2016
COVER | Coding/Billing | 38
Secrets of Successful Coders
Apply 14 strategies to help you climb your way to coding success.
By Stephanie Cecchini, CPC, CEMC, CHISP
[contents]
■ Coding/Billing
■ Added Edge
■ Practice Management
22 Get Paid for Smoking Cessation
52 Ditch the Emotional Baggage to
Become a Respected Auditor
56 Manage Hospital
Staff Cellphone Distractions
Kasandra Bolzenius, CPC
Holly Pettigrew, COC, CPC, CHC
Michelle A. Dick
[continued on next page]
www.aapc.com
July 2016
3
Healthcare Business Monthly | July 2016 | contents
■ Member Feature
16
14 Emory Physician Group Practice Celebrates and Prepares Its Coders
Donna Beaulieu, CRC, C-CDIS, CPC-I, CPMA, CPC, CEMC, CEDC, CFPC, CCP-P, CRP
Hasan Zaidi, MPH, CPC, CEDC, CSPPM
■ Coding/Billing
16 MACRA FAQs
Renee Dustman
20 Think Twice Before Sticking It in Your Ear
Maryann C. Palmeter, CPC, CENTC, CPCO, CHC
24 Providers vs. Payers: Collaboration is the Best Medicine
24
Susanne Myler, COC
28 Cut Costs with Quality Transitional Care Management
Stephen Canon, MD
32 Combat Common Denials in Orthopedic Coding
Michael Strong, MSHCA, MBA, CPC, CEMC
42 Soothe the Sting of 2016 Paravertebral Block Changes
Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CANPC, CASCC, CEDC, CRC,
ICDCT-CM/PCS
44 ICD-10 Restricts Same-day Sick and Well Visits
Debra Mitchell, MSPH, COC
48 WHO Winds Its Gears for ICD-11
50
Brad Ericson, MPC, CPC, COSC
50 The Latest on Multianalyte Assays with Algorithmic Analyses
John Verhovshek, MA, CPC
■ Auditing/Compliance
54 Guard PHI with Sensitivity
Andy Rusch, CPC
■ Practice Management
60 HEDIS: Manage Your Healthcare Outcomes
COMING UP:
•• Cardiac Cath Reports
•• Officer Nominations
•• Audit Defense
•• Medical Device Credits
•• ICD-10 Best Practices
On the Cover: Stephanie Cecchini, CPC, CEMC, CHISP, reveals 14
secret strategies that will help you climb your way to coding success.
Cover photo by Rachel Momeni.
4
Healthcare Business Monthly
Lynn Stuckert, LPN, CPC, CPMA
DEPARTMENTS
7
Letter from Member Leadership
8
Letters to the Editor
9
I Am AAPC
66 Minute with a Member
EDUCATION
62 Newly Credentialed Members
10 AAPC Chapter Association
11 AAPC National Advisory Board
12 Chapter News
47 Dear John
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HEALTHCARE
BUSINESS MONTHLY
Coding | Billing | Auditing | Compliance | Practice Management
July 2016
• You will save a few trees.
Publisher
• You won’t have to wait for issues to come in the mail.
Brad Ericson, MPC, CPC, COSC
[email protected]
• You can read Healthcare Business Monthly on your computer, tablet, or
other mobile device—anywhere, anytime.
Managing Editor
• You will always know where your issues are.
John Verhovshek, MA, CPC
[email protected]
• Digital issues take up a lot less room in your home or office than paper
issues.
Editorial
Go into your Profile on www.aapc.com and make the change!
Michelle A. Dick, BS
vendor index
Renee Dustman, BS
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Ohana Healthcare, LLC........................................................ 65
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Superbill Consulting Services, LLC...................................... 65
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The Coding Institute, LLC.....................................................47
www.codinginstitute.com/books
The HIPAA Institute............................................................ 65
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©2016 Healthcare Business Monthly. All rights reserved. Reproduction in whole or in part, in
any form, without written permission from AAPC® is prohibited. Contributions are welcome.
Healthcare Business Monthly is a publication for members of AAPC. Statements of fact or
opinion are the responsibility of the authors alone and do not represent an opinion of AAPC,
or sponsoring organizations.
CPT® copyright 2015 American Medical Association. All rights reserved.
Ask the Legal Advisory Board
From HIPAA’s Privacy Rule and anti-kickback statute, to compliant coding,
6
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The
AMA is not recommending their use. The AMA does not directly or indirectly practice medi-
to fraud and abuse, there are a lot of legal ramifications to working in
healthcare. You almost need a lawyer on call 24/7 just to help you make
sense of all the new guidelines. As luck would have it, you do! AAPC’s Legal
Advisory Board (LAB) is ready, willing, and able to answer your legal questions. Simply send your health law questions to [email protected] and let
the legal professionals hash out the answers. Select Q&As will be published
in Healthcare Business Monthly.
cine or dispense medical services. The AMA assumes no liability for data contained or not
Medical Coding Legal Advisory Committee:
CPT® is a registered trademark of the American Medical Association.
Timothy P. Blanchard, JD, MHA, FHFMA
Julie E. Chicoine, JD, RN, CPC
Michael D. Miscoe, JD, CPC, CPCO, CPMA, CASCC, CCPC, CUC
Christopher A. Parrella, JD, CPC, CHC
Robert A. Pelaia, Esq., CPC
Stacy Harper, JD, MHSA, CPC
CPC®, COCTM, CPC-P®, CPCOTM, CPMA®, and CIRCC® are registered trademarks of AAPC.
contained herein.
The responsibility for the content of any “National Correct Coding Policy” included in this
product is with the Centers for Medicare and Medicaid Services and no endorsement by the
AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information contained in this product.
Volume 3
Number 7 July 1, 2016
Healthcare Business Monthly (ISSN: 23327499) is published monthly by AAPC, 2233 South Presidents
Drive, Suites F-C, Salt Lake City UT 84120-7240, for its paid members. Periodicals Postage Paid
at Salt Lake City UT and at additional mailing office. POSTMASTER: Send address changes to:
Healthcare Business Monthly c/o AAPC, 2233 South Presidents Drive, Suites F-C, Salt Lake
City UT 84120-7240.
Letter from Member Leadership
Two Unique-to-AAPC
Resources Have Unsurpassed Value
A
s I glanced at the table of contents for this
month’s Healthcare Business Monthly two
things immediately came to mind. My first
thought is how fortunate we are to have a
monthly publication that provides us with
so much valuable information. The topics
are current, varied, and answer the needs of
members for each of our specialties, jobs, and
responsibilities. My second thought is how
valuable our local chapters are to members.
Local Chapters Bring
You the Best at May MAYnia
Looking at all the topics that were
presented across the country for this year’s
May MAYnia, I’m impressed at how the
local chapters went all out to provide
members with some incredible educational
opportunities. The topics were just as varied
as the ones presented in this magazine.
Chapter officers worked hard to make the
meetings successful. Some held all-day
events, others combined May MAYnia into
their regular monthly meeting, adding prizes
and giveaways, and encouraging members
to bring guests. The photos, posts, and
updates kept “AAPC Alex” very busy on the
AAPC Facebook page. The excitement was
contagious.
Take the typical excitement you find at a
normal chapter meeting and step it up a
notch or two and you have the fever that
is May MAYnia. I was both fortunate
and honored to be the speaker at the
Indianapolis, Indiana, local chapter’s May
MAYnia. The spirit of the event stayed with
me for many days.
dream jobs because of connections made at
chapter meetings.
The only sadness I have in regards to local
chapters is how many of my own local
chapter meetings I cannot attend due to my
traveling schedule.
Dive into Your Valuable Resources
I hope you enjoy this month’s edition of
Healthcare Business Monthly. Find your
favorite article and discuss it with peers at
your next chapter meeting. Better yet, think
of an article you want to write for Healthcare
Business Monthly or a topic you’d like to
present at your local chapter. Have no fear!
You’ll be among friends who appreciate your
expertise.
Nothing compares
to seeing members
show up at a meeting
and watching the
networking that starts
immediately.
Take care,
I Love Local Chapter Meetings!
Nothing compares to seeing members
show up at a meeting and watching the
networking that starts immediately. Some
members have made lifelong friends at their
chapter meetings. Others have found their
Jaci Johnson Kipreos, CPC, COC, CPMA,
CPC-I, CEMC
President, National Advisory Board
www.aapc.com
July 2016
7
Please send your letters to the editor to:
[email protected]
Letters to the Editor
Failure to Report a
Crime Is Not a Crime
“Are Auditors, Billers, and Coders Liable
for False Claims?” (May 2016, pages 48-49)
contained an inaccurate statement: “Having
knowledge and being aware of a person or
entity generating fraudulent claims is a crime.”
To clarify, no person has an affirmative duty to
report a crime or to report fraudulent conduct
such that failure to do so is, in itself, a crime.
Coders do not need to fear that they will be
liable for the misconduct of others, especially
when they are instructed to code or bill in a
manner they are not comfortable with.
Although coders have an ethical duty to
advise a provider or entity of what they
perceive to be inappropriate coding or
billing practices, they have no legal duty
to do so, and have no legal duty or AAPC
Code of Ethics duty to report such conduct
to law enforcement. A coder could not be
charged with a crime for failing to report
misconduct no more than a person who
witnessed a murder could be charged for not
reporting what he or she saw to police.
A coder’s liability under the False Claims
Act only arises when he or she is an active
participant in the misconduct (this may
have been the unstated presumption of the
statement cited from the article). In such
cases, a coder might face direct and/or
conspiracy liability. Additionally, a coder
could be held liable for obstruction if he or
she assisted in efforts to conceal the crime
by destroying or altering records in response
to a government investigation.
Michael D. Miscoe, Esq., CPC, CASCC,
CUC, CCPC, CPCO, CPMA
Proper Codes for
Nephrostomy Tube Removal
An example in “CPT® 2016: Urinary
Interventional Coding” (March 2016,
page 19) did not list the proper coding for
nephrostomy tube removal. The example
should have specified:
Example: A patient has an existing
nephrostomy catheter. Diagnostic
nephrostogram is performed (50431),
demonstrating a mid-ureteral stenosis.
Ureteroplasty is performed (+50706). The
nephrostomy tube is removed and not
replaced at the end of the procedure (50389).
Biliary Coding Example
Needs Clarification
The article “Percutaneous Biliary
Interventional Coding” (April 2016, pages
28-31) included an example on page 29 (top
right), which should have specified:
Example: A patient has an existing external
biliary drainage catheter. Diagnostic
cholangiogram is performed (47531),
demonstrating a distal common bile duct
stenosis. Cholangioplasty is performed
(+47542). No tubes are left in place at the
end of the procedure (add 47537 for tube
removal and delete 47531 as bundled with
tube removal).
Thank you
TO THOSE
OF Y
VISITED U OU THAT
S AT
HEALTHCO AAPC
N 2016.
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8
TIERNEY DAVIS HOGAN, RN, MBA, CPC
A
fter a couple years in clinical nursing, I was drawn to the business side
of healthcare. Originally, I thought that meant I would be working
as a utilization review nurse for a health plan. After a couple of years in
medical management for health plans, including utilization review and case
management, I discovered my true interest was in medical claims review.
That gradually led to an interest in reviewing claims not only for medical
necessity but for all guidelines pertaining to coding and billing healthcare
services.
Solidifying Knowledge on the Business Side of Healthcare
After a couple of
years in medical
management
for health plans,
including utilization
review and case
management, I
discovered my
true interest was
in medical claims
review.
I went on to earn my Certified Professional Coder (CPC®) credential in
2007. I now work for a large health plan, where I transitioned from medical claims review to coding specialist project lead on a team responsible for
health plan benefits coding configuration.
My primary work focuses on ensuring that procedure and diagnosis coding configurations of health plan benefits are aligned with state and federal mandates, especially related to preventive care benefits mandated by the
Affordable Care Act.
It is interesting and challenging work. I have learned so much about
U.S. Preventive Service Task Force guidelines, Bright Futures guidelines,
Health Resources and Services Administration Women’s Preventive Services Guidelines, the Centers for Medicare & Medicaid Services FAQs related to preventive services, and state mandates related to preventive care.
#IamAAPC
I Am AAPC
Front- and Back-end Coders Working to Meet Standards
I work on the “back end” with health plan medical directors, ensuring that
coding of insurance benefits align with current standards of practice, as well
as state and federal mandates. My work has led me to greatly respect coders
who work on “the front line” with their physicians, ancillary providers, and
facilities.
#IamAAPC
www.aapc.com
July 2016
9
AAPC Chapter Association
By Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC
Validate Your Expertise
with a Specialty Credential
Show employers that you have coding,
reimbursement, and compliance know-how
in a unique area of healthcare.
istock.com/Casanowe
H
ealth facilities of all
sizes rely on medical
coders, compliance
officers, practice managers,
etc., to protect their livelihood by
obtaining proper reimbursement from
payers and patients for services rendered by providers on staff.
As such, these positions have a high degree of responsibility, and
employers are sometimes reluctant to hire new staff unless they can
prove competence in a specific area. Specialty certifications prove
you have what it takes to get the job done right.
A complete list of specialty credentials is listed on the AAPC
specialty credentials website: www.aapc.com/certification/specialty-credentials.
aspx, as shown in Figure A. Which certifications are right for you?
Find out at www.aapc.com/certification/medical-coding-certification.aspx.
Figure A: AAPC offers 22 specialty credentials.
Prove to Employers You Mean Business
Employers today are looking for applicants with a solid academic
foundation and relevant experience in particular areas of
healthcare. As the industry becomes more demanding, complex,
and competitive, certification gives you a distinct advantage among
other, less qualified job applicants.
Certification shows you are proficient in your specialty area
and committed to quality healthcare. Employers understand
the importance of certification, which is why it’s one of the first
qualifications they look for when scanning for potential candidates.
You’ll find it’s also an asset when you’re negotiating salary.
Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, specializes in dermatology coding. A
national speaker on coding and regulatory issues, she presents at American Academy of
Dermatology annual and summer meetings, AAPC regional conferences, and several other
venues. McNicholas has a wide range of experience in various medical specialties and practice
settings. She is also a certified and approved ICD-10-CM/PCS expert and trainer, a former
member of the AAPC Chapter Association, and has served office for the Des Plaines, Ill., local
chapter.
Choose Your Specialty
AAPC offers 22 specialty credentials you can earn to demonstrate
a superior level of expertise in your respective specialty disciplines.
That means they are standalone certifications with no requirement to
obtain the Certified Professional Coder (CPC®) credential.
Popular core credentials include:
CPMA® Certified Professional Medical Auditor
CPCO® Certified Professional Compliance Officer
CPPM® Certified Physician Practice Manager
CIRCC®Certified Interventional Radiology and
Cardiovascular Coder
CPB®
Certified Professional Biller
CRC®
Certified Risk Adjustment Coder
10
As the industry becomes more
demanding, complex, and
competitive, certification gives
you a distinct advantage among
other job applicants.
AAPC NATIONAL ADVISORY BOARD ■
By Angela Jordan, CPC
NAB Regional Spotlight: Region 6 – Great Lakes
Two representatives team up to promote, serve, and support AAPC and its Region 6 members.
T
he National Advisory Board (NAB) is
turning the spotlight this month to Region
6 – Great Lakes and its representatives. The
Great Lakes region is comprised of Wisconsin,
Minnesota, Illinois, Indiana, Michigan, and
Ohio. The six states of Region 6 cover 388,306
square miles. This region is home to 21,511
AAPC members and 77 local chapters.
Angela (Annie) Boynton, RHIT, CPC,
COC, CPCO, CPC-P, CPC-I, CCS,
CCS-P, of Shrewsbury, Massachusetts, and
Kimberly Reid, CPC, CPMA, CPC-I,
CEMC, of Burlington, Vermont, are the two
NAB representatives who promote, serve, and
support AAPC and its Region 6 members.
Annie Boynton, RHIT,
CPC, COC, CPCO, CPC-P,
CPC-I, CCS, CCS-P
Boynton has served in
the health information
management field for 15
years in provider, payer,
and educational capacities. She is principal of
Boynton Healthcare Management Solutions,
specializing in practice and payer consulting,
compliance, and education. Boynton holds
several certifications in coding, as well as
degrees in health information technology and
healthcare management, and she is pursuing
graduate work in health, hospital, and
pharmaceutical law at Seton Hall University.
The past few years, Boynton has traveled
the country teaching ICD-10 and other
workshops for AAPC. She has also spoken
at several national and regional AAPC
conferences, in addition to numerous chapter
Great Lakes Region Fun Fact
With a name like “Great Lakes” you’d expect a lot of
water. According to the U.S. Geological Survey Water
Science School, Michigan is covered with the highest
percentage of water at 41.50 percent. Minnesota,
known as “the land of 10,000 lakes,” is covered by
8.4 percent water.
meetings and conferences. You have probably
read her many articles in this publication over
the years. She was featured on the cover of the
October 2010 edition of AAPC’s Coding Edge
for her expertise on 5010 transaction prior
to ICD-10 adoption. Boynton is an active
member of the Worchester, Massachusetts,
local chapter.
Outside of work, Boynton is savvy with
genealogy. While working on her family tree,
she discovered she was related to another NAB
member, Chandra Stephenson, CPC, COC,
CPB, CPCO, CPMA, CPC-I, CIC, CCS,
CANPC, CEMC, CFPC, CGSC, CIMC,
COSC. She traced her lineage back six or
seven generations to the same family in the
same little town in Tennessee. It’s impressive
for two relatives to have honored AAPC with
NAB service.
Kimberly Reid, CPC,
CPMA, CPC-I, CEMC
Reid has worked in the
medical field for 28 years.
She began as receptionist
for a walk-in clinic near
Detroit, Michigan. Reid
recalls, “All I had to do was smile, pull charts
and chat it up with the patients. I loved it!
Everything about that job was fascinating,
except when they taught me how to draw
blood. That’s when I knew the coding part of
the medical field was where I belonged.” The
sight of blood made her faint.
Reid worked hard to gain experience in billing
and coding, and later took a position as
coding educator at the University of Vermont
(UVM) Medical Center. When the Medical
Center asked her to teach the Certified
Professional Coder (CPC®) class, she figured
it was high time she became credentialed.
Reid also got involved in the Burlington,
Vermont, local chapter, and worked her way
up the ranks to become president. AAPC
later chose her to become an expert ICD10 trainer, and eventually offered her the
position of director of ICD-10 Training
and Development, at which time she was
mentored by Rhonda Buckholtz, CPC,
CPCI, CPMA, CRC, CHPSE, CENTC,
CGSC, CPEDC, COBGYN.
When traveling became too difficult with a
young son, Reid went back to work for UVM
Medical Center. But when she confessed to
Buckholtz that she missed the camaraderie
she felt at AAPC, her mentor suggested she
apply to be on the NAB. She did, and the rest
is history.
“AAPC has been an incredibly positive
influence in my life. My coding credentials
have given me the opportunity to grow in a
way that I never thought was possible,” Reid
said. “Being part of the NAB allows me to
meet other coders and help them understand
the value of what we do every day.”
Reid has lived in Burlington, Vermont, for the
past 15 years. Although Reid loves Vermont,
she still has strong roots in Michigan, and
proudly displays her Michigander spirit; she
especially loves the Red Wings.
Making Region 6 Stronger
Both Boynton and Reid have a passion for our
profession, and they are dedicated to acting
as a voice to see us through the changes as
healthcare evolves. We encourage you to reach
out to them; they would enjoy hearing from
you. You can reach Boynton at Annie.Boynton@
aapcnab.com and Reid at [email protected].
If you want to be part of something that can
change people’s lives and provide you with
exceptional personal growth, we encourage
you to submit an application to serve on the
NAB. It will be an experience you’ll never
forget!
Angela Jordan, CPC, is managing consultant at Medical Revenue Solutions, LLC, with more than 25 years of
experience in the healthcare field, and has been a member of AAPC for 15 years. Her career path has taken her
from a small family practice, radiology, large physician services group to a
managing consultant. Jordan is on the AAPC NAB and has held many offices in the Kansas City, Mo., local chapter, including president. In 2009, she
served on the AAPC Chapter Association board of directors and was chairwoman in 2012.
www.aapc.com
July 2016
11
Chapter News
By Michelle A. Dick
May MAYnia: Fun and Education Overload
Chapters turn up the value for this annual event.
E
very year AAPC local chapters celebrate May MAYnia, which is a
fun way to provide members with quality education, draw in new
members, and promote networking with colleagues. Four chapters
share how they ramped up participation at their monthly meetings
last May.
Clearwater Gulf to Bay, Florida
The Clearwater Gulf to Bay, Florida, local chapter chose a beach
theme for their May MAYnia celebration, complete with sand
toys, flip-flops, and seashells. They named the foods to correspond
of Clearwater’s officers smoked a pork butt all day, so members could
enjoy pulled pork sandwiches. In addition to the goodies AAPC sent,
they raffled off a gardening basket and a tote bag filled with beach
essentials. They also gave out dozens of “beachy” door prizes. As for
coding education, Laureen Jandroep, COC, CPC, CPPM, CPC-I,
CEO of Certification Coaching Organization, gave a presentation
on modifiers.
The newest member of the Clearwater chapter, Terry Paulus, CPC, a
transplant from Kentucky, said, “The Clearwater Gulf to Bay AAPC
local chapter May MAYnia was the best I have ever experienced in
the 10 years of attending local chapter meetings. The food, fun,
and fabulous raffle items were over the top. Good job Sandi Webb,
Christine Cornforth, and Cindy Lewis. You guys are the best!”
Webb said, “The best part was a larger-than-usual turnout and the
fellowship we all enjoyed that evening.”
Big Stone Gap, Virginia
Clearwater’s “Beach Rules” helped members come out of their shell at May MAYnia.
with the beach theme: “Spinach dip was seaweed dip, pretzel sticks
were driftwood, blue punch was gulf water, and we had a cake with
a shoreline motif on top, as well as Nutter Butter flip-flops,” said
chapter Vice President Sandi Webb, BA, CPC. The husband of one
Nutter Butter flip-flops and shoreline
cake were a big hit at Clearwater’s beach-themed May MAYnia.
12
May was filled with positive activities for the Big Stone Gap,
Virginia, local chapter. On May 1, several members participated
in the Mountain Empire Older Citizens Walkathon. The proceeds
from each walkathon benefited the Emergency Fuel Fund for the
Elderly and assisted senior citizens with home heating-related
emergencies during the winter months. The chapter raised $550. To
top off the chapter’s good deeds, on May 13, six of Big Stone Gap’s
students and AAPC members (five are Certified Professional Coders
(CPCs®)) earned their associate degree in Health Information
Management.
Sabrina Ward, CPC, CCA, CEHRS, CBCS, said, “We are a small
chapter — but thanks to the involvement of our students, we are
Big Stone Gap and their families join Mountain Empire
Community College for a walkathon to benefit senior citizens.
Chapter News
Cynthia Brigg’s PAC Family Trivia game was a big success in Petersburg.
The Big Stone Gap HIM graduates are a proud group.
seeing a growth in our meetings and looking forward to what’s to
come!”
Petersburg, Virginia
May MAYnia was a success for the Petersburg, Virginia, local
chapter. Keisha Sutton, CPC, from The American Congress of
Obstetricians and Gynecologists, or ACOG, spoke for two hours
on defining the obstetrics/gynecology global package. After her
presentation, members played a trivia game that Petersburg President
Cynthia Briggs, CPC, CPMA, created called PAC Family Trivia.
If you are interested in incorporating the game at your next chapter
meeting, here’s how it’s played:
• Each table has 25 cards containing coding-related questions
facing down in the middle of the table.
• Members take turns reading the questions, and the remaining
members at the table try to be the first to answer each question
correctly.
• The member who answers correctly first gets the card. If no one
answers the question correctly the reader keeps the card.
• Whomever has the most cards at the end of the game wins!
Petersburg had over 30 members attend, which is up from last year.
AAPC’s giveaways were a big hit: Two members won ICD-10-CM
codebooks as door prizes and two new coders each won an AAPC
Coder subscription. Briggs said, “All of them wanted me to pass
along their appreciation for the prizes!”
Toledo, Ohio
The Toledo, Ohio, local chapter knows how to pack in a crowd at
May MAYnia. President Robin Moore, CPC, proudly announced
that, “87 members were in attendance, up from 45 last year.” Pizza,
salad, and cake were served;
and Janet Cullum, CPC,
gave a presentation on
documentation.
Moore said, “Our seminar
was such a success last
month, so we wanted to
give back to our members.”
This cake says it all. Nice job Toledo, Ohio!
Toledo offered two
continuing education units to members for only $1, and they gave
away prizes galore: books, gift cards, shirts, and lots of other AAPC
chapter goodies, according to Moore.
It’s a full house listening to Janet Cullum’s presentation at Toledo’s May MAYnia.
No doubt these chapters will see a return on their invested efforts.
Great job officers!
For more May MAYnia celebrations, check out the AAPC Group on
Facebook, www.facebook.com/groups/21496405430/.
Keisha Sutton explains the obstetrics/gynecology global package at Petersburg’s May MAYnia.
Michelle A. Dick is executive editor at AAPC and a member of the Flower City Coders, Rochester, N.Y., local chapter.
www.aapc.com
July 2016
13
■ MEMBER FEATURE
By Donna Beaulieu, CRC, C-CDIS, CPC-I, CPMA, CPC, CEMC, CEDC, CFPC, CCP-P, CRP, and Hasan Zaidi, MPH, CPC, CEDC, CSPPM
Emory Physician Group Practice
Celebrates and Prepares Its Coders
Georgia’s largest healthcare system embraces the new face of
healthcare and prepares its staff for change.
Emory Physician Group Practice coders
celebrate Medical Coders Day.
Establishing Georgia
Medical Coder’s Day
Emory’s Coding Education Department
worked with Governor Nathan Deal’s
office to designate May 19, 2016, as
Georgia’s Medical Coders Day. Emory
was thrilled to receive proclamation
from the governor, recognizing coders
across the state of Georgia for their
invaluable support to physicians, care
teams, insurance payers, and patients.
E
mory Physician Group Practice (Emory) encompasses 2,000
providers, more than 39 specialties at more than 80 locations, six
hospitals, and at least 130 medical coders. This healthcare system
supports its medical coding professionals, and is leading its clinical and
business staff into healthcare’s future: the value-based payment model.
Let’s look at how they honor their coding professionals and help them
prepare for an evolving healthcare industry.
14
Bridging the Provider - Coder Gap
Emory’s Coding Education Department strives to create a strong
partnership among providers, coders, and clinical departments by
serving four key functions:
1. Coding to capture true patient acuity
2. Documentation improvement
3. Strategic initiatives
4. Education engagements
Member Feature
faculty physicians from Emory School of Medicine. Coders
who attend earn free continuing education units from
AAPC.
Emory Coding University is deployed. This is an online
platform of coding- and documentation-related webinars
created by the Coding Education Department (short videos:
10-15 minutes).
2016:
The Provider Shadowing Initiative is initiated for continued
ICD-10 support. Coding educators observe provider workflow to
ensure services rendered are documented and coded accurately.
Since its inception in 2013, the department
has supported multi-specialty service lines
ranging from primary care to surgical
services. Service lines were created
to standardize revenue cycle processes
by allocating designated resources for
success: Coding Educator and Revenue
Cycle Analyst.
Since the inception of the Coding
Education Department, they have focused
on design, development, and integration of
future healthcare reimbursement models.
A Timeline to Help
Revenue and Patient Care
In only a few years, Emory has launched
programs and educational improvements to help employees
transition through healthcare changes. Here are highlights of what
they have accomplished for coding and healthcare professionals:
2013:
The Coding Education Department is created to assist providers,
coders, and clinical departments with coding/documentation needs.
2014:
Professional Medical Coding Curriculum (PMCC) is launched
under guidance and leadership of Donna Beaulieu, CRC, C-CDIS,
CPC-I, CPMA, CPC, CEMC, CEDC, CFPC, CCP-P, CRP. To
date, 175 students have successfully completed the coding course,
which is offered at no cost to Emory healthcare employees as part of
their professional development.
2015:
Specialty-specific ICD-10 readiness documents are created and
deployed to providers via faculty meetings and published on Emory’s
website. A successful transition to ICD-10 was realized with no loss
in physician and coder productivity.
The Coder Development Program is launched to enable
coders to become highly specialized in multiple specialties
and reduce the need for external coders. This monthly
program brings in keynote speakers who are world-renowned
Weekly coding lab sessions are initiated to partner front
end (operations) and back end (account receivables) coders
with coding educators to resolve coding-related denials at a
patient account level.
MEMBER FEATURE
... they have focused on
design, development, and
integration of future healthcare
reimbursement models.
The Coding Education Department is redesigned to prepare
for the Ambulatory Clinical Documentation Improvement
initiative while partnering with physicians and care teams.
Leading Clinicians and
Coders into New Payment Models
With the movement towards value-based reimbursement models and
a strong emphasis towards better population health management, the
Coding Education Department has partnered with their physicians,
care teams, coders, and care coordination centers to assist with
patient acuity capture.
The Ambulatory Clinical Documentation Improvement initiative
was launched to ensure accurate coding/documentation and
predictive analytics around population health management. Emory
instills the following guiding principles for patient acuity capture:
1. Clinical Care – to capture pertinent diseases of each patient
2. Patient Stratification – to identify high-risk and high-cost
patients
3. Care Protocols – to generate care plans to match patient
healthcare needs
By capturing true patient acuity, Emory will be able to improve
patient health outcomes while optimizing revenue streams —
ensuring a win-win-win situation for their patients, providers, and
payers.
Donna Beaulieu, CRC, C-CDIS, CPC-I, CPMA, CPC, CEMC, CEDC, CFPC, CCP-P, CRP, is
assistant director at Emory Physician Group Practice. She is a member of the Atlanta. Ga., local chapter.
Hasan Zaidi, MPH, CPC, CEDC, CSPPM, is senior manager at Emory Physician Group Practice. He is a member of the Atlanta, Ga., local chapter.
www.aapc.com
July 2016
15
■ HOT TOPIC
istock.com/StockFinland
By Renee Dustman
Get answers to questions about the affect 2015 legislation
will have on Medicare Part B reimbursement.
T
he Medicare Access and CHIP Reauthorization Act of 2015
(MACRA) repealed the sustainable growth rate (SGR) formula
— used since 1997 to determine Medicare payment updates — and
established an annual 0.5 percent update to the Medicare Physician
Fee Schedule (MPFS) through 2018. But what happens after that?
Inquiring minds want to know.
A proposed rule published in the Federal Register (FR Vol. 81, No.
89) on May 9 outlines CMS’ intentions for establishing these two
components of the Quality Payment Program.
Note: To determine whether clinicians met the requirements for the
Advanced APM track, all clinicians will report through MIPS in
the first year.
Get to Know What MACRA Has in Store for You
Q: What is MIPS?
A: In 2019, MIPS will replace the Physician Quality Reporting
System, the Medicare Electronic Health Record (EHR) Incentive
Program, and the Value-based Payment Modifier with a more
straightforward approach to quality and value reporting.
Eligible clinicians will be evaluated based on their performance
scores in four categories:
Cost – This category replaces the cost component of the Medicare
Physician Value Modifier Program. Scores will be based on
Medicare claims, so there are no reporting requirements for
clinicians.
Q: What else does MACRA have in store for clinicians?
A: MACRA also requires the Centers for Medicare & Medicaid
Services (CMS) to create a new, streamlined system for
incentivizing clinicians to provide quality care: the Quality
Payment Program. The program allows eligible clinicians to choose
one of two paths for quality reporting:
1. A Merit-based Incentive Payment System (MIPS); or
2. Incentive payments for participation in an Alternative
Payment Model (APM).
16
MACRA FAQ
MACRA doesn’t change how
existing APMs function or reward
value; it rewards participation.
Clinical Practice Improvement Activities – This category
rewards activities that benefit patients, such as those focused on care
coordination, patient engagement, and patient safety.
Advancing Care Information – This category replaces the
Medicare EHR Incentive Program, or Meaningful Use, for
physicians.
Quality – This category replaces the PQRS and the quality
component of the Medicare Physician Value Modifier Program.
According to the proposed rule, clinicians will be able to choose the
activities and measures that are most relevant to their practice.
Each category will be weighted and worth up to a specified number
of points, as shown in Table A.
Table A: MIPS Performance Categories for 2017
Category
Max points
Weight
Quality
80-90 (based on size)
50%
Advancing Care Information
100
25%
Clinical Practice Improvement Activities
60
15%
Cost (Resource Use)
Average score
10%
The MIPS score measures clinicians’ overall care delivery; reporting
is not limited to care provided to Medicare beneficiaries.
Note: CMS proposes to make clinicians’ MIPS scores and APM
performance public on the Physician Compare website.
Q: How will MIPS affect Medicare reimbursement?
A: A MIPS-eligible clinician’s composite performance score (CPS)
will result in a positive, negative, or neutral payment adjustment
beginning in 2019. A clinician’s CPS for 2019 will be based on 2017
performance data in the aforementioned categories. Table B shows
the proposed adjustments to Medicare Part B payments for eligible
clinicians based on their CPS.
Table B: MIPS-adjusted Medicare Part B Payments
Year
Maximum Adjustment
2019
+/- 4%
2020
+/- 5%
2021
+/- 7%
2022
+/- 9%
In the first year, negative adjustments can be no more than -4 percent.
The positive adjustments will be scaled to achieve budget neutrality,
so the maximum positive adjustment could be as much as 4 percent.
In the first five payment years, MACRA allows CMS to reward
exceptional performance. Exceptional performers could earn as
much as an additional 10 percent without a budget neutrality
adjustment.
CMS has not mentioned a cap on the maximum adjustment after
2022, but it’s clear that eligible clinicians stand to lose or gain quite
a bit of money under MIPS.
Q: Who are MIPS eligible clinicians?
A: In 2019-2020, MIPS eligible clinicians include:
• Physicians (medical doctor/doctor of osteopathy and doctor of
dental surgery/doctor of dental medicine)
• Physician assistants
• Nurse practitioners
• Clinical nurse specialists
• Certified registered nurses anesthetists
In subsequent years, the definition of “eligible clinician” may
expand to include other qualified healthcare professionals.
Exempt from MIPS are clinicians in their first year of Medicare
Part B participation; clinicians who bill Medicare up to $10,000
and provide care for 100 or fewer Medicare patients in one year; and
qualifying participants in Advanced APMs.
www.aapc.com
July 2016
17
MACRA FAQ
Q: What is an APM?
A: As defined by MACRA, APMs include:
• CMS Innovation Center models
• Medicare Shared Savings Program
• A demonstration under the Health Care Quality
Demonstration Program
• A demonstration required by federal law
MACRA defines Advanced APMs as those using certified EHR
technology; basing payment on quality measures comparable to
those in MIPS; and either bearing more than nominal financial
risk for monetary losses or participating in a Medical Home model
expanded under the authority of a CMS Innovation Center model.
According to the proposed rule, models considered Advanced
APMs for 2017 include:
• Comprehensive End-stage Renal Disease Care Model
• Comprehensive Primary Care Plus
• Medicare Shared Savings Program (Tracks 2 and 3)
• Next Generation Accountable Care Organization
Note: MACRA doesn’t change how existing APMs function or
reward value; it rewards participation.
Q: What are the advantages of participating in an Advanced APM?
A: Qualifying APM participants (QPs) are excluded from MIPS
and receive a 5 percent lump sum bonus in 2019-2024. Beginning
in 2026, QPs will get a 0.75 percent update to the fee schedule
conversion factor each year, compared to 0.25 percent for non-QPs.
The APM bonus payment will be based on the estimated aggregate
payments for professional services furnished the year prior to the
payment year.
According to Blue Ocean Performance Solutions CEO Chris
Sawyer, “These changes are going to drastically increase physician
ACO participation around the country.”
CMS thinks so, too. “We expect that the number of clinicians who
qualify for the incentive payments from participating in Advanced
APMs will grow as the program matures and as physicians take
advantage of the intermediate tracks of the Quality Payment
Program to experiment with participation in APMs,” writes CMS
in a MACRA Quality Payment Program FAQ.
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18
MACRA FAQ
Q: How can clinicians qualify for incentive payments
for participation in Advanced APMs?
A: Eligible clinicians must meet certain thresholds
to be considered QPs and qualify for incentive
payments. CMS will calculate a percentage threshold
score for each Advanced APM entity using two
methods — payment amount and patient count —
and compare it to the corresponding QP threshold.
Those who reach the threshold are rewarded.
In 2019 and 2020, QPs must have 25 percent of their
payments or 20 percent of their patients come through
an Advanced APM. In 2021 and 2022, QPs must have
50 percent of their payments or 35 percent of their
patients come through an Advanced APM. And in
2023 and beyond, the threshold goes up to 75 percent
for the payment amount method or 50 percent for the
patient count method.
As with MIPS, the QP performance period for the
2019 incentive begins in 2017.
Final Rule
Although this information is based on a proposed
rule, it’s safe to say these changes are in our future. It’s
a very near future, so the time to act is now. Clinicians
who submit Medicare Part B claims should be ready
for the 2017 performance period to ensure future
revenue.
Renee Dustman is executive editor for AAPC, and a member of the Flower City Coders,
Rochester, N.Y., local chapter.
Resources
?
DID
DID
YOU
YOU
KNOW
Quality Payment Program slides: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/
Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-MACRA-NPRM-Slides.pdf
Quality Payment Program fact sheet: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/
Value-Based-Programs/MACRA-MIPS-and-APMs/NPRM-QPP-Fact-Sheet.pdf
Physician Compare website: www.medicare.gov/physiciancompare/search.html
“MACRA in 4 Minutes” (www.youtube.com/watch?v=UXLvu_eop8k)
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The
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July 2016
19
■ CODING/BILLING
By Maryann C. Palmeter, CPC, CENTC, CPCO, CHC
Think TWICE Before
Sticking
It in Your EAR
A
s curious kids, the sage advice “Don’t put anything in your ear
smaller than your elbow” didn’t stop my friends or me from
putting many things into our ears (and mouths and noses) that weren’t
intended to go there. As a (sensible adult) coder, now when an object
ends up in an ear, I need to determine whether it’s there by way of
nature or some other manner, as well as how the object was removed.
Removal of Foreign Object
Removal of a broken cotton swab, an insect, or a Cocoa Puff ™ from
an ear qualifies as the removal of a foreign body. Removal of a foreign
body from the external auditory canal without general anesthesia
is coded 69200 Removal foreign body from external auditory canal;
without general anesthesia. This code is unilateral, so if the patient
sticks a Cocoa Puff ™ in both ears, report 69200 on a single claim
detail line and append modifier 50 Bilateral procedure.
Note: Individual payers may have different rules on billing unilateral
procedures performed bilaterally, and may prefer that the procedure
code be billed on two separate line items, appended with modifier RT
Right side or LT Left side.
The type of removal described by 69200 is performed under direct
visualization with an otoscope. Forceps, a cerumen spoon, or suction
is used to remove the foreign body. In the case of a live insect, mineral
oil is usually dropped into the ear to immobilize the insect before it
is removed.
If the patient cannot tolerate the procedure while awake, general
anesthesia may be used. This may also be the case if the foreign body
is so large that an incision is made into the external meatus to enlarge
the opening before the foreign body can be extracted. In this instance,
20
report 69205 Removal foreign body from external auditory canal; with
general anesthesia. This procedure is also unilateral.
Code 92502 Otolaryngologic examination under general anesthesia is
considered a standard of medical/surgical practice when performed
with the removal of a foreign body. As such, do not report it separately
if the examination is performed on the same ear and during the same
encounter as the foreign body removal.
Removal of Cerumen
Impacted cerumen (ear wax) is typically extremely hard and dry and
accompanied by pain and itching. Impacted cerumen obstructing
the external auditory canal and tympanic membrane can lead to
hearing loss. There are two different methods for removing impacted
cerumen. (For cerumen removal that is not impacted, refer to
evaluation and management codes.)
Cerumen Removal: Instrumentation
Report 69210 Removal impacted cerumen requiring instrumentation,
unilateral if instrumentation is used to remove impacted cerumen.
Code 69210 captures the direct method of impacted earwax removal
using curettes, hooks, forceps, and suction.
CPT® considers this procedure to be unilateral, stating, “For bilateral
procedure, report 69210 with modifier 50.” The Centers for Medicare
& Medicaid Services (CMS) sees things differently. In the 2014
Medicare Physician Fee Schedule, CMS stated its opinion that the
procedure will typically be done on both ears at the same encounter
because “the physiologic processes that create cerumen impaction
likely would affect both ears.” CMS also said, “Given this, we will
■ Coding/Billing
■ Auditing/Compliance ■ Practice Management
istock.com/Vicgmyr
Although removing
foreign bodies
from the ear is an
otolaryngological
pain, coding it
doesn’t have to be.
To discuss this
article or topic, go to
www.aapc.com
In Your Ear
continue to allow only one unit of CPT 69210 to be billed when
furnished bilaterally.” The Medicare Physician Fee Schedule Lookup Tool on the CMS website lists procedure code 69210 as bilateral;
appending modifier 50 is unnecessary.
Bottom line: Medicare will pay the same amount for 69210
whether it is performed on one ear or two, even though the CPT®
descriptor stipulates it is unilateral. Other payer policies may differ
from Medicare’s.
Cerumen Removal: Irrigation
New procedure code 69209 Removal impacted cerumen using
irrigation/lavage, unilateral describes an indirect and less invasive
method of cerumen removal. The creation of this code for CPT®
2016 was warranted to differentiate between direct and indirect
approaches of removing impacted cerumen performed or supervised
by physicians or other qualified healthcare professionals.
Report 69209 when the removal of impacted cerumen does
not require instrumentation. Irrigation/lavage involves using a
continuous low pressure flow of liquid (e.g., saline solution) to
gently loosen impacted cerumen and flush it out, with or without
the use of a cerumen softening agent (e.g., cerumenolytic), which
may be administered days prior to, or at the time of, the procedure.
Only one method of impacted cerumen removal (i.e., either
69209 or 69210) may be reported when both are performed on the
same day, on the same ear. Procedure code 69209 is unilateral. If
performed bilaterally, report 69209 on a single claim detail line with
modifier 50 appended.
Note: Individual payers may have different rules on billing
unilateral procedures performed bilaterally and may prefer the
procedure codes to be billed as separate line items with modifiers
RT and LT for the right and left ears, respectively.
Tip: Don’t confuse procedure code 69020 Drainage external auditory canal, abscess with the
service described by procedure code 69209. Although both describe a method of irrigation/
lavage and/or drainage, 69209 is specific to impacted cerumen and 69020 is specific to
abscesses.
CODING/BILLING
Medicare will pay the same amount for 69210 whether it is
performed on one ear or two, even though the CPT® descriptor
stipulates it is unilateral. Other payer policies may differ from Medicare’s.
Cerumen Removal with Audiologist Service
HCPCS Level II code G0268 Removal of impacted cerumen (one or
both ears) by physician on same date of service as audiologic function
testing was created to allow payment to a physician who removes
impacted cerumen on the same date a contracted or employed
audiologist performs audiologic function testing.
CMS does not separately reimburse audiologists for removal of
cerumen because this is considered inherent in the audiologic function
test. If a physician removes the impacted cerumen on the same day
as the audiologic function testing, however, the physician (or other
qualified healthcare practitioner) may separately report G0268.
The moral of this story is: The next time you’re thinking about
sticking something in your ear to remove some bothersome earwax,
think twice.
Maryann C. Palmeter, CPC, CENTC, CPCO, CHC, is employed with the University of Florida Jacksonville Healthcare, Inc. as the director of physician billing compliance where she provides professional direction and oversight to the billing compliance program of the University of Florida College of Medicine – Jacksonville and its practice plan. She has over 30 years of
experience in federal and state government billing and compliance regulations gained
through working on both the physician billing and government contractor sides of the healthcare industry. Palmeter served on the National Advisory Board from 2011-2013 and served as the board’s secretary from 20132015. She is the education officer for the Jacksonville, Fla., local chapter. Palmeter received AAPC’s “Member of
the Year” award in 2010.
Resources
2014 Medicare Physician Fee Schedule: www.cms.gov/medicare/medicare-fee-for-servicepayment/physicianfeesched/pfs-federal-regulation-notices-items/cms-1600-fc.html
Medicare Physician Fee Schedule Look-up Tool: www.cms.gov/apps/physician-fee-schedule/
search/search-criteria.aspx
www.aapc.com
July 2016
21
■ CODING/BILLING
By Kasandra Bolzenius, CPC
Get Paid for Smoking Cessation
istock.com/Joe Belanger
Proper documentation and verifying coverage criteria prior to
claim submission can improve your chances for reimbursement.
M
any healthcare providers perform tobacco use counseling daily,
but they may not be documenting or reporting it appropriately.
Reliable guidance is needed to ensure all performed services are
claimed and supported by complete documentation.
2. Who are competent and alert at the time counseling is provided;
and
3. Who receive counseling furnished by a qualified physician or
other Medicare-recognized practitioner.
Where Opportunity Knocks
Each payer may have its own restrictions for coverage, so inquire
about a patient’s benefits prior to claim submission.
The Centers for Disease Control and Prevention (CDC) has
produced evidence supporting that tobacco use remains the single
largest preventable cause of death and disease in the United States. A
study in 2010 indicated that seven out of 10 adult smokers wished to
quit; however, studies also indicate that only an estimated 4 percent
to 7 percent of people are able to quit smoking on any given attempt
without medicines or other help. Counseling and other types of
support can increase success rates better than medications alone.
Medical Necessity
The Centers for Medicare & Medicaid Services (CMS) set a standard
for coverage (which commercial payers may not follow). Per MLN
Matters® article MM7133, CMS will cover tobacco cessation
counseling for beneficiaries:
1. Who use tobacco (regardless of whether they have signs or
symptoms of tobacco-related disease);
22
Documentation May Determine Payment
As with any time-based evaluation and management (E/M) service,
documentation must include sufficient detail to support the claim.
Proper documentation for tobacco-use cessation counseling should
include the total time spent face to face with the patient, and what was
discussed. The patient’s desire or need to quit tobacco use, cessation
techniques and resources, estimated quit date, and planned follow
up should be noted within the patient’s medical record. Without
this information, medical necessity for coverage may be questioned,
which could result in denied or delayed payment.
Without documentation of significant and separately identifiable
work, the payment for smoking cessation counseling may be included
in the payment for the primary E/M service.
■ Coding/Billing
To discuss this
www.aapc.com
Smoking Cessation
Examples of incomplete documentation:
• “I have counseled the patient again to quit smoking. The
patient verbalized understanding, but is not ready to quit
smoking.”
• “>3 minutes spent counseling patient on tobacco use.”
Proper Billing Means Prompt Reimbursement
Private payers may follow CMS’ direction when it comes to billing
requirements for these services; however, it’s important to know
your patient’s insurance benefits.
Medicare will cover two cessation attempts per year. Each
attempt may include a maximum of four intermediate or intensive
counseling sessions.
The total annual benefit covers up to eight smoking and tobaccouse cessation counseling sessions in a 12-month period. The
beneficiary may receive another eight counseling sessions during
a second or subsequent year after 11 months have passed since the
first Medicare covered cessation counseling session was performed.
Example: The beneficiary received the first of eight covered sessions
in January 2011. The count starts beginning February 2011. The
beneficiary is eligible to receive a second series of eight sessions
in January 2012. Medicare’s prescription drug benefit also covers
smoking and tobacco-use cessation agents prescribed by a physician.
CMS specifies symptomatic patient criteria as beneficiaries “who
use tobacco and have been diagnosed with a recognized tobaccorelated disease or who exhibit symptoms consistent with tobacco
related disease.”
CPT® descriptions:
99406
pack of cigarettes per day after several failed attempts at quitting.
Approximately 15 minutes were spent counseling the patient
in cessation techniques. He understands continuing to smoke
could lead to stroke and death. The benefits of stopping were also
presented to him. The patient has verbalized his desire to “give it
another try.” He has set his own goal of 30 days to be completely
smoke-free. We will follow up in two weeks to check progress.
CPT® coding:
99407
ICD-10-CM coding:
F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders
J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
Know Your Patient Coverage
If your clinic is just beginning to provide these services to your
patient population, it’s best to verify coverage criteria prior to claim
submission. For instance, Preventive Medicine Services guidelines in
the CPT® codebook state, “Codes 99381-99397 include counseling/
anticipatory guidance/risk factor reduction interventions which
are provided at the time of the initial or periodic comprehensive
preventive medicine examination.” Many payers group tobacco use
cessation counseling under this umbrella and will not reimburse it
separately. Knowledge of potential reimbursement errors keeps the
denial rate low and provider-patient relationships strong.
Kasandra Bolzenius, CPC, is a senior compliance specialist with a large healthcare system
in the Midwest. She regularly provides guidance to healthcare providers, administration, and
medical staff on billing and coding standards, government policy, and internal revenue opportunities. Bolzenius is a member of the Saint Louis West, Mo., local chapter.
Smoking and tobacco cessation counseling visit for the symptomatic patient; intermediate,
greater than 3 minutes, up to 10 minutes
99407
G0436
CODING/BILLING
As with any time-based evaluation and
management (E/M) service, documentation must
include sufficient detail to support the claim.
intensive, greater than 10 minutes
Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate,
greater than 3 minutes, up to 10 minutes
G0437
intensive, greater than 10 minutes
These counseling services must be submitted with appropriate
diagnosis coding to support medical necessity. The claim and
documented encounter should include tobacco use status and
confirmed tobacco-related diseases, as appropriate.
Example: A 67-year-old male Medicare patient presents with
exacerbated COPD on oxygen. This patient continues to smoke one
Resources
www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPSQuickReferenceChart-1TextOnly.pdf
www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/
MLNMattersArticles/downloads/MM7133.pdf
www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/
www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-toquitting-smoking-success-rates
www.aapc.com
July 2016
23
■ CODING/BILLING
By Susanne Myler, COC
istock.com/daizuoxin
PROVIDERS vs. PAYERS
Collaboration is the Best Medicine
I
When providers
and payers work
together, claims
payment issues
get resolved.
24
f you are a coder who works for a large payer organization, your day-to-day work looks different
than that of a coder working for a provider. I’ve worked for both the provider and payer sides, and
I’ve been on both sides of a medical record request. It’s no fun for anyone. To come to a favorable
resolution, it’s important to understand how to navigate these scenarios and to see the payer’s
point of view.
The Roles on Both Sides of the Fence
Provider coders — whether physician, facility, or ancillary (such as home health, lab, ambulance,
etc.) — translate what the provider has documented in the patient record into a claim that will be
paid by a third party or payer. Challenges for provider coders include everything from meeting
productivity quotas, to managing the revenue cycle, and more.
Payer coders have a completely different experience. The coding (and clinical) staff isn’t able to
speak face to face with the provider submitting claims because, rather than working with a few
providers, the staff is working with thousands of them. The provider’s submission (the claim and
subsequent documentation) is all that is available for basing decisions regarding reimbursement,
review, denial, or recoupment.
■ Coding/Billing
Providers vs. Payers
Medical Records Request
What to Do when Requests Are Received
Payers requesting medical records for claims that have already been
paid typically send a letter to the provider’s correspondence address.
The letter generally dictates what types of records are needed (e.g.,
lab reports, radiology reports, etc.). If the request involves supplies
or durable medical equipment, a proof of delivery, Certificate of
Medical Necessity, written order, etc., are necessary. Requests for
claims that are pending or held prior to payment for review usually
are part of the provider remittance advice (PRA). A letter could also
be generated for prior-to-payment requests.
Payers can also use vendors to perform reviews. Vendors must sign a
business associate agreement with the payer if they are performing a
review. A letter disclosing this agreement may be sent to the provider
just prior to a request for medical records. This announcement
letter usually requires no action on the part of the provider unless
it is accompanied by an actual request for specific patient records.
Receipt of an announcement letter does not mean the provider has
been targeted for the review — only that the provider falls within the
scope of claims or providers eligible for review.
If you receive a request from a payer for a patient’s medical records,
it’s usually in response to:
• A general review for all providers claiming a particular service
or combination of services/diagnosis(es)
• A review for certain providers based on peer-to-peer
performance (higher utilization of a particular code when
reviewed next to claims from peers of the same specialty)
• A review of all providers under a particular tax identification
number (TIN) based an external request (such as from the
Centers for Medicare & Medicaid Services (CMS), Office of
Inspector General (OIG), or a state agency)
• A review of a certain provider based on an external request
(such as CMS, OIG, state agency, or member appeal)
There are other reasons for medical record reviews, but this list covers
99 percent of requests. Reviews may be performed either prior to
payment or after payment has been made, depending on the contract
language between the provider and the payer (if a contract exists).
Contracts between providers and payers generally specify the length
of time in which reviews (prior to payment and after) can take place,
as well as other stipulations. If there is no contract, the review time
frame in a particular scenario is at the payer’s discretion.
Payers have an address to which payments are sent, and sometimes
a different address for correspondence. When a request for medical
records has been issued (either by letter or PRA), the time clock
starts for the payer to receive the documentation. Payers typically
reach out to providers after certain time markers to ensure requested
documents have been received to avoid a denial based on non-receipt
of records.
A common complaint payers hear from providers is that the letter/
PRA in which the request is made gets transferred from department
to department so by the time the right person gets the request, it’s
too late and the denial for non-receipt has happened. Payers strive to
have the right mailing addresses, but with thousands of providers of
all types throughout the country, this can be a daunting task.
When a request is received, the provider’s team should:
• Check the date of the letter. If it’s more than a month old,
chances are it has traveled from department to department.
• If you are responsible for sending the requested
documentation, contact the payer by phone or email using
the information on the letter and explain the situation. Any
contact by the provider generally will prolong or restart the
time frame for receipt. Find out the payer’s specific protocols
for documentation receipt. Payers want to work with
providers; they don’t only want to deny claims.
• If you are not the correct person to respond to a
documentation request, and depending on your directives
from your leadership, make sure it gets to the right person.
When the responsible person receives the request, they should
contact the payer immediately, as above.
• When contacting the payer, request additions or changes to
the address (such as an attention line, etc.) to avoid future
issues.
• Review the type of documentation requested, and send those
documents. Completeness and legibility of documentation
is paramount. Incomplete records, or records that cannot be
read, are of no use to reviewers trying to determine whether
services billed as rendered meet the necessary documentation
requirements. For example: For evaluation and management
codes, if there isn’t a clearly defined review of systems, but the
history and medical decision-making are clear, the service
www.aapc.com
July 2016
CODING/BILLING
Contracts between providers and payers generally specify
the length of time in which reviews (prior to payment and
after) can take place, as well as other stipulations.
25
To discuss this
www.aapc.com
Providers vs. Payers
could be either denied or recouped based
on lack of documentation.
• Contact the payer with questions using the
information on the request, as necessary.
Relevance matters: Do not send a 400-page record
unless every page is pertinent to the request.
Keep in mind that a fellow coder likely will be
responsible to decipher the material (at least at
first). Sending records with random pages upside
down, multiple pages containing only a single
sentence, or records that are not pertinent to the
request causes extra work for the person receiving
the documentation, who did not put the review
in place. There’s no reason to shoot the messenger.
If you’ve missed the deadline, and the claim is either
fully denied or is in the process of recoupment
due to non-receipt of documentation, contact
the payer immediately. Many payers are happy
to review the documentation, and may reverse
the denial or recoupment without resubmission of the claim if the
submitted documentation meets necessary criteria.
The payer will have multiple avenues to receive documentation, such
as postal services, secure fax, secure email, and in some cases a secure
FTP site for quick transfer. Whichever method you choose, follow
up to ensure the payer received the documentation.
After the Documentation Is Submitted
Upon receipt of the requested records, the payer clinical team begins
to review the documentation. It takes time to ensure the entire
claim case is reviewed. Sometimes the payer clinical team may ask
for clarification of documentation or additional documentation
if it appears something is missing. The payer clinical team makes
multiple efforts to reimburse the provider, rather than to pursue
denial or recoupment. But it’s common not to receive feedback if the
documentation sent substantiates the service billed (i.e., no news is
good news).
If every attempt is made to substantiate the service using the
documentation submitted, but it cannot be reconciled (and
depending on the scope of the review), a denial or recoupment takes
place. This could mean the entire claim is denied/recouped, or only
a line item from the claim.
26
istock.com/zest_marina
CODING/BILLING
Communication with the payer is important
because, although payers are similar, each has its
own specific procedures for each step in the process.
Typically, a letter is sent with the review outcome (the findings letter)
that narrates the reasons why the payer feels the documentation
does not support the claim as billed. Every provider has some
level of reconsideration and appeal rights; check with the payer as
to what they offer if you disagree regarding the findings. Usually,
instruction is given in the letter as to reconsideration and/or appeal.
Providers who are contracted with the payer often have a “provider
advocate” assigned to their group; you may contact this advocate at
any time for questions regarding correspondence from the payer.
Communication with the payer is important because, although
payers are similar, each has its own specific procedures for each step
in the process.
Payers, like providers, are an important piece of the healthcare
puzzle. Together, we can reach a favorable outcome.
Susanne Myler, COC, has more than 25 years’ experience in the healthcare industry from
claims biller to executive management. She attended Stephen F. Austin State University in
Nacogdoches, Texas, and is employed by a large healthcare payer organization. Myler is a
member of the Abilene, Texas, local chapter.
ZHealth
■ CODING/BILLING
By Stephen Canon, MD
istock.com/KatarzynaBialasiewicz
Cut Costs
with Quality
Transitional
Care Management
Understand the CCM interface and the 2016 fee
schedule to get a handle on avoidable mistakes.
A
lthough patients going home from the hospital are usually on the
road to recovery, many are not functioning at 100 percent, and
often do not know how to get better. Perhaps even worse, primary care
providers may be uninformed about a patient’s hospital admission, or
how to help the patient return to health after discharge. This lack of
coordination (a.k.a., transitional care management (TCM)) between
acute care facilities and primary care providers is a huge problem.
Nearly one in five patients is readmitted to the hospital within 30 days
after hospital discharge, leading to a cost of $24 billion each year.
Transitional Care Management CPT® Codes
28
99495 Transitional Care Management Services with the following required elements: Communication
(direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days
of discharge; Medical decision making of at least moderate complexity during the service
period; Face-to-face visit, within 14 calendar days of discharge
99496 Transitional Care Management Services with the following required elements: Communication
(direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days
of discharge; Medical decision making of high complexity during the service period; Face-toface visit, within 7 calendar days of discharge
Since the rollout of the TCM codes in CPT® 2013, the Centers for
Medicare & Medicaid Services (CMS) has incentivized providers to
lower readmissions and improve care by allowing increased revenue for
these non-face-to-face activities. An additional $70-$100 of revenue
is possible for each patient discharge, if the provider accomplishes the
metrics outlined by CMS for performing an appropriate transition
of care.
TCM Requirements
The original TCM service requirements from January 2013 included
(see Figure 1 on the next page):
• Initial communication within two business days
• Face-to-face visit in seven (high complexity) or 14 (moderate
complexity) calendar days
• Date of service on the 30th calendar day, with day one being the
date of discharge (from January 2013 through December 2015)
Medical decision-making (MDM) of at least moderate complexity
during the service period, and completion of medicine reconciliation
on or before the date of the face-to-face visit, also are TCM
requirements.
■ Coding/Billing
To discuss this
www.aapc.com
TCM
Figure 1
Transitional Care Management Timeline
DAY 1
DAY 2
High
Complexity
Face-to-Face
Visit Due
Make
Initial Contact
DAY 30
TCM
Complete
Check that
patient has not
been readmitted
Schedule/Conduct Face-to-Face Visit
2 BUSINESS
DAYS
Initial
Contact
Deadline
CODING/BILLING
Patient
Discharged
from
Hospital
DAY 14
Moderate
Complexity
Face-to-Face
Visit Due
Providers eligible for TCM billing include primary care providers,
specialists, advanced practitioners, and physician assistants. TCM
service settings include acute care facilities such as inpatient acute
care hospitals (including observation admissions and psychiatric
facilities), long-term care hospitals, and skilled nursing facilities.
Providers may consider the TCM requirements complicated,
especially because workflows do not exist in electronic health
records (EHRs). In addition, CMS recently modified the TCM
requirements in the 2016 Physician Fee Schedule (PFS), limiting
TCM billing with the new chronic care management (CCM) code
and further complicating when and how to bill TCM. Common
mistakes prevent practices from receiving the extra reimbursement.
Knowing the five biggest mistakes of TCM can benefit practices
leveraging (or considering) this opportunity.
Five TCM Mistakes to Avoid
Mistake 1: No discharge notification from the primary care physician
or specialty provider caring for the patient after discharge.
This is largely a system problem due to lack of integration between
the acute care setting and the ambulatory setting. Solutions exist
either in a hospital system with a unified inpatient and outpatient
EHR or through an integrated inpatient and ambulatory solution
with automated integration or a manual process.
Mistake 2: Failure to understand the metrics and requirements
of TCM.
For example: A 52-year-old man is admitted for an acute myocardial
infarction, undergoes cardiac catheterization and stent placement,
and is discharged on Friday, May 27. Awareness that the ambulatory
practice has two business days to finish the initial communication
is imperative for TCM completion. Because Monday, May 30, is a
holiday, the practice has until Wednesday, June 1, to complete the
initial communication.
Mistake 3: Failure to correctly identify TCM candidates.
For example: A 22-year-old G1P0 otherwise healthy woman delivers
a healthy baby by cesarean section and is discharged two days later.
The patient does not qualify for TCM because the required MDM
is lower than the required moderate complexity needed for TCM.
Mistake 4: Failure to schedule the face-to-face visit within the correct
time frame.
The Upside of TCM
Approximately 1.8 million of the 9 million Medicare patients
discharged from a hospital annually are readmitted, leading to
potentially preventable recurrent illness and unnecessary cost.
Some conditions with the highest rates of hospital readmission
include congestive heart failure, septicemia, pneumonia,
congestive obstructive pulmonary disease (COPD), and cardiac
dysrhythmias. More than half of patients who are readmitted
are covered by Medicare (58.2 percent), with Medicaid and
commercial insurance patients comprising a much smaller
percentage, according to the Agency for Healthcare Research
and Quality’s (AHRQ) Healthcare Cost and Utilization Project
Statistical Brief #172, April 2014.
To test whether TCM metrics reduce hospital readmissions
— and, if so, whether the effort justifiably improves patient
outcomes — the University of Kentucky investigated the
effectiveness of TCM, as outlined by Medicare in 2013, by
conducting a meta-analysis of studies. The resulting
literature, “Systematic Review of Ambulatory Transitional Care
Management (TCM) Visits on Hospital 30-Day Readmission
Rates,” is telling.
Only three studies included all elements of TCM outlined by
CMS: two quality improvement studies and one observational
study. All three noted reduced readmission rates, with
varying success between 1.8 percent and 19.9 percent for the
ambulatory practices performing TCM. Other metrics (such as
mortality, quality of life, and functional status change) were
not assessed. The conclusion was that completing TCM metrics
does make a difference in reducing hospital readmissions, but
that more information is needed.
www.aapc.com
July 2016
29
For example: An 80-yearold woman with COPD
and HTN is admitted for
pneumonia and is ready for
discharge three days later
after appropriate treatment
and with continued
outpatient
antibiotic
therapy. Her face-to-face
visit needs to occur within
14 days after hospital
discharge to stay on track
for TCM billing. This
timing — coupled with a
timely initial communication, moderate MDM, and medicine
reconciliation — permits billing for TCM.
Mistake 5: Billing the wrong date of service.
This issue has been exacerbated by the 2016 PFS. In 2013, Medicare
mandated that the date of service be reported as the 30th day after
hospital discharge. Effective January 1, 2016, CMS changed the
date of service requirement to the date of the face-to-face visit within
seven to 14 days following hospital discharge. With this change,
CMS will allow (but not require) submission of the claim when the
face-to-face visit is completed, consistent with global surgery and
bundling rules under the PFS.
Although this may seem to allow for an easier billing process within
the current evaluation and management (E/M) framework, CMS
still requires a single TCM bill to be submitted per service period.
Practices may submit the bill by the seventh or 14th day, but they also
must verify that the patient remains well for the full 30-day service
period, so as not to conflict with another potential TCM event.
How CCM Affects TCM Billing
The rollout of the CCM opportunity in January 2015 created
another complication for TCM billing. With CCM, Medicare
encourages non-face-to-face services for patients with chronic
medical conditions who have not been hospitalized within the
past 30 days. Requirements for CCM include maintenance of a
comprehensive healthcare plan with 20 minutes of clinical staff
time per month, to justify approximately $42 of reimbursement per
Medicare patient per month. Through this initiative, CMS hopes
to encourage maintenance of chronically ill patients to improve
30
istock.com/michaeljung
CODING/BILLING
TCM
health and lower hospital admissions. With the potential revenue
available through CCM, there has been significant interest in this
opportunity.
Medicare and CPT® specify that CCM and TCM cannot be
billed during the same month. You may bill 99490 Chronic care
management services, at least 20 minutes of clinical staff time directed
by a physician or other qualified health care professional, per calendar
month, with the following required elements: Multiple (two or more)
chronic conditions expected to last at least 12 months, or until the
death of the patient, Chronic conditions place the patient at significant
risk of death, acute exacerbation/decompensation, or functional
decline, Comprehensive care plan established, implemented, revised,
or monitored during the same month as TCM if the TCM service
period ends before the end of a given month and at least 20 minutes
of qualifying CCM services are subsequently provided during that
month. CMS expects, however, that the “majority of the time, CCM
and TCM will not be billed during the same calendar month.” (CMS
TCM FAQ, March 17, 2016).
For example: A 64-year-old woman with hypertension and
diabetes mellitus is discharged from the hospital on January 20
after management of an episode of diabetic ketoacidosis. After
completing the metrics for TCM, she remains healthy and out of the
hospital until the service period is completed on February 18. CCM
is resumed on February 19, and greater than 20 minutes of clinical
staff time is directed toward optimization of her insulin regimen
before the end of February. Because the MDM for her TCM episode
was moderate in complexity, and because the metrics for CCM were
met before the end of the month, both 99495 and 99490 codes were
billed in February.
To discuss this
www.aapc.com
TCM
Simplify the Process
Resources
Discharging patients need not be a complicated process. Timely communication
and detailed instructions should be forwarded to the individuals assuming care
after discharge to ensure the patient’s return to health. Leveraging the TCM
opportunity correctly will increase revenue and incentivize improvement in
transitioning patients from the hospital to their home environment, with no repeat
performances.
AHRQ, “Conditions with the Largest Number of Adult Hospital Readmissions
by Payer, 2011,” Anika L. Hines, PhD, MPH, et. al., Healthcare Cost and
Utilization Project Statistical Brief #172, April 2014: www.hcup-us.ahrq.
Stephen J. Canon, MD, is a board certified urologist and associate professor at the University of Arkansas for Medical Sciences (UAMS). He also is chief of pediatric urology at Arkansas Children’s Hospital (ACH), program director of
the UAMS Department of Urology, and the 2010 inaugural recipient of the ACH Auxiliary and John F. Redman, M.D.,
Endowed Chair in Pediatric Urology. Canon received his medical degree from the University of Texas Medical Branch
and completed a Pediatric Urology Fellowship in Columbus, Ohio. He also is chief medical officer and co-founder of Phyzit TCM™, a
cloud-based software application which streamlines the TCM process with lowered readmissions and increased revenue.
CODING/BILLING
Approximately 1.8 million of the 9 million Medicare patients
discharged annually are readmitted to the hospital, leading to
potentially preventable recurrent illness and unnecessary cost.
gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.pdf
University of Kentucky’s UK Knowledge, “Systematic Review of Ambulatory
Transitional Care Management (TCM) Visits on Hospital 30-Day Readmission
Rates,” Roper, Karen L., et. al., 2016: http://uknowledge.uky.edu/
familymedicine_facpub/3/
Frequently Asked Questions about Billing the Medicare Physician
Fee Schedule for Transitional Care Management Services, March 17,
2016: www.cms.gov/medicare/medicare-fee-for-service-payment/
physicianfeesched/downloads/faq-tcms.pdf
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31
■ CODING/BILLING
By Michael Strong, MSHCA, MBA, CPC, CEMC
istock.com/humonia
Combat
Common
Denials in
Orthopedic
Coding
Part 1: Arm yourself with bundling rules and medical policy knowledge.
C
ost control and denials are common in orthopedic care. Over
the next two months, we’ll review common mistakes that lead to
orthopedic claims denials and provide tips to avoid those mistakes.
This month, we’ll discuss unbundling and medical policies.
Next month, we’ll discuss up-coding and missing or insufficient
documentation.
Note: Although this article uses orthopedic examples, much of the
information is applicable in any outpatient setting.
Unbundling
Unbundling of services is among the most common reasons for
denials, particularly in light of National Correct Coding Initiative
(NCCI) edits, American Medical Association (AMA) CPT® coding
rules, and other specialty or payer requirements.
E/M Services with Injection
In orthopedic practice, serial injections frequently prompt unbundling
errors. Over time, the effects of the injection often fades and pain
returns, which my require another injection in the series. If the patient
returns for another injection as part of a series, standard of care, or
treatment plan, do not report a separate evaluation and management
(E/M) service. Even if three months pass between the injections, do
not report an E/M service if there is no significant patient work-up.
32
Before you report both an injection and E/M service appended
with modifier 25 Significant, separately identifiable evaluation and
management service by the same physician or other qualified health care
professional on the same day of the procedure or other service, answer the
following questions:
• Is this a new injury/problem?
• Is this an exacerbation of a previous injury/problem?
• Is this an unanticipated change in the condition?
• Is there a change in the treatment plan?
For example, if pain returns but the provider does not perform a new
work-up to assess the pain, the E/M service may not be warranted.
Documentation should indicate the causal relationship to the pain if
attempting to use exacerbation or a new injury to support a separate
E/M service with modifier 25.
Remember: Every surgical procedure (Yes, an injection is a surgical
procedure listed in the Surgery section of the CPT® codebook)
includes an inherent E/M component as part of the global surgical
package. Performing a history and exam is standard care to assess for
contraindications or reasons not to perform the procedure.
The American Academy of Orthopedic Surgeons (AAOS) addresses
reporting injections and E/M services together in AAOS Now (April
2013 and October 2009). Per AAOS, if a patient returns to the office
■ Coding/Billing
Orthopedic Coding
in three months requiring no imaging or additional assessment,
the repeat injection does not warrant a separate E/M service. If
new imaging studies are performed with additional assessment,
however, a separate E/M service appended with modifier 25 may be
warranted. Both AAOS articles provide in-depth E/M examples and
analysis on this particular subject matter.
Reporting E/M services based on time (rather than components
of history, exam, and medical decision-making) should be the
exception, not the rule. Counseling and/or coordinating care on a
repeated basis for the same patient and same treatment plan may call
into question the medical necessity of the services.
Knee Bundles
Other common unbundling errors involve shoulder and knee
procedure coding. Claim denials of this nature can be avoided when
you understand the payer’s definition of “compartment.”
Both the Centers for Medicare & Medicaid Services (CMS) and the
AAOS recognize three compartments of the knee: medial, lateral,
and suprapatellar. It’s inappropriate to append modifier 59 Distinct
procedural service or one of the X{EPSU} modifiers to unbundle
surgical procedures performed in the same compartment(s).
Example 1: Never report both CPT® 29880 Arthroscopy, knee,
surgical; with meniscectomy (medial AND lateral, including any
meniscal shaving) including debridement/shaving of articular cartilage
(chondroplasty), same or separate compartment(s), when performed
and 29876 Arthroscopy, synovectomy, major, 2 or more compartments
(eg, medial or lateral), per the NCCI manual. Each code represents
the same two compartments of the knee. Because a knee only has
three compartments, one or both compartments involved in each
procedure may overlap.
For instance, if 29876 was performed on the same compartments as
29880, report only 29880. But if the provider performed the services
in the suprapatellar compartment and either the medial or lateral
compartment, report 29880 and 29875 Arthroscopy, knee, surgical;
synovectomy, limited (eg, plica or shelf resection) (separate procedure)
with modifier 59 appended. Modifier 59 is necessary because the
suprapatellar compartment is a separate compartment/structure
from the medial and lateral compartments of the same knee. (Note
that CMS has indicated that separate compartments of the knee do
not qualify as a separate structure for modifier XS Separate structure).
Example 1 does not apply to all situations, as it may be possible
CODING/BILLING
In orthopedic practice, serial injections
frequently prompt unbundling errors.
to report 29876 with other arthroscopic knee procedures in the
same compartment with clear documentation of medical necessity.
Providers should check with payers regarding the three-compartment
rule and bundling edits (i.e., 29876 with 29880).
Shoulder Bundles
Shoulders are a different story. Neither CMS nor AAOS agree
on the areas of the shoulder. CMS considers the shoulder a single
anatomic area or one joint, as affirmed in the NCCI manual. NCCI
edits are adopted nationally for Medicare and Medicaid and many
commercial carriers have some form of NCCI policy in their policies.
Consequently, denials for services performed on the same shoulder
with modifier 59 (or X{EPSU} modifiers) are common. Some
providers and staff attempt to contest these bundling edits due to the
differences between AAOS and CMS interpretation on the shoulder.
Example 2: Under CMS rules, 29822 Arthroscopy, shoulder, surgical;
debridement, limited and 29827 Arthroscopy, shoulder, surgical; with
rotator cuff repair should never be reported together, unless 29822
was performed on the contralateral shoulder.
AAOS and CMS continue to engage, which has resulted in a
suggested change to the NCCI edits effective July 1, 2016, with
policy manual changes slated for December 2016.
Fracture Care
Denials in fracture care are rising. One bone of contention is when
providers report an E/M service with the casting and strapping
codes when using a pre-fabricated or off-the-shelf splint or brace.
Instead, the provider should report the appropriate E/M code with
the appropriate L-series HCPCS Level II code. Refer to the casting
and strapping codes only when the provider custom fabricates the
cast and/or splint using fiberglass, plaster, etc. The supplies used for
custom castings are generally reported with Q codes.
Modifiers 25 and 59
The Office of Inspector General (OIG) released two reports in 2005
on modifiers 25 and 59. According to those reports, modifier 25
is incorrectly reported approximately 35 percent of the time, and
modifier 59 is reported incorrectly approximately 40 percent of the
time. The percentages for both modifiers exceeds the FBI’s definition
of fraud, waste, and abuse.
www.aapc.com
July 2016
33
To discuss this
www.aapc.com
Orthopedic Coding
CODING/BILLING
Denials in fracture care are rising. Providers should not
report an E/M service with the casting and strapping codes
when using a pre-fabricated or off-the-shelf splint or brace.
Medical Policies
Chiropractic Treatment
CMS creates policies on a national level (national coverage
determinations) and Medicare administrative contractors (MACs)
may create their own medical policies on a local level (local coverage
determinations). Although LCD denials may not be upheld at the
appeal level for an administrative law judge, MACs apply them for
denials. LCDs that seem to trip up the most providers are those for
manipulations under anesthesia (MUA), chiropractic treatment,
and total joint replacements.
Chiropractic treatment is always under OIG scrutiny. Most payers,
including workers’ compensation states with treatment parameters,
are likely to deny maintenance chiropractic treatment or excessive
treatment. Often, chiropractors must complete a back or neck
index on patients to obtain authorization for treatment. Many
carriers will deny extra-spinal adjustments; however, extra-spinal
adjustments are often payable in workers’ compensation, personal
injury, and auto claims. Knowing that most payers deny extraspinal adjustments (98943 Chiropractic manipulative treatment
(CMT); extraspinal, 1 or more regions), some unethical chiropractors
will falsely report a higher-level spinal adjustment code (98941
Chiropractic manipulative treatment (CMT); spinal, 3-4 regions or
98942 Chiropractic manipulative treatment (CMT); spinal, 5 regions),
which triggers audits for up-coding and medical necessity.
MUA
Most payers rarely cover MUA. Unique situations for coverage
may include frozen shoulder or knee arthrofibrosis. Many policies
consider MUA to be investigational for the spine or other joints.
Appealing these services is difficult because few Medicare payers
see the medical necessity of these services. Workers’ compensation,
personal injury, and auto insurance carriers, however, may offer
greater opportunities for reimbursement.
Imaging Guidance
Payers often focus on imaging guidance use with injections. As of
January 1, 2015, the following CPT® codes include ultrasound
guidance:
20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound
guidance, with permanent recording and reporting
20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular,
acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with
permanent recording and reporting
20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial
bursa); with ultrasound guidance, with permanent recording and reporting
Many payers require documentation for imaging guidance necessity.
For example, they want to see documentation that the initial attempt
failed, the patient’s condition and/or weight would not allow the
injection to be performed without the imaging guidance, or the
provider performed aspiration for a Baker’s cyst. Imaging guidance
is rarely covered for small joints such as toes or fingers.
Payers will also deny injections performed too frequently. Most
injected drugs work for weeks or months, so repeat injections may
be denied if they are administered in a short time span.
34
ABNs and Other Disclosures
Because there are so many medical and reimbursement policies,
practices should be pro-active in verifying their patients’ benefits
and coverage. This includes obtaining necessary prior authorization
and copies of policies. When it’s clear the services are not covered,
providers should ask the patient to sign an Advanced Beneficiary
Notice (ABN). An ABN will inform patients of their financial
responsibilities for any services they receive.
Michael Strong, MSHCA, MBA, CPC, CEMC, is the bill review technical specialist at SFM
Mutual Insurance Company. He is a former senior fraud investigator with years of experience
performing investigations into fraud and abuse. Strong also is a former EMT-B and college
professor of health law and communications. He is a member of the St. Paul, Minn., local
chapter, and can be contacted at [email protected].
Resources
AAOS Now, April 2013 and October 2009: www.aaos.org/AAOSNow/
Two 2005 OIG reports on modifiers 25 and 59:
Use of Modifier 59 to Bypass Medicare’s National Correct Coding Initiative Edits: http://oig.hhs.
gov/oei/reports/oei-03-02-00771.pdf
Use of Modifier 25: http://oig.hhs.gov/oei/reports/oei-07-03-00470.pdf
Atlantic City, NJ
Anaheim, CA
AAPC - Regional Conf.
Anaheim, CA
September 19-21
Atlantic City, NJ
October 6-8
12 CEUs $695 $445 thru July 31st
Great education featuring, auditing, billing, compliance, coding,
facility and practice management.
Register Today!
Log on to aapc.com/conferences
ANAHEIM
2016
Anaheim, CA
September 19-21
12 CEUs | $695 $445
thru July 31st
Anaheim, CA
Session Highlights
Hot Buttons for Payers
Jonnie Massey, CPC, CPC-P, CPMA, CPC-I
E/M Capture in the Hospital Outpatient
Department
Linda Martien, COC, CPC, CPMA
Bullet-Proof Your Documentation
Brenda Edwards, CPC, CPB, CPMA, CPC-I, CEMC, CRC
How to Analyze Denials and Rejections
Yvonne D Dailey, CPC, CPB, CPC-I
How to Build an Audit Tool
Jaci J. Kipreos, COC, CPC, CPMA, CPC-I, CEMC
Physician Documentation Improvement for
ICD-10-CM
Rhonda Zollars, COC, CPC
Resources for E/M Auditing Panel
Michael D Miscoe, Esq, CPC, CPCO, CPMA, CASCC, CCPC, CUC
Coding Chronic Conditions
ICD-10-CM Code Updates
Risk Adjustment
Brian R Boyce, CPC, CPC-I, CRC
Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC,
CPEDC, CRC
Find all sessions and conference details at aapc.com/conferences
Hotel (Includes taxes and fees)
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ATLANTIC CITY 2 0 1 6
Atlantic City, NJ
October 6- 8
12 CEUs | $695 $445
thru July 31st
Atlantic City, NJ
Session Highlights
Unlocking ICD-10 Combination Codes
E/M Capture in the Hospital Outpatient
Department
Linda Martien, COC, CPC, CPMA
Bullet-Proof Your Documentation
Future of Value-Based Healthcare
Dan Schwebach, MHA, CPPM
Deep Dive: The Incident - To Rule
Michael D Miscoe, Esq, CPC, CPCO, CPMA, CASCC, CCPC, CUC
NCCI and Modifier 59, X{EPSU}
How to Analyze Denials and Rejections
Yvonne D Dailey, CPC, CPB, CPC-I
Coding Chronic Conditions
Angela B Clements, CPC, CPC-I, CEMC, COSC
Risk Adjustment
ICD-10-CM Code Updates
Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC,
CPEDC, CRC
Visit aapc.com/conferences to see all the sessions and conference details
Hotel (Includes taxes and fees)
Harrah's Resort
■ CODING/BILLING
By Stephanie Cecchini, CPC, CEMC, CHISP
Apply 14 strategies to
help you climb your
way to coding success.
There are more than 120,000 certified medical
coders in the United States. Some coders define
their success by income; some by credentials;
some by title; some by their responsibility; and
some by many other benchmarks. How did
those coders achieve their definition of success?
A study and countless interviews uncovered
a remarkable pattern of traits among them:
These coders strategized their way to the top.
Here are 14 “secrets” of successful coders you
can use to climb the ladder to success.
38
■ Coding/Billing
Secrets of Success
Photos by Rachel Momeni.
NO. 1
Visualize Your Goal
CODING/BILLING
A 2010 Princeton study concluded the ideal income for true
happiness is $75,000 per household, per year. That poses the
question: Do you need to earn six figures? To help answer that,
ask yourself:
• Am I hungry enough to succeed?
• Does experience or belongings bring me happiness?
• What work/life balance do I need? (Earning a high
salary often means working longer hours.)
• What income is necessary to achieve the things most
important to me?
Write down what you believe will define your success. Studies
show writing it down allows you to visualize the goal and
increase your odds of reaching that goal.
NO. 2
Start (and Do Not Stop)!
A problem many of us face when we decide to start something
new is that the beginning looks and feels a lot like failure. For
example, when you go to the gym for the first time, it might be
weeks before you see the results from the exercise you are doing,
but you will immediately begin to feel pain in your muscles. It’s
important to work through a slow start, and to stick with your
conviction to reach your goal.
NO. 3
Master What You Have
Many people have all kinds of resources at their disposal, yet
don’t take the time to master any of them. Instead of sitting back
and complaining, “If only I had …,” focus on the resources to
which you already have access, and improvise to overcome your
obstacles. Learn to use the tools you have better than anyone
imagined possible. If you waste time lamenting on what you
don’t have, you’ll miss an important opportunity to master what
you do have.
www.aapc.com
July 2016
39
Secrets of Success
CODING/BILLING
NO. 4
Do What You Love
Have a Sense of Urgency
When you love something, you put tremendous energy into
it. Someone who does not feel passionate about what they do
cannot have the same easy commitment and dedication as
someone who does. For many coders, this will happen in an
area of specialization, such as coding for particular medical
specialty, coding facility versus professional fees, surgical claims,
or evaluation and management (E/M) claims. For others, it
might be working in management, consulting, or teaching.
When you do what you love, you’ll have an enthusiasm that leads
to advanced opportunities.
The most successful coders share an extreme sense of urgency.
This is a Zen-like conviction to get the job done better than
anyone else can. Urgency comes from understanding why
you are motivated to do something. What gets you up in the
morning? What is your destiny? What will keep you pushing
toward your goals no matter what obstacles you face? Look
inside yourself and define your “why.” If you do not know what
your “why” is, and your “why” is not strong, you will find it
difficult to fight for success and win.
NO. 5
Outwork Them
An important shift is happening within our workforce.
Approximately 30 percent of us are Millennials (people born
between 1985 and 1996). Studies show that younger workers
desire more personal time, which makes them less likely to work
extended hours. Those of you willing to put in extended time
will stand out in a sea of coders who are otherwise committed to
family and friends. A powerful work ethic and commitment to
career will set you apart from other employees and demonstrate
that you mean business.
NO. 6
40
NO. 7
NO. 8
Develop Business Acumen
Professional coders are smart, hardworking, committed,
trustworthy, and resilient. They are committed to their ongoing
professionalism, and they constantly hone their subject matter
skills. They seek out education to become more assertive and
confident. They learn how to self-promote, get a mentor, and
effectively network. Successful coders also understand the
financials of their business. They understand costs; revenue;
working capital; earnings before interest, taxes, depreciation,
and amortization (EBITDA); and working within a budget.
They are able to scan their active environment for opportunities
and risks affecting their practice’s bottom line. Gain these skills
and you’ll climb a couple of rungs up the career ladder.
NO. 9
Get Creative
Have Confidence
We are often told to “think outside of the box.” Scientists have
proven, however, that abstractly thinking about something
without some kind of context is exceedingly difficult. Instead,
think about things in different boxes. To do this, successful
coders ask questions — specifically open-ended questions for
which there are no right or wrong answers. For example, instead
of asking, “Doctor, how many review of systems are required for
a 99202?” ask, “Doctor, how do you feel about documenting
E/M services?” This allows for a more creative and customized
discussion, which can lead to a more successful outcome.
It’s surprising to me how many coders fall into the trap of
self-doubt. Even successful coders reportedly struggle with
insecurity. Why? As coders, we must deal with daily criticism,
rejection, arrogance, and pressure. Self-talk is incredibly
important in dealing with all that negativity.
Repeat after me: You are a person of worth.
Start each day with a positive affirmation that focuses on your
strengths. Be optimistic. Relax. And remember that you have
purpose.
To discuss this
www.aapc.com
Secrets of Success
NO. 10
NO. 13
Embrace Change
“I’m sorry! I bumped into you when you stepped out in front
of me!”
“I’m sorry that the CMS compliance rules are so frustrating!”
“I’m so sorry to bug you.”
How many times a day do you say, “I’m sorry?” How many
times do you actually mean it? Many of us use the words to
soften our message before it leaves our mouth. It’s a word we use
out of politeness. But what it actually does is undermine your
leadership ability and authority, which is more of a career killer
than being disliked. Don’t say, “I am sorry you have to learn these
coding rules.” Instead, say, “These rules are difficult, but I can
help you make sense of them.”
What you know is less valuable than your ability to learn and
adapt. Change is necessary to avoid becoming obsolete. One
coder I spoke with earns $225,000 per year. Despite her salary,
she told me the one thing that sets her apart is her ability to
stay current with change. Rather than looking at change as
something to overcome, she chooses to run directly into it.
NO. 11
Tolerate Risk
To get ahead, a certain amount of career experimentation is
usually necessary. This can be scary. In a phenomenon known as
negativity bias (also known as the negativity effect), we tend to
overestimate the risk associated with a change and underestimate
the overall opportunity. Go ahead and take the leap. Ships may
be safest in the harbor, but they are built to be at sea. When the
learning curve is straight up, your salary will often follow.
CODING/BILLING
Don’t Apologize
NO. 14
Don’t Wait
Do not wait to be happy. The only thing that we have, for sure, is
the current moment. If you do not allow yourself to be happy in
the moment you are in, you lose a beautiful gift. Do not put off
going to the park with your kids, or trying the newest things that
interest you. Do not wait to be happy until you are “successful.”
You already may be there.
Stephanie Cecchini, CPC, CEMC, CHISP, is an ICD-10 trainer, a medical coding expert, public speaker, and executive who has been serving the healthcare community for more than 20 years. She is a member of the Salt Lake
City, Utah, local chapter.
NO. 12
Practice Humility
Documentation used for coding can be frustratingly subjective.
In an effort to create a reproducible audit result, coders tend
to create black and white philosophies that help us in our
decision-making. For coders not yet humbled by E/M coding
interpretations, for example, it might be difficult to ask for help,
or even to ask for forgiveness. Remaining open-minded and
collaborative is a common trait among most successful coders.
Be the impetus for creating a coding community where we
demonstrate more patience, respect, gratitude, humility, and
forgiveness with each other.
www.aapc.com
July 2016
41
■ CODING/BILLING
Soothe the
Sting of 2016
Paravertebral
Block Changes
When you know the
bundling rules and how to
report additional sites,
coding is no longer a pain.
F
or 2016, there are several additions to CPT® codes relating to
paravertebral blocks (PVB):
64461
Paravertebral block (PVB) (paraspinous block) thoracic; single injection site (includes imaging
guidance, when performed)
+64462 second and any additional injection site(s) (includes imaging guidance, when performed)
(List separately in addition to code for primary procedure)
64463 continuous infusion by catheter (includes imaging guidance, when performed)
Per their descriptors, all PVB codes bundle imaging guidance; CPT®
specifically instructs us not report the radiology (i.e., computed
tomography or fluoroscopy) separately.
Call on 64462 for Additional Sites
Report an initial PVB injection in the thoracic spinal area with
64461. Report additional thoracic PVB sites with add-on code
64462.
Example: A 46-year-old male presents with severe thoracic pain
due to lung metastasis. He is to undergo PVB injections at T3T6. Injections were performed, with additional injections to each
additional space.
Based on the documentation, the correct coding for this scenario is:
64461 (first level, T3), 64462 x 3 for the three additional levels (T4,
T6, and T6).
space of the thoracic spine (e.g., to attach a drug delivery system) for
continuous infusion of drugs such as anesthetics, steroids, or opioids.
Example: A patient presents to the pain management clinic
for insertion of a pain pump within the paravertebral space for
continuous infusion of Demerol® for his lung metastasis and chronic
pain due to neoplasm. The physician inserts the catheter tip within
the area of T4 and attaches this to the pain pump for delivery of pain
medication and pain management.
When coding PVBs, remember:
• This block is used most common for analgesia/anesthesia for
postoperative pain management.
• Blocks may be necessary for pain management following
certain types of surgery, such as breast surgery or thoracotomy,
or for patients with rib fractures. These necessary blocks may
be separately reportable if the physician documents the block
as separate from the procedure.
Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CANPC, CASCC, CEDC, CRC, ICDCT-CM/PCS,
has been a coder for over 20 years with her most recent position being held at Change Healthcare as a quality analyst/educator. She has many years of experience in several different areas of
coding and serves as an interim instructor in her hometown of Mobile, Ala. Pritchett owns and
operates her own medical billing and coding company, Gulf Coast HIM Solutions located in Mobile, Ala. She shares
her expertise in publications and as a lecturer at conferences such as Coding-Con for The Coding Institute. She has
served as the president and vice president of the Mobile, Ala., local chapter.
Use 64493 for Continuous Infusion
Code 64463 reports placement of a catheter tip in the paravertebral
42
■ Coding/Billing
istock.com/Marccophoto
By Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CANPC, CASCC, CEDC, CRC, ICDCT-CM/PCS
CODING/BILLING ■
By Oby Egbunike, CPC, COC, CPC-I, CCS-P
Ease the Pressure of
Decubitus Ulcer Coding
D
extend up to, but not through, deep
fascia.
• Stage 4: Necrosis of the soft tissue
extending to muscle, tendons, joints,
and/or bone.
• Unspecified stage: There is no
provider documentation specifying
the stage of the ulcer.
• Unstageable ulcer: The provider
cannot clinically determine the depth
of the ulcer, due to eschar or slough
covering the ulcer.
When multiple ulcer sites are documented,
code for each anatomic site and stage.
Sequencing is based on the pressure ulcer
being treated. If all the pressure ulcers are
treated, sequence the code for the most
When multiple ulcer
sites are documented,
code for each anatomic
site and stage.
severe pressure ulcer first. ICD-10 includes
a note with category L89 Pressure ulcer to
“code first any associated gangrene (I96).”
For example, the physician documents
an unstageable pressure ulcer on the right
hip covered in eschar. The appropriate
coding is L89.210 Pressure ulcer of right hip,
unstageable.
In a second example, a patient is diagnosed
with a stage 3 pressure ulcer of the left heel.
Proper coding is L89.623 Pressure ulcer of
left heel, stage 3.
Reference
2016 ICD-10-CM Expert for Physicians
Oby Egbunike, CPC, COC, CPC-I, CCS-P, is a licensed ICD-10-CM instructor for AAPC. She has a
Bachelor of Arts in Business Administration with concentration in Health Information Management from
Northeastern University Boston. Egbunike has more than 10 years of experience in healthcare management, coding, billing, and revenue cycle.
She is associate director of professional coding and education at Lahey
Health. Egbunike is a member of the Boston, Mass., local chapter.
istock.com/Solar22
ecubitus ulcers — also known as bedsores
or pressure ulcers — develop as a result of
compromised circulation to tissues of the
skin. For example, when a patient stays in
one position too long, the weight of the
bones against the skin inhibits circulation
and causes ulceration. This usually occurs
at the heaviest bones, such as the buttocks,
hips, and heels.
Appropriate coding of a pressure ulcer
requires documentation of the location (site),
laterality (if applicable), and stage of the
ulcer. ICD-10-CM pressure ulcer codes are
combination codes that identify the location
(site) of the ulcer, as well as the stage.
Pressure ulcer stage is classified based on the
severity: stages 1-4, unspecified stage, and
unstageable.
• Stage 1: Redness that does not turn
pale when pressed and released with a
fingertip (persistent focal erythema).
• Stage 2: Partial thickness skin loss
involving epidermis, dermis, or both.
• Stage 3: Full thickness ulceration
into subcutaneous fat, which may
ICD-10 coding relies on
documentation that
includes stage, location,
and sometimes laterality.
■ Coding/Billing
www.aapc.com
July 2016
43
■ CODING/BILLING
By Debra Mitchell, MSPH, COC
istock.com/dolgachov
ICD-10
Restricts
Same-day
Sick and
Well Visits
I
Diagnosis code
descriptions don’t
allow split billing for
sick patients who are
at your office for a
preventative exam.
CD-10-CM strictly limits the circumstances under which a provider
may report a preventive visit and a sick visit for the same patient on
the same day. If the patient is symptomatic on arrival for a preventive
visit, per ICD-10-CM guidelines, the visit no longer qualifies as a
preventive encounter. A sick visit may be billed, but the preventive
visit should be rescheduled.
ICD-10 Changes the Rules
Billing a sick visit with a wellness visit (sometimes called “split
billing”) has been common practice. I contend that the adoption of
ICD-10-CM last October has changed the rules, however, making
split billing rarely appropriate. The reason lies in the descriptors for
codes used to report preventive encounters.
Codes describing preventive encounters are found in categories Z00
Encounter for general examination without complaint, suspected or
reported diagnosis and Z01 Encounter for other special examination
without complaint, suspected or reported diagnosis. The codes necessarily
include the category designation within their full descriptors. For
example:
Z00.0- 44
Encounter for general examination without complaint, suspected or reported diagnosis; Encounter for
general adult medical examination
■ Coding/Billing
Same-day Visits
The payer may accept the claim, but
that doesn’t mean it’s coded correctly.
Encounter for general examination without complaint, suspected or reported diagnosis; Encounter
for newborn, infant and child health examinations
Z01.4- Encounter for other special examination without complaint, suspected or reported diagnosis;
Encounter for gynecological examination
If the category descriptor does not apply, neither can the individual
code in that category. By properly including the category designation
into the descriptors, Z00.0-, Z00.1-, and Z01.4- are not appropriate
if the patient has a current complaint, or a suspected or reported
diagnosis. In other words, you cannot report a wellness encounter if
the patient is sick.
Excludes Notes Strengthen the Rule
To reinforce this guideline, ICD-10-CM specifies an Excludes1
note to prevent reporting Z00.0- or Z01 in addition to signs and
symptoms:
Z00.0Type 1 Excludes:
encounter for examination of sign or symptom – code to sign or symptom
Z01
Type 1 Excludes:
encounter for laboratory, radiologic and imaging examinations for sign(s) and symptom(s) ̶ code to the sign(s)
or symptom(s)
Note: The pediatric well visit codes do not have an Excludes1 note
for signs and symptoms, but do carry the category description
for each selection, “Encounter for general examination without
complaint, suspected or reported diagnosis.”
ICD-10-CM defines an Excludes1:
A type 1 Excludes note is a pure excludes note. It means
“NOT CODED HERE!” An Excludes1 note indicates
that the code excluded should never be used at the same
time as the code above the Excludes1 note. An Excludes1
is used when two conditions cannot occur together, such
as a congenital form versus an acquired form of the same
condition.
The Excludes1 notation means you may not list the affected Z00/
Z01 codes with signs or symptoms codes in field 21 of the claim
form, even if you link the diagnoses to different line items in field
CODING/BILLING
Z00.1- 24 of the form. The payer may accept the claim, but that doesn’t
mean it’s coded correctly. A payer is not allowed to override the
Excludes1 edits; only the World Health Organization (WHO),
which maintains the ICD-10 code set, has that authority.
WHO has investigated complaints regarding some Excludes1 edits,
and they published interim advice in October 2015 through the
Centers for Disease Control and Prevention (CDC):
Updated October 26, 2015 (Original posting October 19,
2015) There are circumstances that have been identified
where some conditions included in Excludes1 notes should
be allowed to both be coded, and thus might be more
appropriate for an Excludes2 note. However, due to the
partial code freeze, no changes to Excludes notes or revisions
to the official coding guidelines can be made until October
1, 2016. This new guidance concerning Excludes1 notes is
intended to allow conditions to be reported together when
appropriate even though they may currently be subject to
an Excludes1 note. This coding advice has been approved
by the four Cooperating Parties—the American Health
Information Management Association (AHIMA), the
American Hospital Association (AHA), the Centers
for Medicare and Medicaid Services (CMS), and the
National Center for Health Statistics (NCHS). This
advice will also be published in the 4th Quarter 2015
issue of Coding Clinic for ICD-10-CM and ICD-10PCS.
Question:
We have received several questions regarding the
interpretation of Excludes1 notes in ICD-10-CM when the
conditions are unrelated to one another. How should this
be handled?
Answer:
If the two conditions are not related to one another, it
is permissible to report both codes despite the presence
of an Excludes1 note. For example, the Excludes1 note
at code range R40-R46, states that symptoms and signs
constituting part of a pattern of mental disorder (F01-F99)
www.aapc.com
July 2016
45
To discuss this
www.aapc.com
Same-day Visits
CODING/BILLING
Although you can have a patient who is both bipolar
and experiencing (unrelated) dizziness, a patient
cannot be both well and sick at the same time.
The statement, “If the two conditions are not related to one
another ...” does not allow reporting of same-day well and sick
encounters. Although you can have a patient who is both bipolar and
experiencing (unrelated) dizziness, a patient cannot be both well and
sick at the same time.
CPT® Guidelines Allow Some Exceptions
CPT® guidelines do allow for same-day sick and preventive visits:
If an abnormality is encountered or a preexisting problem
is addressed in the process of performing this preventive
medicine evaluation and management service, and if the
problem or abnormality is significant enough to require
additional work to perform the problem oriented E/M
service, then the appropriate Office/Outpatient code
99201-99215 should also be reported. Modifier 25
should be added to the Office/Outpatient code to indicate
that a significant, separately identifiable evaluation and
management service was provided on the same day as the
preventive medicine service. The appropriate preventive
medicine service is additionally reported.
Notice, however, that this instruction does not address the patient
who presents for a well visit with symptomatic concerns; rather, it
narrowly addresses a visit with abnormal findings or a pre-existing
condition that requires additional workup. In these cases, you may
report an office visit with the preventive visit, as long as there is
documentation of an abnormal finding in the notes (a presenting
symptom is not an abnormal finding). You must be sure to append
modifier 25 to the office visit.
46
istock.com/AlexRaths
cannot be assigned with the R40-R46 codes. However, if
dizziness (R42) is not a component of the mental health
condition (e.g., dizziness is unrelated to bipolar disorder),
then separate codes may be assigned for both dizziness and
the mental health condition. In another example, code
range I60-I69 (Cerebrovascular Diseases) has an Excludes1
note for traumatic intracranial hemorrhage (S06.-). Codes
in I60-I69 should not be used for a diagnosis of traumatic
intracranial hemorrhage. However, if the patient has both a
current traumatic intracranial hemorrhage and sequela from
a previous stroke, then it would be appropriate to assign
both a code from S06- and I69-.
Look to Patient Scenarios for Clarity
Example 1: A patient is scheduled for a well visit. He arrives and is
asymptomatic with no specific complaint, but during the course
of the well visit a problem is discovered. Assuming documentation
is complete, code for the well visit with abnormal findings. Also
code an E/M service (if it was significant) to address the problem,
and append modifier 25. Code the signs and symptoms, unless a
definitive diagnosis is documented.
Example 2: A patient scheduled for a well visit is symptomatic when
he arrives. For dates of service on or after October 1, 2016, you may
not code a well visit, per ICD-10-CM. You must report a sick visit,
and report the signs and symptoms, or (if confirmed) a definitive
diagnosis.
Debra Mitchell, MSPH, COC, is a coding and compliance consultant and auditor, as well as a professional instructor in coding, billing, and medical terminology. She has developed several courses for adult education programs
in medical coding and billing, and has contributed to the development of a coding certification program. Mitchell
was recently named to the Biltmore’s Who’s Who in America’s Professional Women. She is a member of the Columbia, Mo., local chapter.
Resources
WHO interim advice on excluded, CDC, October 2015: www.cdc.gov/nchs/data/icd/Interim_
advice_updated_final.pdf
■ DEAR JOHN
Have a Coding Quandary? Ask John
Do I Use 25 or 59 for Same-day Assessment and E/M?
Q
Can you advise on the appropriate modifier usage
for billing an emergency department evaluation and
management (E/M), such as 99284, with G0396 to avoid
bundling edits? Should the physician apply modifier 25 on
the E/M? Should she apply 59 on G0396? Or should she both apply
25 to the E/M and 59 to G0396?
A
Append modifier 25 Significant, separately identifiable
evaluation and management service by the same physician
or other qualified health care professional on the same
day of the procedure or other service to the appropriate
E/M service code when the provider performs “a significant,
separately identifiable E/M above and beyond the other service
provided, or beyond the usual preoperative and postoperative
care associated with the procedure that was performed” (CPT®
Appendix A: Modifiers).
By contrast, modifier 59 Distinct procedural service “is used to
identify procedure/services other than E/M services, that are
not normally reported together, but are appropriate under
the circumstances.”
In this case, the only (non-E/M) service provided is the alcohol/
substance abuse assessment; therefore, modifier 59 is not
appropriate. To report the significant, separately identifiable
E/M service on the same day as the assessment, proper coding
is G0396 Alcohol and/or substance (other than tobacco) abuse
structured assessment (e.g., audit, dast), and brief intervention 15
to 30 minutes and 99284-25 Emergency department visit for the
evaluation and management of a patient, which requires these 3
key components: A detailed history; A detailed examination; and
Medical decision making of moderate complexity.
Although not required, it’s helpful to document the E/M service
separately in the note. This helps to illustrate the separate nature
of the E/M. The E/M and other procedure or service may be
related (i.e., the reason for the E/M also may be the reason for
the other procedure or service), but the work of the E/M service
must meet all requirements of the chosen level of service.
TCI # 1
www.aapc.com
July 2016
47
■ CODING/BILLING
By Brad Ericson, MPC, CPC, COSC
istock.com/&#169 radiuoz
WHO
Winds
Its Gears
for ICD-11
ICD-11 is in the works, but you can bet your favorite watch
there’s plenty of time before it comes to fruition.
W
hat’s happening with ICD-11? As ICD-10 implementation
loomed last summer, many who were opposed to it argued we
should wait until ICD-11 was available. It would give us time to
implement true interoperability, and avoid the localized disruptions
ICD-10 would no doubt bring, naysayers contended.
But the ICD-10 implementation happened, and by most accounts it
has been less painful than feared. ICD-11 has been forgotten on this
side of the Atlantic, at least.
Swiss Precision
In Switzerland, the World Health Organization (WHO) is crafting
the new code set like a watch, projecting a 2018 release. Member
nations like the United States will then adapt it for their needs, which
will take at least a couple of years. Then the implementation process
begins. But don’t panic about the implementation just yet; it took 17
years to implement ICD-10-CM after it was released by the federal
government.
48
According to Donna Pickett, MPH, RHIA, the chief of classification
and public health data standards at the National Committee for
Health Statistics (NCHS), ICD-11 will be an electronic-only tool,
supporting electronic health records (EHRs) and information
systems. Like ICD-10, ICD-11 is touted as being a data-rich resource,
making work easier for public health efforts, payers, policy makers,
and providers.
Much of the WHO’s work has been marrying its Family of
Classifications with the Standardized Nomenclature of Medicine
– Clinical Terms (SNOMED CT) to link terminologies and
classifications. “In the era of information and electronic health
records,” Pickett told the NCHS’ Coordination and Maintenance
Committee, “it represents a major achievement.” That major
achievement includes using terminology common to all member
nations and more forcefully steers the industry toward electronic
assignment.
■ Coding/Billing
To discuss this
www.aapc.com
ICD-11
What Does it Look Like?
ICD-11 will be quite different from ICD-10, and last year’s
proponents may find it as daunting as ICD-10 seemed. The Centers
for Medicare & Medicaid Services (CMS) cautions, however, that
ICD-10-CM is an essential building block for the implementation
of ICD-11.
ICD-11 has five new chapters:
• Chapter 3 - Diseases of the Blood and Blood-forming Organs
• Chapter 4 - Disorders of the Immune System
• Chapter 6 - Conditions Related to Sexual Health
• Chapter 8 - Sleep-Wake Disorders
• Chapter 26 - Extension codes
• Chapter 27 - Traditional Medicine
The new code set also has a new coding scheme. For example,
chapter numbers will be Arabic rather than Roman. Codes will have
an additional letter in the second character, differentiating it from
ICD-10. The first character always relates to the chapter number.
Codes will be different, too. The foundation of the code — the stem
code — will be in the index. In Pickett’s example, type 1 diabetic
mellitus (DM) is the stem code and appended with another code to
describe the disease.
Example: Patient with type 1 DM with diabetic retinopathy
6A10 Type 1 diabetes mellitus
MG45 Diabetic retinopathy
6110/MG45 Type 1 DM with diabetic retinopathy
In addition to a new format for the codes, which will be provided
in both long and short descriptions, further clarity is added by the
Section X codes. There are three types of Section X extension codes:
• Type I codes add additional detail that accommodates
further medical detail for the stem code, such as laterality or
severity.
• Type II codes add administrative and other usage data, such
CODING/BILLING
Like ICD-10, ICD-11 is touted as being a data-rich
resource, making work easier for public health
efforts, payers, policy makers, and providers.
as the stem code is the main condition, or was present on
admission.
• Type III codes indicate when the associated stem code is used
as a reference, such as in documentation of a patient’s family
history.
Try It On
There is a lot more to ICD-11 than we can inspect here, and a lot of
it is still being tested and discussed. You can access a beta version
and make comments through the WHO’s website. You also can
learn more about their efforts to assure universal ease-of-use and
comprehensive input, which have included the participation of
Topic Advisory Groups (TAGs), newsletters, and other outreach.
The WHO has developed a coding tool that helps you better use
and understand the code set. Using their official process, you
can make proposals for change and help build the code set you
eventually may use. Go to www.who.int/classifications/icd/en/ to see what’s
coming in your future.
Brad Ericson, MPC, CPC, COSC, is publisher at AAPC and a member of the Salt Lake City, Utah, chapter.
Resources
ICD-11 at WHO: www.who.int/classifications/icd/revision/en/
TAG information: www.who.int/classifications/icd/TAGs/en/
NCVHS, Status of ICD-11, Pickett, Donna: www.ncvhs.hhs.gov/wp-content/uploads/2016/01/
Pickett-Status-of-ICD-11-v2-feb-17-2016-revised.pdf
Transitioning to ICD-10. CMS Press Release, Feb. 25, 2015: www.cms.gov/Newsroom/
MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-02-25.html
www.aapc.com
July 2016
49
■ CODING/BILLING
By John Verhovshek, MA, CPC
The Latest on Multianalyte
Assays with Algorithmic Analyses
•
•
•
•
Disease type
Specimen type and analyzed materials
Methodology
A report, such as a probability index or
risk score
For example, the descriptor for 81500
Oncology (ovarian), biochemical assays of two
proteins (CA-125 and HE4), utilizing serum,
with menopausal status, algorithm reported as
a risk score tells us the disease type (ovarian),
the specimen/materials analyzed (proteins
CA-125 and HE4, utilizing serum), and the
type of report (algorithm reported as a risk
score).
When to Turn to Appendix O
W
hen coding for multianalyte assays with
algorithmic analyses (MAAA), it may
help to know the brand name of the test(s)
performed; and when applying the MAAA
codes (CPT® 81490-81599), be careful to
heed all CPT® parenthetical instructions.
Decipher MAAA Codes
An analyte is “a chemical substance that is
the subject of a chemical analysis,” and an
assay is “analysis (as of an ore or drug) to
determine the presence, absence, or quantity
of one or more components” (per MerriamWebster). MAAA involves the analysis of
various materials, the results of which are
used to assign a numeric value. That value
measures, for instance, the activity of a given
disease or a patient’s risk of a particular
disease.
50
For example, CPT® Changes 2016: An
Insider’s View tells us that 81490 Autoimmune
(rheumatoid arthritis), analysis of 12
biomarkers using immunoassays, utilizing
serum, prognostic algorithm reported as a
disease activity score (a new code in 2016),
“may be performed in adults with rheumatoid
arthritis to quantify disease activity. The
result, a disease-activity score, may help
predict risk for subsequent joint damage in
patients with arthritis.”
In the Pathology and Laboratory section
of CPT®, guidelines under subsection
Multianalyte Assays with Algorithmic
Analyses define and explain the MAAA
codes at length. As the CPT® codebook
explains, the MAAA code descriptors provide
important details about the procedures they
represent, such as:
Several MAAA tests are proprietary to a single
clinical laboratory or manufacturer, and are
commonly referred to by brand name (e.g.,
ROMA™, Harmony™, ScoliScore™) rather
than by the details listed in the individual
CPT® code descriptors. To aid in proper code
assignment, CPT® Appendix O Multianalyte
Assays with Algorithmic Analyses lists
a number of MAAA tests by brand name
and lab/manufacturer, matching them to
the appropriate CPT® code. In this way, for
example, you can quickly determine proper
coding for AlloMap® is 81595 Cardiology
(heart transplant), mRNA, gene expression
profiling by real-time quantitative PCR of 20
genes (11 content and 9 housekeeping), utilizing
subfraction of peripheral blood, algorithm
reported as a rejection risk score.
A number of tests listed in Appendix O are
reported using a four-digit number followed
by the letter M, rather than a CPT® Category
I code (e.g., 0004M Scoliosis, DNA analysis of
■ Coding/Billing
istock.com/Shironosov
Look to brand names and parenthetical
instructions when coding these procedures.
To discuss this
www.aapc.com
Don’t Overlook
Parenthetical Instructions
Even if you are able to assign a code by
referencing a brand name using Appendix
O, be sure to check the full code listing in the
Pathology and Laboratory section of CPT®. A
majority of the 20+ MAAA Category I codes
listings include parenthetical guidelines
that are crucial for proper code application.
For example, the complete listing for 81512
Fetal congenital abnormalities, biochemical
assays of five analytes (AFP, uE3, total hCG,
hyperglycosylated hCG, DIA) utilizing
maternal serum, algorithm reported as a
risk score tells us, “Do not report 81512 in
conjunction with 82105, 82677, 84702,
86336.”
What’s Included?
The MAAA codes “encompass all analytical
services required … in addition to the
algorithmic analysis itself.” For example,
you would not separately report technical
lab tests, such as 86140 C-reactive protein, in
addition to an MAAA code because MAAA
codes always include the underlying lab
tests. MAAA codes also include cell lysis
(using an agent or substance to break down
cells into their components), but CPT® rules
allow you to separately report procedures
that are required prior to cell lysis, such
as microdissection (88380 Microdissection
(ie, sample preparation of microscopically
identified target); laser capture and 88381
Microdissection (ie, sample preparation of
microscopically identified target); manual).
Note, as well, that some payers may pay
separately for collection of specimens
(e.g., 36415 Collection of venous blood by
venipuncture).
Coding Examples
The following examples assume the payer
follows CPT® guidelines:
Example 1: CPT® Changes 2016 offers
the following example of 81525 Oncology
(colon), mRNA, gene expression profiling by
real-time RT-PCR of 12 genes (7 content and
5 housekeeping), utilizing formalin-fixed
paraffin-embedded tissue, algorithm reported
as a recurrence score:
A 60-year-old female with stage
T3 mismatching repair (MMR)
positive colonic adenocarcinoma
visits her oncologists two weeks
after surgery. The oncologist orders
an assay to analyze the expression
of 12 genes, including an algorithm
which provides a recurrence score.
The recurrence score predicts the risk
of colon cancer recurrence for the
patient and is used to help inform
adjuvant treatment decisions.
Example 2: The patient is subject to Corus®
CAD test. In Appendix O, this crossreferences to CPT® 81493 Coronary artery
disease, mRNA, gene expression profiling by
real-time RT-PCR of 23 genes, utilizing whole
peripheral blood, algorithm reported as a risk
score. Be sure to check the code listing in
the Pathology and Laboratory section; in
Even if you are able to assign
a code by referencing a brand
name using Appendix O, be sure
to check the full code listing in
the Pathology and Laboratory
section of CPT®.
CODING/BILLING
53 single nucleotide polymorphisms (SNPs),
using saliva, prognostic algorithm reported
as a risk score, which describes ScoliScore™,
Tansgenomic, Inc.).
Whether assigning a Category I code or an
M code, the test being billed “must fulfill
the code descriptor and, if proprietary, must
be the test represented by the proprietary
name listed in Appendix O,” per CPT®
instructions.
In other words: You must make an exact
match to assign a specific code. “Close
enough” doesn’t count. Instead, CPT® tells
us, “When a specific MAAA procedure
is not included in either [Appendix O] or
in the Category I MAAA section, report
the analysis using the Category I MAAA
unlisted code (81599),” and “When an
analysis is performed that may potentially
fall within a specific descriptor, however
the proprietary name is not included in
[Appendix O], the MAAA unlisted code
(81599) should be used” (see also CPT®
Assistant, January 2015).
Appendix O is not an exhaustive list of
brand-name MAAA procedures; in some
cases, you must code solely from the CPT®
code listings, based on the code descriptors.
MAAA
this case, there are no further parenthetical
directions to guide code application.
Example 3: The patient undergoes a test
that meets the descriptor requirements for
81503 Oncology (ovarian), biochemical assays
of five proteins (CA-125, apolipoprotein A1,
beta-2 microglobulin, transferrin, and prealbumin), utilizing serum, algorithm reported
as a risk score, but the test is not OVA1™
by Vermillion, Inc. Per CPT® instruction,
“When an analysis is performed that may
potentially fall within a specific descriptor,
however the proprietary name is not
included in [Appendix O], the MAAA
unlisted code (81599) should be used.” In
this case, 81599 Unlisted multianalyte assay
with algorithmic analysis is appropriate.
Medicare Doesn’t
Accept MAAA Codes
On a final note, Medicare doesn’t accept
the MAAA codes, and (in defiance of
CPT® rules) instead instructs you to bill the
underlying test codes.
When reporting to Medicare, the situation
is more complex and may require some
research. For example, Medicare does not
pay for MAAA 81538 Oncology (lung), mass
spectrometric 8-protein signature, including
amyloid A, utilizing serum, prognostic and
predictive algorithm reported as good versus
poor overall survival, and instead instructs
you (via the 2016 Clinical Laboratory Fee
Schedule final determinations) to report
83789 Mass spectrometry and tandem mass
spectrometry (eg, MS, MS/MS, MALDI,
MS-TOF, QTOF), non-drug analyte(s)
not elsewhere specified, qualitative or
quantitative, each specimen x 8 units.
John Verhovshek, MA, CPC, is managing editor at AAPC and a
member of the Hendersonville-Asheville, N.C., local chapter.
www.aapc.com
July 2016
51
■ ADDED EDGE
By Holly Pettigrew, COC, CPC, CHC
Ditch the Emotional Baggage
to Become a Respected Auditor
Experience shows that as confidence builds, value grows.
W
hen I accepted the position of physician coding auditor for a large
healthcare organization, I was excited and optimistic. The title
“auditor” carries a certain sense of power or prestige, but on the flipside
it also brings to mind negative images of someone who is not welcome.
I imagined myself with a hard edge in a blue or black dress suit, plain
pump shoes, very little makeup, and hair pulled back tightly with a
furrowed brow and briefcase in tow. But in the back of my mind was
my softer side with an optimistic glimmer — I just knew I could
change the organization’s perception of an auditor. I wanted
to be someone who was seen as helpful, valuable, and
essential.
such as “bean counting” for evaluation and management code leveling.
When dealing with colleagues and those I was auditing, I considered
myself a pretty good conversationalist and negotiator, and I was
confident I could deal with emotional responses quite well. I studied
courses on how to become a better presenter, and I knew I needed to
become a better listener. Ultimately, I found that beyond academic
knowledge, it takes a mentally strong
person with unwavering ethics
to be a good auditor.
I began rigorous training. I had more
than 20 years’ experience in the
medical field with extensive medical
terminology knowledge, so I
thought it would be fairly easy
to slide into the auditor role.
That was not the case. As part
of my training, every detail of
my preliminary audits were
carefully scrutinized, and I
became an expert on concepts
Now when I
enter a clinic
door, people are
glad to see me.
“Compliance” and
“ethics” are no longer
scary words.
52
istock.com/Sudowoodo
Sliding into the Auditing Role
Respected Auditor
Here I was, a Certified Professional Coder (CPC®), telling a
provider with at least an MD or DO behind his name how to
correct his documentation as I was pointing out his errors.
Anxiety Levels Take a Steady Climb
Just finding the way to clinics in a giant metroplex is intimidating in
itself. The worst part of the job, however, was the dreaded “failing” of
a provider and needing to rebill. Here I was, a Certified Professional
Coder (CPC®), telling a provider with at least an MD or DO behind
his name how to correct his documentation as I was pointing out his
errors. Giving negative news can be emotionally draining because
generally people like to get along with others. It seemed unnatural
to me at first. I watched the look on the provider’s face as I informed
him that the score on the audit did not meet the necessary level and I
detailed the process for correction. It was a horrible feeling, and I know
he saw it in my eyes. But I was assured by others in my department
it would get better, and that I needed to focus on how much good it
would bring to the company by correcting the coding issues.
As the first few months went on, my anxiety level increased. I would
not sleep the night before an audit when there was a possibility a doctor
would not pass. Was it tempting to alter a detail to pass a physician?
Absolutely, but what kind of auditor would I be? Obviously, not one
with integrity, so I pushed through and did the right thing.
Raise Emotional IQ to Demand Respect
I took steps to become more comfortable with auditing, strengthen my
ethical integrity, and alleviate anxiety. If you find yourself in a similar
situation as an auditor and want to become more confident, here is
my advice:
• Practice breathing exercises while you are waiting in the lobby
to be called into an audit meeting.
• Mentally walk through a meeting, visualizing a genuine, warm
smile as you present your findings.
• Practice delivering both good and bad news, while encouraging
providers to improve their documentation.
• Become skilled at disarming emotional physicians who do not
take criticism well.
• Learn how to read people, so you can connect with them in
some way before the auditing meeting ends.
In short, raise your emotional IQ.
Listening is also a very important part of auditing. At a meeting, a
provider expressed to me that he was not happy with the past auditor
because it seemed like she “always told us what we could not code/
bill and not what we could.” I took this to heart. I searched for missed
items that were documented and could be billed in his specialty.
I find it also helps to:
• Collect teaching tools from every source you can get your hands
on.
• Create your own tools based on feedback from the providers.
• Keep up to date with new technologies.
• Share with providers relevant news released by the Centers for
Medicare & Medicaid Services and Office of Inspector General.
Once providers see your intentions are genuinely in their best interest,
you will gain their respect and rapport. This is what I did, and now
when I enter a clinic, people are glad to see me. “Compliance” and
“ethics” are no longer scary words.
Let Ethical Integrity Guide You
Companies that are more ethical actually have greater stability to
those that are not. According to a Bloomberg.com article, “Why Be an
Ethical Company? They’re Stronger and Last Longer:”
When a company’s ethical compass is pointing true north,
everything else falls into line. This isn’t to say that companies
with great ethics don’t fail. But it does seem to indicate that
companies without good ethics are far more likely to fail due
to their inability to sustain or hear an inner voice to guide
them through the dark times to the light.
Push on auditors. You have a valued place in the medical field.
Holly Pettigrew, COC, CPC, CHC, began her career with Baylor Scott & White Health in 1994.
She has held several positions with her company, from medical transcriptionist to her current
position as physician coding auditor for the Health Texas Provider Network. Pettigrew holds a
Bachelor of Science degree in Business Management and earned her CPC® in 2012. She is a member of the Fort Worth, Texas, local chapter.
Resources
Bloomberg. “Why Be an Ethical Company? They’re Stronger and Last Longer.” Wadhwa, V. (August
16, 2009): www.bloomberg.com/news/articles/2009-08-17/why-be-an-ethical-companytheyre-stronger-and-last-longer
www.aapc.com
July 2016
53
■ AUDITING/COMPLIANCE
By Andy Rusch, CPC
Guard PHI with Sensitivity
Be aware of your surroundings when
discussing a patient’s private medical information.
C
ontrary to the opinion of others, a coder’s job is never boring. We
have the privilege of reading provider notes, which are always
interesting. Sometimes they’re even funny or absurd. As professionals,
however, we must remember that we are working with sensitive
information and need to treat it as such. Patients rightly expect the
healthcare team to protect their private information. A quick review of
HIPAA requirements serves as a good reminder of that, and reinforces
our ability to guard patients’ protected health information (PHI).
Confidentiality Is Key when Handling PHI
Best practices for handling patient information and keeping medical
record integrity include:
• Ensuring the data is accurate within the documentation;
• Preventing unnecessary access to the patient information; and
• Understanding when it’s appropriate to discuss a patient record
with colleagues.
Inappropriate uses of patient information include:
• Discussing patient information within earshot of other patients
or visitors
• Discussing patient information in public areas (cafeterias,
elevators, hallways, etc.)
• Sharing information with other healthcare associates when not
required for duties
• Accessing information of close relatives or people you know
• Discussing patient information with those who are not a part of
the organization’s healthcare team
Integrity Goes Beyond Compliance
Although incidental exposure to patient information may occur within
an organization without serious repercussions, outside exposure must
be kept to a minimum to protect patients’ privacy.
The HIPAA Privacy Rule demonstrates times when discussing patient
information cannot be avoided and is necessary to the roles of the
healthcare team. When disclosure of patient PHI is necessary, there are
measures you can take to minimize the exposure. For example:
• Try not to reveal patient identification information;
• Keep the discussion to a minimum; and
• Move to a more private location, if possible.
Handling PHI appropriately goes beyond HIPAA compliance. For
example, providers need to know they can count on the coding and
health information team to work professionally with patient records.
54
Otherwise, they may be reluctant to work with the team, which can
cause communication issues. Misuse of PHI may also cause a loss of
revenue for the practice. Patients who feel their personal information
is not being kept private or safeguarded may be inclined to seek care
elsewhere.
Precautionary Steps to Shield PHI
To instill faith in your patients and providers, take precautions when
accessing patient information vital to daily tasks, such as coding,
insurance denials, and working within the patient record. For example:
• Access patient information only when it’s necessary to fulfill job
duties;
• Speak softly when discussing patients among co-workers
(which you should only do for job-related purposes); and
• Use security measures such as passwords on computers, locking
mechanisms on paper records, and automatic lock screens on
laptops.
It’s Not Just the Law
In addition to meeting requirements under law, there is a moral and
ethical standpoint to consider when accessing patient records. Suppose
you discover a funny situation in a patient record — for example, due
to an amusing situation or a dictation error — and you share that
information with other associates. Morally, you should consider this
scenario from the patient’s point of view. How would you feel if you were
the patient? Would you think sharing the information was acceptable?
Health information professionals must remember that, although you are
most often working with medical records, numbers, and dollar amounts,
you are also working indirectly with human patients. Consider whether
using the patient information is in the patient’s best interest. There will
always be a risk when sharing patient information, but you must protect
it to the best of your ability. Demonstrating a high level of integrity and
respect for patients is the best way to care for them.
Andy Rusch, CPC, is a coding professional for Ministry Health Care in Wisconsin. He graduated in
2012 with an associate degree in Biomedical Informatics and has been working as a coding specialist for the past four years. Rusch is a member of the Wausau, Wisc., local chapter.
Resources
www.hhs.gov/hipaa/for-professionals/privacy/guidance/incidental-uses-and-disclosures/
index.html
www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/
downloads/SE0726FactSheet.pdf
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All-in-one
Compliance For All
Healthicity - 2
We reinvented compliance management through a complete, flexible solution
that complies with all seven OIG recommendations to ensure you’re compliant,
even when audited.
HEALTHICITY.COM/COMPLIANCEMANAGER
■ PRACTICE MANAGEMENT
By Michelle A. Dick
Without enforcing a policy
for when it’s acceptable for
healthcare professionals to
use cellphones, a patient’s
life could be at risk.
L
et’s face it: We have become a society tied to our cellphones. They
connect us to friends and family, games, directions, events, photos,
business transactions, and even patient emails in an instant. They are
our lifeline to the world’s information. Healthcare professionals use
them to access encrypted messages and secured medical records, and
to converse with colleagues; however, those same phones can become
a life-threatening distraction when misused in a hospital.
Smartphones Are Making the Rounds
Without clear rules and policies for smartphone use, the device can
become a problem for hospital staff. This is especially true during
56
istock.com/Neustockimages
Manage Hospital
Staff Cellphone
Distractions
inpatient attending rounds, which is when supervising staff discuss
and make decisions about patient care with residents. According to
The Doctor’s Tablet blog, “Setting Boundaries on Smartphone Use
in Hospitals,” a study conducted by the Albert Einstein College of
Medicine:
… found that 57% of residents and 28% of faculty reported
using smartphones regularly during these rounds. As we
expected, the clear majority of smartphone use was to access
medical references and resources, but team members also
used their phones for personal texts and e-mails, and 15% of
residents acknowledged using their phones for non-patient
care uses (such as web-surfing).
You may have heard the story in December 2011 of a 56-year-old
male patient with dementia who was harmed because a resident
became distracted while on a smartphone. The patient needed a
replacement percutaneous endoscopic gastrostomy (PEG) tube
and the procedure was successful. Three days after the procedure,
the patient was supposed to stop anticoagulation medication. The
attending physician asked the resident to use her cellphone to enter
the medication data into the hospital’s computer system. Just as the
resident began entering the order into her smartphone to stop the
■ Coding/Billing
Smartphones
medication, she received a text message from a friend regarding an
upcoming party, and she replied through text messaging. She never
entered the information and the healthcare professionals moved on
to the next patient. The patient suffered spontaneous bleeding into
the pericardium from the dose error, which cost him an extra three
weeks in the hospital.
Poor Policy Can Put Your Hospital at Risk
To avoid incidents such as social notifications interrupting patient
care, hospitals are taking action; however, the policies aren’t always
enforced. A nurse in a hospital in North Carolina told Healthcare
Business Monthly that her hospital’s policy says personal phones
while at work are not allowed except for breaks. “We are allowed
to check our work email, but not supposed to check personal email
(which they end up blocking, so you can’t get into it from a work
computer),” she said. The nurse also said that social media is blocked
and staff isn’t allowed on social media during work. “There can be
disciplinary action for what you post on social media if management
or higher ups find out, especially if it violates HIPAA,” she said. As
for doctors at the hospital in North Carolina, they are able to check
personal email while working.
When it comes to enforcing staff policy, however, the nurse revealed:
Even though the policies state no one is supposed to use
their cellphone, everyone does, and I’ve never seen any
disciplinary action for it. Nurses leave their phones right out
on the desk. And doctors, nurse practitioners, or physician
assistants use cellphones for pretty much all communication
from what I see when they are on the unit.
The policy does state that for “extenuating circumstances”
or emergencies you can have your phone out during work if
approved by management.
Are cellphones a problem in your workplace? A good indicator is
“when there are people sitting on their phones when you need help,
or call bells are going off and stuff needs to be done,” the nurse said.
Stringent Policies Are Key
Another nurse who works at a hospital system in Western New York
(WNY) said her hospital’s cellphone policy is in the “Dress Code”
section of the employee manual. The Dress Code policy “prohibits
cell phone use during working hours. This applies to everyone, but
doctors carry their cell phones everywhere and use them because
PRACTICE MANAGEMENT
Because smartphones and other mobile devices may be necessary
for hospital communication between healthcare professionals,
especially doctors, they can’t be restricted all together.
they call patients, each other, etc.” The hospital system discourages
personal internet/Facebook use by blocking the sites. The WNY
nurse said, “If you try to log onto Facebook, for example, you will get
an error message, and an “ACCESS DENIED” message.”
Aside from the provision for doctors, the WNY hospital is more
stringent on their cellphone use, and employees are encouraged to
not use their phones on the premises even when their shift is over.
The WNY nurse said, “Like, if you’re leaving and want to call your
husband to tell him you’re on your way home or whatnot, they
encourage you to wait until you’re in your car to call.” The hospital
feels the sight of an employee on a cellphone sends a message to
visitors that the employee is “unavailable” to help them if they’re lost,
unsure of where to go, etc.
Implement Staff Smartphone Policy and Stick to It
Because smartphones and other mobile devices may be necessary for
hospital communication between healthcare professionals, especially
doctors, they can’t be restricted all together. To avoid healthcare staff
misusing smartphones for non-work related functions that may
compromise patient care, there are policies you can implement.
According to U.S. National Library of Medicine research, these are
some solutions to deter healthcare staff from inappropriately using
smartphones:
• Create specific Wi-Fi hotspot zones for smartphone use.
This will minimize their use in sensitive and restricted areas.
These zones can be in cafés or break rooms where healthcare
professionals are not tending to work-related activities.
• Create no-phone zones in sensitive areas such as intensive care
units (ICUs), operating rooms, and critical care units.
• Have staff personal devices out of reach and use hospitalprovided devices that contain preinstalled job-specific
functions and apps.
• Set up to-do checklists in every room where work-related
tasks are performed to remind healthcare providers of what
needs to be done. This also helps to decrease errors due to
smartphone distraction and related multitasking.
• Set up an intra-company social network for staff to
communicate and exchange information in a secure fashion.
• Have voice-function capabilities integrated into all healthrelated apps used at the workplace, allowing staff to
communicate hands-free when necessary.
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July 2016
57
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PRACTICE MANAGEMENT
• Have staff create a “high alert” list of important phone
numbers, messages, and emails on their phones. These
numbers would be permitted to alert the healthcare
professional during work. All other numbers and emails would
not alert the user and/or go into “do not disturb” mode.
As for keeping protected health information (PHI) secure on hospital
staff smartphones, the U.S. National Library of Medicine suggests
these best practices:
• Ensure all digital data is appropriately encrypted, and network
and devices associated with the network are passwordprotected.
• Limit high-risk share interfaces such as Bluetooth and Infrared.
• Set up required security patches and permission to access
company networks/intranets on personal devices.
• Generate security alerts/warning messages if a compromised or
unauthorized device is used on the network.
• Generate security messages to users who access unscrupulous
or potentially unauthorized websites.
• Establish strict regulations for taking pictures and videos via
smartphones.
• Provide staff with periodic and relevant training in ethics
and conflicts of interest.
• Ensure prior permission is obtained before taking photos
and videos at work. While taking photos and videos, all
must adhere to organizational ethics and conflict-ofinterest policies.
In an upcoming article, we’ll cover how to manage smartphone
distractions and HIPAA violations of patients.
ION
Michelle A. Dick is executive editor at AAPC and a member of the Flower City Coders, Rochester, N.Y., local
chapter.
Resources
Rachel J. Katz, MD, The Doctor’s Tablet, “Setting Boundaries on Smartphone Use in Hospitals”
(December 24, 2013): http://blogs.einstein.yu.edu/setting-boundaries-on-smartphoneuse-in-hospitals/
Rachel J. Katz, MD, The Doctor’s Tablet, “Smartphones, Millennials and Policy on Hospital
Rounds” (February 20, 2014): http://blogs.einstein.yu.edu/smartphones-millennials-andpolicy-on-hospital-rounds/
Agency for Healthcare Research & Quality, “Order Interrupted by Text: Multitasking Mishap”
(December 2011): https://psnet.ahrq.gov/webmm/case/257
U.S. National Library of Medicine, National Institutes of Health “Distraction: an assessment of
smartphone usage in health care work settings,” August 27, 2012:
www.ncbi.nlm.nih.gov/pmc/articles/PMC3437811/
58
Over 7000 ICD-10 Code Changes
AAPC Code Books
Visit aapc.com/medical-coding-books or call on of our
academic advisors at 800-626-2633
■ PRACTICE MANAGEMENT
By Lynn Stuckert, LPN, CPC, CPMA
HEDIS: Manage Your Healthcare Outcomes
Aim to enhance quality of care and reduce costs by meeting
performance measures and three criteria.
he Healthcare Effectiveness Data and Information Set (HEDIS)
consists of a set of performance measures developed by the
National Committee for Quality Assurance (NCQA), and is used by
more than 90 percent of American health plans to compare how well
a plan performs in these areas:
• Quality of care
• Access to care
• Member satisfaction with the health plan and doctors
HEDIS reporting is required for NCQA accreditation and the
Centers for Medicare & Medicaid Services (CMS) Medicare
Advantage Programs, and is used for Consumer Reports health
insurance ranking. HEDIS allows for measurement; standardized
reporting; and accurate, objective, side-by-side comparison of health
plan outcomes.
How HEDIS Measures Are Created
NCQA’s Committee on Performance Measurement — a broadbased group representing employers, consumers, health plans, and
others — debates and collectively decides on the content of HEDIS.
HEDIS measures must meet three key criteria: relevance, soundness,
and feasibility.
Why HEDIS Is Important to Physicians
HEDIS measures track a health plan’s and physician’s ability to
manage health outcomes. Strong HEDIS performance reflects
enhanced quality of care. With proactive population management,
physicians can monitor care to improve quality, while reducing costs.
Participation in a quality incentive program also improves HEDIS
performance and increases a practice’s earning potential.
The Value of HEDIS to Your Patients
HEDIS helps consumers receive optimal preventive and quality care.
It allows them to review and compare health plans’ scores, helping
them to make informed healthcare choices.
How HEDIS Scores Are Used
As the healthcare industry moves toward quality, both state and
federal governments are using HEDIS ratings not only for health
plans, but also for individual providers. Physician-specific scores are
evidence of preventive care at primary care practices. State purchasers
aggregate HEDIS rates to evaluate the effectiveness of a health
60
insurance company’s ability to improve preventive health outreach
to its members.
These ratings serve as a basis for physician quality incentives
programs, such as pay-for-performance and quality bonus funds. A
provider’s individual scoring based on these programs pays increased
premiums using quality indicators, such as those used in HEDIS.
HEDIS Calendar
NCQA has a set deadline of May 15 for health plans to gather all
HEDIS data. Results are analyzed and reported to NCQA in June,
and the NCQA releases Quality Compass results nationwide in
July (commercial edition) and September/October (Medicaid and
Medicare editions).
Patient Privacy and Data Security
All plans and physicians must comply with all applicable federal and
state laws and regulations regarding health plan member privacy
and data security, including HIPAA, the Standards for Privacy
of Individually Identifiable Health Information, and the HIPAA
Security Rule as outlined in the Code of Federal Regulations Title 45.
Under the HIPAA Privacy Rule, data collection for HEDIS is
permitted, and the release of this information requires no special
patient consent or authorization. Abstraction of data falls under
treatment, payment, and healthcare operations.
Three ways HEDIS data is collected:
1. Administrative data – obtained from claims data
• Essential for measuring and monitoring quality, service
utilization, and differences in members’ healthcare needs
■ Coding/Billing
istock.com/greenwatermelon
T
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HEDIS
PRACTICE MANAGEMENT
As the healthcare industry moves toward quality, both
state and federal governments are using HEDIS ratings not
only for health plans, but also for individual providers.
how well Medicare Advantage organizations manage the physical
and mental health of its members at the beginning and the end of
a two-year period. Scores are categorized and percentages reported
as: better, same, or worse than expected. For example: monitoring
physical activity, the member discussed exercise with their doctor
or other health provider in the last year and was advised to increase
or maintain physical activity. The survey question would ask, “Did
you talk with a doctor or other health provider about your level of
exercise or physical activity?”
Tips to Improve HEDIS Scores
• Correct coding of claims is very important: If claims are not
coded correctly the data may not be captured for HEDIS and
may not reflect accurate quality scores.
2. Hybrid data – obtained from claims data and medical record
reviews
• Medical record requests are sent to providers.
3. Survey data – obtained from member and provider surveys
Key Terms to Know
Denominator: Target population.
Numerator: The portion of the target population that had evidence
of appropriate (or inappropriate) care.
Provider specialty: Certain measures must be provided by a specific
provider specialty.
Anchor date: The specific date the member must be enrolled to be
eligible for a measure.
Member experience measures: Represents members’ perspectives
about the care received. Example: being able to obtain appointments
quickly.
Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
survey: CAHPS® surveys represent an effort to accurately and reliably
capture information from consumers about their experiences with
healthcare services. Health plans report survey results to NCQA
who use the results to make accreditation decisions and create
national benchmarks for care and services. Example question: Have
you had a flu shot since July 1, 2015?
Medicare Health Outcome Survey: Provides a general indication of
• Submit claims with the proper ICD-10 or CPT® Category II
codes that count toward measures.
• Avoid missed opportunities. Many patients may not return
to the office for preventive care, so make every visit count.
• Complete outreach calls to noncompliant members.
• Review and update your Patient Assessment form. This form
should yield very useful data over the short and long term.
• Order labs at the beginning of the year and prior to a patient’s
appointment. Repeat lab tests for patients who are not at
their goal, and adjust medication if necessary.
• Educate patients to take medications as prescribed.
• Chart documentation must reflect services billed.
• Take advantage of your electronic health record (EHR).
If you have an EHR, try to build care gap “alerts” within
the system. Paper chart users should develop standardized
documentation templates.
Lynn Stuckert, LPN, CPC, CPMA, has 30 years of experience in large multi-specialty clinics and hospital systems as a nurse, chart auditor, educator, compliance manager, and medical writer. Stuckert has held offices for the City of Palms (Fort Myers, Fla.) local chapter and
the Health Management Association of Southwest Florida.
Resources
www.ncqa.org
NCQA’s Quality Compass: www.ncqa.org/hedis-quality-measurement/quality-measurementproducts/quality-compass
Consumer Reports health insurance ranking: www.consumerreports.org/cro/health/healthinsurance/index.htm
CAHPS® surveys: www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/
Medicare Health Outcomes Survey website: www.hosonline.org/
www.aapc.com
July 2016
61
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Dhivya Priya JP, CPC-A
Diana Sinclair, CPC-A
Diana Marie Andreasen, CPC-A
Diane Marx, CPC-A
Diane Prestwich, CPC-A
Dipali Naik, CPC-A
Dipali Rameshrao Kokare, CPC-A
Divya Krishnakumar, CPC-A
DJ Song, CPC-A
Dodda Manasa, CPC-A
Donald Feliciano, CPC-A
Donna Cross, CPC-A
Donna Ryan, CPC-A
Donna Shiffert, CPC-A
Doretha Mclaurin, CPC-A
Dubose Stephens, CPC-A
Ebony Singleton, CPC-A
Edcel Lyra Reyes Hernandez, CPC-A
Edison Ray Boglosa Garciano, CPC-A
Edu Ryan Tradio Cayme, CPC-A
Ehrin G Taylor, CPC-A
Elane Wiggins, CPC-A
Elena Tarnovetskyy, CPC-A
Eliana Cabrera-Acosta, CPC-A
Elisa Romeo, CPC-A
Elizabeth Alia, CPC-A
Elizabeth Hanna, CPC-A
Elizabeth Hernandez, CPC-A
Elizabeth Robeson, CPC-A
Elson Samuel, COC-A
Emilee Garrett, COC-A
Emma Eberwien, CPC-A
Erica Clark, CPC-A
Erica Rhodin, CPC-A
Erica Wade, CPC-A
Erico Paolo Cuenta Arcigal, CPC-A
Erika Hawk, CPC-A
Erin Al-Hammami, CPC-A
Erin Wright, CPC-A
Esperanza Magboo, CPC-A
Esteban Garcia, CPC-A
Eva Barton, CPC-A
Everla Magdangal, CPC-A
Fairooz Al-Hasnawi, CPC-A
Farhana Begum, CPC-A
Farzana Islam, CPC-A
Faye MacClellan, CPC-A
Felicia Sumner, CPC-A
Franch Mabelle Serna, CPC-A
Francia Geller, CPC-A
Franz Berry Azarcon, CPC-A
Frieda Davis, CPC-A
Gabrielle J Gordon, CPC-A
Gaeya Spencer, CPC-A
Gail Moorehead, CPC-A
Gale Walker, CPC-A
Gandhasari Rameshbabu, CPC-A
Gaurav Rawat, CPC-A
Gayle Stephens, CPC-A
Geetanjali Dilip Bhuvad, CPC-A
Genesis Hairston, CPC-A
Genevieve Ward, CPC-A
Genny Ann Parcon Gepes, CPC-A
Gladys D Garcia, COC-A
Gloria Varela, CPC-A
GLoria Yawn, CPC-A
Gokila Palaniappan, CPC-A
Grace Garland, CPC-A
Grant Michael Baldwin, CPC-A
Grishma Kundalia, CPC-A
Gunni Vinyasa, CPC-A
Gurkirat Virk, CPC-A
Gurrala Nirosha, CPC-A
Gwen Elmquist, CPC-A
Gypsy Boy Saldivia, CPC-A
Haley Norris, CPC-A
Haley Wire, CPC-A
Halima Antoo, CPC-A
Hannah McCarthy, CPC-A
Harsh Makkar, COC-A
Hayley Ireland, CPC-A
Heather Mullins, CPC-A
Heather Berning, CPC-A
Heather Blocher, COC-A, CPC-A
Heather G Bosen, CPC-A
Heather Gruber, CPC-A
Heather Lynn Bryngelson, CPC-A
Heather Williamson, CPC-A
Heidi Breshears, CPC-A
Heidi Hicks, CPC-A
Heidi Milmoe, CPC-A
Heidi Moore, CPC-A
Hemalakshmi Shruthi Vempati, CPC-A
Hemalatha Govindarajan, CPC-A
Heziel Joy Par, CPC-A
Himanshu Singh, CPC-A
Holly Baker, CPC-A
Honorio Lua, CPC-A
Ia Anne Noelle Burla, CPC-A
Ibidun McKiver, CPC-A
Ileen Howard, CPC-A
Ilse Andreas Parcon Acupan, CPC-A
Imran Khan Shaik, CPC-A
India Burdine, CPC-A
Indira Pillas Aranzanso, CPC-A
Insiya Choilawala, CPC-A
Iona Torres, CPC-A
Iragavarapu Bharathi, CPC-A
Irene M True, CPC-A
Irene Torok, CPC-A
Irene Weimer, CPC-A
Iryna Ries, CPC-A
Isabel Ferrer, CPC-A
Isabel Guidi, CPC-A
Ivy Rajan, COC-A
J S Saritha, CPC-A
Jack Matney, CPC-A
Jacqueline Walker, CPC-A
Jagruthi Golusu, CPC-A
Jaime Paulson, CPC-A
Jaime Thomas, CPC-A
James Andrew Yamba, CPC-A
Jami Yount, CPC-A
Jamie Hanmer, CPC-A
Jamie Harvey, CPC-A
Jan Bozzone, CPC-A
Jan Luong, CPC-A
Jana Calhoun, CPC-A
Jane L Bakalian, CPC-A
Janetta Mcgahagin, CPC-A
Janice Herron, CPC-A
Janiecia Queen, CPC-A
Janis Hall, CPC-A
Janna Beckmann, CPC-A
Jasmine Fouts, CPC-A
Jasmine Ricks, CPC-A
Jason Campbell, CPC-A
Jay G. Cooke, CPC-A
Jayanthi Mohan, CPC-A
Jayanthi Selvaraj, COC-A
Jayme Kraynak, CPC-A
Jean Andrick, CPC-A
Jeanette L Mitchell, CPC-A
Jeffrey Clarke, CPC-A
Jen Babcock, CPC-A
Jenila Rubavathy Jeyaraj, CPC-A
Jenna Burt, CPC-A
Jennefer Moody, CPC-A
Jenni Dennis, CPC-A
Jennibeth Marquez, CPC-A
Jennifer Cruz, CPC-A
Jennifer Gentzlinger, CPC-A
Jennifer Hackett, CPC-A
Jennifer Jaramillo, CPC-A
Jennifer Marie Beck, CPC-A
Jennifer Moreshead, CPC-A
Jennifer Simpson, CPC-A
Jennifer Sneen, CPC-A
Jennifer Wilson, CPC-A
Jenny Chambers, CPC-A
Jenny White, CPC-A
Jeoffray Jm Rimando, CPC-A
Jessi Molder, CPC-A
Jessica Barraza, CPC-A
Jessica Blair, CPC-A
Jessica Brooks, CPC-A
Jessica Campfield, CPC-A
Jessica Coffman, CPC-A
Jessica Egan, CPC-A
Jessica Hannans, CPC-A
Jessica Jones, CPC-A
Jessica Marilyn Giron, CPC-A
Jessica Renneke, CPC-A
Jigeth Leyba Bustamante, CPC-A
Jill Alison Drews, CPC-A
Jill Jonette Cornstubble, CPC-A
Jim Gerhardt, CPC-A
Joanna Marie Padilla, CPC-A
Joanne Jacquin, CPC-A
Jodi Surkis, CPC-A
John Angelo Cabauatan, CPC-A
John Mabon, CPC-A
John Neil Coyoca Punay, CPC-A
Johnston Busi, CPC-A
Jonathan Quiki, CPC-A
Joshua Linn, COC-A
Joshua McCarty, CPC-A
Juliann Chun, CPC-A
Julie Ann Patent, CPC-A
Julie Davis, CPC-A
Julie Lotz, CPC-A
Julie Ripley, CPC-A
Julie Zoldos, CPC-A
Jumde Sharada, CPC-A
Jussein Vitug Mallare, CPC-A
Justin Peacock, CPC-A
Jyosthna B Vennapusa, CPC-A
Jyoti Kadam, COC-A
K V N Sreenikhila, CPC-A
Kaitlyn M Altenhoff, CPC-A
Kalyan Mandagadda, CPC-A
Kamille Jovette Salvatierra, CPC-A
Kammi Lauck, CPC-A
Kapil Baburao Suryawanshi, COC-A
Karen Brounstein, CPC-A
Karen D Zuppinger, CPC-A
Karen Gold, CPC-A
Karen McCartney, CPC-A
Karen Mercado, CPC-A
Karen Presha, CPC-A
Kari Nettesheim, CPC-A
Karina Freschlin, CPC-A
Kasturi Dudhane, CPC-A
Katha Wewe, CPC-A
Katherine Duffie, CPC-A
Katherine Lockridge, CPC-A
Kathleen Austria Jagmis, CPC-A
Kathleen Selgado, CPC-A
Kathryn Tutunjian, CPC-A
Kathryn Hartman, CPC-A
Kathryn O’Malley, CPC-A
Kathy Kindschi, CPC-A
Katie Scherer, CPC-A
Katrina Leanne Bunnell, CPC-A
Kayla Kristine Woodring, CPC-A
Kayla Rose, CPC-A
Kelly Marie Schreiner, CPC-A
Kelly Michel, CPC-A
Kelly S Johnson, CPC-A
Kendra Hulkonen, CPC-A
Kendra Nacole Biggs, CPC-A
Kendra Nelson, CPC-A
Kenneth Viray, CPC-A
Kerrie Smith, CPC-A
Kevin Rogers, CPC-A
Kevin Rogers, CPC-A
Kiana Hill, CPC-A
Kim Sayam, CPC-A
Kim Zandro Gozo, CPC-A
Kimberly A McElfresh, CPC-A
Kimberly Bonnaure, CPC-A
Kimberly Brand, CPC-A
Kimberly Gromer, CPC-A
Kimberly Kimble, CPC-A
Kimberly Lemonde, CPC-A
Kimberly McCraine, CPC-A
Kimberly Morris, CPC-A
Kimberly Mulford-Rambis, CPC-A
Kimberly Smith, CPC-A
Kimberly Stremel, CPC-A
Kogila Gopu, CPC-A
Kotte Madhavi, CPC-A
Kranti Eknath Durgade, CPC-A
Kremena Saam, CPC-A
Krishnapriya Krishnamachari, CPC-A
Krista Beckwith, CPC-A
Kristian Cef Manimbo, CPC-A
Kristin Donnellan, CPC-A
Kristin Slack, CPC-A
Kristina Compton, CPC-A
Kristine Gray-Jurgens, CPC-A
Kristine Kramer, CPC-A
Kristy Perkins, CPC-A
Krutika Vijay Golatkar, CPC-A
Krystal Ybarra, CPC-A
Krystina Pena, CPC-A
Kulsoom Shaikh, CPC-A
Kurumurthy Laxman Koli, COC-A
Kymberly Van Loon, CPC-A
Laarni D Marquez, CPC-A
Laarni Dames, CPC-A
Lacey Engelmann, CPC-A
Lakshmi Adusumilli, CPC-A
Lalitha Dhulipala, CPC-A
Larissa Vargas, CPC-A
Latisha Samuels, CPC-A
Laura Conlan, CPC-A
Laura Lewis, CPC-A
Laurel Wilhelm, CPC-A
Lauren Kellett, CPC-A
Lauren M Kailian, CPC-A
Lauren McGhee, CPC-A
Lauren Pilarski, CPC-A
Lauren Ramey, CPC-A
Laurie DeBuhr, CPC-A
Lavanya Arudra, CPC-A
Lawanda N Graves, CPC-A
Leanne Munger, CPC-A
Lekshmi Sukumaran, COC-A
Lella Pavani, CPC-A
Lenore Faith Macmillan, CPC-A
Leslie Canty, CPC-A
Leslie Hewitt, CPC-A
Leslie Lewis, CPC-A
Leslie Mitchell, CPC-A
Letitia Prather, CPC-A
Liezel Guillermo, CPC-A
Liliana Colina, CPC-A
Lillian Herrera, CPC-A, CPMA
Linda Folkerts-Beute, CPC-A
Linda Kay Gifford, CPC-A
Linda Tracey, CPC-A
Lindsay Alzamora-Cook, CPC-A
Lindsey Danielle Anderson, CPC-A
Lindsey Howard, CPC-A
Lindsey Norman Marshall, CPC-A
Lisa Cobb, CPC-A
Lisa Gordon, CPC-A
Lisa S Freeman, CPC-A
Liza M Colon Gonzalez, CPC-A
Lora Johnston, CPC-A
Lora Paige Wood, CPC-A
Lori Cavazos, CPC-A
Lori Monten, CPC-A
Lori Ruby, CPC-A
Lorie Lineback, CPC-A
Lorita M Cassell, CPC-A
Lorrie Hyde, CPC-A
Louise Denlea, CPC-A
Luisa Ortiz, CPC-A
Lydia Ramos, CPC-A
Lynelle Fay Jimenez, CPC-A
Ma Angelica Pascual Garcia, CPC-A
Ma Angelica Pascual Garcia, CPC-A
Ma. Monica Felix, CPC-A
Ma. Nina Krystel Bona, CPC-A
Ma. Sonica Supang, CPC-A
Maakani Sameera, COC-A
Macey Perkins, CPC-A
Madhavarapu Gayathri, CPC-A
Madhavi Bhukya, CPC-A
Mahesh Abbili, CPC-A
Maheswari Anand, CPC-A
Malikanti Manohar, CPC-A
Malladi Rohan Teja, CPC-A
Mamatha Bottu Sethu, CPC-A
Mamatha Thummala, CPC-A
Manali Pathak, CPC-A
Manjusha Dasamalla, CPC-A
Manjushri Ramakrishna Rao, CPC-A
Manohar Alla, COC-A
Marci Penner, CPC-A
Marcia Oliveira, CPC-A
Margarette Bauer, CPC-A
Maria (Lulu) Mireles, CPC-A, CEMC
Maria Romano, CPC-A
Maria Rossana Vicenta De Jesus, CPC-A
Maria Sigg, CPC-A
Marie France Delos Santos Rellosa, CPC-A
Marifi Del Mar Dacillo, CPC-A
Maritoni Kohls, CPC-A
Martha Abby Panghulan, CPC-A
Martha Harris, CPC-A
Martha Taylor, CPC-A
Marvetta Cunningham, CPC-A
Mary Annette Mendonca, CPC-A
Mary Blair, CPC-A
Mary E Macbeth, CPC-A
Mary Escoto, CPC-A
Mary Jane Tulabot, CPC-A
Mary Joyce Englis, CPC-A
Mary M Reyes, CPC-A
Mary McGuiness-Smith, CPC-A
Matthew H Kamien, CPC-A
Matthew Larson, CPC-A
Matthew Staup, CPC-A
Maureen Gamayon, CPC-A
Maurice Nichols, CPC-A
Mayur Pol, CPC-A
Meenu Agarwal, CPC-A
Meera Surendran, COC-A
Megan Rizzo, CPC-A
Megha Nair, COC-A
Meghna Gupta, CPC-A
Melchelle Mirasol, CPC-A
Melinda Frisch, CPC-A
Melissa Baer, CPC-A
Melissa Eurit, CPC-A
Melissa Hackett, CPC-A
Melissa Steien, CPC-A
Melissa Turner, CPC-A
Meredith Harrington, CPC-A
Meredith Parker, CPC-A
Merita Praveen, CPC-A
Merlin Thanga Suba, CPC-A
Michael Henderson Graves Jr, CPC-A
Michele Dursteler, CPC-A
Michele Tutton, CPC-A
Michelle C Dutton, CPC-A
Michelle D Burks, CPC-A
Michelle De Castro Guevarra, CPC-A
Michelle Hammerberg, CPC-A
Michelle Haynie Spruit, CPC-A
Michelle Lackey, CPC-A
Michelle Lafata, CPC-A
Michelle Lande, CPC-A
Michelle Sese, CPC-A
Michelle Wetzel, CPC-A
Minh Vo, CPC-A
Miranda Ruuth, CPC-A
Mirtha Luz Sulca, CPC-A
Mona Richardson, CPC-A
Monica Kocjan, CPC-A
Monica Nandkumar Marathe, CPC-A
Monika Porch, CPC-A
Morgan Renae Rayburn, CPC-A
Mrudula Vijayarao, CPC-A
Mrunali Pralhad Bhosale, CPC-A
Muvva Nagendra Babu, CPC-A
Myrna B Pinillos, CPC-A
Myrna Ordonez, CPC-A
Nagini Sorna Aravintha Losanan, CPC-A
Nagula Manasa, CPC-A
Nagulapally Suresh Kumar, COC-A
Nagunuri Rani, CPC-A
Namrata Jadhav, CPC-A
Nandhini Kothandan, CPC-A
Naritha Galosmo, CPC-A
Narmatha Dhanasekaran, CPC-A
Natalie Mae Malig, CPC-A
Naveen Shanmuganathan, CPC-A
Nazia Hameed, CPC-A
Nea L Carter, CPC-A
Neelam Hawaibam, CPC-A
Neena Juliet Robert, CPC-A
Neha Rajani, CPC-A
Neha Vashishtha, CPC-A
Neil Andrew Salenga, CPC-A
Nela Priyanka, CPC-A
Nicholas Zosky, CPC-A
Nichole Olson-Hanks, CPC-A
Nicole Carino, CPC-A
Nicole Marie Elnicki, CPC-A
Nicole Preto, CPC-A
Nikhil Tyagi, CPC-A
Niki Mehta, CPC-A
Nilanka Rodrigo, CPC-A
Ninfa Webb, CPC-A
Nireesha Kampa, CPC-A
Nisha Viswanathan, COC-A
Niyati Y Patel, CPC-A
Noelle Adrian Marcelo, CPC-A
Noemi Magsino Villafranca, CPC-A
Norene Leavey, CPC-A
Nungshitombi Oinam, CPC-A
Odde Madhukar, CPC-A
Odemaris Ivy, CPC-A
Olga Mokhova, CPC-A
Omayra Pagan, CPC-A
Paarul Sharma, CPC-A
Pamela Green, CPC-A
Panchami Appukuttan, COC-A
Pankaj Satyawan More, CPC-A
Paola Andrea Biares Bayona, CPC-A
Parbati Swain, COC-A
Parveen Kumar, CPC-A
Parvej Mukadam, CPC-A
Patricia Sierra, CPC-A
Patricia Urban, CPC-A
Patrick Moorman, CPC-A
Pavithra Rajendran, CPC-A
Phoebe Delos Reyes, CPC-A
Pia Jennica Marie Acas, CPC-A
Pinki Das, CPC-A
Pogaku Sandeep, CPC-A
Pooja Kottanadan Paul, CPC-A
Pooja Tikkisetty, CPC-A
Prasad Nigade, CPC-A
Prashanth Kumar Manchi Balaraj, CPC-A
Prathyusha B, CPC-A
Proven Dumagpi, CPC-A
Rachel Hall, CPC-A
Rachel Born, CPC-A
Radhika Krishnamurthy, CPC-A
Rahul Goyal, CPC-A
Rajendar Goud Kass, CPC-A
Rajiver Merca, CPC-A
Rakisha Sherrill, CPC-A
Ramanjinamma Kuruba, CPC-A
Rameshreddy Samala, COC-A
Ramya Gunasekaran, CPC-A
Ramya Nettikopula, CPC-A
Rashanda Moye, CPC-A
Rasmitha Gorre, CPC-A
Ravi Pandu, CPC-A
Rayabarapu Haritha, CPC-A
Realiza Pernis, CPC-A
Rebecca Baker, CPC-A
Rebecca Dawn Bates, CPC-A
Rebecca Ferraro, CPC-A
Rebecca L Breitkreutz, CPC-A
Regina Mandelblatt, CPC-A
Regina Turner, CPC-A
Regine Pesino, CPC-A
Rekha Murali, COC-A
Rena Vue, CPC-A
Renee Johnson, CPC-A
Revathy Govindankutty Nair, CPC-A
Rhonda Welch, CPC-A
Rigel Marasigan, CPC-A
Rijo Thomas, CPC-A
Robert Croutcher, CPC-A
Robert Desormeaux, CPC-A
Robert Vincent Lenart, CPC-A
Roberta Morrow, CPC-A
Robin Michelle Guffey, CPC-A
Robin Zenon, CPC-A
Robyn George, CPC-A
Rochelle Mae Calape, CPC-A
Rochelle McLemore, CPC-A
Rocio Almeida, CPC-A
Rocio Corbin, CPC-A
Rohit Chaudhary, CPC-A
Rommel Velasquez Colina, CPC-A
Romona Elizabeth Ghanie, CPC-A
Ron Kristian Timosa, CPC-A
Rona Abella Balbuena, CPC-A
Ronda Black, CPC-A
Rose Tippy, CPC-A
Roselle Garlejo Bambico, CPC-A
Rosetta Miles, CPC-A
Roshni Jaya, COC-A
Ross Louiege Mendoza, CPC-A
Rucha Jadhav, CPC-A
Ruth Jones, CPC-A
Rydal Igat, CPC-A
Sahera Banu, CPC-A, CIC
Sai Priyanka Malisetty, CPC-A
Saikumar Gokulam, COC-A
Sajan Cherian Mathew, COC-A
Salman Hudud, CPC-A
Samantha Suzanne Diaz, CPC-A
Samarateja Gundu, COC-A
Sameer Khan, CPC-A
Sandeep Shivaji Gole, COC-A
Sandra P Salazar, CPC-A
Sandy Liao, CPC-A
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Sandy Martin, CPC-A
Sandy Rogers, CPC-A
Santoshi Pandit, COC-A
Sara Clark, CPC-A
Sara Hackwelder, CPC-A
Sara Harrison, CPC-A
Sara Milano, CPC-A
Sarah Baumann, CPC-A
Sarah Campos, CPC-A
Sarah J Nies, CPC-A
Sarah Redden, CPC-A
Saranya M, CPC-A
Sarath Thekkedath, CPC-A
Sasikala Murugesan, COC-A
Savannah Thompson, CPC-A
Sayli Sutar, CPC-A
Seema Yadav, COC-A
Shampa Rahman, CPC-A
Shan-Chuin Kong, CPC-A
Shannon Carlisle, CPC-A
Shannon Church, CPC-A
Shannon McShane, CPC-A
Shannon Schmidlin, CPC-A
Shanu Varkey, COC-A
Sharad Kumar Sharma, CPC-A
Sharee Black, CPC-A
Shawna Wood, CPC-A
Shelly Clarke, CPC-A
Shenitra Davis, CPC-A
Shermeikia Jones, CPC-A
Sherry Baldwin, CPC-A
Shiela Marie Guiquing, CPC-A
Shiju Mohamed, CPC-A
Shilpa Avinash Deshpande, CPC-A
Shirin Fan, CPC-A
Shirley Mantuano Catoner, CPC-A
Shirlisa Banks, CPC-A
Shital Khedkar, COC-A
Shravan Kumar Kandi, COC-A
Shweta Bhegade, CPC-A
Shweta Mane, COC-A
Siddharth Gangawane, CPC-A
Siman Joseph Dsouza, CPC-A
Sivali Boddu, CPC-A
Sneha B, CPC-A
Sneha Mable, COC-A
Sonal Prakash Phalle, CPC-A
Sonali Ramdas Jadhav, COC-A
Soumya Naiki, CPC-A
Sravani Raikoti, CPC-A
Sreedhanya K, CPC-A
Sridath Jituri, CPC-A
Srikkumaran Thaamotharhan, CPC-A
Srinivas Gundeti, COC-A
Stacey Maurice, CPC-A
Stacey Romanenko, CPC-A
Stephanie D Brooks, CPC-A, CRC
Stephanie Harry, CPC-A
Stephanie Matney, CPC-A
Stephanie Nasalroad, CPC-A
Stephanie Ramoutar, CPC-A
Stephanie Simmons Johnson, CPC-A
Subash Sisupalan, COC-A
Suma George, COC-A
Sumit Shukla, CPC-A
Surepalli Nagalakshmi, CPC-A
Sureshbabu V Eerisetty, CPC-A
Susan Bohaski, CPC-A
Susan McCarthy, CPC-A
Suswetha Kothapalle, CPC-A
Suzette Valdez, CPC-A
Swapnagandha Bhoite, CPC-A
Swapnali Gawade, COC-A
Sybil Norman, CPC-A
Sylvia Duplantier, CPC-A, CPMA
Sylvia Hatley, CPC-A
Tabitha Lichtenwalner, CPC-A
Tache Vaughn, CPC-A
Takia Sands, CPC-A
Tamara Gessell, CPC-A
Tamara Kelly, CPC-A
Tamara Turpin, CPC-A
Tamekia Staton, CPC-A
Taminka Blue, CPC-A
Tammie Lynn Diddens, CPC-A
Tammy Kenny, CPC-A
Tammy Michelle Kersey, CPC-A
Tammy Wilson, CPC-A
Tanvi Zagade, CPC-A
Tanya Bush-Townsend, CPC-A
Tatiana Hockett, CPC-A
Tawn Lynn Hubbard, CPC-A
Taylor Robinson, CPC-A
Taylor Thoren, CPC-A
Teal Leroy, CPC-A
Telidevara Sai Anusha, CPC-A
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Teresa Marshall, CPC-A
Teri Culp, CPC-A
Tesah Linton-Carnes, CPC-A
Thasleena Banu, CPC-A
Tiffany Jacobs, CPC-A
Tina Heinen-Smith, CPC-A
Tina Herron, CPC-A
Tina Hildreth, CPC-A
Tina Marie Caipilan, CPC-A
Tonya Bailey, CPC-A
Tonya Moretz, CPC-A
Tonyah Cole, CPC-A
Tori Li Toda, CPC-A
Tracey Stamey, CPC-A
Tracie Dorton, CPC-A
Travis Soyars, CPC-A
Trixie Mariel Araune, CPC-A
Trupti Dattatray Jambhale, CPC-A
Tushar Arjun Mahadik, COC-A
Tyshawna Murray, CPC-A
Uma Sankaran Chathapuram, CPC-A
Uppula Sathish, CPC-A
V S Pavan Kumar Chinni, CPC-A
Vaishali Patel, CPC-A
Valisha Gorman, CPC-A
Vallapu Sousheel, CPC-A
Vanessa Perez, CPC-A
Vanitha Thankarajan, CPC-A
Vanmathi Sundar, CPC-A
Vasudeo Subhash Chaudhari, COC-A
Vasundhara Dantuluri, CPC-A
Veronica Franco, CPC-A
Vetrivel Mani, CPC-A
Vicki Wiehebrink, CPC-A
Vickie L Sanders, COC-A, CPC-A
Victoria Kidwell, CPC-A
Victoria Leabo, CPC-A
Vidya Shivaji Patil, CPC-A
Vijaylaxmi Vishal Jadhav, COC-A
Vinh Hoang, CPC-A
Vipin Babysarojam, COC-A
Virgie Crouch, CPC-A
Vishal Ramesh Gaikwad, COC-A
Vladimir Cortez, CPC-A
Warren Wilkinson, CPC-A
Wendy Karyle Ramirez, CPC-A
Whitney A Hayes, CPC-A
Whitney N Folsom-Lecouffe, CPC-A
William Moy, CPC-A
William P Douglas, CPC-A
Yahira Colon, CPC-A
Yoel Lovelle, CPC-A
Yogesh Vishnu, CPC-A
Yogita Gonnade, CPC-A
Yoliana Carralero, CPC-A
Zak Bartels, CPC-A
Specialties
Aarthy Sooryanarayanan, CPC-A, COSC
Abigail Erlandson, CPC, CEMC, COBGC, CPCD
Abigail Pipkin, CPC, CENTC, CPCD
Agnieszka Balnis, CPPM
Aileen Magracia Dario, CPC-9-A
Alecia Johnson, CPB
Alyshia Baker, CPC, CPMA
Alyson Rodgerson, CPC, CGSC
Amaechi Lawrence Ofunne, CPC, CPMA,
CEMC, CENTC, CGSC, CPRC
Amanda Proctor, CPC, CPMA, CRC
Amber Long, CPC, CCC
Amy Beecher, CRC
Ana Armstrong, CPC, CPMA, CANPC
Ana Arnold, CPC-A, CHONC
Ana Yanez-Marrero, COC, CPC, CPMA,
CPC-I, CRC
Andrea Hefner, CPC, CPB, CPPM
Andrea Smith, CPC, CPMA
Andrew Myers, CPC-A, CPB
Angela Paine, COC, CPMA, CPC-I, CEMC, CRHC
Angelia Puckett, CPC, CPMA, CEMC, CGIC
Ania Rivero, CPC, CPMA
Anna Krizel Esguerra, CPC-9-A
Anna Marie Grimes, CPC, CPC-P, CRC
Anton Arbatov, CPCO
Aprille Ruiz, CPC, CPB, CGSC
Beth Helsel, CPC, CRC
Beth Reynek, CRC
Beth Schaub, CPC, CPMA
Beverly Jean Maniscalco, CPC, CPCO
Bobette L Haley, CPC, CPMA
Brenda A McManemy, CPC, CCC
Brenda Dominski, CIRCC
Brenda Lor, CPC, COSC
Brenda Venezia, CPC, CUC
Bridget C Brown, CPC, CPMA
Bridgette Lawrence, CPC, CPMA
Brooke Anne Buckley, CPC, CPMA, CEMC
Caitlin Adams, CPC, CPCO
Camille Beauchamp, CPB
Candace Duncan, CPC, CPMA
Candace Elaine McCormick, CPC, CPCO
Candace L Omija, CPC, CPMA, CANPC
Candace Winters, CPC-A, CPB, CPMA
Candi Hume, CPC, CIRCC, CPMA
Caridad J Trujillo, CPC, CRC
Carol Skelton, CPC, CPMA
Carolyn D Francis, CPC, CRC
Casandra Steinhaus, CPC-A, CEDC, CEMC
Cathy Reid, CHONC
Chandra Lynn Stephenson, COC, CPC,
CPCO, CPB, CPMA, CPPM, CPC-I,
CANPC, CCC, CEMC, CFPC, CGSC, CIC,
CIMC, COSC, CRC
Chareva L Reyes, CPC, CPMA
Cheala Hopkins, CPB
Chelsea Barry, CPC, CEMC
Cherice Nicole Witter CCS, COC, CPC, CPC-P,
CPC-I, CRC
Christina Henson, CIMC
Christina Joy McFann, CPC, CIRCC, CCVTC
Christine Marie Hernandez, COC, CPC, CHONC
Christine Theiss, CPB
Cinthia Serna, CPC, CCVTC
Claire Ann Flores, CPC-9-A
Connie Cofer, CPC, CIRCC, CPMA
Corina Bucsi, CPC, CPB, CGSC
Corinne Weckherlin, CPC-A, CPB
Courtenay J Obert, CPC, CRC
Cristina Maria Alvarez, CRC
Crystal Anica Junious-Green, CPC, CPMA
Cynthia Tillman, CRC
Cynthia Ellis, CPPM
Dale R Constantino, CPC, CRC
Dana Petras, CPC, CPMA
Daniela Saito, CPB
Danielle Irwin, CPMA, CEMC
Danielle Mills, CPC, CEDC
Dawn Wittke , CCS-P, CPC, CPMA, CPC-I, CRC
Dayana Ivon Perez-Sanchez, CPC, CPMA, CRC
Debbie Dawson, CPC, CRC
Debbie J Peterson, COC, CPMA
Deborah Smith, CPC, CRC
Debra P Faust, CPC, CPMA
Debra K Rhea, CPC, CPB, CEMC
Denise Suskie, CPC, CPMA, CCVTC
Deva Kiran, CPC-A, CPMA
Diana L Pirtle, CPC, CPMA
Diane Bryand, CPC, CPMA
Dianne Sibal, CPC, CIRCC, CEMC
Diaren Rodriguez, CPC, CPMA
Dolmaya Thogra, COC-A, CIRCC, CPB, CPMA,
CCVTC
Dominique Zapata, CPC, CPMA, CRC
Domonique Perkins, CPC, CEMC, COBGC
Donnine E Day, CPC, CPMA, CEMC, CENTC
Doret Lyn DeBarros, CPC, CPMA, CEDC, CEMC
Earlene Kincaid, CPPM
Ebone Nicole Fleming, CPC, CRC
Elena Castaneda, CRC
Elisa Grisel Torres, CPC, CRC
Elizabeth Napoles, CPC-A, CPMA
Ellen Risotti-Hinkle, CPC, CPMA, CPC-I,
CEMC, CFPC, CIMC, CRC
Erica Marie Marshall, CPC, CENTC, CPRC
Erica S Brownawell, CPC, CCC
Erica Toth, CPC, CPB
Fernando Campos, CRC
Gina M Schirato, CPCO, CPB, CPMA
Girlie A Gamboa, CPC, CRC
Giselle Pastrana, CPC, CRC
Hailey Walker, CPC, CIRCC
Heather Bollman, CPC, CPB, CPC-I
Heather Leigh Mashburn, CPC, CIRCC
Heather Vaughn, COC, CPC, CRC
Hildolidia Rodriguez, CPC, CPMA
Holli A Lancaster, CPMA, CRC
Ilene Flaherty, CPC, CPMA
Indira Olazabal, CPC, CPMA, CRC
Irene Pinto, CPC-A, CPMA
Isbelys C De Armas, CPC, CPMA, CRC
Jaime Sarten, CPC, CRC
James Gleason, CPPM
Jan Rafael Reyes, CPC-9-A
Janell Dawn Kangas, CPC, CPMA, CPPM
Janet Bennett, CRC
Janet Marie Wright, CPC, CPB
Janeth Fernandez RN, CPC, CPCO
Janie Loftis, CPC, CPMA
Jasmin Johnson, CPC, CPB, CEDC
Jean Marie Darnell, CPC, CPB
Jennifer Councilor, CPC, CPMA, CEMC
Jennifer E Baukus, CPC, CEMC
Jennifer Harris, CPC, CRC
Jennifer Janczuk, CPC, CHONC
Jennifer Jean Guindon, CPC, CPB
Jennifer Leppek, CPC, CRC
Jennifer M Hynes, CPC, CCC
Jennifer Purk, CPC, CEMC
Jerri C Hinch, CPC, CRC
Jessica Chen, CRC
Jessica Gielow, CPC-A, CPB
Jessica McHugh, CRC
Jessica Roisin Moore, CPC, CRC
Jessica Williams, CPC, CGIC
Jill Lynn McPheron, CPC, CPMA
JoAnna Long, CPC, CGSC
Joaquin Cutino, CPC, CRC
John Ferrara, CPCO
John Methgen, CPC-A, CPB
Johnna Porter, CPC-A, CRC
Jolene Kappes-Lillquist, CPC, CPCO
Joshua Martin, CPC-A, CRC
Joy L Tolzman, CPC, CRC
Joyce Patterson, CPC-A, CRC
Judy Linda Castonguay, CPC, CEMC
Judy Michael, CPB
Julia Macdougall, CASCC
Juliana Maria Vallarino-Negron, CPC, CPMA
Julie King, CPPM
Julie McNally, CPPM
Kala Nichols, CPB
Karen Roslie, CPPM
Karen Smith, CPMA
Kathleen Christopherson, CPC-A, CPB, CFPC
Kathleen Marshall, CPC, CEMC, CGSC
Kathryn Lindsley, CPMA, CEMC
Kathy Stapleton, CPC, CPMA
Katrina DeBruhl-Covan, CPC, CPB
Kelly D Hall, CPC, CPB, CPMA, CEMC
Kelly Sherrill, COC, CRC
Kim Emmons, CEDC
Kimberly K Olson, CPC-A, CPEDC
Kimberly Krebs, CPEDC
Kimberly Lillis, COC, CPC, CPPM, CEMC,
CHONC
Kimberly Thomas, CPC, CPEDC
Kimberly Timko, CPC, CPMA, CEMC
Kori Sawyer, CPC, CPCO
Kripa Anitha Krishnankutty, CPC-9-A
Kristin Pamela Young, CPCO
Kristin Romero, CRC
Lanette Collins, CPC, CPMA
Larissa Tamayo, CPB
LaShonda Williams, COC, CPCO, CPMA, CEMC
Laura Wheeler, CPMA
Leigh Cyr, CPC, CUC
Leslee Marie Allen, COC, CPC, CIRCC
Leslie Palmer, CPC, CANPC, CHONC
Leslie Michelle Pickens, CPC, COSC
Lily C Garcia, CPC, CRC
Linda Heissenberg, CPPM
Linda Prentice, CPB
Lindsey Pileika, CRC
Lindsey Vitez, COC, CPC, CPCO
Lindsey Webb Lyle, COC, CPC, CIC
Lisa Harding, CPC, CPB, CPMA
Lisa Jane Harris, CPC, CPC-I, CRC
Lisa Janell Fouts, CPC, CPMA, CANPC
Lisa Morris, CPC, CEMC
Lissa Topham, CPC-A, CPB
Lorena Rodriguez, CPMA
Lori Gomez, CPC, CPB
Lori L Koetje, CPC, CEDC, CPRC
Lynda Gail Detmers, CPC, CHONC
Madeline Maceda-Hernandez, CPC, CPMA,
CRC
Maggie Toyos, CPC, CRC
Maranda Goldsmith, CPC, CPMA, COBGC
Marcia Tracey, CRC
Maria D Nunez, CPC, CPMA, CRC
María de los Angeles Gongora Iglesias,
CPC, CRC
Maria Victoria Goguen, COC, CPC, CPB,
CPPM
Marisol Garcia, COC, CPC, CHONC
Mary E Kinney, CPC, CENTC
Maureen Schultz, CRC
Max Jeevin Maria, CPC, CPMA
Maydolis Gutierrez, CPC, CPMA, CRC
Mayrelis Ramos Gonzalez, CPC, CPMA, CRC
Meghana Mohan, CPC-9-A
Melissa Susan Threadgill, CPC, CPMA
Melody Villegas Estrella, CPC-9-A
Michelle Nadolny, CPC, CPMA
Morgan Jones, CPC, COBGC, CPRC
Nadine Gosine, CRC
Nakai Kanoyangwa, CPC-A, CIC
Nancy Rios-Avila, CPC, CPMA, COSC, CUC
Nanette Noprada, CPC-9-A
Nichole Cihak, CPCO
Nicole Howells, CPC-A, CPMA
Nicole Pine, CPMA
Nidhi Singh, CPC, CPMA
Noble Anu John, CPC-9-A
Odelis Lopez, CPC, CRC
O’Shanda Y Pablo, CPC, CRC
Pamela Ediger, CPC, CPMA
Patricia Claybaugh, CPC, CPMA
Paulo Sugawara, CPC, CPMA, CRC
Peggy A Johnson, CPC, CPMA
Pui Fung Tsang, CPB
Rachel D Bates, CPC, CUC
Rachel Steiger, COC-A, CPC-A, CPMA
Rachelle Denis, CPC, CPPM
Rafaela Gallo, CPC, CPMA, CRC
Rayshelle Aparicio, CPC, CRC
Rebecca Cashman, CPC, CPMA
Rebecca Ledvina, CPC, CRC
Rhonda Lynn VanTeeffelen, CPC, CPPM,
CGIC
Richard Spaeth, CPC, CPMA
Rita Antonelli, CPC, CPMA
Ruby Jeanne Weber, CPC, CPMA
Sabrina Suder, CPC, CPMA
Sajonia E. Diaz Velazquez, CPC, CPMA
Sally Khan, CEMC
Sally Kolman, CPC, CPMA, CPPM, CEMC
Samantha Webster, CPC, CHONC
Sandra Garrett, CPC-A, CPB
Sandra Margarita Lazo, CPC, CRC
Sangili Murugan Palanivel, COC, CPC, CPMA
Santhiya Balaguru, CPC-A, CIC
Sara Frischer, COC, CPC, CEDC, CRC
Sarah Collinson, CPC, CPMA, CEMC, CPCD,
CPRC, CRC
Sarah Dargis, CPCD
Sarah E Fox, CPC, CRC
Sarah Ramsey, CPC, CRC
Saravanan Rajentheran, CPC, CPMA
Shana Windover, CPC, CPCO
Shane Lawson, COC-A, CPMA
Sheila Rodriguez, CPC-A, CEMC
Shelby Jensen, CHONC
Silvana Fischman, CRC
Siran Deng, CRC
Sonia Cavazos, CPC, CPMA, CPPM
Sonja D Moon, CPC, CPMA
Sonya Martin, CFPC
Steven Ovens, CPC, CRC
Suharmy Jimenez, CPC, CPMA, CRC
Sumamol Thomas, CPC-9-A
Susan Csikos, CPC, CRC
Susan L Baldwin, COC, CPC, CPMA
Susan M Murphy, CPC, CPB
Susan Wilkinson, CRC
Susanne M Westmoreland, CPC, CPMA, CRC
Suzanne Estes, CRC
Suzanne Winn, CPB
Syed Zaidi, CPC, CEDC
Tami Baker, CPC, CEDC
Tamrisia Braddy, CPC, CEMC
Temiko M Holmes, CPC, CEMC
Tena S Brown, CPC, CEMC
Tennison Yu, CRC
Teresa S Brown, CPC, CPB
Terri L Minotti, COC, CPC, CPB
Tiffany Bustle, CPCO, CPPM
Tina Hopkins, CPC, CRC
Tina Marie Lange, CPC, CPMA
Tina R Wadkins, CPC, CPCO, CPMA, CPPM, CRC
Tong Parngs, CPC-A, CPCO, CPMA
Tracey Louise, CPC, CPC-I, CRC
Tracy Bettis, CRC
Tracy Marshall, CPB
Tracy Swaim, CPB
Tricia Owsley, CPMA
Vania Johnson, CPC-A, CPMA
Vicki Rittenhouse, CPB
Vilma Smith, CPC, CRC
Vishnu Shanam, CIC
Wendy Mcallister, CPB
Wenona Lynn Mason Goc, CPC-A, CPMA
Yan Jiang, CPC, CPMA
YI Yu, CRC
Zakiyyah Wagerle, CPC, CRC
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65
Minute with a Member
Marg M. Strein
the AAPC ICD-10 proficiency test, read
every issue of Healthcare Business Monthly
and all the CMS updates, and code every
quiz I can find.
What advice do you have for new coders?
My advice to anyone seeking employment
in the field of coding is to “be true to
thyself.” Be a trailblazer when needed, and
do not give up when work is challenging or
the path gets rough.
Tell us a little bit about how you got into
coding, what you’ve done during your
coding career, and where you work now.
While attending an online medical coding
program online, I also worked full time
as a lead merchandiser. I am the sole
supporter of my household, but I managed
to dedicate time to learning medical
coding guidelines, anatomy, and medical
terminology.
In 2014, I completed the program with
honors. I knew finding a place in the
coding field would be a challenge, but I
was determined.
In 2015, I was employed in a facility,
coding outpatient same-day surgery
charts. It afforded me the opportunity
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66
to get better acquainted with CPT®,
HCPCS Level II, and ICD-9-CM codes,
and explore general surgery. I relied on
my background, determination, skills,
and AAPC to succeed; and as a result,
I achieved the coding quality scores
required. The position was short term,
however, so I am presently seeking a
position in medical records or coding.
What AAPC benefits do you like the most?
I rely on AAPC’s Healthcare Business
Monthly for coding information,
education, and inspiration. I enjoy and
benefit from the coding exercises, articles,
and inspirational stories from professional
coders, especially those who have
experienced difficulties along their paths
to success.
I am extremely grateful for the Hardship
Scholarship Fund, and I hope to
reciprocate to other members in need when
I can. While job seeking, I continue my
coding education in many ways: I passed
If you could do any other
job, what would it be?
My main goal is to land a job in the coding
industry. I like coding and working with
records very much. Although coding is
my main career choice, I have a Bachelor
of Arts in Sociology and consulting
experience to support me.
How do you spend your spare time? Tell
us about your hobbies, family, etc.
I am a vegetarian and enjoy cooking
Asian, Indian, and French cuisine. I am
an adventurous spirit: I dabble in outdoor
activities and I search for quests to conquer.
In my spare time, I enjoy family, drawing,
yoga, dancing, hiking, and organic
gardening.
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Coding | Billing - Amazon Web Services

Transcription

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