healthcare

HEALTHCARE
BUSINESS MONTHLY
May 2014
www.aapc.com
Coding | Billing | Auditing | Compliance | Practice Management
Orthopaedic Injury Coding
New vs. Established Basics: 30
Understand and apply patient requirements
2014 OIG Work Plan: 48
Target risk areas and amp up audit efforts
Improve Finances with Benchmarks: 56
Get revenue cycles in order pre- and post-ICD-10
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Healthcare Business Monthly | May 2014
COVER | 36
■ Coding/Billing
Don’t Let ICD-10 Orthopaedic
Injury Coding Trip You Up
Heidi Stout, CPC, COSC, CCS-P
[contents]
ICD-10: Orthopedic Injury Coding
■ Coding/Billing
■ Auditing/Compliance
■ Practice Management
New vs. Established Basics: 30
Understand and apply patient requirements
2014 OIG Work Plan: 52
Target risk areas and amp up audit efforts
Improve Finances with Benchmarks: 56
Get revenue cycles in order pre- and post-ICD-10
42 ICD-10-CM External Cause Codes
Tell the Whole Story
48 2014 OIG Work Plan:
Target Your Risk Areas
58 EHRs: Computer Functions
Facilitate Fraud
Evan M. Gwilliam, DC, MBA, CPC, CCPC,
CPC-I, CCPC, CPMA, NCICS, MCS-P
Michael D. Miscoe, JD, CPC, CASCC, CUC,
CCPC, CPCO
Tim McCormack, JD, and Mary Inman, JD
[continued on next page]
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May 2014
3
Healthcare Business Monthly | May 2014 | contents
20
■Coding/Billing
20 Two Friends Inspire Others with Courage
Freda Brinson, CPC, CPC-H, CEMC
24 Not All Spinal Cages Are Created Equal
Paula Vandenberg, CPC, CPC-H
26 Guidelines? What Guidelines?
Ken Camilleis, CPC, CPC-I, CMRS, CCS-P
30 New vs. Established: Brush Up on the Basics
46
G.J. Verhovshek, MA, CPC
32 Balloon Uterine Stent Placement During Hysteroscopic Surgery
Michella Van Antwerp, CPC, CASCC
■Auditing/Compliance
46 Answer Common HIPAA Questions
Marcia L. Brauchler, MPH, CMPE, CPC, CPC-H, CPC-I, CPHQ
■ Practice Management
52 CPT® Code Valuations Matter for Your Bottom Line
52
Candice Ruffing, CPC, CPB, CENTC
56 Revenue Benchmarks Improve Finances During the Big Move
Ken Bradley
60 Invest in Yourself to Advance Your Career
Sylvia Partridge, CPC, CGSC
DEPARTMENTS
EDUCATION
7 Letter from Member Leadership 62 Newly Credentialed Members
COMING UP
66 Minute with a Member
10 Letters To the Editor
Online
Test Yourself – Earn 1 CEU
11 Healthcare Business News
12 AAPC Chapter Association
www.aapc.com/resources/publications/
healthcare-business-monthly/archive.aspx
•• Locum Tenens
14 Local Chapters: 2014-15 AAPC
Chapter Association Board
On the Cover:
•• HEALTHCON
18 Dear John
•• CPT® 20610
28 A&P Tips
•• Care Plan Oversight
•• Physician Communication
4
9 Opinion Page: ICD-10
Healthcare Business Monthly
33 Why I Code
45 A&P Quiz
Heidi Stout, CPC, COSC, CCS-P, explains how anatomy is key to
ICD-10 coding for orthopaedic injuries. Cover design by Tina Smith.
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May 2014
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Editorial
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Letter from Member Leadership
The Day After
T
his letter marks the half-way point of
my National Advisory Board (NAB) appointment and, as with everything in my
life, the time is flying. ICD-10 will get here
before we know it, too. The implementation date may have changed, but the reality of it hasn’t. Many of you are already experiencing ICD-10, either in the preparation
mode or the dual coding mode. At some
point, the new diagnosis code set will be implemented, and we must be prepared—for
the day of, and the “day after.”
Look Beyond the Transition
It seems that we have been so preoccupied
with preparing for the transition that not
enough thought has been given to what will
happen after ICD-10 is impemented.
Industry professionals are already telling us
to expect production slowdowns, learning
curve interruptions, increased denials, resource limitations, and cash-flow disruptions. Many suggest that providers insure
their cash flow by establishing a three to six
month reserve, to use as operational insurance to protect against dips in revenue.
ICD-10 Aftershocks
The aftermath of ICD-10 transition will be
much like an earthquake. The practical definition of an earthquake is a geological seismic adjustment. If you think about it, ICD10 is essentially that: an adjustment.
When an earthquake happens, it’s not just
the area where it occurs that’s affected. A
single earthquake can have hundreds of aftershocks, spreading out like ripples on a
pond from a thrown rock. Each aftershock
is an adjustment to the adjustment or ripple that occurred before it, spreading out
to affect areas that were never directly affected by the original event. In many ways,
ICD-10 will have similar implications—aftershocks, adjustments, and adjustments to
adjustments.
Anticipating and planning for the aftershocks should be part of your ICD-10 readiness plan. But the reality is that every provider and payer is unique, and the transition
and aftershocks experienced by providers
and payers will be equally unique. The aftershocks that will be the most difficult to
manage are the ones that blindside us, the
ones we do not anticipate.
The Timed Environment Is Vulnerable
I believe anything that happens in a “timed”
environment, whether it’s timely filing,
clean claim filing, contract language mandating certain time frames, denials, and internal goals, can be affected by ICD-10. It’s
important to remember that even though
the human part of these processes may understand the delays and slow downs, the automated parts may not.
It behooves every provider to look at where
the lion’s share of their reimbursement
comes from and review the flexibility of
each, including their ICD-10 readiness.
It’s impossible to anticipate every scenario,
but those who make an effort to be mindful
of the day after will have much better footing in dealing with unanticipated problems
as they arise.
It seems that we have
been so preoccupied
with preparing for ICD-10
transition that not enough
thought has been given to
the “day after.”
On a Different Matter Entirely
I look forward to sharing a recap of the wonderful times and inspiration experienced at
April’s HEALTHCON in the June edition.
As always, now and in the days to come, I
wish you the very best.
David Dunn, MD, FACS, CIRCC,
CCVTC, CCC, CPC-H, CCS, RCC
President, National Advisory Board
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May 2014
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Opinion: ICD-10
By Melissa L. Weintraub, CPC
ICD-10 Delayed, Again …
Now What?
Make the most of the
reprieve to prepare for
the inevitable.
I watched the actions of Congress on March 27 and March
31 with bated breath. It came as no surprise that they put another “patch” over the festering Sustainable Growth Rate
(SGR) formula to forestall a severe cut in Medicare payments
to physicians. Whether the patch is the right thing to do is a
completely different story. Incorporating a delay to ICD-10
in the H.R. 4302 bill, however, took me and most of my colleagues completely by surprise. We have all been counting
down to October 1, 2014. At the HIMSS Conference in February, Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner announced that there would be no
further delays of ICD-10. She said it would happen in no uncertain terms.
Why We Should Champion for ICD-10
photo by iStockphoto © Nastiall
I have heard many theories on whether ICD-10 will ever happen. My
money says it will. It must happen for all of the reasons the United
States sought to adopt it in the first place:
• Additional data will be available for tracking public health
• ICD-9-CM is outdated and maximized
With ICD-9-CM, we do not have the granularity of data that can
help in public health planning and initiatives. Granted, I have heard
many physicians complain that no one cares if the injury is on the left
or the right; the granularity of the data is meaningless. Perhaps they
are correct. There is a definite need for the laterality discussion down
the road. For now, let’s talk about the benefits of ICD-10’s specificity.
For example, consider public health awareness of a new cluster of
Group A Streptococcus bacteria (strep throat) that’s showing resistance to antibiotics. That information can be gleaned from ICD-10
diagnosis coding without the need to dig through charts, and provide clues to a potential outbreak.
In another example, imagine a cluster of women who are all developing pregnancy-induced hypertension in the same trimester, approximately the same week of pregnancy, and in the same geographical area. Without ICD-10’s specificity, this sort of thing could go
unnoticed.
The research capabilities with ICD-10’s enhanced data are astronomical, and our ability to use that data to find the cause and effect for diseases is so incredibly important for public health. I find it
mind-blowing that the brakes have been put on again.
Where Do We Go from Here?
ICD-10 has never really been a “coding” problem. The problem lies
in documentation and electronic transmission.
Just because ICD-10 is delayed until at least October 1, 2015 doesn’t
mean our quest for self-improvement and quality care should stop.
Physicians should continue to improve documentation to ensure
quality medical records. Coders should continue to look at records to
assist physicians in knowing what additional information will need
to be documented down the road to ensure proper payments. Payers
should continue their efforts, as well, testing end-to-end electronic
transmission to ensure claims safely move from point A to point B.
We have made great strides in preparing for ICD-10. If we continue
to move forward, not only will we experience fewer growing pains
when ICD-10 is finally released, but we will all be better for it.
Melissa Weintraub, CPC, is coding compliance specialist with Nova Compliance Group in Troy, Mich. She has
more than 20 years of healthcare experience in billing, coding, compliance, education, and software development. Weintraub is a former administrator for both a large health system and billing company in the Detroit area.
A certified ICD-10 instructor, Weintraub teaches ICD-10-CM and ICD-10-PCS programs through the American
Institute of Healthcare Compliance. Weintraub is preparing for her CPC-I credential, and she is a member of the
Macomb Township, Mich., local chapter.
www.aapc.com
May 2014
9
Please send your letters to the editor to:
letterstotheeditor@aapc.com
Letters to the Editor
No Joke: It’s Yolk, Not Yoke
I enjoyed reading “Identify Signs and Symptoms of Allergic Reactions” in March 2014. I did get a bit confused, or more so, amused.
In the list of items that cause allergic reactions on page 23, it says,
“Egg - egg white, egg yoke.” I have seen cartons of eggs, but never all
12 yoked together.
Lee Spitzer, BA, CPC-A
Mid-level Providers May Report Services
“Authenticate Services with Proper Physicians’ Signatures” (March
2014, pages 26-27) states:
Incident-to a physician’s professional services means the
services or supplies are furnished as an integral, although
incidental, part of the physician’s personal professional
services in the course of diagnosis or treatment of an
injury or illness. Only the past, family, and social
history and review of systems may be documented by
ancillary personnel incident-to, and incorporated in the
evaluation and management (E/M) documentation,
which must be reviewed and signed by the billing provider.
To provide additional detail beyond
the scope of the article, please note
that ancillary personnel can also take
vitals. Non-physician practitioners
(mid-level providers) who are also
identified by Medicare in the ancillary personnel category may perform
the entire service. And in an office
that is hospital-based, when a visit is
shared/split, both providers (the physician and qualified non-physician
provider) may document in the note
to substantiate the service.
Additionally, physician assistants must have their notes “signed” by
a supervising physician within three days, as do certified registered
nurse practitioners at periodic intervals (by license, in Pennsylvania;
the rules may differ from state-to-state).
Suzan Hauptman, MPM, CPC, CEMC, CEDC
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Healthcare Business Monthly
Healthcare Business News
Ohio and Feds Indict “Dr. Feel Good” for Fraud
An Akron, Ohio, physician, Adolph Harper, and three of his employees were indicted for illegally prescribing hundreds of thousands
of doses of prescription painkillers and anti-anxiety medications
(OxyContin®, Percocet®, Roxicet®, Opana®, methadone, and others)
from 2009-2012. The prescriptions were for no legitimate medical
purposes, and Harper allegedly continued to write prescriptions to
“patients” even after several died of drug overdoses.
Harper would write prescriptions to patients who presented to his
office with clear signs of drug addiction. Often he did not examine
or even see them at all, but would write prescriptions, according to
the indictment. When Harper was not in the office, a staff member
would write out prescriptions on Harper’s prescription pad.
“The charges describe a defendant who is simply a drug dealer with a
stethoscope who happens to work from a medical office instead of a
street corner,” said U.S. Attorney for the Northern District of Ohio
Steven M. Dettelbach. “His actions destroyed families and lives.”
Harper’s charges go beyond drug distribution; he is also being
charged with health insurance fraud. According to a March 26 press
release from the U.S. Attorney’s Office Northern District of Ohio,
the insurance fraud was specifically for:
1. Submitting insurance claims for services using a higher billing
code than the service justified;
2. Submitting insurance claims for unperformed services;
3. Billing an insurance provider for a service after collecting a cash
payment for the same service; and
4. Causing the submission of insurance claims for prescriptions of
controlled substances that were issued outside the usual course of
professional practice and not for legitimate medical purposes.
Cleveland’s Resident Agent in Charge of Drug Enforcement Administration Geno Corley said, “This case was initiated by the Akron Police Department and investigated by FBI, Health and Human Services with assistance from the DEA Cleveland Resident Office, Ohio
State Board of Pharmacy and the State of Ohio Medical Board.”
“This is great example of how state and federal collaboration can
work to combat prescription drug abuse,” said Kyle Parker, executive director of the Ohio State Pharmacy Board.
Source: March 26 press release from the U.S. Attorney’s Office Northern District of Ohio,
“Akron Physician and Three Employees Indicted For Illegally Prescribing Hundreds of
Thousands of Painkillers and Other Pills” (www.justice.gov/usao/ohn/news/2014/26marad.
html)
Medicare FFS Payment Reduction Continues
The Medicare fee-for-service (FFS) program sequestration that began April 1, 2013 has been extended through April 1, 2015. Claims
with dates of service on or after April 1, 2013 paid under the FFS program continue to be subject to a 2 percent payment reduction.
The Budget Control Act of 2011 requires, among other things, mandatory across-the-board reductions in federal spending, also known
as sequestration. As required by law, President Obama issued the sequestration order on March 1, 2013.
Jurisdiction 11 Medicare administrative contractor Palmetto GBA
explains on its website that the payment reduction applies to all
claims paid under the Medicare FFS program, including drugs and
durable medical equipment, prosthetics, orthotics, and supplies.
Medicare electronic health record incentive payments and payments
to beneficiaries for unassigned claims are subject to the 2 percent reduction, as well.
The reduction is taken from the final payment amount, after the approved amount is determined and the deductible and coinsurance is
applied. Physicians, practitioners, and suppliers who bill claims on
an unassigned basis are encouraged to discuss with beneficiaries the
impact of sequestration on Medicare’s reimbursement.
Palmetto GBA provides this example of how the sequestration affects payments for unassigned claims:
A non-participating provider bills an unassigned claim for a service with a Limiting Charge of $109.25. The beneficiary remains
responsible to the provider for this full amount. However, sequestration affects how much Medicare reimburses the beneficiary. The
non-participating fee schedule approved amount is $95.00, and
$50.00 is applied to the deductible. A balance of $45.00 remains.
Medicare normally would reimburse the beneficiary for 80% of
the approved amount after the deductible is met, which is $36.00
($45.00 x 80% = $36.00). However, due to the sequestration reduction, 2% of the $36.00 calculated payment amount is not paid to
the beneficiary, resulting in a payment of $35.28 instead of $36.00
($36.00 x 2% = $0.72).
For Part B claims, the reduction appears at the line level and for Part
A claims, at the claim level, and is indicated on the electronic remittance advice or standard paper remittance with claim adjustment
reason code 253.
www.aapc.com
May 2014
11
AAPC Chapter Association: Annual Report
By Brenda Edwards, CPC, CPB, CPMA, CPC-I, CEMC
Oh, What a Year!
AAPC Chapter Association chair
reflects on the 2013-2014 board’s
accomplishments.
B
efore I recap the accomplishments of the 2013-2014 AAPC Chapter Association board of directors, I want to provide an excerpt from
our mission statement that sums up our driving force. The AAPC Chapter Association board of directors is:
… established to create, maintain and sustain the infrastructure,
through approachable and accountable representation, necessary
to empower local chapters to function in support of AAPC “Upholding a Higher Standard.” The Board provides policy, rules, regulations, direction and advice to AAPC local chapters and is also
charged with ensuring that the local chapters function in accordance with the mission of AAPC.
This means that you have 16 dedicated, hard-working board members
who have the best interest of your local chapter in mind. There are committees in place to guide you in the right direction by updating the Local Chapter Handbook; advising you monthly in this magazine, forum
posts, and emails; and watching over new chapter growth or those who
may be fighting for life.
The AAPC Chapter Association devotes countless volunteer hours
working with AAPC staff and local chapter officers because we are passionate about seeing local chapters succeed and grow.
Numbers Reveal Growth
• 239 chapters held seminars;
• 281 Certified Professional Coder (CPC®) review classes and nine
(Certified Professional Coder – Hospital Outpatient (CPC-H®)
review classes were held; and
• Many chapters participated in May MAYnia to bring in new
chapter members.
Our board members don’t know how to slow down. Besides serving on
the board of directors and working full time, they were also involved in:
• Presenting nationally as AAPC ICD-10 implementation and
code set trainers
• Presenting AAPC workshops
• Writing articles for AAPC and outside publications, such as
Physicians Practice and BC Advantage
• Speaking on ICD-10 Monitor’s “Talk 10 Tuesday”
• Obtaining additional credentials, including Certified Physician
Practice Manager (CPPM®), Certified Professional Biller
(CPB™), and Certified Professional Compliance Officer
(CPCO®)
• Planning local chapter conferences
• Serving as local chapter officers
• Participating on advisory boards for local colleges
• Speaking at local chapter meetings, regional and national
conferences, and other national organization meetings
• Answering questions that local chapter members posted on
AAPC forums
In 2013, we visited 23 local chapters, and the National Advisory Board
and AAPC employees visited 60 chapters, totaling 83 local chapter visits. That’s nearly seven chapter visits each month.
We’re Here to Help
Nineteen new chapters were opened in 2013, while nine closed due to
lack of available officers. For the first time, chapters in Virginia and
Kansas merged to keep member involvement at the local level.
The board worked hard to bring new resources to local chapter officers.
Presentations covering many different specialties were posted to the officer’s area at www.aapc.com, for use when a chapter needs a speaker or has
a last-minute cancellation.
Local chapters were busy during 2013:
• Local chapters proctored 2,534 exams;
• 4,496 local chapter meetings were approved for continuing
education units;
Robin Zink
12
Healthcare Business Monthly
Melissa Corral
The AAPC Chapter Association has followed former CEO Reed Pew’s
charge to continue to “do good until there is none left to do.”
And current and previous board members, an AAPC local chapter employee, and local chapter members assembled in August 2013 to help
members who lost everything in the Moore, Okla., tornado.
Donna Nugteren
Judy Wilson
Brenda Edwards
Local Chapter Handbook
By Faith C. M. McNicholas, RHIT, CPC, CPCD, PCS, CDC
Rules Are Made Clearer Twice a Year
Parting Is Such Sweet Sorrow
Every year, we have to say goodbye to departing board
members. I’d like to thank Robin Zink, CPC; Melissa Corral, CPC, CPPM; and Donna Nugteren, CPC,
CEMC, who have served for the past three years, as well
as Judy Wilson, CPC, CPC-H, CPC-P, CPCO, CPC-I,
CANPC, CPPM, CPB, who served for the past four years.
We Want You!
The AAPCCA selects five new board members each year. If
you have the drive and determination to give the best that’s
within you, please consider applying for the AAPC Chapter Association board when the call for new members goes
out in November.
Brenda Edwards, CPC, CPMA, CPC-I, CEMC, has 25 years experience in
coding and billing, and is coding and compliance specialist at Kansas Medical Mutual Insurance Company (KaMMCO). She served on the AAPC Chapter Association board of directors from 2010-2014 and held office as chair.
Edwards is an ICD-10 trainer, AAPC workshop presenter, and a frequent
speaker for local chapters and AAPC regional conferences. She is cofounder of the AAPC
northeast Kansas local chapter and has served many officer positions.
Twice a year, the Local Chapter Handbook is revised
and updated by the AAPC Chapter Association’s Local
Chapter Handbook Committee. They work year-round
reviewing it, and release the updates in January and
July. Handbook updates clarify AAPC policies and
guidelines.
Some of the important changes released in the latest
update include:
Chapter 4 – Local chapter officers who fail to
respond in a timely manner to emails, phone calls, or
other communication from AAPC staff, fellow officers,
members, and other officers or chapter members
should be reported to the AAPC national office. If
multiple complaints are received to substantiate the
lack of communication from the officer, AAPC may
remove the officer. This is not the first option, and a
thorough investigation will take place before an officer
is removed.
Chapter 5 – The update provides additional guidance for local chapters who need to replace an officer
during the year. Guidelines require the runner-up
officer to be contacted to see if he or she is interested
in filling the vacancy. If the runner-up is not interested
and there is no second runner-up (or there was no
runner-up at all), a nomination should go out to all
chapter members to find a volunteer to fill the vacant
position. If no one steps forward to volunteer, the
remaining chapter officers can appoint someone from
among the membership to fill the vacant position.
Chapter 6 – Local chapters must ensure election
nominations are submitted and received prior to the
meeting date when elections are conducted.
Chapter 7 – Local chapters must conduct a minimum
of six meetings and four exams per year. Chapters who
don’t hold six or more approved chapter meetings
may be placed on probation or closed the following
year (see section 4.1.1, page 29).
The latest changes and updates appear in bold green
(January updates) or red italics (July updates) for easy
identification when you review the Local Chapter
Handbook. To download the latest version, go here:
http://cloud.aapc.com/localchapters/2014LC_
handbook.pdf.
The Coding Institute, LLC
www.SuperCoder.com
www.aapc.com
May 2014
13
Local Chapters
Chapter Leadership: 2014-2015
AAPCCA Board of Directors
AAPC is proud to announce the 2014-2015 AAPC Chapter Association’s board of directors—a voting board
of 16 coders and one AAPC representative. This elected board is dedicated to providing to local chapters the resources and support necessary to be successful. Two board members represent each region of the country. Here’s
your regional representation.
Region 1 – Northeast
Pamela J. Brooks, CPC, CPC-H
Physician Services Coding Manager, Wentworth Douglass Hospital
Pam Brooks supervises a staff of multi-specialty coders at Wentworth Douglass Hospital in Dover, N.H., where
she’s worked for 12 years. In that time, she also developed a team of medical auditors and educators, surgical coders, and documentation improvement specialists. Working in the medical field since 1991, Brooks first started in
a mental health billing office. She then moved into practice management, overseeing the operations of an eating
disorders practice. She has a Bachelor of Science degree in Adult Education and Workplace Training from Granite State College and is completing her master’s degree in Health Administration from St. Joseph’s College of
Maine. Brooks sits on the advisory board for the Medical Administration Program at Great Bay Community College in Portsmouth, N.H. She enjoys mentoring new coders and helping them find employment opportunities.
Contact: pam.brooks@aapcca.org
Chapter affiliation: Seacoast-Dover, N.H. Offices held: Secretary
Cynthia Colangelo, CPA, CPC, CPC-H
Chargemaster Supervisor, AtlantiCare Regional Medical Center
Cindi Colangelo was introduced to the healthcare field performing feasibility studies with Ernst & Ernst. After
several years in public accounting, she worked in the finance department at Shore Memorial Hospital in Somers
Point, N.J., for almost seven years. For 23 years, Colangelo was responsible for Shore’s chargemaster. She now
works as chargemaster supervisor at AtlantiCare. A coding course in 2001 exposed her to AAPC and led her to
CPC® certification. She earned her CPC-H® in 2012. While president of her local chapter in 2012, the chapter
received third-place honors for the May MAYnia attendance competition.
Contact: cynthia.colangelo@aapcca.org
Chapter affiliation: Somers Point, N.J.
Offices held: President, president-elect, treasurer, education officer
Region 2 – Atlantic
Meeting Coordinator Roxanne D. Thames, CPC, CEMC
Medical Coding Educator/Auditor, Central Penn Management Group
Roxanne Thames has worked in the medical billing and coding field for 20 years. She started her career as a billing office clerk for a nursing home and later worked as a physician biller/coder for a large internal medicine practice in Lemoyne, Pa. Thames received her CPC® in 2005 and her CEMC™ in 2009. She has taught diagnosis coding at Harrisburg Area Community College, with areas of expertise in physician billing, coding and provider education, ICD-9-CM coding, accounts receivable (A/R), collections, evaluation and management (E/M) auditing, and appeals. Thames enjoys mentoring, networking, and visiting with other local chapters.
Contact: roxanne.thames@aapcca.org
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Healthcare Business Monthly
Chapter affiliation: York, Pa.
Offices held: President, president-elect
Local Chapters: 2014-15 Board
Yolanda T. Haskins, CPC
Senior Coding and Reimbursement Specialist, Howard University Faculty Practice Plan
Yolanda Haskins brings over 30 years of experience to the medical billing and coding field, and has worked in
many specialty offices, hospital systems, and as owner of a billing company. She received her CPC® in 2006.
Haskins helped establish the Alexandria, Va., chapter, which now has more than 250 members. She loves mentoring and encouraging new coders.
Contact: Yolanda.haskins@aapcca.org
Chapter affiliation: Alexandria, Va.
Offices held: President, member development officer
Region 3 – Mid-Atlantic
Sharon J. Oliver, CPC, CPC-I, CPMA
Senior Inpatient Biller, East Tennessee State University Physicians and Associates, Quillen College of Medicine
Sharon Oliver has been in the medical profession for more than 28 years. She has been an office manager, certified medical assistant in family practice and obstetrics/gynecology, and a nurse in pediatrics. Oliver has been a
CPC® for nine years and a PMCC instructor for eight years. She is a senior inpatient biller for cardiology, internal medicine, infectious disease, and hospitalists at East Tennessee State University Physicians and Associates,
Quillen College of Medicine. She is a co-contributor for Elsevier publications on ICD-10-CM and Step-By-Step
Medical Coding by Carol J. Buck. Oliver is an instructor for The Coding Institute boot camps and was a top five
finalist for AAPC’s 2011 Member of the Year Award.
Contact: sharon.oliver@aapcca.org
Chapter affiliation: Southern Appalachian Coders
Offices held: President, member development
Peter Davidyock, CPC, CPMA
Coding and Audits, Pawleys Island Pediatrics and Adult Medicine
Peter Davidyock has been coding for four years and has experience in anesthesia, ear, nose, and throat, family
medicine, pain management, cardiothoracic surgery, and electrophysiology. He has coded for a large trauma service and a group of vascular surgeons. Davidyock recently turned toward the private sector, accepting challenging roles to help private practices navigate today’s changing regulations in healthcare. He is a regular presenter
at his local chapter. Davidyock has developed programs with local colleges in his area that allow students to be
part of the chapter experience.
Contact: peter.davidyock@aapcca.org
Chapter affiliation: Conway, S.C.
Offices held: President, secretary/treasurer, education officer
Region 4 – Southeast
Secretary Candice M. Ruffing, CPC, CPB, CENTC
Associate Consultant, Acevedo Consulting, Inc.
Candice Ruffing conducts coding and compliance audit projects; provides consulting services to clients’ management, physicians, and staff; and provides input for developing clients’ annual audit plans. She has more than
15 years experience in coding and billing for multi-specialty physicians. Ruffing enjoys mentoring and guiding
others to fulfill their career goals.
Contact: candice.ruffing@aapcca.org
Chapter affiliation: Stuart, Fla.
Offices held: President, secretary
Kristie Stokes, BSHA, CPC
Remote Coder/Biller, Maryland-based Ambulatory Surgery Center
Kristie Stokes began working in the medical billing and coding field in 1997 as a follow-up clerk for an ambulance service. Since then, she has worked as a medical biller, administrative assistant, assistant manager, manager, and coder. Stokes earned CPC® certification in 2007, and a Bachelors of Science degree in Health Administration through the University of Phoenix in 2009.
Contact: kristie.stokes@aapcca.org
Chapter affiliation: Mobile, Ala.
Offices held: President, vice president
www.aapc.com
May 2014
15
Local Chapters: 2014-15 Board
Region 5 – Southwest
Chair Barbara S. Fontaine, CPC
Business Office Supervisor, Mid County Orthopaedic Surgery and Sports Medicine
Barbara Fontaine’s 30 years in the medical field have taken her from a part-time admissions clerk in a rural Arkansas hospital, to coding and billing for a single family practice physician, and then to a multi-physician clinic,
which became a multi-practice group in northwest Arkansas. Family drew her to St. Louis, Mo., in 2001, where
she joined Mid County Orthopaedic Surgery and Sports Medicine, starting out as a surgery coder. She is now the
business office supervisor. Mid County is now a large multi-specialty organization and part of Signature Health
Services. Fontaine’s focus is on keeping up to date with correct coding and billing for her providers, and continuing education of the physicians and staff. She earned her CPC® in 2001 and became an active member of her local
chapter, serving on several committees before becoming an officer. In 2008, she was awarded as her local chapter’s Coder of the Year and AAPC’s Coder of the Year.
Contact: barbara.fontaine@aapcca.org
Chapter affiliation: St. Louis West, Mo.
Offices held: President, education officer, secretary, member development officer
Amy E. Bishard, BA, CPC, CPMA, CEMC, RCC
Medical Billing and Coding Instructor, Cox College
Amy Bishard’s career in the healthcare industry began in 1999, working part time in a clinic’s business office.
After completing college, she pursued a career in medical coding and obtained her CPC®. Since that time, Bishard has worked in the areas of auditing, coding, and compliance. She teaches in the Medical Billing and Coding Program at Cox College. While serving as 2011 president of the Springfield, Mo., local chapter, she earned
the AAPC Chapter of the Year Award. Bishard enjoys mentoring new members and networking with coders.
Contact: amy.bishard@aapcca.org
Chapter affiliation: Springfield, Mo.
Offices held: President, president elect
Region 6 – Great Lakes
Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC
Manager, Coding and Reimbursement/Government Affairs, American Academy of Dermatology; Proprietor, Coracle
Faith McNicholas has experience in various solo and group practice medical specialties, ranging from cardiology
to endocrinology to dermatology. With a passion for dermatology, she is the assistant editor for Derm Coding Consult, a quarterly coding and regulatory newsletter published by the American Academy of Dermatology (AAD),
and a feature contributor for the Association of Dermatology Managers/Administrators (ADAM) newsletter and the
Journal of Dermatology Nurses Association (JDNA). McNicholas writes on coding, reimbursement, and regulatory
changes and their affect on physician practices. She presents at the AAD annual and summer meetings, AAPC
regional conferences, ADAM and JDNA annual meetings, and AAD monthly webinars and regional symposia.
McNicholas has certification in medical billing, medical coding, management of medical office and healthcare
practice, and holds a degree in Health Information and Management Technology.
Contact: faith.mcnicholas@aapcca.org
Chapter affiliation: Des Plaines, Ill.
Offices held: President, president elect, secretary
Holly Brown, CPC, CPC-H, CEMC
Coding Supervisor, Third-party Auditing Company
Holly Brown has worked in medical billing and coding since 2006, starting out at the front desk of a multi-physician cardiology practice. She quickly learned the billing/coding side and transferred to the billing office, where
she scrubbed charges and helped to code the office visits and procedures. Brown now specializes in quality/training and auditing E/M and outpatient services for physicians and hospitals. She helped to start the St. Augustine,
Fla., chapter in 2009 and served as president-elect and president. In 2012, she worked with other coders in the
area to start the Orange Park, Fla., chapter where she served as president. She enjoys mentoring new coders and
being involved in her local chapter.
Contact: holly.brown@aapcca.org
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Healthcare Business Monthly
Chapter affiliation: St. Augustine, Fla.
Offices held: President, president-elect
Local Chapters: 2014-15 Board
Region 7 – Mountain/Plains
Vice Chair Kathleen R. Burke, CPC, CPB
Health Information Management (HIM) Coding Manager, Tucson Medical Center
Kathy Burke began her healthcare career in 2001 at a medical billing service, working for individual providers
and a small group practice. She is HIM coding manager for Tucson Medical Center—one of the “most wired”
hospitals in the country—where she manages a team of 20 inpatient and outpatient coders, cancer registrars, and
HIM analysts. Burke holds a bachelor’s degree in psychology from Smith College, and is an AAPC workshop
presenter and a frequent speaker at local chapters in Arizona.
Contact: kathleen.burke@aapcca.org
Chapter affiliation: Tucson, Ariz.
Offices held: Education officer
Susan Ward, CPC, CPC-H, CPC-I, CEMC, CPCD, CPRC
Coding and Billing Manager, Travis C. Holcombe, MD
Susan Ward started her career more than 20 years ago in billing and has since evolved into coding and management. She is an AAPC workshop presenter and AAPC ICD-10 trainer. Ward served on the AAPC National Advisory Board from 2007-2009. Her enthusiasm for coding and networking shines when you meet her; she is a
“cheerleader” for AAPC, and attends chapter meetings while traveling. Ward has held offices for AAPC’s West
Valley Glendale chapter, as well as the Phoenix chapter.
Contact: susan.ward@aapcca.org
Chapter affiliation: Glendale, Ariz.
Offices held: President, president-elect, treasurer, education officer
Region 8 - West
Treasurer Erin Andersen, CPC, CHC
Compliance Specialist, Oregon Health & Science University
Erin Anderson has worked in coding and compliance since 2003, performing chart audits and educating providers, coders, and staff on coding and billing. She seizes any opportunity to expand her coding knowledge, and is
an active member of the Rose City chapter in Portland, Ore.
Contact: erin.andersen@aapcca.org
Chapter affiliation: Portland, Ore.
Offices held: President, president-elect, education officer
Linda Martien, CPC, CPC-H, CPMA
Assistant Director of Coding Education, MiMedx, Inc.
Linda Martien began her career as an emergency medical tech more than 30 years ago, and evolved into coding, billing, practice management, and hospital outpatient revenue cycle management. She served and held office on the AAPC National Advisory Board from 2005–2009. Martien has also served in several officer positions with the Jefferson City and Columbia, Mo., chapters. Her love of coding and reimbursement is evident
when you hear her speak.
Contact: linda.martien@aapcca.org
Chapter affiliation: Jefferson City, Mo.
Offices held: President, president-elect, education officer
AAPC Representative
Marti G. Johnson
Director of Local Chapter Support, AAPC
Since 1994, when Marti Johnson joined AAPC, the number of chapters has grown from 30 to more than 520. Her
tenure has been dedicated to the establishment and support of AAPC members and local chapters.
www.aapc.com
May 2014
17
Dear John
Separate E/M with Screening Colonoscopy,
photo by iStockphoto © roobcio
Plus Pre-op Screenings
Q
I’m trying to find a specific, CMS reference that clarifies billing for an E/M service
with screening colonoscopy and billing for
colonoscopy done for pre-op reasons. A GI provider
recently joined our group, and we want these issues
to be settled, right from the start.
Trude Vozzella, CPC, CEMC
A
The definitive Centers for Medicare & Medicaid
Services (CMS) text for screening colonoscopy is
chapter 18 - Preventive and Screening Services, section 60 of the Medicare Claims Processing Manual (www.cms.
gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c18.pdf ).
The manual details the patient requirement for which CMS
will cover a screening colonoscopy, the proper codes to apply,
and frequency limitations. Unfortunately, it does not provide
specific guidance relative to billing an evaluation and management (E/M) service in addition to a (covered or non-covered) screening exam.
CMS does, however, offer ample general guidance on when
you may report a separate E/M service with a minor surgical or endoscopic procedure. Two of many possible examples include:
1. CMS National Correct Coding Initiative manual
states:
The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately
as an E&M service. … If a minor surgical procedure
is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone
to justify reporting an E&M service on the same date
of service as a minor surgical procedure.
2. The CMS Global Surgery Fact Sheet (w w w.c ms.gov/
O u t reach-and-Education/Medicare-Learning-Network-MLN/
MLNProducts/downloads/GloballSurgery-ICN907166.pdf )
specifies:
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Healthcare Business Monthly
The initial evaluation for minor surgical procedures
and endoscopies [this would include screening colonoscopy] is always included in the global surgery
package. Visits by the same physician on the same
day as a minor surgery or endoscopy are included in
the global package, unless a significant, separately
identifiable service is also performed. Modifier 25 is
used to bill a separately identifiable evaluation and
management (E/M) service by the same physician on
the same day of the procedure.
In other words, if the patient is otherwise healthy, CMS guidelines confirm you should not report an E/M with the screening colonoscopy. Only when a patient requires an E/M service that goes beyond the “usual” service— supported by documentation of a medically-necessary history, exam, and medical decision-making—may a separate E/M code be reported,
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 appended.
CMS guidance on this issue is widely observed by commercial
payers, as well as provider advocacy groups. For example, the
American Gastroenterological Association advises on its website (www.gastro.org/practice/coding/coding-faqs-evaluation-management):
How do I bill for a patient seen in our office prior
to a screening colonoscopy with no GI symptoms
and who is otherwise healthy?
A visit prior to a screening colonoscopy for a healthy
patient is not billable. Dear John
If a patient is referred to our office for a screening colonoscopy and the patient is on warfarin, can we bill for
the visit? Yes. If the patient requires some intervention on the part of
the gastroenterologist prior to the procedure, you can bill
a New Patient or Established Patient visit, depending on
whether the patient has received any face-to-face service
To charge a patient separately for
a non-covered pre-op screening
would be unbundling, and might
constitute fraudulent billing.
by any provider of the same specialty in your office within
the last three years. Guidelines for separately billing pre-operative services to Medicare
may be found in CMS Transmittal 1719 (https://www.cms.gov/Regulationsand-Guidance/Guidance/Transmittals/downloads/R1719B3.pdf):
F. Applicability of §1862(a)(7) of the Act to Preoperative
Services.
1. Preoperative Examinations. For purposes of billing under the Physician Fee Schedule, medical preoperative examinations performed by, or at the request of, the attending surgeon does not fall within
the statutory exclusion articulated in §1862(a)(7) of
the Act. These examinations are payable if they are
medically necessary (i.e., based on a determination
of medical necessity under §1862(a)(1)(A) of the Act)
and meet the documentation requirements of the service billed. Determination of the appropriate E/M
code is based on the requirements of the specific type
and level of visit or consultation the physician submits on his claim (e.g., established patient, new patient, consultation).
2. Preoperative Diagnostic Tests. When billing under the Physician Fee Schedule, preoperative diagnostic tests performed by, or at the request of, the
physician performing preoperative examinations,
do not fall within the statutory exclusion articulated
in §1862(a)(7) of the Act. These diagnostic tests are
payable if they are medically necessary (i.e., they may
be denied under §1862(a)(1)(A)).
G. ICD Coding Requirements for Preoperative Services. All claims for preoperative medical accompanied by
the appropriate ICD-9 code for preoperative examination
(e.g., V72.81 through V72.84). Additional appropriate
ICD-9 codes for the condition(s) that prompted surgery
and for conditions that prompted the preoperative medical evaluation (if any), should also be documented on the
claim. Other diagnoses and conditions affecting the patient may also be documented on the claim, if appropriate. The ICD-9 code that appears in the line item of a preoperative examination or diagnostic test must be the code
for the appropriate preoperative examination (e.g., V72.81
through V72.84).
H. Reasonable and Necessary Services. For the purpose of
establishing preoperative services as reasonable and necessary, all claims are subject to applicable national coverage
decisions. In the absence of a national coverage decision,
reasonable and necessary services are determined by carrier discretion. Establishing reasonable and necessary preoperative medical evaluations is facilitated when the ICD9 codes(s) for the condition(s) that prompted surgery, and
for the conditions that prompted the preoperative medical
evaluation (if any), are documented as additional diagnoses on the claim.
The bottom line: CMS will not pay separately for routine pre-op
screening colonoscopy (or other routine pre-surgical screening).
Assuming that the patient does not meet the screening criteria described in chapter 18, section 60 of the Medicare Claims Processing
Manual, a pre-op colonoscopy may be reported and paid separately only if the medical record substantiates medical necessity for the
service—for instance, if the patient develops a new problem (or other significant change of status) in the days prior to surgery. In such a
case, CMS requires you to cite an ICD-9-CM code for preoperative
examination (V72.81-V72.84), but also warns, “these ICD-9 codes
do not, in and of themselves, establish medical necessity, therefore
claims containing these codes may be subject to medical necessity
determinations as described in §15047 H” [cited above].
To charge a patient separately for a non-covered pre-op screening
would be unbundling, and might constitute fraudulent billing. If
the gastroenterologist is performing routine (as opposed to medically-necessary) screenings at the surgeons’ request, he or she may
have to seek reimbursement directly from the referring surgeon.
Have a Coding Quandary?
Ask John
If you have a coding question for AAPC’s Healthcare Business
Monthly, please contact John Verhovshek, managing editor, at
g.john.verhovshek@aapc.com.
www.aapc.com
May 2014
19
■ Coding/Billing
By Freda Brinson, CPC, CPC-H, CEMC
Two Friends Inspire Others
with Their Courage
I’d like to share with you the real experiences of two women diagnosed with various types and stages of cancer. I hope you find their
true stories insightful and inspiring.
Susan
Thirty-three-year-old Susan—wife, mother, sister, daughter, friend,
and full-time apartment manager—noticed changes in her breast.
There was a knot under her arm, and her left breast was more swollen than the right. She assumed that the changes were due to breastfeeding her 8-month-old son, and her doctor agreed.
Susan’s symptoms continued after she was no longer breastfeeding.
She shared her concerns with Lisa, a 32-year-old coworker who noticed changes in her own breast, as well. Both women decided to do
some quick online research.
Susan didn’t like what she found. She also knew her father’s side of
the family had a history of breast and ovarian cancers. She decided
to go for a mammogram. Because of information she had found during her research, Susan wasn’t that surprised when the diagnosis was
finally delivered. Her exact symptoms were listed online, and they
pointed to one thing: inflammatory breast cancer (IBC).
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Healthcare Business Monthly
photo by iStockphoto © Y2jimbob
They share their journeys of
breast cancer diagnoses.
IBC
IBC is an aggressive cancer that occurs in approximately 1 percent
of people with invasive breast cancer. The cancer occurs in the cells
of the breast, but does not form an actual tumor—Susan described
it as “a chicken soup of cancer.”
“So many things run through your head when you get a cancer diagnosis,” Susan said. Her first thought was, “I am going to die. I was
so scared! I wanted to see my children grow up. My baby was only 8
months old.
“I still have those thoughts from time to time,” Susan said, “especially when I’ve had so many relatives die from cancer. And I hear the stories of people ‘beating’ it, only to have it come back later and find out
it isn’t treatable. I will always have that fear, but I have to kick those
thoughts and feelings out of my head because I truly believe that a
positive attitude and outlook is key in getting through this.”
When IBC is diagnosed, it’s at least stage IIIB. Susan was diagnosed
initially as stage IV, but this was later revised to stage IIIC, triplenegative (non-hormone receptive, which is harder to treat). The revision was due to a computed tomography (CT) scan showing lesions
on her lung and liver; positron emission tomography (PET) con-
Coding/Billing: Breast Cancer
I was so scared! I wanted to see my children
grow up. My baby was only 8-months-old.
firmed the spots were too small to biopsy. Between the CT and PET
results, fervent prayers were being lifted on Susan’s behalf: She was,
and continues to be, on many prayer lists.
Diagnosis: Stage IIIC inflammatory cancer of the left midline
breast, primary. ICD-9-CM code: 174.8 Malignant neoplasm of other specified sites of female breast
Susan knew she had to tell her 8-year-old son, Jackson, the news,
but she struggled with what say and how to say it. She and her husband, Chris, decided to tell their son before she started chemotherapy. They explained that she had cancer, but tried to minimize its seriousness.
“We told Jackson that I would have a bunch of doctor appointments,
and I would lose my hair and have surgery to remove my breasts, but
within a year I would be back to normal,” Susan said. The talk went
well, but with a child’s innocence, Jackson asked if she would be a
boy, since she would be bald and boob-less.
illustration by iStockphoto © elinedesignservices
Chemotherapy
Ten days after her diagnosis, Susan began her first of eight rounds of
chemotherapy. At the same time, she had additional testing, including another CT scan, a bone scan, an echocardiogram, a port insertion, and genetic testing. She also met with her oncologist and radiation oncologist.
A cocktail of powerful chemotherapy drugs—Adriamycin® (aka “the
red devil”), Cytoxan®, Neulasta®, and Taxol®—were used to shrink
tumors. The mix was administered every other week as an intravenous infusion, via an implanted port. The infusion lasted approximately three hours, during which time Susan was with other
patients receiving their own rounds of chemotherapy.
Infusions: 96413 Chemotherapy administration,
intravenous infusion technique; up to 1 hour,
single or initial substance/drug with 2 units of
+96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to
code for primary procedure).
Push: +96411 Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure)
Injection: 96372 Therapeutic, prophylactic or
diagnostic injection (specify substance or drug); subcutaneous or intramuscular
Note: Some payers consider Neulasta® to be a chemotherapy agent in
some circumstances. Check with your payer prior to reporting CPT®
code 96401 Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic.
Just after the second chemotherapy treatment, Susan’s hair began to
fall out—not all at once, but in clumps, here and there.
“This was VERY TRAUMATIC!” she emphasized. “I had so much
hair. It was falling out everywhere.” Susan made the decision to shave
her head, and did so at home with the help of her husband and son.
(As someone who has seen the clean-shaved Susan, I can tell you she
is beautiful. Her face is perfect and her eyes are full of life.)
As each treatment was completed, the side effects became more severe. For days following chemo, Susan had strong, flu-like symptoms, including body aches, joint pain, weakness, nausea, and malaise. As she described it, “I was more car sick than anything else. It
really felt like I had the flu, strep throat, and a sinus infection—all
at once. I was extremely tired and nauseous. But I only threw up one
time.
“The Taxol gave me horrible bone pain,” Susan continued. “It’s hard
to describe, but I felt like I had huge weights being thrown on me. It
was hard to walk or put weight on my legs, which was where most of
the pain was.” She also experienced extreme dry mouth, heartburn,
and tingling and numbness in her fingers and toes. Food didn’t taste
the same, Susan said, but she didn’t have the “metal taste” that others
sometimes describe. Her symptoms were treated as best as possible.
Witnessing the side effects was hard on Chris. He tried not to
show his worry in front of Susan, as he knew that would
cause her to worry about him. Chris was able to talk
and vent his fears to his mom.
Mastectomy and More
As Susan and her family prepared for the
Christmas holidays, she was also planning her
next course of treatment. This included a double mastectomy.
Procedural coding: 19306-50 Mastectomy,
radical, including pectoral muscles, axillary and
internal mammary lymph nodes-Bilateral procedure
Susan has the gene BRCA1, which research has shown
www.aapc.com
May 2014
21
To discuss this
article or topic, go to
www.aapc.com
Coding/Billing: Breast Cancer
increases the likelihood that
breast cancer will metastasize to ovarian cancer by 60
percent. A future hysterectomy is planned. Unfortunately, Susan’s sister is also
positive for the BRCA1
gene, and a candidate for
the same procedures as Susan. Her sister’s surgery will
be scheduled following the
delivery of her second child.
Following the mastectomy
and a short recovery (as soon
as she is able to extend her arms over her head), Susan will start her
course of radiation therapy, which will consist of 33 days of 20-minute sessions. After that, the plan is for Susan to return to her life—
without cancer. Susan is confident: “I know I will beat this stupid
cancer!”
Lisa
Following her diagnosis, Susan urged her friend and coworker, Lisa,
(who had also experienced breast changes) to see a doctor. It was a
smart decision.
Early Detection Matters
Following a percutaneous biopsy and lesion excision, a diagnosis of
complex sclerosing lesion (aka, radical scar or fibroadenosis of the
breast) was confirmed. This type of lesion commonly hides behind
or around cancer cells, and may be considered premalignant.
Initial encounter:
CPT®: 19083 Biopsy, breast, with placement of breast localization device when performed, and imaging of the biopsy specimen when performed, percutaneous; first lesion including ultrasounds guidance
ICD-9-CM: 611.72 Lump or mass in breast
Lisa’s pathology returned as sclerosing adenosis with no malignant
cells. Her course of treatment is over, unless she chooses to have reconstructive surgery to correct the slight difference in breast size.
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Healthcare Business Monthly
Surgical encounter:
CPT®: 19285 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance
19125 Excision of breast lesion identified by preoperative placement of
radiological marker, open; single lesion
Modifier 59 Separate procedure and/or modifier 51 Multiple procedures may be required when reporting these codes for the same operative session, depending on the payer.
ICD-9-CM: 610.2 Fibroadenosis of breast
Breast Cancer Is Every Woman’s Concern
In case it isn’t obvious, Lisa and Susan are very special to me. Lisa is
my daughter, and Susan is her best friend. Both women were willing to share their very personal experiences with us because they are
committed to:
1. Getting and staying healthy
2. Doing what they can to instill in all women, but especially women under the age of 40 (the typical age of your first
mammogram), that they need to trust when they discover something different in their bodies, and to push (hard, if
necessary) to get the proper testing done.
Don’t let their experiences be in vain. Talk to your family and friends
(and yourself) about taking care of even the slightest breast changes. Early detection is still the key. Age does not matter: Women under age 40 can and do get breast cancer. Cancer is not always a lump.
You must pay attention to any change.
Both women will also tell you their journeys have not been all bad—
both have learned some very important life lessons. Susan admits
she has had several “come to Jesus” moments, and Lisa has learned
to slow down and take time for herself and her family—not always
easy in our fast-paced world.
Freda Brinson, CPC, CPC-H, CEMC, compliance auditor for St. Joseph’s/Candler Health System in Savannah, Ga., has worked in healthcare for over 30 years. A member of AAPC since
1996, she is president of the newly created Swainsboro, Ga., local chapter. Previously, Brinson
was a member of the Savannah local chapter, serving in various officer positions. She was also
an AAPC Chapter Association board member from 2009-2012.
Photo by iStockphoto © wragg
A cocktail of powerful chemotherapy drugs—
Adriamycin® (aka “the red devil”), Cytoxan®, Neulasta®,
and Taxol®—were used to shrink everything.
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■ Coding/Billing
By Paula Vandenberg, CPC, CPC-H
Not All SPINAL CAGES
Are Created Equal
T
he intervertebral fusion cage is a hollow device
available in many shapes and sizes. The cage may
be made from any of several materials, including titanium or, most commonly, polyetheretherketone
(PEEK). The surgeon places bone graft material inside
the hollowed mid-portion of the cage. The holes in the
cage keep the graft in contact with the bony surface of
the vertebrae. This ensures the bone grafting material bonds with the vertebrae, forming a solid fusion.
Cervical
Understand How Cages Support
Thoracic
Lumbar
photo by iStockphoto© Janulla
Sacral
When coding cage placement,
you must know the type of
device used.
24
Healthcare Business Monthly
The cage helps in several ways: First, it separates and
holds two vertebrae apart. This makes the opening
around the nerve roots (neural foramen) bigger, relieving pressure on the nerves. As the vertebrae separate, the ligaments tighten up, reducing instability
and mechanical pain. The cage replaces the problem
disc while holding the two vertebrae in position until
fusion occurs.
Some cages require separate instrumentation for stabilization of the fusion. Others are designed with
plates attached and/or screws passing directly through
them. These are known as “standalone cages” or “cage
constructs,” and they are used for anterior approach
fusions. Cages falling under this category include:
Centinel Spine’s STALIF TT™ and STALIF C™,
Medtronic’s Sovereign® and Prevail®, Synthes’s ZeroP, LDR’s ROI-C®, and Globus’s Independence® and
Coalition®.
When coding for these standalone cages, you would
not add the instrumentation code (22845-22847) for
the plate and/or screws because these are considered
part of the cage construct. Proper coding is +22851
Application of intervertebral biomechanical device(s) (eg,
synthetic cage(s), methylmethacrylate) to vertebral defect
or interspace (List separately in addition to code for primary procedure), only.
In rare instances, the surgeon may place a standalone
cage, and then place a separately reportable plate
and/or screws to further stabilize the fusion site. In
this case, you may report the instrumentation code
(22845–22847) in addition to +22851.
To discuss this
article or topic, go to
www.aapc.com
Coding/Billing: Spinal Cages
photo by iStockphoto© Janulla
Reading the operative note only, without
researching the type of cage used, may lead
to incorrectly reporting an instrumentation
code for the plate and screw placement.
Know Your Devices
Coders must know the type of devices used during a procedure. Reading the operative note only, without researching the type of cage used, may lead to incorrectly reporting an instrumentation code for the plate and screw placement. For example:
At the C4-C5 level, the anterior longitudinal ligament
and the anterior annulus were excised. Cartilaginous
endplate and nuclear material were removed. The neural foramen were decompressed. Curets were used to prepare the subchondral bone. The C4-C5 disk was markedly degenerative, narrowed and desiccated. Sizing instruments were used. A 6-mm Coalition cage was filled
with BMP and Formagraft and was tamped into place.
Fixation screws were placed through the anterior plate
into the vertebral bodies.
In this example, a Coalition® cage was used and fixation
screws were placed through the anterior plate. The anterior plate and screws are part of the cage construct; making it inappropriate to report an instrumentation code
separately.
There are more than 25 types of standalone cages—all
with different shapes and sizes—and new technology is
constantly emerging, making research an ongoing necessity. A manufacturer’s website can be a great resource.
Paula Vandenberg, CPC, CPC-H, is a performance improvement analyst
with the Surgical Care Affiliates coding team. She has worked in healthcare for
more than 20 years and has been a certified coder for more than 10 years, specializing in spinal/neural coding, with experience in ambulatory surgical center and hospital settings. Vandenberg is a member of the Tucson, Ariz., local
chapter.
Certified Professional Coder
Full time - Valhalla, NY
As a key member of the team you will review and code
operative reports and visits for multispecialty practices,
resolve complex coding scenarios, provide feedback and
documentation advice to the practices and assist with the
resolution of coding related denials.
This position requires at least 3 years of experience in coding
and/or reimbursement activities as well as knowledge of
medical coding and CPT, HCPCS and ICD-9-CM; knowledge
of E/M, surgical coding and reimbursement practices/
strategies; and knowledge of ECW billing system and/or
other related billing system.
Certifications:
• AAPC Certified Professional Coder (CPC) and/or AHIMA
Certified Coding Specialist - Physician (CCS-P)
and at least one of the following:
• AAPC Cardiology Certification (CCC)
• AAPC Cardiovascular and Thoracic Surgery (CCVTC)
• AAPC Obstetrics Gynecology
(COBGC)
• AHIMA Certified Coding
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Apply via email and indicate
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romanon@wcmc.com
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www.aapc.com
May 2014
25
■ Coding/Billing
By Ken Camilleis, CPC, CPC-I, CMRS, CCS-P
Coder’s Voice
Guidelines? What Guidelines?
Make it known: Guidelines drive coding, compliance,
reimbursement, and quality of healthcare.
Y
ou rely heavily on a variety of guidelines to assist in your
work as a coder. Guidelines come from ICD-9-CM and
ICD-10-CM, CPT®, payers, government agencies, and a host
of other sources. There is no “one size fits all” with regard to
payer guidelines and related protocols (e.g., Which payers still
accept consultation codes; and for those who don’t, which
crosswalk codes should be used?)—not to mention that such
rules are constantly changing.
Thankfully, the standard coding reference books (ICD-9/10,
CPT®, and HCPCS Level II) serve as a starting point for proper and optimal coding. Physicians and data processors also
need to understand these guidelines because they not only
drive coding, but also compliance, reimbursement, and quality of healthcare. My personal experience suggests, however,
that the medical community outside of the coding world often
lacks knowledge regarding coding guidelines.
Guidelines Aren’t Common Knowledge
For example, I was once assigned to an evaluation and management (E/M) auditing job, which involved validation of precoded SOAP (subjective, objective, assessment, and plan) and
narrative clinical notes. At first, there seemed to be no methodology to determining the level of the office visits. I asked my
supervisor if her input staff were using the 1995 or 1997 Documentation Guidelines for Evaluation and Management Services. She looked at me like I had two heads and said, “This is
20xx, why would we be working with 1997 guidelines?”
She had no idea what I was talking about. As a result, I had to
go through the painstaking process of validating (and invalidating) all of their codes by scoring the history of present illness, review of systems, etc., for each service. Needless to say,
the E/M levels I came up with were, in many cases, different
from what they had initially coded.
26
Healthcare Business Monthly
In another instance, I was interviewing with a physician regarding clinical documentation improvement (CDI), and
mentioned the “official guidelines.” You and I know that I
was referring to the Official ICD-9-CM Guidelines for Coding and Reporting near the beginning of the ICD-9-CM codebook. After the third time I said “guidelines,” the doctor interrupted and asked, “Ken, can you explain what ‘guidelines’
you’re referring to?” I pulled out an ICD-9-CM codebook and
pointed them out to him. He had no idea these official guidelines even existed. He only worked from the body of the book
to find codes in the Alphabetic Index and the Tabular List.
Spread the Word
As a coder, you understand that guidelines are your friends.
You know from experience that there’s more to proper coding
than simply looking up codes in an index or list. Aside from the
1995 and 1997 Documentation Guidelines to Evaluation and
Management Services, plus the instruction at the beginning
of each section in CPT® (anesthesia, surgery, etc.), there are
additional guidelines sprinkled throughout your codebooks.
Instructional notes, conventions, symbols, and notations are
key to optimal coding. For instance, a knee surgeon who performs an arthroscopic medial meniscectomy and resection of
pathological plica at the same time may expect to be paid for
both services. After all, there are CPT® codes for both procedures: 29881 Arthroscopy, knee, surgical; with meniscectomy
(medial OR lateral, including any meniscal shaving) including
debridement/shaving of articular cartilage (chondroplasty), same
or separate compartment(s), when performed for the meniscectomy and 29875 Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure) for the plica
removal. However, a knowledgeable coder will note the words
“separate procedure” at the end of the descriptor for 29875,
To discuss this
article or topic, go to
www.aapc.com
Coding/Billing: Guidelines
She looked at me like I had two heads
and said, “This is 20xx, why would we be
working with 1997 guidelines?”
which means the service is included as part of the global
charge for the meniscus removal and not paid separately, unless performed contralaterally.
The chapter-specific coding guidelines in section I, subsection C of the Official ICD-9-CM Guidelines for Coding
and Reporting, provide a wealth of information to which
doctors and health information management specialists
should be privy to. Many of these guidelines contain decision-tree type logic that results in deeper levels of nesting of
information. This can be confusing, even for seasoned coders, because of the sheer amount of information imparted.
As you become more experienced, however, you begin to
spot coding patterns that don’t conform to guidelines—for
example, incorrect linkage or sequencing of diabetes and related manifestation codes, hypertension, HIV, sepsis, diseases as cause of symptoms, and unbundling of services
identified by CPT® codes.
With ICD-10 looming, you’ll soon be faced with a completely new set of guidelines. Although the Official ICD-9CM Guidelines for Coding and Reporting are an excellent
foundation, there will be new algorithms in the form of the
instructional notes that will appear throughout the ICD10-CM codebook. The Excludes notes from ICD-9-CM
are a good example of this: In ICD-10-CM, you’ll have two
distinct types of exclusion notes, Excludes1 and Excludes2,
which are both logic-based. There are also notes indicating
the need to extend a code out to seven characters, with the
appropriate choice for the seventh character. Both like and
unlike ICD-9-CM, there are a host of other conventions
and notations in ICD-10-CM with which you’ll need to become familiar.
Drive It Home
Your role as an educator is crucial to compliance and reimbursement. Take each day that goes by in 2014 as an opportunity to educate your providers to specify key information
so everyone in your practice is on the same page.
Ken Camilleis, CPC, CPC-I, CMRS, CCS-P, is an educational consultant and
PMCC instructor with Superbill Consulting Services, LLC. He is also a professional coder for Signature Healthcare, a health system covering much of southeastern Massachusetts. Camilleis is the 2014 education officer for the Quincy Bay
Coders, Quincy, Mass.
www.aapc.com
May 2014
27
A&P Tips
Constant pressure on the skin reduces blood
flow to the area; without enough blood, the
skin can die and an ulcer may form. Pressure ulcers most commonly occur at pressure
points, such as the buttocks, elbows, hips,
heels, ankles, shoulders, back, and back of
head. They are grouped by severity: Stage I is
the earliest stage and Stage IV is the most advanced stage.
jury). This category should not be used to describe skin
tears, tape burns, incontinence associated dermatitis,
maceration, or excoriation.
Stage III: Full-thickness skin loss
Subcutaneous fat may be visible at this stage but
bone, tendon, or muscle are not exposed or directly palpable. Slough may be present but does not obscure the depth of tissue loss. This stage may include
undermining and tunneling. The depth of a Stage
III pressure ulcer varies by anatomical location. The
bridge of the nose, ear, occiput, and malleolus do not
have (adipose) subcutaneous tissue, so Stage III ulcers
may be shallow. In contrast, areas of significant adiposity can develop into extremely deep Category/Stage III
pressure ulcers.
Stage I: Nonblanchable
erythema
In this stage the skin is intact with nonblanchable redness of a localized area that usually is
over a bony prominence. Darkly pigmented skin
may not have visible blanching and the ulcer may
be difficult to detect; its color may differ from the
surrounding area. The area may be painful, firm
or soft, and warmer or cooler as compared to adjacent tissue.
Stage II: Partial thickness
Partial thickness loss of dermis presents as a shallow open ulcer with a red pink wound bed, without slough. An ulcer at this stage may present as
an intact or open/ruptured, serum-filled, or sero-sanginousfilled blister. Or it may appear as a shiny or dry, shallow ulcer
without slough or bruising (bruising indicates deep tissue in-
Stage IV: Full-thickness tissue loss
The bone, tendon, or muscle is exposed and directly palpable at this stage. Slough or eschar may be present. Undermining and tunneling are common. The depth of a
Stage IV pressure ulcer varies by anatomical location.
The bridge of the nose, ear, occiput, and malleolus do
not have (adipose) subcutaneous tissue so these ulcers
may be shallow. Stage IV ulcers can extend into muscle
and/or supporting structures (e.g., fascia, tendon, or joint
capsule), making osteomyelitis or osteitis likely.
Source for staging: National Ulcer Advisory Panel
The Shoulder
The human shoulder is made up of three bones:
1. The clavicle, or collarbone, is a long, narrow, S-shaped, solid bone. It
extends across the front of the shoulder and connects the breastbone
(sternum) with the acromion (outer end) of the scapula.
2. The scapula, or shoulder blade, is a flat bone, roughly triangular
shape. It is placed on a posterolateral aspect of the thoracic cage, and
connects with the clavicle at the front of the body.
3. The humerus, or upper arm bone, is the largest bone of the arm. It
runs from the shoulder to the elbow and connects the scapula and clavicle in the shoulder. The smooth dome-shaped head of the bone lies
at an angle to the shaft and fits into a shallow socket of the scapula to
form the shoulder joint.
Uma Nachiappan, CPC, CCS, holds a graduate degree in commerce and accounting and has 13 years experience in the U.S.
healthcare industry across payer and provider segments. She is head of operations at Synthesis Healthcare Services, LLP.
28
Healthcare Business Monthly
By Uma Nachiappan, CPC, CCS
Clavicle
Scapula
Humerus
photo by iStockphoto © Eraxion
Anatomy in Under a Minute
Pressure Ulcers
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■ Coding/Billing
By G.J. Verhovshek, MA, CPC
New vs. Established:
Brush Up on the Basics
Understand new and established patient
requirements and how to apply them.
New patient
New patient
NO
NO
Exact same
specialty
Exact same specialty
YES
Exact same specialty
YES
DECISION TREE FOR NEW VS. ESTABLISHED PATIENTS
For illustrated purposes only
Received any professional service from
the physician or another physician in
a group of same specialty within last
three years
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Healthcare Business Monthly
additional definitions and details to ensure you make the right designation.
Established Patients Mean Face-to-Face Services
CPT® defines an established patient as meeting several requirements
simultaneously. Namely:
An established patient is one who has received a professional service from
the physician/qualified health
care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to
the same group practice, within
the past three years.
The first requirement is that
a patient has received a “professional service.” Solely within the context of E/M code selection, CPT® defines a professional service as “those face-toface services rendered by physicians and other qualified health
New patient
care professionals who may report evaluation and management services reported by a speNO
cific CPT® code(s).”
The important part here is
“face-to-face.” Medicare policy (CMS Transmittal R731CP,
CR 4032) confirms, “An interpretation of a diagnostic test,
reading an x-ray or EKG etc.,
in the absence of an E/M service
or other face-to-face service with
the patient does not affect the
designation of a new patient.”
A patient would still be new, for
illustration by iStockphoto©alexandragl1
Most professional coders—even relative beginners—are familiar
with the “three-year rule” to determine whether a patient is new or
established with a provider. But that familiar rule has a few wrinkles
that make determining patient status more complex than you might
realize. Even when using the handy Decision Tree for New vs Established Patients in the CPT® codebook’s Evaluation and Management (E/M) Services Guidelines section, you’ll need to know some
To discuss this
article or topic, go to
www.aapc.com
Coding/Billing: New vs. Established
A common conundrum is how to determine the patient’s
status if the provider has seen a patient previously in
another location within the past three years.
instance, if the physician interpreted test results for the patient two
years earlier, but had not provided the patient a face-to-face service
within the previous three years.
requirements before billing as “new” any patient who is established
with another physician of the same specialty/subspecialty within a
group.
New to Whom?
Established Encompasses Covering Providers, too
The second requirement addresses patient status relative to other providers in a group practice. A patient is still new to a provider
when another provider within the same group practice has seen the
patient within the past three years, but that provider is of a different
specialty/subspecialty.
For example, a patient consults with an orthopedist for possible hip
replacement. The patient has seen an internist in the same group five
times in the past three years. In this case, the patient is established
for the internist, but new to the orthopedist.
If a provider is on call for, or covering for, another provider, a patient’s
status is relative to the provider who is unavailable (not the covering
provider). For example, Dr. Smith is covering for Dr. Jones, who is on
a family vacation. Patients who are established with Dr. Jones would
be treated as established with Dr. Smith, even if Dr. Smith has not
seen the patient previously.
Likewise, per CPT® guidelines, “When advanced practice nurses
and physician assistants are working with physicians, they are considered as working in the exact same specialty and exact same subspecialties as the physician.”
Resource: For a list of Medicare-recognized physician specialties,
visit the CMS website: www.cms.gov/Medicare/Provider-Enrollment-andCertification/MedicareProviderSupEnroll/downloads/taxonomy.pdf .
The flip side of this requirement is that when a patient becomes established with a physician who works in group practice, the patient
is established with all physicians of the same specialty/subspecialty
in the group. The American Medical Association (AMA) allows an
exception for new physician’s seeing a patient established to the practice for the first time. CPT® Assistant, November 2008, features the
following Q&A [emphasis added]:
Question: Can new physicians who come on board to a group
practice with their own tax identification numbers charge a new
evaluation and management code for patients they see?
Answer: According to CPT guidelines, a new patient is one
who has received no professional services from the physician or
another physician of the same specialty who belongs to the same
group practice within the past three years. Also, if a physician
is new to this group practice and had never seen or billed a patient
previously through his tax ID number, this should be considered a
new patient for the purposes of this physician billing for his evaluation and management service.
Not all payers agree with this logic; investigate your specific payers’
Patient Status Travels
A common conundrum is how to determine the patient’s status if the
provider has seen a patient previously in another location within the
past three years. CPT® Assistant (June 1999) explains:
Consider Dr. A, who leaves his group practice in Frankfort, Illinois and
joins a new group practice in Rockford, Illinois. When he provides professional services to patients in the Rockford practice, will he report these
patients as new or established?
If Dr. A, or another physician of the same specialty in the Rockford practice, has not provided any professional services to that patient within the
past three years, then Dr. A would consider the patient a new patient.
However, if Dr. A, or another physician of the same specialty in the Rockford practice, has provided any professional service to that patient within the past three years, the patient would then be considered an established patient to Dr. A.
In other words, where the patient is seen doesn’t matter. If the provider treats a patient face-to-face service within the previous three years
(in any location), that patient is established (in all locations).
G.J. Verhovshek, MA, CPC, is managing editor at AAPC.
www.aapc.com
May 2014
31
■ Coding/Billing
By Michella Van Antwerp, CPC, CASCC
Balloon Uterine Stent Placement
During Hysteroscopic Surgery
Should you code the placement
of a balloon uterine stent?
As balloon uterine stent placement following intrauterine hysteroscopic surgery becomes more common, I hear more and more coders
questioning whether they can separately code this procedure. Let’s
set the record straight, right now.
Understand Use of Balloon Uterine Stents
To prevent reformation of moderate to severe adhesions and reduce
uterine bleeding after hysteroscopic adhesiolysis, a balloon uterine
stent (small catheter with a balloon at the end) can be placed in the
endometrial cavity. Balloons designed specifically for this purpose,
such as a Cook® Medical balloon uterine stent, are most often used.
This stent mechanically separates the walls of the endometrial cavity to prevent adhesion reformation. The stent is usually kept in place
for five to seven days to allow adequate healing of the endometrium.
For example, a patient presents for surgery due to a diagnosis of intrauterine adhesions:
The hysteroscope, which had been prefilled with a sorbitol and
mannitol solution, was inserted to the level of the external os. It was
advanced into the cavity under direct vision. Systematic exploration of the cavity revealed findings described above. Miniature scissors were passed through the operating port of the hysteroscope and
all adhesions were lysed. Uterine architecture was now normal. Hemostasis was adequate. Sponge count was reported as being correct.
The cervix was dilated to 9 mm and a small Cook balloon uterine
stent was placed. Hemostasis was still adequate. Once again, the
sponge counts were reported being correct. All the instruments were
withdrawn and the procedure was terminated.
In this case, would placement of the balloon uterine stent be separately reported with 58579 Unlisted hysteroscopy procedure, uterus, or
is it inclusive of the primary procedure?
Look to American Medical Association for Guidance
When this question was recently asked of the AMA, the response
was, “… the placement of the balloon in the uterine cavity is part of
the primary procedure and is not reported separately from the lysis
of adhesions procedure.”
To be clear, placement of a balloon uterine stent is inclusive of the
primary lysis procedure and is not separately reported. The correct
reporting for our example is 58559 Hysteroscopy, surgical; with lysis of
intrauterine adhesions (any method).
The supply for the stent should be reported, however. For those payers requesting “C” HCPCS Level II codes, the correct code (per the
device manufacturer) is C2628 Catheter, occlusion.
Michella Van Antwerp, CPC, CASCC, is a performance improvement analyst with the
Surgical Care Affiliates coding team. She has been in the healthcare field for 17 years and has
been a certified coder for 12 years, specializing in ambulatory surgery center coding and
auditing. She is a member of the Reno, Nev., local chapter.
This stent mechanically separates the walls of the
endometrial cavity to prevent adhesion reformation.
32
Healthcare Business Monthly
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Why I Code
Linda Aiken, CPC
F
or those who have been privileged to walk the
Appalachian Trail, you know the white blazes
mark the way you are to travel. Tracking the blazes keeps you on target and prevents you from getting lost in the wilderness. Similarly, I have been
putting one foot in front of the other to follow the
white blazes that mark my coding career path.
White Blazes Lead the Way
The first white blaze led me to a job as a receptionist for a chiropractor in the early ’90s. Those
were the days when billing involved paper claims
and the doctor could document the encounter
with the word “same” and we would still get paid.
The next white blaze I came across guided me to a
billing manager position for a multi-doctor practice within the chiropractic profession. As I journeyed down my career path, I came along another blaze, which led me to the mental health field
as a billing specialist. And yet another blaze di-
rected me to a billing manager position for an orthopedic office. Here, for the first time, I was required to attend AAPC local chapter meetings.
It was at my first meeting that I came across my
next white blaze.
Rising to New Challenges
The coding world intrigued me; and when given the opportunity to take a coding course, I rose
to the challenge. There has been no greater satisfaction in my life than when I passed the Certified Professional Coder (CPC®) exam last year. I
also was among the first CPCs® to take the ICD10 Proficiency Exam last August, and I’m happy
to report I passed.
I look forward to what ICD-10 will bring to
healthcare, and to the next white blaze that intercepts my path. I know there are all sorts of exciting, new challenges that lie ahead.
www.aapc.com
May 2014
33
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■ Coding/Billing
By Heidi Stout, CPC, COSC, CCS-P
Cover
Don’t Let ICD-10
Orthopaedic Injury Coding
Trip You Up
Recognize new coding
conventions and brush up on
your anatomy for proper coding.
Orthopaedic injury coding in ICD-10 is not business as usual. Codes
can be up to seven characters long, and are organized by anatomic
site rather than by injury type. Codes for post-operative complications are in the body system chapters, and V and E codes are things
of the past. What this amounts to is that coders need to know their
orthopaedic anatomy when ICD-10 is implemented. To keep from
feeling overwhelmed on that fateful day, let’s take a closer look at
some of the new ICD-10 coding conventions you may encounter for
orthopedic injuries.
Combination Codes
New combination codes for conditions and common symptoms,
manifestations, and external causes allow you to report only one
ICD-10 code in scenarios where ICD-9-CM requires two codes.
Example
The documentation says, “Wear of articular bearing surface of internal prosthetic right hip joint.” Proper coding is:
ICD-9
ICD-10
996.46
T84.060-
V43.64
Laterality
There are separate codes for left side, right side, and (in some cases)
bilateral, and even codes that are digit specific.
M22.02
M16.4
S64.490-
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Healthcare Business Monthly
Recurrent dislocation of patella, left knee
Bilateral post-traumatic osteoarthritis of hip
Injury of digital nerve of right index finger (7th character required)
Coding/Billing: Orthopaedic Injuries
The demand for specificity in injury coding is tremendous,
which places increased demand on the physician to document
in detail, and on you to code to a high level of specificity.
Placeholder “X” and 7th Character
ICD-10 uses a placeholder, which is always the letter X. It has two
uses:
5th character: When used as the fifth character for certain six-character codes, the X allows for future expansion without disturbing the
sixth-character structure.
M22.3X1
Other derangements of patella, right knee
7th character: When a code has fewer than six characters and a seventh character is required, the X is assigned for all unused characters
to meet the requirement of coding to the highest level of specificity.
T84.53XS
Infection and inflammatory reaction due to internal right knee prosthesis, sequela
Chapter 19 codes have a seventh character that identifies the episode
of care. With the exception of the fracture codes, most categories in
chapter 19 have three seventh character values:
1. A - Initial encounter
An initial encounter character is used while the patient is receiving active treatment for the condition. Some examples
of initial encounters are surgery, emergency department encounters, and evaluation and treatment by a new physician.
2. D - Subsequent encounter
A subsequent encounter character is used for encounters after the patient has received active treatment for the condition, and now is receiving routine care for the condition during the healing or recovery phase. Examples of subsequent
treatment are cast change or removal, medication adjustment, and other follow-up visits following treatment for the
injury or condition.
3. S - Sequela
A sequela seventh character is used for complications or conditions that arise as a result (i.e., late effect) of a condition or
injury. Examples of sequela are joint contracture after a tendon injury, painful hardware after arthrodesis, and scar formation after a burn.
S51.011A
S51.011D
S51.011S
Laceration without foreign body of right elbow, initial encounter
Laceration without foreign body of right elbow, subsequent encounter
Laceration without foreign body of right elbow, sequela
Complexities of Injury Coding
The demand for specificity in injury coding is tremendous, which
places increased demand on the physician to document in detail, and
on you to code to a high level of specificity.
S82.221A
S66.125A
Displaced transverse fracture of shaft of right tibia, initial encounter for closed fracture
Laceration of flexor muscle, fascia and tendon of left ring finger at wrist and hand, initial encounter
T84.220A Displacement of internal fixation device of bones of hand and fingers, initial encounter
ICD-10-CM groups injuries by anatomic site (e.g., shoulder and upper arm) rather than by injury type (e.g., fracture, wound). Injury
categories are:
• Head (S00-S09)
• Neck (S10-S19)
• Thorax (S20-S29)
• Abdomen, Lower Back, Lumbar Spine, Pelvis, External
Genitalia (S30-S39)
• Shoulder and Upper Arm (S40-S49)
• Elbow and Forearm (S50-S59)
• Wrist, Hand, and Fingers (S60-S69)
• Hip and Thigh (S70-S79)
• Knee and Lower Leg (S80-S89)
• Ankle and Foot (S90-S99)
• Certain Early Complications of Trauma (T79)
• Complications of Surgical and Medical Care, NEC
(T80-T88)
The arrangement of codes in each category follows the same pattern
for each anatomic site. As an example, look at the codes for injuries
to the elbow and forearm:
S50
S51
S52
Superficial injury of elbow and forearm
Open wound of elbow and forearm
Fracture of forearm
www.aapc.com
May 2014
37
Coding/Billing: Orthopaedic Injuries
S53
S54
S55
S56
S57
S58
S59
Dislocations and sprain of joints and ligaments of elbow
Injury of nerves at forearm level
Injury of blood vessels at forearm level
Injury of muscle, fascia and tendon at forearm level
Crushing injury of elbow and forearm
Traumatic amputation of elbow and forearm
Other and unspecified injuries of elbow and forearm
Within the dislocation category S53, note there are now separate
codes for subluxation, in addition to codes for dislocation.
Conduct an in-depth review of the codes for muscle, fascia, and tendon injuries (category S56). There is tremendous specificity within
this category; review these codes carefully and arm yourself with anatomical charts and references to assist you in coding these injuries.
S56.193- Other injury of flexor muscle, fascia, and tendon of right middle
finger at forearm level (7th character required)
In ICD-9-CM, one code was reported for an open wound with tendon laceration; in ICD-10 separate codes are required for open traumatic wound, and muscle/tendon/fascia laceration or nerve laceration. To locate the code for a tendon injury, look under the main term
“injury,” and then “muscle” by site. To locate a code for the wound,
look under the main term “laceration,” then look for the specific anatomic site.
Example
The documentation says, “Lacerated flexor tendon of the left ring
finger (no foreign body/no damage to nail).” Proper coding is:
ICD-9
ICD-10
883.2
S66.125S61.215-
For ICD-10, the appropriate seventh character (A, D, S) must be
added for episode of care.
Don’t Fumble Fracture Coding
The specificity of the ICD-10-CM fracture codes is daunting. Take
great car in making accurate code selections. Displaced vs. non-displaced, open vs. closed, laterality, and type of fracture are some examples of the specificity within the fracture codes. The expanded list
of seventh characters not only describes the episode of care, but also
whether the doctor is treating an open or closed fracture, nonunion,
malunion, or fracture sequela (late effects).
ICD-10-CM guidelines specify a fracture not indicated as open or
closed is coded as closed, and a fracture not indicated as displaced or
not displaced is coded as displaced. An additional code may be required for an open wound with a fracture or dislocation.
The guidelines state that fractures in patients with known osteoporosis are assigned a code from category M80 Osteoporosis with current pathological fracture, even if there is a minor fall or trauma, if
that fall or trauma would not usually break a normal, healthy bone.
The familiar fracture aftercare codes are gone. For traumatic fracture aftercare, you assign the acute fracture code with the appropriate seventh character. Standard seventh characters for fractures are
(there are exceptions to these examples):
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Healthcare Business Monthly
Coding/Billing: Orthopaedic Injuries
The familiar fracture aftercare codes are gone. For
traumatic fracture aftercare, you assign the acute
fracture code with the appropriate seventh character.
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• A - Initial encounter for closed fracture
• B - Initial encounter for open fracture
• D - Subsequent encounter for fracture with routine healing
• G - Subsequent encounter for fracture with delayed healing
• K - Subsequent encounter for fracture with nonunion
• P - Subsequent encounter for fracture with malunion
• S - Sequela
Note: There are initial encounter codes for open and closed fractures, but the subsequent encounter codes do not differentiate between the two.
Codes for some fractures in categories S52 Fracture of forearm and
S82 Fracture of lower leg, including ankle take specificity a step further. For example, codes S52.21- and S52.22- have a different set of
seventh characters. This is a particularly confusing aspect of fracture coding and often requires paging back to locate the correct list
of seventh characters.
Special seventh characters for all codes in the S52 and S82 categories
(with exceptions) are:
• A - Initial encounter for closed fracture
• B - Initial encounter for open fracture Type I or II or open
fracture NOS
• C - Initial encounter for open fracture Type IIIA, IIIB, or
IIIC
• D - Subsequent encounter for closed fracture with routine
healing
EHR
May 2014DISASTER
PLANNING
39
Coding/Billing: Orthopaedic Injuries
• E - Subsequent encounter for open fracture Type I or II with
routine healing
• F - Subsequent encounter for open fracture Type IIIA, IIIB,
or IIIC with routine healing
• G - Subsequent encounter for closed fracture with delayed
healing
• H - Subsequent encounter for open fracture Type I or II with
delayed healing
• J - Subsequent encounter for open fracture, Type IIIA, IIIB,
or IIIC with delayed healing
• K - Subsequent encounter for closed fracture with nonunion
• M - Subsequent encounter for open fracture Type I or II with
nonunion
• N - Subsequent encounter for open fracture, Type IIIA, IIIB,
or IIIC with nonunion
• P - Subsequent encounter for closed fracture with malunion
• Q - Subsequent encounter for open fracture Type I or II with
malunion
• R - Subsequent encounter for open fracture, Type IIIA, IIIB,
or IIIC with malunion
• S - Sequela
Here is the list of options in ICD-10 for coding a fracture of the humerus:
• 2-part surgical neck
• 3-part surgical neck
• 4-part surgical neck
• Greater tuberosity
• Lesser tuberosity
• Greenstick fracture of shaft
• Transverse fracture of shaft
• Oblique fracture of shaft
• Spiral fracture of shaft
• Comminuted fracture of shaft
• Segmental fracture of shaft
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Healthcare Business Monthly
• Simple supracondylar w/o intercondylar extension
• Comminuted supracondylar w/o intercondylar extension
• Lateral epicondyle
• Medial epicondyle
• Incarcerated medial epicondyle
• Lateral condyle
• Medial condyle
• Transcondylar
• Torus
• Salter-Harris Type I physeal
• Salter-Harris Type II physeal
• Salter-Harris Type III physeal
• Salter-Harris Type IV physeal
Share this with your physician as an example of why increased specificity in documentation is necessary.
Invest in Proficiency Now
Don’t put off your ICD-10-CM training. The time that you spend
becoming ICD-10-CM proficient now will pay huge dividends later. Fail to prepare and the negative impact on your productivity will
be significant. Make sure to involve your physicians in the process,
too, as they play a huge role in your organization’s successful transition to ICD-10-CM.
Heidi Stout, CPC, COSC, CCS-P, has over 30 years experience in orthopaedic coding. She is
the director of the orthopaedic surgery division for The Coding Network, LLC, and has her own
consulting business, Coder-On-Call, Inc. Stout has been consulting editor to several medical
coding publications and is a member of the AAPC Orthopaedic Steering Committee. She is a
member of the Monmouth, N.J., local chapter.
■ Coding/Billing
By Evan M. Gwilliam, MBA, DC, CPC, CCPC, NCICS, CPC-I, CCPC, CPMA, MCS-P
ICD-10-CM External Cause
Codes Tell the Whole Story
Use them to report in enhanced detail and
possibly streamline claims submission and
payment adjudication.
At some point in the near future, all claims for healthcare
services in the United States will have to use ICD-10CM diagnosis codes. ICD-9-CM has been the standard
since 1979, but has outlived its usefulness. Because of its
structure, ICD-10-CM provides better data for research
and statistical analysis than ICD-9-CM. Although there
is no national mandate to report them, external cause
codes provide a unique opportunity to report significant
detail not available in ICD-9-CM.
How, Why, When, Etc.
ICD-9-CM contains a lesser-known chapter entitled
“Supplemental Classification of External Causes of Injury and Poisoning.” These codes are distinctive because,
unlike most other ICD-9-CM codes, they are alphanumeric—that is, they start with the letter “E.” These
codes permit the classification of environmental events,
circumstances, and conditions as the cause of injury and
other adverse effects, and are to be used in addition to
codes that report the actual injury. For example:
Photo by iStockphoto© studio_annika
E813.1
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Healthcare Business Monthly
Motor vehicle traffic accident involving collision with other vehicle injuring
passenger in motor vehicle other than motorcycle
Some providers already use these codes voluntarily or
when required on auto insurance claims; however, many
billers are unfamiliar with external cause codes. Unless
a provider is subject to state-based mandates, or a specific payer requires them, you don’t need to report these
codes. The Centers for Medicare & Medicaid Services
(CMS) encourages you to do so, however, because they
provide valuable data for injury research and evaluation
of injury prevention strategies. They may also be helpful for determining liability in third-party injury claims.
It’s possible payers might not ask to review records as often after implementation, if they can find most of the information they need on the claim form via the diagnosis
codes reported. For example, suppose a patient presents
to the doctor’s office and the records reflect:
• The patient had sprain injuries in the neck;
• She was driving a car that struck a sports utility
vehicle;
Coding/Billing: External Cause Codes
Photo by iStockphoto© lisafx
… they provide valuable data for injury research and
evaluation of injury prevention strategies. They may also be
helpful for determining liability in third-party injury claims.
• The driver side air bag was deployed;
• She was texting while on a neighborhood street;
and
• The travel was for work.
All of this information can be reported with one injury
code and several external cause codes in ICD-10.
External Cause Codes Are Versatile
External cause codes were extensively reworked for ICD10-CM. The guidelines state that these codes are most
often reported secondarily to codes from nearby chapter 19, Injury, poisoning, and certain other consequences of external causes (S00-T88). Chapter 19 codes begin
with the letters S or T, and this is where codes for acute
injuries are found, such as those sustained in an automobile accident.
In other words, if the physician were to select a code such
as S13.4xxA Sprain of ligaments of cervical spine, initial encounter, it’s also appropriate to report the external cause of the injury. The S code would act as the primary diagnosis; external cause codes can never be reported first.
In ICD-10-CM, external cause codes are found in chapter 20, which includes codes that start with the letters V,
W, X, and Y. Codes from V00 to V99 are separated into
12 groups, which reflect the patient’s mode of transport.
The first two characters of the code identify the vehicle,
such as V1 for pedal cycle rider, V2 for motorcycle rider, V4 for car occupant, and V5 for occupant of pick-up
truck or van. An example of a complete code that might
be used in the case mentioned above is:
V43.51xA
Car driver injured in collision with sport utility
vehicle in traffic accident, initial encounter
The W codes are for injuries due to slipping, tripping,
stumbling, and falling; the codes from W20 to W49
are categorized as “exposure to inanimate mechanical
forces.” A code found in this section that fits our example case is:
W22.11xA Striking against or struck by driver side automobile airbag, initial encounter
The Y codes contain two important categories: Y92 for
place of occurrence of the external cause and Y93, which
is an activity code. The guidelines state these codes are
to be used with one another, and are only reported on the
initial encounter. Examples of place and activity codes a
doctor might report in our example case are:
Y92.414
Local residential or business street as the place
of occurrence of the external cause
Y93.C2
Activity, hand held interactive electronic device
There are also a few employment status codes in the
Y99 category that could be assigned when Y93 (activity) codes are selected. They describe if the person is employed, in the military, a volunteer, or other status, and
are reported only for the initial encounter. For example,
if the victim was on the clock during the accident, the
following code would indicate it may be related to worker’s compensation:
Y99.0
Civilian activity done for income or pay
Many payers require the submission of paper documentation to substantiate care. One reason ICD-10-CM was
created was to minimize the need for a review of the doctor’s notes. If the codes are detailed enough and reported correctly, a record review would not add much more
information. Payers would have nearly everything they
need to know from the claim form alone. Our example
www.aapc.com
May 2014
43
Photo by iStockphoto© ApplybyTexas
Coding/Billing: External Cause Codes
case, for instance, includes one injury code from chapter
19, and five external cause codes from chapter 20.
Ensure a Happy Ending
External cause code reporting is voluntary (but is encouraged) when ICD-10-CM is implemented. It provides the opportunity to report enhanced detail, and
could streamline the process of claims submission and
payment adjudication. It may also improve the process of
data collection for researchers and policy makers. Physicians and coders, however, must take the time to get familiar with coding guidelines and conventions to take
advantage of this opportunity provided by ICD-10
.
Sources:
Medicare Learning Network, ICN 902143, April 2013
Complete and Easy ICD-10-CM Coding for Chiropractic, 2nd edition, The
ChiroCode Institute, 2013.
“ICD-10-CM. It’s closer than it seems,” CMS News Updates. May 17, 2013.
Evan M. Gwilliam, DC, MBA, CPC, CCPC, CPC-I, CCCPC, CPMA,
NCICS, MCS-P, is the director of education for FindACode, and is the only
chiropractic physician who is also an AAPC certified ICD-10-CM trainer.
He spends most of his time teaching chiropractic physicians and other
health professionals how to get ready for ICD-10-CM. If you are looking
for a speaker or ICD-10-CM resources, he can be reached at DrG@
FindACode.com. Gwilliam is a member of the Provo, Utah, local chapter.
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Healthcare Business Monthly
CPT® & ICD-9 Updates
ICD-10
...and more
A&P Quiz
By Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC
Think You Know A&P? Let’s See …
The patient is an 82-year-old
female residing in a nursing
home. She presents today for
treatment of pressure ulcers.
She has ulcers on her right and
left heels and on the dorsum
of her right foot. The ulcers
have been present for about 6
weeks and are not responding
to treatment. Her pain is 9/10.
Her ulcer on the right heel measures 8.6 cm long by 5.6 cm wide
with a surface area of 34.3 cm. There is erythema around the wound
and surrounding skin is macerated. The wound is covered with dry,
hard, necrotic tissue. There is a minimal amount of exudate. There
was exposed tendon in the base of the wound after necrotic tissue
debridement.
What stage is the patient’s right heel pressure ulcer?
A.
B.
C.
D.
E.
Stage I
Stage II
Stage III
Stage IV
Unstageable
Check your answer on page 65.
Take this monthly quiz, in addition to AAPC’s ICD-10 Anatomy
and Pathophysiology advanced training, to prepare for the increased
clinical specificity requirements of ICD-10-CM.
To learn more about AAPC’s ICD-10 training, go to www.aapc.com to
download AAPC’s ICD-10 Service Offering Summary.
Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, is vice president of ICD-10 Training and Education at AAPC.
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■ Auditing/Compliance
By Marcia L. Brauchler, MPH, CMPE, CPC, CPC-H, CPC-I, CPHQ
Answer Common HIPAA Questions
illustration by iStockphoto© accaello
What changed in
2013 for business
associates?
O
ne of the most significant changes under HIPAA’s final rule,
effective September 23, 2013, was that business associates of
HIPAA covered entities became directly liable for compliance
with certain Privacy and Security Rule requirements. This means
that the U.S. Department of Health & Human Services’ (HHS) Office for Civil Rights (OCR), which enforces HIPAA, now has jurisdiction to audit, regulate, and sanction business associates for noncompliance with HIPAA. Previously, OCR’s ability to ensure compliance of the rules extended primarily only to providers, healthcare
organizations, and insurance companies. Business associates were
bound to compliance with HIPAA only by means of their contract
with the covered entity for which they worked.
Note: HIPAA is the Federal Standards for Privacy of Individually
Identifiable Health Information and/or the Security Standards for
the Protection of Electronic Protected Health Information (45 Code
of Federal Regulations [CFR] Parts 160, 162, and 164).
Who or What Is a Business Associate
HIPAA defines a business associate as a person or entity who performs certain functions or activities on behalf of a covered entity
46
Healthcare Business Monthly
that involve the use or disclosure of protected health information
(PHI). This includes creating, receiving, maintaining, and transmitting PHI. Typical business associate functions and services include claims processing; data analysis; utilization review; quality assurance; billing; benefit and practice management; and legal, actuarial, consulting, management, and/or financial services.
Under the final rule, HHS clarified and expanded who qualifies as
a business associate under HIPAA to include the following types of
entities:
• Health Information Exchange Organizations (HIOs) that
work to oversee the exchange of health information across
different organizations;
• E-prescribing gateways that allow providers to write and send
prescriptions to a participating pharmacy electronically;
• Data transmission service providers (for both paper and
electronic PHI) who require access to PHI on a routine basis;
• Vendors of personal health records (PHRs) who offer PHRs
to individuals on behalf of a covered entity;
• Patient Safety Organizations (PSOs) that receive reports of
Auditing/Compliance: Business Associates
Persons and entities that are part of a covered entity’s
workforce are not considered business associates.
patient safety events or concerns from providers under the
federal Patient Safety Quality Improvement Act of 2005
(PSQIA) (see: 42 U.S.C. 299b-22(i)(1));
• Medical liability insurance companies if they assist with
services such as risk management, assessment activities, or
legal services for which they require access to PHI; and
• Subcontractors of business associates that create, receive,
maintain, or transmit PHI on behalf of the business associate.
This change means even more types of organizations are now considered business associates if they maintain PHI—even if they don’t actually view it. This would include online storage vendors, cloud service providers such as internet-based calendar platforms, and electronic health record (EHR) vendors that are the access point for individuals wanting copies of their medical records.
Who Is Not a Business Associate?
Persons and entities that are part of a covered entity’s workforce are
not considered business associates. This may include temporary
workers, volunteers, interns, and others who work with or for a covered entity, regardless of who pays them (or even if they are paid).
Healthcare providers who receive PHI for the purposes of treating
patients aren’t business associates of the other entity, either.
Entities that act merely as conduits for the transport of PHI, that do
not access the information other than on a random or infrequent basis, are not business associates. This means that entities such as the
U.S. Postal Service, United Parcel Service, Federal Express, internet
service providers, or other delivery services for both digital or hard
copy PHI, that provide mere courier services, are not considered business associates.
Make Sure Your BA Agreement Is Up to Date
HIPAA permits the disclosure of PHI to business associates, but the
assurances of how that information will be appropriately safeguarded must be defined in a contract. This contract is referred to as a business associate agreement (BA agreement), and has been a requirement of HIPAA since 2003.
New responsibilities being passed along to business associates were
required to be incorporated into these agreements by September of
2013. Only existing BA agreements that were in compliance with
HIPAA prior to the final rule being issued in January 2013, receive a
grace period until September of 2014 to ensure that the new responsibilities are incorporated into these written agreements.
What Has Changed in the BA Agreement?
implement administrative, physical, and technical safeguards that
reasonably and appropriately protect PHI. New written agreement
requirements must specify that business associates and their subcontractors:
1. Enter into subcontractor agreements with any downstream
business associates;
2. Comply with applicable requirements in the Privacy and Security Rules;
3. Report any use or disclosure of PHI that is not allowed as per
the contract to the upstream business associate or covered entity; and
4. Ensure that each downstream agreement is at least as strict as
the original agreement between the CE and BA regarding allowable uses and disclosures of PHI.
Take Action Towards Compliance
If you’re a covered entity, you need to identify all of your business associates—especially those that didn’t fit the definition of a business
associate previously, such as data storage companies. Make sure that
you have executed proper BA agreements with them.
If you are a business associate, assess who your subcontractors are
that handle PHI from your covered entities, and make sure you
have entered into appropriate agreements with them to restrict uses
and disclosures of that PHI. Remember, these agreements must be
at least as stringent as those required of you by your covered entity.
It is not a HIPAA requirement that you need to have your business
associates attest to being in compliance with HIPAA and/or audit
them; however, taking reasonable steps to ensure that your business associates understand what is required of them under the final
rule, such as ensuring they are aware that they can now be audited
and fined by the federal government for non-compliance, is advised.
Consider a security questionnaire to evaluate a business associate’s
ability and desire to appropriately safeguard PHI. How the OCR will
enforce violations against business associates in the future remains to
be seen, but the floodgates have been opened.
Marcia L. Brauchler, MPH, CMPE, CPC, CPC-H, CPC-I, CPHQ, is a healthcare consultant
and founder of Physicians’ Ally, Inc. She advises physicians and practice administrators on
managed care contracts, reimbursement, coding, and compliance. Brauchler’s firm sells updated HIPAA policies and procedures at http://www.physicians-ally.com/hipaacompliance.
She is a member of the South Denver, Colo., local chapter.
BA agreements have always required that the business associate will
www.aapc.com
May 2014
47
■ Auditing/Compliance
By Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO
2014 OIG Work Plan:
Target Your Risk Areas
The U.S. Department of Health & Human Services Office of Inspector General (OIG) has released its annual work plan, outlining the new and ongoing hot spots for healthcare fraud and abuse
the federal agency intends to review and audit in 2014. Based on
the civil and criminal sanctions that can result from noncompliance, it behooves providers to pay particular attention to the risk
areas outlined in the OIG work plan and to update their compliance programs accordingly. In particular, take a good look at the
new and ongoing focus areas for the Medicare Part B program.
the more than $1 billion in inappropriate payments relating to
home health benefits. Specific to providers who may be certifying the necessity of home health services, OIG will review compliance with documentation requirements submitted to support
claims paid by Medicare. Providers are encouraged to review standards for certifying home-bound status prior to providing a certification for home health services.
Provider-based Freestanding Hospital-based Clinics
The OIG will continue to evaluate whether a payment disparity exists between reimbursement rates for services performed in
an ambulatory surgical center (ASC) compared to similar surgical services performed in a hospital outpatient department. OIG
will also continue to evaluate payment errors associated with place
of service by Part B providers who perform surgical services in an
ASC.
As a new initiative for 2014, OIG will look at the comparative payment amounts between provider-based facilities—which often receive higher payment amounts for certain services than do freestanding outpatient clinics—and their freestanding outpatient
counterparts. Although there is nothing necessarily onerous or
problematic with billings from hospital-based clinics, OIG will
be reviewing payments. This increased scrutiny may identify outliers, which could lead to additional audit analysis.
ASC and Hospital Outpatient Claims
Rural Health Clinics
OIG remains concerned with skilled nursing facility billing, based
on a 2009 study revealing a 25 percent error rate. OIG is also concerned about questionable billing from Part B providers for services provided to nursing home residents during stays not paid under Part A benefits (such as foot care), stays during which benefits
are exhausted, or due to failure to meet the three-day prior inpatient stay requirement.
OIG is aware the Centers for Medicare & Medicaid Services
(CMS) has not published regulations permitting removal of rural health program clinics that no longer meet location requirements established under the Balanced Budget Act of 1997. OIG
is also aware that rural health clinics that no longer meet the location requirements necessary to qualify for enhanced Medicare
reimbursement are still receiving the enhanced reimbursement
amounts. Rural healthcare clinics are advised to ensure the appropriateness of any enhanced payments they received, and voluntarily refund any inappropriate payments to Medicare.
Home Health
Sleep Disorder Clinics
OIG will focus on newly enrolling home health agencies, due to
OIG noted that an analysis of 2010 Medicare payments showed
Nursing Homes
48
Photo by iStockphoto© ayzek
Use the latest OIG work
plan to amp up your
compliance plan and
audit efforts.
Healthcare Business Monthly
Auditing/Compliance: OIG Work Plan
Photo by iStockphoto© CandyboxImages
Photo by iStockphoto© monkeybusiness
… as a new initiative, the OIG intends
to identify billing trends suggestive
of maintenance therapy billing, given
the history of problems associated
with improper payments.
high utilization for sleep testing procedures billed under CPT®
95810 Polysomnography; age 6 years or older, sleep staging with 4 or
more additional parameters of sleep, attended by a technologist and
95811 Polysomnography; age 6 years or older, sleep staging with 4 or
more additional parameters of sleep, with initiation of continuous
positive airway pressure therapy or bilevel ventilation, attended by a
technologist. OIG will continue to examine payments to providers
and facilities providing sleep testing procedures to determine the
appropriateness of payments.
Ambulance Services
OIG continues to evaluate ambulance billings for transports that
either did not occur or were potentially unnecessary transports to
dialysis facilities. As a new initiative, OIG is reviewing and coordinating its evaluations, audits, investigations, and guidance to ensure compliance with Medicare Benefit Policy Manual requirements, which limit payment for transport services to circumstances where using other means
of transport would endanger the patient’s health.
Anesthesia Services
The appropriateness of personally performed anesthesia
services is a continued focus area. Included in this focus
is the use of modifiers AA Anesthesia services performed
personally by anesthesiologist and QK Medical direction of
two, three, or four concurrent anesthesia procedures involving qualified individuals.
Chiropractic Services
OIG continues to identify improper payments for what
CMS defines as “maintenance” care. This effort has tra-
ditionally focused on analysis of documentation for compliance
with initial and subsequent visit documentation guidance contained in the Medicare Benefit Policy Manual. Of these requirements, compliance with the treatment planning elements is a particular focus, even though these elements are directory (what a
plan “should” contain) in CMS guidance. In addition to those efforts, as a new initiative, the OIG intends to identify billing trends
suggestive of maintenance therapy billing, given the history of
problems associated with improper payments. This effort is likely to focus on visit frequency analysis, as well as the number of encounters for a reported condition (diagnosis).
Laboratory Tests
OIG notes that Medicare is the largest payer of clinical lab
As a new initiative,
OIG is reviewing
and coordinating its
evaluations, audits,
investigations, and
guidance to ensure
compliance…
www.aapc.com
May 2014
49
Auditing/Compliance: OIG Work Plan
services in the nation,
with sharp increases
in costs for lab testing over the past several years due to increased volume of ordered services. As a result, OIG will perform data analysis to identify questionable billing practices.
Diagnostic Radiology Services
An ongoing concern is the rapid increase of diagnostic radiology
testing. The OIG continues to analyze the medical necessity of
high-cost diagnostic radiology tests in an effort to understand this
trend and determine the appropriateness of Medicare payments.
Portable X-ray Services
Similarly, the OIG is reviewing the appropriateness of Medicare
payments associated with the transportation and setup of portable
X-ray equipment. OIG is looking at the qualifications of the technicians who are performing the services, and whether the services were ordered by a medical doctor or doctor of osteopathic medicine. OIG also notes that Medicare has improperly paid portable
X-ray suppliers for multiple trips to nursing facilities and for services ordered by non-physicians.
Electro-diagnostic Testing Services
OIG continues its evaluation of Medicare claims data to identi-
fy questionable billing of electro-diagnostic (EDX) testing services. EDX service providers are encouraged to review applicable local coverage determination (LCD) requirements, and ensure their
documentation demonstrates conformance with applicable coverage requirements.
Documentation of E/M Services
With the advent of electronic health records (EHRs), OIG is particularly concerned with the increased frequency of medical records showing identical documentation across services. OIG is
evaluating multiple records for the same provider (likely to include
multiple records for each patient evaluated) to determine the extent to which documentation vulnerabilities exist (i.e. what OIG
and CMS have labeled as “cloning”). Providers are cautioned to
avoid EHR shortcuts that simply pull information forward, leading to the appearance of cloned documentation.
Ophthalmology Services
Based on 2010 data analysis, Medicare approved $6.8 billion in
improper payments for ophthalmologic services. OIG is continuing its review this year, and is basing it on 2012 claims data.
Physicians
OIG is reviewing compliance of participating providers with assignment rules, as well noncompliance through the billing of excess charges to Medicare beneficiaries. The OIG is using 2012
claims data for this study.
Medicare approved $6.8
billion in improper payments
for ophthalmologic services.
50
Healthcare Business Monthly
photo by iStockphoto© monkeybusinsessimages
Photo by iStockphoto© AlexRaths
OIG is particularly concerned
with the increased frequency of
medical records showing identical
documentation across services.
Auditing/Compliance: OIG Work Plan
photo by iStockphoto© monkeybusinsessimages
The focus is more likely to be on whether
“skilled” services were rendered (oneon-one contact) and necessary, given
the patient’s condition.
Compliance Efforts Heat Up
The federal government has actively increased its crack down on perceived
areas of fraud, waste, and abuse. OIG reported using its exclusion authority
over 3,214 individuals or entities in 2013, precluding them from participation—either directly or indirectly—in federal healthcare programs. OIG
also reported filing 960 criminal actions and 472 civil actions. On the civil
side, these actions included false claims and unjust enrichment lawsuits,
as well as civil money penalties settlements and administrative recoveries
under the self-disclosure protocol. OIG estimates expected recoveries of over
$5.8 billion from these efforts.
Physical Therapists
OIG continues its analysis of services performed and reported
by independent therapists. OIG is anticipated to change their
analysis somewhat, in the wake of the Jimmo settlement, where
CMS acknowledged there is no “improvement standard” as a
necessary predicate to Medicare coverage. The focus is more
likely to be on whether “skilled” services were rendered (oneon-one contact) and necessary, given the patient’s condition.
Want to know more? For the Jimmo v. Sebelius Settlement
Agreement Fact Sheet, go to www.cms.gov/Medicare/Medicare-Fee-forService-Payment/SNFPPS/Downloads/Jimmo-FactSheet.pdf.
Medicare Program Management –
Provider Deactivation
To prevent fraudulent claims submissions, OIG continues to
review provider eligibility to identify and deactivate providers
who have not billed Medicare for more than one year, following federal regulatory provisions.
(http://oig.hhs.gov/reports-and-publications/archives/workplan/2014/WorkPlan-2014.pdf ) to ensure applicable risk areas are well understood.
For each applicable focus area, be certain to review appropriate CMS interpretive guidance and LCDs, as well as Medicare publications and other guidance. To ensure compliance
throughout your organization, incorporate this information
into your compliance plan.
Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, has a Bachelor of Science degree from the United States Military Academy and a juris doctorate degree
from Concord Law School, is the president of Practice Masters, Inc., and the founding partner of Miscoe Health Law, LLC. He is a past (2007-2009) and current (20132015) member of the AAPC National Advisory Board, is an AAPC Legal Advisory
Board member, and is the chair of the AAPC Ethics Committee. Mr. Miscoe is admitted to the practice of law in California and to the bar of the U.S. Supreme Court and the U.S. District
Courts in the Southern District of California and the Western District of Pennsylvania. He has over 20
years of experience in healthcare coding and over 16 years as a compliance expert, forensic coding expert, and consultant. Miscoe is a member of the Johnstown, Pa., local chapter and serves as president.
Take Heed
These areas provide a relevant summary of the new and ongoing OIG efforts that are likely to be most applicable to
outpatient providers. The OIG Work Plan for 2014 also
targets various hospital services, durable medical supplies,
and prescription drug benefits for both Medicare and Medicaid. You are encouraged to review the entire work plan
www.aapc.com
May 2014
51
■ Practice Management
By Candice Ruffing, CPC, CPB, CENTC
CPT® Code Valuations
Matter for Your Bottom Line
RUC survey says reimbursement is based on
pre-service and post-service time components.
1935086
579
19285
96413 22851
I
t wasn’t until last year, after 15 years of working the business side of medicine, that I began to understand how the
value of a CPT® code was developed. Now that I know, I
can see the importance of this. I have found, however, that
not only are most coders unaware of this information, but
many physicians are unaware, as well.
The Secret Formula
Whether the code is an evaluation and management (E/M)
office visit, an outpatient endoscopy, or a complex inpatient
surgical procedure, the components of the final CPT® value are often determined through a Relative Value Scale Update Committee (RUC) survey. The formula to calculate
code values looks like this:
[(Work RVU x Budget Neutrality Adjustor
x Work GPCI) + (Practice Expense RVU
x Practice Expense GPCI) + (Malpractice
RVU x Malpractice GPCI)] = Geographically Adjusted RVU Total x Conversion Factor
= Allowable Amount
As you can see, the formula takes into account many factors, including geographic practice cost indices (GPCI) to
account for cost-of-practice differences among locations.
From the viewpoint of the individual provider billing CPT®
codes, however, perhaps the most significant factor is the
physician work value.
The time an eligible provider spends prior to, during, and
after a procedure (also known as pre-service, intra-service,
and post-service times) is used to determine the work rela52
Healthcare Business Monthly
photo by iStockphoto© studionobra
Work RVUs Include Pre-, Intra-,
and Post-service Components
Practice Management: RVUs
What most physicians do not realize is the RUC
has developed “time packages” for the pre- and
post-service time segments to maintain parity for
similar codes performed by different specialties.
Table 1: Detailed Description of Pre-Service Time Packages (minutes)
Facility
Non-Facility
1A
1B*
2A
2B*
3
4
5
6
Total Pre-Service Time Category Subtotals
20
25
25
39
51
63
7
23
A
Pre-Service Evaluation (IWPUT=0.0224)
13
19
18
33
33
40
7
17
B
Pre-Service Positioning (IWPUT=0.0224)
1
1
1
1
3
3
0
1
C
Pre-Service Scrub, Dress & Wait (IWPUT=0.0081)
6
5
6
5
15
20
0
5
DETAILS
A
History & Exam (Performance and review of appropriate Pre-Tests)
5
5
10
10
10
15
4
9
A
Prepare for Procedure (Check labs, plan, assess risks, review procedure)
2
2
2
2
2
4
1
1
A
Communicate with patient and/or family (discuss procedure/obtain consent)
3
3
3
5
5
5
2
3
A
Communicate with other professionals
0
1
0
3
5
5
0
2
A
Check/set up room, supplies and equipment
1
1
1
1
5
5
0
1
A
Check/prepare patient readiness (Gown, drape, prep, mark)
1
1
1
1
5
5
0
1
A
Prepare/review/confirm procedure
1
1
1
1
1
1
0
0
A
Administer moderate sedation/observe (wait) anesthesia care
0
5
0
10
0
0
0
0
B
Perform/supervise patient positioning
1
1
1
1
3
3
0
1
C
Administer local anesthesia
1
0
1
0
0
0
0
5
C
Observe (wait anesthesia care)
0
0
0
0
10
15
0
0
C
Dress and scrub for procedure
5
5
5
5
5
5
0
0
*Indicates packages that contain moderate sedation
1A
Straightforward Patient/Straightforward Procedure (No sedation/anesthesia care)
3
Straightforward Patient/Difficult Procedure
1B*
Straightforward Patient/Straightforward Procedure (With sedation/anesthesia care)
4
Difficult Patient/Difficult Procedure
2A
Difficult Patient/Straightforward Procedure (No sedation/anesthesia care)
5
Procedure without sedation/anesthesia care
2B*
Difficult Patient/Straightforward Procedure (With sedation/anesthesia care)
6
Procedure with sedation/anesthesia care
Additional Positioning Times for Spinal Surgical Procedures
Additional Positioning Times for Spinal Injection Procedures
SS1
Anterior Neck Surgery (Supine) (eg ACDF)
15 Minutes
SI1
Anterior Neck Injection (Supine) (eg Discogram)
7 Minutes
SS2
Posterior Neck Surgery (Prone) (eg Laminectomy)
25 Minutes
SI2
Posterior Neck Injection (Prone) (eg Facet)
5 Minutes
SI3
Posterior Thoracic/Lumbar
(Prone) (eg Epidural)
5 Minutes
SI4
Lateral Thoracic/Lumbar (Lateral)
(eg Discogram)
7 Minutes
SS3
Posterior Thoracic/Lumbar (Prone) (eg Laminectomy)
15 Minutes
SS4
Lateral Thoracic/Lumbar (Lateral) (eg Corpectomy)
25 Minutes
SS5
Anterior Lumbar (Supine) (eg ALIF)
15 Minutes
www.aapc.com
May 2014
53
Practice Management: RVUs
tive value unit (RVU). What
most physicians do not realize is the RUC has developed “time packages” for the pre- and
post-service time
segments to maintain parity for similar codes performed by different specialties. For
example, the time
spent dictating an
operative note or the
time spent scrubbing
hands prior to a sterile procedure is the same
for an otolaryngologist as
it is for neurosurgeon or cardiologist.
Pre-time packages include three categories:
• Pre-service evaluation
• Pre-service positioning
• Pre-service scrub, dress, and wait times
All of the pre-service categories have a designated maximum
time allowed, based on the procedure type, patient condition,
and site of service.
Pre-service time packages
range from 1a–6. Package 1a is assigned for a
procedure performed
on a straightforward
patient undergoing a
straightforward procedure (without sedation or anesthetic care).
In contrast, pre-service time package 4 is assigned for a difficult patient undergoing a difficult
procedure. See Table 1 (on
the preceding page) for details.
Post-service time packages likewise
maintain parity across specialties for
similar procedure types. The post-service
time packages, designated 7a–9b, vary based on the
type of anesthetic required and complexity of the procedure. Post-service package 7a is assigned for a simple procedure requiring local anesthesia. In contrast, post-service
time package 9b describes a complex procedure performed
under general anesthesia. Each post-service time package
Table 2
Total Post Service Time
7a
Local Simple
Procedure
Details:
Dressing
Repositioning/Transfer of patient
Operative Note
Recovery/Stabilization of patient
Communication with patient/family
Written postop order
54
Healthcare Business Monthly
7b
Local Complex
Procedure
8a
IV Sedation Simple
Procedure
8B
IV Sedation Complex
Procedure
9a
General Anesthesia
Simple Procedure
9b
General Anesthesia
Complex Procedure
photo by iStockphoto©tiler84
If, by contrast, the survey results came in
at 20 minutes for the S/D/W, the society
would have captured the allotted time
and would receive full value.
To discuss this
article or topic, go to
www.aapc.com
Practice Management: RVUs
… if the survey results indicate a post-service time
lower than the time included in the selected post-time
package, the society loses permissible time, leading to a
lower valuation and revenue loss.
includes a maximum time allowance based on time requireunteer to participate in RUC surveys for CPT® valuation to
ments for application of dressing, operative note dictation,
be familiar with the pre-service and post-service time comrepositioning of the patient, communication with the paponents. For more information on the components involved
tient and/or patient’s family, and post-operative orders/pain the CPT® code valuation process, visit www.ama-assn.org/
resources/doc/rbrvs/work-instructions.doc .
pers. See Table 2 (on the preceding page) for details.
When a specialty society submits the results of a survey to
Candice Ruffing, CPC, CPB, CENTC, is an associate consultant with Acevedo
the RUC for code valuation, the RUC experts select the apConsulting, Inc., in Delray Beach, Fla. Her work involves conducting coding and
propriate time package. The survey results are then comcompliance audit projects; providing consulting services to clients’ managepared with the selected time package. The society must subment, physicians, and staff; and providing input for the development of each client’s annual audit plan. Ruffing has over 15 years combined experience in coding
mit the lesser time allotted for final code valuation. For exand billing for multi-specialty physicians. She has served as president and secreample, if the survey results designate a scrub, dress, wait
tary of the Stuart, Fla., local chapter and serves on the 2014-15 AAPC Chapter As(S/D/W) time of 10 minutes for a complex procedure on a
sociation board, representing Region 4.
complex patient, which would otherwise fit into a pre-ser-ad1.pdf 1 1/8/2014 2:10:26 PM
viced time package of 4 with an S/D/W of 20 minutes, the
specialty society is giving up 10 minutes of preservice time. This represents a loss of the work
RVU—and a loss of reimbursement—because
the survey results were less than the package allowance.
If, by contrast, the survey results came in at 20
minutes for the S/D/W, the society would have
captured the allotted time and would receive
full value. Likewise, if the survey results indicate a post-service time lower than the time included in the selected post-time package, the
society loses permissible time, leading to a lowHealth Care Fraud & Abuse Concepts / Health Care Fraud Prevention & Enforcement /
Medical Records / Medical Coding Policies & Guidelines / Chart Auditing Principles
er valuation and revenue loss.
Chart Auditing Practice Exercises / Module Quizzes / End of Course Final Exam
The pre-service period includes all physician
services provided to the patient from the day
Visit our site for access to free medical audit practice quizzes.
prior to the operative procedure until the actual procedure is performed. The intra-service
period includes all “skin to skin” work. The
post-service period includes all physician services provided on the day of the procedure as
soon as the procedure is completed. These values are important because they determine the
rate at which Medicare and other payers reimburse for procedures.
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www.physicianauditconsultants.com
www.aapc.com
May 2014
55
■ Practice Management
By Ken Bradley
photo by iStockphoto © pojoslaw
Revenue Benchmarks Improve
Finances During the Big Move
Monitor financial performance
and mitigate risks associated
with the pre- and post-transition
to ICD-10.
Now is the time for physician practices to get revenue cycles in order—not six months before ICD-10 implementation. If the transition is anything like the adoption of 5010 transaction standards and
national provider identifiers, ICD-10 will lead to more frequent denials and reduced productivity, especially during the initial stages
of implementation. According to projections from the Centers for
Medicare & Medicaid Services (CMS), denials could increase anywhere from 100-200 percent, and days in accounts receivable (A/R)
could grow by as much as 20-40 percent.
56
Healthcare Business Monthly
Source: “Readying Your Denials Management Strategy for ICD-10,” (www.mahealthdata.org/
Resources/Documents/ICD-10%20Resources/Optum-ReadyingYourDenialsManagement
StrategyICD-10.pdf )
By taking a proactive approach and establishing revenue cycle
benchmarks to monitor financial performance pre- and post-transition, your practice can mitigate the risks associated with moving
to ICD-10. These steps not only help providers adequately prepare
for the new code set, but also allow them to identify strategies for
achieving optimal financial health long after the implementation
deadline has passed.
Consider the Past to Secure the Future
Before your practice has to deal with the complexity of ICD-10, identify any potential pitfalls that need to be addressed. By targeting operational inefficiencies now, your practice can eliminate a lot of ex-
To discuss this
article or topic, go to
www.aapc.com
Practice Management: Revenue Benchmarks
By targeting operational inefficiencies now,
your practice can eliminate a lot of extra
work and lost revenue down the road.
tra work and prevent lost revenue down the road. There’s also no better time to automate and streamline manual processes related to eligibility, secondary claims, denials, and appeals.
Also consider conducting a historical review of your revenue cycles. Understanding what a typical September, October, or November looked like in previous years will help you know what to expect
when the transition date arrives. For example, a pediatric group may
discover they have more volume in autumn months, as children
head back to school and catch colds or the flu. This means a practice might experience higher patient volume during the implementation time frame.
Whatever your situation, ICD-10 will likely create some disruptions.
Correcting inefficiencies and having historical insight, however, will
allow your practice to circumvent these obstacles and keep its revenue cycles on track.
Establish Benchmarks
As your practice tightens up the cycle processes, you would do well to
establish benchmarks. Because ICD-10 affects every area of a medical practice, there are several benchmark categories that require
monitoring. These include:
• A/R: Some of the most important metrics you can measure
are A/R days by payer and A/R days over 120 days. These
indicators allow your practice to determine if claims are being
paid in a timely manner.
• Operational: Closely watch metrics for operations such
as denial and rejection counts by category (e.g., prior
authorization or medical necessity). Additional indicators,
including first-pass rate, number of pending claims, workers’
compensation claims, and third-party rejections, should also
be monitored and measured regularly.
• Clinical documentation: To uncover any potential issues
related to clinical documentation, monitor the number of
physician queries, query response time, and coder accuracy,
which can be measured as necessary re-coding.
• Productivity: Track both coder and physician productivity.
Office visits are a key indicator to watch for if your practice
works under fee-for-service payment models. If your practice
is making the transition to value-based care, you may also
need to follow quality metrics as an additional indicator to
measure success.
Measure performance
After your practice decides which benchmarks to monitor, evaluate
current performance to determine how frequently you need to measure metrics going forward. Many clearinghouses incorporate tools
into their systems that can help your practice gauge its performance
relative to industry standards.
If your organization operates below best practice averages, implement any necessary improvements and measure as often as possible
until you reach the target. If you’re already operating at the desired
levels, monitor and measure less frequently, but all metrics should be
benchmarked at least monthly.
Immediately following the ICD-10 compliance date, consider
checking benchmarks more often to ensure all installed changes are
working as planned and that all external entities—including payers—are performing as expected. You should be able to predict how
quickly your practice’s revenue cycle will recover by benchmarking
A/R, rejection, and denial numbers, and by tracking productivity for
clinical and coding staff.
Even with best preparation, however, external factors such as vendors
and payers will play a major role in determining how quickly your
revenue cycle will return to normal.
Strengthen Your Bottom Line
Your practice can’t prepare for the future unless you know what
you’re facing. Revenue cycle benchmarks enable providers to understand where their revenue is today, so they can recognize how
it’s changing and plan for the future. With the right combination of
metrics, you can establish a framework for measuring revenue cycle
performance to enhance revenue cycle efficiencies, avoid cash flow
disruptions, and optimize your practice’s livelihood.
Ken Bradley is vice president of strategic planning and regulatory compliance at Navicure, a
clearinghouse and revenue cycle solutions provider.
www.aapc.com
May 2014
57
■ Practice Management
By Tim McCormack, JD, and Mary Inman, JD
EHRs:
Computer Functions
Facilitate Fraud
image by iStockphoto © maxkabakov
Shed light on the dark side of
electronic health records (EHRs)
to safeguard your practice.
O
rganizations around the country—from government entities to
private insurers—have been touting electronic health records
(EHRs) as a way to increase efficiency, improve patient care,
and reduce costs in the medical field. But new reports are shedding
light on a dark side of EHRs. For the third time in just over a year,
the U.S. Department of Health & Human Services (HHS) warned
that the improper use of EHRs may lead to increased incidence of
Medicare fraud.
EHRs have many benefits: Smoother information sharing, more
legible records, and more accurate drug interactions, to name just
a few. For those reasons, the U.S. government encouraged hospitals and providers around the country to transition to EHRs, offering billions of dollars in incentive payments. Many organizations
took advantage of the inducement, hurriedly instituting their own
EHR systems.
But rapid and widespread EHR adoption has led to extensive problems. In September 2012, the U.S. attorney general and the secretary of HHS sent a letter warning hospitals against cloning medical
records, which could lead to upcoding claims and improperly inflating reimbursement. In July 2013, reports emerged that HHS is conducting audits targeting EHR-related overbilling. Most recently, on
January 14, 2014, the HHS Office of Inspector General issued a report flagging EHR-related fraud as a problem.
To keep your practice from waving red flags, be sure your staff is
aware of the ways EHRs can prompt erroneous billing.
58
Healthcare Business Monthly
Electronic “Shortcuts” to Upcoding
EHR fraud often involves the use of common computer practices originally designed to streamline record keeping, such as copying and pasting text from other medical records and using macros,
menus of pre-selected options, and default settings.
Copy and Paste: The Copy and Paste commands—common in
many computer programs—create serious fraud risk in EHRs. For
example, doctors are paid more for office visits (using evaluation and
management (E/M) codes) if they perform a more extensive examination, take a more detailed history, etc. An unscrupulous physician
may copy and paste notes from prior visits into the current medical
note to make it appear as though he or she performed a more intensive service.
Similarly, in the Medicare managed care context, health plans and
physicians are paid more through the risk adjustment system if a patient is treated for certain (often expensive) conditions. To improperly take advantage of this system, providers or health plans may copy
treatment notes, patient histories, or other information from prior patient visits to appear as though the patient received treatment
in the current year. Doing so fraudulently increases Medicare payments.
Macros, Menus, and Default Settings: EHRs often have functions
that allow the user to insert standardized text into the medical note.
For example, macros allow the user to either copy and paste certain
text from another location in the chart to the current note or auto-
To discuss this
article or topic, go to
www.aapc.com
Practice Management: EHRs & Fraud
In July 2013, reports emerged that HHS is conducting
audits targeting EHR-related overbilling.
matically insert a pre-determined script into the note. Menus allow
EHR users to insert text from a pre-selected list of options. Similarly, other EHR default functions may automatically enter text that
affects billing, although that text may not be accurate for the patient. Such functions create a substantial risk for a physician or other EHR user to unwittingly “write” misinformation in a patient’s
medical record.
For example, a physician may use a macro to copy the patient’s problem list into the current treatment note, simply for ease of reference.
Often, however, such macros copy the problem list into the note in
a way that makes it appear as though the physician has reviewed or
otherwise treated every condition on the list. Such improper over-notation could result in a physician or Medicare managed care plan improperly claiming enhanced risk adjustment payments from Medicare.
Menus, another feature in EHRs designed for easier use, may limit
the available options for diagnosis or procedure codes. For instance,
a menu may only list codes that lead to the highest payment rates,
which improperly leads physicians to upcode their visits. Healthcare
providers and coders also need to exercise care when using the default
settings of an EHR. Those settings could, for example, automatically insert certain text into a note whenever a new note is opened or another action is taken. The user may be unaware of the default text;
and the default text may be inaccurate.
Difficult to Detect Fraud
Fraudulent acts such as these are difficult to catch. Often the documentation looks foolproof; copying is hard to spot and to prove.
This is especially true if the physician or hospital using the EHR has
turned off the “audit logs” (electronic trails showing when documentation was edited) in the software.
Finding this type of fraud often takes a trained eye. For example:
• A medical coder may see boilerplate notes, where a doctor uses
the same language to document 45-minute comprehensive
exams with one patient at every visit, or with many different
patients.
• A physician may notice that when she types a simple
condition into a patient’s chart, the medical record
automatically adds text or makes changes so the diagnosis
appears more complicated or the service more intensive.
• A nurse may notice that when he tries to enter the proper
diagnosis or procedure into the medical record, the system
will not allow him to enter lower-valued codes without taking
extra, often more burdensome, steps.
To prevent your EHR from exposing you to fraud, some possible
steps include:
• If you use an automated text function, such as a macro, go
back and check what text was actually typed into the chart.
Make sure the records show what was meant to say, and that
extra, unwarranted words weren’t added.
• When you use a menu to select a diagnosis, procedure, or
other piece of information, make sure the EHR allows you to
pick the code you want. If it has an incomplete set of options,
talk to someone in your information technology department
about adding the other, missing codes.
• If your EHR has an “audit log” function, make sure it’s on. An
audit log allows you to see who entered what information into
the medical chart, who changed information, and when it
was done. This information is invaluable in determining what
should be in the chart, and in understanding why and how
errors were made.
Prevent Fraud, or Risk Larger Penalties
Employees should be able to report their concerns about upcoding
and other problems with EHRs internally to the compliance department, or by following other internal reporting guidelines. This can
help your practice resolve compliance issues before government action is required.
If you find the organization is non-responsive to employee complaints, you still have options to stop the fraud. The federal False
Claims Act empowers anyone who knows about fraud against the
government to take action. With the help of a lawyer, a whistleblower can file a lawsuit on behalf of the United States against the company filing false claims. The whistleblower is then eligible to receive
a reward, which would be 15 to 30 percent of any money the government recovers.
The government and the public are relying on those inside the medical industry to take a stand against EHR abuse. It’s up to healthcare
professionals to cooperate with colleagues in finance, management,
and treatment to ensure EHRs are used in an effective and compliant
manner. Meeting the promise of EHRs depends on it.
Mary A. Inman, JD, and Timothy P. McCormack, JD, are partners at Phillips & Cohen LLP, an experienced law firm representing whistleblowers (www.
phillipsandcohen.com). Whistleblower cases brought by the firm involve
Medicare and Medicaid fraud, as well as other types of fraud against the government. Phillips & Cohen cases have returned more than $11 billion in civil settlements and related criminal fines to federal, state, and local governments.
www.aapc.com
May 2014
59
■ Coder’s Voice
By Sylvia Partridge, CPC, CGSC
Invest in Yourself to Advance Your Career
Gain the experience you need to get ahead through
credentialing, mentoring, and networking.
It would be beneficial to have another credential; however, you hear a voice in your
head asking, “Why should my employer
benefit, while I foot the bill?” This point of
view will hold you back from reaching your
full potential. To avoid this defeatist attitude, try thinking more positively: “Anything I spend on education or additional
professional development and credentialing is an investment in me.”
You’ve already accomplished a huge undertaking, earning your Certified Professional Coder (CPC®) credential. Now, it’s
time to challenge yourself further and become all you can be. Strategize and map out
a plan for how you can develop yourself professionally and, ultimately, achieve you career goals.
Consider Your Options
AAPC offers a smorgasbord of specialty credentials that enable you to gain and demonstrate advanced coding knowledge in a particular area of healthcare business:
• Certified Ambulatory Surgical Center Coder – CASCC™
• Certified Anesthesia and Pain Management Coder –
CANPC™
• Certified Cardiology Coder – CCC™
• Certified Cardiovascular and Thoracic Surgery Coder –
CCVTC™
• Certified Chiropractic Coder – CCPC™
• Certified Dermatology Coder – CPCD™
• Certified Emergency Department Coder - CEDC™
• Certified Evaluation and Management Coder – CEMC™
• Certified Family Practice Coder – CFPC™
• Gastroenterology – CGIC™
• Certified General Surgery Coder – CGSC™
• Certified Hematology and Oncology Coder – CHONC™
• Certified Internal Medicine Coder – CIMC™
• Certified Interventional Radiology and Cardiovascular
Coder – CIRCC®
• Certified Obstetrics Gynecology Coder – COBGC™
• Certified Orthopaedic Surgery Coder – COSC™
• Certified Otolaryngology Coder – CENTC™
• Certified Pediatrics Coder – CPEDC™
• Certified Plastics and Reconstructive Surgery Coder –
CPRC™
• Certified Rheumatology Coder – CRHC™
• Certified Surgical Foot & Ankle Coder – CSFAC™
• Certified Urology Coder – CUC™
• Certified Professional Biller – CPB™
• Certified Professional Coder-Hospital Outpatient – CPC-H®
• Certified Professional Coder-Payer – CPC-P®
• Certified Professional Medical Auditor – CPMA®
• Certified Professional Compliance Officer – CPCO™
• Certified Physician Practice Manager – CPPM®
60
Healthcare Business Monthly
With all of these specialized credentials
available, it’s easy to energize your career.
The obvious first step is to obtain the specialty credential you currently work in.
Then, branch out to other areas of practical specialization such as auditing, billing,
compliance, or practice management.
Get Connected
If you are new to coding and want to expand
your professional knowledge in a specialty
area, consider finding a mentor in that specialty to guide you. While you still have to
do the work, a mentor can make career progression much easier.
Networking is another great way to learn
and find new opportunities in a specialized
area. Conferences, chapter meetings, and
any other similar gathering are perfect arenas for networking. Seek out people with
experience in the occupation you want. Ask
them how they got where they are in their
careers, and get advice on what you could
do to make your progression easier. As you
build your knowledge, expertise, credibility, and contacts, opportunities will follow.
Take Responsibility for Your Career
Should you leave it to your employer to decide what education you will receive and
how your career will progress? Or should
you invest in yourself and take control of
your own career? From my perspective, investing in you is the obvious answer. If you
agree, don’t waste time. Map out a career
plan for obtaining the experience, education, and specialty credentials you’ll need
to reach your destination. It’s time to begin
your journey of learning and advancement.
For descriptions of credentials AAPC offers
and information on how to obtain your next
credential, go to the AAPC website (www.
aapc.com).
Sylvia Partridge, CPC, CGSC, CPCI, has over 42
years of experience in the medical field. She works for
Athens Regional Specialty Services, a hospital owned
physicians group. She is a three-time past-president
of the Athens, Ga., local chapter, and is education officer. Partridge is a member of the AAPC National Advisory Board.
Kareo Gives You
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scheduling, claims and reporting, and get paid
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software. Connect your clinical side with our
free EHR. And, experience the difference of
having your own customer success coach working
with you to make your practice a best practice!
See for yourself at kareo.com.
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© Copyright 2013 Kareo, Inc.
All rights reserved.
NEWLY CREDENTIALED MEMBERS
Abbey Rollins-Buscay, CPC
Adrienne Coons, CPC
Adrienne L Woods, CPC, CPC-H
Agatha A Prokscha, CPC
Alana Harris, CPC, CPC-H
Alicia Jackson, CPC
Alicia L Donald, CPC
Allison Nissley, CPC
Amanda Brodsky, CPC
Amanda Taylor, CPC
Amber Palladino, CPC
Amy Faulkner, CPC
Anapa Nophlin, CPC
Angela Crouch, CPC
Angela Miller, CPC
Angela Wilcox, CPC
Angeline Baja, CPC
Angie Welbern, CPC-H
Ann Marie Torres-Rodriguez, CPC
Anna Bunting, CPC
Anne Morrow, CPC
Anne Rozsa, CPC
Annette R Aley, CPC
Antoinette Bruce, CPC
Apral Denise Vogel, CPC
April Muhlhauser, CPC, CPC-H
Arnaldo Hernandez, CPC
Articia Hughes, CPC
Ashley Alexandra Tohill, CPC, CPC-H
Ashley Nicole Neville, CPC
Aswani Nair, CPC
Audrey Crooms, CPC
Barbara Earles, CPC
Barbara Lundberg, CPC
Barbara Worley, CPC
Beth McCray, CPC
Beverly Plummer, CPC
Bonnie Moeller, CPC
Brenda Jane Shook, CPC
Brenda Smith, CPC
Brian Johnsen, CPC
Carlie Biesinger, CPC, CPC-H
Carol Lee Robinson, CPC
Caryn Lynn Caballero, CPC
Catherine C Hamilton-Thomas, CPC-H
Catherine Hawkins-Hare, CPC
Cecilia Phillips, CPC-H
Chanell Johnson, CPC
Chasity Greco, CPC
Cherita Starke, CPC, CPC-H
Cheryl Bishop, CPC, CPC-H
Cheryl Gregory, CPC
Christina Akers, CPC
Christina Thomas, CPC
Christine Perry, CPC
Christy Klarman, CPC
Chrystal Gilbert, CPC
Corina Gonzalez, CPC
Crystal Jarvis, CPC
Dallas Barron Peeples, CPC
Dana Inmon, CPC
Dana Lambert, CPC
Dana Marie O’Brien, CPC
Danette Muntz, CPC, CPC-H
Danielle Lanagan, CPC
Darlene Barr, CPC
Darlene Gonzalez, CPC
David Perlman, CPC
Dawn A Christianson, CPC, CPC-H
DeAnn Frye, CPC
Deborah J Lennon, CPC
Deborah Wright-Lapora, CPC
62
Demetryus R Becton, CPC
Denise Craig, CPC
Denise Raquel Baptiste, CPC
Derek Dudley, CPC
Diana Eileen Cuellar, CPC
Diane M. Jensen, CPC
Dinecqua Kornegay, CPC
Diondra Osterberg, CPC
Dominika Sadej, CPC
Donna Lynn Lorenzen, CPC
Donna M DeJoseph, CPC
Drieca D. Hopkins, CPC
E Jean Toms, CPC-H
Ebony Wright-Noel, CPC
Edith Pierre, CPC
Eileen Herron, CPC
Elaina Gonatas, CPC, CPC-H, CPMA,
CGSC
Elizabeth Miranda, CPC
Elizabeth Renee Manning, CPC
Ella Mae Whiteside, CPC
Emily S Hente, CPC
Erica McDougall, CPC
Erika Johnson, CPC
Esmeralda Garcia, CPC
Esperanza Sardina, CPC
Gail A Boothe, CPC
Ginger Fine, CPC
Glenda Jones, CPC
Gloria E. Valentino, CPC
Gloria Michele Price, CPC
Grace Davis, CPC
Gracielle Perkins, CPC
Hanna Fleeman, CPC
Heather Centers, CPC-H
Heather Haider, CPC
Heather Petrone, CPC, CPC-H
Howard Floch, CPC
Irma Edie LaBoyne, CPC
Isela Nunez, CPC
Ivonne I Jacomino, CPC
Jacqueline Brouwer, CPC
Jacqueline Soto, CPC
Jacquelyn Fryers, CPC
Jami Allen, CPC
Jami Randall, CPC
Jamie Hatfield, CPC
Janessa Casares, CPC
Janette Chapman, CPC
Janice Chapple, CPC
Jaquelyne Castillo, CPC
Jeaninne Hosni, CPC-H
Jenifer Alexander, CPC
Jennifer D Stevens, CPC, CPC-H
Jennifer Lee Speight, CPC
Jennifer Libra, CPC
Jennifer Pugh, CPC
Jennifer Susan Peloquin, CPC
Jill Hahn, CPC
Jill Zimmerman, CPC
Jodi Spillar, CPC
Jody Cason, CPC
Jody Hite, CPC
Johanna Ivette Colon Graciani, CPC
Joni Beth Canterberry, CPC
Joyce Schuiteman, CPC
Judith Karle, CPC
Judith R Yessick, CPC
Julie E Krall, CPC
Kandace Morris, CCS-P, CPC, CEMC
Karen Hulka, CPC
Karen R Thrift, CPC
Healthcare Business Monthly
Karen Smith, CPC
Kari Lynn Peet, CPC
Katherine Anne Champa, CPC
Katherine Thomas, CPC, CPC-H
Kathey Coonce, CPC
Kathy Gibson, CPC-H
Katie Eversole, CPC
Kendra Roman, CPC
Kevin Sien, CPC, CPC-H
Kim D Hickman, CPC
Kimberly Rosas, CPC-H
Kimberly Gnazzo, CPC
Kristie Danley, CPC
Kristin Bearden, CPC
Kristina Clark, CPC
Kristina Pishock, CPC-H
Krithika Ammaiyappan, CPC
Krystin Keller, CPC
Lacey Lindquist, CPC
Lacy Koch, CPC
Lacy Sheffield, CPC
Latoria Shinay White, CPC
LaTrelle White, CPC
Laura A Zelenyak, CPC
Lauri Ross, CPC
Laurie Howard, CPC, CPC-H
Lawrence Adams, CPC
Leah Peltier, CPC-H
Leslie Cabrera, CPC
Leslie Stovall, CPC
Leticia E Vargas, CPC
Lindsay Adams Creech, CPC
Lisa Carlson, CPC
Lisa Mancini, CPC
Lora L Kittles, CPC
Lori Russell, CPC
Louise Wise, CPC
Lucretia Nicole Chandler, CPC
Lynette Rogers, CPC
Lynn Harlin, CPC
Mala Sharma, CPC, CPC-H
Malica Martin, CPC
Marcelle Norgan, CPC
Maria Panagiotakis, CPC, CPC-H
Maria Theresa I Guansing, CPC, CPC-H
Marilyn Hadley, CPC, CPC-H
Marjorie Perez, CPC
Marlisa Dwyer, CPC
Mary Ann Sullivan, CPC
Mary Carol Anderson, CPC
Mary F Goff, CPC-H
Mary Hayes, CPC
Mary M Flores, CPC
Mary Poliac, CPC
Mary Skafidas, CPC
Mary Walker Carr, CPC
Maryann Lutz, CPC-P
Maureen Halner, CPC
Mayelin Sanchez, CPC
Mayre Benavente, CPC
Mayuri Kokkula, CPC, CPC-H
Megan Atchison, CPC
Melanie Johnson, CPC, CPC-H
Melissa Brown, CPC
Melissa Hutto, CPC, CPC-H
Melissa Martin, CPC
Melissa Mitchell, CPC
Melissa P Gerrald, CPC
Melissa Sheldon, CPC
Melodi Harrison, CPC-H
Melvia Richard, CPC
Michael Warner, CPC
Michele Wood, CPC
Michelle Marie Mena, CPC
Michelle Smith, CPC
Michelle Wallace, CPC
Naira Margaryan, CPC
Nancy Bell, CPC
Nancy Harty, CPC
Nancy Mash, CPC
Natasha Moore, CPC
Nicole Auclair, CPC
Nicole Dreier, CPC
Nicole Schlieman, CPC
Pamela Edwards, CPC
Patricia Yvonne Gobrecht, CPC
Paula Stanley, CPC
Paulette D Simmons, CPC
Penny B Rutledge, CPC
Pheona Sahadeo, CPC
Porchia Johnson, CPC
Portia Monique Brown, CPC, CPC-H
Preeja Supalithan, CPC
Priscilla Aymong, CPC
Rachel Lake, CPC
Raquel Manzano, CPC
Rayshawn Sheila Clay, CPC
Reanie Greer, CPC, CPC-H, CEDC
Rebecca Ledvina, CPC
Rebekah Ray, CPC, CPC-H
Renee Diehlman, CPC
Reneih Aziz, CPC
Rita McCormack, CPC
Robin Stevens, CPC
Rochelle Burlingame, CPC
Rosalynn Fazio, CPC
Roxanne M Romine, CPC
Ruth Mooney, CPC
Sally Budesa, CPC
Sally J Kulig, CPC
Sandra G Price, CPC
Sara Scott, CPC
Sarah Chainay, CPC
Sarfaraz Ahmed, CPC
Sean Doyle, CPC
Serena Funai, CPC
Sharon Cattell, CPC
Sharon Coe, CPC
Sharon M Brennan, CPC
Shelia Lefler Phillips, CPC
Shelly Fred, CPC
Sherry Roberts, CPC
Shikira Coley, CPC
Shunedra Allen, CPC
Stacey Bailey, CPC, CEMC, CFPC
Staci Mowrer, CPC
Stacie Leigh Sawyer, CPC, CPC-H
Steven Daghfal, CPC
Sudha Madhuri Seelam, CPC
Susan Bowman, CPC
Susan Fraser, CPC-H
Susan Goldstein, CPC
Susan Walton, CPC
Sylvia Majcher, CPC
Symantha Johnson, CPC
Tamala Anthony, CPC
Tameka R Harper, CPC, CPC-H
Tamie Parker, CPC
Tammy Denise Warren, CPC
Tammy Switzer, CPC
Tara McMillan, CPC
Tarin Johnston, CPC
Tawney L Yonkers, CPC
Taylor Spencer, CPC
Teresa O’Brien, CPC
Teresa Wilson, CPC, CHONC
Teresa Wright, CPC
Terri A DeSimone, CPC
Tharuja Raju, CPC
Tina Clingenpeel, CPC
Tina Nichols, CPC, CPC-H, CPMA
Tracee Stock Hagerstrom, CPC, CPPM
Tracy Leet, CPC
Vanessa Marisol Alvarez, CPC
Veronica Flores, CPC
Veronica Sanchez, CPC
Vicki Lynn Kopacz, CPC
Vickie Owney, CPC
Vickie Smith, CPC
Wendi Johnson, CPC
Wendy Liszewski, CPC, CANPC
Wendy Nickelson, CPC, CPC-H
Wendy Stephens, CPC
Yaneiry Lora, CPC
Yesenia Torres, CPC
Apprentice
Abbie D Baker, CPC-A
Abby K Ronco, CPC-A
Adele M Santoianni, CPC-A
Adina Heller, CPC-A
Adria JoAnn White, CPC-A
Adrian Amooie, CPC-A
Aindrila Das, CPC-H-A
Akuete Akwei, CPC-A
Alaina Rubel, CPC-A
Alexandra Dos Santos, CPC-A
Alisha Duncan, CPC-A
Alissa Strick, CPC-A
Allia Abanto, CPC-A
Alonso F Bueno, CPC-A
Alyssa Antoinette Lima, CPC-A
Alyssa Oehler, CPC-A
Amanda Encinas, CPC-A
Amanda Ericson, CPC-A
Amanda Fisher, CPC-A
Amanda Huntley, CPC-H-A
Amanda Irwin, CPC-A
Amanda Irwin, CPC-A
Amanda McLaughlin, CPC-A
Amanda Olvera, CPC-A
Amanda Oswald, CPC-A
Amanda Rice, CPC-A
Amber Halle, CPC-A
Amber McNaught, CPC-A
Ambrianna Shante Hull, CPC-A
Amelia Toussaint, CPC-A
Amy Bloom, CPC-A
Amy Graham, CPC-A
Amy Mertz, CPC-A
Amy O’Brien, CPC-A
Amy Olson, CPC-A
Amy Rizza, CPC-A
Amy Smith, CPC-A
Ana Shahbazian, CPC-A
Andrea Boling, CPC-A
Andrea Stockert, CPC-A
Angela Jauregui, CPC-A
Angela Kinnard, CPC-A
Angela L Goode, CPC-A
Angela Long, CPC-A
Angela M. Esposito, CPC-A
Angela Marie Darfus, CPC-A
NEWLY CREDENTIALED MEMBERS
Anita Lee Sloan-Garcia, CPC-H-A
Anna Ejercito, CPC-A
Anna Marie Melven, CPC-A
Anna Thayer, CPC-A
Anne Cejka, CPC-A
Anne Hunt, CPC-A
Annetta Borntrager Good, CPC-A
Annette Taylor, CPC-A
Annette Watkins, CPC-A
Anthony Corbi, CPC-A
Anu Aljo, CPC-A
Araceli Zambrano, CPC-A
Armida D Rafeld, CPC-A
Asarudeen Abibullah, CPC-A
Ashley Slaby, CPC-A
Ashley A Titus, CPC-A
Ashley Brickle, CPC-A
Ashley Helzer, CPC-A
Ashley Krall, CPC-A
Ashley Nicole Knapp, CPC-A
Ashok Ganganaguntla, CPC-H-A
B Michelle Ramirez, CPC-A
Barbara Gonzalez-Baez, CPC-A
Becky Altmann, CPC-A
Benjamin Jewett, CPC-H-A
Berisia Daniel, CPC-A
Bethany Kline, CPC-A
Beverly Baento Bernardino, CPC-A
Beverly Crowley, CPC-A
Bharathiraja Mani, CPC-A
Bhavani Palraj, CPC-A
Biju Kazhuthammalayil John, CPC-A
Blakelee Elyse Messenger, CPC-A
Bonnie Bronson, CPC-H-A
Brace Tyler, CPC-A
Brandi Anderson, CPC-A
Brandi Miller, CPC-A
Brandi Orent, CPC-A
Brandon Grant, CPC-A
Brenda Erlinger, CPC-A
Brenda Garrison, CPC-A
Brenda Maravilla, CPC-A
Brian Pettway, CPC-A
Brian Cornish, CPC-A
Brian Davis, CPC-A
Briana Gonzalez, CPC-A
Brianna Cooper, CPC-A
Bridget Desautel, CPC-A
Brittany Stone, CPC-A
Brooke Bouwhuis, CPC-A
Caitlyn M Callaghan, CPC-A
Camille Dawn Teodoro Cruz, CPC-A
Candice Zello, CPC-A
Candy Palmer, CPC-A
Candyce Penman, CPC-A
Carlos Rosado, CPC-A
Carmen Cruz, CPC-A
Carol Albios, CPC-A
Carol Jeanine Self, CPC-A
Carol L Ruhl, CPC-A
Carol Louise Ivy, CPC-A
Carol Roth, CPC-A
Caroline Ann Piotrowski, CPC-A
Carolyn Amboy-Leggett, CPC-A
Carrie D. Yearman, CPC-A
Carrie Valdez, CPC-A
Casey Jablonski, CPC-A
Cassandra Renee Bosch, CPC-A
Catherine D. Clark, CPC-A
Cecilia Gallalgher, CPC-A
Cecilia Williams, CPC-A
Chalit Vasnarungruengkul, CPC-A
Chance Mcdaniel, CPC-A
Chanelle Loudermilk, CPC-A
Charlee Barlow, CPC-A
Charlene Sliger, CPC-A
Charlotta Waggoner, CPC-A
Chelsea Matejsek, CPC-A
Chelsea Rae Miller, CPC-A
Chennelle Williams, CPC-A
Cherita Watkins, CPC-A
Chinchumol Sasi, CPC-A
Chris Dwyer, CPC-A
Christa Marie Procida, CPC-A
Christina Casey Skarupa, CPC-A
Christina Sullivan, CPC-A
Christine M Barbagallo, CPC-A
Christine McBride, CPC-H-A
Christine Miller, CPC-A
Cindy Croom, CPC-H-A
Cindy Prince, CPC-A
Clarke Cheaney, CPC-A
Claudia Perez, CPC-A
Connie Hatfield, CPC-A, CPC-H-A
Courtney Shuster, CPC-A
Crystal L Martin, CPC-A
Crystalynn T Bullard, CPC-A
Curtis Baker Ankeny, CPC-A
Cyndi Clark, CPC-A
Dadrianne L Brown, CPC-A
Dale Sill, CPC-A
Damian Vega-Torres, CPC-A
Dana Flippin, CPC-A
Dana Stokes Paveglio, CPC-A
Danel Purvis, CPC-A
DaNette Shoma, CPC-A
Daniel Laure, CPC-H-A
Danielle Hammond, CPC-A
Danielle Marie Young, CPC-A
Danielle McLean, CPC-A
Darla JS Wallace, CPC-A, CPC-H-A
David B Drenga, CPC-A
David Krsnak, CPC-A
David Orr, CPC-A
David Tozser, CPC-A
Dawn Blais, CPC-H-A
Dawn Kinney, CPC-H-A
Dawn Luevano, CPC-A
Dawn Marie Parker, CPC-A
Dawn Rene Harrell, CPC-A, CPC-H-A
Dayne Tonge-Benjamin, CPC-A
Deana M Jochimsen, CPC-A
Deanna Barrie, CPC-A
Debbie Dawes, CPC-A
Debbie Egleston, CPC-A
Debora Bartholomew, CPC-A
Deborah Brown, CPC-A
Deborah Caruso, CPC-A
Deborah Curry, CPC-A
Deborah Dean, CPC-A
Debra Archer, CPC-A
Debra Jackson, CPC-A
Debra Rose, CPC-A
Debra Tilque, CPC-A
Deepti Mylavarapu, CPC-A
Deidra Keita, CPC-A
Dena Salem, CPC-A
Denis Fauni, CPC-A
Denise Ann Wuria, CPC-A
Denise J Goff, CPC-A
Desreen Nadeen Clarke Fader, CPC-A
Devon C Newman, CPC-A
Dhamotharan Veeraragavan, CPC-A
Diana Everson, CPC-A
Diana Incrosnatu, CPC-A
Diane Delaney, CPC-A
Diane Smith, CPC-A
Diane Williams, CPC-A
Dion Jones, CPC-A
Dionne Howard, CPC-A
DLes Jones, CPC-A
Donald Kucharski, CPC-H-A
Donald Strahan, CPC-A
Donna Gregory Burch, CPC-A
Donna Higley, CPC-A
Donna Robinson, CPC-A
Earnestine Sampson, CPC-A
Edward Sookikian, CPC-A
Eileen Nair, CPC-A
Elaine Loyd, CPC-A
Elijah Smalls, CPC-A
Elisabeth Thompson, CPC-H-A
Elizabeth Cowart, CPC-A
Elizabeth Hunt, CPC-A
Elizabeth J Marmon, CPC-A
Elizabeth Sharon Bilinsky, CPC-A
Ellen Boone, CPC-A
Elzbieta Dziedzic, CPC-A
Erica Everhart, CPC-A
Erica Marie Karaisz, CPC-A
Ericka Shulta, CPC-A
Erin Michelle Morongell, CPC-A
Erin Craft, CPC-A
Erin Holte, CPC-A
Erin Reilly, CPC-A
Erin Schnepf, CPC-A
Everett Bernier, CPC-A
Ezhilarasi James, CPC-A
Fatima Lara, CPC-A
Fazeelath Haneef, CPC-A
Ferdinand Nevado Bocala, CPC-A
Francyne Smith, CPC-A
Gabrielle Capobianchi, CPC-A
Gabrielle Grant, CPC-A
Ganesan Pannerselvam, CPC-A
Geneva Kimsey, CPC-A
Geoffrey James Guimapang, CPC-A
Geri Burt, CPC-A
Grace Hongying Xiong, CPC-A
Grace Lue-A-King, CPC-A
Greetha Pushpa, CPC-A
Guillermo Jimenez, CPC-A
Heather Brooks, CPC-A
Heather LaMontagne, CPC-A
Heather McCaffrey, CPC-A
Heather Rogers, CPC-A
Heather Valdez-Maki, CPC-A
Heidi Rae Elliott, CPC-A, CPC-H-A
Helisa Rivera, CPC-A
Hermann E Atencio, CPC-A
Holly Bowers, CPC-A
Irene Kain, CPC-A
Iris Elledge, CPC-A
Jacob Fowler, CPC-A
Jacob Villa, CPC-A
Jacqueline Burt, CPC-A
Jacqueline Simony, CPC-A
Jade Linford, CPC-A
Jaime Estrella, CPC-A
James Quarles, CPC-A
James Wingo, CPC-A
Jamie Scanlon, CPC-A
Jamie Dobnikar, CPC-A
Jamie Henline, CPC-A
Jamie Johnson, CPC-A
Jamie Williamson, CPC-A
Jamila Reynolds, CPC-A
JamunaRani Kaliaperumal, CPC-A
Jana Weir, CPC-A
Janarthanam Vijayarangan, CPC-A
Jane Currie, CPC-A
Jane De Leon, CPC-A
Jane Nurnberg, CPC-A
Janelle Ganoe, CPC-A
Janet Diaz, CPC-A
Janet Bousquet, CPC-A
Janet Nobel, CPC-A
Janet Stevens, CPC-A
Janice A Mohr, CPC-A
Janice Danahy, CPC-A
Janice Rendulic, CPC-A
Ja’Quita D Ebron, CPC-A
Jayalakshmi Chandran, CPC-A
Jayalakshmi PP, CPC-A
Jean Marie Bower, CPC-A
Jean Vallier, CPC-A, CPC-P-A
Jean-Marie Talvo, CPC-A
Jeanne Conlon, CPC-H-A
Jeanne M White, CPC-A
Jeanne Mitchell, CPC-A
Jenna Kirk, CPC-A
Jennifer Bardalamas, CPC-A
Jennifer Blake, CPC-A
Jennifer Brunk, CPC-A
Jennifer Chianca, CPC-A
Jennifer Fyock, CPC-A
Jennifer Gibson, CPC-A
Jennifer Gordano, CPC-A
Jennifer Howland, CPC-A
Jennifer Madden, CPC-A
Jennifer McCammon, CPC-A
Jennifer Olkkola, CPC-A
Jennifer Raybin, CPC-A
Jennifer Schultz, CPC-A
Jennifer Seidner, CPC-A
Jennifer Vista, CPC-A
Jenny Chang, CPC-A
Jenny Tupper, CPC-A
Jeremy Adam Perez, CPC-A
Jesse Cleveland, CPC-A
Jessica Alatorre, CPC-A
Jessica Bucher, CPC-A
Jessica Estepp, CPC-A
Jessica Limeberry, CPC-A
Jessica Loera, CPC-A
Jessica Lynn Collins, CPC-A
Jessica Maypa Ferrer, CPC-A
Jessica Metevier, CPC-A
Jessica Paquette, CPC-A
Jessica Renard Stelly, CPC-A
Jessica Riggs, CPC-A
Jessica Saucedo, CPC-A
Jessica Smith, CPC-A
Jeysonraj Rajesekaran, CPC-A
Jill Aiello, CPC-P-A
Jill D Daniels, CPC-A
Jill King, CPC-A
Joan Hafner, CPC-A
Jocelyn Gener Dizon, CPC-A
Joe Lewin, CPC-A
Joeann Scott, CPC-H-A
John Talbot Riddlebaugh, CPC-A
Jolene Hampton, CPC-A
Jonathan Green, CPC-A
Joni Crist, CPC-A
Joni Tyrrell, CPC-A
Joseph Baker, CPC-A
Joyce Vetter, CPC-A
Judith Moran, CPC-A
Judy Barycki, CPC-A
Judy Mitchell, CPC-A
Julia Frederick, CPC-A
Julia Von Braun, CPC-A
Julie Bailey, CPC-A
Julie Cunningham, CPC-A
Julie Gasser, CPC-A
Julie Mark, CPC-A
Julie Nacey, CPC-A
Julissa Raygoza, CPC-A
Justin Charles Koch, CPC-A
Kacy Ruppe, CPC-A
Kamar Johns, CPC-A
Kanchan Lata Prajapati, CPC-H-A
Kannika Parameswari Selvaraj, CPC-A
Kanyana Prathibha, CPC-A
Kara Addis, CPC-A
Karen Baldwin, CPC-A
Karen Czech, CPC-A
Karen E Leiphart, CPC-A
Karen J Oliphant, CPC-A
Karen Jo McIsaac, CPC-A
Karen Kathleen Kerkove, CPC-A
Karen Kline, CPC-H-A
Karen Tyson, CPC-A
Karina Hussey, CPC-A
Karley Gilbert, CPC-A
Karrye Lee, CPC-A
Karthika Prabhakaran, CPC-A
Kasi McKissick, CPC-A
Kate Sullivan, CPC-A
Katherine Godbey, CPC-H-A
Kathleen Dawson, CPC-A
Kathleen McMahon, CPC-A
Kathleen Senski, CPC-A
Kathy Britsch, CPC-A
Katie Forehand, CPC-A
Katie Pearson, CPC-A
Katie Watson, CPC-A
Katisha Brown, CPC-A
Kavitha Chandran, CPC-A
Kay Wilkins, CPC-A
Kayla Joy Cappetta, CPC-A
Kayla Michelle McNamara, CPC-A
Kelley Anne Hever, CPC-A
Kelley Jo Taylor-Ashbaugh, CPC-A
Kellie Leonard, CPC-A
Kelly Ann Cole, CPC-A
Kelly Corn, CPC-A
Kelly J Boehle, CPC-A
Kelly Lauer, CPC-H-A
Kelly Walker, CPC-A
Kelsea Newsom, CPC-A
Kelsey Cool, CPC-A
Kendra Welborn, CPC-A
Kenya N Price-Harry, CPC-A
Keri Calnan, CPC-A
Khanh Nguyen, CPC-A
Kim Harding, CPC-A
Kim Marie Prather, CPC-A
Kim Miles, CPC-A
Kim Olkowski, CPC-A
Kimberly Dews, CPC-A
Kimberly Jackson, CPC-A
Kimberly Martin, CPC-A
Kimberly Pedersen, CPC-A
Kirti Panke, CPC-A
Kiwana Chevette Jones, CPC-A
Konda Reddy S, CPC-A
Kreistian Ramos, CPC-H-A
Kristal James, CPC-A
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May 2014
63
NEWLY CREDENTIALED MEMBERS
Kristen Banks, CPC-A
Kristen Collins, CPC-A
Kristen Mardis, CPC-A
Kristina Kania, CPC-A
Kristina Olson, CPC-A
Krystal Ann Courtney, CPC-A
Kumud Maurya, CPC-A
Kurt Patschke, CPC-A
Lacy Hill, CPC-A
Lalit Baveja, CPC-A
Lanae Majewski, CPC-H-A
Lashaunda Taylor, CPC-A
LaTonya Malette Morrow, CPC-A
Latrecia Hayes, CPC-A
Laura A Lindsay, CPC-A
Laura Ferrentino, CPC-A
Laura Ludwick, CPC-A
Lauren Bathurst, CPC-A
Lauren Brooke Beasley, CPC-A
Lauren Munoz, CPC-A
Lauren Steckel, CPC-A
Laurie Meeder, CPC-H-A
Laza Gudiel, CPC-A
Leigh Barrett, CPC-A
Lenora Vaughan-Stevenson, CPC-A
Leonie Capulong, CPC-A
Leslie Alderman, CPC-A
Lianna She Cronin, CPC-A
Liju Mary Mathew, CPC-A
Linda Bonagura, CPC-A
Linda Flowers, CPC-A
Linda Hemler, CPC-A
Linda Segal, CPC-A
Linda Townsend, CPC-A
Linda Vann Johnson, CPC-A
Lindsay McMahen, CPC-A
Lindsay Rocha, CPC-A
Lindsey Ann Howard, CPC-A
Lindsey Langolf, CPC-A
Lindsey Morey, CPC-A
Lisa Morales, CPC-A
Lisa Atwood, CPC-H-A
Lisa Candee, CPC-A
Lisa Curtis, CPC-A
Lisa Deutscher, CPC-A
Lisa Fielding, CPC-H-A
Lisa Gilbert, CPC-A
Lisa Holmes, CPC-H-A
Lisa M. Simpson, CPC-A, CPC-H-A
Lisa Marie McNeil, CPC-A, CPC-H-A
Lisa Rushing, CPC-A
Lisa Sindersine, CPC-A
Lisa Wiecerzak, CPC-A
Lisa Wood, CPC-A
Liya Phister, CPC-A
Lois Ingebrigtson, CPC-A
Lorena L Ray, CPC-A, CPC-H-A
Lori Bunk, CPC-A
Lori Moore, CPC-A
Lorissa Feliciano, CPC-A, CPC-H-A
Lorrie A Westbrook, CPC-A
Louise G. Liverman, CPC-A
Lucky Selvaraj, CPC-A
Lucretia L Maxwell, CPC-A
Lynne Renee DeSetta-Fitzpatrick, CPC-A
Madhavi Chelluri, CPC-A
Madhu Chakravarthy, CPC-A
Maggie Kirkbride, CPC-A
Mahjabeen Siddiqui, CPC-A
Malinda Kloster, CPC-A
Mallory Burleson, CPC-A
Mandi Balder, CPC-A
64
Mandy Sue Marotta, CPC-A
Marah Marie Kilby, CPC-A
Marcela Fuentes, CPC-A
Marcus Smith Sr, CPC-A
Margaret Ann Williams, CPC-A
Margaret Diane Mann, CPC-A
Margaret Nohalty, CPC-A
Margo Sandeen, CPC-A
Mari Harvey, CPC-A
Maria Zendejas, CPC-A
Maria Albin, CPC-A
Maria Chipongian, CPC-A
Maria Cristina Waters, CPC-A
Maria Rosen, CPC-A
Maria Turezkaya, CPC-A
Marie Cariker, CPC-A
Marie Rachel Christian, CPC-A
Marife Obdianela Santos, CPC-A
Marissa Verbis, CPC-A
Marla Ward, CPC-A
Marlene Macaluso, CPC-A
Martha Hill, CPC-H-A
Mary A Hernandez, CPC-A
Mary Ann Gallo, CPC-A
Mary Bruening, CPC-A
Mary E Bridges, CPC-A
Mary Simms, CPC-A, CPC-H-A
Mary Soubrouillard, CPC-A
Maryann Kielbasa, CPC-H-A
Matt Jarzombek, CPC-A
Matthew Allen Michelberger, CPC-A
Matthew Gray, CPC-A
Matthew Johnson, CPC-A
Matthew Kopp, CPC-A
Maura Englert, CPC-A
Maura Hubert, CPC-A
Maureen McElrone, CPC-A
Maya Rajendran, CPC-A
Megan Judd, CPC-A
Megan Martinez, CPC-H-A
Megan Olson, CPC-A
Megan Ringlein, CPC-A
Megan Standley, CPC-A
Megan Swilley, CPC-A
Megan Wilhelm, CPC-A
Megan Yetter, CPC-A
Melanie Florence, CPC-A
Melanie Galinger, CPC-A
Melinda Carol Thomas, CPC-A
Melinda Grenz, CPC-A
Melinda Hoffmann, CPC-A
Melinda Schroeder, CPC-A
Melissa Anne DeBoth, CPC-A
Melissa Arneson, CPC-A
Melissa Mullins, CPC-A
Melissa Sanchez, CPC-A
Melissa Schlangen, CPC-A
Mercedez Toler, CPC-A
Michael Ann Jameson, CPC-A
Michael Benne, CPC-A
Michael Ransdell, CPC-A
Michael T Farrell, CPC-A
Michele Barnaby, CPC-A
Michele Rose Mahon, CPC-A
Michele Valdes, CPC-A
Michelle Baird, CPC-A
Michelle Cowart, CPC-A
Michelle Hendricks, CPC-A
Michelle Hoover, CPC-A
Michelle LaPointe-Lewis, CPC-A
Mindy Fields, CPC-A
Mindy Smith, CPC-A
Healthcare Business Monthly
Mischael McKenna, CPC-A
Mistie Lamb, CPC-A
Molly Franco, CPC-A
Molly Marie Gerke, CPC-A
Molly Ray-Conley, CPC-A
Molly Shipley, CPC-A
Molly Shumway, CPC-A
Molly Tilley, CPC-A
Monika Deepak, CPC-A
Monique Olson, CPC-H-A
Monique Richardson, CPC-A
Mounika G, CPC-A
Myana Sathish Kumar, CPC-A
Mythili Arumugam, CPC-A
Nakia Lee Mathews, CPC-A
Nancy LaBorde, CPC-A
Narine Tumanyan, CPC-A
Narmadha M, CPC-A
Natalie Smith, CPC-A
Natasha Nau, CPC-A
Navaneetha Krishnan SS, CPC-A
Navinprabha Prasad, CPC-A
Neethu Mejo, CPC-A
Neha Lohia, CPC-A
Nicholas Bartholomew, CPC-A
Nichole Cull, CPC-A
Nichole Dawn Teater, CPC-A
Nicole Achenbach, CPC-A
Nicole Dixon, CPC-A
Nicole Marie Barnes, CPC-A
Nileena Sidharthan, CPC-A
Nina Rodriguez, CPC-A
Nithya Rajiv, CPC-A
Noelle Richardson, CPC-A
Noemi Delgado, CPC-A
Nychole Mullenax, CPC-A
Omar Crespo Nieves, CPC-A
Pamela Frieze, CPC-H-A
Pamela Gail Verdin, CPC-A
Pamela Jarski, CPC-A
Pamela Schilder, CPC-A
Paola Castillo, CPC-A
Patan Anjumara, CPC-A
Patricia A De Los Santos, CPC-A
Patricia A Grote, CPC-A
Patricia Farrar, CPC-A
Patricia Graves, CPC-A
Patricia Huber, CPC-A
Patricia Lortz, CPC-A
Patrick Cavanaugh, CPC-A
Patrick Cleary, CPC-A
Patty Goodro, CPC-A
Paula Jessica Gundaya Loo, CPC-A
Pauline Fortmiller, CPC-A
Peter Guertin, CPC-A
Peter Lopez, CPC-A
Phyllis Eckert, CPC-A
Piper Swaney, CPC-A
Prathipa RameshBabu, CPC-A
Pujasruthilaya Paladugu, CPC-A
Quenz Charvyrie Zeta Ostia, CPC-A
Rachel Silva, CPC-A
Rachel Steiger, CPC-A
Rachel Witte, CPC-A
Rachelle Gill, CPC-A
Raffi Devaragutta, CPC-A
Raidia Mastromoro, CPC-A
Raja david Narasimhan, CPC-A
Raja Karanam, CPC-A
Raja Priya, CPC-A
Rajanala Suhasini, CPC-H-A
Rajyalaxmi Kurra, CPC-A
Ramina Ravanera, CPC-A
Ramona Jenkins, CPC-A
Rani Thomas Cholankeril, CPC-A
Rebecca Eischens, CPC-A
Rebecca Million, CPC-A
Rebecca Tadlock, CPC-A
Reem Varghese, CPC-A
Regina Culbertson, CPC-H-A
Rekha Subramanian, CPC-A
Renetta Deanne Ruedemann, CPC-A
Reshmi Narayan, CPC-A
Rhonda Michelle Watson, CPC-A
Rhonda RaNae Hinton, CPC-A
RikkiLee Holden, CPC-A
Robbie Francesco, CPC-A
Roberta Moe, CPC-A
Robertha Cervay, CPC-A
Robin Brown, CPC-A
Robin Michaelis, CPC-A
Rohit Dahal, CPC-A
Ronnie Sansome, CPC-A, CPC-H-A
Runa Roy Dey, CPC-A
Rupa Lalai, CPC-A
Russell Bowman, CPC-A
Ruth R Nelson, CPC-A
Ruth Vietri-Green, CPC-A
Ryan Baritot, CPC-A
Ryan Marie DeSantis, CPC-A
Ryann Woike, CPC-A, CPC-H-A
Sailaja LVN Dasari, CPC-A
Samantha Melee Durden, CPC-A,
CPC-H-A
Samantha Nei, CPC-A
Samantha Peterson, CPC-A
Sana Barakat, CPC-P-A
Sandra Sanchez, CPC-A
Sangili Murugan Palanivel, CPC-A,
CPC-H-A
Sanoop George, CPC-H-A
Santhosh Kodakandla, CPC-A
Saori Asada Agriantonis, CPC-A
Sara Biggs, CPC-A
Sarah Roybal, CPC-A
Sarah Ann Brackett, CPC-A, CPC-H-A
Sarah Gibbert, CPC-A
Sarah Green, CPC-A
Sarah Vuttera, CPC-A
Saroeum San, CPC-A
Senthil Kumar Natarajan, CPC-A
Senthilnathan Mohan, CPC-A
Serena Sison, CPC-A
Shakemia Jumpp, CPC-A
Shandale Manning, CPC-A
Shane Claypoole, CPC-A
Shannon M Frickleton, CPC-A
Shanthi Jemima, CPC-H-A
Shari French, CPC-A
Sharon McLaughlin Weber, CPC-A
Shawna Killian, CPC-A
Shawna Robinson, CPC-A
Sheila Fischer, CPC-A
Sheli Grosick, CPC-A
Shemissal Brown, CPC-A
Sherell Hamilton, CPC-A
Sherine Shah, CPC-A
Sherry Jiras, CPC-A
Sheryl A May, CPC-A
Sheryl Chapman, CPC-A
Sheryl Sicklesteel, CPC-A
Silvianne Giarratano, CPC-A
Sivakumar Mani, CPC-A, CPC-H-A
Sivakumar Panchanathan, CPC-A
Sivakumaran Sundararaju, CPC-A
Sivaranjani Palani, CPC-A
Smitha A Kurup, CPC-A
Sonia Noemi Ravnitzky, CPC-A
Sonja Lane, CPC-A
Starr Clare, CPC-H-A
Stefanie Chustz, CPC-A
Stefanie Flynn, CPC-A
Stephan Sharp, CPC-A
Stephanie Acosta, CPC-A
Stephanie Bassett, CPC-A
Stephanie Cherry, CPC-A
Stephanie Granados, CPC-A
Stephanie Kinsella, CPC-A
Stephanie L Brendle, CPC-A
Stephanie Lynn Abdella, CPC-A
Stephanie Newman, CPC-A
Steve Friedli, CPC-A
Steven M Rhoads, CPC-A
Steven Robison, CPC-A
Steven Smith, CPC-H-A
Stimson Agustin, CPC-A
Sue-Ellen Joy Seamands, CPC-A
Summer Cooper, CPC-A
Summerlin Wise, CPC-A
Sunita Patel, CPC-A
Suresh Ramasamy, CPC-A
Susan Bassett, CPC-A
Susan Frank, CPC-A
Susan Honig, CPC-A
Susan K Rugg, CPC-A
Susan L Baldwin, CPC-H-A
Susan Neal, CPC-A
Susan Pulley, CPC-A
Susan Sandy, CPC-A
Susana Kopp, CPC-A
Suzanne Tomlinson, CPC-A
Tabatha Loretta Samuel-Bruce, CPC-H-A
Tabitha Dobish, CPC-A
Tabitha Nadine Chapin, CPC-A
Tamara Guzman, CPC-A
Tameka Wilson, CPC-A
Tamesha Michelle Polite, CPC-A
Tamil Selvi, CPC-A
Tammy Boring, CPC-A
Tammy Gray, CPC-A
Tammy Hutchinson, CPC-A
Tammy Locklear, CPC-A
Tammy Rose, CPC-A
Tammy Wisniewski, CPC-A
Tania Powell, CPC-A
Tannia Adams, CPC-A
Tanuja Devi Kodali, CPC-A
Tanya Edler, CPC-A
Tara Dawn Caldwell, CPC-A, CPC-H-A
Telesa Haynes, CPC-H-A
Tempie Singleton, CPC-A
Teresa Pecnik, CPC-A
Teresa Spencer, CPC-A
Teri Anne H Lain, CPC-H-A
Teri Vitro, CPC-H-A
Terri Heather Nabors, CPC-A
Terri Tolbert, CPC-A
Thao Nguyen, CPC-A
Theresa Holding, CPC-A
Tiffany Gibson, CPC-H-A
Tiffany Marshall, CPC-A
Tiffany Nichole Sluss, CPC-A
Tiffany Remington, CPC-A
Tiffany Robinson, CPC-A
Tim Malchow, CPC-A
TImothy Hooks, CPC-A
NEWLY CREDENTIALED MEMBERS
Tina A Hynes, CPC-A
Tina Baker, CPC-A
Tina Sue Atchison, CPC-A
Tonya Pope, CPC-A
Toria Tozser, CPC-A
Tory Snopl, CPC-A
Tracey E Soboleski, CPC-A
Tracey Ellis-Gorham, CPC-A
Tracie Sexton, CPC-A
Tracy Hetzer, CPC-H-A
Tracy Smith, CPC-A
Travis Waldera, CPC-A
Tricia Lee Dicey, CPC-A
Tricia Lynn Foster, CPC-A
Trina Reavis, CPC-A
Uma Pounraj, CPC-A
Uma Sundaramurthy, CPC-H-A
Umamageswari Solaiappan, CPC-A
Ursula Fleury, CPC-A
Vanessa Nichole McDaniel, CPC-A
Venkata Sudheer Reddy Guvvala,
CPC-H-A
Vicki Fields, CPC-A
Vicki Miller, CPC-H-A
Vicki Taliaferro, CPC-A
Vickie Buel, CPC-A
Victor Vega Cruz, CPC-A
Victoria DeWitte, CPC-A
Victoria R Burton, CPC-A
Victoria Ryan, CPC-A
Virginia Cleary, CPC-A
Virginia Suzanne Sharp, CPC-A
Viswanathan Veerasamy, CPC-A
Von Deneb Vitto, CPC-A
Wayne Schaefer, CPC-A
Wendy Brown, CPC-A
Wendy M. Dodge, CPC-A
Wendy Smoak, CPC-A
Wendy Younger, CPC-A
William Chelune, CPC-A
William Gaviria, CPC-A
Willie Walter Slaton IV, CPC-A
Yacinthe Boehm, CPC-A
Yolanda Armstrong, CPC-A
Young Chung, CPC-A
Yu Fen Su, CPC-A
Yvette Jordan, CPC-A
Yvonne Lamar, CPC-A
Yvonne Silva, CPC-H-A
Specialties
Abimbola Abidemi Owoyemi, CPC, CCC
Alixandrea Dunken, CPC, CFPC
Alka Kapoor, CPC, CPMA
Amanda Coletti, CEDC
Amanda Hartness, CPMA
Amanda Mullen, CPB
Amber Lewis, CPC, CPMA
Amy B Cappelli, CPC, CPB
Amy Bischoff, CPC, CEMC
Amy Frady, CPC, CPPM
Ana Yanez-Marrero, CPC, CPC-H, CPMA,
CPC-I
Andrea Giesecke, CPC-A, CPCD
Andrea Riggs, CPC, CEMC
Angela Spang Laughman, CPC, CANPC
Ann Marie Hays, CPPM
April W LeClear, CPC, CPPM
Arica D Candelaresi-Couch, CPC, COSC
Armadia Williams, CPC-A, CGIC, CGSC
Ashleigh Horton, CPC, CEMC
Ashley A Laughlin, CPC, CPMA, CEMC
Barbara Knigge, CCC
Barbara Thomason, CPC, CPB
Barry Geller, CEDC
Benaan Khorchid, CPPM
Beth Ehlich, CPCO
Beth Eve Schleeper, CPC, CPCO, CPMA,
CPPM, CEMC
Beth Taylor, CPC-A, CPCO
Betty Stump, CPC, CPMA
Bonnee Waldstein, CIRCC
Bonnie Wilson, CPC, CIMC
Brandi Rose Murray, CPC, CANPC
Brice Duffie, CPC, CPMA
Bridget Krueger, CPCO
Bridget Sheerin, CPB
Brittany Shoffner, MSM, CPMA
Bruce Brunson, CPC, CPMA
Bryan Donald Gilpin, CPC, CPPM
Candace Bogen, CCVTC
Carla Serrano, CPC, CIRCC
Carmen Aguilar, CPPM
Carolyn Evon Dodd, CPC, CPMA
Carrie Olinske, CPC-H-A, CPMA
Catherine A Hagen, CPC, CPMA, CEMC
Charity A Dalzell, CPC, CCC
Charnesha Mack, CASCC
Chelle L Johnson, CPC, CPCO, CPPM,
CEMC
Cherie Stutesman, CPMA
Christina M Garland, CPC, CPB
Christine A Smith, CPC, CEMC
Christine Fenimore, CPCO
Clarissa Phillips, CPMA
Concetta A. Price, CPC, CPCO, CPPM
Corrina Rottum, CGIC
Courtney Bonier, CPC, CPCD
Cynthia Castillo, CPEDC
Cynthia Richardson, CPC, CEMC
Daniel William Turner, CPC, CEMC,
CPEDC
Darla Jean DiPaolo, CPC, CCC
David Wright, CPC-A, CPMA, CPPM
Dawn K Medellin, CPC, CCC
Dawn Renee Baltimore, CPC-A, CPPM
Debbie A Johnson, CPC, COBGC
Debbie West, CEMC
Deborah L Ernest, CPC, CPMA
Deborah M Wightman, CPC, CHONC
Debra Esham, CPC, CPMA
Debra L Denson, CPC, CPMA, CPEDC
Denise Burgos, CPC, CPMA
Denise Krahn, CMT, CPC-H-A, CPCO
Denise Levin, CPC, CGSC
Denise Sara Martin, CPC, CEDC
Dhara Bakshi, CPC, CPPM
Dina Billingsley, CPCO
Donna M Zanoli, CPC, CPCO, CPMA
Donna Powell, CPPM
Dorothy Blakeman, CCC
Dr MadhuSudhanRao Kotha, CPC, CPC-H,
CEDC
Edward J Kiehl, CPC, CCC
Eileen Rizzo, CPC-A, CPB
Elier Aleman, CPC, CPMA
Elizabeth Baez, CPC-A, CPMA
Elizabeth C Shoff, CPC, CASCC, CEMC
Elizabeth Hawronsky, CPPM
Elizabeth J Fitzgerald, CPC, CPMA
Elizabeth P Field, CPC, CPPM
Emily Andrews, CPB
Eric Enriquez, CPMA
Florentina C Sandru, CPB
Frances Perez, CPB
Gina Emmenegger, CPC, CPMA, CPC-I,
CEMC, CHONC
Gina Piccirilli, CPC, CPMA
Gina Rutigliano, CPC, CEMC
Gloria Gardeazabal, CPC, CCC
Gregory Romano, CPPM
Heather Lynn Hoak, CPC, CCC
Helen Martin, CPC-A, CPB
Holly B Massey, CFPC
Ian Mark, CPPM
Imran Khan, CPC, CPB
Irina Marinescu, CPC-A, CPB
Jackie Lipez, CCVTC
Jacqueline Martin, CPC, CPRC
Jamie Allen, CPC, CPB
Jan Johnson, CPC, CPB
Janet Seymour, CPMA
Jean M Kayser, CPC, CIRCC
Jeanette Kautzman, CPC-A, CPMA
Jeanne Rozanski, CPC, CUC
Jeannine Marie Mages, CIRCC
Jennifer Pushart, COBGC
Jennifer Clark Osborne, CPC, CPMA
Jennifer Myers, CPC, CPMA, CASCC
Jennifer Rea, CPB, CEMC
Jennifer Suzanne Edgar, CPC, CPCO
Jennifer Waid, CPC, CPMA
Jennilee Ortega, CPC, CPMA
Jermaine Jay Powell, CPC, CPMA, CEMC
Jessica Ann Malek, CPC, CRHC
Joanne Eccleston, CANPC
Joceylyn Labertew, CPC, CPPM, COBGC
Jodi L Smith, CPC, CCC
Jodi Pierce, CPC, CPMA
John D Uecke, CPC, CPB, CPMA
Judith Moran, CPC-A, CPMA
Juovanna J Lowry, CPC, CPMA
Karen Brooks, CPB
Karen E Sowers, CPC, CPB
Karen Jean Bradshaw, CPC, CENTC
Karen Marie Snock, CPC, CPMA
Kassy D Bailey, CPC, CPMA
Kathy Bryan, CPC, CPMA, CEMC, CFPC
Kawanah Polidore, CPPM
Kelli Clark, CPPM
Kelli H Cross, CPC, CPPM
Kelli Pekios, CPC, CPB
Kelly Hall, CIRCC
Kelly Baldenegro, CPC-A, CPB
Kelly Lynn Rickaby, CPC, CPPM
Kelly Richins, CPB, CPPM
Kelly Scruggs, CHONC
Kelly Vawter, CPC, CPB
Kenneth M Harrington, CPCD
Keri Collingsworth, CPPM
Kim Bower, CASCC
Kimberly Rose Kessler, CPC-A, CPPM
Kisha D Rodriguez, CPC-P, CPB, CPPM
Kristie Cuddington, COSC
Kristie Dunson, CPC, CPPM
Krystal Dorlac, CPC, CSFAC
Lani Mayfield, CPC, CPPM
Laura Huck, CPPM
Laurie Troemel, CPC, CPMA
Leigh Ann Dellinger, CPC, CEMC
Linda Loveday, CPC, CPB, CPMA, CEMC
Linda Pascal, CPC, CPMA
Linh Le, CPCO
Lisa Wells, CPCO
Lisa Deleta Davis, CPC, CFPC
Lisa Gaines, CPPM
Lisa Gladson, CENTC
Lisa K Strickler, CPC, CPPM
Lisa Renee Gerber, CPC, CEMC
Lisa Wheeler, CPC, CPPM
Lori Gau, CPPM
Lynn Burkhalter, CPPM
Mallory Wilk, CUC
Maria Stauceanu, CPC, CPPM
Maria Valladares Kadzielawa, CPC, CPC-H,
CPMA, CEMC
Mark Kennerly, CPB
Mark Shortt, CPPM
Mary Jo Warren, CPC, CPB
Mary S Hammond, CPMA
Megan Laurent, CPPM
Melisa Medalle, CPPM
Melissa J Smith, CPC, CPB
Melissa Melton, CIRCC
Melissa Moorer, CPB
Melissa Woods, COBGC
Michael Wu, CPC, CPC-H, CPC-P, CPMA,
CPC-I, CANPC, CEDC, CEMC, CGIC,
CGSC, CHONC, COSC, CUC
Michelle Griffin, CPC, CPMA, CCC,
CEMC
Michelle Marie Rennert, CPC, CPPM
Michelle Post, CPPM
Michelle R Baitey, CPC, CPC-H, CPC-P,
CPB, CPMA, CPC-I
Miranda West, CPC, CPMA, CEMC
Mitchell Perry Hilsen, CPCO, CSFAC
Monika Egan, CPPM
Nachell Crump, CPC-A, CPMA
Nancy Lynch, CPC, CPPM
Nancy Newman, CPC-H, CPMA
Natalie L Eichholzer, CPC, CUC
Paula Renee Driggers Ausaf, CPMA
Paula Williams, CASCC
Paula Zoito, COBGC
Phyllis Davis, CPC, CPCO, CPC-P, CPC-I
Pia Fisher, CPC, COSC
Rebecca Ness, CPC-A, CEMC
Regina Scott, CPC-A, CPPM
Renee Killebrew, CPCO
Rhonda L Griffin, CPC, CPPM
Rob Herrick, CPCO
Robert Hillgrove, CPB
Robin R Young, CPC, CPMA, COSC
Robyn Byrne, CPB
Rocio Perez, CPC, CPMA
Rose Marie Grant, CPC, CPMA
Rosemary Squiabro, CPC, CPMA, CEMC
Ryan Gardiner, CPB
Salma Taher, CPC, CASCC
Sathyaraj Ariamuthu, CPC, CEMC
Sean Puckett, CIRCC
Sharon Wallace, CPPM
Sheila Moose, CPMA
Shelly Albury, CPCD
Sheri Lane Bayless, CPC, CPPM
Shilpa Amin, CEDC
Stacey Rawlyk, CPC, CPPM
Stephanie Hutson, CPC, CPB, COBGC
Stephanie Webber, CPC, CPB
Sundae LK Yomes, CPC, CGIC, CGSC
Susan Bastian Stallone, CPC, CPMA
Susan Foster, CPC-H-A, CPCO
Suzann Kenerly, CPPM
Tabitha Smith, CPPM
Tara Sailors, CPPM
Taree Branch-Swan, CPB
Teresa Levasseur, CPPM
Teresa Renea Bolden, CPC, CPMA
Teri E McConkey, CPC, CPMA
Teri M Starling, CPC, CPPM
Terri Clements, CPB
Theresa Child, CPC-H, CEDC
Tonya York, CPC, CPC-P, CPMA, CEMC
Traci L Wolfe, CPC, CHONC
Tracy Sherman, CPC, CPMA
Valerie B Bates-Hoff, CPC, CPMA
Venus Gogineni, CPC, COBGC, COSC
Vickie Herrada, CRHC
Victor Mo, CPPM
Whitney Clair, CEMC
Zaina Al-Alami, CPC-A, CPB
Zaynet Fernandez, CPC-A, CPMA
www.aapc.com
May 2014
Magna Cum Laude
Ann Marie Spooner, CPC-A
Christine Marston, CPC-A
Danielle Nicole Irwin, CPC-A, CPC-H-A
Dawn McDowell, CPC-H-A
Elizabeth Baptist, CPC-A
Gina Gurrola, CPC-A
Harpreet K Ahuja, CPC, CPC-H
Jamie Anderson, CPC, CIRCC
Jeremy Dale Clark, CPC
Jessica Lee Harris-McKinney, CPC-A
Kieran Kleman, CPC-A
Lisa Giummo, CPC-A
Sarah Neal, CPC-A
Saranya Soman, CPC
Shabina BS, CPC
A&P Quiz
Answer
(from page 45)
The correct answer is D.
Full thickness tissue loss
with exposed bone, tendon, or muscle.
65
Minute with a Member
Gregory Freeman, CPC
Coder, Verisk Health and Thomasville Pediatrics, Thomasville, N.C.
I was hired for
my first coding
job based on my
CPC-A® credential
alone.
Tell us a little bit about your career—how you
got into coding, what you’ve done during your
coding career, what you’re doing now, etc.
I grew up working as a mechanic in the family
business and later as maintenance tech at Guilford Technical Community College, in Jamestown, N.C. Working in an academic environment piqued my interest in the possibility of a new
career. I began taking classes in the Medical Office program in 2008. In the spring of 2010, I enrolled in the AAPC Professional Medical Coding
Curriculum (PMCC) class that my wife, Jerri, was
teaching in High Point, N.C. At the end of the 10week class, I passed the CPC® exam and began my
new career in coding.
I was hired as a contract coder for Verisk Health
in 2012. That, and the year of PMCC classes, was
sufficient enough experience to remove the apprentice designation in the fall of 2013. This January, I started another part-time position with
Thomasville Pediatrics, coding in the insurance
department. I am getting plenty of experience
and I look forward to taking my coding career
to the next level, including obtaining my proficiency in ICD-10. My next goal is to use my coding skills and credentials to work for an organization full time.
What is your involvement with your local
AAPC chapter?
Since becoming a member of AAPC, I have been
attending local chapter meetings in High Point,
N.C. I will be proctoring upcoming CPC® exams,
which I look forward to. I finish school this May;
when I finish my studies, I’ll have time to become
more involved in my chapter.
What AAPC benefits do you like the most?
The AAPC benefit I enjoy the most is the recognition in the industry. I was hired for my first coding
job based on my CPC-A® credential alone. That
66
Healthcare Business Monthly
speaks volumes for the respect employers have for
AAPC credentials. I also enjoy training opportunities provided by AAPC. Last year, when I needed continuing education units (CEUs), I found a
wide variety of opportunities to train and continue my coding education on AAPC’s website.
What has been your biggest challenge as a coder?
My biggest challenge as a coder was learning the
new language. Everything from medical terminology to insurance and reimbursement language
was new to me. The medical coding field uses a
lot of acronyms. There are just too many to list.
Learning these has been a challenge, but it’s been
fun making sense of them all.
How is your organization preparing for ICD-10?
Both organizations I work for have begun ICD10 training. Many physicians who I have talked
to are interested in the change, and are seeking information and training. I believe the next several
months will be a very busy time in healthcare because of this impending change.
If you could do any other job, what would it be?
If I could have any other job, it would be a professional fishing guide somewhere warm and sunny. I am not a very good fisherman, however, so I
am happy learning and growing as a coder at the
moment.
How do you spend your spare time? Tell us about
your hobbies, family, etc.
My family is very important to me. My wife, Jerri
Freeman, CPC, CPC-P, CPC-I, is my best friend
and coding coach. Our two dogs and cat keep us
company and keep us busy. Our four children are
very dear to us and we have one 5-year-old granddaughter who is just precious. I enjoy fishing, riding my motorcycle, gardening, camping, playing
banjo, and listening to music.
ICD-10-CM
Are You Ready?
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track for ICD-10 implementation. AAPC offers:
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¢
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