healthcare

HEALTHCARE

BUSINESS MONTHLY

June 2016

www.aapc.com

Coding | Billing | Auditing | Compliance | Practice Management

CHAPTER OF THE YEAR Monmouth-Ocean, New Jersey Zoom in on ICD-10-CM Glaucoma: 38 Focus on laterality and the stage of the condition

HIV Status: Who Should Know? 42 HIPAA disclosure regulations can be confusing

Strategy Is Key to a Healthy Future: 50 Lay plans for productive staff and patient-centered care

Smart Design. Intelligent Auditing. Healthicity - 1

Customize, manage, train and simplify your audit process. We streamlined your audit process by merging audit workflow, management, and reporting capabilities into one easy-to-use, web-based solution. HEALTHICITY.COM/AUDITMANAGER

Healthcare Business Monthly | June 2016

COVER | Member Feature | 18

Gather Around the Table with the 2015 Chapter of the Year By Michelle A. Dick

[contents] ■ Coding/Billing

■ Auditing/Compliance

■ Practice Management

Creativity, Children Future, Metal

Foundation, Family Wood, Past

ip sh er ion th lat Mo Re ve, Lo

Ab Pro und We spe ance alt rity h

Fame Reputation

Earth

ge led ow om Kn Wisd kills S

H Ble elpf ssi ul P n Fa g, T eopl th rav e, er e l,

Physical Health

Career Path in Life

35 NPI: More than Just a Number

42 Is It OK to Share HIV Status?

54 Feng Shui Your Workspace







Susan Theuns, PA-C, CPC, CHC

Michael Miscoe, Esq., CPC, CASCC, CUC, CCPC, CPCO, CPMA

Bridget Toomey, CPC, CPB, CRCR, RYT-200 [continued on next page]

www.aapc.com

June 2016

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Healthcare Business Monthly | June 2016 | contents 22

■ Conference

■ Auditing/Compliance

14 Record-breaking Attendance at HEALTHCON 2016

40 Healthcare Compliance FAQs



44 Liven Up Compliance Training with Short Videos



By Ana Saiz

■ Coding/Billing



22 Revitalize Wound Care Reporting

Barbara Aung, DPM, CWS, CPMA, CSFAC



46 Keep Providers Focused on Quality Improvement and Implementation Science

Kim Pollock, RN, MBA, CPC, CMDP

28 What’s Next for ICD-10?





50 Strategize for a Healthy Future

Barbara Aubry, RN, CPC, CPMA, CHCQM, FABQUARP



30 Eligibility: What You Need to Know





•• Stuck in Your Ear •• Six Figure Coders •• Payer Requests •• Guarding PHI •• HEDIS On the Cover: The 2015 Chapter of the Year, Monmouth-Ocean, New Jersey, proves to be a family who provides exceptional coding education. Cover photo by Viki Reed (www.vikireedphotography.com), Viki Reed Photography on Facebook and Instagram. 4

Healthcare Business Monthly

Brian Shrift, CISSP, HCISPP

56 Communicate Like a Pro

Michelle Clark, CPC

58 Advance in the Career You Want

38 Get a Closer View of ICD-10-CM Glaucoma Coding

COMING UP:

Lanaya Sandberg, MBA, MHA, CPCO, CPPM, FAHM

■ Added Edge

Oby Egbunike, CPC, COC, CPC-I, CCS-P



Kim Cohee, DPT, PT, OCS, MBA

52 Evaluate Your IT Support

Beth Timpson Schleeper, CPC, CPCO, CPB, CPMA, CPPM, CPC-I, CEMC

32 Modifier 25 for E/M on the Day of an Injection Procedure

50

Mark Schneider, MBA, CPCO, Julie Hamilton, MBA, and Yesenia L. Contreras MHA, CPC-I

■ Practice Management

24 Spine Surgery Quandary: Posterior Lumbar Interbody Fusion

44

Keileigh Neugebauer, MBA, CPCO



Tara Cole, CPC, CPMA

60 Project Xtern Helps Break Barriers

Rhonda Buckholtz, CPC, CPMA, CPC-I, CRC, CHPSE, CENTC, COBGC, CPEDC, CGSC



Brad Ericson, MPC, CPC, COSC

DEPARTMENTS

EDUCATION

7

Letter from the CEO

63 Newly Credentialed Members

8

Letters to the Editor

8

Chat Room

9

I Am AAPC

10 AAPC National Advisory Board 12 AAPC Chapter Association



Online Test Yourself – Earn 1 CEU



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

June 2016

• You will save a few trees.

Publisher

• You won’t have to wait for issues to come in the mail.

Brad Ericson, MPC, CPC, COSC [email protected]

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John Verhovshek, MA, CPC [email protected]

• Digital issues take up a lot less room in your home or office than paper issues.

Editorial

Go into your Profile on www.aapc.com and make the change!

Michelle A. Dick, BS

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Healthcare Business Monthly is a publication for members of AAPC. Statements of fact or

any form, without written permission from AAPC® is prohibited. Contributions are welcome. opinion are the responsibility of the authors alone and do not represent an opinion of AAPC, or sponsoring organizations.

Ask the Legal Advisory Board From HIPAA’s Privacy Rule and anti-kickback statute, to compliant coding,

to fraud and abuse, there are a lot of legal ramifications to working in healthcare. You almost need a lawyer on call 24/7 just to help you make sense of all the new guidelines. As luck would have it, you do! AAPC’s Legal Advisory Board (LAB) is ready, willing, and able to answer your legal questions. Simply send your health law questions to [email protected] and let the legal professionals hash out the answers. Select Q&As will be published in Healthcare Business Monthly. Medical Coding Legal Advisory Committee: Timothy P. Blanchard, JD, MHA, FHFMA Julie E. Chicoine, JD, RN, CPC Michael D. Miscoe, JD, CPC, CPCO, CPMA, CASCC, CCPC, CUC Christopher A. Parrella, JD, CPC, CHC Robert A. Pelaia, Esq., CPC Stacy Harper, JD, MHSA, CPC

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Healthcare Business Monthly

CPT® copyright 2015 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The responsibility for the content of any “National Correct Coding Policy” included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information contained in this product. CPT® is a registered trademark of the American Medical Association. CPC®, COCTM, CPC-P®, CPCOTM, CPMA®, and CIRCC® are registered trademarks of AAPC. Volume 3 Number 6 June 1, 2016 Healthcare Business Monthly (ISSN: 23327499) is published monthly by AAPC, 2233 South Presidents Drive, Suites F-C, Salt Lake City UT 84120-7240, for its paid members. Periodicals Postage Paid at Salt Lake City UT and at additional mailing office. POSTMASTER: Send address changes to: Healthcare Business Monthly c/o AAPC, 2233 South Presidents Drive, Suites F-C, Salt Lake City UT 84120-7240.

Letter from CEO

Value-based Payment, MACRA, and Our Future

W

hen AAPC members get together, as we did at April’s HEALTHCON in Orlando, Florida, we talk about change. We share how best to implement recent changes, examine proposed changes, and speculate on anticipated changes. With all the attention focused on ICD-10 implementation, it has been easy to overlook many other initiatives. One of the biggest initiatives of late is value-based payment, which includes a number of movements — established and new — meant to improve efficacy of care while using providers’ resources more efficiently. The Physician Quality Reporting System; meaningful use; accountable care organizations; the value-based payment modifier; bundled payments; and other facets of the initiative are falling into unison.

Enter MACRA All of these programs culminate in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Included in MACRA are provisions for implementing a Meritbased Incentive Payments System (MIPS) and advanced Alternative Payment Models. In a proposed rule released in April, the Centers for Medicare & Medicaid Services explains their intentions for implementing these provisions, which replace the denounced sustainable growth rate formula. Beginning in 2019, MIPS will determine clinician payment, while APMs will create an opportunity for valuebased payment.

The Monmouth-Ocean, New Jersey, local chapter, our 2015 Chapter of Year, is an example of AAPC members’ ability to make change work. Through popular monthly meetings, the chapter promotes valuable networking and education, and invokes curiosity. Additional trainings and communications keep their members informed, and make this chapter’s extra efforts stand out above the rest. One of the reasons I am grateful to be with AAPC is how all parts — the national office, local chapters, and individual members — face the changing landscape of healthcare with cooperation, support, and optimism. More than 155,000 of us work together to assure all are educated and prepared. Change can be confusing and scary, but it’s exciting, too.

Transition to Success John F. Kennedy said, “Change is the law of life. And those who look only to the past or present are certain to miss the future.” Feefor-service payment is a key component of our present, and value-based payment will be a central part of our future. We will continue to do all we can to help you learn and succeed now and in the future.

More than 155,000 of us work together to assure all are educated and ready.

Sincerely,

Preparing Together AAPC and fellow members are already helping you prepare for the changes ahead through local chapter meetings, webinars, conference presentations, and other communications. It’s our nature to manage the constant change in our field.

Jason J. VandenAkker CEO

www.aapc.com

June 2016

7

Please send your letters to the editor to: [email protected]

Letters to the Editor

HEALTHCARE

BUSINESS MONTHLY

March 2016

www.aapc.com

Coding | Billing | Auditing | Compliance | Practice Management

Fight for Insurance Carrier Payment: 27 Have a game plan that gets you paid

The NPP Scope of Practice Scoop: 48 Meet state practitioner authorization requirements

Time Is Ticking on Old Accounts: 55 Manage unpaid claims now to increase revenue

March2016_HBM.indd 1

11/02/16 9:33 pm

Orthopedic Coders Rejoice: Changes Coming for Shoulder Arthroscopy

A National Correct Coding Initiative (NCCI) edit that will update on July 1, 2016, will negate a prominent aspect of “Hold Strong When Arthroscopy Weighs You Down” (March 2016, pages 34-37). The article states, “NCCI doesn’t allow modifiers for same-shoulder edits.” But the American Academy of Orthopaedic Surgeons (AAOS) has successfully convinced the Centers for Medicare & Medicaid Services (CMS) that the edit never should have been put in place. Common shoulder procedures include: 29824

Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure) 29827 with rotator cuff repair 29828 biceps tenodesis

These procedures are often performed together; however, if the provider debrides a type 1 SLAP [superior labral tear from anterior to posterior] lesion, and debrides the humeral head due to chondromalacia or arthritis (29823 Arthroscopy, shoulder, surgical; debridement, extensive), payers have denied payment for the debridement. This has frustrated orthopedic coders for years. We have a situation that meets the criteria for separate reporting, but because the (soon to be deleted) NCCI edit has been “interpreted” incorrectly, physicians have been unable to receive payment for performing a significant, time-consuming procedure to correct an unrelated pathological condition. I’m grateful that AAOS has pressed this issue, and has convinced CMS to delete the edit, as of July 1. Quinn Webb, CPC

75984 Descriptor Mix Up In “CPT® 2016: Urinary Interventional Coding” (March 2016, page 21), the transcatheter diagnostic radiology code 75984 is described as Injection procedure for ureterog-

Chat Room

HEALTHCON Lights Up Social Media If you post on AAPC’s Facebook page, many AAPC members and employees read your threads. Our staff enjoys reading your posts and receiving feedback, and especially loves when you spread positive messages to fellow members. In April, AAPC’s HEALTHCON lit up Facebook with posts of photos and enthusiastic networking adventures. Two members shared their excitement and gave accolades to staff about their experience: AAPC Chapter Association Sarah Wechselberger, CPC, CPB, CPMA, and Alecia Johnson.

8

Healthcare Business Monthly

raphy or ureteropyelography through ureterostomy or indwelling ureteral catheter. This description is for procedure 50684. The correct description for 75984 is Change of percutaneous tube or drainage catheter with contrast monitoring (e.g., genitourinary system, abscess), radiological supervision and interpretation. Allison A., CPC HEALTHCARE

BUSINESS MONTHLY

April 2016

www.aapc.com

Coding | Billing | Auditing | Compliance | Practice Management

Prospective Payment, not Perspective

In the title and throughout the article, “The Ins and Outs of Inpatient Psychiatric Facility Perspective Payment System” (April 2016, pages 38-41), “perspective” should read “prospective.” Lisa Gillstrom, CPC, CPBB, HUC MS-DRG May Spell TROUBLE: 32

CMS looks at time for mechanical ventilation billing

Rock the Mock Audit: 48

Don’t let an external audit keep you up at night

The Doctor Said What? 52

Have a laugh at ridiculous physician notes

April2016_HBM.indd 1

09/03/16 9:12 pm

SARAH WECHSELBERGER, CPC, CPB, CPMA ers all on my own. I was terrified, but with much effort and a ton of research, I found my way.

Mastering OB/GYN and Learning Other Specialties

I

n 2002, at the age of 21, I was laid off as a customer service representative of an acid-waste piping manufacturer due to a company shut down. It was then I began my healthcare career. I started out as part of the front desk staff for a wellestablished physician practice in Libertyville, Illinois. It was a quick six months at the front desk before I moved to the back office to assist with billing. It was in that role when I got my first look at coding, and I loved it! After about a year, and without notice, the coder I worked with in the billing office quit. I was thrown into figuring out the coding for four obstetrics/gynecology (OB/GYN) provid-

After an informative and rewarding six years with the OB/GYN practice, I relocated to Mountain Home, Arkansas, where I began working for a billing company that exposed me to several different specialties. In 2010, while working for the billing company, I obtained my Certified Professional Coder (CPC®) credential. In 2012, I advanced my career by landing a job at the hospital where I am currently employed. I have gone on to obtain my Certified Professional Medical Auditor (CPMA®) and Certified Professional Biller (CPB™) credentials. In my role at the hospital, I manage the Clinic Coding & Billing Department. Our department is responsible for coding 16plus hospital-owned specialty and family practice clinics.

Realizing the Full Benefits of Local Chapters I’ve become involved in my local chapter and I find it to be rewarding. My first officer role was secretary/treasurer; in 2014, I served as education officer; and this year, I’m serving as the chapter president. I enjoy the networking and outstanding education opportunities at our local chapter meetings. I also serve on the AAPC Chapter Association board of directors as one of the Region 5 representatives. What’s next for me? I’m scheduled to sit for my Certified Risk Adjustment Coder (CRC™) exam. I am AAPC!

#IamAAPC

I Am AAPC

iON Health

#IamAAPC

Healthcare Business Monthly wants to know why you chose to be a healthcare business professional. Explain in less than 400 words why you chose your healthcare career, how you got to where you are, and your future career plans. Send your stories and a digital photo of yourself to: Michelle Dick ([email protected]) or Brad Ericson ([email protected]). www.aapc.com

June 2016

9

■ AAPC NATIONAL ADVISORY BOARD By Angela Jordan, CPC

REGION 8

WEST

Two representatives team up to promote, serve, and support AAPC and its Region 8 members.

T

he AAPC National Advisory Board (NAB) is shining the spotlight this month on Region 8 – West and its representatives. Region 8 — comprised of California, Oregon, Washington, Nevada, Hawaii, and Alaska — is the largest of the eight regions, covering 1,006,700 square miles. This region boasts 58 chapters and is home to more than 18,000 members. Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI, and Boyd P. Murayama, CPC, CPC-I, are the NAB representatives who promote, serve, and support AAPC and its Region 8 members. With Massey working for a commercial payer and Murayama directing a physician practice for a hospital system, they bring two very different perspectives to the NAB.

Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI Massey is the director of a Blues plan Special Investigations Unit located in northern California. She has more than 18 years of experience investigating and managing units dedicated to fighting healthcare fraud. Massey serves on the BlueCross BlueShield Association National Anti-Fraud Advisory Board as well as the National Health Care Anti-Fraud Association board of directors. She is a frequent presenter at local and national conferences for many organizations. Massey is originally from Portland, Oregon. Although she loves Portland, and says she will always consider it home, she was excited to start a new adventure in sunny California in March 2012. 10

Healthcare Business Monthly

She has grown accustomed to California and enjoys all the activities that a milder climate has to offer. Massey obtained her motorcycle endorsement shortly after moving to California. She also frequently rides her bicycle along the American River Bike Trail, kayaks on Lake Natoma, and hikes anywhere she can. Massey has two grown children, and she spends as much time as possible with family and friends – often returning to Portland to visit those she left behind. Massey is passionate about vacation travel. She has been to Italy, Bali, Japan, China, Taiwan, England, Mexico, and all over the United States. Massey is always up for an adventure (zipline anyone?). Her love of adventure started when she was very young and took a trip across the Pacific on a freighter, during a hurricane. Ask her about it sometime!

Boyd P. Murayama, CPC, CPC-I In April 2015 Murayama joined Yavapai Regional Medical Center (YRMC) PhysicianCare — a community-based hospital system in Prescott, Arizona — as director of physician practices and the Management Services Organization (MSO) Group. He is responsible for the overall administrative management of the MSO Group and its physician practice organization, which comprises 58 physicians and non-physician practitioners.

Regional Spotlight

physician recruitment and retention, hospital and professional coding and billing, consulting, compliance, physician education and training, budget management, forecasting, contract negotiation, employee development, etc.

Making Region 8 Stronger If you attended HEALTHCON, we hope you met Massey and Murayama while they were working registration or assisting as room monitors, and witnessed their passion for AAPC and its members. Regardless, we encourage you to reach out to them. Massey can be reached at [email protected] and Murayama at Boyd. [email protected]. Angela Jordan, CPC, is managing consultant at Medical Revenue Solutions, LLC, with more than 25 years of experience in the healthcare field, and has been a member of AAPC for 15 years. Her career path has taken her from a small family practice, radiology, large physician services group to a managing consultant. Jordan is on the AAPC NAB and has held many offices in the Kansas City, Mo., local chapter, including president. In 2009, she served on the AAPC Chapter Association board of directors and was the chair in 2012.

Local Chapter News

Toledo, Ohio, Makes Waves The Toledo, Ohio, local chapter has been busy making the most out of AAPC benefits, education, and networking this year. In March, they held a meeting they won’t soon forget: AAPC’s CEO Jason VandenAkker was the featured speaker. He discussed company updates in his presentation “The State of AAPC.” Rumor has it members traveled from as far as Ft. Wayne, Indiana; Detroit, Michigan; and Cleveland, Ohio, to hear VandenAkker speak. The chapter also offered discounts, prizes, and networking galore at the meeting. As Toledo President Robin Moore, CPC, said on the chapter’s Facebook page, “What else could you ask for?” Speaking of Facebook, Toledo has mastered the power of social media to help members, using it as a tool to expand their membership, post chapter events, provide educational links, and network. Their chapter enthusiasm was also noticed at this year’s AAPC National Conference. Toledo made their presence known adorned in Mickey and Minnie Mouse shirts to celebrate the joys of HEALTHCON at Disney World.

CEO Jason VandenAkker shares his plans for AAPC’s future and inspires Toledo members.

Nothing bonds a chapter like matching Mickey and Minnie shirts at HEALTHCON.

www.aapc.com

June 2016

11

NATIONAL ADVISORY BOARD

Prior to joining YRMC PhysicianCare, Murayama served as assistant hospital administrator and medical group practice director at Hilo Medical Center in Hilo, Hawaii. He served on the executive management team for eight years and was responsible for overseeing all physician-related business for the organization. Murayama built the outpatient multi-specialty practices into what they are today, and recruited the majority of the physicians, staff, and management team employed by Hilo Medical Center’s East Hawaii Region outpatient clinics since the inception of the program. His legacy includes the successful development and Accreditation Council for Graduate Medical Education accreditation of the Hawaii Island Family Medicine Program, which welcomed its first class of family medicine resident physicians in the summer of 2014, as well as the legislative lobbying that made funding the program possible. Murayama has worked in many capacities in the healthcare area, such as director of revenue cycle and patient access, instructor of medical coding and billing curriculum, administrative services officer, administrator, consultant, and pediatric coder and biller. He has performed a wide variety of healthcare administrative functions:

AAPC Chapter Association

STUDY HALL: A KANSAS CITY TRADITION

Incorporate a free and fun study assistance program to help students prepare for exams.

T

he Kansas City, Missouri, local chapter is always looking for ways to assist their members, so when chapter member Rena Hall, CPC, championed a program to assist Certified Professional Coder-Apprentice (CPC-A®) members in becoming full-fledged CPCs, it was well received. The program has since morphed into Study Hall, a free study-assistance program, proven to be a valuable asset to any chapter.

Everyone Benefits Study Hall is neither a replacement for AAPC pre-certification courses, review classes, or mock examinations nor a substitute for mentorships. The program is designed to help the potential examinee prepare for taking the certification exam. Study Hall provides students with guidance for reading test questions, navigating and tabbing code-books, managing their time, and more. Students also learn of other exam prep resources that may benefit them. Many pre-certified coders have little to no money to spend on resources that will help them learn the concepts of coding and assist 12

Healthcare Business Monthly

them through the testing process. Holding Study Hall at no cost to students demonstrates one of the many benefits chapters offer their members. Certified members know how important it is to keep learning, and often attend Study Hall as a refresher course. In return, students benefit from the wisdom these experienced coders share.

Lessons Extend Beyond the Exam “There is a mind set for taking the exam versus the mindset you have to have in a coding position,” said Sherry Wright-Fontenot, CPC, CPMA, CEDC, education officer for the Kansas City local chapter. Through experimentation and feedback from Study Hall attendees, the Kansas City chapter has developed tips and strategies students can use on the test, as well as in their future positions as professional coders. These test-taking and time management strategies are beneficial to candidates sitting for any credential exam, not just the CPC.

istock.com/Qiang Fu

By Brenda Edwards, CPC, CPB, CPMA, CPC-I, CEMC, CRC

AAPC Chapter Association Students are afraid of the exam, even if they have taken it before. It’s our job to help them relax.

Games

Test-taking Tips

Games help familiarize students with CPT®, ICD-10-CM, and HCPCS Level II codebooks. When you are unfamiliar with the books, flipping pages can waste up to 3/4 of an hour during the exam. The following games can help examinees pick up speed when looking up codes: • Scavenger Hunt. Students write down several codes from each section of a codebook on small pieces of paper, throw them in a bowl, and take turns drawing. Time players to see how long it takes them to look up the code. Optionally, reward the person with the fastest time. • Match Game. Students match modifiers to applicable procedure codes. • Meat and Potatoes. In this game, players review an actual operative report. The objective of this game is to find where the “salad” stops and the “entrée” begins. For example, everyone goes to the operating suite, gets prepped, and an incision is made. Have students figure out when the surgical part begins, which is the “entrée” of the report.

Experienced instructors and chapter leaders gathered together to create these suggestions and strategies for examinees: • The only rules you need to follow are those in CPT®, HCPCS Level II, and ICD-10-CM. • The mindset for the exam is different than real life coding — no payer rules apply. • The information noted in the guidelines is an integral part of finding the correct answer. Mark applicable codes with a “g” to ensure you remember to check the guidelines. • Using REALMS allows you to quickly identify E/M modifiers, so you know to skip over answers that include E/M modifiers appended to procedures. This aids in the process of elimination. • Make a list of important pages (diagrams, definitions, etc.) on a blank page in the front or back of each codebook to use for quick and easy reference. • The purpose of the exam is not to make sure you know all of the codes. The purpose is to make sure you know how to reference the codebooks correctly. Remember: It’s an open book test! • Answer all of the questions, even if it’s just a guess.

Hands-on Coding It’s essential to have some hands-on scenarios for the attendees to code. Be ready with instructions about how to look up the necessary terms to select the right code.

Modifier REALMS REALMS is a word association tactic that helps students narrow down which categories of codes may be used with a given modifier: R = Radiology E = Evaluation and management (E/M) A = Anesthesia L = Laboratory and pathology M = Medicine S = Surgery For example, the moderator calls out “modifier 22 Increased procedural services,” and the attendees (with their CPT® codebooks open to the list of modifiers on the inside cover) write in the area before the modifier “R, A, L, M, S.” This will help them remember that modifier 22 may be appended to radiology, anesthesia, lab, medicine, and surgery codes, but not to E/M codes.

Support in Numbers Students are afraid of the exam, even if they have taken it before. It’s our job as officers to help them relax. Study Hall has been supporting people in all stages of their career and education development for years. It’s a safe place to ask questions, as well as to connect with friendly faces. It has helped the Kansas City chapter become more active and friendly, and it can help yours, too. For more information about Study Hall, look under the Local Chapter Officer tab at aapc.com. Brenda Edwards, CPC, CPB, CPMA, CPC-I, CEMC, CRC, has 25 years of 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 20102014 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.

Editor’s Note: Thank you Kansas City, Missouri, local chapter and Renal Hall for sharing this valuable program.

www.aapc.com

June 2016

13

■ HEALTHCON WRAPUP By Ana Saiz

Record-breaking Attendance at Members gather at “the happiest place on Earth” to learn about the business side of healthcare. Nearly 2,700 attendees gathered in April at Disney’s Coronado Springs Resort, in Orlando, Florida, for HEALTHCON — AAPC’s 24th annual national conference. With the highest attendance in AAPC’s conference history, attendees represented every state in the United States, as well as international visitors from the Bahamas, Canada, India, Qatar, South Africa, South America, and United Arab Emirates. The pastel-painted casitas, ranchos, and cabanas of Disney’s Coronado Springs Resort, lining the shores of the shimmering Lago Dorado, paved the way for members and attendees to navigate to sessions, social events, and networking opportunities.

Let’s Get with the Program AAPC CEO Jason VandenAkker opened HEALTHCON with an overview of the organization’s growth, now totaling over 155,000 members, of which nearly 105,000 carry AAPC certifications in medical coding, billing, practice management, auditing, and com-

pliance. VandenAkker referenced Walt Disney’s challenges in creating the Disney Company, noting the failures Walt Disney overcame to achieve his dream of having his cartoons viewed worldwide. VandenAkker reminded healthcare professionals that they will face similar challenges and failures throughout their careers, yet those who are focused on their objective and exercise persistence will persevere. With more than 90 educational sessions covering a wide spectrum of topics, attendees had the opportunity to share and receive the gamut of current events in the industry. Topics included medical coding for outpatient and inpatient services, career development, auditing, compliance, and other essential issues relevant to healthcare business professionals. Many sessions focused on growing trends in the field, such as risk management, telemedicine, value-based payments, and new roles such as scribing, healthcare techniques, and technology. The Anatomy Expo was very popular. Attendees got an indepth look at the anatomic and physiologic degrees of the human body.

We keep moving forward, opening new doors, and doing new things, because we’re curious and curiosity keeps leading us down new paths. —Walt Disney 14

Healthcare Business Monthly

HEALTHCON Wrap-up

The Anatomy Expo is always a HEALTHCON crowd pleaser.

Run4One 4k raises money for the AAPC Hardship Scholarship Fund.

Stephanie Cecchini reveal the $ecrets of $ixFigure Coders.

The Business Healthcare Expo offered attendees insights to facilitate workplace improvements, from human resources to physician compensation. Presenters represented a variety of backgrounds and included the largest panel of physician presenters.

We Are a Generous Bunch AAPC Chapter Association’s Hardship Scholarship Fund, which offers financial aid to AAPC members struggling to cover the cost of membership and certification, raised more than $10,000 via member contributions, a raffle, and the second annual Run4One run/walk event. All proceeds benefit the fund. Brenda Edwards, CPC CPB, CPMA, CPC-I, CEMC, CRC, was very taken back by the generosity of AAPC members. “The thing that touched me the most, and is very near and dear to me, is the response from members to the Hardship Scholarship Fund,” Edwards said. “Michael Miscoe, [Esq, CPC, CPCO, CPMA, CASCC CCPC, CUC] made his donation and challenged attendees to contribute ‘just one dollar,’ which raised $1,500. Well, between the Run4One, the raffle for the quilt, and just the generosity of our members, and AAPC’s matching donation, we exceeded our expectations to help our members in need. I believe this is the most we have ever raised. Jason VandenAkker mentioned the kindness of our members

in his conference welcome speech and the donations really show that kindness.” Alex McKinley, AAPC’s senior marketing communications manager (aka “AAPC Alex” on Facebook), also contributed to the cause by making his way through the crowds, getting to know as many members as possible, and taking pictures with them for a dollar. All contributions went to AAPC Chapter Association Hardship Scholarship Fund.

People Make the Magic Happen As usual, HEALTHCON offered attendees many opportunities to network, reconnect, and learn how to advance their career. Through local chapters, general sessions, breakout sessions, and mingling with exhibitors, HEALTHCON attendees were exposed to a new and exciting world, beyond their wildest imagination. Exhibit hall breaks turned into networking events where attend-

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HEALTHCON Wrap-up It’s kind of fun to do the impossible. —Walt Disney ees walked into a crowded room full of strangers and quickly realized it was the best place to meet vendors, make new friends, and stockpile fun freebies. Speaking of new friends, there were a lot of new faces this year. MariaRita Genovese, CPC, PCS, said there were “so many first time attendees, which demonstrates how our industry is growing in leaps and bounds. HEALTHCON is an amazing networking experience.” The magic was made possible by Melanie Mestas and her AAPC conference team: Sandra Nestman, Rachel Momeni, Amy Evans, and Kira Golding. HEALTHCON will return to Las Vegas, Nevada, on May 7-10, 2017, the 25th anniversary of the annual national conference. Learn more about HEALTHCON at healthcon.com. Ana Saiz is thought leadership coordinator at AAPC.

Thank you

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Healthcare Business Monthly

AAPC Regional Conference

October October 6 6– –8 8| | 12 12 CEUs CEUs

■ MEMBER FEATURE By Michelle A. Dick

Monmouth-Ocean, New Jersey, makes coding education and networking a family matter.

B

eing a family and providing exceptional education is at the heart of the Monmouth-Ocean, New Jersey, local chapter. Officer Liaison of Local Chapters Linda Litster knows why the Monmouth-Ocean won the 2015 Chapter of the Year “What sets them apart is that they continually go above and beyond with the educational material provided for their members. This chapter also has a feel of ‘family.’ For sure this chapter is AAPC”. The Monmouth-Ocean chapter members concur. “It is like visiting 18

Healthcare Business Monthly

with family when you come to a meeting,” said 2016 President Claire Bartkewicz, COC. Bartkewicz also served as the chapter’s 2015 treasurer and has served on the AAPC Chapter Association Board of Directors.

The Meat and Potatoes of this Award Monmouth-Ocean is celebrating their 18th year. New “family” members are added each year; there are approximately 400 members. Monthly chapter meetings usually attract roughly 50 members (the regulars), and January meetings pull in around 100 members. The chapter has a diverse group of members. According to 2015 President Bonnie J. Ivler, RHIA, CPC, “The chapter members come from all areas, such as inpatient, outpatient, physician office, billing companies, long-term care, legal healthcare, financial healthcare, etc.”

Chapter of the Year Photos by Viki Reed (www.vikireedphotography.com), Viki Reed Photography on Facebook and Instagram.

It takes an entire chapter to set out and achieve the Chapter of the Year award, but it also takes dedicated officers. These are the 2015 officers who helped to make this achievement possible last year: • President Bonnie J. Ivler, RHIA, CPC • Vice President Susan Buckman, CPC • Treasurer Claire Bartkewicz, COC • Secretary Gail Clonan, CPC-A • Member Development Officer Kim Bevel, CPC-A • Education Officer John Mustak Rahman, CPC, COC

Family Atmosphere with Full Bellies Nothing says “family” like sitting down for a meal and having good conversation, and that’s what Monmouth-Ocean meetings are like. The chapter has a very relaxed and friendly atmosphere; they do this

“by offering a full hot dinner that starts one half hour before the business meeting,” said Ivler. “Everyone can leisurely sign in and sit and talk, while enjoying great food.” The family dinning atmosphere carries over into their annual holiday party and awards dinner, where they give chapter members a special dinner (fancy tablecloths included) and hand out promotional “Monmouth-Ocean AAPC” gifts to attendees. They also reward members who have “gone the extra mile” in various ways, such as with education scholarships. Every family has a baker or two, and this chapter has Muriel Ayres, CPC-A, and Lynda Tebbs, CPC. In fact, Ayres’ baking has won her blue ribbons at county fair competitions. The best part about her culinary successes is that she shares them with chapter members. Ayers bakes yummy treats and packages them to give away as raffle prizes www.aapc.com

June 2016

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Chapter of the Year Offering Education Galore

2015 chapter officers (l-r) FRONT ROW: Claire Bartkewicz, Bonnie Ivler, Gail Clonan. BACK ROW: Susan Buckman, John Mustak Rahman, Kim Bevel.

at the end of each meeting. Ivler said that Ayers helps in all areas. “She does an amazing job packing up and cleaning up after each meeting, making care packages out of leftovers for anyone to take, and she gives the balance to a local food bank,” Ivler said. The chapter’s other baker, Tebbs, “brings tons of cookies and deserts, just because she likes to give,” said Ivler. “She also is the first person you’ll meet when you walk in our doors for Coders’ Day, and you are offered a great smile.” The officers make sure no one feels left out during a local chapter meal. “When a new member comes to our meetings we always make sure that we have someone for them to sit with,” said Ivler. “We make them feel very welcome and make sure they know our procedures of signing in and getting them a plate, etc.” Although food is one aspect that helps to make this chapter a family, another is that members truly care about each other. “We all do what we do because we enjoy it so much, and we have built really special friendships through this chapter,” Ivler said. “We have been through births, deaths, weddings, illnesses, grandchildren, and more together; and we have always been there for each other.”

Family Is Forever It’s tough when a family member moves away to pursue other opportunities, but it happens — even at the Monmouth-Ocean chapter. Ivler said, “We have a member named Addie [Adeline Hart, CPC] who moved away to another state, and she still not only comes to our events, but comes to work them as though she had never left.” As far as the chapter is concerned, she hasn’t left. “Addie is also involved with her local chapter, where she moved, but we are her ‘home,’” Ivler said. Hart even drove up from Delaware to be in the chapter photos for this article.

Another familial trait is how serious this chapter takes educating their members. Their education materials and offerings surpassed all other chapters in 2015. In addition to holding their required monthly meetings, Monmouth-Ocean proctored five certification examinations, and almost all of them had participants with disabilities, which meant 8-hour exams. Ivler said, “One of our exams was offered on a Sunday to accommodate people with religious or other special needs who otherwise could not take the exam.” Besides winning the 2015 Chapter of the Year award, one of the biggest accomplishments and successes of Monmouth-Ocean in 2015, according to Bartkewicz, was hosting their 11th annual New Jersey Coder’s Day seminar. “We have more than 300 attendees each year, and 20-25 vendors,” said Bartkewicz. “It is such a great day!” And just like family, Monmouth-Ocean members know they’ve got each other’s back. For example, when Lynn Handy, COC, CPC, CPC-I, was stuck in a Texas airport due to a flood, Nancy Clark, COC, CPC, CPB, CPMA, CPC-I, and Judy Wilson, COC, CPC, CPCO, CPC-P, CPB, CPPM, CPC-I, CANPC, did an impromptu presentation using Handy’s PowerPoint slide presentation. Ivler said, “It was an example of the incredible people that we have in AAPC and also the caliber of people. It was just about the best ‘on the cuff’ presentation I have ever witnessed and many people really believed that Judy was a cardiologist!” The Monmouth-Ocean chapter has worked hard to build relationships with area hospitals, too. Ivler said, “We have become very well known in our area, and the hospitals know us. We have the support of a very big hospital group that has a wonderful outreach program.” This connection has enabled the chapter to get “some very special and very interesting speakers,” according to Ivler. Interesting speakers make for exciting presentations, including: • Computer programs to use in the workplace to enhance members’ careers • Healthcare data collecting – how to use it, present it, and set up programs to make it work better for members • Robotic surgery and body parts • Dementia and Alzheimer’s, presented by the Alzheimer’s Association of New Jersey • Chair yoga • Blood pressure, diabetes, heart, and chiropractic screenings were presented at May MAYnia. Advanced practice nurses from the local hospital did screenings on members before the speakers started and during break time. • Proper nutrition to help avoid certain diseases. It was presented

The Monmouth-Ocean chapter plans to stay one step ahead of what technology and online education has been doing to local chapter attendance. 20

Healthcare Business Monthly

Chapter of the Year

We will be out in full force for the regional conference in Atlantic City!

Monmouth-Ocean officers accept the Chapter of the Year award at HEALTHCON.

by a chiropractor, working in conjunction with a Pampered Chef vendor, to teach how to prepare easy, healthy meals. Besides the usual chapter requirements for education, MonmouthOcean offered seminars and other educational opportunities in 2015: • April Audit Validation Seminar – Monmouth-Ocean joined New Jersey Health Information Management Association (NJHIMA) for a half day seminar on Audit Validation, provided pro bono by Deborah Gardner Brown. • Coders’ Day 2015 – The chapter held their 11th annual New Jersey Coder’s Day coding and billing seminar. • Bootcamps – They offered extra boot camps on weekends at very reasonable prices. • Mentoring – Members volunteer to be mentors for newer coders. • Job Posting – The chapter posts on their website job offerings from reliable local sources and also announces them at meetings. • Review Classes – They held review classes for certification exams and ICD-10 proficiency certification. • Joint Meetings – They allow the chapter to supply full dinners and financial aid to their members without having to go to HEALTHCON for these funds. • Exams Are Available to All – Members volunteer on Saturday or Sunday, usually for 8 hours at a time, to give members with disabilities the opportunity to take the certification exam in the time frame necessary. • Officer Training – They participated in Officers’ Training, which was sponsored by the Toms River, New Jersey, local chapter President Kenneth Bruce, CPC.

Charity Abounds Ayres isn’t the only one in the chapter with a giving spirit. Every year, the Monmouth-Ocean chapter awards a scholarship in memory of a past chapter officer, Marie Lassen. Bartkewicz said, “Marie did a

lot of work, but she was a ‘behind the scenes’ type of person. So Marie’s award goes to a member who has helped the chapter a lot during the year, not for any glory or recognition, but kind of incognito.” The chapter calls it the “Unsung Hero Award.” A presentation by the Alzheimer’s Association of New Jersey also moved them to donate the money they would normally use for giveaway favors at May MAYnia to the Alzheimer’s Association of New Jersey. The Monmouth-Ocean chapter also donates to Rose’s Fund for Animals at their award’s dinner every year. An impressive 100 percent of donations go to helping animals. Felecia C. Bernstein, CPC, is very active in this charity and is the muscle behind getting members to support this important charity. Lastly, Monmouth-Ocean donates $500 to Project AAPC every year.

Bright Future Ahead The Monmouth-Ocean chapter plans to stay one step ahead of what technology and online education has been doing to local chapter attendance. “As some chapters have dwindled and lost momentum, Monmouth-Ocean chapter seems to continuously grow and succeed,” Ivler said. Monmouth-Ocean plans to keep attendance up by offering what online continuing education units (CEUs) can’t: social interaction. “It’s very important to keep our education current, but like many other organizations, CEUs can now be gotten at home, online, without having to interact with others,” Ivler said. To keep chapter attendance up, their monthly educational meetings will continue to be social dining events that are centrally located and accessible to parkways and that offer free parking and a great, catered dinner, desert, and beverages for $10. Monmouth-Ocean is excited about the AAPC Regional Conference in Atlantic City, as well. The chapter always has representation at all national and regional conferences, either by Bartkewicz, Clark, or Barbara J. Cobuzzi, COC, CPC, CPCO, CPC-P, CPCI, CENTC. Bartkewicz said enthusiastically, “We will be out in full force for the regional conference in Atlantic City!” They may even rent their own private bus to transport all the chapter members as a group. The chapter plans to continue keeping members up to date on the latest medical technologies. “The future will be wonderful for this chapter as we all plan to keep it current, bring the best education to everyone, and continue to make it an atmosphere for all members to enjoy,” said Ivler. Michelle A. Dick is executive editor at AAPC.

www.aapc.com

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■ CODING/BILLING By Barbara Aung, DPM, CWS, CPMA, CSFAC

Revitalize Wound Care Reporting Clinicians and coders often mistakenly consider the total surface area (length x width) to be the driving force behind code selection. In fact, coding is based on the deepest level of tissue debrided or removed first, and the total surface area second. Let’s look at the codes.

Active Wound Care Management Not Involving Subcutaneous Tissue 97597

Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less

+97598    each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Debridement Involving Subcutaneous Tissue 11042

Debridement, subcutaneous tissue (includes epidermis and dermis, if performed) first 20 sq cm or less

+11045    each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Involving Muscle and/or Fascia 11043

Debridement, muscle and/or fascia (includes epidermis and dermis and subcutaneous tissue, if performed); first 20 sq cm or less

+11046    each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Involving Bone 11044

Debridement, bone, (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less

+11047    each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

W

ound care involves assessment, management, and cleansing of the wound; simple debridement; and removal and reapplication of the wound dressings. Accurate reporting of wound care services requires a thorough understanding of skin anatomy, the codes that describe these services, and documentation requirements.

Go Skin Deep for Debridement Wound care management and debridement involve the largest human organ: the skin. Figure A illustrates the different layers that make up the skin. A solid understanding of this anatomical area is essential for proper code selection. Medicare defines debridement as, “The removal of foreign material and/or devitalized or contaminated tissue from or adjacent to a traumatic or infected wound until surrounding healthy tissue is exposed.” 22

Healthcare Business Monthly

E/M Is Included In most cases, it’s inappropriate to report an evaluation and management (E/M) service in addition to a wound care service (e.g., debridement, application of an Unna’s boot, etc.). The exception occurs if, during the wound care encounter, the provider performs (and documents) a significant, separately identifiable service. The E/M service must be unrelated to the scheduled visit for wound care and require medical evaluation and treatment over and above that for the wound care. Only then may it be appropriate to report an E/M code with a wound care code. To get the E/M code past system edits, append modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service.

■ Coding/Billing

■ Auditing/Compliance

■ Practice Management

istock.com/KatarzynaBialasiewicz

Develop a deeper understanding of debridement coding with this quick review of essential elements.

To discuss this article or topic, go to www.aapc.com

Figure A

Sebaceous gland

Hair follicle

Arrector pili muscle Thick-skin epidermis

Epidermis

Hair shaft

Dermis

Pacinian corpuscle Hair matrix

Hypodermis (subcutaneous layer)

Sweat (eccrine gland) Sensory nerve Blood vessels

Bulb

When multiple wounds are debrided all to the same depth, combine the debrided surface measurements to arrive at the appropriate code(s). The total surface area of each debrided wound must be documented separately, but each debridement may not be reported separately, unless performed on different tissue types. Case Example 1: 15 sq cm of subcutaneous tissue is debrided from the right leg and 10 sq cm of subcutaneous tissue is removed from the left leg. CPT®

Units

11042

1 unit

+11045

1 unit

Use add-on codes when the total area of debrided tissue (at the same depth) is greater than 20 sq cm. Case Example 2: 10 sq cm of muscle is debrided from one wound; 15 sq cm of devitalized tissue (epidermis and dermis) is debrided from a separate wound. CPT®

Units

11043 97597-59

1 unit Distinct procedural service

1 unit

Medicare May Impose Limits Be aware of place of service limitations, especially involving debridement of subcutaneous and deeper tissue. Medicare payers may be of the opinion that clinicians are unlikely to debride muscle and or bone (or possibly even subcutaneous tissue) in an outpatient clinic or office setting. Bone and muscle debridement is generally performed in the operating room. Check relevant local coverage determinations (LCDs) for clarification. Also be aware that the Centers for Medicare & Medicaid Services (CMS) is of the opinion that, after the initial debridement is performed, there usually is nonecrotic muscle and/or bone remaining in a repeat (subsequent) debridement. As such, ongoing care should require only superficial debridement as the wound heals, and this

CODING/BILLING

Illustration copyright 2015 Optum 360

Wound Care

service should be needed less often as the wound resolves itself. Repeated debridement of muscle and bone for extended periods may trigger denials and or audits. Example: Muscle is debrided in the initial surgical debridement of a stage IV ulcer. For the subsequent debridement, only superficial slough is removed. For the initial visit/initial debridement, report surgical debridement code 11043. For the subsequent visit, report selective debridement code 97597.

Documentation Wound care documentation should describe the wound, including size (length x width); depth; total sq cm; appearance; drainage; undermining; peri-wound character; presence of edema, infection, and disease causing underlying problems or complication(s) for the wound healing process. Documentation also should describe the method of debridement (scalpel, nippers, scissors, curette), and which deepest layer of tissue was removed or debrided (fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm; subcutaneous tissue; muscle and/or bone). Chart notes must clearly describe the tissue as being cut away. Make sure the clinician cut away and removed the tissue, and not merely scraped away loose fragment tissues. This is an area where mistakes are made, and there is potential for up-coding (abuse). Such mistakes have repercussions upon audit that can lead to recoupment of monies — or worse, a case of fraud when there is a pattern of consistently coding for a higher level of debridement. Documentation should specify which dressings were applied, postop care instructions provided, progress of the wound, and on follow-up visit notes, future plans. Documentation should also specify wound improvement or measurable changes (e.g., decrease in drainage, inflammation, necrotic tissue or slough, pain, swelling, wound dimension changes, or declining improvement). This documentation helps to substantiate what was done to address the new condition. Steps might include oral antibiotics, further testing, biopsy of the wound, consultations requested for vascular intervention, or podiatric consultation for bracing or off-loading. Remember: If it isn’t documented, it wasn’t done. Barbara Aung, DPM, CWS, CPMA, CSFAC, has been in private practice for 22 years, where she also conducts clinical research in the field of wound healing and podiatric surgery. She serves on the American Podiatric Medical Association’s Coding Committee. Aung is a Panel Physician at Carondelet St. Mary’s Wound and Hyperbaric Center in Tucson, Ariz., a Healogic’s Managed Facility. She is vice president of the Tucson, Ariz., local chapter.

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■ CODING/BILLING By Kim Pollock, RN, MBA, CPC, CMDP

Spine Surgery Quandary: Posterior Lumbar Interbody Fusion A

common question among coders and spine surgeons is whether to bill 63056-59 with 22633, or 63047-59. The answer is complex, but CPT® and Medicare guidelines provide essential guidance.

Interbody Arthrodesis Codes The primary codes we’ll discuss are 22630, 22633, 63047, and 63056. Although not listed below, the advice given here also applies to respective add-on codes: 22632, 22634, 63048, and 63057. CPT® codes: 22630

Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar

22633

Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar

63047

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar

63056

Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disk), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc)

Code 22630 describes a posterior lumbar interbody arthrodesis, also known as fusion. Code 22633 describes a posterior lumbar interbody fusion and a posterolateral fusion performed at the same interspace and segment (also called spinal level, such as L4-L5). CPT® introduced 22633 in 2012 to represent the combination of 22630 and 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) at the same level. Both 22630 and 22633 include “laminectomy and/or discectomy to prepare the interspace other than for decompression” [emphasis added]. Therein lies the confusion: What constitutes decompression that can be separately reported with a Nervous System code? Note that the posterior spine arthrodesis codes are in the Musculoskeletal System section of CPT® (22590-22634), while the posterior spine decompression codes are in the Nervous System section of CPT® (6300163066). This is an important distinction that we’ll discuss further.

Coding Guidelines: 63056 with 22630/22633 CPT® Assistant (November 2011) addresses whether you may report 63056 with 22633. Although the guidance specifically concerns 22630, it logically also applies to 22633 (even though 22633 was not introduced until the following year) because 22633 includes 22630: 24

Healthcare Business Monthly

■ Coding/Billing

■ Auditing/Compliance

■ Practice Management

istock.com/Tharrison

When do you bill 63056-59 with 22633, rather than 63047-59?

Illustration copyright 2015 Optum360

Spine Surgery

Graft site (separately reportable chips)

Answer: No. To report both codes 63056 and 22630 for the same interspace/segment would represent duplicative work. For posterior (PLIF) or transforaminal (TLIF) approach lumbar interbody fusions, CPT code 22630 is used, and the dissection needed to access the disc space in these approaches is considered an incidental component of the fusion procedure. Although code 22630 includes the phrase “including ... discectomy to prepare interspace (other than for decompression)” and code 63056 is a discectomy for decompression, the discectomy described in code 22630 is either the same or more extensive than the discectomy described in code 63056. It’s not proper to report both 63056 and 22633 (or 22630) for procedures at the same spinal level (e.g., L4-L5).

Coding Guidelines: 63047 with 22630/22633 Whether to report 63047 with a posterior lumbar interbody fusion (22630 or 22633) is clear when reviewing CPT® coding guidelines. These arthrodesis codes specify “including laminectomy and/or discectomy to prepare interspace (other than for decompression),” which implies that a laminectomy and/or discectomy code may be separately reported with 22630/22633 when the service is performed for decompression. CPT® Assistant (January 2001) addresses reporting 63047 with 22630 in response to the following questions. Question: In what procedural circumstance would the 63001-63048 code(s) be reported in addition to code 22630? Similarly, in what procedural circumstance would code(s) 63075-63078 be reported in addition to code 22554?

Report 63045 if cervical; report 63046 if thoracic; report 63047 if lumbar; report 63048 for each additional segment

CODING/BILLING

Question: May both codes 63056, Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disk), single segment; lumbar, and code 22630, Arthrodesis, posterior interbody technique, including laminectomy and/ or discectomy to prepare interspace (other than for decompression), single interspace; lumbar, be reported for the same interspace/segment?

Part of the spinous process is removed

The physician uses lateral grafts to fuse the vertebrae; report 22630 for single interspace; report 22632 for each additional interspace

To relieve stenosis, the physician trims the facets and cuts the cervical lamina free with burrs and chisels

With some techniques the lamina remains partially connected and "floats" on the dura

Answer: For both codes 22554* and 22630, if the surgeon is removing disk and/or bony endplate solely with the need to prepare the vertebrae for fusion; then no additional 63000 series code(s) is reported. The appropriate 6304563048, 63075-63078 code(s) should be reported, when in addition to removing the disk and preparing the vertebral endplate, the surgeon removes posterior osteophytes and decompresses the spinal cord or nerve root(s), which requires work in excess of that normally performed when doing a posterior lumbar interbody fusion (PLIF). *Note that it is no longer accurate to report 63075 Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace with 22554 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2 because the combination of these two codes, at the same interspace, was changed in 2011 to 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2. Although there is some overlap between the posterior lumbar interbody fusion codes (22630, 22633) and a decompression code (63047), the clinical example for 22633 published in CPT® Changes 2012: An Insider’s View specifically states that decompression may be separately reported. Per the clinical example, “The necessary portion of the facet joint is removed along with the lateral aswww.aapc.com

June 2016

25

Spine Surgery

pect of the lamina are removed to expose the disc space.” The overlap in services is with the exposure necessary for 22633: Any laminectomy and facetectomy necessary to access the interspace are included in 22633 as part of the approach to perform the interbody fusion. Although newer surgical techniques — such as a transforaminal lumbar interbody fusion (TLIF) — might be performed with a unilateral approach, 22630/22633 are considered to be performed on both sides of the spine, and modifier 50 Bilateral procedure does not apply. The clinical example also states, “The disc space is identified and the posterior annulus is incised, followed by removal of disc material sufficient to allow creation of a bone graft recipient bed.” Because a significant portion of the intervertebral disc must be removed to perform an interbody fusion, a lumbar discectomy (63030, 63042) is an integral element of the procedure and should not be reported with 22630 or 22633. Laminectomy, facetectomy, and discectomy necessary for exposure and access to the interspace are included and would not constitute use of a separate CPT® code for decompression because the services were necessary to accomplish the primary procedure (22630, 22633). The clinical example for 22633 goes on to state that additional decompression beyond the necessary laminectomy, facetectomy, or discectomy to access the interspace may be separately reported. Typically, 63047 reports that additional decompression work. In other words, 22630/22633 includes the necessary laminectomy and facetectomy for exposure of and access to the interspace, but the interbody fusion codes do not include a complete laminectomy for thecal sac decompression or foraminotomies for spinal nerve root decompression. The bottom line is that CPT® considers 63047 with 22630 or 22633 to be an accurate code combination when additional bony work beyond that necessary for exposure of and access to the interspace is performed to accomplish decompression of the thecal sac and/or spinal nerve(s). It’s imperative for the physician documentation to reflect this additional work in the operative report (in the operation statement, at the top of the note, and within the body of the operative report). 26

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CODING/BILLING

Although CPT® allows 63047 to be reported with 22630 or 22633, Medicare prohibits payment for 63047 when performed at the same interspace as the interbody fusion.

Medicare Guidelines: 63047 with 22630/22633 Although CPT® allows 63047 to be reported with 22630 or 22633, Medicare prohibits payment for 63047 when performed at the same interspace as the interbody fusion. This is documented in Chapter 8 of the National Correct Coding Initiative (NCCI) edit guidelines, effective January 1, 2015: 24. CMS payment policy does not allow separate payment for CPT codes 63042 (laminotomy...; lumbar) or 63047 (laminectomy...; lumbar) with CPT codes 22630 or 22633 (arthrodesis; lumbar) when performed at the same interspace. If the two procedures are performed at different interspaces, the two codes of an edit pair may be reported with modifier 59 appended to CPT code 63042 or 63047. Medicare’s decision to disregard CPT® coding rules, and not to pay for decompression, is unfortunate. The ramifications of the conflicting guidelines have resulted in lower physician payments and a loss in work relative value units credited for physician compensation. Specialty society attempts to reverse Medicare’s decision have been unsuccessful. These failed efforts to repeal the NCCI guideline were noted by John Kevin Ratliff, MD, FAANS, in AANS Neu-

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Spine Surgery

Modifier 59 Use The CPT® description for modifier 59 Distinct procedural service states, “Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual.” As previously stated, arthrodesis occurs on the musculoskeletal system and decompression occurs on the nervous system. As such, CPT® allows modifier 59 to be appended to 63047 when reported with 22630/22633 because the decompression work is performed in a different organ system — even though it’s within the same incision. Payers that follow CPT® coding guidelines permit you to report 63047-59 — or even 63047-51 Multiple procedures — with 22630/22633 for procedures at the same interspace (e.g., L4-L5). It’s also acceptable to report to Medicare 63047 (without a modifier) with 22630/22633 to show that the work was performed. Medicare will deny 63047; this denial should be accepted and not appealed. Some secondary payers may reimburse 63047 if Medicare does not, but 63047 must be on the original claim submitted to Medicare. Do not append modifier 59 to 63047 on a Medicare claim when the decompression and interbody fusion were performed at the same interspace (e.g., L4-L5). Table 1 shows examples of the arthrodesis and decompression codes for procedures performed at the same interspace for Medicare and non-Medicare payers. Table 1: Payer

Codes for SAME Comments Interspace Procedures

Medicare

• 22630 or 22633 • 63047 (no modifier)

Non-Medicare • 22630 or 22633 • 63047-51 or 59 (depending on payer preference for modifiers)

• Additional codes including, but not limited to, additional level(s) (22614, 22632, 22634), instrumentation (e.g., 22840, 22851), bone graft (e.g., 20930, 20936), bone marrow aspirate through separate site (38220), operating microscope (69990), and spinal stereotactic navigation (61783) may be separately reported.

Although Medicare guidelines disallow modifier 59 when decompression and fusion are performed at the same interspace, it may be

used when the procedures are performed at different interspaces. For example, a combined posterior lumbar interbody fusion and posterolateral fusion at L5-S1, with an adjacent posterolateral fusion at L4-L5, with decompression at both L5-S1 and L4-L5, may be reported to Medicare with 22633 (L5-S1), +22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) (L4L5) and 63047-59 (L4-L5). Table 2 shows examples of the arthrodesis and decompression codes for procedures performed at different interspaces for Medicare and non-Medicare payers.

CODING/BILLING

rosurgeon (Vol. 25, No. 1), 2016, “We reached out to the NCCI team and made our case. We reviewed our literature with them, and they acknowledged our concerns. Finally, a group of representative spine surgeons reviewed the matter with both NCCI and the CMS. CMS chose to not overturn the edit.”

Table 2 Payer

Codes for DIFFERENT Interspace Procedures

Comments

Medicare

• 22630 or 22633 • 63047-59

Non-Medicare

• 22630 or 22633 • 63047-51 or 59 (depending on payer preference for modifiers)

• Additional codes including, but not limited to, additional level(s) (22614, 22632, 22634), instrumentation (e.g., 22840, 22851), bone graft (e.g., 20930, 20936), bone marrow aspirate through separate site (38220), operating microscope (69990), and spinal stereotactic navigation (61783) may be separately reported.

It All Depends on the Procedure and Payer Although CPT® coding guidelines conflict with Medicare payment guidelines, each guidance is clear: Do not report 63056, 63030, or 63042 with 22630 or 22633 at the same level for any payer, as these services are part of the approach or access to the interspace. You may report 63047 with 22630 or 22633 for decompression and interbody fusion at the same level for payers who follow CPT® guidelines, but you may not append modifier 59 to 63047 for Medicare claims. Kim Pollock, RN, MBA, CPC, CMDP, is a senior consultant and speaker with KarenZupko & Associates, Inc., a physician practice management consulting and training firm based in Chicago, Ill. She is on the faculty for the American Association of Neurological Surgeons coding and reimbursement courses.

Resources John Kevin Ratliff, MD, FAANS, in AANS Neurosurgeon (Vol. 25, No. 1), 2016: http:// aansneurosurgeon.org/departments/laminectomy-and-interbody-fusion-confusion/

National Correct Coding Initiative (NCCI) edit guidelines, Chapter 8, effective Jan. 1, 2015: www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/2016-NCCI-PolicyManual.zip). www.aapc.com

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What’s NEXT for ICD-10

be better options to represent procedures. The last annual updates to the ICD-9-CM and ICD-10 code sets were made on October 1, 2011. According to the CDC: • On October 1, 2012, 2013, and 2014, there were only limited code updates to both the ICD-9-CM and ICD-10 code sets to capture new technologies and he Centers for Disease Control and Prevention (CDC) and the diseases as required by section 503(a) of Centers for Medicare & Medicaid Services (CMS) are poised to Pub. L. 108-173. release thousands of new ICD-10-CM and ICD-10-PCS codes on Oc• On October 1, 2015, there were limited code updates through tober 1, 2016, for implementation in 2017 — ending the code freeze new Section X to ICD-10-PCS to capture new technologies imposed in 2012. The proposed changes are significant, and cannot be and diagnoses as required by section 503(a) of Pub. L. 108wholly covered in this article. While CMS is being generous in an ear173. There were no updates to ICD-10-CM. ly release of the list, due to its volume, there is a likelihood there will be • On October 1, 2016 (one year after implementation of ICDmodifications before this October’s implementation date. 10), regular updates to ICD-10 begin. Of the new codes, 3,549 represent changes to the cardiovascular sys2017 ICD-10-PCS Procedure Codes tem. The changes relate to unique device values, the addition of bifurThe tally of ICD-10-PCS codes for 2017 will be 75,625 — an increase cation as a qualifier, and additional specific body parts, as well as conof 3,651 new codes, with 487 revised code descriptions. Approxi- genital cardiac procedures and placement of an intravascular neuromately 5,400 codes will be added, changed, or deleted. stimulator. All of the revised code titles so far have come from changThe additions are good news for hospital coders because there will ing the number of coronary artery sites to the number of vessels, and the specification of the descending thoracic aorta. Other new codes include expansion of body part detail in the removal and revision of lower joints (think The Birth of an ICD Code of CMS test bundled payment plans for joint replacements). Another addition is the unicondylar knee reThe National Committee for Health Statistic’s (NCHS) ICD-10 Coordination and Maintenance Committee (C&M) meets regularly to review requests for new ICD codes and revise current codes. There is a process placement.

The code freeze is over, and thousands of changes are coming.

T

whereby interested parties can submit proposals for new codes to be created. The first quarterly meeting for 2016 was held on March 9 - 10, in Washington, D.C. The agenda is posted online at: www.cdc.gov/nchs/ data/icd/topic_packet_03_09_16.pdf, and you can watch the actual broadcast on YouTube.com via CMS Live. The next meeting is scheduled for September 13 – 14. Proposals for review at this meeting are due by July 15. For more information go to: www.cdc.gov/nchs/icd/icd9cm_maintenance.htm.

The list of proposed codes is not final. The C&M’s Work Group meets again in July, at which time further changes may occur. The CDC and CMS released the proposed list early to help providers and vendors prepare for the update. The final list will be released August 1, 2016. This list will add clarity concerning which codes will become effective for FY 2017 and which will be held until FY 2018. AHIMA commented on the proposed ICD-10-PCS changes and suggested the proposal should be discussed further in the September C&M meeting and not be implemented on October 1, 2016.

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2017 ICD-10-CM Diagnosis Codes For physicians, the changes are significant. 2017 ICD-10-CM will include 1,943 new codes, 305 deleted codes, and 422 revised codes. For example, there are hundreds of revisions and improvements (299, to be exact) to the diabetes mellitus codes. Here are some examples of others: 2016 - C7A.094 Malignant carcinoid tumor of the foregut NOS 2017 - C7A.094 Malignant carcinoid tumor of the foregut, unspecified

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By Barbara Aubry, RN, CPC, CPMA, CHCQM, FABQUARP

To discuss this article or topic, go to www.aapc.com

Next for ICD-10

N83.00 Follicular cyst of ovary, unspecified side

Barbara Aubry, RN, CPC, CPMA, CHCQM, FABQAURP, is a senior regulatory analyst for 3M Health Information Systems (HIS). As a member of the 3M HIS team that creates and manages medical necessity and other coding data, she works directly with CMS on ICD-10 code assignment for their NCD medical necessity policies. Aubry’s background includes hospital case management and utilization review. She has managed a utilization management department for an HMO and a team of registered nurse auditors, and she was the clinical editor of an e-health patient portal website. Aubry’s core focus is regulatory compliance. She is a member of the Upper Saddle River, N.J., local chapter.

N83.01 Follicular cyst of right ovary N83.02 Follicular cyst of left ovary

There are also code additions, such as: D47.Z2

Castleman disease

F80.82

Social pragmatic communication disorder

tors are responsible for updating policies in advance of the October 1, 2016, effective date. If you use a vendor for billing or coding, check to be sure they can guarantee their product will be ready with the latest codes by October 1.

CODING/BILLING

Some nonspecific codes are deleted and replaced by more specific designations. For instance, N83.0 Follicular cyst of ovary is deleted for 2017 and replaced by the following:

Prepare for the New Codes

Resources

Probably the most important step a coder can take to prepare is not to use unspecified codes, unless there is no other option. CMS has warned that the “right family” of code(s) choice that has been eligible for reimbursement in 2016 will no longer be allowed in 2017. In addition to avoiding unspecified codes (the updates make this easier), be sure to review local and national coverage determinations for coding changes. CMS and its Medicare administrative contrac-

List of new PCS proposed codes: www.cms.gov/Medicare/Coding/

ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials.html.

CDC, Proposed new ICD 10 CM codes for 2017: www.cdc.gov/nchs/data/icd/topic_ packet_03_09_16.pdf and www.cdc.gov/nchs/icd/icd9cm_maintenance.htm

CDC, New Released ICD-10-CM-Codes: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/ Publications/ICD10CM/2017/NewICD10CMCodes_FY2017.txt

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By Beth Timpson Schleeper, CPC, CPCO, CPB, CPMA, CPPM, CPC-I, CEMC

Protect the financial livelihood of your practice through coverage verification and balance collection.

M

aking sure your practice is paid in full for services rendered is a two-step process: First, verify every patient’s eligibility for medical coverage before services are rendered. The turnaround time for claims payment is reduced greatly when coverage is verified prior to services. This step alone will improve cash flow for the practice. Second, collect the remaining balance from the patient. Practices who do not perform these two essential steps during check-in only recover approximately 30 percent of patient balances. That’s 70 percent of potential revenue the practice will never see.

Verify Coverage at Check-in To verify coverage, you’ll need the patient’s: • Name and address • Date of birth • Primary insurance company • Policy number • Group number

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Healthcare Business Monthly

You’ll also need the policy owner’s name and date of birth, and the patient’s relationship to the policy owner. Obtain the policy start and end dates, as well. Tip: Be sure to verify coverage for the specific date of service!

Don’t Forget Secondary Coverage Don’t forget to ask the patient for any secondary coverage. Verify this coverage, as well. Patients with secondary insurance often don’t understand how two insurances work and may give you the wrong one. Note that Medicaid is always the payer of last resort. If a patient is covered under a commercial payer and a Medicaid payer, the Medicaid coverage is secondary (regardless of how the patient wants the claim to be processed). If the patient does not want to send the claim to their primary insurer, they must pay cash. If a husband and wife each have coverage for themselves and each other, the policy the individual owns is primary and the policy owned by the spouse is secondary. For instance, the husband has UnitedHealthcare® (UHC) and his wife has Blue Cross® Blue Shield® (BCBS). She ■ Coding/Billing

■ Auditing/Compliance

■ Practice Management

To discuss this article or topic, go to www.aapc.com

Eligibility

uses her BCBS as primary and his UHC as secondary. He uses UHC primary and BCBS secondary.

Understand the “Birthday Rule” If parents have dual coverage on their children, the parent with the birthday earliest in the year is primary. For example, Mom has BCBS and is born in June and Dad has UHC and is born in November; Mom’s BCBS is primary for the children. The year of birth doesn’t factor in — only the day and month of birth. The National Association of Insurance Commissioners states, “If the parents have the exact same date of birth; the oldest policy is primary.” Be sure to check specific payer guidelines and coverage, as well as COBRA coverage and coverage for divorced parents.

Benefits Matter as Much as Coverage In addition to verifying coverage, also verify the patient’s benefits and how they relate to your practice and the treatment the patient is receiving. Many insurance plans impose a limit to benefits received or the number of specialty visits that are covered. For example, a plan may limit the number of chiropractic visits a patient can have each year. Alternatively, the plan may have a dollar limit. For example, some plans have a lifetime maximum of in vitro fertilization (IVF) treatment. If you are an IVF specialist, this is important information to know up front. Another consideration is how mental/behavioral health claims are processed. Is there a separate address or Electronic Data Interchange (EDI) number? Are these benefits handled differently? Ascertain what services are covered and how the claims are processed as they relate to your specific practice and the services being provided. Benefits also may differ based on the place of service. If services will be provided in a location other than the physician office, will that affect the patient’s benefits and claim processing? Find out.

Patient Responsibility In verifying coverage, you are able to determine what, if any, costs will fall to the patient. For example: • Does the patient have a deductible? If so, is the deductible met? How much is remaining? • Will any services provided be applied to the patient’s deductible?

CODING/BILLING

Don’t forget to ask the patient for any secondary coverage. Verify this coverage, as well. • How is the deductible calculated? On a calendar year or on a plan year? If it’s the plan year, obtain the start and end dates of the plan. • Is there a co-payment? How much? • Are you contracted as a specialist, requiring a higher co-pay amount? These are important questions to answer so the patient is informed of their financial responsibility before receiving treatment; and so the right amount is collected from the patient at the time of service. This step reduces aging accounts and increases practice cash flow.

Now that You Know Why, Here’s How Verifying eligibility can be done a couple of different ways: 1. Electronically: Either go through the payer’s secure portal on their website, or through the practice clearinghouse practice management software. Either way, print the electronic report showing the date and the time. If eligibility for that specific date ever comes into question, there’s a paper trail supporting the transaction. Verify the EDI number for the plan, as well. 2. Phone: Another option is to call each payer to verify eligibility and benefits. Be sure to document the date and time of the call, as well as the representative’s name. To ensure the claim is submitted to the correct place, verify the phone number and address for the particular plan, as well as the EDI number. Phone is usually the best way to verify benefits for a specific procedure.

Once Isn’t Enough On an annual basis, update each patient’s demographics and verify eligibility and benefits. At each subsequent visit, verify eligibility and benefits related to the visit. Beth Timpson Schleeper, CPC, CPCO, CPB, CPMA, CPPM, CPC-I, CEMC, has worked in the medical billing and coding industry for almost 20 years. She owns and operates T & T Consulting Firm (www.medicalbillingphoenix.com), a full service medical billing service, specializing in medical chart auditing, practice management, credentialing, and education. Schleeper also owns Advanced Coding Services (www.advancedcodingservices.com), T & T’s educational component, which offers Certified Professional Coder (CPC®) courses and other AAPC courses. She is a member of the Scottsdale, Ariz., local chapter.

www.aapc.com

June 2016

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■ CODING/BILLING By Oby Egbunike, CPC, COC, CPC-I, CCS-P

Modifier 25 for E/M on the Day of an Injection Procedure When there is a separate E/M service beyond the therapeutic injection, call on modifier 25. Respiratory: No cough or shortness of breath. Cardiac: No chest pain. Musculoskeletal: Swelling on the left wrist. The physician reviews the past medical history, social history, medications, and allergies. No pertinent update. Physical Examination: Vital signs: HT 5' 6", WT: 202 lbs Patient appears to be healthy, well developed, well nourished, and in no acute distress. He is alert and well oriented x 3 with normal mood affect. His skin is pink and well perfused.

nflammation of tendons, joints, or bursa resulting in joint tenderness can be very painful. Often, patients experience pain or decreased motor function in the thumb and wrist. Therapeutic injection (direct insertion of a needle into the tendon or joint for medication administration and fluid aspiration) is performed to reduce pain and inflammation. On the day of the injection procedure, a significant separately identifiable evaluation and management (E/M) service, above and beyond the injection, might also be performed. To ensure payment, append the E/M code 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.

Example No. 1 An established 57-year-old male presents to his physician with complaints of left wrist pain that he noticed four months ago. He has been taking over-the-counter pain reliever, which sometimes relieves the pain. The patient noticed swelling in the area two days ago. Review of Systems: Constitutional: No fever. 32

Healthcare Business Monthly

Assessment and Plan: The physician discusses the clinical impression with the patient. He also discusses the results of all diagnostic testing and the relevance to the current problem. The physician discusses treatment options, both nonoperative and operative, including the benefits and risks of each. The patient and physician discuss options, and the patient wants an injection performed today. Procedure: After informed consent is obtained, the patient is prepped and draped in a sterile fashion. The physician identifies the injection site by palpitation and marks the injection site. A 22-gauge needle is inserted medially, and a mixture of 1 cc of 1 percent lidocaine and 40 mg of kenalog-10 is injected into the tendon sheath. Patient tolerates the procedure well with no immediate complications. Physician recommends immobilizing the thumb and wrist with a splint or brace to help rest the tendons. Follow up is scheduled for six weeks.

Coding 99214-25 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity

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istock.com/Jan Wolak-Dyszyński

I

Musculoskeletal Exam: Both left and right wrists are examined. Finkelstein test on the left wrist is positive for De Quervain tenosynovitis.

Modifier 25 Coding

20550-LT Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”)-Left side J3301

Injection, triamcinolone acetonide, not otherwise specified, 10 mg x 4 units

20550-LT, J3301 x 4 units

Example No. 2

CODING/BILLING

Patient is a 57-year-old male who presents for follow-up of evaluation of his left wrist pain. The physician evaluated him last time and discussed waiting six weeks before considering another injection if his pain did not subside. He improved in some capacity but has continued to have difficulty moving the thumb and wrist when doing something that involves grasping or pinching.

On this follow-up visit, a significant separately identifiable E/M is not coded. There is minimal evaluation required before the procedure is performed. Oby Egbunike, CPC, COC, CPC-I, CCS-P, is a licensed ICD-10-CM instructor for AAPC. She has a Bachelor of Arts in Business Administration with concentration in Health Information Management from Northeastern University Boston. Egbunike has more than 10 years of experience in healthcare management, coding, billing, and revenue cycle. She is associate director of professional coding and education at Lahey Health. Egbunike is a member of the Boston, Mass., local chapter.

Review of Systems: No new injury or traumatic event. Plan: The physician and patient had a lengthy discussion about options, and the patient wants another injection today. Procedure: Informed consent is obtained, and the patient is prepped and draped in a sterile fashion. The physician identifies the injection site by palpitation and marks the injection site. A 22-gauge needle is inserted medially, and a mixture of 1 cc of 1 percent lidocaine and 40 mg of Kenalog-10 is injected into the tendon sheath.

References

Patient tolerates the procedure well, with no immediate complications.

HCPCS Level II 2016

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CODING/BILLING ■ By Susan Theuns, PA-C, CPC, CHC

NPI: More than Just a Number Billing and reimbursement are dependent on the taxonomy code designation and detail.

W

hen the National Provider Identifier (NPI) was implemented in 2005 as part of HIPAA, a new identifier accompanied it: the taxonomy code. With that, the Centers for Medicare & Medicaid Services (CMS) developed the National Plan and Provider Enumeration System (NPPES) to officially assign these unique identifiers of the provider. These codes were created to improve the efficiencies and effectiveness of electronic medical claims submission and electronic health information.

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What’s in a Name? When registering for an NPI, a provider must also select a taxonomy code. Taxonomy codes are nationally standardized 10-digit alphanumeric codes designed to categorize the type, classification and/or specialization of healthcare providers. When the NPI was in its infancy, providers put little importance on selecting a taxonomy code. Now payers — including Medicare and Medicaid — are rejecting claims based on inconsistencies between provided services and taxonomy codes. The Healthcare Provider Taxonomy Code Set is available from the Washington Publishing Company (WPC). Taxonomy codes are maintained by the National Uniform Claim Committee (NUCC), and updated twice yearly with effective dates for changes April 1 and October 1. Information within the hierarchical classifications includes descriptions, definitions, and the codes themselves. The codes can be primary (level I classification) or sub-classifications (levels II and III). The more detailed a classification, the more specialized the description. These codes specify a provider’s area of concentration within their discipline, so being generic is not as effectual as drilling down to the most specific code. Think of this as an unspecified versus a specified code. Depending on a provider’s underlying area of expertise, he or she may want to select more than one taxonomy code. For example, a “hand ■ Coding/Billing

■ Auditing/Compliance

■ Practice Management

surgeon” may be sub-classified under orthopedics or plastic surgery, depending on the physician’s training. Sports medicine is another example; there are eight different taxonomy codes for this specialty under: • Emergency Medicine - 207PS0010X • Family Medicine 207QS0010X • Internal Medicine - 207RS0010X • Orthopaedics - 207XX0005X • Pediatrics - 2080S0010X • Physical Medicine & Rehabilitation - 2081S0010X • Psychiatry & Neurology - 2084S0010X • Chiropractic - 111NS0005X By definition, code selection does not require board certification, per se; but it does require special education, training, experience, and knowledge in the selected area. It is important to carefully select a sub-classification from the correct and most accurate level I classification. www.aapc.com

June 2016

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NPI

Case Studies: Taxonomy Errors Affecting Reimbursement and Functionality As healthcare becomes more technologically integrated, accuracy in electronic claims submission data becomes critical to reimbursement. In today’s world, a slight variation can make the difference between full payment and denial. Because a provider’s taxonomy code resides in the NPI registry, it has a direct relationship to payer credentialing. The taxonomy code identifies any specialty or subspecialty that a provider has. Examples of taxonomy errors and necessary updates are: 1. When a resident or fellow graduates and becomes a boardcertified or state licensed physician; and 2. A provider obtains specialty credentials (e.g., an orthopedist becomes a trauma, hand, or spine specialist; a primary care provider becomes a geriatrics or palliative care specialist or hospitalist, etc.). There are numerous sub-specialties available that affect when a physician can act in a consultant role from a billing perspective. Here are some case scenarios that can result in non-payment or lack of services: Example 1: A registered nurse (RN) completes advanced training and becomes a licensed certified registered nurse practitioner (CRNP). She works in this role for several years before being told by a patient that the prescription she gave her for diabetes supplies was denied by the pharmacy. Upon researching the root cause of the denial, it was discovered that the CRNP had never updated her taxonomy code from RN to CRNP in the NPPES database. Only a healthcare provider can order durable medical equipment and supplies for a patient. Example 2: A general orthopedist sees a patient with a complex orthopedic problem in the office and asks a colleague with more specialized training to see the patient with him. Both physicians (they have the same employer and bill under the same group NPI) try to bill an evaluation and management code for the services they render. One claim is paid and one claim is denied as a duplicate service. Research reveals that, although one physician specializes in trau36

Healthcare Business Monthly

ma and the other in foot and ankle, both use the generic taxonomy code of 207X00000X (as shown in Figure 1). Had they each selected a more detailed code, they both would have been eligible to receive reimbursement for the services they rendered on the same patient, same day.

Figure 1  Taxonomy code description drop down menu from www.wpc-edi-com

Example 3: A geriatrics specialist consults on numerous hospital patients at the request of the admitting hospitalist, an internist. All of the Medicare Part B claims and some commercial claims are denied for these hospitalized patients, and the geriatrician cannot understand why. Investigation of the claims shows duplicate claims for internal medicine subsequent hospital care, no attending of record designation, and care was denied as non-participating under specialty contracts. All of these situations resulted from the provider never updating his taxonomy code from Internal Medicine to Geriatric Medicine when he passed his boards seven years prior. Even the specialty contract recognized him as primary care and disallowed his consults. In addition, the hospitalist had never updated his taxonomy code from “internist” to “hospitalist,” which added another aspect of billing inaccuracy to his claims. Example 4: A new graduate takes a job as a hospitalist and is fully credentialed upon hire, several months after completing her residency program. As a “student” in a residency program, she applies for her NPI and correctly selects taxonomy code 390200000X, as shown in Figure 2.

Figure 2  Primary taxonomy selection for a hospital resident in a training program

However, she neglects to update her taxonomy code to “hospitalist” as the primary designation and “internal medicine” as the secondary when she graduates and takes the new job. This results in rejections and denials, deeming her as ineligible to provide billable services.

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CODING/BILLING

In today’s world, a slight variation can make the difference between full payment and denial.

To discuss this article or topic, go to www.aapc.com

NPI

Example 5: A physician receives an inquiry from state Medicaid questioning whether he is a sole proprietor. The payer is holding claims awaiting his response. A quick check of his NPI profile shows he has not updated it since 2007, at which time he had indicated he was a sole proprietor. Since his initial NPI application, he has become employed by a medical group and is billing under his individual NPI and group NPI. After he accessed the portal and changed the sole proprietor response to “no,” the credentialing issue with Medicaid was resolved. Example 6: Working the rejection and denial billing reports, a director notes a pattern in a physician’s rejections from various payers stating the physician is not eligible to provide that type of service. Careful inspection reveals an outdated and incorrect taxonomy code on the provider NPI profile inconsistent with the services provided, as shown in Figure 3.

Figure 3  Rejection code based on taxonomy mismatch with service

Example 7: After months of patient complaints that no one ever calls them back when they leave messages on the office phone, it was discovered that all four providers in the practice did not think to update their NPI information when a new phone system was installed. They had to change their office phone number with the new system and thought they had it all covered when they notified payers and sent out notices to patients. Many online resources, however, draw their physician data from the NPI database, so failure to update their profiles kept the old number as their contact. Unfortunately, this went on for over a year before someone thought to check the national database. In all of these scenarios, the providers have 30 days to notify NPPES of any changes. Not adhering to this guideline is a self-imposed penalty — that exceeds potential fines from NPPES — because reimbursement can be negatively affected. Possibly because of this, NPPES rarely imposes fines for delayed updates to a provider NPI, although they maintain the right under federal guidelines.

Other Important Considerations Identifiers should be carefully reviewed upon hire and annually to ensure accuracy in reporting and billing. New taxonomy codes are added bi-annually so new sub-specialties may become available that

CODING/BILLING

Taxonomy codes and other elements of NPI registration directly affect a provider’s ability to submit claims, order services, and receive reimbursement.

allow a healthcare provider to be more specific. Providers of all levels should be encouraged to be part of the process. An NPI belongs to the provider for life and is not dependent on the employer, so they need to be engaged and part of the process. Most of the information on the NPPES website is accessible to the public. This means that if a provider puts a home address or home phone or cell phone number for contact, their patients now have access to this information. For this reason, providers should use only business contact addresses and phone numbers for NPI.

Review and Update Regularly Taxonomy codes and other elements of NPI registration directly affect a provider’s ability to submit claims, order services, and receive reimbursement. This often overlooked and neglected piece of a provider’s NPI warrants regular review and updating when changes occur, such as name change, office move, board certification, change in role, or shift in the specialty-focus of a practice, despite official certification. Last, but not least, the provider username and password for NPPES and the NPI database are the same for the Provider Enrollment, Chain, and Ownership System (PECOS), CMS Analysis and Information, and the EHR Incentives Program portal to report meaningful use and Physician Quality Reporting System (PQRS) measures. As with all usernames and passwords, they need to be maintained and carefully protected. This will save a lot of headaches for those who rely on online service portals for their livelihood. Susan Theuns, PA-C, CPC, CHC, is the administrative director of physician practices at MedStar Union Memorial Hospital in Baltimore, Md. In addition to her certifications, she holds degrees in Allied Health, Business Management and Leadership & Education. Theuns serves as a national advisor and is a contributing author for The Business of Medical Practice, 3rd edition. She is a member of the Baltimore, Md., local chapter.

Resources National Uniform Claim Committee: www.nucc.org/taxonomy CMS Center for Program Integrity, Medicare Provider/Supplier to Healthcare Provider Taxonomy Crosswalk, November 2015. National Plan and Provider Enumeration System, https://nppes.cms.hhs.gov/NPPES/Welcome.do Washington Publishing Company, Health Care Provider Taxonomy Code Set, www.wpc-edi. com/reference/ www.aapc.com

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■ CODING/BILLING By Rhonda Buckholtz, CPC, CPMA, CPC-I, CRC, CHPSE, CENTC, COBGC, CPEDC, CGSC

Get a Closer View of ICD-10-CM Glaucoma Coding Laterality and the stage of the condition are key areas to keep an eye on in physician documentation.

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ore than 3 million people in the United States suffer from glaucoma. The disease is a leading cause of blindness worldwide. It’s incurable, and vision lost cannot be regained; however, medication and surgical procedures can halt the loss of vision.

a sponge-like meshwork that acts as a drain, and then leaves the eye. Glaucoma is classified as closed or open angle.

Types of Glaucoma

Closed-angle glaucoma often presents with acute symptoms such as eye pain and blurred vision, and is considered an emergency. Closed-angle glaucoma is less frequent than open-angle. Poor drainage is caused by the angle between the iris and the cornea becoming too narrow and physically blocked by the iris. This condition leads to a sudden buildup of pressure in the eye. istock.com/Trifonenko

The optic nerve may become damaged due to eye pressure. In the front of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. The fluid leaves the chamber at the open angle where the cornea and iris meet. When the fluid reaches the angle, it flows through

Closed-angle Glaucoma

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Open-angle Glaucoma In open-angle glaucoma, even though the drainage angle is “open,” fluids pass too slowly through the drain and build up, causing pressure in the eyes to rise to a level that damages the optic nerve. Another risk factor for optic nerve damage relates to blood pressure. Not everyone who develops increased eye pressure develops glaucoma; each patient handles the pressure differently. Primary open-angle glaucoma reduces blood flow and damages the optic nerve. It also causes optic neuropathy — a condition that causes the axons of the optic nerve to die. Primary open-angle glaucoma is more prevalent than open-angle glaucoma, and is considered the leading cause of irreversible blindness in the world. The condition is less common in those under 40 years of age, and more common in those over 70 years of age. The leading causes of risk include: • Age • Increased intraocular pressure • History of fracture • Race

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Glaucoma

• Family history *Clinical stages of primary open angle glaucoma: • Diabetes Clinical Optic Nerve Nerve Fiber Layer Visual Field Stage • Poor vision • Isolated paracentral • Less bright reflex Mild • Concentric • Certain medications scotomas enlargement of cup • Fine striations to Primary open-angle glaucoma usually results from decreased outflow of aque• Nasal depression or texture • Vertical elongation ous fluid due to an acceleration and exaggeration of normal aging changes in step • Large retinal blood of cup the anterior chamber angle, iris, and ciliary body tissues of the eye. It gener• Diffuse depression vessels clear • Disc hemorrhage to ally occurs bilaterally, but it isn’t always symmetrical in the stage progression. disc ratio >0.5 but • Medium retinal blood vessels less 0.8 • Very narrow neuroretinal rim • Bayoneting of vessels • Markedly increased area of central disc pallor

• Reflex dark • No texture • Large, medium, and small retinal blood vessels clear

• Complete arcuate scotoma in both hemifields • 5° to 10° central island of vision

New for 2017, ICD-10-CM adds laterality codes for glaucoma conditions that were previously missing. Coders and clinicians must work together to ensure that all of the required documentation elements are captured to assign the appropriate code. Glaucoma is a measure for the Physician Quality Reporting System and is included in risk adjustment measures. The transition to valuebased payment models solidifies the need to correctly document and capture * Adapted from Table 3 in Optometric Clinical Practice Guideline on Care of the Patient with Open Angle Glaucoma (www.aoa.org/documents/optometrists/ these codes. QRG-9.pdf).

Rhonda Buckholtz, CPC, CPMA, CPC-I, CRC, CHPSE, CENTC, COBGC, CPEDC, CGSC, is vice president of strategic development at AAPC.

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CODING/BILLING

Be careful to note that unstageable means the physician is unable to determine the stage, not that the physician did not document the stage.

■ AUDITING/COMPLIANCE By Keileigh Neugebauer, MBA, CPCO

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Healthcare Compliance Get answers to the most popular compliance questions.

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ealthcare compliance is an aspect of healthcare touching everyone, from coders to clinicians to patients. Everyone has questions. And as a healthcare compliance consultant, I try to have the answers. Here are some of the most frequently asked questions (FAQs) healthcare entities and providers ask me: Q: There are so many regulations I have to comply with. How can I keep up with them all? A: Healthcare is a highly regulated industry and difficult to navigate legally. It’s best to contract with (or hire) someone who specializes in healthcare compliance to help you understand with which regulations your entity needs to comply, along with developing an internal compliance infrastructure and training. Make sure this professional has relevant experience, is properly certified, and is not on the Office of Inspector General (OIG) excluded individuals list (https://exclusions.oig.hhs.gov).

Q: If I am audited, can I claim ignorance of any wrongdoing? A: N  o. Lack of knowledge will not hold up in an investigation or audit. As a healthcare entity or individual, it’s your responsibility to keep up and comply with state and federal regulations. State or federal officials will hold that you should have known. Q:How often do employees need compliance training? A: E  mployees working in various healthcare roles, including coding and billing, should be trained in appropriate areas (HIPAA, HITECH, etc.) immediately upon hire and at least annually thereafter. Employees should be trained when existing regulations change or are updated and when new regulations are put into place.

• • •

•

 robust compliance program that includes on-going A auditing can optimize billing and reimbursement. A good compliance program that cites patient care and outcomes as a priority facilitates quality reporting. A compliance program increases awareness within the entire organization, creates a team approach and environment, decreases errors and avoidable mistakes, and encourages employee communication. In the event of an audit, a well-designed compliance plan shows due diligence, which may lessen imposed fines or penalties for any wrongdoing.

Q: What resources are available to help me with compliance? A: R  ecommended resources include: OIG (www.oig.hhs.gov), the Centers for Medicare & Medicaid Services (www.cms.gov), the U.S. Department of Health & Human Services (www.hhs.gov), and AAPC (www.aapc.com/compliance-management-software.aspx). These organizations provide informational articles, auditing software, news about updates and alerts, compliance ideas, and more. Keileigh Neugebauer, MBA, CPCO, is a healthcare compliance consultant with more than 10 years of experience in the field. She understands the challenges both from a business and a legal aspect, and she works in conjunction with healthcare organizations (ranging from small physician and dental practices to larger clinics) to provide an innovative healthcare compliance solution. Neugebauer performs audits, builds compliance programs, and customizes infrastructures for each organization while training employees, and is on call for compliance questions and implementation. She is a member of the Woodlands, Texas, local chapter.

Q: How can compliance help my healthcare organization? A: Above all, compliance is about healthcare organizations and professionals upholding their legal and ethical responsibilities. Efforts don’t go unrewarded, however. For example: 40

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5,400

ICD-10 Code Updates Over 5,400 new, revised, and deleted ICD-10 codes have been approved for October 1, 2016 implementation.

How will you find them? With AAPC Coder, quickly search ICD-10, CPT, and HCPCS Level II codes from anywhere you have an internet connection.

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■ AUDITING/COMPLIANCE By Michael Miscoe, Esq., CPC, CASCC, CUC, CCPC, CPCO, CPMA

Is It OK to Share HIV Status? HIPAA regulations create confusion for when physicians should disclose. In regards to “HIPAA Tip: When It’s OK to Share,” posted on AAPC’s blog (www.aapc.com/blog/33801-hipaa-tip/), a reader asks: Because persons with HIV or AIDS are a protected class, does your comment, “As necessary to prevent or lessen a serious and imminent threat to the health and safety of a person or the public.” apply in the instance where you know that your patient is HIV+ and their partner is unaware that they and their newborn baby are potentially affected with HIV? The patient refuses to disclose. Does this rule on HIPAA apply for the physician to be able to disclose to the other parent of the baby?

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Non-TPO [treatment, payment and healthcare operations] disclosures without authorization are generally prohibited under HIPAA. For the circumstances indicated, disclosure is theoretically possible; however, the legality of the disclosure must be analyzed not only under federal law, but also state law. As a general matter, because of the preemption provision of HIPAA, a more restrictive state law precluding a particular disclosure would displace a provision of HIPAA that permits the particular disclosure. HIPAA expressly subordinates authority in this circumstance to a disclosure “authorized by law.” Because HIPAA is the federal law provision that regulates disclosures of health information and provides no definitive answer, look to state law for the legal authority to disclose. There may be a different answer to this question for each state. Besides that general issue, it’s important to understand that, under HIPAA, disclosures are categorized into two basic categories: The first pertains to those that do not require authorization (disclosures necessary for TPO as discussed in the regulations at 45 CFR §164.506(c)). For these disclosures, either an acknowledgment by the patient of “receipt” of the covered entity’s Notice of Privacy Practices, or a good faith attempt at obtaining such acknowledgement, is sufficient to permit disclosure of PHI subject to the minimum necessary 42

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disclosure rule. The second category of disclosures requires an authorization, which is addressed in the regulations at §164.508. Beyond these general provisions, HIPAA addresses disclosures that the covered entity must provide the patient with the opportunity to object (§164.510) and the non-TPO disclosures for which an authorization or opportunity to agree or object is not required (§164.512). The specific type of disclosure addressed by the questioner and the article is one that is permitted for public health authorities as follows: § 164.512 Uses and disclosures for which an authorization or opportunity to agree or object is not required. *** (b) Standard: Uses and disclosures for public health activities. (1) Permitted uses and disclosures. A covered entity may use or disclose protected health information for the public health activities and purposes described in this paragraph to: *** ■ Coding/Billing

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Ask the Legal Advisory Board

AUDITING/COMPLIANCE

Disclosure of the risk of infection in the baby presents no real problem unless the HIVinfected mother is NOT the person authorized to make treatment decisions for the child.

(iv) A person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, if the covered entity or public health authority is authorized by law to notify such person as necessary in the conduct of a public health intervention or investigation; Because the questioner does not tell us if the contemplated disclosure is authorized by state law, or whether the entity contemplating the disclosure is engaged in a public health intervention or investigation, we cannot determine whether the contemplated disclosure is permissible. There are other options based on the specific facts presented, however. Disclosure of the risk of infection in the baby presents no real problem unless the HIV-infected mother is NOT the person authorized to make treatment decisions for the child. Certainly, you can’t disclose anything to a newborn. As a result, the disclosure to the minor child must be made to the person who stands in the shoes of the child for HIPAA purposes – the person who is authorized to make treatment decisions for the child. The mother, who ostensibly also has the disease and who also rightfully makes treatment decisions on behalf of the newborn, is therefore permitted to receive information about the child’s HIV risk. Such a disclosure of the child’s risk to the mother would be (for HIPAA purposes) construed as a disclosure to the patient. There is no issue here as a result. With a domestic partner, or even a legally married partner, disclosure is a bit trickier from a HIPAA perspective. I would not suggest reliance on the public health disclosure authority without more analysis of the specific facts. It is easier and safer to simply obtain authorization from the patient to disclose the patient’s HIV status to the partner. When the patient refuses to permit disclosure of the risk to

a partner based on the patient’s HIV status, the disclosure is only permissible if authorized by law [for the purpose of notifying] such person as necessary in the conduct of a public health intervention or investigation. Use of the public health disclosure authority under Section 512 requires you to first identify the legal authority permitting the disclosure. To this end, I would recommend that the questioner get an opinion in their state from competent state health law counsel who can analyze the specific facts associated with the contemplated disclosure, as well as the relevant provisions of the applicable state law, before proceeding. Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA, is president-elect of AAPC’s National Advisory Board, serves on AAPC’s Legal Advisory Board, and is AAPC Ethics Committee chair. He is admitted to the practice of law in California as well as 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. Miscoe has over 20 years of experience in healthcare coding and over 18 years as a forensic coding and compliance expert. He has provided expert analysis and testimony on coding and compliance issues in civil and criminal cases and represents healthcare providers in post-payment audits and HIPAA OCR matters. Miscoe is a frequent lecturer and is published widely on a variety of coding, compliance, and health law topics. He is a member and past president of the Johnstown, Pa., local chapter.

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■ AUDITING/COMPLIANCE By Mark Schneider, MBA, CPCO, Julie Hamilton, MBA, and Yesenia L. Contreras, MHA, CPC-I

Liven Up Compliance Training with Short Videos

istock.com/Feverpitched

Enhance compliance e-learning to engage employees and physicians.

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nternally developed video is a cost-effective compliance solution that can enhance or replace your current employee training. You can also incorporate video clips in instructor-led trainings and PowerPoint presentations to add powerful visual cues to lectures and static media.

through manuals and binders is a powerful tool. For compliance educators, the ability to assign, track, coordinate assignments, and assess employee skills on a learning management platform is an efficient, enterprise-wide deployment method.

Short Videos Make a Difference

Video Training: A Successful Case Study

Video training may conjure thoughts of a dusty VHS player on a television cart, but with Web-based video clips accessible from mobile devices anywhere, anytime, video training isn’t what it used to be. YouTube and similar websites are powerful learning tools because video engages many senses, which improves recall. The on-demand aspect facilitates learning, as well. Watching a topic-focused video can be both entertaining and educational. For learners, the ability to look up (and retain) targeted information (e.g., a new policy or best practice) without having to pile

The Yale New Haven Health System (YNHHS) Office of Privacy and Corporate Compliance (OPCC) partnered with the Information Technologies Services department at Northeast Medical Group (NEMG) to produce a series of five-minute or less videos on various compliance topics to post online. The series included video courses on: • Modifier 25 • HIPAA Subpoenas • Incident-to • Prolonged Services • Gifts and Gratuities • Safe Cash Handling • Transitional Care • Information Security

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Compliance Videos

AUDITING/COMPLIANCE

Video training may conjure thoughts of a dusty VHS player on a television cart, but with Web-based video clips accessible from mobile devices anywhere/ anytime, video training isn’t what it used to be. From this experience, YNHHS and NEMG recommend the following tips for producing short video clips for the purpose of compliance training: 1. Involve the right people: Consult with experts to ensure your training videos provide accurate information and instruction. YNHHS/NEMG videos were developed in house and the presenters were members of the compliance, information security, and legal departments. 2. Keep it short, make it accessible: To better determine the wants and needs of your target audience, conduct a web-based survey to physicians. In conducting such a survey, YNHHS OPCC learned NEMG physicians want on-demand learning (24/7) in a format that is easy to digest, focused/short, and works within the fast-paced customer service-oriented schedules of providers. 3. Involve the learner: One way you can do this is to include a short, three-question quiz following the course to assess the viewer’s comprehension. Where can you learn how to make short videos? Online of course! Mark Schneider, MBA, CPCO, is compliance lead at YNHHS OPCC in New Haven, Conn.

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Yesenia L. Contreras, MHA, CPC-I, is chief compliance and privacy officer, executive director-compliance & internal audit at Southcoast Health System, New Bedford, Mass.

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■ PRACTICE MANAGEMENT By Kim Cohee, DPT, PT, OCS, MBA

Keep Providers Focused on Quality Improvement and Implementation Q

uality improvement has been the focus of healthcare providers, managers, and administrators for many years. Much of the information gleaned in measuring, tracking, and analyzing quality improvement can benefit an organization, but changes can be difficult to implement with providers and employers.

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Define the Challenge

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Along with a greater focus on quality care, implementation science is being used to describe the incorporation of evidence into healthcare practice. What exactly are quality care and implementation science? Value and cost commonly play a primary role in the definition of quality care. One typical equation is: Value = Quality + Service/Cost (V = Q + S/C) Quality components include safety, efficiency, and effectiveness. Effectiveness relates to value and typically is a factor of patient outcomes and satisfaction. Implementation science is “the study of methods to promote the integration of research findings and evidence into healthcare policy and practice,” as defined by the Fogarty International Center. Key elements of implementation science include: • Investigating and resolving biopsychosocial barriers that hinder implementing successful changes; • Testing innovative methods developed to sustain and advance health programs; and • Determining the relationship between employed interventions and their effect(s).

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Quality Improvement in Action To examine how quality improvement and implementation science can benefit patient care in the clinic setting, consider the following example. The outpatient orthopedic physical therapy clinic where I work recently implemented several projects to improve how patient care is provided. With more than ■ Coding/Billing

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An orthopedic clinic shares its experience, so you can see how to improve patient care using evidencebased analysis.

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Quality Improvement

30 providers at the clinic, questions regarding how best to address specific patient disorders and diagnoses are a part of good evidencebased practice. These questions are often best answered by outcomes data (both patient and provider-driven measures). Patient satisfaction surveys and patient-reported functional scores are common measures for such data. In the clinic, we frequently use patient functioning scores, such as: • Lower Extremity Functional Score (LEFS) • Disability of the Arm and Shoulder (DASH) • Oswestry Disability Index (ODI) • Neck Disability Index (NDI) Our projects are most rewarding, effective, and meaningful when implemented by clinical staff who work day to day with patients. But first, providers and staff must be empowered to recognize current and potential obstacles in everyday care. Facilitating meaningful projects without adversely affecting billable patient care time — or adding to providers’ already busy schedules — can be challenging. We took this challenge on and have learned a great deal.

Our Process

ical to success. This took several meetings to accomplish. Without this step, there was a risk that everyone on the team would go in a different direction. A process map, or flow chart, proved helpful in clarifying the current process and outlining the desired, ideal process. As shown in Figure A, a process map visually steps out a process. For us, this helped to expose barriers to the project and patient care. We also learned that it’s helpful to answer key questions early on, such as: • What key tools are needed? • What metrics and baseline data are required to determine success? • Who has access to the needed data? • How long do data requests take to fulfill? • Is the data easily interpreted or will outside input be needed? • Are there additional staffing needs? For us, key tools included the aforementioned value summary and process map. Figure A

We initiated the project during a brainstorming session, while considering the quality goals of our healthcare system. We then asked for ideas related to specific quality projects and discussed those suggestions. After narrowing the number of projects to six, we asked providers to choose a project to work on. Each resulting group included two to eight providers. Early on, it was clear that some providers were more engaged than others, but this was expected. Three initial steps helped lay the groundwork for making changes: 1. Reviewing established, as well as planned, clinic processes; 2. Determining if the work was implemented as intended; and Each team’s process was outlined in a specific format referred to as a value summary. The value summary organizes the project and documents the ideas and goals in a standardized format. When this was complete, we began assessing what changes could be employed to best meet the needs of our patients. We learned that clarifying the goals and purpose of each idea is crit48

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3. Evaluating if the processes addressed patient needs.

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Access to data can be challenging. Many entities may be vying for the time and resources of those responsible for data acquisition, and your team’s request could be further down the queue than desired. It’s important to keep your team motivated and engaged during the wait time. Implementation of the new process is where your team needs to remain vigilant. Pay attention to details, and make sure that providers, support staff, and anyone else who is involved communicates openly.

Learn from Your Data When your new process is implemented, everyone is communicating, and enough time has passed to acquire new data, you can evaluate the success of the process. This allows you to see the impact of the changes and to celebrate the wins, adjust the process where your expectations were not met, and move on to a new project. Because quality improvement is a desired part of the clinic culture — not just a project with a start and end point — it’s important to keep the initial teams you formed, and ask the groups to choose a new project or perfect the process they implemented initially. Here’s an example: • Questions: Which providers are most effective with patient care? (i.e., the least number of visits with greatest improvement in patient reported functional outcomes) • Goal: Determine best practices for clinical care in patients with low back pain and apply those practices more broadly across the clinic to improve care and decrease patient costs. • Process: Review data regarding patient outcomes and the number of visits for clients with low back pain for all providers. • Barriers: Assess data accessibility, and whether providers are putting information into the electronic health record consistently. • Results: Providers who apply evidence-based practices for low back pain have the fewest number of visits and greatest improvement in patient-reported functional outcomes (hypothesized). • Plan: Educate all providers to apply evidence-based practices consistently with patients experiencing low back pain.

Because quality improvement is a desired part of the clinic culture — not just a project with a start and end point — it’s important to keep the initial teams you formed, and ask the groups to choose a new project or to perfect the process they implemented initially.

PRACTICE MANAGEMENT

Implement Your Process

Quality Improvement

These process examples are an actual project in our clinic, and we are still awaiting the data to determine if our hypothesis is true. So far, the data tells us that providers collect necessary information much more consistently if asked (or told) to do so at every visit. Significant pushback has occurred, with complaints coming from front desk staff, providers, and patients; however, other clinics in our system that attempted to get the necessary data were unsuccessful because patient-reported outcomes were collected only every third visit, or only at intake and discharge. Educating the front desk and providers of these previous failures is beneficial. Providers have begun to educate patients about the importance of the data and how it can help them to improve care. We are looking forward to continuing the projects that prove fruitful in terms of improving quality, costs, and service. The projects that are not fruitful, where the work effort exceeds the benefits of the potential outcomes, will be re-evaluated and either terminated or redesigned. Several groups are moving onto new projects, and our improved focus on quality improvement and implementation science is gradually imbedding into our culture. These changes will be most rewarding for those who enjoy working with colleagues in a structured way, measure what they are doing, and implement meaningful changes that results in improved patient care.

Resources Fogarty International Center: www.fic.nih.gov/ResearchTopics/Pages/ ImplementationScience.aspx Kim Cohee, DPT, PT, MBA, OCS, is the clinical operations director of the University of Utah Orthopaedic Center Therapy Services. She graduated from the University of Utah with undergraduate and doctorate degrees in Physical Therapy and a Master of Science in Exercise Physiology. Cohee received a Master of Business Administration from Western Governors University in 2009, and achieved Orthopedic Clinical Specialist designation in 2006.

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■ PRACTICE MANAGEMENT By Lanaya Sandberg, MBA, MHA, CPCO, CPPM, FAHM

Strategize for a Healthy Future The best laid plans are patient-centered, personalized, and create productive staff.

trategic planning is a blueprint to give a healthcare organization a competitive advantage through distinction. All healthcare organizations, regardless of size, should have a tangible strategy because it facilitates a better understanding of what the organization does, what it wants to become, and how it will get there.

Strategy Types Strategy is a misused buzzword in today’s healthcare business context: It’s not a synonym for business model, approach, or operating model — which all describe processes and procedures to yield positive cash flow. Rather, strategic planning is external facing and attempts to capture and review all the dimensions of relevant, comparable, direct and indirect competitors. Healthcare organizations may choose from an abundance of strategy types. Michael Porter’s Competitive Strategy serves as the foundation for many of today’s business strategies. Porter offers the following four strategies: • Cost Leadership - Offering low prices and focusing on the reduction of expenses, where the primary emphasis is cutting costs to boost market share. This strategy is most advantageous for organizations that have access to capital, are committed to continuous improvement, and have a method to sustain cost reduction that is below their competitors’. • Differentiation - Distinction among services and products through avenues such as customer service and patientcenteredness, quality, performance, and other attributes patients value — high-quality is key here. This strategy is best 50

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Common Themes of Strategic Planning 1. Ensure it is mission-driven. At the heart of strategy are the organization’s goals and objectives, which stem from its mission statement. In healthcare, an organization’s mission statement should be driven by quality and patient-centeredness. Goals must be created carefully by surveying the external environment and internal organizational competencies. One analytical tool for accomplishing this surveillance goes by the acronym SWOT, which stands for strengths (internal), weaknesses (internal), opportunities (external), and threats (external). SWOT sheds light on the environment a healthcare organization operates in and enables it to visualize its future. Key focus areas for organizations today are improving quality outcomes, the patient experience from a customer service perspective, increasing accessibility to specialists, a holistic approach to population health management, and optimization of electronic health records. 2. Take a collaborative, all-encompassing approach. When an organization creates its overarching strategy, all functional areas should be involved in planning to ensure a cohesive approach. It’s also important to have the right contributors from each represented area — those who are change makers and catalysts for innovation. To identify the right contributors, ask yourself: Does the individual have the required expertise? And are they able to relinquish their personal agendas for the best interests of the organization? ■ Coding/Billing

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suited for organizations that have robust marketing and sales, along with research and design programs, and are incubators for innovation. • Cost Focus - Prices are competitively established and targeted to a tapered market. For example, an organization may elect to reduce prices on its chargemaster for the most commonly used services or products to attract more volume and market share. • Differentiation Focus - Offering inimitable products or services to a limited market. Using this strategy, a healthcare organization could focus on a specific patient population, service, or other means of revenue generation. An example is a telemedicine program focusing on homebound patients. There is not a one-size-fits-all strategy; each organization should ascertain which option would best serve its needs. When an organization ascertains which strategy to pursue, it’s then ready to begin the planning process.

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fective if the organization does not have an operating or action plan, per functional area, to support the commitments and direction of the strategic plan.

PRACTICE MANAGEMENT

3. It must be well publicized. Finalized, executable strategies should be shared with all employees because each individual matters and needs to engage in a common mission. Each employee also must thoroughly comprehend how their roles, responsibilities, and outputs impact the strategic vision and success of the organization. 4. Self-awareness is essential. It’s important to recognize and account for assumptions when pursuing a specific tool, technique, or course of action in the strategic planning process. When stakeholders in the planning phase do not reflect on how and why they are thinking the way they are, the organization runs the risk of repeating the same ineffectual actions and unfavorable performance results. Organizational change and improvement hinges on encouraging leaders, managers, and healthcare providers to reflect on this, as well, from a systems thinking perspective. The Plus/Delta method, or lessons learned, can be used throughout the year to identify what worked well and present opportunities for improvement in the next iteration of strategic planning. The “plus” side captures what went well, and the “delta” side identifies improvement areas. 5. Have an agenda. A strategic plan has long-term focus, and typically includes: • An overview of the organization’s mission statement, supporting goals, and objectives; • External trends, such as Medicaid expansion, managed care payment reductions, continued primary care physician and specialist shortages; • An approach for profitable growth (e.g., partnership opportunities, renegotiation of vendor/payer agreements, retention and recruitment of providers, expanding technology capabilities); • Identification of financial and non-financial success criteria; • Competitor analysis (e.g., strengths and weaknesses of the top five competitors). It also includes exploring central trends, consolidations, and innovative care models (e.g., home and community-based care, telemedicine, valuebased arrangements with payers, or greater use of physician extenders); • An analysis of patient mix and what their needs and wants are, and how to improve their experience and engagement; • Key actions that will transform positioning to a differentiator and a pioneer; and • Resources that promote profitable growth, including support from applicable health systems, communitybased organizations, advocacy organizations, state-run medical programs, or accreditation and certification bodies, especially for purposes of care coordination. Remember that a strategic plan is only a means to an end. It’s inef-

Strategic Planning

Monitoring and Oversight Monitor strategic and operating plans on an ongoing basis. Depending on the nature of the organization, there are tools to assist in measurement. There are four different types of measures to use: project, outcome, quality, and efficiency. Examples include: • The quantity of new physician extenders added to a practice; • Change in patient satisfaction scores; • The Healthcare Effectiveness Data and Information Set and quality measurement scores; and • Return on investment, revenues, and the price-earnings ratio (for publically-traded practices). Regardless of the measurement used, monitoring and oversight must be permanently ingrained in the business.

Culture and Strategic Change Strategic and operating plans require deft and masterful execution by healthcare leaders who anticipate transformations on the horizon and prepare their teams for disruptive change ahead. An often overlooked aspect of a strategic plan is follow-through. Leaders must play a continuous role and be responsible for ensuring milestones are praised, wins are not declared prematurely, risks are proactively identified and mitigated, transparent channels of communication are established, and accountability is assumed for any failures.

Key Thoughts With a healthcare delivery system design that promotes competition among providers, the concept of strategic planning is necessary for all organizations. In a healthcare context, it’s imperative that strategic focus remains centered on patients, offers personalized approaches, and creates more productive patients. Lanaya Sandberg, MBA, MHA, CPCO, CPPM, FAHM, is a member of the Chicago, Ill., local chapter.

Resources Michael E. Porter, Competitive Strategy, Simon & Schuster, Inc., Inc., http://books. simonandschuster.com/Competitive-Strategy/Michael-E-Porter/9780684841489 Plus/Delta evaluation method: https://goleansixsigma.com/driving-accountability-tomaximize-results-using-the-plus-delta-tool/ www.aapc.com

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■ PRACTICE MANAGEMENT

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By Brian Shrift, CISSP, HCISPP

If you don’t address vulnerabilities now, the odds are against you when disaster strikes.

I

nformation technology (IT) is a critical part of your healthcare organization. To effectively secure its data and systems, your organization’s IT support must be up to date on the latest trends, technologies, and efficiencies and they must maintain the most current certifications. If you aren’t confident (and, probably, even if you are) that your organization’s data is being managed properly, now’s the time to examine its infrastructure more closely.

It Won’t Happen to Me Too often, I hear clients and business associates say silly things like: 52

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• “It will never happen to me.” • “I’m just a small practice; I’ll never get audited for HIPAA compliance.” • “I’ll never be hacked.” • “My email will never be compromised.” • “My server will never fail.” • “I’ll never have a fire that will destroy my business.” • “No one will steal my laptop.” Contrary to these misconceptions, IT vulnerabilities and the resulting loss of data, data breaches, downed systems, and other nightmares occur regularly in organizations of all sizes. The odds against you are too high and the consequences (financial and otherwise) are too serious to assume the worst will never happen.

Backup and Disaster Recovery A proper backup and disaster recovery plan is vital. If you need a reason why, consider this: If your IT systems are down, you’re losing revenue. Specifics you should examine include: ■ Coding/Billing

■ Auditing/Compliance

■ Practice Management

To discuss this article or topic, go to www.aapc.com

IT Support

Backup Plan – Have a written plan detailing how your systems are backed up, what is being backed up, how often the backup is occurring, and the retention policy of the backup (how long old data is retained). A backup that occurs every five minutes is significantly better than one that occurs each night. Backup Media – On what media is the backup being saved? Find out if it is a backup to tape, hard drive, universal serial bus (USB) drive, online backup, etc. Each presents a mix of pros and cons. For instance, if you’re backing up to tape or USB drive, is that media then taken offsite? If so (and it should be), be sure the backup data is encrypted. This will protect the integrity of the data in the event it’s lost or stolen. If you’re using an online backup provider, ensure it meets your regulatory needs for security and reliability. If you’re backing up to a device that remains onsite, and there’s a fire, flood, or other catastrophic event that ruins both your production data and backup data, will your organization be ruined? Make sure you have a plan B. Mean Time to Recovery (MTTR) – This simply means the average time it takes for your systems to be operational again in the event they go down. This is important because if your systems go down, you’re immediately losing revenue. Determine how long it will take for IT support to get you back online and whether there will be data loss. If your server crashes, will it take four hours or four days to recover? The difference could mean an organization’s survival or failure.

Test Your Backup and Disaster Recovery Solutions You do not have a working backup and disaster recovery plan until it has been tested. Even if your backup reports “Success,” don’t trust it. The only way to ensure success is by testing it.

Questions to Ask an IT Support Vendor If you’re thinking about hiring an IT support vendor, talk to other business partners about their IT support solutions and experiences. Find out whose services they use, and the pros and cons to those services. If you’re ever in doubt about your IT support, or want a second opinion, invite a competitor or outside IT support company to review your systems. A peer review may reinforce recommendations

PRACTICE MANAGEMENT

If your IT systems are down, you’re losing revenue.

IT Support vs. IT Management I describe IT support vs. IT management as “Reactive vs. ProActive.” Many people or companies providing IT support are simply there to provide support in a time of need. IT support is great, but most organizations need more. Someone providing IT management knows you’ll need support, but also proactively works in the background to maintain, monitor, and document your IT systems. IT maintenance used to consist of disk defrags and the occasional service pack. Today, there are a number of proactive measures. For example: • Up-to-date systems patches protect against the latest vulnerabilities; • Reliable anti-virus and spyware protection further guards against hackers; and • Optimized configurations keep systems running smoothly. This isn’t something that’s done once, but repetitively. Just like a regular oil change, if you maintain your systems, they will last longer and perform better. Continuous monitoring is an important proactive measure to prevent downtime, respond to and resolve problems quicker, and prevent revenue loss. IT management should work with the business owner or manager to budget, improve, and plan IT expenditures. Whomever you have in this position should be able to discuss IT with you in language you can understand. You can’t make the best business decisions for your organization if you don’t understand the information provided to you.

made to a client, or confirm there is nothing further of value they can provide. Remember that you get what you pay for. It’s more important to hire someone who wants to work with you and who understands you – someone you can trust as a business partner. This is an important partnership because IT is so critical to your organization.  If you want to test your IT support, copy a folder or two of documents to an alternate location and time how long it takes them to recover the files. This is a nominal task that should take under 30 minutes to accomplish. Brian Shrift, CISSP, HCISPP, is president of Precision Business Solutions.

www.aapc.com

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■ PRACTICE MANAGEMENT By Bridget Toomey, CPC, CPB, CRCR, RYT-200

Feng Shui Your

WO R K SPAC E

F

eng Shui is a classical Chinese philosophy of design. In English, Feng Shui means “wind water,” which in Chinese culture are two universal forces necessary to life. What can Feng Shui do for you at work? It can help you to become more productive by reducing clutter, and it can inspire you to work towards your goals by setting positive intentions in your space. Here are some Feng Shui design techniques for setting up your work space to best serve you and your career.

Use design philosophy to create vibrant and positive energy in your office space. Hang a Mirror A mirror can serve to reflect negative energy entering your space. It also allows you to see who is coming up behind you if you are not able to face the entrance of your work space. Being caught by surprise when someone approaches you from behind creates tension. Any mirror will do, but an eight sided mirror is optimal to represent all the universal forces.

Clean and De-clutter Your Work Space

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Foundation, Family Wood, Past

Ab Pro und We spe ance alt rity h

Fame Reputation

Earth

H Ble elpf ssi ul P n Fa g, T eopl th rav e, er e l,

Physical Health

ge led ow om Kn Wisd kills S

Each corner of your work space, whether it’s a cubicle or a corner office, has a sector representing an area of your life. The north is your career sector; the northeast is your knowledge sector; the east is your family sector; the southeast is wealth; and the center is health and overall wellbeing (see Bagua map). As you place an object in each of these sectors, be mindful of what it represents.

P

Creativity, Children Future, Metal

Object Placement Matters

A MA U G BA

ip sh er ion th lat Mo Re ve, Lo

If you have piles of loose paper lying around, remember that in the age of technology most documentation can be saved electronically. Mindfully review each piece of paper and either recycle, shred, or file it to clear off your work station. An unorganized and messy space creates negative energy and is counterproductive. It can also reflect badly on you in front of your clients, co-workers, and boss.

Career Path in Life

■ Coding/Billing

■ Auditing/Compliance

■ Practice Management

To discuss this article or topic, go to www.aapc.com

Feng Shui

Add a Healthy Plant If your office or cubicle has a lot of corners or angles, use a healthy plant to round out the space. Corners and sharp angles break up the flow of a space, once again creating negative energy. Plants also serve as a natural air purifier. Just don’t forget to give them that all-important element: water!

Choose the Right Colors When choosing colors for your office space, understand what each color represents in Feng Shui design: • Red is a fire element and represents fame and reputation. • Yellow is an earth element and represents unity, health of the business. • Green is a wood element and represents growth, teamwork, new beginnings. • Blue is a water element and represents knowledge and skill building. • Purple is a wood element and represents prosperity. • Gray is a metal element and represents helpful people and travel. • White is a metal element and represents productivity, creative expression. • Black is a water element and represents career, business journey. • Pink is an earth element and represents primary business relationships.

Create Equilibrium To keep your space well balanced you should have representation from all five elements: earth, metal, water, wood, and fire. Depending on where you work, your space may

PRACTICE MANAGEMENT

Each corner of your work space, whether it’s a cubicle or a corner office, has a sector representing an area of your life. weigh highly in one of these areas. In healthcare, we have a lot of metal in our work spaces. To incorporate the fire element, consider adding lighting to brighten dimly lit work areas. To incorporate the water element, add a small water feature in your office space. Strategic placement of a few plants (as mentioned above) covers the earth element. And a few wooden picture frames to display your family photos takes care of the wood element. These are just simple suggestions, but you get the idea.

Setting Intention Every object you bring into your workspace should have an intention, and each intention should be directed toward a goal you’ve set for yourself. Using Feng Shui in your work space won’t help you if you don’t know what your goals are. Create goals you can achieve. Placing coins in your wealth sector with the goal of becoming a millionaire overnight is not an achievable goal (for most of us anyway); but placing coins in your wealth sector with the goal of getting a raise at the end of the fiscal year is an obtainable goal. Seeing those coins will remind you of that goal daily. Bridget Toomey, CPC, CPB, CRCR, RYT-200, works for the University of Iowa Hospitals and Clinics in Patient Financial Services as a revenue cycle coordinator, where she supervises staff on the physician Iowa Medicaid team. She also teaches Kundalini yoga at Heartland Yoga in Iowa City, Iowa. She is certified by the Kundalini Research Institute as a Kundalini yoga teacher and is a member of the International Kundalini Yoga Teachers Association. Toomey is a member of the Iowa City, Iowa, local chapter.

Resources Hale, Fill. The Practical Encyclopedia of Feng Shui. London: Anness Publishing, Ltd., 2002. Print. Ziegler, Holly and Lawler, Jennifer. Feng Shui Your Workspace for Dummies. New York: Wiley Publishing, Inc., 2003. Print.

www.aapc.com

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■ ADDED EDGE By Michelle Clark, CPC

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COMMUNICATE LIKE A PRO

Consider 10 must-have communication skills in today’s environment.

T

he ability to communicate effectively with superiors, colleagues, and staff is essential, no matter what industry you work in. Although our modes of communication have changed in recent years, the goal is still the same. Healthcare business professionals must be able to effectively convey and receive messages in person, on the phone, in email, and through social media. These “Top 10 Communication Skills” will help you communicate like a pro and make a good impression in today’s workforce.

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1

Listen Being a good listener is one of the best ways to be a good communicator. No one likes communicating with someone who only cares about putting in their two cents, and does not take the time to listen. Through listening, you can better understand what the other person is trying to say, and respond appropriately.

2

Watch Body Language Nonverbal cues — such as eye contact, hand gestures, and tone — speak volumes. Paying attention to the other people’s nonverbal signals will make you a better communicator. For example, if someone you’re speaking to isn’t looking you in the eye, they may feel uncomfortable. Check your body language to see if there’s anything you can do to make the person feel more at ease. A relaxed, open stance and a friendly tone, for example, will make you more approachable and encourage others to speak openly with you.

Communicate

3

Be Clear and Concise

8

People will be more open to communicating with you if you convey respect for them and their ideas. Take simple steps to show respect, such as using a person’s name, making eye contact, and actively listening to the person who is speaking. Convey respect through email by taking the time to edit your messages. If you send a sloppily written email, the recipient will think you do not respect them enough to think through your communication, and they will probably misunderstand your message, as well.

Try to convey your message in as few words as possible. Be clear and direct, whether you’re speaking to someone in person, on the phone, via email, or in an instant message. Think about what you want to say before you say it; this will help you to avoid talking excessively and/or causing confusion.

4

Be Friendly A friendly tone, a personal question, or simply a smile, will encourage others to engage in open and honest communication with you. Personalize email messages to make the recipient feel more appreciated. Something as simple as “I hope you had to good weekend” can make a difference.

5

6

Be Empathetic Even when you disagree with someone, try to understand and respect the person’s point of view. Simply saying, “I understand where you are coming from,” demonstrates empathy.

7

9

Be Open-minded A good communicator enters a conversation with a flexible, open mind. Being open-minded allows you to see the other person’s point of view. Be willing to enter into a dialogue, even when you have a difference of opinion, to have more honest and productive conversations.

Give Feedback Being able to give and receive constructive feedback is an important tool in effective communication. Simply saying “good job” to an employee, for example, can greatly increase motivation. Listen to and learn from the feedback others give you.

Be Confident When you are confident, you instill confidence in others. To appear confident (even when you aren’t) remember your other skills: Watch your body language (stand tall and smile) and speak clearly and concisely. Just be careful not to sound arrogant or aggressive.

Be Respectful

10

Pick the Right Medium Knowing which form of communication to use is an important communication skill. People are more likely to respond positively to you if the message matches the medium. For example, serious conversations — such as salary negotiations — are best done in person. Simple questions or requests may be better handled, and less intrusive, if communicated via email.

Honing your communication skills takes effort. As President Theodore Roosevelt once said, “Nothing in the world is worth having or worth doing unless it means effort, pain, and difficulty.” This may seem extreme, but oftentimes the challenges we encounter garner the greatest rewards. Michelle Clark, CPC, works for a multi-specialty clinic of 150+ providers. She also works part time as a coding consultant for Health Solution. Clark has been in healthcare for 25 years, 10 as a coder. She is a former member developmental officer and education officer for Springfield, Mo., local chapter.

…effective communication requires more than an exchange of information. When done right, communication fosters understanding, strengthens relationships, improves teamwork, and builds trust. —Liz Papadopoulos www.aapc.com

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■ ADDED EDGE By Tara Cole, CPC, CPMA

Increase your chances of a promotion by helping your healthcare organization grow and succeed. complexity of coding, and the technical 1. Get comfortable with being Theopportunities that many practice management systems offer, create the need for highly skilled coders who want to learn and develop professionally. Healthcare organizations and physician offices look for these employees, whose valuable input can aid in the growth and success of the business. Here are eight tips that will help you become a key player in your organization:

uncomfortable.

Push yourself to learn new things. The field of coding never should become boring or stagnant. Learn a new specialty. Continue to take on new responsibilities and to move outside of your comfort zone. Life as a coder means constant learning and change. That’s why we love the field!

2. Be open to change. Just because something has been done a certain way through the years doesn’t mean it needs to stay that way, or should. Be open to evaluating opportunities that provide efficiencies and to making changes based on best practice standards.

3. Be curious. Coding is not black and white. Use your critical thinking skills to draw your own conclusions. Supervisors and managers shouldn’t be the only ones finding solutions to problems. Do your homework before bringing a problem or question to them so you can offer solution-based ideas and options. Those ideas can start discussions with your manager and increase your value in the eyes of your employer.

4. Stay connected. Professional connections are valuable in this career. Develop your professional network of peers and profit from the wealth of combined experience.

5. Get technical. If you don’t like computers, coding is probably no longer your gig. Close to 100 percent of coding jobs are now done on a computer. Electronic health records (EHRs) and charge capture have automated many previously manual processes, lessening the need 58

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for data entry and charge posting. Coders typically audit clinical staff and providers’ coding in the EHR, as well.

6. Challenge yourself. If you want to advance in the field of coding, you’ll also need to advance your computer software skills. Reporting is a huge piece of managing or supervising coders. Take classes to learn more about Microsoft Excel and other programs used by your organization.

7. Be honest. Integrity is an extremely important quality, especially in the field of coding. Honesty will gain you trust and respect, but it will also help protect your organization from scrutiny and adverse effects. Coders have advanced insight in certain areas that might not be understood by non-coding professionals. Share your insight with your administration and physicians if something doesn’t seem right. Your input will be appreciated.

8. Use your time wisely. Make sure to take time outside of work time to focus on your career. Read Healthcare Business Monthly and other publications relating to the field to continue learning. Listen to coding webinars not only to obtain continuing education units, but also to increase your knowledge base. If you read for enjoyment, read one business-related book to every three books you read for enjoyment. Do these things and you will become noticed and respected by your organization’s leadership, and increase your chances of a future promotion. Your destiny is up to you. Best of luck! Tara Cole, CPC, CPMA, is the manager of coding and billing integrity for Orthopedic Institute in Sioux Falls, S.D. She has been in the billing and coding industry since 2001. Cole is a member of the Sioux City, Iowa, local chapter.

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Advance in the Career You Want

Join the growing field of

Medical Documentation CDEO

Become a Certified Outpatient Documentation Expert Today!

AAPC - Membership (CDEO)

Visit aapc.com/CDEO to learn more about this new certification.

■ ADDED EDGE By Brad Ericson, MPC, CPC, COSC

Project Xtern Helps Break Barriers

It’s a win/win for the extern, the mentor, and the healthcare industry. I am very thankful to be gaining the training and experience that will serve as the foundation for my career,” McDonald said.

I

t seems so unfair. You studied so hard, staying awake late hours to master new (and often illogical) concepts. You practiced coding until your eyes glazed over, you tabbed your books, and one day, belly filled with butterflies, you successfully tested for your credential. But your lack of experience still keeps you from landing your first job in the coding field. AAPC’s Project Xtern program may help you break through that last barrier. There are approximately 300 Project Xtern sites throughout the country where newly credentialed coders can get hands-on experience. While most externs don’t receive financial pay, the experience and work references you gain can help you land a paying gig. Plus, the program is free to members who qualify, making on-site learning the icing on the educational cake.

Apprentices Get Experience Judy Wilson, CC, CPC, CPCO, CPC-P, CPB, CPPM, CPC-I, CANPC, has hosted a Project Xternship site since 2012, and six aspiring coders have learned not only day-to-day coding, but anesthesia coding, as well. Externs 60

Healthcare Business Monthly

are paired with experienced coders. “Interns do everything coding related,” Wilson said. “We teach them to read and code from the actual surgical and anesthesia records. They find the correct codes and diagnoses for all procedures we do. They also get some billing experience in the way of filing claims and doing follow-up when the claim has denied.” Wilson credits the program with finding some awesome employees. “This is a wonderful program for both the employer and the newly certified coder,” she said. Not only is Project Xtern a chance to learn from experts on site, but it’s also a chance to match new coders with employers. Wilson’s most recent extern, Tracy McDonald, CPC-A, said the biggest surprise of her externship is how much there is to learn. “I was also surprised by the many different paths available to coders,” she said. McDonald found her Project Xternship site through her local chapter. “Our local chapter president, Donna Stewart, COC, CPC, CPCO, CPC-P, CPMA, CPC-I, encouraged me to apply for a coding position with Judy Wilson.

According to Project Xtern Coordinator Ashlyn McGlone, becoming an extern begins with AAPC membership and certification. Benefits of participation are many, including: • Real-world, hands-on experience • Professional work applicable toward removal of your apprenticeship status • Accomplishments to put on your resume • Exposure to prospective employers Project Xtern Approved Official Extern Sites (AOES) aren’t coding schools. They’re physician offices, group practices, billing companies, consultants, specialty facilities, hospitals, and healthcare payers. You can find an AOES at www.aapc.com by looking up Project Xtern or calling 1-800626-2633. If none are available in your area, contact AAPC’s externship department and suggest sites in your area that might be interested. Provide a name, address, and phone number, and we’ll work to contract with the sites. Don’t be afraid to encourage a facility to be a site. It’s a great way to introduce yourself to a potential mentor and to show them how dedicated you are to the field. It’s also a good way to earn AAPC Bucks if a facility you recommend becomes an AOES. Note: AAPC Bucks can be used like money to purchase any AAPC products and services, except membership. Once you locate an AOES, it’s up to you to contact them. Be ready with a resume and proof of AAPC membership, and be sure to look and sound professional at the interview. While externships are normally not paid, some sites may offer some compensa-

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Become an Extern

Project Xtern tion; that’s between you and the AOES. Your hours also are decided by the AOES, but externs typically work 10-40 hours a week for 6 to 12 weeks.

Tips for Extern Success McGlone provides tips for aspiring externs: • Update your resume and references. • Gather the coding resources you’ll need to succeed. • Network with your local chapter, fellow students, friends, and family. The more people who know you’re looking for an externship, the more successful you’ll be. • Show up when you’re scheduled on time. • Communicate well and tactfully with your AOES contacts and coworkers. • Volunteer to assist on others’ vacations and breaks at the AOES.

• Go to in-services, meetings, and other functions that will help you. • Be eager for feedback and constructive criticism from your AOES supervisor. Keep in mind that the externship is to help you learn and demonstrate your skills, and the AOES may not be able to hire you when it’s finished. In fact, most externs go on to find permanent jobs elsewhere thanks to their experience with their mentors at the AOES. Find more information at www.aapc.com/medicalcoding-jobs/project-xtern.

Becoming an AOES McGlone encourages mentors to offer their workplaces to help an apprentice get a foot in the door. The benefits of mentorship include the extra help the aspiring coder brings, the chance to train a candidate in the culture and coding your facility enjoys, and the intrinsic benefits of being a mentor.

Few programs in coding allow facilities to use excellent medical coding and billing assistance from a certified professional at no cost, with no long-term commitment. There is no cost to the facility, and the relationship is between the AOES and the extern. The program is fully HIPAA compliant, and the facility is free to hold the extern to its risk policies. During the relationship, AAPC asks that the AOES provides the extern a minimum of 60 percent hands-on coding and billing experience. An AOES must also evaluate the work habits and abilities of the extern in exchange for what is typically non-paid work. Registration is easily done online, and AOES sites receive a free webinar for doing so. More information is available at AAPC.com, or contact Ashlyn McGlone via email (ashlyn.mcglone@ aapc.com). Brad Ericson, MPC, CPC, COSC, is publisher at AAPC and a member of the Salt Lake City, Utah, chapter.

TCI

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AAPC - Distance Learning

September September 19 19 – – 21 21 | | 12 12 CEUs CEUs

NEWLY CREDENTIALED MEMBERS Can’t find your name? It takes about three months after you pass before your name appears in

Healthcare Business Monthly.

Magna Cum Laude Akhila M S, CPC-A Balaji C, CPC-A Charmaine Frias, CPC-A Cheryl Nix, CPC-A Darylle Anne Canilao, CPC-A Dawn Little, CPC Giovanni Turalva, CPC-A Julie Takahashi, CPC-A Kevin Michael Mueco, CPC-A Kimberlee Chamberlain, CPC-A Kimberlee Helmbold, CPC Lesley Parsons, CPC-A Marianne Vargas, CPC-A Muchanthala Vasantha, CPC-A Niurka Ortiz Pifferrer, CPC-A Orlando Freddy Sanchez, CPC-A Randall Owen Splinter, CPC-A Rasaputra Naveen Chakravarthi, CPC-A Rebecca Lamb, CPC-A Rene Rossen, CPC-A Suraksha Pai, CPC-A Umadevi Ramesh, CPC

CPC® Adelaida Perez, CPC Aleida Santana, CPC Amy Barnes, CPC Andreea Nichell Shelley, CPC Angeal McCormick, CPC, CPC-P Angela Branson-Atkins, CPC Angela Brazelton, COC, CPC Angela Quinn, CPC Anita Garg, CPC Anna Lojewski, CPC Betsy Priest, CPC Brenda Roberts, CPC Camilo Perez, CPC Candace Bunnage, CPC Carrie Wilson, CPC Cathy Martin, CPC Chelsey Knight Sorensen, CPC Chitra Sampath, CPC Christine E Chan, CPC Cindy Prybylko, CPC Claudia Diaz, CPC Cynthia Taylor, CPC Debra Sbrizza, CPC Elmesha Wright, CPC Erica June Gonzalez, CPC Erin Thomas, CPC Francine Carroll, CPC Frank McDonnell, CPC Gina Haffner, CPC Gleinnys Saavedra, CPC Harriet Goldstein, CPC Heather Bradford, CPC

Holly Gillingham, COC, CPC Jacqueline Martin, CPC Jamie L Lasker, CPC Jamie Marie Shamshudeen, CPC Jennifer Bright, CPC, CPB, CPPM Jennifer Martinez, CPC Jessica Ann Chong, CPC Jo-Onda Henderson, CPC Julie Muth, CPC Kacee Downey, CPC Kaley Holloway, CPC Karen Palazzolo, CPC Karen Panzera, CPC Kathy Pittman, CPC Katrina Justine Mason, CPC Kayla Buchanan, CPC Kellie R Lulas, CPC Kim Cranmer, COC, CPC Kimberly Montalbano, CPC Kris L Lang, COC, CPC, CPB, COSC LaShann Denise Long, CPC Laura Jones, CPC Laura Richardson, COC Lianet Santos Mederos, CPC Lisa Burton, CPC Lovina Farden, COC, CPC Lyndee Belanger, CPC Mackenzie Renee Fix, CPC Malissa Long, CPC Maria E Ramirez, CPC Maria Rodriguez, CPC Marlene M Machado, CPC Mary Newell, CPC Melanie Rosario, CPC Melinda M Diaz, CPC Michele Flesch, CPC Michelle Weiffenbach, CPC Michelle Hayes, COC Mira Krizanic, CPC Ngia Xiong Norbu, CPC Nicole Alecia Kainoa, CPC Nicole Hodges, CPC Nyssa Archambault, CPC Olga Poloney, CPC Parvathi Alampuzha, CPC Patricia Garcia, CPC Ruth Emily Tilley, CPC S Jayasree, COC, CPC, CPC-P Shannon McChesney, CPC Shante’ Wright, CPC Shari Smith, CPC Sharon McDaniel, CPC Shauna Marie Williams, CPC Sierra Dawn Seifert, CPC Sonia Swears, CPC Stephanie Boone, CPC Tammy Barnes, CPC Tammy Stough, CPC Tania Vanessa Collazos, CPC Tiffany Morgan, CPC Tonee McIntosh Craft, CPC Vijayakumari Bandaru, CPC Wendy Griffin, CPC Yoaime Williams, CPC Yordanka Pereira, CPC

Apprentice Abhishek Jain H D, CPC-A Abida Farheen, CPC-A

Abinaya Selvan, CPC-A Achulatla Hilsana, CPC-A Adepu Kavitha, COC-A Adithya Balachanran, CPC-A Adla Narsing Rao, CPC-A Adonica Dotson, CPC-A Adrian Payad Laurente, CPC-A Adrianne Todd, CPC-A Aimee Hayes, CPC-A Aimee Moon, CPC-A Ajay Kumar Reddy Somidi, CPC-A Ajay Prasad, CPC-A Ala Yermakovich, CPC-A Alampally Shyam Prasad, CPC-A Aldandi Ashok, CPC-A Alexandra Cosme, CPC-A Alicia Jones, CPC-A Alisha Nielson, CPC-A Allam Aswani, CPC-A Alvin Rae Lat, CPC-A Amanda Flores, CPC-A Amanda Hamilton, CPC-A Amanda Lackey, CPC-A Amanda Maier, CPC-A Amanda Rogers, CPC-A Amanda Scott, CPC-A Amanda Wilcox, CPC-A Amber Carbonneau, CPC-A Amber Ernzen, CPC-A Amoli Chandrakant Mali, CPC-A Amy Atkins, CPC-A Amy Dehmann, CPC-A Amy Edlin, CPC-A Amy Hillman, CPC-A Amy Johnson, CPC-A Amy Rebecca Firebaugh, CPC-A Amy Vannatter, CPC-A Ana Cartagena, CPC-A Ana May Ruiz, CPC-A Anchu Haleema, COC-A Ancy Magthalana, COC-A Andrea Calderon Reynoso, CPC-A Anel Sierra, CPC-A Anentia -, CPC-A Angela Fernando, CPC-A Angela Hairr, CPC-A Angela Perez, CPC-A Angelica Marie Bulanhagui, CPC-A Angelique Cabral Jader, CPC-A Anil Baburao Kulkarni A B, CPC-A Animesh Mishra, CPC-A Anitra Murphy, CPC-A Ankita Shanker, CPC-A Anna Mello, CPC-A Anna Tricia Domingo, CPC-A Anne Wankel, CPC-A Anushree Agarwal, CPC-A April Walters, CPC-A Aravind kumar Putti, COC-A Aris Miguel Lat, CPC-A Armann Marmolejo, CPC-A Arnab Roy Chowdhury, CPC-A Arockia Kavitha Jesu, CPC-A Arpula. Rajesh, CPC-A Arshi Liyakath Sheikh, CPC-A Arshiya Jabeen Viqar, CPC-A Artina Beck, CPC-A Arul Jothi M Mani K, CPC-A Arumugam Chendil Kumar, CPC-A Arun Balan, COC-A Arun D, CPC-A

Arun Harikumar, COC-A Aruna Yepuri, CPC-A Aruneswari Uddandam, CPC-A Arvind Bhat, CPC-A Asha Balakrishnan, CPC-A Ashley Cole, CPC-A Ashley Pagan, CPC-A Ashwini Bajirao Damame, COC-A Ashwini Shantaling Jangam, COC-A Azel Daryl Latorre, CPC-A B Kirthi Kumar, CPC-A Balabadra Nagaraju, CPC-A Balusani Deepkanth, CPC-A Bárbara Pérez, CPC-A Barbara Waggoner, CPC-A Becky Braswell, CPC-A Bernardo Jr. Gorospe, CPC-A Bethanie Woolsey, CPC-A Beverly Daloos, CPC-A Bhabna Saha, CPC-A Bhagyalaxmi T, CPC-A Bhanu Prasad Badala, COC-A Bhanu Priya Nukathoti, CPC-A Bhargavi Vangala, COC-A Bhaskar Mandlem, CPC-A Bhaskar Naidu Kurupati, CPC-A Bhawna Pathania, CPC-A Blair Smith, CPC-A Bollam Swetha, CPC-A Bolledhu Joshi Prasanna Kumari, CPC-A Bommadi Sindhuja, COC-A Bottu Bhanu Prasad, CPC-A Brad Duncan, COC-A Brandi Buchanan, CPC-A Breanna Seals, CPC-A Brenda Campbell, CPC-A Brenda Lewis, CPC-A Brennen Williams, CPC-A Brittany Fulk, CPC-A Brittany Rhilinger, CPC-A Caitlyn Hofmaster, CPC-A Camree Sutton, CPC-A Carl E Qualls, CPC-A Carol Gamble, CPC-A Carol Gorman, CPC-A Cassandra Baker, CPC-A Cassandra Montanez, CPC-A Catalena Cachat, CPC-A Catherine Hodge, CPC-A Cathy Rogers, CPC-A Chandhani Varghese, CPC-A Chandrika Thambidurai, CPC-A Charisse Charlton, CPC-A Charlotte Ingwersen, CPC-A Cherie B Gaston, CPC-A Cherrie Gray, CPC-A Cheryl Acevedo, CPC-A Cheryl McGeachy, CPC-A, CPB Cheryl Petrus, CPC-A Chethan N, CPC-A Chintamreddy Bhargavi, CPC-A Chrissy Adora, CPC-A Christian Pol Farinas, CPC-A Christin Word, CPC-A Christina LeFevre, CPC-A Christine Cline, CPC-A Christine Lichte, CPC-A Christine Woods, CPC-A Christopher James Long, CPC-A Christopher Teves, CPC-A Clare Blatt, CPC-A

Connie Jones, CPC-A Cristina Ramos, CPC-A Cynthia Lynn Kellis, CPC-A Cynthia Noyes, CPC-A Daisy Salcedo, CPC-A Dana Davis, CPC-A Danielle Steward, CPC-A Danielle Zimet, CPC-A David Umpierre, CPC-A Dawn Ann Reading, CPC-A Dawn Crotty, CPC-A Dean Harris, CPC-A Deborah Beigle, CPC-A Deborah Marg, CPC-A Deborah Tingley, CPC-A Deepika Lakshmanareddy, CPC-A Deepti Sharma, CPC-A Denise Aday, CPC-A Dennis Quilatan, CPC-A Denora Baskin, CPC-A Derick Dickinson, CPC-A Devan Holmes, CPC-A Devarsetty Anusha, CPC-A Devatha Saritha rao, CPC-A Devender Kattekola, CPC-A Devender Vishnoi, CPC-A Dharatiben Bhushan Zalavadia, CPC-A Dianne Karla Avila, CPC-A Dilip Kumar, CPC-A Dimitrinka Gantcheva, CPC-A Divakala Uday Kumar, CPC-A Divya Khare, CPC-A Divya D Bp, CPC-A Donna Lydecker, CPC-A Dr. Hiral Shroff, CPC-A Ebrahim Cacapit, CPC-A Eder Cunanan, CPC-A Ekta Yadav, COC-A Elisa Palomino, CPC-A Elizabeth Briehof, CPC-A Elizabeth Cantrell, CPC-A Elizabeth Graham, CPC-A Elizabeth Locke, CPC-A Elizabeth Nichols, CPC-A Elizabeth Squires, CPC-A Elsa Mammen C, CPC-A Emade Time, CPC-A Emily Hurst, CPC-A Emily Tonkinson, CPC-A Enosh Lee, CPC-A Eric Green, CPC-A Erika Smith, CPC-A Erin LeDoux, CPC-A Estrellita Martinez, CPC-A Eun Mi Flores, CPC-A Eunice Dureza Volfango, CPC-A Fatima Mairaj, CPC-A Flor Martinez, CPC-A Foram Vijeshkumar Majmudar, CPC-A Frances E Greenier, CPC-A G. Suchitra, CPC-A Garvandula Rajini, COC-A Gaurav Sharma, CPC-A Gayathri -, CPC-A Geetha Madhavi Gatte, CPC-A Gellie Rose Fernandez, CPC-A Georgene Argoe, CPC-A Gina Atwell, CPC-A Gina Beasley, COC-A Glenda Correa, CPC-A Glenda Leigh Dees, CPC-A

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June 2016

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NEWLY CREDENTIALED MEMBERS Goldi Nayak, CPC-A Gopinath Bobby Sunitha, CPC-A Gowthami Srirangam, CPC-A Grace David, CPC-A Grace Elizabeth, CPC-A Grace Seto, CPC-A Gretchen Eckloff, CPC-A Gwen Tramel, COC-A Haley Hicks, CPC-A Hanumantha Reddy Mittapalli, CPC-A Harika Gunta, CPC-A Harriet Rebecca Stewart, CPC-A Harshad P, CPC-A Harshitha Kallu, CPC-A Heather Carrizales, CPC-A Heather Favorite, CPC-A Heather Harroun, CPC-A Heather Higginbotham, CPC-A Heidi Welch, CPC-A Henriette Muller, CPC-A Hillary Bruzon, CPC-A Hillary Miller, CPC-A Holly Hipes, CPC-A Iluminada Carballosa, CPC-A Irena Philpot, CPC-A Irene A Chomik-Zaretsky, CPC-A Irene Grace Ramiscal, CPC-A Irene Marie Lopez, CPC-A Irfan Pasha, CPC-A Irina Franco, CPC-A Iris Almog, CPC-A Jackie Heitkemper, CPC-A James Hughes, CPC-A Jameson Leonardo, CPC-A Jamie Jewell, CPC-A Jamie Lusk, CPC-A Janaki Venkatesan, CPC-A Janga Mounika, CPC-A Janice Boylan, CPC-A Janice Leigh Scruggs, CPC-A Janine Descartes, CPC-A Jarugula Udaya Bhavana, CPC-A Jasmin Zepeda, CPC-A Jasmine Dugas, CPC-A Jason Sedenio, CPC-A Jaswillah Bettina Ison, CPC-A Jay-Ann Villangca, CPC-A Jayanthi Selvasekaran, CPC-A Jayaprada U, CPC-A Jemel Bruan, CPC-A Jen Sullivan, CPC-A Jenna Harland, CPC-A Jenna Price, CPC-A Jennifer Ann Carollo, CPC-A Jennifer Bax, CPC-A Jennifer Epperson, CPC-A Jennifer Jones, CPC-A Jennifer MacKim, CPC-A Jennifer Miller, CPC-A Jennifer Mosher, CPC-A Jennifer Pritchard, COC-A Jennifer Robin Nilsen, CPC-A Jennifer Silverman, CPC-A Jennifer Wasion, CPC-A Jessica Lancaster Belk, CPC-A Jessica Ortega, COC-A Jessica Pepper, CPC-A Jessica Ritter, CPC-A Jessica Santiago, CPC-A Jessie Holbrook, CPC-A Jessieca Santiago, CPC-A

64

Jhamier Capulong, CPC-A Jillian Fay Manaloto, CPC-A Jintu Joseph, COC-A Jishi Thomas, COC-A Joan Castillo, CPC-A Joanne Mangulabnan, CPC-A Jobelle Contreras, CPC-A Jocelle Navarro, CPC-A Jordan Gist, CPC-A Joy Jones, CPC-A Judy Peel, CPC-A Julie Anne Meule, CPC-A Julie Fontanos, CPC-A Julie Rafinski, CPC-A Julius Dietrich, CPC-A Jyothi Deepati, CPC-A K Bharath, CPC-A K Sai Avinash Babu, CPC-A K. Veerasudhir Kumar, CPC-A Kachera Cottrell, CPC-A Kaci Hall, CPC-A Kacie Geretz, CPC-A Kai Kuan, CPC-A Kala Overbey, CPC-A Kalidindi Lalitha Priyanka, CPC-A Kalpitadhananjay Pashte, CPC-A Kamille Black, CPC-A Kara Marie Mcgugin, CPC-A Karen Beard, CPC-A Karen Bradford, COC-A Karen Crossley, CPC-A Karen Kilgore, CPC-A Karissa Kraner, CPC-A Karla Gregory, CPC-A Karun Reddy Dasari, COC-A Karunakar Burri, CPC-A Katakam Sruthi, CPC-A Katakam Ramya, CPC-A Kate Snyder, CPC-A Kate Wilkins, CPC-A Katherine Johnson, CPC-A Katherine S Schallie, CPC-A Kathleen Bowen, CPC-A Kathleen Fields, CPC-A Kathleen Perrotta, CPC-A Kathy Ross, CPC-A Katsiaryna Rameika, CPC-A Kaveetaa K, CPC-A Kayce Carver, CPC-A Kayla Wandoff, CPC-A Kdie Whitney, CPC-A Keerthi Nayaki, CPC-A Kelly Clendenny Webster, CPC-A Kelly Lambert, CPC-A, CPB Kenya Ryan, CPC-A Kenya Simmons, CPC-A Kerry Vara, CPC-A Kimberly Bingaman, CPC-A Kimberly Friederich, CPC-A Kimmy Austero, CPC-A Kirsten Rody, CPC-A Kirstie Deppiesse, CPC-A Kirstin Miller, CPC-A Kolkuri Govardhan Reddy, CPC-A Kolli Venkat Ramana Naidu, CPC-A Kondru Sruthi, CPC-A Kota Shivakumar, CPC-A Koushik S, CPC-A Kristen Rice, CPC-A Kristi Davis, CPC-A Kristie Muff, CPC-A

Healthcare Business Monthly

Kristol Randall, CPC-A Kristy Lockert, CPC-A Kundavaram Ananth Peterson, CPC-A Lachannet Kelly, CPC-A Lakshmi Balasubramani, CPC-A Lana Andrews, CPC-A Latha Gangappa, CPC-A Laura Scott, CPC-A Laura Smith, CPC-A Lauren Cupps, CPC-A Lenora E Barrett, CPC-A Leshaya Patten, CPC-A Liezl Daduya, CPC-A Lily Towne, CPC-A Linda June Taylor, CPC-A Lisa Ann Brown, CPC-A Lisa Fowlkes, CPC-A Liz Krause, CPC-A Logan Balon, CPC-A Lokesh Ravikumar, CPC-A Lori Horton, CPC-A Lourdes M. Perez-Rosario, CPC-A Louvin Aries Quinto, CPC-A Lyn Wilski, CPC-A Lynn Buscko, CPC-A Lynn Wisswell, CPC-A Madari Jaypal, CPC-A Madhan Sivakumar, CPC-A Madhusudhan Nandini Samarpitha, CPC-A Madineni Swathi, CPC-A Makeeba Ravenell, CPC-A Mallory Lipari, CPC-A Mamatha Pamera, CPC-A Mamatha S, CPC-A Manasa Madas, CPC-A Manoj Kumar Singh, CPC-A Margaret Jyothi Dsouza, CPC-A Maria Christina Graves, CPC-A Maria Elena Ramos Perez, CPC-A Maria Halfmann, CPC-A Maria Noela Quizon, CPC-A Maria Victoria Gomez, CPC-A Marianne Sanchez, CPC-A Marie Flanagan, CPC-A Marie Love Joy Maglente, CPC-A Marie Schacher, CPC-A Marilyn Gonzalez, CPC-A Mariset Orihuela, CPC-A Marissa Shaw, CPC-A Marjories Perez Torres, CPC-A Mark Anthony Canada, CPC-A Mark Zellmann, CPC-A Maroide Delgado, CPC-A Martin Detarro, CPC-A Mary Beth Sheldon, CPC-A Mary Davis, CPC-A Mary Joy Pingkian Rico, CPC-A Mary Margarette Trube, CPC-A Mavis Quaynor, CPC-A Maylin Hernandez, CPC-A McKenzie Tidwell, CPC-A Md Abdul Khader Jeelani, CPC-A Meenakshi Kotturu, CPC-A Megan Anderson, CPC-A Megan Kaczmarczyk, CPC-A Megan Pitts, CPC-A Mel Jefferson Valdez, CPC-A Melanie Casper, CPC-A Melissa Duncan, CPC-A Melissa Ruiz, CPC-A

Melissa Thomas, CPC-A Melita Andal, CPC-A Melonnie Ponce, CPC-A Mercedes Sigarroa, CPC-A Meri Handley, CPC-A Mica Anne Loraine Libutan Ortiguero, CPC-A Michael Cook, CPC-A Michael Morse, CPC-A Michel Looyé, CPC-A Michelle Barbes, CPC-A Michelle Brown, CPC-A Michelle Clapper, CPC-A Michelle Clark, CPC-A Michelle Gillespie, CPC-A Michelle Heath, CPC-A Michelle Lovett, CPC-A Michelle Mergen, CPC-A, CPCO Michelle Wymer, CPC-A Migena Dule, CPC-A Miryala Vinay Kumar, CPC-A Mitesh Patra, CPC-A Mohammed Ali Azher S, CPC-A Mohammed Mukarram Ali, CPC-A MohanaPriya Premkumar, COC-A Molly Fivecoate, CPC-A Mrunali V Patil, CPC-A Mudasir Ahmad Changa, CPC-A Muhammad Zeeshan, CPC-A N Swetha, CPC-A Nabina Dey, CPC-A Naresh Gurrala, COC-A Nasirali Mugutsab Nadaf, CPC-A Natani Soujanya, CPC-A Naveen Krishna Kamavaram, CPC-A Naveen Kumar Cherukupally, COC-A Naveen Mallela, CPC-A Neethumol Soman, CPC-A Nercy Gerardo Agohoy, CPC-A Nhu Nguyen, CPC-A Nichole Harper, CPC-A Nicole Grignon, CPC-A Nicole Lashley, CPC-A Nikki Cinglant, CPC-A Nithin K Francis, CPC-A Noreen Lacourciere, CPC-A Noreen Pollard, CPC-A Norolyn Riggins, CPC-A Norwinna Aquino, CPC-A Olivia Daniels, CPC-A Olivia Yeung, CPC-A P. UdayKishore, CPC-A Paka Santhosh Kumar, CPC-A Pakanati Naresh Reddy, CPC-A Palash Gupta, CPC-A Pallavi -, CPC-A Pam Werkmeister, CPC-A Pamela Ocampo, CPC-A Pamela Stone, CPC-A Panasa Srilatha, CPC-A Paul Irish Baylon, CPC-A Penelope Jeanette Go, CPC-A Pollyana Francis, CPC-A Ponselvi Shiny Inbaraj, CPC-A Poojitha Udaykumar, CPC-A Pothiraj Sasikala, CPC-A Prakash Dutt, CPC-A Prasoona Chittimella, CPC-A Pratima Challa, CPC-A Praveen Yeruva, CPC-A Preeti Kaushik, CPC-A

Prerana Thapa, CPC-A Priscilla Flores, CPC-A Priyanka Mudliar, CPC-A Priyanka Ravi, CPC-A Priyanka Reddy, CPC-A Pulla Rao Gandu, COC-A R Yogeshwari, CPC-A Rachana Chandran, CPC-A Rachel Kiefer, CPC-A Radhakrishnan Ajaykumar, CPC-A Raisa Arul, COC-A Rajakalieswari Subramanian, CPC-A Rajesh C, CPC-A Raji Radhakrishnan S, CPC-A Rajiya Manikindi, CPC-A Raju Dasari, COC-A Ramesh Earla, CPC-A Rammiyaa Balakrishnan, CPC-A Ramya Raghuraman, CPC-A Rani R, CPC-A Rashmi K, CPC-A Ravi Shekhar, CPC-A Rebecca Claeys, CPC-A Rebecca Koronkowski, CPC-A Rehan Ahmed Siddiqui, CPC-A Reicyn Villalobos, CPC-A Remya Haridas, CPC-A Rena Conselva, CPC-A Rhonda Peterson, CPC-A Richard Yates, CPC-A Rintoo Thomas, CPC-A Ritam Rai, CPC-A Robyn Stufflebean, CPC-A Rocell Aguila, CPC-A Ronald Philip Rivas, CPC-A Rosanne Quinnan, CPC-A Rose Brandt, CPC-A Roselyn Bongon, CPC-A Rubal Kataria, CPC-A Ruth Abigail Tabaniag, CPC-A Ruth Beck-Croyle, CPC-A Ruth Concepcion, CPC-A Ryan C Gillispie, CPC-A S L Gangeyula, CPC-A S. Mahammed Hussain, CPC-A Sai Saraswathy Kasiviswanathan, CPC-A Saikrishna Tirumalasetty, CPC-A Samantha DeMunzio, CPC-A Sandel Johnson-Dockery, COC-A, CPC-A Sandhya Kamath, CPC-A Sandip Kumar Pathak, CPC-A Sandra Foley, CPC-A Sanjay Dey, CPC-A Santhosh Kumar Kandre, COC-A Sara Plunkett, CPC-A Sara Rowe, CPC-A Sara Scott, CPC-A Sarah Michelle Wright, CPC-A Saritha Bobbili, COC-A Saroj Kanta Satpathy, CPC-A Sarwat Rizvi, CPC-A Sashi Kumar Mamidala, CPC-A Sathineni Sridhar, COC-A Savannah Vaness, CPC-A Sayali Santosh Akade, CPC-A Seantelle M Plummer, CPC-A Serena Sardo, CPC-A Shailendra Sharma, CPC-A Shailja Mehra, COC-A Shalini -, CPC-A Shamyra Chacon, CPC-A

NEWLY CREDENTIALED MEMBERS Shari Grondahl, CPC-A Sharnay Hall, CPC-A Sharon Medley, CPC-A Sharon Seares, CPC-A Sharvari Srilalitha, CPC-A Shashikala Pathman, CPC-A Shayla Williams, CPC-A Sheela Murthy, CPC-A Shelley Moore, CPC-A Shiny Angeline, CPC-A Shivaranjani Patnam, CPC-A Shree Neupane, CPC-A Sijina N S, CPC-A Silmin Lathiff, CPC-A Silvia Barrett, CPC-A Sivaprasad Valluri, CPC-A Sivashankar Arumugam, CPC-A Sneha -, CPC-A Sneha Bhonsle, CPC-A Sneha Singh, CPC-A Snv Poornima Somanchi, CPC-A Sona Buchanan, CPC-A Sonam Singh, CPC-A Sonia Singh, CPC-A Sonja McGarvey, CPC-A Soumya M Nair, CPC-A Sowmyashree Siddarameshwara, CPC-A Sravan Kumar Karingula, COC-A Sravanthi Manga Sathi, CPC-A Sreekaladevi N, CPC-A Sreenith P.V, CPC-A Srikanth Chitla, CPC-A Srinivasalu Barava, CPC-A Srinivasarao Cheemakurti, CPC-A Stacy Bucy, CPC-A Stacy Starkey, CPC-A Stephani Damin, CPC-A Stephanie Canales, CPC-A Stephanie Davis, COC-A Stephanie Eskew, CPC-A Stephanie Grant, CPC-A Stephon Williams, CPC-P-A Stuart Morse, CPC-A Sua Yang, CPC-A Subhash Babu Chadalavada, CPC-A Sucheta Sarkar, CPC-A Sumit Kumar, CPC-A Sumit Sudam Matkar, COC-A Sunil Kumar A, CPC-A Sunshine Maranion, CPC-A Susan Burk, CPC-A Susan Carter, CPC-A Susan Teresa Cherian, CPC-A Suzanne Hetsch, CPC-A Swati Suresh Patil, CPC-A Syed Abu Iqbal Murshedi, CPC-A Syed Nisar Zohra, CPC-A Tabitha Knappenberger, CPC-A Tammy Lynn Blood, CPC-A Tammy Stecker, CPC-A Tanisha Williams, CPC-A Tara Palmer, CPC-A Tarsha Russell, CPC-A Tekpally Alekhya, CPC-A Tenea Dennis, CPC-A Tequisha Butler, CPC-A Teresa Vasquez, CPC-A Theresa Brown, CPC-A Theresa Main, CPC-A Thiraviya Narayana Pillai, CPC-A Thodimela Mallikarjun, CPC-A

Tholur Rajuranjini, CPC-A Tiffany Ramos, CPC-A Tina Elizabeth Garcia, CPC-A Tintumol Satheesan, CPC-A Tisha McElrath, CPC-A Tony Myers, CPC-A Tonya Carr, CPC-A Toshita Brijraj Singh, CPC-A Traci Ruess, CPC-A Tracy Durbin, CPC-A Tracy Parkin, CPC-A Trang Nguyen, CPC-A Trina Bennington, CPC-A Trista Grover, CPC-A Troy Toombs, CPC-A Trupti Ankush Jogdand, CPC-A Twila Boyers, CPC-A Twila Rowley, CPC-A U Sai Kavitha, CPC-A Umesh Agatarao Salunke, COC-A Ummay Nazmin, CPC-A Unique Postell-Smith, CPC-A Usha Venkatraman, CPC-A Uzair Khan, CPC-A V Ashwini, CPC-A V Remya, CPC-A V Veera Venkata Raju, CPC-A Vaishnavi Vaidya, CPC-A Valerie Green, CPC-A Valery Michael, CPC-A Valluri Bajibabu, CPC-A Vanita Devi, CPC-A Vanny Nuon-Rodriguez, CPC-A Velchicherla Jaya, CPC-A Venkata Ramana Rao Pratti, COC-A Venkata Sai Chandra Prathipati, COC-A Venkatesh Ningamgari, CPC-A Venkatesh Raju, CPC-A Veronica Nicholson, CPC-A Vicki Collier, CPC-A Victoria Sims, CPC-A Vidadala Prathibha, CPC-A Vidhya Sri R, CPC-A Vinaya Gouda, CPC-A Vinayak Shivaji Mate, COC-A Vinit Ashok, CPC-A Vipul Tiwari, CPC-A Waynette D Earven, CPC-A Wendy Vaughn, CPC-A Wyeth De Leon, CPC-A Yazna Veni Revu, CPC-A Yogesh S Y, CPC-A Yolanda King, CPC-A Younkyung Deleon, CPC-A Zeneth Clarke-Patterson, CPC-A

Specialties Adilah Rashid, CPC, CPMA, CEMC Airen Cepero, CPC, CRC Alia Davis, CPC, CPB Alina Diaz, CPC, CPMA, CRC Alix DeZayas, CPC, CPMA, CRC Amanda Powell, CPC, COBGC Amber Honkomp, CPC, CEMC Amy Kalieta, COC, CPC, CPCO, CPC-P Ana Kerst, CPC, CPMA Anand Babu M, COC, CPC, CPMA Andrea Arnzen, CPC, CPMA, CEDC, CEMC Andrea Pearson, CPC-A, CPB

Andrew Sudimack, CPC-A, CPMA Angela Paine, COC, CPC-I, CEMC, CRHC Ania Guillen, CPC, CRC Ann Roseberry McVety, CPC, CRC Anne Kienitz, CPC-P, CPMA Anneka Johnson, CPB April Faye Logue, CRC Arianne Echemendia, CPC, CPMA, CRC Ashleigh Grebiner, CPCO Bianca Cartagena, CPCO Brandee Dautrich, CPC-A, CPB Brian Lacey, CRC Brittany Winfrey, CEMC Carolee Quay, CPC, CEMC Carolina Navarro, CPCD Cecily Rosaline Lourdusamy, CPC, CRC Cerelina Macaraeg, COC, CPC, CRC Christin Thompson, CPC-A, CRC Christina Cardella, CPC, CPCO Christina McGinn, CPC, CPMA Christina Sullivan, CPC-A, CPPM Christine Moore, CPB Connie Bonin, CPC, CPMA Courtney Wallace, CRHC Cynthia DeClerk, CPC, CPMA, CRC Cynthia Zibelin, CRC Dana Ostrander, CPCO Dania Plasencia, CPC, CPMA, CRC Danielle Cudmore, CPB Danielle Thoresen, CPC-A, CPMA Danieyi Martinez, CPC, CPMA, CRC Darlfene Abano, CPC-A, CEDC, CRC David A Klein, CPC, CPMA David Zetterman, CPC-A, CPPM, CFPC Deana Myers-Voyk, CRC Deanna Shores, CPC, COSC Debbie A Ricci, COC, CPC, CPCO, CPB Deborah Diane Stafford, COC, CPC, CPCO, CPMA, CEMC Deborah Patton, CPPM Dee Kelly, CPC, CPCO, CPMA, CEMC, CPCD Delia Maria Perez, CPC, CPMA, CRC Denise Franklin, CPC, CPB Deyris Arias, CPC, CPMA, CRC Diana Brown, CPC, CPMA Dianne A Rodrigue, CPC, CRC Dolmaya Thogra, COC-A, CIRCC, CPB, CPMA Donna Osso, CPB Dorothy Ann DeWees, CPC, CPMA, CPPM, CPCD Dorothy de Leeuw, CPB Dr MadhuSudhanRao Kotha, COC, CPC, CPC-P, CEDC, CPEDC Elena Barbulescu, CPCO, CPMA Elizabeth Anglin, CPC-A, CPB, CPPM Elizabeth Hall, CPPM Elizabeth Urrecho, CPC, CPCO Erin Jones, CANPC Erin Zielinski, CPPM Gabriela Adela Fortney, CPC, CEDC Gail Sears, CPB Gehan Mechel, CPC, CRC Gina M Schirato, CPCO, CPB Gisela Goldstein, CPCO Gloria M Pomares de Leon, CPC, CRC Gustavo Daniel Boullosa, CPC-A, CRC Hien Pham, CPB Idalmis Toledo, CPC, CPMA, CRC Indirakumari Balachandar, CPC, CPB Jade Engel, CPC, CRC

Janet S Hodgdon, CPC, CRC Janine Getchell Bouchard, CPC, CEMC Janis Kuykendall, COC, CPC, CANPC, CEMC, COSC, CSFAC Jennifer Locklear, CPB Jennifer Snodgrass, CPC, CEMC Jennifer Sutton, CPC, CEMC Jessica Thomas, CPC-A, CRC Jill Ward, CPC, CPMA, CPC-I J’Lyn Carruth, CPC-A, CRC Joanna Fernandez, CPC, CPMA, CRC Jodi Riess, CPC, CPMA Josette Fuselier, CPC, CEMC, CGSC Justine Yaun, CPC, CPMA, CRC Karen D Tobin, CPCO Karen Lasnier, CPMA, CGSC Karen Sassadeck, CPPM Katelyn Schmeder, CPB Kathryn Rovito, CPC, CRC Kathy Lindstrom, CPC, CEDC, COSC Kelley Mcandrews, CPC, CPMA Kelly Breaux, CPB Kelly Lauer, COC, CPC, CEMC Kenia Valle Boza, CPC, CPB, CPMA, CRC Kerrie Amos, CPC, CPMA, CPEDC Kim Marie Birkmire, CPC, CPMA Kim Piotrowicz, CPC, CPMA Kimberly Green, CPC, CEMC, CPEDC Kimberly Smith, CPC, CPB Lacie Lewis, CPB LaTia Rochelle Belton, CPC, CPMA Laura Huelskamp, CPC, COBGC Laurie McGovern, CPCO Lisa A Florek, CPC, CIRCC Lisa Glieden, CPC-A, CPB Lisa Mancini, CPC, CRC Lisandra Alvarez, CPC, CPMA, CRC Lisley Lopez, COC, CPC, CPMA, CRC Liuba Quevedo, CPC, CPMA, CRC Lori Montanez, CPC, CPPM Lucille Abrahamsen, CPC, CEMC Lucyma Martinez, CPC, CPMA, CRC Mandi Edwards, CPB Margaret M Kniffen, CPC, CPPM Maria Zamora, CPMA Marie Gilbert, CPMA Marlene Diaz, CPC, CPMA, CRC Mary Ann Lavalle Paschal, CPC, CPB Mary L Clarke, CPC, CPPM Matilde Perez Chon, CPC-A, CPMA, CRC Megan Keller, COBGC Michael Roach, CPB Michelle E Thelian, CPC, CEMC Michelle Reese, CEDC Mittal Patel, CPC, COSC Naira Margaryan, CPC, CPCO, CPMA Nandini HS, COC, CPB Nare Stepanyan, CRC Nayle Durruthy, CPC-A, CPMA, CRC Nicole Calcanes, COC, CPC, CPMA Nicole Maynor, CHONC Odalys Rodriguez, CPC, CPMA, CRC Pat Hill, CRC Patricia Distefano, CPC-A, CRC Patricia Green, CPC, CPCD Patricia M Fitzgerald, CPC-A, COSC Peggy Corchuelo, CPC, CRC Radhakrishnan Annamalai, COC, CPC, CPC-P, CIRCC, CPMA, CANPC, CASCC, CEMC, CIC, CSFAC Raenette C Minjarez, CEMC

Raisy Martinez, CPC-A, CPMA, CRC Rebecca M Johnston, CPB Renee Gillam, CPMA Robin J Devine, CPC, CPMA, CPPM Roxana Evora, CPC, CRC Rupa Mehta, CPC, CPB, CRC Sabrina Stuart, CPC-A, CRC Sandra Gamboa, CPC, CPMA, CRC Sandra Onate, CPC, CPPM Sandy Swartz, CPB Sara Rich, CANPC Saravanakumar Subramanian, CPC-A, CPMA Sharon Gilliland, CPB Sharon Wright, CPB Shu Zhen Liu, CPC, CIRCC, CCC, CCVTC, CIMC Sivakumar Mani, COC-A, CPC-A, CPMA Stefanie Still, CPCO Stephany Vargas, CPC, CPMA, CRC Suresh Kumar Paulsamy, CPC, CEMC Susan Lisker Powell MD MPH, CPC-A, CRC Susan Shepard, CPC-A, CPB Suzanne Howell, CPC, CANPC, CGIC Suzzanne C Hall, CPC, CRC Tamela S Snape, CPC, CPMA, CHONC Tammy J Salman, CPC, CPCO Tania G Cruz, CPC, CPMA, CRC Tania Perez-Pagliery, CPC, CRC Tanya Jones, CPC, CPPM Tawanda Nadine Johnson, CPC, CPMA, CEDC Teresa Lynn Martin, CPC, CPMA Therese Mitchell, CPC, COBGC Tiffany Joseph, COC, CRC Tina Shenouda, CRC Tina George, CPC, CEMC, COBGC Tina Hudson, CPC, CPMA Tolu Olubunmi, CPB Tracy D Bailey, CPC, CPMA Tracy L Duran, CPC, CEMC, CGSC, CIMC Valarie Norman, CPC, CPCO, CPB, CPPM Valerie Eide, CPC, CEMC, COSC Veera Sudheer Babu Ananta, CPC, CPMA Viola Apostoli, CPC, CEMC, CRC Violeta Rodriguez, CPC, CPMA, CPEDC Wendi Coccimiglio, CPC, CPMA Yaimara Suarez, CPC, CPMA, CRC Yasilen Estuche, CPC, CPMA Yisley Rodriguez, CPC-A, CRC Yissel Cruz, CPC, CPMA, CRC Yvette Williams, CPC, CPCO

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