You are on page 1of 64

Perfecting Practice & Revenue Cycle Management

Infuse a Dose of Coding Know-how

EDGE
February 2013

Amy Lee Smith, MBA, CPC, CPC-H, CPMA, CIA, CRMA

Plus: Hospital OIG • Hearing Loss • 2013 Cardiology • Sticky POS • Double Dipping

ICD-10 BRINGS BIG CHANGES.

BIGGER OPPORTUNITIES.
ICD-10-CM/PCS
(takes effect Oct.1, 2014)
2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

668%
INCREASE
ICD-9-CM

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

about 18,000 unique codes

about 140,000 unique codes

= 1 000 code

Simplify ICD-10 with EncoderPro.com from Optum .
M
2013
Draft

140,000 CODES. ACCESSIBLE IN SECONDS.
CD-10 w have 668% more codes than CD-9 — but that doesn t mean the trans t on has to be overwhe m ng As an affordab e s mp fied a ternat ve to cod ng books EncoderPro com — the ndustry eader for web-based cod ng b ng and comp ance so ut ons — prov des one-c ck access to CD-10 codes data and mapp ng too s as we as CPT® and HCPCS code sets
2013
Draft

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Dr

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft

2013
Draft

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

www.optumcoding.com

www.optumcoding.com

www.optumcoding.com

www.optumcoding.com

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

60,000 Users
Re y on EncoderPro com — Maybe t s t me to earn why

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

Call: 1.800.464.3649, opt on 1
The Complete Official Draft Code Set The Complete Official Draft Code Set

ICD-10-CM

ICD-10-CM

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

Visit: optumcod ng.com/trans t on
The Complete Official Draft Code Set The Complete Official Draft Code Set The Complete Official Draft Code Set

ICD-10-CM

ICD-10-CM

ICD-10-CM

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

AAPC membe s ge spec a p c ng Be su e o men on p omo code AAPCe13
ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft

2013
Draft

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

www.optumcoding.com

www.optumcoding.com

www.optumcoding.com

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

2013
Draft
www.optumcoding.com www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft
www.optumcoding.com

2013
Draft

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10-CM
The Complete Official Draft Code Set

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

ICD-10

A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition. www.optumcoding.com/ICD10

Contents

22
[Coding/Billing]

44
[Auditing/Compliance]

54
[Practice Management]

February 2013

[contents]
34
[Coding/Billing]

In Every Issue
7 Letter from the Chairman and CEO 9 Letter from Member Leadership 10 Kudos 12 AAPCCA 14 Letters to the Editor 14 Coding News

Special Features
29 AAPC Conference Guide 62 Minute with a Member

Features
16 Choose with Clarity Hearing Loss Equipment Codes
Marita Cable-Camilleis, CPC

18 Get Busy Learning New Non-cardiac Endovascular Codes
David Zielske, MD, CPC-H, CIRCC, CCC, CCS, RCC

Education
10 A&P Quiz 59 Newly Credentialed Members
Online Test Yourself – Earn 1 CEU

22 2013 Picks for HCPCS Level II
G.J. Verhovshek, MA, CPC

26 Boost Your Knowledge of Lesser-used Modifiers
Terri Brame, MBA, CHC, CPC, CGSC, CPC-H, CPC-I

30 Timely Tidbits: CPT® 2013 Clarifies Time-based Services
G.J. Verhovshek, MA, CPC

Go to: www.aapc.com/resources/ publications/coding-edge/archive.aspx

34 Infuse Yourself with Coding Knowledge
Amy Lee Smith, MBA, CPC, CPC-H, CPMA, CIA, CRMA

Coming Up
• Hospital Candidates • Foot Amputations • Compliance Professionals • Fractures • Therapy G Codes
On the Cover: Amy Lee Smith, MBA, CPC, CPC-H, CPMA, CIA, CRMA , infuses a dose of proper drug administration coding at the Infusion Center at Mary Immaculate Hospital (affiliated with Bon Secours Health System, Inc.) in Newport News, Va. Cover photo by Jennifer Terry Photography (www.jenniferterry.com).

38 Tips Plus More Tips for Cardiology in 2013
David B. Dunn, MD, FACS, CIRCC, CPC-H, CCC, CCVTC

44 Know Double Dipping Etiquette
G.J. Verhovshek, MA, CPC

46 Control Hospital Risk Using OIG’s 2013 Work Plan
Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P

48 New POS Rules Get Sticky for 21 and 22 E/M Services
Michael D. Miscoe, Esq., CPC, CASCC, CUC, CCPC, CPCO, CHCC

54 Optimize Your Patients’ Access to Care
David J. Moore, MD, MS

www.aapc.com

February 2013

3

. Salt Lake City UT 84120-7208.... • Digital issues take up a lot less room in your home or office than paper issues.. for its paid members... The AMA is not recommending their use.. COBGC...... CMRS katherine.....24 Taking the Business of Medicine to the Next Level www..verhovshek@aapc.... CPMA.... Inc...com Vice President of Marketing Bevan Erickson bevan....com Vice President of Live Educational Events Bill Davies...aapc... 2480 South 3850 West. BS Tina M..com Vice President of ICD-10 Education and Training Rhonda Buckholtz....com Address all inquires... and Takeda Pharmaceuticals USA.. AAPC Cutting Edge is a publication for members of AAPC..... UT 84170 (800) 626-CODE (2633) ©2013 AAPC Cutting Edge. CANPC... CENTC rhonda.. CPEDC.com and make the change! February 2013 Chairman and CEO Reed E..com Ingenix is now OptumTM .. CPC-I......... Suite B.jimenez@aapc....montgomery@aapc. CPC-P®...8 www..5 www.. and CIRCC® are registered trademarks of AAPC.50 www......... CRHC raemarie. Pre-Certification Education and Exams advertising index Affymax...... POSTMASTER: Send address changes to: Cutting Edge c/o AAPC..000 Members – Including You! Be Green! Why should you sign up to receive AAPC Cutting Edge in digital format? Here are some great reasons: • You will save a few trees.. relative value units.com Editorial and Production Staff Michelle A.. CPMA..com CodingWebU....... or sponsoring organizations......com ZHealth Publishing.. Pew reed.gov/MLNGenInfo NAMAS/DoctorsManagement.. MA.....e. CPC.25 www.... LLC....ahacentraloffice..com Managing Editor John Verhovshek. 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.NAMAS-auditing. tablet.. Periodicals Postage Paid at Salt Lake City UT and at additional mailing office. nonuse or interpretation of information contained in this product.com HealthcareBusinessOffice.pew@aapc.... LLC.. Salt Lake City UT 84120-7208....2 A leading health services business Raemarie Jimenez. AAS Advertising/Exhibiting Sales Manager Jamie Zayach............zayach@aapc...zhealthpublishing.. Reproduction in whole or in part.... CPT® copyright 2012 American Medical Association...Serving 119.. MBA bill.. without written permission from AAPC is prohibited. or other mobile device -anywhere.. Fee schedules.davies@aapc... The AMA assumes no liability for data contained or not contained herein.. 2480 South 3850 West...cms...buckholtz@aapc. LLC. ..... 15...... anytime.com The Physicians Practice SOS Group®....com Directors... are not part of CPT®.......ppsosgroup.. CPC-I.. Suite B...... contributions..ericson@aapc.... 64 www.. CPC®. Smith.... CPC. • You won’t have to wait for issues to come in the mail... CPC.....CodingWebU..com AHA Central Office...... CPC...........com Medicare Learning Network® (MLN).. www....com The Coding Institute.....com American Medical Association. Go into your Profile on www..matosich@aapc..com Director of Member Services Danielle Montgomery danielle.. CPC-H®...... • You can read AAPC Cutting Edge on your computer...com Director of Publishing Brad Ericson....com Contexo Media. conversion factors and/or related components are not assigned by the AMA.. BS Renee Dustman.HealthcareBusinessOffice. Inc.amabookstore..... in any form.... 4 AAPC Cutting Edge .com Katherine Abel... CGSC.. and the AMA is not recommending their use. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use..john. All rights reserved... and change of address notices to: AAPC Cutting Edge PO Box 704004 Salt Lake City. CPT® is a registered trademark of the American Medical Association.abel@aapc....omontys......erickson@aapc.. CPC-I... CPC g. CPMA. CPMA®.. MPC. Contributions are welcome. BS jamie......... Dick..SuperCoder..... CPCOTM... The AMA does not directly or indirectly practice medicine or dispense medical services.... All rights reserved.... • You will always know where your issues are................com.com Vice President of Finance and Strategic Planning Korb Matosich korb..57 www.....11 www...contexomedia.. 2013 AAPC Cutting Edge (ISSN: 1941-5036) is published monthly by AAPC....41 Official CMS Information for Medicare Fee-For-Service Providers http://www...optumcoding. Statements of fact or opinion are the responsibility of the authors alone and do not represent an opinion of AAPC.29 www....... COSC brad..com Volume 24 Number 2 February 1......21 www....

For more information or to register: www.6 1 0 2013 AHA CODING CLINIC AUDIO CONFERENCE SERIES CODING ADVICE FROM THE CODING EXPERTS 2013 AUDIO CONFERENCE SCHEDULE Wednesday. 2013 • 12:00 – 1:45pm October Surprise – Topic will be Chosen by Participants Wednesday. August 28. 2013 • 12:00 – 1:45pm ICD-9-CM AHA Coding Clinic 2013 Update Part 1 Wednesday. July 31. May 1. 2013 • 12:00 – 1:45pm ICD-9-CM AHA Coding Clinic 2013 Update Part 2 REGISTRATION SPECIAL Register for 3 Audio Conferences.ahacentraloffice. December 4.com/2013audioconferences or 800/775-7654 . March 13. October 2. 2013 • 12:00 – 1:45pm ICD-10-CM and ICD-10-PCS Procedure and Diagnosis Coding for Obstetrics Wednesday. 2013 • 12:00 – 1:45pm ICD-10-CM and ICD-10-PCS Procedure and Diagnosis Coding for the Circulatory System Wednesday. 2013 • 12:00– 1:45pm ICD-10-CM and ICD-10-PCS AHA Coding Clinic 2013 Update Wednesday.E 1 0. receive 50% off 4th conference registration.

NY To register. take on exciting new challenges.com/CPPM . TN New York. CA Nashville. FL Kansas City. MO San Francisco. and to make a great income. CPPM On-Site: 3-Day Boot Camp Date February 13-15 March 13-15 April 15-17 May 8-10 September 11-13 October 16-18 November 13-15 Online: 3-Month Course • Online lectures • At your own pace • Online discussion with other students Location Newark. WA Orlando.aapc. The CPPM® training and credential will establish you as a professional who is committed to success in physician practice management and increase your marketability for advancement in your career.YOUR NEXT CAREER STEP? PRACTICE MANAGEMENT Practice Management is an exciting career in the medical field that offers opportunities to explore new skills. NJ Seattle. visit www.

then at least use it to your advantage. Find the Kernel of Truth Rarely does a concept or theory come “out of thin air. it may take more effort to absorb fully what is said in a conversation or lecture. “Either way you’ll likely learn more. an Inc. It’s the little voice that offers a running commentary when you are listening to someone. Learning should be constant and continuous. Even if you don’t buy into the idea. the less room I have for new ideas and new thoughts.” he reasons. stop and take the other point of view. he explains five ways to increase your brain power by staying “open and impressionable” during intellectual conversations and lectures. Daum says. now I have all sorts of opinions that may refute the ideas being pushed at me. The more I fill my brain with facts. Next time you are listening to information.html. Argue with Yourself “If you can’t quiet the inner voice.aapc. In his article “5 Things That Really Smart People Do” in Inc. … Separate the material from the provider.” 3.” 2. Play like a detective and build your own extrapolation. go to www.Letter from the Chairman and CEO Here’s What Really Smart People Do AAPC offers a full spectrum of education and training programs to make you more knowledgeable in your desired area of expertise. and the action of thinking up questions will help encode the concepts in your brain.” Reed E. magazine. Believe it or not. In the best case you may open yourself to the information being provided.” Somewhere in the elaborate concept that sounds like complete malarkey there is some aspect that is based upon fact.com February 2013 7 . Plus. especially because the health care world is rapidly evolving. Although you have this oasis of health care know-how to take advantage of. you will at least strengthen your own argument. If you’re like most people who are getting older. Quiet Your Inner Voice “You know the one I am talking about. 5.” For Kevin Daum’s entire article. To help you get through learning obstacles as you get older. and your desire to learn should “outweigh your desire to be right. Pretend you don’t know the person or their beliefs so you can hear the information objectively. with more information being thrown at us everyday. “I find as I get older that real learning takes more work.” according to Daum. you should at least identify the little bit of truth from whence it came. Failing that. You may be surprised at what you hear. 5000 entrepreneur. No matter which category you are in you can benefit from behaving like a curious person. make up and write down two or three relevant questions. he says most people generally “assume learning comes naturally. It’s the voice that brings up your own opin- www. Sincerely. figures. it is possible for you to “get in the way of your own learning. inc. You’ll enhance your skills of deduction and may even improve the concept …. this may not be as easy as it sounds.” This is not the case. I’ve excerpted information from Daum’s five steps that I found most informative in the article: ion about the information being provided …. 4.” Daum recommends Googling the questions or asking another person to find the answers. Every time you hear yourself contradicting the speaker.com/kevin-daum/5-things-that-reallysmart-people-do. Pew AAPC Chairman and CEO 1. Focus less on what your brain has to say and more on the speaker. and experience. That voice often keeps you from listening openly for good information and can often make you shut down before you have heard the entire premise. Unfortunately. Suggest to your brain all the reasons why the speaker may be correct and you may be wrong.” It’s important to keep your head clear of your own opinion. Act Like You Are Curious “Some people are naturally curious and others are not. however. it’s up to you to make the most of it. Focus on the Message Not the Messenger “Often people shut out learning due to the person delivering the material.” according to Kevin Daum.

CodingWebU.com

Providing Quality Education at Affordable Prices

Tired of CD-Rom Courses that are out-of-date as soon as you take them? Tired of Audio Conferences where you cannot learn at your own pace? Tired of Online Courses you go through once and cannot access again? If so, CodingWebU.com is your answer!
We are the only program that provides interactive training incorporating audio, text and graphics to ensure you comprehend the information being taught. You will receive live updates as codes change and content is added. You always have access to the most current information, even if you purchased the course three years ago.

2013 Annual CEU Coding Scenarios ARE NOW AVAILABLE! 2012 Annual Coding Scenarios are also available Over 70 Courses Approved for CEUs starting @ $30
Anatomy Medical Terminology Physiology ICD-10 Chart Auditing RAC CPT® & ICD-9 Updates E/M and OB/GYN Pain Management Injections Emergency Department Coding Interventional Radiology Burns, Lesions, and Lacerations Billing & Reimbursement General Surgery Coding Phys. Pract. Revenue Mgm’t Advanced Beneficiary Notices Specialty Coding Modifiers Sleep Disorders Meaningful Use Compliance E|M Coding EHR ...and more

We offer group discounts and reporting for larger customers. We can also create or host custom courses for your employees.

CALL NOW to order your 2013 Coding Books! (484) 433-0495 www.CodingWebU.com

Letter from Member Leadership

Let AAPC Take a Piece of Your Heart

S

t. Valentine’s Day, thanks to its Hallmark card association, is typically celebrated by exchanging cards, candy, and gifts. Being the researcher that I am (and that health care coders and billers are), I was curious to find out the story behind St. Valentine, and if he truly existed. I found out how this “holiday” became part of American culture.

St. Valentine Represents Passion from the Heart
There are several possible explanations for the origins of St. Valentine’s Day, including a pagan festival, Lupercalia, and no less than three saints named Valentine. I dug deeper to learn more about each of these saints. They were noted to be heroic, sympathetic, and romantic figures fighting against constraints and for that which they held dear and believed to be right and true. One legend reveals St. Valentine as the priest who defied Claudius’ law for soldiers to remain unwed by continuing to perform marriages in secret. The second legend states that once imprisoned, St. Valentine fell in love with the jailer’s daughter and before his death sent her a letter signed “From your Valentine.” The third legend depicts St. Valentine as a martyr killed for attempting to help Christians break out of Roman prisons. Regardless of which of the St. Valentine legends holds true, it seems that this month, more than any other, is the time to reflect upon and pursue that which we hold near to our hearts.

AAPC members is apparent. Being a member saves me incalculable hours of work attempting to absorb the nuances of coding for psychiatry, working through nerve conduction study changes, and piecing together the elements of new evaluation and management (E/M) codes for transitional care management services. Calling on fellow AAPC members allows us to share ideas and our work load, and benefits our employers with a collaboration of many years of health care experience.

Aim Your Passion at AAPC
Whether you need to build your AAPC network or expand your existing network to include other specialties or areas of health care administration, there are several ways to accomplish this in 2013: • Attend local chapter meetings, including nearby area meetings. • Contact your local chapter officers regarding members who are looking to build their member network. • Log in and use the AAPC member forums. • Join your fellow members at AAPC regional and national conferences. Belonging to a network of colleagues brings benefits; however, it includes the responsibility of reciprocal action. Be sure to show your passion for coding by contributing your skills, knowledge, and experience to the network. The benefits of your heartfelt effort will come back to you tenfold when you receive the family experience AAPC membership offers. Best wishes,

Holding AAPC Dear to My Heart
The benefits of being an AAPC member continues to be held near and dear to me as the most valuable asset to my health care career. With so many CPT® changes for 2013, the benefit of networking with my fellow

Cynthia Stewart, CPC, CPC-H, CPMA, CPC-I, CCS-P President, National Advisory Board
www.aapc.com February 2013 9

A&P QUIZ
By Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC

Think You Know A&P? Let’s See …
The colon is also called the large intestine. The ileum (last part of the small intestine) connects to the cecum (first part of the colon) in the lower right abdomen. The rest of the colon is divided into four parts: • The ascending colon travels up the right side of the abdomen. • The transverse colon runs across the abdomen. • The descending colon travels down the left abdomen. • The sigmoid colon is a short curving of the colon, just before the rectum.

Test yourself to find out where your anatomy and physiology skills rank:
The physician documents that he removes a polyp found at 19 cm. What part of the colon is this considered? A. Anus B. Rectum C. Rectosigmoid D. Sigmoid The correct answer is on page 20.
Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, is vice president of ICD-10 Training and Education at AAPC.

KUDOS

124 Pounds-worth of Pop Tops for a Good Cause
Louise Dowling, CPC, of the Minneapolis local chapter has a reputation for making things better in the Land of 10,000 Lakes. This year, her chapter officers handed out dozens of Ronald McDonald House (www. rmhc.com) cardboard houses for members to collect pop tops. Stepping up to the plate, Dowling offered to deliver members’ donations in person. After two meetings, she and her fellow chapter members collected nearly 38 pounds of aluminum tabs. Ronald McDonald House Charities provides a “home away from home” for families of seriously ill children receiving treatment at nearby hospitals. Many Ronald McDonald Houses work with local recycling centers to receive money for collecting tabs from aluminum cans. The charitable act hit home for Dowling
10 AAPC Cutting Edge

Photo by iStockphoto © VIPDesignUSA

when she took the donation to the local Ronald McDonald House. She said, “I had a little girl who looked so sick dressed up in a princess dress and tiara come up to me. She asked if I had drunk all that pop and beer by myself. We had a good laugh over that one. She gave me a hug and told me to thank the rest of ‘those [coding] ladies for drinking so much!’ I went to my car and cried and laughed at the same time.” The Minneapolis chapter invited attendees at November’s AAPC state conference to pitch in and donate all of their pop tops. As a result, Dowling and her chapter collected quite a few pop tops at the event, and wound up with a 124-pound total for the year. Kudos to the charitable Dowling and her Minnesota AAPC colleagues!

and agreements • Web site security. the accounting of disclosures. remote access. Handbook for HIPAA-HITECH Security covers such compelling topics as: • The importance of information security • A plan of action to achieve and maintain security • Organizational relationships and documentation requirements • Risk analysis (also required for meaningful use of the EHR incentive program) Softbound. 350 pages Also available as an E-book . and Mark E. RHIA. Hartley. 7" × 10".Sc New for 2013 Third edition HIPAA Plain and Simple: After the Final Rule. CHPS. This second edition of the popular AMA title Handbook for HIPAA Security Implementation presents practical and pragmatic ways to interpret the final regulations and ensure compliance. 256 pages CD-ROM included Also available as an E-book • Administrative. Jones III Forewords by Louis W. Softbound. and contracts with and disclosures to business associates. Frisse. The third edition expands upon the topics of enforcement. physical. Sullivan. 7" × 10" Approx. and encryption • Application of security controls to thwart identity theft • Breach notification requirements Additional features include: • A reprinting of the final Security Rule • Case studies • Questions and answers • A security-related glossary • Policy templates and other tools on CD-ROM • Customizable tables and checklists on CD-ROM HIPAA AFTER the FINAL RULE Carolyn P. social media protections. MLA Edward D. M.ama-assn. and technical safeguards • Business associate relationships. contracts. MD.com or call (800) 621-8335. second edition by Margret Amatayakul.org Published in December Handbook for HIPAA-HITECH Security. CPEHR. third edition Order online at amabookstore. MBA. MD. Handbook for HIPAA-HITECH Security details the new privacy and security requirements brought about by HITECH as they pertain to patients’ health records and medical data. MBA. passwords. FHIMSS So much has changed since 2005 when federal regulations first required compliance with the HIPAA Security Rule. New content includes migrating to operating rules and meaningful use.

Okla. hats. giving back through charitable work. the American Red 12 AAPC Cutting Edge Gainesville. CPC . and the AAPC Chapter Association (AAPCCA) Hardship Scholarship Fund. they collect mittens. Ariz. Louis. Since 2005. chapter supports the organization “Challenged Child and Friends.” As a result of the drive. Members have also participated in several dining out events where they are the host at a local restaurant and invite members to come and dine together. and strengthens local chapters. Cross. who give them to children in abusive or other traumatic situations. Chapter members also formed a cooking team to prepare an Italian feast for the families staying at the house. Kansas City. Alzheimer’s Association. given away at each meeting. the chapter set its sights on the local Ronald McDonald House. In 2012. Louis West chapter) support a variety of causes throughout the year. American Red Cross. an organization Steudler helped to start. Mo. Germaine Steudler. I’d like to highlight the good deeds a handful of our chapters have accomplished. For example. participating in the “Backpack for Kids” program. arts and crafts supplies. At the chapter’s year-end party. Tulsa. American Heart Association. In 2012. Okla. the Minneapolis local chapter participated in several charitable activities. the American Cancer Society. St. Phoenix. Each year. clothing. At Christmas. Members were encouraged to drop them off at chapter meetings for her to collect and deliver back to the charity. the Tulsa. Members also had the opportunity to volunteer at the camp. In the spring. In 2012. The following year they honored her memory by supporting Community Alliance Against Family Abuse (CAAFA). Minneapolis. AAPC’s local chapters are known for providing educational and networking opportunities for its members. The Gainesville. In 2002. Light the Town Pink.6 pounds of pop tops were collected after just two chapter meetings (read Kudos on page 10 for more information). 37. members photo by iStockphoto©hidesy . They also have participated in Komen Race for the Cure. two of these activities were organized by Louise Dowling. these philanthropic endeavors are uniting members and making chapters stronger. In all. The chapter also stepped up to donate 12 blankets and 65 towels for the Hennepin County Animal Shelter. At each local chapter meeting members were encouraged to donate items needed on the “House Wish List. Lesser known is that chapters are taking a more active role in communities. bonds. medical supplies. the chapter collected donations from members for the Society for the Prevention of Cruelty to Animals. there have been two bone marrow matches so far. Ga.org/Supporters. The Grand Canyon Coders have been recognized as one of CAAFA’s supporters on the charity’s website (www. and the MS Walk. They have also raised money for the AAPCCA Hardship Scholarship Fund by holding raffles for an education pack. they select an organization to support. Minn. The Kansas City chapter started a community project committee in 2010. Louise handed out dozens of little Ronald McDonald Cardboard Houses to members to collect pop tops. the chapter holds canned foods drives during the year and. and providing financial support. collecting food items at meetings. in August. In 2011.html). and sporting goods for Camp Hope. Louis Childrens’ Hospital and AIDS research by the restaurant owner. In turn. collects school supplies for local kids in need. St. and money to help support the shelter throughout the year.” which works to keep children with special needs in the mainstream by pairing them with other children in the community. which included attendance at their local chapter seminar and lots of great reference books.Chapter Life By Angela Jordan. the chapter collected toys. several of which are charities also supported by the hospital where they meet. Louis Professional Coders (St. and gloves for the homeless. volunteering their time. ProTulsa continued their charitable work and also donated money to Project AAPC. The coders still collect household goods. Their first project was a silent auction and bone marrow drive held for “Be the Match. Mo.caafaaz. They have also collected teddy bears for local police departments and hospitals. the Phoenix chapter lost one of their members. a children’s cancer camp. CPC Chapters Can Change Lives Charity unites. chapter (ProTulsa) has actively supported their local food bank. Ga.” Participating members’ names were placed in a drawing for a cookbook. and the Blood Bank of Tulsa. Fifty percent of the proceeds are donated to causes like St. In 2011.

AAPCCA: Handbook Corner By Barbara Fontaine. Wilson. and other specialties. Everyone has an area that needs improvement. CPC. we would really love to hear from you. Thanks to the fundraising efforts of our chapters and the generosity of members. Chapters Unite to Support a Cause Whether it’s raising funds for a charity or filling a need in the community. please go to the AAPC website at http://static. CPC. CPC-I. Tune into your chapter by using the “Forum Tools” button at the top of your chapter forum to subscribe. Project AAPC added a second charity. If your chapter adopts this program. learning toys. volunteer. Ms. held silent auctions. and involved in an organization designed to benefit your career and personal development. family practice. CPC. however. Susan Edwards. Mentoring Program Benefits Everyone Involved The goals of the Chapter Mentoring Program are: • • • • To provide a one-on-one opportunity in an area or specialty To promote networking To encourage relationships within and beyond the local chapter level To improve an existing mentoring program. radiology. or sign yourself up to be a mentee. It’s easy and comes right to your inbox. Angela Jordan. Helping Across America In 2010. which was donated to the American Red Cross in Nashville for flood relief. fill it. and has served as Kansas City chapter president. laboratory.000 to the American Red Cross and over $6. or referring him or her to a person who can help. CPCD. Do you remember the first person who believed in you and shared with you his or her knowledge and skills? You could be that person for someone else. along with AAPC liaisons Marti Johnson. Susan Ward. and asked members to donate their coffee or soda pop money for a day. and Heidi Larsen. enthusiastic. The Local Chapter Handbook states that chapters with monthly attendance over 40 members should have both an education officer and a member development officer. ethical member. The Local Chapter Handbook introduction states. You can be a mentee. while developing personal improvement and strong networking opportunities. CANPC. If there’s an open office position. LLC. She has 10+ years experience with health care providers and has worked as a coding and compliance manager of a large physician network and HCA. pain management. She is the AAPCCA Board of Directors chair. AAPC provides step-by-step online instructions to help chapters form a successful mentoring program. which supports food banks nationwide. and this starts in your local chapters. batteries. CEMC. too. CPC. the more credibility you’ll gain for your career and expertise.aapc. In 2011. and raised over $13. each chapter must hold at least six meetings offering continuing education units (CEUs). AAPCCA founded Project AAPC Chapters Aiding People in Crisis (Project AAPC) to encourage chapters to help those affected around the world by natural disasters.com/ppdf/ChapterMentoringPro​ gram1. so here’s an opportunity to get help from experts in the field. Sometimes it’s as easy as sending an email to see how your mentee is doing. Mentoring is a very rewarding endeavor that does not require you to have mentor experience to make a difference in someone’s life. Helping others is contagious and it’s one bug your chapter should be anxious to catch! Designate in the memo area of your check whether you would like the donation to go to the American Red Cross or to Feeding America. Project AAPC has donated over $17. if your chapter already has one in place It’s Easy to Get Started If you are interested or wish to have your chapter involved. If you want to share something. and it doesn’t take a lot of time to be effective.700 to Feeding America. is managing consultant at Medical Revenue Solutions. c/o Local Chapter Department 2480 South 3850 West Salt Lake City. oncology. Amy Bishard. Feeding America. UT 84120 • • • Read the AAPC Local Chapter Handbook for more good advice and soon you will be on your way to becoming all you can be.pdf for upcoming information about the Chapter Mentoring Program guidelines. CPC are encouraged to bring school supplies. raffled quilts. The more your coworkers know and understand about our organization. Watch what you say and whose name you mention. CPPM. AAPC members came together. ENT. You may contact your regional representatives to share your success stories. CEMC. being all you can be means being active. CPC. members who come together for the greater good experience positive change and personal growth within their chapter. and the surrounding area. CEMC. Be a networker and a mentor. and try presenting. outpatient. orthopaedics. CPC-H. Tenn. CPRC. and any office supplies the organization needs.” You are a vital link in this mission as a member. CPC-H. Present yourself as a professional. Increase awareness of AAPC and its membership. “local chapters are essential in setting the standard of professionalism and higher education. CPC-I. Danielle Montgomery. CMRS Chapter Mentoring Program Launches At the 2012 AAPC Regional Conference in Chicago. Roxanne Thames. The following members of the Mentoring Task Force helped develop this new opportunity: Melissa Corral. CPCO. Chapters that donated to Project AAPC sold snacks at meetings. • • • Learn an unfamiliar area of our business Seek assistance in getting organized Resolve difficult workplace situations Mentoring isn’t a daunting task—it’s fun! You’ll make new friends with whom you have a lot in common. CPC. Give a little of your time to help someone in need of a mentor. CPC-P. representing Region 5 – Southwest. Becoming a mentee provides an opportunity to: • Expand your knowledge in a certain field or specialty www. Per the Local Chapter Handbook. the AAPC Chapter Association (AAPCCA) proudly launched the Chapter Mentoring Program.com February 2013 13 . CPC.aapc. answering a coding question.000. Little did we know a flood of historical proportions would hit Nashville. CEDC. Donation jars were also a popular choice for collecting funds. Be All You Can Be: Consult Your Handbook For AAPC members. suggest programs. To carry out AAPC’s vision through your local chapters: • Support your local chapter with your presence. People will see you as a leader and a person to turn to when they need an answer. Challenge yourself and volunteer to help. emergency medicine. inpatient. Partake in AAPC online forums. AAPCCA: Mentoring By Judy A. make it valuable. Attend meetings. Mail donations for Project AAPC to: Project AAPC. • Fulfill your chapter’s needs. If your chapter needs a proctor to hold an exam. CPMA. Jordan’s experience includes surgery.

) See Centers for Medicare & Medicaid Services (CMS) transmittal 2620 for more information: www. complicated.” New text – “If your primary insurer paid the provider. and only if that coverage begins on or after January 1. They offset receivables. Prospective payment system and fee schedule update factors are adjusted by changes in economy-wide productivity. Here are few examples of changes made to CMS MSN message verbiage: Message No. You can implement and use the new MSN messages effective Feb.95 Days AAPC Cutting Edge 14 AAPC Cutting Edge .521 (this is a negative number because it is money owed) Gross Charges: $587. you need to pay the provider the difference between the limiting charge amount and the amount the primary insurer paid your provider. technically. 29.422 / $1.901 . days in A/R will appear overly optimistic. 2013.” For a compete list of easier-to-read MSN messages. If your primary insurer paid the provider. Please To keep up with the Plain Writing Act of 2010. Otherwise.521)] / [$587.” New text – “This service isn’t covered for people under 50 years old. 18. To clarify. which are equal to the 10-year average of private.8 percent (The Affordable Care Act says the CPI-U is reduced by the MFP to get the AIF. 2005.857 / 365 Days] = Days in A/R or $72.pdf. Medicare Summary Notices in Plain English.pdf.13 Original text – “This service is not covered for beneficiaries under 50 years of age.” A reader questions whether “subtraction” is the right way to describe this accounting function because. credits are a “negative” number. 1.com Calculating Credits Owed In the December issue. and then subtract any credits.22 Original text – “The amount listed in the “You May Be Billed” column assumes that your primary insurer paid you.$4. nonfarm business MultiFactor Productivity (MFP) annual changes. the author advises you to. Credits are funds owed by the practice to others.” New text – “This service was denied because Medicare only allows the Welcome to Medicare preventive visit within the first 12 months you have Part B coverage. so subtract credits from receivables. CMS recently redesigned their Medicare Summary Notice (MSN) to revise “outdated. See note (__) for the legal charge limit.gov/Regulations-and-Guidance/ Guidance/Transmittals/Downloads/R2620CP. Medicare Part B coinsurance and deductible requirements apply to payments under the ambulance fee schedule.611 = 44. and obsolete” messages to plain language messages so Medicare beneficiaries can easily understand them.9 percent • CPI-U is 1.” Message No. For 2013: • MFP is 0.Coding News Ambulance Inflation Factored for 2013 The 2013 Ambulance Inflation Factor (AIF) has been released and went into effect Jan. even if it leads to a negative update. refer to change request (CR) 8106 at www.7 percent • AIF is 0. “Determine your total current receivables.901 Credit Balance: . 18. 18.cms. Letters to the Editor Please send your letters to the editor to: letterstotheeditor@aapc.(-$4.cms.22 Original text – “This service was denied because Medicare only allows the one-time initial preventive physical exam with an electrocardiogram within the first six months that you have Part B coverage.857 (Total Receivables . which requires federal agencies to use clear language on all documents intended for the public. here is an example of what the author meant: Receivables: $67. then you only need to pay the provider the difference between the amount the provider can legally charge and the amount the primary insurer paid.” Message No. “Manage Four Key Revenue Cycle Metrics” (pages 33-34).Credits) / (Gross Charges / 365 Days) = Days in Accounts Receivable (A/R) or [$67.gov/Regulations-and-Guidance/Guidance/ Transmittals/Downloads/R1161OTN. The Social Security Act (section 1834(l)(3) (B)) figures a yearly payment update based on the Urban Consumer Price Index (CPI-U) percentage increase for the 12-month period ending with June of the prior year.

AL Madison. FL Montgomery.” through 2013 Class Date 1/24—1/25 2/6—2/7 2/20—2/21 3/4—3/5 3/7—3/8 3/20—3/21 3/27—3/28 4/4—4/5 4/11—4/12 5/1—5/2 5/8—5/9 Class Location Knoxville. NY Biloxi. TN Savannah. CA Memphis.Medical Accreditation NAMAS Enhancing Careers Education “Best money I have spent on a training class or seminar. I would highly recommend this program to my peers.NAMAS-Auditing. WI TRAINING PROGRAM Prepare for the AAPC’s Certified Professional Medical Auditor (CPMA®) credential CPMA Training Tuition $1025—Regular Cost $910—AAPC Members Earn 16 CEUs ® www. MS Orlando. AZ San Diego. VA Phoenix. TN New York. (877) 418-5564 . GA Fairfax.com We will come to you! To request a class in your area call or email and ask about a special booking.

they are also called mini-BTE aids. This implant is also coded like the VSB semi-implant with CPT® 69799 Unlisted procedure. used for bone conductive loss. Slim-tubing behind the ear (BTE) devices without ear molds are called open fit or over the ear. with percutaneous attachment to external speech processor/cochlear stimulator. R. with percutaneous attachment to external speech processor/cochlear stimulator. V5298 Describes Aids NOC Several increasingly popular hearing aids are not yet specifically described by HCPCS Level II codes. osseointegrated implant. Replacement implants are reported with L8619 Cochlear implant. These . For BAHA. While attending a four-day National Hearing Loss Association of America (HLAA) Convention in Providence. rather than on the hearing aid itself. I’d like to share with you some valuable tips for reporting hearing-assistance technology supplies that I picked up at the convention so that you. When implants are placed in both ears. a semi-implantable electromagnetic hearing aid. According to Consumer Reports (“How To Buy a Hearing Aid. may code hearing loss equipment with clarity. but many prosthetic implant/hearing assist supply codes also fall into categories L8613–L8629 and L8690–L8693. external sound processor. they could be coded as V5298 Hearing aid. smallest completely in-the-canal (CIC) devices are called mini-CICs or invisible in the canals. I quickly realized that there is no such thing as too much information. If a patient is diagnosed as having unilateral hearing loss and one deaf ear. temporal bone. a choice of bilateral contra-lateral routing of signals (BICROS) may be appropriate. external speech processor and controller. severity. In other examples for different body locations. These new hearing aids have microphones located in the ear. is fully implantable with no external components. Contra-lateral routing of signals (CROS) is used when a patient has one ear with normal hearing and one deaf ear. and that I had a lot more to learn. binaural. report L9900 Orthotic and prosthetic supply. Some hearing aids may be adjusted for high and/or low frequency hearing losses. knowing what’s out there is key to proper reimbursement. not otherwise specified. includes all internal and external components. too. Captioned telephones such as CapTel® and CaptionCall® may be included in the HCPCS Level II code V5274 Assistive listening device. and/or service component of another HCPCS L code.■ Coding/Billing By Marita Cable-Camilleis. any type. and configuration). 2012. like the one shown in Table A . or simply reported with V5268 Assistive listening device. For example. not otherwise classified. The newest. Bonus tip: Report surgical implantation of cochlear implants with CPT® 69930 Cochlear device implantation. however. accessory.. A child under the age of five would wear a headband for BAHA (or Ponto Pro) without surgery. Alternate Hearing Assistance Technologies Photo by iStockphoto © Eldemir Not all assistive listening devices are specifically coded because of multi-functionality. with mastoidectomy. June 21-24. replacement. HCPCS Level II code 16 AAPC Cutting Edge V5095 Semi-implantable middle ear hearing prosthesis is for Vibrant Soundbridge® (VSB). replacement and L8691 Auditory osseointegrated device. you cannot truly “compare” hearing aids because no two people have the same kind of hearing loss (type. with or without mastoidectomy. If these new hearing aids are not classified. telephone amplifier. Many Code Choices Most familiar hearing aid HCPCS Level II codes are classified to V5030–V5267. and create a more natural sound and less wind noise. middle ear. A small version of ITE is called half shell. temporal bone. Y Many Aid Choices. new sound processor devices for cochlear implants and cochlear bone-anchored hearing aid (BAHA) implants are reported with L8614 Cochlear device. 69714 Implantation. respectively. CPC Choose with Clarity Hearing Loss Supply Codes With so many devices to choose from. Another middle ear implant. called Envoy Esteem®. For an in-the-mouth (ITM) device called SoundBite. One side of chart has the body-location variable and the other side lists hearing loss diagnosis variables mixed with manufacturers’ variables. With so many hearing aids—classified as monaural.I.” July 2009). osseointegrated implant. includes all internal and external components and L8690 Auditory osseointegrated device. integrated system. you may append modifier 50 Bilateral procedure. such as receiver-in-the-canal or receiver-in-the-ear (ITE) devices. ou would think that someone who has a vested interest in audiology would be an authority on the subject. and bilateral—it is easier to keep track of them using a chart. without mastoidectomy or 69715 Implantation.

and Microphones For 2013. To combine all three components (receiver(s). which picks up signals from a loop system Table A CONDUCTIVE LOSS: MIXED LOSS: while cutting off background noise. any type for one receiver or V5282 Assistive listening device.To discuss this article or topic. One example is the increasingly popular “looping” system that is more common in Great Britain and Scandinavia. use V5281 Assistive listening device. Transmitters. any type for two receivers (one for each ear). which are most often used with hearing aids to improve the signal-to-noise ratio. microphone). Another system creates a “public addresstype” system with a wireless microphone. personal FM/DM system.. M. rather than individuals. such as Pocketalkers®. New Receivers. She has severe hearing loss and has worn hearing aids since the age of three. go to www. which may be coupled to a hearing device. not otherwise specified was revised and new codes V5281–V5290 were added to accommodate personal FM/DM auditory devices. which can be turned on for hearingaid compatible phones with optional neck loops plugged in. and the DynaMic is a cordless microphone designed to be used with it. There are also personal loops just for television. infrared systems. T-coils (including related batteries. For example. feedback-suppression capability. so anyone nearby can turn on the telecoil (t-coil) switch of his or her custom-made hearing aid (or cochlear implant) to hear the speaker more clearly. and hearing loop (or induction loop) systems are not available.Ed. Marita Cable-Camilleis.aapc. If the receiver is built into a new hearing aid. TYPE OF HEARING AID OR IMPLANT AIR BONE SENSORINEURAL CONTRALATERAL ROUTING OF SIGNAL CROS BILATERAL CROS DIGITAL PROGRAM DIGITAL BICROS ANALOG ANALOG PROGRAM DIGITAL DISPOSABLE SITE ON BODY In the Mouth (ITM) Inner Ear: Cochlear Implant Middle Ear: Semi-implant (VSB) Completely In the Canal (CIC) In the Canal (ITC) L9900 L8690 L8691 L8614 L8619 V5095 V5242* V5248** V5243* V5249** In the Ear (ITE) V5050* V5130** Behind the Ear (BTE) V5060* V5140** Body Worn V5030* V5040* V5100*** V5120** In Eyeglasses Hearing Aids Not Classified Key: * = monaural ** = binaural V5070 V5080 V5150 V5298 *** = bilateral V5190 V5230 V5180 V5220 V5247* V5253** V5170 V5210 V5244* V5250** V5245* V5251** V5246* V5252** V5254* V5258** V5255* V5259** V5256* V5260** V5257* V5261** V5262* V5263** V5262* V5263** V5262* V5263** V5262* V5263** www. is treasurer of HLAA’s Cape Cod chapter. A modern digital hearing aid may have the ability to be controlled remotely by the patient’s cell phone. any type. She has done considerable research in the field of audiology. and directional microphones) are not currently specified in HCPCS Level II codes for hearing aids.com Coding/Billing: Hearing Loss codes may also include hearing aid compatible smartphones. (2 receivers. Approximately 69 percent of all hearing aids have a t-coil. In this setting. Even a non-deaf person can hear better with a headphone and inductive loop receiver. transmitter. Some assisted listening devices have not yet been coded because they are geared more toward groups. personal FM/DM transmitter assistive listening device for the transmitter only. you may report V5288 Assistive listening device. A complete FM/DM system typically consists of a transmitter and a receiving device.com February 2013 17 . CPC. are useful when FM systems. This allows the listener to better hear in the presence of background noise. and microphone). transmitter. an electromagnetic wire is looped around a room (or a ticket booth) to the speaker microphone. monaural. microphone). transmitter. television amplifier. Inspiro® is an FM transmitter for teachers to wear in the classroom. binaural. FM/DM auditory devices direct sound from a transmitting device (FM/DM transmitter) via a frequency or digitally modulated signal to a receiving device (FM/DM receiver). personal FM/DM system. (1 receiver.aapc. the descriptor for V5267 Hearing aid or assistive listening device/supplies/accessories. transmitting sound to receivers attached to loudspeakers and/or to those attached to hearing aids. Personal amplifiers (V5274). which may be reported with V5270 Assistive listening device.

There is no change to the tunneled chest tube placement code (32550 Insertion of indwelling tunneled pleural catheter with cuff ). percutaneous. cardiac chamber. abscess. We’ll focus on the chest drainage procedures and non-cardiac endovascular codes changes. Code 32554 is used when imaging guidance is not necessary. includes connection to drainage system (eg. 77012). and imaging guidance (ultrasound or fluoroscopy). replaced with 32554 Thoracentesis. for percutaneous drainage (eg. Imaging guidance includes any combination of fluoroscopy ultrasound. stents. which allows separate reporting of 75989 Radiological guidance (ie. Code 32551 Tube thoracostomy. Make certain to report the appropriate catheter placement code (36010–36012 for venous. and now represents an open placement of a chest tube (usually for empyema. percutaneous. endovascular. The catheter tip is in the main pulmonary artery. ultrasound. Contrast injections are mostly used for guidance. with placement of catheter. 76942. when performed. or computed tomography). 36200 for the aorta. when performed. Takeaways: • The AMA created 74 new interventional radiology. traumatic hemothorax. and 36215–36218 for selective vessels above the diaphragm) for the retrieval. fractured venous or arterial catheter). cardiac chamber. • These include intravascular FB removal and thrombolysis services. needle or catheter. CCC. Via right femoral vein approach. radiological supervision and interpretation for image guidance during placement. as needed. needle or catheter. have been deleted for 2013. here’s where to start. includes radiological supervision and interpretation. Snare is placed around the catheter tip in the pulmonary artery and the catheter is retrieved and slowly removed from the body. which described needle or catheter-drainage of chest fluid. 18 AAPC Cutting Edge One Code Describes Intravascular FB Removal A single code now describes retrieval of an intravascular foreign body (FB): 37197 Transcatheter retrieval. 36245–36248 for selective vessels below the diaphragm. with imaging guidance.■ Coding/Billing By David Zielske. which include retrieval of intravascular foreign body and thrombolysis. CIRCC. percutaneous. while 32555 is for procedures with imaging guidance. right heart or main pulmonary artery for catheter placement 37197 for retrieval of the foreign body Note: Usually. Proper coding is: 36013 Introduction of catheter.g. without imaging guidance and 32555 Thoracentesis. while deleting 32 codes for many of the same types of procedures. The procedure requires placement of a catheter and retrieval device or snare to the location of the foreign body. and coronary arterial interventional codes for 2013. MD. CPC-H. of intravascular foreign body (eg. . a retrieval device is advanced into the right atrium. aspiration of the pleural space.. T he American Medical Association (AMA) was very busy last year. Two additional codes for percutaneous chest drainage by placement of non-tunneled chest drainage catheters are 32556 Pleural drainage. without imaging guidance and 32557 Pleural drainage. and coronary arterial interventional codes and deleted 32 codes for many of the same types of procedures. These tubes are placed without imaging guidance. with imaging guidance. or magnetic resonance imaging (MRI). with insertion of indwelling catheter. computed tomography (CT). and other intravascular foreign bodies are easily visible with fluoroscopy. when performed replaces 37203 and 75901. endovascular. creating 74 new interventional radiology. 77002. The old codes allowed for separate reporting of image guidance (e. or pneumothorax). Example 1: Patient is a 40-year-old with fractured central venous access catheter noted on the chest X-ray. a diagnostic angiogram is not necessary because broken catheters. water seal). with insertion of indwelling catheter. CCS. • Differentiate separate from bundled thrombolysis services. The new codes describe chest drainage by a needle or catheter that is removed at the end of the procedure. 36013–36015 for the right atrium and pulmonary artery. 2013 Breathes New Life into Chest Drainage Codes Non-vascular interventional radiology codes 32421 and 32422. fluoroscopy. open (separate procedure) has been revised. lost coils. specimen collection). RCC Get Busy Learning New Non-cardiac Endovascular Codes 2013 CPT® changes for interventional radiology are extensive. aspiration of the pleural space.

The patient is sent to ICU for monitoring.m. 37213 Transcatheter therapy. a contralateral sheath is placed into the right external iliac artery. only 37211 or 37212 may be reported for the thrombolysis. or 37214. or lower extremity artery branch. including follow-up catheter contrast injection. If the infusion continues past the initial day. continued treatment on subsequent day during course of thrombolytic therapy. continued treatment on subsequent day during course of thrombolytic thera- Photo by iStockphoto © johnwoodcok py. The patient is brought back later the same day.m. initial treatment day describes the initial date of treatment for arterial thrombolysis. unilateral. arterial system. when performed is used for arterial or venous thrombolysis on the subsequent day(s) of therapy.com www. any method. Example 2: A 62-year-old patient has an ischemic right leg. to 11:59 p. or exchange. arterial or venous infusion for thrombolysis other than coronary.) are described by a single code. including radiological supervision and interpretation. Code 37213 cannot be reported the same day as 37211.aapc. any method. Code 37211 Transcatheter therapy. venous infusion for thrombolysis. including radiological supervision and interpretation. position change.aapc. while 37212 Transcatheter therapy. position change. Do not report 37214 the same day as 37211 or 37212. any method. within a vascular family) and catheterdirected thrombolytic infusion is initiated (37211). Diagnostic angiography reveals acutely thrombosed right femoral-popliteal bypass graft with chronically occluded native superficial femoral artery (SFA) (75710 Angiography. extremity. The patient is brought back on day two with imwww. radiological supervision and interpretation). for coding purposes. follow-up angiography. Via left femoral arterial puncture. arterial or venous infusion for thrombolysis other than coronary. cessation of thrombolysis including removal of catheter and vessel closure by any method for the final day of therapy. including radiological supervision and interpretation. or exchange. 37213 will be repeated for each additional day that is not the initial or final day of treatment. when performed. any method. and catheter exchanges performed on a single date of therapy (12 a. Use 37214 Transcatheter therapy. including radiological supervision and interpretation. For a single day of therapy.com February 2013 19 . initial treatment day describes the initial day for venous thrombolysis. pelvic.Coding/Billing: Endovascular Thrombolysis Now a “Per Date” Service Percutaneous non-coronary catheter directed thrombolysis is now a “per date of therapy” procedure. A thrombolysis catheter is advanced into the graft (36247 Selective catheter placement. initial third order or more selective abdominal. Followup imaging and catheter exchange for a longer infusion catheter is performed (no additional code because 37211 describes a single day of therapy). arterial infusion for thrombolysis other than coronary. when the infusion is concluded. including follow-up catheter contrast injection. If an infusion is three days or longer. 37212. Thrombolysis infusion.

or when the infusion catheter is repositioned or replaced. Inc. RCC. includes angioplasty within the same vessel. go to www. Optuminsight. David Zielske. CIRCC. MD. Codes 37184-37188 are used to describe these associated percutaneous thrombectomy procedures. and has nothing to code. submitted earlier in the day) at 11:30 pm. Differentiate Separate from Bundled Thrombolysis Services Routinely. unilateral. there are no additional codes submitted when the patient returns to the angiography suite for follow-up imaging. endovascular. Usually. you would not report 37214. femoral. the new cervico-cerebral codes (36222–36228) bundle the catheter placement. an angiographic catheter is placed near the site of thrombus and a diagnostic angiographic study is performed. Both the catheter placement and the imaging supervision and interpretation are reported. it may be disappointing to the on-call physician who performs a follow-up angiogram and catheter exchange (both included with 37211. lower third is not Rectosigmoid 15-17 cm–From the anal verge Sigmoid 17-57 cm–Loop extending distally from border of left posterior major psoas muscle Descending 57-82 cm–Approximately 10-15 cm long and located behind the peritoneum Transverse 82-132 cm–Lies anterior in the abdomen and is attached to the gastrocolic ligament Ascending 132-147 cm–Approximately 20-25 cm long and is located behind the peritoneum Cecum 150 cm–Approximately 6 x 9 cm pouch covered with peritoneum this catheter exchange is bundled with the new thrombolysis codes. other than for thrombolysis during thrombolytic infusion therapy because it is bundled. embolization or infusion.) are described by a single code. when intracranial thrombolysis is performed. This is treated with a stent (37226 Revascularization.m. Many physicians document by centimeters for procedures involving the colon: • • • • • • • • Anus 0-4 cm Rectum 4-16 cm– Also called the rectal ampulla. 20 AAPC Cutting Edge . Excellent result is obtained.Coding/Billing: Endovascular To discuss this article or topic.aapc. open or percutaneous. aging performed.com Thrombolysis infusion. an underlying cause (such as a stenosis) is identified. Do not report 75898 Angiography through existing catheter for follow-up study for transcatheter therapy. we’ll review CPT® 2013 changes to cervico-cerebral imaging. Mechanical arterial or venous thrombectomy may be reported in addition to prolonged thrombolysis infusion procedures. at the start of thrombolysis care. and catheter exchanges performed on a single date of therapy (12 a. upper third is covered by peritoneum. with transluminal stent placement(s). when performed. The sheath is removed (37214) for the final day of thrombolytic therapy. atherectomy. however..g. stent placement). to 11:59 p. Treatment of that abnormality is additionally reported (e. CCS. Tenn. With the change of the thrombolysis codes to “date of therapy” codes. after completion of the thrombolysis. follow-up angiography. showing resolution of thrombus and an underlying 90 percent distal anastomotic stenosis. popliteal artery(s). when performed ). Catheter exchange codes 37209 and 75900 are deleted in 2013 because Anatomical Illustrations © 2012. CCC. Stay tuned: Next month.m. CPC-H. angioplasty. Although the new codes for thrombolysis do simplify coding. is an interventional radiologist and president of ZHealth Consulting and ZHealth Publishing in Brentwood. Note: If the entire procedure had been performed on a single day. A&P Quiz Answer The correct answer to the quiz on page 10 is D.

.

Since April 1. there are 150 changes. Verhovshek. To enact this policy. previously used with dialysis revenue code lines for all end stage renal disease (ESRD) claims and all ESRD hemodialysis claims.g. when appropriate. changes significant enough to clinically warrant a re-evaluation such that a HCPCS/CPT® code for a re-evaluation or a repeat evaluation is billed Also new are two modifiers that may be used to “break” National Correct Coding Initiative (NCCI) edits. 2013. limited or restricted At least 1 percent but less than 20 percent impaired. 1. New Modifiers Among the changes are seven new modifiers for Medicare reporting. Modifiers LM Left main coronary artery and RI Ramus intermedius coronary artery alert the payer that two procedures occurred at separate sites and may be reimbursed separately. CMS created G0290 and G0291. replacing them with new. which corresponded to CPT® codes 92980 and 92981. similar to modifiers LT Left side and RT Right side. limited or restricted At least 40 percent but less than 60 percent impaired. limited or restricted New Supply Codes As always. The modifiers describe the extent of the functional limitation. For 2013. And as shown in Table 2. which must be appended to HCPCS Level II codes G8978-G9176 (new for 2013) to describe a functional limitation (e. G8981G8983 Changing and maintaining body position functional limitation …). For example. more granular codes describing coronary therapeutic services and procedures. CPC 2013 Picks for HCPCS Level II Effective Jan. Modifiers V8 and V9. To maintain the existing policy of differentiating payment for intracoronary stent placement procedures involving nondrug-eluting and 22 AAPC Cutting Edge Photo by iStockphoto © spxChrome . See Table 1 for details. there has been plenty of action when it comes to drug supply codes as temporary codes transition to permanent status and new drugs are added. limited or restricted 100 percent impaired. CPT® deleted 92980 and 92981. limited or restricted At least 60 percent but less than 80 percent impaired. limited or restricted At least 80 percent but less than 100 percent impaired.J.. the HCPCS Level II code set has undergone approximately 150 individual changes. Matching HCPCS and CPT® Changes The Centers for Medicare & Medicaid Services (CMS) designated several new HCPCS Level II codes to take the place of CPT® codes for Medicare reporting. there has been a lot of movement in codes used to describe skin substitutes. plus lots of quality performance measurement G code updates. CH CI CJ CK CL CM CN 0 percent impaired. 2012. since 2003. CMS has assigned coronary stent placement procedures to separate ambulatory payment classifications based on the use of nondrug-eluting or drug-eluting stents.■ Coding/Billing By G. including: • At the outset of therapy episode • On or before every 10 treatment days throughout the course of therapy • At the time of discharge from therapy • At the time the beneficiary’s condition. 2012. MA. not counting those G codes used for reporting to the Physician Quality Reporting System (PQRS) or Medicare demonstration projects (more on those below). The G codes with modifiers must be reported at regular intervals for Medicare patients who receive outpatient therapy services. limited or restricted At least 20 percent but less than 40 percent impaired. were deactivated April 1.

split virus Doxorubicin hydrochloride. full cost recovery add-on. per study dose. Table 2 New Code Old Code Q4119 Q4126 Q4128 Q4131 Q4132 Q4133 Q4134 Q4135 Q4136 C9366 C9368 C9369 Product MatriStem PSMX. liposomal Mometasone furoate sinus implant Florbetapir f18 Bupivacaine liposome Pertuzumab Glucarpidase Taliglucerase alfa Carfilzomib Ziv-aflibercept Aflibercept Belatacept Centruroides (scorpion) immune F(AB)2 Peginesatide Medroxyprogesterone acetate Trade Name AMYVID™ Exparel™ Perjeta™ Voraxaze ® Eleyso™ Zaltrap ® EYLEA® Nulojix ® Anascorp ® drug-eluting stents. which are used with hearing aids to improve the signal-to-noise ratio. or integuply Flex HD. not otherwise specified. 81599. For 2013. In some cases. RS. newly-created CPT® codes have taken the place of now-deleted HCPCS Level II codes.g. Another interesting code is Q9969 Tc-99m from non-highly enriched uranium source. some of which were created to take the place of CPT® codes for Medicare reporting.Coding/Billing: HCPCS II Table 1 New Code Old Code Drug A9586 C9290 C9292 C9293 C9294 C9295 C9296 J0178 C9291 C9286 C9288 Q2047 J1051 J0485 J0716 J0890 J1050 J1055 J1056 J1741 J1744 J2212 J7178 Q2045 Q2046 J7315 J7527 J9002 Q2048 J9019 J9020 J9042 Q2034 Q2049 S1090* C9289 J9020 C9287 J9001 J1680 C9279 Ibuprofen Icatibant Methylnaltrexone Human fibrinogen concentrate Aflibercept Mitomycin. which is newly established to report Tc-99m from non-highly enriched uranium (HEU) sources. 81200-81408. dermaspan. TC-99m is the most widely used radioisotope for diagnosing diseased organs. 81500-81512. Allopatch HD. Category III CPT® code 0308T Insertion of ocular telescope prosthesis including removal of crystalline lens replaced C9732 for ocular telescope prosthesis with removal of crystalline lens. and 86152-86153). allowing the listener to hear better in the presence of background noise. Finally. Mitosol™ Zortress ® Erwinaze™ Adcetris™ Agriflu Imported lipodox Propel™ *Medicare does not accept S codes.com February 2013 23 . ophthalmic Everolimus Doxorubicin hydrochloride Asparaginase (erwinze) Asparaginase. V5267 has been revised to specify Hearing aid or assistive listening device/supplies/accessories.. CMS will make an additional payment of $10 to cover the marginal costs associated with non-HEU Tc-99m production. and PSM Memoderm. CMS designated new HCPCS Level II C codes to parallel the new CPT® codes: HCPCS = CPT® C9600 = 92920 C9601 = 92921 C9602 = 92924 C9603 = 92925 C9604 = 92937 C9605 = 92938 C9606 = 92941 C9607 = 92943 C9608 = 92944 Caldolor™ IRAZYR ® Relistor ® Consult Table 3 on the next page for a list of other new HCPCS Level II codes. tranzgraft. not otherwise specified Brentuximab vedotin Influenza virus vaccine.aapc. while many pathology procedures in the range S3711-S3860 have been deleted and replaced with new CPT® codes describing molecular pathology and multianalyte assays with algorithmic analysis (e. and 10 new codes have been added to describe personal FM/DM auditory devices. or Matrix HD Epifix Grafix ® CORE Grafix ®PRIME hMatrix Mediskin Ez-Derm www. For example.

2012 there have been 114 code additions.J. G0455 S0596* S0353* 44705 N/A N/A S0354* N/A * Medicare does not accept S codes 24 AAPC Cutting Edge .Coding/Billing: HCPCS II To discuss this article or topic. physician interpretation and report Continuous intraoperative neurophysiology monitoring outside the operating room Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner. Since April 1. visit the CMS website (www. established patient with a change of regimen Physician Quality Reporting and Medicare Demonstration Projects G codes in the range G8000–G8999 are designated PQRS codes. CPC. initial Treatment planning and care coordination management for cancer.html).5 percent Medicare payment incentive for years 2012-2014. Eligible professionals (EPs) who successfully report on quality measures in the PQRS are eligible for a 0.cms. physician assistant. HCPCS C9733 G0452 G0453 G0454 CPT® N/A N/A 95941 N/A Service SPY® and other non-ophthalmic fluorescent vascular angiography Molecular pathology procedure. MA.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instru​ ments/PQRS/index. For additional information about PQRS. 2012. visit the CMS website (www. Verhovshek.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/ Medicare-Demonstrations. there has been plenty of action when it comes to drug supply codes. For more information on Medicare Demonstration Projects. is managing editor at AAPC. In 2015.html).aapc.cms. Since April 1. there have been 21 new codes and two code deletions in this section. or clinical nurse specialist Preparation with instillation of fecal microbiota by any method Phakic intraocular lens for correction of refractive error Treatment planning and care coordination management for cancer.com As always. and 122 code revisions to the G codes used to report quality performance measurements. G. as temporary codes transition to permanent status and new drugs are added. EPs and groups that do not report quality data successfully will face a 1.5 percent payment reduction in Medicare payments. and a 2 percent reduction for 2016. go to www. 48 code deletions. G codes in the range G9000–G9999 are applied for Medicare Demonstration Project reporting.

com 21131 .5 4 4 Price $299 179 179 399 199 239 Price 179 179 179 179 179 179 239 Price 179 179 399 239 239 Turn to Contexo University for ICD-10-specific training for you and your organization – we are proud to present a comprehensive ICD-10 Curriculum that includes three suggested tracks to follow to prepare for ICD-10.codingbooks. or pick and choose the courses that apply to you! ICD-10-CM Training Essentials ICD-10 Preparation Analyzer Understanding and Preparing for ICD-10-CM ICD-10 Preparation for Healthcare Professionals: The CM Guidelines Anatomy and Terminology Essentials from an ICD-10-CM Perspective Best Practices for ICD-10-CM Documentation and Compliance Common Coding Scenarios: A Practicum in ICD-10-CM Coding and Documentation ICD-10-CM Specialty Training Mastering ICD-10-CM Coding for Cardiology Mastering ICD-10-CM Coding for OB/GYN Mastering ICD-10-CM Coding for General Surgery/Gastroenterology Mastering ICD-10-CM Coding for Primary Care Mastering ICD-10-CM Coding for Orthopedics Mastering ICD-10-CM Coding for ENT/Allergy Mastering ICD-10-CM Coding for Multi-Specialty Providers ICD-10-PCS Training Essentials Understanding and Preparing for ICD-10-PCS 2 2 $179 ICD-10 Preparation for Healthcare Professionals: The PCS Guidelines 2 2 $179 Anatomy and Terminology Essentials from and ICD-10-PCS Perspective 6.5 4 4 Hours n/a 2 2 8 2 3 Hours 2 2 2 2 2 2 4 Hours 2 2 6. MD 20850 | 1-800-334-5724 | www.Contexo University is proud to present… ICD-10 Curriculum! CEUs n/a 2 2 8 2 3 CEUs 2 2 2 2 2 2 4 CEUs 2 2 6.5 $399 Mastering ICD-10-PCS Coding for Multi-Specialty Providers 4 4 $239 Coding from the Operative Report: A Practicum in ICD-10-PCS Coding & Documentation Register today for these invaluable courses to prepare for ICD-10 now. 2nd Floor | Rockville.contexouniversity. www.com Do you have questions about eLearning and how it works? Call us at 1-800-334-5724 and we’ll be happy to assist you! Contexo Media | 4 Choke Cherry Road.5 6.

by graft. are excellent tools with which to tell the whole story of a procedure or service. there are a few exceptions. Although so-called “CPT® modifiers” are generally familiar and often ap26 AAPC Cutting Edge Modifier 66 Modifier 66 is applied when three or more Photo by iStockphoto © rzdeb HCPCS Level I Modifiers . Among the most important are modifiers 63 Procedure performed on infants less than 4 kgs and 66 Surgical team. 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 and 59 Distinct procedural service. A Takeaways: • HCPCS Level I modifiers are CPT® modifiers. “Do not report modifier 63 in conjunction with . Both can be used with CPT® codes. HCPCS Level II modifiers are developed by CMS. CHC. there are dozens of lesser-known modifiers that can help you report certain services more accurately. MBA.8 lbs).” because the CPT® code has already been valued to include this increased complexity. What coders usually call CPT® modifiers are actually HCPCS Level I modifiers. that most CPT® procedure codes performed on small infants include the notation. HCPCS Level II modifiers are used less often. For example. These modifiers may be any combination of two alphanumeric characters—except for two numbers. when appended correctly. and are maintained by the American Medical Association (AMA). this could garner increased reimbursement. and may be applied to either Level I (CPT®) or Level II service and procedure codes.000 g. Be aware. Modifier 63 When a surgeon performs a procedure on an infant weighing less than 4 kg (4. • Review the full set of modifiers in their entirety to ensure proper selection.. • Both types of modifiers. but what about modifiers RR Rental (use the RR modifier when DME is to be rented) and LS FDAmonitored intraocular lens implant ? In fact. CPC. CPC-I Boost Your Knowledge of ny coder worth his or her wage knows about modifiers 25 Significant.■ Coding/Billing By Terri Brame. or approximately 8. CPC-H. are published in the CPT® codebook as Appendix A. and tend to be less well known (two exceptions are modifiers LT Left side and RT Right side). plied. without cardiopulmonary bypass. you may append modifier 63 to the CPT® code to inform the payer of the increased complexity of the procedure due to the patient’s small size. CGSC. see the parenthetical notation following 33502 Repair of anomalous coronary artery from pulmonary artery origin. by ligation and 33503 Repair of anomalous coronary artery from pulmonary artery origin. Level II modifiers are published by the Centers for Medicare & Medicaid Services (CMS) as part of the annual HCPCS Level II update.. These modifiers are always two digits. however. Lesser-used Modifiers Overlooking these modifiers can result in improper reimbursement. At best. Modifiers Come in Two Flavors There are two levels of HCPCS modifiers.

fifth digit Coronary Arteries LC Left circumflex LD Left anterior descending RC Right coronary artery www. you’ll usually have to send the operative report.Coding/Billing: Modifiers Level II includes quite a few modifiers beyond RT and LT that may be used within certain specialties to allow payment for multiple procedures that would otherwise appear to be duplicate billing. fifth digit T5 Right foot. forth digit F9 Right hand. HCPCS Level II Modifiers Level II includes quite a few modifiers beyond RT and LT (as shown in Table A) that may be used within certain specialties to allow payment for multiple procedures that would otherwise appear to be duplicate billing. For example.aapc. 26418-F8. backbench work. Medicare and other payers that follow the National Correct Coding Initiative (NCCI). if a charge was found through the quality check process to have been keyed with the incorrect provider Table A: Anatomic Level II Modifiers Eyelids E1 Upper left E2 Lower left E3 Upper right E4 Lower right Fingers FA Left hand. and recipient transplantation (e. finger.g.cms. forth digit F4 Left hand. third digit T3 Left foot. For example. ensure the medical necessity of multiple primary surgeons is documented.html). extensor tendon. In the unusual situation.com February 2013 27 . each tendon). Preventing or Overriding Edits Some modifiers may be familiar to insurance specialists in the practice’s billing office. and 26418-F9. primary or secondary. and are important to receiving correct payment: CC Procedure code change (use ‘CC’ when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) is used when submitting a corrected claim to clarify the claim is not a duplicate or an attempt to double bill for the same service. third digit F8 Right hand. the coder would report 26418-F7. fifth digit Toes TA Left foot. third digit T8 Right foot. To identify which fingers were repaired and that three procedures were performed and reported with the same CPT® code (26418 Repair. When submitting a claim with modifier 66. second digit T2 Left foot.gov/Medicare/Medicare-Fee-forService-Payment/PhysicianFeeSched/PFS-RelativeVal​ ue-Files. the CPT® section guidelines for Liver Transplantation). thumb F1 Left hand. modifier 66 was appended to the transplant code to represent the separate surgical teams involved in each transplant stage. forth digit T4 Left foot. second digit F2 Left hand.. great toe T6 Right foot. second digit T7 Right foot. Before solid organ transplantation codes were separated into codes for donor organ removal. surgeons complete parts of a procedure described by a single CPT® code. as well. without free graft. thumb F6 Right hand. second digit F7 Right hand. great toe T1 Left foot. forth digit T9 Right foot. when there are three or more primary surgeons working on a procedure. a plastic surgeon may repair the extensor tendon in three fingers on the right hand following trauma. fifth digit F5 Right hand. third digit F3 Left hand. verify whether modifier 66 is allowed for the procedure by referring to the “Team Surgery” column in the Medicare Physician Fee Schedule Relative Value File (downloadable from the CMS website: www.

and the charge is resubmitted with the correct provider number. Clinical Trials Payers. number. You will likely have to submit an operative report and clearly document medical necessity. of the 2010 oil spill in the Gulf of Mexico. including but not limited to subsequent clean up activities ST Related to trauma or injury Teaching Physicians Coders in academic practices are very familiar with the GC. and should report the service with 60260 Thyroidectomy. For example. with limited neck dissection. the patient has a recurrence of thyroid cancer in a very small amount of retained thyroid tissue. if a patient who is receiving hospice care at home for metastatic cancer is seen in a primary care office for an upper respiratory infection. and so should coders looking to make a career move to academic medicine. These modifiers identify whether the services are part of routine care for the patient’s condition (care that would have been provided regardless of the research) or care that is not routine. Disaster. append modifier GW to allow payment di28 AAPC Cutting Edge rectly from the payer.Coding/Billing: Modifiers The true value of a Level II modifier (in my humble opinion) lies with the modifiers that describe unusual payment situations. in whole or in part. the second surgeon has a legitimate claim to override the MUE and to be paid for his service. For example. but the service should be reimbursed. and is part of the research. reported with 60252 Thyroidectomy. In 2007. The following are just a few examples: CA Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission. to an illness. particularly Medicare. For example. GE. and GR modifiers. Department of Veterans Affairs’ (VA) rules for resident and attending physicians working together: GC This service has been performed in part by a resident under the direction of a teaching physician This service has been performed by a resident without the presence of a teaching physician under the primary care exception This service was performed in whole or in part by a resident in a department of veterans affairs medical center or clinic. often expect clinical research services to be identified on the claim with Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study and Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study. you should append the appropriate CPT® code with CC appended. always verify with the billing office whether they are appropriate. removal of all remaining thyroid tissue following previous removal of a portion of the thyroid because the previous surgery was not technically a total thyroidectomy.S. GW Service not related to the hospice patient’s terminal condition is applied only for patients receiving hospice services. the primary care office should report an evaluation and management (E/M) service with modifier GW. GD Units of service exceeds medically unlikely edit value and represents reasonable and necessary services is used to override medically unlikely edits (MUEs). But there is an MUE for total thyroidectomy because the “total” thyroid can be removed only once. Fifteen years later. some payer contracts may include a reimbursement carve-out for trauma-related services increasing the payment rate. and Catastrophe Services provided following a traumatic event may be reimbursed from a separate fund. These modifiers describe services provided following Medicare or U. and reports 60260-GD to describe the situation. or in some way alter the requirements for reporting a code. CR Catastrophe/disaster related [may currently apply to superstorm Sandy services] CS Item or service related. Medicare implemented a set of MUEs that are applied to CPT® codes to prevent reimbursement for more units of a service than are typically provided. when appropriate. or condition that was caused by or exacerbated by the effects. injury. but the edits may not apply in all circumstances. the coder should append the CPT® code with one of the following: PA PB PC Surgical or other invasive procedure on wrong body part Surgical or other invasive procedure on wrong patient Wrong surgery or other invasive procedure on patient GE GR Trauma. total or subtotal for malignancy. The surgeon removes the remaining tissue. supervised in accordance with VA policy Surgical Misadventures When it is appropriate to report (or internally track) a surgical misadventure. When a patient is in hospice care. qualify for increased reimbursement. physicians must report all services related to the hospice illness to the hospice provider. a Medicare beneficiary may have required a total thyroidectomy to treat thyroid cancer. In the case described. If the patient receives care for a non-related illness. When consider- Miscellaneous The true value of a Level II modifier (in my humble opinion) lies with the modifiers describing unusual payment situations. This modifier may be used when the hospital where the procedure was performed admits . direct or indirect. ing the modifiers below.

Before applying any modifier. the convenient way! (Some courses also have CEU approval from AHIMA. laptop No annoying timeouts. is the compliance education officer for the University of Arkansas for Medical Sciences. etc. ensuring proper reporting and appropriate reimbursement for your practice. Any time. See our Web site. As with any code. FP Service provided as part of the annual family planning program is especially valuable when the patient only has Medicaid coverage for family planning. CHC.aapc. or take it a chapter a day — you choose. office. any time. No expiring passwords. E/M from A to Z (18 CEUs) Primary Care Primer (18 CEUs) E/M Chart Auditing & Coding (16 CEUs) Demystifying the Modifiers (16 CEUs) Medical Coding Strategies (15 CEUs) Walking Through the ASC Codes (15 CEUs) Elements of ED Coding (11 CEUs) Finish a CD in a couple of sittings.      Need CEUs to renew your CPC®? Stay in town. durable medical equipment (DME). Use our CD-ROM (Check our website for a new course on ICD-10) Our CD-ROM/CEU course line-up: From the leading provider of interactive CD-ROM courses with preapproved CEUs Finish at your own speed.com/hbollc Continuing education.htm HealthcareBusinessOffice LLC: Toll free 800-515-3235 Email: info@HealthcareBusinessOffice. CPC. any place. CPC-I .com February 2013 29 .) Easily affordable with EasyPayments! www.HealthcareBusinessOffice. You won’t have to travel. and you can even work at home. quickly or leisurely Just 1 course earns as much as 18. MBA. Photo by iStockphoto © parentx Be with the family and earn CEUs! courses anywhere. ensure the payer accepts the modifier and adhere to any published rules for its use.HealthcareBusinessOffice. Large sections of Level II modifiers also apply to mental health services. At home. CPCH. policies for using modifiers may differ from payer to payer. ℠ Web site: www. Terri Brame.0 CEUs Use any Windows® PC: home.com/easypay. and has presented at two AAPC national conferences. this sampling of CPT® and Level II modifiers will motivate you to review the two modifier sets in their entirety.aapc. Any place. HJ Employee assistance program is append- ed for services provided as part of an employee assistance program. go to www. A coder may need to append GT Via interactive audio and video telecommunication systems for telehealth services.com Follow us on Twitter: twitter.To discuss this article or topic. anesthesia. Hopefully.com Coding/Billing: Modifiers a patient after a surgery is completed rather than before. So visit our Web site to learn more about CEUs. She is a past AAPC local chapter president. H9 Court-ordered notes services rendered due to a court order.com www. CGSC.

at least 16 minutes must be documented to report the code.J.” Some codes describe “24-hour services. eight or more minutes should be documented. For an example. MA. Note that even “face-toface” services may allow you to count some non face-toface time. For example. • Five rules help define what codes should be reported when a length of time is not specified.” as does 95950 Monitoring for identification and lateralization of cerebral seizure focus.g. you don’t need to document a full 60 minutes to report the code. if coding guidelines otherwise allow for time spent away from the patient.■ Coding/Billing By G. Verhovshek. If the unit of service is 15 minutes (therapy codes are an example of these). either the service is not billable. CPC Timely Tidbits: CPT 2013 Clarifies Time-based Services ® When time is a key factor. But at least 31 minutes of service (or “past the midpoint” of 60 minutes) must be provided and documented. For 2013. code-range-specific rules. see the “Total Duration of Critical Care Codes” chart within the Critical Care Services subsection of the Evaluation and Management chapter. but occur before and/or after patient care. CPT® provides time-based codes to report prolonged services without direct patient contact (9935899359). under the subhead Time. For example. If the unit of service is 30 minutes. follow these five basic rules. The CPT® codebook often provides charts with time ranges to help you report timebased services appropriately. Time Means Face-toface Time with the Patient Time spent away from the patient is not billable unless a specific code describes the non face-to-face. or. the American Medical Association (AMA) updated their CPT® codebook to better explain the rules for timebased codes. as long as it bears directly on patient care. time-based critical care codes 99291–99292 include “time spent on the unit or at the nursing station on the floor reviewing test results or imaging studies. if a code describes the “first hour” of service. The revised instructions can be found in the Introduction section of the CPT® Professional Edition (page xii). • Proper determination for length of time helps coding accuracy and eases revenue cycle management. Time billed for these services is not face-to-face with the patient. or you should instead bill an (other) appropriate evaluation and management (E/M) service code (e. If the minimum time to report is not met. or the code descriptor)—there are five basic rules when reporting time-based services. The guidelines stipulate that—in the absence of specific instruction to the contrary (whether in a parenthetical reference. Takeaways: • The CPT® 2013 codebook better defines time when length of time is not mentioned in the code. office visit 99212–99215).. 30 AAPC Cutting Edge 2. 1. For example. time-based services. A Unit of Time is Attained when the Midpoint is Passed For example. if fewer than 30 minutes of critical care (99291) are provided. read all code descriptors and coding guidelines for the code category you are reporting.” To be sure you are reporting all appropriate time. CPT® instructs you to report “appropriate E/M codes. discussing the critically ill patient’s care with other medical staff or documenting critical care services in the medical record. elec- .

If counseling equaled 18 minutes. Medical decision making of low complexity) has a reference time of 15 minutes. If. For these codes. For services lasting fewer than 12 hours. Pick the Closest CPT® states this rule as. physicians providing time-based services should report not only the total time of service. hydration. the Date of Service Doesn’t Change Suppose you begin a time-based service at 10:30 p. hydration.com February 2013 31 . 8 channel EEG) recording and interpretation. the time associated with the concurrent service should not be included in the time used for reporting the time-based service. When there are two time-based choices. which requires at least 2 of these 3 key components: A detailed history. the code with the typical time closest to the actual time is used. the closest reference time is the 25 minutes of 99214.” along with patient status and place of service. use CPT® “reference times. “When codes are ranked in sequential typical times and the actual time is between to typical times. don’t count the time of an unrelated service when reporting a time-based service. each additional hour (List separately in addition to code for primary procedure) twice. Don’t Combine the Time of Unrelated Services “When another service is performed concurrently with a time-based service. read all code descriptors and coding guidelines for the code category you are reporting. instead. Time means face-to-face time with the patient. Medical decision making of moderate complexity) has a reference time of 25 minutes. is managing editor at AAPC. 3. but also start and stop times.” CPT® explains. or any other timebased service. at least 12 hours of service must be documented to report the code. critical care services include floor/ unit time in addition to time spent at a patient’s bedside. the next day. initial.com Coding/Billing: Time-based Codes To be sure you are reporting all appropriate time. which requires at least 2 of these 3 key components: An expanded problem focused history. a level III established patient outpatient visit (99213 Office or other outpatient visit for the evaluation and management of an established patient. pick the closest. You’ll have to read section guidelines and code descriptors to know exactly what you can count as “time” for any given service. MA. Verhovshek. such as modifier 52 Reduced services.” For instance. and that service lasts until 1:30 a. For example. so you would report 99213. Only time spent performing services or procedures specifically within the CPT® definition of critical care may be counted toward critical care time. 15 minutes. For continuous services. CPC. For instance. you would report 96360 Intravenous infusion.. if intravenous hydration is given in the time described above. 2.aapc. A detailed examination. 3. 99292). 5. while a level IV service (99214 Office or other outpatient visit for the evaluation and management of an established patient. 5. use the date in which the service began and re- www. The additional detail goes a long way to support and justify your coding choices. 4. exam.” The rule applies when reporting E/M services using time (rather than the key components of history.m.aapc. time spent providing separately reportable procedures or services should not be included toward critical care time (as reported using 99291. For Continuous Services. The requirements for critical care are different than those of standby services. and medical decision-making) as the controlling factor to qualify for a given level of service—that is. G. when counseling and/or coordination of care comprises more than half the encounter.m. each 24 hours. troencephalographic (eg. while other time-based services do not. 4. Put more simply. An expanded problem focused examination. Best Practices Bonus Tip Whenever possible. prolonged services. the closest reference time is that of 99213. at port the total units of time provided continuously. A unit of time is attained when the midpoint is passed. the service lasted 22 minutes.J. to determine an appropriate E/M service level. When There Are Two Time-based Choices. For example. Per CPT®.To discuss this article or topic. you may need to append a modifier. In such a case. Don’t combine the time of unrelated services. 31 minutes to 1 hour once and +96361 Intravenous infusion. and you would report that code. Be aware that what counts as “time” varies by the kind of service provided. “For continuous services that last beyond midnight. 5 Basic Rules to Follow when Time Is a Key Factor 1. the date of service doesn’t change. go to www.

Please check our website for updated information.ailable September 2012 R N FO IO N AT E R OP IST G RE ICD-10-CM Code Set Boot Camps Step 3 Step 2 General Code Set Training Specialty Code Set Training Roadmap to ICD-10 Check off Step 3 of our ICD-10 Training Roadmap (General Code Set Coder’s Training). Louis Charleston $595 | 16 CEUs State Idaho Virginia Oklahoma South Carolina Mississippi New York Wisconsin West Virginia Florida Massachusetts Tennessee Missouri Colorado Ohio Florida Minnesota North Carolina Texas Washington Arkansas Vermont Georgia Arizona Kentucky Alabama Missouri South Carolina Date 10/3/2013 10/3/2013 10/10/2013 10/10/2013 10/10/2013 10/17/2013 10/17/2013 10/17/2013 10/24/2013 10/24/2013 10/24/2013 10/24/2013 11/7/2013 11/14/2013 11/14/2013 11/21/2013 11/21/2013 11/21/2013 11/5/2013 12/5/2013 12/5/2013 12/12/2013 12/12/2013 12/12/2013 12/12/2013 12/19/2013 12/19/2013 *Dates and locations are subject to change.Day training led by a certified ICD-10 instructor • ICD-10 format and structure with cross-walking and mapping • Complete ICD-10 guidelines and hands on coding exercises Step 1 • AAPC Course Manual for ICD-10-CM Code Set • ICD-10-CM book (expert edition. . • 2. Learn to code for ICD-10 Clinical Modification (ICD-10-CM) and prepare for the ICD-10 Proficiency Assessment. spiral bound) Implementation Step 4 Step 5 ICD-1 Proficiency Assessment Anatomy & Pathophysiology Step 3: General Code Set Training (Boot Camp) City Sacramento Pittsburgh Houston Portland Honolulu Tampa Bay Boston Grand Rapids Monmouth Milwaukee Portland Cincinnatti Albuquerque Omaha San Diego Knoxville Des Moines Harrisburg Hartford Chicago Indianapolis Orange County Great Falls Syracuse San Jose New Orleans Detroit Birmingham State California Pennsylvania Texas Oregon Hawaii Florida Massachusetts Michigan New Jersey Wisconsin Maine Ohio New Mexico Nebraska California Tennessee Iowa Pennsylvania Connecticut Illinois Indiana California Montana New York California Louisiana Michigan Alabama Date 7/11/2013 7/11/2013 7/11/2013 7/18/2013 7/18/2013 7/18/2013 7/25/2013 7/25/2013 7/25/2013 8/1/2013 8/1/2013 8/8/2013 8/15/2013 8/15/2013 8/22/2013 8/22/2013 8/29/2013 8/29/2013 9/5/2013 9/5/2013 9/12/2013 9/12/2013 9/12/2013 9/19/2013 9/26/2013 9/26/2013 9/26/2013 10/3/2013 City Boise Virginia Beach Oklahoma City Colombia Jackson Manhattan Madison Morgantown Jacksonville Boston Nashville Kansas City Denver Cleveland Miami Minneapolis Charlotte San Antonio Seattle Little Rock Burlington Atlanta Phoenix Louisville Mobile St.

Through Mar. and unproctored the lowest s in a m e r AAPC uality price for q ining ICD-10 tra Total: Through March 31: $635-$785 (depending on specialty) Learn more at: www.95 $60 $835-$985 Proficiency Assessment 75 questions.5 hours. 31 Save $200 on Complete Code Set Training Solution General Code Set Specialty Code Set Proficiency Prep and Assessment Step 1 Bundle Includes: Implementation Coder’s Roadmap to ICD-10 Step 3 Step 2 General Code Set Training Specialty Code Set Training 10 Step 4 Step 5 ICD-10 Proficiency Assessment Anatomy & Pathophysiology Step 3: General Code Set Training (Boot Camp) (includes 2013 ICD-10-CM code book and code set manual) $595 16 CEUs Step 4: Specialty Code Set Training (Online) Detailed and advanced training on 12 different specialties $149. online.95-$299. open-book. 3.95 (depending on specialty) 4-8 CEUs Step 5: Proficiency Assessment (Online) Proficiency Prep Tool Simulation of actual assessment with rationales for all answers $29.aapc.com/icd10 .

CRMA Infuse Yourself with Coding Knowledge Tips and tricks for proper drug administration coding. there are several tips and tricks you can use to pick the right code every time. MBA. however. If the profuse number of Office of Inspector General (OIG) audits showing improper payments for drug claims submitted to Medicare every year is any indication. Hydration: CPT® codes 96360-96361 are for pre-packaged fluids and electrolytes. Drug Administration Basics First. These codes are not used to report infusion of drugs or other substances and are not reported by the physician in a facility setting. 34 AAPC Cutting Edge .■ Cover: Coding/Billing By Amy Lee Smith. remember that there are three categories of drug administration: 1. it’s safe to say that drug administration coding can get sticky. CPC. CIA. CPMA. CPC-H. Just like clinicians learn little tricks for properly injecting drugs. Proper drug administration coding requires as much precision as the services themselves.

96409. Therapeutic/Prophylactic/Diagnostic: See Table 1 for CPT® codes to report for the administration of drugs and other substances (other than hydration). or diagnosis (specify substance or drug). Used for infusions running at the same time via the same IV access—must be hung in separate bags. prophylaxis. 2. hydration. up to 1 hour Intravenous infusion. or diagnosis (specify substance or drug). Report for IV infusions of 16-90 minutes. 96366. do not report hydration infusion of 30 minutes or less). or diagnostic injection (specify substance or drug). for therapy. and usually entails significant patient risk and frequent monitoring far beyond that of therapeutic administrations. initial. or diagnosis (specify substance or drug). or 96413 if provided as secondary service after a different initial service is administered through the same IV access. there are three methods by which drugs may be administered: 1. special considerations for preparation. initial. Chemotherapy or other biologic agents/complex drugs: See Table 2 on the next page for appropriate CPT® codes. Report in conjunction with 96365. Report separate codes for each method of administration when chemotherapy is administered by different techniques. Do not report these codes for chemotherapy or other highly complex drugs/biological or when fluids are used to administer the drug(s). Along with three categories of drug administration. 96365 +96366 Report for intervals of greater than 30 minutes beyond one-hour increments.aapc. Injection: Do not use CPT® 96372 Therapeutic. or 96416. 96365. Use for infusions of 31-90 minutes. the fluid administration is incidental hydration and is not separately reportable. Physicians in the facility setting may not use chemotherapy codes. up to 1 hour (List separately in addition to code for primary procedure) Intravenous infusion. for therapy. also report for secondary or subsequent service after a different initial service through same IV access. for therapy. or 96379. 96374. prophylaxis. Report only once per encounter. Report in conjunction with 96365. Medications administered independently as supportive management of chemotherapy are reported separately using 96360. prophylaxis. “Chemo” includes other highly complex drugs or biologic agents such as: • Non-radionuclide anti-neoplastic drugs • Anti-neoplastic agents provided for treatment of non-cancer diagnoses • Certain monoclonal antibody agents • Other biologic response modifiers Table 1: Diagnostic/Therapeutic/Prophylactic Infusion Codes CPT® Code 96360 Use of these codes typically requires advanced practice training and competency. hydration. or diagnosis (specify substance or drug).Coding/Billing: Drug Administration Physicians in the facility setting may not use chemotherapy codes. prophylactic. 96361. Report only once per sequential infusion of same infusate mix (multiple drugs mixed together in one bag is one infusate mix). This code does not include injections for allergen immunotherapy. These codes are not reported by the physician in a facility setting.com February 2013 35 . each additional hour (List separately in addition to code for primary procedure) Intravenous infusion. or disposal. subcutaneous or intramuscular for the administration of vaccines/toxoids. prophylaxis. dosage. concurrent infusion (List separately in addition to code for primary procedure) Report for intervals of greater than 30 minutes beyond one-hour increments. for therapy. 3. also report for secondary or subsequent service after a different initial service through same IV access. 96415. +96361 Intravenous infusion. 96413. additional sequential infusion of a new drug/substance. each additional hour (List separately in addition to code for primary procedure) Intravenous infusion. Although hospitals may report injection codes when the physi- CPT® Description Intravenous infusion. as appropriate. photo of woman by iStockphoto©pixdeluxe +96367 photo of syringe by iStockphoto©Liuhsihsiang +96368 www. 31 minutes to 1 hour Notes Do not report if performed as concurrent infusion service.

96409. or diagnostic injection (specify substance or drug). there is a hierarchy to determine the initial service: 1. Therapeutic/Prophylactic/Diagnostic infusions 5. subcutaneous or intramuscular. +96415 Chemotherapy administration. 96413 Report for infusions of 16–90 minutes. each additional sequential intravenous push of a new substance/ drug (List separately in addition to code for primary procedure) may be reported with 96365. push technique. Report only once per sequential infusion. intravenous infusion technique. The primary reason for the visit is the chemotherapy so it is the initial service. Chemotherapy infusions 2. intravenous. each additional hour (List separately in addition to code for primary procedure) Chemotherapy administration.Cover: Coding/Billing Table 2: CPT® codes for chemotherapy administration CPT® Code 96401 96402 96409 +96411 CPT® Description Chemotherapy administration. the initial service is the primary reason for the visit. Report 96366. Chemotherapy IV pushes 3. physician offices may not. What makes your job so sticky is that these categories and methods can be combined in a number of different ways. The initial code is not necessarily the first service provided. each additional sequential infusion (different substance/drug) up to 1 hour (List separately in addition to code for primary procedure) Report in conjunction with 96413. 96367. Therapeutic/Prophylactic/Diagnostic IV pushes 6. You may use injection codes to report non-antineoplastic hormonal therapy. prophylactic. Report in conjunction with 96413. or 96413 to identify an IV push of a new drug when provided as a secondary service after a different initial service is administered through the same IV access. but also gets an antibiotic injection and a hydration infusion to supplement the chemotherapy. +96417 cian is not present. single or initial substance/drug Notes Report with 96409 or 96413. Determine the “Initial” Service The American Medical Association (AMA) created different codes for “initial” and “subsequent” administrations. single or initial substance/drug is appropriate when intravenous (IV) push is the primary service. each additional substance/drug (List separately in addition to code for primary procedure) Chemotherapy administration. 96374. In the outpatient facility setting. All of these IV push codes are reported for facilities only. intravenous infusion technique. In the physician practice. Report for infusion intervals of greater than 30 minutes beyond one-hour increments. each additional sequential intravenous push of the same substance/drug provided in a facility drug (List separately in addition to code for primary procedure) is used only when the same drug is administered twice in one encounter. single or initial substance/drug Chemotherapy administration. intravenous. up to 1 hour. or diagnostic injection (specify substance or drug). subcutaneous or intramuscular. Therapeutic /Prophylactic/Diagnostic injections 7. the actual chronological order of administration is not important for coding. intravenous push. coding guidelines state there should be only one initial code per encounter. IV Push: CPT® 96374 Therapeutic. prophylactic. intravenous infusion technique. Chemotherapy injections 4. and may be used for infusions lasting 15 minutes or less. So how do you determine what the initial service is when more than one method or category of administration is provided? Although the rules vary depending on where the service is provided. non-hormonal anti-neoplastic Chemotherapy administration. 3. prophylactic. Add-on code +96375 Therapeutic. unless two separate access sites are required. Report 96361 to identify hydration as a secondary service through the same IV access. For example. or 96375 to identify therapeutic infusion/injection as secondary service through same IV access. 2. push technique. Hydration 36 AAPC Cutting Edge . Add-on code +96376 Therapeutic. hormonal anti-neoplastic Chemotherapy administration. all of which are coded differently. Infusion: Refer to Table 1 on the preceding page for infusion codes and their instructions. a patient comes in for chemotherapy. Report 96415 for additional hour(s) of sequential infusion. but not within 30 minutes of each other. or diagnostic injection (specify substance or drug).

check with your payers for clarification). The initial service is the antibiotic injection because the therapeutic injection ranks higher in the hierarchy than the hydration infusion. report only one initial service code. Use subsequent or concurrent codes where appropriate. and concurrent administrations account for additional services provided. Inc. Ms. start and stop times must be clearly and completely documented in the medical record by the clinician. but the stop time is quite often omitted. and supplies Chemotherapy administration codes also include preparation of drugs/agents and any fluids used to administer the chemotherapy. or port • Flush at the conclusion of infusion • Standard tubing.90 minutes 91 . In general.210 minutes 211 . Do not include time spent keeping veins open (see Table 3 for examples). however. Check with your payer to see their requirements for these situations. how do you capture the work when more than one administration is provided during a single encounter? Specific codes for sequential. • If there are multiple IV access sites. Typically. only one initial service code can be reported per patient. but also receives a hydration infusion. In drug administration terms.aapc.. Only when an infusion lasts longer than 90 minutes can you code the “additional hour” code. Table 3: Reporting infusion time Single infusion lasting: Can be coded (assuming documentation is complete): IV push Initial hour Initial hour + 1 additional hour Initial hour + 2 additional hours Initial hour + 3 additional hours 15 minutes or less 16 .To discuss this article or topic. 5 minutes are spent performing or supervising these services with infusion codes. Before you make your code selection. syringes. MBA. section 230. regardless of the administration order (e. where she primarily performs coding and billing audits. • Per the Medicare Claims Processing Manual (chapter 4.com Cover: Coding/Billing … the actual chronological order of administration is not important for coding.270 minutes … and so on ing between 16 and 90 minutes. go to www. Know What’s Included The following services are included in all of the drug administration codes.2) as of 2007. a patient comes into a hospital outpatient department for an antibiotic injection. as appropriate. per separate IV access site. and are not separately reportable: • Use of local anesthesia • IV start • Access to indwelling IV. Time Requirements One of the biggest obstacles when coding drug administration is the common lack of documentation.150 minutes 151 . CPMA. that may not require the presence of a physician.com February 2013 37 . is a senior manager of internal audit with Bon Secours Health System. first IV push given subsequent to an initial one-hour infusion is reported using a subsequent IV push code). CIA. per date of service. CRMA . per IV access site. subsequent. an IV push code may be used for an infusion lasting 15 minutes or less (again. each site may be coded with an initial code and modifier(s). subcutaneous catheter. A different diagnosis is not required. report the appropriate E/M code with modifier 25 in addition to the infusion codes. Other Considerations If a significant.. the presenting problem(s) are minimal. and must be supported by documentation in the record indicating it is medically reasonable and necessary for the drug or substance administrations to occur at separate intravenous access sites. “one hour” means any infusion last- www. “Each additional hour” means increments greater than 30 minutes over the initial hour. The initial code is not necessarily the first service provided. She holds a bachelor’s and a master’s degree in Business Administration with a concentration in finance from The College of William & Mary in Virginia. For example. Amy Lee Smith.aapc. Coding for Multiple Administrations If you can bill only one initial code per patient. CPC-H. The highest-ranking service provided is considered the initial service. Smith is also a Certified Internal Auditor and certified in Risk Management Assurance. separately identifiable evaluation and management (E/M) service is provided. some will accept a code for an IV push even if a stop time is not documented. The start time is normally well documented. it’s important to know time requirements and documentation rules. unless two separate IV sites are required. you cannot report 99211 Office or other outpatient visit for the evaluation and management of an established patient. CPC. while others will not. per date of service.g. Usually. If multiple infusions are administered.

left thoracotomy) +33367 Cardiopulmonary bypass support for TAVR. here’s a list of the new codes with abbreviated descriptors: 33361 TAVR. Swan-Ganz placement and aortic/left ventricular (LV) measurements and imaging to guide and complete the TAVR are included. percutaneous femoral approach 33362 TAVR. intracardiac ischemia monitoring systems. and left atrial (LA) hemodynamic monitoring systems. percutaneous peripheral arterial and venous cannulations • • • • +33368 Cardiopulmonary bypass support for TAVR. are included. pulmonary artery) cannulations • • • Here are some tips for applying these new codes correctly: • The only currently approved device is the Sapien valve. open peripheral cannulations +33369 Cardiopulmonary bypass support for TAVR. Codes 33361-33365 and 0318T Implantation of catheterdelivered prosthetic aortic heart valve. central (eg. You may code for ventricular assist device or intra-aortic balloon pump (33990. Dunn. ventricular assist devices. 33991.■ Coding/Billing By David B. right atrium. To make it easier to differentiate the services. Only one C-P bypass code is submitted during TAVR. s we learned in Part 1 of this two-part series (see “Changes Plus More Changes for Cardiology in 2013. or if there has been a clinical change in the patient since the prior study or during the procedure. if performed. CPC-H. . transaortic approach (eg. Open femoral (34812) and open brachial access (34834) are included in the TAVR codes. open axillary approach 33364 TAVR. open transapical approach (eg. A Transcatheter Aortic Valve Replacement/Implantation (TAVR/TAVI) Codes 0256T-0259T are deleted for 2013. Temporary pacemaker placement for rapid pacing during TAVR. CIRCC. January’s Cutting Edge). CCC. subcutaneous defibrillators. open thoracic approach. MD. 33967. CCVTC Tips Plus More Tips for Cardiology in 2013 Part 2: Catch up on reporting of ablations and newer technology procedures. electrophysiology ablations. you may report it if no prior diagnostic study was performed or a suboptimal study is documented. This month. aorta. the new year brings significant changes to cardiology coding. TAVR requires two physicians to complete the procedure. are also based on approach. open iliac approach 33365 TAVR. median sternotomy) 0318T TAVR. replaced by new codes for TAVR/TAVI. when performed. • The three add-on codes for cardiopulmonary bypass (C-P 38 AAPC Cutting Edge bypass). we cover CPT® coding in 2013 for transcatheter aortic valve replacement (TAVR). If a complete heart catheterization is performed. Code for other percutaneous coronary/cardiac interventions that are performed and medically indicated.” page 40-43. It’s indicated for patients with severe aortic stenosis who are not surgical candidates (determined by a cardiothoracic surgeon). 33970). as well as catheter placements and balloon valvuloplasty. open femoral approach 33363 TAVR. FACS.

percutaneous femoral artery approach +33368 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve.com Anatomical Illustrations © 2012. femoral. here are abbreviated descriptors: 33990 Insert VAD. The C-P bypass codes do not have this requirement. placed usually via the femoral artery. other than transaortic) require modifier 62 Two surgeons for physician billing. transapical. who is not a surgical candidate. append modifier 59 Distinct procedural service to either 33992 Removal of percutaneous ventricular assist device at separate and distinct session from insertion or 33993 Repositioning of percutaneous ventricular assist device with imaging guidance at separate and distinct session from insertion. Ventricular Assist Device (VAD) Codes 0048T and 0050T for VAD are deleted and replaced by new. • You may report 34812 Open femoral artery exposure for delivery of endovascular prosthesis. • Removal and repositioning codes can only be used when at a different encounter. Impella® device 33991 Insert VAD. • Routine closure of artery is not reported separately. percutaneous. puncture and removes oxygenated blood from the left LA back to the TandemHeart™ device (external on patient). The new aforementioned codes are for percutaneous VADs. ie. Codes 33361–33365 and 0318T … require modifier 62 … for physician billing. and then returns it into a second catheter.Coding/Billing: Cardiology TAVR requires two physicians to complete the procedure. February 2013 39 . axillary vessels) (List separately in addition to code for primary procedure) Note: Do not report the temporary pacemaker. arterial access only. • Impella® device is via arterial access only. The venous catheter is placed into the LA via a transseptal www. both arterial and venous access with transseptal puncture. ie. cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg. Example: An elderly patient with severe aortic stenosis. For example. The TAVR is performed via percutaneous approach. with a single catheter that forcefully removes blood from the LV via the distal portion of the catheter and discharges it into the proximal aorta. TandemHeart™ device 33992 Removal of VAD 33993 Repositioning of VAD Follow these tips for proper coding: • VADs are for use in patients with impaired LV function. presents for a TAVR procedure. percutaneous. iliac. If on the same date of service but a different encounter. (eg. • TandemHeart™ device has both venous and arterial access. each physician would report 33361-62 for a percutaneous TAVR. For easy reference. Optuminsight. by groin incision. Correct codes would be: 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve. Inc. Category I CPT® codes. This is performed with C-P bypass via femoral cut-downs and rapid pacing with a temporary pacer.aapc. unilateral when an open arterial exposure is performed to accommodate the larger catheters used in percutaneous VADs.

Optuminsight. when performed. • Ablation of VT (93654) includes 3-D mapping (93613) and LV pacing/recording (93622). when performed. with left ventricular pacing and recording (List separately in addition to code for primary procedure)). transseptal procedure (+93462 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure)). New abbreviated versions of the codes are: 93653 Comprehensive electrophysiologic (EP) evaluation with ablation of supraventricular tachycardia (SVT) 93654 Comprehensive EP evaluation with ablation of ventricular tachycardia +93655 Additional ablation of discrete mechanism of arrhythmia distinct from the primary ablation treated 93656 Comprehensive EP evaluation with ablation of atrial fibrillation via pulmonary vein isolation Anatomical Illustrations © 2012. and 93656 together. use add-on code +93655 or +93657. 93654. .Coding/Billing: Cardiology Repositioning of a percutaneous VAD without imaging guidance is not a reportable procedure. when performed. you may report mapping (+93609 Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (List separately in addition to code for primary procedure) or +93613 Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure)). when performed. Electrophysiology Ablations Electrophysiology ablation codes 93651 and 93652 are deleted. • Do not submit any combination of 93653. CPT® states this code may be reported with 93656. but National Correct Coding Initiative (NCCI) Version 19. Do not report 33992 because the removal is bundled into the new device placement code.0 states not to report 93623 with any of the new ablation codes. • If an existing VAD is removed and replaced with a new VAD. You can report transseptal procedure (93462). and LV pacing/ recording (+93622 Comprehensive electrophysiologic evaluation 40 AAPC Cutting Edge including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia. • Repositioning of a percutaneous VAD without imaging guidance is not a reportable procedure. when performed. If an additional mechanism is ablated. • Pulmonary vein isolation for a-fib (93656) includes the transseptal procedure (93462) and LA pacing/recording (+93621 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia. code this as a new device placement. Inc. • If VAD is placed prophylactically for an intervention and removed at its conclusion. with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure)). • There is a “gray zone” regarding 93623. You can report mapping (93609 or 93613) and LV pacing/recording. do not report 33992. • With ablation of SVT (93653). +93657 Additional ablation of left or right atrium for a-fib remaining after pulmonary isolation at same setting Use these helpful tips for proper EP ablation coding: • The five new ablation codes all include a diagnostic EP study at the time of ablation.

Evaluation and Management (E/M) Services: Complying with Documentation Requirements is an MLN educational tool.All claims submitted correctly! If that’s goal #1. then start with the right tools. More learning starts now.gov/EM-Services. and billing rules. coding. The Medicare Learning Network® (MLN) develops informational resources just for Medicare Fee-For-Service providers. It describes common CERT Program errors and provides information on the documentation needed to support certain claims to Medicare. For example.cms. the CMS’ Comprehensive Error Rate Testing (CERT) Program cites that a number of errors relate to non-compliance with Medicare coverage.com Check out CMS on R Official CMS Information for Medicare Fee-For-Service Providers . Visit http://go. Billing errors can prevent physicians from receiving timely and proper reimbursement for common medical and surgical procedures.

• Add-on code +93657 may be reported only with 93656. • Add-on code +93655 may be reported with 93653. • This system does not allow pacing. and is reported with 0326T. per a parenthetical note following 93621. After this was done. when performed. but the CPT® introductory section states +93622 may be added to 93653. • At generator end of life. as well as reprogramming as necessary. including imaging supervision and interpretation (List separately in addition to code for primary procedure) 0325T Repositioning of electrode and/or generator 0326T EP evaluation (defibrillation threshold testing) 0327T Interrogation of device 0328T Programming of device with iterative adjustments 93613 +93657 Note: Do not code for the EP study (93620) or transseptal procedure (93462). or 93656. • Some of the parentheticals may need updating. followed by a transseptal puncture under intracardiac echocardiography (ICE) into the LA. Example: A patient presents with atrial fibrillation. only 93620 may be used with 93621. follow these tips: • The generator and one lead are placed subcutaneously. Likewise. 93654. and results in fewer potential complications. report 0322T. CPT® adds new Category III codes for S-ICD systems. such as venous stenosis and infected leads within the heart because the lead is in the subcutaneous tissues. This allows for easier insertion over traditional transvenous insertion of electrode. as well as reprogramming as necessary. The correct coding in this case is: 93656 93662 Intracardiac echocardiography during therapeutic/diagnostic intervention. report replacement with 0323T when the depleted generator is removed and a new generator is inserted. when performed. A 3-D map is created.■ Coding/Billing: Cardiology Defibrillation threshold testing (DFT testing) involves induction of arrhythmia and evaluation of sensing and pacing for arrhythmia termination. Shortened descriptions are: 0319T Insertion of complete system 0320T Insertion of electrode only 0321T Insertion of generator only 0322T Removal of generator 0323T Removal and replacement of generator 0324T Removal of electrode 42 AAPC Cutting Edge This is a newer type of defibrillator for treatment of arrhythmias that is totally implanted in the subcutaneous tissues. including the defibrillating lead. • To report removal of an existing subcutaneous lead and generator plus replacement with a new system. • Defibrillation threshold testing (DFT testing) involves induction of arrhythmia and evaluation of sensing and pacing for arrhythmia termination. Intracardiac Ischemia Monitoring Device (IMD) Also new for 2013 are Category III codes (with our abbreviated descriptions) for IMD: 0302T Insertion of complete system. or removal and replacement of both device and electrode . Subcutaneous Implantable Defibrillators (S-ICD) This year. 0324T. followed by ablations performed to achieve pulmonary vein isolation. a parenthetical note instructs you to use +93622 only with 93620. • Report 0327T and 0328T at a different encounter than at the original placement for interrogation or programming of S-ICD (this is not DFT testing). as in a conventional defibrillator. • Use the repositioning code 0325T when performed repositioning of an electrode and/or generator occurs at a different encounter than at the original insertion. To apply the above codes. A complete EP study is performed. and 0319T. there was evidence of continued a-fib and a decision was made to perform additional right atrial ablations. The a-fib then ceased. they are included in 93656. For example.

you’ll find new Category III codes for left atrial hemodynamic monitor. He is a fellow of the American College of Surgeons and a member of the Southern Association for Vascular Surgery. with existing multiple lead. It monitors electrocardiogram signals for acute ST elevation changes and warns the patient via vibratory and auditory alerts. MD. www. • Transseptal code 93462 is bundled with these codes. at the University of Texas. Inc. and 33249 Insertion or replacement of permanent pacing cardioverterdefibrillator system with transvenous lead(s). as is ICE (93662). Dr. IMD (AngelMed Guardian® system) consists of an electrode placed into the right ventricle and a device. and his vascular surgery fellowship at Baylor College of Medicine. David Dunn.To discuss this article or topic. 33240 Insertion of pacing cardioverter-defibrillator pulse generator only. • Report codes 0305T and 0306T at a different encounter than at original placement for interrogation or programming of IMD.aapc.com Coding/Billing: Cardiology The removal of an existing IMD system and replacement with a new system is reported by the single code … Left Atrial Hemodynamic Monitor Intravascular electrode leads in subclavian vein Pulse generator (pacemaker) in subcutaneous pocket Finally. complete with module and pressure sensor lead 0294T Insertion of pressure sensitive lead at time of insertion of pacing cardioverter-defibrillator Pacing electrode lead Defibrillation electrode lead Anatomical Illustrations © 2012. and contributes to Dr. with existing dual leads. CIRCC. or removal and replacement of device 0305T Programming of device with iterative adjustment 0306T Interrogation of device 0307T Removal of IMD system This system monitors LA pressures to identify changes in patients with heart failure to allow potential earlier treatment. This allows the patient to potentially seek earlier treatment of impending ischemic events. Dunn is also certified in vascular surgery. is vice president of ZHealth. or removal and replacement of electrode 0304T Insertion of device only.com February 2013 43 . CCC. Z’s Medical Coding Series.aapc. 0302T. CCVTC. he completed his M. his surgical residency at Scott & White Hospital. 0303T Insertion of electrode only. Consider these tips when applying the above codes: • The removal of an existing IMD system and replacement with a new system is reported by the single code. 33231 Insertion of pacing cardioverter-defibrillator pulse generator only. A diplomat of the American Board of Surgery. He oversees physician coding and instructs ZHealth educational programs. CPC-H. Optuminsight. 33262-33264 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator ….D. FACS. single or dual chamber. or when inserted into combination-type defibrillator devices. Easier-to-follow abbreviated descriptions are: 0293T Insertion of LA hemodynamic monitor. A graduate of Texas A&M University. go to www. He is president-elect of the AAPC National Advisory Board. with existing single lead. • Use 0294T with 33230 Insertion of pacing cardioverterdefibrillator pulse generator only. Tips to apply these codes correctly include: • You may use the above codes alone.

at times. you “cannot use one statement to count as two elements. If you separately report an E/M visit for when the operating surgeon checks on the patient’s recovery (clearly a service related to the surgery). Barton C. if the physician documents “pain since last Tuesday. it’s proper for legitimate recoupment. Such unbundling is prohibited. this type of double dipping can be appropriate. if done correctly.g. within the 90-day global period of a major procedure. you shouldn’t use the same statement twice within the history or within the ROS. That’s a “don’t. publicly remarked that when selecting an E/M service level. some background: Way back in December 1997. surgical. In other words. cedure designation means 44180 is bundled to the related. more extensive procedure (44186). For instance.” McCann was not just any physician: He was executive medical officer of the Health Care Finance Administration (precursor to the Centers for Medicare & Medicaid Services).” As a second example. you would be double dipping on the E/M. you definitely should—or risk leaving legitimate reimbursement on the table. more extensive procedure. and his instructions mattered greatly to coders. Unfortunately. As an example. In the coding world. but in some circumstances. You might think it’s never OK to double dip.” you can’t count that statement in the review of systems (ROS) as relevant to both musculoskeletal and neurological body systems. enterolysis (freeing of intestinal adhesion) (separate procedure). by separately reporting a service that is included in another (already claimed) procedure. but not both.” you cannot count that statement in the history of present illness (HPI) as timing and duration. Contrary to what you may have heard. First.■ Auditing/Compliance By G. and—even if done unintentionally—can quickly land you in hot water with payers. McCann’s intended meaning is that you cannot use a single documented item twice within the same component of the E/M service. McCann. for instance. the Medicare surgical package includes routine post-operative care.. for decompression or feeding)) with lyses of adhesions. CPC Know Double Dipping Etiquette Although it’s usually coding taboo. That’s another “don’t” because the separate pro44 AAPC Cutting Edge photo by iStockphoto©Pannonia . Similarly. his words were immediately taken out of context and applied much more broadly to re- Double Dip “Don’t” The first use of double dip means to bill twice for the same item. if the physician records “no back pain. Double Dip “Do” The second meaning of double dip is to use a single statement in the documentation of an E/M service more than once when determining the level of service provided. if a surgeon performs laparoscopic jejunostomy (44186 Laparoscopy. McCann’s pronouncement about the inappropriateness of this type of double dipping was neither sensational nor controversial.J. For instance.” Taken in context. MD. Verhovshek. jejunostomy (e. It’s one or the other. payers. the term “double dip” has two meanings (neither of which has anything to do with dining etiquette). MA. you wouldn’t report a designated “separate procedure” when it occurs during the same operative session and in the same anatomic area as another. surgical. including related evaluation and management (E/M) services. This type of double dipping is never OK. you cannot report 44180 Laparoscopy. That’s your third legitimate “don’t. and health care regulators.

which makes using the item in both the history and ROS acceptable. CPC. The bottom line: If the physician looks beyond the presenting problem. you would not be able to count the documentation as location and associated signs and symptoms in the history and as relevant to the respiratory system in the ROS. and should be challenged. For example. Verhovshek. G. performing additional work to expand on the problem identified in the chief complaint and HPI. chosen to interpret the rules to mean a single item cannot be used in both the history and ROS. Despite McCann’s clarification. indeed. For example.” And because payers and auditors do have freedom in how they apply documentation guidelines. you shouldn’t use that single complaint for both the history and ROS. agement Services state that you cannot count a single item in both the history and ROS. and was repeated so often that it has been accepted as truth. this (mis)understanding has become one of the greatest coding “urban legends. Setting the Record Straight (Sort of) McCann later disavowed the twisted interpretation of his words. MA. Specifically. McCann’s statement was interpreted to mean that a single item could not apply to both the HPI and ROS. documentation of “cough” alone isn’t sufficient to count for both history and ROS. The Truth Part 1: There are no requirements for documented patient information to be stated or written in any specific format. it is not necessary to mention an area of history twice … to meet the documentation requirements for the ROS. writing. suppose a patient presents with chest pain with dyspnea. But documentation of “abdominal pain. Doing so is not only legitimate. Returning to our earlier example of the patient with documented chest pain with dyspnea. “cough one week.com/downloads/files/PPC_1999_DD_Clarifi​ cation. “You ask if a single statement may be used in the history of present illness and still be counted in the review of systems without actually being written twice …. Under the mistaken interpretation of McCann’s statement. moderate shortness of breath” provides plenty of detail to support both the history and ROS elements. and was repeated so often that it has been accepted as truth. if a patient shows up with only one complaint.com/artman/ publish/article_6570. the “you can’t use the same documented item in both the history and ROS” trope spread far and wide. Similarly. you should look for documented evidence that the physician dug deeper to find more information to assist him or her in identifying what is wrong with the patient and how to treat it (in other words. And the man who is mistakenly credited with having said it was so has publicly stated that it isn’t. however. Repetition of data is not required as long as it is appropriately referred to.shtml for more). you should be sure that the physician truly did provide an ROS). and that’s all the physician documents. if the patient presents with abdominal pain.com February 2013 45 . a level III and a level IV E/M code assignment.J. you may “double dip” and count a single element in both the history and ROS. it may mean the difference between.aapc. for example. Rather.” E/M documentation guidelines are supposed to help you find the correct level of service and “not to be perceived as a burden to the physician.pdf and http://medicalnewswire. either. you may count it in both the history and ROS.Auditing/Compliance: Double Dipping flect a meaning he never intended. some have. no nausea” means the physician asked additional questions beyond the presenting problem. you may count dyspnea as both an associated sign/symptom for the HPI and for respiratory ROS (but you should not count “chest pain” for both cardiovascular and musculoskeletal systems in the ROS). Nothing in the American Medical Association (AMA) or national Medicare guidelines says so. The Truth Part 2: As long as an item is clearly documented. you shouldn’t report that single item in the history and ROS. Neither the 1995 or 1997 Documentation Guidelines for Evaluation and Man- www. Any payer or auditor who continues to insist on the validity of the “double dip urban myth” ought to know better. the “you can’t use the same documented item in both the history and ROS” trope spread far and wide. In fact. is managing editor at AAPC. Despite McCann’s clarification. But (and this is a big “but”). no expectoration.” he concluded (see http:// ercoder.

as he or she pays a higher co-payment. which is an area that has been problematic for facilities in the past. CMS will examine all services provided in that time frame.” and prior OIG work identified improper payments in the DRG window. The Medicare program does not pay separately for these preadmission services when they are delivered in a setting owned or operated by the admitting hospital. CCS-P Facility Control Hospital Risk Using OIG’s 2013 Work Plan Let government reviews help you identify and correct potential compliance risks at your hospital. varied among different providers. In the other portion of this review. the OIG will examine which practices that bill Medicare using provider-based status meet billing requirements. This policy is commonly known as the “DRG window. as well. This classification system change has meant updates in billing for hospitals. the Office of Inspector General (OIG) reports on compliance issues it plans to monitor most closely in the new year. and how billing in 2012. In reviewing the OIG’s areas of concern for hospitals. CPC-P. inpatient coding is an area of risk in a hospital. the beneficiary also loses out in these situations. as well. are appearing for the first time. MHA.■ Auditing/Compliance By Jillian Harrington. so be sure not to forget this area when developing your coding audit plans for the year. the OIG will examine the impact of non-hospital-owned physician practices billing Medicare as provider-based physician practices. however. For example: • Is your facility including all diagnostic and clinically related nondiagnostic services provided within the three-day window? • Have wholly owned and operated physician practices been considered in any previous reviews of these types of claims? Organizations should look closely at these claims and be sure that this item is included in their audit plan for the year. Compliance with billing standards is crucial to assigning appropriate MS-DRGs. They also plan to examine compliance with inpatient billing standards among hospitals. allowing you to take corrective action to reduce risk of Medicare and Medicaid fraud. In this review. Inpatient Billing for Medicare Beneficiaries In 2008. the OIG explains the changes in billing since 2008. Consider each of the following items carefully. based on concerns from the Medicare Payment Advisory Commission. the Medicare Inpatient Prospective Payment System (IPPS) transitioned from the traditional Centers for Medicare & Medicaid Services-Diagnosis Relat46 AAPC Cutting Edge photo by iStockphoto©courtneyK . This study was developed to analyze claims data to determine how much CMS could save if it bundled outpatient services delivered up to 14 days prior to an inpatient hospital admission into the MS-DRG payment. As always. This review provides a great opportunity for hospitals to consider the affects of potential expansion of the DRG window before it occurs. you might catch potential noncompliance in your workplace. This will uncover potential issues with the three-day window. The Medicare program makes additional payment to facilities for services provided in the provider-based clinic setting. Hospitals should exam- Look Out for First-time Reviews Several items in the 2013 Work Plan. Unfortunately. In one portion of the review. in particular. Take this opportunity to examine billing compliance function to verify it is active and functioning well. This information provides a road map your organization can use to develop a compliance audit plan for the year ahead. To evaluate these DRG window payments. Each October. Non-hospital-owned Physician Practices Using Provider-based Status This is a two-part review by the OIG. ed Group (CMS-DRG) system to Medicare Severity-Diagnosis Related Groups (MS-DRGs). CPC. aimed specifically at the hospital industry. DRG Window The Medicare program currently bundles all outpatient services delivered three days prior to an inpatient hospital admission. CPC-I.

www. and areas for future improvement within the Medicare program. and many of the other items continuously monitored by the OIG. certain MS-DRG payments can be changed. This OIG Work Plan looks at transfers overall. A hospital that is transferring a patient to another acute care facility is paid a graduated per diem rate. followed by a second IPPS payment for the rescheduled surgical procedure. Facilities have a great opportunity to review these areas and improve compliance internally. She is a former chief compliance officer and chief privacy official. graduated per Payments for Mechanical Ventilation When a ventilator or respirator is used to take over active breathing for a patient for 96 or more hours in the inpatient setting. and is a former member of AAPC’s ICD10 curriculum development team. For a peek into the areas of risk Payments for Discharges to Swing Beds in Other Hospitals Swing beds are inpatient beds in hospitals that can be used for skilled nursing services or acute care services. observation payments. if any. they are determining how much money is spent on inpatient short stays for canceled surgical procedures without significant services being provided.hhs.8803. This item should always be included in a hospital billing compliance audit plan. This review item provides an opportunity for providers to check that documentation for these types of services is strong and concise. ine their provider-based clinics to determine if they are billing properly. If your facility has physician practices that do not meet the criteria for provider-based clinic billing. This significant difference in relative weight will obviously result in a higher payment to the facility for mechanical ventilation services.com February 2013 47 . generating two bills. with MCC has a relative weight of 1. but also reviews the effectiveness of the claims processing edits used by the Medicare administrative contractors (MACs) to identify claims subject to the transfer policies in place in the Medicare program. such as same-day readmissions. The OIG is on the lookout for this sort of thing. Use the Work Plan to Your Advantage Most of these new items in the OIG Work Plan are reviews of policies. Be sure coding clearly reflects all work provided for patients during their stay.pdf. it’s critical these services are not billed as provider-based. however.com Auditing/Compliance: Work Plan Hospitals should examine their provider-based clinics to determine if they are billing properly. MS-DRG 870 Septicemia with mechanical ventilation. procedures. She holds a bachelor’s degree in health care administration from State University of New York . Take the time to review the existing items in the Work Plan. the OIG has determined large occurrences of initial IPPS payment for a canceled surgical procedure. outlier payments. Medicare does not pay a reduced.8399.Empire State College and a master’s degree in health systems administration from the Rochester Institute of Technology. a hospital that is discharging a beneficiary receives MS-DRG payment in full.aapc. For the initial IPPS payment. Right now. There are often issues where patients are improperly noted as being “discharged” instead of “transferred” from the original facility. 96+ hours has a relative weight of 5.gov/reportsand-publica​ t ions/archives/workplan/2013/WorkPlan-2013. The rate will not exceed the full MSDRG payment that would have been made if the patient was discharged from the original without being transferred. This could result in policy changes in the future for this type of service. CPC-I. Review any clinical documentation you have for mechanical ventilation in your facility: • Are there areas for improving time recording? • Are the minimum standards being met for the MS-DRG grouping 96hour rule? Compliance with Medicare’s Transfer Policy Transfers have been a consistent issue in hospital billing and reimbursement for many years. This review concerns instances when an acute care facility discharges patients from the acute care setting to a swing bed. 96+ hours for physician related-items read “Get a Jump on 2013 Government Reviews” on pages 48-49 of January’s Cutting Edge. and the entire MS-DRG payment is made for both facilities. Payments for Canceled Surgical Procedures From an analysis of data. For example. CPC-P. CPC. Currently. She teaches CPT® coding as an approved AAPC instructor. MS-DRG 871 Septicemia without mechanical ventilation. A move from one clinical setting to another to receive additional care typically is considered a transfer. diem rate if the patient was discharged to a swing bed in another hospital.To discuss this article or topic. few. and your organization may be called upon to provide information in any of these areas. MHA. go to www. however. as well as all services provided for patients. This review will allow the OIG and CMS to examine swing bed policy to determine if a change in reimbursement policies should be made. Medicare makes two payments to hospitals. this is a constant risk area for most hospitals. Under Medicare IPPS guidelines. it is not inappropriate for two bills to be made. creating a significant increase in the payment for that particular MS-DRG. in which case a single payment is made. inpatient services such as laboratory or diagnostic tests were provided by the hospitals because the surgical procedure was canceled. These are still active reviews. Jillian Harrington. as the OIG states in their Work Plan. Have clinical documentation improvement staff members work with providers to clearly document reasons for surgical cancellations.aapc. unless the patient is readmitted to the hospital on the same day. serves as a clinical technical editor for OptumInsight. and has nearly 20 years of experience in the health care industry. CCS-P. The entire 2013 Work Plan can be downloaded at https://oig. It’s clear.

CUC. shall. CCS-P. the POS code reflects the actual place where the beneficiary receives the faceto-face service and determines whether the facility or nonfacility payment rate is paid. Although this may sound easy in theory. The patient is still a registered inpatient and will return to the hospital at the conclusion of the visit. 11. Should the outpatient provider report his or her E/M service using the outpatient E/M codes (9920199215) or can they use the subsequent inpatient E/M codes? Applying the new POS code reporting rule. such as diagnostic test result interpretation). CPC. stay compliant when reporting inpatient transports to outpatient settings. One of those questions came to light through Cynthia Stewart. new Medicare guidance can make POS assignment tricky. tient provider office for an evaluation and management (E/M) service and a procedure. CPC. the facility rate is paid. That guidance has posed new questions that should be addressed regarding these claims. report the inpatient hospital POS code 21 irre- B e sure your place-of-service (POS) code matches the setting where the patient received the service (for faceto-face services). the Centers for Medicare & 48 AAPC Cutting Edge Medicaid Services (CMS) clarified guidance for assigning POS codes on Medicare claims. 2012: “In general. Esq. when she used the following coding scenario to point out discrepancies when reporting in compliance to the new POS reporting rules: “An inpatient is transported to an outpa- . CPCO. In recent transmittal 2563. the service will be denied. CHCC Coding Compass New POS Rules Get Sticky for 21 and 22 E/M Services Although it may mean denials. CPMA. a physician/practitioner/supplier furnishing services to a patient who is a registered inpatient. regardless of where the face-to-face encounter with the beneficiary occurred. Miscoe.■ Auditing/Compliance Michael D. To that end. at a minimum. change request (CR) 7631. CPC-I. effective Oct.” Here is the relevant language from transmittal 2563.” And here is the specific provider instruction added to the Medicare Claims Processing Manual: Special Considerations for Services Furnished to Registered Inpatients “When a physician/practitioner furnishes services to a registered inpatient. CASCC. for a service rendered to a patient who is an inpatient of a hospital (POS code 21) or an outpatient of a hospital (POS code 22). or the setting where the technical portion of the service was delivered (for non-face-to-face services.. However. CPC-H. CCPC. payment is made under the PFS at the facility rate. where an outpatient E/M service is reported with POS 21 or 22.

.Carrier Instructions for Place of Service (POS) Codes (Rev. District Courts in the Southern District of California and the Western District of Pennsylvania. the POS code is generally used to reflect the actual setting where the beneficiary receives the face-to-face service. 9920199215) when billed with POS 21 consistent with this rule. the 2-digit POS code (Item 24B on the claim Form CMS-1500) will match the address and ZIP entered in the service location (Item 32 on the 1500 Form) – the physical/geographical location of the physician.6 (emphasis added). Military Academy.6 . The other option would be for the physician to go to the hospital to do the E/M and pro- cedure work. and only then. if the physician’s face-toface encounter with a patient occurs in the office.com Auditing/Compliance: Place of Service Attempting to avoid the denial by reporting an inpatient E/M service that was not performed. CPC. consistent with the reverse false claims provision of the False Claims Act and the draft implementing regulations.To discuss this article or topic. Miscoe. Then. in general. is not recommended. If the physician/practitioner is aware of the exact setting the beneficiary is a registered inpatient. CCPC. www. if in the above example. 2012. the provider is forced to appeal and validate that reporting is accurate under the above rule. the appropriate inpatient POS code may be reported consistent with the code list annotated in this section (instead of POS 21). chapter 26. In these cases. I have to assume that Medicare administrative contractors will eventually fix their payment systems to comply with this instruction. the patient seen in the physician’s office is actually an inpatient of the hospital. some carriers may not process a payment for an outpatient E/M service (e. CUC. where it exists.aapc. a physician/practitioner may use POS 31.2563. Issued: Oct. For example. is correct. there are two exceptions to this general rule – these are for a service rendered to a patient who is a registered inpatient or an outpatient of a hospital.aapc. the correct POS code — regardless of where the faceto-face service occurs — is that of the appropriate inpatient POS code (at a minimum POS code 21) or that of the appropriate outpatient hospital POS code (at a minimum POS code 22) as discussed in section 10.g. In this example. CHCC.5 of this chapter. Even if paid. However.S. Attempting to avoid the denial by reporting an inpatient E/M service that was not performed.. and POS 61 for patients registered in a Comprehensive Inpatient Rehabilitation Facility. Where payment is denied. In other words. He is admitted to the Bar in California and to practice law before the U. Esq. 2013) For purposes of payment under the Medicare Physician Fee Schedule (MPFS). a Juris Doctorate degree from Concord Law School. especially where that code results in the physician obtaining additional reimbursement. pub 100-4.com February 2013 49 . In these instances. the correct POS code on the claim. for a patient in a SNF receiving inpatient skilled nursing care. It merely instructs the provider to use POS code 21 (or a more specific code. I see the issue where a physician performing an E/M service in an office setting for a patient who is currently a registered inpatient at a facility (and transported to the office location) would be required to report POS 21 for any physician service or procedure performed. reflects the 2-digit POS code 11 for office. CPCO. POS 51. CASCC.* * Medicare Claims Processing Manual. Although it is time consuming to appeal such denials. LLC. could the physician bill the inpatient code—because only in that case is an “inpatient” E/M service provided. where the exact facility status is known) when the outpatient E/M service or other procedure is performed on a patient that is a current registered inpatient at a hospital. POS code 21. For example. especially where that code results in the physician obtaining additional reimbursement. consistent with the following revised instructions to the Medicare administrative carrier (MAC): 10.. the POS code reflects a different setting than the address and ZIP code of the practice location (the physician’s office). A word of caution: Nothing in the above instruction suggests or implies that it would be reasonable to interpret the change as instructing a provider to report an inpatient E/M code for an E/M service performed in an outpatient setting. Internet Only Manual (IOM). Michael D. section 10. Effective: April 1.” According to this provision.S. He is a national speaker and has been published in numerous national publications.11. The problem this instruction potentially creates is that while there is a facility payment rate for an outpatient E/M service. Note that the location of the service in block 32 would be the physician’s office and ZIP code. has a Bachelor of Science degree from the U. which is not yet updated in the processing manual on the CMS IOM website. So. He has nearly 20 years of experience in health care coding and over 15 years as a coding and compliance expert testifying in civil and criminal cases. for inpatient hospital. and founding partner of Miscoe Health Law. is president of Practice Masters. go to www. He is a past member of AAPC’s National Advisory Board and a current member of the Legal Advisory Board. reporting the inpatient hospital POS code 21 is a minimum requirement for purposes of triggering the facility payment under the PFS when services are provided to a registered inpatient. spective of the setting where the patient actually receives the face-to-face encounter. Inc. the provider would have to disclose and refund the overpayment within 60 days. is not recommended. for a patient registered in a Psychiatric Inpatient Facility. I suspect carriers will reprogram their claims processing systems soon to deal with this payment problem.

Permanent J-Code for OMONTYS® (peginesatide) Injection Effective Jan. 1. 2013 J0890 .

and Takeda Pharmaceuticals America.. Laboratory monitoring: Evaluate transferrin saturation and serum ferritin prior to and during OMONTYS treatment. 03-12-00277-A. ESAs increased the risk of death in patients undergoing coronary artery bypass graft surgery (CABG) and deep venous thrombosis (DVT) in patients undergoing orthopedic procedures. serious adverse cardiovascular reactions. ESA dose. nausea.ESA administration Consider the first once-monthly. Warnings and Precautions Increased mortality. MYOCARDIAL INFARCTION. Patients with CKD and an insufficient hemoglobin response to ESA therapy may be at even greater risk for cardiovascular reactions and mortality. in patients receiving treatment for cancer and whose anemia is not due to CKD. IMPORTANT SAFETY INFORMATION WARNING: ESAs INCREASE THE RISK OF DEATH. Inc. De Cock E. . the Affymax logo. Costs of managing anemia with erythropoiesis-stimulating agents during hemodialysis: a time and motion study. Inc. • In 2 trials of OMONTYS® (peginesatide) Injection. Reference: Schiller B. Administer supplemental iron therapy when serum ferritin is less than 100 mcg/L or when serum transferrin saturation is less than 20%. • There is increased mortality and/or increased risk of tumor progression or recurrence in patients with cancer receiving ESAs. Takeda and the Takeda logo are trademarks of Takeda Pharmaceutical Company Limited registered with the U. evaluate for antibodies to peginesatide. monitor monthly. Contraindications OMONTYS is contraindicated in patients with uncontrolled hypertension and in patients who have had serious allergic reactions to OMONTYS. • No trial has identified a hemoglobin target level. Inc. myocardial infarction. Hemodial Int. VENOUS THROMBOEMBOLISM. Serious allergic reactions (see Contraindications): Serious allergic reactions have been reported with OMONTYS. STROKE. THROMBOSIS OF VASCULAR ACCESS AND TUMOR PROGRESSION OR RECURRENCE. cough. Chronic Kidney Disease: • In controlled trials. Inc. Reducing the burden of • In controlled clinical trials of ESAs in patients with cancer. Then. Hypertension (see Contraindications): Appropriately control hypertension prior to initiation of and during treatment with OMONTYS. OMONTYS is not indicated and is not recommended for use in patients with CKD not on dialysis. and/or its subsidiaries. © 2012 Affymax. or health-related quality of life. and the OMONTYS logo are trademarks of Affymax. Lack or loss of response to OMONTYS: Initiate a search for causative factors. and arteriovenous fistula site complication. patients experienced greater risks for death.12(4):441-449. All rights reserved. physical functioning. OMONTYS. Dialysis management: Patients receiving OMONTYS may require adjustments to dialysis prescriptions and/or increased anticoagulation with heparin to prevent clotting of the extracorporeal circuit during hemodialysis. patients with CKD not on dialysis experienced increased specific cardiovascular events. A rate of hemoglobin rise of >1 g/dL over 2 weeks may contribute to these risks. non-EPO ESA offering less-frequent dose administration. and thromboembolism: • Using ESAs to target a hemoglobin level of greater than 11 g/dL increases the risk of serious adverse cardiovascular reactions and has not been shown to provide additional benefit. • In controlled clinical trials of ESAs. If typical causes of lack or loss of hemoglobin response are excluded. Reduce or withhold OMONTYS if blood pressure becomes difficult to control. OMONTYS has not been shown to improve symptoms. Doss S. Please see accompanying Brief Summary. diarrhea. and stroke when administered erythropoiesis-stimulating agents (ESAs) to target a hemoglobin level of greater than 11 g/dL. increased risk for death and serious adverse cardiovascular reactions including myocardial infarction and stroke was observed. INDICATION AND LIMITATIONS OF USE OMONTYS® (peginesatide) Injection is indicated for the treatment of anemia due to chronic kidney disease (CKD) in adult patients on dialysis. or as a substitute for red blood cell (RBC) transfusions in patients who require immediate correction of anemia. Monitor hemoglobin every 2 weeks until stable and the need for RBC transfusions is minimized. Affymax. 24102. Del Aguila MA. • Use the lowest OMONTYS dose sufficient to reduce the need for RBC transfusions.S. Nissenson AR. Patent and Trademark Office and used under license by Takeda Pharmaceuticals America. Use caution in patients with coexistent cardiovascular disease and stroke. or dosing strategy that does not increase these risks. stroke. Adverse reactions Most common adverse reactions in clinical studies in patients with CKD on dialysis treated with OMONTYS were dyspnea. 2008. Immediately and permanently discontinue OMONTYS and administer appropriate therapy if a serious allergic reaction occurs.

10. 13. or dosing strategy that does not increase these risks [see Warnings and Precautions]. Patients with CKD and an insufficient hemoglobin response to ESA therapy may be at even greater risk for cardiovascular reactions and mortality than other patients. A higher percentage of patients (22%) who received OMONTYS experienced a composite cardiovascular safety endpoint event compared to 17% who received darbepoetin alfa in two randomized. • Serious allergic reactions to OMONTYS [see Warnings and Precautions]. progression-free survival and/or decreased overall survival. hospitalization for CHF. because ESAs have shown harm in some settings and the benefit-risk factors for OMONTYS in this setting have not been evaluated [see Warnings and Precautions]. hypotension. cervical cancer. Hypertension OMONTYS is contraindicated in patients with uncontrolled hypertension.38 – 2. 11. • OMONTYS has not been shown to improve symptoms. increased risk for death and serious adverse cardiovascular reactions was observed. 11. ESA dose. and stroke 1. • Using ESAs to target a hemoglobin level of greater than 11 g/dL increases the risk of serious adverse cardiovascular reactions and has not been shown to provide additional benefit. and Thromboembolism • In controlled clinical trials of other ESAs in patients with CKD comparing higher hemoglobin targets (13 . angioedema and generalized pruritus. initiate a search for causative factors (e.17) Stroke 1. and stroke when administered erythropoiesisstimulating agents (ESAs) to target a hemoglobin level of greater than 11 g/dL.3) All-cause mortality. increased risk of death. infection. 10.27) 13. and other thromboembolic events was observed in the higher target groups. stroke. serious adverse cardiovascular reactions. congestive heart failure. Contact Affymax. (1-855-466-6689) to perform assays for binding and neutralizing antibodies. In the absence of antibodies to peginesatide. ESAs increased the risk of death in patients undergoing coronary artery bypass graft surgery (CABG) and deep venous thrombosis (DVT) was observed in patients undergoing orthopedic procedures. MI. The trials had a pre-specified. ≥ 9. • In controlled clinical trials of ESAs in patients with cancer. Reduce or withhold OMONTYS if blood pressure becomes difficult to control. unstable angina or arrhythmia (hazard ratio 1. 13. follow dosing recommendations for management of patients with an insufficient hemoglobin response to OMONTYS therapy. patients experienced greater risks for death. VENOUS THROMBOEMBOLISM. 1. 10. prospective analysis of a composite safety endpoint consisting of death. lymphoid malignancy. multi-center trials of 983 patients with anemia due to CKD who were not on dialysis.0. physical functioning or health-related quality of life. active-controlled. Q3) Achieved Hemoglobin level (g/dL) Primary Endpoint Hazard Ratio or Relative Risk (95% CI) Adverse Outcome for Higher Target Group Hazard Ratio or Relative Risk (95% CI) 1. open-label. .0 (12.68) Hemoglobin Target. Results from clinical trials of ESAs in patients with anemia due to cancer therapy showed decreased locoregional control. bronchospasm. Lower (g/dL) Median (Q1. CONTRAINDICATIONS OMONTYS is contraindicated in patients with: • Uncontrolled hypertension [see Warnings and Precautions]. If typical causes of lack or loss of hemoglobin response are excluded.27 (1. myocardial infarction.48 (0.4) vs.Table 2 Adverse Cardiovascular Outcomes in Randomized Controlled Trials Comparing Higher and Lower Hemoglobin Targets in Patients With CKD ® NHS (N = 1265) Time Period of Trial 1993 to 1996 CHOIR (N = 1432) 2003 to 2006 TREAT (N = 4038) 2004 to 2009 Population BRIEF SUMMARY OF FULL PRESCRIBING INFORMATION OMONTYS® (peginesatide) Injection for intravenous or subcutaneous use WARNING: ESAs INCREASE THE RISK OF DEATH.0.6 (11. non-small cell lung cancer. including anaphylactic reactions. 10. Use caution in patients with coexistent cardiovascular disease and stroke.2. Appropriately control hypertension prior to initiation of and during treatment with OMONTYS. MYOCARDIAL INFARCTION. • In patients receiving treatment for cancer and whose anemia is not due to CKD. or serious adverse events of congestive heart failure. hematocrit hemoglobin administered 30 ± 3% on ≤ 11 g/dL epoetin alfa epoetin alfa 14. THROMBOSIS OF VASCULAR ACCESS AND TUMOR PROGRESSION OR RECURRENCE. and with various malignancies who were not receiving chemotherapy or radiotherapy. stroke. 11.05 (0. These adverse reactions included myocardial infarction and stroke. • Use the lowest OMONTYS dose sufficient to reduce the need for red blood cell (RBC) transfusions [see Warnings and Precautions]. The safety and efficacy of OMONTYS have not been established for use in patients with anemia due to cancer chemotherapy.34 (1.81).0 12. Chronic Kidney Disease: • In controlled trials. INDICATIONS AND USAGE Anemia Due to Chronic Kidney Disease OMONTYS® is indicated for the treatment of anemia due to chronic kidney disease (CKD) in adult patients on dialysis.74) All-cause mortality 1. 12.4 (11.6. MI.32. or stroke 1.9. myocardial ischemia.0 vs. Higher vs. Advise patients of the importance of compliance with antihypertensive therapy and dietary restrictions. iron deficiency.56) All-cause mortality 1. evaluate the patient for the presence of antibodies to peginesatide. 11.11.5 vs. advanced head and neck cancer receiving radiation therapy.8) vs.94 – 1. The design and overall results of 3 large trials comparing higher and lower hemoglobin targets are shown in Table 2 (Normal Hematocrit Study (NHS).14 g/dL) to lower targets (9 . • In controlled clinical trials.3 g/dL) (see Table 2). may occur in patients treated with OMONTYS.54) Patients with Chronic Kidney Disease Not on Dialysis OMONTYS is not indicated and is not recommended for the treatment of anemia in patients with CKD who are not on dialysis.5 (12. • No trial has identified a hemoglobin target level. heart failure. • As a substitute for RBC transfusions in patients who require immediate correction of anemia. WARNINGS AND PRECAUTIONS Increased Mortality. Limitations of Use OMONTYS is not indicated and is not recommended for use: • In patients with CKD not on dialysis because of safety concerns in this population [see Warnings and Precautions]. STROKE. A rate of hemoglobin rise of greater than 1 g/dL over 2 weeks may contribute to these risks. Myocardial Infarction.6) All-cause mortality. Increased Mortality and/or Increased Risk of Tumor Progression or Recurrence in Patients with Cancer receiving ESAs OMONTYS is not indicated and is not recommended for reduction of RBC transfusions in patients receiving treatment for cancer and whose anemia is not due to CKD because ESAs have shown harm in some settings and the benefit-risk factors for OMONTYS in this setting have not been evaluated. Patients with CKD Patients with CKD on Patients with not on dialysis with hemodialysis with CKD not on dialysis coexisting CHF or hemoglobin < 11 g/dL with type II diabetes. thrombosis of hemodialysis vascular access.0 vs. Inc. Immediately and permanently discontinue OMONTYS and administer appropriate therapy if a serious allergic reaction occurs.3) vs. The findings were observed in clinical trials of other ESAs administered to patients with: breast cancer receiving chemotherapy. Dialysis Management Patients may require adjustments in their dialysis prescriptions after initiation of OMONTYS. myocardial infarction.06 – 1.6 (9.03 – 1.0 12.97 – 2. Lack or Loss of Response to OMONTYS For lack or loss of hemoglobin response to OMONTYS.1. not previously CAD.g. Correction of Hemoglobin Outcomes in Renal Insufficiency (CHOIR) and Trial to Reduce Cardiovascular Events with Aranesp® Therapy (TREAT)).28 (1.3 13.. inflammation. bleeding).3 (10.04 – 1.92 (1. 95% CI: 0. Patients receiving OMONTYS may require increased anticoagulation with heparin to prevent clotting of the extracorporeal circuit during hemodialysis.7) All-cause mortality or non-fatal MI 13. Serious Allergic Reactions Serious allergic reactions. Stroke.97.

32. Because many drugs are excreted into human milk. the presence of antibodies was associated with declining hemoglobin levels. In approximately half of all antibody-positive patients.0% 11.3% 9. and Asian patients were 57. IL 60015 OMONTYS is a trademark of Affymax. embryofetal lethality. hemoglobin should be monitored at least monthly provided hemoglobin levels remain stable. .S.4%. 58.3% 19.25 mg/kg.1%.2% 12. CA 94304 Distributed and Marketed by: Takeda Pharmaceuticals America. Thereafter. premonitory symptoms. or change in seizure frequency. Administration of peginesatide by intravenous injection to rats and rabbits during organogenesis was associated with embryofetal toxicity and malformations. 37.5% male. Myocardial Infarction.7% 14. adverse embryofetal effects included reduced fetal weight. OVERDOSAGE OMONTYS overdosage can elevate hemoglobin levels above the desired level. Administer supplemental iron therapy when serum ferritin is less than 100 mcg/L or when serum transferrin saturation is less than 20%. as clinically indicated. In a separate embryofetal developmental study in rats. No overall differences in safety or effectiveness were observed between these subjects and younger subjects. unossification of sternebrae and metatarsals.9% 10. During the first several months following initiation of OMONTYS. Table 3 summarizes the most frequent adverse reactions ( ≥10%) in dialysis patients treated with OMONTYS.2% 11.9% 16. Patients with Chronic Kidney Disease Adverse reactions were determined based on pooled data from two active controlled studies of 1066 dialysis patients treated with OMONTYS and 542 treated with epoetin. respectively. and reduced ossification of some bones. Peginesatide does not bind to serum albumin or lipoproteins as demonstrated in in vitro protein binding studies in rat.5% were age 65 and over.2% 13. increased resorption.7%). sternum anomalies. There was a higher incidence of peginesatidespecific binding antibodies in patients dosed subcutaneously (1. DRUG INTERACTIONS No formal drug/drug interaction studies have been performed.9% 15. In rats and rabbits. The effects in rabbits were observed at doses lower (5% .9%. ADVERSE REACTIONS The following serious adverse reactions are discussed in greater detail in other sections of the labeling: • Increased Mortality. Advise patients to contact their healthcare practitioner for new-onset seizures.8% 14. Reduced fetal weight and delayed ossification in rabbits were observed at ≥ 0. Allergic and infusion-related reactions have been reported in patients treated with OMONTYS. Table 3 Adverse Reactions Occurring in ≥10% of Dialysis Patients Treated with OMONTYS Dialysis Patients Treated with OMONTYS (N = 1066) 18.9%).9%) as compared to those dosed intravenously (0. 29 (1. blood pressure and the presence of premonitory neurologic symptoms should be monitored closely.7% 11. which should be managed with discontinuation or reduction of OMONTYS dosage and/or with phlebotomy. and the percentages of Caucasian.6% 13. The median weight adjusted dose of OMONTYS was 0.1% 10.4% 16. Dosing was every third day in rats for a total of 5 doses and every fifth day in rabbits for a total of 3 doses (0. the requirement for increased doses of OMONTYS to maintain hemoglobin levels. Embryofetal toxicity was evident in rats at peginesatide doses of ≥1 mg/kg and the malformations (cleft palate and sternoschisis.9% 19.6% 11. The population for OMONTYS was 20 to 93 years of age. The dose of 1 mg/kg results in exposures (AUC) comparable to those in humans after intravenous administration at a dose of 0. OMONTYS should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. PEG096 R2_BS L-DSG-1112-1 General Disorders and Administration Site Conditions Seizures have occurred in patients participating in OMONTYS clinical studies.4% 11. and/or transfusion for anemia of CKD. and 3. Nursing Mothers It is not known whether peginesatide is excreted in human milk. Peginesatide was teratogenic and caused embryofetal lethality when administered to pregnant animals at doses and/or exposures that resulted in polycythemia.6% 12. No cases of pure red cell aplasia (PRCA) developed in patients receiving OMONTYS during clinical trials. cleft palate (rats only).3% 18. Immunogenicity Of the 2357 patients tested during clinical trials.2%) had detectable levels of peginesatide-specific binding antibodies. and Thromboembolism [see Warnings and Precautions] • Hypertension [see Warnings and Precautions] • Serious allergic reactions [see Warnings and Precautions] Clinical Trials Experience Because clinical trials are conducted under widely varying conditions.6% 16. Inc.4% 15. Stroke. Thoracic and Mediastinal Disorders Injury.8% 12. Peginesatide neutralizing antibodies were detected in vitro using a cell-based functional assay in 21 of these patients (0. Inc.4% 15. Deerfield. Serious allergic reactions have been reported during postmarketing use of OMONTYS [see Warnings and Precautions].5% 15. Patent and Trademark Office and used under license by Takeda Pharmaceuticals America. adverse findings were observed at lower doses and included increased incidence of fused sternebrae at 0.01 to 50 mg/kg/dose). it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. registered in the U.9% 10. including 938 exposed for at least 6 months and 825 exposed for greater than one year to OMONTYS.4% 15. caution should be exercised when OMONTYS is administered to a nursing woman.07 mg/kg and 113 U/week/kg of epoetin.0% Dialysis Patients Treated with Epoetin (N = 542) 15. Inc.Laboratory Monitoring Evaluate transferrin saturation and serum ferritin prior to and during OMONTYS treatment.35 mg/kg in patients. adverse reaction rates observed in the clinical studies of OMONTYS cannot be directly compared to rates in the clinical trials of other drugs and may not reflect the rates observed in practice. The majority of patients with CKD will require supplemental iron during the course of ESA therapy. Pediatric Use The safety and efficacy of OMONTYS in pediatric patients have not been established. and variations in blood vessels) were mostly evident at doses of ≥10 mg/kg. Geriatric Use Of the total number of dialysis patients in Phase 3 clinical studies of OMONTYS. Poisoning and Procedural Complications Musculoskeletal and Connective Tissue Disorders Postmarketing Experience Because postmarketing reporting of adverse reactions is voluntary and from a population of uncertain size. reduced fetal weight and reduced ossification were seen at a lower dose of 0. Inc.50%) than the dose of 0. In a separate embryofetal developmental study in rabbits.4% 17.3% 10.25 mg/kg. Black (including African Americans). USE IN SPECIFIC POPULATIONS Pregnancy Pregnancy Category C There are no adequate and well-controlled studies in pregnant women. monitor hemoglobin every 2 weeks until the hemoglobin is stable and sufficient to minimize the need for RBC transfusion. Marketed by: Affymax.4% Adverse Reactions Gastrointestinal Disorders Diarrhea Nausea Vomiting Dyspnea Cough Arteriovenous Fistula Site Complication Procedural Hypotension Nervous System Disorders Headache Muscle Spasms Pain in Extremity Back Pain Arthralgia Vascular Disorders Hypotension Hypertension Pyrexia Metabolism and Nutrition Disorders Hyperkalemia Infections and Infestations Upper Respiratory Tract Infection Respiratory. In vitro studies conducted with human hepatocytes or microsomes have shown no potential for peginesatide to induce or inhibit CYP450 enzymes.35 mg/kg in patients on dialysis. Palo Alto. Cases of severe hypertension have been observed following overdose with ESAs [see Warnings and Precautions].9% 17. while 13% were age 75 and over.2% 12.5 mg/kg/dose of peginesatide. Following initiation of therapy and after each dose adjustment. All other trademarks are the property of their respective owners.4% 14. monkey and human sera.

■ Practice Management By David J. Like its Advanced Open Access predecessor. The model strives to optimize care provider access and utilization through the creation and maintenance of intentionally open schedule templates at the start of each day. and • Yield high patient satisfaction scores? Thinking from the patient perspective. wouldn’t it be great if you: • Got dependably an appointment when you actually needed it. Use Tools to Support Open Scheduling Tool No. wouldn’t it be nice if a patient scheduling model and throughput existed that could: • Fill available schedule blocks. To achieve and maintain an open schedule. established patients are offered and encouraged to take same-day appointments. MD. new patients (patients never before seen by the particular provider) are only offered access to a provider on a same-day basis. MS Optimize Your Patients’ Access to Care Create a schedule model that fulfills patient scheduling needs. and allows provider flexibility. Modified Open Access pursues: • Same-day care access as the norm for a practice • A uniform schedule slot time length without special acuity limitations— slots are intentionally designated to average the time a practice needs per patient and to eliminate the need for special appointment handling around acuity issues • An emphasis on provider-specific continuity of care The goal of Modified Open Access and Murray and Tantau’s model is to make the system’s first priority be to “take care” of the patients who are established with a practice and who ultimately are the ones who “take care” of the practice. our team addressed the concern of how to prevent open schedules from refilling with new or transient clientele who may ultimately block out established patients. 1: EPPA Time A behind-the-scenes tool called the established patient priority access (EPPA) time supports priority access to established pa- . Open schedules mean ready access for patients. that is. supports and defends established patients’ access. as with traditional scheduling. improves front staff workload. • Decrease no-show rates. we found that patient throughput volume actually went up because the schedule allowed patients to see their preferred provider reliably. reduces no-shows. Although it may seem counter-intuitive to pursue full schedules by intentionally opening two-thirds of a provider’s schedule. Originally developed by our quality improvement team. Limited Access Is Key Like its predecessor. As we considered implementation logistics. • Reduce appointment handling and rescheduling workload. • Enhance provider schedule flexibility. Limiting new patient access. • Were treated respectfully by your doctor’s office as being competent and capable of managing your own appointment choices. Moore. and viable practice model. Offering Reliable. Modified Open Access achieves ready appointment access by intentionally having schedules two-thirds open at the start of any business day. T hinking from the health care administrator’s perspective. No-show rates markedly declined as a result of the time decrease between when the request was made to when the appointment actually occurred. “Same-Day Appointments: Exploding the Access Paradigm”). sustainable. and only after time slots for established patient care needs are addressed on that day. • Were seen reliably by your own provider. It then utilizes several simple policy tools to ensure that established patients can always get in when they call for either acute or follow-up care—these are tools to maintain the promise of established patient care access. but are limited to appointments within seven days. To make established patients’ access top priority. Modified Open Access differs from the Murray and Tantau model in placing limits on the interval beyond “same-day” for when appointments may be booked. To address this concern and preserve an open and accessible schedule for established patients. new patients are limited to same-day access only. and • Received regular follow-up reminders as necessary? Take Care of Patients Who Take Care of Your Practice Modified Open Access is a scheduling model developed in 2001 and aimed to achieve these goals of a patient-centered. its goal is to capture—in a sustainable way—the innovative care scheduling ideals of the “Advanced Open Access mod54 AAPC Cutting Edge el” (as developed and described in Murray and Tantau’s September 2000 publication.

the model strives to optimize care provider access and utilization through the creation and maintenance of intentionally open schedule templates at the start of each day. up to the allowed full week’s advanced scheduling option. In our busy practice. receptionist phone protocol scripts were developed to aid our receptionists (see Figure A and B). due to an influenza outbreak—then you can protect more established patient slots by moving the EPPA time to a later point in the day. New patients who call for appointments before the day’s established EPPA time are politely informed that no appointments are available at that time. If the schedule is not filling. The scripts encourage filling of first available slots. but remains flexible and can be altered as needed. pressure-valve slots are a tool that allows for a second layer of capacity. pressure-valve slots rarely fill past usual closing time. The EPPA time may be adjusted to accommodate care demand trends observed by the practice. are given equal access to remaining appointments for that same day. 3: Pressure-valve Slots Because patient care demand can be unpredictable in both volume and at what time. If established patient care demand rises—for instance. no limits are ever placed in the schedule on the nature of care requested. Patients. Here’s how pressure-valve slots work: They are a scheduled interval of protected appointment slots built around the usual prac- tice closing time that become available only if the day’s regular appointment slots have saturated. Central to the model’s success is that established patients may. In our primary care setting.. even on a daily basis. tients. the pressure valve—closed till that point—then “opens. Tool No. book an appointment up to a week in advance. After the EPPA time. they have appointment access reliably. at any point. however. They are also useful for understanding the model’s flow of patient call handling. The next available slot is only offered to a subsequent established patient requesting care. In our busy practice setting. The pressure-valve slot tool is embedded in the model to ensure established patients can count on the availability of at least one same-day access option on any day. The scripts also introduce the next tool developed to support keeping the same-day access promise for established patients. This not only defends and sustains the model’s openness. Although the model protocol can be integrated into the practice management scheduling software. urgent. After the EPPA time passes. and are offered a callback if an appointment becomes available after the set EPPA time. If during any point of the day. patients with lower acuity care needs tend to accept more readily the two-thirds open appointment options in the subsequent days.aapc. it satisfies new patient needs. In our experience. Pressure-valve slots help to keep at least one appointment available around closing time to established patients. 4: Follow-up Management Protocol If appointments are not locked in beyond one week for established patients.m. 2: Receptionist Scripts To support this method of handling care demands.m. giving them priority status. need assurance that when they call. but at no point are new patients offered appoint- ments beyond today. Our new patient volume actually increased compared to our prior traditional scheduling model experience. all patients. Tool No. but the capacity beyond the usual closing time allows responsiveness to care needs and demands of established patient clientele..” allowing the first available pressure-valve slot only to be offered to that established patient. both new and established patients are offered any remaining slots for that day. who may not lock in appointments beyond one week in advance. The EPPA time is an internally set time on the clock each day. After 11 a. the EPPA time is usually set at 11a. Tool No. new patients have equal access to any remaining slots for the day and the call-back list also can be used to fill in remaining open slots in the day’s schedule. only established patients are allowed access to that day’s appointments. These pressure-valve slots are available to established patients only.Practice Management In a nutshell. but our patient-centered emphasis remains on accommodating established patient appointment needs. pressure-valve care tends to be acute. effectively opening up the practice to more new patients. which honors the promise of access. and reflects the illnesses affecting the community. a follow-up prompt and reminder system was developed using February 2013 55 www. Before the EPPA time of the day. you can move the EPPA time to an earlier point in the day. scripts for our receptionists remain a valuable tool for implementation and training. and always are open at the start of the day. only our established patients have access to the day’s twothirds open schedule. We found that new patients are happy to accept or be called back for same-day appointments when they are available. no regular appointment slots remain open for an established patient calling for care. new and established. Before 11 a. how are follow-up appointments handled beyond one week? To address this concern. As the pressure-valve slots in a day progress across the interval.m. pressurevalve slots span from one hour prior to our usual closing time to one hour after that time..com .

Would you like to see Dr _X_? Yes Offer: Earliest Available PCP regular Appointment Yes Book PCP Appointment “Sometimes appts become available after _____ (EPPA time). No No reg appointment left? Offer 1st Available Pressure-Valve appointment Declined “Please give us a call on or near the day you want to be seen and we will get you in.Practice Management Figure A Before ______ am EPPA time “Hello. may I help you schedule an appointment?” Yes No “Have you been seen at ______ Clinic before?” Yes Patient Name? / Designated PCP? Yes “We show Dr _X_ is the PCP. appointment left? Offer 1st Available Pressure-Valve appointment Declined Offer PCP Appointment < 1 week No “Please give us a call on or near the day you want to be seen and we will get you in. OR you may check back with us again after____ (EPPA time). Would you like to see Dr _X_? Yes Offer: Earliest Available PCP regular Appointment Yes Book PCP Appointment No address concerns Offer any remaining: same-day + Regular Appointment slots OR “May I put your name on our call-back list or you may check with us again tomorrow after _____(EPPA time)” No No reg. may I help you schedule an appointment?” Yes No “Have you been seen at ______ Clinic before?” Yes No Patient Name? / Designated PCP? Yes “We show Dr _X_ is the PCP.” 56 AAPC Cutting Edge . May I put your name on our call-back list.” address concerns Offer PCP Appointment < 1 week No Figure B After _______ am EPPA time “Hello.

The reminder system’s foundation is based on the underlying principle: No matter what the scheduling model. a final reminder is generated and sent. David J. CCI Edits Checker. follow-up compliance is tracked and providers are kept aware of all patient-specific lapses. He is a graduate of Harvard University School of Public Health’s Masters in Health Care Management and a graduate of Wright State University School of Medicine and Family Medicine Residency in Dayton. He has served in corporate medical director and site director roles in the University’s partner relationship with the North Fork Valley Community Health Center in Hazard. provider schedules had a significant increase in flexibility. Ohio. 2222 Sedwick Drive. code search. go to www. follow-up reminder system was developed to encourage recommended return care interval compliance. it ultimately is the patient’s choice and decision whether to comply with the follow-up recommendations given by his or her provider. The system starts with the provider’s recommended follow-up interval being delivered to the receptionist desk while the patient exits from an existing appointment. Durham. Ky. For more information call 866-228-9252. as well as spin-off benefits of the model. a three-tiered. With no locked-in appointments beyond one week.com/2013-coding-resources. MS.To discuss this article or topic. Use Promo Code: AAPC020. NC 27713 www.com Practice Management our existing practice management software capabilities. patient satisfaction with provider continuity and access has been high. continue to be noted. has served in primary care community health for nearly 20 years and is an assistant professor at the University of Kentucky’s Center for Excellence in Rural Health. Lay Terms and more Your Specialty Coding Alert . The existing patient reminder system then triggers daily batch mailing reminder cards at the provider’s recommend- ed follow-up interval. After allowing a response interval.aapc. MD. CCI edits. Front office staff reported dramatically improved workloads attributed to a significant reduction in appointment rescheduling. and opportunities for software-driven enhancements and streamlining still remain. Appointment Accessibility Shows Favorable Results The patient-initiated access and limited advanced scheduling aspects of the Modified Open Access model resulted in 50 percent or greater reductions of no-show rates versus our prior appointment model.. Ace your 2013 coding with all the advice.supercoder.aapc. “follow up in early May”).12 Print Issues Your Specialty Coding Alert (Annual E-Subscription) – 12 Issues 2013 Illustrated Coding Book for your specialty 2013 Coding Updates for your specialty – Audio CD ICD-10 Coding Alert (Annual E-Subscription) – 12 Issues Bundle and Save 40% on 2013 Coding Resources! Order online at www. or other site traditional appointment model users in our system. The first tier is a general interval follow-up card given to the exiting patient (e.com February 2013 57 . Although initiation of an appointment request falls into the patient’s hands.g. Most importantly. if no appointment is initiated by the patient. Implementation challenges and caveats. Moore. and modifier crosswalks you need in one online solution plus audio training to bring all your staff up to date. With this in mind. Each bundle gets you: Code Search including ICD-10. The Coding Institute LLC.

California San Antonio. Massachusetts Miami. Boston. Tennessee Apr 4 Apr 11 Apr 25 May 2 May 9 May 16 May 16 May 30 Denver. Pennsylvania Seattle.com/2012bootcamps 1-800-626-CODE (2633) . New York Atlanta. Florida Cleveland. Texas Philadelphia. Maryland Jun 6 Jun 20 Jun 20 Jun 27 Jun 27 Jun 27 Manhattan.com/2012bootcamps 800-626-CODE (2633) REMAINING IMPLEMENTATION BOOT CAMPS* DATE LOCATION DATE LOCATION DATE LOCATION Feb 7 Feb 21 Feb 21 Feb 28 Mar 7 Mar 14 Mar 21 Mar 28 Houston. and Resources + Course Manual and ICD-10-CM Book Coder’s Roadmap to ICD-10 Step 3 Step 4 Step 2 Step 1 Anatomy & Pathophysiology Implementation General Code Set Training Specialty Code Set Training 2-Days | 16 CEUs $695 REGISTER TODAY! aapc.ICD-10 IMPLEMENTATION BOOT CAMPS FINAL TRAINING SCHEDULE AAPC’s implementation bootcamps are ending June 27. Washington *Dates and locations subject to change For a complete list of all remaining boot camps. D. 2-Day Boot Camp Curriculum: • Where to Begin – Organizing the Implementation Effort • Understanding the Information Technology Impact • What Needs to Change – Assessing Other Key Areas of Impact • Identifying Documentation Challenges • Building Your ICD-10 Action Plan • Budgeting for ICD-10 • Planning Training Approaches and Resources • Successfully Measuring Outcomes • Introduction to ICD-10 Coding – Crosswalks and Mapping • Hands-on Coding Exercises and Documentation Case Studies • Templates. If you haven’t started preparing for ICD-10 implementation our two-day boot camp can get you on track. Tools. North Carolina Kansas City. Louis. Texas St. Minneapolis Baltimore. Worth. Missouri Long Beach. Colorado San Francisco. Ohio Nashville. CA Phoenix. Georgia Chicago. Texas Charlotte. Illinois Dallas/Ft. Missouri Washington. visit: aapc. Arizona Minnesota.C. These are the LAST implementation training sessions before we transition to code set training and space will be severely limited.

CPC Celine Nadeau. CPC Andrew Weinfeld. CPC Janna Hoffman. CPC Melissa Sartin. CPC Reshmi Jalaja. CPC Lynda A Hopka. CPC James Waddick. CPC Paula Jensen. CPC Jeannie Marie Jones. CPC Tina McGonigle. CPC. CPC Dawn Thomas. CPC Amy Thatcher. CPC-A Ambar Solorzano. CPC Michelle Elfline. CPC Alicia Erdman. CPC-H. CPC Mahalakshmi Shanmugasundaram. CPC Tina D Titsworth. CPC Aruna Padmasuran. CPC Maria Boyd. CPC-P Shiela Armesto. CPC Jennifer Easter. CPC Cheryl Smith. CPC Dana A Sisk.Benjamin. CPC Kimberly Bechtel. CPC-A Apprentices A H S G Dasthagir. CPC-A Alicia McCrudden. CPC Robbie J Hartley. CPC Stormy Grimmer. CPC Whitney Clarahan. CPC-A Dianna Miller. CPC Linda Soltau. CPC-A Annie Nguyen. CPC-H Maria L Kelley. CPC Mayra Garcia. CPC Sangeetha S. CPC-P Elizaveta Bannova. CPC Tiffany Sherese Hurd. CPC-H Tammy Patterson. CPC-H Renee Michele Wallen. CPC-H-A Amy Marie Meeks. CPC Donna L Davis. CPC Ranell Ross. CPC-H-A Courtney McGinnis. CPC Jackie Bussell. CPC Sylvia SanMiguel. CPC Kiriaki Kelly. Smith. CPC-A Dawn Callender. CPC Laura Michelle White. CPC Catherine Porter. CPC Lashonda Wootson. CPC Karen Reese. CPC-A Claudia Castaneda. CPC Mukesh Sarath. CPC. CPC-A Danielle Ruiz. CPC Deborah Renee Callahan. CPC Amber M. CPC-A Ashal Mahoney. CPC Sheela Mary. CPC-A Ann Sweeney. CPC-H Yvonne Betancourt. CPC Ashley Terrell. CPC Stephanie Dawn Kenser. CPC Shirley Baldini. CPC Mary Hauser. CPC Suzanne Link. CPC-A Craig Russell. CPC-P Trupti Patel. CPC-A Danny Nunez. CPC-P Rachel Maria Walters. CPC Rajesh V R. CPC Angela Brooks Latta. CPC-A Christina Mott. CPC Amuthapriya Elangovan. CPC Kristy Lee Seghini. CPC-H Ashley Modin. CPC Robin E Nelson. CPC-A Christina Webb. CPC-A Carol Gaumer. CPC Rhonda Grayson. CPC Teresa Rogalski. CPC Mary C Grove. CPC Tabatha Jackson. CPC Michaline Juckno. CPC-A. CPC Narmatha Arumugam. CPC-A Deepak Babu. CPC Melissa R Hawkins. CPC-A Cindy Chieng. CPC Ashlee Dressler. CPC Cynthia Miles. CPC Laura Anne Henckler. CPC Jeevitha Rajkumar. CPC Manjula Duraivelu. CPC Donnie Dale Clancy. CPC-H-A Crystal L Grove. CPC-A Deborah Job. CPC-A Denise E Torcicollo. CPC-A Barbara Rabatsky. CPC Tatyana Vasilchuk. CPC-H Dorian Wickham. CPC Carissa Cobuluis. CPC Tammy Jennette Scarberry. CGIC Lisa Yvette McKinney. CPC Christine Burke. CPC-A Connie Morrison. CPC Heather Ochoa. CPMA Jennifer Lawson. CPC-A Devonna Niree Nelson. CPC-A Casey Smith. CPC-A Charlene J Watkins. CPC. CPC Suzanne Briggs. CPC Delora Clarissa Carswell. CPC Michelle Lynn Wilbur. CPC-A Barun Kumar. CPC-A Brigida Maria Johnson. CPC-A Bibin Krishnan. CPC-H Tiffany Fite. CPC Brandy Michelle Fields. CPC-A Belinda Strack. CPC-A Antoinette Munsch. CPC-H Sherry Philbrick. CPC-H Rayna Williams. CPC Carmen Borrero Borreli. CPC-H Jeannie Allison Whitaker. CPC-A Conrad D Lippens. CPC. CPC. CPC-A Corin Lee Dunn. CPC-A Denissa Faith Grace. CPC Michelle Blessie. CPC-A Carla Jo Cushman. CPC-A Amy Pridemore. CPC-A Amrita Raveendran. CPC Karen Willett. CPC Thara L. CPC. CPC Christina Pierce. CPC Alethea Cann-Leriger. CPC Vigneshkumar Rajasekaran. CPC Karen A Pietsch. CPC-A Dina Carangelo. CPC Robin J Ward. CPC-A Ciera Nicole Brower. CPC-H Ann Culp. CPC-A Constance McMullen. CPC Alicia Gongora. CPC Anisha V S. CPC Brenda L Melton. CPC Sarah Bass. CPC-H Donna Satterlee. CPC-A Anita Ehly. CPC. CPC-H Tena Siebenmorgan. CPC Kanchana Natarajan. CPC-A Andreena Marie Pulak. CPC-I LeAnn McFarland. CPC Sujitha Narayanan. CPC-A David Szeto. CPC-A Beth Ann Teague. CPC Regina A Wicker. CPC Jennifer Andrews Mangham. CPC Barb King. CPC-A Divyashree Kumaraswamy. CPC-A Alwyn DN. CPC-H Sureko A Hamilton. CPC Priyadharsini Ramalingam. CPC. CPC-H-A Christine Logsdon. CPC Dawn Marie Montecalvo. CPC-H Noushar Shihabudeen. CPC Doris Ruffner. CPC. CPC Francine DiPaolo. CPC-H. CPC-H Nancy Lynn Allison. CPC-A Debbie Zander. CPC Annette M Coffey. CPC-A Arlet Hopkins. CPC Judy Guzman. CPC Dunia Hernandez. CPC-A Daphne Rachkoskie. CPC Dionne Walker. CPC David S Brown. CPC Kolleen Bourland. CPC-A Amy Penman. CPC-A Chaithra Rama. CPC. CPC Anne Whalley. CFPC Emily Woody. CPC-A Bonnie Oakes. CPC Mary Anne Ciriello. CPC Delaina Rider. CPC-A Christopher Brian Glenn. CPC Shannon Holland. CPC-A Dawn C Thoma. CPC Veronica Glasper.aapc. CEDC Candy Cook. CPC-A DiAna Olguin. CPC Cathy Martin. CPC Kathi M Wyllie. CPC Regina Miante. CPC Gopinath Velappan. CPC-A Bingyi Mary Ni. CPC Cheryl Miller. CPC Tamiko Woodfork. CPC-A Beth Taylor. CPC Lauri St. CPC-A Amanda Breznau.Cyr. CPC. CPC Katherine J Huprich. CPC-H. CPC Lakisha North. CPC Sheryl Williams McAdams. CPC-A Cheryl Phillips. CPC Reinhard W Beel. CPC-A Devshree Narvekar. CPC-A Carol E Wildey. CPC-H Thenmozhi Sengottuvel. CPC-A Becky Williams. CPC Laura Kuhlmann. CPC Mindy Dowd. CPC Rebecca Faith Hernandez. CPC-A Ashley Tucker. CPC-A Cheol Lee. CPC Carolyn Boston. CPC Ruby Norton. CPC Angie Stough. CPC-H Sridhar Arumugam. CPC-H Christine Roketa Johnson. CPC. CPC Sue Carney. CPC Laura A Ratcliff. CPC Bobbi Garlow. CPC-A Dania Serrano. CPC Suzan Swain. CPC-A Blaine Rush. CPC Evangeleena Jebakumari Samson. CPC Sue Ann Coffin. CPC-A Anil Singh. CPC-A Desiree Joyce Bryant. CPC Danielle L McVea. CPC-A Alice E Johnson. CPC Patricia Mulvanerton. CPC Deb Richards. CPC-A Anissa Booth. CPC Kelly Anne Tuttle. CPC-A Della R Canter. CPC-A Danyea Kim Hankins. CPC Belia Villegas. CPC Annemarie Deerr-Larmer. CPC. CPC Deborah Sturgille. CPC-A Denielle Caballero Cabahug. CPC-H-A Carolyn Sue Cloer. CPC Jacqueline Patton. CPC Amanda Puzycki. CPC-A Brett L Ricketts. CPC Deborah Reichardt. CPC. CPC Dawn B Rathburn. CPC Amalraj Ignatius. CPC-A Ashwini Rajan. CPC-A Agnieszka Plonska. CPC April Marie Reynolds. CPC-A Algin D N. CPC. CPC-H Barbara Keim. CPC-P. CPC-A Denise M Blair. CPC Delaina Herrera. CPC Farrell Turner. CPC-A Brittany Pankow. CPC Grace Frances Patricio. CPC-H Dianne Rice. CPC-A Chris Gamet. CPC-A Alice A Calipes. CPC Mary Tye. CPC-P Amanda Gallawa Griffith. CPC Daiana Varela. CPC-A www. CPC-H-A Cecilia Colmer. CPC Beth Gawronski. CPC-A Debra Klump. CPC-A Brittney Poling. CPC Mona L Vincent. CPC Jessica Valdivia. CGIC Catherine Cichowicz. CPC-H Candace Smith. CPC Soumya P S. CPC-H Kassandra Wells. CPC Xin Zou. CPC Laurie Stutzman. CPC Lori Budzinski. CPC Christy Lashon Mansuy. CPC Janice-Lamiece Rose. CPC-A Deborah A Creek. CPC-A Amanda Hasser. CPC-A Amanda Soliday. CPC Lorraine M Morreale. CPC Cathy Zardas. CPC Elaine Jacobs. CPC Christina Lynn Walz. CPC-A Charlotte Carrow. CPC Jessica Moran. CPC Rebecca Martinez. CPC Rosemarie Goodwin. CPC Cindy Rohlfing. CPC Jennifer Stamey Hannah. CPC Jermeine Criego. CPC-A Colleen Palmer. CPC Teri M Starling. CPC Megan Pedersen. CPC. CPC Jennifer Olcott. CPC Dawna L Moore. CPC-A Abby Yip. CPC Audrey Anderson. CPC Rebecca Bates. CPC Naomi Martine. CPC Wendy Mitchell. CPC Jennifer Arnsman. CPC. CPC-H Amitha Ramakrishnan. CPMA Heidi Vine. CPC-A Danielle Seaman. CPC Fallon Wise. CPC-H Vishnupriya Kamaraj. CPC-A Aranya (Joy) L Feagins. CPC Sharon Pascasio. CPC Farisa Percy. CPC. CPC Jennifer A Besig. CPC Catherine Peake. CPC Shanna Keith. CPC. CPC LaTashea Renee Huggins. CPC Donna Krysl. CPC. CPC Diana Manger. CPC-A Ben Dominic Palomares. CPC Teresa Blake. CPC-A Connie Sibley. CPC-P Maria K Lorenzen. CPC Julie Madden. CPC-H Mayoury Sirattanatray. CPC Lydia C Rego. CPC Alanna Stuart. CPC Jennifer Swift Hardin. CPC-A Ann Bogari. CPC-A Courtney Johnson. CPC Deborah Tasnady. CPMA Mistie Brock. CPC Nicole C Riedel. CPC-H Jennifer Marchand. CPC Kevin Stuart. CPC-H Jackie Tuttle. CPC Vinutha R. CPC-A Becky Banks. CPC Sandra Frye. CPC Susan N Edge. CPC-A Barbara McQuade-Lantzy. CPC Jamie Morgan. CPC Michele Southerland. CPC-A Arun Kumar Rajavel. CPC Christina Michelle Chrisjohn. CPC Kara Morris. CPC-A Charity A Rouse. CPC Debra Ann Laws. CPC Jill Marie Connor. CPC Divyabharathi Alexander. CPC-A Denise Chase. CPC Bethany Sumner. CPC Dionne Deemer. CPC-H Becky Goodyear. CPC Sonya Muse. CPC Gay Kyzer. CPC Paula Cordova. Jr.com February 2013 59 . CPC Natalie Ryder. CPC Michelle Leigh Moore. CPC-A Courtney Cooper. CPC-H Olga Tsitsugina.newly credentialed members Aida Aquino. CPC-H-A Chandanapalli Haranadh. CPC Reji Krishna. CPC. CPC Sherin Ninan. CPC April Shanae Williamson. CPC-A Adelina Kobeci. CPC-A Diedre P Carter. CPC Heather Golden.

CPC-A Rona Perez. CPC-A Shrimathi Raghupathy. CPC-A Sandhya Raghavan. CPC-A Jessica Fisher. CPC-A Rachell White. CPC-A Ruth Case. CPC-A Kimberly Lynne Miller. CPC-A Ravikiran Nagabhushan. CPC-A Kelly McCormick. CPC-A Judy Block. CPC-A Maranda Merjudio. CPC-A Sally Valdez. CPC-A Rebecca Barton. CPC-A Vipin Cheriyamoothore. CPC-A Heather Soss. CPC-A Mirian Gonzalez. CPC-A Mary Lou Wojciechowski. CPC-A Rhonda Blankingship. CPC-A Karen J Musslewhite.Newly Credentialed Members Donna DiStefano. CPC-A Roberta A Jackson. CPC-A Kayla Lee Malone. CPC-A Julia Genther. CPC-A Inge Barth. CPC-A Sher Kosage. CPC-A Shirlee Ann Kakaruk. CPC-A Kathryne Leah Barnes. CPC-A Kristi Wilson. CPC-A. CPC-A Marin Smith. CPC-A Keri Marie Crowley. CPC-A Shannon Toenyan. CPC-A Mary Hollingsead. CPC-A Lavette D Neal. CPC-A Nancy Arias. CPC-A Jennifer Meade. CPC-A Judy J Taylor. CPC-A Maria Kathlyn Acosta. CPC-A Regina Oginski. CPC-A Roopa Narayanan. CPC-A Kathleen Johnson. CPC-A Lisa Larson. CPC-A Srinivasan Vijayan. CPC-A Shara Franklin. CPC-A Ondrea Maffeo. CPC-A John Bry. CPC-A Tiffani Dahl. CPC-A Simone Mathers. CPC-A Maura Carty. CPC-A Stacey Morache. CPC-A Janet L Holdeman. CPC-H-A Sherryann Sinanan-Ali. CPC-A LaRena Fitz-Gerald. CPC-A Ruth James. CPC-A Emily E Walk. CPC-A Priya Gupta. CPC-A Sasipriya Madhav. CPC-H-A Jean Havel. CPC-A Kim Eskew. CPC-A Lori Hewitt. CPC-A Melissa Mancini. CPC-A Jeanette Robin Weiland. CPC-A Melanie D Briggs. CPC-A Holly Henderson. CPC-A Jean Morris. CPC-H-A Lieu Doan. CPC-A Lisa Robinson. CPC-A Linda Heady. CPC-A Horalia Acosta. CPC-A Jill R Ammons. CPC-A Jennifer Swank. CPC-A Kunal Chatterjee. CPC-A Ramesh Sampath. CPC-A Lina Ungureanu. CPC-A Ramona Merritt. CPC-A Nicole Walker. CPC-A Krystle Lister. CPC-A Zak Federer. CPC-A Kimberly Biagioni. CPC-A Kenny M. CPC-A Raghava Danwada. CPC-A Sarah McCauley. CPC-A Mrinalini Sekhar. CPC-A Yutian Galloway. CPC-A Rebecca Pascucci. CPC-A Raghuraman Sundhararaju. CPC-A Tabitha Foxx. CPC-A Vijayadeepa Pandiyan. CPC-A Linda Tittle. CPC-A Donna Ford. CPC-A Kokiladevi Gopinath. CPC-A Georgeta Moise. CPC-A Kakasaheb Kachole. CPC-H-A Karen Francis. CPC-A Sherry Sawyers. Lee. CPC-A Pavithra Ramalingam. CPC-A Terri Peebles. CPC-A Evelyn D Knott. CPC-A Rachel Garena. CPC-H-A Kim Greening. CPC-A Lindsay Owens. CPC-A Sonia Ithier Hopkins. CPC-A Sattie Jugmohan. CPC-A Maryann McMillan. CPC-A Lakenia Warren. CPC-A Janet Yoder. CPC-A Katherine Seebeck. CPC-A Kristine Claire Lefebvre. CPC-A 60 AAPC Cutting Edge . CPC-A Pamela Tarpley. CPC-A Jennifer Gabriela Dejamco. CPC-A Lois Widener. CPC-A Marianne Kusbit. CPC-A Subha Ramachandran. CPC-A Shanmugavadivel Virudhagiri. CPC-A Jill Vierck. CPC-A Mansoor Thangal. CPC-A Linda Hatch. CPC-A Lori Deniece Wise. CPC-A Unia Patterson. CPC-A Edna Gonzalez. CPC-H-A Melissa Lulling. CPC-A Jackie Rogers. CPC-A Jing Yun Wu. CPC-A Heather Walsh. CPC-A Michael Harmon. CPC-A. CPC-H-A Suvega Selvaraj. CPC-A Nicole Webb. CPC-A Suganthi Raju. CPC-A Rena P Lening. CPC-H-A Kristen Theisen. CPC-A Gina L Fulcher. CPC-A Kelsey Sorensen. CPC-A Venkata Rakesh Chakravarthy. CPC-A Judy Louise Ashey. CPC-A Julianne Johnson. CPC-H-A Rajasekar Rajendran. CPC-A Pamela Klaus. CPC-A Staci Kuhnhenn. CPC-A Krystal LaForrest. CPC-A Nalagonda Priyanka. CPC-A Sharlene Sorenson. CPC-A Rachel D Ouellette. CPC-A Holly Jarvis. CPC-A Sintoria Johnson. CPC-A Pauline Ellen Thalmann. CPC-A Rebekah Voorhis. CPC-A Stacie Hyla Friedman. CPC-A Patricia Alvis. CPC-A Teresa Lyon. CPC-A Sabine Parmley. CPC-A Melonie Gibson. CPC-A Lori Shinault. CPC-A Moses John Llamas. CPC-A Joan Elaine Erickson. CPC-A Tony Vakkachan. CPC-A Prathima Vaddepally. CPC-A Sri Bhanu Tejaswi Thummoju. CPC-A Robert Maars. CPC-A Lisa Fisher. CPC-A Kristine Johnson. CPC-A Tellaboina Satyabhaskar. CPC-A Purvi Shah. CPC-A Lynette Valverde. CPC-A Regine Delus. CPC-A Michelle Grist. RDH. CPC-A Heidi Stutz. CPC-A Sreekanth Reddy. CPC-A Marianne Moll. CPC-A Gail Yu. CPC-A Julie A Miller. CPC-A Rebecca Palmer. CPC-A Victoria Slavik. CPC-A Eileen Coutras. CPC-A Susan Gosselin. CPC-A Stephanie Ann Honeycutt. CPC-A Sovena Homer. CPC-A Shandi Ann McCutcheon. CPC-A Komala Valli Selvaraj. CPC-A Lori Brown. CPC-A Kelli Pekios. CPC-A Ninette Santa Cruz. CPC-A Jennifer Haselby. CPC-A Mahendran Selvam. CPC-A Jordan Strombeck. CPC-A Jenny Sexton. CPC-A Kelly Mckay. CPC-A Georgia Dodge. CPC-A Rebecca Cox. CPC-A Patricia McAlister. CPC-A Jacquelyn Broten. CPC-A Tiffany Miklas. CPC-A Wendy Gonzalez. CPC-A Jeannette Rosas. CPC-A Huiyi Miao. CPC-A Indira Mahendrada. CPC-A Troiline Frezzell. CPC-A Elizabeth Hewett. CPC-A Jennifer Porter. CPC-A Sarah Donaldson. CPC-A Laurie Richardson. CPC-A Marcy Mote. CPC-A Mary Anna Williford. CPC-A Jessica Hathaway. CPC-H-A Paige McSain. CPC-A Harriet Cohen. CPC-A Donya Carol Tucker. CPC-A Vishnu Sharma. CPC-A Kara Scott. CPC-A Revathi E. CPC-A Kristen Palmer. CPC-A Suja Chandrapaul. CPC-A Shelly Figg. CPC-A Meghan Allen. CPC-A Kim Nguyen. CPC-A Lora Bolton. CPC-A Tiffany F Valery. CPC-A Hilary Mulligan. CPC-A Mary Jones. CPC-A Robert Pezzillo. CPC-A Larry Poms. CPC-A Prabha Chandrasekaran. CPC-A Lisa C Smith. CPC-A Rajni Kanth. CPC-A Komathi B. CPC-A Robert Simonds. CPC-A Robert Neklesa. CPC-A Jenny Estrada. CPC-A Julie Kiekhoefer. CPC-A Lisa Campbell. CPC-A Gina Conoan. CPC-A Pamela Yap. CPC-A Mary T Hathorne. CPC-A Sarah Moody. CPC-H-A Swathi Goud Kurra. CPC-A Tracey Denise Holzbog. CPC-A Kelly Hart. CPC-A Tim Varghese. CPC-A Patricia Murrin. CPC-H-A Vicki Doherty. CPC-A Sharon Maureen Stovall. CPC-A Tasha Letrease Bryant. CPC-A Samantha Blattner. CPC-A Rhonda Jane Hanna. CPC-A Monica Lynn Wenzell. CPC-A Keelie Dalonzo. CPC-A Joyce Favier. CPC-A Kathleen Cott. CPC-A Suman Patra. CPC-A Melissa Bouchikas. CPC-A Tina Schweitzer. CPC-A Gwendolyn Lawhorn. CPC-A Donna Place. CPC-A Steven Graessle. CPC-A John Bennett. CPC-A Jill Doyle. CPC-A Joan Ferguson. CPC-A Yvonne Rosenzweig. CPC-A Prakash Shannugam Authoor. CPC-A Leah Trippanera. CPC-A Rebecca Cooper. CPC-A Sarah Ward Coudon. CPC-A Josette Fuselier. CPC-A Terese Mastrofrancesco. CPC-A Jazsmine Jacobs. CPC-A Shamanthkumar Mandava. CPC-A Valerie Ortiz. CPC-A Sandeep Kumar. CPC-A Jenelle Keppley. CPC-A Jamie Schwaller. CPC-A James W Lim. CPC-A Naveen Selvaraj. CPC-A Jeanne Uhing. CPC-A Farine Ali. CPC-A Holly Hindel. CPC-A Madhusmitha Gunjate. CPC-A Scott Kreutzer. CPC-A Lynn Kriedeman. CPC-A Teresa A Hawken. CPC-A Sandy Steele. CPC-A Stephanie Jo Weiner. CPC-A Tora Arlene Knowles. CPC-A Stephanie McPherson. CPC-A Laurie Hubbard. CPC-A Joan Keller. CPC-A Marilyn Bernache. CPC-A Tina Miller. CPC-A Marc A Cox. CPC-A Srinath Dachepalli. CPC-A Esmeraldo Batingana. CPC-P-A Katy Niemchick. CPC-A Orsolya Simmons. CPC-A Sarah Hollier. CPC-A Jordan Heath. CPC-A Jamie Krajewski. CPC-A Jennifer R Fair. CPC-A Sulochanadevi Sundararajah. CPC-A Zelenne I Esteves. CPC-A Kelly Pethtel. CPC-A Megan Kime. CPC-A Sue Sansoucy. CPC-A Jill Visser. CPC-A. CPC-A Morgan Jones. CPC-A Reginald Brock. CPC-A Shareen Jalaludin. CPC-A Jessica Schroeder. CPC-A Lalima Mehrotra. CPC-A Gowri Manohari Natarajan. CPC-A Pamela Beaver. CPC-A Gopalakrishnan Thangavelu. CPC-A Marybeth Daley. CPC-A Gina Grady. CPC-A Leslie Boulette. CPC-A M McGehee. CPC-P-A Jordan C Burchell. CPC-A Jennifer Courtney. CPC-A Kandy Nies. CPC-A. CPC-A Michelle Blackshear Harper. CPC-A Sargunaraj Raja. CPC-A Lynn Archer. CPC-A Valorie Ann Hoffmaster. CCC Mary Massey. CPC-A Jayanthi Vadivelu. CPC-A Jennifer Lyn Moore. CPC-A Tena Hill Wynne. CPC-A Machelle Beckley. CPC-A Tabatha JK Osteen. CPC-A Susan Redmond. CPC-A Tamara Jane Sutton. CPC-A Melinda Trusty. CPC-A Leigh Willard. CPC-A Samantha Messer. CPC-A Edwin Johnson. CPC-H-A Kim Cioe. CPC-A Melinda C Severt. CPC-A Rebecca Ann Holderman. CPC-A Jennifer Mary Baumann. CPC-A Shweta Taneja. CPC-A Lisa Davidson. CPC-A Shiny Anand. CPC-A Suzanne Greene Lenske. CPC-A Suresh Babu. CPC-A Lynn Klim. CPC-A Supriya Harishchandra Bhandakkar. CPC-A Michael Dosdos. CPC-A Lisa Hendricks. CPC-A Phyllis Joanne Tabano Valencia. CPC-A Mary Wainio. CPC-A Kathy Hudson. CPC-A Lauren Gail Poe. CPC-A Karen Luckeroth. CPC-A Satheesh Kumar. CPC-A Linette Navarro. CPC-A Elyssa Ann Luebbering. CPC-A Gail Nadeau. CPC-A Kim Bair. CPC-A Meenakshi Nain. CPC-A Lucinda Jane Waber. CPC-A Elena Delgado. CPC-A Mary L Thomas. CPC-A Renee Diaz. CPC-A Ronelle Bones. CPC-A Kiwanna Faulkner. CPC-A Lokesh Chaluvegowda. CPC-A Megan Manning. CPC-A Prem Vinoth Kumar. CPC-A Jaiganesh Palani. CPC-A Massiel Javier. CPC-A Francelaine Saintelus. CPC-A Tricia Carter. CPC-A Rajitha Goli. CPC-A Prabakar Murugan Sekar. CPC-A Premila Kumarankandath. CPC-A Jackie Shoun Ringersma. CPC-A Suzanne M Matz. CPC-A. CPC-A Pamela S Long. CPC-A Jamie Pylman. CPC-A LaTosha Bridgewater. CPC-A Katrina Cartwright. CPC-A Jennifer Austin. CPC-A James Rausch. CPC-A Marianne Amster. CPC-A Nandhini Jayakumar. CPC-A. CPC-A Maria Lynn Schuster. CPC-A Stephen S. CPC-H-A Jessica Jose. CPC-A Stacy Burney-Jones. CPC-A Marcia Stewart. CPC-A Venece R Martin. CPC-A Nancy Quach. CPC-A Tania Cuevas. CPC-A Shannon Kropp. CPC-A Gary Edward Anderson. CPC-A Sky Boggs. CPC-A Elisabeth Parker. CPC-A Laura Alber. CPC-A Marleen Hernandez. CPC-A Jessica Johnson. CPC-A Holly Christine Wideman.

CPMA Amy Michelle Benton. CPMA. CPMA Nancy Flowers. CPC. COBGC Clarence Milton Stewart. Johnson. James. CPC. CPC. CEMC Gail Vogt-McGeehan. CPPM Melanie Cooper. CPCO Deborah Kubida. CANPC Aleida S Padron. CPMA Jan Turley. COSC Mary Buike. CPC. CPC. CPC Eileen Camillone. CPC.com/webinars | 800-626-CODE (2633) www. CHONC Sandy Colson. CPMA Annette Fay Rawlins. CPC. CEMC Mary Gore. CPC. CPC. CEMC Tracy Lee Rada. CPC. CPC. CPC. CANPC Kathryn J Kasper. CHONC Specialties Donna Beaulieu. CEDC Komal Meisuria. CPC. CPC. CPC-A Anna Wade. CPMA. CANPC Teresa M Berry. CPC. CPC. CEMC. COBGC Stacey Lynn Wilson. CPC Aniladiv Acuna. CPC. CPC. CPC. CASCC Rachel Elaine Briggs. COBGC Kimberly Mathews. CPPM Krista Jackson. CPC-A Vanmathi Sivaraman. CCVTC Naomi A Hinton. CPC Wilmieniza Yamson Sale. CCC Ashley D Miller. CPC Julia M Serrano. CPC Gagan T Kadahalli. CPMA. CHONC Karen Guadalupi. CCC Holly Brown. CCC. CPC Sylvia Cram. CPC-A Monica Persaud. CPRC Marilyn L Koerner. CEDC Shawn Dunn. CPC. CPC-A Norma R Romero. CPMA Angela M Wilson. CPC. CPMA. CPC-H Tonia Haralson. CRHC Jonathan Robert Sanford. CPC. CPC-H. COBGC Cristina M Nicoara. CPC.new for 2013! Get your required annual CEUs with 6-packs of exclusive webinars not found in the coding/billing subscription. CEDC James Thomas Carter. CEDC Donna Kay Ring. CPC. CPMA Nicole Marie Clatterbuck.aapc. CPC Denise G Lopez. CPPM Cathy S Jennings. CPC Diana David. CPC-A. CPC. CPC-A Yeima Perez. CPMA. CRHC Amy Joanne Coffee. CPC-A Diana L Hutchings. CPC-A. COSC Vandna Chaudhary. CPMA. CIRCC Gigi Georgina Price. CCVTC Lori J Lawson. CPC Christine Schmotzer. CPMA Cynthia S Tucker. CPC. CHONC Marilyn Glidden. CPC. CPEDC Tiffany Nicole Taylor. CPMA Tina Louise Daley. CPC Maritza Isabel Vazquez Lopez. CPC. CSFAC Colette Mink. CPC. CPC. CPC. CPC-A Chitra Lakshmanan. CENTC Angela Scott. CGSC Marilyn Kitchens Cecil. CPC. CPC. CPC Gisela Miller. CPC-H. CPC. CASCC Ruth Kerekes. CPC Johanna Marie Novoa. CHONC Charles B Harvey Jr. CPC Joe Jose Moreno. CEMC Melanie Lewis. CPC. CHONC Mary Bort. CPC. CGIC Tasha Todd. CPPM Julie Brandt. CCC. CPC Mary Deano. CPC-H. CPC Ann Forrister. CPC-A Brigette Burton. CPC. COSC Elizabeth Frias. CEMC Johnita Smith. CPMA Cathy E Roberge. CPC. CPMA Shawn Marie Muench. CPC. CPC Heidi Beggan. CPRC Kerry Beth Atkins. CCC Dena Ferrante Wilcox. CPC-A. CPPM. CPC Kristin Jacobs. CPMA Tara K. CRHC Philip G Brown. CPC-A Anisia L Torres. CPRC Kathleen M Kampe. CPMA Connie Moering. CPC. CPC. CPC-P Kristina S Lauer. CPC. CPC. CRHC Cynthia Anne Owens-Muller. COSC Kathleen M Sherbrooke. CENTC Sandra Gamboa. COBGC Deidre Jandeska. CPMA Jennifer Westfall. CPC-P. CPC. CPC Shahina Jaffer. CPMA Brooke Thao. CPC-H. CPC. CPMA. CEMC Jade Harden. CPC. CIRCC Terri Brown. CPC. CPC-A Avani Hart. CPC. CPMA. CPC. CGSC Jennifer Young. CPEDC Courtney Polito. CPMA.com February 2013 61 . CEMC Robin Erinn Bay. CPC. CEMC Dianna Schrimsher. CPC. CPC Rafaela Gallo. CPC. CPMA Christine M Schaefer. CPC. CPMA Cynthia A. CPMA. CPMA Brenda Lea Parker. CPC. CPC. CPC. CPMA. CANPC. CPC. CPMA Heather Renee Smith. CPC-A. CPC. CPC-I. CPCD Kellie Dress. CRHC Windy Baughman. CPC. CPC-H. CPC-H. COBGC Lydia Chitwood. CRHC Margaret Coyle. CPC William Fiala. COSC Sunny Triana. CCC Tracy Alise Sarver. CPC Freddy Mercado. CPC. CPC Shari Brauch. CPC Odalys Rodriguez. CEDC Beth Eve Schleeper. CPC. CEDC. CPC. CPC. RHIT. CPC. CPC. CPC. CPC-A Emilio Sanchez. CPC Amanda Briggs. COBGC Leslie Dailey.D ACS-AN. CPC r fo w 3 Ne 201 2013 WEBINAR SUBSCRIPTIONS The Best CEU Value on the Planet We’ve made this easy . CPC. CPC-A Ronna A Pate. CRHC Nikki Strang. CHONC Laurie J Hartford. CPC. CPC-A Genoveva C Prieto. CPC. CPCD. CPC. CHONC Tanya Baker. RN. CPC. CEMC Edward Johnson. COSC Diana M Morehead. CPMA Tiffany Bobbitt. CANPC. CPMA. CPC. CPC. CPC-H.aapc.Newly Credentialed Members Alicia Ajon Flynn. CPCO Jill D Conley. CPC. COBGC Mary Rikley. CPC. CPC. CGSC Lori Ann Gelgut BBA. CPC-A. CPC. CPMA Erin Terrones. COSC Trista L Johnson. CPC. CFPC Fiona B Lange. CPC-A Magna Cum Laude Evelyn Medina. CEMC Dale Smith. CHONC Gloria Brogan Ph. CPC Tina L Pelton . CPC. CPC. CPMA Sandra Ebersole. CPC. CPC Ann Fullerton. COSC Darla Jeanell Morrison. CEMC. CASCC Elizabeth Apicella. CPC. CPC. CPMA Sebrena Atencio. CPC. BSN. CPC. CPC. CPPM Gail Acton. CPCD Rodolfo P Bangilan. CPC. CPC. CPMA. CPCO Eleinys Pupo. CRHC David Carr. CPC Richard Campbell. CPCO. CHONC Cassandra Allison. CEDC Candiss A Grannis. CPCO. CPC. CPC-H. CEMC Denise Dula. CIRCC RuthAnn C Hansen. CHONC Barbara Struve. CPPM Nancy Love Weith. CPMA. CPMA Robin Szuchman. CPC. CEMC Michael Lee Taylor. CPC Yonaicris de las Maria Plasencia. CPC. CPC-A Thomas Allen Brown. CPC. CPC-A. CPMA Maura Macri. CPC. CGSC Thelma Mae Bishoff. CPC-A Mirella Platon. CPC. CANPC Sheena Lunsmann. CPC Charlotte Perrone. CPC Heidy Villiers. CPMA Helen Marie Gerdes. CPC. CPC. CPCO. CPMA Nancy L Henry. CPMA Sabrina R Leichtman. CANPC Peter Weiser. CPC Darlean Yankovich. • • • • • • Approved $299 COMPLIANCE Approved Ten Essential Tips for Efficient EMR Templates • Key Steps to Develop a Quality Assurance Program • Manage Contracts Like a Pro • What are Government Audits Really Looking For? Teaching E/M Coding to Physicians: A Doctor’s Prospective Specialized Surgical Chart Auditing Getting to the Roots of Thriving Leadership and Management Ten Simple Indicators that Will Lead Your Practice to Financial Success Maximizing Systems Integration and Automation • • • • • • Confident Compliance Planning What to Do When Your Compliance Plan Breaks OIG’s Self Disclosure Protocol Conquering E/M Auditing Challenges Within EMRs Delivering Audit Results to Providers in an Effective Manner Developing a Successful Auditing Compliance Plan Key Steps in Hiring the Right Physician That Which is Measured Improves: Key Indicators and Data Analytics Create Simple and Effective Financial Dashboard AUDITING • PRACTICE MANAGEMENT CPPM Approved • • www. CPC. CPMA Tanika Jennings. CPMA. CPC Eileen O’Carroll McCully. CPC-A. CPC-A Dolores Zaldivar. CPC. CPMA Elizabeth Ann Cook. CPC. CPC. CCVTC Malgorzata Tyszko. CGSC Amanda Banks Nelson. CPC-I. CPC-H. CEMC JoAnne M Wolf. CIRCC Carolyn A Griffiths. CGIC. CEMC Crystal Mayer. CPC. CPC Allegra Wheeler. CEMC Bobbi Jeanette Martin. CPC-A Yuanling B Nuez. CPC Rosalina Cespedes. CPC-A Kerry L Fulks .

what would it be? I love learning and teaching other people what I have learned. I then moved to the billing department. We also enjoy going to Disney World. As we approach the 2014 deadline. not a career. I am super excited the AAPC National Conference is at Disney World this year! I might bring my husband with me. per the client. we have grown to over 130 members in less than a year—a huge accomplishment! The wonderful people in the chapter have received so much support from other local chapters in the area. I also train new employees and keep staff up-to-date with changes. After a year. I’m able to network and speak with other professionals about the work they do and I have met so many incredible people in the process. Helping others learn is what is so great about the coding and auditing field. and hands-on coding exercises. I took surgical technician program classes at a local college and. What AAPC benefits do you like the most? I love networking through AAPC. etc. What has been your biggest challenge as a coder? The biggest challenge for me was finding confidence to speak to others about coding. While working at the urgent care office. which is only a short two hour and 30 minute drive for us. go to www. CPC-H. it would be an educator. If I could have any other job. Local chapter meetings are another great way to meet other professionals and to find jobs and externships for newly certified members. performing front desk duties and answering patients’ billing questions. In 2004. In 2009. speaking to members and answering health benefit questions. accept a position in a cardiology office. I am a quality gatekeeper who performs internal quality on all full-time and contract outpatient coders. We enjoy going to the movies and being with family and friends. CPC. Fla. The education will consist of webinars. lectures. I found a great 10-week class and. what I really enjoy is constantly learning and keeping up with guidelines and regulations—the back office side of the industry. I realized I didn’t enjoy the clinical side of health care. which was created in February 2012. We bought annual passes two years ago and take advantage of it every chance we get. I even turned down a surgical tech position to 62 AAPC Cutting Edge If you could do any other job. In 2010. I began working in the health care industry in 1999 as an insurance company’s customer service representative. where I worked the front desk and did patient scheduling for three years. That’s where I really started getting involved with coding. Local chapters open so many doors. I have met several members who are always helpful and send any information after researching. Being accepted in the coding community gave me the confidence I needed to create a new chapter. CEMC Quality Gatekeeper. and it shows. There are constant changes and you need to keep up with the new processes and codes. What is your involvement with your local AAPC chapter? I am president of the Orange Park. If I have a coding question. we are ramping up education and preparing everyone for implementation. I have been involved with AAPC and local chapters.■ Minute with a Member To discuss this article or topic.com Holly Brown. How do you spend your spare time? Tell us about your hobbies. etc. began an internship at a local hospital. I take advantage of any information that I can and practice with coding exercises to stay current with changes. I am more confident in my work. I began working for a local urgent care center as a registrar. family. with whom I love to spend time and travel. and I subscribe to email updates and articles through AAPC. I enjoy the convenience of the forums. Tell us a little bit about your career— how you got into coding. My company has an ICD-10 and research development team that will train all coding and auditing personnel. thanks to an amazing instructor. upon finishing the course.aapc. I began working for a thirdparty auditing company and I have worked there ever since. what you’re doing now. Fla. I was transferred to the provider line and spoke with physician offices regarding submitted and denied claims. There are so many avenues for speaking with other professionals. I passed the Certified Professional Coder® (CPC®) exam on the first try. Jacksonville. I can easily scroll until I find my answer or ask a new question and get a timely response. so he can enjoy some Disney time while I attend the conference. I have always been on the quieter side and I considered my past jobs as work. During the job search as a surgical tech. entering office charges and scrubbing billed codes. With the help of many dedicated friends and other coding professionals. We have a 7-year-old cocker spaniel who keeps us busy when we’re home. I have been married for five years to Josh. chapter. Since . what you’ve done during your coding career. How is your organization preparing for ICD-10? I have attended ICD-10-CM workshops and seminars.

• ICD-10 Code Set Training Begins in Orlando Two Complete Tracks • 26 Specialty Coding Sessions • Six Auditing Sessions • Four Billing Sessions • Three Compliance Sessions • Four Facility Sessions • Six Practice Management Sessions • CPPM Boot Camp available concurrent with this Event NATIONAL CONFERENCE Walt Disney World Resort .You could be here . .com/orlando2013 . .aapc.Florida 2013 AAPC Learn more and register at: www.

2013 Special Conference Pricing—$695 www. FL NAMAS’ CPMA® Training will be offered as a pre-conference event at the AAPC National Conference April 11-12.com 877-418-5564 . 2013 Two day Live training event for CPMA® examination prep 16 CPMA® /CPC® CEUs Convenience of same session testing on April 13.Join NAMAS at the AAPC Conference April 2013 in Orlando.NAMAS-auditing.